The Psychologist May 2013

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psychologist vol 26 no 5

may 2013

Why is it so hard to give up smoking?

Lynne Dawkins considers the role of nicotine and alternatives

Incorporating Psychologist Appointments ÂŁ5 or free to members of The British Psychological Society

letters 314 news 322 careers 360 looking back 378

political conflict and youth 336 the connected brain 340 interview with Alain de Botton 344 eye on fiction: The Yellow Birds 348

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letters 314 an open letter to clinical psychology; cognitive fMRI; greening of psychology; humour issue; lobbying for social change; and much more news and digest conduct disorder; predicting reoffending; children and TV; autism research priorities; frontiers of brain research; Elizabeth Loftus talk; anti-stigma campaign; face blindness; psychologists appointed to top jobs; and nuggets from the Society’s free Research Digest service

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Why is it so hard to quit smoking?

Lynne Dawkins explores the habit and a new device to help kick it

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Professor Ian J. Deary is Professor of Differential Psychology and Director of the University of Edinburgh Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE; www.ccace.ed.ac.uk). He has been collaborating with renowned artist Fionna Carlisle on a project to produce an exhibition of drawings and portraits of research participants and the Portrait of Professor Ian J. Deary (in progress), by Fionna scientists who are studying them. ‘Portraits of Carlisle (pictured). ‘Big picture’ ideas? jon.sutton@bps.org.uk. an Intelligent Scotland’ is exploring the fascinating story of research on cognitive ageing in Scotland. story of this unique group of research participants and On 4 June 1947, Scotland tested the intelligence of the fact that Professor Deary and his team have almost every child born in 1936: 70,805 of them (see discovered a slight but significant association between News, December 2012). Professor Deary and colleagues rediscovered this test, the Scottish Mental Survey of 1947, male facial symmetry and lifetime cognitive ageing. This single piece of research has brought artist and scientist in the late 1990s and recognised its potential for research together to reflect on our different approaches to into ageing. Since then these data have been used to deconstructing the human face and personality. study how people differ in their thinking skills across the This photograph shows Carlisle with the portrait of lifecourse and why people with different childhood Professor Deary, roughly half way through the painting. intelligence live longer.

For more on her work, see www.fionnacarlisle.com.

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Political conflict and youth Brian K. Barber suggests how research could better assess the impact of war on young people

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The connected brain Gaby Pfeifer looks at reading and memorising in the internet era

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Interview: A student of life Lucy Maddox talks to the philosopher, television presenter and entrepreneur Alain de Botton

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Eye on fiction: The Yellow Birds John Marzillier on Kevin Powers’ novel, and what it can teach us about trauma

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President’s column; Award for Outstanding Doctoral Research Contributions; and more careers and appointments

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we meet health psychologist Rory O’Connor; Terry Sexton tells us of his journey from building site to psychology; and Nisa Shahul Hameed considers a challenging path into the profession

may 2013

THE ISSUE ‘Giving up smoking is the easiest thing in the world,’ the author Mark Twain famously said. ‘I know because I’ve done it thousands of times.’

This is no longer the generation of the Marlboro man; there can be few people left in any doubt that smoking is a Bad Thing, in health terms and financially. Yet virtually all unaided attempts to quit smoking are unsuccessful. Why is it so hard to stop?

On p.332, Lynne Dawkins considers the issue from a psychological perspective. What is the role of nicotine, and what of the other conditioned effects that become such a part of the smoking ritual? Dawkins considers a modern alternative, the electronic cigarette.

Could this be the key to dealing with the challenge at a psychological and behavioural level?

Elsewhere we have our usual diverse mix of news, reviews, and a host of other regular features.

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Dr Jon Sutton

reviews 368 death of a soldier; blogs from Dorothy Bishop and Tal Yarkoni; ‘Brainstorm’ at Islington Community Theatre; Bedtime Live; plus exhibitions, apps and more new voices a mindful moment for older adults: Alice Malzfeldt with the latest in our series for budding writers (see www.bps.org.uk/newvoices)

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looking back spook hunting and ghost busting: Elizabeth Valentine on psychologists and psychical research between the wars

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one on one

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…with Almuth McDowall

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ARTICLE

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Why is it so hard to quit smoking?

Lynne Dawkins explores the role of nicotine and non-nicotine contributions to smoking and considers a promising new device for kicking the habit

I

questions

How important is the nicotine delivery in the maintenance of the smoking habit?

resources

West, R. (2006). Theory of addiction.

Oxford: Wiley-Blackwell. www.e-cigarette-forum.com/forum

references

Smoking is the single most preventable major cause of illness and early death, with nearly one in five deaths (in those aged 35 or above) caused by smoking.

Smoking has a multitude of effects on health, that most smokers are aware of. So why do more than one in five adults continue to smoke?

And why is it so hard to give up?

Barrett, S.P. & Darredeau, C. (2012). The acute effects of nicotine on the subjective and behavioural responses to denicotinized tobacco in dependent male and female smokers. Behavioral Pharmacology, 23(3), 221–227.

Bullen, C., McRobbie, H., Thornley, S. et al. (2010). Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine

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Why, given that e-cigarettes are almost certainly much safer than cigarette smoking, is there so much resistance to their use?

n England cigarette smoking is responsible for an estimated 81,700 deaths per year, in other words, 223 people a day – or nine people an hour – die from their smoking ‘habit’. An estimated 36 per cent of all respiratory disease deaths, 29 per cent of cancer deaths and 14 per cent of all circulatory disease deaths are attributable to smoking. This figure rises to 87 per cent of deaths from chronic obstructive lung disease and 82 per cent of deaths from lung, bronchus and trachea cancer (NHS Information Centre: tinyurl.com/cym3apk).

On an individual level, a long-term regular smoker loses an average of 10 years of their life (Doll et al., 2004). That is, approximately 8 out of 10 non-smokers live beyond 70 years compared to only half of long-term smokers (Kenny, 2012). If it doesn’t kill you, smoking has multiple other ways of making your life a misery: it increases the risk of stroke, angina, emphysema, high blood pressure, thrombosis, asthma, cataracts, ulcers, erectile dysfunction and many more (tinyurl.com/74jlw). Given that most smokers are aware of these harmful effects, why do 21 per cent of the adult population continue to smoke? (NHS Information Centre: tinyurl.com/cym3apk). And why are more than 95–97 per cent of unaided quit attempts unsuccessful (Hughes et al., 2004)?

The problem with nicotine Whilst tobacco smoke contains thousands of chemicals, it is the nicotine content that is generally thought to keep people

delivery. Tobacco Control, 19, 98–103.

Corrigall, W.A., Coen, K.M. & Adamson, K.L. (1994). Self-administered nicotine activates the mesolimbic dopamine system through the ventral tegmental area. Brain Research, 653, 278–284.

Dawkins, L., Powell, J.H., West, R. et al.

(2007). A double-blind placebo controlled experimental study of nicotine. II: Effects on response inhibition and executive functioning.

hooked. Smoking is an extremely effective way of delivering nicotine to the brain. It is rapidly absorbed through the lungs into the bloodstream, where it is carried directly to the heart and reaches the brain in about 6–10 seconds (akin to an intravenous injection: Rose et al., 2000).

Because of this direct route, nicotine does not get a chance to dissipate, so the high concentration of nicotine in the lungs from a puff on a cigarette remains in the blood as this ‘hit’ (often referred to as a ‘bolus’) until it reaches the brain. Whilst addictive, nicotine is relatively safe; it’s the carbon monoxide (CO; which prevents oxygen transportation around the body) and tar (which deposits in the lungs and airways and contains carcinogens) that carry the health risks of smoking.

The brain has its own receptors for nicotine – so-called ‘nicotinic acetylcholine’ receptors. Many of these are located on the cell bodies in the ventral tegmental area (VTA), the origin of the dopamine ‘reward’ pathway that projects to the nucleus accumbens (N.Acc).

Dopamine release in the N.Acc is usually concerned with naturally rewarding activities (such as eating, drinking, sexual activity, and so on), but addictive drugs can ‘hijack’ this system resulting in faster and greater amounts of dopamine release (NIDA, 2010). When nicotine activates the nicotinic receptors in the VTA, it results in massive dopamine release in the N.Acc (Corrigall et al., 1994).

In this way, nicotine and other addictive drugs are positively reinforcing – they tap into the normal instrumental learning mechanism which has evolved to ensure that pleasurable or rewarding activities are repeated. This mechanism, moreover, operates outside of conscious awareness, setting up a strong motivational drive to smoke, which may conflict with conscious thoughts, beliefs and plans.

Negative reinforcement, by contrast, involves escaping from or avoiding aversive or unpleasant stimuli. Smoking also taps into this system – via the withdrawal syndrome. When a regular

Psychopharmacology, 190, 457–467.

Dawkins, L., Turner, J., Hasna, S. & Soar, K. (2012). The electronic-cigarette: effects on desire to smoke, withdrawal symptoms and cognition.

Addictive Behaviors, 37(8), 970–973.

Doll, R., Peto, R., Boreham J. et al.

(2004). Mortality in relation to smoking: 50 years' observation on male British doctors. British Medical Journal, 328, 1519–1533.

Etter, J.F. & Bullen, C. (2011). Electronic cigarette: Users profile, utilization, satisfaction and perceived efficacy.

Addiction, 106(11), 2017–2028.

Etter, J.F. & Stapleton, J.A. (2006).

Nicotine replacement therapy for long-term smoking cessation: A meta-analysis. Tobacco Control, 15, 280–285.

Hughes, J.R., Keely, J. & Naud, S. (2004).

Shape of the relapse curve and long-

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smoker stops smoking, they can experience aversive withdrawal symptoms (e.g. irritability, depression, restlessness, poor concentration, increased appetite) and strong urges to smoke. Nicotine ingestion, especially via smoking, extinguishes these symptoms.

symptoms and craving (Rose et al., 2010) as well as elicit positive subjective effects comparable to smoking tobacco that contains nicotine (Barrett & Darredeau, 2012). Animal studies also show that nicotine administration is much stronger in the presence of sensory cues (e.g. a light or a tone; Sorge et al., 2009). So, nicotine in combination with other salient Is the smoking habit just about sensorimotor cues might be a particularly nicotine ingestion? powerful recipe for the development of Although the nicotine content is clearly smoking addiction. a critical component of tobacco addiction, When a habit has been learned in the animal studies report that establishing context of a particular set of cues (e.g. with reliable nicotine self-administration is a cup of coffee or tea; the sight and smell more difficult than for other rewarding of smoke; the tactile sensation of a drugs such as heroin, cocaine and alcohol cigarette in the hand) these cues can then, (Matta et al., 2007). A growing body of via classical conditioning, act as ‘secondary evidence also points to the role of nonreinforcers’ – they become moderately nicotine factors in supporting smoking reinforcing in their own right. For behaviour. Anecdotally, smokers prefer example, the ‘catch’ in the throat smoking to other forms of nicotine associated with smoking, or manipulating administration (e.g. patch, gum, nasal a cigarette in one’s hand, are unlikely to be spray) and in the lab, smokers have been pleasant in their own right, but smokers shown to prefer smoking a denicotinised describe such things as pleasurable. It is cigarette over likely that such sensations receiving have been so closely intravenous associated with the primary nicotine (Rose rewarding effects of et al., 2010). nicotine, that they have Smokers also come to elicit a pleasant report enjoying sensation and contribute the sensory and to the process of smoking tactile addiction. To borrow an components example from West (2006): of smoking, if we take a 20-a-day including the smoker who takes hand-mouth approximately 12 puffs on activity, taste, each cigarette – that person smell and is repeating the sensations in the reinforcement process 240 respiratory tract times a day, that is, 87,600 (Parrot & Craig, times a year and, if they 1995) and if these continue to smoke for 25 During a quit attempt, sensations are years, that amounts to encountering a cue can be removed, smoking 2,190,000 times. Thus, it is easy particularly troublesome satisfaction to see how deeply entrenched declines (Perkins the ‘habit’ can become and how et al., 2001). In cues closely associated with the fact, a number of studies have now primary reinforcer – nicotine – can come reported that denicotinised tobacco to be strongly reinforcing in their own smoking can alleviate nicotine withdrawal right.

term abstinence among untreated smokers. Addiction, 99(1), 29–38.

Hughes, J.R., Rennard, S.I., Fingar, J.R. et al. (2011). Efficacy of varenicline to prompt quit attempts in smokers not planning to quit. Nicotine Tobacco Research, 13(10), 955–964.

Kenny, T. (2012). Smoking: The facts. www.patient.co.uk/health/SmokingThe-Facts.htm Matta, S.G., Balfour, D.J., Benowitz, N.L.

et al. (2007). Guidelines on nicotine dose selection for in vivo research.

Psychopharmacology, 190(3), 269–319.

NIDA (2010). Drugs, brains, and behavior: The science of addiction. tinyurl.com/bqvfbn8 Parrot, A.C. & Craig, D. (1995).

Psychological functions served by nicotine chewing gum. Addictive Behaviors, 20(3), 271–278.

Perkins, K.A., Donny, E. & Caggiula, A.R.

read discuss contribute at www.thepsychologist.org.uk

Cues may have a priming effect on the individual, that is, they whet the addict’s appetite for the desired drug effect, inducing craving and motivation to use.

During a quit attempt, encountering a cue (the sight or smell of a cigarette) can be particularly troublesome, making it more likely that craving and a lapse to smoking will occur. But how can cues elicit such strong control over behaviour? What’s going on in the brain?

One well-accepted explanation (Robinson & Berridge, 1993) suggests that the dopamine reward pathway, which ordinarily mediates how ‘noticeable’ and ‘attention grabbling’ things are in the environment, becomes sensitised (more easily activated) because of the repeated exposure to nicotine. This means that when cues associated with smoking are encountered they become much more attention grabbing, salient and soughtafter, causing increasing wanting and craving. This, in conjunction with the increasing evidence that smokers find it harder to inhibit over-learned tendencies (Dawkins et al., 2007), makes it extremely hard for the smoker to resist the urge to smoke (especially in the context of cigarette-related cues) during a quit attempt.

To recap, nicotine is positively reinforcing (it triggers dopamine release in the N.Acc) and abstinence from nicotine is punished (it is associated with withdrawal symptoms and craving). The strong association between the primary reinforcer, nicotine, and non-nicotine smoking-related cues (conditioned stimuli) results in strong secondary reinforcing processes. Part of the reinforcing process of smoking is likely therefore to include conditioned sensory and behavioural aspects of cigarette smoking (e.g. the handling of the cigarette, the ‘catch’ of smoke in the throat). The process of associative learning therefore results in a highly overlearned behaviour. Since the mechanisms underlying the conditioning process are unconscious, the smoker simply feels a powerful desire to smoke, which varies

(1999). Sex differences in nicotine effects and self-administration: Review of human and animal evidence. Nicotine and Tobacco Research, 1, 301–315.

Perkins, KA., Gerlach, D., Vender, J. et al.

(2001). Sex differences in the subjective and reinforcing effects of visual and olfactory cigarette smoke stimuli. Nicotine and Tobacco Research, 3, 540–546.

Robinson, T.E. & Berridge, K.C. (1993).

The neural basis of drug craving: An incentive-sensitization theory of addiction. Brain Research Reviews, 18: 247–291.

Roddy, E. (2004). Bupropion and other non-nicotine pharmacotherapies.

British Medical Journal 328(7438), 509–511.

Rose, J.E., Behm, F. M., Westman, E.C. & Johnson, M. (2000). Dissociating

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according to the presence of external cues as well as his or her internal state.

Sensitisation of the dopamine reward pathway with chronic nicotine use establishes a heightened desire or craving for nicotine, especially in the presence of smoking-related stimuli. Thus nicotine addiction can be thought of as a deeply entrenched pattern of behaviour under powerful stimulus control because of repeated reward and punishment effects.

Efficacy of currently available ‘quit smoking’ aids With the considerable evidence that smoking behaviour is driven by nicotine addiction and that nicotine itself is relatively safe, came the introduction of nicotine replacement therapy (NRT) – nicotine in the form of patch, gum, lozenge, inhalator and nasal spray. The rationale is to partially replace the nicotine derived from cigarette smoking thus alleviating craving and withdrawal symptoms and reducing the need to smoke. Over 100 placebo-controlled trials suggest that use of NRT doubles a smoker’s chances of quitting successfully to 6–12 months (see Silagy et al., 2005, for a meta-analysis). However, given that the success rate for unaided quit attempts is so low, this means that, even with NRT, 93 per cent of quit attempts ultimately end in failure (Etter & Stapleton, 2006).

What about newer pharmacotherapies – Zyban (bupropion) or Champix (varenicline)? Zyban acts by increasing the availability of noradrenaline and dopamine thus mimicking the effect of nicotine and helping to reduce craving and withdrawal symptoms. Its success rate is comparable to NRT, doubling the chances of quitting successfully over placebo (Roddy, 2004). Champix partially activates the nicotinic acetylcholine receptors, helping to relieve symptoms of craving and nicotine withdrawal. It also prevents nicotine from activating these receptors so cigarette smoking does not trigger dopamine release, in turn reducing the motivation to smoke. A meta-analysis of

nicotine and nonnicotine components of cigarette smoking. Pharmacology, Biochemistry and Behavior, 67, 71–81.

Rose, J.E., Salley, A., Behm, F.M. et al.

(2010). Reinforcing effects of nicotine and non-nicotine components of cigarette smoke.

Psychopharmacology, 210, 1–12.

Siegel, M. (2011). The rest of the story: Tobacco news analysis and commentary. tinyurl.com/blgw643

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Although the existing literature does not merit a conclusion that e-cigarettes are safe in absolute terms, they are clearly much safer than tobacco cigarettes

placebo-controlled trials sponsored by the drug company suggests that it is three times better than placebo (Wu et al., 2006) with a 14 per cent success rate (Hughes et al., 2011). Champix however, has been associated with a number of side-effects, most worryingly psychiatric effects including agitation, depressed mood, suicidal thoughts and an increased risk of heart attack (see Siegel, 2011).

A 14 per cent success rate, even in the absence of side-effects, is still far from impressive. So why are these methods so unsuccessful? NRT and other pharmacotherapies address the nicotine addiction (by replacing it, mimicking it or preventing it from having its rewarding effects), but they lack the important sensory and behavioural cues associated with cigarette smoking. In other words, they do not address the associative learning processes that have occurred throughout a lifetime smoking habit.

Rose et al. (2000) have shown that the combination of IV nicotine (which resembles the bolus of nicotine achieved from cigarette smoking) and smoking a denicotinised cigarette (which provides the sensory and behaviour aspects of smoking, CO and tar but no nicotine) produced

Seigel, M. & Cahn, Z. (2010). Evidence suggests e-cigs safer than cigarettes: Researchers claim. tinyurl.com/cb86sza Silagy, C., Lancaster, T. & Stead, L. et al.

(2005). Nicotine replacement therapy for smoking cessation. The Cochrane Library, Issue 1. Chichester: Wiley.

Sorge, R.E., Pierre, V.J. & Clarke, P.B.S. (2009). Facilitation of intravenous nicotine self-administration in rats by

effects similar to those of own-brand smoking.

What we need then is a device that replaces not only the nicotine from cigarette smoking, but also the ‘activity’ of smoking. If we could manufacture a device that could deliver nicotine effectively without the CO and tar and that mimicked the act of smoking – thus maintaining some of the secondary reinforcing aspects – maybe we would have a better method of helping smokers to quit.

Perhaps such a device is already here?

The electronic cigarette Electronic cigarettes (sometime referred to as ‘Electronic Nicotine Delivery Systems’; ENDS) are battery-operated devices that resemble cigarettes and deliver nicotine via inhaled vapour. Since their introduction into the market in 2004 by the Ruyan Group (also known as Dragonite) in China, electronic cigarettes (e-cigarettes) have gained popularity worldwide and are mainly sold via the internet. Removable cartridges (mouthpieces) contain glycerol or propylene glycol, flavouring, and varying amounts of nicotine. The nicotine

a motivationally neutral sensory stimulus. Psychopharmacology, 207, 191–200.

Vansickel, A.R., Cobb, C.O., Weaver, M.F., & Eissenberg, T.E. (2010). A clinical laboratory model for evaluating the acute effects of electronic ‘cigarettes’. Cancer Epidemiology, Biomarkers & Prevention, 19, 1945–1953.

Vansickel, A.R. & Eissenberg, T. (2012).

Electronic cigarettes: Effective nicotine delivery after acute administration. Nicotine and Tobacco Research, Feb 6, doi:10.1093/ntr/ntr316 West, R. (2006). Theory of addiction.

Oxford: Wiley-Blackwell.

Wu., P., Wilson, K., Dimoulas, P. & Mills, EJ. (2006, 11 Dec). Effectiveness of smoking cessation therapies. BMC Public Health, 6, 300.

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solution is vapourised by the heating times this level (Siegel & Cahn, 2010). element/atomiser which is activated by Let’s face it, inhaling any chemical into ‘drawing’ on the device or pressing a the lungs is likely to be associated with button. ‘Smoking’ an electronic cigarette some harm, but compared to the multiple (often referred to as ‘vaping’) therefore known health risks associated with mimics the act of smoking: the user holds cigarette smoking which kills 81,700 the device and draws on it like a cigarette; people per year in England alone, the the vapour produced resembles smoke health risks of the non-combustible eand is drawn into the lungs and exhaled cigarette is likely to be in orders of like smoke; tobacco (or menthol) magnitude lower. Following a review of flavouring resembles the taste of inhaled the literature, Professor Siegel from Boston tobacco smoke. In short, it addresses the University concluded that although the sensory and behavioural components of existing literature does not merit a smoking that are being increasingly conclusion that e-cigarettes are safe in recognised as important contributors to absolute terms, they are clearly much safer the reinforcing effects of smoking (see than tobacco cigarettes. In fact, ‘the truth Rose et al., 2010). Furthermore, since no is we know a lot more about what is in tobacco is burned, inhaling nicotine in electronic cigarettes than in regular this way has the potential to provide cigarettes’ (Siegel & Cahn, 2010). a safer alternative to cigarette smoking since it eliminates the harmful tars and Can the e-cigarette help carbon monoxide associated with smokers to quit? smoking. Nevertheless, uncertainty Although a product that delivers nicotine remains concerning efficacy of nicotine and incorporates the sensory and delivery via e-cigarettes and how they behavioural aspects of smoking has should be regulated. considerable potential to reduce the E-cigarettes are already banned in public health burden associated with some countries (including Australia, tobacco smoking, smokers are only Thailand, Brazil) and cannot be imported likely to switch to einto others (Canada). These cigarettes if they same countries however, are easy to use, continue to sell tobacco – ‘the “we know a lot more effectively replace only consumer product that about what is in the primary and will kill half its users when electronic cigarettes” secondary reinforcing used as intended’ aspects of smoking and (smokefree.org.nz/face-facts). can reduce nicotine Both the World Health craving and withdrawal symptoms. Whist Organization (WHO) and the US Food clinical trials have yet to be completed, and Drug Administration (FDA) have a recent large online survey reported over voiced concerns over the contents of the 90 per cent of users stated that e-cigarette cartridges, the properties of the vapour, use had helped them to quit smoking or and whether the products are safe or reduce their cigarette consumption (Etter effective. In the absence of clinical & Bullen, 2010). Two published reports controlled trials, they have asked of e-cigarette use in naive users, however, manufacturers not to make cessation showed inefficient nicotine delivery claims, and the Royal Pharmaceutical (Bullen et al., 2010; Vansickel et al., Society has recently announced that 2010), although craving and (to a lesser physicians should not recommend them extent) withdrawal symptoms were to their patients. The EU is currently alleviated. A reduction in craving and consulting over regulation and the MHRA withdrawal symptoms in the absence of (Medicines Health Regulatory Authority) raised blood nicotine levels is consistent will decide this year whether to ban, with the notion discussed earlier that regulate or do nothing. other sensorimotor factors associated In 2009 the FDA conducted a chemical with smoking contribute to its reinforcing content analysis of 19 e-cigarette cartridges effects. and reported the presence of diethylene In a study conducted in our lab at the glycol (a poison) and tobacco-specific University of East London (Dawkins et al., nitrosamines (TSNAs; known cancer2012), abstinent smokers given a 0 mg causing agents) in some of the cartridges, (placebo) e-cigarette reported comparable as well as inaccurate reporting of nicotine reduction in craving and withdrawal content. What it failed to mention symptoms after five minutes of use to however, was the maximum level of those given 16 mg nicotine. After 20 nitrosamines found in e-cigarettes was minutes, compared with the placebo comparable to that found in nicotine group, craving and withdrawal symptoms replacement therapies. TSNA levels present were further reduced in males but not in cigarettes, by comparison, are 1000

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females receiving nicotine. These gender differences are consistent with an emerging body of evidence suggesting that the smoking behaviour of men may be reinforced more by nicotine intake, and in women more by non-nicotine-conditioned responses to smoke stimuli (Perkins et al., 1999). We also observed an improvement in working memory with nicotine (relative to placebo) in the whole sample, suggesting that nicotine delivery is at least sufficient to improve the mild cognitive impairment often observed during abstinence.

Interestingly, in a recent study of experienced vapers using their own devices, Vansickel and Eissenberg (2012) demonstrated significantly elevated blood nicotine levels, comparable to those achieved via cigarette smoking. This latter study clearly suggests that e-cigarettes are capable of delivering adequate levels of nicotine but that new users may need to overcome a learning curve with regard to the nature of vaping and product choice.

To conclude Increasing evidence suggests that people smoke for both the nicotine and the nonnicotine, sensorimotor (conditioned) effects. Current pharmacotherapies for smoking cessation address only the former.

The e-cigarette delivers nicotine without tobacco combustion and mimics the act of smoking, thus replacing some of the important sensorimotor aspects of smoking. It therefore has the potential to provide pleasure as well as save lives.

Whilst survey results suggest that ecigarettes are a highly effective nicotine replacement, such respondents are likely to be positively biased and we await the results of clinical trials to determine whether this promising new device can indeed improve our current arsenal of smoking cessation techniques.

The health risks and safety aspects of e-cigarettes are a frequently – and sometimes sensationally – expressed concern. On balance, however, e-cigarettes are probably doing people very little harm and, in all likelihood, doing people a lot of good if they are using these as a complete or partial alternative to tobacco smoking.

What is very apparent is that the potential to contribute to improved public heath certainly merits further research.

Lynne Dawkins is a Senior Lecturer at the University of East London l.e.dawkins@uel.ac.uk

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Moving and inspiring Dr Margaret Evison is a consultant clinical psychologist specialising in palliative care. She is also a mother with two children; a daughter, Elizabeth, and a son, Mark. This book is about the death of Margaret’s son.

Lieutenant Mark Lawrence Evison, 1st Battalion Welsh Guards, died of his wounds in Selly Oak Hospital, Birmingham on 23 May 2009 having been wounded in action at Haji-Alem, Helmand Province, Afghanistan on 9 May 2009 and aeromedically evacuated from the military hospital at Camp Bastion to Birmingham the following day. Lt Evison had been an officer in the British Army for less that 18 months, in Afghanistan on his first tour of duty there for less than a month and, with his platoon, in the turreted fort patrol base of Haji-Alem for just over two weeks.

By all accounts, Mark Evison was an exceptional young officer, rated by his soldiers, peers and superiors as one of the most capable young officers in the battalion, and destined for great things. His mother describes him as a caring, compassionate, charming, able and handsome young man and his death, like all deaths, was a tragedy.

But Mark Evison’s death was more than a tragedy. It was the result of a complex web of circumstances involving the timing of medical evacuation helicopter flights, the contents of field medical packs and the adequacy of radios. It was the latter that caused Lt Evison to step out of cover, perhaps to get a better signal, when he was hit by the fatal shot to his shoulder from a sniper’s bullet, the second that may or may not have aided a speedy stabilisation of his wounds and the former that may have affected transporting Mark Evison back to hospital at Bastion within the ‘golden hour’ deemed necessary to maximise his chances of survival.

Death of a Soldier is the collage of hospital notes, entries from Mark’s journal, reports from superiors, letters, SIB reports1 and transcripts of the inquest into his death that was assembled by Margaret as she tried, in a relentless quest, to try to piece together the jigsaw of complexities and tragedy Death of a Soldier: A surrounding the circumstances of his fatal wounding, his Mother’s Story evacuation by helicopter across the dusty plains of Margaret Evison Afghanistan and onwards in three aircraft from Afghanistan to Birmingham and his subsequent care and death in Selly Oak. Death of a Soldier is an account of ‘a dying observed’, with all the events that led up to his eventual death in hospital viewed mostly in retrospect, sometimes second- or third-hand (although Channel 4, with Dr Evison’s permission, showed the helmet-camera footage of the battle in which he was shot in October 2010). In this book, the author’s grief is not observed in the way that the grief of C.S. Lewis was2 but is nonetheless so apparent in every page that this courageous and hugely impressive psychologist has written about the death of her beloved son. She writes: I would not have believed that the pain of a child’s death could be so wracking, so complete. It is the breaking up of intense biological bonds built to nurture and endure, it is a shattering of what was intended. One knows of nature’s anger with the unnatural splitting of an atom: so a parent feels a child’s death.

I was moved and inspired by this book, and think that you will be too.

1 2

The SIB is the Army’s equivalent of the CID, the Special Investigation Bureau.

In A Grief Observed (1961) C.S. Lewis reflects on his experience of bereavement following the death of his wife.

I Biteback Publishing; 2012; Hb £16.99 Reviewed by Jamie Hacker Hughes who is an Independent Mental Healthcare Consultant and Visiting Professor, Anglia Ruskin University

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A consuming read Food and Addiction: A Comprehensive Handbook Kelly Brownell & Mark Gold Against a global backdrop of widespread obesity, Food and Addiction takes a clear stance that addiction to food is as real as any other addiction.

Libertarians will shudder at some points; discussion of how people are to control portion size in particular comes off as patronising. On the other hand, much of the ideas at work here give the reader a practical sense of how one’s own consumption could be better controlled (e.g. by choosing less energy-dense food), and the book tackles the controversial topic of food addiction with perspectives from psychology, physiology, public health and other disciplines.

The short length of the chapters and the two-columnsa-page layout give this book a page-turning quality.

Nonetheless, the book as a whole has a measured pace; the first two sections cover addiction and feeding in depth, before the two topics are brought together for the remainder.

There’s no shortage of selfhelp books on food addiction, often written from a perspective of personal recovery. Want a broader empirical look at food and addiction? Add this to your bookshelf.

I Oxford University Press; 2012; Hb £75.00 Reviewed by Andrew P. Allen a postdoctoral researcher at University College Cork

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Opening a window on adolescence Brainstorm Islington Community Theatre Adolescence is the period of life during which we start to figure out who we want to be. It is a time of increasing capacity to make sense of the world and the people in it. It is a time of discovery, coincidence, immense passion and, of course, profound self-consciousness, embarrassment and conflict. The teens behind the production Brainstorm are not only able to recreate the tumultuous – albeit oftmisunderstood − world of adolescence on stage, but also bring the audience into this world by opening windows onto the mind.

The play begins with its entire cast on stage as one teenaged girl begins to tell a story about someone she knew who died while riding a bicycle. Although the story begins as a monologue, multiple voices chime in at times derailing the story into tangents on pop stars, memories and parental aspirations, before returning back to the main thread. This opening scene, at once chaotic and fluid, feels like peering into one teenager’s stream of consciousness.

As the opening scene fades, a projection screen plays a video montage of various scientists describing the still-developing teenage brain, interlaced with shots of teens alone in rooms singing songs, skateboarding down stairs and other stereotypical behaviours described by the scientists. This opening video appears to confirm just what adults have always suspected – that their teenagers’ behaviour is biologically based in the brain and what we can expect from teens is immature, reckless behaviour.

However, the play itself explores this relationship between the teenage brain and behaviour by taking the stereotypes down to the individual level. At times it feels like a beautifully constructed public service announcement for adults; one meant to remind them of the complexities of teenagers' lives and brains. The production carefully weaves in scientific evidence to support their message that the adolescent brain is not simply an immature adult brain, but that the teen brain it is different from the adult brain. The performance reminds us that teenagers and their brains harbour remarkable potential to change the world because of these differences.

A fascinating skirmish BishopBlog Dorothy Bishop Readers of this publication may well be familiar with Professor Dorothy Bishop, the academic, blogger and all-round good egg.

We interviewed her in the January issue (see tinyurl.com/bsz44rr), just after she had won runner-up in the inaugural UK Science Blog Prize for http://deevybee.blogspot.co.uk. She is also building up quite a following on Twitter (@deevybee), which has been abuzz lately with discussion of her musings.

For those of you unfamiliar with blogging as a form of communication, this is no personal brain dump full of pictures of cats and word searches. Bishop says what others might be thinking, skewering one issue after another in a series of practical and thought-provoking posts. At the time of writing, there’s an excellent piece on ‘Ten things that can sink a grant proposal’ which includes sage advice such as: ‘An

Many scenes of the play involve communicating with parents, often around conflicts involving personal and parental aspirations. The scenes are interspersed with poetry, alluding to the teen brain as visiting a new city where one has not yet figured out the shortcuts. At one point the audience is treated to a realtime ‘brain scan’ where the actors anonymously respond to statements projected onstage by lighting a representative lamp via remote. Each statement is more provocative and illuminating than the last, ranging from ‘I want to be a lawyer’ (no lamps light up) to ‘I am in love with someone on this stage’ (half the lamps light up).

Islington Community Theatre (www.islingtoncommunitytheatre.com) works with young people from across the entire second decade (ages 9–21 years) in close collaboration to create and perform professional-quality theatre performances. I had the great opportunity to witness one of the first rehearsals of this show, and was immediately struck by the level of control the young actors had on the production. The directors, Ned Glasier and Emily Lim, have an impressive ability to draw a story from each of a dozen voices, and facilitate the development of those stories rather than impose an already structured narrative. This is likely one of the reasons the production was so powerful at the same time as feeling authentic. Given that adolescence is a time in which heightened self-consciousness can make going out in public with a family member seem like torture, witnessing such bare openness was at times overwhelming.

I Reviewed by Kate Mills and Sarah-Jayne Blakemore, University College London

overoptimistic proposal assumes that results will turn out in line with prediction and has no fall-back position if they don't.

A proposal should tell us something useful even if the exciting predictions don't work out. You should avoid multi-stage experiments where the whole enterprise would be rendered worthless if the first experiment failed.’

But the main attraction in March was an exchange between Bishop and the authors of a paper she had criticised, on video games and dyslexia. The study, by Sandro Franceschini and colleagues and published in Current Biology, had just 10 participants per group and Bishop thought this underpowered. Two of the authors, Andrea Facoetti and Simone Gori, replied on Bishop’s blog that many other studies have used equally small samples. ‘This is undoubtedly true,’ Bishop said, ‘but it doesn’t make it right’. Bishop to Queen 4, Check.

The study authors also commented that ‘bashing other people’s work without any collected data that prove or at least support that claims [sic] seemed to us really unfair,

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honestly’, saying that ‘the suited arena for a scientific discussion should be the peer reviewed international journals’. This led Bishop to share her thoughts on so-called ‘post publication peer review’. In her opinion, ‘journal editors should have recognised this as a pilot study and asked the authors to do a more extensive replication, rather than dashing into print on the basis of such slender evidence’. As for whether a blog is the appropriate forum for such discussion, Bishop wrote: ‘I don’t enjoy criticising colleagues, but I feel that it is entirely proper for me to put my opinion out in the public domain, so that this broader readership can hear a different perspective from those put out in the press releases.

And the value of blogging is that it does allow for immediate reaction, both positive and negative.’

Judging from the wider reaction to her blogging, she has plenty of support for that view.

I Reviewed by Dr Jon Sutton who is Managing Editor of The Psychologist

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Making interventions work in education Handbook of Implementation Science for Psychology in Education Barbara Kelly & Daniel F. Perkins (Eds.) This book aims to explore and explain what makes psychological interventions work and how to enhance the impact in natural educational contexts characterised by the lack of experimental control.

It pulls together the epistemological, methodological and theoretical aspects of implementation science, covering various practitioners’

frameworks and approaches, specific interventional methodologies and programmes in the key areas derived from educational and psychological theory and research.

What is really interesting and innovative about this book is that it makes headway in clarifying concepts of implementation science, defining its overall readiness in terms of resources, skills, effective delivery and evaluation, concerning an unbalanced account of awareness and practice in the current evidencebased programmes, and suggesting professional roles such as interventionist field specialists.

This book is different from other intervention-related books in several aspects. It does not

Ethical treatment Side Effects Steven Soderbergh This captivating film is apparently director Steven Soderbergh’s last and stars Jude Law as Dr Banks, the current psychiatrist of patient Emily Taylor (Rooney Mara). After Banks asks Taylor’s former psychiatrist (Catherine Zeta-Jones) for advice he sets off a chilling chain of events.

Psychiatric drugs are the keystone of this film, as the title suggests, with various aspects of the psychiatric and psychological milieu cleverly coming in and out of focus throughout. The relationship between a psychiatrist and their client, the free will of the patient and the ethical issues surrounding the behaviour of large pharmaceutical companies all feature, resulting in the occasional feeling that you are watching a number of different films at once. That is, however, until the final act when Soderbergh expertly brings everything together. This film is both a psychological thriller and a court-room drama, with a couple of scenes of a sexual nature thrown in for good measure.

Jude Law’s character comments on the difference between America and the UK with regard to treatments for mental health disorders and their associated stigma. This may be of particular interest to readers of The Psychologist; however, these comments and the many representations of various issues relating to mental health are sure to result in some interesting post-film conversations for lay people, experts and all in between. Rooney Mara’s portrayal of someone experiencing severe depression should have you on the edge of your seat during the film, and keep you talking afterwards.

Hers is not the only depiction of a life spiralling downwards, and this film is one of Jude Law’s best.

Those familiar with the themes should not assume this will be a bore; the beauty of this film is that you will want to watch it again.

I Reviewed by Charlie Lea who is a PhD Student at Royal Holloway, University of London

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solely tackle the ‘classical’ barriers to effectiveness (such as accessibility, variability and unpredictability). It equally demonstrates the emergence of successful, constructive evidence-based implementations developed by rigorous, alternative protocols that are complementary of traditional paradigms. It

explores implementation frameworks in a range of educational contexts; some are from a wide lens and others have narrow focuses. It underlines the subtleness and complexity of developing implementations, and critically demands systematic, analytical approaches to evaluating effectiveness in a dynamic ecology of education with the purpose of fostering a shared vision in psychology and education.

I would recommend this book as a useful resource for those who are involved in understanding, designing, delivering, measuring and improving interventions in realworld educational contexts.

I Cambridge University Press; 2012; Hb £90.00 Reviewed by Qing Wang who is a doctoral researcher in educational psychology at the University of Bristol

Psychological understanding of design Designs of the Year Awards Design Museum, London Described as ‘the Oscars of the design world’, London’s Design Museum (http://designmuseum.org) has currently devoted a floor to this annual Design of the Year Awards. International designs from seven categories have been nominated: architecture, digital, fashion, furniture, graphics, transport and product.

The event has been curated to mix the categories together, giving a pleasing hodge-podge of designs from different areas. The exhibition showcases high-brow couture alongside everyday design, such as the non-stick ketchup bottle. Attractive graphic designs include the covers of Ralph Ellison’s books designed in the jazz-era style, and Adam Thurlwell’s book written with type-faces running in

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Flatten, talk and check Horizon: How to Avoid Mistakes in Surgery BBC In this programme, Dr Kevin Fong who is a Consultant in Anaesthesia at University College Hospital, London, explored the human factors that can impact upon patient safety, focusing on the lessons that can be learned from other professions. The Elaine Bromley case is used throughout the programme to consider how the decisions and actions that members of a surgical team take under pressure can lead to adverse outcomes – in this case, leading to the death of the patient 13 days after a routine operation.

Dr Fong began by demonstrating a simple experiment designed to examine the impact of cognitive load.

This showed that, when experiencing cognitive load, our capacity to monitor other stimuli

reduces significantly, seriously impairing our situational awareness. The fire service has developed a range of techniques to enhance the situational awareness of fire-fighters, who regularly deal with competing demands in emergency situations. Simulations allow them to practise decision making under extreme pressure, and the training is resulted in considerable benefits. Such techniques are now being used to help doctors in training to develop strategies to cope under pressure. Dr Sarah Cheavley-Williams, also of University College Hospital, is leading the development of human factors simulation training within their medical training programme. Dr Fong suggested that improved situational awareness gained

all different directions, and with pull-out sections in amongst the book to emphasise the chaotic nature of the story.

Two exhibits stood out to me from a health psychology perspective. The first was an app which aims to encourage exercise by making it more fun to run. The ‘Zombies, Run!’ app creates an interactive running experience. This is a personalised gaming environment which combines music from your playlists on your smartphone with voiceovers and sound effects. The app tells you where to run to escape the zombies.

The second exhibit that caught my eye was Australian cigarette packaging. This has gone further than UK cigarette packaging, in that nearly all of the packet is made of up disturbing imagery of smoking-related diseases and brand logos are absent. All colour palettes have been replaced by Pantone 448C, identified as the least attractive colour for packaging from market research by the Australian Department for Health and Ageing.

These two designs show psychological understanding being harnessed to provide useful interventions in an everyday context.

The first shows short-term reward being used to reinforce exercising behaviour, the second shows health promotion campaigns harnessing the power of imagery and acting to limit the subliminal power of branding.

Whether it is the psychology of design you are interested in or not, the exhibition is worth checking out, for the diversity of the exhibits and to see what is being rated in the world of design at present.

I Reviewed by Lucy Maddox who is a clinical psychologist in the NHS and Associate Editor for ‘Reviews’

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through the use of such techniques may have enabled the consultants involved in the Elaine Bromley case to take a step back and consider alternative treatment options, rather than merely repeat the unsuccessful interventions that they had already tried.

Lessons that can be learned from safety procedures used by the aviation industry and Formula One (F1) racing were also considered in the programme. Surgical checklists have recently been developed based on those used in aviation in order to enhance team working and decision making during surgical procedures.

An evaluation of the benefits of using these checklists conducted in eight countries, has found a 35 per cent reduction in surgical complications and death overall.

This success is attributed in part to a ‘flattening’ of the hierarchical structure traditionally found in surgical teams. The potential negative implications of such hierarchies was well illustrated by Elaine Bromley’s case – during her surgical procedure, a nurse had suggested an alternative solution to the consultants several times, but she had been

ignored. A flattened structure and clearer communication channels may well have led to a different outcome.

The importance of leadership, clear roles for team members, and designated personal responsibility for a small number of tasks are the lessons that can be learned from F1 racing. Introducing such processes directly after surgery and during patient handover to ICU has led to a 40 per cent drop in human error. Again, clear communication, flattened hierarchies and well-defined roles combine to support medical staff in making accurate and effective judgements to benefit patient outcomes.

Finally, Dr Fong presented evidence that introducing training to help medical staff recover quickly from errors, the development of procedures that are standardised, but will encourage innovation where required, together with effective multidisciplinary teamwork can help medical teams reduce human error and deliver a powerful impact on patient safety.

I Reviewed by Siobhan Wray who is a Senior Lecturer at Sheffield Hallam University

Another episode of Horizon looked at the cognitive and social foundations of taste: recognised as the sense most associated with pleasure. The evolutionary nature of taste featured strongly, describing our preferences for sweet and fatty foods as high-calorie sources, rather than bitter and sour flavours indicating potential harmful toxins. Various researchers described their quests to locate the ideal, natural sugar-replacement to satisfy our evolutionary needs: varying from tomato-based to ‘Miracle berry’ sources.

Perhaps most interesting to me was the work of psychologist Professor Linda Bartoshuk on the individual variability of taste receptors on the tongue and their extreme effect on flavour perception.

With evidence from both large-scale research and case studies, this programme provided a broad, interesting introduction to taste research. Ending with a discussion on the social environment of human eating, the documentary ended with some resonating thoughts on taste and the obesity epidemic in modern society: ripe for future Horizon coverage.

I Reviewed by Emma Norris who is a PhD student at University College London

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Art and analysis The Rinse Cycle Jim Shaw

Our best friends? Perhaps…

Attachment to Pets: An Integrative View of Human–Animal Relationships with Implications for Therapeutic Practice Henri Julius, Andrea Beetz, Kurt Kotrschal, Dennis Turner & Kerstin UvnäsMoberg Co-authored by biologists and psychologists, this book delivers an excellent review of both biological and psychological theories and studies, providing a valuable resource for beginners and more knowledgeable readers on both human–human and human–animal relationships.

The focus is mainly on the biological effects of oxytocin (a physiological chemical involved, amongst other functions, in the reduction of stress and fear), the psychological theories of attachment and caregiving, and the development of dysfunctional human–human interactions.

Evidence for the benefits of human–animal interactions is also explored, and the authors then postulate a model of human–animal relationships, incorporating these factors, to explain how animalassisted therapy can help human well-being and human–human relationships. The book finishes with a brief chapter on the practical implications of this model for therapy.

Despite being a thin volume, it is densely packed with information. Overall I really enjoyed the book, it furthered my knowledge on the topic, ignited my interest as both a researcher and a therapist, and it was fascinating to think of the potential for future research and animal-assisted therapy.

I Hogrefe; 2013; Pb £27.90 Reviewed by Kate Sparks who is a Chartered Psychologist

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Jim Shaw’s work will always attract the attention of a psychologist; if not for the themes of the art (perceptions of pain, exploring suicide through ripped up self-portraits, analyses of dreams and the unconscious mind, narcissism) then for the artist's description of himself. As a self-diagnosed 'attention deficit sufferer' and interpreter of his own dreams, Jim Shaw certainly puts on a good show. His series have previously been shown only in isolation; however, for the first time, they have been brought together in ‘The Rinse Cycle’ at BALTIC in Gateshead, a two-floor exhibition comprising over 100 pieces taken from Shaw’s back catalogue (see tinyurl.com/cjabdrr).

I was fortunate enough to attend his end of show Q&A session with the BALTIC curator, and I couldn't resist asking a few non-arty questions.

First I asked how someone with ADD has the persistence to work on one series for years. Although he sets out with a theme, he answered, the diversity of the pieces within each theme represent his frequent loss of focus, changes in direction and need to start something new. The final theme, he revealed, is usually the sum of its somewhat eclectic parts, rather than a focus from the start. Maybe this is the art equivalent of naming that last factor in an exploratory factor analysis.

Some of his most disturbing works come from his ‘Dream Drawings’, which serve as pieces in their own right but also as a repository for his future pieces. When asked about his dream pieces, Shaw suggested that most dreams are boring, but when you start making your dreams into art for a living, the subconscious kicks in to provide you with material. This seems like quite useful system for a commercial artist.

My non-arty questions seemed to surprise Shaw, but the answers removed some of the arty mystique of his work. Whether his pieces are actually manifestations of his subconscious or just consciously creative is neither here nor there; the themes make sense, even if they are applied post-hoc, and the individual pieces are amazing.

I BALTIC Centre for Contemporary Art (November 2012 to February 2013) Reviewed by Dr Mark Wetherell who is a Reader in Psychobiology & Health Psychology at the University of Northumbria

Beyond hot air to inconvenient truths [citation needed] Tal Yarkoni In the wake of the Stapel research fraud case, initiative after controversy has hit psychology, to the point where it almost feels like the discipline is engaged in a very painful and public form of selfflagellation. The Psychologist has of course contributed to the debate, with various news items and our special issue on replication (tinyurl.com/psycho0512).

Now Tal Yarkoni, a postdoctoral fellow in the Department of Psychology and Neuroscience at the University of Colorado at Boulder, has stepped into

the fray with a fascinating post on his blog (tinyurl.com/talyarkoni).

You could be forgiven for thinking that academic psychologists have all suddenly turned into professional whistleblowers, Yarkoni begins. ‘Everywhere you look, interesting new papers are cropping up purporting to describe this or that common-yet-shady methodological practice, and telling us what we can collectively do to solve the problem and improve the quality of the published literature.’ Yarkoni emphasises that he thinks

these developments bode well for the long-term health of our discipline, seeing them as ‘solid indications that we psychologists are going to be able to police ourselves successfully in the face of some pretty serious problems’.

Yet Yarkoni points out that with any zeitgeist shift, there are always naysayers.

He has found himself arguing – ‘with somewhat surprising frequency’ – with people who ‘for various reasons think it’s not such a good thing that Uri Simonsohn is trying to catch

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Sensationalised sleep struggles Bedtime Live Channel 4 This programme about children’s sleep difficulties had a primetime slot and was hosted by clinical psychologist Professor Tanya Byron and Jake Humphreys, former Formula One anchor on the BBC. Although they seemed like an odd pairing, it was great to see an applied psychologist at the helm, as I have regularly had to ‘undo’ some of the more unhelpful advice ‘Supernanny’ Jo Frost has given over the years. Jake Humphreys, however, seemed a bit out of place and didn’t appear to add much to the show. His main role was asking Professor Byron scripted questions, and he frequently made comments that appeared patronising and unhelpful, such as ‘aww but he’s so cute in that Spider Man costume’!

A number of different families of children of various ages took part in the programme, which involved cameras being placed in their homes to film bedtimes. The goal was to have each child in bed asleep by 9pm, and throughout the programme live footage of families’ progress with this was shown. Each family featured was assigned a ‘sleep expert’ who talked them through exactly how to respond to behaviour as it happened, via a headset. The sleep experts were practitioners experienced in supporting families with sleep issues and included a health visitor and a sleep physiologist. Live footage was interspersed

fraudsters, or that social priming findings are being questioned, or that the consequences of flexible analyses are being exposed’. Yarkoni then helpfully summarises why ‘the arguments for giving a pass to sloppy-but-common methodological practices are not very compelling’.

Yarkoni painstakingly rebuts arguments such as ‘But everyone does it, so how bad can it be?’, ‘But psychology would break if we could only report results that were truly predicted a priori!’, ‘But mistakes happen, and people could get falsely accused!’, ‘But it hurts the public’s perception of our field!’ and ‘But unreliable effects will just fail to replicate, so

with comments and explanations from Professor Byron, in addition to segments where results of parent polls (conducted via the Bedtime Live website) were discussed and lay explanations of related topics such as brain function were provided.

The advice given to families was well founded and clear, but many golden opportunities to discuss the wider context of the presenting difficulties were missed.

For instance, the programme followed one family’s struggle with their two-year-old son’s insistence on being breastfed but made no reference to attachment nor the family’s feelings about their role transition, which clearly seemed to be part of the issue.

The show would have also benefited from more discussion about the principles behind the advice being given in order to help families have a better understanding of why responding in a particular way was so important.

Although the premise of the show seemed like it could be a useful, credible resource for a specific group of parents, what bothered me was the way people’s struggles were sensationalised, which is a common feature nowadays of such docudramas. What should have been the programme’s main aim of trying to help families with a very real and challenging problem seemed to get somewhat lost along

what’s the big deal?’

Interestingly, he then runs aground on ‘But it would hurt my career to be meticulously honest about everything I do!’

‘Researchers have many incentives to emphasise expediency and good storytelling over accuracy,’ Yarkoni admits, ‘and it would be disingenuous to suggest otherwise… researchers who have, shall we say, less of a natural inclination to second-guess, double-check, and crossexamine their own work will, to some degree, be more likely to publish results that make a bit of a splash.’ Yarkoni says this is a classic tragedy of the commons: what’s good for a given individual, career-

wise, is clearly bad for the community as a whole.

A blog isn’t necessarily the place to find a solution, although Yarkoni says that it may be ‘to restructure the incentives governing scientific research in such a way that individual and communal benefits are directly aligned’ – as he admits, ‘a long and difficult process.’ But a blog is the place to move beyond hot air between two people, airing these inconvenient truths in a way that reaches a wider audience and encourages reasoned debate in the comments below.

I Reviewed by Dr Jon Sutton, Managing Editor of The Psychologist

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the way whilst the producers clearly zoomed in on the shock value and drama. Even the set was reminiscent of a game show.

Families were encouraged and praised for their efforts, but it somehow didn’t feel sincere with the extensive use of ‘sweetheart’ and ‘darling’.

Overall, it is positive to see that psychologists are now getting involved with providing more robust, evidence-based advice for common difficulties such as children’s sleep problems via the popular media but we still have a long way to go…

I Reviewed by Fleur-Michelle Coiffait, PsyPAG Chair and trainee clinical psychologist, University of Edinburgh/NHS Lothian

A timely contribution Community Psychology and the Socio-economics of Mental Distress: International Perspectives Carl Walker, Katherine Johnson & Liz Cunningham (Eds.) This book takes a critical look at the globalisation of Western psychology and the ensuing individualisation and medicalisation of mental health. Chapters by professionals and academics from around the world consider community psychology approaches as an alternative to this.

Community psychology is a growing and dynamic discipline within psychology and so this book provides a timely contribution to the field. This is particularly so given the book’s emphasis on socio-economics and the discourses of neo-liberalism, in the context of a changing global economy. In the final chapters, culturally sensitive psychology responses to unique economic challenges are presented from countries as diverse as Canada, the US, the Philippines and Sri Lanka.

I found the themes and ideas in this book thought-provoking, making me reflect on my own understanding of mental health and clinical practice. Every chapter is thoroughly researched, well written and full of helpful references. Recommended audiences would include mental heath professionals, researchers, policy makers, students of sociology and psychology, as well as anyone with an interest in critical community psychology and, fundamentally, the causes of mental distress.

I Palgrave Macmillan; 2012; Pb £29.99 Reviewed by Dr Rachel Smith who is a Clinical Psychologist with East London NHS Foundation Trust and Clinical Tutor at the University of East London

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Download, play, and help neuroscience The Great Brain Experiment Wellcome Trust Centre for Neuroimaging Launched at the start of this year's Brain Awareness Week (11–17 March 2013), The Great Brain Experiment is a mobile gaming app for Android and iOS with a serious purpose; crowdsourcing data in order to learn more about memory, self-control, attention, decision making and happiness. Four appealing games with cute animations test players’ wits and allow researchers at the Wellcome Trust Centre for Neuroimaging to gather data from a wider population than usual.

‘How much can I remember?’ tests working memory by asking the player to remember and recreate increasingly speedy and complex patterns of red circles, whilst ‘Am I impulsive?’ is reminiscent of Fruit Ninja; players must smash falling apples and pears but resist the urge when the fruits are rotten.

The attentional blink effect is tested by ‘How much do I see?’, in which participants look out for the second of the same category in a quickly presented series of images. Finally, our happiness in relation to risk-taking and its outcomes is examined in the points-gambling based ‘What makes me happy?’.

The games are fun and quite addictive (although maybe not as much so as Angry Birds, which may be a good thing!), with the nice touch that you can compare your scores against the nation as well as any friends also playing.

So, download, play, and help neuroscience.

I Reviewed by Jen Tidman, the Open University

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A life-changing event Sample book titles just in: The Psychological Significance of the Blush W. Ray Crozier & Peter J. de Jong (Eds.) Strangers in a Strange Lab: How Personality Shapes our Initial Encounters with Others William Ickes The Devil Within: Possession and Exorcism in the Christian West Brian P. Levack Windows on the Abyss K.M. Hartmann The Sleep Room F. R. Tallis Working Memory: The Connected Intelligence Tracy Packiam Alloway & Ross G. Alloway (Eds.) Between Mind and Nature: A History of Psychology Roger Smith The Oxford Handbook of Retirement Mo Wang (Ed.) The Oxford Handbook of The Psychology of Appearance Nichola Rumsey & Diana Harcourt (Eds.) The Education of Selves: How Psychology Transformed Students Jack Martin & Ann-Marie McLellan Advances in Culture Psychology M.J. Gelfand et al. (Eds.) For a full list of books available for review and information on reviewing for The Psychologist, see www.bps.org.uk/books Send books for potential review to The Psychologist 48 Princess Road East Leicester LE1 7DR Remember, ‘Reviews’ now covers psychology in any form: books, films, apps, plays, web, TV, radio, newspapers, etc.

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Baby Britain season BBC Three It’s well worth seeing if you can catch up with the ‘Baby Britain’ season on BBC iPlayer (see tinyurl.com/c9g3l2o). A special season of BBC Three programmes explored what it means to be a young parent in Britain today, and how having a baby changes your life. Stacey Solomon explored why young mums get postnatal depression and what help is available; ‘Don’t Just Stand There… I’m Having Your Baby’, ‘The Baby Bomb’, and ‘We’re Having a Baby’ followed ‘clueless first time dads’ and other new families taking a crash course in pregnancy and childbirth; and ‘A Special Kind of Mum’ looked at life as a young, disabled mum.

I watched ‘Prison Dads’, a documentary from Ruth Kelly covering six months in the lives of fathers at Glen Parva in Leicester – the biggest young offenders institution in Britain.

Prisoners there are five times more likely to be dads than

other men their age. Although the offences and treatment of their beleaguered other halves of some of the dads featured made it rather difficult to identify with them, you’d need a heart of stone not to get a tear in the eye at the dawning realisation that ‘That’s all gone now, for good that is. Won’t see him do his first words, trying to crawl, all that funny baby stuff’.

The children are growing up with the situation and don’t know any different, with one being told that Dad is ‘on naughty holiday’. These dads are just kids themselves, hankering after schooldays as they chat in their cells. You just have to hope that they will have plenty of professional support on release, to face up to their adult responsibilities.

I Reviewed by Dr Jon Sutton who is Managing Editor of The Psychologist for the British Psychological Society

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investigated were Rudi Schneider and Helen Duncan.

Rudi Schneider was a young Austrian who took part in over 50 séances at Price’s laboratory between 1929 and 1932.

William Brown, then Wilde Reader at Oxford University and a Harley Street psychotherapist, attended seven – examining the medium, serving as a Elizabeth Valentine on psychologists and psychical research between the wars ‘controller’ and taking physiological measurements. On one occasion he witnessed ‘magnificent phenomena’: curtains billowing, a basket jumping about on his knee, something stepping he close connections between on his foot, flowers flung out of a cabinet, the SPR reached a peak in 1920. However, psychologists and the Society for a loud bang behind the sitters, a table top by 1930 it was in disarray, split by Psychical Research (SPR) at the end torn from its legs and flung over their factions, and several rival institutions of the 19th century are well known. What stepped into the breach. Amongst these heads. He wrote a letter to The Times is less well known is that senior British describing his experiences, attributing was Harry Price’s National Laboratory of academic psychologists were engaged in them to some unseen agency and Psychical Research, which opened in 1926 psychical research as late as the 1930s. mysterious power, and recommending with ‘a flurry of media attention’.

William McDougall and William Brown careful scientific investigation.

The Laboratory specialised in the attended and assisted at séances at Harry Helen Duncan was a Scottish study of physical mediums, i.e. those who Price’s National Laboratory of Psychical housewife, a sometime bleachworks demonstrated physical phenomena such Research; Jack Flugel, Cyril Burt, Alec employee, who married a cabinet maker as levitation, apports (the movement of Mace and Francis Aveling were members injured in World War I, by whom she objects without apparent cause), of his University of London Council for had 12 pregnancies and ‘ectoplasm’ (a white Psychical Investigation and supported six surviving children. substance, taken as psychical research in various ways. All She weighed 17 stone and materialisations of the “psychology was still at except Aveling were members of the SPR. worked as a medium. She dead by bereaved sitters) a transitory stage at Harry Price was a salesman for paper attended five séances at the and false limbs. Such this period, establishing merchants and an amateur psychical National Laboratory in mediums had the researcher, but his values were those of 1931, at several of which advantage of providing its boundaries” a businessman rather than a scientist.

William Brown, William spectacles for the public Lacking scientific credentials and McDougall and Jack Flugel as well as observable defensive about his working-class were present. Duncan entered a data for scientists. Price background, he craved publicity and was cabinet, went into trance, was taken over prided himself on his scientific approach prepared to sacrifice truth in pursuit of by a ‘control’ (a trance personality) and and amassed an enormous amount of his goals. A complex and controversial produced ectoplasm. Price delighted in equipment to demonstrate this: cameras, figure, The Economist accused him of taking stereoscopic photographs. He dictaphones, rheostats, timing devices, being ‘a rogue, a falsifier, and a became convinced that Duncan was ultra-violet and infra-red apparatus and manufacturer of evidence’. Why did swallowing cheesecloth when in the even an X-ray machine. Great pains were reputable psychologists collaborate with cabinet, which she then regurgitated – taken to attempt to prevent cheating. him? not easily seen by sitters in the red light.

Mediums were searched internally and The Society for Psychical Research So he arranged for her to be X-rayed after externally and sewn into a special was founded in 1882 in an era of the fourth séance. Duncan evaded garment with luminous strips attached. In spiritualism. Many of its members and examination by staging a hysterical fit. one case, an electrical circuit was arranged presidents were and are psychologists.

As Price relates: – the medium and sitters were connected She jumped up, and dealt her World War I led to increased interest in to each other by gloves and socks husband a smashing blow on the telepathy and the possibility of survival containing metallic strips: if the circuit face; she then made a lunge at Dr. after death as a result of the massive was broken, a bell rang.

William Brown, who dodged the number of bereavements. Membership of Two notable mediums that Price

Spook hunting and ghost busting

references

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Dingwall, E.F., Goldney, K.M. & Hall, T.H. (1956). The haunting of Borley Rectory.

A critical survey of the evidence.

London: Duckworth.

Gregory, A. (1977). Anatomy of a fraud: Harry Price and the medium Rudi Schneider. Annals of Science, 34, 447−549.

Hall, T.H. (1978). Search for Harry Price.

London: Duckworth.

Price, H. (1942). Search for truth: My life

for psychical research. London: Collins.

Valentine, E.R. (2012). Spooks and spoofs: Relations between psychical research and academic psychology in Britain in the inter-war period. History of the Human Sciences, 25(2), 67–90.

blow… Dr. Brown, thinking she would like a drink, went to fetch a glass of water. Immediately, without the slightest warning, the medium jumped up, unfastened the door, rushed into the street, where she had another attack of hysterics. Her husband dashed after her, followed by a procession of sitters…: Dr. William Brown with a glass of water; Professor McDougall with towel; Professor Flugel; … a lady with smelling salts; myself with brandy flask (kept for such emergencies)…

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It subsequently transpired that Duncan had passed the cheesecloth to her husband during the fracas; he refused to be searched. Duncan was convicted of fraud on several occasions.

Faced with problems over the accommodation of his laboratory, Price explored possible collaborations but without success. In 1933 he made a formal offer to the University of London to found a Department of Psychical Research. He was prepared to donate his equipment, a large collection of relevant books and an annual stipend. The offer was considered by many boards and committees of the University. Jack Flugel, as secretary, helped steer it through the Board of Studies in Psychology. In the end the idea was approved in principle – psychical research was deemed suitable for university study, at least at postgraduate level – but the offer was declined on account of limited space and finances.

Despite this, the following year Price managed to set up a ‘University of London Council for Psychical Investigation’. This consisted of four psychologists (Jack Flugel and Cyril Burt from University College; Alec Mace from Bedford College and Francis Aveling from King’s College), two philosophers (one of whom was Cyril Joad, the well-known broadcaster), a theologian, a physicist, a physician and a mathematician, plus Price as director and his secretary. The Council was to oversee research with funds provided by Price; and research was indeed conducted in all three colleges.

Burt had his wife carrying out cardguessing experiments. Flugel took part in a television broadcast of fire-walking at Alexandra Palace, in which Freddy Grisewood was the commentator. Burt and Flugel, together with their wives, visited the haunted Borley Rectory with

Price. Burt, as head of the Department of Psychology at University College, received Price’s equipment, though the Provost of the College thought it unwise to hold séances in a laboratory frequented by younger students, as undesirable rumours might get about. The X-ray machine went to Guy’s Hospital. Price’s books were donated to the University Library (where they remain to this day); it took three days to move them. The University wined and dined Price at the Athenaeum. For a while Price managed to keep both academics and journalists on board. But members of his Council

of providing evidence against what they regarded as materialist and mechanist dogmas. McDougall saw this as a moral issue. Thirdly, psychology was still at a transitory stage at this period, in the process of establishing its boundaries.

Paranormal phenomena were regarded by many as part of the subject matter of psychology. A key factor in the mutual attraction of Price and the psychologists may have been their common enterprise in straddling the still fluid boundaries between professional and amateur. They aimed to assert scientific authority and expertise while also appealing to the

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It was then striking midnight.

We found Mrs. Duncan clutching the railings and screaming at the top of her voice. A crowd soon collected.

Her husband tried to pacify her. The medium – who weighed 17 stone – was, of course, still in her black sateen séance combinations. It was a most extraordinary sight. Then the police rushed up and an ambulance was sent for. However, Professor McDougall and the other medical men present were able to satisfy the police that it was merely a woman in hysterics and that nothing serious was the matter. With this assurance – and something of a more material nature – the officers departed. (Price, 1942, pp.180–82)

Harry Price in his laboratory

became irritated at his sacrifice of truth in pursuit of publicity and his disregard for them. On Joad’s recommendation, the Council was wound up in 1938.

Ironically, given Price’s frequent exposure of cheating in others, he was accused of fraud and deception himself (Gregory, 1977; Hall, 1978) and, as in the case of Borley Rectory, of creating phenomena (Dingwall et al., 1956). So why did the psychologists collaborate with him? Several reasons can be adduced: Firstly, there is evidence that McDougall interested Brown, Flugel and Burt in psychical research while they were students of his at Oxford. Secondly, McDougall, Brown, Burt and Mace espoused vitalist and dualist doctrines.

Psychical research offered the possibility

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general public. Thus Price flaunted his equipment and courted journalists, such as the editors of Nature, The Listener and the Daily Mail. The academics had established scientific credentials but took an active part in public life, advising the government, lecturing, writing popular books and broadcasting. Their relationship reveals much about the negotiations that psychologists engaged in at this critical period in their history.

I Elizabeth Valentine is Emeritus Professor of Psychology at Royal Holloway, University of London, and Honorary Senior Research Associate, University College London E.Valentine@rhul.ac.uk A more detailed account can be found in Valentine (2012).

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