Deep Brain Stimulation

Deep Brain Stimulation

When I hear about electromagnetic brain stimulation, I immediately think of the old-style electro-convulsive therapy (ECT) portrayed in movies, like Jack Nicholson’s character in One Flew Over the Cuckoo’s Nest [1]. In the film, Nicholson’s character (as well as many others) are sent to the presumably painful “Shock Therapy”, where they essentially have a battery connected to their head to “reset” them.

 

However, this is far from an accurate (or fair) representation of what is available today. In modern times, we have two major modalities available: electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).

The first, ECT, is much different than what is portrayed in the movies [2]. The ECT that is available today (and the style that has been employed since the late 1950s) is much more civilized than is portrayed [2]. In particularly difficult to treat depression and anxiety disorder, ECT is often adopted to address and ultimately treat these persistent symptoms [3]. ECT works by inducing small, controlled seizures that offer some therapeutic benefit [3]. In these scenarios, the patient is always given muscle relaxers, so that the patient does not harm themselves during the convulsions that are induced. Overall, it is a much more scientific and civilized process than what is commonly imagined.

A bit more recent development in cerebral stimulation therapies is Transcranial Magnetic Stimulation (TMS). TMS grew out of the work that had already been established with ECT, and simply built upon it to create a second option that was (ideally) less invasive and intimidating to the patient [4]. TMS was originally developed to be used as a diagnostic tool—and eventually some therapeutic uses became apparent [4]. It wasn’t until 2008 that TMS finally became approved by the US Food and Drug Administration [4].

TMS is a technique in which an electromagnetic wand is passed over the cranium, or simply just near the head [6]. The coil is simply metal that is attached to an electric generator which delivers electrical pulses—ultimately delivering electromagnetic pulses intended to interact with natural electromagnetic brain wave outputs [6]. TMS is able to directly target specific regions of the brain in order to address certain neurological issues. In this way, they are able to address major issues without causing damage to other non-necessary brain regions. The technique ultimately helps to “reset” the person, much like in ECT [3].

In two major studies by University of Pennsylvania and Mayo Clinic, TMS was able to help individuals with memory [3]. In one of these studies, the patients were read a list of words while they were receiving TMS directed toward the lateral temporal cortex region of their brain [7]. The patients who were receiving TMS stimulation to this region of their brain as they were being read the list of words were able to remember the words significantly better than those who did not [7]. That is because the lateral temporal cortex is responsible for language understanding [7]. It was further confirmed by another study by UPenn which showed that when this cortex was not stimulated at the exact right time, the significant increase in memory was not present [8].

An interesting study found that ECT is slightly more effective that TMS on some psychiatric disorders, including major depression that was resistant to other methods of treatment [5]. In addition, ECT addressed the symptoms of anxiety while TMS did not [5]. Although ECT was more effective, patients still said they would have preferred TMS should both treatments be covered by their insurance [5].  This was shown to be related to the feelings of stigma and fear associated with ECT [3]. For example, films such as One Flew Over the Cuckoo’s Nest [1] paint a terrifying and animalistic picture of brain stimulation. People seemed to much prefer something that would offer even a fraction of the relief in order to avoid the fear of a perceived tortuous scenario [3].

Overall, it is clear that brain stimulation deserves a little more attention from both the general public and the behavioral health community. It is clear with several different research studies that brain stimulation, whether it come in the form of ECT or TMS can be greatly effective for a range of psychological and neurological disorder that have few other treatment options. However, TMS seems to provide a workaround to a major barrier that ECT has: negative stigma. Since the development of TMS is relatively new compared to ECT, it hasn’t had the same ability to be impacted by popular media.  Instead, it seems to offer similar benefits to patients who are in need of this more radical level of treatment. It also serves as a stepping stone into ECT—should it ever become necessary.

References

  1. Zaentz, S., & Douglas, M. (Producers), & Forman, M. (Director). (1975). One Flew Over the Cuckoo’s Nest  [Motion picture]. United States: United Artists
  2. Estridge, B. (2011). Jack Nicholson did for shock therapy what Jaws did for sharks: An expert argues that ECT has been stigmatised. Retrieved from http://www.dailymail.co.uk/health/article-2012924/Jack-Nicholson-did-shock-therapy-Jaws-did-sharks.html
  3. Payne, N. A., & Prudic, J. (2009). Electroconvulsive therapy Part I: a perspective on the evolution and current practice of ECT. Journal of psychiatric practice15(5), 346.
  4. Horvath, JC; Perez, JM; Forrow, L; Fregni, F; Pascual-Leone, A (March 2011). “Transcranial magnetic stimulation: a historical evaluation and future prognosis of therapeutically relevant ethical concerns”. Journal of Medical Ethics37(3): 137–43. doi:1136/jme.2010.039966.
  5. Rapposelli, D. (2016). TMS Versus ECT: That Is the Question | Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/major-depressive-disorder/tms-versus-ect-question
  6. Lopez-Ibor, J. J., López-Ibor, M. I., & Pastrana, J. I. (2008). Transcranial magnetic stimulation. Current Opinion in Psychiatry, 21(6), 640-644.
  7. Kucewicz, M. T., Berry, B. M., Miller, L. R., Khadjevand, F., Ezzyat, Y., Stein, J. M., … & Gorniak, R. (2018). Evidence for verbal memory enhancement with electrical brain stimulation in the lateral temporal cortex. Brain.
  8. Kucewicz, M. T., Berry, B. M., Miller, L. R., Khadjevand, F., Ezzyat, Y., Stein, J. M., … & Gorniak, R. (2018). Evidence for verbal memory enhancement with electrical brain stimulation in the lateral temporal cortex. Brain.

There’s no such thing as a normal brain

Well, that’s good to hear. One of my old supervisors called it “graduate student disease”. As soon as we would cover a disorder in class or practicum, suddenly everyone in my cohort agreed that they had it. We spend so much time dwelling on psychopathology that it is next to impossible not to see some of the characteristics reflected in ourselves.

Thankfully, none of us actually had any major psychopathologies (aside from some anxiety, but who doesn’t in graduate school, right?). I’m sure that you all, my loyal readers, are also (for the most part) alright. Which brings us to our topic for this week. There is no such thing as a normal brain [1]. In fact, psychology shows us that there is not really any such thing as a “normal person” either [2].

 

To illustrate this point, we can go back to an example of the 1920s United States Air Force. Todd Rose details a specific instance in the Air Force at the genesis of jet-powered planes [3]. The government agency hired several research assistants to take the measurements of many pilots in order to find the mean measurements of them all [3]. The cockpits of the planes would then be fitted to the “average pilot” [3]. As the reader has probably anticipated, this did not turn out to be the best method. Even with the extreme accuracy and breadth of data collected, there were still a staggering number of “pilot errors” and complaints of not fitting within the cockpit [3].

It wasn’t until the 1940s that finally a Lieutenant decided to compare the measurements of each of the Air Force’s pilots to the arithmetic mean “individual” that they had created from all the data points [3]. Surely the average would at least account for a decent proportion of those individuals, right? [3]. What Lieutenant Daniels found was that there was not even one individual who fit into the “average” measurements that were taken [3]. That’s right, ZERO [3].

It’s easy to brush this off as a fluke. However, our field seems to back this up. Holmes and Patrick [4] agreed that variability is not only normal, but it is necessary. They explained that there is a larger issue with our society that encourages the population to push toward some artificial, imagined average [4]. They encourage variations in our culture and in our population [4]. It is important as an adaptive and evolutionary function [4].

In the past, our society essentially needed averages so that we could attempt to address the majority of the population or “do the most good”. However, in our extremely progressive world, science has allowed to tailor everything to the individual. Rose and Ogas describe this as a “science of the individual” [2]. They explain that there is enough knowledge to conform the systems of nutrition, genetics, medicine, neuroscience, biology, and even psychology to the individual [2].

However, how do we know a psychopathology then? Surely each difference being necessary in an evolutionary standpoint cannot stand up when faced with the idea of disordered behavior [1]. Avram Holmes [4] argues that there simply cannot be a single phenotype alone that is worth diagnosing a psychological disorder. Behavior develops and is maintained as it serves some sort of function for the individual [5]. This means that the behavior alone is not implicitly “good” or “bad” [1].

Holmes [4] described studying a myriad of phenotypes simultaneously to understand whether or not a person should be diagnosed with something that is clinically relevant. With this in mind, biomarkers are then much more difficult to see as adequate predictors of psychological illnesses [4]. He explains that that there a single biomarker would never be enough to cause a psychological illness. In order to better predict this, he notes that a broader approach should be taken [1].

This is good news for those of us suffering from “graduate school disease”. When we see single variations in ourselves that could lend itself to a disorder, that is never enough to be able to diagnose a psychopathology or disordered behavior [1].

This is also good news for our clients. As budding clinicians, we are required to take into consideration the entire picture of the client—to tailor our field to fit more with the model of “the science of the individual” [2]. There is no singular line that we can draw between a “healthy” or “normal” brain compared to a “pathologized” or “disordered” one, let alone person [1].

 

References

  1. Cell Press (2018, February 20). When it Comes to Our Brains, There’s No Such Thing as Normal. NeuroscienceNews. Retrieved February 20, 2018 from http://neurosciencenews.com/brain-normal-8527/
  2. Rose, T., & Ogas, O. (2018). There Is No Average Person. Here’s Why.. Psychology Today. Retrieved 19 April 2018, from https://www.psychologytoday.com/us/blog/the-science-the-individual/201601/there-is-no-average-person-heres-why
  3. Rose, T. (2016). The end of average: How to succeed in a world that values sameness. Penguin UK.
  4. Holmes, A. J., & Patrick, L. M. (2018). The myth of optimality in clinical neuroscience. Trends in cognitive sciences.
  5. Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis.

Train Your Brain for Confidence on Exam Day

Exam day is often associated with anxiety. Whether the thought of taking the EPPP evokes negative emotions from test taking in your school days or more recent graduate school days, the anxiety can impact your EPPP test score.

Confidence on exam day is key to succeeding. So, how do you combat test anxiety and replace it with confidence?

Begin by understanding why the thought of test taking evokes anxiety.

Neurologically, due to your past experiences of anxiety during exams, the mere thought of test taking now ignites the feeling of anxiety in your brain’s cingulate gyrus, which is located deep in the cortex. Your brain has made an association between test taking and anxiety. Therefore, the two have been “wired” together in your brain and anxiety is now a habitual response to the thought of test taking.

To replace anxiety with confidence on exam day, your brain has some rewiring to do. Thankfully, due to the brain’s remarkable plasticity, certain associations can be reversed.

Throughout the Taylor Study Method process, you will take roughly 4,000 questions before EPPP exam day. If, during those practice questions, you stimulate the conditions of a test within the safe and relaxed environment of the TSM study process, your brain can begin to associate testing with relaxation or calmness.

In a way, TSM is providing you with 4,000 moments for your brain to adopt the habit of relaxing during an exam.

During these moments, you can actively practice desensitizing yourself to anxiety by going through stress relief strategies. To combat stress as it arises you might do a power stance, express gratitude, or focus on breathing. The more you practice stress-relief techniques and learn to relax during mock exam questions, the more your brain will remain calm at the thought of test taking.

Ultimately, by the end of the TSM study process, you will be capable of replicating your relaxed state throughout the actual EPPP exam.

And, as if reducing anxiety isn’t enough, taking 4,000 test questions before the exam has multiple benefits. Frequent testing improves memory and reinforces the information you will need to pass the EPPP. Practice tests can also reflect how well you understand the material before you take the test, so they can be an indicator of when you are ready to sit the exam.

The consequence of habitual relaxation during test taking, paired with increased memory and a surety that you’re ready, is confidence. And confidence during exam day is crucial to a passing score.

Are you interested in allowing our 4,000 test questions to help you combat test anxiety and pass the EPPP? Find out the many ways TSM can support you specifically to pass the EPPP.

For more information on how TSM can help you prepare confidently for your exam, call us at 877-510-5445.

 

Further Reading

 

 

A Healthy Brain for Exam Prep Success

How do you spend your time when you’re not studying or working? What you do during your time off may be just as important as what you do while you’re studying. Be careful how you treat your brain!

Just as an Olympic athlete will take care of his body even during off season when he is not training or competing, those preparing for the EPPP  (or any major exam) should take care of their minds even during those times of the day when you’re not actually studying.

Neuroscientists have done experiments on habitual actions and have noticed that they can literally alter the physiological structure of the brain. Something as simple as responding immediately to a text message, mindlessly scrolling through Facebook or Twitter, or checking your email with every notification can be enough to train your brain to find attentiveness difficult, to find quiet contemplation awkward, and to find sustained concentration and patience to be a chore.

In other words, our neoplastic brains adapt to the situations we put them in, and this adaptation is not always for the better. When you pass your EPPP and become a licensed psychologist, you will need qualities like attentiveness, concentration, patience, and contemplation. What you do now – minute to minute – is creating the neuropathways in your brain that make these qualities easier or more difficult.

Of course, no one can live completely free of distractions. And it’s important you have time to relax doing something enjoyable. There’s nothing wrong with spending time on social media or texting someone back quickly. The key, however, is to confine such activity to your off hours and to give your full attention and focus to your studies when you sit down to study. Best of all, if you create the habit of applying full focus during study time, you’ll find it easier to apply that focus in other study sessions and for the marathon that is exam day.

Multitasking and EPPP Exam Prep

Earlier this year in a couple live broadcasts, Dr. Graham Taylor answered questions about multitasking and EPPP exam prep. His two-part series explored some of the common challenges people face when trying to navigate their EPPP preparation around other commitments like family, a job, and internships, and how to effectively overcome these challenges. In the second video, Dr. Taylor considered the dark side of multitasking and shared some research showing that the more you multitask, the worse you become at it.

Can You Trust Your Memory During the EPPP Exam?

Memorization is part of EPPP exam preparation. How reliable is your memory, though?

Psychologist Dr. Julia Shaw says we are essentially creating our own fictional past every time we think back on a personal memory. She says “It’s such a terrifying but beautiful notion that every day you wake up with a slightly different personal past.” Her research even leans in to how the unreliability of memory has impacted our criminal justice system.

While memorizing facts for the EPPP exam is a reliable use of memory, we are all constantly creating false personal memories. Dr. Shaw says in her blog post, How False Memory Changes What Happened Yesterday, “The question isn’t whether our memories are false, it’s how false are our memories.” Every day we recreate our memories, “if ever so slightly.”

False memories are “recollections of things that you never actually experienced.” Whether they be minor memory errors, “such as thinking you saw a yield sign when you actually saw a stop sign” or grander errors “like thinking you took a hot air balloon ride that never actually happened,” everyone has a memory that is not 100% trustworthy.

Can this affect your EPPP exam score? Continue reading

Use the Right Mindset to Pass the EPPP

Whether you are a confident genius or an anxious test taker, your mind is either working for you or against you, especially when it comes to your ability to pass the EPPP.

Maybe your entire life you’ve been told that you’re a genius who will succeed at anything. Perhaps school came easily to you and you acknowledged your stroke of genius for many successes. If you think this is a positive mindset which will help you pass the EPPP, you’re wrong.

On the other hand, maybe you’ve been told your entire life that you’re almost good enough but not quite. Perhaps school was full of failing grades but you excused yourself from trying harder because you just weren’t good enough anyway. If you think is a negative mindset which will hinder your EPPP score, you’re onto something.

The point is that, in these scenarios, the mind is working against both the genius and the failure.

So, what is the right mindset to pass the EPPP?

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How to Overcome Test Anxiety with help from the Russian Special Forces

It’s not what you think.  While the difficulty of Special Forces training around the world is known to be extreme, especially among the few who have actually endured it, what the Russian Spetsnaz goes through is on another level.

The stresses that such rigors impose upon those undergoing it would also likely be unbearable for them were it not for the psychological tools they are provided with to help them cope.

Where do these tools come from?  They are found within the Russian Martial Art simply known as the “System” or Systema in Russian.  While its core skills and training methods are believed to be about eleven hundred years old, it was scientifically refined into its current form in the later half of the twentieth century by Soviet researchers and engineers (think Ivan Drago’s trainers in Rocky IV).

However, the communist government restricted its knowledge and practice to only its most capable forces within the Spetznaz and KGB.  It was not until the fall of Communism that this secretive system was revealed to anyone outside of these elite units.

 

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Six Thinking Errors and How to Avoid Them

Research shows that much of what we experience in life is fundamentally ambiguous and open to a variety of interpretations. (For more about that, see our earlier article, ‘Gratitude as a Way of Seeing.’) One of the ways we make sense of life’s circumstances is by the meanings we ascribe to those circumstances. The problem arises when we impose negative meanings onto our experiences that are based on a distorted view of reality.

Psychologists who have studied human thought and communication have identified some common distortions or “thinking errors” that cause many people negatively to frame their experiences. There are many lists of these thinking errors on the internet, but below are ones I have identified as being the most common and relevant to everyday life.

 

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10 Steps to Learning Anything Twice as Quick

We often assume that the ability to quickly learn material and master different fields of study comes down to how smart a person is, or how good of a memory they have. But research increasingly suggests that raw talent has very little to do with overall success in life, including success in learning. Instead, success has a lot to do with the strategies and techniques you choose to follow.

Over the years I’ve been blessed to work with TSM in researching the techniques used by various experts who have become leaders. Many of these strategies have been woven into our learning platform.

Whether you’re a high school student studying for a final exam, a college student struggling to keep up in class, or a psychology student preparing to take the EPPP, these learning techniques can make the difference between success and failure. These ten strategies can also spell the difference between a study process that is full of stress and frustration vs. one that is fulfilling and fun.

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