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The Pregnant Brain - review
This programme explored the latest research suggesting that mums-to-be are 'chemically reprogrammed in preparation for maternity'. The presenter, Zoe Williams, talked to psychologists and sociologists about the evidence for maternal programming, the effects of stress on the brain and fetus, and the notorious 'mushy brain' of the pregnant woman.
During pregnancy, a woman's hormone levels rise to more than 100 times those seen during any other naturally occurring life event. It is less recognised, said Dr Laura Glynn (Chapman University, California), that there are profound changes in the stress hormone system. This has given rise to the idea that such hormone changes throughout pregnancy play a role in shaping the maternal brain and behaviour to optimise motherhood: in effect, that mothers are made not born.
Unfortunately the evidence is complex, with much of it coming from animal models. 'We can at least say we've been to the very core of planet pregnant rat', Williams said. Craig Kinsley (University of Richmond) pointed to evidence of greater surface area on neurons, using the metaphor of 'a car at the lights spinning its wheels, revving up and revving up and then going when the time is right'.
Is this rewiring echoed in the human brain? Dr Rebecca Pearson (University of Bristol) presented research with 101 first-time pregnant women 11 weeks into their gestation, before hormone levels would have started to rise, repeated at 37 weeks. She demonstrated that attentional, physiological and perceptual systems prioritise different functions later in pregnancy (for example becoming more distracted by the aversive sound of a crying infant).
The second half of the programme tackled with the societal implications of such research. In particular, asked Williams, does research on the impact of stress, antenatal depression and diet on the developing fetus represent an attempt 'to locate every possible outcome for the fetus in maternal behaviour'? Does it encourage expectant mothers to become worried about worrying?
Professor Carmine Pariante (Institute of Psychiatry) had an interesting conclusion for pregnant mothers: 'We want them in a way to get worried, because we want to help them. In a way we want to send two parallel messages: normalising as much as possible for most women, but advising women who are really suffering to seek help.' The scientific evidence, Pariante says, 'should remind us that a woman who is pregnant is the responsibility of the whole society.'
Williams did a good job of summarising the complexities and sensitivities of the area, when she concluded 'we should be wary that such research isn't understood in a simplistic way, which plays into the hands of those who might argue that a domestic role for women is biologically predestined, or, by the same logic, that unorthodox families are biologically inferior. But it would also be a great shame if our rather babyish cultural desire to see pregnancy as an unambivalently beautiful state were to get in the way of scientific enquiry which is revealing the complex interplay between the mother and the fetus.'
- Reviewed by Jon Sutton, Managing Editor of The Psychologist. Listen to the programme. Read more about the maternal brain in the August 2010 issue of The Psychologist.
The grand dame of British science
Desert Island Discs' Kirsty Young introduces Professor Uta Frith as a 'grand dame of British science'. This is in light of her groundbreaking contributions to our understanding of autism, which led to an honorary damehood. Uta explains that to develop an understanding of autism it is necessary to look behind the behaviours to comprehend what is at the core of this phenomenon. Can we take the same approach to discover what is at the core of the phenomenon that is Uta Frith?
Born in Germany in May 1941, Uta describes a childhood which was largely protected from the harsh realities of war. She reveals her mother's sense of determination and her father's artistic talents, which appear to have influenced her self-confidence and capacity to look at the world differently. Motivated by a passion to learn, Uta arrived in England where her interest in cognitive psychology was further inspired. It was here that she nurtured her career and her family, having two sons with her husband Chris Frith.
Uta explains that her ability to manage a successful scientific career and a family was achieved by the employment of a full time nanny. Although recognising that this decision would be unpopular to some, Uta reflects that these choices were based on her own views of what she thought was right. Although this issue would not be presented in the same way to a man, Uta does not adopt an overt feminist stance but retains the clear mindedness of a scientist.
Uta's sense of pragmatism and humility appear to be attributes which are woven throughout her personal and professional relationships. A fellow Professor, Athene Donald, recently described her as 'the exact opposite of a jerk', and for somebody who studies deficits in social communication it was striking how adept she was at complimenting Kirsty Young on her questions.
I was also struck by Uta positioning her intellectual contributions to science as a small (albeit integral) part of the narrative. Her heroes are her participants with autism and their parents, from whose perspectives she has learned a great deal. Now in her retirement, she supports today's female scientists, hoping to inspire them to make time for fun via her 'science and shopping network'.
Uta's enduring love for a profession which loves her right back was clear. She will never tire of discovery, admitting she is just as baffled by autism as she always was, and describing the brain as a garden, full of the most interesting things that have to be cultivated and constantly checked. It was also fascinating to hear of Uta's discovery of psychology, and her excitement at a pioneering time: the overturning of psychoanalysis. 'You don't have to just fall in with these big stories, you could look at it in a different way'.
Accompanying her to the desert island will be a handwritten medieval manuscript and the doll's house made for her by her husband and sons. Uta says she remains a very great puzzle to herself, but to me these items reveal what is at her core; an inquisitive mind with a passion to understand others and a loving woman whose life is intrinsically woven into her family's genealogy.
- Listen again
- Reviewed by Donna Peach, who is a postgraduate student who volunteered for this review by following us on Twitter
Conference report - Therapeutic Models and Diabetes
Approximately 40 psychologists from across the UK attended this informative event focusing on 'Therapeutic Models and Diabetes'. The day started with three lectures followed by an opportunity to attend two workshops, such as working with medical teams; weight management and type 2 diabetes; and needle phobia.
The first lecture of the day was titled 'Cognitive Analytical Therapy (CAT) and Diabetes', delivered by Jackie Fosbury, Psychotherapist. Patients with diabetes often present with complex difficulties and struggle to consistently adhere to their diabetes management (dietary, lifestyle, medication etc). The focus of CAT is on the patients' relationship with their diabetes and how this is reciprocated by other relationships that they have had. The change in diabetes management is a change in the relationship with the diabetes, which is initiated through the use of transference within the therapeutic relationship.
The second lecture introduced the use of Acceptance and Commitment Therapy (ACT) to support people with diabetes and focussed on work with children. The session was delivered by Dr Sarah Maynard, Clinical Psychologist. ACT is a skills based approach that emphasises developing a way of valued living whilst accepting the illness and symptoms of diabetes. Dr Maynard presented a case example and included a range of resources and skill based material that she has drawn on in her practice. She also discussed the need for more research in using this approach with this patient group.
The final lecture of the day was delivered by Dr Mark Davies, Clinical Psychologist, looking at traumatic adjustment to a diagnosis of diabetes. Dr Davies discussed information processing models in relation to trauma and related this to a diagnosis of diabetes. He emphasised that supporting the patient to process their experience of the diagnosis would help to reduce their negative symptoms. There was a discussion about the different types of traumas that may be present including fear and shame traumas, and the use of Cognitive Behavioural therapy (CBT) as an evidence based approach for working with these experiences.
The second half of the day provided delegates with an opportunity to participate in a variety of group workshops, with the aim of sharing skills and knowledge to further best practice.
In the weight management and diabetes workshop, attendees reflected on the shame often experienced by individuals with a diagnosis of obesity in addition to diabetes and the effect this has on their perceived ability to change their behaviour. There was also a discussion regarding the role of psychology in weight management and the need to work with staff teams as well as directly with patients to ensure a holistic approach.
A workshop on needle phobia and diabetes included the group sharing experiences where in practice insulin and its effects are found to be the feared stimulus rather than the needle or injection. Similarly, identifying the trigger that provokes an anxiety response in paediatric patients was discussed.
Attendees at the working in medical teams workshop discussed the role of psychology and psychotherapy in a healthcare setting with a particular focus on how to work with other disciplines that may or may not share the same philosophies in working practice.
Running throughout the afternoon was an opportunity to draft a response to the Allied Mental Health Professionals (AHP) Toolkit following its exclusion of psychological input from patient care. Attendees reflected on how it felt to be excluded from the document given it could potentially influence commissioning decisions. However, there was also recognition of the need to respond in a manner that would raise the profile of psychological input in diabetes care whilst acknowledging the positive proposals of the toolkit.
The conference was brought to a close with a group discussion to consolidate learning from the day. There was an emphasis on looking to the future, reviewing in particular, how to raise the profile of psychology and psychotherapy in diabetes care. It was evident that the conference had inspired clinicians to continue the important work they do and increased both individual and collective confidence to move forward in developing psychology and psychotherapy in diabetes care.
For further information about the Diabetes Network, please contact Clare Shaban, Consultant Clinical Psychologist.
Review written by Dr Michelle Huggins, Clinical Psychologist, St Andrew's Healthcare & Emma Hodges, Trainee Clinical Psychologist, Exeter University.
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