Review What Is Mental Effort: A Clinical Perspective, 2024, Wolpe et al.

What Is Mental Effort: A Clinical Perspective
Wolpe; Holton; Fletcher

Although mental effort is a frequently used term, it is poorly defined and understood. Consequently, its usage is frequently loose and potentially misleading. In neuroscience research, the term is used to mean both the cognitive work that is done to meet task demands and the subjective experience of performing that work.

We argue that conflating these two meanings hampers progress in understanding cognitive impairments in neuropsychiatric conditions because cognitive work and the subjective experience of it have distinct underlying mechanisms. We suggest that the most coherent and clinically useful perspective on mental effort is that it is a subjective experience. This makes a clear distinction between cognitive impairments that arise from changes in the cognitive apparatus, as in dementia and brain injury, and those that arise from subjective difficulties in carrying out the cognitive work, as in attention-deficit/hyperactivity disorder, depression, and other motivational disorders.

We review recent advances in neuroscience research that suggests that the experience of effort has emerged to control task switches so as to minimize costs relative to benefits. We consider how these advances can contribute to our understanding of the experience of increased effort perception in clinical populations. This more specific framing of mental effort will offer a deeper understanding of the mechanisms of cognitive impairments in differing clinical groups and will ultimately facilitate better therapeutic interventions.

Link | PDF (Biological Psychiatry)

 

This is huge and needs to be recognised and understood, especially with NIH study. Also all the talking therapies that are targeting the central nervous system such as the "body scan method"

Words are important because used with double meaning is giving misinformation and confusing understanding. We can see this with Functional Neurological Disorder to the patient means their function is impaired because of disease and to the therapist it is conversion disorder.

 

Thanks for posting this paper.

The BPS/FND effort preference folks propose that the subjective experience of effort is disrupted due to misinterpretations by pt, misunderstanding bodily symptoms etc. And their 'solution' is for pts to approach feared activities (due to exacerbation of unpleasant symptoms) and in time pts can learn nought bad happens etc. And the sun shines, flowers bloom and all is OK with the world. Which does not happen and pts often feel a lot worse/relapse.

The effort pwME need to put into tasks, including trivial ones, is quite markedly different to healthy people. They must exert more to achive parity compared to before they were ill and compared to healthy people. Cognitive and physical tasks.

When I assess patients with ME cognitive functioning with some neuropsychological tests they generally perform less well than people without ME. Their difficulties are related to severity. And the obvious effort pwME put into the testing is apparent too. Assessing healthy people can be quite hard in comparison as they are quicker and carry out tasks with more ease and fluidity.

 

It still comes down to:

Is the pt misinterpreting the signals they experience due to their own misinterpretations or because these are warning signs and signals generated to indicate to the person to take care, reduce exertion, exercise etc or face the consequences?

The double meaning is still the double meaning.

And FND can be about saying one thing to patients but communicating and ambiguity to the other doctors involved in pt care. But it'll also be used in good faith too as a way of explaining 'dunno'.

I just wish for more honesty. Why not just say 'dunno'?

It's really not credible to have professional relationship with doctors if they are not honest. Same with psychologist/therapist.

I get that tentatively some pts and families might react badly to bad news etc but this culture of swerving reality, being unable to say dunno and not being straight is not helping anyone, clinicians or patients.

Dressing things up with labels with ambiguity meaning and endless baggage. Sigh.

 

Somewhat, but I don't think it makes it a useful definition. Mental effort is obviously subjective, mostly how much effort someone is putting into something, but it can be objectively measured. Not well, but it definitely can.

The main problem is not here, it's in the notion of whether that effort is at capacity, if someone is trying, if not their hardest, at least putting as much as they can be expected. There aren't any standardized tests like CPET where power can be precisely measured. For sure batteries of tests can be developed with cognitively demanding tasks, but this is far from being as good as a single test that can not only measure power exerted, but the metabolic response.

But things are just as difficult there anyway. This is pretty much what's argued about us, that if we have lower performance on CPETs, it just means that we didn't give a maximal effort. There is no actual way to determine this. No more than it's possible to determine whether someone is lying, made all the much more difficult that sometimes people genuinely believe lies.

And just the same, I don't think it's fair to argue that people with brain injuries, ADHD or whatever is meant by motivational disorders don't give their best efforts. There is simply no way to evaluate this yet.

I don't think the discipline is at the point where it's capable of doing these things yet. And maybe not ever. How do we ever know whether someone is giving their best effort at any moment, physically, cognitively, emotionally? There is almost always another gear. And sometimes a few ones after that. Put people into a dangerous situation, where they have to fight for their life, and they will often keep going way past where they would normally have stopped. Usually at a cost, and can't be sustained.

So the whole "control task switches so as to minimize costs relative to benefits" is probably right, at least partially. In most studies trying to get data for this, it's not really worth putting a lot of effort, the benefits aren't really there. And they can't go around this, it's just a limit of experimentation, made even worse by the significant differences between individuals.

 

We have to recognised where the term has come from and how it will be used by both medical profession and the DWP.

As far as the CEP test goes I would pose this question - do we question those with Asthma? - There is no need for a biomarker to diagnose asthma nor do patients get questioned when they do the blow test so why should those with ME be any different?

So, there was two listing that I could find that explained "Effort Performance one was “Expectancy Theory” which links the effort to an outcome. This states that making more effort will improve performance. That a high level of performance will bring reward. That the outcome – your reward – will be attractive. Which seems to tie in with the papers explanation of the brain reward continuum?

Then there was This opinion piece

This paper states that “At the heart of the psychology of convenience lies the brain’s relentless pursuit of efficiency. It’s a survival mechanism, deeply ingrained in our neural circuitry”.

It goes on with an analogy “you’ve just finished a long day at work, and you’re faced with the choice of ordering takeout or cooking a meal from scratch”.

This it would seem is a thinking choice and nothing to do with an inability to produce enough energy to cook. Ordering a takeout is convenient, not sure the brain circuitry of an innate mechanism is what they are explaining here. It goes on – "it requires less effort, less time and less cognitive engagement. Your brain, seeking to conserve its finite cognitive resources and energy, nudges you toward the easier option. It’s a decision known as “cognitive heuristic”.

Even with all they have found with the physical problems, this is the outcome of explanation of cell exhaustion and not as explained as the deauer state.

In short they are getting us to back them up and be quiet yet again and we are back to square 1.

Until such time as Brian Wailtt is made to explain in plain English, what he means by introducing this term and apologies to us as a community, how can anyone expect the ME community to get behind those that should and do know better.

Brian is now in charge of Long covid, and is causing a conundrum of his own - how do we get change and balance when he is in charge?

 

That sounds like typical psychological nonsense to me: sounds sort of plausible, and can't actually be tested in any way. Is that what they learn in psychology school: how to create hypotheses that can't be tested?