New research suggests that growing up in a high stress environment may not be a totally negative experience for children as they develop unique strengths and abilities.
The traits learned can be used to help tailor education, jobs, and interventions to fit them, say researchers.
Stress-adapted children and youth possess traits — such as heightened vigilance, attention shifting, and empathic accuracy — that aren’t tapped in traditional learning and testing situations.
In addition, these skills may actually allow at-risk children to perform better than their peers from low-risk backgrounds when faced with uncertainty and stress.
Most research to date has focused on detrimental effects of growing up under stressful conditions and the deficits in cognitive development that can result, say University of Utah researchers. “We’re not arguing that’s wrong, but that it is only part of the picture,” says Bruce J. Ellis, a psychology professor.
“The other part is that children fine-tune their abilities to match the world that they grow up in, which can result in enhanced stress-adapted skills. We’re trying to challenge a world view and give consideration to an alternative adaptation-based approach to resilience.”
The study “Beyond Risk and Protective Factors: An Adaptation-based Approach to Resilience” is forthcoming in the journal Perspectives on Psychological Science.
Co-authors include JeanMarie Bianchi, University of Arizona; Vladas Griskevicius, University of Minnesota; and Willem E. Frankenhuis, Radboud University Nijmegen.
The new study challenges the prevailing view that children who experience high-stress environments are at risk for impairments in learning and behavior. Current belief also suggests interventions are needed to prevent, reduce, or repair the damage that has been done to them.
These high-stress environments include neighborhood danger; exposure to environmental chemicals; bad housing conditions; neglectful and abusive parenting; low-quality childcare; and peer and school violence.
Research has shown that the more stressors children are exposed to, the more their performances in traditional learning and testing situations is compromised.
Most interventions are aimed at countering these deficits and getting “children and youth from high-risk backgrounds to act, think, and feel more like children and youth from low-risk backgrounds,” the authors say. In other words, the dominant approach assumes at-risk youth are somehow broken and need to be fixed.
Virtually no research attention has been paid to what strengths and abilities youth possess as a result of growing up in high-risk environments, Ellis said.
Although there is a rich body of literature examining adaptive responses in birds and rodents to stressful environments, the first theoretical work related to humans was published in 2013 by co-author Frankenhuis, followed by the first experiments in 2015 by co-author Griskevicius, Ellis said.
That research showed repeated or chronic stress does not exclusively impair cognition and can improve forms of attention, perception, learning, memory, and problem-solving.
“Our argument is that stress does not so much impair development as direct or regulate it toward these strategies that are adaptive under stressful conditions,” Ellis said.
“Stress-adapted children and youth may perform better on tasks that involve situations and relationships that are relevant to them, such as social dominance. They also may perform better in settings that do not attempt to minimize the reality of daily stressors and uncertainties.”
These stress-adapted skills should be understood, appreciated and seen as building blocks for success, Ellis said.
A first, essential step is that researchers catalog the strengths and abilities of people who grow up in high-stress environments and focus on how to leverage those abilities to enhance learning, intervention, and developmental outcomes.
Source: University of Utah/EurekAlert
New research explores the tremendous success of social media discovering that social media users can be classified into four major groups. In the study, Brigham Young University communications professors investigate why social media platforms have essentially changed the way people interact with the world.
Investigators explain that on an average day, 1.28 billion people check their Facebook account. And, if you expand this to monthly, nearly 2 billion people access the site.
According to one recent estimate, the average Facebook user spends 35 minutes a day on the platform — which makes for a whole lot of daily and monthly minutes.
“What is it about this social-media platform that has taken over the world?” asked lead author Tom Robinson. “Why are people so willing to put their lives on display? Nobody has ever really asked the question, ‘Why do you like this?'”
Based on subject responses, the research team identified four categories of Facebook users: relationship builders, town criers, selfies and window shoppers.
Relationship builders post, respond to others’ posts and use additional Facebook features primarily in an attempt to fortify relationships that exist beyond their virtual world.
“They use it as an extension of their real life, with their family and real-life friends,” Robinson said.
People in this group identified strongly with such statements as “Facebook helps me to express love to my family and lets my family express love to me.”
Town criers, on the other hand, experience a much larger gap between their real and virtual worlds.
Unconcerned with sharing photos, stories or other information about themselves, they instead “want to inform everybody about what’s going on,” Robinson said.
Like town criers from days of yore, “they’re pushing out information.” They repost news stories, announce events — but may otherwise neglect their profile pages, preferring to update family and friends through alternative means.
Selfies use Facebook to self promote.
Like relationship builders, they post pictures, videos and text updates — but unlike relationship builders, they’re focused on getting attention, likes and comments.
Study participants in this category identified highly with the statement “The more ‘like’ notification alarms I receive, the more I feel approved by my peers.”
Selfies, said study co-author Kris Boyle, use the platform “to present an image of themselves, whether it’s accurate or not.”
Window shoppers, like town criers, feel a sense of social obligation to be on Facebook but rarely post personal information.
Unlike town criers, these users, said study co-author Clark Callahan, “want to see what other people are doing. It’s the social-media equivalent of people watching.”
Window shoppers identified with such statements as “I can freely look at the Facebook profile of someone I have a crush on and know their interests and relationship status.”
For this study, the researchers compiled a list of 48 statements identifying potential reasons people use Facebook.
Subjects sorted the statements in a way that reflected their personal connection to the ideas, then rated each statement on a scale from “most like me” to “least like me.”
Finally, the researchers interviewed each subject to get a deeper understanding of their rankings and ratings.
Though previous Facebook-related research has explored users with relationship-builder and selfie characteristics, Robinson said, the town criers and window shoppers were an unexpected find.
“Nobody had really talked about these users before, but when we thought about it, they both made a lot of sense.”
Facebook users may identify to some degree with more than one category — Boyle noted that most people have at least some selfie tendencies, for example. But users typically identify more with one than others.
“Everybody we’ve talked to will say, ‘I’m part of this and part of this, but I’m mostly this,'” said Robinson, who calls himself a relationship builder.
So what’s the value in the label?
“Social media is so ingrained in everything we do right now,” Boyle said. “And most people don’t think about why they do it, but if people can recognize their habits, that at least creates awareness.”
Interactions between gut bacteria and the brain may play an important role in human health and behavior.
In a new study, researchers at the University of California, Los Angeles have discovered that microbiota in the gut interacts with brain regions associated with mood and behavior in healthy humans. The findings add to the growing body of evidence of a significant link between the gut and the brain.
Earlier studies have shown that microbiota, a community of microorganisms in the gut, can influence behavior and emotion. Rodent models have demonstrated the effects of gut microbiota on emotional and social behaviors, such as anxiety and depression, but there has been little scientific evidence in humans.
For the new study, the researchers wanted to identify brain and behavioral characteristics of healthy women clustered by gut microbiota profiles. A total of 40 women gave fecal samples for profiling, and magnetic resonance images were taken of their brains as they looked at images of individuals, activities or other objects that evoked an emotional response.
The women were divided by their gut bacteria composition into two groups: 33 had more of a bacterium called Bacteroides; the remaining seven had more of the Prevotella bacteria.
Women in the Bacteroides group showed greater thickness of the gray matter in the frontal cortex and insula, brain regions involved with complex processing of information. These women also had larger volumes of the hippocampus, a region involved in memory processing.
In contrast, women in the Prevotella group displayed more connections between emotional, attentional and sensory brain regions and lower brain volumes in several regions, such as the hippocampus.
In this group, the women’s hippocampus was less active as they looked at negative images. They also rated higher levels of negative feelings such as anxiety, distress and irritability after looking at photos with negative images than did the women in the Bacteroides group.
The new findings support the concept of brain-gut-microbiota interactions in healthy humans. Researchers still do not fully understand whether the bacteria in the gut influence the development of the brain and its activity when unpleasant emotional content is encountered, or if existing differences in the brain influence the type of bacteria that reside in the gut.
In either case, however, the findings could lead to important changes in how we perceive human emotions.
For many being anxious, stressed, or even being too excited can cause sleepless nights. Although emotions are recognized to affect wakefulness and even cause insomnia, the underlying mechanisms for why this occurs has been unclear.
Now, from an animal study, Japanese researchers believe they have discovered a neurochemical root cause on how emotions can trigger insomnia. Scientists believe the finding could led to future discovery of drug targets for anxiety disorder and/or sleep disorders.
Investigators explain that biological responses occur when we evolutionarily encountered predators, or as we adapt to a novel environment or expect a reward.
These stressful or emotionally-salient situations require individuals to shift their behavior to a vigilant state, altering their physiological conditions through modulation of autonomic and endocrine functions. This response begins in a part of the brain called the amygdala, specifically in the nucleus of the nerve nexus called the stria terminalis (BNST). The amygdala, which is generally considered as a key player in stress response, fear and anxiety.
The BNST controls endocrine and autonomic reactions in response to emotionally-salient stimuli along with behavioral expression of anxiety and fear. The region does this by sending projections to various brain regions including relay nuclei of the autonomic nervous system, hypothalamic regions and the central nucleus of the amygdala.
Takeshi Sakurai, Vice Director of the International Institute for Integrative Sleep Medicine (WPI-IIIS and his team found that acute optogenetic excitation of GABAergic neurons in BNST during non-rapid eye movement (NREM) sleep in mice resulted in immediate transition to a wakefulness state.
The stimulation did this without the function of orexins, highly important neuropeptides for maintaining wakefulness. Notably, stimulation of the same neurons during REM sleep did not show any effects on sleep/wakefulness states.
Prolonged excitation of GABAergic neurons in BNST by a chemogenetic method evoked a longer-lasting, sustained wakefulness state, and it was abolished by administering a receptor blocker in advance, meaning that orexins are involved in this phenomenon.
“Our study revealed a role of the BNST GABAergic system in sleep/wakefulness control, especially in shifting animals’ behavioral states from NREM sleep to wakefulness.
It also provides an important insight into the pathophysiology of insomnia and the role of orexin in arousal regulation, which will hopefully lead to the first step to develop remedies for sleep disorders,” Sakurai says.
Source: University of Tsukuba
Research has shown that spending time in a tranquil outdoor environment is able to increase one’s sense of well-being and reduce stress and pain. In contrast, litter, graffiti and road noise all have the potential to raise anxiety and agitation.
Planting trees, bushes and flowers in an urban environment — a process called ‘greening’ — is a proven way to improve the tranquility of the residents, but until now, architects and planners have had to make assumptions as to the exact impact these changes will have.
Now, UK scientists at the University of Bradford have developed the world’s first tool designed to rate relaxation levels in urban environments and public spaces — it is called the Tranquillity Rating Prediction Tool (TRAPT).
“Currently, architects design urban environments to provide open spaces where people can relax. While it’s guided by certain principles, it’s not scientific. TRAPT provides a robust and tested measure of how relaxing an environment currently is, or could be once built,” said lead researcher Professor Greg Watts.
Watts believes that the tool could help those involved in city planning better understand the impact of ‘greening’ on urban spaces. In time, the tool could allow users to optimize green spaces as part of the property development process, all before any work begins to rejuvenate run-down suburbs and town centers.
The TRAPT system uses three measures of an urban environment: soundscape, landscape and moderating factors (natural features like trees, shrubs, flowers or water). Then the environment is given a score between 0 and 10. For example, Glen Etive in the Scottish Highlands, an outstanding tranquil environment, was given a high average score of 9.1.
“TRAPT provides the user with a simple measure for understanding how tranquil and relaxing it can be. By varying different factors – the amount of greenery, or introducing noise attenuating barriers or quieter road surfaces for instance – planners can understand the impact of their decisions,” Professor Watts adds.
Based at the Bradford Centre for Sustainable Environments, Professor Watts and his team have spent over 10 years testing and validating the system in both laboratory and field studies.
“We’re confident that our testing has helped us to create a tool that provides a realistic and reliable measure of relaxation,” said Watts. “TRAPT could be used to help architects design rewarding and relaxing urban environments. Planners can use it to assess how tranquil new developments would be, making changes to the plans if required.”
The tool could be useful for environmentalists in their efforts to protect old-growth trees, shrubs or urban green spaces and for residents who desire more trees, shrubs and flowers to improve the appearance of jaded town centres and suburban areas.
“These measures should also help to counter threats such as over development, tree removal or traffic densification that might threaten existing benefits,” said Watts.
The findings are published in the journal Urban Forestry and Urban Greening.
Source: University of Bradford
New research suggests that some childhood psychiatric disorders increase the risk of developing addiction later in life. Experts believe the findings emphasize the need for early detection and intervention for childhood mental health issues.
In the study, investigators combined a large amount of data from previous studies (meta-analysis) and discovered a correlation between various psychiatric disorders among children and later risk of developing addictions.
The findings appear in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP).
The research team was led by investigators from the Child Study group at the Vrije Universiteit in Amsterdam and Accare, the Center for Child and Adolescent Psychiatry at the University Medical Center Groningen, in the Netherlands.
Scientists found that individuals diagnosed in childhood with attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD)/conduct disorder (CD), and depression had an increased risk of developing addictions.
Interestingly, results concerning anxiety were less clear. The risk may depend on the specific type of anxiety disorder, but to date, no studies have focused on this topic.
“We know that ADHD in childhood increases the risk for later substance-related disorders, but until now, no systematic evaluation of other childhood psychiatric disorders had been conducted,” said Dr. Annabeth P. Groenman.
“Our findings show that not only ADHD increased the risk of addictions, but that other childhood psychiatric disorders also increased risk. This indicates the importance of early detection of mental health problems in a wider group. Addiction is a major cause of immense personal, familial, and societal burden, and prevention is therefore an important goal.”
The study re-analyzed data of 37 previous studies containing a total of 762,187 individuals, of whom 22,029 had ADHD, 434 had disruptive behavior disorders (such as ODD/CD), 1,433 had anxiety disorder, and 2,451 had depression. The researchers identified studies looking at childhood psychiatric disorders and later addiction.
Disruptive behaviors (ODD/CD) frequently co-occur with ADHD, in approximately 30 percent of cases. This so-called “comorbidity” is often thought to be the main cause of addictions in individuals with ADHD.
However, the results suggest that co-occurring ODD/CD in ADHD does not fully explain the risk of addictions in this group.
Professor Jaap Oosterlaan, principal investigator of the Child Study Group comments:
“Now that we have firmly established children with psychiatric disorders as a high-risk group for later substance-related disorders, the next step is to make parents, clinicians, and the government aware of these risks and work together in reducing the risks for addiction and its debilitating consequences.”
Rejection is difficult for everyone — and for some, it can lead to antisocial and self-defeating reactions.
A new study looks at this circumstance and questions what would it take to persuade people to counteract this spiral toward isolation and instead re-engage in healthy relationships?
Researcher Jayati Sinha, PhD, a professor of marketing at Florida International University, suspected that messages that appeal to emotion — rather than rationality — would be help motivate people in these situations to pursue social activities again.
“When people feel excluded, they keep thinking about that negative experience, and this depletes mental resources,” Sinha said.
“This makes it harder to process rational details, so an emotional message is more appealing.”
To test this hypothesis, Sinha’s team asked participants in one group to write about details of an experience when they felt excluded, and another group to write about an event when they felt included.
The third group wrote about a neutral event (the experience of waking up the previous day). Then they showed groups different types of blood donation advertisements.
The emotional ad emphasized that blood donation was the gift of life, while the other ad emphasized the number of lives saved.
The group that had written about feeling socially excluded was much more likely to prefer the emotional ad, while the other groups preferred the rational ad.
To test whether the messages would translate into action, the researchers conducted another experiment in which the participants viewed different messages about recycling.
The emotional ad stated that “The plastic bottles you recycle today will become a new carpet in the future,” while the rational ad presented facts about the number of recycled bottled needed to make a carpet.
The participants who were primed to feel socially excluded were much more likely to recycle the plastic juice bottles they received during the experiment if they had seen the emotional message, but the rational ad was more effective for the other groups.
These findings offer hope to groups that are at risk of feeling isolated, such as the elderly, disabled, widowed, divorced or people living alone, Sinha said.
Policy makers and businesses might have more success helping these groups participate in positive activities if messages focus on visual images and words that arouse emotions, rather than highlighting product benefits, deals and convincing arguments.
“People who feel excluded may be struggling to take care of themselves, so the goal is to communicate to them in ways that persuade them to make changes that improve their quality of life,” Sinha says.
New research finds that cancer caregivers are a vulnerable population as they are at risk for a steady decline in physical health.
Moreover, investigators discovered depression symptoms are the only significant predictor of caregivers’ future health problems.
Researchers believe the findings show the importance of early assessment and care for depressive symptoms among caregivers. Intervention early in the cancer survivorship trajectory may help to prevent premature health decline among this important population.
The study, found in Cancer, is the longest follow-up to date of caregivers’ physical health following providing care to a loved one with cancer. It was funded by the American Cancer Society.
Cancer caregiving has been associated with worsening health among caregivers. To explore possible predictors of this decline, researchers led by Kelly M. Shaffer, Ph.D., of Memorial Sloan Kettering Cancer Center, analyzed survey data from 664 cancer caregivers.
The investigators examined changes in caregivers’ physical health from year two to year eight following a family member’s cancer diagnosis to find predictors of declining health.
At two years after diagnosis, caregivers’ health was slightly higher than the national mean. But over the following six years that advantage dissipated, as caregivers experienced a small yet notable decline in health.
Investigators found having elevated depressive symptoms was the only predictor of the physical health decline. They discovered caregivers with high depressive symptoms showed twice the rate of physical health decline of caregivers with an average level of depressive symptoms.
“Adverse effects of depression on physical health have been well-documented in the general population,” write the authors.
“These findings extend evidence to the cancer caregiving context, known to have many psychosocial stressors and challenges, and highlight the importance of depression specifically to caregivers’ premature physical health decline.”
The authors say caregiver distress screening could be more widely adopted hand-in-hand with efforts to implement similar screening for patients, including technology-based assessment using brief and straightforward questions to assess whether a caregiver has been experiencing depression.
“Identifying caregivers in need, and connecting these caregivers to effective and accessible psychosocial services, are imperative next steps to improve comprehensive care for families facing cancer,” said Dr. Shaffer.
A new study of predominantly low socioeconomic status minority children finds children with a food allergy also more likely to experience childhood anxiety.
Researchers at Columbia University’s Mailman School of Public Health and Albert Einstein College of Medicine studied the link between food allergy and childhood anxiety and depression.
They found that although children with a food allergy had a significantly higher prevalence of childhood anxiety, food allergies were not associated with symptoms of childhood depression or with symptoms of anxiety or depression among their caregivers.
The topic is pertinent as food allergies are increasingly common among youth in the U.S. with recent estimates as high as 8 percent. Until now little was known about the prevalence of food allergy in low socioeconomic ethnic minority populations.
The researchers studied 80 pediatric patients ages 4-12 years, 8 years old on average, with and without food allergy and their caregivers from urban pediatric outpatient clinics in the Bronx, New York.
They controlled for an asthma diagnosis in the children, as anxiety and mood disorders are more prevalent among youth with asthma and especially more common in low socioeconomic minority children.
The findings are published in the Journal of Pediatrics.
Among the children with a food allergy, 57 percent reported having symptoms of anxiety compared to 48 percent of children without a food allergy. Approximately 48 percent of the children had symptoms of depression with or without a food allergy.
“Management of food allergy can be expensive both in terms of food shopping, meal preparation, and the cost of epinephrine auto-injectors, which expire annually,” said Renee Goodwin, PhD, in the Department of Epidemiology at the Mailman School of Public Health and lead author.
“These demands could result in higher levels of anxiety for those with fewer financial resources and further heighten anxiety symptoms in children and their caregivers.”
The results suggest that food allergy is particularly linked to elevated social anxiety and fear of social rejection and humiliation.
“There are a number of possible explanations for the relationship found between food allergy diagnosis and increased social anxiety issues in this sample of pediatric patients,” noted Dr. Goodwin.
“Management of a potentially life-threatening condition may be anxiety provoking, and some children may experience increased social anxiety about being “different” from other children depending on their age and how food allergy is managed by adults in a particular setting.”
The researchers also point out a possible explanation for not finding a link between food allergy and depression in children. Investigators posit the sample was young, and the mean age of onset for depression is significantly later than anxiety.
“It would be worthwhile to examine these relationships among older adolescents and young adults with food allergy who are at the peak of risk for depression onset, especially because early anxiety is associated with increased risk for subsequent onset of depression,” said Jonathan Feldman, PhD, professor at Ferkauf Graduate School of Psychology, Yeshiva University.
“With the high prevalence of food allergies today, education in schools remains a priority,” said Dr. Goodwin.
“Given the strong association between food allergy and social anxiety in children future investigations on the food allergy-mental health relationship are also warranted in clinical, school, and community-based settings which could aid in the development of interventions.”
The concept of Complex Post Traumatic Stress Disorder, known as C-PTSD for short, was first developed in the early 1990s. As with all scientific advances, not everyone realized its importance immediately and time was required to both refine and propagate the idea. The World Health Organization, for example, still does not recognize C-PSTD as a distinct health problem, though it may be included in the new list, scheduled for publication in 2018. The widespread slowness in recognizing C-PTSD is sometimes frustrating for those of us working in the field of psychology, trauma, and behavioral health. C-PTSD can produce severe depression, anxiety, and even psychotic episodes, which in turn can lead to serious physical symptoms. When healthcare practitioners are not aware that the problems they are dealing with are really results of C-PTSD, then treatment is much less likely to be effective.
The traumatologist, John Briere, was once quoted as saying, only half in jest, that “if Complex PTSD were ever given its due …. the DSM (The Diagnostic and Statistical Manual of Mental Disorders used by all mental health professionals) would shrink to the size of a thin pamphlet.” There is certainly very good evidence that C-PTSD is a much more prevalent problem than generally recognized. The C-PTSD advocacy organization, Out of the Storm, makes a strong case that there are hundreds of millions of undiagnosed cases worldwide. While the data we have is incomplete, what there is paints a picture in which, as they put it, “the numbers are staggering to contemplate”.
One obstacle, then, to giving the best help to sufferers of C-PTSD is a lack of awareness. Another is that, as a relatively new diagnosis, much still remains to be discovered about the mechanism by which C-PTSD comes about. A promising new study1, however, may represent a major advance in our understanding of what C-PTSD is, which in turn would help us better identify and treat it.C-PTSD and Childhood Trauma
C-PTSD differs from its better-known cousin PTSD mostly in that it is the result of a series of destabilizing incidents that happen over a period of time, even years. Each one on its own would not be sufficient to induce trauma, but their cumulative effect does. The typical case of C-PTSD involves an adult who, as a young person, was the victim of repetitive, chronic, and prolonged trauma involving harm and abandonment by a primary caregiver. Such mistreatment can include ‘passive’ slights, such as a parent withholding love or affection, or never giving praise.
It may seem intuitive that people react to such unhealthy relationships by developing the common symptoms of C-PTSD, such as, among others, shame, guilt, and an inability to regulate emotions or find enjoyment in life. This is because, unfortunately, we all know of too many examples where children of abusive parents go on to develop mental health problems. However, on reflection, this is not such an obvious result. Human beings have been forged by millions of years of evolution in order to survive, grow and procreate. Wouldn’t it make more sense for evolution to endow us with the ability to shrug off childhood traumas so that we can get on with having a successful life?
The new study suggests that C-PTSD is best understood as a learning process that has gone wrong. Part of the way we are designed for survival is that we are flexible enough to learn to thrive in very different environments. The skills you need to survive and succeed in the Savannah are very different from those you need in a modern city. During childhood, we go through a long process of learning how to avoid danger and how to deal with danger when it comes around. This is an essential part of adapting to our environment.
During this process of learning and adaptation, the relationship of the young person to his or her caregivers plays a central role. There are many dangers that a vulnerable child might face that they are unable to cope with alone. To navigate these kinds of danger and discover the appropriate way of responding, the child relies on caregivers, especially parents, for guidance and also protection. If the caregiver does not fulfill this role, or, worse, is perceived by the child as a source of danger then this process is interfered with. The child experiences dangers which he or she cannot adapt to and learns self-protective strategies that are actually deeply maladaptive in normal situations. In adult life, they are more likely to mistakenly interpret situations as dangerous and then respond in ways that are self-destructive. When a child grows up learning that the world around them is not safe, he or she takes this view of the world into adult life, with wide-ranging and damaging consequences.Progress in Treating C-PTSD
The study suggests ways that treatment of C-PTSD can be improved. In particular, conceptualizing C-PTSD as a result of a learning process perverted through mistreatment indicates that successful treatment involves the therapist facilitating a new learning process by functioning “as a transitional attachment figure, using the therapy to generate the missing resilience-building processes of childhood.” Providing individualized treatment would mean looking closely at the ways in which the adaptive process of learning has been distorted. Some sufferers from C-PTSD will fail to process information, leaving them feeling helpless and unable to interpret the world around them. Others will err in the opposite direction and overinterpret details, which should be filtered out. To use an example given in the study, if they receive ill treatment at the hands of someone wearing a red jacket, then they will erroneously “focus on red jackets as signals of danger.”
Successful therapy is based on identifying the specific ways in which the way each individual processes information about potential and actual danger, in order to guide them to healthier thought patterns. In this way, the psychological profession can make a meaningful difference to the life of those suffering from this extremely serious, and still under-recognized condition.
- Crittenden, P. M. & Heller, M. B. (2017). The Roots of Chronic Posttraumatic Stress Disorder. Chronic Stress, 1, 1-13. doi: 10.1177/2470547016682965
Emerging research suggests psychological support can help patients at high risk of developing chronic pain reduce use of opioids and live a fulfilling life.
Opioid addiction has reached epidemic proportions and is often the result of normal medical practices. Although treatment approaches are changing, new approaches to manage patients are sorely needed.
A new Canadian study of 343 post-surgical patients shows that an innovative, multidisciplinary hospital-integrated pain program can achieve reductions in pain and anxiety. In the two-year study, researchers found that patients who received psychological services in addition to medical pain-management strategies had greater reductions in opioid use, and their mood improved.
The study, “Acceptance and Commitment Therapy to Manage Pain and Opioid Use after Major Surgery: Preliminary Outcomes from the Toronto General Hospital Transitional Pain Service,” appears in the Canadian Journal of Pain.
First author Muhammad Azam, a Ph.D. candidate at York University and senior authors Dr. Joel Katz, Affiliate Scientist, and Dr. Hance Clarke, from the Toronto General Hospital Research Institute (TGHRI) led the study.
Although psychological approaches to help patients cope with pain have been used previously, the study used a novel approach to combine a specific psychological approach with mindfulness meditation training to help patients wean off high-doses of opioids and reduce their pain-related distress and disability.
“If we lower how many opioids patients are taking, but leave them disabled and not able to live their lives, that is not helpful,” says Dr. Aliza Weinrib, one of the authors of the paper and a clinical psychologist who developed the innovative psychology program.
“Patients can learn to respond to their pain in a different way, making it less overwhelming. They don’t have to be so tied to their medications,” explains Weinrib. Weinrib teaches the approach to surgical patients at TGH.
Patients in the study were those at highest risk for developing chronic pain and persistent high-dose opioid use after major surgery. All attended the Transitional Pain Service (TPS) at TGH between 2014 and 2016. TPS is the first hospital-integrated, comprehensive, long-term post-surgical pain management program of its kind.
Patients on high-dose opioids willing to consider tapering to improve their pain management were referred to a clinical psychologist, as part of their treatment in the TPS. They had chronic post-surgical pain, pre-existing chronic pain, clinical depression, problematic, or higher than expected opioid use, and difficulty in coping with pain. These patients were taught coping skills grounded in Acceptance and Commitment Therapy (ACT).
Instead of focusing solely on reducing pain intensity, this psychological treatment encourages patients to engage in meaningful life activities, while promoting mindfulness and acceptance of difficult experiences such as pain.
Patients can be taught these skills in three or four sessions, by setting personally meaningful goals, observing and describing pain and the thoughts and feelings that come with pain, identifying avoidance behaviors and tracking how they can increase pain, distress, and interfere with the ability to live life fully.
Study results between the two groups showed that both decreased their pain intensity, anxiety symptoms, and opioid use.
But the patients who participated in the psychology program — who initially reported higher opioid use, anxiety, depression, and higher sensitivity to pain — showed significantly improved outcomes. Specifically, the psychology-plus group experienced greater reductions in opioid use, greater depression relief, and less disruptions in their daily living as a result of their pain than those patients who received TPS physician-guided treatment alone.
“There’s the pain in your body, and there’s the pain in your heart about not being able to do the things that you love,” notes Dr. Weinrib. “We can help people move towards what is important to them, even through their pain. We can help people reduce their pain of not living.”
Paul Ross, 60, has had 13 surgeries in the past 35 years, resulting in constant chronic pain and prescriptions for high doses of hydromorphone, which is used to treat severe pain that isn’t controlled by other opioid drugs. For the past five years, he has wanted to stop using the opioid, and decreased his dose on his own. But he could not wean himself off it completely.
“I was waking up six times a night to inject myself, but I was never without pain,” he recalls, adding that he injected his dose because he could not absorb the medication in pill form. “I don’t want to be like this. I was a zombie. It affected my life, my family, how I functioned, and my mood.”
Since becoming a patient at TPS in February 2017, he has stopped using hydromorphone, and instead relies on a personally tailored program of alternate medications, individual psychological sessions, group therapy, and eventually yoga. While he still has periods of pain, he now has the skills to manage it and live an active, less disabled life.
“This program has given me the tools to live a fuller life despite my pain. I practice mindfulness; I can talk to people there who understand me. For the first time in a long time, I have alternatives to simply increasing opioids, and practical tools to counter my despair. They gave me hope,” he says.
An estimated 15 percent to 19 percent of all Canadians suffer from chronic, non-cancer pain, which is pain that lasts for more than three months and interferes with their daily activities. It is the leading cause of health resource use and disability among working-age adults.
In Ontario, admissions to publicly funded treatment programs for opioid-related problems doubled from 2004 to 2013, from 8,799 to 18,232.
Dr. Hance Clarke, who is also Assistant Professor in the Department of Anesthesia at the University of Toronto, points out that recent US and Canadian guidelines for managing non-cancer pain stress that alternative treatments should be tried before considering opioids to avoid dependence or addiction.
But there is little data on post-surgical patients who receive psychological support and how that could help them and potentially others to manage pain, opioid use, psychological distress, and disability, says Dr. Clarke.
“This study and our clinical work in TPS suggest that that there is a powerful role for interventions other than the prescription pad in helping patients manage their pain and suffering, taper their opioids, and lead rewarding lives.”
A reported 350 million people worldwide suffer from depression, and current pharmacological approaches using selective serotonin reuptake inhibitors (SSRIs) carry a hefty price tag and the risk of side effects.
A recent study published in the journal PLoS One, shows that over-the-counter magnesium appears safe and effective to treat mild to moderate depression.
Magnesium is an important element for body functions as heart rhythm, blood pressure and bone strength. Moreover, the mineral magnesium plays a role in combating inflammation in the body and has been proven to have an association with depression.
However, until now, few clinical trials have studied the supplement’s effects.
Emily Tarleton, M.S., R.D., C.D., a graduate student in Clinical and Translational Science and the bionutrition research manager in the University of Vermont’s Clinical Research Center, and colleagues conducted a clinical trial of over-the-counter oral magnesium tablets for mild-to-moderate depression.
Their results showed that magnesium is safe and effective and comparable to prescription SSRI treatments in effectiveness.
Researchers conducted an open-label, blocked, randomized cross-over trial involving 126 adults in outpatient primary care clinics. Study participants, who were currently experiencing mild-to-moderate depression, had a mean age of 52, with 38 percent of them male.
Participants in the active arm of the study received 248 milligrams of elemental magnesium per day over six weeks, while those in the control arm received no treatment. Depression symptom assessments were conducted on all participants on a bi-weekly basis.
The study team found that in 112 participants with analyzable data, consumption of magnesium chloride for six weeks resulted in a clinically significant improvement in measures of depression and anxiety symptoms.
In addition, these positive effects were shown quickly, at two weeks, and the supplements were well-tolerated and similarly effective regardless of age, sex, or use of antidepressants, among other factors.
“This is the first randomized clinical trial looking at the effect of magnesium supplementation on symptoms of depression in U.S. adults,” Tarleton said.
“The results are very encouraging, given the great need for additional treatment options for depression, and our finding that magnesium supplementation provides a safe, fast and inexpensive approach to controlling depressive symptoms.”
Tarleton and colleagues say the next step is to see if their promising results can be replicated in a larger, more diverse population.
Researchers at the University of Michigan and University of California-Santa Barbara have found teens experience digital dating abuse at similar rates, but girls reported that they were more upset by these behaviors and reported more negative emotional responses.
Digital dating abuse behaviors include the use of cell phones or the internet to harass, control, pressure, or threaten a dating partner.
“Although digital dating abuse is potentially harmful for all youth, gender matters,” said Dr. Lauren Reed, the study’s lead author and an assistant project scientist at University of California-Santa Barbara.
The study, which will appear in the Journal of Adolescence, involved 703 Midwest high school students who reported the frequency of digital dating abuse, if they were upset by the “most recent” incidents, and how they responded.
Students completed the surveys between December 2013 and March 2014.
Participants reported sending and receiving at least 51 text messages per day, and spending an average of 22 hours per week using social media. Most participants reported that they text/texted their current or most recent dating partner frequently.
The survey asked teens to indicate how often they experienced problematic digital behaviors with a dating partner.
Concerns include being “pressured me to sext” (sending a sexual or naked photo), being sent a threatening message, having private information assessed without permission, and having their whereabouts and activities monitored.
Girls indicated more frequent digital sexual coercion victimization, and girls and boys reported equal rates of digital monitoring and control, and digital direct aggression.
When confronted with direct aggression, such as threats and rumor spreading, girls responded by blocking communication with their partner.
Boys responded in similar fashion when they experienced digital monitoring and control behaviors, the study showed.
Boys often treat girls as sexual objects, which contributes to the higher rates of digital sexual coercion, as boys may feel entitled to have sexual power over girls, said study co-author Dr. Richard Tolman, University of Michigan professor of social work.
Girls, on the other hand, are expected to prioritize relationships, which can lead to more jealousy and possessiveness, he said. Thus, they may be more likely to monitor boys’ activities.
Patients with coronary heart disease who experience persistent moderate to severe mental distress face a much higher risk of death, according to a new study published online in the journal Heart. But no such link was found for those experiencing persistent mild or occasional distress over the long term.
Although prior research has suggested a link between anxiety/depression and an increased risk of heart attack and stroke, most of these studies were conducted soon after the event, and were based on a single assessment, say the researchers. And the definitions of chronic/persistent stress in other longer term studies have varied widely.
For the new study, the researchers looked at the association between occasional or persistent mental distress and the risk of death in 950 people (aged 31 to 74) with stable coronary heart disease. All of the participants were part of the Long Term Intervention with Pravastatin in Ischaemic Disease Trial and had had a heart attack or been admitted to hospital for unstable angina in the preceding three to 36 months.
To gauge levels of mental distress, the participants completed a validated general health questionnaire at six months, 1, 2, and 4 years after the event.
Mental distress was rated according to severity and the length of time it lasted at each of the assessments: never distressed; occasional (of any severity); persistent mild distress on three or more occasions; and persistent moderate distress on three or more occasions. The patients’ health and survival were then tracked for an average of 12 years.
During the monitoring period, 398 people died from all causes and 199 died from cardiovascular disease.
According to the questionnaire, 587 (62 percent) of participants said they had not been distressed at any of the assessments, while around one in four (27 percent) said they had experienced occasional distress of any severity. Around one in 10 (8 percent) said they had experienced persistent mild distress, and 35 people (3.7 percent) complained of persistent moderate distress.
Patients in this last group were nearly four times as likely to have died of cardiovascular disease and nearly three times as likely to have died from any cause as those who said they had not been distressed at any of the assessments.
No such associations were observed among patients who had reported persistent mild distress or those who said they had only experienced it occasionally. The findings remained true even after adjusting for other potentially influential risk factors.
Since this is an observational study, no firm conclusions can be drawn about cause and effect, say the researchers. And confining the assessments to a period of four years might have underestimated the true impact of persistent distress.
Nevertheless, the researchers say that the increase in risk of death was substantial. “These findings suggest that in patients with stable [coronary heart disease], long term mortality risk is related to the cumulative burden of psychological distress,” they wrote.
In a linked editorial, Dr. Gjin Ndrepepa of the Technical University, Munich, Germany, describes the research as an “important and elaborative study which helps to uncover the intricate relationship between psychological distress and cardiovascular disease.”
He said mental distress activates the sympathetic nervous system and boosts stress hormone levels, which, if persistent, can produce potentially harmful physiological changes, some of which may be permanent. Distress can also prompt unhealthy behaviors.