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Independent thought

“If we wished to analyze how much in all our own concepts and imagination is ours, and how much is socially suggested, the analysis would perhaps have a discouraging result. The independent thinker too would become aware with shame how like he is to the sponge that has sucked itself full of water; for in just the same way his own ideas, images, and concepts are suggested to him by his social surroundings.” (Ludwig Gumplowicz, The Sociological Idea of the State, 1902, cited in Martin Green, 1999, Otto Gross: Freudian Psychoanalyst 1877-1920.)

Computing number needed to treat from control group recovery rates and Cohen’s d

Furukawa and Leucht (2011) give a  formula for calculating the number needed to treat (NNT), i.e., (p. 1)

“the number of patients one would need to treat with the intervention in question in order to have one more success (or one less failure) than if treated in the control intervention”

based on the control group event rate (CER; for instance proportion of cases showing recovery) and Cohen’s d – an effect size in standard deviation units.

R code below:

NNT = function(d, CER) {
1 / ( pnorm( d - qnorm(1-CER) ) - CER )
}

Reference

Furukawa, T. A., & Leucht, S. (2011). How to obtain NNT from Cohen’s d: comparison of two methods. PloS one, 6(4), e19070.

Monitoring patients using control charts

Interesting collection of studies using control charts to monitor measures from individual patients.

Reference

Tennant, R., Mohammed, M. A., Coleman, J. J., & Martin, U. (2007). Monitoring patients using control charts: a systematic review. international journal for quality in health care, 19(4), 187-194.

 

Authors/Year/Sample size Results
Hayati et al. [18], 2006 (n = 45) Control charts, based on peak flow readings taken at work had a sensitivity of 86% and specificity of 88% compared with a gold standard measure (Specific Inhalation Challenge, SIC). 2/3 individuals with a positive diagnosis based on SIC had lower peak flow readings at work than at home, suggesting potential errors with the gold standard measure
Alemi and Neuhauser [19], 2004 (n = 3) Control charts for all three asthmatic patients in the study showed special cause variation on at least one occasion. One patient showed no attacks after changes in their asthma care regime. One patient showed special cause variation (a decrease in attacks), which was associated with a reduction to exposure to irritants at home
Boggs et al. [20], 1998 (n = 3) Patient 1: Peak flow readings ranged between 92% and 76% of personal best. The patient’s control chart was in statistical control: future peak flow readings likely to continue to fall within a safe range Patient 2: Peak flow readings ranged between 86% and 54% of personal best, indicating that the patient was at high risk of severe asthma. Changes in the patient’s treatment regime brought readings into statistical control Patient 3: Peak flow readings ranged between 17% and 101% of personal best, indicating that peak flow readings were not in statistical control. Changes in the patient’s treatment regime brought readings into statistical control
Gibson et al. [21], 1995 (n = 35) Exacerbations identified using 9 action points for identifying exacerbations (3 based on control chart exceedences, 6 based on action points taken from published guidelines) were compared with exacerbations identified by clinical assessment (using retrospective data collected by patients). The two methods with the highest sensitivity and specificity (peak flow rate < 80% of personal best, 2/3 successive measures between 2 and 3 lower sigma) were compared. True positive rate: peak flow rate < 80% = 88%, control chart (2/3 successive measures 2–3 lower sigma) = 91% (P = NS). False positive rate: peak flow rate < 80% = 47%, control chart (2/3 successive measures two- to three-sigma) = 23%. (P = 0.002). An action point of a single measure > 3 lower sigma detected 72% of exacerbations before they were clinically identified. An action point of 2/3 points 2–3 lower sigma identified 19% of exacerbations earlier. An action point of 4/5 points between 1 and 2 lower sigma identified 60% of exacerbations earlier
Hebert and Neuhauser [22], 2004 (n = 1) Patient 1: In the first period of observation, mean systolic blood pressure was 131.1 mmHg (Upper and Lower control limits 146.3 and 115.9 mmHg, respectively). In the second period of observation, the control chart indicated a significant drop in blood pressure (mean = 126.1 mmHg) (Upper and Lower control limits 143.3 and 109, respectively). Qualitative interviews showed a high level of patient acceptability (satisfaction in observing improvements in blood pressure, improved knowledge of own blood pressure measurements)
Solodky et al. [23], 1998 (n = 3) Case-series: In both patients, all seven systolic blood pressure readings taken after treatment fell below the mean for the seven pre-treatment values Case-study: The control chart for the period before treatment showed a mean blood sugar level of 130 mg/dL: upper control limits were exceeded on two occasions. The control chart for the period after treatment showed a drop in mean blood sugar levels to 97: upper control limits were exceeded on two occasions
Piccoli et al. [24], 1987 (n = 38) CUSUM charts of serum creatinine following kidney transplant had a sensitivity of 85% and a specificity of 94% in identifying positive or negative changes in renal function compared with gold standard measures (full clinical assessment). There was no significant difference in the time take to detect a change in renal function using either detection method

New Statesperson leftish restaurant reviews

The great thing about New Statesman is how easy it is now to steer clear of the political gossipy crap it uses to pad out its pages. Nicholas Lezard’s column is always my first read (see him in full flow on pub quizzes over there), followed swiftly by Will Self’s restaurant reviews.

Here’s Self:

“I often buy ready-made Caesar salads from supermarkets, because they come with the croutons in a separate little bag and I can then experience the delight of throwing them straight in the bin. What was worse was that these LPQ [Le Pain Quotidien] croutons were extra-large – an ordinary sized crouton is merely a crunchy impediment but a big crouton is a piece of stale fucking bread. If I wanted bread I had plenty to hand – and it was complimentary!”

Or how about:

“The Euroserf growled whether I wanted a large or a small mineral water, and when I asked for specificity she testily conceded that ‘large’ was a litre.

“A litre! What kind of a weirdo goes into a chain restaurant on a Wednesday evening and drinks enough mineral water to leach the amino acids from his brain?”

Great way to avoid hearing about the latest escapades of the Bullingdon bastards.

Psychotherapy techniques – beyond the brands

The therapeutic brands are misleading as there’s a lot of overlap in techniques.

I like this simple table from Mick Power (2010, p. 49) of the different techniques, expressed in a cross-brand way.

powertherapytypes

Power argues that

“… therapy heightens access to cognitive–emotional structures and processes that relate to past and present significant objects and significant others including the therapist. In the context of this heightened access, there is the common therapeutic goal that patients will relearn, cope more successfully with, view more realistically, reinterpret or reconstruct; that is, in some way view more constructively the object, person or situation that has been the source of their distress or conflict.”

Fonagy and Bateman (2006, p. 425) go somewhere similar with the interrelationship part of this:

“It is possible that psychotherapy in general is effective because it arouses the attachment system at the same time it applies interpersonal demands (psychotherapy technique), which require the patient to mentalize, to confront and experience negative affect, and to confront and review issues of morality (superego). Why might this be helpful? We speculate that thinking about feelings, thoughts, and beliefs in the context of attachment is helpful because in this “paradoxical” brain state there may be more access to modifying preset ways of conceptualizing the contents of one’s own and other’s minds, as well as issues of morality and social judgment. Activating the attachment system harnesses brain biological processes partially to remove the dominance of constraints on the present from the past (long-term memory) and creates the possibility of rethinking, reconfiguring intersubjective relationship networks.”

Both are jargon heavy, though.

References

Fonagy, P., & Bateman, A. W. (2006). Mechanisms of change in mentalization‐based treatment of BPD. Journal of Clinical Psychology, 62, 411-430.

Power, M. (2010). Emotion-focused cognitive therapy. London: Wiley

A couple of ways to pass false belief tasks earlier

1. Have some siblings (Perner, Ruffman, & Leekam, 1994)

sibsToM

Why? After spending a few paragraphs carefully ruling out a bunch of interpretations, they settle on:

“… as Dunn and Dale (1984) suggest, children do engage more frequently in creative social role taking with siblings than with anybody else. And since a benefit can be gained from joint pretence with a younger as well as with an older sibling, pretend play is perhaps our best candidate for a cooperative activity which furthers the eventual understanding of false belief.”

2. Having a Montessori education also seems to help (Lillard & Else-Quest, 2006). 80% of 5 year olds at Montessori schools passed the test compared to 52% at control schools. (A lottery approach was used to select who ended up at the Montessori school.) I wonder could the key advantage be mixed-age classrooms?

References

Lillard, A., & Else-Quest, N. (2006). The early years: Evaluating Montessori education. Science313(5795), 1893-1894.

Perner, J., Ruffman, T., & Leekam, S. R. (1994). Theory of mind is contagious: You catch it from your sibs. Child development65(4), 1228-1238.

What started empirical studies of false belief?

Here’s Martin Doherty (2009) with a nice introduction to the empirical study of verbal false belief tasks:

“… According to Piaget’s theory, young children are profoundly egocentric: They are only able to consider things from their own point of view until they are about 7 years or older. What is now known as theory of mind was considered to emerge as part of a general escape from the confines of egocentrism in middle childhood. This diverted attention away from the surprisingly rapid development of the ability to understand others’ beliefs around the age of 4 years. Researchers driven by a powerful theory can sometimes miss the blindingly obvious.

“The change was brought about by an influential paper by two primatologists, David Premack and Guy Woodruff (1978): “Does the Chimpanzee Have a Theory of Mind?” This question of chimpanzee theory of mind remains hotly contested, but in a commentary on the paper, the philosopher Daniel Dennett suggested a way of determining the answer. He briefly sketched what has become known as the false belief task, taking as one example a Punch and Judy show. Children squeal with glee as Mr Punch prepares to throw a box over a cliff. Although they have seen Judy escape from the box while Punch’s back was turned, it is “obvious—obvious enough for four-year-old children—that Punch believes (falsely) that Judy is in the box” (Dennett, 1978, p. 569). Dennett’s reference to 4-year-olds is a notable piece of foresight. The method was put into developmental practice by Heinz Wimmer and Josef Perner soon after. They found that 4- to 5-year-old children can indeed predict the actions of someone with a false belief.”

Reference

Doherty, M. J. (2009). Theory of Mind: How Children Understand Others’ Thoughts and Feelings. Psychology Press.

Consensual non-monogamy

Interesting paper by Terri Conley and colleagues on consensual non-monogamy. Hope there are many studies to come to begin to fill in the gaps in data.

“Is participation in consensual non-monogamy [CNM] stigmatized? […] participants rated either monogamous or CNM relationships on a variety of dimensions. The responses to CNM relationships (relative to monogamous relationships) were overwhelmingly negative […]. Across three experimental studies, we demonstrated that high degrees of bias were expressed toward CNM relationships and individuals within them. Moreover, no legal protections surround consensual non-monogamy, meaning that a person could be, for example, fired explicitly for engaging in this behavior.”

“… we currently have no evidence that sexual exclusivity invariably leads to greater intimacy and relationship satisfaction than CNM. Instead, some evidence suggests that consensual non-monogamy can be satisfying and functional for couples.”

“Although only a few studies have examined jealousy in CNM relationships, their results indicate that jealousy is more manageable in these relationships than in monogamous relationships (Bringle & Buunk, 1991; de Visser & McDonald, 2007) and is experienced less noxiously (Ritchie & Barker, 2006).”

“… large numbers of people who are in ostensibly monogamous relationships have been cheated on at some point, and moreover, cheated on in ways that put them at risk for STIs.”

“A quick glance at cultures around the world demonstrates that monogamous practices are actually non-normative rather than pervasive […]. Departures from monogamy are often perceived to be sinful, yet the Bible clearly condones non-monogamy in multiple instances…”

Reference

Conley, T. D., Ziegler, A., Moors, A. C., Matsick, J. L., & Valentine, B. (2012). A Critical Examination of Popular Assumptions About the Benefits and Outcomes of Monogamous Relationships. Personality and Social Psychology Review.

Each investigation is an original research project

“There have been many studies of social factors in relation to schizophrenia. These include attempts to discover whether schizophrenia occurs more or less frequently in one or other ethnic groups, social class, sex, ordinal position in the family, and so on. The conclusion from such studies has often been that social factors do not play a significant role in the ‘aetiology of schizophrenia’. This begs the question, and moreover such studies do not get close enough to the relevant situation. If the police wish to determine whether a man has died of natural causes or has committed suicide, or been murdered, they do not look up prevalence or incidence figures. They investigate the circumstances attendant upon each single case in turn. Each investigation is an original research project, and it comes to an end when enough evidence has been gathered to answer the relevant questions.” (Laing, 1967, Politics of Experience.)