A reader recently sent in a comment wondering about the possible role of vitamin B12 supplementation in psychiatry.
Here's a brief review of the literature:
http://www.ncbi.nlm.nih.gov/pubmed/21191533 --a small case report of b12-deficient individuals responding better to antidepressants after b12 supplementation.
http://www.ncbi.nlm.nih.gov/pubmed/20976769
--survivors of stroke who took folic acid 2mg/d, b6 25 mg/d, and b12 0.5 mg/d had slightly lower rates of depression; there was an impressive 7 year follow-up period
http://www.ncbi.nlm.nih.gov/pubmed/20716710
this cross-sectional study using a diet questionnaire found an association between dietary folate & b6 and lower rates of depression in a sample of over 6000 adolescents; no association was found regarding b12.
http://www.ncbi.nlm.nih.gov/pubmed/20519557
a study from the American Journal of Clinical Nutrition, which showed a relationship between higher folate and b12 levels, and lower rates of depression, over 7 years of follow-up.
http://www.ncbi.nlm.nih.gov/pubmed/19175490
another study finding an association between low b12 & folate levels and higher rates of depression. Here, the b12 association was specifically for women. Looking more closely at the data, I find that the results are not overwhelmingly strong or convincing; I suspect there could be many confounding factors influencing the association.
http://www.ncbi.nlm.nih.gov/pubmed/18854539
this is an important study from JAMA showing that high dose folate, b6, and b12 supplements did not improve the course of dementia. Furthermore, 28% of the vitamin group experienced depression, compared to 18% of the placebo group.
http://www.ncbi.nlm.nih.gov/pubmed/18557664this study from the Journal of Clinical Psychiatry showed very little protective effect of vitamin b6, b12, and folate supplementation to prevent depression in older men. However, I see the vitamin group did slightly better than the placebo group, but not well enough to meet criteria for statistical significance.
In summary, there is a little bit of evidence of benefits from b12 in psychiatry, but the results are not overwhelmingly strong unless there is evidence of deficiency. It is worthwhile to have B12 levels checked. It appears not to be dangerous to take supplements; I suppose it is reasonable to aim for the higher part of the recommended serum levels, and to adjust any supplementation accordingly. Having said that, I acknowledge the possibility that some individuals may have a more beneficial effect from b12 supplementation, perhaps there could be selected cases in which this could act synergistically or as an augmentation with other treatments for depression, or perhaps there could be cases of subtle deficiency.
B12 deficiency is not uncommon; this can occur due to malabsorption (as in pernicious anemia or bowel disease), or due to dietary deficiency (e.g. in vegans). If the cause of low b12 is malabsorption, is may be necessary to have b12 injections. Once again, it is important to have b12 levels checked, and make decisions about supplementation if the level is low.
Wednesday, April 13, 2011
Tuesday, February 15, 2011
Looking at affected body parts reduces pain
Here's an interesting little study showing that acute physical pain is diminished in intensity when one is looking at the affected body part; if this body part is artificially made to look larger, then the subjective pain is reduced even further.
http://www.ncbi.nlm.nih.gov/pubmed/21303990
In applying this type of idea to psychological pain, I guess one could say that "looking at the affected body part" could translate to discussing the problem in a therapeutic dialog.
A limitation of the study, and with pain studies in general, is that a brief intervention for an acute pain may not necessarily be equivalently helpful as a prolonged intervention for a chronic pain. In fact, some effective physical treatments for acute pain potentially exacerbate a chronic or recurrent pain disorder (e.g. using opiates to treat mechanical back pain or migraine).
However, I believe that studies of this type do illustrate that simple, brief psychological techniques can be surprisingly powerful in modulating perceptions or sensation.
http://www.ncbi.nlm.nih.gov/pubmed/21303990
In applying this type of idea to psychological pain, I guess one could say that "looking at the affected body part" could translate to discussing the problem in a therapeutic dialog.
A limitation of the study, and with pain studies in general, is that a brief intervention for an acute pain may not necessarily be equivalently helpful as a prolonged intervention for a chronic pain. In fact, some effective physical treatments for acute pain potentially exacerbate a chronic or recurrent pain disorder (e.g. using opiates to treat mechanical back pain or migraine).
However, I believe that studies of this type do illustrate that simple, brief psychological techniques can be surprisingly powerful in modulating perceptions or sensation.
Working memory exercises for treating addictions?
Here's a link to an interesting article from Biological Psychiatry this month:
http://www.ncbi.nlm.nih.gov/pubmed/20965498
It is based on the notion that the decision to engage in an addiction is often made based on a short-term, possibly impulsive, analysis of benefits and risks; consequently, longer-term risks or benefits associated with the behaviour are undervalued. This phenomenon is termed "delay discounting." Resistance to delay discounting could be considered a cognitive faculty that would help, on an intellectual level, with making a healthy decision in the face of strong impulses in the moment.
The authors note a relationship between addictive disorders and increased delay discounting. They also note a previously described relationship between delay discounting and reduced working memory function.
Based on these relationships, they did a controlled study of persons with stimulant addiction, in which the active group did a set of memory training exercises for 1-2 months. They found that the memory exercises led to improved (reduced) delay discounting.
This study does not show that memory exercises directly improve the course of addictive disorders; but it does present a promising therapeutic idea which I think is currently underutilized in the therapeutic community, not only for addictions but for other types of problems.
Cognitive exercises could have a variety of benefits for various psychological problems:
1) the improvement one would see with practice could help with self-esteem
2) arguably, the exercises would favourably alter the balance between executive function and visceral, limbic emotional drives (which could often be turbulent or disruptive)
3) the exercises could be an introduction to the various mental and physical disciplines required to effect psychological or behavioural change
In terms of the specific exercises used in this study, I do think that the number of practice sessions was far too small. I believe that most psychologically beneficial activities start to show substantial results after 50-100 hours of practice. This study used only a maximum of 15 training sessions. The memory practice itself could have been organized in a more engaging, game-like manner. I think of some quite unique working memory games from the lumosity.com website, which tap into a type of activity most people would rarely work on directly, but yet are quite entertaining and allow gradual progress.
In summary, this was an interesting article looking at the promising theme of using cognitive training exercises as part of the treatment of a psychological problem. This is a relatively new idea, showing up only a few other times so far in the research literature.
http://www.ncbi.nlm.nih.gov/pubmed/20965498
It is based on the notion that the decision to engage in an addiction is often made based on a short-term, possibly impulsive, analysis of benefits and risks; consequently, longer-term risks or benefits associated with the behaviour are undervalued. This phenomenon is termed "delay discounting." Resistance to delay discounting could be considered a cognitive faculty that would help, on an intellectual level, with making a healthy decision in the face of strong impulses in the moment.
The authors note a relationship between addictive disorders and increased delay discounting. They also note a previously described relationship between delay discounting and reduced working memory function.
Based on these relationships, they did a controlled study of persons with stimulant addiction, in which the active group did a set of memory training exercises for 1-2 months. They found that the memory exercises led to improved (reduced) delay discounting.
This study does not show that memory exercises directly improve the course of addictive disorders; but it does present a promising therapeutic idea which I think is currently underutilized in the therapeutic community, not only for addictions but for other types of problems.
Cognitive exercises could have a variety of benefits for various psychological problems:
1) the improvement one would see with practice could help with self-esteem
2) arguably, the exercises would favourably alter the balance between executive function and visceral, limbic emotional drives (which could often be turbulent or disruptive)
3) the exercises could be an introduction to the various mental and physical disciplines required to effect psychological or behavioural change
In terms of the specific exercises used in this study, I do think that the number of practice sessions was far too small. I believe that most psychologically beneficial activities start to show substantial results after 50-100 hours of practice. This study used only a maximum of 15 training sessions. The memory practice itself could have been organized in a more engaging, game-like manner. I think of some quite unique working memory games from the lumosity.com website, which tap into a type of activity most people would rarely work on directly, but yet are quite entertaining and allow gradual progress.
In summary, this was an interesting article looking at the promising theme of using cognitive training exercises as part of the treatment of a psychological problem. This is a relatively new idea, showing up only a few other times so far in the research literature.
Monday, January 31, 2011
Omega-3 deficiency and low dietary omega-3 to omega-6 ratio may exacerbate depression and reduce neuroplasticity
Here's an interesting update on the dietary fatty acid issue, as it pertains to mood disorders and neuroplasticity:
http://www.nature.com/neuro/journal/vaop/ncurrent/full/nn.2736.html
This article, published in Nature Neuroscience (January 30, 2011), is an example of some good research being done by a group at the University of Bordeaux in France. They demonstrate substantial negative neurophysiological changes in mice as a result of an omega-3 deficient diet. It is interesting to note that the brain's endocanniboid system is specifically affected by omega-3 deficiency, according to this research.
This is further evidence supporting the importance of attending to a healthy diet, in maintaining optimal mental health. Omega-3 fatty acids are one element of a healthy diet. While omega-6 fatty acids are also needed in the diet, these lipids behave to some degree competitively with omega-3. Therefore, the ratio of dietary omega-3 to omega-6 is is very important. Western diets tend to have an unhealthy ratio of these lipids, due to excessive omega-6.
An ongoing issue of debate has to do with whether plant sources of omega-3 (primarily ALA) are as useful as fish sources (DHA and EPA). Existing evidence shows that DHA and EPA are more important. ALA can be converted in the body to DHA and EPA, but the efficiency of this may vary from person to person.
Wikipedia has a nice review of this subject: http://en.wikipedia.org/wiki/Omega-3_fatty_acid
but some of the sources are less than ideal.
It is interesting to consider that the DHA/EPA issue is not a "micronutrient" issue. They could be considered "macronutrients." The solid mass of the brain consists mostly of lipids (60-80 % of the non-aqueous mass); DHA and EPA make up over 10% of this lipid mass, which is a very high concentration.
Here's a link to a paper which quantifies the high fractions of omega-3 lipids in brain mass:
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=921064 --this paper also showed that dietary changes substantially altered the proportion of omega-3 lipids in brain tissue
http://www.nature.com/neuro/journal/vaop/ncurrent/full/nn.2736.html
This article, published in Nature Neuroscience (January 30, 2011), is an example of some good research being done by a group at the University of Bordeaux in France. They demonstrate substantial negative neurophysiological changes in mice as a result of an omega-3 deficient diet. It is interesting to note that the brain's endocanniboid system is specifically affected by omega-3 deficiency, according to this research.
This is further evidence supporting the importance of attending to a healthy diet, in maintaining optimal mental health. Omega-3 fatty acids are one element of a healthy diet. While omega-6 fatty acids are also needed in the diet, these lipids behave to some degree competitively with omega-3. Therefore, the ratio of dietary omega-3 to omega-6 is is very important. Western diets tend to have an unhealthy ratio of these lipids, due to excessive omega-6.
An ongoing issue of debate has to do with whether plant sources of omega-3 (primarily ALA) are as useful as fish sources (DHA and EPA). Existing evidence shows that DHA and EPA are more important. ALA can be converted in the body to DHA and EPA, but the efficiency of this may vary from person to person.
Wikipedia has a nice review of this subject: http://en.wikipedia.org/wiki/Omega-3_fatty_acid
but some of the sources are less than ideal.
It is interesting to consider that the DHA/EPA issue is not a "micronutrient" issue. They could be considered "macronutrients." The solid mass of the brain consists mostly of lipids (60-80 % of the non-aqueous mass); DHA and EPA make up over 10% of this lipid mass, which is a very high concentration.
Here's a link to a paper which quantifies the high fractions of omega-3 lipids in brain mass:
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=921064 --this paper also showed that dietary changes substantially altered the proportion of omega-3 lipids in brain tissue
Monday, January 24, 2011
"Outlier": The causes of high achievement
Outlier by Malcolm Gladwell, is a brilliant book about the causes of success, outstanding achievement, and personal greatness.
Gladwell describes a variety of interesting life stories, of people with outstanding ability or outstanding achievement, then looks carefully at the factors leading to these successes.
He does not claim that "inborn traits" or hereditary factors are unimportant. But he shows quite convincingly that inborn talents correlate with achievement only to a certain point. Individuals with extreme talents tend not to achieve more than those with merely "sufficient" talents. A recurring theme in this book, shown through one example after the next, is that the simple stories many people might have, to account for a person's great achievements, are often appealing and believable, but are in fact often inaccurate or at the very least incomplete.
He shows that various situational biases can have a profound, snowballing effect on the course of successfulness in a person's life. A trite detail such as birthdate can lead to a cascade of advantages or disadvantages for athletes, which then accumulate over many years (his example is of successful hockey players being much more likely to have an early birthday--if you're born in December, this is an instant disadvantage, as you will be a little bit smaller and weaker on average compared to your teammates, therefore the older players will tend to outperform you, leading to a smaller chance of you being noticed or advanced to a more challenging team, or to be deemed "gifted" and given more ice time, etc.)
He emphasizes the role of thousands of hours of intensive practice being required to master a skill. Those who have 10 000 hours of practice under their belt early on in their lives--particularly if some serendipitous quirk of fortune allowed them to be one of the only individuals, or one of the first, to gain this experience-- have a strong chance of succeeding spectacularly in their fields. He gives examples such as Bill Gates, or the Beatles, or some of the most successful New York lawyers doing a particular type of law.
One of the psychologists cited in this book, who has studied the area of "exceptional achievement" is AK Ericsson, who generally argues that "extended, intense practice" is the primary determinant of elite performance, as opposed to inborn talent. The ability to do this type of practice, of course, requires or is greatly facilitated by, motivational resources as well as environmental opportunity, parental support, a culture which favours such as endeavour, etc.) Here are some references to articles of his:
http://www.ncbi.nlm.nih.gov/pubmed/17905932
http://www.ncbi.nlm.nih.gov/pubmed/17642130
I suspect that heredity is quite relevant, but may manifest itself in many ways aside from what many people might assume. Factors that could be considered at first glance to be a disadvantage, either hereditarily or environmentally, may, in the world of successfulness, end up being compelling advantages.
Guillermo Campitelli is another excellent researcher in this field; here's a reference to one of his recent papers: http://www.ncbi.nlm.nih.gov/pubmed/17201516. The evidence here, looking specifically at chess players as a model of acquiring expertise, affirms the extreme importance of thousands of hours of practice, but also recognizes that some players improve much more than others with the same amount of practice. This is probably the influence of inherited talent. Maybe there could be other hidden variables, including family or cultural factors. He suggests that the age at which the practice begins is another important variable.
It should be noted that, in this literature, "deliberate practice" refers to a type of activity which is specifically directed towards performance improvement, is adequately difficult, has feedback about performance, and which has opportunity to correct errors. This differs from "ordinary" work experience, which may be quite a bit less intense and much less geared towards improving skills. I suspect that the quality of "deliberate practice" may vary quite a bit, depending on the degree of immersion, concentration, energy, engagement, and meaningfulness there is in the action. I wonder if enjoyment of the practice is a major variable too, I would be interested to see if some of these researchers would look at this. If someone finds their 100 hours of practice meaningful and enjoyable, I have to wonder if they might advance much more than someone whose 100 hours were a drudgery.
Another excellent angle of discussion in Gladwell's book has to do with understanding a person's cultural background and childhood developmental history, as extremely important determinants of success. This leads to discussions about opportunity, pedagogical technique and policy, etc. Sometimes cultural or developmental factors cause individuals to lack a certain skill necessary to succeed, or put individuals at risk of recurrent severe problems or frustrations. Good examples are given, including the story of a profoundly gifted intellect who was never able to share his talents; and of highly trained pilots who were too quietly respectful of authority to be able to proactively use strong assertive social skills to prevent an aviation disaster.
I'll add to this post later on, to expand some thoughts about achievement and success. In the meantime, I think Outlier is a worthwhile and entertaining read.
Gladwell describes a variety of interesting life stories, of people with outstanding ability or outstanding achievement, then looks carefully at the factors leading to these successes.
He does not claim that "inborn traits" or hereditary factors are unimportant. But he shows quite convincingly that inborn talents correlate with achievement only to a certain point. Individuals with extreme talents tend not to achieve more than those with merely "sufficient" talents. A recurring theme in this book, shown through one example after the next, is that the simple stories many people might have, to account for a person's great achievements, are often appealing and believable, but are in fact often inaccurate or at the very least incomplete.
He shows that various situational biases can have a profound, snowballing effect on the course of successfulness in a person's life. A trite detail such as birthdate can lead to a cascade of advantages or disadvantages for athletes, which then accumulate over many years (his example is of successful hockey players being much more likely to have an early birthday--if you're born in December, this is an instant disadvantage, as you will be a little bit smaller and weaker on average compared to your teammates, therefore the older players will tend to outperform you, leading to a smaller chance of you being noticed or advanced to a more challenging team, or to be deemed "gifted" and given more ice time, etc.)
He emphasizes the role of thousands of hours of intensive practice being required to master a skill. Those who have 10 000 hours of practice under their belt early on in their lives--particularly if some serendipitous quirk of fortune allowed them to be one of the only individuals, or one of the first, to gain this experience-- have a strong chance of succeeding spectacularly in their fields. He gives examples such as Bill Gates, or the Beatles, or some of the most successful New York lawyers doing a particular type of law.
One of the psychologists cited in this book, who has studied the area of "exceptional achievement" is AK Ericsson, who generally argues that "extended, intense practice" is the primary determinant of elite performance, as opposed to inborn talent. The ability to do this type of practice, of course, requires or is greatly facilitated by, motivational resources as well as environmental opportunity, parental support, a culture which favours such as endeavour, etc.) Here are some references to articles of his:
http://www.ncbi.nlm.nih.gov/pubmed/17905932
http://www.ncbi.nlm.nih.gov/pubmed/17642130
I suspect that heredity is quite relevant, but may manifest itself in many ways aside from what many people might assume. Factors that could be considered at first glance to be a disadvantage, either hereditarily or environmentally, may, in the world of successfulness, end up being compelling advantages.
Guillermo Campitelli is another excellent researcher in this field; here's a reference to one of his recent papers: http://www.ncbi.nlm.nih.gov/pubmed/17201516. The evidence here, looking specifically at chess players as a model of acquiring expertise, affirms the extreme importance of thousands of hours of practice, but also recognizes that some players improve much more than others with the same amount of practice. This is probably the influence of inherited talent. Maybe there could be other hidden variables, including family or cultural factors. He suggests that the age at which the practice begins is another important variable.
It should be noted that, in this literature, "deliberate practice" refers to a type of activity which is specifically directed towards performance improvement, is adequately difficult, has feedback about performance, and which has opportunity to correct errors. This differs from "ordinary" work experience, which may be quite a bit less intense and much less geared towards improving skills. I suspect that the quality of "deliberate practice" may vary quite a bit, depending on the degree of immersion, concentration, energy, engagement, and meaningfulness there is in the action. I wonder if enjoyment of the practice is a major variable too, I would be interested to see if some of these researchers would look at this. If someone finds their 100 hours of practice meaningful and enjoyable, I have to wonder if they might advance much more than someone whose 100 hours were a drudgery.
Another excellent angle of discussion in Gladwell's book has to do with understanding a person's cultural background and childhood developmental history, as extremely important determinants of success. This leads to discussions about opportunity, pedagogical technique and policy, etc. Sometimes cultural or developmental factors cause individuals to lack a certain skill necessary to succeed, or put individuals at risk of recurrent severe problems or frustrations. Good examples are given, including the story of a profoundly gifted intellect who was never able to share his talents; and of highly trained pilots who were too quietly respectful of authority to be able to proactively use strong assertive social skills to prevent an aviation disaster.
I'll add to this post later on, to expand some thoughts about achievement and success. In the meantime, I think Outlier is a worthwhile and entertaining read.
Friday, January 21, 2011
Writing about worries can ease exam anxiety
Here's another simple research finding, published recently in Science by Sian Beilock: students who spent ten minutes--immediately before a test--writing down their thoughts about what was causing them fear, performed substantially better on the test.
http://www.ncbi.nlm.nih.gov/pubmed/21233387
I'll have to review this paper in more detail to comment further, but I think it is another simple anxiety-management tactic for exam or performance preparation. A frantic review or a frantic bout of anxious rumination right before an exam is unlikely to help -- an anxiety-management exercise such as expressive writing is very much more likely to help, and a study like this is strong evidence of this.
The article shows that the effective action was specifically to write about negative thoughts and feelings during the ten minutes before the beginning of a stressful exam. A control activity--of writing about anything that comes to mind--was not effective. So the effectiveness of this technique was not simply due to distraction.
I would be interested to see the authors' opinions and/or research about whether specific journaling techniques could work particularly well, or less well, in various anxiety scenarios. Sometimes, purely "negative" journaling can end up being a somewhat ruminative activity which entrenches negative emotional states and attitudes (e.g. one can get worked up in a cynical, pessimistic rant, which could increase or magnify one's following cynicism or pessimism, or increase one's filtered attention to negative events in the day).
See the following references:
http://www.ncbi.nlm.nih.gov/pubmed/12173682
http://www.ncbi.nlm.nih.gov/pubmed/17120515
A "balanced" journaling style, which includes room for free discussion of thoughts and feelings, but also room for positively-focused or constructive discussion may prevent this risk of snowballing rumination or negativity from a journaling activity. One simple aspect of this experiment was that the journaling was immediately before a performance, and was very time-limited (10 minutes); these factors may reduce the potential for the journaling to be a negative or ruminative behaviour, and may increase the chance of the activity serving to process anxious emotion effectively.
http://www.ncbi.nlm.nih.gov/pubmed/21233387
I'll have to review this paper in more detail to comment further, but I think it is another simple anxiety-management tactic for exam or performance preparation. A frantic review or a frantic bout of anxious rumination right before an exam is unlikely to help -- an anxiety-management exercise such as expressive writing is very much more likely to help, and a study like this is strong evidence of this.
The article shows that the effective action was specifically to write about negative thoughts and feelings during the ten minutes before the beginning of a stressful exam. A control activity--of writing about anything that comes to mind--was not effective. So the effectiveness of this technique was not simply due to distraction.
I would be interested to see the authors' opinions and/or research about whether specific journaling techniques could work particularly well, or less well, in various anxiety scenarios. Sometimes, purely "negative" journaling can end up being a somewhat ruminative activity which entrenches negative emotional states and attitudes (e.g. one can get worked up in a cynical, pessimistic rant, which could increase or magnify one's following cynicism or pessimism, or increase one's filtered attention to negative events in the day).
See the following references:
http://www.ncbi.nlm.nih.gov/pubmed/12173682
http://www.ncbi.nlm.nih.gov/pubmed/17120515
A "balanced" journaling style, which includes room for free discussion of thoughts and feelings, but also room for positively-focused or constructive discussion may prevent this risk of snowballing rumination or negativity from a journaling activity. One simple aspect of this experiment was that the journaling was immediately before a performance, and was very time-limited (10 minutes); these factors may reduce the potential for the journaling to be a negative or ruminative behaviour, and may increase the chance of the activity serving to process anxious emotion effectively.
Testing improves learning
Here's another recent bit of research, published in Science, demonstrating the value of doing a test ("retrieval practice"), immediately after learning something. Those who did the tests, instead of other study techniques, had much better retention 1 week after learning something.
http://www.sciencemag.org/content/early/2011/01/19/science.1199327.abstract
This finding is consistent with my believe that a lot of study time is inefficient, because it encourages the studier to push forward to "get more reading done", before the reading which was just done has been consolidated well or reviewed. Even though "pushing forward" may seemingly cover more pages of text, it accomplishes less long-term learning. A much more efficient use of time is to pause, review, and do a test on the material at just the right interval. If the interval is too short, the tests will be too easy, and the review will also be an inefficient use of time. If the interval is too long, too much will have been forgotten already, the tests will be too hard, and it will make you have to go over the same material again, another inefficiency.
I don't believe findings such as this one necessarily contradict ideas about flexible or "constructivist" approaches to education. Nor do I believe it has anything to do with the controversial area of standardized tests for children or professional schools, etc. Standardized tests are not a mechanism for education, they are assessment tools (how good they are as assessment tools would be a subject for a good debate).
There are some instances in which pausing frequently to review could disrupt a larger thematic appreciation of a subject or experience--it would be like pausing a movie every ten minutes to answer questions about the plot or characters--so, of course, sometimes this technique would have to be set aside.
I think that flexible, personalized educational approaches are extremely important--but this evidence about the merits of retrieval practice testing can be applied to any such style. Its immediate value is in helping people use their time more efficiently for many study tasks.
A previous post also deals with the subject of study efficiency, and actually cites a more densely technical analysis showing more or less the same result, though it adds information about the frequency with which one should optimally pause to test oneself: http://garthkroeker.blogspot.com/2010/04/optimal-learning-training-schedules.html
http://www.sciencemag.org/content/early/2011/01/19/science.1199327.abstract
This finding is consistent with my believe that a lot of study time is inefficient, because it encourages the studier to push forward to "get more reading done", before the reading which was just done has been consolidated well or reviewed. Even though "pushing forward" may seemingly cover more pages of text, it accomplishes less long-term learning. A much more efficient use of time is to pause, review, and do a test on the material at just the right interval. If the interval is too short, the tests will be too easy, and the review will also be an inefficient use of time. If the interval is too long, too much will have been forgotten already, the tests will be too hard, and it will make you have to go over the same material again, another inefficiency.
I don't believe findings such as this one necessarily contradict ideas about flexible or "constructivist" approaches to education. Nor do I believe it has anything to do with the controversial area of standardized tests for children or professional schools, etc. Standardized tests are not a mechanism for education, they are assessment tools (how good they are as assessment tools would be a subject for a good debate).
There are some instances in which pausing frequently to review could disrupt a larger thematic appreciation of a subject or experience--it would be like pausing a movie every ten minutes to answer questions about the plot or characters--so, of course, sometimes this technique would have to be set aside.
I think that flexible, personalized educational approaches are extremely important--but this evidence about the merits of retrieval practice testing can be applied to any such style. Its immediate value is in helping people use their time more efficiently for many study tasks.
A previous post also deals with the subject of study efficiency, and actually cites a more densely technical analysis showing more or less the same result, though it adds information about the frequency with which one should optimally pause to test oneself: http://garthkroeker.blogspot.com/2010/04/optimal-learning-training-schedules.html
Monday, January 10, 2011
Reading Exercises
A common problem I find among university students is difficulty reading quickly or efficiently. Reading problems can also occur in conjunction with depression.
The best thing to do to improve reading skills is, of course, to read more. But a phenomenon which often happens when reading any text, but especially longer texts, such as novels, is that you can lose track of what you have just been reading. Whole sections of the text may end up being skimmed superficially, as part of your attention lapses or wanders, while still maintaining a basic pace of absent-minded reading. This leads to a lack of enjoyment or feeling of mastery with reading, dampened morale, sapped motivation, contributing further to any depression which had been present, and deterring further reading efforts.
An approach to this type of problem requires you to stop to reflect or answer questions frequently about what you have just read. Whenever you test yourself regularly, your learning and retention are greatly increased. Most good introductory university textbooks are set up this way. But not very much in the line of non-textbook reading.
So, I have been trying to find resources to help with reading skill, for adults. Elementary-school language textbooks or readers seemed like a reasonable thing to check. I certainly recommend that adults at least periodically read books which have been written for children or adolescents. The best things I've found online are from ESL (English as a second language) programs. Even if you are an advanced reader, or have spoken English all your life, I think that ESL exercises could be good for improving reading skill.
Cognitive-skills training websites tend not to offer very much in terms of language learning or improving reading fluency or retention. I wish that the cognitive skills website people could develop more along these lines: reading-oriented games don't seem very difficult to imagine or design, compared to other types of games.
Here's a list of a few sites I've found, where you can practice English reading skills:
http://web2.uvcs.uvic.ca/courses/elc/studyzone/
This is an excellent free resource from the University of Victoria (in BC). For the reading exercises, choose an "English language level" (beginner to advanced), then follow the links about reading.
Houghton Mifflin College
This site also offers timed readings with questions afterwards.
Quizzes Based On VOA Programs (ESL/EFL)
This link goes to a site where you have to read a text a sentence at a time, and fill in the blanks from a list of options, according to what makes sense or is grammatically correct. While some might find this type of exercise too easy, I think it is a nice way to remain more interactive with the text. If you do find it easy, you can just try to do it faster, and make it into a game.
Another useful thing to look for is an online book club which has discussion questions about the book you're reading. Some sites have questions for each chapter, which is the type of thing I'm recommending, so that you can pause frequently to review what you have just been reading. I haven't found a single site which has chapter-by-chapter questions for a wide variety of books, but here's an example of a specific site, giving questions about Great Expectations by Charles Dickens (a great book, by the way):
http://www.victorianweb.org/authors/dickens/ge/pva107.html
The best thing to do to improve reading skills is, of course, to read more. But a phenomenon which often happens when reading any text, but especially longer texts, such as novels, is that you can lose track of what you have just been reading. Whole sections of the text may end up being skimmed superficially, as part of your attention lapses or wanders, while still maintaining a basic pace of absent-minded reading. This leads to a lack of enjoyment or feeling of mastery with reading, dampened morale, sapped motivation, contributing further to any depression which had been present, and deterring further reading efforts.
An approach to this type of problem requires you to stop to reflect or answer questions frequently about what you have just read. Whenever you test yourself regularly, your learning and retention are greatly increased. Most good introductory university textbooks are set up this way. But not very much in the line of non-textbook reading.
So, I have been trying to find resources to help with reading skill, for adults. Elementary-school language textbooks or readers seemed like a reasonable thing to check. I certainly recommend that adults at least periodically read books which have been written for children or adolescents. The best things I've found online are from ESL (English as a second language) programs. Even if you are an advanced reader, or have spoken English all your life, I think that ESL exercises could be good for improving reading skill.
Cognitive-skills training websites tend not to offer very much in terms of language learning or improving reading fluency or retention. I wish that the cognitive skills website people could develop more along these lines: reading-oriented games don't seem very difficult to imagine or design, compared to other types of games.
Here's a list of a few sites I've found, where you can practice English reading skills:
http://web2.uvcs.uvic.ca/courses/elc/studyzone/
This is an excellent free resource from the University of Victoria (in BC). For the reading exercises, choose an "English language level" (beginner to advanced), then follow the links about reading.
Houghton Mifflin College
This site also offers timed readings with questions afterwards.
Quizzes Based On VOA Programs (ESL/EFL)
This link goes to a site where you have to read a text a sentence at a time, and fill in the blanks from a list of options, according to what makes sense or is grammatically correct. While some might find this type of exercise too easy, I think it is a nice way to remain more interactive with the text. If you do find it easy, you can just try to do it faster, and make it into a game.
Another useful thing to look for is an online book club which has discussion questions about the book you're reading. Some sites have questions for each chapter, which is the type of thing I'm recommending, so that you can pause frequently to review what you have just been reading. I haven't found a single site which has chapter-by-chapter questions for a wide variety of books, but here's an example of a specific site, giving questions about Great Expectations by Charles Dickens (a great book, by the way):
http://www.victorianweb.org/authors/dickens/ge/pva107.html
Tuesday, January 4, 2011
Tetris or sleep deprivation to treat or prevent PTSD?
Here's a reference to an interesting 2009 study showing that playing tetris for 30 minutes can interfere with memory consolidation of upsetting visual imagery:
http://www.ncbi.nlm.nih.gov/pubmed/19127289
This is an example of evolving evidence that an important period for consolidation of memories occurs in the first 24 hours after an experience. A consolidated implicit association between the factual components of memory and strong negative emotions may also form most strongly during this initial post-exposure period.
The same group published a 2010 study showing that a game like tetris was more effective than a quiz-type game activity for reducing visual flashbacks following exposure to upsetting imagery:
http://www.ncbi.nlm.nih.gov/pubmed/21085661
I think the message here is not that tetris in particular has some kind of unique medicinal properties, but that a non-passive activity which requires continuous, intense visual attention is most effective at reducing consolidation of intrusive visual memory. A distracting activity lacking strong visual involvement may be less likely to interfere with this consolidation mechanism.
Other research has suggested that propranolol, a beta-blocking drug, can reduce post-traumatic memory consolidation, particularly the troubling implicit or emotional component responsible for psychological symptoms of PTSD. (see my other post, http://garthkroeker.blogspot.com/2009/02/beta-blockers.html)
Some of the standard psychological treatments in the immediate post-trauma period may be harmful, such as critical incident stress debriefing. If individuals are compelled to revisit details of their trauma in a group setting, during the sensitive 24-hour post-incident window, this may increase rather than decrease memory consolidation. I think this tactic is especially problematic if there is social pressure or overt prescriptive advice from professionals to do this, when the individual may not wish to talk about the trauma. This type of pressure may feel coercive rather than freely consensual, a dynamic which could be re-traumatizing.
In another recent study (http://www.ncbi.nlm.nih.gov/pubmed/20889142 ), sleep deprivation following exposure to upsetting visual stimuli was shown to reduce aspects of implicit memory consolidation. This is consistent with other evidence showing that sleeping facilitates learning, by helping to consolidate recently acquired memories.
In conclusion, I think it is useful to know some simple techniques which could reduce the harm which traumatic experience can immediately impose upon the brain's memory systems. Immediate distraction with an absorbing visual activity, such as tetris, could be helpful. Sleeping right away may not be helpful, and may actually increase consolidation of traumatic memory.
For consolidated symptoms of PTSD, and for longstanding troubling thoughts, memories, images, and emotions, etc. it is clear that therapeutic dialog can be very helpful, provided the setting is safe, non-pressured, comfortable, with a strong sense of trust. Such gentle dialog could begin the process of weakening the strong negative emotional grip that the traumatic experiences may have in daily life. The evidence mentioned above has to do with reducing the incidence of PTSD in the first place, through specific tactics to be undertaken immediately after the trauma.
We could infer, conversely, that engaging in distracting activities, such as video games, after doing an activity that you would want to remember vividly (such as studying, or some other pleasurable or meaningful event), could lessen retention of these positive experiences (so, you shouldn't distract yourself with an absorbing visual activity right after studying). Also, having a good sleep after a pleasurable event, or after studying, would be expected to make these experiences more permanent in your factual and emotional memory. So, it's important to be conscious of what you do, during, but also after, events of significance.
http://www.ncbi.nlm.nih.gov/pubmed/19127289
This is an example of evolving evidence that an important period for consolidation of memories occurs in the first 24 hours after an experience. A consolidated implicit association between the factual components of memory and strong negative emotions may also form most strongly during this initial post-exposure period.
The same group published a 2010 study showing that a game like tetris was more effective than a quiz-type game activity for reducing visual flashbacks following exposure to upsetting imagery:
http://www.ncbi.nlm.nih.gov/pubmed/21085661
I think the message here is not that tetris in particular has some kind of unique medicinal properties, but that a non-passive activity which requires continuous, intense visual attention is most effective at reducing consolidation of intrusive visual memory. A distracting activity lacking strong visual involvement may be less likely to interfere with this consolidation mechanism.
Other research has suggested that propranolol, a beta-blocking drug, can reduce post-traumatic memory consolidation, particularly the troubling implicit or emotional component responsible for psychological symptoms of PTSD. (see my other post, http://garthkroeker.blogspot.com/2009/02/beta-blockers.html)
Some of the standard psychological treatments in the immediate post-trauma period may be harmful, such as critical incident stress debriefing. If individuals are compelled to revisit details of their trauma in a group setting, during the sensitive 24-hour post-incident window, this may increase rather than decrease memory consolidation. I think this tactic is especially problematic if there is social pressure or overt prescriptive advice from professionals to do this, when the individual may not wish to talk about the trauma. This type of pressure may feel coercive rather than freely consensual, a dynamic which could be re-traumatizing.
In another recent study (http://www.ncbi.nlm.nih.gov/pubmed/20889142 ), sleep deprivation following exposure to upsetting visual stimuli was shown to reduce aspects of implicit memory consolidation. This is consistent with other evidence showing that sleeping facilitates learning, by helping to consolidate recently acquired memories.
In conclusion, I think it is useful to know some simple techniques which could reduce the harm which traumatic experience can immediately impose upon the brain's memory systems. Immediate distraction with an absorbing visual activity, such as tetris, could be helpful. Sleeping right away may not be helpful, and may actually increase consolidation of traumatic memory.
For consolidated symptoms of PTSD, and for longstanding troubling thoughts, memories, images, and emotions, etc. it is clear that therapeutic dialog can be very helpful, provided the setting is safe, non-pressured, comfortable, with a strong sense of trust. Such gentle dialog could begin the process of weakening the strong negative emotional grip that the traumatic experiences may have in daily life. The evidence mentioned above has to do with reducing the incidence of PTSD in the first place, through specific tactics to be undertaken immediately after the trauma.
We could infer, conversely, that engaging in distracting activities, such as video games, after doing an activity that you would want to remember vividly (such as studying, or some other pleasurable or meaningful event), could lessen retention of these positive experiences (so, you shouldn't distract yourself with an absorbing visual activity right after studying). Also, having a good sleep after a pleasurable event, or after studying, would be expected to make these experiences more permanent in your factual and emotional memory. So, it's important to be conscious of what you do, during, but also after, events of significance.
Saturday, January 1, 2011
"The King's Speech"
I recently watched this movie ("The King's Speech"), which I thoroughly enjoyed.
I found it to be a nice story about the potential benefits of therapeutic change, and about the ingredients required to achieve this.
The literal facts of the story were interesting, but like a plot of a play, are not important in themselves to appreciate the theme or message.
The story has to do with the relationship between Prince Albert--who would become King George VI--and a seemingly unconventional speech therapist he met to deal with his stuttering problem.
I see the stuttering/speech therapy angle of the story (and its implied psychodynamic underpinnings) to be more of a metaphor for psychological symptoms. The facts about the causation of stuttering do not include a prominent role for psychodynamic factors or childhood trauma, etc. But the therapy for any problem, irrespective of its cause, is often helped greatly through psychodynamic insights and focus, particularly if the context of the problem has affected relationships and sense of self.
The compelling message I found about therapy in general, was that symptoms in the mind can obstruct the attainment of greatness or satisfaction in achievement or character. I see this often -- that there is tremendous potential in an individual, almost a sense that there is a special place or purpose for the person in the world, but this potential is obstructed and trapped because of symptoms, psychological injury, or illness. For a therapeutic endeavour to be helpful, it requires trust, a safe and balanced therapeutic frame, and a good rapport. I like the idea that playfulness, spontaneity, physical activity, and humour are essential elements of therapeutic benefit in this story. The other ingredient for therapeutic change--often under-emphasized in many stories--is that the work required needs to be very intense and disciplined. A good therapist can have the role of trusted confidante, listener, teacher, or advisor, but also of a behavioural coach, to help and encourage the long and difficult daily work involved to effect behavioural and psychological change.
Another great thing about this movie is the soundtrack, which includes some of my very favourite, wonderful and thematically relevant pieces by Mozart and Beethoven.
I found it to be a nice story about the potential benefits of therapeutic change, and about the ingredients required to achieve this.
The literal facts of the story were interesting, but like a plot of a play, are not important in themselves to appreciate the theme or message.
The story has to do with the relationship between Prince Albert--who would become King George VI--and a seemingly unconventional speech therapist he met to deal with his stuttering problem.
I see the stuttering/speech therapy angle of the story (and its implied psychodynamic underpinnings) to be more of a metaphor for psychological symptoms. The facts about the causation of stuttering do not include a prominent role for psychodynamic factors or childhood trauma, etc. But the therapy for any problem, irrespective of its cause, is often helped greatly through psychodynamic insights and focus, particularly if the context of the problem has affected relationships and sense of self.
The compelling message I found about therapy in general, was that symptoms in the mind can obstruct the attainment of greatness or satisfaction in achievement or character. I see this often -- that there is tremendous potential in an individual, almost a sense that there is a special place or purpose for the person in the world, but this potential is obstructed and trapped because of symptoms, psychological injury, or illness. For a therapeutic endeavour to be helpful, it requires trust, a safe and balanced therapeutic frame, and a good rapport. I like the idea that playfulness, spontaneity, physical activity, and humour are essential elements of therapeutic benefit in this story. The other ingredient for therapeutic change--often under-emphasized in many stories--is that the work required needs to be very intense and disciplined. A good therapist can have the role of trusted confidante, listener, teacher, or advisor, but also of a behavioural coach, to help and encourage the long and difficult daily work involved to effect behavioural and psychological change.
Another great thing about this movie is the soundtrack, which includes some of my very favourite, wonderful and thematically relevant pieces by Mozart and Beethoven.
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