The Psychologist May 2013

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may 2013vol 26 no 5

Why is it so hard togive up smoking?Lynne Dawkins considers the role of nicotine and alternatives

political conflict and youth 336the connected brain 340interview with Alain de Botton 344eye on fiction: The Yellow Birds 348

£5 or free to members of The British Psychological Society

letters 314news 322

careers 360looking back 378

Incorporating Psychologist Appointments

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may 2013vol 26 no 5

‘Giving up smoking is the easiestthing in the world,’ the author MarkTwain famously said. ‘I knowbecause I’ve done it thousands oftimes.’

This is no longer the generationof the Marlboro man; there can befew people left in any doubt thatsmoking is a Bad Thing, in healthterms and financially. Yet virtually allunaided attempts to quit smokingare unsuccessful. Why is it so hardto stop?

On p.332, Lynne Dawkinsconsiders the issue from apsychological perspective. What isthe role of nicotine, and what of theother conditioned effects thatbecome such a part of the smokingritual? Dawkins considers a modernalternative, the electronic cigarette.Could this be the key to dealing withthe challenge at a psychological andbehavioural level?

Elsewhere we have our usualdiverse mix of news, reviews, and a host of other regular features. And did you know that if you are a Society member you can read ThePsychologist on tablet, smartphoneand Kindle? Just log in viahttp://tinyurl.com/yourpsych toaccess your options.

Dr Jon Sutton

THE ISSUE

Political conflict and youthBrian K. Barber suggests how researchcould better assess the impact of war onyoung people

The connected brainGaby Pfeifer looks at reading andmemorising in the internet era

Interview: A student of lifeLucy Maddox talks to the philosopher,television presenter and entrepreneurAlain de Botton

Eye on fiction: The Yellow BirdsJohn Marzillier on Kevin Powers’ novel,and what it can teach us about trauma

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Professor Ian J. Deary is Professor ofDifferential Psychology and Director of theUniversity of Edinburgh Centre for CognitiveAgeing and Cognitive Epidemiology (CCACE;www.ccace.ed.ac.uk). He has been collaboratingwith renowned artist Fionna Carlisle on aproject to produce an exhibition of drawings andportraits of research participants and thescientists who are studying them. ‘Portraits ofan Intelligent Scotland’ is exploring thefascinating story of research on cognitive ageingin Scotland.

On 4 June 1947, Scotland tested the intelligence ofalmost every child born in 1936: 70,805 of them (seeNews, December 2012). Professor Deary and colleaguesrediscovered this test, the Scottish Mental Survey of 1947,in the late 1990s and recognised its potential for researchinto ageing. Since then these data have been used tostudy how people differ in their thinking skills across thelifecourse and why people with different childhoodintelligence live longer.

Fionna Carlisle tells us: ‘I became fascinated by the

story of this unique group of research participants andthe fact that Professor Deary and his team havediscovered a slight but significant association betweenmale facial symmetry and lifetime cognitive ageing. Thissingle piece of research has brought artist and scientisttogether to reflect on our different approaches todeconstructing the human face and personality.

This photograph shows Carlisle with the portrait ofProfessor Deary, roughly half way through the painting.For more on her work, see www.fionnacarlisle.com.

Portraits of intelligence Portrait of Professor Ian J. Deary (in progress), by FionnaCarlisle (pictured). ‘Big picture’ ideas? [email protected].

letters 314an open letter to clinical psychology; cognitive fMRI; greening of psychology;humour issue; lobbying for social change; and much more

336

340

348

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careers and appointments 360we meet health psychologist RoryO’Connor; Terry Sexton tells us of hisjourney from building site to psychology;and Nisa Shahul Hameed considers a challenging path into the profession

336

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death of a soldier; blogs from Dorothy Bishop and Tal Yarkoni; ‘Brainstorm’ atIslington Community Theatre; Bedtime Live; plus exhibitions, apps and more

looking back 378

reviews 368

spook hunting and ghost busting: Elizabeth Valentine on psychologists andpsychical research between the wars

a mindful moment for older adults: Alice Malzfeldt with the latest in our series for budding writers (see www.bps.org.uk/newvoices)

one on one 380…with Almuth McDowall

news and digest 322conduct disorder; predicting reoffending; children and TV; autism researchpriorities; frontiers of brain research; Elizabeth Loftus talk; anti-stigmacampaign; face blindness; psychologists appointed to top jobs; and nuggets from the Society’s free Research Digest service

society 352President’s column; Award forOutstanding Doctoral ResearchContributions; and more new voices 376

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Why is it so hard to quitsmoking? Lynne Dawkins explores the habitand a new device to help kick it

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Barrett, S.P. & Darredeau, C. (2012). Theacute effects of nicotine on thesubjective and behavioural responsesto denicotinized tobacco in dependentmale and female smokers. BehavioralPharmacology, 23(3), 221–227.

Bullen, C., McRobbie, H., Thornley, S. etal. (2010). Effect of an electronicnicotine delivery device (e cigarette)on desire to smoke and withdrawal,user preferences and nicotine

delivery. Tobacco Control, 19, 98–103. Corrigall, W.A., Coen, K.M. & Adamson,

K.L. (1994). Self-administered nicotineactivates the mesolimbic dopaminesystem through the ventral tegmentalarea. Brain Research, 653, 278–284.

Dawkins, L., Powell, J.H., West, R. et al.(2007). A double-blind placebocontrolled experimental study ofnicotine. II: Effects on responseinhibition and executive functioning.

Psychopharmacology, 190, 457–467. Dawkins, L., Turner, J., Hasna, S. & Soar,

K. (2012). The electronic-cigarette:effects on desire to smoke,withdrawal symptoms and cognition.Addictive Behaviors, 37(8), 970–973.

Doll, R., Peto, R., Boreham J. et al.(2004). Mortality in relation tosmoking: 50 years' observation onmale British doctors. British MedicalJournal, 328, 1519–1533.

Etter, J.F. & Bullen, C. (2011). Electroniccigarette: Users profile, utilization,satisfaction and perceived efficacy.Addiction, 106(11), 2017–2028.

Etter, J.F. & Stapleton, J.A. (2006).Nicotine replacement therapy forlong-term smoking cessation: Ameta-analysis. Tobacco Control, 15,280–285.

Hughes, J.R., Keely, J. & Naud, S. (2004).Shape of the relapse curve and long-

Smoking is the single mostpreventable major cause of illnessand early death, with nearly one infive deaths (in those aged 35 orabove) caused by smoking.Smoking has a multitude of effectson health, that most smokers areaware of. So why do more than onein five adults continue to smoke?And why is it so hard to give up?

In England cigarette smoking isresponsible for an estimated 81,700deaths per year, in other words, 223

people a day – or nine people an hour –die from their smoking ‘habit’. Anestimated 36 per cent of all respiratorydisease deaths, 29 per cent of cancerdeaths and 14 per cent of all circulatorydisease deaths are attributable tosmoking. This figure rises to 87 per centof deaths from chronic obstructive lungdisease and 82 per cent of deaths fromlung, bronchus and trachea cancer (NHSInformation Centre: tinyurl.com/cym3apk).

On an individual level, a long-termregular smoker loses an average of 10 yearsof their life (Doll et al., 2004). That is,approximately 8 out of 10 non-smokerslive beyond 70 years compared to only halfof long-term smokers (Kenny, 2012). If itdoesn’t kill you, smoking has multipleother ways of making your life a misery: it increases the risk of stroke, angina,emphysema, high blood pressure,thrombosis, asthma, cataracts, ulcers,erectile dysfunction and many more(tinyurl.com/74jlw). Given that mostsmokers are aware of these harmful effects,why do 21 per cent of the adult populationcontinue to smoke? (NHS InformationCentre: tinyurl.com/cym3apk). And whyare more than 95–97 per cent of unaidedquit attempts unsuccessful (Hughes et al.,2004)?

The problem with nicotineWhilst tobacco smoke contains thousandsof chemicals, it is the nicotine contentthat is generally thought to keep people

hooked. Smoking is an extremely effectiveway of delivering nicotine to the brain. Itis rapidly absorbed through the lungs intothe bloodstream, where it is carrieddirectly to the heart and reaches the brainin about 6–10 seconds (akin to anintravenous injection: Rose et al., 2000).Because of this direct route, nicotine doesnot get a chance to dissipate, so the highconcentration of nicotine in the lungsfrom a puff on a cigarette remains in theblood as this ‘hit’ (often referred to as a‘bolus’) until it reaches the brain. Whilstaddictive, nicotine is relatively safe; it’sthe carbon monoxide (CO; whichprevents oxygen transportation aroundthe body) and tar (which deposits in thelungs and airways and containscarcinogens) that carry the health risks of smoking.

The brain has its own receptors fornicotine – so-called ‘nicotinicacetylcholine’ receptors. Many of these arelocated on the cell bodies in the ventraltegmental area (VTA), the origin of thedopamine ‘reward’ pathway that projects to the nucleus accumbens (N.Acc).Dopamine release in the N.Acc is usuallyconcerned with naturally rewardingactivities (such as eating, drinking, sexualactivity, and so on), but addictive drugscan ‘hijack’ this system resulting in fasterand greater amounts of dopamine release(NIDA, 2010). When nicotine activates thenicotinic receptors in the VTA, it results inmassive dopamine release in the N.Acc(Corrigall et al., 1994).

In this way, nicotine and otheraddictive drugs are positively reinforcing –they tap into the normal instrumentallearning mechanism which has evolved toensure that pleasurable or rewardingactivities are repeated. This mechanism,moreover, operates outside of consciousawareness, setting up a strong motivationaldrive to smoke, which may conflict withconscious thoughts, beliefs and plans.Negative reinforcement, by contrast,involves escaping from or avoidingaversive or unpleasant stimuli. Smokingalso taps into this system – via thewithdrawal syndrome. When a regular

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West, R. (2006). Theory of addiction.Oxford: Wiley-Blackwell.

www.e-cigarette-forum.com/forum

How important is the nicotine delivery inthe maintenance of the smoking habit?Why, given that e-cigarettes are almostcertainly much safer than cigarettesmoking, is there so much resistance totheir use?

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Why is it so hard to quitsmoking?Lynne Dawkins explores the role of nicotine and non-nicotine contributions tosmoking and considers a promising new device for kicking the habit

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smoker stops smoking, they canexperience aversive withdrawal symptoms(e.g. irritability, depression, restlessness,poor concentration, increased appetite)and strong urges to smoke. Nicotineingestion, especially via smoking,extinguishes these symptoms.

Is the smoking habit just aboutnicotine ingestion?Although the nicotine content is clearly a critical component of tobacco addiction,animal studies report that establishingreliable nicotine self-administration ismore difficult than for other rewardingdrugs such as heroin, cocaine and alcohol(Matta et al., 2007). A growing body ofevidence also points to the role of non-nicotine factors in supporting smokingbehaviour. Anecdotally, smokers prefersmoking to other forms of nicotineadministration (e.g. patch, gum, nasalspray) and in the lab, smokers have beenshown to prefer smoking a denicotinisedcigarette overreceivingintravenousnicotine (Rose et al., 2010).Smokers alsoreport enjoyingthe sensory andtactilecomponents of smoking,including thehand-mouthactivity, taste,smell andsensations in therespiratory tract(Parrot & Craig,1995) and if thesesensations areremoved, smokingsatisfactiondeclines (Perkinset al., 2001). Infact, a number of studies have nowreported that denicotinised tobaccosmoking can alleviate nicotine withdrawal

symptoms and craving (Rose et al., 2010)as well as elicit positive subjective effectscomparable to smoking tobacco thatcontains nicotine (Barrett & Darredeau,2012). Animal studies also show thatnicotine administration is much strongerin the presence of sensory cues (e.g. alight or a tone; Sorge et al., 2009). So,nicotine in combination with other salientsensorimotor cues might be a particularlypowerful recipe for the development ofsmoking addiction.

When a habit has been learned in thecontext of a particular set of cues (e.g. witha cup of coffee or tea; the sight and smellof smoke; the tactile sensation of acigarette in the hand) these cues can then,via classical conditioning, act as ‘secondaryreinforcers’ – they become moderatelyreinforcing in their own right. Forexample, the ‘catch’ in the throatassociated with smoking, or manipulatinga cigarette in one’s hand, are unlikely to bepleasant in their own right, but smokersdescribe such things as pleasurable. It is

likely that such sensationshave been so closelyassociated with the primaryrewarding effects ofnicotine, that they havecome to elicit a pleasantsensation and contribute to the process of smokingaddiction. To borrow anexample from West (2006):if we take a 20-a-daysmoker who takesapproximately 12 puffs oneach cigarette – that personis repeating thereinforcement process 240times a day, that is, 87,600times a year and, if they

continue to smoke for 25years, that amounts to2,190,000 times. Thus, it is easyto see how deeply entrenchedthe ‘habit’ can become and howcues closely associated with the

primary reinforcer – nicotine – can cometo be strongly reinforcing in their ownright.

Cues may have a priming effect on theindividual, that is, they whet the addict’sappetite for the desired drug effect,inducing craving and motivation to use.During a quit attempt, encountering a cue(the sight or smell of a cigarette) can beparticularly troublesome, making it morelikely that craving and a lapse to smokingwill occur. But how can cues elicit suchstrong control over behaviour? What’sgoing on in the brain?

One well-accepted explanation(Robinson & Berridge, 1993) suggests that the dopamine reward pathway, whichordinarily mediates how ‘noticeable’ and‘attention grabbling’ things are in theenvironment, becomes sensitised (moreeasily activated) because of the repeatedexposure to nicotine. This means thatwhen cues associated with smoking areencountered they become much moreattention grabbing, salient and sought-after, causing increasing wanting andcraving. This, in conjunction with theincreasing evidence that smokers find itharder to inhibit over-learned tendencies(Dawkins et al., 2007), makes it extremelyhard for the smoker to resist the urge tosmoke (especially in the context ofcigarette-related cues) during a quitattempt.

To recap, nicotine is positivelyreinforcing (it triggers dopamine releasein the N.Acc) and abstinence fromnicotine is punished (it is associated withwithdrawal symptoms and craving). Thestrong association between the primaryreinforcer, nicotine, and non-nicotinesmoking-related cues (conditionedstimuli) results in strong secondaryreinforcing processes. Part of thereinforcing process of smoking is likelytherefore to include conditioned sensoryand behavioural aspects of cigarettesmoking (e.g. the handling of thecigarette, the ‘catch’ of smoke in thethroat). The process of associativelearning therefore results in a highly over-learned behaviour. Since the mechanismsunderlying the conditioning process areunconscious, the smoker simply feels apowerful desire to smoke, which varies


smoking

term abstinence among untreatedsmokers. Addiction, 99(1), 29–38.

Hughes, J.R., Rennard, S.I., Fingar, J.R.et al. (2011). Efficacy of varenicline toprompt quit attempts in smokers notplanning to quit. Nicotine TobaccoResearch, 13(10), 955–964.

Kenny, T. (2012). Smoking: The facts.www.patient.co.uk/health/Smoking-The-Facts.htm

Matta, S.G., Balfour, D.J., Benowitz, N.L.

et al. (2007). Guidelines on nicotinedose selection for in vivo research.Psychopharmacology, 190(3), 269–319.

NIDA (2010). Drugs, brains, and behavior:The science of addiction.tinyurl.com/bqvfbn8

Parrot, A.C. & Craig, D. (1995).Psychological functions served bynicotine chewing gum. AddictiveBehaviors, 20(3), 271–278.

Perkins, K.A., Donny, E. & Caggiula, A.R.

(1999). Sex differences in nicotineeffects and self-administration:Review of human and animalevidence. Nicotine and TobaccoResearch, 1, 301–315.

Perkins, KA., Gerlach, D., Vender, J. et al.(2001). Sex differences in thesubjective and reinforcing effects ofvisual and olfactory cigarette smokestimuli. Nicotine and TobaccoResearch, 3, 540–546.

Robinson, T.E. & Berridge, K.C. (1993).The neural basis of drug craving: Anincentive-sensitization theory ofaddiction. Brain Research Reviews,18: 247–291.

Roddy, E. (2004). Bupropion and othernon-nicotine pharmacotherapies.British Medical Journal 328(7438),509–511.

Rose, J.E., Behm, F. M., Westman, E.C. &Johnson, M. (2000). Dissociating

During a quit attempt,encountering a cue can beparticularly troublesome


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according to the presence of external cuesas well as his or her internal state.Sensitisation of the dopamine rewardpathway with chronic nicotine useestablishes a heightened desire or cravingfor nicotine, especially in the presence ofsmoking-related stimuli. Thus nicotineaddiction can be thought of as a deeplyentrenched pattern of behaviour underpowerful stimulus control because ofrepeated reward and punishment effects.

Efficacy of currently available‘quit smoking’ aidsWith the considerable evidence thatsmoking behaviour is driven by nicotineaddiction and that nicotine itself isrelatively safe, came the introduction ofnicotine replacement therapy (NRT) –nicotine in the form of patch, gum,lozenge, inhalator and nasal spray. Therationale is to partially replace thenicotine derived from cigarette smokingthus alleviating craving and withdrawalsymptoms and reducing the need tosmoke. Over 100 placebo-controlled trialssuggest that use of NRT doubles asmoker’s chances of quitting successfullyto 6–12 months (see Silagy et al., 2005,for a meta-analysis). However, given thatthe success rate for unaided quit attemptsis so low, this means that, even with NRT,93 per cent of quit attempts ultimatelyend in failure (Etter & Stapleton, 2006).

What about newerpharmacotherapies – Zyban (bupropion)or Champix (varenicline)? Zyban acts byincreasing the availability of noradrenalineand dopamine thus mimicking the effect ofnicotine and helping to reduce craving andwithdrawal symptoms. Its success rate iscomparable to NRT, doubling the chancesof quitting successfully over placebo(Roddy, 2004). Champix partially activatesthe nicotinic acetylcholine receptors,helping to relieve symptoms of craving and nicotine withdrawal. It also preventsnicotine from activating these receptors so cigarette smoking does not triggerdopamine release, in turn reducing themotivation to smoke. A meta-analysis of

placebo-controlled trials sponsored by the drug company suggests that it is threetimes better than placebo (Wu et al., 2006)with a 14 per cent success rate (Hughes etal., 2011). Champix however, has beenassociated with a number of side-effects,most worryingly psychiatric effectsincluding agitation, depressed mood,suicidal thoughts and an increased risk ofheart attack (see Siegel, 2011).

A 14 per cent success rate, even in the absence of side-effects, is still far fromimpressive. So why are these methods sounsuccessful? NRT and otherpharmacotherapies address the nicotineaddiction (by replacing it, mimicking it or preventing it from having its rewardingeffects), but they lack the importantsensory and behavioural cues associatedwith cigarette smoking. In other words,they do not address the associativelearning processes that have occurredthroughout a lifetime smoking habit. Rose et al. (2000) have shown that thecombination of IV nicotine (whichresembles the bolus of nicotine achievedfrom cigarette smoking) and smoking adenicotinised cigarette (which provides thesensory and behaviour aspects of smoking,CO and tar but no nicotine) produced

effects similar to those of own-brandsmoking.

What we need then is a device thatreplaces not only the nicotine fromcigarette smoking, but also the ‘activity’ ofsmoking. If we could manufacture a devicethat could deliver nicotine effectivelywithout the CO and tar and that mimickedthe act of smoking – thus maintainingsome of the secondary reinforcingaspects – maybe we would have a bettermethod of helping smokers to quit.Perhaps such a device is already here?

The electronic cigarette Electronic cigarettes (sometime referredto as ‘Electronic Nicotine DeliverySystems’; ENDS) are battery-operateddevices that resemble cigarettes anddeliver nicotine via inhaled vapour. Sincetheir introduction into the market in2004 by the Ruyan Group (also known asDragonite) in China, electronic cigarettes(e-cigarettes) have gained popularityworldwide and are mainly sold via theinternet. Removable cartridges(mouthpieces) contain glycerol orpropylene glycol, flavouring, and varyingamounts of nicotine. The nicotine

nicotine and nonnicotine componentsof cigarette smoking. Pharmacology,Biochemistry and Behavior, 67, 71–81.

Rose, J.E., Salley, A., Behm, F.M. et al.(2010). Reinforcing effects of nicotineand non-nicotine components ofcigarette smoke.Psychopharmacology, 210, 1–12.

Siegel, M. (2011). The rest of the story:Tobacco news analysis andcommentary. tinyurl.com/blgw643

Seigel, M. & Cahn, Z. (2010). Evidencesuggests e-cigs safer than cigarettes:Researchers claim.tinyurl.com/cb86sza

Silagy, C., Lancaster, T. & Stead, L. et al.(2005). Nicotine replacement therapyfor smoking cessation. The CochraneLibrary, Issue 1. Chichester: Wiley.

Sorge, R.E., Pierre, V.J. & Clarke, P.B.S.(2009). Facilitation of intravenousnicotine self-administration in rats by

a motivationally neutral sensorystimulus. Psychopharmacology, 207,191–200.

Vansickel, A.R., Cobb, C.O., Weaver, M.F.,& Eissenberg, T.E. (2010). A clinicallaboratory model for evaluating theacute effects of electronic‘cigarettes’. Cancer Epidemiology,Biomarkers & Prevention, 19,1945–1953.

Vansickel, A.R. & Eissenberg, T. (2012).

Electronic cigarettes: Effectivenicotine delivery after acuteadministration. Nicotine and TobaccoResearch, Feb 6,doi:10.1093/ntr/ntr316

West, R. (2006). Theory of addiction.Oxford: Wiley-Blackwell.

Wu., P., Wilson, K., Dimoulas, P. & Mills,EJ. (2006, 11 Dec). Effectiveness ofsmoking cessation therapies. BMCPublic Health, 6, 300.

Although the existing literature does not merit a conclusion that e-cigarettes are safe inabsolute terms, they are clearly much safer than tobacco cigarettes



smoking

solution is vapourised by the heatingelement/atomiser which is activated by‘drawing’ on the device or pressing abutton. ‘Smoking’ an electronic cigarette(often referred to as ‘vaping’) thereforemimics the act of smoking: the user holdsthe device and draws on it like a cigarette;the vapour produced resembles smokeand is drawn into the lungs and exhaledlike smoke; tobacco (or menthol)flavouring resembles the taste of inhaledtobacco smoke. In short, it addresses thesensory and behavioural components ofsmoking that are being increasinglyrecognised as important contributors tothe reinforcing effects of smoking (seeRose et al., 2010). Furthermore, since notobacco is burned, inhaling nicotine inthis way has the potential to provide a safer alternative to cigarette smokingsince it eliminates the harmful tars andcarbon monoxide associated withsmoking. Nevertheless, uncertaintyremains concerning efficacy of nicotinedelivery via e-cigarettes and how theyshould be regulated.

E-cigarettes are already banned insome countries (including Australia,Thailand, Brazil) and cannot be importedinto others (Canada). Thesesame countries however,continue to sell tobacco – ‘theonly consumer product thatwill kill half its users whenused as intended’(smokefree.org.nz/face-facts).Both the World HealthOrganization (WHO) and the US Foodand Drug Administration (FDA) havevoiced concerns over the contents of thecartridges, the properties of the vapour,and whether the products are safe oreffective. In the absence of clinicalcontrolled trials, they have askedmanufacturers not to make cessationclaims, and the Royal PharmaceuticalSociety has recently announced thatphysicians should not recommend them to their patients. The EU is currentlyconsulting over regulation and the MHRA(Medicines Health Regulatory Authority)will decide this year whether to ban,regulate or do nothing.

In 2009 the FDA conducted a chemicalcontent analysis of 19 e-cigarette cartridgesand reported the presence of diethyleneglycol (a poison) and tobacco-specificnitrosamines (TSNAs; known cancer-causing agents) in some of the cartridges,as well as inaccurate reporting of nicotinecontent. What it failed to mentionhowever, was the maximum level ofnitrosamines found in e-cigarettes wascomparable to that found in nicotinereplacement therapies. TSNA levels presentin cigarettes, by comparison, are 1000

times this level (Siegel & Cahn, 2010). Let’s face it, inhaling any chemical into

the lungs is likely to be associated withsome harm, but compared to the multipleknown health risks associated withcigarette smoking which kills 81,700people per year in England alone, thehealth risks of the non-combustible e-cigarette is likely to be in orders ofmagnitude lower. Following a review ofthe literature, Professor Siegel from BostonUniversity concluded that although theexisting literature does not merit aconclusion that e-cigarettes are safe inabsolute terms, they are clearly much saferthan tobacco cigarettes. In fact, ‘the truth is we know a lot more about what is inelectronic cigarettes than in regularcigarettes’ (Siegel & Cahn, 2010).

Can the e-cigarette helpsmokers to quit?Although a product that delivers nicotineand incorporates the sensory andbehavioural aspects of smoking hasconsiderable potential to reduce thepublic health burden associated withtobacco smoking, smokers are only

likely to switch to e-cigarettes if they are easy to use,effectively replace the primary andsecondary reinforcing

aspects of smoking andcan reduce nicotine

craving and withdrawal symptoms. Whistclinical trials have yet to be completed, a recent large online survey reported over90 per cent of users stated that e-cigaretteuse had helped them to quit smoking orreduce their cigarette consumption (Etter& Bullen, 2010). Two published reportsof e-cigarette use in naive users, however,showed inefficient nicotine delivery(Bullen et al., 2010; Vansickel et al.,2010), although craving and (to a lesserextent) withdrawal symptoms werealleviated. A reduction in craving andwithdrawal symptoms in the absence ofraised blood nicotine levels is consistentwith the notion discussed earlier thatother sensorimotor factors associated with smoking contribute to its reinforcingeffects.

In a study conducted in our lab at theUniversity of East London (Dawkins et al.,2012), abstinent smokers given a 0 mg(placebo) e-cigarette reported comparablereduction in craving and withdrawalsymptoms after five minutes of use tothose given 16 mg nicotine. After 20minutes, compared with the placebogroup, craving and withdrawal symptomswere further reduced in males but not

females receiving nicotine. These genderdifferences are consistent with an emergingbody of evidence suggesting that thesmoking behaviour of men may bereinforced more by nicotine intake, and inwomen more by non-nicotine-conditionedresponses to smoke stimuli (Perkins et al.,1999). We also observed an improvementin working memory with nicotine (relativeto placebo) in the whole sample, suggestingthat nicotine delivery is at least sufficientto improve the mild cognitive impairmentoften observed during abstinence.

Interestingly, in a recent study ofexperienced vapers using their owndevices, Vansickel and Eissenberg (2012)demonstrated significantly elevated bloodnicotine levels, comparable to thoseachieved via cigarette smoking. This latterstudy clearly suggests that e-cigarettes arecapable of delivering adequate levels ofnicotine but that new users may need toovercome a learning curve with regard tothe nature of vaping and product choice.

To concludeIncreasing evidence suggests that peoplesmoke for both the nicotine and the non-nicotine, sensorimotor (conditioned)effects. Current pharmacotherapies forsmoking cessation address only the former.The e-cigarette delivers nicotine withouttobacco combustion and mimics the act of smoking, thus replacing some of theimportant sensorimotor aspects ofsmoking. It therefore has the potential to provide pleasure as well as save lives.Whilst survey results suggest that e-cigarettes are a highly effective nicotinereplacement, such respondents are likely to be positively biased and we await theresults of clinical trials to determinewhether this promising new device canindeed improve our current arsenal ofsmoking cessation techniques.

The health risks and safety aspects of e-cigarettes are a frequently – andsometimes sensationally – expressedconcern. On balance, however, e-cigarettesare probably doing people very little harmand, in all likelihood, doing people a lot ofgood if they are using these as a completeor partial alternative to tobacco smoking.What is very apparent is that the potentialto contribute to improved public heathcertainly merits further research.

Lynne Dawkinsis a Senior Lecturer at theUniversity of East [email protected]

“we know a lot moreabout what is inelectronic cigarettes”


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Moving and inspiringDr Margaret Evison is a consultant clinical psychologist specialising in palliative care. She is also a mother with two children; a daughter, Elizabeth, and a son, Mark. This book is about the death of Margaret’s son.

Lieutenant Mark Lawrence Evison, 1st Battalion Welsh Guards, died of his wounds in Selly OakHospital, Birmingham on 23 May 2009 having been wounded in action at Haji-Alem, HelmandProvince, Afghanistan on 9 May 2009 and aeromedically evacuated from the military hospital at

Camp Bastion to Birmingham the following day. Lt Evison hadbeen an officer in the British Army for less that 18 months, inAfghanistan on his first tour of duty there for less than amonth and, with his platoon, in the turreted fort patrol base of Haji-Alem for just over two weeks.

By all accounts, Mark Evison was an exceptional youngofficer, rated by his soldiers, peers and superiors as one of themost capable young officers in the battalion, and destined forgreat things. His mother describes him as a caring,compassionate, charming, able and handsome young man andhis death, like all deaths, was a tragedy.

But Mark Evison’s death was more than a tragedy. It wasthe result of a complex web of circumstances involving thetiming of medical evacuation helicopter flights, the contents of field medical packs and the adequacy of radios. It was thelatter that caused Lt Evison to step out of cover, perhaps to get a better signal, when he was hit by the fatal shot to hisshoulder from a sniper’s bullet, the second that may or maynot have aided a speedy stabilisation of his wounds and theformer that may have affected transporting Mark Evison backto hospital at Bastion within the ‘golden hour’ deemednecessary to maximise his chances of survival.

Death of a Soldier is the collage of hospital notes, entriesfrom Mark’s journal, reports from superiors, letters, SIBreports1 and transcripts of the inquest into his death that wasassembled by Margaret as she tried, in a relentless quest, totry to piece together the jigsaw of complexities and tragedysurrounding the circumstances of his fatal wounding, hisevacuation by helicopter across the dusty plains ofAfghanistan and onwards in three aircraft from Afghanistan to Birmingham and his subsequent care and death in SellyOak. Death of a Soldier is an account of ‘a dying observed’, with all the events that led up to his eventual death in hospitalviewed mostly in retrospect, sometimes second- or third-hand(although Channel 4, with Dr Evison’s permission, showed the

helmet-camera footage of the battle in which he was shot in October 2010). In this book, theauthor’s grief is not observed in the way that the grief of C.S. Lewis was2 but is nonetheless soapparent in every page that this courageous and hugely impressive psychologist has written aboutthe death of her beloved son. She writes:

I would not have believed that the pain of a child’s death could be so wracking, so complete. It isthe breaking up of intense biological bonds built to nurture and endure, it is a shattering of whatwas intended. One knows of nature’s anger with the unnatural splitting of an atom: so a parentfeels a child’s death.

I was moved and inspired by this book, and think that you will be too.

1 The SIB is the Army’s equivalent of the CID, the Special Investigation Bureau.2 In A Grief Observed (1961) C.S. Lewis reflects on his experience of bereavement following the death of his wife.

I Biteback Publishing; 2012; Hb £16.99Reviewed by Jamie Hacker Hughes who is an Independent Mental Healthcare Consultant andVisiting Professor, Anglia Ruskin University

A consuming readFood andAddiction: A ComprehensiveHandbookKelly Brownell &Mark Gold

Against a global backdrop ofwidespread obesity, Food andAddiction takes a clear stancethat addiction to food is as realas any other addiction.Libertarians will shudder atsome points; discussion of howpeople are to control portionsize in particular comes off aspatronising. On the other hand,much of the ideas at work heregive the reader a practicalsense of how one’s ownconsumption could be bettercontrolled (e.g. by choosing lessenergy-dense food), and thebook tackles the controversialtopic of food addiction withperspectives from psychology,physiology, public health andother disciplines.

The short length of thechapters and the two-columns-a-page layout give this book apage-turning quality.Nonetheless, the book as awhole has a measured pace; thefirst two sections cover addictionand feeding in depth, before thetwo topics are brought togetherfor the remainder.

There’s no shortage of self-help books on food addiction,often written from a perspectiveof personal recovery. Want abroader empirical look at foodand addiction? Add this to yourbookshelf.

I Oxford University Press; 2012;Hb £75.00Reviewed by Andrew P. Allena postdoctoral researcher atUniversity College Cork

Death of a Soldier: AMother’s StoryMargaret Evison

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Readers of this publication may well befamiliar with Professor Dorothy Bishop, theacademic, blogger and all-round good egg.We interviewed her in the January issue (seetinyurl.com/bsz44rr), just after she had wonrunner-up in the inaugural UK Science BlogPrize for http://deevybee.blogspot.co.uk. Sheis also building up quite a following onTwitter (@deevybee), which has been abuzzlately with discussion of her musings.

For those of you unfamiliar withblogging as a form of communication, this is no personal brain dump full of pictures ofcats and word searches. Bishop says whatothers might be thinking, skewering oneissue after another in a series of practicaland thought-provoking posts. At the time ofwriting, there’s an excellent piece on ‘Tenthings that can sink a grant proposal’ which includes sage advice such as: ‘An

overoptimistic proposal assumes thatresults will turn out in line with predictionand has no fall-back position if they don't. A proposal should tell us something usefuleven if the exciting predictions don't workout. You should avoid multi-stageexperiments where the whole enterprisewould be rendered worthless if the firstexperiment failed.’

But the main attraction in March was anexchange between Bishop and the authorsof a paper she had criticised, on videogames and dyslexia. The study, by SandroFranceschini and colleagues and publishedin Current Biology, had just 10 participantsper group and Bishop thought thisunderpowered. Two of the authors, AndreaFacoetti and Simone Gori, replied on Bishop’sblog that many other studies have usedequally small samples. ‘This is undoubtedlytrue,’ Bishop said, ‘but it doesn’t make itright’. Bishop to Queen 4, Check.

The study authors also commented that‘bashing other people’s work without anycollected data that prove or at least supportthat claims [sic] seemed to us really unfair,

honestly’, saying that ‘the suited arena for a scientific discussion should be the peerreviewed international journals’. This ledBishop to share her thoughts on so-called‘post publication peer review’. In heropinion, ‘journal editors should haverecognised this as a pilot study and askedthe authors to do a more extensivereplication, rather than dashing into print onthe basis of such slender evidence’. As forwhether a blog is the appropriate forum forsuch discussion, Bishop wrote: ‘I don’t enjoycriticising colleagues, but I feel that it isentirely proper for me to put my opinion outin the public domain, so that this broaderreadership can hear a different perspectivefrom those put out in the press releases.And the value of blogging is that it doesallow for immediate reaction, both positiveand negative.’

Judging from the wider reaction to herblogging, she has plenty of support for thatview.

I Reviewed by Dr Jon Sutton who isManaging Editor of The Psychologist


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A fascinating skirmish

BishopBlogDorothy Bishop

Adolescence is the period of life during which we start to figure outwho we want to be. It is a time of increasing capacity to make senseof the world and the people in it. It is a time of discovery, coincidence,immense passion and, of course, profound self-consciousness,embarrassment and conflict. The teens behind the productionBrainstorm are not only able to recreate the tumultuous – albeit oft-misunderstood − world of adolescence on stage, but also bring theaudience into this world by opening windows onto the mind.

The play begins with its entire cast on stage as one teenaged girlbegins to tell a story about someone she knew who died while ridinga bicycle. Although the story begins as a monologue, multiple voiceschime in at times derailing the story into tangents on pop stars,memories and parental aspirations, before returning back to themain thread. This opening scene, at once chaotic and fluid, feels likepeering into one teenager’s stream of consciousness.

As the opening scene fades, a projection screen plays a videomontage of various scientists describing the still-developing teenagebrain, interlaced with shots of teens alone in rooms singing songs,skateboarding down stairs and other stereotypical behavioursdescribed by the scientists. This opening video appears to confirmjust what adults have always suspected – that their teenagers’behaviour is biologically based in the brain and what we can expectfrom teens is immature, reckless behaviour.

However, the play itself explores this relationship between theteenage brain and behaviour by taking the stereotypes down to theindividual level. At times it feels like a beautifully constructed publicservice announcement for adults; one meant to remind them of thecomplexities of teenagers' lives and brains. The production carefullyweaves in scientific evidence to support their message that theadolescent brain is not simply an immature adult brain, but that theteen brain it is different from the adult brain. The performancereminds us that teenagers and their brains harbour remarkablepotential to change the world because of these differences.

Many scenes of the playinvolve communicating withparents, often around conflictsinvolving personal and parentalaspirations. The scenes areinterspersed with poetry, alludingto the teen brain as visiting a newcity where one has not yet figuredout the shortcuts. At one pointthe audience is treated to a real-time ‘brain scan’ where theactors anonymously respond tostatements projected onstage bylighting a representative lamp viaremote. Each statement is moreprovocative and illuminating thanthe last, ranging from ‘I want tobe a lawyer’ (no lamps light up) to‘I am in love with someone on thisstage’ (half the lamps light up).

Islington Community Theatre(www.islingtoncommunitytheatre.com) works with young peoplefrom across the entire second decade (ages 9–21 years) in closecollaboration to create and perform professional-quality theatreperformances. I had the great opportunity to witness one of the firstrehearsals of this show, and was immediately struck by the level ofcontrol the young actors had on the production. The directors, NedGlasier and Emily Lim, have an impressive ability to draw a storyfrom each of a dozen voices, and facilitate the development of thosestories rather than impose an already structured narrative. This islikely one of the reasons the production was so powerful at the sametime as feeling authentic. Given that adolescence is a time in whichheightened self-consciousness can make going out in public with a family member seem like torture, witnessing such bare opennesswas at times overwhelming.

I Reviewed by Kate Mills and Sarah-Jayne Blakemore, UniversityCollege London

Opening a window on adolescence

BrainstormIslington Community Theatre


solely tackle the ‘classical’barriers to effectiveness (suchas accessibility, variability andunpredictability). It equallydemonstrates the emergence ofsuccessful, constructiveevidence-basedimplementations developed byrigorous, alternative protocolsthat are complementary oftraditional paradigms. It

explores implementationframeworks in a range ofeducational contexts; some arefrom a wide lens and othershave narrow focuses. Itunderlines the subtleness andcomplexity of developingimplementations, and criticallydemands systematic, analyticalapproaches to evaluatingeffectiveness in a dynamicecology of education with thepurpose of fostering a sharedvision in psychology andeducation.

I would recommend thisbook as a useful resource forthose who are involved inunderstanding, designing,delivering, measuring andimproving interventions in real-world educational contexts.

I Cambridge University Press;2012; Hb £90.00Reviewed by Qing Wang who isa doctoral researcher ineducational psychology at theUniversity of Bristol

Making interventionswork in education

Handbook ofImplementationScience forPsychology inEducationBarbara Kelly &Daniel F. Perkins(Eds.)

This book aims to explore andexplain what makespsychological interventions workand how to enhance the impactin natural educational contextscharacterised by the lack ofexperimental control.

It pulls together theepistemological, methodologicaland theoretical aspects ofimplementation science,covering various practitioners’

frameworks and approaches,specific interventionalmethodologies and programmesin the key areas derived fromeducational and psychologicaltheory and research.

What is really interestingand innovative about this book is that it makes headway inclarifying concepts ofimplementation science,defining its overall readiness in terms of resources, skills,effective delivery and evaluation,concerning an unbalancedaccount of awareness andpractice in the current evidence-based programmes, andsuggesting professional rolessuch as interventionist fieldspecialists.

This book is different fromother intervention-related booksin several aspects. It does not

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Psychological understanding of design

Designs of the Year AwardsDesign Museum, London

Described as ‘the Oscars of the design world’, London’s DesignMuseum (http://designmuseum.org) has currently devoted a floorto this annual Design of the Year Awards. International designsfrom seven categories have been nominated: architecture, digital,fashion, furniture, graphics, transport and product.

The event has been curated to mix the categories together,giving a pleasing hodge-podge of designs from different areas. Theexhibition showcases high-brow couture alongside everyday design,such as the non-stick ketchup bottle. Attractive graphic designsinclude the covers of Ralph Ellison’s books designed in the jazz-erastyle, and Adam Thurlwell’s book written with type-faces running in

Ethical treatmentSide EffectsSteven Soderbergh

This captivating film is apparently director Steven Soderbergh’s lastand stars Jude Law as Dr Banks, the current psychiatrist of patientEmily Taylor (Rooney Mara). After Banks asks Taylor’s former

psychiatrist (Catherine Zeta-Jones) for advice hesets off a chilling chain of events.

Psychiatric drugs are the keystone of this film,as the title suggests, with various aspects of thepsychiatric and psychological milieu cleverlycoming in and out of focus throughout. Therelationship between a psychiatrist and their client,the free will of the patient and the ethical issuessurrounding the behaviour of large pharmaceuticalcompanies all feature, resulting in the occasionalfeeling that you are watching a number of differentfilms at once. That is, however, until the final act

when Soderbergh expertly brings everythingtogether. This film is both a psychological thriller and

a court-room drama, with a couple of scenes of a sexual naturethrown in for good measure.

Jude Law’s character comments on the difference betweenAmerica and the UK with regard to treatments for mental healthdisorders and their associated stigma. This may be of particularinterest to readers of The Psychologist; however, these commentsand the many representations of various issues relating to mentalhealth are sure to result in some interesting post-film conversationsfor lay people, experts and all in between. Rooney Mara’s portrayalof someone experiencing severe depression should have you on theedge of your seat during the film, and keep you talking afterwards.Hers is not the only depiction of a life spiralling downwards, and thisfilm is one of Jude Law’s best.

Those familiar with the themes should not assume this will be a bore; the beauty of this film is that you will want to watch it again.

I Reviewed by Charlie Lea who is a PhD Student at Royal Holloway,University of London


In this programme, Dr KevinFong who is a Consultant inAnaesthesia at UniversityCollege Hospital, London,explored the human factors thatcan impact upon patient safety,focusing on the lessons that canbe learned from otherprofessions. The Elaine Bromleycase is used throughout theprogramme to consider how the decisions and actions thatmembers of a surgical teamtake under pressure can lead toadverse outcomes – in this case,leading to the death of thepatient 13 days after a routineoperation.

Dr Fong began bydemonstrating a simpleexperiment designed to examinethe impact of cognitive load.This showed that, whenexperiencing cognitive load, ourcapacity to monitor other stimuli

reduces significantly, seriouslyimpairing our situationalawareness. The fire service hasdeveloped a range of techniquesto enhance the situationalawareness of fire-fighters, whoregularly deal with competingdemands in emergencysituations. Simulations allowthem to practise decisionmaking under extremepressure, and the training isresulted in considerablebenefits. Such techniques arenow being used to help doctorsin training to develop strategiesto cope under pressure. DrSarah Cheavley-Williams, alsoof University College Hospital, is leading the development ofhuman factors simulationtraining within their medicaltraining programme. Dr Fongsuggested that improvedsituational awareness gained

through the use of suchtechniques may have enabledthe consultants involved in theElaine Bromley case to take a step back and consideralternative treatment options,rather than merely repeat theunsuccessful interventions thatthey had already tried.

Lessons that can be learnedfrom safety procedures used bythe aviation industry andFormula One (F1) racing werealso considered in theprogramme. Surgical checklistshave recently been developedbased on those used in aviationin order to enhance teamworking and decision makingduring surgical procedures. An evaluation of the benefits of using these checklistsconducted in eight countries,has found a 35 per centreduction in surgicalcomplications and death overall.This success is attributed in partto a ‘flattening’ of thehierarchical structuretraditionally found in surgicalteams. The potential negativeimplications of such hierarchieswas well illustrated by ElaineBromley’s case – during hersurgical procedure, a nurse had suggested an alternativesolution to the consultantsseveral times, but she had been

ignored. A flattened structureand clearer communicationchannels may well have led to a different outcome.

The importance ofleadership, clear roles for team members, and designatedpersonal responsibility for a small number of tasks are the lessons that can be learnedfrom F1 racing. Introducing suchprocesses directly after surgeryand during patient handover toICU has led to a 40 per cent dropin human error. Again, clearcommunication, flattenedhierarchies and well-definedroles combine to supportmedical staff in making accurateand effective judgements tobenefit patient outcomes.

Finally, Dr Fong presentedevidence that introducingtraining to help medical staffrecover quickly from errors, thedevelopment of procedures thatare standardised, but willencourage innovation whererequired, together with effectivemultidisciplinary teamwork canhelp medical teams reducehuman error and deliver apowerful impact on patientsafety.

I Reviewed by Siobhan Wraywho is a Senior Lecturer atSheffield Hallam University


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all different directions, and with pull-out sections inamongst the book to emphasise the chaotic nature of thestory.

Two exhibits stood out to me from a health psychologyperspective. The first was an app which aims to encourageexercise by making it more fun to run. The ‘Zombies, Run!’app creates an interactive running experience. This is apersonalised gaming environment which combines musicfrom your playlists on your smartphone with voiceovers andsound effects. The app tells you where to run to escape thezombies.

The second exhibit that caught my eye was Australiancigarette packaging. This has gone further than UK cigarette

packaging, in that nearly all of the packet is made of updisturbing imagery of smoking-related diseases and brand

logos are absent. All colour palettes have been replaced by Pantone448C, identified as the least attractive colour for packaging frommarket research by the Australian Department for Health andAgeing.

These two designs show psychological understanding beingharnessed to provide useful interventions in an everyday context.The first shows short-term reward being used to reinforceexercising behaviour, the second shows health promotioncampaigns harnessing the power of imagery and acting to limit thesubliminal power of branding.

Whether it is the psychology of design you are interested in ornot, the exhibition is worth checking out, for the diversity of theexhibits and to see what is being rated in the world of design atpresent.

I Reviewed by Lucy Maddox who is a clinical psychologist in the NHSand Associate Editor for ‘Reviews’

Flatten, talk and check

Horizon: How to Avoid Mistakes in SurgeryBBC

Another episode of Horizon looked at the cognitive and socialfoundations of taste: recognised as the sense most associated with pleasure. The evolutionary nature of taste featured strongly,describing our preferences for sweet and fatty foods as high-caloriesources, rather than bitter and sour flavours indicating potentialharmful toxins. Various researchers described their quests to locatethe ideal, natural sugar-replacement to satisfy our evolutionaryneeds: varying from tomato-based to ‘Miracle berry’ sources.Perhaps most interesting to me was the work of psychologistProfessor Linda Bartoshuk on the individual variability of tastereceptors on the tongue and their extreme effect on flavourperception.

With evidence from both large-scale research and case studies,this programme provided a broad, interesting introduction to tasteresearch. Ending with a discussion on the social environment ofhuman eating, the documentary ended with some resonatingthoughts on taste and the obesity epidemic in modern society: ripefor future Horizon coverage.

I Reviewed by Emma Norris who is a PhD student at UniversityCollege London


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Our best friends? Perhaps…

Attachment to Pets: AnIntegrative View ofHuman–AnimalRelationships withImplications for TherapeuticPracticeHenri Julius, Andrea Beetz,Kurt Kotrschal, DennisTurner & Kerstin Uvnäs-Moberg

Co-authored by biologists andpsychologists, this book delivers anexcellent review of both biological andpsychological theories and studies,providing a valuable resource for beginnersand more knowledgeable readers on bothhuman–human and human–animalrelationships.

The focus is mainly on the biologicaleffects of oxytocin (a physiological chemicalinvolved, amongst other functions, in thereduction of stress and fear), thepsychological theories of attachment andcaregiving, and the development ofdysfunctional human–human interactions.Evidence for the benefits of human–animalinteractions is also explored, and theauthors then postulate a model ofhuman–animal relationships, incorporatingthese factors, to explain how animal-assisted therapy can help human well-beingand human–human relationships. The bookfinishes with a brief chapter on the practicalimplications of this model for therapy.

Despite being a thin volume, it isdensely packed with information. Overall Ireally enjoyed the book, it furthered myknowledge on the topic, ignited my interestas both a researcher and a therapist, and itwas fascinating to think of the potential forfuture research and animal-assistedtherapy.

I Hogrefe; 2013; Pb £27.90Reviewed by Kate Sparks who is aChartered Psychologist

Art and analysis

The Rinse CycleJim Shaw

Jim Shaw’s work will always attract theattention of a psychologist; if not for thethemes of the art (perceptions of pain,exploring suicide through ripped upself-portraits, analyses of dreams andthe unconscious mind, narcissism)then for the artist's description of himself. As a self-diagnosed 'attention deficit sufferer' and interpreter of his own dreams, Jim Shaw certainly puts on a good show. His series havepreviously been shown only in isolation; however, for the first time, they have been broughttogether in ‘The Rinse Cycle’ at BALTIC in Gateshead, a two-floor exhibition comprising over100 pieces taken from Shaw’s back catalogue (see tinyurl.com/cjabdrr).

I was fortunate enough to attend his end of show Q&A session with the BALTIC curator,and I couldn't resist asking a few non-arty questions.

First I asked how someone with ADD has the persistence to work on one series foryears. Although he sets out with a theme, he answered, the diversity of the pieces withineach theme represent his frequent loss of focus, changes in direction and need to startsomething new. The final theme, he revealed, is usually the sum of its somewhat eclecticparts, rather than a focus from the start. Maybe this is the art equivalent of naming that lastfactor in an exploratory factor analysis.

Some of his most disturbing works come from his ‘Dream Drawings’, which serve aspieces in their own right but also as a repository for his future pieces. When asked about hisdream pieces, Shaw suggested that most dreams are boring, but when you start makingyour dreams into art for a living, the subconscious kicks in to provide you with material. Thisseems like quite useful system for a commercial artist.

My non-arty questions seemed to surprise Shaw, but the answers removed some of thearty mystique of his work. Whether his pieces are actually manifestations of hissubconscious or just consciously creative is neither here nor there; the themes make sense,even if they are applied post-hoc, and the individual pieces are amazing.

I BALTIC Centre for Contemporary Art (November 2012 to February 2013) Reviewed by Dr Mark Wetherell who is a Reader in Psychobiology & Health Psychology at theUniversity of Northumbria

In the wake of the Stapelresearch fraud case,initiative after controversyhas hit psychology, to thepoint where it almost feelslike the discipline isengaged in a very painfuland public form of self-flagellation. The Psychologisthas of course contributed tothe debate, with variousnews items and our specialissue on replication(tinyurl.com/psycho0512).Now Tal Yarkoni, apostdoctoral fellow in theDepartment of Psychologyand Neuroscience at theUniversity of Colorado atBoulder, has stepped into

the fray with a fascinatingpost on his blog(tinyurl.com/talyarkoni).

You could be forgiven for thinking that academicpsychologists have allsuddenly turned intoprofessional whistleblowers,Yarkoni begins. ‘Everywhereyou look, interesting newpapers are cropping uppurporting to describe thisor that common-yet-shadymethodological practice,and telling us what we cancollectively do to solve theproblem and improve thequality of the publishedliterature.’ Yarkoniemphasises that he thinks

these developments bodewell for the long-termhealth of our discipline,seeing them as ‘solidindications that wepsychologists are going tobe able to police ourselvessuccessfully in the face ofsome pretty seriousproblems’.

Yet Yarkoni points outthat with any zeitgeist shift,there are always naysayers.He has found himselfarguing – ‘with somewhatsurprising frequency’ – withpeople who ‘for variousreasons think it’s not such a good thing that UriSimonsohn is trying to catch

Beyond hot air to inconvenient truths

[citation needed] Tal Yarkoni


This programme about children’s sleepdifficulties had a primetime slot and washosted by clinical psychologist ProfessorTanya Byron and Jake Humphreys, formerFormula One anchor on the BBC. Althoughthey seemed like an odd pairing, it was greatto see an applied psychologist at the helm,as I have regularly had to ‘undo’ some of themore unhelpful advice ‘Supernanny’ Jo Frosthas given over the years. Jake Humphreys,however, seemed a bit out of place anddidn’t appear to add much to the show. Hismain role was asking Professor Byronscripted questions, and he frequently madecomments that appeared patronising andunhelpful, such as ‘aww but he’s so cute inthat Spider Man costume’!

A number of different families ofchildren of various ages took part in theprogramme, which involved cameras beingplaced in their homes to film bedtimes. Thegoal was to have each child in bed asleep by9pm, and throughout the programme livefootage of families’ progress with this wasshown. Each family featured was assigned a ‘sleep expert’ who talked them throughexactly how to respond to behaviour as ithappened, via a headset. The sleep expertswere practitioners experienced insupporting families with sleep issues andincluded a health visitor and a sleepphysiologist. Live footage was interspersed

with comments and explanations fromProfessor Byron, in addition to segmentswhere results of parent polls (conducted viathe Bedtime Live website) were discussedand lay explanations of related topics suchas brain function were provided.

The advice given to families was wellfounded and clear, but many goldenopportunities to discuss the wider context of the presenting difficulties were missed.For instance, the programme followed onefamily’s struggle with their two-year-oldson’s insistence on being breastfed butmade no reference to attachment nor thefamily’s feelings about their role transition,which clearly seemed to be part of the issue.The show would have also benefited frommore discussion about the principles behindthe advice being given in order to helpfamilies have a better understanding of why responding in a particular way was soimportant.

Although the premise of the showseemed like it could be a useful, credibleresource for a specific group of parents,what bothered me was the way people’sstruggles were sensationalised, which is a common feature nowadays of such docu-dramas. What should have been theprogramme’s main aim of trying to helpfamilies with a very real and challengingproblem seemed to get somewhat lost along

the way whilst the producers clearly zoomedin on the shock value and drama. Even theset was reminiscent of a game show.Families were encouraged and praised fortheir efforts, but it somehow didn’t feelsincere with the extensive use of‘sweetheart’ and ‘darling’.

Overall, it is positive to see thatpsychologists are now getting involved withproviding more robust, evidence-basedadvice for common difficulties such aschildren’s sleep problems via the popularmedia but we still have a long way to go…

I Reviewed by Fleur-Michelle Coiffait,PsyPAG Chair and trainee clinicalpsychologist, University of Edinburgh/NHSLothian


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A timely contributionCommunity Psychology andthe Socio-economics ofMental Distress:International PerspectivesCarl Walker, KatherineJohnson & Liz Cunningham(Eds.)

This book takes a critical look at theglobalisation of Western psychology and theensuing individualisation and medicalisationof mental health. Chapters by professionalsand academics from around the worldconsider community psychology approachesas an alternative to this.

Community psychology is a growing anddynamic discipline within psychology and sothis book provides a timely contribution tothe field. This is particularly so given thebook’s emphasis on socio-economics andthe discourses of neo-liberalism, in thecontext of a changing global economy. In thefinal chapters, culturally sensitivepsychology responses to unique economicchallenges are presented from countries asdiverse as Canada, the US, the Philippinesand Sri Lanka.

I found the themes and ideas in thisbook thought-provoking, making me reflecton my own understanding of mental healthand clinical practice. Every chapter isthoroughly researched, well written and fullof helpful references. Recommendedaudiences would include mental heathprofessionals, researchers, policy makers,students of sociology and psychology, aswell as anyone with an interest in criticalcommunity psychology and, fundamentally,the causes of mental distress.

I Palgrave Macmillan; 2012; Pb £29.99Reviewed by Dr Rachel Smith who is aClinical Psychologist with East London NHSFoundation Trust and Clinical Tutor at theUniversity of East London

fraudsters, or that socialpriming findings are beingquestioned, or that theconsequences of flexibleanalyses are beingexposed’. Yarkoni thenhelpfully summarises why‘the arguments for giving apass to sloppy-but-commonmethodological practicesare not very compelling’.

Yarkoni painstakinglyrebuts arguments such as‘But everyone does it, sohow bad can it be?’, ‘Butpsychology would break ifwe could only report resultsthat were truly predicted apriori!’, ‘But mistakeshappen, and people couldget falsely accused!’, ‘But ithurts the public’sperception of our field!’ and‘But unreliable effects willjust fail to replicate, so

what’s the big deal?’Interestingly, he then runsaground on ‘But it wouldhurt my career to bemeticulously honest abouteverything I do!’‘Researchers have manyincentives to emphasiseexpediency and good story-telling over accuracy,’Yarkoni admits, ‘and itwould be disingenuous tosuggest otherwise…researchers who have, shallwe say, less of a naturalinclination to second-guess,double-check, and cross-examine their own workwill, to some degree, bemore likely to publishresults that make a bit of a splash.’ Yarkoni says thisis a classic tragedy of thecommons: what’s good for a given individual, career-

wise, is clearly bad for thecommunity as a whole.

A blog isn’t necessarilythe place to find a solution,although Yarkoni says that itmay be ‘to restructure theincentives governingscientific research in such a way that individual andcommunal benefits aredirectly aligned’ – as headmits, ‘a long and difficultprocess.’ But a blog is theplace to move beyond hotair between two people,airing these inconvenienttruths in a way that reachesa wider audience andencourages reasoneddebate in the commentsbelow.

I Reviewed by Dr JonSutton, Managing Editor ofThe Psychologist

Sensationalised sleep struggles

Bedtime LiveChannel 4


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reviews

Download, play, and help neuroscienceThe Great Brain ExperimentWellcome Trust Centre for Neuroimaging

It’s well worth seeing if you cancatch up with the ‘Baby Britain’season on BBC iPlayer (seetinyurl.com/c9g3l2o). A specialseason of BBC Threeprogrammes explored what itmeans to be a young parent inBritain today, and how having ababy changes your life. StaceySolomon explored why youngmums get postnatal depressionand what help is available;‘Don’t Just Stand There… I’mHaving Your Baby’, ‘The BabyBomb’, and ‘We’re Having aBaby’ followed ‘clueless firsttime dads’ and other newfamilies taking a crash course inpregnancy and childbirth; and ‘ASpecial Kind of Mum’ looked atlife as a young, disabled mum.

I watched ‘Prison Dads’, adocumentary from Ruth Kellycovering six months in the livesof fathers at Glen Parva inLeicester – the biggest youngoffenders institution in Britain.Prisoners there are five timesmore likely to be dads than

other men their age. Althoughthe offences and treatment oftheir beleaguered other halvesof some of the dads featuredmade it rather difficult toidentify with them, you’d need a heart of stone not to get a tearin the eye at the dawningrealisation that ‘That’s all gonenow, for good that is. Won’t seehim do his first words, trying tocrawl, all that funny baby stuff’.

The children are growing upwith the situation and don’tknow any different, with onebeing told that Dad is ‘onnaughty holiday’. These dadsare just kids themselves,hankering after schooldays asthey chat in their cells. You justhave to hope that they will haveplenty of professional supporton release, to face up to theiradult responsibilities.

I Reviewed by Dr Jon Suttonwho is Managing Editor of ThePsychologist for the BritishPsychological Society

Launched at the start of this year's Brain Awareness Week (11–17 March2013), The Great Brain Experiment is a mobile gaming app for Android and iOSwith a serious purpose; crowdsourcing data in order to learn more aboutmemory, self-control, attention, decision making and happiness. Fourappealing games with cute animations test players’ wits and allowresearchers at the Wellcome Trust Centre for Neuroimaging to gather datafrom a wider population than usual.

‘How much can I remember?’ tests working memory by asking the playerto remember and recreate increasingly speedy and complex patterns of redcircles, whilst ‘Am I impulsive?’ is reminiscent of Fruit Ninja; players mustsmash falling apples and pears but resist the urge when the fruits are rotten.The attentional blink effect is tested by ‘How much do I see?’, in whichparticipants look out for the second of the same category in a quicklypresented series of images. Finally, our happiness in relation to risk-takingand its outcomes is examined in the points-gambling based ‘What makes mehappy?’.

The games are fun and quite addictive (although maybe not as much so as Angry Birds, which may be a good thing!), with the nice touch that you cancompare your scores against the nation as well as any friends also playing.So, download, play, and help neuroscience.

I Reviewed by Jen Tidman, the Open University

A life-changing eventBaby Britain seasonBBC Three

cont

ribut

e Sample book titles just in:The Psychological Significance of the Blush W. Ray Crozier & Peter

J. de Jong (Eds.)Strangers in a Strange Lab: How Personality Shapes our Initial

Encounters with Others William IckesThe Devil Within: Possession and Exorcism in the Christian West

Brian P. LevackWindows on the Abyss K.M. HartmannThe Sleep Room F. R. TallisWorking Memory: The Connected Intelligence Tracy Packiam

Alloway & Ross G. Alloway (Eds.)Between Mind and Nature: A History of Psychology Roger SmithThe Oxford Handbook of Retirement Mo Wang (Ed.)The Oxford Handbook of The Psychology of Appearance Nichola

Rumsey & Diana Harcourt (Eds.)The Education of Selves: How Psychology Transformed Students

Jack Martin & Ann-Marie McLellanAdvances in Culture Psychology M.J. Gelfand et al. (Eds.)

For a full list of books available for review and information onreviewing for The Psychologist, see www.bps.org.uk/books

Send books for potential review to The Psychologist 48 Princess Road EastLeicester LE1 7DR

Remember, ‘Reviews’ now covers psychology in any form: books,films, apps, plays, web, TV, radio, newspapers, etc.

To contribute, e-mail [email protected] or tweet your suggestions to @psychmag.


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investigated were Rudi Schneider andHelen Duncan.

Rudi Schneider was a young Austrianwho took part in over 50 séances atPrice’s laboratory between 1929 and 1932.William Brown, then Wilde Reader atOxford University and a Harley Streetpsychotherapist, attended seven –examining the medium, serving as a‘controller’ and taking physiologicalmeasurements. On one occasion hewitnessed ‘magnificent phenomena’:curtains billowing, a basket jumpingabout on his knee, something stepping on his foot, flowers flung out of a cabinet,a loud bang behind the sitters, a table toptorn from its legs and flung over theirheads. He wrote a letter to The Timesdescribing his experiences, attributingthem to some unseen agency andmysterious power, and recommendingcareful scientific investigation.

Helen Duncan was a Scottishhousewife, a sometime bleachworksemployee, who married a cabinet makerinjured in World War I, by whom she

had 12 pregnancies and six surviving children. She weighed 17 stone andworked as a medium. Sheattended five séances at theNational Laboratory in1931, at several of whichWilliam Brown, William

McDougall and Jack Flugelwere present. Duncan entered a

cabinet, went into trance, was taken overby a ‘control’ (a trance personality) andproduced ectoplasm. Price delighted intaking stereoscopic photographs. Hebecame convinced that Duncan wasswallowing cheesecloth when in thecabinet, which she then regurgitated – not easily seen by sitters in the red light.So he arranged for her to be X-rayed afterthe fourth séance. Duncan evadedexamination by staging a hysterical fit. As Price relates:

She jumped up, and dealt herhusband a smashing blow on theface; she then made a lunge at Dr.William Brown, who dodged theblow… Dr. Brown, thinking she wouldlike a drink, went to fetch a glass ofwater. Immediately, without theslightest warning, the mediumjumped up, unfastened the door,rushed into the street, where she hadanother attack of hysterics. Herhusband dashed after her, followed bya procession of sitters…: Dr. WilliamBrown with a glass of water;Professor McDougall with towel;Professor Flugel; … a lady withsmelling salts; myself with brandyflask (kept for such emergencies)…

The close connections betweenpsychologists and the Society forPsychical Research (SPR) at the end

of the 19th century are well known. Whatis less well known is that senior Britishacademic psychologists were engaged inpsychical research as late as the 1930s.William McDougall and William Brownattended and assisted at séances at HarryPrice’s National Laboratory of PsychicalResearch; Jack Flugel, Cyril Burt, AlecMace and Francis Aveling were membersof his University of London Council forPsychical Investigation and supportedpsychical research in various ways. Allexcept Aveling were members of the SPR.

Harry Price was a salesman for papermerchants and an amateur psychicalresearcher, but his values were those of a businessman rather than a scientist.Lacking scientific credentials anddefensive about his working-classbackground, he craved publicity and wasprepared to sacrifice truth in pursuit ofhis goals. A complex and controversialfigure, The Economist accused him ofbeing ‘a rogue, a falsifier, and amanufacturer of evidence’. Why didreputable psychologists collaborate withhim?

The Society for Psychical Researchwas founded in 1882 in an era ofspiritualism. Many of its members andpresidents were and are psychologists.World War I led to increased interest intelepathy and the possibility of survivalafter death as a result of the massivenumber of bereavements. Membership of

the SPR reached a peak in 1920. However,by 1930 it was in disarray, split byfactions, and several rival institutionsstepped into the breach. Amongst thesewas Harry Price’s National Laboratory ofPsychical Research, which opened in 1926with ‘a flurry of media attention’.

The Laboratory specialised in thestudy of physical mediums, i.e. those whodemonstrated physical phenomena suchas levitation, apports (the movement ofobjects without apparent cause),‘ectoplasm’ (a whitesubstance, taken asmaterialisations of thedead by bereaved sitters)and false limbs. Suchmediums had theadvantage of providingspectacles for the publicas well as observabledata for scientists. Priceprided himself on his scientific approachand amassed an enormous amount ofequipment to demonstrate this: cameras,dictaphones, rheostats, timing devices,ultra-violet and infra-red apparatus andeven an X-ray machine. Great pains weretaken to attempt to prevent cheating.Mediums were searched internally andexternally and sewn into a specialgarment with luminous strips attached. Inone case, an electrical circuit was arranged– the medium and sitters were connectedto each other by gloves and sockscontaining metallic strips: if the circuitwas broken, a bell rang.

Two notable mediums that Price

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Dingwall, E.F., Goldney, K.M. & Hall, T.H.(1956). The haunting of Borley Rectory.A critical survey of the evidence.London: Duckworth.

Gregory, A. (1977). Anatomy of a fraud:Harry Price and the medium RudiSchneider. Annals of Science, 34,447−549.

Hall, T.H. (1978). Search for Harry Price.London: Duckworth.

Price, H. (1942). Search for truth: My life

for psychical research. London:Collins.

Valentine, E.R. (2012). Spooks and spoofs:Relations between psychical researchand academic psychology in Britain inthe inter-war period. History of theHuman Sciences, 25(2), 67–90.

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It was then striking midnight.We found Mrs. Duncan clutching

the railings and screaming at the topof her voice. A crowd soon collected.Her husband tried to pacify her. Themedium – who weighed 17 stone –was, of course, still in her blacksateen séance combinations. It was a most extraordinary sight. Then thepolice rushed up and an ambulancewas sent for. However, ProfessorMcDougall and the other medicalmen present were able to satisfy thepolice that it was merely a woman inhysterics and that nothing seriouswas the matter. With this assurance –and something of a more materialnature – the officers departed. (Price,1942, pp.180–82)

It subsequently transpired that Duncanhad passed the cheesecloth to herhusband during the fracas; he refused tobe searched. Duncan was convicted offraud on several occasions.

Faced with problems over theaccommodation of his laboratory, Priceexplored possible collaborations butwithout success. In 1933 he made aformal offer to the University of Londonto found a Department of PsychicalResearch. He was prepared to donate hisequipment, a large collection of relevantbooks and an annual stipend. The offerwas considered by many boards andcommittees of the University. Jack Flugel,as secretary, helped steer it through theBoard of Studies in Psychology. In the endthe idea was approved in principle –psychical research was deemed suitablefor university study, at least atpostgraduate level – but the offer wasdeclined on account of limited space andfinances.

Despite this, the following year Price managed to set up a ‘University of London Council for PsychicalInvestigation’. This consisted of fourpsychologists (Jack Flugel and Cyril Burtfrom University College; Alec Mace fromBedford College and Francis Aveling fromKing’s College), two philosophers (one ofwhom was Cyril Joad, the well-knownbroadcaster), a theologian, a physicist, aphysician and a mathematician, plus Priceas director and his secretary. The Councilwas to oversee research with fundsprovided by Price; and research wasindeed conducted in all three colleges.Burt had his wife carrying out card-guessing experiments. Flugel took part in a television broadcast of fire-walking at Alexandra Palace, in which FreddyGrisewood was the commentator. Burtand Flugel, together with their wives,visited the haunted Borley Rectory with

Price. Burt, as head of the Department ofPsychology at University College,received Price’s equipment, though theProvost of the College thought it unwiseto hold séances in a laboratory frequentedby younger students, as undesirablerumours might get about. The X-raymachine went to Guy’s Hospital. Price’sbooks were donated to the UniversityLibrary (where they remain to this day); ittook three days to move them. TheUniversity wined and dined Price at theAthenaeum. For a while Price managed tokeep both academics and journalists onboard. But members of his Council

became irritated at his sacrifice of truth inpursuit of publicity and his disregard forthem. On Joad’s recommendation, theCouncil was wound up in 1938.

Ironically, given Price’s frequentexposure of cheating in others, he wasaccused of fraud and deception himself(Gregory, 1977; Hall, 1978) and, as in the case of Borley Rectory, of creatingphenomena (Dingwall et al., 1956). Sowhy did the psychologists collaboratewith him? Several reasons can beadduced: Firstly, there is evidence thatMcDougall interested Brown, Flugel andBurt in psychical research while they werestudents of his at Oxford. Secondly,McDougall, Brown, Burt and Maceespoused vitalist and dualist doctrines.Psychical research offered the possibility

of providing evidence against what theyregarded as materialist and mechanistdogmas. McDougall saw this as a moralissue. Thirdly, psychology was still at atransitory stage at this period, in theprocess of establishing its boundaries.Paranormal phenomena were regarded bymany as part of the subject matter ofpsychology. A key factor in the mutualattraction of Price and the psychologistsmay have been their common enterprisein straddling the still fluid boundariesbetween professional and amateur. Theyaimed to assert scientific authority andexpertise while also appealing to the

general public. Thus Price flaunted hisequipment and courted journalists, suchas the editors of Nature, The Listener andthe Daily Mail. The academics hadestablished scientific credentials but tookan active part in public life, advising thegovernment, lecturing, writing popularbooks and broadcasting. Theirrelationship reveals much about thenegotiations that psychologists engaged in at this critical period in their history.


looking back

I Elizabeth Valentine is Emeritus Professorof Psychology at Royal Holloway, Universityof London, and Honorary Senior ResearchAssociate, University College [email protected] more detailed account can be found inValentine (2012).

Harry Price in his laboratory

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The Psychologist May 2013

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