A new study at Duke University finds that boosting brain activity in regions related to thinking and problem-solving may help buffer against anxiety.
The researchers found that people at greater risk for anxiety were less likely to develop the disorder if they had higher activity in the dorsolateral prefrontal cortex, a brain region responsible for complex mental operations.
The new findings, published recently in the journal Cerebral Cortex, may be a step toward tailoring mental health therapies to the specific brain functioning of individual patients.
“These findings help reinforce a strategy whereby individuals may be able to improve their emotional functioning — their mood, their anxiety, their experience of depression — not only by directly addressing those phenomena, but also by indirectly improving their general cognitive functioning,” said Dr. Ahmad Hariri, a professor of psychology and neuroscience at Duke.
Previous research from this team shows that people whose brains exhibit a high response to threat and a low response to reward are at greater risk for developing symptoms of anxiety and depression over time.
In the current study, Hariri and Matthew Scult, a clinical psychology graduate student in the department of psychology and neuroscience at Duke, set out to determine whether higher activity in the dorsolateral prefrontal cortex could help shield these at-risk individuals from developing a mental health disorder.
“We wanted to address an area of understanding mental illness that has been neglected, and that is the flip side of risk,” Hariri said. “We are looking for variables that actually confer resiliency and protect individuals from developing problems.”
The dorsolateral prefrontal cortex is considered the brain’s “executive control” center, allowing us to focus our attention and plan complex actions. This region is also involved in emotion regulation. In fact, well-established types of psychotherapy, such as cognitive behavioral therapy (CBT), engage this area of the brain by equipping patients with strategies to reframe or re-evaluate their emotions.
For the study, the researchers looked at the data of 120 undergraduate students who were enrolled in the Duke Neurogenetics Study. Each participant completed a series of mental health questionnaires and underwent functional Magnetic Resonance Imaging (fMRI) while engaging in tasks meant to activate specific regions of the brain.
Each participant answered simple memory-based math problems to stimulate the dorsolateral prefrontal cortex. They also viewed angry or scared faces to activate a region of the brain called the amygdala, and played a reward-based guessing game to stimulate activity in the brain’s ventral striatum.
The researchers were particularly interested in at-risk individuals who showed a combination of high threat-related activity in the amygdala and low reward-related activity in the ventral striatum.
By comparing participants’ mental health assessments at the time of the brain scans as well as in a follow-up approximately seven months later, the researchers found that these at-risk individuals were less likely to develop anxiety if they also had high activity in the dorsolateral prefrontal cortex.
“We found that if you have a higher functioning dorsolateral prefrontal cortex, the imbalance in these deeper brain structures is not expressed as changes in mood or anxiety,” said Hariri.
According to the researchers, the dorsolateral prefrontal cortex is particularly skilled at adapting to new situations. Individuals whose brains exhibit the at-risk signatures may be more likely to benefit from therapies that boost the brain’s dorsolateral prefrontal activity, including CBT, working memory training or transcranial magnetic stimulation (TMS).
However, the researchers warn that it remains unclear whether brain-training exercises improve the overall functioning of the dorsolateral prefrontal cortex, or only hone its ability to complete the specific task being trained. More studies involving diverse populations are needed to confirm these findings.
“We are hoping to help improve current mental health treatments by first predicting who is most at-risk so that we can intervene earlier, and second, by using these types of approaches to determine who might benefit from a given therapy,” said Scult.
Source: Duke University
Making a decision between two options that have both positive and negative elements, such as deciding between a job with a high salary but long hours, and a lower-paying job that allows for more leisure time, is not always easy.
Neuroscientists at the Massachusetts Institute of Technology have now discovered that making decisions in this type of situation, known as a cost-benefit conflict, is dramatically affected by chronic stress.
In a study of mice, they found that stressed animals were far likelier to choose high-risk, high-payoff options.
The researchers also found that impairments of a specific brain circuit underlie this abnormal decision-making, and they showed that they could restore normal behavior by manipulating this circuit.
If a method for tuning this circuit in humans were developed, it could help patients with depression, addiction, and anxiety, which often feature poor decision-making, the scientists claim.
“One exciting thing is that by doing this very basic science, we found a microcircuit of neurons in the striatum that we could manipulate to reverse the effects of stress on this type of decision making,” said Dr. Ann Graybiel, a professor at the Massachusetts Institute of Technology and a member of the McGovern Institute for Brain Research. “This, to us, is extremely promising, but we are aware that so far these experiments are in rats and mice.”
In 2015, the MIT researchers first identified the brain circuit involved in decision making that involves cost-benefit conflict. The circuit begins in the medial prefrontal cortex, which is responsible for mood control, and extends into clusters of neurons called striosomes, which are located in the striatum, a region associated with habit formation, motivation, and reward reinforcement.
In that study, the researchers trained rodents to run a maze in which they had to choose between one option that included highly concentrated chocolate milk, which they like, along with bright light, which they don’t, and an option with dimmer light but weaker chocolate milk.
By inhibiting the connection between cortical neurons and striosomes, using a technique known as optogenetics, the researchers found that they could transform the rodents’ preference for lower-risk, lower-payoff choices to a preference for bigger payoffs despite their bigger costs.
In the new study, the researchers performed a similar experiment without optogenetic manipulations. Instead, they exposed the rodents to a short period of stress every day for two weeks.
Before experiencing stress, normal rats and mice would choose to run toward the maze arm with dimmer light and weaker chocolate milk about half the time. The researchers gradually increased the concentration of chocolate milk found in the dimmer side, and as they did so, the animals began choosing that side more frequently.
However, when chronically stressed rats and mice were put in the same situation, they continued to choose the bright light/better chocolate milk side even as the chocolate milk concentration greatly increased on the dimmer side.
This was the same behavior the researchers saw in rodents that had the prefrontal cortex-striosome circuit disrupted optogenetically.
“The result is that the animal ignores the high cost and chooses the high reward,” said Alexander Friedman, a McGovern Institute research scientist and the paper’s lead author.
The researchers believe that this circuit integrates information about the good and bad aspects of possible choices, helping the brain to produce a decision. Normally, when the circuit is turned on, neurons of the prefrontal cortex activate certain neurons called high-firing interneurons, which then suppress striosome activity.
When the animals are stressed, these circuit dynamics shift and the cortical neurons fire too late to inhibit the striosomes, which then become overexcited, the researchers explained. This results in abnormal decision making.
“Somehow this prior exposure to chronic stress controls the integration of good and bad,” Graybiel said. “It’s as though the animals had lost their ability to balance excitation and inhibition in order to settle on reasonable behavior.”
Once this shift occurs, it remains in effect for months, the researchers found. However, they were able to restore normal decision making in the stressed mice by using optogenetics to stimulate the high-firing interneurons, suppressing the striosomes.
This suggests that the prefronto-striosome circuit remains intact following chronic stress and could potentially be susceptible to manipulations that would restore normal behavior in humans whose disorders lead to abnormal decision making, the researchers said.
“This state change could be reversible, and it’s possible in the future that you could target these interneurons and restore the excitation-inhibition balance,” Friedman said.
The study was published in Cell.
New research suggests that policies that put children with special needs into classrooms with their peers who have no disabilities, may be harmful to the children unless schools develop programs to create a culture of acceptance.
Proponents of mainstreaming have focused on the possible benefits for both traditional and special needs students by co-mingling the students into the regular classroom.
The new study, published in the journal Autism, finds that more needs to be done as negative school experiences can have harmful long-term effects on pupils with Autism Spectrum Conditions.
Researchers from the University of Surrey found that experiences of social and emotional exclusion in mainstream schools can adversely affect how pupils with autism view themselves. The detrimental self-perception can increase their risk of developing low self-esteem, a poor sense of self-worth and mental health problems.
Examining 17 previous studies in the area, researchers discovered that how pupils with autism view themselves is closely linked to their perceptions of how other’s treat and interact with them.
They found that a tendency of many pupils with the condition tend to internalize the negative attitudes and reactions of others toward them. This perception, combined with unfavorable social comparisons to classmates, leads to a sense of being ‘different’ and more limited than peers.
Negative self-perception can lead to increased isolation and low self-esteem making pupils with autism more susceptible to mental health problems.
Researchers discovered that the physical environment of schools can also impact a children’s ability to interact with other pupils and succeed in school. For example, sensory sensitivity, which is a common characteristic of autism and can magnify sounds to an intolerable level. This in turn, can lead to everyday classroom and playground noises such as shrieks and chatter to becoming a source of anxiety and distraction.
The sensitivity to a loud environment can impact a pupil’s ability to concentrate in the classroom and ability to socialize with others, further increasing isolation and a sense of being ‘different.’
Investigators did discovered benefits from mainstreaming as pupils with autism developed supportive friendships and felt accepted by classmates. This bonding helped the ASD child alleviate their social difficulties and made them feel good about themselves.
These findings suggest it is crucial for schools to create a culture of acceptance for all pupils to ensure the long-term wellbeing of pupils with autism in mainstream settings.
Lead author of the paper Dr Emma Williams, from the University of Surrey, said: “Inclusive mainstream education settings may inadvertently accentuate the sense of being ‘different’ in a negative way to classmates.
“We are not saying that mainstream schools are ‘bad’ for pupils with autism, as other evidence suggests they have a number of positive effects, including increasing academic performance and social skills.
“Rather, we are suggesting that by cultivating a culture of acceptance of all and making small changes, such as creating non-distracting places to socialise, and listening to their pupils’ needs, schools can help these pupils think and feel more positively about themselves.
“With over 100,000 children in the UK diagnosed with autism, it is important that we get this right to ensure that pupils with autism get the education they deserve and leave school feeling accepted, loved and valued, rather than with additional mental health issues.”
Source: University of Surrey
A new U.K. study finds that stress experienced by emergency call handlers can compromise their long-term psychological well-being, a new report shows.
Those working in this role are the first to receive a traumatic call and are then responsible for making critical decisions in assessing what type of emergency response is required.
Previous research on how stress affects health care workers has largely focused on clinical or front-line professionals; i.e., paramedics and firefighters. However, little is known about how the work demands affect the mental health of the call handlers.
Examining 16 studies from across the world, researchers from the University of Surrey, University of Dundee, Anglia Ruskin University and Kingston University/St George’s, University of London, identified key factors which cause operatives stress and potentially impact on their psychological health.
Exposure to traumatic and abusive calls was found to negatively affect call handlers. Although the dispatchers are not physically exposed to emergency situations, evidence demonstrated that they experienced trauma vicariously.
In one study, participants reported experiencing fear, helplessness, or horror in reaction to 32 percent of the different types of calls that they received.
A key stressor for call handlers was a lack of control over their workload due to the unpredictability of calls and a lack of organizational recognition of the demands of managing their assignments.
One study reported that ambulance dispatchers felt out of control of their workload after returning from rest breaks, so many wound up not taking scheduled breaks, leading to exhaustion.
A lack of high-quality training in dealing with high-pressure calls was identified by some dispatchers as contributing to stress levels. In one instance, police dispatchers reported concern about their performance in handling fluid situations such as robberies in progress or suicidal callers, in case they did not make the correct decisions.
“Call handlers across different emergency services consistently reported their job as highly stressful, which in turn affects their psychological health. This undoubtedly impacts on their overall well-being, leading to increased sickness and time away from work, putting additional strain on the service and their colleagues, said co-author Mark Cropley, a professor in Health Psychology at the University of Surrey.
“Although handlers are not experiencing trauma first-hand, the stress that they experience when responding to such calls should not be overlooked.”
Co-author Professor Patricia Schofield, of Anglia Ruskin University, said, “Call handlers are the front line of emergency care but are often overlooked when it comes to studies about stress affecting the police, fire and ambulance services. This study finds evidence that staff are at risk of burnout, due to high workload, inadequate training, and a lack of control.
“It’s important that these staff are considered and interventions made to ensure that they can cope with their workload — these people make vital decisions which affect lives.”
Another co-author, Professor Tom Quinn from Kingston University & St George’s, University of London, said, “Most people probably don’t recognize the stressful conditions under which emergency call center staff work. Now that we have explored and summarized the evidence to identify the challenges these important staff face, we plan to develop and test interventions to reduce the burden on them and improve their well-being.”
Source: Surrey University
In a decade-long study, Canadian researchers found that more than two-thirds of children and teens in Ontario with acute concussions did not receive medical follow-up care or clearance as recommended by current guidelines.
Concussions can have long-term effects on memory and cognition and can increase vulnerability to mental disorders such as depression and anxiety.
“Despite improvement over the past several years, the rate of follow-up visits after a pediatric concussion diagnosis remain unacceptably low.” said senior author Dr. Roger Zemek, director of clinical research at the Children’s Hospital of Eastern Ontario.
“This reinforces the ongoing need to ensure that the latest concussion guidelines are implemented broadly in order to standardize the approach to concussion diagnosis and management.”
For the study, Professor Alison Macpherson in the Faculty of Health, School of Kinesiology & Health Science at York University, and former York University Ph.D. student Liraz Fridman, analyzed data from more than 120,000 children aged five to 19 years. The aim of the study was to investigate whether concussed youth go on to receive follow-up visits in accordance with the recommended guidelines.
The researchers looked at population-based data from the Institute for Clinical Evaluative Sciences (ICES) consisting of all concussion-related visits to emergency department and physician offices in Ontario from 2003-2013.
The team measured the percentage of children and youth seen for follow-up. Over the decade of the study, the findings reveal that there was an increase in the number of children who came in for follow-up care after being evaluated for a concussion before 2013.
In Ontario, concussion-related emergency department and office visits rates per 100,000 children have quadrupled from 2003 to 2013, with similar increases found in the United States. In 2003, 11 percent of children and teens were seen for a follow-up after sustaining a concussion and by 2013 that number jumped to 30 percent.
Still, over two-thirds did not receive follow-up care in accordance with international recommended guidelines.
“That two-thirds of children were still not being seen for follow-up was surprising considering that international recommendations have been in place since 2001,” said Fridman.
“A lack of sufficient follow-up care puts children and youth at risk for another concussion or more serious consequences,” added Macpherson.
The researchers say it is unclear why most concussed children do not receive adequate follow-up and treatment. However, the findings show the need for better education programs for health care professionals, parents, coaches, children, and youth which may help improve follow-up rates.
Source: York University
A new study suggests that greater screen time — whether in the form of computers, cell phones or tablets — may have contributed to a spike in depression and suicide-related behaviors and thoughts among American teens, particularly girls, between 2010 and 2015.
The study, led by a researcher at San Diego State University (SDSU), sheds new light on the need for parents to monitor how much time their children are spending in front of media screens.
“These increases in mental health issues among teens are very alarming,” said study leader Dr. Jean Twenge, professor of psychology. “Teens are telling us they are struggling, and we need to take that very seriously.”
Twenge, along with SDSU graduate student Gabrielle Martin and colleagues Drs. Thomas Joiner and Megan Rogers at Florida State University, analyzed questionnaire data from more than 500,000 U.S. teens from two anonymous, nationally representative surveys that have been conducted since 1991. They also studied suicide statistics kept by the U.S. Centers for Disease Control and Prevention.
The findings show that the suicide rate for girls aged 13-18 increased by 65 percent between 2010 and 2015, and the number of girls experiencing suicide-related outcomes — feeling hopeless, thinking about suicide, planning for suicide or attempting suicide — increased by 12 percent. The number of female teens reporting symptoms of severe depression increased by 58 percent.
“When I first saw these sudden increases in mental health issues, I wasn’t sure what was causing them,” said Twenge. “But these same surveys ask teens how they spend their leisure time, and between 2010 and 2015, teens increasingly spent more time with screens and less time on other activities. That was by far the largest change in their lives during this five-year period, and it’s not a good formula for mental health.”
The team looked back at the data to see if there was a statistical relationship between screen-time and depressive symptoms and suicide-related outcomes.
They discovered that 48 percent of teens who spent five or more hours per day on electronic devices reported at least one suicide-related outcome, compared to only 28 percent of those who spent less than an hour a day on devices. Depressive symptoms were more common in teens who spent a lot of time on their devices as well.
The findings add to previous evidence showing that spending more time on social media is linked to unhappiness.
In contrast, the results show that spending time away from these devices and engaging in in-person social interaction, sports and exercise, doing homework, attending religious services, etc., is associated with fewer depressive symptoms and suicide-related outcomes.
Although economic struggles are often thought to be linked to depression and suicide, the U.S. economy was improving between 2010 and 2015, so it is unlikely to be the primary driver of these increases, Twenge noted.
“Although we can’t say for sure that the growing use of smartphones caused the increase in mental health issues, that was by far the biggest change in teens’ lives between 2010 and 2015,” she said.
The study findings are published in the journal Clinical Psychological Science.
Source: San Diego State University
In the largest research study of its kind to date, researchers have determined cognitive behavioral therapy (CBT) provides lasting benefits for children with obsessive compulsive disorder (OCD).
OCD is an extremely stressful psychiatric disorder that affects between 0.25 and 4 percent of all children. OCD can cause kids to have unwanted thoughts, feelings, and fears. These obsessions can make a child feel anxious and may lead to compulsive behaviors or rituals.
Fortunately, new research shows that cognitive behavioral therapy provides long-term benefits for children and adolescents aged 7-17.
In the study, coined the “Nordic research project,” investigators from Aarhus University and child and adolescent psychiatry clinics in Norway and Sweden, found that children and adolescents who benefited from the therapy were also free of patterns of compulsive behavior and compulsive thoughts one year after the treatment ended.
“The study makes clear that cognitive behavioral therapy reaches beyond the treatment period. This knowledge is important, both for the practitioners, but not least for the affected children and their families,” said Dr. Per Hove Thomsen, one of the researchers behind the study and professor at Aarhus University.
“OCD is a very difficult disorder which demands a colossal amount of the child in question. It is almost impossible to live a normal life as a child and teenager with a normal level of development, if you need to wash your hands a hundred times a day in a particular way in order not to be killed, which is something that compulsive thinking can dictate.
For the same reason, early intervention is necessary before the disorder has disabling consequences in adulthood,” explains Thomsen.
The children from the study with OCD were treated with a cognitive behavioral psychological approach. Therapists helped individuals learn to refrain from acting on compulsive thoughts and instead incorporate new thought patterns.
CBT intervention also involves the whole family, as the effect is strengthened by the mother and father supporting the methods that the child is given to overcome the OCD.
Lead author David R.M.A Højgaard, Ph.D., said the treatment approach includes close observation of the child or teenager after the initial therapy is completed.
“The results of the study indicate that to maintain the effect in the longer term you need to remain aware and detect OCD symptoms so you can nip them in the bud before they develop and become worse. This is done by offering booster sessions to refresh the treatment principles and thereby prevent OCD from getting a foothold again,” said Højgaard.
Researchers believe the study design which analyzed care in child and adolescent psychiatry clinics shows that care can be provided in a variety of settings.
“The biggest challenge facing OCD treatment is that there are not enough specially trained therapists and treatment facilities to meet needs. The study shows that if the level of training of therapists is consolidated and if supervision is provided, then it is possible to provide treatment in an isolated corner of Norway that is just as effective as the treatment provided at a university clinic,” Thomsen said.
The study is part of The Nordic Long Term OCD Treatment Study (NordLOTS) and comprises 269 children and adolescents with OCD from Denmark, Norway and Sweden.
The results showed that 92 per cent of the 177 children and teenagers who immediately benefited from the treatment were still healthy and free of symptoms one year after the treatment ended. Of these, 78 per cent had no clinical symptoms of OCD.
The study appears in the Journal of the American Academy of Child and Adolescent Psychiatry.
Source: Aarhus University
A new study finds that we tend to project our own experiences with stress onto other people, which can sometimes result in miscommunication and missed opportunities. For example, a person who thrives on high levels of stress may not understand why another person is so burned out.
“Your stress mindset will affect your judgement of other people’s stress responses,” said researcher Nili Ben-Avi from Tel Aviv University’s (TAU) Coller School of Management. “But we have shown that even if stress affects you positively, it can distort the way you see your colleagues, your employees, your spouses, even your own children. We should be very careful about assessing other people’s stress levels.”
Lead researcher Professor Sharon Toker at TAU Coller School of Management says that it comes down to whether we see stress as a positive or a negative.
The study specifically looked at whether a person’s individual mindset regarding stress can color the way he or she will perceive a colleague or employee’s health, work productivity and degree of burnout.
“This research informs the way managers assess their employees’ ability to take on different workloads,” said Toker.
“If a manager perceives that a certain employee doesn’t suffer from stress, that manager will be more likely to consider the employee worthy of promotion. But because the manager believes that stress is a positive quality that leads to self-sufficiency, the manager will also be less likely to offer assistance if the employee needs it.”
The findings can have implications at home as well. “It may also inform our relationships with our spouses or with our children. For example, a typical ‘tiger mom’ is sure that stress is a good thing. She may simply not see how burned out her child may be,” Toker said.
For the study, the researchers recruited 377 American employees for an online “stress-at-work” questionnaire. Participants were asked to read a description of “Ben,” a fictitious employee who works long hours, has a managerial position and needs to multitask. The employees then rated his burnout levels and completed a stress mindset questionnaire about Ben.
“The more participants saw stress as positive and enhancing, the more they perceived Ben as experiencing less burnout and consequently rated him as more worthy of being promoted,” said Toker.
The researchers also investigated whether or not they could manipulate the participants’ perceptions of stress and consequently change how they perceive other people’s stress. They conducted a series of further experiments among 600 employed Israelis and Americans to determine whether their stress mindset could be cultivated or changed.
The participants were randomly assigned to either an “enhancing” or “debilitating” stress mindset group of 120-350 people. Using a technique called “priming” — prompting participants to think of the word “stress” in either positive or negative terms — the researchers asked the participants to write about past stress experiences in either a “positive/enhancing” or “negative/debilitating” way.
Next, participants read a description of Ben’s workload and had to assess Ben’s burnout, rate of productivity and psychosomatic symptoms. Participants were also asked whether Ben should be promoted and whether they would be willing to help him with his workload.
Study participants primed to have a positive/enhancing stress mindset rated Ben as suffering less from stress-related symptoms and were consequently more likely to recommend Ben for promotion. They were also less likely to offer him help. But those primed to feel as though stress was debilitating/negative felt that Ben was more burned out and consequently less fit to be promoted.
The study findings are published online in the Journal of Experimental Social Psychology.
A new international study discovers psychosocial factors, including work and financial stress, significantly increase the risk of having a heart attack or myocardial infarction. Currently, few doctors ask about stress, depression or anxiety during an annual examination.
Researchers believe inquires on stress, and suggestions on where to obtain information to improve coping skills and enhance resiliency, should become standard practice, just as current standards have physicians asking about smoking.
The INTERHEART study, presented at the 18th Annual Congress of the South African Heart Association, discovered the odds of myocardial infarction was 5.6 times higher in patients with moderate or severe work stress compared to those with minimal or no stress.
Individuals with significant financial stress had a 13-fold higher odds of having a myocardial infarction.
“The role of psychosocial factors in causing disease is a neglected area of study,” said lead author Dr. Denishan Govender, associate lecturer, University of the Witwatersrand, Johannesburg.
“The study showed that psychosocial factors are independently associated with acute myocardial infarction (heart attack) in Africa but as far as we are aware there are no other published local data,” said co-author Professor Pravin Manga, professor of cardiology, University of the Witwatersrand.
In other words, stress, even in the absence other cardiovascular conditions such as high blood pressure or elevated cholesterol, can significantly increases the risk of a heart attack.
This study included 106 patients with acute myocardial infarction who presented to a large public hospital in Johannesburg. A control group of 106 patients without cardiac disease was matched for age, sex and race.
All participants completed a questionnaire about depression, anxiety, stress, work stress, and financial stress in the previous month. A Likert scale was used to grade the experience of each condition.
Investigators assigned four resiliency profiles to classify how well a person was coping with financial stress:
- individuals were assessed as having no financial stress if they were coping financially;
- mild financial stress if they were coping financially but needed added support;
- moderate financial stress if they had an income but were in financial distress;
- significant financial stress if they had no income and at times struggled to meet basic needs.
Levels of psychosocial conditions were compared between groups and used to calculate associations with having a heart attack.
Self-reported stress levels were common, with 96 percent of heart attack patients reporting any level of stress, and 40 percent reporting severe stress levels.
There was a three-fold increased risk of myocardial infarction if a patient had experienced any level of depression (from mild to extremely severe) in the previous month compared to those with no depression.
Govender said, “Our study suggests that psychosocial aspects are important risk factors for acute myocardial infarction. Often patients are counselled about stress after a heart attack but there needs to be more emphasis prior to an event.
“Few doctors ask about stress, depression or anxiety during a general physical and this should become routine practice, like asking about smoking. Just as we provide advice on how to quit smoking, patients need information on how to fight stress.”
Source: European Society of Cardiology
Women who struggle with anorexia nervosa or obesity exhibit low levels of a neuroactive steroid known as allopregnanolone, a metabolite of the hormone progesterone, according to a new study published in the journal Neuropsychopharmacology.
Previous studies have linked low levels of allopregnanolone (allo) to depression and anxiety, which are common mood symptoms in both anorexia and obesity. Low levels of allo have also been found in people with post-traumatic stress disorder (PTSD). But until now, the chemical and its impact on mood has not been measured in anorexic or obese women.
Allo binds to receptors and enhances the signal of the neurotransmitter gamma-aminobutyric acid (GABA), generally producing a positive mood and feelings of well-being. More than 50 percent of women with anorexia nervosa have depression or anxiety, and 43 percent of adults who are obese have depression.
“Depression is an incredibly prevalent problem, especially in women, and also particularly at the extremes of the weight spectrum,” said study leader Dr. Karen Miller, professor of medicine at Harvard Medical School.
“The hope is that a greater understanding of mechanisms contributing to these disorders —including abnormalities in the regulation of hormones and their neuroactive metabolites — may lead to new targeted therapies in the future.”
The study involved 12 women with anorexia nervosa with amenorrhea (not having menstrual periods) whose body mass indices were less than 18.5; 12 normal-weight women with BMIs between 19 and 24; and 12 obese women with BMIs at 25 or higher.
None of the women had received a diagnosis of depression or had ever taken antidepressants. The average age of the participants was 26 years old.
Participants gave blood samples and completed questionnaires to measure levels of depression and anxiety. The lab used gas chromatography and mass spectrometry to pick up extremely small levels of sex hormones and metabolites in the participants’ blood serum, saliva and brain tissue.
The researchers found that in women with anorexia nervosa and in obese women, blood levels of allo were 50 percent lower than they were in women with normal BMIs. Women who were clinically obese had allo levels approximately 60 percent lower than normal-weight women.
In addition, levels of allo in all participants correlated with the severity of their depression and anxiety symptoms as measured by the questionnaires. Participants with lower levels of allo had greater severity of depression symptoms.
“We are beginning to see more and more evidence that low allo levels are tightly linked to depression, anxiety, post-traumatic stress disorder, and other mood disorders,” said Dr. Graziano Pinna, associate professor of psychiatry in the University of Illinois at Chicago (UIC) College of Medicine and an author on the paper.
“To see that women with anorexia nervosa and obesity have low levels adds to the picture that the role of allo is under-recognized in mood disorders.”
The researchers also found that progesterone levels were similarly low across all groups. This suggests that the low allo levels may have been caused by improper functioning of enzymes responsible for the metabolism of progesterone into allo.
“Women with anorexia nervosa had low progesterone because they were amenorrheic, and the other two groups also had low progesterone levels because their blood was taken in the follicular phase when progesterone is naturally low,” said Pinna.
“That we found that obese women had lower allo levels than normal weight participants adds to growing evidence that this steroid is involved in depression and anxiety regardless of how much progesterone is available to begin with.”
Pinna believes that the enzymes that convert progesterone into allo may not be working properly, causing decreases in allo that lead to mood disorders.
“Drugs that increase the efficacy of these enzymes may be useful in helping to boost allo levels,” he said. “But more research is needed to figure out exactly the deficit in the metabolism of progesterone into allo so that precision medicines using allo as a biomarker can be developed.”
Emerging research finds that all forms of sexual harassment can cause psychological harm, especially among female teens.
In the study, Norwegian investigators divided the types of harassment into two main groups: non-physical harassment and physically coercive sexual behavior, such as unwanted kissing, groping, intimate touch, and intercourse.
Researchers focused on non-physical sexual harassment described as: derogatory sexual remarks about appearance, behavior and sexual orientation, unwanted sexual attention, being subject to rumoring, and being shown sexually oriented images, and the like.
“Being exposed to non-physical sexual harassment can negatively affect symptoms of anxiety, depression, negative body image and low self-esteem,” say Associate Professor Mons Bendixen and Professor Leif Edward Ottesen Kennair. Bendixen and Kennair are associated with the Norwegian University of Science and Technology’s (NTNU) Department of Psychology.
The research, which appears in the International Journal of Public Health, posed questions about sexual harassment experienced in the previous year and received responses from almost 3,000 high school students in two separate studies.
The responses present a poignant picture. Notably, the effects of sexual harassment are worst for girls. However, the provocations are not exclusively something boys do against girls. It’s just as common for boys to harass boys in these ways.
Girls and boys are equally exposed to unpleasant or offensive non-physical sexual harassment. About 62 per cent of both sexes report that they have experienced this in the past year.
“Teens who are harassed the most also struggle more in general. But girls generally struggle considerably more than boys, no matter the degree to which they’re being harassed in this way,” Kennair notes.
“Girls are also more negatively affected by sexual harassment than boys are,” adds Bendixen.
Being a girl is unquestionably the most important risk factor when teens report that they struggle with anxiety, depression, negative body image or low self-esteem.
Conspicuously, non-physical sexual harassment is the second most important factor for mental health struggles. In fact, harassment is more strongly associated with adolescents’ psychological well-being than being subjected to sexual coercion in the past year or sexual assault prior to that.
Bendixen and Kennair believe separating the types of harassment into two main groups: non-physical harassment and physically coercive sexual behavior, such as unwanted kissing, groping, intimate touch, and intercourse, is critical.
Physical sexual coercion is often characterized as sexual abuse in the literature.
Studies usually lump these two forms of unwanted behavior together into the same measure. This means that a derogatory comment is included in the same category as rape.
“As far as we know, this is the first study that has distinguished between these two forms and specifically looked at the effects of non-physical sexual harassment,” says Bendixen.
Comments that for some individuals may seem innocent enough can cause significant problems for others.
For instance, not everyone interprets slang or slurs the same way. If someone calls you a “whore” or “gay,” you may not find it offensive. For this reason, the researchers let the adolescents decide whether they perceived a given action as offensive or not, and had them only report what they did find offensive.
The article presents data from two studies. The first study from 2007 included 1384 high school students. The second study included 1485 students and was conducted in 2013-2014. Both studies were carried out in Sør-Trøndelag county and are comparable with regard to demographic conditions.
The results of the first study were reproduced in the second. The findings from the two studies matched each other closely.
The researchers also took into account a number of other potentially influential factors, such as having parents who had separated or were unemployed, educational program (vocational or general studies), sexual minority status, immigrant status, and whether they had experienced physical coercion in the past year or any sexual assaults previous to that.
“We’ve found that sexual minorities generally reported more psychological distress,” says Bendixen. The same applied to young people with parents who are unemployed.
On the other hand, students with immigrant status did not report more psychological issues. Bendixen also notes that sexual minorities did not seem to be more negatively affected by sexual harassment than their heterosexual peers.
However, the researchers did find a clear negative effect of non-physical sexual harassment, over and beyond that of the risk factors above.
Still many questions persist on what can be done to reduce behaviors that may cause such serious problems for so many?
Kennair concedes that he doesn’t know what can help.
“This has been studied for years and in numerous countries, but no studies have yet revealed any lasting effects of measures aimed at combating sexual harassment,” Bendixen says. ”
We know that attitude campaigns can change people’s attitudes to harassment, but it doesn’t result in any reduction in harassment behavior.”
Bendixen and Kennair want to look into this in an upcoming study. Their goal is to develop practices that reduce all forms of sexual harassment and thereby improve young people’s psychological well-being.
Emerging research suggests cognitive behavioral therapy (CBT) can be an important strategy to help individuals learn to manage chronic pain. Experts believe CBT has the potential to help millions of Americans overcome opioid dependency.
“Cognitive behavioral therapy is a useful and empirically based method of treatment for pain disorders that can decrease reliance on the excessive use of opiates,” write Drs. Muhammad Hassan Majeed of Natchaug Hospital, Mansfield Center, Conn., and Donna M. Sudak of Drexel University College of Medicine, Philadelphia.
In a new paper they discuss evidence supporting the use of CBT to avoid or reduce the use of opioids for chronic pain. The acknowledgement that use of opioid (sometimes called opiate) medications to treat chronic noncancer pain has reached epidemic proportion has lead researchers to search for pain management alternatives.
Even with use of opioids, there has been little change in the amount and severity of pain reported by Americans over the past decade.
“There is no evidence that supports the use of opioids for the treatment of chronic pain for more than one year, and chronic use increases the serious risks of misuse, abuse, addiction, overdose, and death,” Drs. Majeed and Sudak write.
They believe that CBT is an important alternative to opioids for treatment of chronic pain. The goal of CBT is to help patients change the way they think about and manage their pain.
The idea is not that pain (in the absence of tissue damage) “is all in your head”–but rather that all pain is “in the head.”
Cognitive behavioral therapy helps patients understand that pain is a stressor and, like other stressors, is something they can adapt to and cope with.
Interventions may include relaxation training, scheduling pleasant activities, cognitive restructuring, and guided exercise–all in the context of an “empathic and validating” relationship with the therapist.
These interventions “have the potential to relieve pain intensity, improve the quality of life, and improve physical and emotional function,” according to the authors.
“Therapy helps the patient see that emotional and psychological factors influence perception of pain and behaviors that are associated with having pain,” explain Majeed and Sudak.
“Therapy…puts in place cognitive and behavioral strategies to help patients cope more successfully.”
The authors cite several recent original studies and review articles supporting the effectiveness of CBT and other alternative approaches for chronic pain. Many publications suggest CBT has a “top-down” effect on pain control and perception of painful stimuli.
CBT has also been found useful in normalizing reductions in the brain’s gray matter volume, which are thought to result from the effects of chronic stress.
Overall, cognitive behavioral therapy is moderately effective in reducing pain scores, while avoiding or reducing the opioid risks of overuse, addiction, overdose, and death.
It can be used as a standalone treatment; in combination with other treatments, including effective non-opioid medications; or as part of efforts to reduce the opioid doses required to control chronic pain.
Unfortunately, CBT and other non-pharmacological approaches are underused due to unfamiliarity, time pressure, patient demands, ease of prescribing medications, and low reimbursement rates.
Researchers note that significant investment of resources will be needed to train practitioners and to widely integrate the use of CBT into chronic pain treatment. The authors suggest that the President’s Commission on the opioid crisis might fund such training programs as a preventive strategy to curb opioid abuse.
“There is a need for a paradigm shift from a biomedical to a biopsychosocial model for effective pain treatment and prevention of opioid use disorder,” Dr. Majeed comments.
“Increased use of CBT as an alternative to opioids may help to ease the clinical, financial, and social burden of pain disorders on society.”
Source: Wolters Kluwer Health/EurekAlert
New research suggests mental health providers should prescribe a non-pharmaceutical, natural remedy to aid the management of depression — exercise.
Investigators believe a strategy that combines physical activity with psychotherapy can be a very effective method to improve mood and relieve depression.
In the study, Michigan State University (MSU) and University of Michigan (U-M) researchers asked 295 patients receiving treatment at a mental health clinic whether they wanted to be more physically active and if exercise helped improve their mood and anxiety.
They also asked if patients wanted their therapist to help them become more active.
Eighty-five percent said they wanted to exercise more and over 80 percent believed exercise helped improve their moods and anxiety much of the time.
Almost half expressed interest in a one-time discussion, with many participants also wanting ongoing advice about physical activity with their mental health provider.
The study appears in the journal General Hospital Psychiatry.
“Physical activity has been shown to be effective in alleviating mild to moderate depression and anxiety,” said Carol Janney, lead author of the study and an MSU assistant professor of epidemiology.
“Current physical activity guidelines advise at least 30 minutes, five days a week to promote mental and physical health, yet many of those surveyed weren’t meeting these recommendations.”
More than half of the participants said their mood limited their ability to exercise, which Janney said provides an opportunity for physicians and therapists in clinics to offer additional support.
“Offering physical activity programs inside the mental health clinics may be one of many patient-centered approaches that can improve the mental and physical health of patients,” Janney said.
Marcia Valenstein, senior author and professor emeritus in psychiatry at U-M, agreed.
“Mental health treatment programs need to partner with fitness programs to support their patients’ willingness to exercise more,” she said.
“This support might come from integrating personal trainers into mental health clinics or having strong partnerships with the YMCA or other community recreational facilities.”
Both Valenstein and Janney said that psychiatrists and other providers might discuss with patients the general need to exercise, but few actually sit down with patients and create a comprehensive exercise plan for them or regularly make sure they are adhering to a specific goal.
“Mental health providers such as psychiatrists and therapists may not have the necessary training to prescribe physical activity as part of their mental health practice,” Janney said.
“But by teaming up with certified personal trainers or other exercise programs, it may help them prescribe or offer more recommendations for physical activity in the clinic setting.”
Results also showed that over half of the patients surveyed showed interest in getting help from a personal trainer and were willing to pay a bit extra, but that the topic of physical activity was rarely discussed by their physician.
“This is a missed opportunity,” Valenstein said. “If we can make it easier for both therapists and their patients to have easier access to physical activity services, then we are likely to help more patients reduce their depression and anxiety.”
Once the effectiveness of this approach is proven, she added, health insurers might consider moving in the direction of covering services that help people exercise.
“Several insurers already do this for diabetes prevention, so it’s not out of the question.”
Source: Michigan State University
New research explains how sleep deprivation disrupts our brain cells’ ability to communicate with each other. The disconnect can lead to temporary mental lapses that affect memory and visual perception.
“We discovered that starving the body of sleep also robs neurons of the ability to function properly,” said senior author Dr. Itzhak Fried, professor of neurosurgery at the David Geffen School of Medicine at University of California, Los Angeles (UCLA) and Tel Aviv University.
“This paves the way for cognitive lapses in how we perceive and react to the world around us.”
Fried led an international team in studying 12 UCLA epileptic patients who had electrodes implanted in their brains in order to pinpoint the origin of their seizures prior to surgery.
As part of the procedure, patients are asked to stay awake all night to speed the onset of an epileptic episode and shorten their hospital stay.
In the current experiment, researchers asked the patients to categorize a variety of images as fast as possible while their electrodes recorded the firing of nearly 1,500 single brain cells across the group in real time.
The scientists zeroed in on the temporal lobe, which regulates visual perception and memory.
Performing the task grew more challenging as the patients grew sleepier. As the patients slowed down, their brain cells did, too.
“We were fascinated to observe how sleep deprivation dampened brain cell activity,” said lead author Dr. Yuval Nir of Tel-Aviv University.
“Unlike the usual rapid reaction, the neurons responded slowly, fired more weakly, and their transmissions dragged on longer than usual.”
In short, a lack of sleep interfered with the neurons’ ability to encode information and translate visual input into conscious thought. The same phenomenon can occur when a sleep-deprived driver notices a pedestrian stepping in front of his car.
“The very act of seeing the pedestrian slows down in the driver’s over-tired brain,” he explained. “It takes longer for his brain to register what he’s perceiving.”
In a second finding, the researchers discovered that slower brain waves accompanied sluggish cellular activity in the same regions of the patients’ brains.
“Slow sleep-like waves disrupted the patients’ brain activity and performance of tasks,” said Fried.
“This phenomenon suggests that select regions of the patients’ brains were dozing, causing mental lapses, while the rest of the brain was awake and running as usual,” said Fried.
The study’s findings provoke questions for how society views sleep deprivation.
“Inadequate sleep exerts a similar influence on our brain as drinking too much,” said Fried.
“Yet no legal or medical standards exist for identifying over-tired drivers on the road the same way we target drunk drivers.”
The importance of learning more on the effects surrounding sleep deprivation and conversely, the benefits of deep sleep, cannot overstated. Future studies will investigate the mechanism responsible for the cellular glitches that precede mental lapses.
Previous studies have tied sleep deprivation to a heightened risk of depression, obesity, diabetes, heart attacks, and stroke, as well as medical errors.
New research suggests that parenting styles can influence kids biologically and influence emotional control. Investigators found that less yelling, criticism and other harsh parenting approaches, including physical punishment, has the power to calm children with attention deficit hyperactivity disorder.
Researchers from Ohio State University evaluated physiological markers of emotional regulation in preschool children with ADHD before and after a parent and child intervention designed to improve family relations.
They discovered changes in parenting — including less yelling and physical discipline — led to improvements in children’s biological regulation.
“This is the first study to show that improved parenting changes kids biologically,” said Dr. Theodore Beauchaine, the study’s senior author and a professor of psychology.
“The idea is to change family dynamics so these highly vulnerable kids don’t run into big problems down the road, including delinquency and criminal behavior.”
The study appears in the journal Clinical Psychological Science.
During the study, parents of 99 preschoolers with ADHD received parenting coaching, half during 20 weekly two-hour sessions and half during 10 similar sessions.
The parents learned skills including problem-solving, positive parenting techniques and effective responses to their children’s behaviors.
Meanwhile, their children met with therapists who reinforced topics such as emotional regulation and anger management.
Before the training began, parents (usually moms) and their children engaged in play sessions that included an intentionally frustrating block-building exercise.
Parents dumped a large container of blocks on the floor and were told not to touch the blocks and to coach their children on how to build progressively complex structures.
During the exercise, the children were tethered to equipment that recorded their heart activity. Abnormal patterns of heart activity are common among children who have trouble controlling their emotions, including some children with ADHD, Beauchaine said.
After parent coaching was complete, the researchers had families return to the lab for retesting to determine if the training sessions led to changes in parenting and heart activity among children.
Reductions in negative parenting were found to drive improved biological function in children. However, increases in positive parenting had no effect.
The researchers also observed each parent and child during a 30-minute play session in the family home and video-recorded positive and negative parenting approaches.
Positive parenting included praise, encouragement and problem-solving. Negative parenting included critical statements, physical discipline and commands that gave children no opportunity to comply.
Less-harsh parenting also was linked to improved behavior in children, a finding that bolsters previous research in this area. “Negative interactions between parents and children have a big effect on kids,” Beauchaine said.
Greater improvements in parenting were seen in those who had 20 weeks of classes, versus 10. Regardless, the intervention was relatively short, Beauchaine said.
“Just 20 weeks to observe this much change is somewhat surprising,” he said.
Children in the study all struggled primarily with hyperactivity and impulsivity, as opposed to inattention. Some 76 percent were boys, which is similar to ADHD rates in the general population.
Families were participants in Beauchaine’s work with collaborators at the University of Washington. One limitation of the study is that it did not include a control group of parents and children who did not receive lessons.
Source: Ohio State University
Inadequate social skills do more than impede communication as new research finds the inability to communicate effectively may increase the risk for mental and physical health problems.
University of Arizona researchers discovered that people with poor social skills tend to experience more stress and loneliness, both of which can negatively impact health.
“We’ve known for a long time that social skills are associated with mental health problems like depression and anxiety,” explains study author, Chris Segrin, head of the UA Department of Communication.
“But we’ve not known definitively that social skills were also predictive of poorer physical health. Two variables — loneliness and stress — appear to be the glue that bind poor social skills to health. People with poor social skills have high levels of stress and loneliness in their lives.”
The study, published in the journal Health Communication, is among the first to link social skills to physical, not just mental, health.
The study is based on a survey of a nationally representative sample of 775 people, age 18 to 91, who were asked to respond online to questions designed to measure social skills, stress, loneliness, and mental and physical health.
Social skills refer to the communication skills that allow people to interact effectively and appropriately with others.
Segrin focused on four specific indicators of social skills:
• the ability to provide emotional support to others;
• self-disclosure, or the ability to share personal information with others;
• negative assertion skills, or the ability to stand up to unreasonable requests from others;
• and relationship initiation skills, or the ability to introduce yourself to others and get to know them.
Study participants who had deficits in those skills reported more stress, more loneliness, and poorer overall mental and physical health, Segrin said.
While the negative effects of stress on the body have been known for a long time, loneliness is a more recently recognized health risk factor.
“We started realizing about 15 years ago that loneliness is actually a pretty serious risk for health problems. It’s as serious of a risk as smoking, obesity or eating a high-fat diet with lack of exercise,” Segrin said.
Segrin likens the experience of loneliness to the way people feel when they’re in a hurry to get out the door and can’t find their keys — except the feeling never truly goes away.
“When we lose our keys, 99 percent of the time we find them, the stress goes away, we get in the car and it’s over,” he said.
“Lonely people experience that same sort of frantic search — in this case, not for car keys but for meaningful relationships — and they don’t have the ability to escape from that stress. They’re not finding what they’re looking for, and that stress of frantically searching takes a toll on them.”
The good news, Segrin says, is that social skills have proved to be amenable to intervention.
“For people who really want to improve their social skills and work on them, there’s therapy, there’s counseling and there is social skills training,” he said.
Unfortunately, however, many people who have poor social skills don’t realize it, Segrin said.
“One of the problems with possessing poor social skills is lack of social awareness, so even if they’re not getting the date, they’re not getting the job, they’re getting in arguments with co-workers or their spouse, they don’t see themselves as a problem,” Segrin said.
“They’re walking around with this health risk factor and they’re not even aware of it.”
Social skills are mostly learned over time, beginning in your family of origin and continuing throughout life. Yet, some scientific evidence suggests that certain traits, such as sociability or social anxiousness, may be at least partly hereditary, said Segrin, who has studied social skills for 31 years.
While Segrin doesn’t address it in his current study, he says that technology, for all its benefits, may be taking a serious toll on social skills, especially in young people.
“The use of technology — texting, in particular — is probably one of the biggest impediments for developing social skills in young people today,” he said.
“Everything is so condensed and parsed out in sound bites, and that’s not the way that human beings for thousands of years have communicated. It makes young people more timid when they’re face-to-face with others, and they’re not sure what to say what to do. There’s no social interaction, and I fear that’s really hurting young people.”
Parents can help with their children’s social skills — and, in turn, their health — not only by limiting screen time but also by making sure children are regularly exposed to situations that require in-person social interaction, Segrin said.
“It could be a summer camp, a sporting program, a church group — something where they can hang out with peers and just talk and do things together,” he said.
Segrin believes future studies should explore how other aspects of social skills might impact health. He also is interested in looking at how social skills impact those struggling with chronic illness.
“I want to get the word out about how valuable good communication skills are,” Segrin said. “They will not just benefit you in your social life but they’ll benefit your physical health.”
Source: University of Arizona
Although depression among new mothers is a well-identified condition, experts have only recently understood that some new fathers are also at risk.
A new Swedish study shows that depression among new fathers may be even more common than previously believed. Investigators also determined that today’s screening instruments often fail to detect this depression, placing new fathers at risk because they do not receive the help they need.
It is important to detect depression in new parents not only for their own sake, but also because depressed parents often become less perceptive to the needs of their child — particularly if the child cries a lot.
Lund University researchers explain that babies of depressed parents tend to receive less stimulation which, eventually, could lead to slower development. In some cases, depression may lead to neglect of the child or inappropriately forceful behaviors.
“These behaviors are not unusual – depression does not only involve major suffering for the parent, but also a risk for the child”, says Elia Psouni, associate professor of developmental psychology and co-author of the study. Additional coauthors include psychologists Johan Agebjörn and Hanne Linder.
In Sweden, all new mothers are screened for depression. This detection efforts reveal that an estimated 10-12 per cent of women become depressed during their first year after giving birth. Fathers, however, are not screened, but previous international studies suggest that the proportion of depressed fathers amounts to just over 8 per cent.
The new study of 447 new fathers showed that the established method of detecting depression by using the Edinburgh Postnatal Depression Scale or EPDS, failed to detect many depression symptoms.
“This means that current statistics may not tell the whole truth when it comes to depression in new fathers”, says Elia Psouni.
“The screening method does not capture symptoms which are particularly common in men, such as irritation, restlessness, low stress tolerance, and lack of self-control.”
Although one-third of the depressed fathers in the study had thoughts of hurting themselves, very few were in contact with the healthcare system.
Among those who were classified being moderately to severely depressed, 83 per cent had not shared their suffering with anyone. Although difficult to know, the corresponding figure for new mothers is believed to be 20-50 per cent.
“Telling people you feel depressed is taboo; as a new parent, you are expected to be happy. On top of that, previous research has shown that men are often reluctant to seeking help for mental health issues, especially depression; therefore, it’s doubtful that they would reveal their suffering to a pediatric nurse”, says Elia Psouni.
For the study, a new questionnaire was developed that the researchers believe will lead to improved screening methods for all fathers. The method they developed, which combines questions from EPDS and GMDS (Gotland Male Depression Scale), proved to be well-suited for capturing dads with multiple symptoms of depression.
When it comes to screening depression in fathers, Psouni thinks that the period to consider should be longer than the 12 months currently applied in studies of new mothers.
“Among dads, depression is common even at the end of the first year, which may be due to the fact that they rarely get help, but there may be other explanations.
Whatever the reason, it is important to monitor dads’ wellbeing as their part of the parental leave usually occurs towards the end of the child’s first year of life.”
Source: University of Lund/EurekAlert
In a new Swedish study, patients with severe and moderately severe depression showed significant improvement after 10 sessions of individual art therapy compared to those in the control group.
The research was conducted by licensed occupational and art therapist Christina Blomdahl, Ph.D., as part of her dissertation at Sahlgrenska Academy at the University of Gothenburg in Sweden.
Blomdahl recruited 43 patients with severe or moderately severe depression to participate in individual hands-on art therapy which she had developed herself. The control group involved 36 people with the same levels of depression but who did not take part in art therapy.
The majority of the study participants were so debilitated by their depression that they had been unable to work. All of the participants were given different combinations of medication, cognitive behavioral therapy, psychodynamic therapy and physical therapy.
The individual art therapy took place in psychiatry or primary care and was conducted by a specially trained therapist. Each session began with a short briefing and a relaxation exercise. The patients used a variety of art tools, such as crayons and watercolors, and all of the lessons followed a predetermined curriculum.
“They followed the manual I had created in order to ensure that it was scientific, but although everyone was given the same theme to go on the patients responded very differently to the exercises,” said Blomdahl.
“The materials were simple, allowing people to doodle and feel free to express themselves the way they wanted to, and then they would talk about the picture and its significance to the participant.”
After participating in 10 one-hour-long treatment sessions, the patients had improved on an average of almost five points on a rating scale used for depression. Some of the factors assessed were anxiety, sleep, initiative and emotional involvement.
These improved ratings are a huge boost for patients with depression, often leading to a notable change in everyday life and perhaps the ability to return to work. No change was seen in the control group.
“The conclusion is that it was the art therapy that facilitated their improvement,” said Blomdahl. “The focal point was that people felt like they were meeting themselves; that the picture served as a mirror where you could see and make new discoveries about yourself, a bit like coming to life.”
“Even the people who did not experience any direct benefit from the treatment had shown improvement. Painting pictures based on themes and discussing the pictures with the therapist promotes self-reflection and brain stimulation that takes place outside of the conscious mind,” she said.
“It is my hope that art therapy will be used in health care again. Based on evidence requirements it has been more or less scrapped by psychiatry, but this is one of the largest studies that has been conducted in this area, and it is a step that may lead to more people being trained in it and the method being used again.”
Source: University of Gothenburg
New research suggests obesity places women with lupus at risk of becoming depressed and may increase disease activity, pain and fatigue.
The new report was presented at annual meeting of the American College of Rheumatology, in San Diego.
Lupus is a chronic (long-term) inflammatory autoimmune disease in which an unknown trigger causes the body’s immune system to attack its own healthy tissues.
The most common type of lupus is systemic lupus erythematosus (SLE), a complex, multiple symptom disease that can cause inflammation, pain and damage to various parts of the body.
While anyone can develop lupus, it occurs 9-10 times more often in women than in men and is 2-3 times more common among women of color.
Obesity is a common comorbidity for people with SLE. While prior research shows that obesity can worsen systemic inflammation in the general population and contributes to worse disease-related outcomes in rheumatoid arthritis, its impact in lupus patients is not well-established.
In the new study, a group of researchers at the University of California, San Francisco, sought to determine whether excess adiposity, or too much body fat, in women with lupus is independently associated with worse patient-reported outcomes (PROs).
“We know from prior research that patients with lupus experience worse health-related quality of life and greater symptom burden compared to the general population, but we do not yet have a complete explanation for these worse experiences,” said Sarah Patterson, M.D.
“For example, neither disease-specific factors such as disease activity nor sociodemographic factors such as poverty fully explain the observed severity of these symptoms.
And because we are interested in understanding how lifestyle factors such as exercise and weight management impact outcomes in lupus, we sought to determine if excess fat associates with worse perceived outcomes in this disease.”
Participants in the sample for the study were drawn from the Arthritis Body Composition and Disability (ABCD) Study. They had to be at least 18 years old, female and have a diagnosis of SLE verified by medical record review.
The researchers evaluated obesity’s association with disease activity, depressive symptoms, pain and fatigue. The study controlled for potential confounders: age, race, education, income, smoking, disease duration, disease damage, and use of glucocorticoid medications such as prednisone.
The patients in the study’s sample of 148 patients were 65 percent white, 14 percent Asian and 13 percent African-American. Their mean age was 48. Of the lupus patients in the sample, 17 percent had a poverty-level income and 86 percent had education beyond high school.
When the researchers measured obesity among the lupus patients in the study, they found that 32 percent met the FMI definition of obesity and 30 percent met the BMI definition.
Using a statistical model, obesity as defined was associated with worse scores for each patient reported outcome: greater disease activity, higher levels of depressive symptoms, more pain and more fatigue.
The study’s results show that obesity is independently associated with worse outcomes in women with SLE, including increased disease activity, depressive symptoms, pain and fatigue.
“Our findings have important clinical implications because the PROs we measured, particularly pain and fatigue, are known to have profound effects on quality of life and remain a major area of unmet need for people with lupus,” said Patterson.
“The relationship we observed between excess fat and worse outcomes underscores the need for lifestyle interventions targeting lupus patients who are overweight.
“More research is needed in this area, but it is possible that such interventions will reduce both cardiovascular risk and the severity of debilitating symptoms common in this disease. In the meantime, I hope this work sparks greater interest and motivation among rheumatologists to address weight management with their lupus patients.”
A new Danish study finds that people who suffer from psychogenic non-epileptic seizures (PNES) — a condition characterized by spasms similar to epileptic seizures but which are unexplained and untreatable — have a lower level of the hormone neuropeptide Y (NPY) in their blood.
NPY is a hormone associated with an increased resilience for dealing with stress.
PNES seizures look like epileptic seizures with cramping in the arms and legs and tossing of the head. A seizure can last from a few seconds to many hours. Many of the patients — mostly women — have been undergoing epilepsy treatment for years with no effects other than the side effects from the epilepsy medicine.
The new hormone finding is a big step towards improved diagnosis and treatment of PNES seizures. These seizures are categorized under the group of disorders known as functional disorders, a collective term for up to 30 physical diseases where it is not clear whether the disease is physically or mentally contingent.
“In the past, patients were called hysterical women. We stopped calling patients that a long time ago but the patients are still severely affected by a disorder that is difficult to understand and describe, both for the patients themselves and the outside world,” said Dr. Michael Winterdahl, associate professor at the Department of Clinical Medicine at Aarhus University.
“And so far, it has not been possible to identify why people develop these seizures. It just appears to be an unfortunate combination of various factors which predispose, trigger and maintain the seizures.”
“It clearly places a terrible strain on both the person affected and their relatives. Moreover, it is frustrating for the patients to find that there is not a physiological cause which you can do something about.”
For the study, researchers measured the concentration of a wide range of hormones in the blood of 15 women with PNES and 60 control subjects. In addition to significantly lower NPY levels in the PNES patients compared with the healthy control group, the researchers also discovered changes in stress hormones. The same changes are also seen in people with post-traumatic stress disorder (PTSD).
Winterdahl believes the new findings can have a bearing on how the healthcare system deals with PNES patients.
“We have now finally demonstrated a biological cause for these otherwise unexplained seizures. This knowledge alone can be enough to remove the sense of powerlessness experienced by both patients and practitioners,” said Winterdahl.
In addition, study participants who showed low levels of NPY also reported experiencing a higher degree of different types of abuse such as sexual abuse, violence, bullying, feelings of abandonment and the experience of reduced quality of life.
Winterdahl believes the new knowledge about NPY’s role may be used to screen for vulnerability towards prolonged stress in the future, perhaps even in the form of a simple blood sample like those used in the study.
“We know that the amount of NPY that is released in a stressful situation is genetically determined. Some people are genetically more resistant to stress, while others are particularly vulnerable,” said Winterdahl.
The findings are published in the scientific journal Stress.
Source: Aarhus University