Therapist Musings

News Item: Neuroscience

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Friday, March 11th, 2011

Brain Organ that Monitors Danger
Also Seeks Pleasure

An almond-shaped brain organ, the amygdala has long been associated with translating the sensory input of dangerous situations into the emotion of fear, then signaling the body to prepare for an immediate response, either fight, flight or freeze.  Now new research, as reported in Science News, reveals its role in the perception of, and response to, far more enjoyable events.

Well connected to regions of the cerebral cortex that process incoming signals from the five senses, the amygdala works in tandem with the prefrontal cortex, the brain’s command center, to determine optimum actions in the face of threats.  Modern imaging tools that can zoom in on neuronal activity have allowed researchers to ferret out amygdala cells that identify, assess, and assign value to, potentially beneficial situations.

Feelings provide valuable information about the environment.  It makes sense then that the amygdala, as part of the limbic system—a region of the brain that handles emotional experiences and responses to them—would play a crucial role not just in avoiding danger but also in pursuing goals associated with the pleasurable gratification of needs.

One research team, taking advantage of the availability of a small group of patients who had undergone procedures requiring placement of electrodes in their brains, monitored amygdala nerve cells in subjects evaluating the worth of assorted junk foods.  Of the 51 amygdala neurons tracked, 16 demonstrated direct correlation with the volunteers’ ratings of individual treats.  Results of a study like this also raise questions about the role the amygdala might play in addiction.

In an experiment that looked at the amygdala’s part in decision making, scientists found one set of nerve cells registered good surprises while another registered bad.  Having two distinct types of amygdala neurons evaluating surprise according to positive versus negative content insures the most effective responses to unpredictable events.

To determine which of two brain organs directs the show, other scientists explored connections between the prefrontal cortex, also active in assigning value, and the amygdala.  Using unfortunate but very smart monkeys, experimenters short-circuited the amygdala in some of them after training all of them to play a computer game where choosing one picture over another garnered a better reward.

The researchers discovered that even without a working amygdala, monkeys still selected pictures leading to the best outcome on most of the trials.  Zeroing in on neurons in the orbitofrontal cortex (sensory integration, sense of self, self-reflection) and anterior cingulate cortex (attention, mood regulation, internal states monitoring , decision making), they detected a decrease in neuronal activity in the latter.

More intriguing, monkeys without a functioning amygdala exhibited no emotional response (determined by pupil diameter and heart rate in response to the reward).  Retaining the cognitive ability to select wisely, they lacked any emotional engagement with their successful choices.

These findings have implications for childhood trauma survivors whose brains developed  to cope with brutal, often random, assaults by people expected, and depended upon, for love and care.  Stress and trauma have been found to inhibit neurogenesis (cell growth) in the hippocampus, a part of the brain that, working in concert with the amygdala and prefrontal cortex, consolidates all aspects of experience into narrative memory.

Could changes have occurred in nerve cell growth in the amygdala as well?  For example, an incest survivor with childhood-based Post-traumatic Stress Disorder who has a hair-trigger response to any form of unexpected touch might have an impaired amygdala rendering her/him unable to distinguish, on the fly, between good touch and bad.  A malfunctioning amygdala might also predispose someone to remain in a dysfunctional or abusive relationship, spurning positive ones, if the ability to discern rewards has been affected by early abuse or neglect.

The curious lack of emotional engagement that monkeys minus amygdalas displayed as they selected available rewards seems like anhedonia, the inability to feel pleasure,  a symptom of depression.  PTSD sufferers often complain about not being able to feel good or even okay.  The monkeys’ disconnection between what their cortices know and what their bodies feel also suggests depersonalization, a type of dissociation associated with trauma, where the victim looks at her/himself from a distance.  Later in life, survivors complain that their bodies feel alien to them and that they don’t feel anything.

As neuroimaging expands knowledge about the workings of the brain on the cellular level, the potential exists for greater understanding of the way early abuse and neglect affects the developing brain’s ability to react effectively to life’s ups and downs, especially in relationships with others.  More effective treatment could then be devised to ensure recovery for all who live with childhood-based PTSD.


News Item: Neuroscience

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Friday, December 17th, 2010

Rx for Happiness:
Be Here Now

Minds stray more than 30 percent of the time during all activities (except perhaps sex).  Regardless of whether one’s thoughts turn to worrisome or pleasant topics, letting them wander correlates with a downward shift in mood.

To gather the data, researchers employed a specially created iPhone app that randomly prompted experimental subjects to report on current activities, feelings and thoughts, rating the last two as pleasant, unpleasant or neutral.  Positive thoughts failed to uplift mood, and negative and neutral ones made people feel worse.

Reported in Science News, the results speak only to the short-term effect of reveries.  The scientists did acknowledge that letting one’s mind range beyond the task at hand might be beneficial in the long run, offering opportunities to reflect on the past and plan for the future.

The study seems to reinforce the notion that living in the moment enhances well-being.  Though not part of the comments quoted in the article, the findings raise questions about whether the concentration problems of those suffering from various anxiety disorders (including Post-Traumatic Stress Disorder) contribute to their general inability to feel good (anhedonia), a defining symptom of depression.


News Item: Addiction and Art Website Launched

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Wednesday, December 8th, 2010

Demand Grows for
Art About Addiction

What began with annual exhibits and coalesced into a volume of images and statements by artists affected by alcoholism and other addictions has found a home on the Web.  Margaret Dowell, who along with Patricia B. Santora and Jack E. Henningfield (all PhDs) shepherded that process over the course of several years, has taken it upon herself, with the help of webmaster Don Dunsmore to launch the Addiction and Art website.

Originally supported by the now defunct Innovators Combating Substance Abuse Program, a national program office of the Robert Wood Johnson Foundation at the Johns Hopkins School of Medicine, the Art and Addiction annual competitions invited artists to submit work related to their experiences with alcohol and other substances, provided an exhibition opportunity and gave cash awards to the best of them.

In 2008, that year’s selected pieces traveled to San Juan, Puerto Rico, for display at the annual scientific meeting of the College on Problems of Drug Dependence.  Two years later, the Johns Hopkins University Press published the story of the Art and Addiction exhibitions in a professional volume now called Addiction and Art.  A review on these pages highlighted the power of these images to convey the suffering of those caught up in substance abuse and dependence, either their own or that of someone close to them.

With the goal of fostering the use of visual art to enhance awareness and sensitivity to the devastating effects of addiction and to assist others interested in sponsoring similar art competitions and shows, Innovators had developed a replicable protocol, included in the book.  Dr. Dowell began the new website as a way to encourage and document these shows.  In an email, she had this to say:

I had been involved in organizing several, including the model at Carroll Community College (where I am an adjunct professor), and helped with writing the Innovators guidelines for Addiction and Art Exhibitions.  I witnessed the masses that turned out for these shows – the galleries were PACKED…..there is so much interest in this topic.

She soon noticed another need.  Visitors to the site wanted images they could use immediately in their prevention and treatment efforts.  Currently exploring how to make that happen, Dr. Dowell continues to build a community of artists and professionals interested in harnessing the power of images to confront addiction.  Stay tuned.


News Item: Neuroscience

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Friday, November 5th, 2010

Economic Bubbles
& the Brain

Like many people, Read Montague wondered about the inevitable cycles of boom and bust that plague economies.  Being a neuroscientist, he devised an experiment to find out what happens in the brain when investors continue to pour money into businesses, real estate, stocks, and gold, despite the inevitable tumble destined to follow when values rise beyond reason during times of irrational exuberance.

An article in the New York Times Magazine described how Montague gave subjects $100 each to play a game where they invested in various market situations that unbeknown to them mimicked historical rises before crashes.  During the game, Montague monitored their brain activity.

At the beginning, on the economic upswing as the players amassed profits, their brain activity showed nothing unusual.  In keeping with the good feeling that accompanies gratifying experiences, neurons pumped out dopamine, the reward neurotransmitter.  As subjects continued to benefit from the rising market, the dopamine increased their excitement and spurred on more investing as they scrambled for money.

After a while, something strange happened.  Nearing the time the bubble would burst, the neurons slowed production of dopamine, as if to say, “Whoa, there!”  Then just before the run ended, the dopamine neurons stopped firing completely.  Rather than heed the cautionary feeling of that change in mood, investors continued putting money into the market, rationalizing the risks by reasoning their good fortune would go on forever.  The prefrontal cortex, center of higher brain functions like cognition and self reflection, overrode the intuitive feeling in the rest of the brain.

Ordinarily, engaging cognition to manage emotional responses works out well.  Apparently, there are times when thinking processes only serve to justify and defend behaviors that when considered from a different perspective, wouldn’t really make sense.  The prefrontal cortex possesses enormous powers of self deception that can be tempered by paying attention to feelings, a valuable source of additional information.


News Commentary: Teens Suffer Depression Relapses

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Wednesday, November 3rd, 2010

Psychiatry Treats Symptoms
Not Patients

Half of the adolescents treated for depression in a recent study suffered a recurrence of symptoms within five years.  The study, reported in the New York Times, also found that girls were more likely to relapse than boys.  The research protocol consisted of three options: an antidepressant, cognitive behavioral therapy, or a placebo pill.

About the results, the study’s lead author concluded, “It looks like we don’t have a treatment yet that really prevents recurrence.”  In searching to explain the increased vulnerability of girls to relapse, he offered, “Maybe it has to do with something in girls…stressful life events or the way people cope with stress.”  A doctor who was not part of the study suggested it might be linked to hormonal changes or that “women tend to brood more, so the slightest stress is multiplied many times.”

Doctors so caught up in the biological aspects of depression stray from the reality of life for teenagers in general, and the particular challenges faced by so many adolescents who have suffered various kinds of trauma: from childhood sexual abuse to living in violent neighborhoods, from loss of a family member to having serious medical problems.  The list is, unfortunately, endless.

In choosing possible protocols, the researchers left out psychotherapy, that practice of engaging in conversation with the person who suffers.  Instead, treatments were selected based on their uniformity of practice and hence replicability by others; psychotherapy does not lend itself to standardization because of its focus on relationship.

Meanwhile, the adolescents get lost in the process.  The girls, more likely to have experienced sexual abuse than boys, get blamed for not being able to handle the stress in their lives.  They “brood.”  Perhaps the problem lies not with the teenagers but with adults unable to handle finding out what truly ails these young people.


News Commentary: Antipsychotic Drug Prescriptions for Children

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Friday, September 3rd, 2010

Diagnosis-Driven Treatment
Profits Big Pharma,
Not Children

Within days of an article in The New York Times Magazine with a title posing the question Can Preschoolers Be Depressed? a special report appeared in the same newspaper (Child’s Ordeal Shows Risks of Psychosis Drugs for Young) about the use of off-label, heavy-duty antipsychotic medications for the same age group.  Not unlike big tobacco’s attempts to expand its market base by appealing to young consumers with cartoon characters like Joe Camel, the pharmaceutical industry sends representatives to the offices of pediatricians and child psychiatrists to leave behind promotional items like Legos emblazoned with the logo for Risperdal, one such drug.

Insufficient research to support prescribing these drugs for small children has not prevented the practice, which finds ready takers among low-income families without the resources to understand or access other options like parenting instruction and family and individual therapy.  At their wit’s ends, mothers of so-called difficult children follow the advice of their doctors to give their two-year-olds drugs with serious side effects like weight gain and diabetes.

In the piece questioning the existence of diagnosable depression in young children as early as infancy, naysayers insist it’s inadvisable to label symptoms like anhedonia (inability to feel pleasure), low energy, poor appetite, insomnia, poor self-esteem and pervasive negativity as an emotional disorder.  Variability of expression and the immaturity of the brain, the say, renders it premature to label small children in that way.

Those who support the diagnosis point to scans showing similar changes in the hippocampus and certain neural networks in the brains of depressed children and adults.  Other studies link depressive symptoms in children with family problems;  e.g., a mother’s depression can quickly impose itself on her baby by virtue of her own joylessness and lack of responsiveness.  In addition, children are ill equipped to handle emotionally and physically overwhelming experiences like abuse and neglect, death and/or separation from caregivers, and any of the many other calamities that can befall them.  When children act out their distress in developmentally appropriate ways, they too often become a problem to be fixed, rather than being seen as the canary in the coal mine heralding impending doom.

To recognize the reality of depression in young children, one need only listen to adults whose early lives were rife with difficulties.  Traumatic experiences like incest and other forms of abuse have devastating effects on the still-forming brain.  Living in circumstances where caregivers struggle with their own pain- and anxiety-filled existence weighs heavily on the spirits of children.  As quiet as it’s kept, four-year-olds have been known to deliberately swallow bleach and six-year-olds to throw themselves down a flight of stairs with their arms at their sides, all in hopes of escaping what for them has become a prison of pain.

Yet to establish a diagnosis of depression in children provides a rational for medicating them with the same antipsychotic drugs being used for acting out behaviors like aggression, self-injury, tantrums and severe mood swings.  Any of these symptoms,  signs of distress in a child, requires attention to the entire environment, including parents, siblings and others involved in the child’s life.  Helping the caregivers invariably helps the children.  Drugging children solves nothing and interferes with normal brain development, only one of many side effects.

Both cited articles mention successes with early interventions that take advantage of the plasticity of the young brain.  Certainly, ensuring a safe environment for the child takes precedence.  In yet one more report of severe neglect resulting in the death of a preschooler, the family was not unknown to child protective services.  Evidence suggests that the four-year-old girl with congenital health problems who weighed all of  15 pounds had been physically restrained with twine.  Perhaps she had become too much for an overwhelmed mother to handle, not unlike the children of some of the mothers who desperately seek help from their doctors and receive only psychotropic prescriptions for their children.

The way to assist frustrated parents lies not in the direction of prescribing narcotizing drugs to those among their children who broadcast otherwise silent family problems.  The best approach requires a commitment of time and resources to uncover and address the specific environmental challenges interfering with the child’s healthy development.


News Item: Communicative Musicality

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Friday, August 27th, 2010

Mother & Baby Duet:
Instrumental in Social Development

A mother hums to her little boy as she changes him on the shelf in a restroom while he looks with wide-eyed curiosity at the stranger attracted by the sounds.  On the train, another mother sings playfully to her child in a stroller.

All that billing and cooing does much more than entertain and/or soothe an infant.  Recent research strongly suggests that it plays a vital role in preparing children to learn the language, practices and rituals of their cultures.

In a special report on music appearing in Science News, babies were described as coming into the world prepared to engage musically, crying with the same melodic patterns found in their mothers’ conversations.  The singsong nature of motherese, the universal language of babyspeak, takes advantage of that innate ability; adults automatically speak in a higher-pitched and exaggerated manner when addressing infants and toddlers.

One researcher, psychobiologist Colwyn Trevarthen, believes that babies have an active part in this exchange with their mothers, recognizing  when an adult invites them to respond and at times initiating the musical interactions.  In addition to building a foundation for later learning, what Trevarthen has come to call communicative musicality also provides for emotional expression and sharing between parent and child, crossing cultures with only minor variations.

The critical nature of these formative experiences is best appreciated in their breach.  Studies conducted by psychologist Maya Gratier of women diagnosed with depression and/or borderline personality disorder (BPD) demonstrate how a mother’s own inability  to respond to the desperate attempts of her baby to engage musically has negative consequences for the child’s development.

Because of their personal histories of severe childhood abuse and neglect, women with BPD have difficulty sustaining ordinary relationships and controlling their impulses.  They feel empty emotionally, fear abandonment, tend to elicit angry responses from others, and end up in intense, tumultuous relationships.

Ill equipped because of their own early deprivation, these mothers produce sounds devoid of any musical sense when trying to speak motherese.  They utter repetitive, sometimes odd, noises that lack rhythmic flow.  Seemingly unaware of their children’s desire to participate, they create no entry point for it.  Babies of these mothers give up and withdraw or actively demonstrate their distress by becoming fussy and upset.  Although the depressive women in Gratier’s studies could generate more variety in their communications with their infants, they did so in a low, flat voice lacking rhythmic timing.

Flexibility and expressiveness are prerequisites for musical attunement with one’s baby.  These women (and others like them) can give no more than they have received.  Children raised without the benefit of rhythmic relationships miss out on the opportunity to successfully complete a critical stage of development and encounter difficulties in subsequent social situations, starting in preschool.

Research findings like these point to the importance of early intervention for mothers with histories of severe childhood abuse and neglect, perhaps in the form of music lessons for the mother and infant duet.  Not only could it benefit the child, it could also teach the woman a skill she had missed out on learning as a baby.


News Commentary: Army Fails to Support Troops

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Wednesday, August 18th, 2010

Personality Disorder Diagnosis
Instrumental in Denial of Benefits

Between 2005 and 2007, the Army discharged about 1,000 soldiers a year with a diagnosis of personality disorder, effectively barring them from receiving veteran health care and combat-related disability payments.  Unlike Post-traumatic Stress Disorder (PTSD), caused by encounters with life-threatening events, a personality disorder has its roots in early life, rendering it a pre-existing condition and therefore not the Army’s responsibility.

After a 2007 article appeared in The Nation noting those figures, the Army announced a new policy that required higher level review of all cases.  Soon after that, diagnoses  of personality disorder dropped to 75 percent of their previous level while those of  PTSD skyrocketed, reaching 14,000 by 2008.  Despite this coincidence, the Army steadfastly denies that it had inappropriately discharged all those service members.

In a recent New York Times report on the issue, a personality disorder was described as “a deeply ingrained maladaptive pattern of behavior” whose symptoms could be mistaken for those of the “anger, irritability, anxiety and depression” associated with PTSD.

There are ten categories of personality disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), only two of which contain any of those symptoms:  Antisocial Personality Disorder (“irritability and aggressiveness”) and Borderline Personality Disorder (“dysphoria, irritability or anxiety,” “inappropriate, intense anger or difficulty controlling anger”).  Both of these labels carry major stigma, the first because it describes a person without conscience and the second by virtue of its pejorative connotations in the mental health field.

Studies have found up to three quarters of people with Borderline Personality Disorder (BPD) have histories of childhood sexual and physical abuse.  Not surprising then that its symptoms mirror those of PTSD.  Assaults on children during the critical years of brain development affect their ability as adults to manage emotions and relate to others.

In selecting the personality disorder diagnosis, the Army managed its bottom line at the expense of the women and men who suffer mental anguish from their war experiences.  Apparently this practice has not abated; Army psychiatrists have discovered another diagnosis that blames the victim, Adjustment Disorder, characterized by “marked distress that is in excess of what would be expected given the nature of the [psychosocial] stressor.”  Congress is looking into that one.

One has to wonder at the shabby treatment service members continue to receive at the hands of the institutions designated to serve them.  Saving money by denying benefits to those who need and deserve them constitutes unconscionable behavior, not unexpected from narcissistic or antisocial personality types but from the United States military?


News Item: Emotions

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Monday, August 16th, 2010

Exercise Cools Rage Reactions

In a recent Sunday Times Magazine article, the phys ed writer Gretchen Reynolds described a recent study that found that for young men with “high trait anger,” which she translated as having “a very short fuse” and being “habitually touchy,” exercise took the edge off their intense emotions.

Extrapolating from studies that demonstrated a link between low levels of serotonin and aggression in animals, and mood disorders in humans, the researchers hypothesized that because the neurotransmitter serotonin increases with exercise, it probably plays a role in the modulation of anger.

Individuals with traumatic histories often react defensively with rage when triggered, usually by situations that their brains associate with previous hurts.  In addition, the development of a healthy serotonin regulatory system in the brain can be negatively impacted by early trauma, leaving the adult without the full benefit of a neurotransmitter that has been shown to calm nerves.

It comes as good news then that exercise has the potential to help trauma survivors deal effectively with their reactivity.  The freedom experienced once runaway emotions come under control opens up possibilities for exploring the stories embedded in them, one more reason to push away from that computer or get off the couch and take a brisk walk.


News Item: Emotions

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Monday, August 9th, 2010

Frown Muscle Needed for
Recognizing Negative Emotions

Better think twice before getting that shot of Botox between the brows.

Putting on an emotional face activates areas of the brain responsible for the subjective experience of that feeling.  Without that link, scientists have discovered, recognizing related emotions in others becomes more difficult and creates a disadvantage in social situations.

In research described in Science News, women who had received Botox injections took longer to read sentences describing angry or sad situations than they did for descriptions of happy situations.  Because the shots paralyze frown muscles, researchers hypothesize that they gradually erode the connection between those muscles and the neural networks involved in coordinating negative emotions.

Not sure about the validity of these findings?  Break into an authentic grin and notice how that brightens your mood.  Turn down the corners of your mouth and see what happens.  Then reflect on what life would be like without the ability to experience anger.