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.

Dr. Graham Taylor Discusses Changes Coming to the EPPP

As part of TSM’s ongoing mission to help you prepare for the EPPP, Dr. Graham Taylor has been offering weekly broadcasts via Facebook Live. These broadcasts, which occur every Thursday at 12:00 pm PST at our Facebook page, are open to the public. Viewers are encouraged to write in their questions, which Dr. Taylor will address during the live stream.

Last week Dr. Taylor spoke about important changes that are coming to the EPPP. In addition to the new test, known as “EPPP Step 2”, the ASPPB is also introducing changes to the existing EPPP. These changes will be implemented on February 15th 2018 and affect how the various domains are weighted. Watch the video below to learn everything you need to know about these changes.

Life After the EPPP: What Psychology Careers Are Available?

In our earlier post, ‘10 Steps for Becoming a Licensed Psychologist’, we looked at the steps involved in becoming a licensed psychologist.

In this post I want to address what happens on the other side of licensure. What are the practical benefits of passing your EPPP and becoming licensed? What type of career paths are open to licensed psychologist?

Sometimes people suppose that the only thing psychologists do is offer psychotherapy to clients. But a working as a psychotherapist is only one of a variety of psychology careers available.

Some psychologists pursue careers in academia, working as college professors or researchers. Others psychology careers can be found in industry, sport, entertainment or business. Many of these careers do not even require licensure, but simply a degree in psychology.

On their website, the American Psychological Association recognizes fifteen specialties in professional psychology. Let’s consider some of the most common.

Sports Psychologists

A sports psychologist  might explore how psychology affects sports strategy. He or she might also work with athletes on the mental and emotional aspects of training. Areas of interest to sports psychologist include the psychology of motivation, visualization, confidence, self-talk, mindfulness and relaxation.

All of the NFL teams have a sports psychologist on the payroll. Our earlier post ‘Develop a High Performance Mindset’ explored some of the insights of Michael Gervais, a psychologist who works for the Seattle Seahawks.

Industrial Psychologists

Industrial psychologists (also known as occupational or organizational psychologists) work in both white color and blue color professions helping businesses prevent and troubleshoot problems. This can include helping office workers get along better, finding ways to increase employee wellbeing, discovering ways to optimize work-force performance, analyzing the relationship between humans and machines in factory contexts, plus much more.

Researchers

As already mentioned, some psychologists pursue careers as researchers. Psychology researchers usually work within a university or laboratory context, and could study such things as social psychology, neuropsychology, perceptual psychology, evolutionary psychology, marketing and countless other topics.

Other Jobs Psychologists Are Doing

Here are some others jobs that a degree in psychology can help prepare a person to perform:

  • Clinical psychologist
  • Counselling psychologist
  • Educational psychologist
  • Forensic psychologist
  • Further education teacher
  • Health psychologist
  • High intensity therapist
  • Occupational psychologist
  • Primary care graduate mental health worker
  • Psychological wellbeing practitioner
  • Sport and exercise psychologist
  • Jobs where your degree would be useful include:
  • Actuarial analyst
  • Advertising account planner
  • Advice worker
  • Careers adviser
  • Counsellor
  • Data analyst
  • Forensic accountant
  • Human resources officer
  • Market researcher
  • Physician associate
  • Play therapist
  • Psychotherapist

Within each of these psychology careers there are an almost endless amount of specialties. For example, a clinical psychologists might specialize in working with a certain age group, such as children teens or adults. Others might specialize in helping people who suffer from a particular disorder. A market researcher might specialize in food, or aroma, or clothing.

In addition to work as professional psychologist, a degree in psychology may also qualify a person to enter into other fields where a degree in psychology may be perceived as an asset. Many different jobs require someone who understands human behavior, emotion, and thought processes.

How to Discuss Politics Without Alienating Your Friends in 5 Steps

There’s an American maxim which says you shouldn’t discuss religion or politics in polite society. It’s hard not to have some sympathy with this advice, especially during the election cycle. After all, just look at how our political debates have become an emblem of all that is degenerate in our political discourse.

Even among friends, conversations about who should be our next president can quickly become divisive and alienating, while frank discussion of political disagreements rarely proves constructive and edifying.

Well, I’m here to suggest the impossible: political disagreements, when handled right, can actually be constructive and relationship-building.

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Emotional Intelligence and Your EPPP Score

Emotional intelligence (EQ) could predict a successful EPPP score.

EQ is the measure of a person’s capability to identify and manage his or her emotions as well as the emotions of others. Dr. Travis Bradberry, co-author of Emotional Intelligence 2.0, spoke at the 2016 Global Leadership Summit explaining why EQ is important when it comes to success.

According to Bradberry, EQ be broken down into four parts: Continue reading

From Internship to Licensure

If you’re an aspiring psychologist who has finished your internship yet remains unclear what to do next, you’re not alone.

Learning to navigate the bumpy road from internship to postdoc to licensure is something that many people find challenging. In an article for the American Psychological Association, Tori DeAngelis’ described summed up the basic difficulty:

“Grad school is no easy street, but it is a fairly comprehensible and predictable process, at least until you finish your internship. From postdoc to license, though, the path is less clear: There is no system to guide you, and the rules are complex and varied. Your state’s licensing procedures might bewilder you, for example. Or your postdoctoral training might not offer the experience you need for licensure.”

Thankfully, guidance is available for this confusing process. To provide some guideposts for would-be psychologists, DeAngelis offers 11 steps to help simplify what could otherwise be a confusing road. His article ‘After the Internship‘ is a must-read for anyone who is approaching the end of their internship.


Further Reading

Why Struggle and Frustration Are Good (Study Myths Part 4)

I am grateful to TSM for inviting me to contribute the next article in their series on study myths.

This ongoing series has aimed to debunk some of the myths about memory and learning that pervade so many people’s understanding of the study process. While this series has been focused on students preparing to pass their psychology licensure exam, the research has applications for anyone trying to master material or develop new skills.

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Corporations Hire Focus Experts

Online distractions are costing the United States millions of dollars a year in lost productivity, according to some estimates. That’s why corporations are now hiring experts to help train office workers how to stay focused.

Google is among the numerous organizations hiring experts to train offer seminars in attention.

Chade-Meng Tan, a Google engineer who began teaching employees about focus in 2007, helps workers learn self-mastery over unhelpful mental habits. (See the video ‘Meng on Mindfulness.’) For example, when they find their mind wandering while reading, they are encouraged to practice mindfulness in bringing their attention back.

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Remembering Oliver Sacks

Oliver Sacks died last month, following an amazing career as a neuroscientist and author.

More than a million copies of Dr. Sacks’ books are in print in the United States, in addition to being translated into over 25 languages and made into feature movies. His vivid accounts of his neurological patients had an incalculable impact on the public’s understanding of the brain.

The 82-year old author died at his Manhattan home following a battle with cancer, leaving behind thirteen books and countless articles, which opened up the complex and daunting world of neuroscience to ordinary people.

Dr. Sacks was the embodiment of focus, a theme we explore quite a bit at TSM. “I am very tenacious, for better or worse,” he wrote in A Leg to Stand On. “If my attention is engaged, I cannot disengage it. This may be a great strength, or weakness. It makes me an investigator. It makes me an obsessional.”