Psychology & Psychiatry – Brain Blogger Health and Science Blog Covering Brain Topics Sat, 30 Dec 2017 16:30:10 +0000 en-US hourly 1 How Does Starting School Early Impact Educational Attainment? Wed, 13 Dec 2017 16:30:56 +0000 A singular cutoff point for school entry results in age differences between children of the same grade. In many school systems, September-born children, begin compulsory education in September of the year in which they turn five, making them relatively older than summer born children who begin school aged four.

Research on these annually age-grouped cohorts reveal relative age effects (RAEs) that convey the greater achievements accrued by the relatively old (RO) students compared to the relatively young (RY) students. RAEs are pervasive. Across OECD countries, in fourth grade, RY students scored 4–12% lower than RO students, while in eight grade the difference was 2–9% lower. RAEs are most evident in early formal education and can diminish as children mature. In 2016 for instance, Thoren, Heinig, and Brunner published a study on three grades attending public school in Berlin, Germany, and showed that the RAE in disappeared for reading by grade 8 and was reversed for math in favor of RY students.

Investigating the mechanisms involved is important because RAEs can remain evident in high-stakes exams taken at the end of compulsory education. RAEs may impact educational attainment, which is defined as an individual’s highest educational qualification (i.e., compulsory schooling, apprenticeship, or university education). For example, research by Sykes, Bell, and Rodeiro found that 5% less August-born GCSE students than September-born GCSE students chose at least one A level. Likewise, August-born students were 20% less likely to progress to university than September-born students. RO students also outperformed RY students on college admission tests to a university in Brazil, which significantly impacted the probability of being accepted to that university. Moreover, in Japan the percentage of graduates (aged 19–22 and 23–25) was two points greater for those born in April than those born in March. Collectively, these findings indicate that RAEs impact educational attainment because of their direct link to students’ acceptance to higher education. Since much of children’s development occurs within compulsory education, a natural question is whether educators act to alleviate or exacerbate RAE.

RAEs emerge primarily because of within-group maturity differences among RO and RY children (age-at-school-entry effect). RO children, have a one-year developmental advantage over RY children when they sit exams (age-at-test effect). Based on these advantaged test scores and maturation, RO children receive special opportunities from educators to excel in school. Using attainment, program participation, and attendance data from 657 students aged 11–14 from a secondary school in North England, a study by Cobley, McKenna, Baker and Wattie found that RO students were more likely than RY students achieve high scores across various subjects and be admitted to gifted programs. Even if RO students accepted to gifted programs are not actually gifted, the prestige of attending such programs would help them to foster strong positive self-esteem, which can persist over time. In turn, RO students may experience enhanced learning and praise long after small age differences are important in and of themselves.

Conversely, teachers lower their expectations of RY students because RY students appear less developed and intelligent than RO students. Interestingly, having RO classmates can prompt a spillover effect that boosts RY students’ grades, but also increases the probability that RY students will to be pathologized. This research suggests that RAEs emerge as a consequence of maturity differences but are maintained by the magnitude and persistence of social factors, such as educator-student interaction. Another study also reported RAEs in the diagnosis and treatment of ADHD in children aged 6–12 in British Columbia. Incorrect diagnosis can unnecessarily limit RY students’ academic performance by diminishing their self-esteem and task involvement, which are school achievement predictors.

If these inequalities decline over time, the influence of RAE on educational attainment is arguably minimal. However, if relative advantages such as skill accumulation persist in favor of RO students throughout formal education, RAEs translate into academic disadvantages for RY students. For instance, RY students’ negative self-perceptions of academic competence and learning disability can mediate the relationship between depressive symptoms and school dropout in adolescence. In turn, lack of formal education or poor academic performance makes entry to higher education arduous. Research illustrates with 16-year-old RY students scoring 0.13 standard deviations lower than RO students. This test score predicted that RY students would have a 5.8% higher potential dropout rate from high school and a consequently 1.5% lower college admission rate than RO students. Initial gains for RO students partly explain why they have a 10% greater probability of attending top-ranking universities and why they are more likely to graduate from university than RY students.

Research on the impact of RAE on educational attainment is not as straightforward as discussed thus far. Cascio and Schanzenbach used experimental variation by randomly assigning students to classrooms. Results showed improved test scores for RY students up to eight years after kindergarten and an increased probability of taking a college-entry exam. These positive spillover effects are evident when RY students, in a relatively mature peer environment, strive to catch up with higher-achieving RO students and end up surpassing them. Since RO students may strain under the expectations placed on them to be top of the class, RY students have an opportunity to catch up. Alternatively, RO students may not have the same incentive as RY students to work hard for academic success because RAEs already work in their favor. To overcome RAEs and succeed academically, RY students need greater persistence and attention than RO students in their schoolwork, which helps them gain a motivated mindset that benefits lifelong learning. For example, RY students in high school are more likely than RO students to study and compensate for poor academic achievement in middle school.

At a university in Italy, RY students obtained better grades than RO students. This reversal effect was also reported at university in the UK. The researchers postulated that due to RAEs, the RY students developed social skills more slowly. Therefore, RY students had less active social lives and more time to concentrate on educational attainment. The impact of RAEs on educational attainment is, subsequently, probabilistic not deterministic. Although research by Abel, Sokol, Kruger, and Yargeau indicated that RAEs do not affect the success of either RO or RY students’ university applications, they reported that more RO than RY students applied to medical school. In addition, Kniffin and Hank’s study did not find RAEs that influence whether a university student obtains a PhD. These two studies suggest that RAEs do not have such an important influence on college acceptance or educational attainment once in college. Instead, RAEs are a salient influence in so far as students in compulsory education obtain the necessary grades to apply to university in the first place.

The acquisition of higher mental functions and schooling over time helps normalize the student population by minimizing the attainment gap between RO and RY students, which helps explain why RAEs lessen in university. In addition, universities are often learning environments with great diversity in age (i.e., mature and repeat students), culture (i.e., international students), and academic achievement (i.e., doctorate/master’s students). Perceived developmental parities are inherently less important in university because classroom composition becomes heterogeneous, mitigating and masking the remaining relative age differences. Given this knowledge, greater classroom heterogeneity could be applied to compulsory education to minimize RAEs. Students in mixed-grade classrooms in Norwegian junior high schools, for example, outperformed students in single-grade classrooms on high-stakes school finishing exams. With this classroom composition, it is not disproportionately skewed in favor of younger/older students, the losses for RO students following class mixing would not outweigh the gains of the RO students. With more heterogenous classes, educational attainment could subsequently become less influenced by RAEs and a more equalized pursuit.

Since mitigating the impact of RAE on educational attainment depends partly on the strength of compensating investments such as classroom environments, streaming remains controversial. Academic streaming involves separating students according to innate ability. In reality, streaming is based on students’ prior academic performance, which is an imperfect measure of ability that can lead to misallocations. Streaming in early education can be particularly unfair because RY students do not get the opportunity to more closely approximate older classmates’ mental and physical development when sitting exams. In Germany for instance, being relatively old increased test scores by 0.40 standard deviations, increasing the probability of attending the highest secondary school track (gymnasium) by 12%. RY students are also at risk of being unfairly streamed into lower-ability classes because they are more likely than RO students to be diagnosed with behavioral problems and learning disabilities. Streaming thereby provides students with unequally differentiated educational experiences of teaching, competition, and opportunity that limit their academic exposure. Therefore, postponing streaming can reduce the impact of RAEs on educational attainment by ensuring that any developmental gaps have time to narrow.

Unequal educational experiences can limit RY students’ educational attainment. In 2015, the average number of 25–64-year-olds with tertiary education was greater for countries who exhibit almost no streaming, such as Ireland (42.8%), compared to the OECD average (35%). Is it the case that streaming at multiple stages can rectify initial misallocations while still enhancing academic achievement? In Austria, children are streamed in grade five (aged ten) and in grade nine (aged fourteen). In one study, RY students in grade five were 40% less likely to be streamed into higher classes, but the second streaming, in grade nine, helped mitigate RAEs by giving students the opportunity to upgrade to a higher stream. In a complex interplay, streaming and RAEs can reinforce and be reinforced by existing socioeconomic inequalities. In this vein, the researchers concluded that RAEs only disappeared for students with favorable parental backgrounds in the second streaming. In contrast, RY students with unfavorable parental backgrounds were 21% less likely than RO students to move to a high-ranking school. As previously mentioned, learning at the wrong academic level can strain academic achievement and reduce the chances of continuing to higher education.

Socioeconomic status is the extent to which learning opportunities are disadvantaged as a result of low-income. Socioeconomic status can exacerbate the impact of RAEs on educational attainment. Huang and Invernizzi’s research examined a cohort of 405 students in a high poverty, low performing school from the beginning of kindergarten until the end of grade two. Results concluded that early-age literacy achievement gaps between RO and RY students narrowed over time but did not fully close by the end of grade two. Similarly, a Madagascar-based study by Galasso, Weber, and Fernald indicated that differences in home stimulation are dependent on the wealth gradient and accounted for 12–18% of the predicted gap in early outcomes between advantaged and disadvantaged children. At least in early education, these findings suggest that diminished academic performance and exacerbated RAEs are in direct proportion to socioeconomic status. Thus, greater flexibility regarding age at entry in compulsory schooling could help lessen the impact of RAE on academic performance.

Suziedelyte and Zhu published a “Longitudinal Study of Australian Children” and reported that starting school early benefits children from low-income families who, compared to children from high-income families, have limited access to learning resources at home and formal pre-school services. However, a three-month postponement of the cutoff enrollment date (increasing grade age) can increase both academic success and the likelihood of repeating a grade. Similarly, a one year delay in school enrollment (redshirting) can produce a 0.303 standard deviation decrease in test scores and lead to significantly lower math scores for students identified with a disability when compared to nonredshirted students with disability. These mixed findings suggest that equalizing educational attainment opportunities among RO and RY students, by implementing a flexible entry cutoff point, varies as a function of individual difference. Therefore, managing and mitigating RAEs requires greater sensitivity to confounds such as socioeconomic status.

The impact of starting school early on educational attainment is mediated by social factors, school policy, and socioeconomic factors, resulting in individual differences in learning outcomes. RAEs fade throughout formal schooling and can even reverse in higher education. The relative age phenomenon, nevertheless, caveats that ascribing merit to students based on relative age can lead to the provision of unequal learning opportunities and harmful pathologies. Unfortunately, the mechanisms that underpin the impact of RAEs on educational attainment are currently quite speculative and inconclusive. In this sense, existing findings warrant further empirical research and reveal the need for more comprehensive methods for determining an appropriate school entry cutoff point.


Abel, E., Sokol, R., Kruger, M., & Yargeau, D. (2008). Birthdates of Medical School Applicants. Educational Studies, 34(4), 271-275.

Barrett, P., Davies, F., Zhang, Y., & Barrett, L. (2015). The Impact of Classroom Design on Pupils’ Learning: Final Results of a Holistic, Multi-Level Analysis. Building And Environment, 89, 118-133.

Bedard, K., & Dhuey, E. (2006). The Persistence of Early Childhood Maturity: International Evidence of Long-Run Age Effects. Quarterly Journal Of Economics, 121(4), 1437-1472. doi:10.1162/qjec.121.4.1437

Billari F., & Pellizzari, M. (2011). The Younger, the Better? Age-Related Differences in Academic Performance at University. Journal Of Population Economics, 25(2), 697-739. doi:10.1007/s00148-011-0379-3

Cascio, E., & Schanzenbach, D. (2016). First in the Class? Age and the Education Production Function. Education Finance And Policy, 11(3), 225-250. doi:10.1162/edfp_a_00191

Cobley, S., McKenna, J., Baker, J., & Wattie, N. (2009). How Pervasive are Relative Age Effects in Secondary School Education?. Journal Of Educational Psychology, 101(2), 520-528. doi:10.1037/a0013845

Crawford, C., Dearden, L., & Greaves, E. (2011). “Does When You are Born Matter? The Impact of Month of Birth on Children’s Cognitive and Non-Cognitive Skills in England.” IFS Briefing Note: BN 122, Institute of Fiscal Studies.

Crawford, C., Dearden, L., & Meghir, C. (2010). When You Are Born Matters: The Impact of Date of Birth on Educational Outcomes in England. Institute for Fiscal Studies, 2-4, 21-22. doi:10.1920/wp.ifs.2010.1006

Elder, T., & Lubotsky, D. (2009). Kindergarten Entrance Age and Children’s Achievement: Impacts of State Policies, Family Background, and Peers. Journal Of Human Resources, 44(3), 641-683. doi:10.1353/jhr.2009.0015

Fortner, C., & Jenkins, J. (2017). Kindergarten Redshirting: Motivations and Spillovers Using Census-Level Data. Early Childhood Research Quarterly, 38, 44-56. doi:10.1016/j.ecresq.2016.09.002

Galasso, E., Weber, A., & Fernald L. C. H., (2017). Dynamics of Child Development: Analysis of a Longitudinal Cohort in a Very Low Income Country. The World Bank Economic Review, lhw065.

Huang, F., & Invernizzi, M. (2012). The Association of Kindergarten Entry Age with Early Literacy Outcomes. The Journal Of Educational Research, 105(6), 431-441. doi:10.1080/00220671.2012.658456

Kniffin, K., & Hanks, A. (2015). Revisiting Gladwell’s Hockey Players: Influence of Age Effects upon Earning the PhD. Contemporary Economic Policy, 34(1), 21-36. doi:10.1111/coep.12114

Leuven, E., & Rønning, M. (2014). Classroom Grade Composition and Pupil Achievement. The Economic Journal, 126(593), 1164-1192. doi:10.1111/ecoj.12177

Matta, R., Ribas, R., Sampaio, B., & Sampaio, G. (2016). The Effect of Age at School Entry on College Admission and Earnings: A Regression-Discontinuity Approach. IZA Journal Of Labor Economics, 5(1). doi:10.1186/s40172-016-0049-5

Matsubayashi, T., & Ueda, M. (2015). Relative Age in School and Suicide among Young Individuals in Japan: A Regression Discontinuity Approach. PLOS ONE, 10(8), e0135349. doi:10.1371/journal.pone.0135349

Morrow, R., Garland, E., Wright, J., Maclure, M., Taylor, S., & Dormuth, C. (2012). Influence of Relative Age on Diagnosis and Treatment of Attention-deficit/hyperactivity Disorder in Children. Canadian Medical Association Journal, 184(7), 755-762. doi:10.1503/cmaj.111619

N.A. (2015) Education attainment – Adult education level – OECD Data. Retrieved 10 April 2017, from

Nam, K. (2014). Until When Does the Effect of Age on Academic Achievement Persist? Evidence from Korean Data. Economics Of Education Review, 40, 106-122. doi:10.1016/j.econedurev.2014.02.002

Pehkonen, J., Viinikainen, J., Böckerman, P., Pulkki-Råback, L., Keltikangas-Järvinen, L., & Raitakari, O. (2015). Relative Age at School Entry, School Performance and Long-term Labour Market Outcomes. Applied Economics Letters, 22(16), 1345-1348. doi:10.1080/13504851.2015.1031864

Pekrun, R., Lichtenfeld, S., Marsh, H., Murayama, K., & Goetz, T. (2017). Achievement Emotions and Academic Performance: Longitudinal Models of Reciprocal Effects. Child Development. doi:10.1111/cdev.12704

Peña, P. A. (2015). Creating Winners and Losers: Date of Birth, Relative Age in School, and Outcomes in Childhood and Adulthood”, unpublished manuscript.

Puhani, P., & Weber, A. (2006). Does the Early Bird Catch the Worm? Instrumental Variable Estimates of Early Educational Effects of Age of School Entry in Germany. Empirical Economics, 32(2-3), 359-386. doi:10.1007/s00181-006-0089-y

Quiroga, C., Janosz, M., Bisset, S., & Morin, A. (2013). Early Adolescent Depression Symptoms and School Dropout: Mediating Processes Involving Self-Reported Academic Competence and Achievement. Journal Of Educational Psychology, 105(2), 552-560. doi:10.1037/a0031524

Roberts, S., & Stott, T. (2015). A New Factor in UK Students’ University Attainment: The Relative Age Effect Reversal?. Quality Assurance In Education, 23(3), 295-305. doi:10.1108/qae-01-2013-0008.

Robertson, E. (2011). The Effects of Quarter of Birth on Academic Outcomes at the Elementary School Level. Economics Of Education Review, 30(2), 300-311. doi:10.1016/j.econedurev.2010.10.005

Schneeweis, N., & Zweimüller, M. (2014). Early Tracking and the Misfortune of Being Young. The Scandinavian Journal Of Economics, 116(2), 394-428. doi:10.1111/sjoe.12046

Suziedelyte, A., & Zhu, A. (2015). Does Early Schooling Narrow Outcome Gaps for Advantaged and Disadvantaged Children?. Economics Of Education Review, 45, 76-88. doi:10.1016/j.econedurev.2015.02.001

Sykes, E., Bell, J., & Rodeiro, C. (2009). Birthdate Effects: A Review of the Literature from 1990-on (pp. 3-4). Cambridge, England: University of Cambridge.

Thomas, J. (2012). Combination Classes and Educational Achievement. Economics Of Education Review, 31(6), 1058-1066. doi:10.1016/j.econedurev.2012.07.013

Thoren, K., Heinig, E., & Brunner, M. (2016). Relative Age Effects in Mathematics and Reading: Investigating the Generalizability across Students, Time and Classes. Frontiers In Psychology, 7 (n/a).

Zhang, S., Zhong, R., & Zhang, J. (2017). School Starting Age and Academic Achievement: Evidence from China’s Junior High Schools. China Economic Review. doi:10.1016/j.chieco.2017.03.004

Image via frolicsomepl/Pixabay.

]]> 0
Ketamine for Rapid Treatment of Depression Wed, 27 Sep 2017 15:30:01 +0000 A team of researchers funded by the National Institutes of Health (NIH) recently discovered why the drug ketamine may act as a rapid antidepressant.

Ketamine is best known as an illicit, psychedelic club drug. Often referred to as “Special K” or a “horse tranquilizer” by the media, it has been around since the 1960s and is a staple anesthetic in emergency rooms and burn centers. In the last 10 years, studies have shown that it can reverse — sometimes within hours or even minutes — the kind of severe, suicidal depression that traditional antidepressants can’t treat.

Researchers writing in the August 2010 issue of Archives of General Psychiatry reported that people in a small study who had treatment-resistant bipolar disorder experienced relief from depression symptoms in as little as 40 minutes after getting an intravenous dose of ketamine. Eighteen of these people had previously been unsuccessfully treated with at least one antidepressant medication and a mood stabilizer; the average number of medications they had tried unsuccessfully was seven. Within 40 minutes, 9 of 16 (56 percent) of the participants receiving ketamine had at least a 50 percent reduction in symptoms, and 2 of 16 (13 percent) had full remission and became symptom-free. The response lasted an average of about a week.

In a small 2006 NIMH study, one of the first to look at ketamine for depression, 18 treatment-resistant, depressed (unipolar) patients were randomly selected to receive either a single intravenous dose of ketamine or a placebo. Depression symptoms improved within one day in 71 percent of those who were given ketamine, and 29 percent of the patients became nearly symptom-free in a day. Thirty-five percent of patients who received ketamine still showed benefits seven days later.

In the most recent study published online in the journal Nature in May 2016, researchers discovered that a chemical byproduct, or metabolite, is created as the body breaks down ketamine. The metabolite reversed depression-like behaviors in mice without triggering any of the anesthetic, dissociative, or addictive side effects associated with ketamine.

As put by Carlos Zarate, MD, of the National Institute of Mental Health (NIMH), and a study coauthor and pioneer of research using ketamine to treat depression:

This discovery fundamentally changes our understanding of how this rapid antidepressant mechanism works, and holds promise for development of more robust and safer treatments. By using a team approach, researchers were able to reverse-engineer ketamine’s workings from the clinic to the lab to pinpoint what makes it so unique.”

In response to the Nature report, Sara Solovitch of The Washington Post wrote that:

experts are calling [ketamine] the most significant advance in mental health in more than half a century.

She reported that many academic medical centers, including Yale University, the University of California in San Diego, the Mayo Clinic, and the Cleveland Clinic, have all begun offering ketamine treatments off-label for severe depression.

It all sounds too good to be true, right?

The Drawbacks of Ketamine

The predominant drawback of ketamine is the lack of data.

There haven’t been enough clinical trials on the drug to assure its safety, and there’s a lack of information on the long-term effects of its use.

Ketamine’s effects are also short-lived. To be used as an effective antidepressant, it would need to be administered regularly, which leads to concerns about addiction, tolerance, and, again, long-term effects. The data that we do have on long-term use comes from people who have taken ketamine recreationally, as well as those who have used it to treat chronic pain.

One 2014 study published in the British Journal of Clinical Pharmacology included among possible side effects, psychedelic symptoms (hallucinations and panic attacks), nausea, cardiovascular stimulation, memory defects, and bladder and renal complications.

Still, the drug holds promise for uncovering new ways of treating depression and offers hope for the most severe and complicated mood disorders that baffle psychiatrists today.

Richard J. Hodes, MD, director of the National Institute on Aging, commented on the most recent NIH study and the importance of furthering the research:

Unraveling the mechanism mediating ketamine’s antidepressant activity is an important step in the process of drug development. New approaches are critical for the treatment of depression, especially for older adults and for patients who do not respond to current medications.

Join Project Hope & Beyond, the new depression community.

This guest article appeared on Ketamine: A Miracle Drug for Depression? and was originally posted on Sanity Break at Everyday Health by Therese J. Borchard.


Diazgranados, N., Ibrahim, L., Brutsche, N., Newberg, A., Kronstein, P., & Khalife, S. et al. (2010). A Randomized Add-on Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Bipolar Depression. Archives Of General Psychiatry, 67(8), 793. DOI: archgenpsychiatry.2010.90.

Zanos, P., Moaddel, R., Morris, P., Georgiou, P., Fischell, J., & Elmer, G. et al. (2016). NMDAR inhibition-independent antidepressant actions of ketamine metabolites. Nature, 533(7604), 481-486. DOI: 10.1038/nature17998.

Zarate, C., Singh, J., Carlson, P., Brutsche, N., Ameli, R., & Luckenbaugh, D. et al. (2006). A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression. Archives Of General Psychiatry, 63(8), 856. DOI: 10.1001/archpsyc.63.8.856.

Image via stevepb/Pixabay.

]]> 0
The Science of Raising a Friendly Psychopath Tue, 06 Dec 2016 16:00:24 +0000 What makes someone a psycopath? Nature or nurture? And can we stop at risk children from growing up into dangerous adult psycopaths? One of the oldest queries in psychology — Nature Vs Nurture — asks if what makes us who we are is predisposed by our DNA, or by life experiences. It is a pretty poignant question when it comes to psychopaths, who are estimated to account for up to 50% of all serious crimes in the US.

Clinically known as anti-social personality disorder in the DMS-V, some troublesome psychopathic traits include:

• an egocentric identity
• an absence of pro-social standards in goal-setting
• a lack of empathy
• an incapacity for mutually intimate relationships
• manipulativeness
• deceitfulness
• callousness
• irresponsibility, impulsivity and risk taking
• hostility

Although these characteristics may be unpleasant, not all psychopaths are dangerous or criminals, and not all dangerous criminals are psychopaths. Counter-intuitively there are pro-social psycopaths too. Nonetheless, some psychopaths do pose a genuine threat for the safety of others.

The real unsolved problem when it comes to psychopathy is how to treat the personality disorder. Although certainly not to be considered impossible with the malleable brains we have even as adults, Dr. Nigel Blackwood, a leading Forensic Psychiatrist at King’s College London, has stated that adult psychopaths can be treated or managed, but not cured. Curing adult psycopathy is considered a near-impossible challenge.

Therefore, understanding when and how psychopathy develops from child to adult is an important part of the research engine that will hopefully identify what parents, caregivers and governments can do to prevent an at risk child from growing up to be a dangerous psycopath.

Development of psycopathic personalities is mainly due to genes

Enter new psychopathy research published in Development and Psychopathology by lead author Dr. Catherine Tuvblad from the University of Southern California. Her research was a twin-based study designed to overcome many previous drawbacks and limitations. Ultimately, the study was designed to provide a more reliable indication of the extent to which genes or the environment, that is nature or nurture, is responsible for the development of psychopathic personality features as a child grows into a young adult.

In the study, 780 pairs of twins and their caregivers filled out a questionnaire that allowed for measuring features of child psychopathy at ages 9–10, 11–13, 14–15, and 16–18. This included measuring psychopathic personality features indicative of future psychopathy, such as high levels of callous behavior towards peers and problems adhering to social norms.

The changes in the childrens’ psychopathic personality features between age groups was considered to be:

• 94% due to genetics between the ages of 9-10 and 11-13, and 6% environmental
• 71% due to genetics between the ages of 11–13 and 14–15, and 29% environemental
• 66% due to genetics between 14-15 and 16-18<, and 44% environmental This suggests that environmental factors may gradually play a greater part in changing the levels of psychopathic features a child develops in later teenage years, which is very promising for the development of future interventions for the prevention of psychopathy. It should be noted that while the childrens' test results pointed to the environment around them becoming increasingly important to their psycopathic behavior, their parents almost exclusively thought that the psycopathy they observed in their children was purely genetic. Considering parents are largely responsible for their child's environment, its not that surprising. Nurture is important at key developmental stages in psychopathy development

The analysis also revealed that there may be a key turning point in the development of psychopathy during the age range studied. The authors considered this turning point to be caused by the onset of puberty, when gene-environment interactions that are highly significant in inhibiting or promoting the development of psychopathy are at play.

Interestingly, the data also indicates that if these rapid gene-environment based changes in psychopathic traits occur early on (e.g. 11-13), any later additional environmental changes to psychopathic traits would be minimal. In other words, once the psychopathic personality traits are set during puberty, they tend to last into later years.

Other research has found that there may be other key turning points on route to becoming a psychopath much earlier in life. One study found that the total number of early negative life events between the ages of 0-4 were positively correlated with the emotion-based aspects of psychopathy. The findings suggest that early environmental factors could have important implications for the development of psychopathic traits and may also impact attachment to parents for children with genetic potential for psychopathy.

So although psychopathy is largely genetic, where it’s mostly down to if you have the right combination of genes needed to become a psychopath or not, life experiences during puberty and early infant years could make or break a potential psychopath.

The cure for psychopathy is love?

So what does science suggest as a successful environmental antidote to developing psychopathy? Believe it or not, love!

One neuroscientist, Dr. James Fallon, made a shocking discovery that on paper he is a psychopath. For example, he had a version of the monoamine oxidase A (MAOA) gene that is linked with violent crime and psychopathy. Also known as the warrior gene, MAOA encodes an enzyme that affects the neurotransmitters dopamine, norepinephrine, and serotonin.

His brain scans also resembled those of a psychopath. He had low activity in certain areas of the frontal and temporal lobes linked challenges with empathy, morality and self-control. In his family tree, there were also seven alleged murderers.

Although Dr. Fallon, in his own words, is obnoxiously competitive, kind of an asshole and won’t even let his grandchildren win games, he was certainly not a dangerous psychopath. So why not? His genes and even his brain screamed potential for antisocial psychopathy.

His answer was that the love he received from his mother led to him becoming a pro-social psycopath. And a newly published study tends to agree with him. OK love in itself is not enough. But, how a mother expresses that love in guiding the child’s pro-social behavior and in setting good examples of pro-social behavior might be the real key.

A new discovery coming from research on adopted infants suggests this is the case. Researchers found that the development of one of the largest child risk factors for psychopathy, that is highly heritable from biological mothers with severe antisocial behaviors — callous-unemotional behavior — was inhibited by high levels of positive reinforcement at 18 months by the adopted mother.

Further research will hopefully identify a whole repertoire of ways parents, schools and governments alike can lovingly nurture the development of at risk children through these key developmental stages. Ultimately, this could stop a large amount of future violent criminals literally in their diapers, before they even start.


Bartels, M., Hudziak, J. J., van den Oord, E. J. C. G., van Beijsterveldt, C. E. M., Rietveld, M. J. H., & Boomsma, D. I. (2003). Co-occurrence of Aggressive Behavior and Rule-Breaking Behavior at Age 12: Multi-Rater Analyses. Behavior Genetics, 33(5), 607–621. doi:10.1023/a:1025787019702

Hawes, S. W., Byrd, A. L., Waller, R., Lynam, D. R., & Pardini, D. A. (2016). Late childhood interpersonal callousness and conduct problem trajectories interact to predict adult psychopathy. Journal of Child Psychology and Psychiatry. doi:10.1111/jcpp.12598

Hyde, L. W., Waller, R., Trentacosta, C. J., Shaw, D. S., Neiderhiser, J. M., Ganiban, J. M., … Leve, L. D. (2016). Heritable and Nonheritable pathways to early callous-unemotional behaviors. American Journal of Psychiatry, 173(9), 903–910. doi:10.1176/appi.ajp.2016.15111381

Miller, J. D., Jones, S. E., & Lynam, D. R. (2011). Psychopathic traits from the perspective of self and informant reports: Is there evidence for a lack of insight? Journal of Abnormal Psychology, 120(3), 758–764. doi:10.1037/a0022477

Neumann, C. S., & Hare, R. D. (2008). Psychopathic traits in a large community sample: Links to violence, alcohol use, and intelligence. Journal of Consulting and Clinical Psychology, 76(5), 893–899. doi:10.1037/0022-006x.76.5.893

Rogers, T. P., Blackwood, N. J., Farnham, F., Pickup, G. J., & Watts, M. J. (2008). Fitness to plead and competence to stand trial: A systematic review of the constructs and their application. Journal of Forensic Psychiatry & Psychology, 19(4), 576–596. doi:10.1080/14789940801947909

Tuvblad, C., Wang, P., Bezdjian, S., Raine, A., & Baker, L. A. (2015). Psychopathic personality development from ages 9 to 18: Genes and environment. Development and Psychopathology, 28(01), 27–44. doi:10.1017/s0954579415000267

Image via jarmoluk / Pixabay.

]]> 0
How to Secure Therapy Completion with Meta-Intervention Mon, 05 Dec 2016 16:00:53 +0000 Keeping messages brief and simple is more effective when trying to encourage patients to complete a health care program, according to new research.

In a study that analyzes six years of data, a team of researchers found small “nudges” in the right direction were a simple, inexpensive, and effective way to increase completion of health care programs, leading to a 16 percent jump in the completion rate for an already fastidious audience.

Dr. Dolores Albarracin, a professor of psychology and business administration at the University of Illinois and one of the co-authors of the study said that:

“Retention and completion are critical components of the effectiveness of health care interventions in real-world conditions, so a 16 percent increase in completion is significant.”

She noted that most health care intervention programs — for example, 10 sessions with a counselor — are expensive to implement and deliver:

“Patients start but they often drop out, which is not beneficial and is a huge deadweight loss of resources for everyone. That’s why increasing retention rates is vital for public health, because multi-session behavioral interventions or a series of appointments with a health care provider are more efficacious when completed.”

For the study, a randomized control trial with more than 700 eligible patients in Florida was conducted to identify a simple, effective intervention to increase the completion of an HIV-prevention counseling program delivered at the Duval County Department of Health.

The study involved two factors: One representing an instrumental message and the other an empowering message. The messages were brief videos played immediately after the counseling program.

The instrumental message reminded participants that they could discuss issues other than HIV with their counselor. The empowering message was designed to make them feel free, independent and in charge of their decision to return — a strategy that doubled enrollment in programs in other work by the same team, according to the study.

The idea was to use brief, simple marketing messages not for a commercial product. As Albarracin explains:

“health programs to get people to complete interventions that change detrimental behavior. These messages were designed to either empower clients as agents responsible for their own change or to highlight the instrumental outcomes of the intervention in terms of participants’ lives by addressing health concerns other than HIV, such as employment or education.”

Results indicated that the instrumental message alone produced more completion than either the empowering message alone or combined with the instrumental message.

The success of the simple, post-session message, which the researchers termed “meta-intervention,” comes down to the power of the nudge as a “gentle reminder to do something,” Albarracin said:

“The word ‘nudge’ has such a nice connotation to it because it reminds us that we need to find strategies that are simple and cost-effective. In a health care setting, you need something that’s practical, implementable and inexpensive. This is that kind of approach.”

For people who are vulnerable or disadvantaged, repeated contact with the health care system is important, according to Albarracin.

“Contact with the public health system is often the front door to accessing a lot of other public services — mental health services, career and employment services, and other forms of social assistance,” she said. “So the public health system might design a program with health in mind, but the audience who is buying into the program has multiple goals in mind, not just health.”

Having a good job or access to other services is just as important, which is why you have to sell the benefits of the program from the perspective of the audience, not of the provider, according to Albarracin:

“Social marketing is a marriage between psychological approaches and an approach that has the consumer in mind. Make it recipient- and patient-centered, not provider-centered. The instrumental message capitalizes on that.”

This guest article originally appeared on Brief ‘Nudge’ Can Help Patients Finish Health Program by Rick Nauert PhD.

Albarracín, D., Wilson, K., Durantini, M. R., Sunderrajan, A., & Livingood, W. (2016). A meta-intervention to increase completion of an HIV-prevention intervention: Results from a randomized controlled trial in the state of Florida. Journal of Consulting and Clinical Psychology, 84(12), 1052–1065. doi:10.1037/ccp0000139

Image via Picudio / Pixabay.

]]> 0
Homosexuality Link to Child Sex Abuse Confirmed — Gender Nonconformity Mon, 21 Nov 2016 16:00:01 +0000 Can sexual abuse make you gay? The short answer according to new research is, no. Child sexual abuse is not a common cause of being gay. But, new research says that the opposite is true. There is something common in the childhood of homosexual men that makes them a target for pedophilia and sexual abuse — gender non-conformity.

Many homophobic religious institutions make unfounded claims about same-sex sexual child abuse causing homosexuality, like those coming from the pro-heterosexual, anti-gay activist group, Heterosexuals Organized for a Moral Environment (HOME):

We can see that sexual abuse can theoretically account for every case of homosexuality…

Under the lens of science these claims are considered ridiculous and laughable at best, often followed by outrageous and scientifically unfounded claims that being gay is the cause of pedophilia.

Nonetheless, non-heterosexuals with a history of same-sex sexual abuse as a child often ask if this made them desire the same-sex as an adult. Similarly, gay men and women who were sexually abused by the opposite sex as a child, ask if this caused a sexual fear and revulsion towards the opposite sex that ‘made’ them gay.

Whether the pedophile or child molester was gay or straight, gay victims tend to ask the same question at some point, “Did sexual abuse make me gay?”

Research indicates that this isn’t true of straight people abused as children, they are less likely to question if being abused made them straight. Thus it is often argued that it is the culturally ingrained negative views of gay people, particularly of gay men, or simply belonging to a minority group, that the question is even asked in the first place.

Even so, it is still a common view that sexual abuse can ‘turn’ a child gay despite no convincing or reliable evidence that premature sexual activity or child sexual abuse grossly changes sexual orientation.

The main withstanding argument in support of this view is that child sexual abuse is more common in the gay community than the straight community. In fact, meta-analysis indicates that sexual minority school children were on average almost 4 times more likely to experience sexual abuse than heterosexual children.

The latest research stands against this argument, providing the most convincing causal evidence yet that it is a common aspect of many gay men’s childhoods that is linked with higher rates of sexual abuse in boys who later identify as gay in adulthood — not sexual abuse ‘making’ a child gay.

Published in Sexual Abuse: A Journal of Research and Treatment the new research suggests that a child’s gender nonconformity, which is more common for non-heterosexuals, that may make them more desirable targets for pedophiles and child abusers.

To clarify, gender nonconformity you may also know as gender bending. Gender nonconformity is when people identify with or behave like what is culturally considered typical for the opposite sex, going against the gender grain if you will. For example, boys that like to play dress-up, or girls that prefer rough play.

In the study, 1753 participants filled out an online survey that regarding their sexual orientation, history of child abuse, and the degree of gender nonconformity they recall from childhood, including the activities and kinds of play and types of clothes they liked.

Although other research has suggested a link between gender nonconforming and sexual abuse in children, whether nonconforming caused abuse, or abuse caused nonconforming had not previously been assessed this directly. By using a special type of analysis called instrumental variable analysis, the new study was able to estimate causal relationships. It is therefore study able to more confidently address the complex question “Can sexual abuse make you gay?”

In line with other research, gay participants (being male or female homo and bisexuals) in the new study had greater odds (~45% greater) of being sexually abused in childhood than heterosexual participants.

They also found that heterosexual and non-heterosexual men who are more gender nonconforming (i.e. ‘feminine’) in childhood had higher chances of abuse than sexual orientation matched boys who are more gender conforming (i.e. ‘masculine’). In other words being gay or not had nothing to do with it. It was whether boys behaved like stereotypical boys or not that was key.

However, gender non-conforming girls were not at higher risk of sexual abuse than conforming girls in the present study. It is research supported factoid that gender nonconformity in girls, like being a ‘tomboy’, is generally more socially accepted, approved of and tolerated in Western cultures than gender nonconforming in boys, who are often considered as mama’s boys, sissies or brats.

The authors suggest that gender nonconforming boys are less generally approved of partly due to cultural femi-negativity. Cultural femi-negativity being where femininity is particularly devalued when it does not adhere to gender norms. The idea that abusers target children with feminine qualities as to make for more compliant and less socially valued abuse targets fits well with the study and the body of research as a whole considering more girls are targets of pedophilia and child molestation than boys, and that more gender non-conforming feminine boys are targeted more than masculine conforming ones, whether they are gay or not.

This also makes sense when considering research suggesting that most abusive pedophiles are generally aroused by youth, and that the child’s sex, at the core of their desires, is pretty immaterial. Whether they abuse mainly boys or girls, it’s about a child being a child, ease of access to that child and avoiding getting caught through ease of controlling the child.

Whereas adult child molesters, who can be a pedophiles (i.e. someone specifically attracted to children) but are not necessarily pedophiles, get a sexual kick out of domination, power and control, marking those with more feminine qualities as being easier and less risky targets.

Importantly, the research suggests that it is having feminine personality traits and behaviors more common to gay boys, i.e. gender nonconforming, that leads to such high rates of child abuse cases in gay men. There is no credible research as of yet that indicates that it is common that child sexual abuse is a cause of being gay.

It seems that there is something, or somethings, about gender-non-conforming in boys that puts them at an increased risk of sexual abuse. If research now focuses on exploring further what those somethings are we can better protect children from the traumas of sexual abuse.


Bailey, M. J., Vasey, P. L., Diamond, L. M., Breedlove, M. S., Vilain, E., & Epprecht, M. (2016). Sexual orientation, controversy, and science. Psychological Science in the Public Interest, 17(2), 45–101. doi:10.1177/1529100616637616

Coyle, E. F., Fulcher, M., & Trübutschek, D. (2016). Sissies, mama’s boys, and Tomboys: Is children’s gender Nonconformity more acceptable when Nonconforming traits are positive? Archives of Sexual Behavior, 45(7), 1827–1838. doi:10.1007/s10508-016-0695-5

Friedman, M. S., Marshal, M. P., Guadamuz, T. E., Wei, C., Wong, C. F., Saewyc, E. M., & Stall, R. (2011). A Meta-Analysis of disparities in childhood sexual abuse, parental physical abuse, and peer Victimization among sexual minority and sexual nonminority individuals. American Journal of Public Health, 101(8), 1481–1494. doi:10.2105/ajph.2009.190009

Xu, Y., & Zheng, Y. (2015). Does sexual orientation precede childhood sexual abuse? Childhood gender Nonconformity as a risk factor and instrumental variable analysis. Sex Abuse. doi:10.1177/1079063215618378

Image via Unsplash / Pixabay.

]]> 0
Affection, Not Money, Key to Child Health Tue, 18 Oct 2016 11:34:04 +0000 Growing up in a well-off home can benefit a child’s physical health even decades later, but a lack of parent-child warmth, or the presence of abuse, may eliminate the health advantage of a privileged background, according to a Baylor University study.

Assistant professor of sociology at Baylor University, Matthew A. Andersson, Ph.D., explains:

Previous research has associated high socioeconomic status with better childhood nutrition, sleep, neighborhood quality, and opportunities for exercise and development of social skills. But good parent-child bonds may be necessary to enforce eating, sleep, and activity routines.

For example, if parent-child relationships are strained or abusive, meals may be less coordinated among the family, and children may be more likely to eat sugary or high-fat foods as snacks or even in place of meals.

Sleep and activity routines also may become irregular, keeping children from developing healthy lifestyles and social and emotional skills useful for successful aging, Andersson said.

Unfortunately, although good parent-child bonds in economically disadvantaged homes, promote health, they do not seem to lessen the negative impact of low socioeconomic status as the children age, Andersson said.

Previous research has shown parents with less education and fewer financial advantages are more apt to threaten or force obedience rather than have constructive dialogue, and that may lessen warm relationships.

In addition, disease rates or inflammation among those children when they become adults have been linked strongly to abuse, mistreatment, or lower levels of parental warmth.

The study on Midlife Health and Parent-Child Relationships appears in the Journal of Health and Social Behavior.

For the study, health at midlife was defined as being free from 28 possible conditions, among them cancer, circulatory or respiratory disease, endocrine diseases, nervous system diseases, infectious and parasitic diseases, skin or digestive disease, and musculoskeletal conditions. Andersson explains the take-home message:

Much research continues to view socioeconomic status and parent-child bonds as highly related or even interchangeable. But in fact they may quite independently influence a child’s well-being. The key takeaway is that without adequate parent-child relationship quality to match, socioeconomic advantage during childhood may not offer much protection at all against major chronic disease as children become adults and reach middle age.

For the study, Andersson analyzed data on disease or poor health of middle-aged adults drawn from the National Survey of Midlife Development in the United States (MIDUS).

He surveyed 2,746 respondents ages 25 to 75 in 1995 about their childhood treatment by parents. He conducted surveys again about 10 years later, with 1,692 of the individuals taking part.

The follow-up analysis, adjusted for personal background in 1995 and for probability of dropping out of the MIDUS study, revealed that childhood abuse continued to undermine any protection from disease linked to childhood socioeconomic advantage.

This guest article originally appeared on Lack of Affection May Cancel Health Benefits of Well-Off Family


Andersson, M. A. (2016). Chronic disease at Midlife: Do parent-child bonds modify the effect of childhood SES? Journal of Health and Social Behavior, 57(3), 373–389. doi:10.1177/0022146516661596

Image via Pezibear / Pixabay.

]]> 0
Best Strategy to Manage Stress Depends on the Person Fri, 14 Oct 2016 11:22:46 +0000 People use different coping strategies to deal with stressful events, and some people use coping strategies more than others. Three techniques for keeping perspective through the ups and downs of life that have been studied are:

Mindfulness: Staying aware in the present moment
Reappraisal: Finding ways of reinterpreting negative events to give them more positive meaning
Emotion Suppression: Putting negative emotions out of side and out of mind

To learn more about how these strategies work on a day-to-day basis, a team of researchers recently performed a study of 187 participants looking at how use of these strategies affected people’s moods.

Overall, different strategies had different benefits for different people.

Mindfulness helped people keep their emotions balanced in two ways. It both increased people’s levels of positive emotions and decreased their levels of negative emotions.

Emotion suppression turned out to have the exact opposite effect. When people used more emotion suppression, they reported higher levels of negative emotions and lower levels of positive emotions.

For reappraisal, the picture was a little more nuanced. For about half the people in the study, reappraisal seemed to be of no use in regulating their negative emotions. Overall, appraisal tended to be more helpful for people who were older: for older participants, using appraisal was associated with lower levels of negative emotions while for adolescents, it was linked to higher levels of negative emotions!

These results indicate that there’s no one-size-fits-all coping strategy that works for everyone. Finding whatever way of dealing with stressful situations works best for you is the way to go.

That said, some strategies seem like promising places to look. Mindfulness is an especially promising candidate while for many emotion suppression will do more harm than good. And reappraisal? You’ve probably got about a fifty-fifty chance on that one.

This guest article originally appeared on Mindfulness, Reappraisal, Emotion Suppression: Which Coping Strategies Work?


Brockman, R., Ciarrochi, J., Parker, P., & Kashdan, T. (2016). Emotion regulation strategies in daily life: Mindfulness, cognitive reappraisal and emotion suppression. Cognitive Behaviour Therapy. doi:10.1080/16506073.2016.1218926

Image via lecreusois / Pixabay.

]]> 0
The Science of a Happy Family – Leisure Time Wed, 12 Oct 2016 11:22:43 +0000 Family fun often means new activities and destinations but a new study suggests leisure time spent at home in familiar pastimes may be a better route to happiness.

The lead author of a newly published study in the World Leisure Journal, Dr. Karen K. Melton, assistant professor of child and family studies at Baylor University talks causality:

That may be because when the brain is focused on processing new information, such as taking part in an unfamiliar activity with unfamiliar people in a new location, less ‘brain power’ is available to focus on the family relationships,

While research results suggest that all quality time together contributes to satisfaction with family life, “all family leisure is not equal,” she said.

The best predictor of happiness for families may be spending quality time together in familiar activities inside the home. And that’s great news for families who have little time or few resources.

Researchers performed the online research beginning with a sample of 1,502 individuals in 884 families in the United Kingdom. Each family unit taking part in the online research had at least one child between the ages of 11 and 15.

Participants answered questions about whether they took part in family leisure in the past year, and if so, what activities (from 16 categories) they did, how much time they spent doing them and how frequently they did so.

Melton said that the catchy expression “The family that plays together, stays together!” carries two misconceptions: that all family leisure brings positive results and that all family activities are equal.

Family members also can express stress and conflict as well as pleasure during leisure time. The activities alone will not heal the scars of hurting families.

Melton noted that some studies support the idea that eating together is one of the best predictors of functioning families, while watching TV is seen as ineffective for individual happiness or family function. Melton warns, however, that each family is different and that a one-size-fits-all notion is often incorrect.

For some families, quality togetherness is having dinner together or playing games; for others, it may be hobbies, videos, TV or music… At the end of the day, what matters is that we are social beings who crave a sense of belonging and connectivity.

This guest article originally appeared on Leisure Time At Home May Be Best Path to Happy Family

Melton, K. K., & Zabriskie, R. B. (2016). In the pursuit of happiness all family leisure is not equal. World Leisure Journal, 58(4), 311–326. doi:10.1080/16078055.2016.1228154

Image via ArtsyBee / Pixabay.

]]> 0
Challenging Goal? Improve Focus by Engaging Your Brain Mon, 10 Oct 2016 11:22:42 +0000 New research confirms anecdotal observations that people can easily be distracted if they want to be, and that the ability to concentrate on a task and stay disciplined is best accomplished when an individual is interested.

Investigators say their findings provide evidence that one’s motivation is just as important for sustained attention to a task as is the ease with which the task is done.

The research also challenges the hypothesis, proposed by some cognitive neuroscientists, that people become more distractible as they tackle increasingly difficult tasks.

A report of the new study appears in the Journal of Experimental Psychology: General. The authors of the study, University of Illinois psychology professors Drs. Simona Buetti and Alejandro Lleras write:

People must almost continuously balance their need for inner focus (reflection, mental effort) with their need for attending to the world. But, when the need for inner focus is high, we may have the impression that we momentarily disengage from the world entirely in order to achieve a heightened degree of mental focus.

Buetti and Lleras designed several experiments to test whether people are more easily distracted when the mental effort required to complete a task goes up, as is generally assumed in their field.

The researchers first asked participants to solve math problems of varying difficulty while photographs of neutral scenes — for example, cows in a pasture, a portrait of a man, a cup on a table — flashed on a computer display for three seconds, enticing the subjects to look at them.

An eye-tracking device measured the frequency, speed, and focus of participants’ eyes as they completed the math problems.

The results showed that participants who were engaged in an easy version of the task were more likely to look at the distractors than those engaged in an extremely challenging version. These results run counter to current theories, the researchers said. As put by Buetti:

This suggests that focus on complex mental tasks reduces a person’s sensitivity to events in the world that are not related to those tasks

This finding corresponds to research on a phenomenon called “inattentional blindness,” in which people involved in an engaging task often fail to notice strange and unexpected events. As put by the authors:

Between the inner world of solving a problem and the outer world — what’s going on around you — there seems to be a need to disengage from one when heightened attention to the other is required…Interestingly, when participants completed a mix of easy and hard tasks, the difficulty of the task did not seem to affect their distractibility.

This finding led the researchers to hypothesize that the ability to avoid being distracted is not driven primarily by the difficulty of the task, but is likely the result of an individual’s level of engagement with the endeavor. They call this concept the “engagement theory of distractibility.”

The team did further studies to test this idea, manipulating subjects’ enthusiasm for the task with financial incentives. To the researchers’ surprise, this manipulation had little effect on participants’ distractibility. However, as explained by Buetti there were large differences between people in terms of their distractibility:

The more participants struggled with a task, the more they reflexively avoided distraction, irrespective of financial incentive. So, the take-home message is: Characteristics of the task itself, like its difficulty, do not alone predict distractibility. Other factors also play a role, like the ease with which we can perform a task, as well as a decision that is internal to each of us: how much we decide to cognitively engage in a task.

This guest article originally appeared on Motivation Linked to Ability to Stay on Task


Buetti, S., & Lleras, A. Distractibility is a function of engagement, not task difficulty: Evidence from a new oculomotor capture paradigm. (2016). Journal of Experimental Psychology: General, 145(10), 1382–1405. doi:10.1037/xge0000213

Image via keijj44 / Pixabay.

]]> 0
How to Deal with Destination Memory Issues – Did I Already Tell You? Fri, 16 Sep 2016 08:50:30 +0000 Have you ever realized or been informed that the person you are talking to has already heard the joke or story you are telling?

I already told your this?

If you have been in this situation, you are not alone. You are dealing with what experts call, destination memory.

Destination memory is the ability to remember to whom you told what. The reason that so many of us have problems with it, is that it has been found to be weaker than other forms of memory regardless of age.

Why is Destination Memory Weaker?

• According to Nigel Gopie and Colin MacLeod, the researchers who coined the term destination memory, we may have more practice and feedback developing other forms of memory like explicit memory, our memory for facts, dates, vocabulary etc. or implicit memory, our memory for riding a bike, driving a car etc. You’ve heard the expression, “ It’s like riding a bike, you never forget it.” The destination of what we say may be weaker because we have more need to remember the fact than the person with whom we share it.

• Gopie and Mackleod’s research findings reported in 2009 in Psychological Science reveal that when students are asked to speak a fact they are trying to memorize out loud to someone’s picture, their later performance on remembering the facts and faces declines compared to students who asked to simply memorize facts matched with faces.

• One hypothesis is that the telling of the fact to another person is actually a competing task that interferes with memory. Perhaps we suppress the memory of our audience to reduce the interference.

• Certainly more research is needed, but for now…

How Do You Improve Destination Memory?

These researchers suggest that saying the recipient’s name before you share your information increases the likelihood of remembering to whom you told what. “Joe, I have to tell you what happened at the office last week.”

How Do You Actually Avoid The Embarrassment Of Re-telling A Story?

It is suggested that if uncertain, you might preface the story with a caveat like “Stop me if I told you this – it’s just so interesting to me…. Or “I might have told your this, if so…. etc.”

Should We Correct Our Partner’s Destination Memory?

Think twice. If it is a choice between “Honey, you already told them about our nightmare cruise,” or relying on the patience of your listening friends – go with the friends.

Destination Memory Doesn’t Have to Count Between Partners

The telling and re-telling of stories old and new – particularly of shared experiences is not only inevitable between partners – it is desirable. It is a little bit like the “ mutual stuff” both partners accept as their shared clutter in the place they call home. Such stories are welcomed and appreciated as the favorite legends of their relationship.

Whereas the kids no longer want to hear about the “nightmare cruise” and the friends no longer care, the couple can take them off the shelf over and over and enjoy the re-telling. It is part of their fabric, their shared oral history, and the destination that they share.

This guest article originally appeared on Do you have a problem with destination memory?


Gopie, N. and MacLeod, C.M. (2009) ‘Destination memory: Stop me if I’ve told you this before’, Psychological Science, 20(12), pp. 1492–1499. doi: 10.1111/j.1467-9280.2009.02472.x.

]]> 0
Coping with Trauma in Netflix’s Unbreakable Kimmy Schmidt Thu, 15 Sep 2016 15:30:09 +0000 The original 2015 Netflix series Unbreakable Kimmy Schmidt, starring Ellie Kemper, is pure comedy at its finest as quirky — and certainly bubbly — 29 year-old Kimmy Schmidt moves from Indiana to New York City for a fresh start. She finds a home with Titus, the dramatic and eccentric roommate looking for stardom (played by Tituss Burgess), has adventures with Lillian, the tough-as-nails and offbeat landlord (played by Carol Kane), and begins to work as a nanny for Jacqueline, a snobby but lovable socialite (played by Jane Krakowski).

But underneath the literally laugh out loud dialogue and hilarity is a serious — and comparatively unique — storyline. In episode one, we learn that Kimmy was kidnapped along with three other young women by a reverend who told them the world was ending; she spent fifteen years of her life immersed in an apocalypse cult, living in an underground bunker until they were finally freed.

And as wondrous as it is for Kimmy to have a second chance at life, you could imagine she may have some post traumatic stress to confront. After all, while she was living in the bunker for fifteen years, her main objective was to adapt to the experience. And to survive.

In season one, we find Kimmy back in the real world again. Her lack of awareness regarding pop culture or societal trends or famous news headlines surely gives way to humor, and her immense drive to surpass her past and move on is admirable. We watch Kimmy help friends who are struggling, take G.E.D courses and even become entangled in a love triangle. And through it all, Kimmy upholds an extremely optimistic disposition. (Though I should note that Kimmy does have a bright disposition, in general).

However, remnants of Kimmy’s kidnapping seep in between the cracks. We see her have a night terror; we see her highly startled from various triggers; we see her react to those triggers with aggression; and, we see her deal with unpleasant moments by counting to ten (an exercise she practiced in the bunker).

In one episode, Kimmy contemplates having plastic surgery. She does not desire recognition; she does not want her experience of victimization to define her. But before she can go through with the procedure, she realizes that fixing the outside won’t matter. Fixing the inside is what counts.

While it’s hinted at that Kimmy would benefit from talking to someone, it’s season two that truly showcases Kimmy’s progress. We see her have flashbacks and erratic sleep patterns and indigestion issues (insinuating she may have some emotional purging to do). We see her put others needs before her own, as if she doesn’t value her own needs at all; as if she’s simply invisible.

When she wakes up on a roller coaster and doesn’t know how she got there, she knows that’s her ‘wake up call’ to seek professional help.

And while her therapist has her own set of problems (played by Tina Fey), Kimmy does begin to deal with not only what happened in the bunker, but deep-seated emotions that preceded her kidnapping, too. (And I don’t want to be a “spoiler,” but let’s just say she has some unfinished issues with her mother.)

Another motif worth mentioning is the strong feminist approach to the show as well; feminist in the sense that these women survived such adversity and will continue to acquire the strength they need to live their lives.

In a 2015 interview with Ellie Kemper for Collider, she’s asked how she balances Kimmy’s optimism with her strength, and how she still finds the humor in such a role:

What makes this character very special is that, sure, if you saw her at the post office, you might think, ‘Oh, here’s a woman in bright pink pants with red hair who’s smiling,’ but you never would guess the resilience that lies inside. That union of traits is what makes her so special. She’s not hardened by it. She’s still optimistic and wanting to believe that the best can happen. She wasn’t defeated by this horrible thing.

Unbreakable Kimmy Schmidt is not your average television series. It’s multi-faceted with emotional depth, relaying the inspirational message that resiliency can always be fostered — that trauma could lead to redemption.

This guest article originally appeared on Unbreakable Kimmy Schmidt: Coping with Trauma

]]> 0
Best and Worst in Psychology and Psychiatry – August 2016 Mon, 12 Sep 2016 15:25:29 +0000 Every month we scour the 1000s of new research publications in psychology and psychiatry for trending and field progressing findings. Making the top five best findings this month include the influence our bank balance has on our mental state, and how our mental state can also help empty our bank balance. The worst findings, the bearers of bad news, include how Youtube may add to misunderstanding schizophrenia, the lack of advantages from giving children antidepressants, and the longterm psychological effects of earthquake disasters.

August 31st also marks the birthdate of American psychologist, the late Edward Lee “Ted” Thorndike (1874 – 1949). Celebrated for his work on comparative psychology (studying the psychology and behavior of animals) that led to the theory of connectionism in 1940, it forever changed the fields of artificial intelligence, neuroscience, philosophy of mind, and of course, psychology. The main principle of connectionism is that functions of the mind and cognition can be described by interconnected networks of simple units. Low and behold, today, neural networks and their role in making us who we are, both in health and disease, is bordering on common knowledge.

BEST: Higher Spiritual Intelligence for Improved General Health and Happiness

384 students from Shahid Bahonar University of Kerman in Iran filled out questionnaires that are established measured of one’s level of spirituality, overall health and happiness. Researchers looked for links between spirituality level, health and happiness and found levels of spiritual intelligence are related to general health and happiness.

However, not all aspects of spirituality lead to greater health and happiness. In particular, an aspect of spiritual intelligence called, existential critical thinking (i.e. the capacity to critically contemplate the nature of metaphysical issues (e.g. reality, universe, time, and death) predicted poorer health but greater happiness.

In addition, the researchers suggest that a high sense of personal meaning may create resilience even in the face of hardship, which would account for a strong sense of personal meaning being correlated with higher levels of happiness.

BEST: Compassion Meditation Increases Charitable Donation

Two studies were designed to identify the “active ingredients” of compassionate meditation, and to see if these active ingredients influence charitable donations. In a randomized-controlled trial, relative to control conditions, compassionate mediation increased charitable donations via meditation changing certain feelings and attributions.

The feelings that compassion mediation can change that then lead to greater charitable donations are tenderness, personal distress, instrumentality (how much would a donation help the sufferer), and blamelessness (how much the sufferer is to blame for their position). A sense of similarity towards the person in need can lead to increased helping behaviour, but this was only if associated with the aforementioned prosocial feelings.

BEST: Mindfulness During Pregnancy Improves Mental Health, Well-being and Self-Confidence Towards Childbirth

The review assessed 8 studies examining mindfulness intervention effects on prenatal well-being in expecting mothers. Findings indicate potential benefits of mindfulness interventions for reducing levels of depression, anxiety, and negative moods during pregnancy. There is also evidence for improved self-compassion and perceived childbirth self-efficacy.

Importantly, expecting mothers practicing mindfulness that are at risk of low wellbeing during pregnancy had even greater positive results from mindfulness interventions.

BEST: Having “Cash On Hand” is Important for Life Satisfaction

In a field study using 585 bank customers in the UK, researchers looked for connections between liquid wealth (the cash you have on hand) and responses to the Satisfaction With Life Scale questionnaire. It was found that individuals with higher liquid wealth were found to have more positive perceptions of their financial well-being, which, in turn, predicted higher life satisfaction, suggesting that liquid wealth is indirectly associated with life satisfaction.

This relationship remained even for those in debt or in the green, for big spenders or frugal spenders, and investors or non-investors. Therefore, to improve the well-being of citizens, the researchers suggest that policymakers should focus not just on boosting incomes but also on increasing people’s immediate access to money.

BEST: Uncalculating Cooperation is a Sign of Trustworthiness

Humans often help one another as there are benefits for everyone involves, but sometimes people are helpful without any obvious benefit for themselves. A study published in PNAS asked why people help others when presumably there is no obvious worthwhile benefit for them to do so?

Participants in the study played economic game experiments, and were shown to be more likely to engage in seemingly selfless uncalculating cooperation when their decision-making process was observable to others. Additionally people who help out of the kindness of their hearts were seen as more trustworthy than people who help in a calculating way.

Researchers in the present study took these combined findings to suggest that reputation concerns provide an answer as to the motives behind uncalculating cooperation: people cooperate in an uncalculating way to signal their trustworthiness to observers.

WORST: Schizophrenia Presentations on YouTube Offer a Distorted Picture of the Disorder

The accuracy of depictions of schizophrenia in 4,200 YouTube videos was rated independently by two consultant psychiatrists. Only 35 of the 4,200 videos were non-duplicates and actually claimed to involve a patient with schizophrenia.

Out of the 35 videos that met the eligibility and adequacy criteria, only 12 accurately depicted acute schizophrenia. Accurate videos were characterized by persecutory delusions (83%), inappropriate affect (75%), and negative symptoms (83%).

Despite 10 of the 12 accurate videos having good educational utility, the 23 inaccurate videos had similar view counts. Finding a truly educational and accurate depiction of schizophrenia on YouTube is a bit like finding a needle in a haystack.

WORST: Poor Efficacy and Tolerability of Antidepressants for Major Depressive Disorder in Children

Meta-analysis of 34 research trials, including 5260 participants and 14 antidepressant treatments, was used to compare and rank the effectiveness of antidepressants and placebo for treating major depressive disorder in young people.

Trials of amitriptyline, citalopram, clomipramine, desipramine, duloxetine, escitalopram, fluoxetine, imipramine, mirtazapine, nefazodone, nortriptyline, paroxetine, sertraline, and venlafaxine were included.

The quality of evidence for use of antidepressants was rated as very low due to low efficacy and high levels of adverse effects, with only fluoxetine (Prozac) being statistically significantly more effective than placebo.

WORST: Exercise Addicts are Similar to Workaholics

Currently, it is uncertain what truly constitutes an exercise addiction, despite an increasing need for understanding addictive exercise behaviour in order to develop effective interventions.
The study in question, involving participants from sport and exercise relevant domains, including physicians, physiotherapists, coaches, trainers, and athletes, identified 63 features of exercise addiction, and found that these fit well with a model that describes workaholics, the Work Craving model.

The features fit well with the three components of the model: the learned component, negative perfectionism; the behavioral component, an obsessive – compulsive drive; and the hedonic component, involving improving self-worth and reducing negative mood and withdrawal symptoms.

Additionally and importantly, there was a strong consensus among experts that excessive exercise can exist without a concurrent eating disorder.

WORST: Link Between Inflammatory IL-7 and Depression Differs with Gender

Interleukin 7 (IL-7), a protein involved in B and T cell development and differentiation, has been shown to be altered in depression, although the role between inflammation, the immune system and depression is poorly understood.

Lower levels of IL-7 were found to be associated with higher scores for depression in both men and women. However, this depended on the fraction of blood used. Low IL-7 in the serum of blood (the clear liquid that blood cells and clotting factors float in) was linked with depression in men, while low Il-7 in the plasma (the red fluid composed of blood cells and clotting factors) was linked with depression in women.

While researchers can only speculate what this gender difference means, it may be important when considering development of targeted therapeutic interventions utilizing anti-inflammatory medications for individuals with depression.

WORST: Long-term Psychological Consequences Among Adolescent Survivors of the Wenchuan Earthquake in China

The study assessed the longer-term psychological consequences of teenage survivors of natural disasters through analyzing data from secondary school students who were living in Sichuan province 6 years after the Wenchuan earthquake.

Having two or more kinds of traumatic experiences was associated with higher psychological symptom scores and suicidal ideation as compared with having no traumatic experience.

Although causality could not be inferred, severely traumatized adolescent survivors of the earthquake were found to suffer from psychological symptoms even 6 years after the disaster, indicating a need for long-term psychological support.


Amirian, M.-E. and Fazilat-Pour, M. (2015) ‘Simple and Multivariate relationships between spiritual intelligence with general health and happiness’, Journal of Religion and Health, 55(4), pp. 1275–1288. doi: 10.1007/s10943-015-0004-y.

Ashar, Y.K., Andrews-Hanna, J.R., Yarkoni, T., Sills, J., Halifax, J., Dimidjian, S. and Wager, T.D. (2016) ‘Effects of compassion meditation on a psychological model of charitable donation’, Emotion, 16(5), pp. 691–705. doi: 10.1037/emo0000119.

Cipriani, A., Zhou, X., Del Giovane, C., Hetrick, S.E., Qin, B., Whittington, C., Coghill, D., Zhang, Y., Hazell, P., Leucht, S., Cuijpers, P., Pu, J., Cohen, D., Ravindran, A.V., Liu, Y., Michael, K.D., Yang, L., Liu, L. and Xie, P. (2016) ‘Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: A network meta-analysis’, The Lancet, . doi: 10.1016/s0140-6736(16)30385-3.

Hall, J.R., Wiechmann, A., Edwards, M., Johnson, L.A. and O’Bryant, S.E. (2016) ‘IL-7 and depression: The importance of gender and blood fraction’, Behavioural Brain Research, 315, pp. 147–149. doi: 10.1016/j.bbr.2016.08.026.

Jordan, J.J., Hoffman, M., Nowak, M.A. and Rand, D.G. (2016) ‘Uncalculating cooperation is used to signal trustworthiness’, Proceedings of the National Academy of Sciences, 113(31), pp. 8658–8663. doi: 10.1073/pnas.1601280113.

Macfarlane, L., Owens, G. and Cruz, B. del P. (2016) ‘Identifying the features of an exercise addiction: A Delphi study’, Journal of Behavioral Addictions, , pp. 1–11. doi: 10.1556/2006.5.2016.060.

Matvienko-Sikar, K., Lee, L., Murphy, G. and Murphy, L. (2016) ‘The effects of mindfulness interventions on prenatal well-being: A systematic review’, Psychology & Health, , pp. 1–20. doi: 10.1080/08870446.2016.1220557.

Nour, M.M., Tsatalou, O.-M. and Barrera, A. (2016) ‘Schizophrenia on YouTube’, Psychiatric Services, , p. doi: 10.1176/

Ruberton, P.M., Gladstone, J. and Lyubomirsky, S. (2016) ‘How your bank balance buys happiness: The importance of “cash on hand” to life satisfaction’, Emotion, 16(5), pp. 575–580. doi: 10.1037/emo0000184.

Tanaka, E., Tsutsumi, A., Kawakami, N., Kameoka, S., Kato, H. and You, Y. (2016) ‘Long-term psychological consequences among adolescent survivors of the Wenchuan earthquake in china: A cross-sectional survey six years after the disaster’, Journal of Affective Disorders, 204, pp. 255–261. doi: 10.1016/j.jad.2016.08.001.

]]> 0
Could Targeting Mitochondria be the Key to Treating Psychosis? Mon, 05 Sep 2016 15:00:51 +0000 One of the hottest cellular organelles of the year so far has to be mitochondria. Deleting them has been shown to reverse cellular aging, mitochondria transplants have been shown to reverse pulmonary hypertension, and they are promising targets for developing cures for and understanding neurodegenerative diseases like Parkinson’s, Alzheimer’s and dementia.

To add to the list, scientists the world over are revealing that mitochondrial dysfunction may be a central component of major psychosis (schizophrenia, and in particular bipolar disorder) and perhaps other mental illnesses. Importantly, this means that re-establishing healthy mitochondrial function may be the key to successful treatments and therapies.

Once free-living bacteria that were engulfed by another cell over a billion years ago, mitochondria are now best known as the energy providing powerhouses of our cells. They are also vital to other cellular processes including the formation of reactive oxygen species, cell cycle/growth and survival, balancing calcium ion levels, and neurotransmission.

Multiple lines of scientific evidence indicate that mitochondrial abnormalities and dysfunction are critically involved in psychosis, but what exactly is going on in a cell to create this dysfunction is not yet fully understood.

There are many complex, intertwined molecular pathways that collectively support the healthy functioning of mitochondria, and that is why multiple different abnormalities and mutant molecules can cause mitochondrial dysfunction that impairs neuronal functioning and can cause death of neurons in schizophrenia and bipolar disorder.

Authors of a recent review published in the Canadian Journal of Psychiatry state that:

Bipolar disorder and schizophrenia are complex diseases that cannot be characterized by a singular narrow pathway. Rather, numerous subtle alterations likely converge upon particular pathways (i.e., mitochondrial function) to produce functional alterations.

Some of the earliest points in these mitochondrial function-linked pathways that something could go wrong with and promote psychosis include:

  1. Mutations and altered expression of nuclear and mitochondrial genes

    Mitochondria have their own DNA called mtDNA that we inherit from our mothers, and our cells have their own double stranded DNA, one strand inherited from our mother, the other our father. There are many heritable mutations in both mtDNA and DNA that have been reported in bipolar disorder and schizophrenia that can alter mitochondrial function. Similarly, gene-environment interactions, where our life experiences and stresses can epigenetically alter how genes are expressed, have been identified for genes that are necessary for healthy mitochondrial function in people with major psychosis.

  2. Altered mitochondrial dynamics and trafficking
    Initial investigations suggest a role for altered mitochondrial dynamics and trafficking in schizophrenia, although these processes have not yet been extensively explored in schizophrenia or bipolar disorder. Impairment in mitochondrial trafficking (i.e. the movement and localization of mitochondria within neurons) can produce alterations in neurotransmitter release and synaptic function. Impairment in mitochondrial dynamics (i.e. how mitochondria divide and multiply as well as fuse together in the formation of large networks of 1000s of mitochondria per cell) has been suggested to lead to altered neural connectivity.
  3. Perturbed calcium ion flux and cell signalling
    Calcium ions are essential to the synchronization of neuronal electric activity, which is mediated by mitochondria. It also acts as an intracellular signal integral to the functioning of neurons, eliciting responses such as altered gene expression, cell death/survival, cell metabolism and neurotransmitter release at neuronal synapses. It’s a cyclic relationship in the brain of those with psychosis, where disruptions in either mitochondrial function or calcium ion flux have the potential to exacerbate one another. Impairments in calcium signalling can lead to mitochondrial dysfunction, while impairments in mitochondrial function can lead to problems with calcium signalling.

The future: Mitochondria as a target for treating psychosis

Much more intensive research is required to better understand the complex processes involved in the dysfunction of mitochondria in mental disorders, and how treatments can restore their function.

Although not confirmed in patients with psychosis, physical exercise may be one of the best non-pharmacological strategies used to reverse brain dysfunction. Endurance training involves adaptations that can lead to the upregulation of tissue-protective mechanisms, including increased mitochondrial biogenesis and function, and improvement in antioxidant networks, leading to more effective control of free radical production.

Ultimately, further research could lead to the prescription of lifestyle changes, interventions, therapies and even mitochondria-protecting drugs. It may be that by helping restore mitochondrial biogenesis and function, this can improve the chances of successfully treating psychosis, and, if preliminary research findings are valid, perhaps mood disorders and other mental illnesses too.


Anglin, R. (2016). Mitochondrial Dysfunction in Psychiatric Illness The Canadian Journal of Psychiatry, 61 (8), 444-445 DOI: 10.1177/0706743716646361

Correia?Melo, C., Marques, F., Anderson, R., Hewitt, G., Hewitt, R., Cole, J., Carroll, B., Miwa, S., Birch, J., Merz, A., Rushton, M., Charles, M., Jurk, D., Tait, S., Czapiewski, R., Greaves, L., Nelson, G., Bohlooly?Y, M., Rodriguez?Cuenca, S., Vidal?Puig, A., Mann, D., Saretzki, G., Quarato, G., Green, D., Adams, P., von Zglinicki, T., Korolchuk, V., & Passos, J. (2016). Mitochondria are required for pro?ageing features of the senescent phenotype The EMBO Journal, 35 (7), 724-742 DOI: 10.15252/embj.201592862

Di Maio, R., Barrett, P., Hoffman, E., Barrett, C., Zharikov, A., Borah, A., Hu, X., McCoy, J., Chu, C., Burton, E., Hastings, T., & Greenamyre, J. (2016).  -Synuclein binds to TOM20 and inhibits mitochondrial protein import in Parkinsons disease Science Translational Medicine, 8 (342), 342-342 DOI: 10.1126/scitranslmed.aaf3634

Hollis, F., van der Kooij, M., Zanoletti, O., Lozano, L., Cantó, C., & Sandi, C. (2015). Mitochondrial function in the brain links anxiety with social subordination Proceedings of the National Academy of Sciences, 112 (50), 15486-15491 DOI: 10.1073/pnas.1512653112

Machado, A., Pan, A., da Silva, T., Duong, A., & Andreazza, A. (2016). Upstream Pathways Controlling Mitochondrial Function in Major Psychosis: A Focus on Bipolar Disorder The Canadian Journal of Psychiatry, 61 (8), 446-456 DOI: 10.1177/0706743716648297

Mill J, Tang T, Kaminsky Z, Khare T, Yazdanpanah S, Bouchard L, Jia P, Assadzadeh A, Flanagan J, Schumacher A, Wang SC, & Petronis A (2008). Epigenomic profiling reveals DNA-methylation changes associated with major psychosis. American journal of human genetics, 82 (3), 696-711 PMID: 18319075

Radak Z, Chung HY, & Goto S (2008). Systemic adaptation to oxidative challenge induced by regular exercise. Free radical biology & medicine, 44 (2), 153-9 PMID: 18191751

Scaini, G., Rezin, G., Carvalho, A., Streck, E., Berk, M., & Quevedo, J. (2016). Mitochondrial dysfunction in bipolar disorder: Evidence, pathophysiology and translational implications Neuroscience & Biobehavioral Reviews, 68, 694-713 DOI: 10.1016/j.neubiorev.2016.06.040

van der Wijst, M., & Rots, M. (2015). Mitochondrial epigenetics: an overlooked layer of regulation? Trends in Genetics, 31 (7), 353-356 DOI: 10.1016/j.tig.2015.03.009

Wang C, Du W, Su QP, Zhu M, Feng P, Li Y, Zhou Y, Mi N, Zhu Y, Jiang D, Zhang S, Zhang Z, Sun Y, & Yu L (2015). Dynamic tubulation of mitochondria drives mitochondrial network formation. Cell research, 25 (10), 1108-20 PMID: 26206315

Image via DasWortgewand / Pixabay.

]]> 0
Does Electroshock Therapy for Mental Illness Work? It Depends On Your Genes Fri, 02 Sep 2016 15:00:48 +0000 Scientists in Italy have pinpointed an important gene that could be used to predict the chances of success of electric shock treatment, especially for those with major depressive disorder and bipolar disorder that are resistant to other treatments.

Psychotherapy and lifestyle changes works for some people, drugs work for others, and for those less fortunate, nothing seems to work to treat their depression. For these treatment resistant individuals, one of the most effective treatments is electroconvulsive therapy, also known as electroshock treatment.

Despite demonstrating relatively high effectiveness in treating various mental disorders in multiple studies, sticking electrodes to someone’s head and electrocuting their brain is clearly controversial to say the least, especially seeing as it can come with serious side effects including both short-term and long-term memory loss, prolonged seizures and stroke. Knowing in advance from analyzing someone’s genes if electroconvulsive therapy will work or not is a definite, risk-avoiding and cost-effective plus.

In fact, researchers are approaching a consensus that it is each individual’s unique neurobiology, formed from genetic pot luck and a lifetime of gene-environment interactions shaping the networks in our brains and neuronal gene expression, that ultimately decides which type of treatment will work.

This is simply because some treatments affect certain brain regions and cellular processes differently than other treatments do. It’s a very complex key (i.e. a treatment’s unique neurobiological effects) meets a vastly complex lock (i.e. a person’s unique neurobiology) scenario.

For example one study published in JAMA psychiatry reports that patients with major depression that have low activity in a brain region called the anterior insula before treatment will respond better to cognitive behavioural therapy (CBT) than those with high activity in this brain region before treatment, who respond better to the antidepressant Lexapro.

The latest electroconvulsive therapy research concerns genetic biomarkers for responsiveness to electroshock treatment for people with major depressive disorder and bipolar disorder, who have already been deemed resistant to treatment.

As is done routinely in Ireland, Britain, northern Europe and North America, a series of electric shocks were given three times per week, for 2-3 weeks. Out of the 100 patients in the study, 69% had reduced depression symptoms and were considered responsive to treatment with electroconvulsive therapy, while the remaining 31% where considered non-responsive.

The STAR*D study

The hunt for genes predictive of electroconvulsive therapy success was guided by results from the largest and longest study ever conducted to evaluate depression treatment, the NIMH-funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. The researchers in the present study focussed on Glutamate Receptor Ionotropic Kainate 4 (GRIK4) gene variants (i.e. single DNA nucleotide mutations) as they were found to be associated with being non-responsive to antidepressant therapy.

The glutamate system and its components, like GRIK4, are a large part of the neurobiology and treatment of major depressive disorder, which is characterized by brain region-specific imbalances and dysfunctional metabolism of the neurotransmitters glutamate and GABA (gamma-amino-butyric acid).

There were statistically significant results found for two GRIK4 gene variants, with particular mutations being predictive of electroconvulsive therapy success or failure. For the first gene variant (rs11218030), simply the presence of one G allele, irrespective of the second allele, presented five times the risk of non-response to electroconvulsive therapy compared to AA homozygotes. For the second gene variant (rs1954787) the opposite was true, GG homozygous patients had double the risk of non-response than compared with having at least one A allele.

Moreover, the researchers had shown in previous research that the G allele carriers of rs11218030 GG homozygotes of rs1954787 have a higher risk of developing a psychotic symptomatology during a depressive episode, which in itself is the strongest negative predictive factor regarding treatment success.

The GRIK4 gene is particularly relevant to response to electroconvulsive therapy for depression as it encodes a protein found in specific brain areas like the hippocampus that makes it critical for rapid excitatory neurotransmission, learning and memory, complex cognitive behaviours, mood and personality, and can negatively impact neuroplasticity, i.e. the death of neurons from overactivaton of glutamate receptors and signalling pathways.

Interestingly, electroconvulsive therapy in humans and animal models has been shown to result in the normalization of glutamate deficits and GABAergic neurotransmission, particularly in the hippocampus as well as other brain areas.

It therefore looks like electroconvulsive therapy works through these neurochemical changes to renurture neuroplasticity and produce the neuronal remodelling required to overcome depression. Importantly, as the results suggest, variants of glutamate signalling genes, like the GRIK4 gene, either hinder or facilitate these neurochemical changes, where facilitation promotes neuroplastic recovery from depression and perhaps other mental illnesses.

Treating patients resistant to electroconvulsive therapy

So what about the 31 treatment resistant individuals in the study that were also resistant to electroconvulsive therapy. How do we treat them?

Another study reported that for the three severely treatment resistant patients included in the research, all responded well to a novel therapeutic regimen combining electroconvulsive therapy with injections of the drug ketamine. This is very interesting, as ketamine mainly acts through binding to NMDA (N-methyl-D-aspartate) receptors, which results in an increase in glutamate neurotransmission in GABAergic interneurons.

Combined, the two aforementioned studies suggest that by altering glutamate signalling pathways in the brain of treatment-resistant depressed patients using specialised drugs, this can create a window of opportunity for electroconvulsive therapy treatment to exert its effects in normalizing glutamate deficits and neurotransmitter imbalances, and stimulating neurogenesis.

Finding a genetic biomarker for electroconvulsive therapy response in the glutamate signalling system, adds to the slowly growing library that includes two dopamine-related genes and a serotonin-related gene.

By furthering this research, there may come a day in the not too distant future where specialized algorithms will consider genetic, clinical and other biological data in accurately predicting treatment response and prescribe the best treatment regimen from specific to the individual, and their unique presentation of depression or any other mental illness.


Anttila, S., Huuhka, K., Huuhka, M., Rontu, R., Mattila, K., Leinonen, E., & Lehtimäki, T. (2006). Interaction between TPH1 and GNB3 genotypes and electroconvulsive therapy in major depression Journal of Neural Transmission, 114 (4), 461-468 DOI: 10.1007/s00702-006-0583-6

Chen, Z., Yu, H., Yu, W., Pawlak, R., & Strickland, S. (2008). Proteolytic fragments of laminin promote excitotoxic neurodegeneration by up-regulation of the KA1 subunit of the kainate receptor The Journal of Cell Biology, 183 (7), 1299-1313 DOI: 10.1083/jcb.200803107

Huuhka, K., Anttila, S., Huuhka, M., Hietala, J., Huhtala, H., Mononen, N., Lehtimäki, T., & Leinonen, E. (2008). Dopamine 2 receptor C957T and catechol-o-methyltransferase Val158Met polymorphisms are associated with treatment response in electroconvulsive therapy Neuroscience Letters, 448 (1), 79-83 DOI: 10.1016/j.neulet.2008.10.015

Kautto, M., Kampman, O., Mononen, N., Lehtimäki, T., Haraldsson, S., Koivisto, P., & Leinonen, E. (2015). Serotonin transporter (5-HTTLPR) and norepinephrine transporter (NET) gene polymorphisms: Susceptibility and treatment response of electroconvulsive therapy in treatment resistant depression Neuroscience Letters, 590, 116-120 DOI: 10.1016/j.neulet.2015.01.077

Kallmünzer B, Volbers B, Karthaus A, Tektas OY, Kornhuber J, & Müller HH (2016). Treatment escalation in patients not responding to pharmacotherapy, psychotherapy, and electro-convulsive therapy: experiences from a novel regimen using intravenous S-ketamine as add-on therapy in treatment-resistant depression. Journal of neural transmission (Vienna, Austria : 1996), 123 (5), 549-52 PMID: 26721476

Lowry ER, Kruyer A, Norris EH, Cederroth CR, & Strickland S (2013). The GluK4 kainate receptor subunit regulates memory, mood, and excitotoxic neurodegeneration. Neuroscience, 235, 215-25 PMID: 23357115

Mathews, D., Henter, I., & Zarate, C. (2012). Targeting the Glutamatergic System to Treat Major Depressive Disorder Drugs, 72 (10), 1313-1333 DOI: 10.2165/11633130-000000000-00000

Minelli, A., Congiu, C., Ventriglia, M., Bortolomasi, M., Bonvicini, C., Abate, M., Sartori, R., Gainelli, G., & Gennarelli, M. (2016). Influence of GRIK4 genetic variants on the electroconvulsive therapy response Neuroscience Letters, 626, 94-98 DOI: 10.1016/j.neulet.2016.05.030

Sanacora G, & Saricicek A (2007). GABAergic contributions to the pathophysiology of depression and the mechanism of antidepressant action. CNS & neurological disorders drug targets, 6 (2), 127-40 PMID: 17430150

Yüksel C, & Öngür D (2010). Magnetic resonance spectroscopy studies of glutamate-related abnormalities in mood disorders. Biological psychiatry, 68 (9), 785-94 PMID: 20728076

Image via wilhei / Pixabay.

]]> 0
Best and Worst of Psychology and Psychiatry – July 2016 Tue, 16 Aug 2016 15:00:05 +0000 It’s a meta-analysis month again. Meta-analysis, when approached rigorously, can provide much more confidence in research findings by combining and analysing data from multiple studies. This month I will report more than the standard number of 10 studies because some meta-analytic findings from different papers complimented one another, painting a bigger, more detailed picture.


Therapists perceived as empathic and genuine have a strong relationship with clients

The first meta-analysis of its kind assessed how therapist empathy and genuineness contribute to the therapeutic alliance (i.e. the relationship between client and therapist). Analysis of 53 studies found that therapeutic alliance was significantly related to perceptions of therapist empathy as well as therapists’ genuineness.

Effect sizes for the relationships were large, highlighting the importance of therapists cultivating an empathetic and genuine relationship with their clients, particularly seeing how the strength of the therapeutic alliance is integral to therapeutic effectiveness.

MDMA-assisted therapy best for adults and trauma-focused CBT best for children with PTSD

Two meta-analyses assessed the efficacy of various interventions for the treatment of post-traumatic stress disorder, one in adults, one in children.

For children and adolescents, the analysis compared psychological and psychopharmacological interventions for the PTSD treatment. In particular, trauma-focused cognitive behavioural therapy (CBT) had a large effect on PTSD symptoms, however there was very little evidence to support the use of drugs in psychopharmacological interventions. Again this points to the need to severely limit the prescription of drugs for mental health problems in youth populations.

For adults, the analysis compared the efficacy of the most widely accepted treatment for PTSD, prolonged exposure therapy, and ±3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. MDMA-assisted psychotherapy had a larger therapeutic effect as observed by the therapist and the patient, and a lower percentage of patients dropping out of therapy than prolonged exposure therapy. This meta-analysis is rather groundbreaking as it gives very solid grounds for popularizing MDMA-assisted psychotherapy as the “go to” therapy for treating adult PTSD.

Psychotherapy can reduce stomach problems in IBS even 12 months after treatment

Forty-one trials were included in a meta-analysis, comprising data from 2,290 individuals (1,183 assigned to psychotherapy and 1,107 assigned to a control condition), to assess the immediate, short-term, and long-term effictiveness of psychotherapy for reducing gastrointestinal problems in adults with irritable bowel syndrome (IBS).

It was found that psychotherapy had a medium effect immediately after therapy, with this medium strength effect being maintained after short-term follow-up periods (1-6 months after treatment) and long-term follow-up periods (6-12 months after treatment). This indicates that psychotherapy should be an essential part of IBS treatment.

Being a conscientious, open introvert is best recipe for preventing cognitive decline in old age

Certain personality traits have been linked with risk of dementia. Although the slowing of our brain in its use to understand the world is a natural part of aging, there are tremendous differences in the rate of decline from person to person, which is partly due to personality and psychology.

Using a collective sample of over 13,000 participants, the analysis found that higher neuroticism was associated with worse performance on global cognitive function and greater decline in memory. Conversely, conscientiousness and openness were associated with better memory performance and less cognitive decline over time. Additionally conscientiousness and lower extraversion (i.e. higher introversion) were associated with better cognitive status and less decline.

Exercise improves physical and psychological quality of life in people with depression

It has been stated that pharmacological antidepressants on average have a 50:50 chance of having any clinical benefit. Even for those that there is a benefit, the impairment of their quality of life in the physical, psychological, social and environmental domains typically remains.

The meta-analysis of the 6 studies meeting strict inclusion criteria found exercise to be a useful strategy to improve the physical and psychological domains of quality of life but not the social and environmental domains. Much more rigorous research is needed to find out what aspects of exercise (e.g., duration, intensity, modality and group or individualized sessions) work best depending on the individual (e.g., age, gender, depression severity).


Higher levels of depression in female sex workers linked to increased risk of STIs

The paper explored the associations between the psychological health of female sex workers and HIV risk by analyzing eight publications. They found that the prevalence of probable depression was as high as 62.4%. The majority of studies showed that higher scores in psychological health problems were associated with increased HIV risk behavior, in particular inconsistent condom use, or sexually transmitted infections.

Meta-analysis was used to examine the association between depression and inconsistent condom use and found that higher scores in depression put women at 2-3 times higher risk of inconsistent condom use, which puts them at greater risk of HIV and other sexually transmitted diseases.

Transition to menopause and menopause linked with double risk of depression symptoms

In an analysis of 11 studies, a women had double the risk of depressive symptoms during the perimenopause as compared to the premenopause, but not compared to the postmenopause. Moreover, symptoms were much more severe during perimenopause when compared to the premenopause. However, it is important to note that the odds of developing clinical depression were not significantly different between the stages of menopause.

Premenopause simply means when a woman is still having her typical menstrual cycle. Perimenopause refers to when women are going through the transition to menopause (i.e. when menstruation ceases and a women becomes infertile).

This means that women transitioning to menopause (i.e. perimenopause) and postmenopausal women have double the risk of depression symptoms than in their younger more fertile years, where perimenopause may offer a window of opportunity for early recognition and prevention of depression.

Additionally, a link between severity of vasomotor symptoms (e.g. hot flashes) and depressive symptoms was found during perimenopause, making vasomotor symptoms another early indicator or depression risk.

Conception-assisted mothers of twins and multiple births have higher depression risk than mothers of singletons

Eight papers constituting 2,993 mothers were included in the meta-analysis. Mothers of assisted reproductive technology (ART) multiple births were significantly more likely to have depression and stress than mothers of ART singletons, but were no different from mothers of naturally conceived multiples.

Further research is necessary to discover what makes depression and stress risks higher for multiple births specific to assisted reproductive technology to find ways to prevent post-natal distress, and negative consequences for fetal growth and development, and possibly develop an international framework to improve support for families of multiples.

Feeling unaccomplished linked with doubting of self-efficacy and job burnout

A meta-analytical review of 57 studies totalling over 20,000 participants found the effect that one’s level of self-efficacy (i.e. belief in one’s ability to succeed in specific situations or accomplish a task) has on increasing levels of job burnout (i.e. a special form of job stress involving physical, emotional or mental exhaustion combined with doubts about your competence and the value of your work) was of medium size.

One component of burnout in particular was heavily affected by personal beliefs of one’s level of self-efficacy, beliefs in one’s level of personal accomplishment. Belief in your ability to get the job done is linked with feeling proud and satisfied with your personal achievements at work. This protects from burnout. Whereas feeling unaccomplished is linked with feeling unable to perform well; this exacerbates burnout.

The effect of beliefs of accomplishment on burnout was strongest in teachers (compared to health-care providers), older workers, and those with longer work experience. Interestingly, personal accomplishment was previously proposed to be removed from burnout level tests, which is not supported by this meta-analysis.

Paternal depression in new fathers relatively common, more so if mum is depressed too

While postnatal depression in mothers is extensively researched and documented, little attention has been paid to depression in fathers. A total of 74 studies from 1980 to 2015 totalling over 40,000 participants found an average of 8% of men experience paternal depression during the transition to parenthood, with higher rates of maternal depression coinciding with higher rates of paternal depression, and the highest rates (13%) found in North America. Meanwhile, prevalence rates were not found to be affected by paternal age, education, parity, history of paternal depression, and timing of assessment. Considering how common paternal depression is, screening policies and interventions are recommended, especially when maternal depression is also present.

It should be noted that there was a large difference in rates from study to study indicating the importance of standardizing the measurement method. In fact, over 50 additional studies have been published since the analysis was conducted, increasing the likelihood of obtaining more accurate prevalence rates in the near future.


Amoroso, T., & Workman, M. (2016). Treating posttraumatic stress disorder with MDMA-assisted psychotherapy: A preliminary meta-analysis and comparison to prolonged exposure therapy Journal of Psychopharmacology, 30 (7), 595-600 DOI: 10.1177/0269881116642542

Cameron, E., Sedov, I., & Tomfohr-Madsen, L. (2016). Prevalence of paternal depression in pregnancy and the postpartum: An updated meta-analysis Journal of Affective Disorders, 206, 189-203 DOI: 10.1016/j.jad.2016.07.044

de Kruif, M., Spijker, A., & Molendijk, M. (2016). Depression during the perimenopause: A meta-analysis Journal of Affective Disorders, 206, 174-180 DOI: 10.1016/j.jad.2016.07.040

Laird, K., Tanner-Smith, E., Russell, A., Hollon, S., & Walker, L. (2016). Short-term and Long-term Efficacy of Psychological Therapies for Irritable Bowel Syndrome: A Systematic Review and Meta-analysis Clinical Gastroenterology and Hepatology, 14 (7), 937-9470000 DOI: 10.1016/j.cgh.2015.11.020

Luchetti, M., Terracciano, A., Stephan, Y., & Sutin, A. (2016). Personality and Cognitive Decline in Older Adults: Data From a Longitudinal Sample and Meta-Analysis The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 71 (4), 591-601 DOI: 10.1093/geronb/gbu184

Morina, N., Koerssen, R., & Pollet, T. (2016). Interventions for children and adolescents with posttraumatic stress disorder: A meta-analysis of comparative outcome studies Clinical Psychology Review, 47, 41-54 DOI: 10.1016/j.cpr.2016.05.006

Nienhuis, J., Owen, J., Valentine, J., Winkeljohn Black, S., Halford, T., Parazak, S., Budge, S., & Hilsenroth, M. (2016). Therapeutic alliance, empathy, and genuineness in individual adult psychotherapy: A meta-analytic review Psychotherapy Research, 1-13 DOI: 10.1080/10503307.2016.1204023

Schuch, F., Vancampfort, D., Rosenbaum, S., Richards, J., Ward, P., & Stubbs, B. (2016). Exercise improves physical and psychological quality of life in people with depression: A meta-analysis including the evaluation of control group response Psychiatry Research, 241, 47-54 DOI: 10.1016/j.psychres.2016.04.054

Shoji, K., Cieslak, R., Smoktunowicz, E., Rogala, A., Benight, C., & Luszczynska, A. (2015). Associations between job burnout and self-efficacy: a meta-analysis Anxiety, Stress, & Coping, 29 (4), 367-386 DOI: 10.1080/10615806.2015.1058369

van den Akker, O., Postavaru, G., & Purewal, S. (2016). Maternal psychosocial consequences of twins and multiple births following assisted and natural conception: a meta-analysis Reproductive BioMedicine Online, 33 (1), 1-14 DOI: 10.1016/j.rbmo.2016.04.009

Yuen, W., Tran, L., Wong, C., Holroyd, E., Tang, C., & Wong, W. (2016). Psychological health and HIV transmission among female sex workers: a systematic review and meta-analysis AIDS Care, 28 (7), 816-824 DOI: 10.1080/09540121.2016.1139038

Image via johnhain / Pixabay.

]]> 0