The State of Psychology in Ecuador

Psychology here in Ecuador is a strange thing. Firstly, there is currently very little legal protection over the professional title, anybody with a degree in psychology is a ‘psychologist’. I could legally set up private practice here as a Clinical Neuropsychologist if I wanted to, despite having no clinical training. Indeed there are lots of ‘Clinical Psychologists’ here who have no clinical training. Their titles being based on postgraduate academic qualifications from abroad. Ironically, those who do have clinical training usually only have an undergraduate degree in ‘Clinical Psychology’. So most trained clinical psychologists have no postgraduate qualifications.

There is also a tendency to faddishness. Sub-academic pseudo-psychology is peddled by numerous life coaches, brain trainers, aroma therapists and other cranks. When professional psychology is considered an undergraduate degree, then this is understandable. Many students are just not sufficiently trained to spot pseudoscience. Not surprisingly, what passes as mental health care sometimes borders on superstition and charlatanism. For example, I’ve heard of some ‘clinical psychologists’ using tarot cards as part of their therapy, others horoscopes. Many use hypnotic regressions to ‘past lives’.

How can a country have gotten to a state where graduates (aka Clinical Psychologists) think that tarot and horoscopes are real psychology? One reason is that supernatural beliefs are very common here anyway, so things like tarot are respected by the public and tend to go unchallenged. Another issue is the lack of expertise in Ecuador, there are simply not enough people in the country with doctorate qualifications to staff the universities. Thus, many professors have only masters degrees, and of varying quality at that. Worse, for many years there were few checks on the validity of qualifications, and so there are professors here with PhDs that were bought over the internet. These frauds are the likely source of much of the full-blown mumbo jumbo that passes as psychology. When ‘real’ psychology is taught, it’s frequently based on pop-science paperbacks and TED talks, with little distinction made between entertainment and academia.

Fortunately, the current government is taking steps to improve standards in higher education. For example they are recruiting more experts from abroad and sending Ecuadorian students to top universities in the USA and Europe for postgraduate training (there are very few postgraduate opportunities within Ecuador). The students get their fees paid and generous grants if they agree to return to Ecuador afterwards. The government is also checking all professors’ qualifications and adding the details to an open-access database, so the public can check who really has professional training. In addition, legal steps are being taken to require a postgraduate qualifications for professional psychological practice. With time these steps should improve the current dire situation nationally.

Independent of the government provision, at Universidad San Francisco de Quito we now have the best trained psychology faculty in the country, including several professors with (real) doctorates from respected universities in North America. Some of these are Ecuadorian, some foreigners. We have brought skills in research and clinical work that have generally not been available in Ecuadorian psychology departments before. The potential therefore exists to greatly improve psychology training, and over time, the quality of mental health care provided by the country's next generations of psychologists. 

Quito Brain and Behavior Laboratory

Yesterday I gave a presentation at the inaugural Brain Meeting of the Quito Brain and Behavior lab. The presentation was on neurocognitive function and socioeconomic status. Not everybody’s cup of tea, but it attracted about 20 academics from various fields. That was what we wanted, there are lots of people here who want to do some brain based research, and the monthly Brain Meetings are a way to get them together. Hopefully, this will encourage research and collaborations. The meetings will be held at 4pm every first Tuesday of the month during the teaching semesters.

The advertising poster for the inaugural Brain Meeting of the new lab. 

The Brain Meetings are organized by the Quito Brain and Behavior lab, which is being set up at Universidad San Francisco de Quito by me and Dr. Ana F. Trueba, a psychophysiologist. With her interest and expertise, and my background in neuropsychology and psychopathology, we are forming an international class research group on brain sciences. We both have a lot of experience in running projects, and publishing data in international journals, so forming the lab is helping us to extend this. In addition we have a paid research assistant and several graduate and undergraduate volunteers who are gaining research experience in the lab. Recently an expert in genetics and cognitive neuroscience also joined the group. 

We currently have two projects running, one on predication of academic performance with neuropsychological tests, and the other a validation study on various tests of premorbid function. We are also developing a new battery of cognitive tests that could be used in various clinical studies, for example to measure cognitive decline in dementia. The development of these tests is important because there are currently few assessment tools that are validated for use in Ecuador. By producing our own, we can facilitate future research. We also have studies planned on the role of cortisol and inflammation markers in sub-clinical psychopathology, and some experimental studies of the effects of the hormone and neuromodulator oxytocin. As more collaborators join us, the number and range of projects will increase.

The lab houses a reasonable neuropsychological test library, in fact possibly the biggest in Ecuador. This includes several commercial tests (such as Wechsler tests, Delis Kaplan Executive Function System) as well as many more experimental tests. In addition, we already have some physiological recording equipment, and the university is in the process of buying eye-tracking systems, which will be used in neuromarketing research. So there is plenty of potential. The next Brain Meeting will be held on March 3rd at 4pm at Universidad San Francisco de Quito. 

“Street Children” Research

The concept of ‘street child’ is a difficult one. It includes both homeless children and those who have homes to go to, but spend a lot of time working in urban environments. In fact, it also includes many, many other life contexts. However, it has been a convenient label to describe the poor children often seen unaccompanied in many of the cities of Latin America, Africa and Asia. It’s a term easily understood by the public and hence favored by charities that appeal to the public. However, possibly a more accurate term would simply be urban poor children.

Whether we refer to them as ‘street children’ or simply ‘urban poor children’ is to a large extent a gentile discussion for armchair sociologists. It makes precious little difference to the tens of millions of children worldwide trying to get through their days. Nevertheless, research is needed to inform professionals involved with street children and to combat the abundant stereotypes of street children (generally negative) and present the true situation, regarding the extreme poverty, mental illness, resilience etc. of this significant global demographic.

We have recently published two journal articles on the lives of street children. Most recently a review article in the Psychologist. This examined some of the strengths as well as weaknesses of development associated with street connectedness.

Our recent article in the Psychologist made the front cover. The photo shows a boy who works selling gum to motorists in Quito, Ecuador.  

The other article, published in the InternationalJournal of Mental Health and Addiction describes a study of former street children in Quito. This was research involving three students as research assistants in which we estimated levels of post-traumatic stress disorder (PTSD). We found it to be shockingly high at around 60%. PTSD is not just a mental health concern, it also has significant effects on brain development of children. Thus potentially affecting the course of their whole lives and the success or failure of their struggles with poverty. In fact, we are working on a third journal article looking at the effects of street-connectedness and poverty on neuropsychological development. It appears that, at least in the context of Quito street children, there are particular delays in the development of social cognition skills as measured by Theory of Mind tasks. Such tasks measure the ability to understand the contents of other people's minds. The data seem to suggest therefore that rather than driving specific development, street connectedness in children may delay development of some of the highest cognitive processes.

Many 'street children' are simply working because their families are very poor. Here we see a shoe shine boy working in La Paz, Bolivia

However, on the other hand, studies in Brazil and Bolivia have found the opposite, that street children do indeed develop some skills better than conventionally educated children. This is an interesting and important topic and we intend to continue the line of investigation here in Ecuador. 

Psychology in Suriname

Paramaribo, the capital city of Suriname, has hosted an international psychology conference this week. It has been focused on Caribbean issues, but to some extent this also includes Latin American issues. Although interestingly, Suriname is one of the few places that is in South America, but not Latin America, being mainly Dutch speaking. Although most delegates were from Suriname or Caribbean islands, there were a few international visitors from Europe, the USA, Asia, and me from Ecuador. In fact this was the first presentation credited to the newly formed Quito Brain and Behavior Lab.

The Caribbean Psychology Conference, opening ceremony being blessed by an Amerindian shaman.

I was presenting some of my work on neuropsychological function of 'street children', this is an issue relevant to several Caribbean nations. I've presented my data on PTSD previously (and also it's just been published), but this was the first presentation of the neuropsychological data. It was generally well received with a packed room of 40 delegates to hear my presentation. Although mine was one of only two or three neuropsychological presentations, indeed it was of only a handful that included data, the majority being mainly rhetoric driven. Nevertheless, I met some people doing interesting work and making such connections is the most important aspect of academic conferencing.

The Binaural Beats Project

Binaural beats are a curious phenomenon. If you listen to two tones through earphones, one to each ear, you can create a detectable pulsing sound. The pulse, or beat, is at the same frequency as the difference between the two tones. So for example a 400 hertz tone to the left ear combined with a 410 hertz tone to the right ear, produces a psychological beat sound at 10 hertz (i.e. pulsing 10 times each second). Therefore this beat doesn’t exist in either tone, and it’s not being heard by either ear. In fact it doesn’t exist in the real world, just in your perception. Furthermore, these beats can be detected in brain signals, they have been recorded in the cat inferior colliculus, amongst other brain areas, by single cell recordings, and in the human brain by electroecephalography (EEG). In fact, binaural beats have the potential to entrain brain waves, artificially altering the frequency of electrical brain activity.

These binaural beats have been known about for many years, however, recently the internet has made the audio tracks easily available. With a computer and earphones, anybody can listen to them via YouTube. And lots of people are, under the belief that you can improve concentration, learning, relaxation etc. The tabloid media have taken the opportunity to make a moral panic out of it, renaming it ‘i-dosing’, complete with horror stories of people over-i-dosing. In fact there is little evidence for the induction of psychological states with binaural beats, and the greatest danger may simply be of hearing damage if they are listened too at high volume.

The media´s typical ridiculous response to binaural beats

Nevertheless, in theory, if brain waves can be entrained, this would be a very useful tool in psychology and neuroscience. So research on this topic is needed. Together with a biophysics student from Escuela Superior Politécnica de Chimborazo in Riobamba, we have been testing out the potential of theta frequency binaural beats on cognitive function and emotional state. The experiment involves participants listening to electronic music for 15 minutes, and then performing a range of cognitive tasks designed to measure creativity and initiation. In addition their emotional states are recorded. In one condition there is a theta frequency binaural beat embedded in the music, in the other condition a very similar pair of sinusoidal waves that do not produce a binaural beat.

Data collection at Universidad San Francisco de Quito. Marco Lopez performs cognitive tests while the participant listens to the binaural beats. 

This research is ongoing. We’ll report what we find in a future blog post. 

The Scientist Practitioner Model

I'm not the only psychologist here at Universidad San Francisco de Quito, but I'm probably the only scientist-psychologist. There is a tendency here to focus heavily on therapy, which is fine. I´m sure good therapists do good work. My concern is that psychology has to be empirically based. A solid factual basis is needed so that what works is applied to clinical practice and what is merely psycho-babble is rightly kept out of the clinic. This is why all psychologists need to be trained as both scientists and practitioners.

This isn't anything new, the scientist-practitioner model in clinical psychology training has been highly influential in Europe and North America for decades. The basis of it is simply that any psychological practitioner must also be a capable scientist. There are many benefits to such an approach.

Firstly, psychologists who research keep themselves at the vanguard of the discipline. A professional career in psychology can last more than 40 years. Forty plus years of change and development. A psychologist who rests on their laurels will ultimately become an anachronism.

Secondly, psychologists need to be able to judge if their own practice is effective. Scientific training equips practitioners with a nuanced understanding of expectations, spontaneous recovery, placebo and nocebo effects. The history of medicine is replete with cases of ineffective, or even harmful treatments being continued because doctors lacked the clarity of observation to see what was really happening (think leaches, blood letting etc.).

Thirdly, even if psychologists don´t research or audit their own performance, they need to be evidence-based. Without real evidence to support practice, psychologists risk becoming merely psychological quacks, with their own versions of blood-letting and leaches. Being evidence based means being able to understand empirical research. Research published in reputable peer-reviewed journals. This means understanding research methodology, understanding statistics, and being information literate. An excellent book on this topic, written for medical doctors, but still relevant to psychologists is ´How to Read a Paper´ written by Trisha Greenhalgh (free PDF version here).

In fact, the list could go on and on. The scientist-practitioner model is a no-brainer.

Consequently I am trying to inject as much science as I can into the training of psychologists here in Ecuador. The irony of it all is that I am not a scientist practitioner myself. This is because I am an academic psychologist. I've never treated a patient, my training is all in research. A bachelors degree, PhD and several postdoctoral research positions. Nevertheless, my research has always been in clinical fields, mainly psychiatry and neurology.

As a first step I have introduced research projects as a key part of the assessment all of my courses. Again this has multiple benefits, researched projects have a significant validity that promotes deep learning, and simultaneously students are learning academic research skills. To facilitate this I have produced a detailed guide to writing psychology lab reports. This can be downloaded here.

But it's more than just lab reports. The internet revolution has thrown up more misinformation than information, people all over the world are being bombarded with nonsense dressed as fact. Students too often lack the skills to separate the wheat from the chaff, the nonsense from the fact. As scientist-practitioners we need to primarily rely on material published in peer reviewed journals, and this is something that I´m also emphasizing across my courses.  This skill is often called ´information literacy´. That can be a topic for a future blog post. 

UK, Ecuador, Japan then Ecuador again

This blog is about the psychology work I’m involved with here in Ecuador. It’s a not a comprehensive review of psychology in the country. Although I hope it will provide some exposure to what’s going on here and help to promote Ecuadorian psychology in general. My other motive is to promote interaction with psychologists and researchers, those here in Ecuador or in other countries.   

I’m British, what am I doing in Ecuador? Well back in 2008 I was research fellow at the University of Sheffield in the UK. In that year my supervisor had just left to return to the USA, so there was a potential opening for a tenured position. In fact, it had my name on it. Unfortunately, at about the same time, the world financial markets started to crash, the University decided it was time to cut-back on expenditure. No job for me.

I decided to try a new strategy: Move to Ecuador. At first I taught English as it’s the easiest work to find as foreigner. Pretty soon I had a couple of courses of psychology teaching and some academic writing classes at Universidad San Francisco de Quito, reputed the best university in the country. Two years of that and I had a new plan. Move to Japan and teach there instead.

Japan is a great country, unfortunately its university system is awful. I taught at Chuo University in Tokyo for two years and even managed, despite the University, to do some research. In the meantime, my former University in Ecuador offered me a professorship. So I’m back in Quito. Ecuador is a great country, and I’m teaching at a university that values research. In fact, I've got several research projects moving since my return, 3 months ago. If you have any research ideas, or you have any questions, get in touch.