Memory research has come a long ways since the early research many of us learned in psychology classes. There is the famous Bell Laboratories research into short-term memory which resulted in the famous axiom of “7 plus or minus two” – which refers to how many “slots” we can utilize “in our head” in real-time, keeping it there to “process,” sequence, manipulate.

This is essentially considered “working memory” in the new parlance, but this early research is the basis for our (original) 7-digit telephone number. Beyond that (i.e., with the introduction of area codes) those whose limit is recalling 7 digits comfortably, learned to “chunk” the information so that 212 or 415 area codes were remembered as a unit, so as to take only slot. Essentially, this is human RAM, while other reasoning skills rely on this as part of our larger “processor.”

Now back to humans and human memory…

One of the presentations I attended at the annual meeting of the American Psychological Association harkens back to basic research and focuses on a series of studies into “social memory”, looking at the extent to which memorizing and retrieving information may be impacted by the situation — specifically, if it is a group collaborative effort versus solitary memory.

The title of the presentation was particularly provocative, in this age of connectedness to devices, social networks, and smart phones:

Social Influences on Memory:
The Perils of Learning and Remembering with Others

I was prepared for some new findings about impact on attention span, or inferences about how the echo chamber of “fact” presentation among groups or in popular media might present a “peril.” Or the risks and benefits of remembering through discussion via tweeting or remembering a friend’s Facebook wall, etc.  This was not the case, nor was it entirely perilous to have people learning or recalling in groups.

Suparna Rajaram, Ph.D presented a series of very rigorous studies which did find a number of situations when “social learning” was relatively ineffective compared to singular memory. One of the variables which emerged was “rehearsal,” or the repetition/re-exposure to a bit of memory which is generally seen as an important aid in initial memory, but which appears to be an important factor in retrieval as well.

These studies go beyond “state dependent learning” (which posits that it is easier to recall something when in the same frame as when the initial learning took place), and highlight how collective memory, just as individual memory skills, reflect things in groups as well as individuals, such as the level of ability to organize.

If you take 5 people and ask them to recall 5 items from a list, it is possible that they’ll each remember different things so that the cumulative result is better than any one individual. On the other hand, as though who play Boggle know well, you can also have a situation where the same few words are recalled by everyone, “canceling out” the result of a longer list.

A big factor appears to be how the task is presented, mediated, and organized, with effective groups able to harness the collective power, and disorganized groups doing worse on recall than single individuals. And so group memory, like individual memory, can be seen as one component of “executive functioning” with the effective use of “working memory” as well as the organizing and sequencing of the task a part of the overall task.

How good does our memory need to be, individually? How much can we rely on others to effectively help us recall learned materials?

Sir Michael Rutter was introduced by past-APA President Richard Suinn. Sir Michael (Sir/Dr. Rutter?) not only has a voluminous body of writing about resilience, but is considered “the father of modern child psychiatry”.

Sir Rutter described the development of his interest, from his family origins to his work studying genetics and coping mechanisms (e.g., Gamezy & Rutter, 1983) to his interest in longitudinal studies which suggest “protective factors” at play. As a medical practitioner he was long aware of the ongoing relationship between genetic and environmental factors. Throughout his presentation he referred to this interaction, and how there is a process, distinct from single static traits which inoculate against the devastation of stress. In a way reminiscent of HS Sullivan’s Interpersonal Theory of Psychiatry, he described how, in fortuitous circumstances, some people can leapfrog over a state of dysfunction and regain normal life, for reasons beyond one factor alone (genetics or environment).

“Resilience = Relative resistance to environmental risk experiences, OR the overcoming of stress or adversity, OR a relatively good outcome despite risk experiences.”

Resilience is NOT, Rutter said, “just social competence or positive mental health.” He has some reservations about some of the efforts to “teach resilience,” for example as part of a standardized school curriculum. Schools who try to teach resilience in the same manner as teaching ABC’s, he said, “are bound to fail.”

Sir Rutter has observed that there are various coping mechanisms which may inoculate against damage, including what he terms “steeling effects”. One example might be parachute jumping, where “parachute jumping leads to physiological adaptation” and a habitual steeling against fear or physiological survival responses. Generally, “if you want to be resistant to infection the worst possible thing you could do is avoid ALL exposure.” Similarly, to participate in the normal activities of life, one needs to develop some resistance/coping mechanisms. Add to the paradigm psychological defenses in addition to physiological ones, and notions such as Bandura’s concept of “self-efficacy” (as well as that of “mindfulness”) take on additional importance.

Moving now from one hugely popular topic to another….

APA attendees were also treated to an unforgettable, immersive experience in the form of a powerful and unique presentation by another legend in psychology, Dr. Steven Hayes. Hayes is widely known for his ACT philosophy and therapeutic strategy. That’s Acceptance and Commitment Therapy. Celebrated as an empirically-supported (read: “evidence-based”) cognitive/behavior approach, it draws additionally from “relational frame theory” and differs from most other approaches with its core focus on “mindfulness.” Rather than trying to squash unwanted thoughts, one becomes mindful and acceptant and able to transcend one’s own self-defeating responses.

The technique and philosophical underpinnings are far too complex to summarize here — with Dr. Hayes himself commenting that he was mindful of time and place and would not address the minutia of his approach. But what he presented can never be forgotten by those who watched and listened, as he shared a powerful combination of his own life narrative along with examples of factors which shape our daily lives.

Dr. Hayes began a multi-media presentation with a “slide” depicting a black & white television, in the 1950’s. This was to begin some personal reflections, only a few of which can be shared here, but which were powerful and made it easy to see where some of Hayes’ ideas may have originated — such as the toxicity of “objectification” in our language and popular culture, feeding the polarization and hatred which pervade societies. A sample:

1956. A little boy watching his mother.

He didn’t understand at the time. But he knew something powerful had happened, between what was shown on the television and the reaction of his mother (who spit at the TV and turned it off). Thirty five years later he gave his mother’s assumed name (taken to escape certain death in the Holocaust) to his own daughter.

Objectification. Judgment. Lack of Acceptance: “Guess what? If you can apply it to others you can apply it to yourself. And if it’s not you, then it’s the person sitting on either side of you.”
Therapists need to be mindful, too

1984. “Watching my African-American daughter come into a room.” And seeing the reaction.

History and society’s responses were sampled. Hayes noted the characteristics and power of rhetoric: “We are swimming in a sea of language,” objectifying and disabling our humanity.

And the goal? “Psychological flexibility: We want people to be open, active, and centered. The Buddhists are right.”

Physicians are acutely aware of the need to know the research, and most ethical codes demand informed consent. Both health and mental health professionals provide information to their patients about effectiveness, efficacy, and other treatment options which may be equivalent.

Here is what a panel of  distinguished psychologists and ethics experts had say, which for most present sounded both reasonable (i.e., not rigid to the point of possibly actually doing harm) and grounded in the true intent of ethics among most healers/therapists — to help.

Dr. Gerald Koocher, editor of Ethics and Behavior, and his fellow panelists addressed what has been the theoretical model of ethical practice for some time now: the 3-legged stool. Basically this model calls for treatment decisions to be based upon 1) Best research based evidence 2) clinical expertise 3) Patient context.

Aside from some conceptual difficulties with the 3 legged model in a figurative sense, it was noted that 2-legged stools (aka “benches”) can be even more sturdy, as can one good leg in  strong concrete. So if life is a box of chocolates, ethics is a 3-legged stool.

So what’s important? Don’t providers now get that we need to base statements and decisions on sound evidence? Ah, but maybe it’s not that easy. Some real-world dilemmas are faced every day by clinicians who might be happy to follow a specific rule diligently, but what happens when life gets in the way of plans? And what about children?

Some important points include how “clients have preferences;” while “evidence” may show a combination of medication and therapy to be most effective for the most people, a parent may not want the medication part.

Therapists too may have preferences which can include ingrained but untenable allegiance to particular “schools” (for example trying to treat enuresis psychoanalytically, as opposed to providing a bell and pad, at risk of facing “symptom substitution”). One of the panelists asked where one might go to find every single situation and the evidence for best treatment for each. I followed up with this question, too. Answer: It’s not easy!

So, aside from the risks and benefits of “manualized” treatment — which has few advocates among practitioners I speak with — what is most important to keep in mind when trying to be both ethical and effective, using our skills, “evidence,” and judgment borne from experience? A great deal of importance must be assigned to the initial phase of outlining and agreeing to a course of treatment.

As Dr.Scott Lilienfeld described it, “We have a role as a clinician also as a persuader.” Dr. Koocher re-iterated a mantra shared by many: “The critical thing to evoke change is the therapeutic relationship.” This is not merely a fact borne from research, but a consideration in such cases where a client has a strong preference. Then again, as Dr. Nordal (of APA’s Practice Directorate) cautioned, “A client may not have a preference for something but it may be because they’re uninformed.” And thus informed consent is doubly important at the beginning of a therapeutic relationship.

Now I would like to add, for those who may think I was speaking about online therapy, I wasn’t. This is the type of consideration psychologists and other healthcare providers are constantly making. Face to face. Now imagine online interactions: still applicable, no? And this is why I am happy to be able to report on new evidence for online intervention efficacy, too!

I would like to segue briefly to a few uniquely online/digital age ethical points, made in the next symposium I attended, another ethics luminary with a continuing interest in 21st Century life, Dr. Jeffrey Barnett (past-ethics chair). I love his presentation title:

Ru red e 4 ths? The Practice of Psychology in the Digital Age

My very quick synopsis for here & now: Aside from being mindful that what goes up online is forever, as the prior panel emphasized, informed consent is (as the teens say) sooooo important! He shared some disclaimer forms covering “friending” policy upfront (informed consent!), and addressed the ethical aspects of Googling/researching a client or student without consent/discussion/reason. So much here: generational differences, FB privacy, positive use of the web in therapy sessions, impact of tweeting, so much more…  Welcome to the 21st Century!

The presentation I attended the first day of the convention highlighted ongoing research and discussion ranging from support group participation to self-guided cognitive training in the Mood Gym, to positive psychology’s approach: “teaching happiness.”

We now have more than a decade of growing “evidence” for support groups’ efficacy – in this era where “evidence-based” is a mantra. Introduced by Dr. John Grohol, himself a pioneer in the promotion of online mental health resources, the first presenter was Dr. Azy Barak, widely known for maintaining and contributing to a vast bibliography of research involving Internet-based applications. He has both researched and developed numerous support groups, and has a particular interest in exploring the factors which contribute to positive outcomes for support group participants.

The two main mechanisms identified as key factors in positive experience among support group members are (1) the psychological effects of expressive writing [e.g., Pennebaker] and (2) group process dynamics, as classically described by Yalom. Some stages are fairly universal, while others may hold special appeal online, and bring both opportunities and challenges. Think: development of group cohesion, universality, ventilation, experience of mutual support, an atmosphere of advice giving & receiving, and shared learning.

Research to date has generally shown that participants tend to report satisfaction and relief, despite ongoing debates about proving “effectiveness” absolutely – the same efficacy vs. effectiveness discussion raging in f2f outcome research.

Dr. Barak and his colleagues conducted a series of 4 studies, targeting different populations (types/severity of distress) and using different methodology – the brief version being that some were part of an open-group environment, others closed, most using a forum format, free and anonymous. The study focused on identifying factors related to more positive ratings of the experience at “post-test” via self-ratings. In general the results indicate a significant relationship between level of participation (sending and receiving messages) and positive outcome. Questions at the end included one about contributing factors beyond participation level. In one word, Dr. Barak pointed to a big one: Motivation. Other speakers also spoke of “engagement” as a challenge.

Helen Christensen, Ph.D. described an automated CBT-based program deployed since 2001 and now used by 300,000 people world-wide: Mood Gym. It has shown positive results targeting anxiety, depression, and prevention. It is easily “scalable” and quite cost-effective after start-up. It is also part of a larger system which includes a portal for researchers and offers quite an extensive database. One study was conducted in Australia, in 30 schools across the country including Aboriginal areas. After 6 months of Mood Gym training, anxiety levels were significantly lower among both boys and girls, though only the boys experienced a significant drop in depression. Dr. Christensen emphasized how important she sees it to offer preventive tools, and of course this involves working with young people. There are some common barriers however, such as initial engagement, acceptance of the program as potentially helpful, adherence (staying with it rather than dropping out), and concern about online safety. Thus far continuation has been fairly strong, especially given the context that 70% of patients drop out of traditional f2f therapies.

Dr. Alicia Parks, former student of Martin Seligman (“positive psychology”) and researcher now at the U of P Positive Psychology Center, moves the notion of online help-seeking away from conventional “treatment.”  She stated some reservations about CBT online and ventured that a more “positive” approach than treating symptoms is simply to “teach happiness.”

It needs to be said, as she did several times, the target population that they’ve been working with in a large study elicited by authentichappiness.org is those with “sub-clinical depressive symptoms”. This is a large group, for whom there is evidence that the “Positive Psychotherapy” (PP) program yields the benefit of a positive emotional experience and fosters resilience. Moreover, “it can counter depressive problems without having to label a disorder”. She sees this approach holding great potential, based on research, in terms of (1) effectiveness (2) motivation (improving “with learning through positive psychotherapy”); and (3) stigma – “People may be more willing to pursue happiness than seeking to fix a problem”.

The program involves a 6-week program consisting of completing 6 different exercises “targeting very different aspects of happiness”. It is done online, although as she pointed out, not fully automated. (Should it be? Would that impact “happiness”?) Food for thought.