Their statement marks a milestone in Psychiatry. The institution has a history of racist practices dating back to its inception in 1844, including its founding segregated treatment system. At the time, the diagnosis ‘drapetomania’ was accepted – a diagnosis of mental illness for Black people who disliked the idea of being enslaved. Racist theories of white superiority were continually evidenced by the APA’s ‘scientific’ research. Despite outcry from its ethnic minority members, the APA continued to stay silent on racist practices throughout the US Civil Rights Movement. Their 2021 apology statement and historical addendum finally acknowledge their historic support of a racist agenda and apologise to those affected. But is this really the turning point they describe?
The statement makes no attempt to explain why it has not come sooner. The APA’s newest President Jeffrey Geller, MD, MPH, spearheaded its publication. As quoted by the APA’s newspaper Psychiatric News, he stated, “the events of 2020 – the killings of Black people by police, the health inequities laid bare by the pandemic – were an eye-opener for many among our membership.” A disappointing, but typical, admission of the distress levels BAME people must endure to be recognised.
The apology must be followed by tangible action to avoid going down in history as performative. ‘Anti-racist’ is a critical phrase the APA used to describe their future. Real anti-racism will require them to change their racist policies, meaning all those leading to racist outcomes. Currently, they acknowledge that leadership, education and training, research, and outcomes for patients must all be improved. Still today, we inappropriately pathologise people dealing with the effects of racism. Although their apology is admirable, it must preface structural change.
All related disciplines will need to take positive action to overcome the inequality of our social services. The APA’s institution-wide apology is a necessary step for scientific integrity. But more importantly, it is a step towards practitioners who recognise the intergenerational trauma that has been created and continues to be perpetuated by our disciplines.
As a future psychologist in the UK, I implore the British Psychological Society (BPS) to follow suit. In June of 2020, the BPS released a statement in solidarity with those feeling pain due to the year’s racial injustices. Yet, after being called out in July, they silently removed an article available on their website ‘evidencing’ the low IQ of ‘Negroids’ and small genitalia of ‘Mongoloids’. Countless incidents such as these show that although an apology is only a first step, many institutions are still not ready to take it. They would first need to grasp what it is they are apologising for.
The psychology of apologies tells us that little concern for the victim and worries about self-image are barriers to apologising. An institutional apology, therefore, shows basic respect for those impacted by racist research and practice. Institutional egos are notoriously fragile, so I commend the APA for doing the right thing. However, an apology could never heal the pain their racism has caused for entire generations. It must now be the catalyst of a radical transformation into an organisation that carries no lingering trace of racism and condemns prejudice utterly, in thought, word and deed, to history.
Alex is currently studying ourMSc in Experimental Psychology. She previously completed a BSc in Mathematics at King’s College London.
Journalists often ask me how the public will behave when the next set of Covid-19 restrictions begins. Will they accept the rules or ignore them? This matters crucially right now. With rising infections in many areas of the country, and with the new variant of the virus rampant, physical distancing and other behavioural interventions are more important than ever.
The first thing I point out in response is that adherence to most of the behavioural regulations has been very high (often over 90%) throughout the pandemic.
The second thing I say is that adherence to physical distancing and avoiding contacts with others goes up in lockdown periods This probably reflects the recognition in the public that the greater restrictions signal greater need to adopt the mitigating measures.
Yet both anecdotes and the survey data suggest that adherence to 2m physical distancing declined in early December following the end of the second ‘lockdown’. It’s worth looking more closely at these dynamics of physical distancing, because this behaviour is perhaps the most visible form of adherence, and it is the one where breaches are often the subject of critical comments.
The UCL Covid-19 Social Study (data collected up to 13th December) shows that ‘complete’ and ‘majority’ compliance went up during the November ‘lockdown’, but that ‘as these [restrictions] have been eased in the past month, compliance has started to decrease again’.
The Office for National Statistics weekly survey for data collected period 2 to 6 December noted a drop (albeit small) in distancing behaviour (whereas for other protective behaviours the compliance rate remained high).
Data from Office for National Statistics, 2-6 December 2020, showing distancing behaviours
It is true, of course, that the behavioural interventions are hard to endure – and some (such as self-isolation) are a lot harder than others (such as handwashing). But recent analysis of public responses over the course of the pandemic is not consistent with the notion of ‘fatigue’. The review showed that (1) Overall adherence has been high, as already mentioned (2) There is not a linear decline (3) Intention has also remained high.
What is the real psychology that determines levels of adherence to physical distancing? There is now plenty of evidence on the psychological predictors. First, knowledge and perception of risk matter. Second, there is the belief that physical distancing is effective in providing protection. Third, a number of studies show that social norms, and in particular whether relevant others are doing the same, predicts own adherence. Fourth, group identification has been found to be a predictor, including national identification and identification with the family. Fifth, linked to this, we physically distance as a way of caring for others, and so empathy for those most vulnerable to the virus is also a predictor. Finally, a negatively predictor is low trust in government. This last point ties in with what we know about predictors of other behavioural mitigations, confidence in government action against the virus, being one of the most important.
Levels of public adherence to physical distancing have varied over time. There is evidence that key public events have affected the psychological predictors and hence adherence to distancing.
In May, there was a clear reduction in reported distancing (identified in both the ONS survey and the UCL Covid-19 Social Study) which appeared to be linked to two developments. First there was a change in the messaging (from ‘stay home’ to ‘stay alert’); this impacted upon people’s understanding of what they should actually do, as it was an injunction about how to feel rather than a specific behaviour.
Also in May, there was for some people an alienation from the government in response to the Cummings incident, which starkly revealed that while most people would be fined for breaking the rules, some would not.
Timeline of COVID-related messages and key COVID events
There was a further decline in adherence levels in July. This appeared to be a result of a signalling effect whereby there was a media fanfare around ‘freedom’ and ‘end of lockdown’ leading up to the relaxation of restrictions on July 4th.
The decline in public adherence to physical distancing observed in early December may be due to a signalling effect similar to that in July. The positive publicity around the vaccine (approved December 2nd), the announcement of the relaxation for 5 days at Christmas (made on 24th November), and the ending of the second ‘lockdown’ (December 2nd) all came at the same time. Together they may well have communicated that risk is now lower and therefore less stringent adherence to physical distancing is required.
But with rising Covid infections in many areas of the country, and with the new variant of the virus at large, physical distancing and other behavioural interventions are more important than ever. For the public, it’s worth reminding ourselves that:
Most of your neighbours and wider circle are observing physical distancing most of the time (norms)
Think of those most vulnerable to the virus (empathy)
Do it for ‘us’ as a way of showing you care (group identification)
For the UK government, it’s important to avoid those actions that undermine these public beliefs and perceptions, and to increase those actions that support public understanding of and engagement with physical distancing and the other mitigating behaviours. This would mean:
During the COVID-19 pandemic, Dr Bryan Singer’s lab at SARIC has started assessing how patterns of drug and alcohol use, as well as behavioural addictions such as gambling, have been changing. Participants were given several online questionnaires asking them to compare their behaviours during the pandemic to the previous year (research conducted by Adam Dickinson and Vlada Yarosh). While the data collected are still preliminary, some interesting patterns have emerged. In our previous work, we have proposed that the act of drug-seeking may not always be dominated by habitual behaviours, as some research groups suggest; we argue that individuals who have an addiction may need to adapt to ever-changing circumstances to obtain their drug of choice. Our initial findings regarding alcohol use during the pandemic support this idea; individuals changed their behaviours to adapt to where and how they acquired alcohol (Figure 1). Preliminary data regarding cannabis use are similar. These initial findings highlight that drug- and alcohol-use may continue to be problematic during the pandemic and that individuals may be adapting how they pursue drugs and alcohol to continue their use.
In a second effort to investigate if the reasons for alcohol and drug use have been changing during COVID-19, we have identified, thus far, two possible relationships. First, alcohol-use is strongly associated with employment status; individuals who have lost their job and have remained unemployed are at increased risk of showing symptoms of an alcohol use disorder. While we have not found a similar relationship between employment status and cannabis use, it appears that the degree of cannabis use is positively correlated with pandemic-related worry. Together, these preliminary findings suggest that during the pandemic how people are obtaining and why people are using alcohol and drugs may be changing.
Across research groups, SARIC is committed to understanding all aspects of alcohol use disorder and devising novel treatments to help individuals and communities impacted by the condition. Dry January, which is supported by research from SARIC’s Dr Richard De Visser, requires that individuals commit to an alcohol-free life during the month; this has a long-term effect, helping people to reduce their alcohol-consumption throughout the year. Therefore, minimising alcohol use during January’s COVID-19 lockdown in the UK should reduce drinking in subsequent months, as pandemic-related restrictions are lifted and life slowly returns to normal.
Imagine you’re on a busy train texting a friend when you notice a stranger sneakily reading your texts from over your shoulder. Your natural response would probably be to recoil as you realise your privacy is being invaded. So why is it that when we’re online and under the watchful eye of data-hungry corporations, most of us wouldn’t think twice about readily sharing that same information?
Privacy Paradox
When asked directly, most people report valuing their personal privacy and being intent on protecting it, but research shows that those same people will often forgo it in exchange for more convenient ways to work and socialise. This is known as the ‘Privacy Paradox’; people claim to care about their personal data but then do very little to protect it online.
Some theories have explained this contradiction by claiming that users are simply making reasoned cost-benefit privacy calculations, while others suggest that we are falling victim to a range of cognitive biases. However, in a recent paper Azim Shariff, William Jettinghoff and I argue that a more complete understanding of this phenomenon requires looking back to our evolutionary roots.
The Evolution of Privacy
Broadly speaking, privacy functions to selectively control access to oneself or one’s group. We suggest that within our ancestral past, the role of privacy has been to help protect our body, territory, and reputation while around others. Consequently, millions of years of face-to-face interaction have seen us develop a toolkit of privacy-based intuitions which help to manage both our physical and psychological boundaries. Yet these evolved intuitions are often ill-equipped to deal with the emerging challenges of the digital environment.
An ‘evolutionary mismatch’ describes the negative consequence that occurs when a trait that evolved within one environment enters another. A classic mismatch example is our fondness for high-calorie foods – this was an adaptive trait within the ancestral environment where such foods were nourishing yet sparse. But today, when there’s a McDonald’s on every high street, this same trait can lead to obesity and diabetes. And so it is with privacy traits, too. Below we describe three related mismatches:
Ownership Psychology
Working out who owns what can be a tricky business, however, humans have developed a set of ownership conventions to guide this process. Important cues like ‘who first possessed an object’ help to intuitively discern ownership within the interpersonal environment, but these cues often gets blurred online. For example, who is the first possessor of a Facebook user’s data, Facebook or the user? This ownership ambiguity often leaves us unsure about what is ours and whether we ought to then protect it.
Personal Space
Physical privacy enables us to navigate social space without becoming overstimulated. But within an online space, social cues relating to size, nature, and proximity of onlooking crowds tend to disappear. As a result, we’re often worse at managing self-disclosure: sending that regrettable late-night tweet to your 200 followers is a lot easier than announcing it to an in-person crowd of 200.
Reputational Concern
Giving off a good or bad impression comes with social rewards and repercussions. As such, we instinctively modify what we say or do around others. For instance, if you had an Amazon employee sat in your living room recording your every utterance – unlikely, I know – you’d be wary about what you were saying. But when Amazon’s smart speaker Alexa is doing just that silently in the background, chances are that you talk freely and without a filter.
Many modern technological surveillance devices lack the anthropomorphic cues necessary to trigger our instinctive reputational concern and downstream privacy behaviour.
A Future
E.O. Wilson once described us as having, “Stone Age emotions, medieval institutions, and godlike technology”. Indeed, expecting Stone Age brains to self-manage personal data in the ever-changing digital environment is both unreliable and unrealistic. Reading the privacy policy for every website you visit in a year alone would take roughly one month! Instead, online culture and expectations need to change – we as consumers must demand more top-down privacy protection from these godlike technologies. Afterall, none of us want someone looking over our shoulder.
Joe Green is a PhD student under the supervision of Dr Matt Easterbrook. Joe’s research studies how moral intuitions affect our attitudes towards modern issues like Universal Basic Income, automation, and online privacy.
The UK national threat level was raised to ‘Severe’, the second highest level, on the 3rd November 2020 after a series of terrorist attacks in France and Austria. This level means an attack is thought to be ‘highly likely’. This blogpost discusses the psychology around this decision and its potential impacts. I will also discuss the relevance of threats and threat-level to a new ESRC-funded research project into crowd responses to perceptions of hostile threat, often problematically known as ‘stampedes’. Before we discuss the research project, let’s review the incidents leading up to this decision by the Joint Terrorism Analysis Centre (JTAC).
With roots that can be traced back to a Danish depiction of the Prophet Muhammad in 2005, through the 2015 Charlie Hebdo attack, the latest attacks in France in September and October 2020 began in response to depictions of the Prophet Muhammad in France. The pictures were republished again by Charlie Hebdo on 1 September 2020, a day before a trial connected to the 2015 attack began. Depictions of the Prophet are forbidden within Islam and seen as blasphemous by some. On 25th September two people were injured with a meat clever in an attack outside the Charlie Hebdo offices. Statements by the French and Turkish premiers arguably added to rising tension. On 16th October 2020, a school teacher, Samuel Paty, was beheaded and his attacker shot dead by police, ostensibly in response to the teacher showing the pictures to his high-school students in a class on freedom of speech. After Vienna also witnessed an Islamist Terror attack on 2nd November 2020, the concern among British security services was that violence could spread to the UK.
While the concern motivating the Joint Terrorism Analysis Centre’s (JTAC) decision to increase the terror threat level is not unfounded, it is not clear what impact this increase will have. Raising the threat level undoubtedly sends a message that ‘we’ (the UK) are under attack from ‘them’. The impact is therefore likely to be experienced differently by different groups in society depending on how they define themselves and are defined by others in terms of the UK ‘us’ and ‘them’. The effect is likely to be felt most by ‘suspect communities’. People perceived as belonging to ‘suspect communities’ will face increased suspicion, potentially fueling a narrative of persecution. In the US official discourse has been argued to legitimize the ‘war on terror’ through clash of civilizations rhetoric. These discourses may simultaneously alienate communities and legitimize and empower people to act against ‘suspect communities’.
The ‘threat level’ system has been criticized by some commentators as ‘absurd abstractions of no help to anyone except the security lobby raising cash through fear’. Indeed, the threat level is primarily a tool for security services to assess and respond to the risk of terrorism. However, as we have seen from the Covid-19 crisis, messaging from the government about different threats is integral to public perceptions of, and responses to, threats. When raising the terror threat level the Home Secretary Priti Patel asked the public to be ‘alert but not alarmed’, much like Theresa May did 10 years before her. Raising the threat level is a piece of government messaging that appears more abstract than concrete. What does the public do with that message?
MI5 state that while a direct public response is unnecessary, vigilance is encouraged, especially ‘given the current national threat’. The consequences, if not the desired goal, of publicly raising of the national threat level may be increased vigilance.
Indeed my work in the ESRC ‘stampedes’ project has found potential evidence of increased vigilance in an increase in evacuations due to false alarms raised as a result of misperceived threats posed by things like unattended bags, exploding battery packs or bearded black men carrying umbrellas. This suggests that people increased their levels of vigilance around spotting potential signs of terrorism that correspond to particular notions of terrorism.
These incidents are represented in graph 1 below.
Some of these false alarm incidents were slow evacuations like when a fire alarm goes off and people reluctantly walk outside once they realise it’s not a drill. Others were much more urgent affairs where people ran for their lives. Perhaps the most famous of these ‘urgent’ crowd response incidents in recent years was on Black Friday 2017, the busiest shopping day of the year, on Oxford Street, London. This incident saw hundreds of people running from what they thought was a terrorist attack, thoughts which turned out to be unfounded.
Graph 2 below illustrates the pattern for both urgent (Orange) and non-urgent (Blue) evacuations.
Both urgent and non-urgent evacuations follow a distinct pattern that peaks in 2017, with a second peak in 2019. 2017 was the most deadly year for terrorist attacks in Britain in over a decade. This makes it difficult to disentangle the effect of messaging from the very real increase in frequency of deadly attacks. However, it is notable that the increase in both urgent and non-urgent evacuations correlates with an increase in the threat level through which government messaging to the public encouraged continued vigilance. Furthermore, while the terror threat level may be abstract, government advice if caught in a terror attack is the much more direct behavioural instruction to ‘Run, Hide, Tell’.
Graph 3 below illustrates the correlation.
With the benefit of hindsight, running from an ambiguous noise that turns out to be a false alarm may seem like an irrational overreaction from the public. You are very unlikely to be caught up in a terrorist incident and extremely unlikely to be injured or die as a result of one. However, a climate of heightened vigilance reflecting an increase in deadly attacks, increasingly visible counter-terrorism policing operations, and sensationalist media discourse meant an attack on Oxford Street was plausible. Furthermore, much like members of the public involved in the ‘stampede’, emergency services acted as if they were dealing with a real attack. Armed police and paramedics rushed to the scene, shops and roads were closed, and shoppers faced a range of instructions to avoid the area or shelter in shops. In this context, a calculation that the possible cost of not acting and being caught in an attack came to outweigh the risk of acting and looking foolish. As previously mentioned the government’s advice if caught in a terror attack is to ‘Run, Hide, Tell’. Rather than over-reacting, arguably the public followed the government’s advice.
Moreover, 2017 did see an increase in both the frequency and severity of terror attacks. There was an objectively higher risk of being subjected to a terror attack that year. The risk remained extremely small for an average member of the public but it was greater. Evaluation of this risk may also have been altered by the sensationalist media reports that reported false alarms as if they were near misses rather than misperceptions. Despite this, people were ridiculed for ‘panicking’ (especially Olly Murs).
Evidence gathered as part of our ‘false alarms and ‘stampedes’ project problematizes the pathologizing of the public as prone to ‘panic’, noting that in most emergency situations there is a tendency for the public to underestimate risk while in certain other contexts (high actual incidence, high relevance, high cost) people may be more likely to perceive threat, even if there isn’t one. Additionally, the emergency services are rarely criticized as panicking even when they make similar risk assessments as the public. The project is also working with the emergency services to analyze their role in these situations. There is a particular focus on developing effective different messaging for authorities during crowded events where a hostile threat is perceived. This messaging is likely to be much more direct and concrete than the abstract threat level can be.
Clearly, correlation itself does not imply causation. The effect of increasing the threat level is difficult if not impossible to disconnect from the increasing attacks it reflects. The increase in misperceptions of hostile threats and the increase in urgent public responses to these misperceived threats could be related to the increase in frequency, magnitude or relevance of real attacks without any reference to the national threat level. Neither is increased vigilance alone enough to explain this shared social behaviour. The role of shared understanding of the stimuli and environments that signal threat indicates the inability of individual vigilance to provide a full explanation of our collective (mis)perceptions and responses. Yet it does appear to be a necessary component in a full explanation. Despite these limitations, I hope to have pointed to some of the areas where psychology can help understand collective fear responses to perceived terrorist threats.
With Christmas songs on repeat, a tree in the corner waiting to be decorated and an apple pie in the oven, I still struggle to comprehend how the year has come around so quickly. Although this is supposed to be the time when people reconnect with their loved ones and for some, their religion, it feels more like the time of stressful last-minute shopping mall marathons accompanied with wild guessing people’s hobbies and hidden wishes, often resulting in…, useless presents, if I may. Since this year’s Christmas is going to be substantially different for many, perhaps we can extend the learning and re-learning we have all been forced into throughout the year. I hope to encourage you to re-think not only how to gift to those we cannot physically see this year, but also what businesses and values our gifts support and represent. With colleagues’ lovely contributions, I have compiled a list of sustainable and ethical gift ideas and more. I hope we can all continue to contribute to this wonderful collection of ideas via Padlet. Plants are personally my favourite present for any occasion (and perhaps the most literally appropriate for the purposes of this blog). I have never met anyone who was not happy to receive a plant. After all, they make a great decoration, purify the air and watching them grow can be a source of personal satisfaction. I think you might have just enough time to propagate your own plants in order to reduce the production and import burdens, as well as financial for yourself. Books are probably my second favourite choice, but perhaps a slightly more difficult present to choose for those you do not know so well. I sometimes try to guess what kind of genres people like, but I am guilty of gifting books I have personally enjoyed and felt like people could learn a lot from. I would be happy to share my suggestions via email, but I have also added a column to the suggestions Padlet, if you want to share yours. If you already have an idea for your present, why not exploring sustainable and ethical alternative products you could purchase instead. As part of a Green Tip about fast fashion, Charlotte and I made a Padlet collection of great businesses with ethical and sustainable clothes, shoes and accessories. If you are specifically keen on converting your recipients to a more sustainable lifestyle, zero waste kits are also a great idea. These range from cosmetic to utensil items and there are some great suggestions on the Christmas gift Padlet. If possible, I encourage you to support small local businesses and avoid purchasing your presents via Amazon, despite the incredible convenience it represents. Why I avoid purchasing from Amazon should be a whole new Green Tip by itself, but I found a useful short blog for the meantime. However, perhaps we should ask ourselves whether we need a present this year at all. There are plenty of wonderful initiatives facilitating donations to those in need and ethical investments instead (e.g. lendwithcare, chooselove), which sounds like a much better idea than a present you do not need or enjoy. As promised, I would also like to share some tips on how to deliver your presents in a sustainable and ethical manner. Mar and Charlotte have shared a great range of resources on the Padlet about alternative gift-wrapping materials(e.g. newspaper, fabric gift wraps, cardboard boxes and many more), as most wrapping paper and plastic sellotape cannot be recycled. I would also like to encourage you to purchase your presents either locally to you if you are planning on gifting the presents in person or getting in touch with shops local to your recipient and arranging a delivery through them. This way you reduce the delivery costs and its carbon footprint, as well as support small local businesses, which might be crucial for their survival considering circumstances. Lastly, Kristy shares some great ways of how to await and celebrate Christmas sustainably on the Padlet, such as charity shop filled advent calendars and handmade cloth crackers, such great ideas! I want to conclude with some food for thought. There are many communities who did not get to spend their religious holidays with their families this year, and we should keep this in mind with gratitude. Moreover, in all this bliss and Christmas songs on repeat, it is easy to forget there are many who will not be able to spend this Christmas with their loved ones or have no one to spend it with. And I worry this year might be an especially lonely one for many elderlies and those at risk. Perhaps the best and the most sustainable gift you can give to many is letting them know you’re thinking of them, that be a call, a letter, a card, an email or a message. After all, Christmas is supposed to be about much more than just presents. Happy almost-Christmas, Maruša
Fifty million people live with dementia worldwide, the most common cause of which is Alzheimer’s – a progressive, neurodegenerative disease. Although the past 12-months have seen Aducanumab expediated for FDA approval – the first new drug with the potential to reduce cognitive symptoms in over 15 years, we’re still without a treatment capable of reversing or slowing the progression of Alzheimer’s Disease. Consequently, early prevention is a top priority, with our research at Sussex exploring new avenues to mitigate risk in individuals with a genetic susceptibility for future Alzheimer’s Disease.
Specifically, we will be investigating brain hyperactivity as a marker of Alzheimer’s Disease risk, proxied using functional magnetic resonance imaging (fMRI) which measures how much oxygen is delivered to specific brain regions in support of various cognitive processes. Individuals with emerging Alzheimer’s Disease show brain hyperactivity across the network of regions which support memory, including in a structure called the hippocampus. This is followed by a period of hypoactivity as the disease develops. Whilst increased activation was first thought to be a strategy the brain uses to help overcome Alzheimer’s related damage, growing evidence suggests hyperactivity drives disease progression, highlighting an exciting new target for preventative interventions.
Inverted U-shaped trajectory of brain activity as Alzheimer’s Disease (AD) progresses from the asymptomatic, preclinical stage through Mild Cognitive Impairment (MCI) and subsequent dementia diagnosis.
Like Alzheimer’s Disease, epilepsy is characterised by aberrant patterns of brain activity. Supporting the potential for treatment overlap, administering a very low-dose of a well-tolerated, anti-epileptic – Levetiracetam, is reported to decrease brain hyperactivity in adults with Mild Cognitive Impairment, a diagnosis which often precedes progression to Alzheimer’s Disease. This pharmacological manipulation was associated with improved memory performance, motivating a number of clinical trials to investigate the clinical benefit of Levetiracetam for reducing the symptoms of Alzheimer’s Disease. Repurposing existing drugs in this way offers a number of advantages; being much more cost-effective than the development of new compounds, with the potential for more rapid translation from the lab to current healthcare practice.
Our ongoing research, funded by Alzheimer’s Society, explores brain hyperactivity in carriers of an APOE e4 allele – the strongest genetic risk factor for sporadic Alzheimer’s Disease, found in ~ 20% of the population. This gene is an important target for early life intervention as e4 differences in brain function and cognition are reported from youth, with my doctoral research establishing the onset of subtle cognitive disadvantages by the end of the 5th decade. Critically, young and middle-aged APOE e4 carriers show increased activation across the same network of memory-associated brain regions as individuals in the very earliest stages of Alzheimer’s Disease, highlighting an exciting new avenue for lifespan risk reduction.
In a series of studies at the University of Sussex, we will be establishing how the cognitive consequences of brain hyperactivity changes across the lifespan in e4 carriers. In addition, we will test for the first time if a very low dose of Levetiracetam can reduce patterns of hyperactivity in mid-age e4 carriers, using this manipulation to more directly test how aberrant brain activation patterns contribute to the emergence of cognitive disadvantage in this ‘at-risk’ group. By focusing on risk reduction earlier in the lifespan, this research contributes to the discussion between scientists, clinicians and policy-makers around how we identify individuals at greater risk for Alzheimer’s Disease prior to symptom onset, and best utilise our advancing knowledge for individualised risk management. A recent Lancet commission reports 40% of dementia cases can be prevented or slowed through lifestyle management; a personalised approach to medicine which additionally considers an individual’s genetic make-up may further reduce the emergence of Alzheimer’s Disease dementia.
Dr Claire Lancaster is an Alzheimer’s Society Research Fellow working as part of the Behavioural and Clinical Neuroscience group.
Age is not synonymous with poor health, but Alzheimer type dementia (AD) is a disease of the brain for which age is the biggest risk factor – the older you are, the greater your risk of developing the disease. But it certainly is not inevitable, and in the School of Psychology, we have been exploring some of the other risk factors that play a significant role in determining who ages well and who develops changes in the brain and cognition that indicate all is not progressing normally.
Alzheimer type dementia doesn’t happen overnight. It involves a gradual process of change, transition states that progress idiosyncratically in each individual. And we know that they make be happening for several decades before the ‘classic’ symptoms of AD -memory problems and difficulties with independent living – begin to show.
In collaboration with colleagues in BSMS, we have been studying the changes from early adulthood onwards that occur in carriers of a variant of the Apolipoprotein E (APOE) gene. APOE functions to regulate the movement of cholesterol around the body but like many genes, it comes in different ‘allelic’ variations. Everyone has two alleles, some combination of 2 of its 3 major alleles: e2, e3, e4. Most of the population have two e3s; but around 20% of the population carry at least one e4 allele. The e3 and e4 alleles differ by one amino acid, but having an e4 rather than an e3 allele vastly changes your lifetime risk for Alzheimer type dementia – around 4-fold if you have a single e4 and around 12-fold you have a double e4. Your individual APOE genotype therefore represents an important risk factor for late-onset AD.
Through funding from the BBSRC, the Alzheimer’s Society, and some additional funded PhD posts, we have been researching APOE associations with cognition and brain changes across adulthood. The research topics have included human brain imaging, human cognition, as well as brain imaging and behaviour in transgenic animals. We have identified subtle differences in brain and behaviour that help to build a detailed picture of the changes that mark accelerated ageing and potential for pathological trajectories, including brain energy differences, brain structural changes, and differences in performance on certain cognitive tasks. Our work has highlighted that even from early adulthood, carrying an e4 allele means that your brain is behaving differently. The image below is a composite image showing brain regions where our studies have indicated that the e4 brain is working harder than a typical e3 brain.
Our work has shown that as we get older, the brain regions identified in this image gradually activate less well – they seem to age prematurely. Our ongoing animal studies include work translating human tests of cognition into mouse behavioural paradigms, so that we can explore this effect more clearly across the age span, and in highly specific brain regions. Our ongoing human studies are exploring early blood-brain barrier changes, and computational measures of brain region inter-connectivity between APOEe3 and APOEe4 individuals, with a focus on specific key regions of the brain. We are excited also to welcome back Dr Claire Lancaster, who completed her PhD with us in 2018, and who has been awarded an Alzheimer’s Society Research Fellowship to explore the detailed consequences of, and the potential ways to counter, the early brain changes observed in APOEe4 carriers.
This exciting work is complemented by additional studies being completed in the School of Life Sciences that focus down on the cellular mechanisms that drive these changes.
Our work is contributing to developing a detailed picture of one of the key risk factors for late onset AD. We take this opportunity to thank all of those individuals who have given their time by volunteering to participate in our research studies. We couldn’t have done it without you.
Jenny Rusted is a Professor of Experimental Psychology in the Behavioural and Clinical Neuroscience Group. She specialises in dementia and cognitive ageing and is co-director of the Alzheimer’s Society Doctoral Training Centre.
The topic of student perceptions of written feedback is an under-researched area which is surprising given that universities typically struggle disproportionately with the Assessment and Feedback questions in the National Student Survey (NSS). We know that feedback is very much valued by students but we also know, both from peer-reviewed research and from simply asking students, that they often find it hard to actually use their feedback and that they get very frustrated by what they perceive to be inconsistencies in the quality and quantity of feedback they receive across markers. With that in mind, I set about exploring the student perception of feedback further with the hope of developing our systems and improving our students’ experience of receiving feedback on their work.
Focus groups conducted in 2020 revealed that students wanted more guidance to help them understand the essay marking criteria. It is quite common for students to think that they understand what they are supposed to be doing with regard to a particular element of essay writing (e.g. structuring an essay), only to be marked down for it in the next submission. Part of the issue, it seems, is that the marking criteria can be vague when it comes to describing specific elements of essay writing. This leads to an incomplete understanding of what the marker is looking for and subsequently confusion when interpreting feedback. So how can we remedy this? I propose a more specific and structured framework of marking criteria that identifies individual elements of essay writing that are important (e.g. how to signpost the reader effectively by means of paragraph structure). For this to be effective, it is crucial that students have sufficient guidance to help them understand what the individual elements mean and – and this is key – are able to identify what it looks like in an essay when this is done well or inadequately.
The same focus groups unanimously agreed that students wanted consistency in their feedback, particularly with regard to how useful it is. Students want practical suggestions as to how they could go about improving an area of their essay writing, and this, they said, was in short supply. I argue that giving meaningful practical tips to help students improve their essay writing is actually really hard to do. In my experience, even excellent essay writers struggle to explain exactly what they do that makes them excellent essay writers. They just, kind of, learn how to do it. What we need therefore are experienced educators who have acquired a toolbox of tips and tricks to help students improve their essay writing. The problem is that there are not enough of these to cover the sheer volume of scripts that need to be marked. A solution – we complement our structured and detailed framework of the marking criteria with a set of specific and practical suggestions compiled by experienced educators, each linked to specific elements of essay writing.
So this is what I did. I started by creating a 15-item rubric that breaks down and details the key elements of essay writing identified in the existing marking criteria. When essays are marked the marker links each comment made to one of the elements so the student has a specific idea about what exactly they did that was ‘good’ or ‘needs attention’. Each item in the rubric is explained in detail in a series of marking criteria videos in which I use previously marked essays to demonstrate what effective and not-so-effective practice looks like. Next, I created a supporting feedback guidance document in which I exhaustively list all the issues that markers observe in student essays, organised by the 15 criteria of the rubric. Issues are colour coded into a traffic light system so that students can see how severe an impact the issue has on their grade. Next to each issue are practical suggestions about how to avoid the issue reoccurring in the next essay submission. The magic of the approach is that markers can simply link an in-essay comment to the issue in the guidance document. That means that there is less room for inconsistencies across markers, and markers have more time available to focus on being extra clear when making more individualised feedback comments in the essay.
Evaluation of this new approach is in its infancy but early indications are that it is very well received by both students and markers alike. We know that feedback is an essential component in the learning cycle so fingers crossed we’ve just succeeded in oiling the wheels a little!
by Dr Rotem Perach, Prof Jennifer Rusted, Prof Pete Harris, Dr Eleanor Miles
Ever felt so excited that you found yourself telling your life story to a stranger? Or so anxious about something that you could think about little else? We know that our emotions often affect our decisions, for example, by shaping the kind of information we attend to and the goals we hold. People with Alzheimer’s type Dementia (AD) often experience changes in both their emotions and judgements. So, for people with AD, does this change the way their emotions influence their decision-making?
‘Emotion regulation’ is the term used to describe the processes by which people exert influence on their emotional experiences and their subsequent responses. Persons with AD can experience difficulties in some aspects of emotion regulation. For example, as the disease progresses, the ability to recognize emotion in people’s faces decreases. However, it seems that other emotion regulation capacities that are less cognitively demanding, such as automatic control over emotion, are unchanged. Given that people with AD continue to make many decisions in different areas of their everyday lives, including decisions involving leisure and social activities, care arrangements, and financial issues, we completed a literature review to investigate the state of knowledge on the relationship between decision-making in everyday life and emotion regulation in persons with AD and other types of dementia.
To our surprise, we found only two studies on this association in people with AD. In one study, people with AD showed higher levels of apathy (often a symptom of AD), in comparison to cognitively healthy people. However, differences in apathy were not associated with decision-making performance. In the second study, people with AD and cognitively healthy people showed no differences in physiological (autonomic) arousal (used to measure emotional processing) relating to making a moral decision in a fictitious scenario. In neither study of people with AD, therefore, was there evidence of an association between the measures of emotion regulation and the decision being made. However, in studies of people with other types of dementia, we found evidence in support of the association between emotion regulation and decision-making, depending on the measures used.
Overall, our review found mixed evidence concerning the associations between emotion regulation and decision-making in (AD and other types of) dementia in seven studies and identified important gaps in the dementia literature. For example, dementia studies so far have focused on emotional experience, but not investigated the use of emotion regulation strategies in association with decision-making. This gap raises important questions. For example, does a person’s tendency to suppress their emotional expressions or to positively frame everyday experiences affect their decision-making in everyday life and consequent wellbeing?
At the University of Sussex we are examining such questions as part of a large long-term study called DETERMIND (DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers).
Free access to our scoping review on decision-making and emotion regulation in persons with dementia will be made available here when the article is published.
The authors of the article are part of the DETERMIND team at the University of Sussex:
Rotem Perach is social and health psychology research fellow. His areas of expertise include older persons, health behaviours, sleep, and wellbeing.
Jenny Rusted is a Professor of Experimental Psychology in the Behavioural and Clinical Neuroscience Group. She specialises in dementia and cognitive ageing and is co-director of the Alzheimer’s Society Doctoral Training Centre.
Pete Harris is an Emeritus Professor. Until his retirement in September 2020, he was the lead of the Social and Applied Psychology Group. For the last 15 years, he has been studying the effects of self-affirmation, largely on health and more recently on educational attainment and on pro-environmental behaviour.
Eleanor Miles is a Senior Lecturer and part of the Social and Applied Psychology Group. Her research focuses on self-regulation, and how it interacts with emotional, physical and social functioning
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