Still 'Profiteering From Anxiety'

Late last year, the excellent Neurobonkers blog covered a case of 'Profiteering from anxiety'.

It seems one Nader Amir has applied for a patent on the psychological technique of 'Attentional Retraining', a method designed to treat anxiety and other emotional problems by conditioning the mind to unconsciously pay more attention to positive things and ignore unpleasant stuff.

For just $139.99, you can have a crack at modifying your unconscious with the help of Amir's Cognitive Retraining Technologies.

It's a clever idea... but hardly a new one. As Neurobonkers said, research on these kinds of methods had been going on for years before Amir came on the scene. In a comment, Prof. Colin MacLeod (who's been researching this stuff for over 20 years) argued that "I do not believe that a US patent granted to Prof Amir for the attentional bias modification approach would withstand challenge."

Well, in an interesting turn of events, Amir has issued just Corrections (1,2) to two of his papers. Both of the articles reported that retraining was an effective treatment for anxiety; but in both cases he now reveals that there was

an error...in the article a disclosure should have been noted that Nader Amir is the co-founder of a company that markets anxiety relief products.

Omitting to declare a conflict of interest... how unfortunate.

Still, it's an easy mistake to make: when you're focused on doing unbiased, objective, original research, as Amir doubtless was, such mundane matters are the last thing you tend to pay attention to.

Amir, N., and Taylor, C. (2013). Correction to Amir and Taylor (2012). Journal of Consulting and Clinical Psychology, 81 (1), 74-74 DOI: 10.1037/a0031156

Amir, N., Taylor, C., and Donohue, M. (2013). Correction to Amir et al. (2011). Journal of Consulting and Clinical Psychology, 81 (1), 112-112 DOI: 10.1037/a0031157

Language That Is Person-First

An editorial in the Canadian Medical Association Journal by Roger Collier highlights the problem of Person-first language: Laudable cause, horrible prose

Person-first language (or language that is person-first, as it prefers to be known) is the nice idea that rather than calling someone, say, "blind", we should call them "a person who is blind", so as to remind everyone that they're not defined by their blindness but are a person first... clever, eh?

No. For one thing, it's just bad English. As Collier puts it: "There’s a reason Ernest Hemingway didn’t call his novel The Person Who Was Male and Advanced in Years and the Sea."

He goes on to quote linguist Helena Halmari who highlights a number of problems with the approach:

In English, emphasis naturally occurs at the end of sentences... so by pushing mention of a disability or disease deeper into a sentence, adherents to person-first language may actually be adding stress to those words. “What you have at the end of a sentence is the new information that gets the most attention,” says Halmari.

Worse yet...

Tucking the disability behind the noun may contribute to stigma rather than reduce it. After all, most adjectives with positive connotations precede nouns. We do not typically say a “person who is beautiful,” for instance, or a “person who is intelligent.” Sticking a word in the shadow of a noun can create the impression that there is something inherently wrong with it - that it should be hidden.

As a 'person with mental illness', I entirely agree. I am a man, a neuroscientist, a blogger; I'm not ashamed of those things, so I don't feel the need to erect linguistic fences between them and my person. I am also a psychiatric patient, a depressive, mentally ill; I'm not ashamed of that, either, and I resent the implication - however well-intentioned - that I should.

To me that's the really troubling part of this: the should aspect. The only reason you should not call someone something, is because they ask you not to.

Person-first advocates claim to be speaking on behalf of the 'group' who are harmed and offended by the current use of language - but who gave them that right? They don't speak for me, or anyone but themselves. I don't see 'the mentally ill' as a group at all, but even if it is one, they're certainly not our  elected representatives.

So non-person-first language doesn't offend me. In fact, I'm more worried by the idea that people will assume that, because I'm mentally ill, I want them to use person-first language. Now that's offensive.

DSM-5: A Ruse By Any Other Name...

In psychiatry, "a rose is a rose is a rose" as Gertrude Stein put it. That's according to an editorial in the American Journal of Psychiatry called: The Initial Field Trials of DSM-5: New Blooms and Old Thorns.

Like the authors, I was searching for some petal-based puns to start this piece off, but then I found this "flower with an uncanny resemblance to a MONKEY" which I think does the job quite nicely:

Anyway, the editorial is about the upcoming, controversial fifth revision to the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (APA).

A great deal has been written about the DSM-5 over the past few years, as "the rough beast, its hour come round at last / Slouches towards Bethlehem to be born" (see, I can reference early-20th-century poetry too).

But now the talk has moved into a new phase, because the results of the DSM-5 'field trials' are finally out. In these studies, the reliability of the new diagnostic criteria for different psychiatric disorders was measured. The new editorial is a summary and discussion of the field trial data.

Two different psychiatrists assessed each patient, and the agreement between their diagnoses was calculated, as the kappa statistic, where 0 indicates no correlation at all and 1 is perfect.

It turns out that the reliabilities of most DSM-5 disorders were not very good. The majority were around 0.5, which is at best mediocre. These included such pillars of psychiatric diagnosis like schizophrenia, bipolar disorder, and alcoholism.

Others were worse. Depression, had a frankly crap kappa of 0.28, and the new 'Mixed Anxiety-Depressive Disorder' came in at -0.004 (sic). It was completely meaningless.

The American Journal editorial was written by a group of senior DSM-5 team members. I'm sure they wanted to write a triumphant presentation of their work, but in fact the tone is subdued, even apologetic in places:

As for most new endeavours, the end results are mixed, with both positive and disappointing findings...Experienced clinicians have severe reservations about the proposed research diagnostic scheme for personality disorder...like its predecessors, DSM-5 does not accomplish all that it intended, but it marks continued progress for many patients for whom the benefits of diagnoses and treatment were previously unrealized.

Remember: this is the journal published by the organization responsible for the DSM and even they don't much like it.

But the real story is even worse. The previous editions of the DSM also conducted field trials. These trials had a system to describe different kappa values: for example, 0.6-0.8 was 'satisfactory'.

However, the new DSM-5 studies used a different, lower threshold. They simply moved the goalposts, deeming lower kappa values to be good. At one point, they wrote that values of above 0.8 would be 'miraculous' and above 0.6 a 'cause for celebration', yet this wasn't the view of previous DSM developers.

The indispensable 1boringoldman blog has a nice graphic showing the results of the DSM-5 trials, with the kappas graded according to the old vs. the new criteria. As you can see, the grass is greener on the new side.

The fact is that the DSM-5 field trial results are worse than the results from DSM-III, the 1980 version that's served mostly unchanged for 30 years (DSM-IV made fairly modest changes.) The reliabilities have got worse - despite the editorial's claims of 'continued progress'. It's true that the DSM-5 field trials were a lot bigger and conducted rather differently, but still, it's a serious warning sign.

Finally, there was great variability in the results between different hospitals - in other words the reliability scores were not, themselves, reliable. Some institutions achieved much higher kappa values than others, but it's anyone's guess how they managed to do so.

Still, there's great news: the DSM-5 is just a piece of paper (well, a big stack of them). Any psychiatrist is free to ignore it - as the creator of the more reliable DSM-IV (not III, oops) is now urging them to do.

Freedman R, Lewis DA, Michels R, Pine DS, Schultz SK, Tamminga CA, Gabbard GO, Gau SS, Javitt DC, Oquendo MA, Shrout PE, Vieta E, and Yager J (2013). The Initial Field Trials of DSM-5: New Blooms and Old Thorns. The American Journal of Psychiatry, 170 (1), 1-5 PMID: 23288382

The Case Of The Missing Parasites

Collembola or "Springtails" are a common group of bugs - they're technically not insects although much like them - found all over the world.

There's no evidence that these critters are parasites for humans - except for one strange scientific report claiming to have found Collembola body parts in skin scrapings from people diagnosed with delusional parasitosis - a psychiatric disorder characterised by the belief that one is infested with parasites.

According to said 2004 paper by Altschuler et al, these patients are not delusional after all. This paper has been popular in the delusional parasitosis community.

However, insect expert Matan Shelomi says that Altschuler et al's best photo of the so-called Springtails was probably Photoshopped. He explains that in the only pic to clearly show anything resembling a 'bug' (there were many others, but none look convincing), the raw microscope image shows nothing but a blurry blob.

Altschuler et al claimed to have enhanced the contrast, but when Matan did that, there was still no visible critter. However, in the published image, a rather sinister bug is clearly seen. How did it get there?

Either the image contrast was somehow selectively enhanced just for the 'bug' part - which, of course, presumes that the bug was there, and is quite invalid - or more likely,

The level of detail present in Altschuler et al.’s enhanced image, particularly in the areas of the legs and a very odd pair of stripes along the abdomen, does not appear when contrast is applied equally. Such detail, however, can easily be created using functions such as Burn, Dodge, and Colorize on Photoshop®,when applied to select portions of the image manually as if via paintbrush.

However, Shelomi says, even if such fraud is proven, there may be nothing anyone can do: the journal the original paper was published in has since folded, so it would be impossible to retract it, and the author runs an independent non-profit and is hence not subject to scientific misconduct regulations.

Thanks very much to @benmeg for sending me a copy of this paper.

Shelomi M (2012). Evidence of Photo Manipulation in a Delusional Parasitosis Paper. The Journal of parasitology PMID: 23198757

The New "Mood Disorder" That Isn't One

The storied history of "Disruptive Mood Dysregulation Disorder (DMDD)", a controversial new child psychiatric disorder proposed for inclusion in the new DSM-5 manual, continues.

If DSM-5 is officially published (it's due in 2013), kids will be deemed DMDD if they show

severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation.

At least three times a week. Would giving that label be helpful?

Pittsburg psychiatrists David Axelson and colleagues have just shown that the DMDD concept is deeply flawed. They took a large sample of kids assessed for emotional or behavior problems, and compared those who would meet the new DMDD criteria, to those who wouldn't.

"DMDD" turned out not to be correlated with anxiety or mood symptoms in either the child or their parents - rather unusual for a so-called 'Mood Dysregulation Disorder' which is found in the 'Depressive Disorder' section of the DSM-5.

However, DMDD was correlated with - and in fact "could not be delimited from" - two existing disorders, "Conduct Disorder" and "Oppositional Defiant Disorder". It wasn't even a more severe form of those disorders, it was pretty much the same thing.

So, DMDD seems to be nothing to do with mood, but instead covers a pattern of misbehavior which is already covered by not one but two labels already. Why add a misleadingly-named third?

Well, the back-story is that in the past ten years, many American kids and even toddlers have got  diagnosed with 'child bipolar disorder'  - a disease considered extremely rare everywhere else. To stop this, the DSM-5 committee want to introduce DMDD as a replacement. This is the officially stated reason for introducing it. On the evidence of this paper and others it wouldn't even achieve this dubious goal.

The possibility of just going to back to the days when psychiatrists didn't diagnose prepubescent children with bipolar (except in very rare cases) seems to not be on the table.

Axelson D, et al (2012). Examining the proposed disruptive mood dysregulation disorder diagnosis in children in the Longitudinal Assessment of Manic Symptoms study. The Journal of Clinical Psychiatry, 73 (10), 1342-50 PMID: 23140653

Beware Small Positive Studies

A Letter in the prestigious American Journal of Psychiatry offers a skeptical response to a paper published there recently.

The original article claimed amazing benefits of a safe and cheap brain stimulation technique in treating schizophrenia. But Dutch letter-writers Sommer et al aren't convinced.

It's a short piece and worth quoting:

We read with interest the article by Brunelin et al. in the July issue, which described the application of transcranial direct-current stimulation (tDCS) in the treatment of both auditory hallucinations and negative symptoms simultaneously... An effect size of 1.58 was reported for refractory hallucinations, which is remarkably large when compared with the effect sizes of antipsychotic medication (0.4–0.6).

Clinical trials involving nonconvulsive brain stimulation in schizophrenia were first introduced in 1999. Initial effect sizes were very large while samples were small. Some years later, large negative studies were published. To date, 17 placebo controlled transcranial magnetic stimulation (TMS) studies on hallucinations have been published. The mean weighted effect size is now around 0.3. Yet, the negative correlation between effect size and year of publication suggests that over time, the mean effect size may become smaller.

When selective serotonin reuptake inhibitors (SSRIs) were introduced for depression, effect sizes greater than 1.0 were reported, which created their legacy as a wonder drug. Over the course of 20 years, the mean effect size of SSRIs decreased to around 0.3. A similar trend was demonstrated for cognitive-behavioral therapy.
 
This trend likely results from publication bias. A remarkably high effect size suggests the discovery of a new wonder treatment. Studies with such findings are therefore easily published in high-impact journals. In contrast, studies of similar sample size with marginally or nonsignificant findings are less likely to be accepted for publication. Usually, after some years, negative studies with large sample sizes become available. This is when meta-analyses start to detect a decrease in efficacy.

In this view, the Brunelin et al. study is exemplary of an initial placebo-controlled study applying a new technique: it included a small sample, found remarkably large effects, and is published in a high-impact journal.
 
We sincerely hope that tDCS is the exception to the rule— as a cheap, safe, and highly effective method to treat both refractory hallucinations and negative symptoms is most welcome. However, given the previous observations for other new treatments, it is realistic to expect that 10 years from now the mean weighted effect size of tDCS will be around 0.3.

Sommer et al are talking about the famous 'decline effect', in which the size of an effect mysteriously shrinks the more people study it, which I've written about before.

I suspect the authors are right in this case; playing science devil's advocate though, it's unfair and unscientific to assume that a new treatment that looks promising will eventually turn out to be mediocre, just because that's happened to other treatments before.

After all, some things look awesome because they are - penicillin, for example, was heralded as a new wonder drug... and it was.

I very much doubt that tDCS is the new penicillin. But I do think that this kind of speculation is ultimately not very useful. Rather than bemoaning the errors of the past and wondering whether they'll be repeated, we should reform science to make sure they don't.

Sommer IE, Aleman A, Slotema CM, and Schutter DJ (2012). Transcranial stimulation for psychosis: the relationship between effect size and published findings. The American Journal of Psychiatry, 169 (11) PMID: 23128925

The Persistence of "Past-Life" Memories

Many children spontaneously report memories of 'past lives'. For believers, this is evidence for reincarnation; for others, it's a psychological oddity.

But what happens when they grow up?

Icelandic psychologists Haraldsson and Abu-Izzedin looked into it. They took 28 adults, members of the Druze community of Lebanon. All of the participants had been interviewed about their past life memories by the famous reincarnationist Professor Ian Stevenson in the 70s, back when they were just 3-9 years old.

Did they still 'remember'? Most of them thought they did:

Twelve of the 28 participants are sure that they still have clear memories of their past life, and an additional 12 believe that they still have some of their childhood memories, so 86% of our sample still report some memories of a past life... one man was not sure about the source of the memories, two remembered speaking of past life memories as a child, but do not have these memories now, and one thought she might only remember something of her past life because these memories were much talked about in her family.

However - it turned out that they weren't always the same memories they'd originally reported.

As children they reported on average 30 distinct memories of past lives. As adults they could only remember 8, but of those, only half matched the ones they'd talked about previously:

This indicates that half of the statements remembered today are either fictional or distortions of the original childhood memories, or that the old lists of statements might have been incomplete.

In other words, they probably suffered from a false memory of a false memory - the mind is weird. Despite this, past lives seemed more memorable than real early-childhood:

We asked our participants what they remembered from their preschool years. We were surprised how little they remembered, and some could not remember anything. Our general impression is that past-life memories are better remembered into adult life than are normal memories from preschool years.

There was no evidence that these people suffered from any particular psychological problems as a result of their experiences, but 21% did say that overall, they preferred their past lives to their real ones.

Personally, I have a very vivid memory, not of a past life per se but rather of a very early stage in my own: I remember lying in my cot, unable to get out, rather bored, and waiting for my parents to get me up for the day.

This may really be my earliest memory, but the more I've thought about it, the less likely it seems. Could I have known what time it was, and that my parents would eventually come, when I was unable to even stand up by myself?

Maybe. But maybe it was just a later childhood dream about being a baby that seemed real. At that age, the line between dreams and reality is blurry as parents who've had to comfort a child after a nightmare will attest. I suspect this accounts for many of these 'past lives'.

Haraldsson E, and Abu-Izzedin M (2012). Persistence of "past-life" memories in adults who, in their childhood, claimed memories of a past life. The Journal of nervous and mental disease, 200 (11), 985-9 PMID: 23124184

More on False Positive Neuroimaging

Back in June, I warned that the ever-increasing number of clever methods for analyzing brain imaging data could be a double-edged sword:

Recently, psychologists Joseph Simmons, Leif Nelson and Uri Simonsohn made waves when they published a provocative article called False-Positive Psychology - Undisclosed Flexibility in Data Collection and Analysis Allows Presenting Anything as Significant.

It explained how there are so many possible ways to gather and analyze the results of a  simple psychology experiment that, even if there's nothing interesting really happening, it'll be possible to find some "significant" positive results purely by chance...

The problem's not just seen in psychology however, and I'm concerned that it's especially dangerous in modern neuroimaging research.

In a comment on that post, The Neurocritic pointed out that Michigan PhD student Joshua Carp had put forward the same argument in a conference presentation, several months previously.

Now Carp's published a paper on the topic: On the plurality of (methodological) worlds: estimating the analytic flexibility of fMRI experiments. It's free to access, so check it out.

Whereas I just talked the talk by listing lots of possible ways in which you could analyze a given set of data, Carp walked the walk, and actually did loads of analyses. He took a single dataset, the results of a simple experiment and looked at it in almost 7000 different ways. Each set of results was then thresholded to correct for multiple comparisons in 5 ways, for a grand total of 35,000 outputs.

The variants he considered ranged from how much smoothing to apply, to how to correct for head motion, and many more.

What happened? In a nutshell, the different options made a difference - and the variability was the largest in parts of the brain that were most activated (the "blobs" that lit up). In other words, analytic flexibility makes the most difference in the most interesting places. See the picture at the top.

The location of the maximum peak activation also varied. This is not unexpected, and not, in itself, that worrying - the great majority of the peaks clustered in a few small areas. However, it underlines that different options really can make a difference.

Carp concludes:

Nearly every voxel in the brain showed significant activation under at least one analysis pipeline. In other words, a sufficiently persistent researcher determined to find significant activation in virtually any brain region is quite likely to succeed...

If investigators apply several analysis pipelines to an experiment, and only report the analyses that support their hypotheses, then the prevalence of false positive results in the literature may far exceed the nominal rate. However, analytic flexibility only translates into elevated false positive rates when combined with selective analysis reporting. If researchers reported the results of all analysis pipelines used in their studies, then it would not be problematic.

To the author’s knowledge, there is no evidence that fMRI researchers actually engage in selective analysis reporting. But researchers in other fields do appear to pursue this strategy.

In my experience, fMRI researchers are actually fairly conservative in terms of using different analyses, and certainly I doubt anyone has ever run thousands of them just to get the result they want and I'd estimate that most published findings are not the result of more than a handful of 'attempts' at most.

However it's a serious concern that it could happen, and importantly it's getting ever-easier to do this, with the continuing increase in computer power making running an analysis quicker and cheaper than ever. As to what to do about it, Carp makes several suggestions, and here's one I made earlier...

Joshua Carp (2012). On the plurality of (methodological) worlds: estimating the analytic flexibility of fMRI experiments Front. Neurosci. DOI: 10.3389/fnins.2012.00149

Psychiatrists: Does Fire Put Out Fire?

If you're trying to fight fire, should you use fire?

This, pretty much, is the question asked by a group of psychiatrists in a new paper: Will disruptive mood dysregulation disorder (DMDD) reduce false diagnosis of bipolar disorder in children?

The background here is that there's growing concern that bipolar disorder, previously thought to be extremely rare in prepubescent children, is now being diagnosed, inappropriately, in children - specifically in American children. This epidemic of so-called "pediatric bipolar disorder" (PBD) shows no signs of abating.

In response to these concerns, the proposed new fifth edition of the Diagnostic and Statistical Manual (DSM-5) is slated to introduce a new disorder - DMDD. The stated purpose of DMDD is to prevent children getting a diagnosis of PBD - but only by giving them another diagnosis instead.

As I said in 2010 (note, TDDD is the old name of DMDD)

We can all sympathize with the sentiment behind TDDD - but this is fighting fire with fire. Is the only way to stop kids getting one diagnosis, to give them another one? ... Can't we just decide to diagnose people less? Apparently, that would be a rather too radical change...

Now, according to the authors of the new paper, if DMDD becomes an official diagnosis, it would only slightly reduce the number of PBD diagnoses - and

If indeed DMDD is a true entity, we suspect that, like bipolar disorder, it, too, will be overdiagnosed.

This was based on a study of 82 kids who were admitted to a specialist children's psychiatric hospital. Of the children, 30% met DMDD criteria based on parental report - but only half of those diagnoses were confirmed by observation of the child'd behaviour in hospital. Parents, in other words, over-rated DMDD symptoms. A rigorous DMDD diagnosis would only "save" a minority of children from a PBD diagnosis.

Even in those cases where "DMDD" seems most justified, it's really not clear who would benefit from giving them another diagnosis because they always qualified for 3 or more other diagnoses. Take a look at this table, showing the frankly ridiculous array of "different" disorders diagnosed in 12 children - the ones who were rated most likely to be "bipolar" by parental report -

Many parents reported "bipolar" symptoms but only 2 of 12 were judged to be actually bipolar; those two incidentally were aged 11 and 12 - consistent with the old view that bipolar is very rare before puberty.

So even if DMDD is a marginally better diagnosis than PBD - do we really need to give out any more diagnoses to kids like this?

The funny thing is that overdiagnosis of PBD is just about the only concern that the DSM-V committee is responding to at all. There are plenty of other well-publicized concerns: overdiagnosis of ADHD, overdiagnosis of depression... most of these are about overdiagnosis to be honest. Anyway, in those cases, DSM-V is proposing to either do nothing much, or actually expand the diagnostic criteria.

For PBD, they are at least trying, so perhaps they deserve some points for effort.

Margulies DM, Weintraub S, Basile J, Grover PJ, and Carlson GA (2012). Will disruptive mood dysregulation disorder reduce false diagnosis of bipolar disorder in children? Bipolar disorders, 14 (5), 488-96 PMID: 22713098

Whole Brain Teaching...?

Oh dear. The Kansas City Star asks: Teachers learn ways to keep students' attention, but are brain claims valid?

Probably not. Unless you're buying a brain scanner or a plush brain, product 'brain claims' are generally just marketing patter. But let's see.

When Chris Biffle called out the word "Class!" Wednesday morning at Walsh University, 450 teachers and administrators yelled back, "Yes!"

"Class class?" he said. "Yes! Yes!" they replied.

"Classity classity," he said.
"Yessity yessity," they chanted back.

Biffle, one of the co-founders of Southern California-based Whole Brain Teaching LLC, is leading a two-day conference about his method. He calls the technique "Class-Yes." Whole Brain Teaching's website says "Class Yes" activates the prefrontal cortex of the brain and "readies students for instruction"...

Whole Brain Teaching reminds me of Brain Gym, a notorious bit of British neuro-nonsense from a few years ago. According to the WBT research page, they have over 50,000 registered teachers and 2 million views of their videos. This also informs us that:

Class-Yes: Our primary attention-getter activates the prefrontal cortex, often called the CEO of the brain... Little if any learning can take place if the prefrontal cortex is not engaged.

while even "mirror neurons" have a role to play:

Mirror: Many brain scientists believe that we learn by mirroring the gestures and activities of others. They have identified mirror neurons scattered throughout the brain that are activated by mimicking the behavior we observe. Our own experience in WBT classroom indicates that when a class mirrors our gestures and, when appropriate, repeats our words, a powerful learning bond is created between students and teachers.

There are lots of problems here, but here's the most fundamental: the theory behind the system seems to be that activating particular parts of students' brains, through a special task, will help them to use that part of their brain when it comes to the actual lesson a few minutes later. But I know of no evidence that bits of the brain "warm up" like that; if anything they're more likely to "wear out" through lack of energy and nutrients although I don't think that's likely either.

If such warm-ups did work, your best bet for activating your primary visual cortex, for example, would be to stare at a rapidly-changing pattern of random colors for a few minutes. That wouldn't improve your vision. It would just give you a headache.

In fact, why not just activate your entire noggin, pharmacologically? Just grab some pentylenetetrazol - a drug that blocks inhibitory signals between brain cells. Snort a few lines of that and if you survive the resulting seizure, go and learn something and see if you're really good at it.

I'm not saying Whole Brain Teaching is useless, I'm not saying anything about the method itself, but the "brain" claims are misleading. Many of the things they recommend are teaching aids and classroom exercises, and no doubt those are helpful. Plus, psychological factors like teacher motivation, student engagement, and a positive atmosphere are vital in learning, and it doesn't matter if you achieve them through neurosciencey gimmicks, they're still going to help... well, except in terms of educating people to spot neurosciencey gimmicks.

But that's teaching. It's nothing to do with the brain.

B. F. Skinner vs. the Rorschach Test

What happened when the world's most no-nonsense psychologist took a Rorschach test?

A fun little paper reports on B. F. Skinner's Rorschach results. He agreed to be tested as part of a 1953 project psychoanalysing various eminent scientists. The scientists were anonymous at the time but now Norwegians Cato Grønnerød et al have dug them out of the archives (Skinner has been dead since 1990).

Skinner was the world's leading exponent of behaviourism, a school of thought that held roughly that it's impossible to know anything about "inner" mental states or thoughts, and that they might not even exist, so all we could do was look at and try to predict behaviour (edit: see comments for clarification).

It was never an especially convincing idea to be honest and behaviourism is now pretty much dead although many of the techniques pioneered by Skinner live on in the form of tests on lab animals to determine the addictiveness of drugs and so forth.

But in the mid-20th century it was very popular and Skinner was a well-known figure, the Jonah Lehrer of his day in many ways although rather more controversial.

Anyway. Grønnerød et al report that when Skinner was asked to describe those famous inkblots -

The most evident feature of the protocol is the huge number of responses, showing a highly productive and creative person. But complexity is sacrificed for quantity... No perceptual distortions are evident, and reality testing and ability to function neutrally are in place. We found no signs of cognitive distortions, although some responses have an idiosyncratic twist... He might be an assertive person with a tendency to view relations as generally competitive and an area for the expression of his own needs, rather than an area of mutual support and belonging.

Although he shows an interest in others, the balance between real and whole humans and other human representation suggests that perception of self and others is based more on fantasies and wishes than on real-life perceptions... “Necrotic looking,” “wounded animal,” and “sheep pushing the two wolves away” might reflect projected aggression. These processes point to more primitive defense mechanisms...

Which is exactly the kind of speculation that Skinner spent his career trying to put a stop to. Still, it's an interesting paper, although I think it tells you more about the Rorschach than about Skinner.

Grønnerød C, Overskeid G, and Hartmann E (2012). Under Skinner's Skin: Gauging a Behaviorist From His Rorschach Protocol. Journal of personality assessment PMID: 22731841

Another Antidepressant Crashes & Burns

Yet another "promising" novel antidepressant has failed to actually treat depression.

That's not an uncommon occurrence these days, but this time, the paper reporting the findings is almost as rubbish as the drug: Translational evaluation of JNJ-18038683, a 5-HT7 receptor antagonist, on REM sleep and in major depressive disorder

So, Pharma giant Janssen invented JNJ-18038683. It's a selective antagonist at serotonin 5HT-7 receptors, making it pharmacologically rather unusual. They hoped it would work as an antidepressant. It didn't - in a multicentre randomized controlled trial of 230 depressed people, it had absolutely no benefits over placebo. A popular existing drug, citalopram, failed as well:

About the only thing JNJ-18038683 did do in humans was to reduce the amount of dreaming REM sleep per night. This REM suppressing effect is also seen with other antidepressants and this is evidence that the drug does do something - just not what it's meant to. Being charitable you could call this a failed trial.

Ouch! But it gets better. Unhappy that JNJ-18038683 bombed, Janssen reached for their copy of the Cherrypicker's Manifesto. This is a new statistical method, proposed by fellow Pharma company GSK in a 2010 paper, which consists of excluding data from study centres with a very high (or very low) placebo response rate.

Anyway, after applying this "filter" JNJ-18038683 seemed to do a bit better than placebo, but the benefit over placebo still wasn't statistically significant - with a p value of 0.057, the wrong side of the sacred p=0.05 line (on page 33).
Yet Page 33's "trend towards statistical significance" magically becomes "significant" - in the Abstract:

[with] a post hoc analyses (sic) using an enrichment window strategy... there was a clinically meaningful and statistically significant difference between JNJ-18038683 and placebo.

Well, no, there wasn't actually. It was only a trend. Look it up.

That aside, the problem with the whole filter idea is that it could end up biasing your analysis in favour of the drug, leading to misleading results. The original authors warned that "data enrichment is often perceived as a way of improperly introducing a source of bias... In conventional RCTs, to overcome the bias risk, the enrichment strategy should be accounted for and pre-planned in the study protocol." They should know, as they invented it, but Janssen rather oddly say the exact opposite: "This methodology cannot be included in a protocol prospectively as it will introduce operational bias in that scheme."

Hmm.

Anyway, even after the filter technique, citalopram didn't work either... bad news for citalopram, except, was it citalopram at all? This is really unbelievable: Janssen don't seem clear on whether they compared their drug to citalopram, or to escitalopram - a quite different drug.

They say "citalopram" in most cases, but they have "escitalopram" instead, in three places, including, mysteriously, in a "hidden" text box in that graph I showed earlier:

I'm not making this up: I stumbled upon a text box which is invisible, but if you select it with the cursor, you find it contains "escitalopram"! I have no idea what the story behind that is, but at best it is seriously sloppy.

Come on Janssen. Raise your game. In the glory days of dodgy antidepressant research, your rivals were (allegedly) concealing data on suicides and brushing whole studies under the carpet, to make their drugs look better. Despicable, but at least it had a certain grandeur to it.

Bonaventure, P., Dugovic, C., Kramer, M., De Boer, P., Singh, J., Wilson, S., Bertelsen, K., Di, J., Shelton, J., Aluisio, L., Dvorak, L., Fraser, I., Lord, B., Nepomuceno, D., Ahnaou, A., Drinkenburg, W., Chai, W., Dvorak, C., Carruthers, N., Sands, S., and Lovenberg, T. (2012). Translational evaluation of JNJ-18038683, a 5-HT7 receptor antagonist, on REM sleep and in major depressive disorder Journal of Pharmacology and Experimental Therapeutics DOI: 10.1124/jpet.112.193995

The 70,000 Thoughts Per Day Myth?

Following on from a discussion on Twitter, I've been trying to find out the origin of the strange meme that the average person has "70,000 thoughts per day".

That's a lot of thoughts. It's about 3000 per hour or 50 per minute, just under one per second.

A lot of people believe this, according to Google. Even that esteemed neuroscientist and philosopher Dr Deepak Chopra agrees, although - being a rigorous, skeptical scientist, he acknowledged some error in his measurements and said "60,000 to 80,000".

But where does this number come from?

Searching for the source, I discovered that 70k is only one such estimate. Other popular figures include 15k ; 60k ; and "12k to 50k". This last one is the only number that ever seems to come with a citation as to the source: it's attributed to "The National Science Foundation (NSF)".

This claim was made at least as far back as 2003 by a certain Charlie Greer ("Helping Plumbing, HVAC, and Electrical service contractors Sell More at Higher Profits").

But the NSF is a funding organization. Their main job is to hand out US government money to all kinds of different researchers. They don't do research as such, or at least not much, so it seems unlikely that the NSF actually said this. Perhaps they funded the research that did. But whose research? I can't find any specific sources at all.

One suggestion made on Twitter was that it could derive from Daniel Kahneman's idea that the "psychological present" is a window of about 3 seconds - everything else is either past or future.

Kahneman has in fact used NSF funding, although so have most scientists in the USA.

Now Kahneman himself said in a talk recently that there are 600k of these "psychological presents" per month, i.e. 20k per day. If you divide a day into 3 second chunks you get about 29k a day, but I guess if you assume we're asleep for a third of the day that makes 20k.

OK. I'm not sure life is really composed of neat equal chunks like that, and anyway, those are chunks of experience, not "thoughts"; but even if you ignore that, the weird thing is that very few people think we have 20k thoughts per day. 70k is far more common on Google.

Does anyone know where this number comes from?

Child Bipolar Disorder Still Rare

Bipolar disorder usually strikes between the ages of 15 and 25, and is extremely rare in preteens, according to a major study: Age at onset versus family history and clinical outcomes in 1,665 international bipolar-I disorder patients

The findings are old hat. It's long been known that manic-depression most often begins around the age of 20, give or take a few years. Onset in later life is less common while earlier onset is very unusual.

The main graph could have been lifted from any psychiatry textbooks of the last century:

The red bars are the data. Ignore the black line, that just shows an imaginary 'even' distribution over the lifespan.

Why am I blogging about these remarkably unremarkable results? Because they undermines the theory, popular in certain quarters but highly controversial, that 'child bipolar' or 'pediatric bipolar' is a major health problem.

The study confirmed that early-onset bipolar I does exist, but just 5% of the bipolar I patients had an onset before the age of 15. Assuming a lifetime prevalence of 1% for bipolar I disorder, which is about right, that makes about 0.05%, 1 in 2000 kids, about the same prevalence as Down's Syndrome. Even that's an overestimate, though, because this sample was enriched for early-onset cases: some of the participating clinics were child and adolescent only.

There's a few caveats. This was a retrospective study, that took adults diagnosed bipolar, and asked when their symptoms first appeared. It's possible that early onset cases were under-sampled, if they were less likely to survive to adulthood, or get treated. The generally milder bipolar II might also be different from the bipolar I studied here. But in general, these numbers support the traditional view that childhood bipolar is just not very prevalent.

Baldessarini, R., Tondo, L., Vázquez, G., Undurraga, J., Bolzani, L., Yildiz, A., Khalsa, H., Lai, M., Lepri, B., Lolich, M., Maffei, P., Salvatore, P., Faedda, G., Vieta, E., and; Tohen, M. (2012). Age at onset versus family history and clinical outcomes in 1,665 international bipolar-I disorder patients World Psychiatry, 11 (1), 40-46 DOI: 10.1016/j.wpsyc.2012.01.006

You Are Not "Your Brain"

Best-selling mysterymonger Deepak Chopra announces Good News: You Are Not Your Brain.

We are not our brains. We are "conscious agents"... It's very good news that you are not your brain, because when your mind finds its true power, the result is healing, inspiration, insight, self-awareness, discovery, curiosity, and quantum leaps in personal growth. The brain is totally incapable of such things. After all, if it is a hard-wired machine, there is no room for sudden leaps and renewed inspiration...

Chopra is saying that you are a conscious agent, with the power of self-awareness and curiosity etc. Which is true. He then says that "The brain is totally incapable of such things", but you are, therefore, you are not your brain.

The problem is that Chopra has a concept of "the brain" which is essentially a passive, "hard-wired machine". He's right that we are not such a machine; his mistake is to call that machine "the brain", because brains aren't like that either.

But this is not a mistake unique to Chopra. As I wrote previously, the concept of "the brain" is inherently misleading -

What do we mean when we talk about "the brain"? Easy, right? It's this (picture of a human  brain). But this is not an image of a brain. It's an image of a dead brain. In a living brain, all kinds of interesting things are happening. Things we literally can't begin to imagine. Because these are hard to visualize, they can't enter the mental picture.

To picture the living brain as just a yellowy lump is like picturing Wikipedia as a disc. It's accurate as far as it goes, but it misses the whole point. You could download Wikipedia onto a BluRay disc, and then you could describe that disc as "Wikipedia" and you wouldn't be wrong, but Wikipedia is much more than a silver circle.

"The brain" brings to mind an inert squishy lump of a certain size and color. This mental image corresponds perfectly well to a dead brain - which is all the proof needed, I think, that it fails to capture the essence of a living one.

"The brain", in other words, is a mere simplified caricature of the brain.

So when Chopra says "You are not your brain", he is right, in the sense that you are not what Chopra (or anyone else) understands by "your brain", but that doesn't mean you're not your brain.

This mistake also crops up in more serious discussions. There are philosophical arguments that go something like this: the human mind can do things that it is inconceivable for a brain to do. Therefore, the mind is not the brain. But couldn't it be that it is the brain, itself, which is inconceivable?

The Amazing Financial Robot Scam

The BBC reports on an interesting example of a very modern scam: US charges British twins over $1.2m 'stock robot' fraud.

The scam had two parts. For investors, there was the the "stock picking robot" called Marl, which supposedly told you which stocks to buy. You could buy a copy of Marl for $28,000 - or get a newsletter featuring Marl's wisdom, for just $47.

In reality Marl didn't pick anything. The stock tips were provided by the teenage scammers, the Hunters, themselves. Not because they thought they were good stocks, but because the companies behind the stocks paid the Hunters fees for their promotional services via a separate "equitypromoter.com".

What's interesting about the scheme is that everything "worked", just not the way it was meant to. Investors paid to get tips as to what stocks would rise; they did rise, just not for the reasons they thought.

So Marl was a lot like one of those quack treatments in medicine, that claim to treat a certain disease, and do indeed make people who take it feel better, but - contrary to what they claim - through the placebo effect.

There's other similarities too, as you can find out on the rather fascinating good-stocks.com site which helped sell Marl. Like many quack treatments it had:

• An elaborate 'mechanism of action' that blinds with science - Marl uses an "evolutionary framework"to "Develop what professional traders call a 'sixth sense'" and can "process 1,986,832 mathematical calculations per second."
• Lots of amazing success stories and testimonials from satisfied customers
• An attractive creation myth - Marl was invented by "Two Uber Geeks" who both had a record of success in more conventional stock trading, but unlike their conventional colleagues, were able to invent Marl by thinking outside the box; this is reminiscent of the many quacks who simultaneously flout their medical or academic qualifications while accusing medicine and academia of ignoring them.

Overall this is a fascinating story of greed and lies and if you like that sort of thing you'll enjoy surveying the electronic ruins of a classic scam e.g. here and here...

Preventing Psychosis?

Can we prevent psychosis?

In a major study just published, Early detection and intervention evaluation for people at risk of psychosis, 288 young British adults who were deemed to be 'at risk of psychosis' were randomized to get cognitive therapy (CT) or a control condition. The hope was that it could prevent transition to serious psychotic illness.

The primary outcome measure was how many of them later went on to get diagnosed with full-blown psychosis. 2 years later, 7% of the CT group and 9% of the controls had, so that's no significant benefit of treatment. CT slightly reduced the level of mild psychotic-like symptoms, but not how much distress they caused.

So, in other words, no we can't prevent psychosis, not with CT alone at any rate. But there's lots more interesting stuff here...

Now a transition rate of some 8% over 2 years is lower than in previous studies and might suggest that the concept of the 'psychosis risk syndrome'  or 'at-risk mental state' (under consideration for inclusion in DSM-5) is a bit dodgy. The venerable Prof. Allen Frances thinks so. But he misses the fact that the rate was 18% when you also count the people who went psychotic during the baseline assessments (to be fair to Frances, the authors buried that bombshell quite deep in the Discussion).

Still, that's still 82% false positives. Is that too high?

We can't tell, from a study like this. As in any disease screening program, we need to know the relative costs and benefits of true and false 'hits', as well as the percentages of them.

Here's some food for thought on that note. One of the key tenets of the CT model of psychosis is that 'psychotic' symptoms are a more or less normal response to stress, and that psychosis is maintained by a cycle of thoughts and feelings in which these experiences are themselves a source of concern, because they're felt to be abnormal, pathological, or otherwise threatening, thus leading to more stress, and more symptoms, and hence more concern... and so on. CT aims to break that cycle.

Check it out (image from here, coauthored by Graham Dunn, senior author of the present work.)

If you accept that, then it seems that literally the worst possible thing you could say to someone in the 'at risk mental state' is "Watch out! You're at risk of going psychotic!" According to CT, exactly that line of thinking is the root of the whole problem.

The authors of this paper indeed write that "Key ingredients of the approach [include] a focus on normalising psychotic-like experience". But who deemed them abnormal in the first place? The patient, all by themselves... or some well-meaning professional? It's not clear.

We are told that the patients were "seeking help for symptoms", but why? Of their own accord, or after someone else raised concerns? 45 people were referred to the study but excluded because they said that they didn't want help. So there was at least some degree of professional 'railroading', driven by the idea that people with such symptoms ought to seek help

If you accept the CT account of psychosis, then I'd say you ought to think very seriously about whether this whole thing isn't equivalent to giving everyone an X-ray to detect cancers. The X-rays might end up causing more tumours than they find.

I wonder if the authors of this study considered this.

Anyway. Keith Laws of LawsNeuroBlog has a good post about the study and the rather overexcited way it's been received in the press (even, er, the BMJ...)

Despite the authors not being able to make any claims about CT positively affecting transition rates... and the lack of any medication analysis (in fact all patients were unmedicated as an entry requirement) they conclude:

"On the basis of low transition rates, high responsiveness to simple interventions such as monitoring, a specific effect of cognitive therapy on the severity of psychotic symptoms, and the toxicity associated with antipsychotic drugs, we would suggest that antipsychotics are not delivered as a first line treatment to people meeting the criteria for being in an at risk mental state"

So the article in the UK Guardian entitled Drugs not best option for people at risk of psychosis, study warns is not simply misunderstanding by a journalist, but what looks like author spinning.... The BMJ press release itself is headlined Cognitive therapy helps reduce severity of distress among psychotic patients - even though the paper (and the press release itself!) clearly states:

"Cognitive therapy did not significantly affect distress related to these psychotic experiences...nor levels of depression, social anxiety, or satisfaction with life..."

Morrison, A., French, P., Stewart, S., Birchwood, M., Fowler, D., Gumley, A., Jones, P., Bentall, R., Lewis, S., Murray, G., Patterson, P., Brunet, K., Conroy, J., Parker, S., Reilly, T., Byrne, R., Davies, L., and Dunn, G. (2012). Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial BMJ, 344 (apr05 1) DOI: 10.1136/bmj.e2233

Psychology vs Astrology

Are personality tests any more accurate than astrology?

A lovely study I just came across examined this question: Science Versus the Stars. The researchers took 52 college students and got them to complete a standard NEO personality questionnaire. They also had to state the date, time and place of their birth.

Three weeks later, the participants were then given two personality summaries - one based on the personality tests, and one on their astrological chart generated with a computer program.

The trick was that everyone also got a pair of bogus summaries, one of each kind. These were simply someone else's results, picked at random from the other 51 volunteers. They weren't told which were the fakes and which were real - they had to work it out, based on which one matched them best.

The results showed that the subjects were no better than guessing when trying to tell which of the two astrology charts was theirs. They were able to pick their own personality scores better than chance, although only 80% of them got it right, and guesswork gets you to 50% - so this is not all that impressive. Psychology beat astrology, but hardly by a landslide.

This study is a modern update of Shawn Carlson's classic 1985 Nature paper, A double-blind test of astrology. In Carlson's experiment, though, people weren't even able to accurately pick out their own personality scores.

When asked to say which of the four reports was the best match overall match to their personality, 55% of the participants picked their own real personality one - but no fewer than 35% preferred one of the astrology charts, and 10% went for someone else's personality scores. Hmm.

The authors say

the present results represent less of an endorsement of psychological measures than a further indictment of astrology.

but I think it's interesting that even under very favorable conditions (only one fake personality test), people were well short of perfect accuracy at spotting their own psychological scores - which they had themselves produced by filling out a questionnaire, just weeks before. Whether that tells us more about the NEO test, the participants' memory, or the fact that all the students at Conneticut College are pretty much the same, I'll leave it for you to judge...

Wyman, A., and Vyse, S. (2008). Science Versus the Stars: A Double-Blind Test of the Validity of the NEO Five-Factor Inventory and Computer-Generated Astrological Natal Charts The Journal of General Psychology, 135 (3), 287-300 DOI: 10.3200/GENP.135.3.287-300

The Mystery of Trephination

Why did ancient peoples cut holes in their heads?

The Woman of Pritschoena died around 4,500 years ago in what's now Saxony-Anhalt, Germany. Her skeleton was discovered in 1913 by a local archaeologist. Thanks to being buried in a gravel pit, her remains are exceptionally well preserved.

The Woman's skull is a fine example of trephination - the practice of deliberately cutting holes in the skull. She was trephined not once but twice, as you can see in the images above taken from a paper just out. In both cases, the skull around the hole shows clear evidence of healing, which shows that the Woman must have survived the procedures.

Trephination is a historical mystery. Stone-age peoples around the world were fond of doing it - trephinations have been found on skulls from Europe, the Americas and Asia. The authors of this paper say that there are records of at least 800 trephined skulls.

In some parts of Europe, it seems that the survival rate for the operation was over 90%. It was a delicate procedure, with stone tools used to carefully scrape away and remove the bone without damaging the tissue underneath. But no-one knows why they did it. Some argue that it may have been used as a treatment for epilepsy or mental illness, but it's impossible to really know what it was meant to achieve.

Alfieri, A., Strauss, C., Meller, H., Stoll-Tucker, B., Tacik, P., and Brandt, S. (2012). The Woman of Pritschoena: An Example of the German Neolithic Neurosurgery in Saxony-Anhalt Journal of the History of the Neurosciences, 21 (2), 139-146 DOI: 10.1080/0964704X.2011.575117