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Marvin S. Beitner, Ph.D.
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Terrorism: Causes, Motivation and Rush to Judgment

The Boston Marathon Bombing has again raised the issues of the causes and prevention of terrorist acts. The two men who appear to be responsible, Dzhokhar Tsarnaev and Tamerlan Tsarnaev were quickly identified and apprehended. The ubiquitous presence of video cameras, the rapidity of internet communication and the wide scope of social media are new elements in our society that made this possible.

(1) Sociological Causes  of terrorist acts involve powerful shared belief systems. For example, the Fatwa calling for the death of Salman Rushdie is a legal Islamic pronouncement in Islam that potentially may influence any one of millions of Muslims to take action. It has been reported that Tamerlan Tsarnaev had recently abandoned the life style that was typical of his age group in our society for a commitment to the Islamic faith. There have also been reports that he may have been more directly and personally influenced by others in his recent trip to Chechnya. The most common sociological causes involve religious, political and cultural belief systems.
(2) Psychological Motivation of terrorist acts involves the personality and unique motivation  of the individual. For example someone who is personally isolated, frustrated and emotionally disturbed may take action out of rage or out of desire to be recognized. The Texas Tower Shooting, the murder of John Lennon and some shopping mall and school shootings are examples. Sociological and psychological causes are not mutually exclusive, but one or the other may play a predominant role. For example, the "Unabomber," who lived a bizarre life of isolation appears to be a person whose psychiatric problems fueled his need to act out his rage as directed at a sociological or political issue.
(3) Rush to Judgment by the media results in many distorted or blatantly false "news reports." The rush to judgment is driven by two factors. One is the commercially driven need to be "first to report." The other is our need to understand and know what is happening in our lives. One great evolutionary advantage that has allowed us to survive in a world of faster and stronger creatures is the great curiosity and need to  understand and explain events and their causes. This gave us the advantage of being able to learn, to plan and to cope with challenges in a highly effective manner. Unfortunately, our need to understand sometimes makes us leap to unwarranted, premature and false conclusions and to take actions that we later may regret. We must guard against that proclivity.

"Professional opinions" about celebreties in the news.  OUCH OUCH: “Hanging up on Dr. Laura”

A Los Angeles Times letter to the editor from Eugene Strull, a physician, commenting on the brouhaha about “Dr. Laura” (Laura Schlesinger, radio personality) touches upon the all too frequent "professional opinions" offered about famous or celebrity figures.

Dr. Strull pointed out, "Any doctor of psychology who is qualified to treat patients would never make a diagnosis and offer advice after allowing the patient only a minute or two to present their problems."

True, true, oh so true! The "ouch" is the pain that I share with other psychologists when a radio show host is incorrectly assumed to be a psychologist. The antics of a radio show host “advising” callers who have problems and truly need help is painful to hear for any psychologist. This is doubly true when the callers, listeners, news broadcasters and even physicians such as Dr. Strull think that the radio personality is a psychologist.

“Dr. Laura” does not claim to be a psychologist; she is not licensed to practice psychology, and she is running an entertainment show. Like any other entertainment show, the purpose is to generate a large audience and to make it commercially successful. I presume that she uses the title, "Dr. Laura" because she has a Ph.D. degree in physiology. Since she is giving people personal advice, it is understandable that people assume that “Dr. Laura” means a doctor of psychology. To my knowledge she has never claimed to be a psychologist.

There have been a myriad of radio and television personalities who entertain audiences by delving into the personal problems of people and offering advice. This tradition goes back to the original “Dear Abby” and “Ann Landers” newspaper columns. They entertained their readers with wit and they made astute observations about human nature but they were never mistaken for professional psychologists.

The "Dr. Laura" and "Dr. Phil" formats can be immensely successful as mass media enterprises because we are all naturally fascinated by people and their problems. However, most psychologists would be skeptical of the possibility of successfully entertaining an audience, abandoning the principle of privacy in a counseling or psychotherapeutic relationship and at the same time providing ethical and effective professional services in the field of psychology.

So when you listen to or watch such shows, remember that this is entertainment and by all means, do not use them as a source of professional advice to follow in your own life.

(June 26, 2010 From Dr. Beitner's BLOG
Disclaimer: It is possible for a psychologist to analyze someone only by working with him personally as a patient. For this reason, my comments about public or historical figures are intended only as illustrations of general psychological principles that apply to the human condition and an expression of how one psychologist views the world.

Sigmund Freud is reputed to have said to a group of industrialists, “Show me the agitator in your factory, and I will show you a man who is in rebellion against his father.” I am not at all sure if this is a correct quotation of Dr. Freud, who, incidentally, was right about many things and wrong about many things. However, the quotation provides good material to illustrate how a psychologist views human behavior. 

For example, it does make sense, psychologically, to speculate that an “agitator” in a factory may be driven, unconsciously, in his behavior by memories of having been unfairly treated by his father. Such experiences could indeed generate feelings of anger and rebelliousness against all paternal authority figures, including his employer. However, this does not mean that the rebellion of the “agitator” in the factory has no justifiable basis for his complaint.  It may indeed be true that there are real health or safety issues, or unfairness in how that factory is run. To speculate about the inner personal psychodynamics of human behavior does not in any way undermine the validity of the external circumstances addressed. 

Psychologists talk about “multiple determination” of behavior. The human mind is extremely complex; it is not like a light switch, or like the basic component of a computer, both of which have only an “on” and “off” position. Therefore we might say that a person who is psychologically “in rebellion against his father” may indeed be more highly motivated to rebel against some real unfairness in his adult world. In this case, we might say that two of the “multiple determinants” of the “agitator’s” behavior are the actual unfairness in the factory, and the unconscious rebellion against his father.

We find similar psychologically valid themes represented in compelling fiction as well. For example, “The Girl With the Dragon Tattoo” was abused as a child by her father. She rebelled violently against him in childhood, and then in adulthood sought revenge by punishing paternal figures that were exploitive, abusive or unfair to her or to others.

Turning to news events, we could view military authority as being based upon a powerful and rigid exercise of paternalistic control of lower ranked individuals by higher ranked individuals. This is a quite structure that is found in military organizations throughout history.

General Stanley McChrystal recently was called on the carpet by the president and ousted from his command because of his failure to respect the quintessential American principle of complete civilian authority over the military.

Article 88 of the Uniform Code of Military Justice is titled: Contempt Toward Officials and it states: “Any commissioned officer who uses contemptuous words against the President, the Vice President, Congress, the Secretary of Defense, the Secretary of a military department, the Secretary of Transportation, or the Governor or legislature of any State, Territory, Commonwealth, or possession in which he is on duty or present shall be punished as a court-martial may direct.”

Certainly we know that any U.S. General is aware of this rule, which is a specific application of the general rule that requires all enlisted men or officers of lower rank to respect the authority of higher ranking officers.

So why would he make such verbal blunders as “Bite me” for Biden, etc? I know nothing at all about General McChrystal’s personal background. But a psychologist would say that such an unexpected and foolish lapse of judgment in such a bright, accomplished, successful and knowledgeable military man is highly irrational. Therefore it might be related to an unconscious need to rebel against the father figure represented by civilian authorities above him.

Without having any specific knowledge about a public figure’s personal history, a psychologist knows that every human being shares this common experience: we have all started as helpless, ignorant children in relationships with parental figures who were, by comparison, wise, knowledgeable and powerful. And we all have struggled in growing up to achieve a level of knowledge and power equal to or greater than our parents.

(As Mark Twain put it, “When I was a boy of fourteen, my father was so ignorant I could hardly stand to have the old man around. But when I got to be twenty-one, I was astonished by how much he'd learned in seven years.”)

Many a foolish word has been spoken and many a foolish action has been taken, that has been motivated by powerful unconscious thoughts and feelings related to this common human experience of struggling against our parents from the position of ignorance and helplessness of childhood.

In this case, the shockingly unexpected statements that have put General McChrystal’s military career in jeopardy may be related to the historical parent-child dynamic experienced by all of us as described above. He has been referred to as the “Runaway General” precisely because he failed to restrain himself in a manner required by his position under civilian authority.

News stories of interest about weight control: 
Another reason to avoid fat and sugar in your diet. Jeffrey I Gordon of Washington University in St. Louis hasMarvin S Beitner PhD, Psychologist Lic. PSY1036, Marriage Counselor Lic. M646, Long Beach office convenient from Lakewood, Los Alamitos, Palos Verdes, Rolling Hills; Fountain Valley office convenient from Newport Beach, Huntington Beach, Anaheim, Costa Mesa published an article in Science Translational Medicine (11-11-2009) about the types of bacteria in the human gut that are involved in normal digestion. His work suggests that  that certain types of bacteria promote weight gain. A high fat, high sugar diet appears to increase the presence of these "fattening" bacteria  within 24 hours of consuming this type of food. A person with a large proportion of these bacteria will gain more weight on the same amount of food than a person with a low proportion of these bacteria.  

The published results of recent long term studies of weight control at Stanford University's Prevention Research Center, the Harvard School of Public Health and the Pennington Biomedical Research Center of Louisiana State University are consistent with the approach I have developed based on the study of the results of previous research as well as my experience with patients in my own practice. These findings are summarized briefly in a February 26, 2009 Los Angeles Times front page article entitled "Weight Loss Boils Down to Calories." 

The findings indicate that conventional diets are not very successful in the long term. They result in an average weight loss of 13 pounds after 6 months, but a disappointing average loss of only 9 pounds after two years of dieting. The use of popular programs that recommend different, and contradictory proportions of fat, protein and carbohydrate in the diet was found to result in no advantage for any one of these programs. ("The winner is...not low carb, not low fat, not high protein...") The only significant finding was that people lost weight when they reduced their total caloric intake. The conclusion is that the prospect for  permanent weight loss depends upon the effective establishment of long term changes in eating habits that succeed in reducing total caloric intake on a regular, on-going basis. See my page on Weight Control for more information on this subject.

Psychology Today is a  website that has interesting articles about news in the field. It also provides a list of therapists of various disciplines. In reading the articles, it is always important to remember that articles presented in the popular press are usually written by a journalist, not by a psychologist. The studies cited are necessarily briefly reported, somewhat oversimplified and sometimes may even be misinterpreted by the writer. Go to the source study cited by the author if the conclusions presented are really important to you. Sometimes you can Google the name of the study or researcher and come up with original source material. Wikepedia or WebMD  are usually  pretty good sites to visit if you want to check on some technical terms used in articles about psychology.

Previous News & Media Psychological Issues: The HBO series "In Treatment" is in re-runs. Is it a good representation of how psychotherapy really works? What about the issue of attraction between psychologist and patient and how it is handled in this series? I usually cringe when I see how painfully unrealistically, unethically and hokey psychotherapy is portrayed in a movie or television drama. Part of the problem is the understandable lack of psychological expertise and knowledge on the part of the writers. Another problem is the need to present a coherent picture of the complex psychotherapeutic process in a limited television time slot while keeping it moving fast enough to keep the interest of the viewing audience. 

However, the writers of In Treatment  have done a pretty good job considering these challenges. For the most part the interactions are consistent with what might actually occur in psychotherapy. There are a few obvious mistakes, one of which has to do with the psychologist's relationship with his patient, Laura.  

Paul, the psychologist, blunders grossly in his handling of Laura's feelings for him (transference) and his  feelings for her (countertransference.) His failure to deal with the transference issues properly ultimately leads to his flagrantly unethical, and potentially disastrous pursuit of a romantic relationship with Laura. He has essentially abandoned his proper role as the  treating therapist, and has capitalized on his position of trust as a therapist for his own personal gratification. Such an action on the part of a psychologist could and should result in the loss of his/her license to practice psychology. Paul's rationalization that they can pursue a romantic relationship because she is "no longer" his patient does not in any way mitigate this act of malpractice, because her perception of him has been shaped by the psychotherapeutic relationship. This cannot be changed by terminating therapy and does not relieve him of his ethical constraints as a psychologist.

In Laura's assertion to Paul  that her feelings for him are no different than the romantic feelings in any other relationship,  she (not surprisingly) fails to understand the transference issues involved. A patient's feelings of sexual attraction, or love or hate, toward a treating therapist are qualitatively different from such feelings in any other relationship. Such feelings are defined as "transference" because the relationship is so uniquely lopsided in terms of the knowledge the therapist and patient have of each other and the nature of their interaction. Paul's startling inability even to touch Laura when he attempts to move from the role of therapist to  that of "lover" is not surprising. The basic building blocks of a social or romantic relationship are never had been established in psychotherapy. The potential damage of their interaction is obvious. Laura perceives Paul as "testing" her regarding a romantic relationship. Because of the power projected onto the therapist, any outcome that does not fulfill the hopes and fantasies of the patient can be devastating to the self worth of the patient.

Psychotherapy necessarily involves a complete focus on the patient's life, feelings, personal thoughts and well being, with minimum information being revealed about the therapist. Furthermore, by definition, the psychotherapeutic relationship is structured as a one sided relationship in the sense that the psychologist functions as the expert, as the knowledgeable, authoritative person who is there to help the patient emotionally and psychologically, an effect that is not expected to be reciprocated. The patient is there to benefit from the psychologist's help, not to help the psychologist, nor to find out about the personal life of the psychologist.  

Taking into consideration these differences, it is not hard to understand that Laura's "love" for Paul can only be based on the image of the attentive, helpful, supportive, concerned therapeutic role that Paul plays in her life. It cannot be based on her knowledge of Paul as a person, because he is properly constrained to the role of therapist in her presence, which precludes his revealing his personal life to her, a boundary that Paul actually violates as soon as he expresses to Laura his "love" for her. 

This discussion only touches upon the complexity of these transference issues. Dealing with transference and countertransference issues present            `                                                                    s difficult personal "boundary" problems, which, if mishandled,  can result in professional malpractice and in harm to the patient.

The recent Dr. Phil and Britney Spears controversy touches upon important questions about psychology, psychotherapy and issues of  privacy and confidentiality in a relationship between patient and psychologist. Many people who watch the Dr. Phil show incorrectly assume that he is a psychologist. However, Dr. Phil does not claim to have a license to practice psychology, nor does he call himself a psychologist.  Since Dr. Phil's show is considered a form of entertainment, not the practice of psychology, no license is required for what he does on his show. On the other hand, he could not treat Britney Spears or any other patient in a hospital or in a private setting in California because state law requires a  psychology license to practice psychology in the state of California. For information on how you can determine whether Dr. Phil or anyone else is a psychologist, click on Check Qualifications. For a more detailed discussion by a psychologist of the Dr. Phil - Britney Spears controversy, you may copy the following address into your browser. (This will take you out of my website.) 

From Clinical Psychiatry News, March 2008
   An Institute of Medicine report says that providing appropriate psychosocial services to all cancer patients and their families should become a new standard of care. It is encouraging that the importance of psychological factors as affecting treatment of medical problems is now getting more recognition by the medical profession.

   A study reported by Leslie S. Kinder, Ph.D. of the Veterans Affairs Puget Sound Healthy Care Systems in Seattle suggests that depression may be a better predictor of health outcomes and mortality among veterans than PTSD.


TABLE OF CONTENTS of Additional Recent Psychology Publications

Unlike the other pages in this website, the following material was not written by 
Dr. Beitner. It includes recent articles of interest from various publications. The sources include the Monitor on Psychology, which is a copyrighted professional journal of the American Psychological Association. You may locate the article of interest to you by clicking on the title listed in the table of contents below. These articles are included on the website for the interest of the reader and to provoke thought on these subjects. The articles have not been evaluated by Dr. Beitner and inclusion of this material does not represent an endorsement by Dr. Beitner

(1) What to know about discontinuation of psychotropic medications.  

(2) Psychologists are taking a more comprehensive approach to wellness at work.

(3) Diagnosis of Multiple Childhood Trauma

(4) Love is not Sex: Why Romantic Love is not limited by Gender

(5) Love as a Primal Drive

(6) Does Love Last?

(7) Phantom Pain and the Brain

(8) Hostility and Coronary Heart Disease: Don't Get Mad

(9) Building a Stronger Heart

(10) Helping Others, Helping Ourselves

(11) Is Altruism Real?

(12) Tourette's Syndrome

(13) Coping with PTSD through Cognition

(14) Social Isolated and Sick

(15)  Comparing Left-Brain (Right Handed) vs. Right Brain (Left Handed) People


Empty bottles: Easing clients off meds

What to know about discontinuation of psychotropic medications.  

By Laurie Meyers
Monitor Staff

Monitor on Psychology
Volume 38, No. 3 March 2007

What is the practitioner’s role when a patient comes off medication? What should a psychologist do for a client who is experiencing significant side effects? And what about clients on multiple medications?

As the health professional who often has the most contact with a client, a psychologist may be in the best position to spot or even help prevent seriously adverse reactions to medication withdrawal—if he or she knows what to look for.

“Psychologists need to be on top of what patients are taking,” says John Sexton, PhD, one of 10 participants in the U.S. Department of Defense (DoD) 1991–1997 pilot program to grant psychologists prescriptive authority. “It’s important for us to know what is going into a person’s body.”

Discontinuation dilemmas

A particular red flag to watch for: It’s all too common for patients to abruptly stop taking medication on their own, which can have unpleasant or dangerous consequences, says Sexton, who is now working in psychological and counseling services at the University of California at San Diego .

Patients may not discuss discontinuing medication with the physician who prescribed the medication, or they may not pay attention to the tapering directions they are given, points out psychologist Michael Enright, PhD, APRN, who works in a primary-care clinic in Wyoming and can prescribe because he holds a nurse-practitioner’s license. So, it’s important for practitioners to consult with the prescribing physician when possible, to get information such as the original drug dosage and how long tapering should continue, he adds. Psychologists should also be aware of the following side effects associated with particular classes of psychotropic drugs:

• Antidepressants—Due to the short time they stay in the body, some selective serotonin reuptake inhibitors (SSRIs)—a class that includes drugs such as Zoloft, Prozac, Paxil and Lexapro—can cause a discontinuation syndrome with symptoms including nausea, headache, problems sleeping, tingling or shock-like sensations, and, in some cases, flu-like symptoms. Paxil and Effexor—which is actually a serotonin-norepinephrine reuptake inhibitor—are the most likely to cause the syndrome and Prozac is the least likely, Enright notes. These reactions can be uncomfortable, but are not generally life threatening, he says.

Psychologists can help ease the patient’s discomfort by explaining that the symptoms are temporary. They can also teach patients to self-monitor and to contact their physician or visit the emergency room for serious symptoms such as irregular heartbeat, difficulty breathing, depersonalization and suicidal thoughts or urges, say Enright and Sexton. It’s also important for practitioners to watch for rebound anxiety or depression, emphasizes Enright. In some cases of severe withdrawal, the physician may prescribe a short course of Prozac, which is so long-acting that it requires little or no tapering. Another option is to increase the dosage of the current medication and taper more slowly, he notes. Other antidepressants can also cause similar withdrawal side-effects such as nausea and flu-like symptoms.

• Benzodiazepines—Because they are potentially addictive substances, benzodiazepines—which are usually prescribed for panic and anxiety—can be harder to taper and should never be stopped abruptly, says Sexton. Short- acting benzodiazepines like Xanax can cause seizures, coma and even death if the patient does not come off them slowly enough, he explains. Valium or Librium are longer acting and require less tapering, but withdrawal can still cause shakiness, Sexton notes.

• Mood stabilizers and antipsychotics—Lithium and other mood stabilizers such as anticonvulsants can cause seizures and rebound mania, characterized by symptoms such as agitation, rapid speech, racing thoughts and mood instability, if a patient stops taking them suddenly, says Sexton. “Mood stabilizers are a very difficult medication to discontinue in patients with a history of mania because you risk taking away the one thing that may be keeping that person stable,” says Elaine Orbana Mantell, PhD, another graduate of the DoD pilot program who still prescribes for the Air Force at Eglin Air Force Base in Florida. If a client shows signs of rebound mania, ask for a release to contact the prescribing physician, urges Mantell. Patients who are discontinuing mood stabilizers and are also taking an antidepressant should also consider the risk of triggering a rebound manic episode with unopposed antidepressant use, she adds. Antipsychotic withdrawal can cause a significant rebound in psychotic symptoms, notes Enright. Psychologists should proceed with caution, track a client’s symptoms closely and work with the prescribing physician, he adds. A serious psychotic or manic episode—one in which a patient loses touch with reality or exhibits behavior that is dangerously erratic—is an emergency and requires immediate action, say experts.

• Stimulants—Medications such as Ritalin and Strattera—prescribed for attention-deficit disorder and attention-deficit hyperactivity disorder—can cause discontinuation symptoms such as lethargy, lack of motivation, and, in some cases, depression, says Mantell. Patients should also taper Dexedrine, because it is an addictive substance that can cause jitteriness, shakiness and other symptoms of substance abuse withdrawal.

The power to unprescribe?                       

If a psychologist has the power to prescribe, he or she also has the authority to unprescribe, says Enright. However, non-prescribing psychologists are in a trickier situation when they see a client they think is overmedicated or ready to taper, he says. Practitioners who spot side effects that may indicate overmedication or a bad drug reaction should consult with the prescribing physician if possible, and should also let the patient know about their concern. Let clients know that side effects that seriously affect health and quality of life are not normal and that they should talk to a physician about changing or stopping their drug regimen, Enright explains. What about clients who are on multiple medications? Proceed with care, Enright stresses. In cases of severe bipolar disorder, schizophrenia or other psychosis, the prescribing physician may have been struggling to end a spiral of suicidal depression or repeated psychotic breaks, he notes. Even as a prescribing psychologist, Enright hesitates to immediately start tinkering with medication in these cases. It’s best for any psychologist faced with a patient on multiple medications that include mood stabilizers and antipsychotics to monitor and work closely with the prescribing physician, he says. In some cases, the client will still require multiple medications, but a psychologist may be able to help reduce the number.

Ultimately, psychologists can help by advocating for their clients, say experts. They can use their diagnostic skills to determine what symptoms a patient has and whether the medication actually alleviates them, says Enright. In some cases, medications such as benzodiazepines may be useful in the short term for panic or acute anxiety, but the goal should be to work on cognitive and therapeutic solutions, he adds. Enright advises monitoring all patients on medication—particularly those on several—for drug interactions and side effects that are markedly decreasing the patient’s cognitive ability or quality of life. Talk to the prescribing physician about any concerns, he suggests. Psychologists who aren’t in practice with physicians may find it useful to establish collaborative relationships with local psychiatrists or other physicians, Enright says.

Patients with depression and anxiety disorders may be on multiple medications as well. Enright himself sometimes prescribes a small amount of Wellbutrin to counteract the sexual side effects of SSRIs. Because people metabolize medications differently, sometimes two drugs might be prescribed because they enhance each other, making the combination more effective for that particular patient, Enright adds. Ultimately, however, the client should be on as few medications as possible.

Whole workplace health

Psychologists are taking a more comprehensive approach to wellness at work.

By Amy Cynkar
Monitor Staff

Monitor on Psychology
Volume 38, No. 3 March 2007

Job stress costs U.S. industries nearly $300 billion a year in absenteeism, employee turnover, diminished productivity and medical, legal and insurance fees, according to the American Institute of Stress. So it’s no wonder many companies provide employees with such perks as telecommuting, flexible work schedules, onsite health and fitness centers, even health insurance for their pets. They can’t afford not to.

And psychologists are helping these organizations figure out how to cost-effectively keep employees healthy and performing at their best—not just by reducing work stress, but by guiding companies to think more holistically about the ways their workplace practices affect physical and mental health, says Matthew J. Grawitch, PhD, primary research consultant for APA’s Psychologically Healthy Workplace Award program and lead author of a recent workplace study review—published last summer in the Consulting Psychology Journal: Practice and Research (Vol. 58, No. 3, pages 129–147)—indicating that Americans relate nearly a quarter of their life satisfaction to their job happiness.

“The whole concept of a psychologically healthy workplace emphasizes the interplay between the organization and the employees, and recognizes that there are going to be some benefits and some costs associated with every kind of program that is put in place,” notes Grawitch, chair of the organizational studies program at St. Louis University.

These days, organizations are abandoning the “keeping up with the Joneses” philosophy on employee benefits in favor of a more comprehensive approach to employee well-being. The payoff, say psychologists, comes in the form of healthier and more productive workers, and a boost to an organization’s bottom line. The trend, they say, also brings a larger appreciation for the skills psychologists bring to the workplace.

A multi-tiered approach

While the notion of a healthy workplace has evolved over the past 60 years, research from as far back as 1990 suggests a strong link between healthy workplace practices and organizational improvement. In fact, says Grawitch, in designing the awards program, APA reviewed research by psychologists and others and identified five categories of employer practices that foster both employee well-being and organizational performance:

• Employee involvement: Empowering employees by involving them in decision-making and giving them more job autonomy.

• Work-life balance: Offering employees flexible work scheduling and other benefits that help them manage the demands they face both inside and outside of work.

• Employee growth and development: Providing opportunities for continuing education, tuition reimbursement and leadership development.

• Health and safety: Providing benefits that help employees optimize their physical and mental health and develop healthy lifestyles, such as stress-management, weight-loss and smoking-cessation programs.

• Employee recognition: Rewarding employees both monetarily and non-monetarily through performance-based bonuses and pay increases, profit-sharing, employee awards programs and simple but genuine expressions of thanks.

Research has shown that these practices, especially when combined, relate to positive trends in employee job satisfaction, organizational commitment and morale.

“Organizations are starting to understand that simple interventions when a problem arises don’t work, and that truly improving the health of a workplace is more complex and long term, and must be built into the culture,” says David Munz, PhD, an organizational psychologist and professor of psychology at St. Louis University.

Leveraging expertise

A number of progressive companies, for example, provide employees with free gym memberships or build onsite fitness centers, at an employee’s suggestion. Some even provide employees’ families with gym discounts. Programs such as these, Grawitch notes, encompass employee involvement, health and safety and work-life balance. Psychologists are even showing some companies how to expand this type of benefit into an employee recognition tool by rewarding employees who lose the most weight each quarter, or featuring employees who recently quit smoking in the company newsletter.

Employers haven’t always viewed such programs as necessary. But as research repeatedly demonstrates their value, organizations increasingly turn to psychologists for help in everything from teaching employees good communication skills to researching the effects of on-site yoga classes on employee absenteeism, says Lou Perrott, PhD, chair of APA’s Business of Practice Network Steering Committee.

“It’s a new enough area that psychologists are just evolving ways to adapt their skills to the workplace—there’s not a ready-made opening,” he says. “We need to make psychologists more aware of the potential that exists for them in helping organizations improve worker health.”

El Nuevo Dia

Interested in attending lunchtime talks on improving family health? How about subsidized onsite after-school day care? For offering such benefits, El Nuevo Dia, a newspaper company in San Juan , Puerto Rico , accepts top honors in March as one of six winners of APA’s National Psychologically Healthy Workplace Award (see "APA honors 2007 Psychologically Healthy Workplace Award winners"). The organization applied for a local award in 2006 at the encouragement of Ivonne Moreno-Velazquez, PhD, past-president of the Asociación de Psicologia de Puerto Rico (APPR).

“When you walk into an organization that has a psychologically healthy workplace, you can feel it,” says Moreno-Velazquez. “El Nuevo Dia is a great example of an organization that is really looking out for its employees, and will hopefully inspire other companies in Puerto Rico to re-evaluate the health of their organizations and develop initiatives to improve it as well.”

In 2004, to encourage the spread of holistically healthy workplaces in her territory, Moreno-Velazquez, a psychology professor at the University of Puerto Rico , founded the student group Healthy Organization Workgroup (HOW).

HOW serves students looking to gain real-life experience in healthy workplace development, and is working to revamp the commonwealth’s perspective on the value of employee health. To get a handle on the region’s workplace problems, students are collecting statistics on, for example, work-related accidents and illnesses in Latin America and Puerto Rico . The group also holds free workshops for local employers on how to build a psychologically healthy workplace. In addition, the group helps run APPR’s territorial-level Psychologically Healthy Workplace Award program.

Moreno-Velazquez also leads local workshops on how to evaluate the impact of employee wellness programs. She teaches employers how to measure a program’s effectiveness in terms of impact on worker health, productivity and retention.

“Some organizations cannot see the economic impact of these practices...because they don’t measure it,” she says. “We have to show organizations that building psychologically healthy workplaces is the smart thing to do, and is a matter of productivity and social responsibility.”

A new diagnosis for childhood trauma?

Some push for a new DSM category for children who undergo multiple, complex traumas.

By Tori DeAngelis
Monitor on Psychology
Volume 38, No. 3 March 2007

Many children traverse the terrain of childhood with few major upsets. But an unfortunate number face the opposite fate, suffering repeated and often serious traumas—everything from abuse and neglect to persistent community violence to caregivers impaired by illness, alcohol or depression. No one knows how many children are affected, but one gauge is the number of children reported annually to child protection services for abuse and neglect—3 million. About 1 million of those cases are substantiated, according to a 2003 report by the Administration on Children, Youth and Families.

Yet no one diagnosis adequately captures the plight of these youngsters, and that’s why a new diagnosis is needed for them, asserts a working group of child psychiatrists and psychologists developing such a diagnosis for possible inclusion in the 2011 iteration of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, published by the American Psychiatric Association. As it stands now, these children are often misdiagnosed and incorrectly treated, working group members argue. The team is an interest group of the National Child Traumatic Stress Network, a consortium of 70 child mental health centers founded and funded by the Substance Abuse and Mental Health Services Administration that brings together clinicians who work with children who have complex trauma histories.

To fill the gap, the group is proposing a diagnosis called “developmental trauma disorder” or DTD, to capture what members see as central realities of life for these children: exposure to multiple, chronic traumas, usually of an interpersonal nature; a unique set of symptoms that differs from those of post-traumatic stress disorder (PTSD) and a variety of other labels often applied to such children (see "Current trauma diagnoses"); and the fact that these traumas affect children differently depending on their stage of development.

“While PTSD is a good definition for acute trauma in adults, it doesn’t apply well to children, who are often traumatized in the context of relationships,” says Boston University Medical Center psychiatrist Bessel van der Kolk, MD, one of the group’s co-leaders. “Because children’s brains are still developing, trauma has a much more pervasive and long-range influence on their self-concept, on their sense of the world and on their ability to regulate themselves.”

The 10-member group has been meeting since 2005, gathering relevant research, hashing out possible criteria and devising a strategy for getting the diagnosis to a rigorous enough place to be considered. They admit they have much work ahead before that happens, given the labor involved in gathering case materials, developing instruments and testing those instruments in the field for validation.

But they are committed to the task because they believe state mental health systems currently flounder on treatment plans for these children because they lack an accurate framework for understanding their problems.

“We think DTD has a strong scientific basis to it,” says University of California Los Angeles child expert Robert Pynoos, MD, co-director of the trauma network and co-leader of the working group. “But it also has a common-sense resonance with community mental health workers and with families who are looking for a proper understanding of their troubled child or teenager. If we could introduce a rigorous diagnosis like this, it could have a significant impact on thousands of children.”

Building a case

To make its case that science supports the DTD diagnosis, the group is examining large databases of children who can help inform the potential diagnosis. For example, members of the child trauma network, which sees up to 50,000 children per year, are building a core data set where they’re finding out not only what kind of traumas children have experienced, but when they occurred and for how long. The group also is tracking a 20-year longitudinal study of 4,000 Australian child survivors of natural disasters that includes life-history questions. The team will look at differences between children who report interpersonal traumas and those who don’t, van der Kolk notes.

In addition, the team is drawing from the attachment, developmental and interpersonal trauma literature, says University of Connecticut psychologist Julian Ford, PhD, a group member and an affiliate of APA Divs. 12 (Clinical) and 56 (Trauma). Ford outlines some of this research in a paper in the May 2005 Psychiatric Annals (Vol. 35, No. 5, pages 410–419).

The team is considering two research streams, Ford says. One finds that children who experience interpersonal trauma show a disrupted ability to regulate their emotions, behavior and attention. For instance, studies show that when caregiving in animals is disrupted or withdrawn, they become anxious and highly reactive to stressors, and when they are older, are less likely to explore their environments, Ford notes.

The other research area shows that much of children’s later ability to think clearly and solve problems in a calm, non-impulsive way stems from their experiences in the first five to seven years of life. A case in point is an ongoing retrospective study of 17,337 adult managed-care users funded by Kaiser Permanente and the Centers for Disease Control and Prevention, cited by van der Kolk in the May 2005 Psychiatric Annals (pages 401–408). It found a highly significant relationship between reported traumatic childhood experiences such as sexual and physical abuse, and later episodes of depression, suicide attempts, alcoholism, drug abuse, sexual promiscuity and domestic violence. It also discovered that the more adverse childhood experiences a person reports, the more likely he or she is to develop life-threatening illnesses such as heart disease, cancer and stroke.

In addition, the team is including the latest findings on the neurobiological consequences of traumatic interpersonal stress. For instance, studies show that women abused as children who recall memories of abuse or are confronted with stressful cognitive challenges have strong reactions in brain areas that signal threat, but reduced mobilization of brain areas related to focusing attention and categorizing information, Ford’s paper notes.

Finally, the group is piecing together information on how complex interpersonal trauma can differentially impact each stage of development, says Pynoos. It also is incorporating the fact that effects of early trauma can spill over into other stages, even if those traumas have stopped occurring, he notes.

Finding the right treatment

Group members are investigating existing child trauma treatments. They’re also gathering information on new interventions geared specifically to working with these youngsters.

One type of promising treatment teaches children self-regulation skills—in essence, helping them see how they have adapted in the face of trauma. The treatment helps them modify those adaptations in creative ways so they can shift out of survival mode and into one more appropriate to their developmental stage, according to Ford. Similar therapies focusing on self-regulation help children to achieve developmental competencies that they were unable to acquire initially, says Pynoos.

Involving parents or caregivers is critical too, emphasizes University of California San Francisco psychologist and group member Alicia Lieberman, PhD. Parents who maltreat their children often are dysregulated themselves, a phenomenon known as “intergenerational transmission of trauma,” she notes.

In the intervention—Parent-Child Psychotherapy, which she created and which is supported by research—“we help the mother or father become attuned to their own dysregulation,” she says, “and that helps them become more responsive to the child’s dysregulation.” As one example, Lieberman’s team recently saw an abused mother and her toddler in treatment. At one point the child fell and hit his head, and lifted his arms to the woman for help. She responded, ‘“Don’t you hit me!”’ Lieberman recalls. The team’s job was to help the woman understand where her reaction was coming from, and to learn more appropriate ways of responding to and caring for her child, Lieberman explains.

Experts’ view of DTD

The group is tackling an important and overlooked phenomenon, other child experts concur.

“The idea of isolating reliable and valid diagnostic criteria to identify this group of children is one whose time has come,” says University of California Los Angeles child expert Karen Saywitz, PhD, who chairs an APA interdivisional Task Force on Child and Adolescent Mental Health. “The group’s ideas are well-grounded in recent advances in research on parent-child attachment, neurobiological developments, information processing and treatment outcomes.”

APA Div. 56 (Trauma) President Judie Alpert, PhD, a psychologist at New York University , agrees that the group correctly identifies the connection between certain children’s symptoms and interpersonal trauma. “Without this clarity, we have only limited understanding of these children’s difficulties and a disjointed approach to treatment,” she notes.

The proposed diagnosis highlights the importance of bringing relationship factors more fully into the DSM, adds Emory University psychologist Nadine Kaslow, PhD, who discusses this need in an article in the September 2006 Journal of Family Psychology (Vol. 20, No. 3, pages 359–368) along with lead author Steven Beach, PhD, and colleagues.

“Often we develop psychological difficulties in the face of interpersonal challenges,” says Kaslow, chief psychologist at Grady Memorial Hospital in Atlanta and winner of a 2006 APA Presidential Citation for her work reaching out to psychology trainees, postdoctoral fellows and training sites after Hurricane Katrina. “It is very appealing to see people thinking not just individually, but contextually and systemically.”

But the experts also caution that it’s vital the group be sure its research is airtight so they are sure they are identifying the right youngsters, and so such a potential diagnosis is not mis- or overused.

“People vary dramatically in their resilience to adversity,” says Saywitz, “so it is important the group is vigilant in its efforts to prevent misuse of a new diagnostic category and the untested treatments that may well arise.”

The group’s accurate fingering of a widespread problem likewise underscores the need for better trauma training in graduate school, Alpert says. “When trauma is discussed in courses that focus on diagnosis and the DSM,” she says, “trauma often receives short shrift.”

Despite these caveats—and no matter what happens with the diagnosis in the short term—the group does a major service by bringing these youngsters and their needs to the attention of the public, funders and policy makers, Saywitz believes.

“If the debate over DTD is a catalyst for such a discussion,” she notes, “it will benefit not only these children and families, but our society as a whole.”

Love's not sex

Why romantic love isn't limited by a person's sexual orientation.

Christopher Munsey
Monitor Staff

Monitor on Psychology
Volume 38, No. 2 February 2007

Most people think romantic love and sexual desire go hand in hand, and that you can't have one without the other.

But a psychologist who argues that it's not that simple, bases her findings on follow-up interviews with a group of women she's followed for more than a decade. Developmental psychologist Lisa Diamond, PhD, started noticing something interesting about her study group's love lives.

Most of the women identified themselves as non-heterosexual, but several reported falling in love with, and developing sexual desire for, individual men in their lives, says Diamond, a University of Utah psychology professor.

Talking to them, Diamond at first thought the women were mistaken about what they were feeling or were confused about their own sexual orientation.

“The more I started listening to their voices, the more I started to think I was wrong,” Diamond says.

Diamond started studying the women's experiences for her master's thesis. She's kept in touch with the participants for more than 10 years, interviewing them individually about their sexual identities, sexual desires and romantic relationships every two years.

After reviewing work by other love researchers and delving into accounts of love and friendship across cultures, Diamond developed what she describes as a biobehavioral model distinguishing love and sexual desire.

In her model, she proposes that sexual desire and romantic love are functionally independent; that romantic love is not intrinsically oriented to same-gender or other-gender partners; and that the links between love and desire are bidirectional.

Based on her model, Diamond thinks it's possible for someone who is heterosexual to fall in love with someone of the same gender, and for someone who is homosexual to fall in love with someone of a different gender.

Diamond's model offers a new interpretation of the implications of the ideas developed by psychologists Phillip Shaver, PhD, and Cynthia Hazan, PhD, who see adult romantic love as similar in certain respects to the infant/caregiver attachment bond, but with attachment and caregiving running in both directions between partners and with sexuality added to the mixture.

While Diamond argues that a person can fall in love with someone to whom they wouldn't usually be sexually attracted to, Shaver sees sexual attraction as one of the three behavioral systems contributing to the blossoming of adult romantic love, making it different from childhood attachments.

Other psychologists such as Pamela Regan, PhD, who studies how adults think about love and sex, say that most people view sexual attraction as an essential ingredient in the development of romantic love, the spark needed to set passion burning.

The links between love and desire

Diamond bases her model on the notion of romantic love evolving from the attachment bond formed between infant and caregiver.

As described in her 2003 article in Psychological Review (Vol. 110, No.1, pages 173–192), her model argues that while the goal of sexual desire is sexual union for the purpose of reproduction, romantic love is governed by the attachment or pair-bonding system, with its goal of maintaining an enduring bond between two individuals.

Sexual desire is driven by the gonadal hormones of estrogens and androgens. Animal research indicates that attachment is mediated by the neuropeptide oxytocin, with a more robust oxytocin-receptor network present in the female brain.

And since romantic love, she hypothesizes, is an outgrowth of infant/caregiver attachment, there's no way to “code” romantic love for gender.

That's because highly dependent infants become attached to the most responsive caregiver present, whether it's a woman or a man, she says.

Diamond also argues that the links between love and desire are bidirectional, because sexual desire can facilitate affectional bonding, and affectional bonding can facilitate sexual desire.

Most people perceive connections between the two experiences. Owing to cultural factors, people are expected to form romantic bonds with people they desire.

But they are not expected to experience novel sexual desires for people they love who are not “appropriate” partners, as judged by society.

An example of the type of relationships that fit in with Diamond's model are the intense friendships developed between girls at boarding schools in the 1800s, called “smashes,” and between same-sex individuals in other gender-restricted environments, such as combat units in the military, and college sororities and fraternities.

And because the links between love and desire are bidirectional, developing sexual desires running counter to a person's sexual orientation is possible too.

“It appears to be something everybody is capable of,” says Diamond.

Now a psychology professor at University of California , Davis , Shaver helped bring attachment theory to psychology's understanding of romantic love, and sees some aspects of romantic love across a variety of relationships.

While teaching at the University of Denver in the late 1980s, Shaver and Hazan developed a concept of love as being a combination of three different behavioral systems: attachment, caregiving and sex.

Describing himself as familiar with Diamond's work, Shaver says it's possible to see the elements of romantic love in things like the crushes that young children, particularly girls, develop for each other in elementary school.

In such relationships, children become possessive of another person, and can feel some of the anxiety, jealousy and distress at separation experienced by adults in romantic relationships, Shaver says.

“I think you could have one or two of these motivational systems active, and then you'd see a partial form of the full-blown romantic reaction,” he says.

But once a person goes through puberty, all three systems come together for many people's experience of passionate love, he says.

“And then a lot of the driving force, even if the person doesn't know it, is sexual,” he says.

Romantic love's essential ingredient

Regan's work supports a more familiar understanding of love and desire.

Now a social psychologist at California State University Los Angeles, Regan started out as an English major in college. Her study of sublimated sexual desire was confined to novels such as “ Wuthering Heights ,” and its portrayal of doomed lovers and thwarted desire.

She switched to studying psychology when she found she could study passion and desire full time.

From the years of research she and her students have done studying how people think about passionate love and sexual desire, Regan has concluded that sexual desire is an integral part of heterosexual adults' passionate love.

“Those are definitely connected experiences,” she says.

As described in a 1998 article in the Journal of Social and Personal Relationships (Vol. 15, No. 3, pages 411–420), people asked to list the features of passionate love overwhelmingly list sexual attraction as one of its key aspects.

In another study, when presented with information packets supposedly filled out by couples who either said they were “in love” with each other, “loved” each other or “liked” each other, participants rated the couples who said they were “in love” as experiencing the highest levels of sexual attraction, Regan says.

In studies cataloging the experiences of dating couples, Regan found men and women who described themselves as “in love” scored very high on measures of sexual attraction, as presented in an article in Social Behavior and Personality (Vol. 28, No. 1, pages 51–60).

While she thinks sexual desire is a key ingredient to passionate love, Regan says there's a difference between what people find sexually attractive and what they find romantically attractive.

“What turns you on physically is not necessarily what turns you on romantically,” she says.

In a curious twist, while both men and women find the attribute of physical appearance as sexually attractive, men misunderstand what women seek, and women misunderstand what men seek, Regan says.

Men think women find a man with resources highly sexually attractive—while women think men find a woman who's stereotypically feminine attractive. The truth is men and women both list physical appearance as the quality that's most sexually attractive.

But the list is more comprehensive for romantic attraction. Both men and women list qualities of kindness, warmth, a sense of humor, sociability, trustworthiness and a stable personality as attributes sought in a romantic partner.

Some attributes make the list for both sexual attractiveness and romantic interest, such as a sense of humor, she says.

Judging from her review of what men and women self-report on their daily levels of sexual desire, Regan says men have a stronger sex drive than women.

She notes that social pressures that approve of an openly expressed sex drive in men, and disapprove of it in women, may influence those results.

More than a feeling

New research suggests love may be a drive as primal as thirst or hunger.

Sadie F. Dingfelder
Monitor Staff

Monitor on Psychology
Volume 38, No. 2 February 2007

Conducting research with lovesick college students poses some special challenges. At least that's what Arthur Aron, PhD, and his colleagues found while running a brain imaging study a few years ago. His participants—students who had recently fallen madly in love—had no trouble with the first part of an experiment: lying in a brain-imaging machine, gazing at their partners' pictures and thinking about the person they loved. But when Aron asked students to shift their attention to a picture of an acquaintance, he ran into trouble.

“They couldn't stop thinking about their partners,” says Aron, a social psychology professor at Stony Brook University .

After months of pilot testing, Aron, Lucy Brown, PhD, and Helen Fisher, PhD, and their colleagues discovered that they could distract participants by showing them a randomly generated number and making them count backwards by sevens for several minutes. Only afterward could they think about their acquaintances.

“One subject told us that having done that in the study helped her go to sleep at night,” Aron says.

The great lengths the student had to go through to stop pondering her partner illustrates what a powerful force romantic love is, says Aron. But, contrary to popular opinion, that force is not an emotion, he contends. Rather, it is a motivational state, perhaps one as fundamental as hunger and thirst.

Recent research by Aron and others supports this theory. For instance, functional magnetic resonance imaging (fMRI) studies show that dopamine-rich areas of the brain light up when we think about a romantic partner. Those regions, such as the ventral tegmental area (VTA), are known as the motivation and reward system, and appear to activate whenever people get something they deeply desire—food, water, cocaine or perhaps a girlfriend's phone call. Some behavioral research, as well as people's description of romantic love, lends further support to the theory, Aron says.

“For many people, the experience of falling in love is like being in a desert and suddenly seeing water out there,” notes Aron.

Exquisite suffering

A parched man in the desert may feel elated upon spotting an oasis. But if the water turns out to be a mirage, he'll experience an entirely different set of strong emotions, notes Lucy Brown, PhD, a neurology professor at the Albert Einstein College of Medicine in New York . The fact that love, like thirst, can lead to a wide variety of intense feelings suggests that it's closer to being a drive than an emotion in its own right, she says.

“People tend to think when you are in love you are happy, but love can also mean feeling anxious, angry, sad,” says Brown.

An as-yet-unpublished study by psychology graduate student Bianca Acevedo confirms Brown's hunch. Acevedo, in her fourth year at Stony Brook University , gave 183 students a list of 69 emotion words, such as affection, jealousy and bliss. She then gave them one of four target terms—anger, fear, joy, sadness or love—and asked them to check off all the emotion words that related to their target term.

She found that people checked off about seven more list items when given the target term “love” than they did with the other targets. What's more, the students linked both positive and negative words to “love,” whereas words like “joy” garnered only positive associations.

“We believe this shows that love, in general, operates differently than emotions,” Acevedo says. Those who think of love as an emotion may be misdirected by the fact that love can cause such strong emotions, she notes.

Some emotion researchers take issue with that stance. Gian Gonzaga, PhD, a psychologist and the senior research scientist at eHarmony Labs, says that the flash of love, the warmth and affection that you feel for just a few moments when you think about a lover, is an emotion. And like other emotions, love has a distinct nonverbal display, according to a 2006 study by Gonzaga and his colleagues in Emotion (Vol. 6, No. 2, pages 163–179). The researchers videotaped 63 couples while they reminisced about their first date. During these exchanges, participants tended to lean toward each other, smile and gesture with open hands, the researchers found.

In contrast to Acevedo's findings, the participants in Gonzaga's study reported feeling a consistent set of positive emotions, including high levels of happiness and arousal and low levels of discomfort and fear.

The conflicting results may come from the varying definitions of love used by different schools of researchers, Gonzaga notes.

“There are a lot of theories of love and love across time,” Gonzaga notes. “In some conceptions love isn't always a good thing. It isn't always a happy thing.”

Drug-like effects

While there may be moments of placidity, the larger experience of love is a mixed bag, Aron agrees. In fact, participants in Aron's fMRI study, published in the Journal of Neurophysiology (Vol. 94, No. 1, pages 327–337), reported a variety of different emotions as they gazed at their partners—and their brains, too, showed a diverse array of activation patterns. Some participants who reported being happily in love even reacted to the photos with increased amygdala activity—a response associated with fear and anxiety.

Those fretful participants might have been worried about the possibility of losing their partners, notes Brown, a study co-author.

“With love, emotion is certainly involved, and emotion areas of the brain are involved, but it is going to be much more dependent on the individual's personality and attachment style,” she says.

While the participants in Aron's study felt many different emotions when thinking of the person they loved, they did have one thing in common—they all showed activation in the VTA, the right posterodorsal body and the medial caudate nucleus. These dopamine-rich regions of the brain signal satiation of deep needs, notes Helen Fisher, PhD, an anthropology professor at Rutgers .

“All of the basic drives are associated with the dopamine system, and so is romantic love,” Fisher notes.

The increase in energy that people newly in love experience—their ability to stay up all night talking—may be due to a flush of dopamine, Fisher says. Dopamine-system activation is also related to focused attention, underpinning the feeling that one person is the new center of your world, she says.

Some of the same systems activated in people who are happily in love are also similar to those activated among people who have been recently rejected, according to an as-yet-unpublished study by Fisher and her colleagues. They had 15 lovelorn students lie in an fMRI machine and look at pictures of their former partner or a familiar acquaintance.

As with the happily in love students, the lovelorn showed increased activation in the motivation and reward systems when they thought about the person they loved. Unlike the happily in love students, the lovelorn also showed activation in their right nucleus accumbens, an area of the brain associated with taking big risks.

Taken together, the studies paint a picture of love acting in a manner not unlike cocaine, which also works through the dopamine system and causes intense craving, says Fisher.

“Addictions are very powerful, and all of the addictions are associated with dopamine in one way or another,” she notes.

Seeing love as an intense drive to be close to someone, rather than an emotion, may help clinicians understand the yearning people have for their loved-ones, says Fisher. It could also help us predict how people will react when they can't get what they want, she says.

“Many instances of homicide and suicide and stalking are associated with romantic love, and the more we can understand the basic processes in the brain, the more we can understand why people commit these crimes,” says Fisher.

The eternal question: Does love last?

One school of thought holds love is destined to ebb. Another finds it all depends on the lovers.

Laurie Meyers
Monitor Staff

Monitor on Psychology
Volume 38, No. 2 February 2007

Some psychologists say romantic love endures, while others disagree. Here's a look at both sides.

Every flame dies down

Romantic, passionate love is fleeting, says Elaine Hatfield, PhD, a psychology professor at the University of Hawaii who has been studying love since the 1960s. “Passionate love provides a high, like drugs, and you can't stay high forever,” she says. In fact, companionate love—the less passionate, but affectionate emotion that is associated with long-term commitment—declines over time as well, says Hatfield.

In 1981, Hatfield and fellow social psychologist Jane Traupmann, PhD, performed a series of interviews that assessed the level of passionate and companionate love in a random sample of 953 dating couples, newlyweds and older women who had been married for an average of 33 years. In findings presented in a chapter of the book “Aging: Stability and change in the family” (1981. New York : Academic Press), they found that passionate love decreased precipitously over time. Asked to rate their feelings on a scale that included the responses “none at all,” “very little,” “some,” “a great deal,” and “a tremendous amount,” steady daters and newlyweds expressed “a great deal” of passionate love for their mates, but starting shortly after marriage, love declined steadily, with the group of older women saying that they and their husbands felt “some” passionate love for each other.

“The prevailing wisdom was that passionate love would last for a few years and then companionate love would grow, but it also declines,” notes Hatfield, who has continued to write and give presentations about passionate and companionate love. She adds that it tends to decline at the same rate as romantic love, and generally never stops declining. Hatfield's findings are backed by other, more recent research. In a 1999 study published in the Journal of Personality and Social Psychology (Vol. 76, No. 1, pages 46–53), social psychologist Susan Sprecher, PhD, found that couples in relationships may subjectively feel like their love and commitment is increasing with time, but it is actually declining. In a study of dating couples, Sprecher administered two questionnaires to each member five times over a four-year period. The questionnaires included a survey asking about feelings of love, satisfaction and commitment and another one that contained scales to measure actual levels. She found that in the second round, love decreased for men and satisfaction decreased for both sexes. However, for the couples who stayed together, measures of commitment increased. Interestingly, she also found that among couples who broke up, both men and women were likely to report a decrease in satisfaction and commitment before the break-up, but no change in feelings of love.

So what keeps marriages and other long-term relationships together? Passionate love must come back intermittently, like small sparks that keep the relationship smoldering, Hatfield theorizes.

She does allow that there “are some couples with really good marriages who have come to love, like and understand each other, and so the companionate love is maintained or even grows.”

Both fan the flame

Psychologist Robert J. Sternberg, PhD, thinks that love doesn't have to decline, but in order for it to flourish, both partners must share the same love “story.”

For Sternberg, a former APA president who is dean of the School of Arts and Sciences at Tufts University and has been studying love since the 1980s, the logical psychological theories about love—including his own—were at odds with the way people actually think about love: Most people seem to see it as story-based.

“I was interested in the fact that people seem to relate strongly to love stories,” he says, noting that people seek them out in books, magazines, on television and in the movies.

“Is there any way to capture the story essence?” he wondered.

In a series of interviews in the 1990s with college and graduate students who ranged in age from 17 to 26 years old, Sternberg identified about 25 stories that people use to describe love. As Sternberg detailed in his book, “Love is a story” (1998. New York: Oxford University Press), the stories range from the “travel” story (“I believe that beginning a relationship is like starting a new journey that promises to be both exciting and challenging”) to the “humor” story (“I think taking a relationship too seriously can spoil it”) to the “autocratic government” story (“I think it is more efficient if one person takes control of the important decisions in a relationship”). In the 2001 study published in the European Journal of Personality (Vol. 15, No. 3, pages 199–218), Sternberg and his co-authors found that the type of story wasn't the deciding factor in forming a lasting relationship, but having matching stories was.

It's not the only thing that makes a relationship work, but it's important, says Sternberg.

“If the stories don't match, sooner or later people become unhappy or unfulfilled,” he found, adding that the more people's stories matched, the happier they were.

Phantom pain and the brain

An actual touch, or an imaginary one? It’s all the same to (some parts of) your brain.

By Sadie F. Dingfelder
Monitor Staff

Monitor on Psychology
Volume 38, No. 1 January 2007

Scientists have long conceptualized the part of the brain known as the primary somatosensory cortex (S1) as where it first registers touch sensations. Prick your finger and S1 springs into action, sending raw information about the injury’s location to higher brain areas for further interpretation, according to most neuroscience textbooks.

Those textbooks may need new editions. S1 doesn’t simply catalogue physical sensations: It also registers sensory illusions that are generated elsewhere in the brain, according to a recent study in PLOS Biology (Vol. 4, No. 3, pages 459–466). In fact, as far as S1 is concerned, there’s no difference between a real or imaginary touch, says lead author Felix Blankenburg, PhD, a neuroscience researcher at University College London (UCL). Other researchers, including David Ress, PhD, a neuroscience professor at Brown University , are finding similar results in S1’s cousin, the primary visual cortex.

Together, the research paints a picture of a deeply integrated brain, one that begins making sense of information at the earliest stages of perception, says Ress.

“You use a lot of your brain to make a visual decision,” he says. “The whole system is probably used as an integrated whole in order to create visual consciousness.”

Tactile illusions

Tap people’s arms rapidly at the wrist and then at the elbow, and they will feel a phantom tap right in the middle, as if a rabbit were hopping the arm’s length. Blankenburg and his colleagues, including Jon Driver, PhD, director of the Cognitive Neuroscience Institute at UCL, harnessed this phenomenon, known as the cutaneous rabbit illusion, to see how tactile illusions play out in the brain.

The researchers strapped electrodes to the arm of 10 adult participants, placing the electrodes at three points between each participant’s elbow and wrist. While the participants lay in a functional magnetic resonance imaging (fMRI) machine, the researchers delivered pulses to the electrodes. In one condition, participants experienced real sensations hopping up their arms, as experimenters activated the three electrodes in succession. In another condition, participants only thought they felt the sensation hopping up their arms, as researchers delivered pulses first to the electrode near their wrist and then to one by their elbow.

Participants reported feeling the illusory touch and the real one equally strongly, and their brains agreed—the S1 area registered both sensations at the same location in the brain and with a similar amount of neural activity.

“This is quite remarkable because traditionally we thought S1 formed a map of the body that faithfully represents the actual touch on the skin, but our results suggest this is not always the case,” says study author Christian Ruff, PhD, a psychology and neuroscience researcher at UCL. Instead, S1 seems to be representing what we feel—not what is actually there, he adds.

Where is S1 getting its false information? One possibility is that higher areas of the somatosensory cortex, the ones that would integrate information about the time and location of a tap on the skin, also register raw sensory information and then force their interpretation on S1, says Ress, who also studies perception.

In fact, while S1 showed no differences in activation during real and imagined touch, the right premotor cortex showed increased activation during the illusory touch, and that area may be at least part of the illusion’s source, Ruff observes.

“It could be that signals from higher-level brain structures can influence the primary sensory cortex via neural feedback connections,” Ruff notes.

Visual mistakes

Researchers who study an entirely different sense—vision—are coming to similar conclusions. Scientists traditionally claim that the primary visual cortex, or V1, registers sensory information and then kicks it tohigher-level areas for processing. A study published in a 2003 issue of Nature Neuroscience (Vol. 6, No. 4, pages 414–420) suggests otherwise.

The study’s four adult participants lay in an fMRI machine while watching a screen that showed a faint vertical grating on a similarly patterned background, or just the background alone. Participants had one second to view the screen and then one second to press a button indicating whether they had seen the vertical grating —a process repeated several hundred times for each participant.

Analysis of their brain activity showed high levels of activity in V1 both when the participants saw the grating and when they just thought they saw it. What’s more, the V1 area was similarly quiet when participants did not see the grating as when they just missed it.

These results, like those of the Blankenburg study, help explain why false perceptions sometimes feel quite real, says Ress.

“If you think you perceive a sensation, then the lower-level primary sensory area that is associated with that false perception actually becomes involved,” he notes.

However, he cautions that fMRI data doesn’t always match up with the electrical activity of the brain.

“It’s a very indirect measure of neural activity, and we are still not exactly sure what it means,” he notes.

That said, this line of research could eventually help amputees who suffer from phantom limb pain, Blankenburg says. If phantom pain comes from the lowest level of the sensory system, effective drugs or therapy could target that area.

In the distant future, research on the translation of sensation to perception may lead to machines that transmit visual signals directly into the brains of blind people, allowing them to see. But if higher level areas of the brain feed information to the lower areas, as is suggested by this line of research, such applications wouldn’t just be able to transmit raw data straight into people’s primary cortices, Ress posits.

“The design of something that emulates cortical processing becomes more complicated when the brain is a recursive network,” he says.

Don’t be mad

More research links hostility to coronary risk.

By Nadja Geipert

Monitor on Psychology
Volume 38, No. 1 January 2007

 In 1959, cardiologists Meyer Friedman and Ray Rosenman observed in top medical journals that competitive, deadline-driven, hypervigilant men—so-called Type A personalities—faced a significantly increased risk for coronary heart disease.

Yet ensuing large epidemiological studies failed to confirm the connection, and most health psychologists abandoned the concept in the late 1980s in favor of a component often found in Type A people: hostility.

A meta-analysis presented by German researcher Michael Myrtek, PhD, in his chapter on heart disease, Type A and hostility in the recently published APA book “Contributions Toward Evidence-based Psychocardiology: A Systematic Review of the Literature” (see “One heart—many threats”) confirms that there is no significant association between Type A personalities and heart disease, but that there is a connection between hostility and coronary heart disease.

“The consensus is really that it is not all aspects of Type A behavior, but just the hostility component,” says Redford Williams, MD, director of the behavioral medicine research center at Duke University School of Medicine.

David Krantz, PhD, chairman of the department of medical and clinical psychology at Uniformed Services University , agrees: “You can be ambitious. You can be time pressured. But if you’re not hostile and angry, your risk is lower,” he says.

Today, the heart disease-hostility link has gained significant credence among investigators, even though the exact nature of the connection remains up for debate. One hot-button issue is that several studies have linked hostility with other well-established risk factors like smoking, obesity, depression and socioeconomic status. But, with the help of technological advances, researchers have also discovered evidence that hostility contributes independently to the pathogenesis of heart disease through lipid accumulation, increased blood pressure and heart rate and platelet physiology.

New findings

Psychologists conceptualize hostility as consisting of three components: the emotion, the expression and the cognition—so-called cynical mistrust. Most research has focused on the cognitive hostility aspects of distrust, antagonism and general manipulativeness and how these traits relate to medical measures like blood pressure and heart rate or traditional cardiac risk factors like smoking.

A study co-authored by Krantz in the July issue of Psychosomatic Medicine (Vol. 67, No. 4, pages 546–52) found that in 506 women with suspected artery disease, those with higher hostility scores were more likely to have subsequent coronary events like hospitalizations for angina, nonfatal myocardial infarction, stroke and congestive heart failure in the next three to six years. This remained true even after the investigators adjusted for other risk factors, suggesting that hostility indeed constitutes an independent risk factor.

Another study published in the February issue of Neuropsychobiology (Vol.53, No.1, pages 26–32) found a positive association between increased hostility and increased plasma homocysteine levels, which is also considered an independent risk factor for coronary heart disease.

In another example of high-tech experimentation, University of Pittsburgh School of Medicine (UPSM) researchers used carotid-artery imaging to evaluate a connection between intimal-medial thickening—a measure of subclinical atherosclerosis—and hostility in white and African-American middle-aged women. They found that each one-point increase in hostility scores predicted a significantly higher intimal-medial thickening. The results were published in the November issue of the American Heart Journal (Vol.152, No. 5, pages 982.e7–13).

“These new technologies allow one to measure atherosclerosis in healthy people way before there are any symptoms of the disease and offer opportunities to examine the associations between hostility with sub-clinical disease,” says study co-author Karen Matthews, PhD, professor of psychiatry, epidemiology and psychology and director of the cardiovascular behavioral medicine research training program at UPSM.

Hostility’s complex role

Other research points to hostility’s overlap with other well-established psychological and physical risk factors.

For example, a recent study published online in Psychosomatic Medicine examined hostility, depression, anxiety and trait anger as it related to coronary heart disease in U.S. Air Force Veterans. The study concluded that while each individual psychological attribute was a significant predictor of coronary disease, it was really the co-variation of the four traits that posed the biggest risk.

Meanwhile, a meta-analysis published in the July issue of Health Psychology (Vol.25, No.4, pages 493–498) found a relationship between hostility and the following measures: triglycerides, body mass index, waist-to-hip ratio, glucose levels, socioeconomic status, alcohol consumption and smoking. The results suggest hostility plays a complex role in the etiology of heart disease.

Such findings lead the study’s lead author Jerry Suls, PhD—a health psychologist at the University of Iowa —to believe future research should focus on the connections among the different risk factors. “It probably isn’t wise to split the traditional physical risk factors for cardiac risk from the psychological ones because there is so much connection between the two types,” he says.

Building a stronger heart

Psychologists have hit on successful behavioral techniques to reduce cardiovascular disease. The next challenge is dissemination.

By Laurie Meyers
Monitor Staff

Monitor on Psychology
Volume 38, No. 1 January 2007  

Psychology helps heal metaphorical broken hearts, but what can it do for real ones? It can help keep them from breaking in the first place through behavioral interventions for major heart disease risk factors such as smoking, physical inactivity and diabetes.

Two major preventive ingredients are proving important: Focus on the constructive—what people can do to help themselves—and follow up, says psychologist Elyse Park, PhD, an assistant psychiatry professor at Harvard Medical School .

“It’s about building up efficacy and motivating them to see things positively,” she says.

Park also believes that health professionals shouldn’t wait for people at risk for heart disease to come find them. “The patients who come forward are more successful, but sometimes being reached out to can really help patients,” she notes.

Up in smoke

Cigarette smoking increases the risk of cardiovascular disease by itself and can also interact with other factors to further increase risk, according to the American Heart Association. Smoking increases blood pressure, decreases exercise tolerance, increases the tendency for blood to clot and decreases “good” cholesterol. Taking into consideration all of these effects, smoking accounts for almost 440,000 deaths annually.

So how do you get people to quit? A combination of behavioral change counseling and pharmaceutical assistance works best, says Park, who has worked with cancer patients and survivors, expectant and new parents and other groups who are trying to quit smoking. Interventions should be targeted to an individual’s barriers, she says. “Try to figure out what motivates them to smoke, what is their quit history and their support system, and help them set goals,” Park says.

For instance, in a 2006 study published in Obstetrics & Gynecology (Vol. 108, No. 1, pages 83–92), Park and her team found that a telephone intervention targeted specifically at pregnant women was more effective than an untargeted method in light smokers or those who had previously tried to quit. However, the intervention was not more effective in heavy smokers, who likely need additional strategies such as pharmaceutical therapy or more intensive counseling.

Events like a heart attack, cancer diagnosis or pregnancy can also be what Park calls “teachable moments” which can give extra motivation. The counseling in the cessation therapy would target condition-specific issues such as the negative effects that smoking has on a fetus or how quitting smoking can reduce the risk of a repeat heart attack.

On the move

Physical activity helps reduce the risk of heart disease by improving blood circulation throughout the body, reducing cholesterol levels, controlling blood pressure and reducing weight gain, according to the American Heart Association. However, only about 30 percent of Americans 18 or older engage in 30 minutes or more of leisure-time physical activity five or more times a week, recent Centers for Disease Control and Prevention estimates suggest. Health professionals are working to increase that number through a variety of means.

One approach is to teach a successful exercise regimen involving planning and self-regulation, says Martina Kanning, a sports psychology researcher at the University of Stuttgart .

“You have to plan your [exercise] actions—when you will do it, and what you will do,” notes Kanning, who was one of the contributors tothe recent APA book release “Contributions Toward Evidence-Based Psychocardiology: A Systematic Review of the Literature” (see “One heart—many threats”).

Behavioral techniques can be useful in addressing this, but future research should determine what works consistently, she says. One approach is to give people specific small steps that they can take to start improving their fitness and well-being, says John Jakicic, PhD, a professor of exercise physiology at the University of Pittsburgh . Jakicic is running a citywide fitness campaign, “ America on the Move in Pittsburgh .”

It’s based on a national initiative pioneered by the America on the Move Foundation, which was co-founded by James O. Hill, PhD, a physiological psychologist. The foundation has conducted several small studies suggesting that setting small goals can have appreciable results. For instance, a 2004 study in the Journal of Physical Activity and Health (Vol. 1, No. 3, pages 181–190) indicated that a community-based effort to encourage people to take an additional 2,000 steps a day can increase physical fitness levels. A 2006 study in Obesity (Vol. 14, No. 8, pages 1392–1401) showed that families with obese children who increased their steps and altered their food intake by eating at least two servings of cereal a day were able to prevent weight gain.

The goal of America on the Move is activity, and each community does it a little differently. Jakicic sees Pittsburgh ’s as the most progressive because of a community coalition he’s built that includes big business, local grocery stores, restaurants, the parks conservancy and the media. He also hopes to involve primary-care physicians and local school districts.

“Our goal is to take more simple steps to make people more healthy, because Pittsburgh is a pretty unhealthy city,” says Jakicic. “[We are saying] here is how you can eat healthy, this is how you can be active.”

The coalition has used the media to get out the message about Pittsburgh ’s parks and bike trails and other ways to add 2,000 steps a day. “One time around the football field [at the University of Pittsburgh ] is 2,000 steps,” Jakicic says. “We also point out various landmarks—from this landmark to that landmark is 2,000 steps,” he adds. “We also stage public events where we do something simple like go on a walk during the lunch hour.”

The coalition also worked with the city’s largest grocery chain to develop a “healthy foods” section in all of its stores. The chain is also developing plans for stores that will be like the organic market chain Whole Foods.

Defeating diabetes

In the United States , the 20.8 million people who have diagnosed and undiagnosed diabetes are two to four times more likely to die from heart disease than those without the condition, the American Diabetes Association (ADA) estimates. In addition, ADA estimates that about 54 million Americans have prediabetes, a condition in which glucose levels are elevated, but not yet high enough to be diagnosed as diabetes. Research has indicated that these elevated levels may already be causing damage—especially to the heart and circulatory system.

The good news? A 2002 large-scale study of the Diabetes Prevention Program, published in the New England Journal of Medicine (Vol. 346, No. 6, pages 393–403), has shown that the onset of diabetes can be delayed or even prevented through lifestyle interventions. Those same interventions can also help keep diabetes under control.

“We had a 58 percent reduction in diabetes risk with lifestyle treatment,” says psychologist Elizabeth Venditti, PhD, one of the principal investigators on the Diabetes Prevention Program.

The lifestyle treatment consisted of modifying diet to achieve a seven percent body weight loss and performing 150 minutes of exercise a week. “I think the fact that the goals were very clear and there was a sense of ‘this is what you can achieve’ made it more effective,” says Venditti.

The participants received training in keeping a food diary and monitoring calorie intake, weighing themselves regularly to make the connection between behavior and results, reading food labels, and putting together an activity program. They also worked on overcoming barriers and learning problem-solving skills such as how to make healthy choices when eating in a restaurant or to avoid the urge to overeat on social occasions. Participants were also prepared for regaining weight, and how to get back on track after that happens. Follow up was also crucial, says Venditti.

“We created this place where people knew they could be held accountable,” she says.

Getting such interventions to the neediest patients is the next challenge?, says Venditti.

“We have the behavioral methods, but access and delivery are lagging behind,” stresses Venditti. Health-care professionals now needs to focus on how to create a health-care environment where people will have a place to go for “lifestyle” checkups once they get going on these kinds of interventions, she adds.

“There needs to be long-term contact,” she asserts. “It doesn’t have to be frequent— just something where the person feels accountable.”

Helping others, helping ourselves

Psychologists are studying why people volunteer, and how organizations can hold on to volunteers in the long term.

By Lea Winerman
Monitor Staff

Monitor on Psychology
Volume 37, No. 12 December 2006

Like many people who generally enjoy their careers, Dan Toporek nevertheless sometimes wondered if there were something missing—something else he could be doing to contribute to global improvement and well-being.

Instead of quitting his job, though, Toporek, the vice president of corporate communications for the travel Web site Travelocity, decided to put his company’s name and resources to use. He and several co-workers convinced their bosses to launch a new program called Travel for Good to promote volunteer vacations.

On such vacations—sometimes called “voluntourism”—people spend their trip time on activities like cleaning up national parks or building houses for Habitat for Humanity. And these vacations are becoming steadily more popular. One nonprofit service vacation organizer, GlobeAware, says that its registrations have increased 33 percent since 2000. Another—Earthwatch—has seen a 40 percent increase over the past several years.

Toporek and his colleagues spent many hours outside their regular workdays putting together the Travel for Good program, which includes a Web site that provides information about GlobeAware, Earthwatch and other groups, and competitive grant awards that will provide money for Travelocity employees and customers to take service vacations. The program launched in September.

“We’ve gotten a lot of employees involved in running it,” Toporek says. “We’re really excited, so we don’t mind putting in the extra time.”

This kind of behavior might be admirable—but, from a psychologist’s point of view, it’s also puzzling. Whether it be Toporek and his colleagues spending extra hours at work, or their customers who give up relaxation time on vacation, people who volunteer are doing work that promises them no obvious personal gain and may involve significant costs.

Yet in the United States , nearly one out of three adults regularly spends some time volunteering, according to University of Minnesota psychologist Mark Snyder, PhD, who studies volunteerism. And in this season of gifts and giving—and of New Year’s resolutions—volunteering may be on even more people’s minds than usual.

“When I initially started thinking about this, I was struck by how much easier it was to come up with reasons why people shouldn’t volunteer than why they should,” Snyder says. “It’s time consuming, it’s stressful, it takes time away from your job or family or leisure.” What is it, he began to ask, that propels so many people to donate their time, their energy and their efforts anyway?

Multiple motives

Snyder and his colleagues have been working to answer that question for more than 20 years. In the mid-1980s, he and Claremont Graduate University psychologist Allen Omoto, PhD, began studying volunteers providing care for patients with HIV/AIDS.

“These people embodied all the details of volunteering,” Snyder says. “They were developing an ongoing, helping relationship with a complete stranger. And it was with the backdrop of a lot of stress—working with someone who has a serious illness.”

Omoto agrees, adding, “in the context of HIV there were particularly high costs [to volunteering], because of the prejudice and discrimination at that time.”

Snyder, Omoto and their colleagues eventually surveyed volunteers who did all kinds of other community work too, as well as young, middle-aged and older volunteers.

Over the years, they’ve identified five primary motivations for volunteering:

Values. Volunteering to satisfy personal values or humanitarian concerns. For some people this can have a religious component.

Community concern. Volunteering to help a particular community, such as a neighborhood or ethnic group, to which you feel attached.

Esteem enhancement. Volunteering to feel better about yourself or escape other pressures.

Understanding. Volunteering to gain a better understanding of other people, cultures or places.

Personal development. Volunteering to challenge yourself, meet new people and make new friends, or further your career.

Different types of volunteers have slightly different levels of these motivations, according to Snyder. Younger volunteers, for example, are more likely to volunteer for career-related reasons, while older volunteers more often cite abstract ideas of good citizenship and contributing to their communities.

Still, Snyder says, “In many ways it’s the similarities across types of volunteering that are striking.”

Somewhat more recently, the researchers have begun to study thefactors that help organizations hold on to volunteers. For example, in one study, published in 1998 in the Journal of Personality and Social Psychology (Vol. 74, No. 6, pages 1516–1530), psychologist E. Gil Clary, PhD, and Snyder surveyed 61 hospital volunteers about their motivations for volunteering, and then later about their experiences as a volunteer. They found that the people whose experiences best matched their motivations were more satisfied with the experience. Those same people also said that they’d be more likely to continue volunteering.

“People have an agenda when they volunteer—and that’s in the best sense of the word,” says Clary. “So outcomes depend on whether an organization can fulfill the volunteer’s agenda.”

Interestingly, the researchers have also found that people who have more seemingly “selfish” motivations—esteem enhancement, personal development and understanding—are more likely to stick with a volunteering organization longer than people with more “other focused” motivations, such as values, according to Omoto.

“It could be because the volun-teering is more likely to satisfy those motivations,” he says. “If your values say you should help people, you could probably always switch to another organization that also helps people.”

Omoto and Snyder say that their research could help organizations that rely on volunteers. For example, if the organizations can figure out their volunteers’ primary motives for volunteering, then they could tailor ads and other recruitment strategies to address those motivations—and they could try to steer the volunteers to activities most likely to satisfy them.

Theoretical underpinnings

Psychologists who investigate the real-world motivations of real-life volunteers do so against the background of other researchers who study and discuss the theory of altruism.

These researchers are mainly concerned with whether altruism, as a concept, actually exists. Do people do altruistic things—including volunteering—because they are truly altruistic and selfless, or because they themselves receive some sort of benefit from every altruistic-seeming act?

University of Kansas psychologist Dan Batson, PhD, believes that true altruism exists as a motivational state with the goal of increasing another person’s welfare. He theorizes that such selflessness is based on the empathy people feel for others. In a classic study, for example, he asked participants to watch as a confederate received fake “shocks” for failing a memory test. He found that when he asked people to imagine that person’s pain, those who said that they felt compassion for the person also said they’d be willing to take several shocks on the person’s behalf, even though they were allowed to leave the experiment at any time.

“We as humans are capable of a motive that has another’s welfare as the ultimate goal,” Batson says.

But Arizona State University psychology professor Robert Cialdini, PhD, disagrees. He says that while empathy does lead to increased helping, it does so not because of pure altruism but because thinking of another person’s pain makes us sad, and one way to make ourselves feel better is to be helpful. Another possibility is that taking another person’s perspective actually causes us to feel some overlap between ourselves and that other person, Cialdini says, and so we help them the way we would help ourselves.

As evidence for this, Cialdini has found that when participants are made to feel similar to another person—by giving them a fake electroencephalogram exam and telling them that they have sibling-like similar brain waves—and then are told to empathize with that person, they’re more likely to help them. But when people don’t feel similar to another person, they’re less likely to help that person, even if they’re instructed to empathize with them.

“What we argue is that taking the perspective of another person can indeed lead to increased helping,” Cialdini says. “But we don’t assign it to a kind of pure altruism. We say that it’s associated with a form of egoism, in which the self receives enhanced benefits.” Certainly in the animal kingdom, egoism, it seems, is the driver of apparent altruism (see “Altruism: an accident of nature?”).

Most psychologists who study volunteerism say that although such theoretical arguments are important, they may not have much bearing on the practical question of why people volunteer.

“I don’t doubt that, from a theoretical perspective, one can derive differences,” Snyder says. “But in the real world, these things are intimately wrapped up. The same act of volunteering can have an altruistic component, reflecting a true concern for the welfare of others, but also an egoistic component, in that the volunteer receives clear benefits to the self. It’s better to see the two feeding each other, rather than being in competition.”

Altruism: an accident of nature?

Bees, bats, ravens and humans often help one another. But usually there’s a hidden agenda.

By Sadie F. Dingfelder
Monitor Staff

Monitor on Psychology
Volume 37, No. 12 December 2006

Bernd Heinrich, PhD, was hiking through the woods in Maine when he happened upon a group of ravens feasting on a dead moose. They were making quite a ruckus, recalls Heinrich, a biology professor at the University of Vermont . In fact, the birds used a loud call that Heinrich had never heard before, a call that seemed to attract even more ravens to the area. Their behavior puzzled the researcher.

“Ecological theory would tell you that a food bonanza would be defended and not shared,” he says.

But the birds were sharing. Some of the ravens even returned to their roost to recruit more animals, Heinrich observed. The strange behavior inspired the biologist to conduct a series of field studies, which he eventually published in the book “Ravens in Winter” (Simon and Schuster, 1989).

Heinrich’s helpful ravens are now a classic example of animal altruism, says Jeff Stevens, PhD, a psychology professor at the Max Planck Institute for Human Development in Germany . But like most examples of animal altruism, the apparently selfless act had selfish benefits.

The sharing ravens, it turned out, were juveniles who had found the moose carcass in a mature raven’s territory. By bringing other young ravens to the feast, they avoided being chased off by the territory-holding bird. For any behavior to survive natural selection, it needs to help an animal or its genetic material, he notes.

“True altruism...paying a cost to help another individual and never ever receiving any kind of benefit, is not very common,” Stevens says. “It wouldn’t make much sense biologically for that to happen.”

Help a brother out

More commonly, when an animal assists another, there is a hidden reward for the helper, says Nigel Barber, PhD, a Maine-based psychologist and author of “Kindness in a Cruel World” (Prometheus Books, 2004). Perhaps the most widespread form of altruism, he notes, is the case of a parent protecting and feeding its young. Birds will rob themselves of nutrition to regurgitate food into the gaping maws in their nest. But even if an altruistic act endangers a parent’s own life, it makes evolutionary sense to increase the likelihood one’s young will survive, Barber notes.

“They are acting in the interest of their genes, if not their own lives,” he says.

A similar principle is at play when an animal assists its siblings or cousins, says Stevens. This is the case when worker bees devote themselves to feeding the offspring of the hive’s queen, instead of trying to reproduce themselves. The bee phenomenon puzzled Charles Darwin, and may be why he sat on his theory of natural selection for more than 20 years. The answer, proposed by biologist William Hamilton in the 1960s, is that sterile worker bees are helping to further their genes because they are so closely related to the young they are helping to raise.

“Most examples of altruism do involve kin,” Stevens says.

That’s true of humans too, notes Barber. Many studies have shown that while people do help strangers, they are more likely to give money to relatives. Additionally, adopted children, on average, get a smaller share of inheritances than biological children, according to an analysis of 1,538 California estates, published in a 1992 issue of Ethology and Sociobiology (Vol. 13, No. 5, pages 495–522).

“This may support kin selection, but I think that is probably not doing justice to the complexity of the situation,” says Barber, noting that some adopted children may enter into a family as toddlers or even teens, and subsequently may not develop as close as a relationship with their parents.

Even for bats, familiarity—as well as their genetic relatedness—seems to increase the likelihood of altruistic behavior.

Primitive insurance policies

Vampire bats have a fast metabolism and a food supply that is high in protein but low in fat. That means that they must feed on the blood of cattle or other animals every 36 hours, or they die.

So it surprised biologist Gerald Wilkinson, PhD, when he discovered, in the 1980s, that female bats would share their blood with unlucky hunters, regurgitating blood into the mouths of female roost mates.

“I had observed a lot of cases of them feeding their own young, which is how they wean their young from milk to blood, but this was the first time I had seen adults feeding other adults,” notes Wilkinson, now a program director at the National Science Foundation.

In a 1984 study, published in Nature (Vol. 308, No. 1, pages 181–184), Wilkinson reported that the animals did tend to feed closely related kin. But they also would feed “friends”—unrelated bats they roosted with. The friend would return the favor later, Wilkinson reports.

As a result of the animals’ inborn tendency to share, female bats manage to live upwards of 15 years, says Wilkinson. Stingy male bats survive about half that long.

“The adaptive rationale behind all of this is sort of an insurance policy,” says Barber. “You pay in a small amount and benefit when you need it later.”

Whether the bats are aware of their sharing policy is a matter of contention. It’s possible that they are born with a useful rule: help out familiar animals. Most of the time, that rule helps propagate their genes, as most roost mates are related, says Stevens.

In fact, pure altruism may be an accident of evolution, researchers suggest. A vampire bat that feeds an unrelated roost mate is, in effect, mistaking it for a sister. A bird that adopts another animal’s chick does so because it’s compelled to feed every hungry mouth in its nest. And raven researcher Bernd Heinrich treats his dog as part of the family because the human tendency for empathy has run amok, he says.

“It’s part of our social nature to help those that we are associated with,” says Heinrich “It’s not that we evolved to love dogs, and as a side product we love our babies. It is just the opposite.”  


Nix the tics

New research debunks Tourette’s syndrome myths and lays the groundwork for a behavioral intervention.

By Sadie F. Dingfelder
Monitor Staff

Monitor on Psychology
Volume 37, No. 12 December 2006

Most researchers agree that the roots of Tourette’s syndrome are largely biological. The disorder’s characteristic tics—head jerks, eye blinks and grunts, to name a few—seem to stem from abnormalities in the basal ganglia or with dopamine function. What’s more, people with the disorder generally experience tics as involuntary, which would seem to make Tourette’s a poor candidate for behavior therapy, notes psychologist John Piacentini, PhD, director of the Child OCD, Anxiety and Tic Disorders program at the University of California , Los Angeles .

“For the last 50 years, Tourette’s has been considered a neurological disorder with very little role for behavioral interventions,” Piacentini says.

However, attitudes are changing, he says. Though previously people believed that the tics of Tourette’s could only be stopped by medication, new research indicates that environmental contingencies play a role in tic expression. For instance, people suppress tics if they are rewarded for doing so, according to several recent studies.

This finding is promising, but a barrier remains: Many medical professionals still falsely believe that holding in tics leads to an explosion of tics later, notes Michael Himle, a fifth-year graduate student and Tourette’s syndrome researcher at the University of Wisconsin–Milwaukee .

“There is a lot of belief out there that when a child suppresses their tics, what you get is a rebound effect,” Himle says. “Some professionals have used this to caution against the use of behavior therapy.”

Research by Himle and others is countering that belief, and, as a result, funding agencies are now taking a serious look at nonpharmacological treatments for Tourette’s. In fact Piacentini and his colleagues recently received about $6 million in grants from the National Institute of Mental Health to try out a new behavioral technique for treating Tourette’s. The treatment, known as the Comprehensive Behavioral Intervention for Tics, (CBIT) combines behavior therapy with an attempt to root out anything that might be inadvertently rewarding tic attacks.

“This is a really exciting time,” Piacentini notes. “We are...developing behavioral interventions for what at root cause is a neurological disorder.”

Debunking myths

Fifty-five percent of medical professionals believe that Tourette’s tics can’t be controlled and 77 percent believe that if tics are suppressed, they will be even worse later, according to a 2004 survey published in Cognitive and Behavioral Practice (Vol. 11, No. 1, pages 298–305). The survey of 78 neurologists, family practitioners, psychiatrists and clinical psychologists showed that many members of the medical community held beliefs about Tourette’s syndrome that were false or untested, says study author Douglas Woods, PhD, a University of Wisconsin–Milwaukee psychology professor.

“It’s almost Freudian, this idea that you can try to repress an unwanted urge, and the more you suppress it the more it will bubble up somewhere else,” Woods notes.

Woods and his student Himle set out to test those assumptions. In a study published in a 2005 issue of Behaviour Research and Therapy (Vol. 43, No. 1, pages 1443–1451), they rewarded seven children, ages 8 to 11, for suppressing their tics. They told the children a “tic detector” would reward them with a token for every 10 seconds they did not tic. They also said the tokens were worth a few cents each, but regardless of their performance, all the participants received $2 at the end of the study.

While the children believed the tic detector worked automatically, a behind-the-scenes experimenter actually controlled the dispensing of the tokens. The tics exhibited by the participants in the study—which included throat clearing, nose scrunching and grunting—were too complex and subtle to be detected by a machine, Woods notes.

Before introducing the tic detector, the researchers recorded the frequency of the children’s tics. Afterward, they also “turned off” the machine for five minutes and instructed the participants to tic freely, to measure any rebound effect.

They found that the children were able to suppress their tics—they expressed a tic during 16 percent of the 10-second intervals when they were being rewarded, as opposed to 50 percent of the intervals at the beginning of the experiment. Though the children returned to a high rate of tics once they thought the machine was off, they flinched and grunted less after the suppression period than they did at the beginning of the experiment.

That same year, another study—published in Behavior Modification (Vol. 29, No. 5, pages 716–745)—showed no rebound effect for tic suppression in five people with Tourette’s syndrome, ranging in age from 7 to 20. In that study, psychology professor Raymond Miltenberger, PhD, and his North Dakota State University asked the participants to consciously suppress their tics for 30 minutes while watching television or while holding a conversation with an experimenter. In both cases the participants were only modestly able to control themselves—though some were much better than others. And, during a 30-minute period afterward they did not tic more than they had at the beginning of the experiment.

“There is really no support for a rebound effect, based on that study,” says Miltenberger. “And what we found is that kids have variable ability to control their tics to begin with.”

In addition to debunking the rebound myth, the studies demonstrate that environmental factors can influence the expression of Tourette’s syndrome, says Woods.

The findings also show that people can control their tics—especially if rewards are involved, Woods adds. That is an important foundation for therapy; however, chasing after clients with a coin-dispensing “tic suppressor” would not be a good way to help them control their behavior, he notes.

Tools for tic suppression

Most people with Tourette’s are treated with drugs, says Roger Kurlan, MD, a psychiatry professor and Tourette’s syndrome researcher at the University of Rochester .

“Behavioral interventions for tics...have never been shown to have more than modest potential benefit,” he notes. For that reason, people with Tourette’s are generally prescribed medications like risperidone, an antipsychotic, or clonidine, a blood pressure medication. The drugs do reduce tics, but the side effects are often worse than the symptoms they treat, says Woods.

“The antipsychotics have a 70 to 80 percent tic reduction, but the side effects are abysmal,” he notes. “They experience weight gain and fatigue, have dry mouths—and a lot of parents just don’t want to put their kids on medication.”

The time is ripe for an alternative treatment, says Piacentini. So he is leading a consortium of scientists who are using the basic science foundation to develop a new behavioral treatment for the disorder. Currently, they are testing CBIT with 120 adults and 120 children in a randomized controlled trial funded by the National Institute of Mental Health, with administrative support from the Tourette Syndrome Association.

The intervention hinges on findings that show Tourette’s tics can be affected by environmental and internal reinforcement. While a tic attack in the lab might be discouraged by a token reward system, in school it might be discouraged by the likelihood of teasing. Or, alternately, a child who gets out of doing household chores due to a tic attack might tic more when it’s time to wash dishes, notes Joyce Chang Lee, PhD, a clinical psychologist who is applying the CBIT treatment as part of her postdoctoral fellowship at the University of California, Los Angeles.

“We try to change those things and stress that the child be treated as normally as possible,” Lee says. For instance, parents might let children take a break if they have a tic attack during chore time, but should send them back to finish afterward, she says.

In addition to removing external rewards, Lee and her colleagues teach children to break the internal reward system for doing tics. Many people with Tourette’s syndrome report a premonitory urge or sensation right before they flinch or flail, notes Lee. So, over the course of eight one-hour sessions, she teaches them to be aware of that feeling and then perform a quick countermeasure to quash the tic.

For instance, one child she worked with would feel tension build up in his arm right before he flung it outward. Lee taught him to hold his arms tightly by his side whenever he started to feel that tension build.

The training tends to weaken tics over time, Lee says.

“Usually what happens is, once they use the competing response, the premonitory urge fades away,” she notes.

The treatment addresses the symptoms of Tourette’s, not its root causes. But it can make a big difference in the lives of people with the disorder, Woods says. In fact, pilot data show that people who undergo the treatment have a 30 to 60 percent reduction in their tics—an improvement that is comparable to many medications, he says.

And giving children tools to control their tics can reduce embarrassment and social stigma, Lee says.

“My first time working with children with Tourette’s was a difficult experience because they have behaviors that are so distressing for them; it was really hard to watch,” says Lee. “But it has been so rewarding to see the changes that have been made and the improvements in their lives.”  


Coping through cognition

Advanced cognitive skills may offer protection from post-traumatic stress disorder, according to new research.

By Lea Winerman
Monitor Staff

Monitor on Psychology
Volume 36, No. 10 November 2006

People who score highly on cognitive tests may be less vulnerable to post-traumatic stress disorder (PTSD) than people with only average scores, according to a study in the August issue of the Journal of Abnormal Psychology (Vol. 115, No. 3, pages 484–495).

The study, which examined Vietnam War veterans and their twin brothers, found that such traits as high general IQ and advanced verbal memory skills may offer some protection.

Psychologists have long known that, on average, Vietnam veterans who develop PTSD don’t do as well on some neurocognitive tests as veterans without PTSD, according to Harvard Medical School and Manchester VA Medical Center psychologist Mark Gilbertson, PhD, the lead author of the study. But researchers didn’t know whether those cognitive deficits were a result of PTSD or a risk factor that existed before the trauma. The new study’s twin-sample design allowed the researchers to investigate the causality question.

“[The twin study] gave us a unique sample to look at the question of vulnerability versus toxicity,” Gilbertson says.

He says he hopes the results may lead researchers to develop methods to teach people at risk for trauma exposure—such as police officers, firefighters and soldiers—new ways to protect themselves against PTSD.

Same genes, different experiences

In the study, Gilbertson and his colleagues tested 43 Vietnam War veterans and those veterans’ twin brothers, none of whom had been exposed to combat. Nineteen of the veterans developed PTSD, while none of the noncombat twin brothers did.

The researchers gave all 86 participants a battery of cognitive tests, including a general IQ test and tests of verbal memory, visual memory, attention, visuospatial ability and executive function.

They found, as expected, that the veterans with PTSD had significantly lower IQ, verbal memory, attention and executive function scores than veterans without PTSD. They also found, however, that the noncombat twins mirrored their brothers’ scores: Those whose brothers had developed PTSD generally had significantly lower scores than those whose brothers had not. And in both cases, the twins’ scores didn’t differ significantly from the scores of their combat-exposed brothers.

The results, Gilbertson says, suggest that the cognitive differences in the literature represent pre-existing, familial genetic risk factors for PTSD, rather than trauma-induced cognitive problems.

“It’s hard to get at these chicken-or-the-egg, cause-or-effect issues,” says Tulane University psychologist Jennifer Vasterling, PhD, who also studies cognitive function and PTSD. “Using this twin paradigm was a very innovative way of beginning to address it.”

Also important, Gilbertson says, is that almost all of the participants— Vietnam vets and brothers; those with PTSD and those without—scored well within the range of normal.

“Most of the vets and their brothers performed in the average range on all the tasks,” he says. “The folks who didn’t develop PTSD were above average.”

In other words, it’s not that people with low cognitive skills are more likely to develop PTSD; it’s that people with above-average skills are less likely to develop it.

“This is not a deficit factor, but a protective factor,” Gilbertson says.

Of course, cognitive ability is not the most important factor that determines whether a person will develop PTSD, according to Vasterling—that is still likely to be the severity and potency of the trauma. And having an extra-good memory, she says, doesn’t guarantee you’ll never develop PTSD.

“The nastier and more persistent the trauma, the more likely you are to develop PTSD—those tend to be the most potent predictors,” she says. “I think it’s important to highlight that because the last thing people need is to feel like, ‘Oh, there’s something innately wrong with me because I developed PTSD.’”

Remembering in words or images

But why would cognitive skills help protect a person from PTSD?

“That’s a good question, and one we’re not able to definitively answer,” Gilbertson says. It’s possible, he suggests, that people with better verbal skills more naturally put their memories into words. Verbally encoded memories, he says, may be less likely to produce flashbacks and other hallmarks of PTSD than memories encoded in images.

It’s also possible that high IQ scores simply reflect better problem-solving abilities, says Richard McNally, PhD, a Harvard University psychologist and PTSD researcher not involved with the study. “Recovering from the effects of intense emotional experience is certainly a problem to be solved,” he says.

Finally, McNally suggests, high IQ and other cognitive skills may make it easier for people to do the sorts of things that re-engage them in postwar life: going to school, getting a job and recruiting social support from friends and colleagues.

The next research step, Gilbertson says, is to try to figure out more precisely which cognitive skills protect people from PTSD.

“Once we figure that out, the question then becomes: Are those skills that we can teach or enhance in folks that don’t have them as intuitively?” he says. “I think that since there do appear to be cognitive resilience factors, it would be worth it to invest money in finding out what those factors are, so we can use them to build resilience in everyone.”  

Socially isolated and sick

New animal research sheds light on the intricate ways chronic stress and loneliness affect health.

By Sadie F. Dingfelder
Monitor Staff

Monitor on Psychology
Volume 36, No. 10 November 2006

Loneliness kills, according to research dating back to the 1970s. In one classic study, published in the American Journal of Epidemiology (Vol. 109, No. 2, pages 186–204), socially isolated people in Alameda County, Calif., were between two and three times more likely to die during the nine-year study than those who had many friends.

“The increase in morbidity with social isolation is equal to that of cigarette smoking,” notes Martha McClintock, PhD, a University of Chicago psychology professor who researches social isolation and stress.

But while the pathway from smoking to cancer is largely established, the path from loneliness and other forms of chronic stress to many health consequences—including increased risk for cancer, cardiovascular illness and Alzheimer’s disease—is not, she says. In humans, some of the effect may be due to the practical benefits of having a social network, says Gretchen Hermes, a fourth-year MD-PhD student at the University of Chicago . For instance, people with many friends might be more likely to brush their teeth and exercise. And gregarious people may have more friends who bring them food or medicine when they get sick.

But new animal studies suggest that there are direct, physiological pathways from loneliness and other chronic stressors to illness. And those pathways may differ depending on gender and temperament, with male and behaviorally inhibited animals being particularly susceptible, researchers are finding.

Acute stress: an immune booster?

Hermes and her colleagues found that, overall, social isolation suppressed wound healing in male and female rats, according to a study published last year in the American Journal of Physiology-Regulatory, Comparative and Integrative Physiology (Vol. 290, No. 1, pages 273–282). However, when they also acutely stressed the rats by trapping them in a small tube, the socially isolated female rats surprised researchers with an enhanced immune response, while the socially isolated male rats showed a further suppression of the immune response.

The researchers housed 60 female and 60 male rats either in groups of five or in isolated cages for more than three months. Then they injected half of the animals with a few milligrams of seaweed, right under their skin. The substance is harmless, but the immune system identifies it as foreign and surrounds it with scar tissue before absorbing it back into the body.

Both male and female isolated rats took longer to heal the wound than their group-housed brothers and sisters, the researchers found. While rats don’t often face seaweed injections in the wild, the procedure taps into an underlying defense against many common illnesses, McClintock says.

“The basic inflammatory response is involved in a whole variety of different diseases, ranging from heart disease to infectious diseases and some forms of cancer,” she notes.

Though socially isolated male and female rats responded similarly to the seaweed test, differences emerged when they were also exposed to an acute stressor. Two weeks before the seaweed injection, the researchers placed half of the socially isolated animals in a restraint tube for 30 minutes, a procedure that mimics the experience of being trapped in a collapsing burrow, says Hermes.

For the female rats, the trial revved up their immune systems—and they healed faster than those who didn’t spend time in the restraint tube. The acutely stressed males, conversely, showed a slowed immune response.

“The females were much more resilient,” Hermes notes.

The results fit with research on humans, says McClintock.

“Men who are lonely, or bereaved, or who lose their partners are known to be more vulnerable to disease and death, whereas women are more resilient,” she notes.

The differences in both rats and humans may stem from the evolutionary pressure, McClintock theorizes. To pass on their genes, male animals only need to live long enough to mate. Female animals have to make it for the long haul.

“They need to survive to deliver and to take care of their young,” she notes. “You can imagine it would be beneficial for evolution to select for females who could respond to a brief stressor with augmenting their immune function.”

The cost of inhibition

One strength of the study is that they were able to randomly assign animals to social or isolated groups, notes McClintock. “That doesn’t happen in nature,” she says. For instance, some rats and humans tend to seek out others, while behaviorally inhibited animals will more likely live in isolation.

Even discounting of the effect of isolation, behavioral inhibition does seem to carry a health cost, according to a study published in the July issue of Hormones and Behavior (Vol. 50, No. 1, pages 454–462). In fact, behaviorally inhibited rats—those that tend to explore less because they find novel environments more threatening—died of natural causes a full six months earlier than their easygoing sisters, researchers found.

Penn State biobehavioral health professor Sonia Cavigelli, PhD, and her colleagues tested the temperament of 81 female rats when they were 20 days old, by placing them in an unfamiliar room, which included opaque walls and novel objects. Some of the animals moved freely around the room and sniffed the objects, while others huddled in the corner.

The animals then were housed in groups of three and lived out their natural lifespan. The particular strain of rat used in the study tends to live about two years, and they usually die of cancerous tumors that begin in their mammary glands, says Cavigelli.

While all the animals tended to die of tumors over time, the gregarious animals developed them about six months later than the inhibited ones. This may be because the inhibited animals don’t socialize as much as other animals, or they may just get startled more often.

“Individuals that go through the stress response more frequently go through faster wear and tear on the system,” Cavigelli notes.

Both studies shed light on the intricate mechanisms through which chronic stress, due to either social isolation or hypervigilance, can kill, says McClintock. 

“They really begin to get to the richness of the dynamic,” she notes. “In the area of stress, immunity, social context and sex, one shouldn’t expect simple main effects.”

The Cognitive Functioning of Right Handed vs. Left Handed People is compared in A Monitor on Psychology article by Monitor Staff writer Michael Price, (Volume 40, No. 1 December 2009).

Michael Price explains in this article that right handed people have a left hemisphere dominant brain while  left handed people have a right hemisphere dominant brain. In most people the dominant brain side specializes strongly in speech and language, while the other side specializes in processing images and emotions. This specialization is present in 95% of right handed people, but only about 20% of left handed people have brains that divide up cognitive functions so rigidly. Within each group, some people have a strongly lateralized brain, while others have more symmetrical brains. The article refers to a study by Michael Corballis, Ph.D., a psychologist at the University of Aukland in New Zealand. Dr. Corballis states that there is an advantage in the lateral specialization.

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