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Linking Depressive Symptoms & Academic Achievement in UK Adolescents

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Research Paper Title

Depressive symptoms and academic achievement in UK adolescents: a cross-lagged analysis with genetic covariates.

Background

The relationship between adolescent depressive symptoms and academic achievement remains poorly understood. The aim of this study was to help clarify the nature and directionality of this association.

Methods

The researchers used a sample of 13,599 British adolescents (main sample of N=3,809 participants). They fitted cross-lagged panel models using four repeated measures of self-reported depressive symptoms and four measures of academic achievement based on British national records between 11-18 years, separately for male and female adolescents and considering polygenic risk scores (PRS) for educational attainment and depression, alongside other child and parental covariates.

Observational design, variation around measurement times, missing data.

Results

The researchers found evidence of an overall negative association that was stronger in boys (R=-0.21, 95% CI -0.31 to -0.11) than in girls (-0.13, -0.31 to 0.05). Higher depressive symptoms were associated with lower academic achievement at a later stage up to the end of compulsory education (16 years), when the direction of the association reversed, although girls with lower achievement also appeared vulnerable to depressive symptoms at previous stages. The genetic variables derived for this study showed stronger associations for academic achievement, but the PRS for depression also showed a negative association with academic achievement in girls. Child intelligence quotient and peer victimisation also showed relevant associations.

Conclusions

Depressive symptoms and academic achievement should be considered jointly when designing school-based programmes for children and adolescents, alongside gender, child ability and school experience. Including genetic information in research can help to disentangle average from time-varying effects.

Reference

Lopez-Lopez, J.A., Kwong, A.S.F., Washbrook, L., Tilling, K., Fazel, M.S. & Pearson, R.M. (2021) Depressive symptoms and academic achievement in UK adolescents: a cross-lagged analysis with genetic covariates. Journal of Affective Disorders. 284, pp.104-113. doi: 10.1016/j.jad.2021.01.091. Online ahead of print.

On This Day … 21 February

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People (Births)

  • 1892 – Harry Stack Sullivan, American psychiatrist and psychoanalyst (d. 1949).
  • 1914 – Jean Tatlock, American psychiatrist and physician (d. 1944).
  • 1961 – Elliot Hirshman, American psychologist and academic.

Harry Stack Sullivan

Herbert “Harry” Stack Sullivan (21 February 1892 to 14 January 1949) was an American Neo-Freudian psychiatrist and psychoanalyst who held that “personality can never be isolated from the complex interpersonal relationships in which [a] person lives” and that “[t]he field of psychiatry is the field of interpersonal relations under any and all circumstances in which [such] relations exist”. Having studied therapists Sigmund Freud, Adolf Meyer, and William Alanson White, he devoted years of clinical and research work to helping people with psychotic illness.

Jean Tatlock

Jean Frances Tatlock (21 February 1914 to 04 January 1944) was an American psychiatrist and physician. She was a member of the Communist Party of the United States of America and was a reporter and writer for the party’s publication Western Worker. She is most widely known for her romantic relationship with Robert Oppenheimer, the director of the Manhattan Project’s Los Alamos Laboratory during World War II.

The daughter of John Strong Perry Tatlock, a prominent Old English philologist and an expert on Geoffrey Chaucer, Tatlock was a graduate of Vassar College and the Stanford Medical School, where she studied to become a psychiatrist. Tatlock began seeing Oppenheimer in 1936, when she was a graduate student at Stanford and Oppenheimer was a professor of physics at the University of California, Berkeley. As a result of their relationship and her membership of the Communist Party, she was placed under surveillance by the FBI and her phone was tapped.

She suffered from clinical depression and committed suicide on 04 January 1944.

Elliot Hirshman

Elliot Lee Hirshman (21 February 1961) is an American psychologist and academic who is the president of Stevenson University in Owings Mills, Maryland since 03 July 2017. Prior to Stevenson University he served as president at San Diego State University and served as the provost and senior vice president of the University of Maryland, Baltimore County.

What is Method of Factors?

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Introduction

The Method of Factors is a technique in cognitive behavioural therapy (CBT) to organise a session of exposure therapy.

Background

Rather than generating a list of objects or situations in advance (a static hierarchy) representing escalating levels of arousal and intensity of fear for a particular phobia, the Method of Factors involves identifying a fear-provoking stimulus, then identifying those features of the stimulus that control the intensity of fear.

The hierarchy then emerges in the course of the exposure session as the patient seeks to maintain a moderately high arousal. Because of this emergent nature, it is referred to as a Dynamic Hierarchy (Brady & Raines, 2009).

Reference

Brady, A. & Raines, D. (2009) Dynamic Hierarchies: A Control System Paradigm for Exposure Therapy. The Cognitive Behaviour Therapist. 2(1), pp.51-62.

What is Exposure Therapy?

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Introduction

Exposure therapy is a technique in behaviour therapy to treat anxiety disorders. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger. Doing so is thought to help them overcome their anxiety or distress. Procedurally, it is similar to the fear extinction paradigm developed studying laboratory rodents. Numerous studies have demonstrated its effectiveness in the treatment of disorders such as generalised anxiety disorder (GAD), social anxiety disorder, obsessive-compulsive disorder (OCD), post traumatic stress disorder (PTSD), and specific phobias.

Brief History

The use of exposure as a mode of therapy began in the 1950s, at a time when psychodynamic views dominated Western clinical practice and behavioural therapy was first emerging. South African psychologists and psychiatrists first used exposure as a way to reduce pathological fears, such as phobias and anxiety-related problems, and they brought their methods to England in the Maudsley Hospital training programme.

Joseph Wolpe (1915-1997) was one of the first psychiatrists to spark interest in treating psychiatric problems as behavioural issues. He sought consultation with other behavioural psychologists, among them James G. Taylor (1897-1973), who worked in the psychology department of the University of Cape Town in South Africa. Although most of his work went unpublished, Taylor was the first psychologist known to use exposure therapy treatment for anxiety, including methods of situational exposure with response prevention – a common exposure therapy technique still being used. Since the 1950s several sorts of exposure therapy have been developed, including systematic desensitisation, flooding, implosive therapy, prolonged exposure therapy, in vivo exposure therapy, and imaginal exposure therapy.

Medical Uses

Generalised Anxiety Disorder

There is empirical evidence that exposure therapy can be an effective treatment for people with generalised anxiety disorder, citing specifically in vivo exposure therapy, which has greater effectiveness than imaginal exposure in regards to generalized anxiety disorder. The aim of in vivo exposure treatment is to promote emotional regulation using systematic and controlled therapeutic exposure to traumatic stimuli.

Phobia

Exposure therapy is the most successful known treatment for phobias. Several published meta-analyses included studies of one-to-three hour single-session treatments of phobias, using imaginal exposure. At a post-treatment follow-up four years later 90% of people retained a considerable reduction in fear, avoidance, and overall level of impairment, while 65% no longer experienced any symptoms of a specific phobia.

Agoraphobia and social anxiety disorder are examples of phobias that have been successfully treated by exposure therapy.

Post Traumatic Stress Disorder

Virtual reality exposure (VRE) therapy is a modern but effective treatment of post-traumatic stress disorder (PTSD). This method was tested on several active duty Army soldiers, using an immersive computer simulation of military settings over six sessions. Self-reported PTSD symptoms of these soldiers were greatly diminished following the treatment. Exposure therapy has shown promise in the treatment of co-morbid PTSD and substance abuse.

Obsessive Compulsive Disorder

Exposure and response prevention (also known as exposure and ritual prevention; ERP or EX/RP) is a variant of exposure therapy that is recommended by the American Academy of Child and Adolescent Psychiatry (AACAP), the American Psychiatric Association (APA), and the Mayo Clinic as first-line treatment of obsessive compulsive disorder (OCD) citing that it has the richest empirical support for both youth and adolescent outcomes.

ERP is predicated on the idea that a therapeutic effect is achieved as subjects confront their fears, but refrain from engaging in the escape response or ritual that delays or eliminates distress. In the case of individuals with OCD or an anxiety disorder, there is a thought or situation that causes distress. Individuals usually combat this distress through specific behaviours that include avoidance or rituals. However, ERP involves purposefully evoking fear, anxiety, and or distress in the individual by exposing him/her to the feared stimulus. The response prevention then involves having the individual refrain from the ritualistic or otherwise compulsive behaviour that functions to decrease distress. The patient is then taught to tolerate distress until it fades away on its own, thereby learning that rituals are not always necessary to decrease distress or anxiety. Over repeated practice of ERP, patients with OCD expect to find that they can have obsessive thoughts and images but not have the need to engage in compulsive rituals to decrease distress.

The AACAP’s practise parameters for OCD recommends cognitive behavioural therapy, and more specifically ERP, as first line treatment for youth with mild to moderate severity OCD and combination psychotherapy and pharmacotherapy for severe OCD. The Cochrane Review’s examinations of different randomised control trials echoes repeated findings of the superiority of ERP over waitlist control or pill-placebos, the superiority of combination ERP and pharmacotherapy, but similar effect sizes of efficacy between ERP or pharmacotherapy alone.

Techniques

Exposure therapy is based on the principle of respondent conditioning often termed Pavlovian extinction. The exposure therapist identifies the cognitions, emotions and physiological arousal that accompany a fear-inducing stimulus and then tries to break the pattern of escape that maintains the fear. This is done by exposing the patient to progressively stronger fear-inducing stimuli. Fear is minimised at each of a series of steadily escalating steps or challenges (a hierarchy), which can be explicit (“static”) or implicit (“dynamic” – refer to Method of Factors) until the fear is finally gone. The patient is able to terminate the procedure at any time.

There are three types of exposure procedures. The first is in vivo or “real life.” This type exposes the patient to actual fear-inducing situations. For example, if someone fears public speaking, the person may be asked to give a speech to a small group of people. The second type of exposure is imaginal, where patients are asked to imagine a situation that they are afraid of. This procedure is helpful for people who need to confront feared thoughts and memories. The third type of exposure is interoceptive, which may be used for more specific disorders such as panic or post-traumatic stress disorder. Patients confront feared bodily symptoms such as increased heart rate and shortness of breath. All types of exposure may be used together or separately.

While evidence clearly supports the effectiveness of exposure therapy, some clinicians are uncomfortable using imaginal exposure therapy, especially in cases of PTSD. They may not understand it, are not confident in their own ability to use it, or more commonly, they see significant contraindications for their client.

Flooding therapy also exposes the patient to feared stimuli, but it is quite distinct in that flooding starts at the most feared item in a fear hierarchy, while exposure starts at the least fear-inducing.

Exposure and Response Prevention

In the exposure and response prevention (ERP or EX/RP) variation of exposure therapy, the resolution to refrain from the escape response is to be maintained at all times and not just during specific practice sessions. Thus, not only does the subject experience habituation to the feared stimulus, but they also practice a fear-incompatible behavioural response to the stimulus. The distinctive feature is that individuals confront their fears and discontinue their escape response. The American Psychiatric Association recommends ERP for the treatment of OCD, citing that ERP has the richest empirical support.

While this type of therapy typically causes some short-term anxiety, this facilitates long-term reduction in obsessive and compulsive symptoms. Generally, ERP incorporates a relapse prevention plan toward the end of the course of therapy.

Mindfulness

A 2015 review pointed out parallels between exposure therapy and mindfulness, stating that mindful meditation “resembles an exposure situation because [mindfulness] practitioners ‘turn towards their emotional experience’, bring acceptance to bodily and affective responses, and refrain from engaging in internal reactivity towards it.” Imaging studies have shown that the ventromedial prefrontal cortex, hippocampus, and the amygdala are all affected by exposure therapy; imaging studies have shown similar activity in these regions with mindfulness training.

Research

Exposure therapy can be investigated in the laboratory using Pavlovian extinction paradigms. Using rodents such as rats or mice to study extinction allows for the investigation of underlying neurobiological mechanisms involved, as well as testing of pharmacological adjuncts to improve extinction learning.

On This Day … 20 February

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People (Births)

  • 1893 – Elizabeth Holloway Marston, American psychologist and author (d. 1993).

People (Deaths)

  • 1996 – Solomon Asch, American psychologist and academic (b. 1907).

Elizabeth Holloway Marston

Elizabeth Holloway Marston (20 February 1893 to 27 March 1993) was an American attorney and psychologist. She is credited, with her husband William Moulton Marston, with the development of the systolic blood pressure measurement used to detect deception; the predecessor to the polygraph.

She is also credited as the inspiration for her husband’s comic book creation Wonder Woman, a character who was also fashioned on their polyamorous life partner, Olive Byrne.

Career and Family

Elizabeth received her BA in psychology from Mount Holyoke College in 1915 and her LLB from the Boston University School of Law in 1918, one of just three female graduates of the School of Law that year.

Elizabeth married William Moulton Marston in 1915. She first gave birth at age 35, then returned to work. During her long and productive career, she indexed the documents of the first fourteen Congresses, lectured on law, ethics and psychology at several American universities, and served as an editor for Encyclopaedia Britannica and McCall’s. She cowrote a textbook, Integrative Psychology, with her husband and C. Daly King. In 1933, she became the assistant to the chief executive at Metropolitan Life Insurance.

Sometime in the late 1920s, Olive Byrne, a young woman William had met while teaching at Tufts University, joined the household. Elizabeth Marston had two children, Pete and Olive Ann, while Olive Byrne also gave birth to two of William’s children, Byrne and Donn. The Marstons legally adopted Olive’s boys, but Olive remained a part of the family, even after William’s death in 1947.

Olive stayed home with the children while Marston worked. Continuing at MetLife until she was sixty-five, Elizabeth sponsored all four children through college – and Byrne through medical school and Donn through law school as well. She and Olive continued living together until Olive’s death in 1990. Both Olive and Marston “embodied the feminism of the day.”

Systolic Blood-Pressure Test

Marston enrolled in the master’s degree programme at Radcliffe College while her husband William attended the doctoral program in psychology at Harvard, which at that time enrolled only male students. She worked with William on his thesis, which concerned the correlation between blood pressure levels and deception. He later developed this into the systolic blood-pressure test used to detect deception that was the predecessor to the polygraph test.

In 1921, Marston received her MA from Radcliffe and William received his PhD from Harvard. Although Marston is not listed as William’s collaborator in his early work, a number of writers refer directly and indirectly to Elizabeth’s work on her husband’s blood pressure/deception research. She appears in a picture taken in his polygraph laboratory in the 1920s, reproduced in a 1938 publication by William.

In Popular Culture

  • Marston’s life is depicted in Professor Marston and the Wonder Women, a fictional biographical drama also portraying her husband William; Olive Byrne; and the creation of Wonder Woman.
    • Marston is portrayed in the film by British actress Rebecca Hall.
  • Asteroid 101813 Elizabethmarston was named in her memory.
    • The official naming citation was published by the Minor Planet Center on 25 September 2018 (M.P.C. 111800) along with the naming of Asteroid 102234 Olivebyrne.

Solomon Asch

Solomon Eliot Asch (14 September 1907 to 20 February 1996) was a Polish-American gestalt psychologist and pioneer in social psychology. He created seminal pieces of work in impression formation, prestige suggestion, conformity, and many other topics. His work follows a common theme of Gestalt psychology that the whole is not only greater than the sum of its parts, but the nature of the whole fundamentally alters the parts. Asch stated: “Most social acts have to be understood in their setting, and lose meaning if isolated. No error in thinking about social facts is more serious than the failure to see their place and function” (Asch, 1952, p. 61).

Asch is most well known for his conformity experiments, in which he demonstrated the influence of group pressure on opinions. A Review of General Psychology survey, published in 2002, ranked Asch as the 41st most cited psychologist of the 20th century.

Book: Therapy with a Map: A Cognitive Analytic Approach to Helping Relationships

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Book Title:

Therapy with a Map: A Cognitive Analytic Approach to Helping Relationships.

Author(s): Steve Potter.

Year: 2020.

Edition: First (1st).

Publisher: Luminate.

Type(s): Paperback and Kindle.

Synopsis:

A therapeutic relationship is a web of interactions, tasks and processes in space and time. It is not easy to stay aware of the relationship in the thick of talking and trying to help someone; but doing so boosts flexibility and enables deeper formulation. A therapist who can attend not only to a specific therapeutic model, but also to relational factors underlying all therapy, has a far greater chance of enabling change.

Therapy with a Map sets out a therapeutic process of talking accompanied by visual conversation maps set down in real time on paper. Like all maps, these help us to find our way, notice when we are lost, track our route and survey the wider landscape. The book uses mapping to introduce the tools and concepts of Cognitive Analytic Therapy (CAT), along with other relational, conversational and narrative approaches. By mapping patterns of thinking and relating, therapists can help clients to develop self-understanding, solve problems, and take away a freer, more self-aware relationship with themselves in the world.

Book: Working Effectively with ‘Personality Disorder’

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Book Title:

Working Effectively with ‘Personality Disorder’: Contemporary and Critical Approaches to Clinical and Organisational Practice.

Author(s): Joanne Ramsden (Author and Editor), Sharon Prince (Editor), and Julia Blazdell (Editor).

Year: 2020.

Edition: First (1st).

Publisher: Luminate.

Type(s): Paperback and Kindle.

Synopsis:

The history of personality disorder services is problematic to say the least. The very concept is under heavy fire, services are often expensive and ineffective, and many service users report feeling that they have been deceived, stigmatised or excluded. Yet while there are inevitably serious (and often destructive) relational challenges involved in the work, creative networks of learning do exist – professionals who are striving to provide progressive, compassionate services for and with this client group.

Working Effectively with Personality Disorder shares this knowledge, articulating an alternative way of working that acknowledges the contemporary debate around diagnosis, reveals flawed assumptions underlying current approaches, and argues for services that work more positively, more holistically and with a wider and more socially focused agenda.

Table of Contents

  • Foreword by John Livesley.
  • Introduction (Jo Ramsden, Sharon Prince and Julia Blazdell).
  • PART 1: CONTEMPORARY AND CRITICAL PERSPECTIVES ON PERSONALITY DISORDER:
    • Chapter 1: Life and Labels: Some Personal Thoughts about Personality Disorder (Sue Sibbald).
    • Chapter 2: Personality Disorder: Breakdown in the Relational Field (Nick Benefield & Rex Haigh).
    • Chapter 3: The Scale of the Problem (Sarah Skett & Kimberley Barlow).
    • Chapter 4: The Politics of Personality Disorder A Critical Realist Account (David Pilgrim).
    • Chapter 5: The Importance of Personal Meaning (Sharon Prince & Sue Ellis).
    • Chapter 6: The Organisation and Its Discontents: In Search of the Fallible and Good Enough Care Enterprise (Jina Barrett).
  • PART 2: GOVERNANCE PRINCIPLES SUPPORTING SERVICES TO ENACT CONTEMPORARY AND CRITICAL PERSPECTIVES:
    • Chapter 7: Access to Services – Moving beyond Specialist Provision while Applying the Learning (Jo Ramsden).
    • Chapter 8: Reimagining Interventions (Alan Hirons & Ruth Sutherland).
    • Chapter 9: Service User Involvement and Co-production in Personality Disorder Services An Invitation to Transcend Re Traumatising Power Politics (Melanie Ann Ball).
    • Chapter 10: Partnership Working (David Harvey & Bernie Tuohy).
    • Chapter 11: Outcomes (Mary McMurran).
    • Chapter 12: Contained and Containing Teams (Jo Ramsden).
    • Chapter 13: Co-Produced Practice Near Learning: Developing Critically Reflective Relational Systems (Neil Gordon).

Book: Psychopathy: An Introduction to Biological Findings and Their Implications

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Book Title:

Psychopathy: An Introduction to Biological Findings and Their Implications.

Author(s): Andrea L. Glenn and Adrian Raine.

Year: 2014.

Edition: First (1st).

Publisher: NYU Press.

Type(s): Hardcover, Paperback, and Kindle.

Synopsis:

The last two decades have seen tremendous growth in biological research on psychopathy, a mental disorder distinguished by traits including a lack of empathy or emotional response, egocentricity, impulsivity, and stimulation seeking. But how does a psychopath’s brain work? What makes a psychopath?

Psychopathy provides a concise, non-technical overview of the research in the areas of genetics, hormones, brain imaging, neuropsychology, environmental influences, and more, focusing on explaining what we currently know about the biological foundations for this disorder and offering insights into prediction, intervention, and prevention. It also offers a nuanced discussion of the ethical and legal implications associated with biological research on psychopathy. How much of this disorder is biologically based? Should offenders with psychopathic traits be punished for their crimes if we can show that biological factors contribute? The text clearly assesses the conclusions that can and cannot be drawn from existing biological research, and highlights the pressing considerations this research demands.

Book: Handbook of Psychopathy

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Book Title:

Handbook of Psychopathy.

Author(s): Christopher J. Patrick (Editor).

Year: 2018.

Edition: Second (2nd).

Publisher: Guildford Press.

Type(s): Hardcover, Paperback, and Kindle.

Synopsis:

Widely considered the go-to reference – and now extensively revised with over 65% new material – this authoritative handbook surveys the landscape of current knowledge on psychopathy and addresses essential clinical and applied topics. Leading researchers explore major theoretical models; symptomatology and diagnostic subtypes; assessment methods; developmental pathways; and causal influences, from genes and neurobiology to environmental factors. The volume examines manifestations of psychopathy in specific populations as well as connections to antisocial behaviour and recidivism. It presents contemporary perspectives on prevention and treatment and discusses special considerations in clinical and forensic practice.

New to This Edition

  • Extensively revised with more than a decade’s theoretical, empirical, and clinical advances.
  • Many new authors and topics.
  • Expanded coverage of phenotypic facets, with chapters on behavioural disinhibition, callous–unemotional traits, and boldness.
  • Chapters on DSM-5, clinical interviewing, cognitive and emotional processing, and serial murder.
  • Significantly updated coverage of aetiology, assessment methods, neuroimaging research, and adult and juvenile treatment approaches.

Book: Psychopathy – A Very Short Introduction

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Book Title:

Psychopathy – A Very Short Introduction.

Author(s): Essi Viding.

Year: 2019.

Edition: First (1st).

Publisher: OUP Oxford.

Type(s): Paperback, Audiobook, and Kindle.

Synopsis:

Psychopathy is a personality disorder that has long captured the public imagination. Newspaper column inches have been devoted to murderers with psychopathic features, and we also encounter psychopaths in films and books. Individuals with psychopathy are characterised in particular by lack of empathy and guilt, manipulation of other people and, in the case of criminal psychopathy, premeditated violent behaviour. They are dangerous and can incur immeasurable emotional, psychological, physical, and financial costs to their victims and their families. Despite the public fascination with psychopathy, there is often a very limited understanding of the condition, and several myths about psychopathy abound. For example, people commonly assume that all psychopaths are sadistic serial killers or that all violent and antisocial individuals are psychopaths. Yet, research shows that most psychopaths are not serial killers, and, equally, there are plenty of antisocial and violent offenders who are not psychopaths. This Very Short Introduction gives an overview of how we can identify individuals with or at risk of developing psychopathy, and how they differ from other people who display antisocial behaviour. Essi Viding also explores the latest genetic, neuroscience, and psychology evidence in order to illuminate why psychopaths behave and develop the way they do, and considers whether it is possible to prevent or even treat psychopathy.