The woman whose new memories are erased each night

Psychologists have documented what they believe to be a clinical first - the case of an amnesic woman whose memory for new material is erased each night that she goes to sleep (movie fans will recognise this as a plot device in the 2004 film 50 First Dates). Referred to as case FL, the woman developed these symptoms after she hit her head in a car accident in 2005, aged 48. Brain scans and neurological exams revealed no signs of brain damage, thus suggesting the woman is exhibiting what's known as psychogenic or functional amnesia - that is, symptoms in the absence of any detectable organic cause.

FL claims that on any given day her memory for newly acquired material is fine until she has a night's sleep, during which the new memories are erased (unlike standard cases of psychogenic amnesia, she says her memories from before her accident are preserved). FL's performance on lab-based memory tests was largely in keeping with her claims, with one key exception. Christine Smith and her team deployed some trickery, intermingling test items (scenes) from earlier in the day with items from previous days. FL's memory for items that she thought were from earlier in the day, but were actually seen on earlier days, was intact and comparable to the memory performance of healthy controls.

So was FL faking it, perhaps in pursuit of a compensation claim? Smith's team don't think so. Although healthy controls who were asked to fake FL's symptoms performed similarly on the memory tests, there were also differences. For example, unlike the healthy fakers, FL showed deficits in motor learning, and her confidence for test items dropped with repeated testing whereas theirs increased.

The researchers' theory is that FL truly believes she has the memory deficit that she describes and that unconscious processes may be involved in its manifestation. FL denied having seen the film 50 First Dates, which was released a year before her accident. However, she admitted that the film's female lead, Drew Barrymore, was her favourite actress, so she may have been aware of its plot. The film 'may have influenced FL's concept of how memory could fail after a car accident', the researchers said. 'The brain uses preexisting concepts of memory and through altered brain function creates a particular constellation of symptoms.'

What about treatment? Reassuring FL that evidence had been found for the intact functioning of her overnight memory proved unsuccessful. What did work was testing the limits of FL's memory-washing system. Thirty-six hours without sleep and her memories were okay. An hour's nap during the day and they were okay. In the end, it was established that FL can sleep at night for up to four to six hours at a time without experiencing the sense that she's lost the day's memories. By setting an alarm each night to wake her after bouts of three and a half hours sleep, FL has managed to overcome her strange condition. 'At our most recent contact (March 2010), she and her husband reported that she continues to use this regimen successfully,' the researchers said.
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Smith, C., Frascino, J., Kripke, D., McHugh, P., Treisman, G., & Squire, L. (2010). Losing memories overnight: A unique form of human amnesia. Neuropsychologia, 48 (10), 2833-2840 DOI: 10.1016/j.neuropsychologia.2010.05.025

Further reading: Amnesia at the movies.

9 evidence-based study tips

The September issue of The Psychologist magazine is a free-to-view student special containing a feature (pdf) by the Research Digest editor on the journey from A-level to Undergrad psychology, including the following 9 evidence-based study tips:

Adopt a growth mindset. Students who believe that intelligence and academic ability are fixed tend to stumble at the first hurdle. By contrast, those with a ‘growth mindset’, who see intelligence as malleable, react to adversity by working harder and trying out new strategies. These findings come from research by Carol Dweck, a psychologist based at Stanford University. Her research also suggests lecturers and teachers should offer praise in a way that fosters in students a growth mindset – avoid comments on innate ability and emphasise instead what students did well to achieve their success.

Sleep well. A 2007 study covered on the Research Digest found that lack of sleep impairs students’ ability to learn new information. Twenty-eight participants attempted to remember a series of pictures of people, landscapes, scenes and objects. Crucially half had slept normally the previous night whereas the other half had been kept awake. When tested two days later, after everyone had had two nights of normal sleep, Matthew Walker found that the previously sleep-deprived students recognised 19 per cent fewer pictures in a recognition memory test.

Forgive yourself for procrastinating. Everyone procrastinates at some time or another – it’s part of human nature. The secret to recovering from a bout of procrastination, according to a 2010 study covered by the Digest, is to forgive yourself. Michael Wohl and colleagues followed 134 first year undergrads through their first two sessions of mid-term exams. Those who had forgiven themselves for procrastination prior to the initial mid-terms were less likely to procrastinate prior to the second lot of exams and tended to do better as a result.

Test yourself. A powerful finding in laboratory studies of learning is the ‘testing effect’ whereby time spent answering quiz questions (including feedback of correct answers) is more beneficial than the same time spent merely re-studying that same material. In a guest post for the Research Digest, Nate Kornell of UCLA explained that testing ‘creates powerful memories that are not easily forgotten’ and it allows you to diagnose your learning. Kornell also had a warning: ‘self-testing when information is still fresh in your memory, immediately after studying, doesn’t work. It does not create lasting memories, and it creates overconfidence.’

Pace your studies. The secret to remembering material long-term is to review it periodically, rather than trying to cram. In a 2007 study covered by the Digest, Doug Rohrer and Harold Pashler showed that the optimal time to leave material before reviewing it is 10 to 30 per cent of the period you want to remember it for. So, if you were to be tested eleven days after first studying some material, the ideal time to revisit it would be a day later. If it’s seven months from your initial study of the material to an exam, then reviewing the material after a month is optimal.

Vivid examples may not always work best. Common sense tells us that effective teaching involves dreaming up interesting real-life examples to help teach complicated, abstract concepts. However, in a 2008 study by Jennifer Kaminski and colleagues, students taught about mathematical relations linking three items in a group were only able to transfer the rules to a novel, real-life situation if they were originally taught the rules using abstract symbols. Those taught with the metaphorical aid of water jugs and pizza slices were unable to transfer what they’d learned.

Take naps. Numerous studies have shown that naps as short as ten minutes can reduce subsequent fatigue and help boost concentration. It’s only recently, however, that researchers have turned their attention to napping technique. Dayong Zhao and colleagues recruited 30 undergrad regular nappers and tested whether it makes any difference if you nap lying down or leaning forward with your head rested on a desk. Zhao’s team found that a post-luncheon twenty-minute nap in either position was associated with increased performance at an auditory oddball task (listening to a series of tones and spotting the odd one out), but only napping lying down was associated with an increased P300 brain wave signal during the task recorded via EEG – a sign of increased mental alertness.

Get handouts prior to the lecture. Students given Powerpoint slide handouts before a lecture made fewer notes but performed the same or better in a later test of the lecture material than students who weren’t given the handouts until the lecture was over. That’s according to a study by Elizabeth Marsh and Holli Sink, reported by the Research Digest, which involved dozens of undergrads watching video clips of real-life lectures. The researchers warned their results are only preliminary but they concluded that ‘in situations where students’ notes are likely to reiterate the content of the slides, there is no harm from releasing students from note-taking.’

Believe in yourself. Self-belief affects problem-solving abilities even when the influence of background knowledge is taken into account. Bobby Hoffman and Alexandru Spatariu showed this in 2008 in the context of 81 undergrad students solving mental multiplication problems. The students’ belief in their own ability, called ‘self-efficacy’, and their general ability both made unique contributions to their performance. ‘In learning situations,‘ the researchers concluded, ‘there is a natural tendency to build basic skills, but that is only part of the formula. Instructors that focus on building the confidence of students, providing strategic instruction, and giving relevant feedback can enhance performance outcomes.’

Other features in this month's issue of The Psychologist include: Charles Spence on his mouth-watering research into multi-sensory perception; Janelle Ward studies the last statements from those on death row; Psychologist editor @jonmsutton poses questions for psychology’s Twitterati; Thomas L. Webb on ensuring students get more out of taking part in research; José Cuenca offers reflections as a research student in psychology, in the first of a new series aiming to unearth budding talent; and Nestar Russell explores the early evolution of Stanley Milgram’s first official obedience to authority experiment. Plus there's the usual mix of news, views, and reviews. Digital previews of earlier issues are also available.

How good are we at estimating other people's drunkenness?

Sloshed, trollied, hammered, plastered. We've done a sterling job of inventing words for the inebriated state, but when it comes to judging from their behaviour how much a person has drunk, we could do (a lot) better. That's according to a review of the literature by US psychologist Steve Rubenzer.

We all have our trusted indices for judging other people's drunkenness. Perhaps it's when the eyeballs start floating about as if under the control of a clumsy puppeteer. Or maybe the effusive 'you know I love you' delivered with a trickle of dribble. However, the vast majority of studies find that lay people, police officers and bartenders are in fact hopeless at distinguishing a drunk person from a sober one, at least at moderate levels of intoxication. To take just one example, after watching drunk and sober people being interviewed and negotiating a stair case, bartenders rated them as slightly, moderately or very drunk with an accuracy of just 25 per cent.

It's a similar story when participants are equipped with more structured means of detecting drunkenness. One 1958 study, for example, found no relation between doctors' assessments of people's intoxication (based on pulse rate, general appearance, gait and mental status) and the subsequent performance of those people on a driving course.

Rubenzer also looked at the evidence for specific indicators of intoxication. Alcohol causes reddening of the eyes, the literature shows, but the association between intoxication level and onset or amount of redness is unreliable. Another indicator is smell. The more a person has drunk, the more likely that their breath will be judged by observers to smell of alcohol. However, this indicator is hampered by the lack of a scientific explanation (alcohol has no odour), not to mention the risk of contamination by food smells. Speech slowing and slurring is another sign of intoxication but people are only modestly accurate at using this as a measure. Predictably enough, impaired walking, the last of the specific indicators, tends to increase the more a person has drunk but it only becomes reliable at very high intoxication levels.

The review finishes by looking at established 'sobriety tests': Nystagmus (jerky eye movements when following a moving target); the Romberg (whether a person sways or falls when they stand, eyes closed, with their feet together, arms at their sides); the Finger to Nose; the Finger to Finger; Saying the Alphabet; and the Hand Pat (alternating between clapping with the palms and backs of hands). In summary, performance on these tests does tend to decline as alcohol intake increases but the evidence for this at lower levels of intoxication is mixed and false positives (sober people categorised as drunk) are a frequent occurrence.

'...[J]udging low to moderate levels of intoxication in strangers is a difficult task,' Rubenzer concludes. 'A variety of professions that might be expected to show substantial skill assessing intoxication do not. [And] no behavioural or physical sign has emerged that is consistently related to a specific level of blood alcohol concentration level without large variation among individuals, with the possible exception of nystagmus.'
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Rubenzer, S. (2010). Judging intoxication. Behavioral Sciences & the Law DOI: 10.1002/bsl.935

Feeling clean makes us harsher moral judges

As the dirt and germs are wiped away, we're left feeling not just bodily but also morally cleansed - a kind of metaphorical virtuosity that leads us to judge others more harshly. That's according to Chen-Bo Zhong's team, who invited 58 undergrads to a lab filled with spotless new equipment. Half the students were asked to clean their hands with an antiseptic wipe so as not to soil the shiny surfaces. Afterwards all the students rated the morality of six societal issues including pornography and littering. Those who'd wiped their hands made far harsher judgments than those who didn't.

It was a similar story in a follow-up study with hundreds of participants recruited via a nation-wide database. Those primed to feel clean by reading a short passage that began 'My hair feels clean and light. My breath is fresh ...' made far harsher moral judgements about 16 social issues compared with those primed to feel dirty by a passage beginning, 'My hair feels oily and heavy. My breath stinks ...'

A third study was identical to the second, except that after reading either the dirty or clean passage of text the 136 undergrad participants also ranked themselves against their peers on several factors including intelligence, attractiveness and moral character. As before, those primed with the clean text made more harsh moral judgements on social issues. Crucially, this association was entirely mediated by their having an inflated sense of moral virtuosity compared with their peers (by contrast, reading the clean vs. dirty text made no difference to self rankings on the other factors).

'Acts of cleanliness have not only the potential to shift our moral pendulum to a more virtuous self, but also license harsher moral judgement of others,' Zhong and his team concluded.
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Zhong, C., Strejcek, B., & Sivanathan, N. (2010). A clean self can render harsh moral judgment. Journal of Experimental Social Psychology, 46 (5), 859-862 DOI: 10.1016/j.jesp.2010.04.003

Link to earlier related post: Your conscience really can be wiped clean.

The Special Issue Spotter

We trawl the world's journals so you don't have to:

Diagnosis, diagnosis, diagnosis: towards DSM-5 (Mental Health Journal). Open Access.

First-year maternal employment and child development in the first seven years (Monographs of the Society for Research in Child Development).

Culture and psychological science (Perspectives on Psychological Science).

Special Issue on Language Development (Brain and Language).

Play, Talk, Learn: Promising Practices in Youth Mentoring (New Directions in Youth Development).

Special Issue: European Personality Reviews 2010 (European Journal of Personality).

DSM-5 and the ‘Psychosis Risk Syndrome' (Psychosis).

Approaches to cognitive modelling (Trends in Cognitive Sciences).

What clients think CBT will be like and how it really is

Some people expect cognitive behavioural therapy (CBT) to be more prescriptive than it is, and therapists to be more controlling than they really are. That's according to a series of interviews with 18 clients who undertook 8 sessions (14 hours) of CBT to help with their diagnosis of generalised anxiety disorder.

Henny Westra and colleagues selected for interview nine clients whose therapy had ended positively and nine whose therapy had ended poorly. Four of the clients were male. There were four CBT therapists - two men and two women. One was PhD qualified, two were senior clinical psychology grad students, one was junior.

The vast majority of client comments (84 per cent) relating to expectations were that the CBT was not what they'd anticipated. Clients whose outcome was good tended to say they'd been pleasantly surprised - the therapist was collaborative and non-judgmental, and they'd had the opportunity to direct the therapy and choose what to talk about. Of the therapeutic process, the positive outcome clients felt, to their surprise, that they could trust the process, felt comfortable, and that they learned more than they expected. Both good and poor outcome clients worked harder in therapy than they anticipated.

Unsurprisingly, the poor outcome clients tended to say they'd been disappointed by the therapeutic process. In the majority of cases, they took pains not to blame their therapist, instead attributing their lack of progress to time constraints, poor health, their own unrealistic expectations, or their failure to remember the techniques. Direct criticism of the therapist was rare (even though interviewees were reassured their comments were confidential). One person said it would have been better not to have waited until session seven to discuss a key subject from their past.

Sixteen per cent of expectation-related comments conveyed that therapy was just as had been expected. One good outcome client in this category said they thought the therapist would get to the root of their problems, and he did. Poor outcome clients, by contrast, tended to make superficial remarks: 'it was fairly similar to what I expected, I guess'.

The broader context for this research is that client expectations are one of several factors that are known to be associated with therapeutic success (with positive expectations tending to precede good outcomes). However, very little research until now has looked at expectancy violations - that is, when therapy isn't what was expected, for good or bad.

'The findings ... suggest that expectancy disconfirmation in CBT, particularly negative expectations for the therapist and the therapy process, is a common and potentially powerful phenomenon in the experiences of CBT clients with good outcomes,' the researchers said.

A major shortcoming of this research is that the interviews weren't conducted until after the final therapy session, so it's possible that clients recalled their earlier expectations in light of their positive or negative experiences in therapy.
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Westra, H., Aviram, A., Barnes, M., & Angus, L. (2010). Therapy was not what I expected: A preliminary qualitative analysis of concordance between client expectations and experience of cognitive-behavioural therapy. Psychotherapy Research, 20 (4), 436-446 DOI: 10.1080/10503301003657395

Flynn effect for memory could invalidate neuropsychologists' tests

In Western countries, scores on IQ tests have been rising for several decades - the Flynn effect, named after the political scientist James Flynn. Now Sallie Baxendale at the Institute of Neurology has provided evidence that a similar effect has occurred for the standardised memory tests that are used by clinical neuropsychologists, a finding with implications for the diagnosis of memory problems in contemporary patients.

Baxendale focused on the Adult Memory and Information Processing Battery (AMIPB) - 'the most commonly used memory battery amongst clinical neuropsychologists in the UK' - published in 1985, and its successor, the Brain Injury Rehabilitation Trust Memory and Information Processing Battery (BMIOB), published in 2007. The two tests feature different wording and design but they both make equivalent demands: learning and recalling lists of words, and learning and recalling abstract line drawings.

Baxendale compared the performance of the two participant samples that provided the original normative data (the 'norms') for the two tests. These are the healthy participants, spanning four age ranges, whose average performance provides the benchmark for assessing patients. The normative data for the AMIPB was provided in 1985, or thereabouts, by 184 British people aged 18 to 75; the normative data for the BMIPB was collected in 2007 or thereabouts from 300 British people aged 16 to 89.

On one hand, there was little evidence of any difference in average performance on verbal learning and recall between the 1985 and 2007 samples (the exceptions were verbal learning in the 31-45 years age range and verbal recall in the oldest age range, both of which were superior in the 2007 sample). By contrast, visual learning and recall were both superior in the 2007 sample compared with the 1985 sample, at all four age ranges: 16-30; 31-45; 46-60; and 61-75. This is consistent with the traditional Flynn effect, which is most pronounced for non-verbal intelligence tests.

Baxendale said her findings have implications for diagnosis because present-day patients may, pre-trauma or pre-illness, have had elevated non-verbal learning and recall scores in comparison to the old normative data. Therefore, such patients could be impaired relative to their own healthy baseline, and yet appear unaffected compared with the out-of-date normative data. 'This may present a confound for neuropsychologists concerned with the lateralising and localising significance of memory test profiles,' Baxendale said.
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Baxendale, S. (2010). The Flynn effect and memory function. Journal of Clinical and Experimental Neuropsychology, 32 (7), 699-703 DOI: 10.1080/13803390903493515

Video protects girls from the negative effects of looking at ultra-thin models

'No wonder our perception of beauty is distorted' - that's the concluding catchphrase of a one-minute video called 'evolution' made by Dove a few years ago to show how cosmetics and computer trickery are used to create the unrealistic portrayals of female models on advertising billboards. Now a team of researchers at the University of the West of England, led by Emma Halliwell, have tested whether viewing this short video can buffer young girls against the negative effects of looking at images of ultra-thin female models. Past research found such a benefit when adult women viewed a similar video but this is the first time the idea has been investigated with young girls.

One hundred and twenty-seven girls, aged ten to thirteen, from two schools in the South of England, were recruited for what they thought was an evaluation of 'attitudes to health, appearance and magazines'. In keeping with the cover story, tests of body satisfaction and esteem were embedded among other questionnaires to try to conceal the true purpose of the study.

Consistent with past research, girls who looked at thin models subsequently reported lower body satisfaction and confidence compared with girls who looked at pictures of landscapes (in turn, prior research has linked lower body self-esteem with increased risk of developing an eating disorder). The key finding was that this negative effect was not seen among the girls who watched the Dove video first, before looking at the ultra-thin models. The body self-esteem and confidence of these girls was just the same as among girls who watched the video and then looked at pictures of landscapes.

'Theoretically, we assume that the intervention disrupted the upward social comparisons that many young girls make when viewing idealised media images,' the researchers concluded. 'Moreover, we propose that the comparison is avoided because the media models have been construed as artificial and, therefore, an inappropriate comparison target.' Halliwell and her team added that future research will be needed to test the truth of this reasoning and whether the benefits of watching the evolution video, or others like it, can be sustained over time.
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Halliwell E, Easun A, & Harcourt D (2010). Body dissatisfaction: Can a short media literacy message reduce negative media exposure effects amongst adolescent girls? British journal of health psychology PMID: 20687976

Link to Dove's Evolution video.

Extras

Eye-catching studies that didn't make the final cut:

What do we mean when we say a public figure has integrity?

Ageing associated with a deficit in recognising hand gestures (even when other cognition remains intact).

What clinical psychologists think about gifts from clients.

Rats with resistance to cocaine addiction.

Music as a memory enhancer for patients with Alzheimer's.

Review paper on Transcranial direct current stimulation (tDCS) and Galvanic Vestibular Stimulation (GVS) - new methods for safely and temporarily altering brain function.

Review paper on boundary extension - the tendency for our memories of scenes to bleed over the edges (see earlier).

Three cases of developmental prosopagnosia ('face blindness') from one family.

The link between the Dark Triad and love styles. Seriously.

Brain training in elderly associated with increased cortical thickness.

People with stronger social relationships live longer.

Hunting the successful psychopath

Put aside the dramatic Hollywood portrayals. Suited, married, high achieving, some of them walk among us. No, not vampires or super-heroes but 'successful psychopaths'. Like their criminally violent cousins - the standard psychopaths - these people are ruthless, callous, fearless and arrogant. But thanks to their superior self-control and conscientiousness, rather than landing in prison, they end up as company chief executives, university chancellors and Queen's Council barristers. Well, that's the idea anyway. But it's an idea that's proven difficult for psychologists to investigate. After all, if you advertise for volunteers for a study of successful people who are psychopathic, you're not likely to get many responses.

Stephanie Mullins-Sweatt and her collaborators tried a different tack. They surveyed hundreds of members of the American Psychological Association's Division 41 (psychology and law), criminal attorneys and professors of clinical psychology about whether they'd ever known personally an individual who was successful in their endeavours and who also matched Hare's definition of a psychopath: 'social predators who charm, manipulate and ruthlessly plow their way through life ... completely lacking in conscience and feeling for others, they selfishly take what they want and do as they please, violating social norms and expectations without the slightest sense of guilt or regret.'

Of the 118 APA members, 31 attorneys and 58 psychology professors who replied, 81, 25 and 41, respectively, said they'd previously known a successful psycho. The examples given were predominantly male and included current or former students, colleagues, clients, and friends (sample descriptions here). The survey respondents were asked to rate the personality of the successful psychopath they'd known and to complete a psychopathy measure of that person. These ratings were then compared with the typical profile for a standard (unsuccessful) psychopath.

The key difference between successful and standard psychopaths seemed to be in conscientiousness. Providing some rare, concrete support for the 'successful psychopath' concept, the individuals described by the survey respondents were the same as prototypical psychopaths in all regards except they lacked the irresponsibility, impulsivity and negligence and instead scored highly on competence, order, achievement striving and self-discipline.

'The current study used informant descriptions to provide information about successful psychopaths,' the researchers concluded. 'Such persons have been described in papers and texts on psychopathy but only anecdotally. This was the first study to conduct a systematic, quantitative analysis of such persons.'
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Mullins-Sweatt, S., Glover, N., Derefinko, K., Miller, J., & Widiger, T. (2010). The search for the successful psychopath. Journal of Research in Personality, 44 (4), 554-558 DOI: 10.1016/j.jrp.2010.05.010