Differential Patterns of Distractibility in College Students with ADHD: Implications for Classroom Instruction and Accommodations

Also to be presented at Lilly International Conference on College Teaching at Miami University this November is the following project:

Jonathan J. Hammersley, Ph.D. & Kristy M. Keefe, Psy.D

Abstract:

Attention Deficit Hyperactivity Disorder (ADHD) and attentional difficulties, including neurocognitive research, assessment, and classroom accommodations, are important to effective teaching. The current project discusses prior neurocognitive research, and explains how such data can be utilized to better understand and assess students with ADHD, leading to classroom accommodations. In addition, unique characteristics of adult ADHD, their impact on classroom instruction and guidelines for ADHD as a disability, and rationale for accommodations are addressed with audience members.

 
Students with Attention Deficit Hyperactivity Disorder (ADHD) and related clinical attentional difficulties are of utmost importance to faculty in higher education. Further research can clarify roles that environmental distractors play in such difficulties. Applying neurocognitive research and assessment to relevant classroom accommodations is also important to effective teaching. The current project discusses prior neurocognitive research, including a recent series of studies by the authors on emotional cueing and distractibility in college students. We explain how such data can be utilized to better understand and assess students with ADHD, leading to classroom accommodations.
 
The study of emotional cueing and distractibility can provide useful implications for clinical assessment and teaching. Stimuli to which individuals are predisposed to attend may provide insight into emotional distraction as it relates to clinical disorders that include ADHD. The present proposal focuses on clarifying the impact of ADHD symptoms on cueing and distraction in college students, and appropriate academic accommodations to reduce their impact.  

Variations of the covert attention task developed by Posner (i.e., Posner, Snyder, & Davidson, 1980) are useful for studying particular attentional deficits, including lateralized information processing discrepancies (Swanson, Posner, Potkin, Bonforte, Youpa, Fiore, Cantwell, & Crinella, 1991) or in automatic versus controlled, executive attentional functions. For example, an important aspect of attention, which is examined in Posner’s covert attention task (COAT) paradigm, is that humans typically show substantially faster reaction times following 800-millisecond relative to 100-millisecond delays between an arrow cue (ß or à) and a subsequent target.

Incorporating affective imagery (i.e., sad or happy faces) into Posner’s COAT paradigm can be especially useful for measuring emotional cueing and distraction. Measuring visual spatial attention to cued targets is also a way to measure psychological and neurobiological mechanisms driving attention and distraction (Rafal, 1996). Specific brain regions may play roles in covert attention; the right parietal lobe appears involved in visual orienting, and the left parietal lobe may play a minor role. Also, the right hemisphere may process more globally while the left hemisphere processes more local information (Posner, 1996).

Attentional deficits are probably involved in a number of other clinical disorders than ADHD, as emotional distress seems to is related to increased attention to negative events (Wells & Matthews, 1994). Positive or negative emotional state appears to have a substantial impact upon attention. Brain anatomy modulating both emotion and attention sheds light on associations between these processes. The anterior cingulate cortex (ACC), part of the brain’s limbic system, regulates aspects of both cognitive and emotional processing separately (Bush, Luu, & Posner, 2000), with subsections primarily involved either cognitive or affective information. Moreover, the cognitive division is not only activated by cognitively demanding tasks, but is inactive during intense emotion; the affective division, however, can be activated during emotion but suppressed during cognitive demands.

Thus, emotion seems to affect cognitive processing, and vice versa. It should follow that certain disorders involving disregulated attention, such as ADHD, are related to differential emotional distractibility during cognitive task performance that is apparent in both laboratory and classroom settings.

In a series of pilot and clinical studies, the authors first assessed ADHD symptomatology. Modified COATs were utilized to measure lateralized responses to cued targets, using emotionally salient or emotionally neutral images as either cues or distractors. Performance on the modified COAT was examined in normal college students or in individuals reporting clinically relevant ADHD symptoms. The results of the study demonstrate how individuals with attentional deficits were differentially cued or distracted by emotional imagery, in relation to those without attentional deficits during computerized attention tasks.

In addition, the current project discusses implications of ADHD research and assessment, including classroom accommodations that are useful to both students and faculty. Specifically, unique characteristics of adult ADHD in college students such as working memory and recall deficits and their impact on traditional classroom instruction are reviewed. Assessment instruments used to provide ADHD diagnoses and to suggest accommodations are reviewed and discussed, including rationale for accommodations. Questions regarding assessment and qualifications for accommodations are also addressed with audience members, and suggestions are provided to increase the effectiveness of teaching this specific population of students. Guidelines for the categorization of ADHD as a disability in colleges are also addressed.
 

Baseline-Dependent Moderation of the Effects of Nicotine on Spatial Attention

The below project was presented at the 16th Annual Duke Nicotine Conference in September 2010 and will be submitted as a manuscript to Nicotine & Tobacco Research

Jonathan Hammersley, Ph.D., David Gilbert, Ph.D., Adam Rzetelny, Ph.D., Robert Radtke, Ph.D., & Norka Rabinovich, B.A.

ABSTRACT

The present study assessed the effects of nicotine on spatial attentional orienting in 52 habitual smokers (27 females and 25 males), using a covert attention (arrow-cued) target detection task (COAT). Analysis of covariance (ANCOVA) and a subsequent analysis of variance (ANOVA) demonstrated that relative to placebo, 14 mg nicotine patch produced shorter reaction times (RTs) across task conditions. In addition, individuals slower RTs in placebo condition task performance, based on their mean performance on the two placebo days, benefitted more from nicotine across conditions than did those who had faster RTs in placebo performance. Nicotine also enhanced the validity effect (shorter RTs to validly cued vs. invalidly cued visual field), but the validity effect benefit due to nicotine did not differ as a function of overall baseline placebo vigilance performance. Findings support the view that nicotine enhances spatial attentional orienting to a greater extent in individuals who are low (slower) during placebo abstinent (baseline) conditions. Results are discussed in terms of individual differences in baseline performance, situational arousal / habituation and associated mediators and moderators.

BACKGROUND

Experimental studies indicate that nicotine and other cholinergic drugs affect a variety of attentional systems (e.g., Levin & Simon, 1998). The covert attention task (COAT) requires central fixation centrally while covertly directing attention to one side of a screen when cued by a central arrow, and one responds to a peripheral target (Posner, 1980; Posner & Petersen, 1990). Reaction times (RTs) to targets are typically more rapid when targets are preceded by valid versus invalid cues (validity effect). Research examining effects of nicotine on spatial attention are somewhat limited or inconsistent and typically use a different, peripherally-cued version of the COAT. Some studies suggest that nicotine and other cholinergic agonists enhance visuospatial reorienting during the COAT and related tasks (Thiel, Zilles, & Fink, 2005). A few studies suggest that in smokers nicotine may reduce reaction times for invalid trials without influencing valid trials (Witte, Davidson, & Marrocco, 1997) or have a general speeding effect, but no effect specifically associated with attentional orienting (Hahn, Ross, Yang, Kim, Huestis, & Stein 2007). 

Griesar et al. (2002) reported that, in nonsmokers, transdermal nicotine, relative to placebo, reduced RTs to targets during the COAT and was associated with a trend for nicotine to increase the validity effect. However, this latter effect only approached statistical significance, possibly due to small sample size (N= 12). As the effects of nicotine in nonsmokers frequently differ from the effects in smokers (Heishman, Henningfield, & Singleton, 2002; Newhouse, Potter, & Singh, 2004), these prior findings make it important to assess the effects of nicotine on attentional orienting in smokers using the standard COAT.

Eysenck (1980, 1997) proposed that nicotine’s effects are moderated by pre-drug baseline brain activation level that in turn is influenced by a combination of genetically influenced dispositional traits, situational arousal and fatigue potential of the environment. Consistent with baseline theory, Patterson et al. (2010) recently found that poorer working memory on a rapid information processing task (the N-Back) during abstinence predicted more rapid resumption of smoking. The present investigation assessed the possibility that inconsistency of the effects of nicotine on attentional orienting may depend on individual differences in be baseline attentional functioning, such that individuals with poor placebo baseline performance would benefit more from nicotine than those with better placebo baseline functioning (See Perkins, 1999 and Newhouse, Potter, & Singh, 2004, for a review of evidence supporting this effect for nicotine’s influence on attention generally).

METHODS

Participants

Participants used in analyses were 27 female and 25 male smokers with a mean age of 23.3 years (7.1 SD, 18-47 range) who smoked an average of 18.38 (5.4 SD, 10-40 range) cigarettes per day. Nicotine dependence was assessed with the FagerströmTest of Nicotine Dependence (FTND; Heatherington, Kozlowski, Frecker, & Fagerström, 1991). The mean FTND score was 4.36 (1.5 SD, 1-8 range), indicating a moderate degree of dependence. Two males and two females were African Americans and the remaining participants were Caucasian.  

Participants were recruited by newspaper ads and postings in the university community. Exclusion criteria included smoking fewer than 10 cigarettes per day for the past year, habitual cigarette estimated nicotine deliveries of less than 0.6 mg, reported use of psychoactive drugs or medications other than caffeine, marijuana, and alcohol, excessive alcohol use (more than 28 drinks/week), age less than 18 or more than 48 years, non-English speaking, atypical sleep cycles, pregnancy, and serious medical or uncorrected visual problems. Age was restricted because RTs become slower and sight poorer with age. Participants (N = 8) exceeding the maximum allowable CO or more than 3 drinks of alcohol the evening before, or reporting fewer than 5 hours of sleep, illness, or other drug use, including marijuana,resulted in rescheduling the session.

Design and Procedure
Participants were instructed not to smoke for 12 hours preceding each the experimental session, and only those who adhered to this abstinence were included in data analysis (CO-biochemically verified). During each of four experimental sessions (following two orientation sessions) participants completed the Posner (1980) COAT twice. Experimental days were separated by a minimum of 48 hours and a maximum of 5 days. The study was double blind for the nicotine versus placebo status of the patches, and patches and task orders were counterbalanced across sessions. Each participant received a nicotine patch on one of the first two experimental sessions and a second nicotine patch during one of the last two experimental sessions.

Tasks
Each COAT consisted of 180 trials, with left, right and no-arrow cues each appearing on 60 trials within a block. Of the 120 arrows, 96 (80%) were valid and 24 (20%) were invalid. Each trial consisted of a 1000 ms prompt to blink, a 500 ms central cross, a central arrow cue pointing left or right or absent, and an asterisk presented left or right of the cross (Figure 2). Instructions were to respond as rapidly as possible without sacrificing accuracy by pressing either the left or right key on a response box, and RTs were recorded to the nearest millisecond (ms).

RESULTS

Covert Attention Task (COAT)The covariate in a preliminary analysis of covariance (ANCOVA) was mean placebo RT time across all condition (experimentally manipulated independent factors). Both this initial ANCOVA and a subsequent ANOVA use the following factors: Nicotine (nicotine vs. placebo) × Validity (valid vs. invalid cue) × Patch Exposure (first vs. second day of exposure to the nicotine and placebo patches) × Visual Field (left vs. right target location) × Gender × Exposure (first two vs. last two experimental sessions). The ANOVA also included an additional between-subjects factor—Placebo-RT to which individuals were assigned based on their performance on the mean of the two placebo days RTs (bottom, middle, and top thirds of mean placebo RT).

The ANOVA revealed significant main effects for Validity and Nicotine, as well as significant Nicotine × Placebo-RT and Nicotine × Validity interactions. As expected, there was a highly significant main effect of Validity, F(1,46) = 288.030, p < .001, partial eta2 = .86, such that validly cued targets were associated with shorter RTs than invalidly cued targets. Nicotine was associated with a shorter (quicker) RTs to all cued targets than placebo (270.3ms vs. 290.4ms), F(1,46) = 80.96, p < .001, partial eta2 = .64; however, these effects of nicotine were moderated by cue validity such that nicotine shortened RTs more in the valid than invalid condition (Fig 1), Nicotine × Validity, F(1,46) = 5.909, p = .019, partial eta2 = .114. Consistent with the ANCOVA results, the effects of nicotine were also moderated by mean placebo-RT, Nicotine × Placebo-RT level, F(2,46) = 6.373, p = .004, partial eta2 = .217, such that longer RTs on placebo were associated with greater RT benefits (Figure 3).  
Relative to placebo, RT-reducing effects of nicotine were greater on the second exposure to nicotine (session 3 or 4) than on the first exposure (session 1 or 2) across valid and invalid conditions, , F(1,46) = 6.442, p = .015, partial eta2 = .123. There were no significant main effects of Gender involving Nicotine on RTs, and ANCOVAs using FTND dependence scores and age as covariates did not result in impact on main effects or interactions.

 

DISCUSSION

Overall, our findings are supportive of the hypothesis that NRT can enhance covertly cued attentional orienting, but that these effects are greater in those with slower placebo RTs, and are greater upon second testing, possibly due to lowered situational arousal potential/habituation to the experimental setting. Nicotine enhanced the validity effect, the tendency to benefit from valid relative to invalid spatial cues. This is consistent with the findings of Griesar et al. (2002) who found similar effects in nonsmokers. Present effects of nicotine on the COAT performance were placebo-baseline and task practice dependent.  

The present study was limited by a relatively modest in sample size and was not a fully representative sample of smokers, with respect to age, length of smoking history, and race. Effects of nicotine in very light, heavier, older, and substance abusing smokers were not assessed, nor can effects be generalized to ex-smokers and non-smokers.  While we refer to the effects of nicotine relative to placebo, the observed effects could reflect either effects of nicotine withdrawal alleviation in habitual smokers or inherently beneficial effects of nicotine.

Effects of Nicotine on Emotional Distraction of Attentional Orienting

I was co-author on an article in collaboration with the Southern Illinois University Integrative Neuroscience Lab ( http://www.smokelab.siuc.edu/ ), submitted to the Journal of Nicotine & Tobacco Research - details and summary below:

Effects of Nicotine on Emotional Distraction of Attentional Orienting: Evidence of Possible Moderation by Dopamine Type 2 Receptor Genotype

David G. Gilbert, Adam Rzetelny, Jonathan Hammersley, Norka E. Rabinovich, Stacey L. Small, and Jodi I. Huggenvik
Southern Illinois University at Carbondale

Abstract
Introduction: Growing evidence suggests that attentional bias to and distraction by emotional stimuli moderate affective states and motivation for nicotine and other drug use.
Methods: The present study assessed the effects of nicotine and genotype on distraction by emotional picture stimuli during general attentional orienting in overnight-deprived 45 habitual smokers.
Results: Relative to placebo, 14 mg nicotine patch produced shorter reaction times (RTs) and individuals with two DRD2 A2 alleles exhibited the greatest RT benefit from nicotine following emotionally negative pictures after the longest delay (800 ms), but benefitted least from nicotine following positive pictures after the shortest delay (400 ms).  In contrast, at the shortest delay, A1 carriers did not benefit from nicotine following emotionally negative pictures but did following positive ones.
Conclusions: These genetic differences in the effects of nicotine on attention immediately following emotionally positive versus negative stimuli may reflect differential excitatory and inhibitory transmitter processes related to reward approach (reward) and avoidance (punishment) sensitivities of dopamine-related and other neural networks that support positive and negative affect.

In A2 individuals, nicotine’s ability to reduce distraction by negative, relative to positive and neutral stimuli, appears to rely on processes that develop between 600 and 800 ms after distractor offset. This finding in A2 individuals is consistent with other findings and theory (Gilbert, 1995; Gilbert, Rabinovich et al., 2008) suggesting that nicotine is effective in attenuating processing of negative affect when the negative stimulus is more temporally more distal and less proximal. For example, Gilbert, Rabinovich et al. (2008) found that nicotine reduced negative affect more during the distal periods (shortly after stressors) than during actual stressor exposure and reduced attentional bias (eye-gaze) toward negative pictures, relative to positive pictures, during the later but not earlier portions of picture presentations. Together, these findings suggest that in A2 individuals nicotine enhances distraction by (attention to) emotionally positive stimuli relative to neutral stimuli after brief delays (400 ms) but at 800 ms delays nicotine attenuates distraction by negative distractors (relative to both positive cues and to neutral distractors which no longer differ from each other).

Differential reward vs. threat sensitivity in nicotine-deprived A1 carriers appeared in the present study only at the earliest (400 ms) delay. An ability of nicotine to reduce impulsivity associated with nicotine abstinence state-dependent (and possibly temperamentally based) reward relative to punishment sensitivity could help explain the association of smoking with impulse-related disorders such as attention deficit hyperactivity disorder (Gilbert, 1995).

KEY WORDS:  nicotine, smokers, DRD2, genotype, attention, attentional orienting, distraction, emotion, prime

Neurodevelopment and plasticity: Associations with literature, music, and perception (Or, some cool ways our brains change through learning)

The below post is the text for a presentation to be given this November at Lilly International Conference on College Teaching, Miami University, in Oxford, OH.
see: http://celt.muohio.edu/lillycon/presenters.php

          Our brains are very specialized to learn and adapt to our environments. Human brains are constantly fine-tuning, not only through adolescence but throughout our entire lives, which is among the things that make us unique as humans. We know that neural developments underlie changes in maturity, judgment, and planning abilities that occur during adolescence. Other interesting neural changes relate to wide ranging phenomena that include learning musical skills, synesthesia, poetry, and even recovery from depression. Have you wondered why certain people seem “born” to be writers, artists, or musicians? This may be partly true, based on development of neurocognitive mechanisms that also arise from genetic predispositions.

          First, we know that our brains can continue to change throughout our lives, based on a variety of neuroscience evidence. Esteemed neurologist Oliver Sacks, who once wrote about interesting and unique cases of brain dysfunction in his book “The Man Who Mistook His Wife for a Hat,” discusses neurologically how changes in areas such as the fusiform gyrus after vision loss can have dramatic effects (Sacks, 1985; Sacks, 2010). The fusiform gyrus is an area that is especially activated during facial recognition, as soon as 2 days after birth in infants, and comprises part of the “what” pathway in our brains. A relatively little-known phenomenon that can occur in patients with visual deficits (including in Sacks himself) is visual hallucination due to lack of visual input. Brain rewiring, due in part to invasion of adjacent neurons into vacant spots left by neurons no longer receiving input, seems to stimulate the fusiform gyrus into causing hallucinations of teeth, lips, and other facial features that do not exist.

Relatively recent research (i.e., Jacobs, 2004) also indicates that neurogenesis or the growth of new neurons and dendrites, especially in the hippocampus, can underlie recovery from depression as a result of antidepressant medication. Accumulated stress and depressive symptoms appear to suppress neurogenesis, and antidepressants such as fluoxetine appear to reverse this process. The hippocampus is a structure especially important to learning and memory, particularly the storage and consolidation of short term into long term memories. If stress and depression can have such impact on the suppression of neurogenesis in the hippocampus, and antidepressants can seemingly “jump start” the process, what role might neurogenesis play in learning and education, and how can educators hope to impact this process?

Other evidence of the brain’s limited but fascinating ability to reorganize itself is seen in studies of rats and fish. Jewel fish reared with other fish in an enriched environment, for example, have noticeably richer dendritic branching (Kalat, 2007). How more enriched learning environments might lead to greater dendritic branching and brain growth is unknown for human students, but recent neuroimaging studies on the brains of musicians might shed some light on the subject. Neural plasticity accompanying musical skill development was examined by Gaser and Schlaug (2003), who showed using MRI studies that extensive music practice can prompt brain tissue growth, especially in areas responsible for listening to music, reading music, and hand control. Wan and Schlaug (2010) further argue that musical training may have long-lasting behavioral or cognitive benefits or even lead to continued brain plasticity, which may suggest increased ability to learn and adapt.

Finally, neuroscientists Hubbard and Ramachandran have discussed the neurocognitive mechanisms of synesthesia, or the experience of one sensory perception in response to stimulation of another sense (e.g., Hubbard & Ramachandran, 2006). Pure synesthesia such as hearing musical notes and seeing color is estimated to occur in about 1 in 500 individuals (Day, 2005). According to Hubbard and Ramachandran (2006), synesthesia also suggests that axons from one region branch into another, and may be a remnant of insufficient neuronal “pruning” during early neurodevelopment. These researchers also suggest that synesthesia has a genetic basis, and milder forms may be involved in individuals who are particularly good at metaphors and vivid literary descriptions, such as poets or novelists. There is also evidence that the way in which we name objects is due in part to synesthesia-like phenomena.

That our brains are very specialized to learn and store information, and the many interesting ways that educators aim to make permanent changes to our students’ brains, are subjects that higher education faculty should consider.

The Importance of Integrative Clinical Research in Understanding Mental Illness, Developing Interventions, and Promoting Recovery

Article written for NAMI – KY chapter:

I first became involved with collaborating with NAMI during my time as a researcher in the Department of Psychiatry and Neuroscience Clinical Research Center at Indiana University School of Medicine in Indianapolis. While there, I developed an interest in researching severe mental illnesses such as schizophrenia and bipolar disorder to better understand them and help develop new interventions. One of the unique features and major benefits of such a research center was the eclectic, multidisciplinary nature of the research staff, which included many experts in fields of psychology, psychiatry, neuroscience, nursing, and social work. Such diversity among researchers allowed for patient safety, effective and innovative clinical research discoveries, and an attempt to advance mental illness treatment and recovery through scientific approaches. The integrative nature of the research encouraged the involvement of researchers from across multiple disciplines and areas of expertise, with the goal of promoting improvement and advancing of treatment and recovery. Such integrative clinical research can positively impact quality of life in persons with mental illness, improve understanding of mental illness by family and friends of these individuals, and increase collaborative opportunities among researchers and advocacy groups such as NAMI. Understanding the importance of the process of clinical research may be beneficial in developing the best diagnoses, treatments, and recovery for those impacted by mental illness.



Before my psychiatric research experience at IU in Indianapolis, I was involved in integrative neuroscience research pertaining to nicotine and smoking. It was here that I began to appreciate the integrative approach to clinical research and the use of multidimensional research methods to produce a more rich, meaningful consideration of human behavior that is often quite complex. Factors in mental illness, too, do not occur independently of one another but often interact with and influence each other. Multidisciplinary or integrative clinical research can be so important because many areas of functioning are often impacted in mental illness: mood, memory, thinking, concentration, perception, work and school performance, social interactions, and interpersonal relationships, to name several. In examining multiple factors in an integrative fashion, novel ideas for treatments and recovery can often develop. For example, an area that gained necessary attention in recent years was evaluating newer interventions thought to be effective for improving cognitive and neurological difficulties in persons with schizophrenia and schizoaffective disorder. Struggles in such areas as information processing, attention, memory, visual learning, and problem solving are important needs for which to develop improved treatments. Cognitive impairments have been shown to relate to everyday problems, like unemployment, social withdrawal, and quality of life issues, so it is important to examine how improving neurocognition may also improve these other difficulties. Such research might also include measures of real-world, daily functioning and quality of life, such as social interaction or work performance. This would not be possible without integrative and multidimensional clinical research.



In line with the idea of integrative clinical research, the Integrative Clinical and Affective Neuroscience (ICAN) lab and students enrolled in the Applied Clinical Research course at Union College are working on a number of innovative studies to investigate the maintenance and development of mental illness symptoms. One of our interests is discovering cognitive mechanisms involved in mood disorders, anxiety, other psychological disorders such as ADHD, and how individuals experiencing psychological problems might use nicotine or caffeine to self-medicate. As has been described by other psychological researchers, many if not most forms of mental illness might be considered a type of attentional disorder – from someone with depression ruminating and able to focus mostly on negative perceptions of the self, world, and future, to an individual with an anxiety disorder being oversensitive to potentially threatening situations. Thus, our research interests relate to the intersection of emotion and attention, and how these and other areas are integrated. One recent finding to which our data points is how college students who are prone to experience higher levels of ADHD symptoms may actually benefit from emotional distraction during task performance.



Both researchers and research participants are essential to further the development of such treatments and scientific advancements for mental illness, and I would therefore urge interested individuals to look for research participation opportunities in your area.

A participant in mental health research may typically complete questionnaires about mood, personality, perceptions, and cognitions across anything from a single day to several weeks of testing. Another important area in psychological science is the dissemination of findings, especially as it pertains to new treatment approaches, risk factors, and recovery models in mental illness. Conference attendance by students and research faculty, publication of findings in peer-reviewed journals and other mediums, and reaching more diverse audiences are crucial. Likewise, collaboration between those on the front lines of research and treatment and advocacy organizations such as NAMI can be quite important and fruitful. Progress toward this goal was recently made on our campus, as the NAMI “In Our Own Voice” consumers came to speak for this public education program to our psychology students. This is a wonderful opportunity for advocacy and sharing information with psychology students and faculty, in a unique format above and beyond what can be found in a textbook. I hope to see this program continue to be utilized, and hope to collaborate with NAMI on conveying our mutual goals regarding mental illness.

Clinical Psychology On Screen

It is hard to think of a more inaccurately, and sometimes unfairly, portrayed profession that appears on television or in movies than clinical psychology.  Psychologists are often shown by Hollywood to sleep with clients, hang out with patients, violate multiple ethical standards, and frequently say touchy, feely things like "It's alright" and "It's not your fault."  Perhaps the scientific researcher in general - often shown in older movies as the "mad scientist" type - is also often inaccurately and unfairly portrayed.  Perhaps attorneys - often shown in TV shows to be highly involved in exciting, important trials and delivering well-received, brilliant monologues in court rather than spending the vast majority of their time poring over boring legal documents - are shown to be doing much different activities from day to day than is accurate. 

However, I contend that psychology is right up there with any other profession in terms of inaccurate Hollywood portrayal. 

Usually, the layperson, undergraduate psychology major, and beginning therapist-in-training imagines therapeutic interventions as involving a lot of reassurance, trying to make the client feel better, and saying things such as "Everything will be OK."  That is actually not the truth - things are very likely NOT OK, or else the client would not be seeking psychological services in the first place.  And often times, the therapist must challenge clients, point out inappropriate behaviors to clients, and tell unpopular truths to their clients - all things which are definitely NOT intended to make the person feel better in the moment, but which are often quite necessary to produce lasting, important changes in thinking or behavioral patterns.  It is difficult to often have to feel like the "bad guy" in a therapy session, and something that takes a great deal of training, close supervision, and open dialogue to conquer. 

If only clinical psychology was so simple as simply offering a few reassuring words to suddenly "cure" a client or lead a client to a monumental break-through!  When I give graduate students or student interested in applying to graduate doctoral programs advice, one of the first tips I mention is to avoid saying catch phrases or cliches such as "I only want to help people" or "I should be a psychologist because I am such a caring person" during interview sessions.  I think it undermines their goal of becoming a scientist-practitioner and really delving into the intricacies and complexity of practicing empiricallly validated treatments and interventions.  Since human behavior and emotion is so vastly complicated, it should only make sense that interventions to change and improve maladaptive behaviors or emotions would also be equally complicated.  By continuing to point out this fact, and combat the perception largely put forth by Hollywood of what a career in clinical psychology entails, hopefully the reality of actually practicing and training as a clinical psychologist continues to be put forth.

Understanding Mental Illness Through Clinical Research

Below is an exerpt from NAMI’s (National Alliance on Mental Illness) newsletter – I wrote a piece for them last year describing clinical research, advancement of treatment for mental illness, and the neuroscience clinical research center at Indiana. Perhaps it will be of interest to students or other faculty or clinicians, in terms of what kind of research goes on, how to evaluate treatments, or what comprises a psychiatry research center. First, below is Poe if he had access to Prozac: 

Neuroscience Clinical Research Center : Hoping to Better Understand Mental Illness Through Research
The Neuroscience Clinical Research Center (NCRC) at Indiana University School of Medicine is a research facility based primarily at Larue D. Carter Memorial Hospital and dedicated to studying symptoms and factors in severe mental illnesses such as schizophrenia and bipolar disorder. Directed by Dr. Anantha Shekhar of Indiana University School of Medicine’s Department of Psychiatry, the NCRC strives to better understand severe mental illnesses and develop new treatments for these illnesses. The NCRC is comprised of a staff of RN research coordinators, a clinical psychologist, psychiatrists and psychiatry residents, clinical psychology interns, a fulltime psychometrician, and research technicians, who are all dedicated to excellence in the treatment of persons with severe mental illness. The NCRC facilities include neurobiology laboratories, as well as several interview/assessment rooms and staff offices. Such a diverse research and treatment team and state of the art research facilities allow close and frequent monitoring of individuals participating in studies, which is essential for safe and effective clinical research. By basing such studies in a hospital setting, participants being put on medication or being discontinued from other medications can always have hospital support staff and medical professionals nearby in the rare cases of serious side effects or adverse reactions.
It is our belief that the advancement of care comes through the advancement of science, and it is our goal to provide cutting-edge treatments available through ongoing clinical trials of new medications and therapies that evaluate safety, tolerability and efficacy. Improving and advancing treatment of severe mental illness has a major impact on the quality of life of persons with mental illness, as well as on family and friends of such individuals. In collaborating with mental health advocacy organizations, such as NAMI, the NCRC hopes to enhance understanding of the process of clinical research and why it is essential for developing the best treatments for mental illness. Our research specializes in treating persons with mental illness by not only utilizing clinical trials, but also with conventional medication treatments as well. Since mental illnesses such as bipolar disorder and schizophrenia affect the lives of so many persons with these illnesses as well as their family and friends, many areas of functioning are impacted including mood, memory, thinking, concentration, perception, work and school performance, social interactions, and interpersonal relationships. Therefore, clinical trials research is necessary to evaluate new approaches and interventions with mental illness that that may be effective in treating a variety of these areas of difficulty. For example, two of our newer studies are evaluating medications that are thought to be effective in reducing some of the cognitive and neurological difficulties in persons with schizophrenia, such as information processing speed, attention, alertness, memory, visual learning, reasoning, and problem solving. Such difficulties are important areas for which to develop treatments, as cognitive impairments have been shown to be even more closely related to problems in everyday functioning, like unemployment and social withdrawal, than positive symptoms such as delusions and hallucinations.
Many people might wonder what clinical research means, generally speaking. A clinical trial is a research study that is designed to test new medications or procedures to assess whether they work the way they are supposed to and are safe, whether we can learn new uses for existing medications or procedures, and to more closely examine the effects of medications over longer periods of time such as a year or more. Nearly all medications that are available on the market today have gone through clinical research trials, and because of these trials many life-saving treatments are available for hundreds of diseases such as cancer and HIV. The Federal Drug Administration (FDA) is the branch of government that oversees the development of new drugs, and helps to enforce the rules and regulations that clinical trials research must follow in order to develop new and safe drugs. The researchers and the individuals who participate in such research help to further the development of such treatments and cures. In psychiatry, recent developments such as atypical antipsychotic medications, which have greatly reduced side effects compared to previous medications, have helped to improve the overall quality of life for persons with mental illness.
How, then, are such medications evaluated for their ability to improve functioning, treat symptoms, and improve quality of life in mental illness? Outcome measures in psychiatry clinical trials are selected based on previous evidence showing that they are able to validly, reliably, and meaningfully assess the levels of current symptoms related to a mental illness as well as measure change in such symptoms. In other words, we need to be able to measure not just the number of current symptoms and how severe the symptoms are, but also how such symptoms change with treatment and how improvement in symptoms translates to improved functioning in the real world. The medications being evaluated for improving cognitive deficits, for example, are assessed using several measures of cognition that have been evaluated in prior research as being appropriate for use in measuring cognitive change in schizophrenia. Such clinical trials also aim to include measures that have real-world measures of functioning and quality of life, such as social skills, work performance, and basic skills in daily living activities. Other psychiatry research studies might measure symptoms of depression and alleviation of such symptoms in response to treatment; hence, outcome would be measured by tests which have been shown to accurately assess and be sensitive to change in the occurrence of depressive symptoms. Individuals who participate in such studies in the NCRC are screened to assess whether they qualify for a particular study, get paid for each study visit, and area closely monitored for any physical, emotional, or psychological responses to the treatment. They typically complete many questionnaires about mood, personality, perceptions, and cognitions across several weeks of testing, and those who choose to participate in studies include both hospital inpatients as well as outpatients from the surrounding community.