- Michael Koenigs: Welcome everyone to the Neuroscience
and Public Policy Seminar.
I'm very pleased to introduce our speaker today,
Dr. Arielle Baskin-Sommers, an associate professor
of psychology at Yale University.
Dr. Baskin-Sommers is no stranger to Madison.
She's a star alumna of our clinical psychology PhD program,
during which time she worked with Professor Joe Newman
on his longstanding program
of research with state prison inmates.
Following her time in Madison,
she completed an internship and fellowship
at McLean Hospital at Harvard Medical School
before taking her current faculty position at Yale.
She's received numerous early career awards
from professional organizations, including
the Society for the Scientific Study of Psychopathy,
the Association for Psychological Science,
and the Society of Criminology.
Her record's been funded by both
the National Institute of Health
and the National Institute of Justice.
What I find particularly impressive about her work
is how her program of basic research on the psychological
and biological mechanisms of psychopathy
have been used to inform novel treatment strategies
for this serious and costly disorder.
Dr. Baskin-Sommers is one of the world's leading experts
on psychopathy, particularly with regard
to its manifestation and psychobiological mechanisms
in the criminal offender population.
So we're very pleased to have her here.
Please join me in welcoming Dr. Baskin-Sommers.
[audience applauding]
- Well, thank you so much for having me
and coming out here in the midst
of all the crisis that is going on.
I'm really excited to be back in Madison,
my first time since receiving my PhD here,
and I'm excited to share some of the work
our lab has been doing along with other labs
to identify mechanisms
that contribute to antisocial behavior.
And today I'll be focusing on a prototypic individual
who engages in antisocial behavior,
that is the psychopath.
And so, I'll be starting by really defining what I mean
by psychopathy and distinguishing it
from other mental health disorders
that we commonly see in the criminal justice system.
Then talk about how generally psychopathy is viewed
in the eyes of the law and policies
that surround the handling of this type of disorder
in the criminal justice system,
and how some of our mechanistic work
might challenge that view and assumption.
And then use that type of model
to talk about treatment and management programs
that might be more targeted mechanistic base.
So to start in terms of psychopathy,
generally when I'm talking about this disorder,
I'm talking about individuals who
display a combination of characteristic traits
that fall into four domains.
The first being individuals who are
generally quite glib and superficially charming,
and they can be very manipulative.
You really actually enjoy engaging with them,
enjoy having a conversation with them,
despite sometimes knowing the things that they do
or how they've just conned someone
or committed an act that you might seem
quite heinous or really difficult to understand.
And so to exemplify this set of traits,
I wanna play a brief clip
from ESPN's documentary about O.J. Simpson.
In this clip, I would like you to hear
how other people describe their engagement with O.J.
and how, despite knowing what he possibly did
to his ex-wife and others,
and then certainly did following that trial,
how they still really felt
that they were drawn in by this individual.
- Woman: O.J., I wanna say I don't like you,
I can't stand you,
I wanna call you names, I wanna throw you right out of here,
but you know what?
- O.J.: Your husband's watching, better watch it. [laughs]
- You've done it to me.
Can I invite you to a party?
- Yeah, sure, I'll be there.
- Woman: His friends would call it the O.J. effect.
They would say, "Yeah, you got O.J.'d."
Being O.J.'d is being charmed.
The confusion that you feel
after you've been in his presence,
I don't think he was not guilty,
but I was in touch with the fact
that I wanted to think he was not guilty.
- So those are the types of characteristics
that really fall within the interpersonal domain.
Another domain is the affective traits of psychopathy,
and so what's meant by this is a general sense
of shallow affect, either a lack of depth in emotion,
so they might express or feel certain emotions,
but very briefly in a fleeting way,
or a lack of breadth in emotion,
so they actually don't feel a lot of emotion,
but might feel certain ones like anger very strongly.
You also tend to see with psychopathy,
individuals displaying a lack of regret
about the decisions that they've made
and the implications for themselves,
and remorse, the effect on other people.
And very characteristic is a general sense
of a lack of empathy or callousness.
So this next video, if it plays,
is an interview with someone who is on death row
for murdering a family.
They're gonna go through a few details
that can be somewhat brutal, so I just wanna warn people.
But I want you to listen, if you're willing,
to how this man describes his emotions.
It's almost like a drug, an adrenaline rush.
You don't hear the types of words
that we would typically associate
with fear, anger, or sadness.
And then when challenged or confronted
with difficult information,
how the interviewee really shuts down
and doesn't even engage with the interviewer.
- Man: When you kill someone.
- Man: It's just like that drug, I'm after that drug again.
I don't have a on and off switch,
I'm just after that drug.
I'm after that feeling.
[tense music]
- Narrator: During the beating, Elaine Dardeen
went into spontaneous labor, giving birth to a daughter
who investigators believed to be alive at the time.
The new baby was also beaten to death
and the body of Dardeen's husband turned up a day later,
shot three times in the head.
- Okay, and so then the last set of characteristics
that we associate with psychopathy are pretty common
across a lot of individuals
who find themselves in the criminal justice system,
and these are impulsive and antisocial traits.
So what makes this different in individuals with psychopathy
is that they generally
are showing a lack of decision-making
that considers future orientation,
so not considering the consequences
that might result from their behavior
for the next day or a following month.
So they might quit jobs frequently
and not have another one lined up.
They might move on a whim and not think through
these types of decisions.
But they don't always show kinda the classic impulsivity deficits
that you would expect to see on a lot of neuropsych tests.
So they're not traditionally showing
cognitive control problems in the way that you would see
with other types of individuals
who very classically have impulse control problems.
In terms of antisocial behavior,
you see this starting actually quite young
in individuals with psychopathy,
with an average age of onset of around five or six
of beginning to engage in some sort of
criminal or violent behavior.
I'll never forget one of my first interviews
was with someone who's currently
incarcerated at Dodge Correctional,
and he said the first time he stabbed someone
was when he was four,
and he stabbed his preschool teacher with scissors.
And so you begin to hear these stories
that can be quite intense,
and then they start very early in life.
The other really interesting thing
about individuals with psychopathy
is they actually are quite versatile
in terms of the crimes they commit.
So they tend to be kinda the Jacks and Jills of all trades
when it comes to criminal activity.
You see on average individuals with psychopathy
committing at least six different types of crime.
So this might be a drug charge, an assault charge,
arson, fraud, miscellaneous charges.
And so they don't tend to be specialists
in terms of their crimes,
and this is one of the common misconceptions
that serial killers are most often psychopaths,
and that's not generally true
because most serial killers are actually specialists.
Their job is to kill people.
And that's not what you tend to see
with individuals with psychopathy,
who tend to just kind of commit crimes on a whim
in almost the same way that
we've talked about their impulsivity.
So hopefully, fingers crossed,
my favorite video clip is coming up,
which comes from HBO's documentary about Robert Durst.
So for those that are not familiar,
Robert Durst comes from the Durst family
who owns a lot of real estate in New York City.
So he's very well-off, very wealthy.
At the point that this clip is going to start,
he was on the run from the police
for potentially killing his landlord.
- Narrator: Police searched his rental car outside
[camera flashes]
and found two loaded guns,
[camera flashes]
some marijuana,
[camera flashes]
$38,000 in cash, and an ID for one Morris Black.
- Man: Why would a guy with $520 in his pocket
and $37,000 in the trunk
walk into a Wegmans and steal a sandwich?
- So just for context, Wegmans' hoagies are about $8.50.
They're very good, but I'm not sure
they're worth potentially getting caught by the police.
But that kinda last question that this documentary asks
is really at the center of a lot of the work we do.
Like how is it that if you have the means and resources
to do something legally,
that you might make a decision that
we would all kinda consider shocking
or defying any sort of logic?
So when we talk about psychopathy,
we're really talking about individuals
that are displaying these two types of traits,
the Factor 1 traits being
interpersonal and affective traits,
and the Factor 2 traits being impulsive and antisocial.
These traits combined is what we would consider psychopathy.
It's represented about 1% of the general population,
which is a similar rate to schizophrenia,
but about 20-25% of currently incarcerated individuals.
We usually, particularly within a criminal justice setting,
will use Hare's Psychopathy Checklist Revised,
which is an interview that essentially covers
all of those characteristics that I just described to you.
We then score the 20 items and are able to get
a continuous score anywhere from 0 to 40,
and then also use a clinical cut score
of 30 or above in the United States
to be able to assess psychopathy.
And keeping in mind these two sets of characteristics
is really important because if we look at any one set alone,
we actually might confuse it with other disorders.
So for example, the interpersonal
and affective characteristics overlap substantially
with narcissistic personality disorder,
particularly in terms of the callousness
and lack of empathy.
But generally, you don't see
in narcissistic personality disorder
an increase in antisocial or certainly criminal behavior.
Similarly, if we were to look at Factor 2 traits alone,
the impulsive and antisocial traits,
this substantially overlaps
with antisocial personality disorder,
which really is similar to psychopathy,
but without the interpersonal and affective traits.
And so you commonly would see these types
of externalizing, impulsive, and antisocial behaviors
in these two disorders.
So if we look at just the behavior alone,
it might seem like these disorders are similar,
and it's really looking at the mechanisms
and considering psychopathy as really
a combination of these traits
that allow us to see it as a separate type of disorder
that's important to consider in its own right,
particularly in the eyes of the criminal justice system.
So now I'm gonna talk a little bit about how psychopathy,
then, is viewed in the eyes of the law currently
and how some of the science that we've been doing
might challenge that view.
So psychopathy currently is not considered
a form of serious mental illness in the eyes of the law.
That is more commonly something like schizophrenia,
a mood disorder, bipolar disorder,
some anxiety disorders, or post-traumatic stress disorder.
And because of this, it's rarely considered
in terms of competency or culpability hearings.
So it would not be possible
for an individual with psychopathy
to be considered not guilty
by reason of mental defect or insanity.
Sometimes psychopathy is considered
at a mitigation stage, so at the sentencing phase,
particularly because we know that psychopathy
is associated with genetic risk.
You see a heritable risk factor of about 0.7
for the callous emotional trait,
so it seems to load quite heavily in terms of genetics.
There's also a lot of work that suggests
that individuals with psychopathy experience
early life traumas, and there's a lot of work,
and some I'll talk about today,
suggesting that there is no neurobiological aberrancies
in individuals with psychopathy.
So despite all of these characteristics,
which commonly we would consider in a mitigation stage,
the success with which psychopathy
is considered a mitigating condition is inconsistent.
So it's sometimes tried, but the application of it
and the outcome of whether it actually reduces a sentence
is not totally consistent.
And so we might wanna consider, then,
how their knowledge base
about underlying mechanisms for psychopathy
might challenge the position of this disorder
in the eyes of the law.
So some of the things we know about individuals
with psychopathy is that they really show difficulties
with emotion processing and emotion recognition.
But there's a nuance to their difficulty,
so for example if you ask individuals with psychopathy
to identify this emotion, which is showing fear,
but it's somewhat ambiguous,
they tend to be pretty bad at that.
But if you show them a classically
very clear fear face,
they are able to do that emotion identification.
And so while psychopathic individuals
certainly have difficulties processing emotion
and have difficulties identifying emotions in others,
there are some circumstances in which they're able to do it,
and it's essentially when it is very clear,
which emotion typically is not,
or very obvious in the sense of the goal,
the thing that they are trying to attend to,
which again very rarely is emotion
the thing that we're walking around attending to,
unless you're basically in a therapy session.
That's the only time where I think
focusing on your emotion is your goal.
We also see that psychopathy is associated
with deficiencies in the amygdala,
so this is both structural and functional evidence,
and ventromedial prefrontal cortex
across a variety of contexts and different types of tasks.
So there is really strong evidence
that there's something disrupted in emotion processing
in individuals with psychopathy.
We also in our lab recently completed
a connectivity analysis using graph theory
to look at hubs of emotion processing
and whether there are certain regions of the brain
that might act as essential communicator
to other regions of the brain.
So you might imaging saying,
"Well, is this red dot here a hub of emotion processing
"that might then communicate to other regions
"that would be important for considering that information?"
And essentially, we see that individuals with psychopathy
are really less likely,
so looking at this upper region,
to have emotion networks as a central hub
of neural communication.
This was just in resting state using graph theory.
We've now begun to replicate this
in a sample of nine to ten-year-olds
who are showing callus, unemotional traits,
and see that the lack of emotion processing
as a hub of communication predicts, then,
their deficiencies on the types
of emotion identification tasks that I just described.
So this is one set of difficulties
we see in psychopathy.
Another set is not just that they seem
to be deficient in emotion processing,
but they seem to be really good at goal-directed behavior.
So individuals with psychopathy
are amazing at focusing on their goals
and essentially screening out any distractor.
So an example of this is if your goal
was to focus on the letter N,
but the red box suggested that you might receive a shock,
all of us would still tend to the red box
'cause we wanna know if we're gonna get a shock or not,
whereas individuals with psychopathy
basically ignore the red box and just focus on the N.
But if you ask them to focus on the red box,
they can do that just fine.
So again, suggesting that they can focus on things
that might be threatening or emotional,
it just depends on their goal.
In a non-emotion context,
if you are asking individuals with psychopathy
to name the color of the box here, blue,
they're actually gonna show
less interference with the word red.
All of us might stop and pause a little bit
because blue and red are not the same thing,
we have to think about it, use a little cognitive control.
Individuals with psychopathy show
markedly reduced interference.
And in line with that, we actually see
that individuals with psychopathy show
increased activity in the prefrontal cortex,
particularly during decision-making tasks,
including moral decision making
and more complex emotion tasks.
In the same graph theory paper,
we also recently were able to look at
how efficiently information is communicated
in individuals with psychopathy starting with resting state.
And so you might imagine one way
for these three regions of the brain to communicate
is in a very linear type of way.
So information goes from one hub to the next, to the next,
and the advantage of this is that it's quick communication
with dots or hubs that are right next to one another,
but that over time there is a loss
of fidelity in information,
and it's actually quite inefficient
if you end up wanting to communicate
with the hub that's all the way up here.
So this is what we might call
a line-like communication pattern.
The alternative is something that's more
like this red or maroon color,
which is a star-like communication.
There's one central communicator
that then receives all the information
and communicates any information,
neurally or otherwise, out to all of the other hubs.
So my grad student, when he presents this information,
basically says it's like how all the grad students
come and talk to me,
and then I just scream out at all the other grad students,
which, you know, I'll take it,
but I'm not sure as he means it
as nicely as I mean it in this instance.
And so we can be able to quantify for each individual
how well their neural communication
is something that is line-like,
the black and white dots,
or more star-like, with the star-like being
a more efficient pattern.
And what we see is that individuals with psychopathy,
again, this upper region here,
are actually showing more efficient organization
of particularly dorsal attention networks.
This was just resting state,
but similarly we're now replicating this
to suggest that this efficient pattern,
while on the surface might seem like a good idea,
kinda too much of a good thing can be bad.
And so it ends up being essentially hyper-efficiency
that is then predicting the reduction in interference
in some of the other types of task that I suggested.
And while it, again, might be good
to not be as distracted by other information,
information outside of our goal can be very informative.
It can cause us to stop and reflect.
In Robert Durst's case, if he had just taken a moment
to think about the potential consequences
of "What would happen if I steal a hoagie
"in this high-security Wegmans,
"and might that end me up in prison?"
That is essentially hyper-efficiency,
in the moment getting his goal,
but leading to a long-term consequence.
So a lot of the work that we had done up to this point
really looks at basic processing
and in some instances, just about
simple resting state connectivity.
And we were interested in seeing whether some of this dynamic
of looking at what your goal is in the moment
versus using that information for a future
might translate into some other types of emotions,
like regret, that are really important
in the context of the criminal justice system.
And so a more complex emotion like regret
can be considered in actually two different ways
based on decision and neuroscience.
One way is commonly what researchers and clinicians
will refer to as retrospective regret.
That is when you do something and you learn
you could have done better or differently
once you find out the outcome.
And that is distinguished, again, conceptually and neurally
from what we call prospective regret,
which is the use of the experience of regret
to then inform or change your decisions moving forward.
And so to look at this particular type of,
set of regret options,
we ran a counterfactual task, which I will show briefly.
Essentially, individuals just picked a circle
and were told that randomly a ball will bounce around,
allowing them to win or lose points.
And then they were asked to rate how they felt
about winning or losing points
when they found out their outcome,
rate how they felt when they found out
what they could have gotten if they picked the other circle,
and to do that repeatedly over time.
So let's see if this one works.
So I'm selecting this circle.
For some reason...
The video seems very strange, I'm not sure.
It looked better in real life. [laughs]
So I get 70 points.
And I'm asked to do this repeatedly.
So we're able to actually measure a few things here.
We can measure how people respond
when they find out what they got.
So basically in the instance where
the circle shows that I got 70 points, how do I feel?
And essentially, what we see is that
individuals with psychopathy actually report
more regret when they find out what they got
and more pleasure when they find out
that they got something positive,
like 210 points instead of 70 points.
Then we can also look at the regret score
that happens when you find out
what you could have gotten if you picked the other circle.
So in this instance, I should be pretty pleased
that I got 70 points 'cause I could have lost 70 points.
And what we similarly see here in the red
is that individuals higher on psychopathy
are showing more emotional responses,
in this instance regret,
when they found out what they could have gotten
if they picked the other circle.
And so kinda similar to the basic
emotion threat processing information
that I just described,
when you ask individuals with psychopathy,
"How are you feeling in response
"to this information right here?",
they actually respond similarly,
and in some instances even more intensely
than individuals lower on psychopathy.
But the question is,
do they do anything with that experience?
And that's where we end up finding
that individuals with psychopathy in the red here
essentially show no use of prospective regret signals.
So while in the moment they show retrospective regret,
that doesn't inform, then, future decision making
on the next trials of the task.
We were able to show that this particular type of phenomenon
in individuals with psychopathy
also predicted the number of incarcerations that they had.
So again, if you continue to make
decisions in the moment,
you might know what you're doing,
but in the future it's not being affected
by that previous experience.
So at this point, if someone's brain
tends to process information differently,
if they're actually seeing the world at a different speed,
which would be a potential translation
of the efficiency data,
and they have a disconnect between
what they did in a certain moment and what they're doing,
is it possible that actually in the moment,
the time of the crime, the thing that the law cares about,
that they actually don't understand
whether their behavior was appropriate or not,
or that they actually have a disruption
in a cognitive capacity
that undermines them being of sound mind,
which the other kind of legal phrase
that we tend to think about?
And so rather than being hyperemotional,
they're actually hyperrational.
But it's still an overexpression of a particular type of capacity
that then undermines regulated behavior.
And is it possible that showing
these kind of fundamental, at-rest neural differences
that occur both structurally and functionally
is consistent with what the law would consider to be
an extreme mental and emotional disturbance?
And what we usually think about in the law
is emotional disturbance that, again, is hyperemotional,
that you were manic and you had so much energy
and you had so much emotion
that it led you to commit a crime.
In this instance, we might actually
be talking about something that's the opposite,
but equally detrimental.
You didn't experience enough of the emotion
to be able to use that to affect your behavior.
So we're kinda left at this point,
certainly within translating science
into the criminal justice system,
with asking a question of whether
we're handling individuals with psychopathy appropriately.
And that we might need to think about
whether distinguishing kinda the knowing right from wrong
that psychopathic individuals
can often tell us they know what they did was wrong,
how that might be different than what's happening
at any particular moment
or how they're processing information,
while also in the context of understanding
that these individuals are committing
callous and heinous crimes at times,
and so how do you most appropriately protect society,
which is part of the goals of the criminal justice system.
So in the next section I'm gonna talk about
how we typically manage individuals
with psychopathy in treatment
and how some of our understanding
of the underlying mechanisms of their behavior
might inform new strategies.
So as I've already mentioned,
individuals with psychopathy are overrepresented
in the criminal justice system,
with about 25% of incarcerated individuals
meeting a formal diagnosis of psychopathy.
You tend to see that individuals with psychopathy
are given longer sentences than other individuals,
and that they disproportionately account for
the days in segregation and the disciplinary infractions
that they're receiving while they're being housed
within a jail or prison.
And so similar to some of the emotion
and cognition work we've done,
we were kind of left with the question
of is it possible that how individuals with psychopathy
are taking in information might affect
how they are navigating the criminal justice system,
and particularly during their incarceration?
And so one of the phenomenon that you might be interested in
is that do individuals with psychopathy
have a capability of taking the perspective of other people?
Can they understand that what they do might affect others,
or that how they are being portrayed
or they're interacting with others
affects some communication difficulties
that they might be having?
And so similar to the regret work
because psychologists and neuroscientists
like to make things complicated and parse things a lot,
there are actually lots of different parts
of theory of mind and perspective-taking
that we can think about.
And so one is called controlled theory of mind
or controlled perspective-taking,
and this is being asked to deliberately
take the perspective of other people.
And up until this point,
this is where most of the work in psychopathy had been,
it's using kinda the classic Sally-Anne task
where you see a narrative about this little girl
who's in a kitchen and she leaves the kitchen
and her mother comes in and moves the cookies,
and you're asked "Does Sally-Anne know
"where the cookies are?"
And basically your job is to take Sally-Anne's perspective.
Is there any way she could have known
that her mother moved the cookies
when she left the kitchen?
So it's very deliberate, it's very explicit.
And what most of the work had shown at this point
was that individuals with psychopathy can do this.
So it made it seem like, well, psychopathic individuals
can take your perspective and they just don't care,
and so that's why they're doing
all of the things that they're doing
that might con you out of your money
or hurt you in some sort of way.
But there's this other part of perspective-taking
called automatic perspective-taking,
which is more effortlessly having
the perspective of others affect your own.
So for example, my job right now
is actually not to take your perspective.
My job is to deliver this talk
in somewhat of a coherent fashion.
But seeing people nod along or falling asleep
or rolling their eyes
might influence what I say next or what I do,
and that more implicit process might then change my behavior.
And we actually tend to see that this
automatic tendency develops starting very early,
including infancy, and begins to grow neurobiologically
over time in different structures
than what you might expect from a more controlled process,
which typically we associate with the TPJ
or other sort of kinda more general
theory of mind regions or circuits.
So we wanted to be able to test
is it actually that individuals with psychopathy
are totally capable of taking peoples' perspectives,
or is there something, again, more nuanced going on
that might help us understand why it is
that they seemingly ignore the thoughts and feelings
of other people?
And so to do this, we used an avatar task
that had two conditions.
One modeled a controlled type of setting
where we told individuals that you are
supposed to take his or he's perspective.
This was currently collected in a sample of all men
who were incarcerated, so that's why it's always he.
The avatar was wearing the exact same type of outfit
or jumpsuit, whatever you wanna call it,
as the people that we were testing,
because there's been a lot of work
showing that theory of mind and perspective-taking
can be influenced by in-group and out-group bias.
So you're told take his perspective,
and then you're shown a number, two here,
and you're asked yes or no, can the avatar see two dots?
And so the answer here would be yes,
the avatar can see two dots.
Then in the automatic condition,
you are told to take your perspective, the number two,
and the question yes or no, can you see two dots?
And the correct answer here is actually no.
So you can see three dots,
but the avatar sees two dots here,
unless the avatar had eyes in the back of his head,
and this creates interference for people.
Because the avatar sees two dots but I could see three,
I tend to be a little slower.
People are very accurate at this task,
so it's not like it translates
into not being able to give the right answer,
it just slows us down and causes us
to stop and think a little bit more.
So what we found, essentially, was that
individuals with psychopathy were able
to do the controlled processing.
When told deliberately,
"Take the perspective of the avatar," they can do it.
This replicates previous research.
But when put in the automatic condition,
"Take your perspective," they essentially showed
less interference from the avatar,
which is this region right here.
So while they have an ability to engage in perspective-taking,
they have less of a tendency to automatically do so.
And this predicts their engagement
in interpersonal crimes like assaults,
but not crimes that don't involve other people
like a theft or some sort of destruction of property
that's not more face-to-face in terms of an interaction.
And so what this might suggest from a management perspective
is that correctional officers or other staff
actually shouldn't assume that individuals with psychopathy
can see the environment
in the same type of way that they do.
Now, we could think about very nuanced
communication strategies
or changes in how you handle individuals
that leverage our understanding
of how they're doing some basic process
like perspective-taking.
And so again the question becomes,
are psychopathic individuals actually unmanageable,
or is it just that we need to work with them differently?
And so as of actually yesterday, we got approval and funding
to start a project that actually trains COs,
corrections officers, in communication strategies
that kind of works off of some of this type of work
of adjusting how they explain their decisions,
particularly when they're giving
a disciplinary infraction to someone
who's currently incarcerated.
And rather than asking something more general
that requires some sort of automatic perspective-taking,
like, "Do you know what you did?"
Actually asking very deliberately,
which we know psychopathic individuals can do,
"What do you see from my perspective?"
Or "What happened from my perspective?"
So this would just be one example.
It's not like this is the whole training.
But essentially, using a lot of this type of work
to be able to think about alternatives for communication
that would allow us to capitalize
on what individuals with psychopathy can do
and circumvent the things that they have difficulty doing.
Similar to some of the management difficulties
that we have with individuals with psychopathy,
we also see that they are not
as responsive to treatment as you would hope.
So most of the treatment approaches in psychopathy
tend to try and use what traditional therapies would be,
contingency management, so rewarding more positive
or pro-social behavior,
cognitive behavioral therapy,
asking individuals with psychopathy
or others to think about their feelings,
to think about their thoughts and challenge them.
And what we generally see is that
they're minimally effective at best.
We tend to see that individuals with psychopathy
drop out sooner if they have a choice,
and that they're generally noncompliant.
There's some work to suggest
that if they do show positive gains,
they never return to what we could consider
kind of a normal baseline.
So they might show some improvement,
but it's not going to return them to a level
that we would consider more typical functioning.
And there are a couple studies to suggest, actually,
if you give psychopathic individuals
the traditional treatments, they don't get better.
You actually make them better at being psychopaths.
So they use all of the things like talking about emotions
and challenging their thoughts and feelings
to more effectively con and manipulate other people,
which generally is not our goal of treatment,
so is not a great outcome for the state of treatment.
And so again, we're kind of left with this question,
are individuals with psychopathy actually untreatable
or is it that they're just not receiving
the correct treatments?
And a lot of what the traditional treatments require
is some people to be, certainly,
aware of and able to recognize their emotions
to then be able to manage them.
For individuals to be able
to take other people's perspectives
or recognize how their behavior might affect others,
and certainly for people to notice
patterns in their behavior.
But we know with psychopathy,
all of those things are dysfunctional.
They have difficulty identifying emotions,
they have difficulty, certainly, automatically seeing
how their behavior might affect others,
or incorporating another's perspective.
And they certainly have difficulty
connecting all the dots of their life, essentially.
It's almost like each moment they come upon
is essentially brand new.
And so we're asking them to engage in treatments
that really are not going to be likely effective
if we just take a moment and think about
the neurobiological difficulties that they're having.
So what we wanted to do was try and say,
"Okay, well, we have two things.
"We know that individuals with psychopathy
"are probably disproportionately put in treatment
"when they're in the criminal justice system,
"'cause they are seen as severe and difficult to manage,
"and so they get referred frequently
"to treatment programs.
"But we also don't have the most effective treatments.
"But what we do have is decades of amazing research
"that allow us to understand what's going on
"with how they think and feel emotions.
"And so can we kinda combine those two?"
So we developed a computerized treatment
to be able to try and train and target
the neurobiological and cognitive-affective deficits
that we see in psychopathy.
So I'm just gonna show you
the psychopathy arm of this training.
Essentially, all of these tasks required
that you learn to integrate and notice contextual cues.
So the one task, for example, that was given on the computer
is this reversal learning task,
where you see an elephant and you see a giraffe,
you start winning points by selecting the elephant,
and then all of a sudden, you start losing points
when you select the elephant
and you actually need to switch to select the giraffe
'cause that's the one that's gonna win you points.
And usually, psychopathic individuals
are not good at this task.
So there's a lot of work from James Blair's group
that suggests they have reversal learning deficits.
And what it comes down to is that
they're really having difficulty
tracking the contextual information.
They're just focused on whatever the goal is at the moment
and not noticing the switch in the contingency.
In the next task, we had people
have to respond to whether the string in the middle
was letters, numbers, or both,
but they pressed one button if it was a green box
and another it was a yellow box.
So to do this task well, individuals with psychopathy
have to attend to both the goal, the thing in the middle,
and the contextual cue, the color of the box.
Again, there had been work prior to this stage
to suggest that psychopathic individuals
do pretty poorly on this task
because they have difficultly integrating
the two pieces of information.
Then in the last game that we had them play,
we showed them emotion faces
and then eyes looking left or right.
And on most of the trials, you only had to tell us
are the eyes looking left or right?
So if their eyes are looking left,
you press the left button,
and if the eyes are looking right,
you press the right button.
But each day you came to play this task,
you were told about your target emotion.
So today's target emotion is fear.
If the face is showing fear,
you actually press the button opposite of the eye gaze.
So if the eyes are looking left,
you really press the right button,
and if the eyes are looking right,
you really press the left button.
But only for the fear faces, not for any other.
So to do this task well, you have to notice
both the eye gaze and the emotion on the face.
In a previous study, we had shown, again,
psychopathic individuals don't do very well on this task
because they had a lot of difficulty, certainly quickly,
integrating the emotion on the face and what their goal is,
which is really just focus on the eyes.
So we had people come in,
this was collected in individuals
who were referred for treatment
who were currently incarcerated but hadn't received it yet.
All of the participants had
a substance use disorder diagnosis,
and so they were generally being referred for treatment
related to substance use problems.
We were able to do a clinical interview
and evaluate them for psychopathy,
and then give this training, which we call
the training to attend to contextual information,
once a week for six weeks.
They completed a series of tasks before the training,
the training took an hour,
and then they came back after the six weeks
and completed the same tasks again.
And then some of the individuals with psychopathy
were randomized into another treatment
that had nothing to do with contextual processing.
So it was just how do you manage your emotions
and not overreact to them?
All computer-based, all pretty simple.
No real connection or other therapeutic discussion.
They were shown graphs at the end of each day
of their progress, which actually tends
to be very motivating when you're not doing very well.
Most people wanna try and improve and earn more points.
When you are doing well, you wanna keep up with it,
and when you're kind of being stagnant,
you're told it sometimes takes a lot of effort
to learn something new.
So really, the only motivational feedback
were these graphs that were shown at the end.
So, first looking at the training tasks,
again, six weeks once a week for an hour,
we see that individuals with psychopathy
in the white bar here,
who received the attention to context training,
showed significant improvement over the six weeks.
But if they received the training
that was not meant for them,
the affective cognitive control one,
they did not improve.
And this was interesting,
but it really could've just been a practice effect
because individuals with psychopathy
started out so poorly on all of the tasks.
When you kind of suck at something,
the only way to go is up.
And so while this was exciting,
this wasn't like a, "I could retire" moment.
So what we did was look at the pre-post task,
the tasks we gave right before they started the training
and then that they completed right after.
And these tasks included collecting startle potentiation,
which might be an indirect measure
of amygdala responsivity,
different ERP or event-related potential responses
that were markers of how well
they attended to certain information,
and other tasks that other researchers had shown
might be deficient in individuals with psychopathy.
And we essentially show, again,
that the individuals with psychopathy
who received the attention to context training
showed small but still significant improvement
pre and post.
So while before they might have shown a deficit
in startle potentiation in response to threat,
they now no longer were showing that deficit.
But only if they received the deficit-matched training,
not if they received the one
about controlling their emotions.
And again, this is really interesting.
The issue is these are all laboratory-based tasks,
and while we are showing change,
what does that mean for real behavior?
So the other thing that we were able to do
because everyone was currently incarcerated
was collect information about disciplinary reports
that they might have gotten while incarcerated.
And so while you're in prison,
you could get a disciplinary infraction or a ticket
for a variety of things.
It could be for not having your shirt tucked in,
it could be for standing out of line or not showing up,
or it could be for like shanking and stabbing someone.
So we have a number of infractions that we can examine,
and we started by looking at the severity of infraction
because whether you get a ticket or not in prison
is somewhat dependent on what unit you're on
and what correction officer you're dealing with.
But the level or the severity
is a little bit harder to personalize.
It's supposed to be more objective, supposed to be.
So what this is showing you is an absolute value
of improvement two months post the training
on the severity of conduct reports,
and what we see is that individuals
who got the attention to context training
who had psychopathy
showed less severe, so more positive means less severe,
conduct reports two months after receiving this training.
And again, if they got the one
that was more about just generally controlling emotions,
they really didn't show any change.
So what we're able to see here, really,
is that individuals with psychopathy
are capable of processing contextual cues
like emotion, like punishment, like interference,
which is actually hard to change.
We basically wanted to make something they're really good at
a little bit worse so that they could behave in a way
that might be more controlled and considerate of information.
And that we're able to leverage our understanding
of the basic cognitive-affective mechanisms
to develop treatments that more directly target
the types of deficits they have.
Now I wanna be clear, I don't think
giving every incarcerated individual an iPad
is going to solve our problems.
I think what this type of treatment likely might do
is allow for some practice and development,
neurobiologically, of individuals with psychopathy
to kinda normalize how they process information,
or certainly build compensatory strategies
for taking in information in a more typical way,
and then refer them to the traditional treatments,
which we actually know in the criminal justice system work.
Like cognitive behavioral therapy, contingency management,
if given the way that they should be given,
work for individuals who are incarcerated,
just not individuals with psychopathy.
And so we might need to give them
a little bit of pretreatment
before we put them in the typical types of treatments.
And then ultimately if we could do this,
it really raises questions about the appropriate facility
for individuals with psychopathy,
and this is something
that Europe does much better than the United States,
where actually more frequently, individuals with psychopathy
are put in a forensic mental health center,
not in a traditional jail or prison
that we might examine here.
So overall, what I've mentioned to you
is that psychopathy is certainly
disproportionally represented in the criminal justice system,
and this one syndrome accounts for a lot of the cost of crime
because of their repeated acts, repeated incarcerations,
and referrals to treatment, even though the treatment
is not effective for these individuals.
And that we have seen a lot of work, again,
from our lab and others that suggests
that these individuals are not seeing or interacting
with the world in the same way that other people are.
But that they can experience emotion
and they can take other people's perspectives,
and by having this more nuanced understanding,
we might be able to actually consider
different ways for communicating or treating these individuals.
And that by bringing all of that work together,
we could understand that their behavior is changeable
and is fact is not something
that we should just give up on and not consider
as a disorder that is worth effort
and worth consideration for improvement.
So I wanna thank you all for listening,
and I also wanna thank Mike, certainly,
for inviting me here.
It's so fun to be back in Madison.
For my lab, who are amazing and do a lot of this work.
For Wisconsin, who started my work in corrections,
and then Connecticut who has allowed us
to build a lab inside of the prisons there.
And then all of the funding agencies who support this work.
So thank you.
[audience applauding]