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Confidence and Insight into Working Memories Are Shaped by Attention and Recent Performance.
Working memory is capacity limited, and our ability to access information from working memory is variable, but selective attention to working memory contents can improve performance. People are able to make introspective judgments regarding the quality of their memories, and these judgments are linked to objective memory performance. However, it remains unknown whether benefits of internally directed attention on memory performance occur alongside commensurate changes in introspective judgments. Across two experiments, we used retrospective cues (retrocues) during working-memory maintenance to direct attention to items in memory. We then examined their consequence on introspective judgments. In the second experiment, we provided trial-wise feedback on performance. We found that selective attention improved confidence judgments and not just performance of the probed item. We were also able to judge participants' genuine insight into working-memory contents through the correlation between confidence judgments and memory quality. Neurophysiologically, alpha desynchronization correlated first with memory error and then confidence during retrocueing, suggesting a sequential process of attentional enhancement of memory contents and introspective insight. Furthermore, we showed that participants can use feedback on the accuracy of confidence judgments to update their beliefs across time, according to performance. Our results emphasize flexibility in working memory by showing we can selectively modulate our confidence about its contents based on internally directed attention or objective feedback.
Association between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: a cross-sectional study.
BACKGROUND: Exercise is known to be associated with reduced risk of all-cause mortality, cardiovascular disease, stroke, and diabetes, but its association with mental health remains unclear. We aimed to examine the association between exercise and mental health burden in a large sample, and to better understand the influence of exercise type, frequency, duration, and intensity. METHODS: In this cross-sectional study, we analysed data from 1 237 194 people aged 18 years or older in the USA from the 2011, 2013, and 2015 Centers for Disease Control and Prevention Behavioral Risk Factors Surveillance System survey. We compared the number of days of bad self-reported mental health between individuals who exercised and those who did not, using an exact non-parametric matching procedure to balance the two groups in terms of age, race, gender, marital status, income, education level, body-mass index category, self-reported physical health, and previous diagnosis of depression. We examined the effects of exercise type, duration, frequency, and intensity using regression methods adjusted for potential confounders, and did multiple sensitivity analyses. FINDINGS: Individuals who exercised had 1·49 (43·2%) fewer days of poor mental health in the past month than individuals who did not exercise but were otherwise matched for several physical and sociodemographic characteristics (W=7·42 × 1010, p<2·2 × 10-16). All exercise types were associated with a lower mental health burden (minimum reduction of 11·8% and maximum reduction of 22·3%) than not exercising (p<2·2 × 10-16 for all exercise types). The largest associations were seen for popular team sports (22·3% lower), cycling (21·6% lower), and aerobic and gym activities (20·1% lower), as well as durations of 45 min and frequencies of three to five times per week. INTERPRETATION: In a large US sample, physical exercise was significantly and meaningfully associated with self-reported mental health burden in the past month. More exercise was not always better. Differences as a function of exercise were large relative to other demographic variables such as education and income. Specific types, durations, and frequencies of exercise might be more effective clinical targets than others for reducing mental health burden, and merit interventional study. FUNDING: Cloud computing resources were provided by Microsoft.
Concurrent visual and motor selection during visual working memory guided action.
Visual working memory enables us to hold onto past sensations in anticipation that these may become relevant for guiding future actions. Yet laboratory tasks have treated visual working memories in isolation from their prospective actions and have focused on the mechanisms of memory retention rather than utilization. To understand how visual memories become used for action, we linked individual memory items to particular actions and independently tracked the neural dynamics of visual and motor selection when memories became used for action. This revealed concurrent visual-motor selection, engaging appropriate visual and motor brain areas at the same time. Thus we show that items in visual working memory can invoke multiple, item-specific, action plans that can be accessed together with the visual representations that guide them, affording fast and precise memory-guided behavior.
A quantitative model of trust as a predictor of social group sizes and its implications for technology
The human capacity for working together and with tools builds on cognitive abilities that, while not unique to humans, are most developed in humans both in scale and plasticity. Our capacity to engage with collaborators and with technology requires a continuous expenditure of attentive work that we show may be understood in terms of what is heuristically argued as ‘trust’ in socio-economic fields. By adopting a ‘social physics’ of information approach, we are able to bring dimensional analysis to bear on an anthropological-economic issue. The cognitive-economic trade-off between group size and rate of attention to detail is the connection between these. This allows humans to scale cooperative effort across groups, from teams to communities, with a trade-off between group size and attention. We show here that an accurate concept of trust follows a bipartite ‘economy of work’ model, and that this leads to correct predictions about the statistical distribution of group sizes in society. Trust is essentially a cognitive-economic issue that depends on the memory cost of past behaviour and on the frequency of attentive policing of intent. All this leads to the characteristic ‘fractal’ structure for human communities. The balance between attraction to some alpha attractor and dispersion due to conflict fully explains data from all relevant sources. The implications of our method suggest a broad applicability beyond purely social groupings to general resource constrained interactions, e.g. in work, technology, cybernetics, and generalized socio-economic systems of all kinds.
Social Brain: Evolution
Increases in brain size within different mammalian lineages, and in particular increases in neocortex volume within primates, appear to be associated with shifts to more intense forms of sociality. In primates, this is reflected in a strong correlation between neocortex volume and social group size, as well as in correlations with various behavioral indices of social complexity. This relationship seems to be underpinned by cognitive abilities such as the theory of mind, which, while specialized for social tasks, may nonetheless be the emergent properties of more fundamental cognitive abilities associated with executive functions. As a result, there is some evidence to suggest that the frontal lobe may play a disproportionate role in managing social skills.
Improving usability of Electronic Health Records in a UK Mental Health setting: a feasibility study.
BACKGROUND: Electronic Health Records (EHRs) can help clinicians to plan, document and deliver care for patients in healthcare services. When used consistently, EHRs can advance patient safety and quality, and reduce clinician's workload. However, usability problems can make it difficult for clinicians to use EHRs effectively, which can negatively impact both healthcare professionals and patients. OBJECTIVE: To improve usability of EHRs within a mental health service in the UK. METHODS: This was a feasibility study conducted with two mental health teams. A mixed-methods approach was employed. Focus group discussions with clinicians identified existing usability problems in EHRs and changes were made to address these problems. Updated EHR assessment forms were evaluated by comparing the following measures pre and post changes: (1) usability testing to monitor time spent completing and duplicating patient information in EHRs, (2) clinician's experience of using EHRs, and (3) proportion of completed EHR assessment forms. RESULTS: Usability testing with clinicians (n = 3) showed that the time taken to complete EHR assessment forms and time spent duplicating patient information decreased. Clinician's experience of completing EHR assessment forms also significantly improved post changes compared to baseline (n = 71; p
Patient-reported harm from NHS treatment or care, or the lack of access to care: a cross-sectional survey of general population prevalence, impact and responses.
OBJECTIVES: The aim of this article is to provide an estimate of the proportion of the general public reporting healthcare-related harm in Great Britain, its location, impact, responses post-harm and desired reactions from healthcare providers. DESIGN: We used a cross-sectional survey, using quota sampling. SETTING: This research was conducted in Great Britain. PARTICIPANTS: The survey had 10 064 participants (weighted analysis). RESULTS: In our survey 9.7% participants reported harm caused by the National Health Service (NHS) in the last 3 years through treatment or care (6.2%) or the lack of access to care (3.5%). The main location where the harm first occurred was hospitals. A total of 37.6% of participants reported a moderate impact and 44.8% a severe impact of harm. The most common response to harm was to share their experience with others (67.1%). Almost 60% sought professional advice and support, with 11.6% contacting the Patient Advice and Liaison Service (PALS). Only 17% submitted a formal complaint, and 2.1% made a claim for financial compensation. People wanted treatment or care to redress the harm (44.4%) and an explanation (34.8%). Two-thirds of those making a complaint felt it was not handled well and approximately half were satisfied with PALS. Experiences and responses differed according to sex and age (eg, women reported more harm). People with long-term illness or disability, those in lower social grades, and people in other disadvantaged groups reported higher rates and more severe impact of harm. CONCLUSIONS: We found that 9.7% of the British general population reported harm by the NHS, a higher rate than reported in two previous surveys. Our study used a broader and more inclusive definition of harm and was conducted during the COVID-19 pandemic, making comparison to previous surveys challenging. People responded to harm in different ways, such as sharing experiences with others and seeking professional advice and support. Mostly, people who were harmed wanted help to redress the harm or to gain access to the care needed. Low satisfaction with PALS and complaints services may reflect that these services do not always deliver the required support. There is a need to better understand the patient perspective following harm and for further consideration of what a person-centred approach to resolution and recovery might look like.
Stuttering: Our Current Knowledge, Research Opportunities, and Ways to Address Critical Gaps.
Our understanding of the neurobiological bases of stuttering remains limited, hampering development of effective treatments that are informed by basic science. Stuttering affects more than 5% of all preschool-age children and remains chronic in approximately 1% of adults worldwide. As a condition that affects a most fundamental human ability to engage in fluid and spontaneous verbal communication, stuttering can have substantial psychosocial, occupational, and educational impacts on those who are affected. This article summarizes invited talks and breakout sessions that were held in June 2023 as part of a 2-day workshop sponsored by the US National Institute on Deafness and Other Communication Disorders. The workshop encompassed topics including neurobiology, genetics, speech motor control, cognitive, social, and emotional impacts, and intervention. Updates on current research in these areas were summarized by each speaker, and critical gaps and priorities for future research were raised, and then discussed by participants. Research talks were followed by smaller, moderated breakout sessions intended to elicit diverse perspectives, including on the matter of defining therapeutic targets for stuttering. A major concern that emerged following participant discussion was whether priorities for treatment in older children and adults should focus on targeting core speech symptoms of stuttering, or on embracing effective communication regardless of whether the speaker exhibits overt stuttering. This article concludes with accumulated convergent points endorsed by most attendees on research and clinical priorities that may lead to breakthroughs with substantial potential to contribute to bettering the lives of those living with this complex speech disorder.
A feasibility study of a preventative, transdiagnostic intervention for mental health problems in adolescence: building resilience through socioemotional training (ReSET).
BACKGROUND: Adolescence is a developmental period during which an estimated 75% of mental health problems emerge (Solmi et al. in Mol Psychiat 27:281-295, 2022). This paper reports a feasibility study of a novel indicated, preventative, transdiagnostic, school-based intervention: Building Resilience Through Socioemotional Training (ReSET). The intervention addresses two domains thought to be causally related to mental health problems during adolescence: social relationships and emotion processing. Social relationships were targeted using principles from interpersonal psychotherapy, while emotion processing was targeted using cognitive-emotional training focused on three areas of emotion processing: Emotion perception, emotion regulation and interoception. The aims of this feasibility study were to (i) assess the acceptability of integrating group-based psychotherapy with individual cognitive-emotional training, (ii) evaluate the feasibility of our recruitment measures, and (iii) assess the feasibility of delivering our research measures. METHODS: The feasibility study involved 41 adolescents, aged 12-14, who were randomly assigned to receive the ReSET intervention or their school's usual mental health and wellbeing provision. RESULTS: Qualitative data from intervention participants suggested the programme was experienced as a cohesive intervention, with participants able to draw on a combination of skills. Further, the cognitive-training tasks were received positively (with the exception of the interoception training task). The recruitment and research measures were successfully delivered in the school-based setting, with 97.5% retention of participants from baseline to post-intervention assessment. Qualitative data was overwhelmingly positive regarding the benefits to participants who had completed the intervention. Moreover, there was only limited data missingness. CONCLUSIONS: We conclude that a trial of the ReSET intervention in a school setting is feasible. We discuss the implications of the feasibility study with regard to optimising school-based interventions and adaptations made in preparation for a full-scale randomised controlled trial, now underway.
Disentangling the Component Processes in Complex Planning Impairments Following Ventromedial Prefrontal Lesions.
Damage to the ventromedial prefrontal cortex (vmPFC) in humans disrupts planning abilities in naturalistic settings. However, it is unknown which components of planning are affected in these patients, including selecting the relevant information, simulating future states, or evaluating between these states. To address this question, we leveraged computational paradigms to investigate the role of vmPFC in planning, using the board game task "Four-in-a-Row" (18 lesion patients, 9 female; 30 healthy control participants, 16 female) and the simpler "Two-Step" task measuring model-based reasoning (49 lesion patients, 27 female; 20 healthy control participants, 13 female). Damage to vmPFC disrupted performance in Four-in-a-Row compared with both control lesion patients and healthy age-matched controls. We leveraged a computational framework to assess different component processes of planning in Four-in-a-Row and found that impairments following vmPFC damage included shallower planning depth and a tendency to overlook game-relevant features. In the "Two-Step" task, which involves binary choices across a short future horizon, we found little evidence of planning in all groups and no behavioral differences between groups. Complex yet computationally tractable tasks such as "Four-in-a-Row" offer novel opportunities for characterizing neuropsychological planning impairments, which in vmPFC patients we find are associated with oversights and reduced planning depth.