Manipulative, dishonest and lacking in empathy – the traits that describe a psychopath aren’t particularly pleasant. But the idea that they are also fiendishly clever – as often portrayed in films and TV – isn’t quite true. In fact, in general, psychopaths seem to have below-average intelligence.
You have probably met a psychopath at some point in your life. They make up around 1 per cent of the population, says Brian Boutwell at St Louis University in Missouri. A person is classified as a psychopath if they achieve a certain score on a test of psychopathic traits, which include callousness, impulsiveness, aggression and a sense of grandiosity. “Not all psychopaths will break the law or hurt someone, but the odds of them doing so are higher,” says Boutwell.
Because many psychopaths are charming and manipulative, people have assumed they also have above-average intelligence, says Boutwell. Psychologists term this the “Hannibal Lecter myth”, referring to the fictional serial killer, cannibal and psychiatrist from the book and film The Silence of the Lambs.
But Boutwell wasn’t convinced. “Psychopaths are impulsive, have run-ins with the law and often get themselves hurt,” he says. “That led me to think they’re not overly intelligent.”
Not so smart
To investigate, Boutwell and his colleagues analysed the results of 187 published studies on intelligence and psychopathy. These papers included research on psychopaths in prison as well as those enjoying high-flying careers. They also included a range of measures of intelligence.
Overall, the team found no evidence that psychopaths were more intelligent than people who don’t have psychopathic traits. In fact, the relationship went the other way. The psychopaths, on average, scored significantly lower on intelligence tests. “I think the results will surprise a lot of people,” says Boutwell.
Matt DeLisi at Iowa State University hopes that the findings will help put the Hannibal Lecter myth to rest. “The character promulgated the notion that psychopaths were highly intelligent, and there were real offenders that embodied this, like Ted Bundy,” says DeLisi. “But I have interviewed thousands of offenders, some of which are very psychopathic, and I have found that the opposite is true.”
Towards a treatment
In his experience, DeLisi says psychopaths tend to do poorly at school. “They are very sensation-seeking,” he says. “They don’t like to sit and read books – they end up engaging in substance abuse.” In his own interviews, he has found psychopaths to be rather inarticulate, and to swear a lot. “They talk over you in a brusque, aggressive style,” he says.
Boutwell hopes that his research will add to a growing understanding of how psychopathy works, and whether we might be able to treat it. As things stand, psychopaths tend to be considered “untreatable”, and many of those who have been incarcerated end up reoffending. “Psychopathy isn’t amenable to psychotherapies,” says Boutwell. “As we better understand psychopathy, we should be better able to develop treatment and rehabilitation for psychopaths.”
Changing the way people perceive psychopaths might also affect the way they are treated by the criminal justice system. “If they have low intelligence, you could say that they are likely to offend again, or you could say that if they have cognitive difficulties, a lengthier prison sentence is not going to help them,” says Boutwell. “You could make the argument in either direction.”
For the first time, it is empirically proven that cognition can be improved with brain training – according to Prof. Dr. Lindenberger, Director of the Max-Planck Institute for Human Development in Berlin.
Only one year ago, Lindenberger was part of an academic group who published “Ageing in Berlin”, featuring a memorandum clearly stating brain training to not improve trainers everyday abilities. Now, however, Lindenberger and colleagues have published a study encouraging the use of brain training to improve cognition.
The COGITO study is the largest and probably most convincing study in the field of brain training. 101 young adults aged 20-31 years and 103 persons aged 65-80 years trained for 1 hour every 2-3 days, for a total of 100 sessions. A single training session was comprised of 12 exercises: 6 for comprehension and speed (similar to “Flash Glance”); 3 for working memory (“Dual 1-Back”); and 3 for information recall (similar to “Memo Pair”). The brain training exercises were adjusted at the beginning of the study to suit the participant’s performance, as indicated by the pre-tests.
The study was designed to test how effective brain training is at improving general cognitive abilities, and to see if age influences these improvements. In addition, the researchers wanted to evaluate if progress in brain training is transferrable to every day life.
Significant improvements in cognition were observed – especially for working memory. We need working memory to plan, understand complex topics, solve problems, and learn new things. All participants, regardless of age or sex, showed improvements in working memory capacity following the training. The researchers suspect that training positively altered and strengthened the neuronal connections between the two frontal lobes of the brain, hence participant’s progress in brain training could be observed in other areas of life
Professor Dr. med. Falkenstein:
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World memory champion Dr. Karsten:
„I know of no other program which is so intense and effective. Only when you reach your limit, you can really improve!“
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Our new ‘MemoWork’ course specifically focuses on training your working memory, designed with the help of scientists from the Free University in Berlin. This intensive course includes personalized exercises tailored to your abilities, and requires 4- to 8-weeks of training to guide you to better cognition. The efficacy of the program has been extensively tested, and comes with a money-back guarantee – because we’re that confident you’ll like it! The course’s exercises have received much publicity for their effectiveness. We promise you’ll notice a difference!
I have two phobias: Trypohobia and blood phobia. What follows is a description of my first and most severe phobia.
Trypophobia is relatively unknown peculiar phenomenon that affects thousands of people. The term ‘trypophobia’ itself was only coined in 2005. It is not recognised as a phobia technically, but it does seem to be a uncontrolled reaction or response (typically fear, anxiety, revulsion and/or self-defense) of a kind of pattern of holes or bumps. It seems to affect all kinds of people young and old and across different cultural barriers which suggests it is not a culturally learned response. Often, a trypophobe will not know that anyone else suffers from the same experiences that they do.
For a long time I wondered why do certain patterns give me goosebumps? As long as I can remember since I was a kid I had this reaction, and there was very little information about it on the Internet that I could find. I wanted to add my knowledge on it.
What triggers it and what doesn’t?
The effect of a triggering image on any individual trypophobe can vary from no response to a severe reaction, but many trypophobes will agree that certain images are triggering. Generally speaking, any kind of cluster (of say at least 7) of holes or bumps (and in some cases, lesions) may cause discomfort. For me, asymmetric/non-uniform patterns are worse. Others have said that the texture of the holes (in the sense of touch) matters. Some repetitive patterns like honeycomb, clusters of bubbles on the surface of water, the texture of crumpets and the bumps in your skin on your knees when you kneel in carpet for too long can also be triggering.
You can do a Google search for “trypophobia” and many of the images that turn up will illustrate the concept.
To know more about triggers, we must explore why trypophobes have this reaction.
Why do trypophobes have this reaction?
There is not much research data on trypophobia to conclusively explain this reaction. From what I’ve read, and what I’ve experienced, my best guess is that certain kinds of clusters are similar in nature (visually) to some degenerative diseases, pox, infections/infestations, swarms, etc., which one would do well to avoid. You could bring some kind of evolutionary hypothesis into this, the revulsion and therefore aversion of anything that looks like this would be beneficial for survival.
For most, when the clusters/pattern is on something natural/biological such as skin, the reaction is worse. Perfectly symmetrical patterns like the holes in a cheese grater may not be triggering at all (like in my case) due to its visual uniformity (man-made appearance.) But again, different people are sensitive to different things.
As it is, trypophobes are not generally aware of any particular reason they have a reaction. It is like getting goosebumps when it gets cold; it is a reaction one cannot typically prevent.
I have done some small experimentation with this since I am affected by trypophobia, and it is very interesting to me (I’m sort of a scientist at heart.) In my case, the visual scale of holes makes a big difference. For example, looking at something from a certain distance may have no affect on me, but viewing it from further back may trigger a response. It doesn’t seem to depend so much on the “understood” scale (compared relative to other objects around it) as the visual scale – how many of the holes can be seen, how much detail, how big they are, the spaces in between them, etc.
What are the reactions to triggering images?
Reactions vary from person to person. Speaking only from my own experience, the first and most noticeable reaction I get is goosebumps. I always get goosebumps when I am triggered, and my hairs stand on end. It will continue until I am no longer triggered. I believe this is part of some kind of overall self-defense/self-preservation mechanism. At the same time, I feel anxious. I feel as though there is possibly some kind of danger. My mind starts analysing the image and for long exposure, it is all I can think about. Heart rate increases. It can have such a strong presence in the mind that it affects your ability to focus on a task. To that extreme level, it is a little bit debilitating.
The worst, though, is having the triggering images flash into your head. Continuously, more and more, until you start to feel panicky and feverish. In my opinion it is a very unpleasant experience to have a war with your mind, in trying “not” to think about something, which is slowly driving you crazy. After extended exposure, I got more sensitive to trypo triggers. I started to get reactions from simple everyday things like the shower head, bubbles of oil in the frying pan, and even the texture of toilet paper.
Others have said their reactions include things like anger (possibly aggression which can be linked to self-preservation), a desire to destroy the clusters, as well as wanting to cry (a natural reaction after being scared.) One thing that trypophobes all have in common is a very strong revulsion. Most will physically move further away (subconsciously) or look away from the image with disgust. Other common reactions include itching, skin crawling, and being sick to the stomach.
How can I get rid of it?
It takes a lot of mental solidarity to reduce your sensitivity to trypophobic triggers. I don’t believe you will be able to get rid of any reaction altogether, especially to the more severe triggers, but being able to control your reaction and curb the effect it has on you is a good start.
Firstly, I don’t recommend take the exposure/desensitizing route if you already experience any of the reactions above. Being exposed to a lot of triggers in a short amount of time can make you panicky. A lot of the images aren’t real and just created for shock value. Some people have said desensitizing works, and it can, depending on how you do it. Don’t go on a binge looking at triggers until you’re sick. If you’re out and about and see a trigger you can take the time to share your phobia with someone close to you. Being able to explain it and share it can turn it into a good experience and help condition you to associate less negativity with triggers.
Accept that you are not in control of the physical reaction your body has, and know that it is natural. Just like goosebumps, or getting hungry, these are natural feelings and it isn’t something to worry about. What you are in control of is how you deal with it.
If you need to, remind yourself that you are not in any danger.
Do not reinforce yourself into a corner of fear. The more you label trypophobia as something scary, the more it is scary, to you. It is uncomfortable and unpleasant, but do not encourage it by saying things like “This is going to give me nightmares,” and “I’m so afraid to click on this link.” Just forget those thoughts. Own it, don’t be a prisoner to it.
Finally, do not expose yourself more than you have to. I know there is a deathly curiosity that comes along with trypophobia. It takes a lot of willpower to pass up an opportunity to freak yourself out. But once you are able to say, “No, I don’t want to see that,” and go on to do other things, you will be one step closer to feeling more at ease.
By doing these, over time, your reactions to trypo images should decrease.
What are some of the worst triggers?
Here is a list of well-known trypophobia triggers. You will know immediately if you have trypophobia if you experience anxiety in response to these stimuli.
Lotus seed pod, lotus breast, lotus seeds photoshopped onto skin (there are many of these), etc.,
Surinam toad giving birth
Tafoni (rock formation)
The “frozen peas” image, most likely also photoshopped
I normally don`t ask my readers to share any of my posts. But I would be very grateful if you consider this one. I find this article fascinating, and even if I haven`t completely figured out what it means, I think it will broaden your mind and maybe inspire you to get out there and explore the world.
This is a reblog of an article published in The Guardian that I was made aware of by my friend Monty. It fits nicely to what I have been thinking about myself recently. I won`t start theorizing here, but before you read the article, feel free to read this or this post if you are interested To briefly sum it up: After reading “Smashing Physics” by J. Butterworth, I feel the answers we are searching for closing in. The universe is still a mystery, but research is increasing rapidly. The more we know, the easier it becomes to understand the universe. In my gut I know this will lead to us surviving as a human species; We will be able to apply the science in myriad of ways. Sometimes it feels like we are at the brink of extinction, but I stubbornly refuse to be that dogmatic. To prevent us from destroying ourselves, you must do your part. The best thing is; Doing your part is easy: You must search for your purpose in life. If you do, the universe will give you what you need.
Physicists have announced the discovery of gravitational waves, ripples in the fabric of spacetime that were first anticipated by Albert Einstein a century ago.
“We have detected gravitational waves. We did it,” said David Reitze, executive director of the Laser Interferometer Gravitational-Wave Observatory (Ligo), at a press conference in Washington.
The announcement is the climax of a century of speculation, 50 years of trial and error, and 25 years perfecting a set of instruments so sensitive they could identify a distortion in spacetime a thousandth the diameter of one atomic nucleus across a 4km strip of laserbeam and mirror.
The phenomenon detected was the collision of two black holes. Using the world’s most sophisticated detector, the scientists listened for 20 thousandths of a second as the two giant black holes, one 35 times the mass of the sun, the other slightly smaller, circled around each other.
At the beginning of the signal, their calculations told them how stars perish: the two objects had begun by circling each other 30 times a second. By the end of the 20 millisecond snatch of data, the two had accelerated to 250 times a second before the final collision and a dark, violent merger.
The observation signals the opening of a new window onto the universe.
Why discovering gravitational waves changes everything
“This is transformational,” said Prof Alberto Vecchio, of the University of Birmingham, and one of the researchers at Ligo. “We have observed the universe through light so far. But we can only see part of what happens in the universe. Gravitational waves carry completely different information about phenomena in the universe. So we have opened a new way of listening to a broadcasting channel which will allow us to discover phenomena we have never seen before,” he said.
“This observation is truly incredible science and marks three milestones for physics: the direct detection of gravitational waves, the first detection of a binary black hole, and the most convincing evidence to date that nature’s black holes are the objects predicted by Einstein’s theory.”
The scientists detected their cataclysmic event using an instrument so sensitive it could detect a change in the distance between the solar system and the nearest star four light years away to the thickness of a human hair.
And they did so within weeks of turning on their new, upgraded instrument: it took just 20 milliseconds to catch the merger of two black holes, at a distance of 1.3 billion light years, somewhere beyond the Large Magellanic Cloud in the southern hemisphere sky, but it then took months of meticulous checking of the signal against all the complex computer simulations of black hole collision to make sure the evidence matched the theoretical template.
The detector was switched off in January for a further upgrade: astronomers still have to decipher months of material collected in the interval. But – given half a century of frustration in the search for gravitational waves – what they found exceeded expectation: suddenly, in the mutual collapse of two black holes, they could eavesdrop on the violence of the universe.
Prof B S Sathyaprakash, from Cardiff University’s school of physics and astronomy said “The shock would have released more energy than the light from all the stars in the universe for that brief instant. The fusion of two black holes which created this event had been predicted but never observed.”
The finding completed the scientific arc of prediction, discovery and confirmation: first they calculated what they should be able to detect, then decided what the evidence should look like, and then devised the experiment that clinched the matter. Which is why on Thursday scientists around the world were able to hail the announcement as yet another confirmation of their “standard model” of the cosmos, and the beginning of a new era of discovery.
Astronomers have already exploited visible light, the infrared and ultraviolet, radio waves, x-rays and even gamma-rays in their attempt to understand the mechanics of stars, the evolution of the galaxies and the expansion of the universe from an initial big bang 13.8bn years ago.
Thursday’s announcement was the unequivocal first detection ever of gravity waves. The hope is that gravity wave astronomy could start to answer questions not just about the life of stars but their deaths as well: death by collision, death in a black hole, death in some rare stellar catastrophe so fierce that, for a few thousandths of a second, the blast is the brightest thing in the universe.
Even before the Ligo detectors in two US states reopened for business late last year, researchers were confident that a detection would follow swiftly. The announcement came after months of speculation, and decades of theoretical and practical work by an international network of more than a thousand scientists and engineers in Britain, Europe, the US and around the world.
Professor Kip Thorne, of the California Institute of Technology, and one of the founding fathers of Ligo, said that until now, astronomers had looked at the universe as if on a calm sea. All of that had changed.
“The colliding black holes that produced these gravitational waves created a violent storm in the fabric of space and time, a storm in which time speeded up and slowed down, and speeded up again, a storm in which the shape of space was bent in this way and that way,” he said.
Prof Neil Turok, director the Perimeter Institute for Theoretical Physics at Waterloo in Canada, and a former research colleague of Prof Stephen Hawking, called the discovery “the real deal, one of those breakthrough moments in science”.
The discovery, he said, completes a scientific arc of wonder that began 200 years ago, when the great British scientist Michael Faraday began to puzzle about how action was transmitted across the distance of space; how the sun pulled the Earth around. If the sun moved 10 yards, very suddenly, would the Earth feel the difference?
He reasoned that something must cross space to transmit the force of gravity. Faraday’s reasoning inspired the great British mathematician James Clerk Maxwell to think about how an electric force travelled, and arrive at an understanding of light and a prediction of radio waves.
“Einstein, when he came to write down his theory of gravity, his two heroes were Faraday and Maxwell,” said Turok. “He tried to write down laws of the gravitational field and he wasn’t in the least surprised to discover that his predictions had waves, gravitational waves. The Ligo discovery signals a new era in astronomy, he said.
“Just think of radio waves, when radio waves were discovered we learned to communicate with them. Mobile communication is entirely reliant on radio waves. For astronomy, radio observations have probably told us more than anything else about the structure of the universe. Now we have gravitational waves we are going to have a whole new picture of the universe, of the stuff that doesn’t emit light – dark matter, black holes,” he said.
“For me the most exciting thing is we will literally be able to see the big bang. Using electromagnetic waves we cannot see further back than 400,000 years after the big bang. The early universe was opaque to light. It is not opaque to gravitational waves. It is completely transparent.
“So literally, by gathering gravitational waves we will be able to see exactly what happened at the initial singularity. The weirdest and wonderful prediction of Einstein’s theory was that everything came out of a single event: the big bang singularity. And we will be able to see what happened.”
• The headline to this article was amended on 12 February 2016. An earlier version said the discovery was a breakthrough after two centuries of expectation. This has been corrected.
A Norwegian study of twins expands the role of genetics in the development of a personality disorder, yet cautions that expression of a disorder depends on a combination of genetic and environmental factors.
In the study, experts posited that avoidant and dependent personality disorders are characterized by anxious or fearful traits.
People with avoidant personality disorder are often anxious in the company of others and prefer to be alone. On the other hand, people with dependent personality disorder feel more secure in the company of others and tend to need other people for decision-making and excessive support.
Prior studies have suggested that genetic factors explain about one-third of the individual differences in these personality disorder traits, while the remaining variation is best explained by environmental influences.
However, the study format used by earlier researchers was a single-occasion interview. In the new study, researchers used two different measures of assessment at two different time-points in order to better measure personality disorders traits.
In 1998, researchers coordinated testing of 8,045 young adult twins using a questionnaire that included questions about personality disorder traits. Some years later, 2794 of these twins took part in a structured diagnostic interview.
Both identical (monozygotic) and fraternal (dizygotic) twins participated. Identical twins share 100 percent of their genetic material, while fraternal twins share on average 50 percent — meaning they are genetically similar to other siblings.
Researchers then compared how similar the two types of twin pairs were on a particular trait. As such, the variation between individuals was calculated and assigned to either a genetic or environmental source.
The researchers found that two-thirds of the variation in avoidant and dependent personality disorder traits could be explained by genes and that the most important environmental influences were those unique to each twin. The environmental influences can be any factor(s) that contribute to the twins in a pair being different, e.g. the influence of different friends, teachers, activities or various life events.
Researchers state that it is important to emphasize that the term heritability does not refer to individuals per se.
Heritability is a statistic that relates to the population as a whole, and is expressed as a proportion of how much the total variation in a trait, such as personality disorders, is influenced by genes.
By using two different assessment techniques at different times, researchers were better able to estimate the role of heritability than in studies that measure personality disorder once and with one instrument only.
The dual method applied in the current study allowed researchers to capture the core of these personality disorder traits and not random effects, or effects specific to a certain time point or method of assessment, said Ph.D. student and first author of the study Line C. Gjerde.
The key finding that genes are so influential in the development of personality disorders emphasizes the importance of obtaining a thorough family history from patients with symptoms of such disorders.
However, this does not mean that personality disorders are not treatable. Gjerde emphasizes that the strong genetic influence found in the study does not imply any form of determinism or prediction of disease development. That is, if a person has a family history of personality disorders, this does not necessarily mean that he or she will develop a personality disorder.
Whether or not a genetic vulnerability leads to the expression of a certain trait or disorder depends on a complex interplay of both genetic and environmental factors.
According to a new study, mindfulness meditation exhibited even stronger physical pain reductions than morphine, says the study’s lead investigator
Dr. Fadel Zeidan, assistant professor of neurobiology and anatomy at Wake Forest Baptist Medical Center, has studied mindfulness for 15 years and has observed improved health outcomes as a result. “But what if this is all just a placebo?” he wondered. “What if people are reporting improvements in health and reductions in pain just because of meditation’s reputation as a health-promoting practice?” He wanted to find out, so he designed a trials that included a placebo group.
Zeidan recruited 75 healthy, pain-free people and scanned their brains using an MRI while they experienced painful heat with a 120-degree thermal probe. Then, the researchers sorted them into four groups and gave them four days of training. Everyone thought they were getting the real intervention, but most of them were getting a sham treatment.
“I want to be restrained about the efficacy of mindfulness, and the way to be restrained about it is by making it harder and harder to demonstrate its effectiveness,” Zeidan says.
First, there was a placebo cream group that participants were told reduces pain over time, Zeidan says (it was really just petroleum jelly). For four days, they rubbed it on the back of their leg and tested it against that painfully hot thermal probe. Little did they know, the researchers cranked down the heat each day; the participants thought the cream was working.
Another group was taught a kind of fake mindfulness meditation—they were told to breathe deeply for 20 minutes but were given no instructions on how to do it mindfully. The control group was subjected to 20 minutes of a very boring book on tape: The Natural History and Antiquities of Selborne.
For the real intervention, people sat for 20 minutes with straight posture, closed their eyes and listened to specific instructions about where to focus one’s attention and how to let thoughts and emotions pass without judgment. “Our subjects are taught to focus on the changing sensations of breath and to follow the breath with the mind’s eye as it goes down the chest and abdomen,” Zeidan says.
After four days, everyone re-entered the MRI machine and endured the same pain from the 120-degree probe. They were told to use their training—breathing deeply, mindfully meditating or the cream. They used a lever to indicate the physical intensity and emotional unpleasantness of the pain.
They found that people in all of the groups had greater pain reductions than the control group. The placebo cream reduced the sensation of pain by an average of 11% and emotional unpleasantness of pain by 13%. For the sham mindfulness group, those numbers were 9% and 24% respectively. But mindfulness meditation outperformed them all. In this group, pain intensity was cut by 27% and emotional pain reduced by 44%.
That shocked Zeidan. Past research has indicated that the opioid morphine reduces physical pain by 22%—and mindfulness had surpassed even that. But the MRI results, which showed how pain was registering in their brains, surprised him even more. People who had practiced mindfulness meditation seemed to be using different brain regions than the other groups to reduce pain.
“There was something more active, we believe, going on with the genuine mindfulness meditation group,” Zeidan says. This group had increased activation in higher-order brain regions associated with attention control and enhanced cognitive control, he says, while exhibiting a deactivation of the thalamus—a structure that acts as the gatekeeper for pain to enter the brain, he explains. “We haven’t seen that with any other technique before.”
It’s an important preliminary study, Zeidan says, but exactly who will benefit from meditation’s impact on pain is still unknown. “We’re now at the stage, at least in my lab, where we have enough evidence that meditation reduces pain and it does it in a really unique fashion, different from any other technique we’ve seen,” he says.
And as for the questions left unanswered? “We don’t have the studies yet,” he says, “but we’re getting there.”
I have worked as a psychologist for 4 years now, and in two of them I have been Learning EMDR. I use EMDR when I work with trauma, with positive results. To become a specialist in Norway, we must write an article about a subject we choose for ourselves. I wrote it last year, and in december it was accepted. I wrote a case study, and will present the result in the following post. I have tried to translate it from Norwegian, so there might be some writing errors I haven`t spotted. If you do notice anything, please let me know.
EMDR (eye movement desensitization and reprocessing) is a treatment method recommended by APA for post-traumatic stress disorder (PTSD). Shapiro proposed an Adaptive Information Model in 2001, that focus on how EMDR works. New research that combines EMDR with brain scanning, shows direct effect of EMDR. This task wants to look closer on the research related to EMDR and how it functions. It will do this by looking at existing literature, and by describing a patient who was tested with neuropsychological tests before and after EMDR. One hypothesis is that changes reflected on brain scans, might manifest themselves in different neuropsychological test-scores.
Introduction EMDR (eye movement desensitization and reprocessing) is a treatment model developed by F. Shapiro (2001) to treat PTSD. The method entails eye movements while the patient thinks of unpleasant memories, and research shows sustained improvement in patients with PTSD and other mental disorders (Luber, 2010; Solomon & Shapiro, 1997; Wilson, Becker & Tinker, 1995, 1997). EMDR is recommended in the APA guidelines as a treatment for PTSD (American Psychiatric Association, 2004), and therapists who are trained in other treatments, such as control-mastery, cognitive behavioural therapy and gestalt therapy have written about how EMDR has been an important adjunct in their treatment (Manfield, 1998). Research shows that EMDR leads to reduction of PTSD symptoms (Foa et al., 2009), and there are several hypotheses that seek to explain how EMDR works (Popper & Christman, 2008; Shapiro, 2001 & Pagani et al., 2013). This abstract will look at different explanatory models.
Shapiro presented the Adaptive information processing hypothesis (AIP) in 2001 to explain how EMDR might work. Brain scans have tried to confirm or deny Shapiro`s hypothesis (2001; Harper, Rosolkhani-Kalhorn & Drozd, 2009). If there are structural and functional on brain scans before and after EMDR, it will be interesting to investigate whether this also may be related to better results on neuropsychological tests. Patients with brain injuries cost society large sums (Humphreys et al., 2013). Research shows that treatment of cognitive impairments in schizophrenic, is cost-effective (Reeder et al., 2014; Hogarty, 2004). One finds similar results on cognitive improvement programs that focus on AD / HD, depression and eating disorders (Steveson, 2002; O`Connell et al., 2006; Tchanturia et al., 2008). The task will go into depth on how EMDR affects cognitive function by focusing on earlier research, and by discussing a patient who has been tested with neuropsychological tests before and after EMDR. The working hypothesis is that treatment with EMDR, will be reflected on neuropsychological tests scores. In that regard, this abstract is just intended as an example and weaknesses of a small study like this will discussed.
Research on EMDR and brain
Uri Bergman has summarized recent research on EMDR and brain in the book neurobiological foundations for EMDR practice. He points out that much basic research on the brain is done, but what is lacking is to integrate the knowledge with clinical research. Susan Hart (2012) indicate the same in “Neuroaffective psychotherapy with adults,”. She writes that neuropsychology is an important supplement for understanding and improving clinical treatment approaches. Research on this integration, is still in its infancy, but this abstract will investigate studies that do exist. A recent summary of all the research that has been done over the past three years by Pagani, Högberg, Fernandez & Siracusano (2013) shows that despite the fact that there are still relatively few studies of EMDR and how EMDR works on PTSD, the summarized research show that EMDR is the only form of psychotherapy that have shown significant changes on brain scans.
Brain Imaging Techniques: There are two main categories of brain scanning methods. The first includes electromagnetic techniques, which has good temporal resolution. This makes it easier to detect when something happens in the brain. EEG (electroencephalography), ERP (event-related potential) and MEG (magnetoencephalography) fall within this category. The second group consists of scanning methods that are more sensitive to WHERE in the brain something happens. This is examined either by measuring the difference in blood flow in the brain, or changes in metabolism. Techniques that fall in this category are fMRI (functional magnetic resonance imaging), SPECT (single photon emission computed tomography), PET (positron emission tomography) and NIRS (near-infrared spectoscopy). There are advantages and disadvantages with both (Cabeza & Nyberg, 2000). The task will show studies done EMDR using brain scanning techniques that fall within both categories.
EEG and EMDR
A study examined 14 patients who received EMDR treatment using EEG. The study found no change in EEG after using EMDR (Samara et al, 2011). Other studies have demonstrated changes using EEG (Christman et al., 2003, Elofsson et al., 2008). A study conducted by Pagani et al. (2013), tested 10 patients with EEG while they received treatment with EMDR. They were compared with a group of 10 individuals who did not meet criteria for PTSD. This study is important because it directly examined changes in the brain during EMDR. EEG showed differences in activation of frontal areas after EMDR.
EMDR and SPECT
Six policemen who developed PTSD after shootings at work were evaluated with brain scans (SPECT) before and after treatment. It turned out that all got better from EMDR treatment, which also coincided with changes in the brain. Activity in the left and right occipital lobe, parietal lobe, left and right precentral frontal lobe went down. There was also greater blood flow to the left inferior frontal gyri. One of the biggest SPECT studies with EMDR is carried out so far is Pagani et al. study of blood flow after EMDR in 2007. 15 patients with PTSD were scanned before and after treatment with EMDR. A control group which had experienced the same trauma, but which had not developed PTSD were also scanned before and after with SPECT. It turned out that those treated with EMDR had a normalization of blood flow in parieto-occipital lobe, visual cortex, normalization in the hippocampus and increased activity in the lateral prefrontal cortex
3. Hypotheses concerning how EMDR Works Adaption integration hypothesis: In 2001, Shapiro came with the adaptation integration hypothesis (AIP) to explain why EMDR works. This hypothesis indicates that it is the integration of different networks, that leads to change. Harper, Rasolkhani-Kaòhorn & Drozd (2009) are more specific, by pointing out that activating AMPA (alpha-amino-3-hydroxy-5-methyl-4-isoxazole) receptors blocks the transfer of pathological memories to the anterior cingulate cortex (ACC) from the amygdala. A study by Bender, Bender, Brasier & Feldman in 2006 shows that direct stimulation of AMPA receptors, delete traumatic memories in animals, and Pagani et al. (2013) points out that this stimulation is similar to the stimulation given by EMDR. A case study of a bipolar patient, where fMRI was used before and after EMDR, showed changes indicating reactivation of a defective neural network (Landin-Romero et al., 2013). A study from the Park, Park, Lee & Chang (2012) showed changes in plasma levels of BDNF (brain dirived neurotropic factor) after eight men with complex PTSD got eight hours of EMDR. BDNF may thus conceivably be of importance for improvement. Corks & Christman (2008) refers to research that shows a clear improvement in episodic memory (tested with various memory tests) after EMDR.
Armstrong and Vaughan (1996) put forward an orientation response hypothesis on how EMDR works. An orientation response occurs when it is necessary to look for new information in the environment. This is a reflex that has been important for primates through evolution, because it moves the attention to new opportunities or threats, providing a physiological feedback to the body that indicates whether the situation is safe or not. Stick Gold (2008) hypothesized that this orientation response is activateded during REM sleep.
Increased interaction between hemispheres:
Christman, Garvey, Propper & Phaneuf (2003) conducted a study in which they used both horizontal and vertical movements to test effect on retrieval of episodic memories. They found that it was only the horizontal movements that led to increased retrieval of episodic memory, which supports the integration occurs through interaction between the hemispheres. Corks & Christman (2008) writes that increased interaction between the hemispheres in itself leads to less stress, which may also explain how EMDR works. A study by Gunter & Bodner (2008) found lack of support for hypothesis mentioned, because both horizontal and vertical eye movements reduced discomfort by traumatic memory, which supports the working memory hypothesis and not increased interaction between the hemispheres.
Corks & Christman (2008) points out that more research is needed that focuses on other forms of bilateral stimulation, before one can say anything more about how EMDR works.
Working Memory Hypothesis:
One of the hypotheses related to how EMDR works, is research that examines whether the use of working memory leads to reduced discomfort by recalling memories. When the traumatized both must follow finger movements, while keeping the traumatic memory in memory, this requires resources that provide less space to store a living representation of memory. This in turn reduces the emotional discomfort (Engelhart, van den Hout, Janssen van der Beek, 2010). Using the visual and spatial components of working memory, is more demanding for working memory than other forms of information (Andrade Kavanagh & Baddeley, 1997). A study showing that use of working memory leads to decreased discomfort. Hornsveld (2010) tested three groups who had memories associated with loss. Some would recall memories while they conducted eye movements, some only recall, and some recall while they listened to music that was associated with relaxation. The group that performed eye movements improved more than those that just recalled or listened to music, suggesting that the use of working memory through eye movements was what had an effect. Engelhard et al. (2010) wrote that people with lower working memory capacity who had to perform mathematical calculations, improved more when they thought of unpleasant memories, than those who had greater capacity. They also underline that if the memory-load becomes too large, there will be no capacity left to hold the unpleasant memory, which will therefore not cause any effect. Van den hout et al (2010) did a meta-analysis of research done so far, pointing out that the working memory hypothesis has most of the support today. They have done studies that indicate that the discomfort of memories will be reduced when working memory load increases, for example, when patients must count backwards while recalling unpleasant memories.
Presentation of the patient:
The patient is a woman in her fifties functioning normally until the early 2000s when she was in a car accident. The patient had a traumatic childhood, but had no psychiatric history before the crash. One study show (Kopnen, S, Taimin & Portin R, 2002) that almost half of a group of car accident victims, had received an axis 1 diagnosis 30 years after the accident.
After the accident she started to cut herself, was suicidal, dissociated, had a restrictive food intake and was admitted to both hospital and outpatient care. In the period 2005-2010 she was more hospitalized than home. Her longest hospitalization lasted for 1.5 years. The woman was near death due to hypokalaemia, and she had several suicide attempts until four years ago. Four years after the accident, she got divorced after a long marriage. Before the car accident the patient was a mother of four, in a good marriage, had an active life both inside and outside the home. She and her husband also had children in foster care. The woman was diagnosed with Atypical Anorexia Nervosa, severe type. She was hospitalized at a trauma unit in Norway twice a few years ago. After this she was followed up locally and had weekly outpatient consultations. The patient has been examined by experts in connection with insurance claims, and the findings suggest brain damage as a result of the car accident. The accident is seen as the cause of subsequent symptoms that were not present before the accident, despite traumatic upbringing. The patient describes a lethargy which according neuropsychologist corresponds to damage to the left frontal lobe. Generally, it appears that cognitive residual symptoms often occur after head injuries in car accidents (Murray & Lopez, 1997).
In February 2014 the patient showed clear improvement psychologically. This has been confirmed clinically, through questionnaires, through and through information from others. The patient still had cognitive residual symptoms, which could not be explained on the basis psychological difficulties.
Method, neuropsychological testing:
The tests the patient took included samples of sensory-motor function (Grooved Pegboard Halstead-Reitan), attention functions (tal-memory of WAIS-IV, spatial memory span of WMS III, Trail-making test and Stroop D-KEFS), cognitive speed (memory mapping from Rban), verbal abilities (WAIS-IV and the memory tests from RBAN) and executive functions (Wisconsin Card Sorting Test). The neuropsycholgoist also tested her With WAIS-IV (an intelligence test).
Findings from neuropsychological testing the 14/01/14
On fine motor coordination, she has large side differences in disfavor of the right hand (which supports the hypothesis of a injury on the left side). The patient still has difficulty with balance, in spite of frequent sessions With a physiotherapist in addition to physical exercise. When she walks outside, she can easily “fall” to the right.
On ability tests, the patients verbal scores is in the middle of the normal range, somewhat lower scores on verbal abstraction. Non-verbal samples were located in the upper normal range. Samples of working memory is variable but generally low. On a selection of attention tests she scores low. She has normally good scores on a 5-divided visuospatial test which requires cognitive shifts, and scores in the upper normal range and over on a verbal flow task. Samples of cognitive speed is variable, from the lower normal range to above the normal range. Impulse control is under age expectation. A task with sustained attention is also below expectation for her age. Two samples of immediate memory gives scores in the low border areas. On recent memory she has scores well below the threshold area. On all the tests she uses a lot of time when tasks are difficult, but she can be systematic. She “falls out” relatively regularly, both on verbal and non-verbal tests.
Conclusion neuropsychological testing the 14/01/14:
The testing was done on a woman in her fifties who was in a car accident. The test results show impaired memory, attention and concentration. She also had problems with immidiate and retrieved memory.
This will make daily life harder for the patient. She will notice the cognitive problems in everyday activities depending on cogntive functions. She will have problems with learning new things, and have low energy levels.
Treatment with EMDR
The patient had regular conversations with me since January 2013. She received 30 sessions, and despite regular improvement, still had problems with cognitive functions. The focus of this abstract is five hours with EMDR. The layout is as follows: First we find a target memory (target), then focus on the sensations in the body, while measuring discomfort and identifying emotions related to the memory. The aim of processing is to reduce the mental discomfort related to the unpleasant memory.
In the treatment two scales to measure subjective changes, were used. This was SUD (Subjective units of distress) and VOC (validity of cognition). The SUD goes from 1-10 and the VOC from 1-7. To begin with the discomfort (SUD) is normally high, and through processing with EMDR, the SUD normally falls. When working with SUD and VOC, we install an alternative positive thought that can replace her negative thought. The standard protocol of Shapiro (2001) was used during processing.
Installation of mental resource: 01/23/14:
The purpose of the resource installation: Helping the patient to endure the discomfort without using an avoidance strategy. The patient remembers that she always felt calm when she saw eagles flying in. She wanted to imagine that she flied like an eagle. I did several short sets of eye movements, to strengthen the link between peace and the feeling of being an eagle flying. The patient almost feels like an eagle, and is completely calm after several sets of eye movements. She scores 1 on SUD when processing ends.
Target Memory 1 EMDR: 05.03.14
The first unpleasant memory we started working on is that she lies in bed, hearing her parents argue. She feels a lot of discomfort when she thinks about this. Through eye movements she works chronologically through the event. She begins with the fear she felt in bed, and feels like a small child here and now (shrinks together in the chair). The discomfort decreases steadily, until she is down 1 on discomfort scale. Her negative thought was: “It’s my fault.” At the end the negative thought feels untrue. The thought “I was just a kid, and it was not my fault.” gets a rating of 6 on the VOC scale.
Target Memory 2 EMDR: 04.10.14
We started the session by examining previous target for any residual discomfort. She tells me that she hasn`t thought about the unpleasant memory since the previous session. No discomfort arise when she thinks about it in the session, but she notices she still worries about whether she is good enough, especially as grandmother. When I use the “body scan”, her discomfort is down to zero when she thinks back on the quarrel between her parents.
The target we work on in this session is an unpleasant memory attached to a bus tour where she was afraid of a man (details omitted for anonymity reasons). The discomfort is high (7-8) when processing starts. She feels fear in the stomach and chest. The discomfort goes down eventually, and the picture becomes less threatening. There is still some discomfort (2/3) left at the end of the session.
Target Memory 3 EMDR: 23.04.14
We start with examining the previous target: She has not thought about the specific memory or experienced flashbacks since the last session. But in her life, things have happened that has reactivated other unpleasant memories. One of these is the target for treatment: How she feels when her father criticizes her. Her negative cognition is “I am not confident”. Discomfort is according to the patient 15 on a scale from 1-10 scale when we start processing the target.
The discomfort decreases during processing. First her discomfort goes down to 5, and after a while she gets thoughts and images that make her feel stronger, while her father appears as “weaker.” The patient experiencing a reversal, where her mental image of father, actually “shrinks”. She also feels like the image becomes more distant. At the beginning of the processing it’s hard to breathe, but after a couple of eye-movements her breathing becomes normal. According to the patient, she starts to feel free, and is not so tense anymore. At the beginning of the processing, she had tendencies of dissociating (freeze state) but the feeling of paralysis decreases when we reduce the discomfort of the memory. At the end of our session her discomfort was below zero and she feels that it is absolutely true that she is safe, when she thinks back on the target.
Target Memory 4 EMDR: 05/02/14.
The session lasts 2×45 minutes. There is no remaining discomfort from the previous target. The target for this session is a specific episode from the last week with her mother, when she had to clean a cottage and her mother commented that she did a poor job. The discomfort is 8-9 at startup and the negative thought is “I have no value.” The positive cognition is: “I have value.” At the beginning she feels like a 15 year old who must fight for her rights. She says it feels like a betrayal, that her mother still does not let her decide for herself. After some sets of eye movements, her discomfort decreases. Her discomfort decreases further, and she gets more positive thoughts, like that her brother takes good care of her parents now, and she does not need to take care of them all the time. The discomfort goes down to zero, and the thought “I have value” feels completely true at the end of the session. When I do the body scan, she feels completely relaxed, and she says that the turmoil in her chest, is now gone.
Results neuropsychological testing 28.05.14
A week before the neuropsychological examination the patient was on a trauma unit for a planned 1 week follow-up. She describes this as difficult. She still satisfied the criteria for an eating disorder, but otherwise she showed improvements.
From neuropsychological report:
Tests that were taken were Grooved Pegboard from the Halstead Reitan battery, number-memory of WAIS-IV, spatial memory span of WMS III, Trail-making test from Stroop, D-KEFS, symbol search and coding of WAIS-IV, memory mapping from Rban, figure copying and memory tests from Rban.
The previous testing 14.01 shows that the patient has a15 points improvement on immediate memory. Delayed recall has also gone up by 34 index points (Rban). She shows more uneven results on samples requiring cognitive efficiency, and has a slight decline on a visuospatial tasks requiring cognitive shifts, some decline and some increase of verbal fluency, and a sample with requirements for impulse control show lower results. Measure speed has gone down two scaled scores on two different samples. A sample of working memory is similar to previous testing, another test is somewhat lower.
Estimate: In summary, at the second testing there is still a somewhat uneven result when it comes to cognitive efficiency, while memory tests are clearly better.
Neuropsychological tests are affected by how you feel. The patient had a bad week when she was tested for the second time, and this could have influenced her and made her performance worse. The woman underperformed on most tests, but not on the memory tasks. Better results on Rban is significantly better than expected with regards to the first testing and that she did poorly on other tests. This is interesting considering further research.
Weaknesses of the task and the presentation of the case:
There is still little research on EMDR and how EMDR works. It is conceivable that there are other variables than eye movements that work, including alliance with the therapist. Although patients scored better on neuropsychological testing after EMDR, one person is not enough to draw any conclusions about the population as a whole, as the improvement on memory functions might be due to other factors (Lofthus & Guyer, 2002). The improvement on memory tests are significant, which supports the hypothesis that improvement is not due to chance. To say more about this effect, more patients must be tested. Research also requires a control with previous trauma and brain damage (preferably in the frontal areas) that have had normal trauma treatment (cognitive therapy). The two Groups would then have to be tested with neuropsychological tests before and after treatment. To get a clearer result, preferably up to 200 people should be compared with each other. This is a comprehensive project that will take time, but this case study could help to establish a hypothesis for future research. As mentioned earlier, a summary of research in recent years show that EMDR causes changes that can be seen on brain scans (Pagani Högberg, Fernandez & Siracusano, 2013), but no research is done on whether this leads to better results on neuropsychological tests. Basic research on PTSD and neuropsychological testing, suggesting that patients with PTSD score lower on neuropsychological tests of verbal memory, attention and visual memory (Samuelson, Metzler, Rothlind, Choucroun, Neylan, Lenoci & Clare Henn-Haase, 2006). Another issue is that the patient had a complex psychiatric history after the car accident. She developed an eating disorder, depression, anxiety and had several hospital admissions due to intoxications and self-harm. It can be difficult to find more people with a similar symptom picture. It is also conceivable that those who wish to participate in research, differs from those who do don`t. It might be that attention in itself, helps to improve the function and thus result in neuropsychological tests. In this regard, it should be emphasized that usually the test-retest reliability is good in patients with brain damages (Calamie, Markon & Tranel, 2013). For this reason it is interesting that the woman had a marked improvement on memory tests from RBAN.
Moreover, other studies have tested the patient before and after EMDR with symptom checklists. This was not done in this task, and it is conceivable this would have contributed to the understanding of changes in test results. According to the patient she has been stable in mental function in the months of the study; She followed her eating plan, did not harm herself, and managed to regulate emotions and behavior in an appropriate manner. The patient was not depressed or anxious.
The EMDR treatment was conducted over four months, with five targets including resource installation. This is a small number of targets, and the therapist did not always get the discomfort down to zero in regards to the unpleasant memories. It is important to process the target so that the discomfort is zero, but Manfield (1998) points out that this is not always possible. Nevertheless, further research should work towards reducing the discomfort to zero, and the positive thought should feel completely true. It would also be preferable to process more than just 5 targets.
The patient was a woman in her fifties. It would be interesting if patients in other age groups would responded similarly, as research indicates normal changes in executive functions by aging (Treitz, Heider & Daum, 2007).
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Evaluation of the Evidence for the Trauma and Fantasy Models of Dissociation
Constance J. Dalenberg
California School of Professional Psychology at Alliant International University, San Diego
The relationship between a reported history of trauma and dissociative symptoms has been explained in 2 conflicting ways. Pathological dissociation has been conceptualized as a response to antecedent traumatic stress and/or severe psychological adversity. Others have proposed that dissociation makes individuals prone to fantasy, thereby engendering confabulated memories of trauma. We examine data related to a series of 8 contrasting predictions based on the trauma model and the fantasy model of dissociation. In keeping with the trauma model, the relationship between trauma and dissociation was consistent and moderate in strength, and remained significant when objective measures of trauma were used. Dissociation was temporally related to trauma and trauma treatment, and was predictive of trauma history when fantasy proneness was controlled. Dissociation was not reliably associated with suggestibility, nor was there evidence for the fantasy model prediction of greater inaccuracy of recovered memory. Instead, dissociation was positively related to a history of trauma memory recovery and negatively related to the more general measures of narrative cohesion. Research also supports the trauma theory of dissociation as a regulatory response to fear or other extreme emotion with measurable biological correlates. We conclude, on the basis of evidence related to these 8 predictions, that there is strong empirical support for the hypothesis that trauma causes dissociation, and that dissociation remains related to trauma history when fantasy proneness is controlled. We find little support for the hypothesis that the dissociation–trauma relationship is due to fantasy proneness or confabulated memories of trauma.
Keywords: trauma, dissociative disorder, dissociation, suggestibility, fantasy