Saturday, April 29, 2017

The Loved Ones



As someone who tries to use language precisely, I dislike it when terms stray into inaccuracy. For example, the phrase “making love” has tended to annoy me for years, as it is sometimes used as an all-purpose stand-in term to describe any sexual intercourse. Although I’m sure such inaccuracy isn’t the intention (people just want a euphemism), the term nonetheless seems to imply that sexual activity is somehow inherently loving. However, this pet peeve is a bit flippant compared to a somewhat similar example I’ve noticed more recently.

In my recent work on dementia caregivers, one can end up thinking quite a bit about the best way to use language in describing patients and those who care for them. The majority of dementia carers who aren’t professional carers are either children or spouses of the patient. However, you do see siblings, sometimes nephews/nieces, or even friends or neighbours. “Carer” or “caregiver” (as opposed to “family member”) works fine, as it describes what they do.

What then is the best single collective term to use for those being cared for? “Patient” or “person with dementia” is fine, but doesn’t capture who they are with relation to the carer. “Family members” covers most, but not all, patients with unpaid carers. “Loved ones” looks like a good one -the patient doesn’t have to be a family member of their carer for us to call the patient a “loved one”. And does it not capture the idea of care as loving? I recall seeing a video of an elderly man caring for his wife with a caption along the lines of “If this isn’t true love, what is?”

One afternoon, while speaking with a carer, she took the opportunity to share some of her thoughts and feelings. She had been caring for her husband with dementia for a number of years. After speaking more broadly about caring for her husband, she came to the topic of love and marriage: “You know, sometimes I ask myself whether after x years of marriage, do I still love this man?…And really, the answer is no. Well, you’re a young man-I suppose it’s something you’ll understand when you’re older…”

Another carer (again caring for her spouse) spoke of how she no longer loved her husband at a gathering of carers. She added that it’s not something she felt she could say to her (adult) children. Maybe she just wanted to get it off her chest when speaking to other carers, or perhaps she wanted to see if she wasn’t the only one who felt this way. On hearing what she had said, another carer (caring for a parent) suggested that maybe the first carer didn’t like her spouse any more, but she did love him. The first carer who had spoken of her feelings restated them.

I can see how people might identify with the carer who made the “not liking, but still loving” suggestion. Perhaps there is a temptation not to take these statements about an end of love at face value. We could be suggesting that carers perform love, even if they don’t feel it, if we say things like “If this isn’t true love, what is?” But if we try to downplay these feelings (or lack of feelings), are we not also downplaying how, in some cases, there is great social pressure to stay in the full-time carer role? (Particularly if society at large is not giving them enough help). And are we not more generally downplaying the level of altruism such carers are showing?


If caring for someone you love is heroic, caring for someone you no longer love is more so.

Related posts

Saturday, April 8, 2017

A brief guide to accusing someone of hypocrisy



A man who moralises is usually a hypocrite.
Oscar Wilde

"I consider myself a vegetarian because there is no meat in here." A tongue-in-cheek comment in the 2am queue in McDonald's from some woman I had met an hour or two previously. In an argumentative train of thought and taking her comment a bit too seriously, I nonetheless refrained from voicing aloud the idea that she was doubly hypocritical; firstly for describing herself as a veggie when she eats meat and secondly for dissing McDonald's when clearly about to buy their stuff.

But when is it best to accuse someone of being a hypocrite? It's something I've thought a bit over the past while. Here are some questions to consider:

1. Is the person really a hypocrite?

1a. Do their actions contradict their current stance, or is it just their previous stance/opinion that contradicts their current stance?

To state the obvious, being a hypocrite involves saying/doing something and then doing/saying something else that contradicts that. It's worth thinking clearly about whether the person has really done anything or is just giving one opinion and then opining differently later on. (This may be harder in the case of politicians or more powerful people, where speech acts may have quite tangible consequences).

1b. Do they just have a short memory about something they previously said?

People are notoriously inconsistent about their preferences and opinions, including those about hypocrisy itself, and may at different times believe that something is THE most important aim. "You must respect others' religious views" and "the rights of women should be upheld" may strike the same person as very highly important principles, but depending on the situation one particular view may be more salient than the other. As a result, they may segue from suggesting that westerners should leave religious minorities alone to advocating (or maybe even engaging in) strong intervention if women's rights are in some way compromised by a religious minority.

1c. A question of extent

If a person is vocally against a strong instance of a crime, are they a hypocrite if they commit a much milder version of the same (or very similar) crime? Unfortunately, we all have to live in a physical and practical world. It would be nice to always live up to the standards of a particular view, but this may not always be very practical...

1d. To what extent can they freely choose their actions?

Without wanting to get bogged down in a debate about free will, someone may be pressurised into selling out their views. If someone is threatened with job loss, blackmail, or even harm to their family they may be pushed into actions that contradict their genuinely-held values.

1e. Are their actions as an individual inconsistent with their views on broader societal issues?

The anarchist drawing the dole, the climate change warrior driving their petrol-burning car...If the person is vocally advocating for societal change, do their actions as an individual really have to stand up to what they are advocating for society at large? If someone speaks out against violence against women (a societal issue) but is controlling his wife with threats of violence, that's pretty damn hypocritical. However, the climate change warrior is probably only making a negligible contribution to the problem (whereas one battered wife is in itself a clear wrong). Furthermore, the advocate for societal change still has to exist in a society which may not allow them to function without contributing in some way to climate change (see also 1d above).


2. What's in it for you?

It's worth pausing to think why you want to accuse someone of hypocrisy.

2a. Is your key aim to prove your own point?

Are you using the person's hypocrisy about a matter as a way of "proving" that their stance on an issue is wrong? This is a logical fallacy. Maybe there are better examples, but a topical example in Ireland is that many pro-choice advocates seem to point out the (sometimes glaring) hypocrisy of various pro-life individuals or institutions and just leave it at that, without going on to make their own case for why the freedom to choose to have an abortion/bodily integrity outweighs the preservation of the fetus/embyro/zygote etc.* This can be self-sabotaging, as one misses out on the opportunity to showcase why your point of view makes sense in its own right.

2b. Are you trying to discredit the person, or their argument?

Pointing out hypocrisy may go some way towards undermining your opponent's argument/actions, or at least their rationale for speaking/acting this way. However, is the real agenda here to actually undermine people's perception of your opponent's character?

Given some of the issues raised above, most people with an opinion may come off as a bit hypocritical at some point. In this sense I wonder how much of a character assassination an accusation of hypocrisy really is (unless the really damning thing is some awful act they committed that they're now being a hypocrite about).

In any case, deciding what your key aim really is will help in making a more cogent case.

2c. Do you actually want to get through to the person?

If so...


3. How can you get through to the person?

Perhaps you really feel this is a moment where you can show someone the error of their ways, or at least a contradiction in their thought patterns. But consider...

3a. Do they actually care?

The expressed opinion of the person may simply be telling people what they want to hear, before pounding out business-as-usual in their actions.

It can be surprising how often one is fighting a lost cause.

3b. Will they think that you are just trying to discredit them as a person or just using their hypocrisy as a "proof" of your own point-of-view, or defence of your own actions?

If they think you're falling into some of the positions mention above, then they are unlikely to think that they're going to actually pick up anything worth learning by listening to you.

3c. If you're outlining their opinion, are you giving a fair account of what they've said?

As argued by Daniel Dennett and others, one should try and develop the best account of what your opponent is really trying to argue, or what the aims of their actions are, before you start criticising them. Going after a straw man is not really the best use of one's time.


Obviously these suggestions are easier to make than to follow. Just earlier I saw an argument online that seemed somewhat contradictory, and I nearly went off on a train of thought whereby I speculated that the person would engage in a number of other hypocritical arguments (that were purely imagined by me at this point). Had I put anything down in writing I'm sure I would be failing to heed a number of points here.

What a hypocrite, ay?

Related posts
Daniel Dennett book review
Being right wing and doing the right thing



*This is just an example of how someone might frame the debate on this issue; I realise people may have more/less utilitarian stances on this.

Saturday, March 18, 2017

Conference Review: American Psychosomatic Society Meeting 2017



There's a film-making legend that Michael Caine accepted a role in a particular movie immediately after reading the opening line "EXT. South of France. Day". When one sees "Seville, Spain" for a conference, this in itself could be sufficient reason to go. A beautiful city, bike-friendly but not so veggie-friendly (one menu helpfully lists a dish with eggs and fish under "vegetables"). But I'm here for the American Psychosomatic Society's Annual conference. Thanks to the generosity of their Young Investigator Program, I had registration fees written off this year, so with so many interesting talks on it was an offer I couldn't refuse!

At lunch the day before the conference proper began, one researcher was voicing a scepticism with findings from psychological research in general, at least in terms of their ability to translate into tangible outcomes for people in everyday life. Hey presto, here's a slide from the first morning session:



Not that the society hasn't concerned itself with the major issues of the day-the major addresses of this conference acknowledge the anti-intellectual spectre of the Trump administration, a source of anxiety for US researchers hoping to fund (and disseminate) their work. This breadth of focus of the society goes back to its beginnings. This being the 75th birthday of the APS, the opening plenary by Joel Dimsdale delved into the Society's history. Formed during World War II, there was a heavy focus on military psychology and the impact of combat. During the Nuremburg trials, a number of APS figures were involved in psychological profiling of Nazi war criminals, including a brain postmortem. Although the methods may have been outdated (an unblinded evaluation of Rorschach), it remains the only psychological study of cabinet-level war criminals. It'd be a difficult study to replicate!

On that note, perhaps some of the difficulty in getting research applied comes down to the replication crisis within psychology and other disciplines. If the research can't be replicated, it's unlikely to be applied, and statistical analysis that leads to false positives may confound the problem. A session on statistics in the post p < .05 era began with some fairly basic 101 on p-values (a tad dull to wade through, although a show-of-hands at the beginning did suggest a lack of understanding of p-values even in a professional audience). More interesting were the suggestions of tips on what to do next, such as using effect sizes rather than p-values for our benchmark for replication.

Larger sample sizes are one way of avoiding replication issues, and a session on the genomics era certainly delved into big data. From my own perspective a talk by Brenda W. Penninx was particularly interesting, as she focused on the genetics of depression. Her work had the interesting approach of both identifying genetic similarities between depression and other conditions, but also delving into the differences within depressive phenotypes (e.g. some people have lower appetite and sleep less, other sleep more and have a higher appetite). It will be interesting if she can show genes that are predictive of treatment response in future analyses.

A talk by David Clark on Friday really brought a focus to a national level, describing Improving Access to Psychological Therapies (IAPT) in the United Kingdom. Although IAPT targets depression as well as a variety of anxiety disorders, Clark grounded things by giving the specific example of social anxiety, and how cognitive therapy can address the thoughts and behaviours that can exacerbate anxiety in people with social anxiety. They've collected a lot of data from IAPT, which has been shown to be cost effective. It made me wonder why we can't do something similar in Ireland.

At the poster sessions, in keeping with trying to gain more replicable and generalisable results, a number of posters on various topics tapped into large cohort/prospective studies. It was also good to see other people covering caregiver research, with researchers from Madrid finding that psychological therapies could reduce blood pressure in dementia caregivers, and a systematic review from researchers in Bath, UK indicating that problem-focused coping in particular was associated with better outcomes in younger carers (aged under 18). Belgian researcher Natalie Michels presented a poster on microbiome research-this is another area of investigation that will be generating large datasets and will again challenge us to avoid false positives. With regard to false positives in abstract screening, my own poster on dementia caregiving was somewhat upstaged by a truly "interesting" poster beside it, manned by 5 or 6 Japanese researchers, which indicated in its rationale that different deities emit different forms of light. Provocative stuff...

In terms of "walking the talk", at least in our own lives, the conference had well-being sessions every day. Mindfulness sessions included mindful walking (which I attended; good fun) as well as loving kindness meditation and T'ai Chi. Un/fortunately, although the Society also strive to have healthy options at their conferences, the venue was rather keen to keep the pastries and treats flowing at the coffee breaks-as well as showing the Sevilla fondness for meat I mentioned above!

All in all this was a forward-thinking meeting, with researchers, clinicians and thinkers who weren't going to let the sunny weather stop them from focusing how to ensure our discipline remain relevant to life outside the academy.

Related posts
Conference Review: APS 2016
APS 2016: Young Investigator Colloquium


Sunday, February 26, 2017

Theatre review: Mic Drop


Gareth Stack, writer/director; Me, critic; Adam Tyrell, actor

Enter Perry Pardo. Successful entrepreneur; envied, rich, a go-getter. He had to work his way to top to become the man he is today, and if you're not willing to come with him, then fine, stay part of the 99.9%. Think of Tom Cruise's character in Magnolia, but instead of women, his conquest (or perhaps his enemy) is everyone else. 

Mic Drop, a new play from Gareth Stack, comprises a motivational talk by Perry Pardo, who must contend with indifferent AV staff, an audience that can never be as engaged as he wants, and his own demons to deliver his message of crawling your way to the top by any means necessary. But for all his go-out-there-and-get bravado, Perry is well aware that Ireland, and the world, are not meritocracies.

The script is finger-licking for any actor, and in the words of Pardo, Tyrell takes it and eats it with his f(ck)ng mouth. It's perhaps the most intense one-man performance I've seen since Jonathan Capdevielle's role as a serial killer (and his victims) in Gisele Vienne's production of Dennis Cooper's Jerk. Tyrell struts and frets his half hour on the stage like his life depends on it (no doubt Pardo believes that it does). Modafinilled out of his box, Pardo is itching for confrontation but has to content himself with feeding off the nervous quiet of the audience.

Mic Drop has its final performance tonight as part of the Smock Alley Scene and Heard festival. It is a 30 minute, abridged version of a longer play, but manages to pack more into those 30 minutes than most do in 90.  The unabridged version will be worth looking out for.

Related posts
Theatre Review: Autumn Royal

Saturday, February 11, 2017

HRB Seminar on Stress: Part II



Thanks to generous funding from the Health Research Board, we at UCC Dept. Psychiatry & Neurobehavioural Science and the APC Microbiome Institute were able to host an international research seminar. This was a chance for some leading researchers in the areas of caregiving stress to discuss their research and ideas.

Shireen Sindi of the Karolinska Institute in Sweden set the scene for our discussion of stress. She touched on classic work from the late sixties by Mason, highlighting key factors for producing a stress response, such as a stressor's unpredictability, its unfamiliarity and a person’s sense of control (or lack thereof). This work has since been borne out in a large review by Dickerson & Kemeny, who found that release of cortisol tended to be most clearly associated with such aspects of stress.

Dr Sindi made the interesting point that people may often lack insight into their own chronic stress levels, particularly in the case of physiological stress. This raises the question of whether self-report and physiological measures may show less concordance when tapping into more long-term stress. Speaking of long-term stress, she pointed out evidence that chronic stress in childhood may lead to very difficult-to-reverse changes in the amygdala (a region of the brain associated with processing emotion such as fear).

Brent Mausbach from the University of California at San Diego opened by highlighting a classic finding from Schulz and colleagues, indicating that caregivers were at increased risk for mortality at follow-up, specifically those with high levels of caregiver strain. He then discussed some of his own findings, looking at caregivers and whether they had depression and/or distress with challenging behaviours in the patient, with cardiovascular disease (CVD) as the outcome. Those who suffered from both depression and high distress in their caring role had an increased risk for CVD-a rather startling result.

Professor Mausbach went on to discuss some really interesting results from his group following caregivers over time in terms of measures of inflammation and clotting; interleukin-6 and D-dimer were higher in dementia caregivers compared to controls, and also increased at a sharper rate. These biological markers are associated with heightened risk of CVD, so these findings neatly suggest a biological mechanism as to how psychosocial stress can lead to negative health effects over time.

It wasn’t all bad news; he also highlighted promising preliminary data on treatment. The team at San Diego used behavioural activation (getting people to engage more in activities they enjoyed) as a way to treat depression in caregivers, thereby treating CVD risk. This behavioural activation approach, which allowed carers to develop their own tailored intervention, led to greater improvement than a typical intervention (education and support).

Kathryn Lord brought things back to basics, challenging assumptions underlying work in the area of caregiver stress, particularly the concept of “challenging behaviour”. Lord suggested that the classification of a given behaviour as challenging risks ignoring the perspective of the patient, who may act as they have genuine grievances with how they are being cared for. Dr Lord posited that a person-centred approach to care should inquire into the meaning of a patient’s behaviour, and whether they are trying to communicate something about their environment.

Dr Lord also warned of being too ready to attribute any behaviour that causes others difficulty to dementia. Patients with dementia can have pre-existing issues with others that can pre-date the dementia that can nonetheless be missed by care workers (or indeed family caregivers). 

Like Brent Mausbach, Dr Lord had some very nice intervention data from a randomised clinical trial for family carers using the START program. This program was developed by the Livingston team at UCL in the US, and Dr Lord’s team adapted this program for a UK population. Although it only lasted 8 weeks, START reduced the risk of depression at follow-up years later in the carers who completed it. It was also cost-effective; interestingly carer’s health costs actually went up in START group (perhaps due to increased health-seeking behaviour), but the patients’ health costs went down by more than the increase seen in the carers.

Noted intellectual-about-town Andrew P. Allen wrapped things up, highlighting similar themes in his own research that chimed with previous speakers, including immune data suggesting increased inflammatory cytokines in carers compared to controls, as well as a positive impact of psychosocial interventions for carers (with cognitive performance as the outcome). He also tied this area in with the brain-gut axis, mentioning evidence of altered microbiota in major depression, evidence from France of increased prevalence of IBS in carers as well as the potential for probiotic supplementation to attenuate stress.

Related posts:
HRB seminar on carer stress
He ain't heavy, he's my carer

Sunday, February 5, 2017

Theatre review: "Autumn Royal": Limited time, limited space



We are seated on the stage of the Everyman Theatre, Cork, in just two rows of chairs. Stacks of washing machines form the walls behind them, and the kitchen floor almost impinges on the audience's seats. Although this is a close-up view, when the performances begin, they remain more theatrical than cinematic. While always remaining in character, Siobhán McSweeney and Shane Casey play to the crowd in a manner that is more like unaffected stand-up comedy than self-conscious breaking of the fourth wall.

They play Timothy and May, a brother and sister from Cork who are caring for their ill father. Tim is 36; May is somewhat older. The soundtrack chimes with the ticking of a clock. May and Timothy are aware that they are not getting younger, and they point out that their father could live for years or maybe decades. Banana and peanut butter sandwiches are made at intervals throughout the play, a repetitive task. Days are too slow; years too fast. Boredom is fought with gossip about locals.

One wonders how well references to specific places around Cork city and county will travel, but it wouldn't be true to the characters for them to purely to speak in universal terms that transcend place; Timothy and May are stuck in this particular place. Timothy for example might have more perspective if he could fulfil his pipe dream of travelling to Australia, but for now the siblings are where they are. May is concerned with how the neighbours will respond to them placing their father in a nursing home. The street hems them in as much as the house.

Although much of the comedy is broad, there is a darker tone throughout. As the characters' fantasies stray towards the homicidal, I can't help but imagine an epilogue where an older actor represents the elderly father, challenging the audience on the extent to which they identify with May and Timothy. But like Daphne Du Maurier's Rebecca, we only see the father through the eyes of others (though he is heard clamouring from upstairs). Maybe this isn't one to see with your folks.

Autumn Royal will be playing next at the Project Arts Centre in Dublin 7-11th Feb and at The Dock Leitrim 23rd February. (Both shows are sold out as far as I'm aware)

Related posts
He ain't heavy, he's my carer
Thoughts on compassion fatigue

Sunday, January 8, 2017

In defence of sometimes being in the moment



As you may be aware, I have an interest in mindfulness. I both practice mindfulness and research its effects in the context of chronic stress. 

A rather disgruntled piece from a couple of months back in the Sunday Review of the New York Times has been getting some ongoing attention on social media. My response to it is a bit delayed, but if you are interested, here is a link to the original article (which I quote at some length in italics in this post):

http://www.nytimes.com/2016/11/26/opinion/sunday/actually-lets-not-be-in-the-moment.html 

Whippman opens:

I’m making a failed attempt at “mindful dishwashing,” the subject of a how-to article an acquaintance recently shared on Facebook. According to the practice’s thought leaders, in order to maximize our happiness, we should refuse to succumb to domestic autopilot and instead be fully “in” the present moment, engaging completely with every clump of oatmeal and decomposing particle of scrambled egg. Mindfulness is supposed to be a defense against the pressures of modern life, but it’s starting to feel suspiciously like it’s actually adding to them. 

I'd probably be flattering myself if I called myself a "thought leader", but I can say that mindfulness is intended to be a non-judgemental awareness of the present moment. The "decomposing particle of scrambled egg" probably ain't aesthetically pleasing to the author, but I guess mindfulness is more about trying to get away from the judgment calls we naturally make. Easier said than done, but mindfulness is a practice, not something one is supposed to get overnight.

The point about mindfulness adding to our pressures is interesting though; I think a point that is implicit here is feelings about our own feelings. If one doesn't start to feel an effect from a practice like mindfulness after a few weeks, there is of course the risk that we might start to think that we are particularly resistant to psychological self-improvement. Some people take longer than others to "get into" mindfulness (and some will naturally give up on the practice over time). This is something a skilled mindfulness instructor should be able to pick up with clients. In any case, good mindfulness materials will be at some pains to reassure novices that they should not beat themselves up if their minds (naturally) start to wander as they engage in meditation (I know my own mind still wanders quite a lot mid-meditation after a few years of practice).

Perhaps the single philosophical consensus of our time is that the key to contentment lies in living fully mentally in the present. The idea that we should be constantly policing our thoughts away from the past, the future, the imagination or the abstract and back to whatever is happening right now has gained traction with spiritual leaders and investment bankers, armchair philosophers and government bureaucrats and human resources departments.... 
 

Surely one of the most magnificent feats of the human brain is its ability to hold past, present, future and their imagined alternatives in constant parallel, to offset the tedium of washing dishes with the chance to be simultaneously mentally in Bangkok, or in Don Draper’s bed....What differentiates humans from animals is exactly this ability to step mentally outside of whatever is happening to us right now, and to assign it context and significance. Our happiness does not come so much from our experiences themselves, but from the stories we tell ourselves that make them matter.

Whether or not one is an "armchair philosopher" (capable of identifying "perhaps the single philosophical consensus of our time"), one can indeed take great pleasure from mentally projecting oneself into the past or future (whether or not it is a realistic version of said past or future). However, to use this point to "refute" the way most people use mindfulness meditation is nothing more than the slaying of a straw man. Taking a moment at the end of the day to simply focus on your own breath, your own posture etc. is useful for people who would otherwise be prone to thinking about their anxieties about the future and/or their resentments about the past.   

But still, the advice to be more mindful often contains a hefty scoop of moralizing smugness, a kind of “moment-shaming” for the distractible, like a stern teacher scolding us for failing to concentrate in class....This judgmental tone is part of a long history of self-help-based cultural thought policing. At its worst, the positive-thinking movement deftly rebranded actual problems as “problematic thoughts.”...This is a kind of neo-liberalism of the emotions, in which happiness is seen not as a response to our circumstances but as a result of our own individual mental effort, a reward for the deserving. The problem is not your sky-high rent or meager paycheck, your cheating spouse or unfair boss or teetering pile of dirty dishes. The problem is you.

It is, of course, easier and cheaper to blame the individual for thinking the wrong thoughts than it is to tackle the thorny causes of his unhappiness. So we give inner-city schoolchildren mindfulness classes rather than engage with education inequality, and instruct exhausted office workers in mindful breathing rather than giving them paid vacation or better health care benefits. 

Truly nothing makes me #triggered like the implication of neoliberalism being thrown at psychology. Never mind that I help to run free mindfulness classes for caregivers. (Okay, okay, I'm taking a broader social point too personally). Of course, if individual therapeutic approaches are treated as if they are going to solve all of society's ills then these ills will remain. We should be vigilant to the very real threat of psychological therapies being seen as a cure-all in this way. But I'm also reminded of Christopher Hitchens's sarcastic remark along the lines of "Oh well, we can't do everything, so let's do nothing". Even in fairer societies people will face challenges, and if a way thinking can help them to build resilience then this is a good thing.

I'm concerned there's an implication here that people think mindfulness will turn people into doormats. Being mindful doesn't mean that you can't recognise that you are being wronged, nor does it mean that you can't act to right this wrong or protect yourself or your community. 

In reality, despite many grand claims, the scientific evidence in favor of the Moment’s being the key to contentment is surprisingly weak. When the United States Agency for Healthcare Research and Quality conducted an enormous meta-analysis of over 18,000 separate studies on meditation and mindfulness techniques, the results were underwhelming at best. 

Although some of the studies did show that mindfulness meditation or other similar exercises might bring some small benefits to people in comparison with doing nothing, when they are compared with pretty much any general relaxation technique at all, including exercise, muscle relaxation, “listening to spiritual audiotapes” or indeed any control condition that gives equal time and attention to the person, they perform no better, and in many cases, worse.

The meta-analysis Whippman discusses should certainly give pause to anyone who thinks that mindfulness is everyone's "key to contentment". However, the 18,000 studies she mentions are simply the titles that were screened in the systematic review-the conclusions of the article are actually based on evidence from 47 studies. This is still a lot of evidence, but although many studies focused on people with anxiety problems, the evidence came from people with really quite diverse clinical problems (the analysis did not include studies looking at mindfulness in healthy populations). It should also be noted that it is generally quite difficult to show effects that are greater than an active control. In particular, exercise has a strong antidepressant effect, so to suggest for example that mindfulness is "no better than" exercise is weak criticism. Nonetheless, it should be borne in mind that the observed beneficial effects of mindfulness on anxiety and depression were mild-moderate. 

I think another point being lost in this quick overview is the strong individual variability in response to mindfulness. As with many other therapeutic approaches, a lot of people benefit but a few will experience negative effects; it should be noted that mindfulness comes with risks (it may be that people prone to panic attacks in particular should exercise caution). More common than an actively unpleasant reaction is the feeling that "mindfulness simply isn't of interest for me". This decision that it "doesn't float my boat" may happen after a few sessions (I suspect Whippman falls within this group) or oftentimes the minute someone hears a brief description of what mindfulness is. And if mindfulness doesn't make someone tick, and other activities do, then good for them. 

But perhaps the conclusion I'm most concerned that people will draw from this article is not that mindfulness will have no major effect overall in randomised controlled trials compared to a strong active control (which could happen due to strong individual differences in response), but rather that mindfulness does nothing at all-that it is a kind of homeopathy of the mind, when it fact it can have quite profound effects on the way people think, often for good, but sometimes in more ambivalent or even negative ways as well.

In any case, if the dishes are a pain in the neck, feel free to mentally travel wherever your imagination may take you. And if that is where your mind is at present, try to experience the fun as fully as you can!


Related posts:
Mindfulness and the mind

Sunday, January 1, 2017

A conversation concerning cognition and creativity

The following is an edited version of an interview appearing in

Europe's Journal of Psychology, 2016, Vol. 12(4), doi:10.5964/ejop.v12i4.1323


Lynda Loughnane: Thank you very much for agreeing to meet me. To begin, you have mentioned Type 1 and Type 2 thinking in relation to creative thinking in your blog. Can you talk a bit more about this please?
Andrew P. Allen: Type 1 and Type 2 thinking are broad terms to describe levels of thinking. Type 1 thinking is thought to be quite fast or automatic, or if not automatic, at least heuristic. Type 2 thinking is considered more step by step and logical; often tied to more formal styles of thinking such as logic or mathematics. It is probably better to think of this as a continuum rather than two completely distinct boxes. I've been partly motivated by one cognitive psychologist who described various aspects of cognition and different ways of thinking about Type 1 and Type 2; Steven Sloman (1996) described how creative thinking and imagination would be archetypical of Type 1 thinking, so automatic. However, Kevin Thomas and I have argued that both types of thinking are quite important to creative thinking (Allen & Thomas, 2011); this can be linked to different stages of the creative process. Stage theory within creativity goes back to Wallas in the 1920s (Wallas 1926). It states that one would have, within the creative process, the initial stage of conceptualisation of what you want to do creatively. Then the person often reaches an impasse where they may have to stop for a while, which is a stage of problem solving or a subtype of creative thinking. There is an incubation stage where you leave the problem aside for a while. Perhaps they then get inspired later on by some other thing that they encounter in their life. They have insight where they start having new ideas. Beyond that, once they have these insights, there is a lot of leg work within the creative process generally. In fairness to Sloman, he did include verification as under the Type 2 thinking which has been included in stage theories of creativity as part of the creative process. The overarching idea behind this paper I was writing was to highlight how both types of thinking can be quite important to the creative process and how the differing roles during different phases of the creative process are important as well.
Lynda Loughnane: I absolutely agree with you, speaking from an artist's point of view. Of course Type 1 is that moment of 'Oh, I am inspired, I have an idea' but you also go through a lot of Stage 2! You slog through it ... to put it in layman terms!
Do you think that the heuristic Type 1 thinking is similar to affect? What I mean by affect is that gut reaction you have to something.
Andrew P. Allen: Let's look at the work of Paul Slovic (e.g. Slovic et al, 2002). He describes affect as being a form of heuristic thinking - that you can use your gut reaction, if you like, as a source of information about how you wish to deal with a particular aspect of your life or a decision that you want to make. For example, if you have a negative affect toward something; even if you are not able to articulate exactly why you feel negatively about it, you might, nonetheless take that affect and have a kind of heuristic reaction. This is a type of decision making rule, whereby if you have a negative response towards something or a negative affect, then you are going to ignore this option within your decision making plan. Whereas, if you have an initial positive affect, you might not choose that option immediately but you might seek more information about it rather than writing it off, which is quite often the case if you have the negative affective response. I certainly think affect and heuristics can tie together.
Lynda Loughnane: With my work, I would like to hope that the two types of thinking would be sparked in the viewer. First, the gut reaction, then the 'not quite sure what I am looking at but I want to figure out what it is' reaction. Do you think it is possible for an artwork to do this?
Andrew P. Allen: In your question, you've asked if the artwork itself can do it: let's start with the viewers themselves responding to it. A lot of people who move through busy galleries will only have so much time to engage in any particular piece. If something hits them at a gut level, they can then begin to think of it on a more ‘step by step’ level. If someone wishes to engage in this verification, if you like, as a consumer rather than a producer of a creative work - they can stretch the thinking out in a more step by step level of appraisal. That doesn't mean that that won't continue to be influenced by, for example, their initial negative response. Step by step thinking isn't always completely objective. It can still be coloured by their initial intuition about the piece of art. I should say when I talk about Type 1 and Type 2 thinking, even in themselves, there are differing theories about how these two forms of thinking interact in general. For example whether Type 2 can override Type 1 or, to some extent, that Type 1 comes back or can change in response to Type 2 and so forth. There is still a lot of debate in general about how these two forms of thinking can interact (e.g. Evans, 2007), particularly given that there is a probably a continuum between conscious processing involving some decision making and then something which is very logical and formal.
Lynda Loughnane: You had some very interesting blog reports about mindfulness, which states it has the ability to bring the attention to the present moment. Do you think it is possible to interact with a piece of art on its own terms, or do we always bring our own past projected self to this interaction?

Andrew P. Allen: Within attention people talk about 'top down' attention which is driven by things such as previous experience or what our motivations are, like the baggage we bring to our thinking about things, versus 'bottom up' thinking, which can be more driven by sensory input. I understand why people might think that we always bring our past or projected self into an interaction with art. Although we might have certain sensory inputs which we don't control, for example, we turn one way in the gallery versus that way; our own sensory inputs are often motivated by our own decisions, in terms of whether we decide to look at particular forms of art or if we decide to pursue this particular genre, to consume this or that form of artistic input. The real question here is can we escape from that and to what extent. If we see something that for us is really quite novel, something that is quite new, then I think our cognitive baggage, within a few seconds, will have to have some impact upon that. I do think that within a certain amount of time, you are going to have to think about your past interpretations of other pieces of art and how it relates. At least in some limited sense, you can try to approach a piece of art on its own terms and try to have some kind of 'bottom up' attention, particularly with a complex piece of work; seeing the actual content in terms of what it is trying to portray, but I do think it is significantly difficult to try to break away from our past psychological baggage when consuming art.
You mentioned mindfulness as well in terms of bringing the attention to the present moment so yes, perhaps mindfulness is one potential way of dealing with current experience. With mindfulness, you focus on things like your own body, and your own sensations of your immediate body. I see no reason why it couldn't be used to focus your awareness on things that are external to you such as a piece of art to control your attention in such a way as to focus on the particular piece that you are trying to understand. If your mind wanders to previous pieces of art that you have seen or perhaps an emotional response, then using mindfulness techniques, you might be able to gently redirect your attention back to the piece of art itself, on its own terms without a runaway stream of consciousness about something else you have been ruminating on in the past.
Lynda Loughnane: The fact that the piece of art is produced by somebody else who has their own consciousness and their own set of agendas behind that piece of art, makes it quite hard to be with the art piece just as an object and not feel the draw of the person behind the art.
What are your thoughts on how the creative process affects the behaviour of a person and does the act of engaging in a creative process, or being exposed to a piece of art change the way the person 'sees' their reality? There are two very distinct questions within that one question; one is interacting with art and one is viewing art.
Andrew P. Allen: In terms of cognition generally, we can think of cognition as extended in terms of how we think, which does not simply draw on what is going on in our brains - we can interact with tools around us to augment cognition. Vlad Glaveanu (2014) has talked about this in more depth. Say you are a sculptor, in order to create a sculpture, you might be interacting with the different components of the piece. You may be turning them over in an attempt to perceive them from different perspectives and to ascertain how they can interact with the other components that make up the whole. In that sense, the process of going through, perhaps a Type 2 process, and how you respond to that on an affective level, can bring about different aspects of cognition. I think you might see the different components that you have chosen to study in a greater depth both in terms of their basic physical characteristics such as their mass, shape and form and your response to them, as well gauging the response of a potential audience. That would impact on how you see what you are interacting with. 
In terms of being exposed to art, from a consumer point of view, that is perhaps a trickier question because cognition may not be extended to the same level, unless the artist is actually encouraging you to poke about the sculpture. Perhaps it is not as strong or striking as the active process of creating art itself, but that depends to what extent the person is actually engaging with the art work. If they are actively engaged, then I imagine a lot of the same mechanisms would apply.
Lynda Loughnane: Do you think practices such as meditation or other activities which activate what is sometimes called the 'Inner Eye' such as chanting or praying have an effect on the cognitive or perceptive abilities of practitioners? What happens at a neurological level with such activities, in relation in particularly to sight, as this is my area of interest ... do practitioners see or perceive differently?
Andrew P. Allen: In terms of the neuroscience, Michael Posner and his colleagues recently wrote an interesting review about neuroscience and mindfulness (Tang et al., 2015). There is evidence that mindfulness can alter activity in the anterior cingulate cortex, which is associated with more complex cognition such as conflict monitoring. For example, if you are responding to a task where you have to attend to multiple aspects of different stimuli. Then with a particular trial, you have to respond to one particular aspect of that stimuli, but there is another aspect that makes you want to respond in a different way, you then have to monitor that kind of conflict. It seems mindfulness can help with that as well as with sustained attention, which I am particularly interested in. This is the ability to remain processing a particular steam of information without being distracted, essentially. There is evidence that the frontal cortex activity can be enhanced by mindfulness practice. It is intuitive that this would be the case, because when you are engaged in mindfulness practice, you are trying to sustain your attention on sensations within you. For example, if you are doing a body scan, you specifically want your attention on your breath. If you then start to think about what you are going to have for your lunch, that is a distraction, so you try to gently bring your attention back to your breath. In this way mindfulness is a practice of sustained attention. In that sense it is encouraging to see that regions of the brain associated with these kind of processes, can be enhanced by engaging in mindfulness practice.
What is also interesting about mindfulness is that it can be used in stress reduction. Mindfulness based stress reduction is quite a widely practiced form of mindfulness. One of the areas I am interested in is the interaction between stress and cognition. For example, with conditions of chronic stress (e.g. caring for a relative with dementia) you might anticipate that over time this can have a negative impact on the brain through, for example, excessive cortisol activation. If there are ways of attenuating stress, it might have a positive knock-on effect on cognition. Indeed, there is evidence that interventions to reduce stress can improve cognitive performance in dementia caregivers (c.f. review by Allen et al., 2016).
Lynda Loughnane: Speaking from an artist's point of view, you can get so involved in being present with the creative process that involvement with an art activity can be hugely stress relieving; you are so focused on the present moment that nothing else permeates the process. It's an effective tool for mindfulness, I personally find.
Andrew P. Allen: Csikszentmihalyi (1996) talks about 'flow'. It seems to be quite a mindful kind of state where you become very absorbed in a particular activity. This idea of 'flow' came from the study of the psychology of creativity. It seems to be an archetypical part of creative work, an archetypical example of flow state.
Lynda Loughnane: When you get into a state of flow it's an amazing place to be! Thank you again very much. 
Andrew P. Allen: Thank you.

References [TOP]

  • Allen, A. P., Curran, E., Duggan, Á., Cryan, J. F., Ní Chorcoráin, A., Dinan, T. G., . . . Clarke, G., (2016). A systematic review of the psychobiological burden of informal caregiving for patients with dementia: Focus on cognitive and biological markers of chronic stress. Neuroscience and Biobehavioral Reviews, 73, 123-164.
  • Allen, A. P., & Thomas, K. E. (2011). A dual process account of creative thinking. Creativity Research Journal, 23(2), 109-118. doi:10.1080/10400419.2011.571183
  • Csikszentmihalyi, M. (1996). Flow and the psychology of discovery and invention. New York, NY, USA: Harper Collins.
  • Evans, J. S. B. T. (2007). On the resolution of conflict in dual process theories of reasoning. Thinking & Reasoning, 13(4), 321-339. doi:10.1080/13546780601008825
  • Glăveanu, V. P. (2014). Distributed creativity: Thinking outside the box of the creative individual. Cham, Switzerland: Springer.
  • Sloman, S. A. (1996). The empirical case for two systems of reasoning. Psychological Bulletin, 119(1), 3-22. doi:10.1037/0033-2909.119.1.3
  • Slovic, P., Finucane, M., Peters, E., & MacGregor, D. G. (2002). Rational actors or rational fools: Implications of the affect heuristic for behavioral economics. Journal of Socio-Economics, 31(4), 329-342. doi:10.1016/S1053-5357(02)00174-9
  • Tang, Y. Y., Hölzel, B. K., & Posner, M. I. (2015). The neuroscience of mindfulness meditation. Nature Reviews Neuroscience, 16(4), 213-225. doi:10.1038/nrn3916
  • Wallas, G. (1926). The art of thought. New York, NY, USA: Harcourt Brace.

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