Richard G. Petty, MD

Emotional Eating

A new study from Miriam Hospital's Weight Control and Diabetes Research Center in Providence, Rhode Island, has just been published in the journal Obesity. The research suggests that dieters who tend to eat in response to external factors like parties and celebrations, have fewer problems with their weight loss than those who eat in response to internal factors such as emotions. The study also found that emotional eating was associated with weight regain in people who had successfully lost weight

The researchers analyzed individual's responses to questions in a well-known research tool called the Eating Inventory which is designed to assess three aspects of eating behavior:

1. Cognitive restraint
2. Hunger
3. Disinhibition

The main focus was on the third item, since some previous research has suggested that disinhibition as a whole is an accurate predictor of weight loss.

The disinhibition scale evaluates impulsive eating in response to emotional, cognitive, or social cues.

There were two groups in the study. The first consisted of 286 overweight men and women who were currently participating in a behavioral weight loss program. The second group included 3,345 members of the National Weight Control Registry (NWCR), an ongoing study of adults who have lost at least 30 pounds and kept it off for at least one year. 

The investigators found that the components within the disinhibition scale could be grouped into two distinct factors: external and internal disinhibition.

An example of external disinhibition would be the person who overeats when they are with someone who is also overeating, or the person who just overeats at a party, picnic or celebration.

The person with internal disinhibition eats in response to thoughts and feelings such as loneliness, upset or anxiety.

In both groups internal disinhibition was a significant predictor of weight over time. For participants in the weight loss program, the higher the level of internal disinhibition, the less weight an individual lost over time. The same was true for maintainers in the NWCR: Internal disinhibition predicted weight regain over the first year of registry membership.

Before starting a weight management program it is very helpful to know which group you are in. It provides us with a quick and easy method of tailoring the program to the individual, and tells us where to put our efforts.

Sleep Deprivation and Emotional Instability

Most of the time we are in control of our moods, rather than our moods being in control of us. One of the main things that we learn as we get older is not simply to damp down our emotional reactions, but to make them “contextually relevant:” we produce the right emotional response for the right situation. Yet we also know that there are exceptions: times when our emotions over-run any attempts at our control.

Second, we all know that sleep deprivation can be a Bad Thing. It is known to impair a range of mental and physical activities, including immune function, metabolic control and many cognitive processes, including learning and memory.

It has long been suspected that sleep deprivation can have significant effect on mood. Many of us feel irritable and distractible if we haven’t slept enough, and you may have had the experience of being up all night and feeling a little bit “high” in the morning. It has also been known for centuries that mood disorders are very commonly associated with sleep disturbances, and sleep disturbance is often the first sign that someone with mood problems is running into trouble. So mood and sleep must be linked in some way.

Despite these common observations, there has never been that much empirical evidence for the impact of sleep deprivation on mood, and in particular the effects of sleep deprivation on the brain.

An important new study by researchers from Harvard Medical School and the University of California at Berkeley has just been published in the journal Current Biology, and it is beginning to fill in some of the gaps in our knowledge.

The amygdala is known to be involved in processing of emotionally salient information, particularly unpleasant or aversive stimuli. In mature individuals, the emotional centers of the brain are usually controlled and modulated by an array of connected systems, mainly in the frontal regions of the brain. One particularly important part of the frontal lobes that is involved in controlling the amygdala is the medial-prefrontal cortex (MPFC). Under normal conditions the MPFC is supposed to exert an inhibitory, top-down control of the amygdala, so that we only generate appropriate emotional responses.

The scientists worked with 35 volunteers who were deprived of sleep for 35 hours. Blood flow can be used to deduce which specific regions of the brain are active. The researchers used functional magnetic resonance imaging (fMRI) to examine the blood flow – and therefore activity - in the brains of the volunteers in real time, both during and after sleep deprivation.

After going without sleep, the participants were asked to look at images that were designed to trigger angry or sad emotional responses. The investigators discovered that the amygdala showed 60% higher reactions to the images compared with people who are not sleep-deprived.

This is an extraordinarily large effect and implies that sleep deprivation knocks out the normal control mechanisms in the frontal lobes so that the sleep-deprived brain reverts to a more primitive pattern of activity. As a result we become unable to put emotional experiences into context and produce controlled, appropriate responses.

If we needed any more reasons to get a good night’s sleep, this one is very powerful. It also re-iterates something very important: if you or a loved one have had problems with mood, anger or anxiety, it is essential to watch your sleep pattern. Any change may be a harbinger or trouble, and is an excellent early warning that you or they need a hand to make sure that things stay on an even keel.

"Your brain shall be your servant instead of your master, you will rule it instead of allowing it to rule you.”
--Charles E. Popplestone (American Author of Every Man a Winner, 1936)

“Control your emotions or they will control you”
--Chinese Proverb

“For the uncontrolled there is no wisdom, nor for the uncontrolled is there the power of concentration; and for him without concentration there is no peace. And for the unpeaceful, how can there be happiness?”
--Bhagavad Gita (Ancient and Sacred Sanskrit Poem Incorporated into the Mahabharata)

“He who controls others may be powerful, but he who has mastered himself is mightier still.”
--Lao Tzu (Obscure Chinese Philosopher, Founder of Taoism and Alleged Author of the Tao-Te Ching, c. 604-c. 531 B.C.E.)

“ . . . let every man be swift to hear, slow to speak, slow to wrath.”
--The Bible, James 1:19

“When angry, count ten before you speak; if very angry, a hundred.”
--Thomas Jefferson (American Writer, Philosopher, Politician and, from 1801-1809, 3rd President of the United States, 1743-1826)

Emotion and Cancer Survival

There is some research coming out in the December issue of the journal Cancer from some researchers at the University of Pennsylvania School of Medicine and other colleagues. The results surprised me, particular since I know some of the authors, and they are first rate investigators.

For over thirty years, most research studies have claimed to find an association between emotions, attitudes and beliefs, and the chance of survival form several types of cancer. Entire psychological wellness and psychotherapy programs have been designed around that premise.

The study suggests that emotional wellbeing has no effect on the chances of surviving head and neck cancer. People with negative emotions had the same survival rate as people with positive emotions.

Patients from two Radiation Therapy Oncology Group clinical trials completed a quality of life questionnaire known as the Functional Assessment of Cancer Therapy-General (FACT-G) at the start of the trials. So these assessments were added on to studies of different cancer treatments. One trial was looking at what is known as “dose fractionation strategies” and the other was looking at combined chemotherapy and radiation treatments.

The FACT-G questionnaire included a collection of items called the Emotional Wellbeing Scale. This was assessed against overall survival.

There were 1,093 at the start of the trials, of whom 646 died during the period of the study. One of the reasons for trusting the data is that this large sample together with the consistency in the treatment the patients received have made this study one of the most statistically robust ever conducted.

Emotional state did not predict survival, and the results did not change when the researchers took into account possible effects such as interactions between emotional wellbeing and the methods of the study, gender, the primary site of the cancer, or the stage of the cancer.

There are several important points:

• The study only included head and neck cancer patients. These are often very traumatic cancers, but they do not usually involve the endocrine system. Some of the best data on emotions and survival come from studies of breast cancer, which often involves disturbances of hormones that may themselves have an impact on mood and survival. And mood can have a big impact on hormones
• The patients in the study had to keep coming to appointments, and to follow instructions, so they may not be representative of all people with head and neck cancer

But the most important thing is this: before critics jump off the deep end, let’s be very clear.

The study is not saying that having an optimistic or positive emotional outlook does not bring benefits to cancer patients. All it is saying is there is no evidence that it prolongs life.

Psychotherapy, art therapy, bibliotherapy and many others can all provide a great many emotional and social benefits.

They may not add anything to the years that a persons lives, but they may add greatly to the life in those years.

Chocolate, Comfort Foods and Depression

Most people have done a bit of comfort eating from time to time: candies and chocolates are usually the favorites. That’s not a coincidence. Not only do they taste good, but chocolate also contains chemicals that may improve mood, and sugar can have an indirect impact on the uptake of specific amino acids into the brain, where they go on to form the chemical neurotransmitters involved in inter-cellular communication and learning.

On the more serious side, some types of mood disorders, particularly seasonal affective disorder, premenstrual syndrome and the so-called “atypical depression” are often associated with quite sever cravings for chocolate.

So I was very interested to see a paper from colleagues in Australia in this month’s issue of the British Journal of Psychiatry.

Gordon Parker and Joanna Crawford examined links between chocolate craving in people who are depressed and both personality style and atypical depressive symptoms, with a web-based questionnaire completed by nearly 3000 individuals reporting clinical depression.

People accessing a mood disorder consumer information website (http://www.blackdoginstitute.org.au) were invited to participate in an online survey of lifetime treatments for a depressive episode, together with some interesting evaluation tools.

Half of the respondents said that they craved chocolate, and the number was slightly higher in women. They said that they felt that chocolate helped with depression, anxiety and irritability. The ones who said that chocolate helped were more likely to score higher on a “neuroticism” scale, particularly irritability and rejection sensitivity.

Five years ago the same team found that atypical depression was associated with a personality that was especially sensitive to rejection, and also tended to be linked with several symptoms - including food cravings – that tie in with behaviors aimed to try and make us feel better and to maintain internal balance.

The results suggest that people with certain personality styles derive personal benefit from comfort eating. Some research has linked carbohydrate craving to the opioid system in the brain, and it is possible that munching on chocolate may be an example of genuine self-medication. People eat to chocolate to calm down their ability to feel emotional distress.

The trouble is, of course, that although chocolate is yummy and may even be therapeutic, too much can be a bad thing. Weight problems are common in people with chronic depression, especially the “atypical” type.



“Chocolate causes certain endocrine glands to secrete hormones that affect your feelings and behavior by making you happy. Therefore, it counteracts depression, in turn reducing the stress of depression. Your stress-free life helps you maintain a youthful disposition, both physically and mentally. So, eat lots of chocolate!”
--Elaine Sherman (American Culinary Expert, Teacher and Writer, 1938-2001)

"Look, there’s no metaphysics on earth like chocolates.”
--Fernando Pessoa (Portuguese Poet, 1888-1935)

Memory and Emotion

Your humble reporter has had more than his fair share of major life events. As a sixteen year old I was a passenger in car that had a meeting with another vehicle driving down the wrong side of the road. This was in England, where folk always do drive on the “wrong” side, but the fellow who was kind enough to arrange the collision could never explain why he was driving on the “American” side.

The interesting thing is that the memory of the crash is seared into my memory: I can remember the license plate of the vehicle that hit us. Some people call that a “flashbulb memory.”

If you live in the United States you probably have clear and fairly accurate memories of where you were and what you were doing on September 11th 2001.

This kind of experience is not uncommon: most of us have noticed that events that occur during heightened states of emotional arousal, such as fear, anger, happiness and sex are far more memorable than less dramatic occurrences. The emotional “load” of an event is a key factor in remembering it. Previous studies have confirmed that heightened states of emotion can facilitate learning and memory.

This makes good evolutionary sense: emotionally charged events are likely to be the ones that we need to remember. From an evolutionary perspective, it is more important to remember where Mr. Saber-tooth Tiger lives, rather than the names of the Kings and Queens of England.

Therefore the regions of the brain that are responsible for the storage of memories need to distinguish between important experiences and those that less significant for survival. The brain must have some mechanisms for giving priority to emotionally charged memories, so that they are converted and stored in long-term memory.

The downside is that in some situations, for instance posttraumatic stress disorder (PTSD), this process can become pathological and people can be tormented by persistent vivid memories of traumatic events.

Writing in the journal Cell, researchers from Johns Hopkins University and their collaborators at Cold Spring Harbor Laboratory and New York University may have identified the biological basis for this phenomenon. Memories in the brain are held in neurological circuits and each new experience creates a new circuit. The investigators have found that the hormone norepinephrine, which is released during emotional arousal, serves to "prime" nerve cells to remember events. They do this by increasing the neurons’ chemical sensitivity at the precise sites where nerves rewire to form new memory circuits.

Norepinephrine is often described as one of the "fight or flight" hormones and it is likely also involved in the third type of response to a threat, which is “freeze.” In the brain norepinephrine energizes the circuit-building process by adding phosphate molecules to a nerve cell receptor called GluR1. The phosphates help guide the receptors to insert themselves next to a synapse.

So when the emotionally-charged brain needs to form a memory, the nerves have plenty of available receptors to quickly adjust the strength of the connection and lock that memory into place.

The researchers targeted the GluR1 receptor after discovering that if it is disrupted in mice, the little creatures develop spatial memory defects. They tested the idea by either injecting healthy mice with adrenaline or exposing them to fox urine, both of which increase norepinephrine levels in the brain.

They then analyzed the brains of the mice and found increased phosphates on the GluR1 receptors and an increased ability of these receptors to be recruited to synapses.

When the researchers put mice in a cage, gave a mild shock, took them out of that cage and put them back in it the next day, mice who had received adrenaline or fox urine were likely to "freeze" in fear, compared with mice who had not been exposed to the adrenaline or fox pee. This implies an enhancement of their memory of the cage and its unpleasant associations.

In a similar experiment with mice genetically engineered to have a defective GluR1 receptor, adrenaline injections had no effect on mouse memory. So this provides us with further evidence of the "priming" effect of norepinephrine on the receptor.

There has been a lot of recent interest in using medications like beta-adrenoreceptor blocker propranolol – which prevents some of the actions of norepinephrine -  to prevent the development of PTSD in people who have been exposed to extreme trauma, and this research may provide the scientific basis for this kind of therapy.

On the other hand, this research leads me to predict that people with overactive GluR1 receptors may be constantly curious about their environment, but also likely to be chronically anxious and more likely to develop PTSD.

We have known for years that propranolol and other beta-blockers may attenuate some of the physical symptoms associated with anxiety. Most people had assumed that the medicine worked by reducing heart rate, shaking and sweating. But experienced clinicians usually find that beta blockers that cross the blood/brain barrier work best, and it may well be that these drugs also have direct actions in the brain itself.

“Recollection is the only paradise from which we cannot be turned out.”
--John Paul (a.k.a. Johann Paul Friedrich Richter, German Novelist and Humorist, 1763-1825)

“The existence of forgetting has never been proved:  We only know that some things don't come to mind when we want them.”
--Friedrich Wilhelm Nietzsche (German Philosopher, 1844-1900)

“The moment we find the reason behind an emotion … the wall is breached, and the positive memories it has kept from us return too. That's why it pays to ask those painful questions. The answers can set you free.”
--Gloria Steinem (American Feminist, Political Activist and Editor, 1934-)

Emotions and Recovery from Hip Surgery

A patient's emotional state plays a significant role in his or her recovery from hip surgery according to research from Saint Louis University. This research was particularly interesting because the researchers were not looking for a link.

Orthopedic surgeons typically use two tests to determine if a patient has recovered from hip surgery: one is a clinical measure of hip function and the second is a patient questionnaire that looks at a number of factors that may play a role in the overall success of the surgical procedure. Originally the research was simply designed to see if the two measures, the clinical one that has been in use for decades, the other, a new subjective scale, correlated in some way.

The clinical test found good-to-excellent results, while the self-test taken by the same patients showed significantly worse recovery. The disparity could be explained by a section of questions on the self-test that are not addressed by the clinical test: those dealing with emotional well-being. After post-operative mobility, the patient's emotional status was the most important factor in determining how well he or she thought recovery was going.

It is common for doctors to think that patients are doing well because they have achieved a good technical result. But if the patient is still miserable, depressed and in pain, we should not congratulate ourselves on a job well done.

Yet a great many people are denied the help that they need. For instance they may have already had depression or they may be depressed because of pain and immobility. It does not really matter which came first. If the psychological aspects of the illness or the surgery are not addressed, people are not likely to recover. The same goes for having poor nutrition or poor social supports.

The whole point of Integrated Medicine is to address every aspect of a person: physical, psychological, social, subtle and spiritual.

This study provides further evidence that if we only look at the physical aspects of a problem or an intervention, we are going to miss the boat.

Teen Driving Risks

I have been very concerned about the burgeoning evidence of the dangers of being distracted while driving.

My concerns have been buttressed by a new report.

A national survey of more than 5,600 high school students conducted by an alliance between The Children's Hospital of Philadelphia and State Farm Insurance Companies indicates that high school students are routinely driving under highly dangerous conditions.

Teens who participated in the study say they routinely drive while fatigued and while talking on cell phones, and that they let strong emotions cloud their judgment. Many also admitted that they are not wearing seatbelts.

The National Teen Driver Survey represents 10.6 million 9th, 10th, and 11th grade students in U.S. public high schools.

The survey results are available as a downloadable report on Keeping Young Drivers Safe, a new Web site for parents and educators from the Children's Hospital of Philadelphia/State Farm alliance. The site is packed with practical information on developing a plan that will enable new drivers to develop the skills and habits they need to stay safe.

You can also visit the site at www.chop.edu/youngdrivers, where you will find information on working with a new driver to set goals and rules; developing a timeline for parent-guided driving lessons; and developing a parent/teen driving agreement.

Why is Laughter Infectious?

When I was a very young student Monty Python’s Flying Circus was being shown on TV for the first time. The TV room in the halls of residence would normally be home to one or two sleeping stalwarts. But on Monty P. nights we would have seventy or eighty of us crammed into a small room: the sharing of laughter made the whole show ten times funnier.

I think that we’ve all had the experience of infectious laughter. It’s easy enough to see that it can be a social lubricant. But how does it work?

We have known for some time that when we are talking to someone, we often mirror their behavior, copying the words they use and mimicking their gestures. You may know that deliberately copying other people is a technique that we use when we are trying to influence others. It has seemed likely that the same applies to laughter.

Researchers at University College and Imperial College in London have shown that positive sounds such as laughter or a rousing and triumphant "woo hoo!" trigger a response in the listener's brain. This response occurs in the regions of the brain that are activated when we smile, as though preparing our facial muscles to laugh. The research, funded by the Wellcome Trust, Action Medical Research and the Barnwood House Trust, is published in the Journal of Neuroscience.

The research team played a series sounds to volunteers whilst measuring their brain's response using an fMRI scanner. Some of the sounds were positive, such as laughter or the triumphant woo hoo’s, while others were distinctly unpleasant, such as screaming or retching. All of the sounds triggered a response in the volunteer's brain in the region of the premotor cortex. This is part of the brain that prepares the facial muscles to respond to emotion. The response was greater for positive sounds, suggesting that these were more contagious than negative sounds. The researchers believe that this explains why we respond to laughter or cheering with an involuntary smile.

When we are in a group and encounter positive emotions, the brain responds by automatically priming us to smile or laugh. This gives us a way of mirroring the behavior of others, which in turn helps our social interactions. Presumably it plays an important role in building strong bonds between individuals in a group.

There is a global movement which started in India called the laughter clubs, in which people get together to have a really good belly laugh. It has been claimed that these group giggles reduce the chance of developing depression. The data is not good, but there’s one thing for sure: it’s unlikely to cause you much harm.

“Laugh and the world laughs with you; cry and you cry alone.”
--Horace (a.k.a. Quintus Horatius Flaccus, Roman Poet and Satirist, 65-8 B.C.E.)

“What a force is laughter.”
--Alexander Solzhenitsyn (Russian Writer and, in 1970, Winner of the  Nobel Prize in Literature, 1918-)

“The arrival in town of a good clown is of more benefit to the people than the arrival of 20 asses laden with medicine.”

--Thomas Sydenham (English Physician and a Founder of Modern Clinical Medicine and Epidemiology, 1624-1689)

The Seat of the Emotions and the Gateway to Reason

“If passion drives, let reason hold the reins.”
--Benjamin Franklin (American Author, Inventor and Diplomat, 1706-1790)

For many centuries reason and emotion have usually been held to be two poles of a magnet, the North and South of the psyche. Every now and then someone has proposed some other psychological lodestone, but most have finally devolved into this simple binary model.

Yet a moment’s introspection shows us that reason and emotion are inextricably linked. We know from people with alexithymia and a dizzying array of “personality disorders,” that a real-life Mr. Spock would be a hobbled creature. Yet we also know that simple binary models of pleasure and pain as the drivers or behavior are over simplified. It appears that one of the great attainments of many mammalian species - and who knows how many others - is an ability to be moved by more complex considerations of loyalty, propriety and even morality.

There is an important study in this month’s issue of the Journal of Neuroscience. The amygdala is a central processing station in the brain for emotions and is involved in laying down emotional memories. A shock or extreme pleasure may both leave their traces in the amygdala, so it plays a key role in survival.

But this new research shows that the amygdala also plays a role in working memory, a higher cognitive function that is critical for reasoning and problem solving. If you ask someone for a telephone number and you instantly dial the number and then forget it, that is working memory in action. If you choose to remember the number for later, it moves out of working memory into longer term memory stores. In some senses working “memory” is a little bit of a misnomer: it is a function that enables us to manipulate information extremely rapidly.

In two different functional magnetic resonance imaging (fMRI) studies with a total of 74 participants, individual differences in amygdala activity predicted behavioral performance on a working memory task. The experimental subjects were asked to look either at words, such as rooster, elbow, and steel, or faces of attractive men and women. Then they were asked to indicate whether or not the current word or image matched the one they saw three frames earlier. Try it for yourself, and you will see that this is quite challenging. The subjects’ brains were scanned while completing the tasks.

People with stronger amygdala responses during the working memory task also had faster response times.

This is exceptionally important for anyone interested in thinking and learning: it shows that a region of the brain thought to be involved primarily, or perhaps even exclusively, in processing emotions is also involved in higher cognition, even when there is no emotional content.

I think it most likely that the amygdala may be involved in vigilance, perhaps preparing people to better cope with challenging situations and also improving their ability to sort information according to its relevance to the current situation. This is something that people with poor resilience find hard to do, so it may be that the amygdala is involved in developing and maintaining resilience.

This study helps to prove the total inter-relatedness of emotion and cognition and supports learning strategies that are based upon integrating emotion with facts. One of the ways in which health care students are able to remember enormous numbers of facts is by attaching them to patients with whom they have worked. Emotion, interest and empathy can dramatically accelerate learning.

The Omnipresent Ohrwurm: Ten Secrets for Having an Idea Remembered

Last month I wrote something about a phenomenon that I’m sure that you’ve experienced: having a tune get stuck in your head. James Kellaris has used the term “Ohrwurm” to describe this phenomenon.

I made brief mention of the way in which research into the ohrwurm may inform other fields, such as addictions.

The other big topic that may be illuminated by the ohrwurm phenomenon is the way that ideas, trends and fashions gain traction.

Some successes are created: you may or may not like Madonna or Britney Spears, but both of them are talented. The question is this: why did they first make it? In some senses both had the right set of talents be molded into a highly successful products. People in the music business saw their potential and that both were just right for the market of the time. Thousands of similarly gifted people just never had the opportunity to be made into stars.

Some successes are the results of memes. I’m speaking here about memes with a little “M,” to differentiate them from the Memes of spiral dynamics. Ideas, fashions and trends spread through society like the measles.

But are there any characteristics of psychological or social ohrwurms? What is it about some ideas, concepts or products that just have a great big hook that makes them not just memorable but irresistible?

People have been asking that question for years, but now it begins to look as if we might be getting close to generating some sensible answers based not on market research or focus groups, but on neuroscience.

A book called Made to Stick will be coming out in the New Year and identifies some of the characteristics of ideas that become popular and stick in people’s minds. The authors’ have come up with:

• Simple
• Unexpected
• Concrete
• Credible
• Emotional Story

I’m sure that they are on to something.

But I think that there is more.

In the original piece about the ohrwurm I mentioned three characteristics of a tune that gets stuck in our heads:

• Simple
• Incongruous
• Repetitive

The same principles and a few more are crucial in getting a message to resonate:

1. Simplicity: It’s much easier to believe that the motivators of human behavior are pain and pleasure, or that Men are from Mars and Women from Venus, than getting into the messy realities of human motivations and interpersonal relationships
2. Clarity: The simple idea must be expressed in a cogent and incisive way
3. Incongruity: This is essential: we know that the brain is hardwired to respond to novelty. Yet despite being incongruous, the odd, strange, unexpected idea must afterwards fit into the rest of our knowledge and beliefs about the world. We can only take so much incongruity!
4. Repetition: Few ideas - whether true or false - are embraced and adopted if they are only heard once
5. Emotional resonance: You are unlikely to be interested in or remember something that has no emotional meaning for you
6. Integrity: The idea or concept must have internal consistency
7. Believability: The idea needs to come from a trustworthy source
8. Consonant: The idea or concept needs to resonate with your own core beliefs or core values
9. Practical: Most people need to be able to see simple, concrete actions that they can take
10. Beneficial: There is a sliver of self-interest within all of us: something else that is hardwired. Unless we can see that we will derive some benefit from an idea, it is unlikely to have much traction

Now I am going to let you in on a secret. I do a lot of public speaking and I could not work out why my talks, lectures and speeches seemed to be so popular.

One day a friend from Canada told me that he had also been mystified by my popularity as a speaker. Then he told me that he had discovered my secret: I am a storyteller. It took me a while to grasp what he was saying, but then I realized that it was true. Whether presenting research data, ways to improve your life or an inspirational speech I constantly tell stories. And so does every other good speaker that I know. And the keys to telling good stories?

They are these ten points.

Try them out for yourself and see what you think.

“A man's success in business today turns upon his power of getting people to believe he has something that they want.”
--Gerald Stanley Lee (American Professor, Writer and Lecturer, 1862-1944)

Alexithymia

There is an important psychological symptom that can cause a great deal of distress, particularly in relationships. It is called alexithymia.

The Harvard psychiatrist Peter Sifneos originally coined the term in 1972 to describe people who had extreme difficulty in emotional cognition. The word “alexithymia” literally means “no words for mood.” People with this problem lacked the ability to understanding, processing or describing their feelings verbally. As a result, most people who have the problem are largely unaware of their own feelings or what they signify. As a result they only rarely talk about their emotions or their emotional preferences, and they are largely unable to use their feelings or imagination to focus and fuel their drives and motivations.

People with alexithymia seem unable to fantasize and many report multiple somatic symptoms. However, alexithymia is also associated with a number of other complaints, such as hypertension, irritable bowel syndrome, substance use disorders, and some anxiety disorders. Their speech is often concrete, mundane and closely tied to external events. So they will describe physical symptoms rather than emotions, and don’t understand that their bodily sensations are signals of emotional distress.

Alexithymia lies on spectrum: regular readers will remember some of our discussions about categorical and dimensional diagnoses. For some people it is little more than an inability to get in touch with their emotions. But at the other end of the spectrum are a number of illnesses in which alexithymia may occur, including schizoid personality disorder, posttraumatic stress disorder, anorexia nervosa or Asperger's syndrome. It is also much more common in victims of trauma.

Much has been written about alexithymia: a literature search earlier today generated over 8,500 publications.

It is still not clear what causes alexithymia. But this much is clear: in some people, there is a strong inborn predisposition to developing it, while in others it can develop in response to life events such as being raised in a low socioeconomic group with little social stimulation, trauma or chronic stress. For this reason we often talk about primary and secondary alexithymia.

Some neuropsychological studies have indicated that alexithymia may be due to a disturbance to the right hemisphere of the brain, which usually plays a predominant role in processing emotions. Other studies show evidence that there may be a deficit in the transmission of information between the hemispheres of the brain, with emotional information from the right hemisphere not being properly transferred to the language regions in the left hemisphere. Other studies have suggested that alexithymia may be related to a dysfunction of the anterior cingulate cortex a region of the brain involved in the control of attention, empathy, emotion and the anticipation of rewards.

Alexithymia can have some serious consequences. Apart from making relationships very difficult, it is more common in people who have near-fatal asthma attacks or have poor diabetic control. People with a history of alcohol abuse who have alexithymia are more likely to relapse. Alexithymia may predispose people to developing the insulin resistance syndrome.

As you can see, alexithymia can be dangerous: we have to have words for our feelings, or the feelings will express themselves though our bodies. It can predispose us to just about every stress-related illness, and even some illnesses that we don’t normally think of as stress-related. Since alexithymia is all about an ability to express emotions, it can be thought of as a social or informational disease. If we cannot inform others about our wants and needs, and if our minds cannot send us signals to say that something is going wrong, there could be a catastrophe lying in wait for us.

People with extreme forms of alexithymia can be very difficult to help using conventional medicine.

However, many people have minor degrees of alexithymia, and these can be helped by therapies designed to help them express emotions:

1. First is to become aware of the problem: I’ve had good success with asking people to keep an emotions “log book:” if they are having odd symptoms, how good are they about having appropriate emotions? I ask them to keep a note of their emotions in response to normal interactions with other people, or while watching television or a movie. If the person feels nothing while watching something really emotional, that can help him or her see that there is a problem. Simply learning to be more expressive can help mild cases: there are an array of forms of psychotherapy that can help.
2. In mild cases, we have had some good results with flower essences. There’s not a shred of scientific proof that they help, but clinically they often do. The same goes for two other helpful approaches:
3. Homeopathy: there are over a dozen remedies that may help
4. Tapping therapies

Attention Deficit Disorder and Executive Functioning

“Not to have control over the senses is like sailing in a rudderless ship, bound to break to pieces on coming in contact with the very first rock.”
--Mahatma Gandhi (Indian Nationalist and World Teacher, 1869-1948)

The Mahatma's statement could apply to most people stuggling with attention deficit disorder.

There is an important idea in neurology and psychology called "Executive functioning.” This refers to our ability to be able to make and carry out plans, direct our attention, focus and also to control our internal states: our impulses and emotions and to be able to switch from one task to another. In other words it is a key part of our ability to self-regulate our behavior, mind and emotions.

Most evidence now indicates that executive function is mediated by the regions of the dorsolateral prefrontal cortex. It happens that these same regions are amongst those that seem to undergo beneficial changes in people who practice meditation.

For people interested in attention deficit disorder, I’d like to recommend a book, “Attention Deficit Disorder: The Unfocused Mind in Children and Adults,” by Thomas E. Brown. In the book he encapsulates some up-to-date research indicating that one way of conceptualizing some of the difficulties faced by people with attention deficit disorder, is to break them down into the six major “domains” of executive functioning:

1. Activation: Organizing, prioritizing and getting to school or work
2. Focus: Tuning in, maintaining focus and shifting attention
3. Effort: Sustaining effort, regulating alertness and adjusting processing speed
4. Emotions: Modulating emotions and managing frustration
5. Memory: Holding and manipulating information and retrieving memories
6. Action: Monitoring and regulating actions

It can be very helpful for people to understand why they face the problems that they do, and how each may be amenable to a different type of help.

What we have done below is to re-draw and slightly simplify an extremely helpful diagram from Dr. Brown’s book, that will make it easier for you to see that kind of problems you or a loved one may be facing, and how treatment and coping strategies will be directed toward whichever of these is causing the most trouble in a person’s life.

(You can click on the diagram to see a large version of it.)

Women, Asthma and the Brain

There’s been a longstanding puzzle in medicine. Well actually there are lots of them, but here’s one that may be a puzzle no more.

For many years now, it’s been known that asthma is more common in women, and also that psychological stress can cause flare ups of asthma.

Many women experience “menstrual flaring:” a worsening of asthma around the time of their menstrual period. There is also a strange paradox: some women with asthma wheeze less if they take an oral contraceptive, while some non-asthmatic women begin to wheeze when they take it. In some women pregnancy makes asthma worse, and in others it affords months of relief of symptoms. Women who are obese are more likely to get asthma, presumably because their intra-abdominal fat stores are churning out inflammatory mediators.

Researchers from the University of Wisconsin have shed  some important light on this link between asthma and the brain. In research published in the Proceedings of the National Academy of Sciences. In the study, six patients with mild asthma were exposed to ragweed or dust-mite extracts. The subjects were shown three different categories of words: asthma-related (e.g., "wheeze"), non-asthma negative ("loneliness") or neutral ("curtains").

Using functional magnetic resonance imaging, they showed that activity in two regions, known as the anterior cingulate cortex and the insula showed increased activity when the asthma-related words were heard compared with the other types. What is more, this enhanced activity was specifically linked to physiologic signals from the ragweed and dust-mite extracts. So being exposed to asthma-relevant emotional stimuli is associated with markers of inflammation and airway obstruction in asthmatic people exposed to an asthma-producing antigen.

In people with asthma and other stress-related conditions, these brain regions may be hyper-responsive to disease-specific emotional and physiologic signals. Taken together, these could contribute to problems that worsen the asthma, such as inflammation.

And one of the ways of making these regions of the brain hyper-responsive? Bathe them in estrogen.

That still does not explain why pregnancy and the oral contraceptive makes some women’s asthma better, and does the opposite in others. But it may just have to do with the “set point” of the cells in these regions of the brain. In the same way that we might set the thermostat in out house. An already hyper-responsive brain might be normalized and an under-active one stimulated to be over-active.

We need to do some more experiments, but these are a great start.

If you ever wheeze, have a look to see if there are stressors or hormonal events that trigger you. Whether you are being treated with homeopathy, herbals or conventional therapy, knowing when to expect trouble gives you the power to adapt you treatment when you are entering a risky time in your life.

Cutting and Self-injury

There’s an extremely disturbing trend: ever-increasing numbers of young people who are cutting themselves. Once rare, and something usually seen only in people with serious psychiatric illness, many school children encourage and goad each other into doing it, and there are websites dedicated to cutting, on which young people compare notes and even give each other advice on how to conceal what they are doing, by cutting themselves in places like the lower back.

We have been offered a great many explanations for this worrying development, but not much in the way of evidence. We know that most people who cut themselves are female adolescents or young adults, and apart from the obvious physical dangers, there is evidence that this behavior may lead to a more serious psychological condition called Borderline Personality Disorder. This can be a serious problem that carries a high risk of suicide. It is also of some theoretical interest, because there seem to be genuine cultural differences in borderline personality disorder. An estimated 5.8 million to 8.7 million Americans, mostly women, suffer from it, but it is far less common in most of Western Europe and Australia. Research over the last decade has indicated that the condition is becoming more common in these regions. People with the borderline personality disorder have a wide spectrum of difficulties that are marked by emotional instability, difficulty in maintaining close relationships, eating disorders, impulsivity, chronic uncertainty about life goals and addictive behaviors such as using drugs and alcohol. They also have major impact on the medical system by being among the highest users of emergency and in-patient medical services. Glen Close’s character Alex Forrest in the movie Fatal Attraction, had some of the features that we might expect in some with borderline personality disorder.

Researchers from the University of Washington in Seattle have reported that adolescent girls who engage in cutting behavior have lower levels of the chemical transmitter serotonin in their blood. They also have reduced levels of activity in the parasympathetic nervous system as measured by what is called respiratory sinus arrhythmia, a measure of the ebb and flow of heart rate as we breath. Low levels of this measure are typically found in people who are anxious or depressed. The study included 23 girls aged 14 to 18, who engaged in what psychologists call “parasuicidal” behavior. Participants were included if they had engaged in three or more self-harming behaviors in the previous six months or five or more such behaviors in their lifetime. The comparison group consisted of an equal number of girls of the same ages who did not engage in this behavior.

In line with previous research, the adolescents in the parasuicide group reported far more incidents of self-harming behavior than did their parents.

The findings of low serotonin and low parasympathetic activity support the idea that the inability to regulate emotions and impulsivity can trigger self-harming behavior. The primary problem is an inability to manage their emotions: the people who cut themselves have excessively strong emotional reactions and they have extreme difficulty in controlling those emotions. Their self-harming behavior may serve to distract them from these emotions.

A characteristic feature of borderline personality disorder is not just self-injurious behavior but also stress-induced reduction of pain perception. Reduced pain sensitivity has been experimentally confirmed in patients with the condition. The increasing incidence of the condition in Europe is attracting many European investigators and colleagues from Mannheim in Germany have recently traced the neurological circuits involved in this stress-induced reduced pain perception.

There is good evidence that people who cut themselves are more likely to have been victims of sexual abuse or violence as children, though that obviously does not mean that every person who harms themselves has had something bad happen to them in childhood. Sadly the research has become more complex because of the numbers of people who have been given false memories of abuse by well-meaning psychologists.

Treating people who cut themselves, whether or not they have borderline personality disorder can be very challenging. The first thing is to treat any underlying mood or anxiety disorder. A combination of medications and psychotherapy is normally used, with people making claims for the value of different types of therapy. Many therapists also say that they have helped people who cut themselves with tapping therapies, acupuncture, homeopathy and qigong. I’ve not been able to find any credible research evidence to support the use of those therapies, though I’ve also seen some success stories.

We also have the puzzle about why cutting and borderline personality disorder seems to have been less common in other parts of the world and are now increasing. There is research to show that it’s not just a matter of recognition or of calling the illness something else in Europe. I have a friend who is a senior academic at an Ivy League University, and an expert on borderline personality disorder. During a sabbatical in Scotland some 15 years ago, he could not find a single case. This matters, because if we can identify what’s changed, we may have some clues about treatment. There are hundreds of candidates, including environmental stress, diet and toxins.

There’s an important new study in which 13 children with autism showed marked improvement in some of their challenging behaviors when they were given 1.5gms of omega-3 fatty acids each day. This was only a six week study, but it needs to be replicated using larger numbers. It is also important to be alert to the possibility that some makes of omega-3 fatty acids on the market contain mercury. The one that we have found best so far has been OmegaBrite. http://www.omegabrite.com/ It will also be useful to see if dietary supplementation will help self-injurious behavior in other types of people.

Here is a list of some of the better information sites about self-harm.

The key to success with helping complex problems, as I point out in great detail in Healing, Meaning and Purpose, is a comprehensive approach:

Combinations are Key

Heroes and Villains

“Nothing is as infectious as example.”
--François Duc de la Rochefoucauld (French Writer and Moralist, 1613-1680)

I was just expecting to learn something about what's been going on in the world today, when I came across this excellent blog item by Chess Grandmaster Susan Polgar.

Just have a look at this extraordinary video.

What amazed me just as much as the video, was that one of the commentators on Susan's blog defended the action of the adult, on the grounds that the assaulted child had played a foul, saying, "As a parent, how easy would you find it to stand by if that happened to your kid?"

The answer to that should be, "Very easy indeed."

Adults are supposed to have some modicum of self-control.

Adults also have a responsibility to model good behavior, not just for their own children, but for all other children as well.

It reminded me of the quotation: "If you can't be a good example, then you'll just have to be a horrible warning."
--Catherine Aird (a.k.a. Kinn Hamilton McIntosh, English Writer and Creator of “Inspector Sloan”, 1930-)

I've been involved in competitive games for most of my life, and of course they can inflame emotions. But it is how we act on those emotions that matters. I used to have an excellent chess coach named Craig Jones. He has done a lot for scholastic chess, and I remember being horrified by the antics of some parents at chess tournaments. Those scenes from the movie Searching for Bobby Fischer are not an exaggeration.

Being a victim of your emotions is bad enough. Being a lousy role model is the worst kind of irresponsibility.

I actually prefer another term to "role models." I call them heroes. And the opposite of a hero is, I suppose, a villain.

“Young people need models, not critics...”
--John Wooden (American Basketball Coach, 1910-_

Re-Writing Our Life Stories and Developing Resilience

“Every man’s story is important, eternal and sacred.”
--Herman Hesse (German-born Swiss Novelist, Poet and, in 1946, Winner of the Nobel Prize for Literature, 1877-1962)

In Healing, Meaning and Purpose, I spend a lot of time discussing the nature of memory – that it does not work like a video recorder, but is a dynamic process – and the value of re-writing your life story. This is a remarkably powerful technique.

What is particularly interesting and useful is to uncover events in our lives that have had two characteristics. First, is that they had a strong subjective impact. And second, that they generated meaning. Breaking up with a partner might generate a lot of emotion and lead you to believe that you are not good in relationships or it could make you think that the other person didn’t appreciate you. Losing a game of football may be painful, but will likely not generate much meaning. Unless your team is on a thirty game losing streak….

A recent study from Quebec published in the Journal of Personality, studied events that we use to define ourselves. Researchers looked at the subjective impact and the meaning-making effect of these self-defining events. This is what they found. When we remember events in our lives that we feel had a major impact on our life story or on our sense of identity, we tend to downplay the negative and emphasize the positive.

When we are asked to think back to those events, we tend to report less sadness and more pride than we actually felt at the time. For positive memories, people reported equally intense positive emotions – for example love - and less negative emotions – such as fear - compared with how they recalled feeling at the time.

What this means is that in the face of change, adversity and opportunity, we are always trying to maintain a positive and coherent sense of self. This is a component of psychological resilience. Someone with clinical depression loses the ability to maintain this positive and coherent sense of self.

This work is also important for people trying to fashion a more positive view of him or herself. While it is usually a good idea to cultivate a positive mental attitude, there are some people for whom such an approach can be disastrous: they are the ones who thrive on negativity. Which one are you?

Simply deciding to change your view of yourself will likely have only a very short-term effect unless you identify and work with cardinal life events. Some forms of psychotherapy revolve around trying to identify the key events that have fashioned our sense of self and that have contributed to our identity. You can begin that process for yourself.

But that is only one part of the equation.

Any long-term change will also involve the attitudes and expectations of other people: none of us lives in a vacuum. I have known countless supremely self-confident musicians, artists and even scientists, whose careers have never got started, because nobody agreed with their evaluation of themselves.

There are a number of ways of presenting yourself in a way that will inspire confidence in other people, and I shall discuss some of those in one of my future programs.

“Every story can be told in different ways.”
--Greek Proverb

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