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Understanding of the magnificence and uniqueness of the brain is important for realizing the goals of aging. We must respect its central role in our lives and work to see what we must do to enhance its health throughout life. The brain is precisely responsive to activities and its structure is changed by learning. It is also uniquely sensitive to damage and has a limited capacity for repair, compared to other body parts. What we do changes the brain, and the nature of our mental activities modifies the ability of the brain to resist declines with aging and disease. Cognitive involvement in educational, occupational, and recreational tasks throughout life, as well as physical activities, helps to enhance resistance to decline with age and diseases such as Alzheimer’s. This chapter examines how the four reserves (cognitive, physical, psychological, and social) help to maintain brain function with age. Recent research has uncovered the influence of our partner microbes in the gut on learning, memory, and age-related diseases of the brain. These developments beautifully illustrate how there are things we can all do to maintain brain function with age.
A critical component of the theory of the multiple reserves is that the health of the body is good for the health of the brain. The brain is dependent on all other body parts for maintenance of its functions. This dependence upon other bodily functions is especially prominent in older persons, because of their lower reserve capacities. Research has shown that intensive blood pressure control is more effective than standard blood pressure control in reducing the risk of cognitive impairment. It is certainly true that "what is good for the heart is good for the brain.” It is valuable to have the best possible heart, lung, kidney, liver, and endocrine function. Diabetes increases the risk of Alzheimer’s disease as well as small and large strokes. Avoidance of obesity and physical exercise can lower the risk of diabetes. A high-fiber diet can improve insulin responsiveness and diminish the severity of diabetes. The recommendations in this book are good for the health of the heart, lungs and other organs as well as directly beneficial to the nervous system. Good systemic health means good physical reserve. Good physical reserve helps to maintain healthy brain function throughout life.
Because their multiple reserves are typically lower, older people are more sensitive to the toxic effects of environmental agents. The liver’s ability to detoxify chemicals declines with age, as well as the ability of the kidney to excrete toxins. Everyone, especially the aged, should limit exposure to environmental toxins, including air pollution, solvents, heavy metals, pesticides, herbicides, and other dangers. Exposure to toxins early in life may lower a person’s physical reserve and result in cognitive impairment with aging. Exposure to pesticides and other toxins has been linked to Parkinson’s. Air pollution is also a risk factor for dementia. Considerable evidence shows that smoking increases the risk of cognitive impairment, stroke, Alzheimer’s, heart disease, and cancer. Excessive alcohol intake can damage several parts of the body and our physical reserve. It can also impair our cognitive reserve through impaired memory and learning. People over age 60 shouldn’t drink more than two doses of alcohol per day for men and one for women. Alcohol abuse can lead to depression and poor psychological reserve with loss of friends causing impaired social reserve. Excess use of alcohol can also contribute to falls, car accidents, liver damage seizures, and stroke.
It is important to avoid injuries at all stages of life. Older people are at a relatively higher risk of developing injuries as well as dying from injuries, compared to younger people. Falling is an important cause of death amongst older persons. The risk of hip fracture increases exponentially with age in both men and women. It is reported that 30% of people with a hip fracture will die in the following year. Physical exercise can help by building stronger bones and muscles. Although driving is important for functional independence and development and maintenance of social relationships, older people may develop impaired driving performance and a formal driving evaluation may be advisable. Also, the danger of cumulative and repetitive trauma to the brain has been known for many years and head injuries double the risk of Alzheimer’s. The human brain is not well protected from damages inflicted by physical forces. All injuries to the head are bad, including big ones and repetitive small ones. All forms of head injuries must be avoided throughout life.
At the time of the instigation of the Nottingham Study of Neurotic Disorder, the revolution instigated by DSM-III was in full swing. ‘Neurotic disorders’ still received some attention but usually as a precursor to newer (superior) descriptions. Philip Snaith (1991) was still able to entitle the second edition of his book, Clinical Neurosis, and explained why in his first chapter.
Many people with anxiety do not seek therapy due to negative views of treatment. Although close others (e.g. romantic partners, family members, close friends) are highly involved in treatment decisions, the role of specific relational behaviours in treatment ambivalence has yet to be studied.
Aims:
This study examines the relationship between social predictors (perceived criticism and accommodation of anxiety symptoms by close others) and treatment ambivalence.
Method:
Community members who met diagnostic criteria for an anxiety-related disorder (N = 65) and students who showed high levels of anxiety (N = 307) completed an online study. They were asked to imagine they were considering starting cognitive behavioural therapy (CBT) for their anxiety and complete a measure of treatment ambivalence accordingly. They then completed measures of perceived criticism and accommodation by close others. Linear regression was used to examine the predictive value of these variables while controlling for sample type (clinical/analogue) and therapy experience.
Results:
Greater reactivity to criticism from close others and greater accommodation of anxiety symptoms by close others were associated with greater treatment ambivalence in those with anxiety. These predictors remained significant even when controlling for therapy history and sample type.
Conclusions:
When it comes to treatment attitudes, relational context matters. Clients demonstrating ambivalence about starting therapy may benefit from discussion about the impact of their social environment on ambivalence.
Over the past two decades, society has seen incredible advances in digital technology, resulting in the wide availability of cheap and easy-to-use software for creating highly sophisticated fake visual content. This democratisation of creating such content, paired with the ease of sharing it via social media, means that ill-intended fake images and videos pose a significant threat to society. To minimise this threat, it is necessary to be able to distinguish between real and fake content; to date, however, human perceptual research indicates that people have an extremely limited ability to do so. Generally, computational techniques fair better in these tasks, yet remain imperfect. What's more, this challenge is best considered as an arms race – as scientists improve detection techniques, fraudsters find novel ways to deceive. We believe that it is crucial to continue to raise awareness of the visual forgeries afforded by new technology and to examine both human and computational ability to sort the real from the fake. In this article, we outline three considerations for how society deals with future technological developments that aim to help secure the benefits of that technology while minimising its possible threats. We hope these considerations will encourage interdisciplinary discussion and collaboration that ultimately goes some way to limit the proliferation of harmful content and help to restore trust online.
Little is known about the relationship between sentence production and phonological working memory in school-age children. To fill this gap, we examined how strongly these constructs correlate. We also compared diagnostic groups’ working memory abilities to see if differences co-occurred with qualitative differences in their sentences.
Method
We conducted Bayesian analyses on data from seven- to nine-year-old children (n = 165 typical language, n = 81 dyslexia-only, n = 43 comorbid dyslexia and developmental language disorder). We correlated sentence production and working memory scores and conducted t tests between groups’ working memory scores and sentence length, lexical diversity, and complexity.
Results
Correlations were positive but weak. The dyslexic and typical groups had dissimilar working memory and comparable sentence quality. The dyslexic and comorbid groups had comparable working memory but dissimilar sentence quality.
Conclusion
Contrary to literature-based predictions, phonological working memory and sentence production are weakly related in school-age children.
Communicating evidence that a policy is effective can increase public support although the effects are small. In the context of policies to increase healthier eating in out-of-home restaurants, we investigate two ways of presenting evidence for a policy's effectiveness: (i) visualising and (ii) re-expressing evidence into a more interpretable form. We conducted an online experiment in which participants were randomly allocated to one of five groups. We used a 2 (text only vs visualisation) × 2 (no re-expression vs re-expression) design with one control group. Participants (n = 4500) representative of the English population were recruited. The primary outcome was perceived effectiveness and the secondary outcome was public support. Evidence of effectiveness increased perceptions of effectiveness (d = 0.14, p < 0.001). There was no evidence that visualising, or re-expressing, changed perceptions of effectiveness (respectively, d = 0.02, p = 0.605; d = −0.02, p = 0.507). Policy support increased with evidence but this was not statistically significant after Bonferroni adjustment (d = 0.08, p = 0.034, α = 0.006). In conclusion, communicating evidence of policy effectiveness increased perceptions that the policy was effective. Neither visualising nor re-expressing evidence increased perceived effectiveness of policies more than merely stating in text that the policy was effective.
Digital CBT refers to the use of digital tools, platforms or devices to deliver or enhance cognitive behavioural therapy assessment, formulation, treatment, training and supervision. The ‘Advances in Digital CBT’ special issue aimed to document examples of innovative digital CBT practice in this rapidly developing field. In this paper, we have briefly summarised and synthesised the advances demonstrated in this group of articles. These include developments in our understanding of mental health apps, the use of digital tools as an adjunct to therapy, the effectiveness of remotely delivered CBT in routine clinical practice, our understanding of user experiences and involvement, and in digital CBT research methods. We consider the extent of current knowledge in these areas and identify where gaps in evidence lie and how the field could be taken forward to address these. Lastly, we reflect on the broader digital CBT picture and offer our suggestions of six key directions for future research: using robust study designs to evaluate and optimise digital tools; translating and culturally adapting digital tools and practices; understanding and addressing digital exclusion; exploring, reporting and addressing possible negative effects; improving user involvement in design and evaluation; and addressing the implementation gap for digital tools. We suggest that further advances in these areas would be of particular benefit to the digital CBT field.
Key learning aims
(1) To gain an overview of the articles in the special issue and an understanding of the advances in digital CBT they represent.
(2) To understand how the advances suggested by the present studies could be taken forward and extended.
(3) To consider key future directions for further advances in digital CBT.
Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a cognitive behavioural therapy-based group treatment programme for patients with borderline personality disorder (BPD). STEPPS has demonstrated its effectiveness for (younger) adults. However, there are no studies into the effects of STEPPS for older adults.
Aim:
The aim was to explore the outcome of STEPPS in older adults with personality disorders.
Method:
In this naturalistic pre- vs post-treatment study, older patients with a personality disorder, reporting emotion regulation difficulties, were included. The primary outcome was BPD symptoms. Secondary outcomes included psychological distress and maladaptive personality functioning.
Results:
Twenty-four patients, with a mean age of 63.9 years (SD=4.6), completed the 19-week programme. Nine patients (23.1%) did not complete the treatment. There were no significant differences in age, gender or global severity between completers and patients dropping out. There was a significant pre- vs post-treatment decrease of BPD symptoms, with a large effect size (Cohen’s d=1.577). Self-control improved significantly and demonstrated a large effect size (r=.576). Furthermore, identity integration improved significantly, with a medium effect size (Cohen’s d=.509). No significant differences were reported for most domains of psychological distress and maladaptive interpersonal personality functioning.
Conclusions:
The findings in this pilot study suggest STEPPS is a feasible treatment programme for older adults with personality disorders and emotion regulation difficulties. Adaptations to the program, for a better fit for older adults, however, might be needed.
Digital image correlation (DIC) techniques were used to evaluate strain distributions along tensile gage lengths immediately after yielding of a medium manganese steel (7 wt% Mn) in samples cold rolled in the range of 1–6 pct. With an increase in cold work, DIC confirmed that the yielding behavior transitioned from nucleation and propagation of a single localized deformation zone (Lüders band) to uniform deformation, that is, no evidence of strain localization. At intermediate amounts of cold work, a unique yielding behavior was evident where the initially-low positive strain hardening rate increased with tensile strain until conventional strain hardening (i.e., decrease in strain hardening rate with strain). The intermediate yielding behavior was associated with the development of multiple non‑propagating regions of strain localization, an observation not previously evident without the use of DIC.
Imagery rescripting (ImRs) is a therapy technique that, unlike traditional re-living techniques, focuses less on exposure and verbal challenging of cognitions and instead encourages patients to directly transform the intrusive imagery to change the depicted course of events in a more desired direction. However, a comprehensive account of how and in what circumstances ImRs brings about therapeutic change is required if treatment is to be optimised, and this is yet to be developed. The present study reports on the development of a coding scheme of ImRs psychotherapy elements identified in the literature as potential ImRs mechanisms. The codes were assessed in relation to short-term outcomes of 27 individuals undergoing ImRs for post-traumatic stress disorder. The timing of the change in the image, degree of activation of the new image and associated cognitive, emotional and physiological processes, self-guided rescripting, rescript believability, narrative coherence and cognitive and emotional shift were identified as being related to symptom change and so are potentially important factors for the re-scripting process.
This book is unique among modern contributions to behavioral economics in presenting a grand synthesis between the kind of behavioral economics popularized by Richard Thaler, earlier approaches such as those of the 1978 Nobel Laureate Herbert Simon, evolutionary psychology, and evolutionary economics from Veblen and Marshall through to neo-Schumpeterian thinking. The synthesis employs a complex adaptive systems approach to how people think, the lifestyles they build, and how new production technologies and products are gradually adopted and produce changes. Using a huge range of examples, it takes behavioral economics from its recent focus on 'nudging' consumers, to the behavior of firms and other organizations, the challenges of achieving structural change and transitioning to environmentally sustainable lifestyles, and instability of the financial system. This book will be of great interest to academics and graduate students who seek a broader view of what behavioral economics is and what it might become.
Ownership is universal and ubiquitous in human societies, yet the psychology underpinning ownership intuitions is generally not described in a coherent and computationally tractable manner. Ownership intuitions are commonly assumed to derive from culturally transmitted social norms, or from a mentally represented implicit theory. While the social norms account is entirely ad hoc, the mental theory requires prior assumptions about possession and ownership that must be explained. Here I propose such an explanation, arguing that the intuitions result from the interaction of two cognitive systems. One of these handles competitive interactions for the possession of resources observed in many species including humans. The other handles mutually beneficial cooperation between agents, as observed in communal sharing, collective action and trade. Together, these systems attend to specific cues in the environment, and produce definite intuitions such as “this is hers,” “that is not mine.” This computational model provides an explanation for ownership intuitions, not just in straightforward cases of property, but also in disputed ownership (squatters, indigenous rights), historical changes (abolition of slavery), as well as apparently marginal cases, such as the questions, whether people own their seats on the bus, or their places in a queue, and how people understand “cultural appropriation” and slavery. In contrast to some previous theories, the model is empirically testable and free of ad hoc stipulations.
An ideography is a general-purpose code made of pictures that do not encode language, which can be used autonomously – not just as a mnemonic prop – to encode information on a broad range of topics. Why are viable ideographies so hard to find? I contend that self-sufficient graphic codes need to be narrowly specialized. Writing systems are only an apparent exception: At their core, they are notations of a spoken language. Even if they also encode nonlinguistic information, they are useless to someone who lacks linguistic competence in the encoded language or a related one. The versatility of writing is thus vicarious: Writing borrows it from spoken language. Why is it so difficult to build a fully generalist graphic code? The most widespread answer points to a learnability problem. We possess specialized cognitive resources for learning spoken language, but lack them for graphic codes. I argue in favor of a different account: What is difficult about graphic codes is not so much learning or teaching them as getting every user to learn and teach the same code. This standardization problem does not affect spoken or signed languages as much. Those are based on cheap and transient signals, allowing for easy online repairing of miscommunication, and require face-to-face interactions where the advantages of common ground are maximized. Graphic codes lack these advantages, which makes them smaller in size and more specialized.