Evaluate the Current Usefulness and Future Potential of Functional Brain Imaging in Two Areas of Applied Psychology

Since I’m mad busy with revision at the moment I thought I’d share an essay I wrote in my first term of first year. This is probably my favourite of my essays, partly because it was a subject I was interested in and partly because I got a good grade for it – A* 😀

Evaluate the Current Usefulness and Future Potential of Functional Brain Imaging in Two Areas of Applied Psychology

Introduction

Functional brain imaging, Functional Magnetic Resonance Imaging (fMRI) in particular, has opened new avenues of applied psychology such as lie detection and detection of consciousness in patients with disorders of consciousness. After a brief and simplified explanation of how fMRI works the positives, negatives and ethical implications of lie detection will be discussed. This will be followed by a discussion of the progress, potential flaws and risks, and ethical implications of detection of consciousness in patients with disorders of consciousness. Concluding, it will be shown that while progress has been made in both areas, lie detection still remains controversial and unreliable, while detection of consciousness is progressing  toward methods for unambiguous classifications of states of consciousness.

How Functional Magnetic Resonance Imaging Works

Functional Magnetic Resonance Imaging (fMRI) is advancement on Magnetic Resonance Imaging (MRI) that allows rapid-detection of activation in areas of the brain. In simplistic terms, an fMRI scan consists of a magnetic pulse (often termed the Radio Frequency or RF Pulse) being transmitted to the brain, and a subsequent Nuclear Magnetic Resonance signal, caused by resonance induced in certain nuclei, being detected (Buxton 2002). Using Blood Oxygen Level Dependence (BOLD) the metabolism rate, and thus brain activation, can be measured. BOLD imaging works on the basis that unlike oxygenated blood, deoxygenated blood is paramagnetic and thus reduces the MR signal returned. As an area of the brain activates the level of deoxygenated blood decreases, and thus the MR signal increases. These signals can then be mapped onto an image of the brain.

 Lie Detection using fMRI

Research has shown that there is potential for fMRI techniques to be useful for detecting if a participant is attempting deceit. This works by looking at the areas of the brain that are activated when the participant is called to tell the truth, to establish a “base state”, and comparing this to the activation that is seen when the participant is attempting to deceive (Langleben 2008). This “cognitive subtraction” is then analysed to identify areas of the brain that are identified with deceit, such as the Pre-Frontal Cortex (PFC) as identified by Spence (2008), and more specific foci identified by Christ et al. (2009).

A review by Luber et al. (2009) showed that the research into detection of deceit using fMRI can also be put into use to inform research into use of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). Deceit-condition behaviour can be modified by stimulating areas of the brain involved in deceit, thus increasing the reaction time of participants or increasing the size of motor potentials after motor-cortex stimulation.

Studies have shown that fMRI lie detection has an accuracy of between 76% to over 90% (Langleben 2008). Techniques employing fMRI have inherent improvements in detection of deceit over current peripheral nervous system (PNS) exploiting techniques, such as the Skin Conductance Response (SCR), as fMRI is a more direct source and suffers less noise from other sources and less risk of countermeasure actions, such as controlling the autonomic system (Luber et al. 2009). Also SCR and Electroencephalography (EEG) tests are subject to countermeasures such as artificially increasing the salience of truth statements (Langleben 2009).

However fMRI techniques are still somewhat susceptible to the saliency issue (Langleben 2005), and critically suffer from a reliance on compliance of the participant. As mentioned above the technique relies on a comparison of truth and deceit states of the brain, and in order to collect this data the participant must give genuine truth responses when called to (Langleben 2008, Spence 2008). The participant also has to be physically compliant enough to remain still in the fMRI machine to allow accurate scans to be obtained, since it is highly sensitive to any movement during scanning (Spence 2008).

The validity of the experimental paradigm is also critical to accurate results. Luber (2009) and Spence (2008) have both discussed this concern, raising the issue of whether the participant is really called to deceive, and whether activation of different areas of the brain is a certain indicator of deception. The amount of processing required to arrive at a conclusion is also a source of potential error, with manual intervention and interpretation required and inferences drawn from correlational data (Luber 2009). The experimenter and imager must manipulate the images to fit the model, including realignment, normalisation, and smoothing, then choose a statistical model to apply and decide how much noise in the original scans to accept or ignore (Spence 2008). This may explain why there is a lack of replication in experimental results in this topic, with different areas of the PFC reported to have higher activation, and one study even showing higher PFC activation in the truth state (Langleben et al. 2005, Luber 2009, Spence 2008)

Ethically the use of functional brain imaging to detect deception is controversial for a number of reasons. Firstly there are concerns over how safe fMRI really is (Farah 2002). Privacy of the participant is another ethical issue that must be considered, since the imaged captured and the analysis performed could reveal information and opinions of the participant other than those intentionally under investigation, such as racial prejudices for example (Farah & Woolfe 2004). There are also concerns in application; it does not take a great leap to imagine how techniques for detection of deceit could be used in a forensic or national security setting to elicit information from a participant for legal or illegal use. Finally there are concerns over the public perception and media portrayal of fMRI that are especially relevant for a controversial issue such as lie detection that captures the public interest. Media portrayal of fMRI studies often lack a critical component, painting an optimistic interpretation of the studies which can mislead the public and create a false conception of the accuracy of the technique (Brown & Murphy 2010, Racine et al. 2005).

Although many advances have been made in fMRI lie detection it has not yet developed to a stage that provides results that are accurate and reliable enough for the uses for which it is hoped to be put to For example, as evidence in court for a variety of cases including “competence to waive Miranda rights, subjective experience of pain in tort cases, custody determinations, mens rea defenses for fraud, kidnapping, burglary, and even murder” (Brown & Murphy 2010:1132). However if the ethical issues are carefully considered by safeguarding the safety and strict confidentiality of the participant as well as ensuring that anyone interpreting or using the results of the analysis are well educated in the shortcomings of the technique; perhaps it can be used to supplement current approaches, both physiological and psychological, for voluntary participants.

Detection of Consciousness in Patients with Disorders of Consciousness

There are different disorders of consciousness which can be difficult to differentiate, such as coma, vegetative state, locked in syndrome, and minimally conscious state (Schnackers et al. 2009). Patients with consciousness impairments are currently misdiagnosed up to 43% of the time (Coleman 2009, Monti 2010). The diagnosis of a patient’s state carries important ethical implications. These include the options and choice of clinical treatment, the discussions removal of life support in cases of long term persistent vegetative state, and prognosis (Coleman 2009, Eickhoff et al. 2008, Vanhaudenhuyse et al. 2010).

Eickhoff et al. (2008) showed that a comatose woman with a rating of 4 on the Glasgow Coma Scale (GCS) exhibited the same brain activation to visual, auditory, and physical stimulus as healthy controls, as well as activation of Broca’s area (involved in comprehension of language) to speech stimulus. The study also indicated that emotional content of the speech, specifically familiarity of the speaker to the patient, was processed. Monti et al. (2010) found that four patients they assessed who had previously been classified as being in vegetative state showed responses to imaging and communication tasks, and on further testing one patient seemed to be able to respond to yes or no questions. There has also been promising research into the default mode network (DMN), a network of brain areas that are more active at rest than when the participant is involved in cognitive tasks. The research suggests that connectivity strength of the DMN correlates to levels of consciousness (Vanhaudenhuyse et al. 2010).  This recent research is particularly useful since it looks at passive brain activity and therefore does not require the cooperation of the patient (Vanhaudenhuyse et al. 2010).

While research has shown activation of certain areas that are distinct for deceit conditions against truth conditions, we must be careful how we interpret this. We must be wary of the unproven nature of neuro-essentialism; the assumption that subjective phenomenological inferences can be made directly from physiological activity (Brown & Murphy 2010, Eickhoff et al. 2008, Racine et al. 2005, Shamoo 2010). This is particularly relevant with fMRI since what is being measured is not neuronal activity but metabolism of oxygen, which is an indirect measurement (Brown & Murphy 2010, Buxton 2002). Despite progress and some success in detecting consciousness, there is still more work required to establish unambiguous classifications of the various consciousness-states (Riganello et al. 2009). As mentioned above, there are ethical and practical concerns over the safety of fMRI and the possibility of breaching the privacy of the participant. The issues of neuro-essentialism is obviously especially important in this area as the results of the imaging study could potentially be used in life-ending and withdrawal of care decisions, so there is even more need to be certain that the physiological activity does correlate to subjective consciousness (Racine et al. 2005). In addition to these concerns there is the extra concern of consent. Obviously patients with disorders of consciousness cannot give informed consent. (Farah 2002).

The issue of neuro-essentialism applies to the entire field of neuro-psychology, however within the area of disorders of consciousness it will be difficult to collect enough data to be able to confidently say that the neurological behaviour correlates to specific levels of consciousness, not least due to the relatively small number of patients available for this kind of study. However the uncertainty over neuro-essentialism could be argued to be outweighed by the potential benefits in terms of improved care and better informed decisions regarding end-of-life choices. Consent in this instance could be argued to fall ethically on the same ground as for critical medical treatment, since the results of the fMRI would be used for determining appropriate clinical care and whether to continue providing life-support.

In summary regarding detection of consciousness, the current methods of diagnosing levels of consciousness are fallible. The new fMRI techniques are still at an early stage and there is much work to be done before they can be put into clinical practice, however the current research is promising and looks like it is leading toward important new ways to determine levels of consciousness in patients with disorders of consciousness.

Conclusion

Lie detection and detection of consciousness in patients with disorders of consciousness using fMRI are still in early stages and require development before they are useful. Both suffer from ethical issues which have to be carefully considered and managed, such as privacy concerns (Farah & Woolfe 2004), safety (Farah 2002), and issues around accuracy and reliability of the analysis, particularly in relation to the issue of neuro-essentialism (Racine et al. 2005). The accuracy of fMRI lie-detection is uncertain (Luber 2009, Spence 2008), rendering the technique of questionable suitability for applied use, for example in court rooms (Brown & Murphy 2010). The techniques could potentially be used in conjunction with existing approaches to slightly improve overall reliability. On the other hand research into detection of consciousness has made significant progress by positively identifying consciousness in some patients previously described as being in vegetative state (Monti et al. 2010) and new research into the DMN looks promising (Vanhaudenhuyse et al. 2010).

References

Brown, T. & Murphy, E. (2010). Through A Scanner Darkly: Functional Neuroimaging As Evidence Of A Criminal Defendant’s Past Mental States, Stanford Law Review, 62(4), 1119-1209

Buxton, R. (2002). Introduction to Functional Magnetic Resonance Imaging Principles and Techniques, Cambridge University Press: Cambridge

Christ, S.E., Van Essen, D.C., Watson, J.M., Brubaker, L.E., McDermott, K.B.  (2009). The Contributions of Prefrontal Cortex and Executive Control to Deception: Evidence from Activation Likelihood Estimate Meta-analysis,  Cerebral Cortex 19 (7), 1557-1566

Coleman, M.R., Davis, M.H., Rodd, J.M., Robson, T., Ali, A., Owen, A.M., Pickard, J.D. (2009). Towards the routine use of brain imaging to aid the clinical diagnosis of disorders of consciousness, Brain: A Journal of Neurology 132 (9), 2541-2552

Eickhoff, S.B., Dafotakis, M., Grefkes, C., Stöcker, T., Shah, N.J., Schnitzler, A., Zilles, K., Siebler, M. (2008). fMRI Reveals cognitive and emotional processing in a long-term comatose patient, Experimental Neurology, 214 (2), 240-246

Farah, M. (2002). Emerging Ethical Issues in Neuroscience, Nature Neuroscience, 5 (11), 1123-1129

Farah, M., and Woolfe, P. (2004). Monitoring and Manipulating Brain Function, New Neuroscience Technologies and Their Ethical Implications, Defining right and wrong in brain science: Essential readings in neuroethics, 37-57. Washington, DC US: Dana Press, 2007. PsycINFO, EBSCOhost (accessed November 5, 2010).

Langleben, D., Loughead, J., Bilker, W., Ruparel, K., Childress, A., Busch, S., et al. (2005). Telling Truth From Lie in Individual Subjects With Fast Event-Related fMRI, Human Brain Mapping, 26(4), 262–272

Langleben, D (2008). Detection of deception with fMRI: Are We There Yet, Legal & Criminological Psychology, 13(1), 1-9

Luber, B., Fisher, C., Appelbaum, P., Ploesser, M., Lisanby, S., (2009). Non-invasive brain stimulation in the detection of deception: Scientific challenges and ethical consequences. Behavioral Sciences & the Law, 27(2), 191-208

Monti, M., Vanhaudenhuyse, A., et al. (2010). Willful modulation of brain activity in disorders of consciousness. The New England Journal of Medicine, 362(7), 579-589.

Riganello, F. & Sannita, W. (2009). Residual brain processing in the vegetative state, Journal of psychophysiology 23(1), 18-26

Racine, E., Bar-Ilan, O., & Illes, J. (2005). fMRI in the public eye. Nature Reviews Neuroscience, 6(2), 159-164

Schnackers, C., Vanhaudenhuyse, A., Giacino, J., Ventura, M., Boly, M., Majerus, S., Moonen, G., Laureys, S., (2009). Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment, BMC Neurology, (9) art. no. 35

Shamoo, Adil E. (2010) Ethical and Regulatory Challenges in Psychophysiology and Neuroscience-Based Technology for Determining Behaviour. Accountability in Research, 1(17), 8-29

Spence, Sean A.  (2008). Playing Devil’s Advocate, Legal and Criminological Psychology, 13(1), 11-25

Vanhaudenhuyse, A., Noirhomme, Q., Tshibanda, L., Bruno, M, Boveroux, P, Schnakers,P., Soddu, A., Perlbarg, V., Ledoux, D., Brichant, J., Moonen, G., Maquet P., Greicius, M., Laureys, S.,  and Boly, M. (2010). Default Network connectivity reflects the level of consciousness in non-communicative brain-damaged patients, Brain: A Journal of Neurology, 133(1), 161-171

Being an Ambassador

I have been a Student Ambassador for Widening Participation pretty much since my first week at Brunel. I was introduced to the scheme by the ambassadors that facilitated Head Start Week that I attended in my first year (a week before freshers week where certain students have the opportunity to come in, experience various lectures and seminars, and get to explore the campus and services). As a ambassador for widening participation I get to talk to younger students from under represented backgrounds about the benefits and experience of higher education. I give short talks on my experience as a student, take groups on tours of the campus, and try to fill young students with an interest and enthusiasm for higher education that they might not otherwise have.

And there are days like today, where I am at a higher education fayre at a college. I am here to talk to students and parents and there are a lot more practical questions to answer (most groups on campus are primary or middle school so much more general interest).

I love this work, I love having the opportunity to encourage people from a more difficult background (like myself) to aim higher, to believe in themselves and aspire to be better than the opportunities given to them. And as a student I have to admit that, being paid work, the money is certainly welcome!

Remembering Parts of the Brain

As promised, here are the videos that help memorise parts of the brain 🙂

Part 1

Part 2

Freud pt.1

Its interesting that despite my long interest in psychotherapy I have never read or studied Freud. To be honest I have always been put off by the overemphasis of sexual and aggressive drives, and now I’ve read more about Freud’s theories I still feel the same about it. However I do now appreciate more just how much he is to be thanked for; I can see how many other schools of psychoanalysis have drawn from and adapted his ideas. So I will attempt to summarise Freud’s theories very briefly here.

Freudian psychoanalysis is built around three models: The topographic, the structural, and the developmental.

The first model splits the mind into the Conscious, the Pre-conscious, and the Unconscious. The Conscious contains those things that you are aware of and attend to (pay attention to). The Pre-conscious contains those things that you could be aware of, if you attended to them (a physical example would be someone standing on the edge of your vision). Finally Freud’s major and vital contribution: the Unconscious. Here lie things that you are not aware of, and cannot become aware of simply by attending to them. Freud believed that everything in our Unconscious has an innate force pushing it towards consciousness, but anything that could be threatening or objectionable to our conscious selves (such as certain sexual fantasies) is pushed back into our unconscious through a process called repression. However if this objectionable material is mutated and disguised, perhaps as a joke, a dream, or a slip of the tongue (often called a Freudian slip) it may be let through into our consciousness.
This conflict between consciousness and unconsciousness forms, Freud believed, our personalities, behaviours, and mental disorders.

Some time after the above theory, which is the only of Freud’s theories to stand up to empirical testing, Freud proposed the structural model. Here he proposed three collections of thought types (they were never meant to be taken as individual entities or personalities the way they have often been mis-interpreted today): the Id, the Ego, and the Super Ego.

The Id houses all our desires and fantasies, which Freud believed all came from sexual or aggressive drives. It is concerned primarily with immediate gratification and avoiding a state of unpleasure.

The Super Ego contains all the commands and rules of society. It is the aspect of our minds that deals with deciding what is appropriate in different contexts, and tries to control the chaotic Id.

The Ego mediates between these two, helping us balance desires against societal restrictions, resolving the conflict.

The final model Freud proposed is the developmental model, however I will save that for my next post 😉

Psychology Related Graphic Novels

I have just finished reading Stitches by David Small, a graphic novel about his childhood growing up in a loveless home. I also received Psychiatric Tales for Christmas, another excellent graphic novel (ish). I am always amazed at how powerful graphic novels can be, so I thought I’d make a quick list of some psychology related graphic novels that I consider worth reading. Please let me know if you know of any more!

Couch Fiction – Phillipa Perry and Junko Graat
This graphic novel is not particularly “story” driven, but does give a great insight into the therapy process. We follow a therapist seeing her new client, and while the troubles he has and her dealing with him are about as simple as can be, being able to see into the minds of both people gives a unique insight into what it is like both to be a client and a therapist. The footnotes at the bottom of most pages then explain the process further, including explaining certain terms and also the intentions of the therapist.
An interesting graphic novel especially worth reading for anyone who wants to know more about what psychodynamic therapy is about.

Psychatric Tales – Darryl Cunningham
This “graphic novel” is clearly intended to give people insight into what working on a psychiatric ward is like. It is split into focused sections like “elderly”, “cutting”, and “bipolar”, and the author clearly has plentiful experience and hold the values of respect, caring, and understanding close. Recommended for anyone interested in learning about psychiatric wards or mental health in general.

Depresso – Brick
Ok, I admit I’ve not had a chance to read this one yet. But it looks good!

Stitches – David Small
Growing up in a loveless house is difficult in any circumstances, but it wasn’t until later that this young man finally found out how much damage he suffered at the hands of his parents. An emotional story of a trapped child, and triumph over adversity.

Work Placement Reports – Problems with essay plans

I have completed my reflective account for my work placement and I am pretty proud of it. I managed to use (vaguely) a recognised model of reflective practice and I suspect I may be one of the few people to write a reflective account with references 😛 (Not that this is necessarily a good thing, I hope I don’t get marked down for it! :S)

The other part of my assignment is coming along nicely although I think I really should have had a tighter focus considering the word limit of 1,500 words. Out of that limit I have so far written…4,000 words :S And even then I’ve dropped out two sections that I had in my plan!

My very detailed essay plan!

I write very detailed plans in mind mapping software, branching off topics and subtopics until I know exactly what I am going to write for almost every sentence and what references I am going to use where. My biggest problem is that I tend to find references first then decide what I want to write, and then I want to use every reference I have found. The problem with this is that it can lead to a very disjointed final essay as it is effectively a collection of many points that don’t always flow particularly well.

While looking again at mind mapping software I came across Rationale, which due to the cost I am not especially interested in but I did like the template they demonstrate on the video on their website – starting an assignment it lays out boxes for you to input two reasons with support, and an objection and rebuttal. While this is a little oversimplified for a final plan (for me) I think starting with this approach would really help the focus of my assignments.

Another approach I have heard of that I would like to start using, which could be tied in with the above, is to create a plan that has a point on it for each paragraph you intend to write. This again helps focus and streamline the writing.

For now I have to stick with what I’ve done and learn for next time. I am juggling 47 references now and I just don’t have the energy to start the plan again!

If you are interested in mind mapping software, XMind is available for free and is very good.

A nice surprise

I have been struggling with a thumping headache all day so our Indian themed Christmas lunch was a nice break from getting frustrated at my inability to read journals. It was made even nicer when I was surprised by a lovely thankyou card from the team and a WHSmith voucher 🙂

My reflective report made me realise just how much I have learned while I have been here (far more than I could do justice in the 1500 words I had!) My placement here has been fantastic and I am so grateful for all the opportunities I have been given, including the opportunity to continue working here as a paid staff member. I am also thankful that it has put me in touch with so many other people in the field and the doors that has opened for me.

I have missed uni, and my friends there, but I will never regret this placement 🙂

The Road Ahead

I have been struggling recently with the dilemma of whether I really want to become a clinical psychologist or to do a qualification in psychodynamic therapy instead. I have to admit that I have little, if any, interest in a career in research and that puts me one clinical because I know there is a large focus on research work. Really what I want to be doing is helping people in a therapeutic setting. On the other hand clinical psychology is far more stable as a career, and even offers the opportunity of doing some therapy training once I have qualified as a clinical psychologist (although generally it isn’t a good idea to do it the other way since clinical admissions boards can consider that your thinking is too restricted for clinical work once you have trained as a therapist!).

Today I received some compliments which made me feel a lot more confident in my choice of going for clinical training. A clinical psychologist that I work with on my placement, someone whose opinion I value highly, when we were discussing this very issue exclaimed enthusiastically “you HAVE to become a psychologist…there are few people like you!”

I also discussed my concern that I have little research experience and that might be held against me if I applied for a clinical course. Much to my surprise I was offered the opportunity to become a research assistant on a very interesting piece of qualitative research which is quite unique! There was even brief mention that I just might get my name on the resulting publication!! (although I am trying not to let myself get excited about this part in case it doesn’t happen). As you can imagine I am pretty ecstatic about this!! 😀

So, the challenge is on. I am aiming squarely at a First (makes a huge difference to your chance of being accepted onto a clinical course) and I will do whatever is needed to get there. The next three years are all about getting that First!

Induction End of Week 1

Well it has been quite a week! I have spent a long time learning about infection control, clinical risk, Rio (the patient records software), child safeguarding, vulnerable adult safeguarding, how to safely carry weights, and health and safety. I have had a test, got to know a group of professionals from a whole range of fields with a collective four hundred years experience in mental health, acted as Second Judge in a role play court case investigating the (imaginary) suicide of a service user and whether the mental health services held any responsibility, had my hands glow green under uv light, acted like a robot and a child, given a presentation prepared in two minutes, and eaten a lot of chips from the work rehabilitation cafe. Oh, and I bumped into an ex Brunel student!

And the induction isn’t even over yet!

On a side note I bumped into my manager the other day and she said she was very impressed by my re-edited DVD and was on her way to a meeting with the director and would sing my praise. I have to admit that thought did bring a happy smile to my face 🙂

Trust Induction

I have to admit, when I looked at the timetable and saw the first day of my induction was filled with tutorials on confidentiality policy, equality and diversity regulations, and fire safety training I let out a subtle groan. Having been employed before I have done all these things at least once already so there is nothing more I could learn right? Wrong.

While the confidentiality session was very familiar material, especially since I have done it to death very recently, the Freedom of Information Act material was new to me, as was much of the Equality and Diversity session since there have been so many legal changes over the past couple of years. And the fire safety…well nothing new there but I did get to blast a chair with CO2 which was fun 🙂