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
Friday, January 21, 2011
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.
Thursday, October 28, 2010
Psychiatry & Dentistry
There could obviously be psychiatric issues in dentistry, such as phobias. A good dentist could be quite therapeutic in this regard.
But there are a other dental issues that have to do with psychiatry.
For example, having unhealthy gums probably causes increased transient bacteremia each time one eats; this is caused by the mechanical stimulation of gums with a high bacterial load leading to leakage of bacteria into the blood circulation. This would not be expected to cause a systemic infection, but it would stimulate an immune response. Some research suggests that this type of recurrent phenomenon causes heightened systemic inflammation, which in turn stresses the brain.
Here are some references which show a relationship between gum disease and systemic inflammation; this causative relationship is further associated with increases in the risk of various systemic diseases, and overall mortality.
http://www.ncbi.nlm.nih.gov/pubmed/20306866
http://www.ncbi.nlm.nih.gov/pubmed/20502435
http://www.ncbi.nlm.nih.gov/pubmed/18052701
http://www.ncbi.nlm.nih.gov/pubmed/19909639
http://www.ncbi.nlm.nih.gov/pubmed/17559634
http://www.ncbi.nlm.nih.gov/pubmed/20960226
http://www.ncbi.nlm.nih.gov/pubmed/19774803
http://www.ncbi.nlm.nih.gov/pubmed/20509364
The existing research shows a link between oral disease and increased risk for various other diseases, such as cardiovascular disease. We can hypothesize that any factor increasing risk for cardiovascular disease would also be deleterious to the brain, as it would affect the brain's very sensitive vascular system. Not much research clearly proves this risk. Here is a reference which starts a discussion on the subject:
http://www.ncbi.nlm.nih.gov/pubmed/19864654
Here's another, suggesting that controlling or preventing gum disease is a preventable risk factor for Alzheimer's Disease:
http://www.ncbi.nlm.nih.gov/pubmed/18631974
So, it is a relevant part of preventative mental health care to take good care of your teeth, including regular dental visits!
There are other overlaps between psychiatry and dentistry. Many people, when depressed, neglect daily dental care. Psychotic symptoms can arise over dental issues (e.g. believing there is a transmitter implanted in a filling). Various overvalued ideas can persuade people to seek arguably unnecessary dental procedures (e.g. regarding mercury amalgam filling removals). While mercury is likely to be of some risk, e.g. regarding the development of autoimmune reactions, it is likely that many people overestimate the degree of risk, or falsely attribute symptoms to the type of dental fillings they have. Therefore, a business may arise of expensive filling replacements which are medically unnecessary. Here are a few articles about this: http://www.ncbi.nlm.nih.gov/pubmed/16042501
http://www.ncbi.nlm.nih.gov/pubmed/16393137
http://www.ncbi.nlm.nih.gov/pubmed/18517065
http://www.ncbi.nlm.nih.gov/pubmed/16448848
Another dentistry/psychiatry intersection has to do with cosmetic dentistry, and orthodontics. Orthodontic treatment is associated with at least a temporary increase in self-esteem, and possibly even an improvement in motivation. (reference: Karen Korabik, "Self Concept Changes during Orthodontic Treatment", Journal of Applied Social Psychology, 1994, 24, 11, pp. 1022-1034). Korabik's earlier work showed that orthodontic treatment led to individuals being perceived in a more positive way by others, with regard to impressions of personality, intelligence, as well as appearance (even, for example, based on pictures in which teeth were not visible). (Basic and Applied Social Psychology 2, 59-66, 1981). This phenomenon illustrates a problem with human nature, that we would infer things about one another based on superficial factors. The power of such superficial phenomena, relationally, is usually also short-lived and superficial, yet I do think that simple esthetic practices, if available, could be at least a small positive in affecting interpersonal dynamics, and therefore be a small positive influence in maintaining a healthy mood.
But there are a other dental issues that have to do with psychiatry.
For example, having unhealthy gums probably causes increased transient bacteremia each time one eats; this is caused by the mechanical stimulation of gums with a high bacterial load leading to leakage of bacteria into the blood circulation. This would not be expected to cause a systemic infection, but it would stimulate an immune response. Some research suggests that this type of recurrent phenomenon causes heightened systemic inflammation, which in turn stresses the brain.
Here are some references which show a relationship between gum disease and systemic inflammation; this causative relationship is further associated with increases in the risk of various systemic diseases, and overall mortality.
http://www.ncbi.nlm.nih.gov/pubmed/20306866
http://www.ncbi.nlm.nih.gov/pubmed/20502435
http://www.ncbi.nlm.nih.gov/pubmed/18052701
http://www.ncbi.nlm.nih.gov/pubmed/19909639
http://www.ncbi.nlm.nih.gov/pubmed/17559634
http://www.ncbi.nlm.nih.gov/pubmed/20960226
http://www.ncbi.nlm.nih.gov/pubmed/19774803
http://www.ncbi.nlm.nih.gov/pubmed/20509364
The existing research shows a link between oral disease and increased risk for various other diseases, such as cardiovascular disease. We can hypothesize that any factor increasing risk for cardiovascular disease would also be deleterious to the brain, as it would affect the brain's very sensitive vascular system. Not much research clearly proves this risk. Here is a reference which starts a discussion on the subject:
http://www.ncbi.nlm.nih.gov/pubmed/19864654
Here's another, suggesting that controlling or preventing gum disease is a preventable risk factor for Alzheimer's Disease:
http://www.ncbi.nlm.nih.gov/pubmed/18631974
So, it is a relevant part of preventative mental health care to take good care of your teeth, including regular dental visits!
There are other overlaps between psychiatry and dentistry. Many people, when depressed, neglect daily dental care. Psychotic symptoms can arise over dental issues (e.g. believing there is a transmitter implanted in a filling). Various overvalued ideas can persuade people to seek arguably unnecessary dental procedures (e.g. regarding mercury amalgam filling removals). While mercury is likely to be of some risk, e.g. regarding the development of autoimmune reactions, it is likely that many people overestimate the degree of risk, or falsely attribute symptoms to the type of dental fillings they have. Therefore, a business may arise of expensive filling replacements which are medically unnecessary. Here are a few articles about this: http://www.ncbi.nlm.nih.gov/pubmed/16042501
http://www.ncbi.nlm.nih.gov/pubmed/16393137
http://www.ncbi.nlm.nih.gov/pubmed/18517065
http://www.ncbi.nlm.nih.gov/pubmed/16448848
Another dentistry/psychiatry intersection has to do with cosmetic dentistry, and orthodontics. Orthodontic treatment is associated with at least a temporary increase in self-esteem, and possibly even an improvement in motivation. (reference: Karen Korabik, "Self Concept Changes during Orthodontic Treatment", Journal of Applied Social Psychology, 1994, 24, 11, pp. 1022-1034). Korabik's earlier work showed that orthodontic treatment led to individuals being perceived in a more positive way by others, with regard to impressions of personality, intelligence, as well as appearance (even, for example, based on pictures in which teeth were not visible). (Basic and Applied Social Psychology 2, 59-66, 1981). This phenomenon illustrates a problem with human nature, that we would infer things about one another based on superficial factors. The power of such superficial phenomena, relationally, is usually also short-lived and superficial, yet I do think that simple esthetic practices, if available, could be at least a small positive in affecting interpersonal dynamics, and therefore be a small positive influence in maintaining a healthy mood.
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