Psychologists and psychiatrists feel less empathy for patients when their problems are explained biologically

The idea that mental illness is related to brain abnormalities or other biological factors is popular among some patients; they say it demystifies their experiences and lends legitimacy to their symptoms. However, studies show that biological explanations can increase mental health stigma, encouraging the public perception that people with mental illness are essentially different, and that their problems are permanent. Now Matthew Lebowitz and Woo-young Ahn have published new evidence that suggests biological explanations of mental illness reduce the empathy that mental health professionals feel towards patients.

Over two hundred psychologists, psychiatrists and social workers were presented with vignettes of patients with conditions such as social phobia, depression or schizophrenia. Crucially, some of these vignettes were accompanied by purely biological explanations focused on factors like genes and brain chemistry, while other vignettes were accompanied by psychosocial explanations, such as a history of bullying or bereavement. Next, the mental health professionals reported their feelings by scoring how far a range of adjectives - such as "sympathetic", "troubled" and "warm" - fitted their current state.

Vignettes accompanied by biological explanation provoked lower feelings of empathy from the clinicians, and this was true regardless of their specific profession. Both biological and psychosocial explanations triggered similar levels of distress, so the reduced empathy associated with biological explanation was not simply due to psychosocial explanations being more upsetting. The mental health professionals rated the biological explanations less clinically useful; biological explanation also prompted them to have less faith in psychotherapy and more confidence in drug treatments.

Similar results were found in a follow-up study in which clinicians and social workers were presented with vignettes and explanations that reflected a combination of psychosocial and biological factors, but with one approach more dominant than the other. The idea was that this would better reflect real life. In this case, explanations dominated by biological factors prompted lower empathy from clinicians.

Lebowitz and Ahn suggest biological explanations provoke reduced empathy because they have a dehumanising effect (implying patients are "systems of interacting mechanisms") and give the impression that problems are permanent. With biological approaches to mental illness gaining prominence in psychology and psychiatry these are potentially worrying results. A silver lining is that both medically trained and non-medical clinicians and social workers in the study saw biological explanations as less clinically useful than psychosocial explanations.

A weakness of the research is the lack of a baseline no-explanation control condition - this means we can't know for sure if psychosocial explanations increased empathy or if biological explanations reduced it. Also, as the researchers admitted, the vignettes and explanations were greatly simplified. Nonetheless, the findings may still give reason for concern. Lebowitz and Ahn suggest reductions in empathy may be avoided if clinicians understand that "even when biology plays an important etiological role, it is constantly interacting with other factors, and biological 'abnormalities' do not create strict distinctions between members of society with and without mental disorders."

_________________________________

Lebowitz, M., & Ahn, W. (2014). Effects of biological explanations for mental disorders on clinicians’ empathy Proceedings of the National Academy of Sciences, 111 (50), 17786-17790 DOI: 10.1073/pnas.1414058111

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

Loneliness is a disease that changes the brain's structure and function

Loneliness increases the risk of poor sleep, higher blood pressure, cognitive and immune decline, depression, and ultimately an earlier death. Why? The traditional explanation is that lonely people lack life’s advisors: people who encourage healthy behaviours and curb unhealthy ones. If so, we should invest in pamphlets, adverts and GP advice: ignorance is the true disease, loneliness just a symptom.

But this can’t be the full story. Introverts with small networks aren’t at especial health risk, and people with an objectively full social life can feel lonely and suffer the consequences. A new review argues that for the 800,000 UK citizens who experience it all or most of the time, loneliness itself is the disease: it directly alters our perception, our thoughts, and the very structure and chemistry of our brains. The authors – loneliness expert John Cacioppo, his wife Stephanie Cacioppo, and their colleague John Capitanio – build their case on psychological and neuroscientific research, together with animal studies that help show loneliness really is the cause, not just the consequence, of various mental and physical effects.

The review suggests lonely people are sensitive to negative social outcomes and accordingly their responses in social settings are dampened. We know the former from reaction time tasks involving negative social words (lonely people respond faster), and tasks involving the detection of concealed pain in faces (lonely people are extra sensitive when the faces are dislikeable). Functional imaging evidence also shows lonely people have a suppressed neural response to rewarding social stimuli, which reduces their excitement about possible social contact; they also have dampened activity in brain areas involved in predicting what others are thinking – possibly a defence mechanism based on the idea that it’s better not to know. All this adds up to what the authors characterise as a social "self-preservation mode."

Meanwhile, animal models are helping us to understand the deeper, biological correlates associated with loneliness. For mice, being raised in isolation depletes key neurosteroids including one involved in aggression; it reduces brain myelination, which is vital to brain plasticity and may account for the social withdrawal and inflexibility seen in isolated animals; and it can influence gene expression linked to anxious behaviours.

What about changes to our neural tissue? Human research is suggestive: in one study, people who self-identified as lonelier were more likely to develop dementia. Here, initial cognitive decline could be causing loneliness, but animal work gives us some plausible mechanisms for loneliness’ impact: animals kept in isolation have suppressed growth of new neurons in areas relating to communication and memory, just as very social periods such as breeding season see a pronounced spike in growth.

Other basic brain processes are also upset by isolation. Isolated mice show reduced delta-wave activity during deep sleep; and their inflammatory responses also change, meaning that in one study, three in five isolated mice died following an induced stroke, whereas every one of their cage-sharing peers survived the same process.

The research is clear that loneliness directly impacts health, so we need to do what we can to help people free themselves from social marginalisation. I’ve seen one approach during my time serving with time banking charities, in which people give their own time in return for someone else’s in a different situation – a process that can build social networks. Also the issue is acquiring momentum through the Campaign to End Loneliness and technology solutions such as the RSA’s Social Mirror project – an app that tells people about local social groups and activities. Mainstream health is also picking this up under the term “social prescription” (physicians advise patients of social groups and activities and “facilitators” help the patients take up the opportunities). But amongst all the institutional activity, we mustn’t forget our individual duties: sometimes all that’s needed is to reach out.

_________________________________

Cacioppo, S., Capitanio, J., & Cacioppo, J. (2014). Toward a neurology of loneliness. Psychological Bulletin, 140 (6), 1464-1504 DOI: 10.1037/a0037618

Post written by Alex Fradera (@alexfradera) for the BPS Research Digest.

Can a brain scan tell us anything about the art of creative writing?

When an accomplished creative writer gets on with their craft, their brain operates in a somewhat different way to a novice's. A new imaging study suggests that the expert approach may be more streamlined, emotionally literate, and initially unfiltered.

Katharina Erhard with her colleagues from the German universities of Greifswald and Hildesheim asked participants to read a fragment of a story, to brainstorm what could continue the narrative, and then, for two minutes, to write a continuation of the story. Their brains were scanned throughout. This is an improvement on previous studies that have simply involved participants imagining a story while lying in a scanner.

Participants were 20 experts - students on competitive creative writing courses with over 10 years experience and a weekly average of 21 hours practice - and 28 novices practicing less than an hour per week. Independent judges considered the experts' writing significantly more creative: "unmade laundry, unloved days" was how one expert closed his response to an account of a bitter bachelor killing himself in a laundry, whereas a tale of a violinist losing his instrument in the snow conjured this image: "the glacier, winding its tongue around the sounds, suddenly gulped the violin". The differences between expert and novice brain activation during the writing phase offers some tantalising clues to how such quality emerges.

In the frontal cortex, expert brains showed greater activity in areas crucial to language and goal selection, including across the inferior frontal gyri (IFG). Verbal creativity has been associated with left IFG activation many times before, but involvement of the right IFG was unexpected. The area is associated with emotional language processing, such as interpreting expressive gestures, so this may suggest that experts are attending more deeply to the emotional currents of text and their ideas. Together with recent evidence that metaphor comprehension recruits the right temporal lobe, this suggests a role for processes housed in the right hemisphere when a verbal task is more abstract and less factual.

Expert writing also involved more activation in the left caudate. This is part of the basal ganglia, long known to be critical to learning and expert performance, and seems to reflect ordinarily cortical cognitive processes becoming automatised and bundled together within the deeper brain. In this case, these may be to do with visually processing text, as the experts showed less activation in occipital areas involved in visual and perceptual processing.

One final finding: during brainstorming, expert brains showed increased activation relative to novices in several regions associated with speech production. Taking these findings together, they paint a picture of expert creative writers: ideas bubble within them, already on the road from concept to expression, readily communicable, almost rising into their throats. These are handled by neural systems streamlined to take care of the basics, while the writer devotes greater attention to the emotional interpretation of their text. It will be down to future researchers to verify or reject this characterisation - and hopefully, some great future writers to tell us about it. Maybe you.

_________________________________

Erhard, K., Kessler, F., Neumann, N., Ortheil, H., & Lotze, M. (2014). Professional training in creative writing is associated with enhanced fronto-striatal activity in a literary text continuation task NeuroImage, 100, 15-23 DOI: 10.1016/j.neuroimage.2014.05.076

Post written by Alex Fradera (@alexfradera) for the BPS Research Digest.

"Place cells" discovered in the rat brain

John O'Keefe
Image: Nobelprize.org

This month John O'Keefe, May-Britt Moser and Edvard Moser were awarded the Nobel Prize in Physiology or Medicine for their work identifying the brain's "GPS system" - the internal maps that allow us to understand our position in space. The Moser's discovery of grid cells this century built upon O'Keefe's earlier accomplishment at UCL in London, the discovery of place cells in the brain. Here, we look back to his 1971 "Short Communication" in the journal Brain Research which presented his preliminary evidence for place cells in rats.

Earlier research had suggested that damage to a rat's hippocampus (a bilateral brain structure in the temporal lobes) causes it to become confused when attempting spatial tasks. O'Keefe wanted to look in detail at what different hippocampal regions were up to when a rat moves around, specifically to see whether there was a neural system "which provides the animal with a cognitive, or spatial, map of its environment".

Together with student Jonathan Dostrovsky, O'Keefe inserted microelectrodes through the skulls of 23 rats, each arriving at a slightly different position in the hippocampus. Each rat could then explore its limited environment - a 24cm by 36cm platform - while the experimenters recorded neural activity from the electrodes.

In all, the study took recordings from 76 different positions in the hippocampus. Some turned out to fire in response to particular behaviours, such as walking, eating, or grooming; some while the rat was aware of something; some during sleep; some for no detectable reason at all. But electrodes at eight locations only gave their full response "when the rat was situated in a particular part of the testing platform facing in a particular direction" (italics in original). This was the first ever discovery that different brain cells represent unique location and orientation information.

O'Keefe and Dostrovsky attempted to find straightforward explanations for this spatial sensitivity. But eliminating sound cues (by silencing fans and other unmoving sound sources) and olfactory ones (by rotating the testing platform) had no effect on the neural activity of these eight “place cells*”. This solidified the possibility that the eight weren't responding to information arriving through the senses from "out there", but from a representation of space that existed within the brain.

Our findings "suggest that the hippocampus provides the rest of the brain with a spatial reference map," concluded O'Keefe and Dostrovsky. As explained by Hugo Spiers in next month’s Psychologist magazine, this evidence opened up investigations into spatial memory and cognition, which began to demand some kind of coordinate system feeding into the place cells themselves. That idea was finally cashed out by the Mosers, who established that the entorhinal cortex, a key interface between the hippocampus and the neocortex, contains grid cells that perform this function by encoding atop space grids of hexagons in a honeycomb fashion familiar to anyone who has played too many wargames.

A systematic investigation into the through-lines between neural activity, cognition and behaviour, the body of work by O’Keefe and the Mosers is groundbreaking, genuinely surprising, and provides fertile ground for continued exploration, not only of rats, but of ourselves: minds within bodies within space.
_________________________________

  O'Keefe, J., & Dostrovsky, J. (1971). The hippocampus as a spatial map. Preliminary evidence from unit activity in the freely-moving rat Brain Research, 34 (1), 171-175 DOI: 10.1016/0006-8993(71)90358-1

*note the term "place cell" was not used in this paper.

Post written by Alex Fradera (@alexfradera) for the BPS Research Digest.

Neuroscience does not threaten people's sense of free will

A key finding from neuroscience research over the last few decades is that non-conscious preparatory brain activity appears to precede the subjective feeling of making a decision. Some neuroscientists, like Sam Harris, have argued that this shows our sense of free will is an illusion, and that lay people would realize this too if they were given a vivid demonstration of the implications of the science (see below). Books have even started to appear with titles like My Brain Made Me Do It: The Rise of Neuroscience and the Threat to Moral Responsibility by Eliezer J. Sternberg.

However, in a new paper, Eddy Nahmias, Jason Shepard and Shane Reuter counter such claims. They believe that Harris and others (who they dub "willusionists") make several unfounded assumptions about the foundations of most people's sense of free will. Using a series of vivid hypothetical scenarios based on Harris’ own writings, Nahmias and his colleagues tested whether people's belief in free will really is challenged by "neuroprediction" - the idea of neuroscientists using brain activity to predict a person's choices, and by the related notion that mental activity is no more than brain activity.

The research involved hundreds of undergrads at Georgia State University in Atlanta. They were told about a piece of wearable brain imaging technology - a cap - available in the future that would allow neuroscientists to predict a person's decisions before they made them. They also read a story about a woman named Jill who wore the cap for a month, and how scientists predicted her every choice, including her votes in elections.

Most of the students (80 per cent) agreed that this future technology was plausible, but they didn't think it undermined Jill's free will. Most of them only felt her free will was threatened if they were told that the neuroscientists manipulated Jill's brain activity to alter her decisions. Similar results were found in a follow-up study in which the scenario descriptions made clear that "all human mental activity just is brain activity", and in another that swapped the power of brain imaging technology for the mind reading skills of a psychic. In each case, students only felt that free will was threatened if Jill's decisions were manipulated, not if they were merely predicted via her brain activity or via her mind and soul (by the psychic).

Nahmias et al said their results showed that most people have a "theory-lite" view of free will - they aren't bothered by claims about mental activity being reduced to neural activity, nor by the idea that such activity precedes conscious decision-making and is readable by scientists. "Most people recognise that just because 'my brain made me do it,' that does not mean that I didn't do it of my own free will," the researchers said.

As neuroscience evidence increasingly enters the courtroom, the findings have important implications for understanding how such evidence might influence legal verdicts about culpability. An obvious limitation of the research is its dependence on students in Atlanta. It will be interesting to see if the same findings apply in other cultures.

_________________________________

Nahmias, E., Shepard, J., & Reuter, S. (2014). It’s OK if ‘my brain made me do it’: People’s intuitions about free will and neuroscientific prediction Cognition, 133 (2), 502-516 DOI: 10.1016/j.cognition.2014.07.009

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

Remembering and imagining both engage the same key brain region, but they depend on distinct neural processes

credit: Gray's Anatomy/Wikipedia

Remembering and imagining appear to be very different functions, one recovering true information from the past, the other considering the unreal or exploring the future. And yet many patients with damage to the hippocampus (a structure in the temporal lobes) - and resultant memory impairment - struggle in imagining the future. Moreover, neuroimaging data show the hippocampus is involved in both tasks. Taken together, this evidence suggests that memory for the past and imagination for the future may depend on shared neural processes.

A new imaging study by Brock Kirwan and his colleagues confirms at a broad anatomical level that both memory and future imagination call on similar regions of the hippocampus. But the research also shows how these two mental functions do depend on distinct neural processes after all.

Fourteen study participants were invited into a scanner where they were presented with photographs in a series of runs. One run contained only personal photographs that the participant had taken in the last five years; another presented photos of unfamiliar situations, known to be novel to each participant thanks to a biographical survey they completed earlier.

After each image, the participants had to either recall what they’d just seen (in the case of the personal photos), or imagine the presented situation (in the case of the unfamiliar photos), as vividly as possible, for 8.5 seconds. It was during these contrasting mental tasks that the key scanning data were collected. Participants then immediately rated the vividness of each memory or imagined situation, and only trials that met a threshold of vividness were included in analysis (this disqualified the bulk of the “imagine” trials).

The two tasks activated different brain areas: a range of frontal areas for the imagining task; cingulate and parahippocampal areas for the remembering task. But both tasks were also associated with activation within the hippocampus itself - in the left anterior and (more weakly) posterior regions, specifically. Next, the researchers used a “classifier accuracy analysis”, which essentially gives a computer a bunch of information unfolding over time (in this case, patterns of activation across hippocampal voxels, each measuring about 2 cubic millimetres) and asks it to identify from the patterns of activity, which mental process was ongoing at the time - remembering or imagination.

The computer was far from perfect at this task, but it did significantly better than chance. This shows that if we zoom in enough, we find there are some consistent differences in how the neural resources of the hippocampus are put to work in remembering and imagining. This raises the question - what role is the hippocampus serving when we imagine the future? One possibility is that it makes available raw materials (memories?) that are then recombined to create an imagining. However it does it, the new research confirms that the hippocampus appears to be crucial to the creation or recreation of realities beyond our current sensory inputs: a key component of mental time travel.

_________________________________

Kirwan CB, Ashby SR, & Nash MI (2014). Remembering and imagining differentially engage the hippocampus: A multivariate fMRI investigation. Cognitive neuroscience, 1-9 PMID: 24967816

--further reading--
Mental time travel.

Post written by Alex Fradera (@alexfradera) for the BPS Research Digest.

How our judgments about criminals are swayed by disgust, biological explanations and animalistic descriptions

We expect of our jurors and judges calm, reasoned evaluation of the evidence. Of course we know the reality is rather different - prejudice and emotional reactions will always play their part. Now two new studies add insight into the ways people's legal judgements depart from cool objectivity.

Beatrice Capestany and Lasana Harris focused on two main factors - the disgust level of a crime, and whether or not the perpetrators' personality was described in biological terms. Seventeen participants were presented with pairs of crime vignettes, with each crime in a pair matched for severity in terms of US Federal sentencing guidelines, but one crime high in disgust value, the other low. For example, one vignette described a man pulling a gun on a love rival, taking aim and missing. The matching vignette described a man who stabbed his boss with scissors, once in the neck and once in the back, causing serious blood loss.

Each vignette concluded with a personality description that was either trait-based (e.g. Gerald has an impulsive personality) or biological (e.g. Terry has a gene mutation that makes him impulsive). These contrasting personality descriptions were always irrelevant to the crime - so, in the aforementioned impulsivity examples, the crime in question was pre-meditated.

Capestany and Harris found that participants recommended more serious punishments for crimes that were more disgusting. This sounds like emotion clouding judgment. But in a sense, greater disgust made participants more reliable decision makers because when disgust levels were high, the participants' recommendations more closely matched Federal sentencing guidelines. Perhaps, the researchers surmised, this is because the US legal system is rooted in historical moral judgments that were guided by disgust reactions.

Capestany and Harris also scanned the brains of their participants. This revealed greater engagement of brain regions involved in logical reasoning when participants were presented with crimes higher in disgust. In other words, a stronger emotional reaction to the crime actually led to greater activation of neural areas involved in logic.

When it came to the influence of the personality descriptions, participants judged criminals to be less culpable when they'd been described in biological terms, presumably because biological factors are perceived as deterministic and reduce the sense that the criminal has control over their behaviour. The brain scans showed greater recruitment of logical reasoning centres when vignettes included trait (non-biological) descriptions of the criminal's personality, so perhaps participants jumped to conclusions when given biological information.

"Biological personality descriptions dehumanise the person, reducing them to a mechanistic, biological organism and not a human being whose mental states are highly unique and salient during responsibility judgments," the researchers said.

Another way that a suspect can be dehumanised is by describing their actions in animalistic terms. This is what happened in the the UK with the real life case of Raoul Moat in 2010, after he shot three people in England. He was described in the media as a "brute" and like "an animal in the wild" when he went on the run.

A team led by Eduardo Vasquez has investigated people's sentencing decisions when criminal acts are described in animalistic terms (e.g. "... the perpetrator slunk onto the victim's premises ... He roared at the victim before pounding him with his fists") versus in non-animalistic terms, but with wording matched for seriousness (e.g. "the perpetrator stole onto the victim's premises ... He shouted at the victim before punching him with his fists").

Seventy-six participants recommended more serious sentences (one to two years extra duration) for criminals whose behaviour was described in animalistic terms. A follow-up study suggested this was because criminals described in animalistic terms were predicted to be more likely to re-offend.

Vasquez and his colleagues said their results "add to a growing body of literature examining the consequences of dehumanisation". They admitted that the implications for actual trials are unclear - after all, the descriptions they used are rarely heard in court. Nonetheless, they said there could be real-life relevance: "Media reports influence legal proceedings and most people rely on the media for information about criminal justice... People exposed to these [animalistic] descriptions may vote for harsher policies to address crime."

_________________________________

Capestany, B., & Harris, L. (2014). Disgust and biological descriptions bias logical reasoning during legal decision-making Social Neuroscience, 9 (3), 265-277 DOI: 10.1080/17470919.2014.892531

Vasquez, E., Loughnan, S., Gootjes-Dreesbach, E., & Weger, U. (2014). The animal in you: Animalistic descriptions of a violent crime increase punishment of perpetrator Aggressive Behavior, 40 (4), 337-344 DOI: 10.1002/ab.21525

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

Neurosurgeons find small brain region that turns consciousness on and off, like the key in a car's ignition

The 54-year-old epilepsy patient - her name remains concealed to protect her privacy - was lying on the operating table while surgeons explored inside her brain with electrodes. They were looking for the source of her epileptic seizures. Suddenly, after they applied electricity to a small region, buried deep, near the front of the brain, the woman froze and her eyes went blank. She was awake, but entirely unresponsive.

The precise area the surgeons had zapped included a sliver of tissue known as the claustrum, which is part of a network that supports awareness. Mohamad Koubeissi and his colleagues state that nobody has ever examined the effects of stimulating this specific brain region before, despite this kind of surgical procedure having been performed for decades. Just as geographers still surprise us with reports of having discovered previously unchartered parts of the earth, it takes one aback to hear of unexplored areas of neural terrain.

Intrigued by the woman's response to the stimulation of this specific brain region, the surgeons investigated further. Ten further stimulations, and on every occasion zapping the claustrum had the same effect. By contrast, zapping an area just 2.7mm away did not.

Perhaps the woman was simply paralysed by the electrical stimulation? The effects are more intriguing than that. If given an instruction prior to the stimulation, such as words to utter or movements to make, she continued this for a few seconds after the stimulation began, but then descended into still, unresponsive stupor. It was also striking to observe that as soon as the stimulation ended, the woman regained consciousness. However, she had no memory of the preceding moments during the stimulation period.

The researchers also examined the synchronisation of activity across the brain during the stimulation of the claustrum. They found that it increased synchronisation across the brain, possibly to a debilitating level. If so, this would match the situation observed in epileptic seizures that trigger loss of consciousness.

Caution is required - after all, this is a single case study, and the patient in question was missing part of one hippocampus, removed during earlier treatment for epilepsy. Nonetheless this is an intriguing finding. "... [T]he disruption of consciousness that we herein describe has never been precipitated by electrical stimulation of any other site in the human brain," the researchers said.

Speaking to New Scientist magazine, lead author Koubeissi likened the claustrum to a car's ignition. While both the brain and the car are made up of many functioning parts, "...there's only one spot where you turn the key and it all switches on and works together," he told them. "So while consciousness is a complicated process created by many structures and networks - we may have found the key." If these results can be replicated, the hope is that stimulation of the claustrum may offer a way to treat disorders of consciousness associated with epileptic seizures.

_________________________________

Mohamad Z. Koubeissia, Fabrice Bartolomei, Abdelrahman Beltagy, Fabienne Picard. (2014). Electrical stimulation of a small brain area reversibly disrupts consciousness.  Epilepsy & Behavior Volume 37, August 2014, Pages 32–35

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

Mirror writing: What does it reflect about how we all write?

Our story starts with a wheeze: a schoolboy punished with lines saves time by wielding two pens at once. Exploring the ease with which he can play with writing, what began as a diversion eventually becomes an artistic practice that incorporates mirrored and inverted script into paintings. What can investigation of this skill offer to science?

Mirror writing in Western script flows from right to left, writing first A, then l, e, x to produce xɘlA. It's reported both in neurologically impaired patients and healthy practitioners such as Lewis Carroll, Leonardo da Vinci, and our own case participant, 65-year old "KB".

This phenomenon is no mere curiosity. It challenges popular theory that says we have a mental programme for writing that represents the act step by step, from start to finish; a programme most practised with our dominant hand, but abstract enough to be available by other means. This account has empirical support: when we write from our shoulder to mark a large canvas, some handwriting flourishes are still preserved, and this is true even when we grip a pen with our teeth! The standard theory predicts that writing with our non-dominant hand would be somewhat awkward, and non-dominant mirror writing extremely so: the work of using an unpractised hand compounded by the additional need to remap this high-level recipe.

But the mirror-writing evidence simply doesn't agree. Comparisons of static script produced by right-handed individuals with mirror-writing competence (such as KB, although his handedness is not clear-cut), shows that the closest thing to their normal handwriting (with their dominant hand) isn't normal left-hand, or even mirrored-right, but mirrored left-hand script.

Now a team led by Robert McIntosh have gone further (pdf), using an electronic tablet to record the order, timing and nature of individual strokes of KB's stylus. In terms of accuracy, speed, and similarity of stylus-strokes, they found that KB’s mirrored-left writing is the best match to his natural writing, confirming and strengthening the data to date.

Perhaps KB's mirrored left-hand writing is so assured simply because it's the most practised. To address this, the researchers looked at upside-down writing, a much more recent addition to his repertoire. Left-mirrored was again the best match to right-forward – even though neither look that similar to upright right-forward.

This new investigation with KB supports the idea that writing is not stored as universal coordinates, but instead as movements relative to body position: a capital "A" beginning with an "up and away from the body" pen-stroke. This is why writing with our non-dominant hand is awkward, as every stroke violates these principles, even though its output is "the right way around" perceptually. Indeed, mirror-writers including KB show little fluency or appetite for reading mirrored text, suggesting that motor and perceptual representations of writing are rather different.

KB is part of a small breed - the deliberate mirror-writer - and McIntosh's team are interested in taking this methodology to other populations, both healthy and neurologically impaired, to see whether this vision of mirror-writing is reflected elsewhere.

 _________________________________

  McIntosh RD, De Lucia N, Della Sala S. (2014) Mirror man: a case of skilled deliberate mirror writing. Cognitive Neuropsychology.

-further reading-
Mirror-writing: Robert D. McIntosh and Sergio Della Sala explore some intriguing phenomena (in The Psychologist magazine).
Your brain unscrambles words in the mirror but then switches them back again.

Post written by Alex Fradera (@alexfradera) for the BPS Research Digest.
Image: Christian Jarrett

Are voluntary and involuntary memories encoded by different brain systems?

Some memories we aim to remember, others just show up. One proposal is that uninvited memories, such as those that intrude in Post-Traumatic Stress Disorder (PTSD), are encoded and stored in a distinct memory system. But a new neuroimaging study led by Shana Hall suggests that similar brain areas are involved whether our memories come spontaneously or by intent.

During a functional imaging brain scan, 26 participants made perceptual judgments about a sequence of 100 sounds piped into headphones. All the sounds had been repeatedly presented earlier, half of them paired with images the participants were instructed to associate with the sound. At scan-time, 14 participants in a voluntary recall condition attempted to call to mind each relevant, related image. In contrast, the involuntary recall group did not perform this deliberate recall task. Afterwards, all participants worked through the sounds once more and indicated which ones had triggered an image in the scanner, either spontaneously or by intent.

Regardless of whether a participant was trying to recall images or not, the trials where image recall occurred led to activation in a range of areas including medial temporal lobe, posterial midline cortex, and angular gyrus. These areas aren’t particularly surprising, with links to various memory and visual processes already established in previous studies. But what the results imply is that there is considerable overlap between what happens in the brain when we’re remembering on purpose compared with by accident.

Surely some neural activity differentiates the two experiences? Yes, but it’s fairly specific: participants in the voluntary recall condition showed more activation in their left dorsolateral prefrontal cortex (DLPFC). This was true across all trials, including those that involved sounds previously unassociated with any image. It seems the brain region wasn’t involved in reproducing a memory, but in the strategic search for memories. This fits with what we already know about the function of DLPFC. Beyond this activity (which we would be surprised not to find, given that these participants were specifically asked to search for memories), there was no significant difference in brain activation between the voluntary and involuntary recall groups.

So, all in all, the study suggests that the systems that support everyday voluntary and involuntary memories may have more in common than differences. However, researchers of clinical disorders, such as PTSD, that involve involuntary memories, focus proposals for a distinct system around the especially traumatic nature of such memories. As such, it would be interesting to bring this methodology to explore memories for negative emotional content, and indeed to clinical groups who experience traumatic involuntary memories, to better understand what makes such memories like and unalike.

_________________________________

Hall, S., Rubin, D., Miles, A., Davis, S., Wing, E., Cabeza, R., & Berntsen, D. (2014). The Neural Basis of Involuntary Episodic Memories Journal of Cognitive Neuroscience, 1-15 DOI: 10.1162/jocn_a_00633

Post written by Alex Fradera (@alexfradera) for the BPS Research Digest.

It's shocking - How the press are hyping the benefits of electrical brain stimulation

A commercially available tDCS device

There is a "rising tide" of hype regarding the potential benefits of weak electrical stimulation of the human brain. That's according to a trio of Canadian neuroscientists writing in the journal Neuron.

Veljko Dubljević and his colleagues performed literature searches on mentions of transcranial direct current stimulation (tDCS) in the academic and mainstream print media. tDCS involves the application of weak electrical current to the scalp, with the aim of altering neuronal function. There have been numerous recent reports of this practice leading to forms of cognitive enhancement - however, it's possible there are detrimental drawbacks and the long-term consequences are unknown.

Dubljević and his team found that research and media coverage of tDCS has increased dramatically since 2006. There were over 250 academic papers published on the technique in 2013 (up to October of that year), compared with fewer than 25 in 2006. Similarly, they identified nearly 70 mainstream media articles in 2013 (up to October), compared with fewer than 10 in 2006.

They also noted the way the media has focused disproportionately and uncritically on the cognitive enhancement potential of tDCS. Whereas the majority (45 per cent) of academic studies are on therapeutic uses of the technique, such as to treat depression (versus just 13 per cent on enhancement), the media focused as much on enhancement (42 per cent) as on therapeutic uses (42 per cent). Typical headlines include "A tiny zap to improve memory" (The Philadelphia Inquirer) and "Jump start your brain" (Boston Magazine).

And while the scholarly press often included caveats and warnings about side-effects, these were rarely mentioned in the popular press. Instead, the media coverage tended to include "misleading statements" and to "sensationalise" the capabilities of tDCS. Reportage on electrical brain stimulation was also often accompanied by the perpetuation of brain myths, such as the idea that we only use 10 per cent of our brain power.

Dubljević and his colleagues call on professional societies, government bodies, researchers and science writers to do more to inform the public about the safety concerns regarding tDCS, to explain better the mechanisms of action (many of which are not fully understood), and to present a more realistic picture of the likely benefits. This is especially urgent, they argue, given the lack of regulation of tDCS devices, and their increasingly widespread availability.

"Given the rapid evolution of tDCS in the public domain and in academia, tackling its social, ethical, and policy implications requires a multifaceted response," they said.

_________________________________

Dubljević, V., Saigle, V., & Racine, E. (2014). The Rising Tide of tDCS in the Media and Academic Literature Neuron, 82 (4), 731-736 DOI: 10.1016/j.neuron.2014.05.003

--further reading--
Read this before zapping your brain
The age of the superhuman

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

The world shifts to the right when you're sleepy

When you're drowsy, new research shows that what's happening on your left often sounds to you as though it's happening on your right. Perhaps that's why it can be so tricky to land a punch on the alarm clock in the morning!

Corinne Bareham and her team asked 26 healthy volunteers (17 women; all right-handers) to relax in a comfortable reclining chair, to close their eyes, and listen to a series of tones. The tones occurred either on the left or right side of space, some further from the centre than others.

After each tone, the participants pressed a button to indicate whether they thought it had originated on the left or right side of space. While this was going on, the researchers recorded the participants' surface brain activity using EEG (electroencephalography). This provided an objective marker of their sleepiness.

The task may appear easy, but when the participants were sleepy, they mislocated nearly 25 per cent of left-sided tones to the right. This compares to an error rate of under 14 per cent when they were alert. "A participant was 17 times more likely to show a right-ward shift with drowsiness ... than a leftward shift, or no shift," the researchers said. In contrast, the participants were slightly more accurate at locating right-hand tones when sleepy compared with when alert.

The finding that tiredness triggers a shift in attention to the right-side of space is not new - researchers have shown this before. However, past demonstrations of the phenomenon have used visual stimuli. This study is novel because of its use of auditory tones and because of the highly accurate measurements of participants' alertness.

Research on this topic has clinical relevance. The drowsiness-induced attentional shift towards the right side of space is similar to a phenomenon known as "spatial neglect" that's observed in patients who have suffered right-hemisphere brain damage. People with left-sided brain damage show the opposite pattern - they tend to ignore the right-hand side of space. However, right-hemisphere brain damage leads to more prolonged and profound spatial neglect than left-sided damage, and this new study offers a clue as to why.

One explanation for spatial neglect following left or right-sided brain damage is that the two hemispheres of the brain are usually in competition, so that when one is damaged, balance is lost, and attention is skewed towards the same side of space as the brain damage. However, people with right-sided brain damage suffer twice, because damage to the right hemisphere is known to induce sleepiness, which - as this study shows - also leads to a skewing of attention to the right side of space.

In the researchers' words, patients with right-hemisphere damage are "doubly compromised" - by the loss of hemispheric balance, and by the effects of drowsiness. The good news is that this insight offers an avenue for treating patients with right-sided brain damage. "The results here confirm that the maintenance of alertness should be ...[an] important therapeutic target," the researchers said.
_________________________________

  Bareham, C., Manly, T., Pustovaya, O., Scott, S., & Bekinschtein, T. (2014). Losing the left side of the world: Rightward shift in human spatial attention with sleep onset Scientific Reports, 4 DOI: 10.1038/srep05092

--further reading--
Hemispheric bias shifts with tiredness
Space is compressed by a fast turn of your head
Novelty seekers are biased to the right

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

Antidepressant brain stimulation: Promising signs or continuing doubts?

Depression is a growing public health concern, affecting 1 in 9 people at some point in their lives, and with a third of sufferers experiencing little or no benefit from medication. The World Health Organization predicts that by 2020 depression will become the second leading cause of disability worldwide. By 2026 it is expected to afflict nearly 1.5 million people in the UK, costing the economy more than £12bn every year.

Faced with this crisis, scientists have looked for alternative solutions to medication. Since the mid 1990s there has been a steady interest in developing brain stimulation methods as antidepressants, particularly for patients who are resistant to drug therapy. The general logic of this approach is that because depression is associated with abnormally low activity in the left prefrontal cortex, methods that increase prefrontal activity, such as transcranial magnetic stimulation (TMS), might help promote recovery.

A new Taiwanese study now reports that a particularly potent form of transcranial magnetic stimulation called theta burst stimulation could lead to benefits in treatment-resistant depression. Cheng-Ta Li and colleagues compared the efficacy of three different types of theta burst stimulation: a protocol believed to increase activity in the left prefrontal cortex, one that reduces activity in the right prefrontal cortex, and a combined protocol that seeks to achieve both in the same treatment session. Compared with sham (placebo) stimulation, the team found that two weeks of daily treatment using the combined protocol was most effective, reducing self-ratings of depression by about 35 per cent.

Self-ratings of depression were reduced by about 35 per cent

These results are promising but preliminary. The sample size was small, including just 15 patients per group, and the trial was not preregistered. Such limitations are common in a literature that is dominated by controversy and small exploratory reports. A major 2007 study, which concluded that TMS is clinically effective (and which led to the treatment becoming approved by the FDA) was later criticised for selectively reporting positive outcomes, deviating from its registered analysis protocol, and being contaminated by uncontrolled placebo effects. The most recent review of evidence to date concluded that the benefits of TMS, while measurable statistically, are so small as to be clinically insignificant. And as to how these benefits of TMS arise in the first place – well, the truth is we have almost no idea. Our best guess is 'because dopamine'.

These uncertainties, in turn, raise concerns about ethics and regulation. With a growing number of companies offering TMS as a private healthcare intervention, and with standard treatments running into thousands of pounds, the fact that its efficacy remains unproven and unexplained is especially pertinent.

Notwithstanding these issues, this latest study by Li and colleagues is a helpful addition to the literature and suggests that more potent neurological interventions, such as theta burst stimulation, have potential. But realising that potential will require a commitment to rigorous and unbiased research practices. We need meticulously preregistered studies to prevent negative findings being censored and to ensure that authors don’t cherry pick analyses that 'work' or engage in other questionable research practices. We need studies with larger samples to determine which individual differences determine the efficacy of TMS and to generate reproducible effects. And we need a renewed focus on understanding the neurobiology underlying any benefits of TMS.

Once these challenges are met, brain stimulation may well provide a complementary treatment for depression. For now, though, the jury is out.

_________________________________

Li CT, Chen MH, Juan CH, Huang HH, Chen LF, Hsieh JC, Tu PC, Bai YM, Tsai SJ, Lee YC, & Su TP (2014). Efficacy of prefrontal theta-burst stimulation in refractory depression: a randomized sham-controlled study. Brain : a journal of neurology PMID: 24817188

Post written for the BPS Research Digest by guest host Chris Chambers, senior research fellow in cognitive neuroscience at the School of Psychology, Cardiff University, and contributor to the Guardian psychology blog, Headquarters.

Where exactly in your body are YOU?

From Alsmith & Longo 2014

Although you probably consider all of your body is yours, if you're like most people, you also have a feeling that your very essence, your self, is more localised. Past research has turned up mixed findings for where exactly this spot is. In some studies people say they are located in their head, near the eyes. Other research has found that people consider the self to be located in the chest. The varied results are probably partly due to the different methods used. Some studies have focused on people's judgments about their own essence; others have involved participants marking the location of another person's self on a drawing of the body.

According to Adrian Alsmith and Matthew Longo - another problem with past studies is that they haven't given participants the option to choose more than one location. In their new paper, the researchers invited 10 participants to stand opposite a pointer mounted on a stand (see picture). As the researcher rotated the pointer up or down, each participant had to say when it was pointing "directly at them". The starting angle and height of the pointer was varied from trial to trial. Also, the participants were sometimes blindfolded, in which case they moved the pointer themselves to a position that felt like it was pointing directly at them. There were 96 trials per person in all.

The researchers divided the chosen pointer positions into five areas, depending on whether its final position was pointed at: lower torso, upper torso, neck, lower face, or upper face. There was a clear bias for the participants to direct the pointer towards their upper torso, and even more often, towards their upper face.

"Each of the two regions … has a high degree of functional salience which explains their status as natural candidates for self-location judgments," the researchers said. Consistent with these findings, we still refer to the heart and chest in many everyday sayings, such as "learn by heart" and to "love with all my heart". Yet we're aware too that our mental functioning is located in the brain, and of course it feels as though we look out at the world through our eyes.

Although participants showed a clear bias for the upper chest and upper face, they tended to be inconsistent and to vary their choices between the two. Alsmith and Longo said this novel finding suggests that "no single body part is judged as the unique seat of the self."

So what influenced whether participants chose the upper torso or upper face? The researchers said that this varied according to the starting position of the pointer - participants tended to choose the body location (torso or face) that was reached first. This wasn't simply due to laziness because otherwise responses would have been biased toward the lower torso when the pointer started in a low position. Instead it seems the participants' decisions were influenced by whether their attention was first directed towards their upper torso or face. Another detail was that participants' responses did not vary systematically according to whether they were blindfolded or not.

"To the extent that … self-location judgments tell us anything about the concept of the self as a spatial entity, they tell us that the concept is inherently ambiguous," concluded Alsmith and Longo. From a critical perspective, it's a shame that the participant pool was so small. It would also be interesting to conduct the same study across different cultures and with people holding diverse religious beliefs.

_________________________________

Alsmith AJ and Longo MR (2014). Where exactly am I? Self-location judgements distribute between head and torso. Consciousness and cognition, 24, 70-4 PMID: 24457520

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.