What can peering into the brain tell us about the success of stop-smoking campaigns?

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Image by Flickr: @Petras Galligas

Smoking kills. That point is hardly under dispute with over 6 million deaths worldwide attributable to tobacco use. However, the best way to get people to stop smoking is considerably more contentious. One stark example of this is the inclusion of graphic images of the effects of smoking on the front of cigarette packaging. According to a large WHO report published in 2009, this campaign has been successful but clearly there are still plenty of people who keep smoking. What is it that makes one person want to quit after seeing images of diseased lungs and another happy to continue? That is exactly the question asked by a recent study by Emily Falk and colleagues in a study published earlier this month.

The study by the team at the University of Pennsylvania asked what patterns of brain activity were associated with an intention to stop smoking in response to anti-smoking images. In their study they placed a sample of 46 regular smokers in a brain scanner and showed them pictures from a recent stop-smoking campaign. While in the scanner, the participants were required to passively view graphic images of the effects of smoking and were then asked to what extent the image made them want to quit. They were also sent emails as part of a large anti-smoking campaign with the same images and a link to a stop-smoking website. The researchers were interested whether or not each participant clicked that link which, in their eyes, indicates interest in quitting smoking. The brain activity observed while the participant was viewing the anti-smoking image was used to predict their intention to quit following  while in the scanner and later when they received an email about a stop-smoking campaign.

The researchers were interested in specific regions of the brain: the amygdala, the ventromedial prefrontal cortex (vmPFC) and networks associated with regulating negative emotions. The amygdala is an area deep within the brain which responds to emotional stimuli and a greater response of this region usually signifies something with strong emotional relevance. The vmPFC is involved in goal-directed behaviour (amongst many other things) and bring together information on offer from different brain regions to come to a decision – usually in a social context. Understandably then, examining these regions is useful to understand what persuades someone to stop smoking.

When Emily Falk and colleagues examined the results, they found that those images which produced the greatest amygdala and vmPFC response were more likely to make smokers consider quitting. However, this was not the full story. The team also showed that activity in regions of the brain involved in regulating emotions was important. As this activity increased, then the predictive ability of the amygdala and vmPFC decreased. For stop-smoking campaigns this supports the claim that emotional responses (at least in the brain) may predict how effective a campaign is. It is also suggests that the extent to which an individual moderates their initial emotional response is important and may explain why campaigns targeting the negative effects of smoking work for some and not others.

However, this study did not directly test the ability of the participants to regulate their emotions so it’s a bit of a leap to say that this is why they responded more strongly to the negative images. Also, intention to quit is different from actually quitting. Ultimately, brain scanning is time consuming and expensive and so it is hardly going to be rolled out to individually tailor stop-smoking campaigns any time soon. However, that doesn’t stop this study being a cool insight into why, in terms of what the brain is getting up to, some people are persuaded to change their behaviour compared to others.

Inquisitive Tortoise

Back to Work for this Old Tortoise

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Photo by Pixabay on Pexels.com

I’ve been fairly quiet these past few months and it seems embarrassing that my last post was in October 2018. There’s been a good reason for this though – honest. Just before Christmas I handed in my PhD thesis after just over three years of working on, with, and against the formidable pile of paper on my desk. I’m not quite free yet, I still have to defend it at viva, but my brain has breathed a brief sigh of relief as I can think about other things again.

It’s weird.

Anyway, now that I’m nearly finished I wanted to get started doing the thing I love again – like writing about science! It’s honestly amazing (and a little scary) how much head space my PhD had taken up but that just means there is now this big space where blog ideas can flourish instead. I’m working on something currently so expect new blogs this month about, wait for it, something other than sleep! There will also be sleep stuff creeping in too as I can technically call it viva-prep then…

Until then, please check out this fantastic blog run by postgrads (including yours truly) at the University of Manchester. The Research Hive is full of excellent sci-comm writers talking about the thriving research going on in my adopted home.

Inquisitive Tortoise

How Staring at Screens Might Just Help You Sleep at Night

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Despite a late night scrolling through Instagram, Sam managed to sleep soundly. HansSplinter@Flickr

Insomnia disorders affects around 10% of adults with a much larger number not receiving sufficient or adequate sleep on a nightly basis. Although sleep is being taken more seriously by individuals, by healthcare professionals and even the media there is still an unmet need to improve how much sleep we get, and the daytime malaise associated with it. A recent study published last month provides some hope to this issue. A large-scale randomised controlled trial from the university of Oxford has recently shown that a digital intervention for insomnia is effective at improving not just sleep but daytime functioning too.

For those diagnosed with insomnia, characterised by a difficulty initiating or maintaining sleep, medication, psychological therapies and a plethora of alternative treatments are available. Cognitive behavioural therapy (CBT) for insomnia has shown to be particularly effective in alleviating insomnia symptoms and, unlike medication, in maintaining these sleep improvements. CBT for insomnia focuses on changing maladaptive thoughts and behaviours which maintain the cycle of poor sleep. One component involves promoting good sleep hygiene – the practise of removing sleep-inhibiting items from the bedroom (e.g. smartphones) and encouraging sleep-promoting behaviours (e.g. reduction of alcohol and caffeine).

In our digital age, researchers are increasingly looking towards technology for to tackle large scale health concerns and challenges. For sleep, this seems paradoxical. Psychologists are looking to screens to help fix a problem, in part, created by constant screen usage. However, digitally delivered CBT for insomnia (dCBT) has been shown to be effective to help reduce the symptoms of insomnia and even mental health symptoms. This has huge implications for healthcare. The reduced cost, time, and ease with which a large group of individuals can be helped makes digital interventions ideal.

While we already know that dCBT is effective at improving sleep we know little about its effect on daytime functioning. Insomnia’s impact is felt both at night and during the day, and it is the day-to-day symptoms of fatigue and poor concentration which will usually lead an individual to seek help in the first place. Currently, we don’t know much about the impact of digital interventions on these important symptoms of insomnia. This is where a large randomised controlled trial by Colin Espie and his team at Oxford came in. They recruited a big sample of individuals suffering from insomnia and provided them, by randomly allocation, to either the dCBT program Sleepio or an online sleep hygiene course.

The study participants were assessed at baseline (as they were given the treatment), at 4 weeks (midway through the treatment), at 8 weeks (at the end of the treatment) and at 24 weeks (6 months after completing the treatment). They were assessed on daytime functioning (e.g. physical health, psychological well-being and sleep-related quality of life), insomnia symptoms, cognitive symptoms and symptoms of mental health (e.g. mood, anxiety, and depression).

Overall, participants reported better physical health, psychological wellbeing and sleep related quality of life in the dCBT compared to sleep hygiene group, and all of these effects increased from the mid-treatment point (4 weeks) to the follow-up 6 months later. In addition, it seemed that improvements in insomnia scores were able to explain about half to 80% of the differences in functioning seen between the two groups.

Interestingly, the study also showed improvements in mental health outcomes such as anxiety, depression and cognitive failures which hints at the usefulness of targeting sleep to help reduce more than insomnia. Again, these changes were, in part, explained by improvements in insomnia between the two groups. They found that just under half 48% completed the full 6 sessions of digital CBT for insomnia (dCBT) over the 8-week period it was offered to them. However, this number is to be expected for this form of intervention.

This exciting new study showed that dCBT is effective in improving both the night and daytime symptoms of insomnia and further confirmed that intervening in sleep is effective digitally. With large trials like this it is hard to ignore the benefits of tech when it comes to treating health conditions. Insomnia is not the only health condition to benefit from digital interventions and it certainly will not be the last. The strange paradox of technology causing and treating insomnia is not lost on those that study sleep but increasingly it seems that turning on your phone can actually help you drift off with a good night’s sleep.

Now excuse me while I refresh Twitter again before going to bed.

Inquisitive Tortoise

 

“That’s when my mental health started to get cloudy”: Becoming an expert by experience

The latest blog post is, for a change, not written by me but is a full-length interview by Laura Hemming, a PhD student in clinical psychology at the University of Manchester. Her research concerns the role of alexithymia in suicidal thoughts and behaviours, and as part of her research she consults ‘experts by experience’ to ensure her work is informed by those who it affects the most.

You can read a shortened version of this article here.

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Almost half (44%) of people in England may experience a mental health problem in their lifetime and it is commonly reported that people experiencing mental health problems may also face challenges relating to stigma and discrimination. For instance, one survey found that 88-91% of surveyed people using mental health services reported one or more experiences of discrimination.

Further to this, it is thought that around 22% of people using mental health services will also be in contact with at least one other ‘cluster’ of service, e.g. substance misuse. This reflects the issue of complex and multiple needs which affects many people, and may serve to amplify the level of stigma and discrimination experienced.

Time to change is a charitable organisation that aims to reduce the stigma and discrimination experienced by people with mental health problems by encouraging the public to have more frequent and meaningful conversations about their mental health. In tandem with this, people with mental health problems are increasingly being encouraged to speak about and use their experiences to promote change to both mental health services and research. This has recently been recognised as something which may be empowering for individuals, and may serve to combat some of their experiences of stigma and discrimination.

Here at the University of Manchester, we aim to ensure that our research in the faculty of biology, medicine and health is in line with our social responsibility priorities. This led me to develop a patient and public involvement group to assist with my PhD research into understanding prisoner suicide and aggression. In this article, Gary[1] speaks to me about his experiences of multiple complex needs, and also about how these life experiences have helped him in his role as an expert by experience.

Gary, could you tell me a little bit about your experiences and understanding of multiple and complex needs?

I wasn’t aware of the phrase ‘multiple and complex needs’, but then I was diagnosed with having all four; substance misuse, reoffending behaviour, mental health and homelessness. Not necessarily all in that order though – they all link in with each other.

I was homeless and that’s one of the multiple and complex needs that can lead on to the rest. Now, they [services] got me off the streets in [year], and into my own flat. But, I took the streets with me. I was still vulnerable you see and I ended up using [substances] again. Substance misuse – there’s another multiple and complex need. And I fell in with bad company. And my flatmate, for some reason, he kicked off one night, and he [physically hurt me]. And while I was ringing the ambulance to say look, I need help, he set fire to my front door. So I broached it with the council, the housing council, but they didn’t seem to be able to put me in a safer area, while they were dealing with re-housing. So, I thought the best thing for me was to go back on the streets. I started drinking and using [substances] again. The lack of sleep, the constant moving on by the police, the constant paranoia that I was going to get arrested because I was in the wrong place because of my ASBO [Anti-Social Behaviour Order]. Everything built up, the stresses built up so I started using [substances] more, everything just rolled into one and that’s when my mental health started to get cloudy.

I wondered if you could tell me a little bit about what, if any, your experiences of stigma and discrimination have been?

The police. I’ve been doing some work with the police around mental health engagement. It was non-existent for me. Some years ago, I’d been in police custody for 37 hours and then from there I went straight into prison. A couple of days later when I was in prison, nobody had even noticed that I was going through some form of psychosis. And then this lad actually said ‘get him out of my sight, before he hurts me or I hurt him. His head’s gone’. So that made me feel even worse. The police just thought you was creating [trouble]. At the time that I got arrested, I’d given up at that point. I’d got a bottle of brandy and I’d given up. So I ran at the police and I smashed the bottle. But then something clicked in my head that what I was about to do, I was looking at some serious [prison] time. So rather than hurt the policeman, I hurt myself.  And for [the police] not to see that I needed help with that, do you know what I mean? And I was like well, are these people not aware that I need help? Are they just perceiving me to be a drunken troublemaker on the streets? You know, I need help here.

Employment rights. I’ve got a void in my life of 10 years. It’s been, like, a decade. A decade that I can’t get back. And it’s hard to explain on employment forms that this is where I was. If I could get a video camera, and just say ‘look at this’, put it all on a DVD, and just say ‘watch this DVD’- ‘that was me, this is where I was. That’s what happened for 10 years. But this is who I am now and this is where I wanna be’. That would be a lot easier. But actually putting it down pen to paper, it brings back how much you’ve lost out.

It’s hard actually getting to grips with emotions again. And actually realising that they’re normal emotions. Because a lot of my life for that decade, what I considered to be normal, other people perceived to be abnormal and vice versa. It was people shying away from me because I wasn’t right. So it’s working my way through that. It wasn’t nice to have people perceive me as abnormal, because deep down, I knew that that was not me. That made me feel frustrated and that built up into a lot of rage. I felt hate for the first time. That wasn’t very nice actually. I was afraid of hurting someone so I did actually self-harm, and it was the first time I’d self-harmed since I was thirteen. And then I felt even worse because I was thinking to myself, ‘look, you’re [older] now, you shouldn’t be doing what children do!’ But it was like a release.

I was quite ashamed when the Psychologist diagnosed me with level 2 PTSD [Post Traumatic Stress Disorder]. I thought that was only for soldiers. But they said the ongoing trauma that you’ve had has been a cycle. So I was just adding bricks to that bag, while I was trying to swim and it was dragging me down. Each time I was getting arrested, placed in prison, I was coming out to the streets, back to the same old, and it was just another brick, another brick in that bag. And I was going down, down, down. I scared the CBT lady because I said ‘I keep getting flash thoughts and feelings, where I think, if somebody says the wrong thing, I’ll snap’. And she said ‘you’ve got to go up a level – I can’t deal with what’s going on in your head’. So that made me feel even more paranoid about it. Was I a fruit loop? Was I a menace to society, so to speak?

I know that you’re involved with lots of projects which aim to change things so that other people don’t have to go through the same experiences as you have. Do you feel like that’s had any impact on your experiences of stigma and discrimination?

Your lived experience that you present, a lot of the time it just gets placated. But the people I’ve come across in the last eighteen months, they’ve actually acknowledged my experience.  And they’ve been appreciative of the experience that I try to bring. It’s like the work we’ve been doing with your PhD. That’s going somewhere, you know, that’s tangible. The group, we all gel. We all come at different levels, but we all have relevant things to say. And we’re all really appreciative, each one of us, of our lived experience. And we’ve seen the work actually progress to where it is now. So we’re seeing something tangible arise from that, it’s not been placated, it’s not been, you know, ‘thank you very much for your time, now jog on. We’ve ticked our boxes’.

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It’s like this grassroots organisation I work with. We’re trying to advocate change from within and utilise people’s lived experiences positively. It sounds like I should be in speaker’s corner doesn’t it? But that’s how I feel! And for me to say that is a big step because I would have wanted to say that maybe 2-3 years ago, them thoughts, them feelings were still in my head, but it wasn’t coming across like that. It just came out ‘meh’.

People have said to me quite often over this past year, that I’ve ‘owned’ what’s going on. I’ve actually acknowledged the fact that yes, I have got PTSD and I shouldn’t be ashamed of it. I’ve actually been asking the right questions and I’ve actually pulled people and said, when they come out with different terminologies, acronyms, can you just explain yourself? And I’ve passed that on to other people where I’ve seen them being a bit flustered, and I’ve actually said look, they’re not having a pop at you, it’s just that you’re taking what they’ve said the wrong way, this is what they’re trying to say. You know I put it into layman’s terms. Because I’ve had to go through that myself.

But utilising my lived experience, it’s like, I like to use art quite a bit to visualise a story. I used it when I was working in a rehabilitation unit, working with people in recovery from drugs and alcohol. I mean, the services are swamped. But people are trying to change how things are going. And it’s great to see that social responsibility is beginning to happen, and Universities are thinking about what they can offer. It’s great talking to you and telling you about what’s happened, and knowing that it might be used down the line. It’s like you’re influencing further down the line, in a small way. It’s great, it’s a good feeling. I think it’s great getting these experiences across to young people and letting them know that it’s okay to say ‘look I need help’. A lot of people are going to have multiple and complex needs, and it’s about being aware of that.

If you would like to learn more about the ways in which the University of Manchester is placing lived experience at the heart of its research, you can find out more here.

If you have been affected by any of the issues raised in this article, you can get support from the following sources:

The Samaritans – telephone: 116 123

Mind – telephone: 0300 123 3393, textphone: 86463

 

[1] Names and other details have been changed to preserve anonymity

Science, Sleepy Dogs and an Even Sleepier Dad

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Let Sleeping Dogs Lie (In Bed)

The life of a wandering hipster has its downsides. Living in rented accommodation and moving around a lot makes it hard to look after pets but entering my step-mom’s ever-growing menagerie makes up for the lack of animals in my day to day life. It’s hard to feel sad when four fluffy clouds bounce their way excitedly towards you. My dad, on other hand, begs to differ.

Their nightly habit of bolting into bed leaves little to no room for him; their sleep is clearly more important. Besides a basic space issue when trying to share a bed with four energetic bundles of fluff is there any science behind keeping your dogs out of the bedroom at night? A study conducted last year by Salma Patel and her colleagues at the Mayo Clinic tracked humans and their dogs sleep to test whether sharing the bed with your bouncy companion interferes with shuteye.

Traditionally sleep tracking in dogs has been an invasive procedure but with improving technology we’re able to study their sleep in a similar way to humans. We can use movement-trackers not entirely dissimilar to a FitBit (the fabulously named FitBark) to infer sleep from dogs’ movement or a more-involved setup in a sleep lab using a procedure like that used to track humans’ sleep. Sleep tracking has shown several overlaps in the importance of drifting off for both humans and dogs. For example, getting sufficient sleep influences how well dogs learn new information, and, like humans, dogs’ sleep structure (e.g. REM) and quality is influenced by positive and negative social interactions during the day.

Salma Patel and her colleagues at the Mayo Clinic tracked the sleep of dogs and humans using movement trackers over the course of seven days. They compared sleep when dogs were in the bed versus on the bedroom floor in a group of predominately female pet-owners within the United States. A wide range of dog breeds were represented but there were not enough participants to see whether the size of the dog influenced sleep too. When they looked at the data, the researchers found that the percentage of time spent in bed asleep (known as sleep efficiency) decreased from 83% when dogs slept on the bedroom floor to 80% when they slept in the bed. However, the dog location made no difference on how long it took the owners to actually fall asleep. Amusingly, the change in location did not affect the dogs’ sleep. Although the change in sleep efficiency was statistically significant for the slumbering humans, it is still only small and fits within the normal range.

This fun study is far from perfect, but it does highlight the lack of research looking at how the sleep of pets and humans interact. The absence of which is noteworthy when you consider that pets and humans do influence one another’s sleep. For now, perhaps don’t worry about inviting your single doggo into bed with you but maybe think twice if that number, as for my poor dad, commonly exceeds four.

Inquisitive Tortoise

How a recently discovered waste disposal system in the brain might be protecting us from Alzheimer’s

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Last month, a team led by Jonathan Kipnis at the University of Virginia further identified the role that a ‘recently’ discovered waste disposal system in the brain has on memory, normal ageing and when these both go wrong such as in Alzheimer’s disease. Their work paves the way to start seeing cognitive decline with age not as inevitable but preventable.

Within our bodies the lymphatic system forms branching highways alongside organs and blood vessels and serves a number of vital functions. One is the removal of waste from cells busy keeping us alive. Our brains are no different and produce waste proteins and molecules as a result of working hard throughout the day – and night. Although we were aware of rudimentary ways the brain removed its waste from functioning cells, scientists were confused by the apparent absence of a lymphatic system within the brain. However, three years ago, it seemed that scientists had found them.  In the outer most layers of the brain known as the meninges these aptly named meningeal lymphatic vessels were subsequently shown to serve a waste disposal function in the brain.

This is the point in the story where the recent paper in Nature picks up. The team from the University of Virginia firstly destroyed the meningeal lymphatic vessels in a group of mice and found, as a result, that they were unable to drain waste from the brain as effectively. The same result was found whether the vessels were destroyed chemically, physically tied or damaged via genetic mutation.

More importantly, damaging the clearance system did not just affect its ability to remove ‘waste’ but it also impacted the memory of the mice. When given multiple cognitive tests, the mice performed worse on navigating from memory and fear memory.  By contrast, when old mice were given a drug to improve the effectiveness of the meningeal lymphatic system at draining waste, these older mice took less time to solve a memory puzzle reliant on navigation. Their memory had improved by targeting the brain’s ability to efficiently clear waste.

Finally, the researchers wanted to look at how these findings might relate to ageing – namely Alzheimer’s disease. They found that trying to enhance the waste disposal system in the brain had no effect on mice genetically predisposed to develop Alzheimer’s. Yet, when these mice were subjected to a drug which damaged the lymphatic vessels regularly for 6 weeks a familiar pattern emerged. These mice, compared to controls who did not receive the drug, showed accumulation of a protein called amyloid-beta in the outer layers of the brain and in the hippocampus – a part of the brain involved heavily in navigation memory amongst many other functions.  Amyloid beta, and its excess in the brain, is a hallmark of Alzheimer’s and this final study suggests that the meningeal lymphatic system may play a role here.

It is still early days, and this work is currently limited to mice, but these results point towards new avenues to mitigate age-related decline in health and memory. If it’s possible to improve the function of the brain’s waste disposal systems, including the meningeal lymphatic pathway, then perhaps we can reduce the accumulation of amyloid beta and stave off the debilitating symptoms of Alzheimer’s for longer.

Until then, perhaps try a good night’s sleep.

Inquisitive Tortoise

Video Games Make You Violent? Science Begs To Differ…

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Video games are to blame for school shootings – not easy access to guns.

I probably don’t need to tell you who said that earlier this year but he is far from alone in that opinion. Scores of vocal critics have spoken out against the tyranny of violent video games and how they are to blame for some of the more horrific crimes committed by young people. In the absence of hard evidence, anecdotes and analogies commonly appear. However, despite emotion playing a large part in opinions on this topic, a recent experimental study in Molecular Psychiatry, led by Simone Kuhn, challenged this view with a rather comprehensive study.

Previous research linking violent video games to aggressive tendencies has been based on short-term outcomes. Typically, someone would be exposed to a video game for a short period of time (e.g. up to 2 hours) and would then be tested immediately on aggression. In some cases, such studies would confirm society’s bias – playing a violent game did seem to make the participants more violent themselves. Yet, this was not a consistent finding.

This by itself should raise doubts for those championing the immediate removal of violent video games. There was, prior to Simone Kuhn’s study, another problem with these previous forays into the societal concerns about gaming. These studies were set-up to address the wrong question. Instead of looking at whether video games had long-term effects on children’s behaviour, previous studies only looked at the short-term (e.g. does playing violent video games produce an immediate increase in violence?) As a result, it was impossible to make any concrete claims about what the long-term – and arguably more important – effects were.

Instead it was claimed that multiple short-term exposures to violence in video games would produce a long-term and more permanent change in personality and behaviour – this is what the General Aggression Model argues. Not convinced by this theoretical explanation, Simone Kuhn and her colleagues at the Max Planck Institute for Human Development, and the University Clinic Hamburg-Eppendorf stepped in to test this assertion experimentally: do violent video games produce an increase in violence, aggression or psychopathology in the long-term?

The team set-out to answer this in a simple but powerful way. They recruited a sample of ninety healthy volunteers who were assigned to play a violent video game (GTA V), a non-violent video game (Sims 3), or to not play any video game but still be tested throughout (control group). Importantly, participants who took part had no prior experience of GTA or the Sims and had limited video game experience in general.

Those who were randomly assigned to the video game groups were required to spend at least 30 minutes playing their GTA or the Sims for a total of 2 months. After this, all participants were tested at the start of the study, after the 2-month gaming period, and another 2 months after session.

Everyone who took part in the study completed a comprehensive set of tests which tapped into aggression, empathy, anxiety, depression, ability to communicate with others, and mental capabilities in areas such as working memory. Simone Kuhn and her team argued that this allowed for a more complete analysis of the purported link between violent video games and negative social outcomes. They hypothesised that the participants would show no increase in aggressive or violent tendencies or behaviours following assignment to the violent video game.

This was exactly what they found.

This study found no changes in any of the measures across the testing sessions. More importantly, they showed no difference in performance between the violent or non-violent gamers (e.g. those playing GTA were no more likely to show an increase in aggression than those who played the Sims). Unlike previous studies which only looked at this association in the short term (e.g. an hour or day after gaming ceased), this study showed that the relative long-term effects were non-existent. There were one or two increases in negative social outcomes (e.g. aggression and impulsivity) found but amidst 208 other analyses these may simply have been due to chance.

It’s important to note that this study only looked at this link in adults aged between 18 to 45 years old and did not assess children. Although it is still an important piece to add to the violence debate, it is important that vocal advocates of this link between video games and aggression tend to focus their attention on young children. This is not an irrational stance as children have been shown to be more vulnerable to the violent video games in the short term – even if that effect is still inconclusive.

For now, it seems that violent video games are poorly associated with increases in violence. This is a powerful study but replication of its findings over longer periods and with more diverse populations will provide powerful evidence against this claim. Until that emerges, perhaps don’t trust those who claim that providing evidence is an unnecessary hindrance in the face of ‘feels’ and emotion.

Inquisitive Tortoise

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