Richard G. Petty, MD

Career Contentment

I am very happy to report that my friend Jeff Garton's new book - Career Contentment: Don't Settle for Anything Less - has just come out.

As you will see from my review, I just love the book, and it is amazing how Jeff's work and mine fit together.

We are going to be having a panel discussion about the book on www.Business.VoiceAmerica.com on Thursday March 6th at 3PM Eastern, which is noon Pacific time. The discussion is also going to be archived for people in other time zones. I plan to put up a link as soon as it is available.

There is a nice press release here.

I hope that you can listen in: I think that you will get a lot of food for thought!



“Contentment is natural wealth, luxury is artificial poverty.”
-Socrates (Greek Philosopher, 469-388 B.C.E.)

Jazz and the Brain

It is remarkable how good the brain is at coordinating multiple regions at once. A new study published in today's issue of the journal Public Library of Science (PLoS) One has used functional magnetic resonance scanning (fMRI) to examine musicians engaged in highly creative and spontaneous jazz improvisation. They found that a large region of the brain involved in monitoring one's performance is shut down, while a small region involved in organizing self-initiated thoughts and behaviors is highly activated. The researchers propose that this and several related patterns are likely to be key indicators of a brain that is engaged in highly creative thought.

During the study, six highly trained jazz musicians played keyboard under two conditions. In the first scenario, called the Scale paradigm, the music was based on a simple C major scale. Using only their right hand, the volunteers first played the scale up and down in quarter notes. Next, they were asked to improvise, though they were limited to playing quarter notes within the C major scale.

The second scenario, called the Jazz paradigm, examined higher-level musical improvisation. This paradigm was based on a novel blues melody that the volunteers had memorized beforehand, and had been written by one of the researchers. Again, using only their right hand, the musicians played the tune exactly as they had memorized it, only this time accompanied through headphones by a pre-recorded jazz quartet. When they were asked to improvise, the musicians listened to the same audio background, but they were free to spontaneously play whatever notes they wished.

The brain scans were nearly identical for the low-level and high-level forms of improvisation, supporting the idea that the change in neural activity was due to creativity and not the complexity of the task.

Much of the change between improvisation and memorization occurred in the prefrontal cortex, the region of the frontal lobe of the brain that helps us think and problem-solve. It is also involved in generating the sense of self. The dorsolateral prefrontal cortex is responsible for monitoring our own performance and it shuts down completely during improvisation, while the much smaller, centrally located region at the foremost part of the brain – the medial prefrontal cortex - increases in activity. The medial prefrontal cortex is believed to be involved in self-initiated thoughts and behaviors, and it becomes very active when a person describes an event that has happened to him or makes up a story.

The suppression of inhibitory, self-monitoring brain mechanisms helps to promote the free flow of novel ideas and impulses. This is an unusual pattern of brain activity that closely resembles the pattern seen in people when they are dreaming.

Another unusual finding was that there was increased neural activity in each of the sensory areas during improvisation, including those responsible for touch, hearing and vision, despite the fact that there were no significant differences in what individuals were hearing, touching and seeing during both memorized and improvised conditions. This suggests that when the brain wants to be creative, a whole range of sensorimotor processing is increased. At the same time systems that regulate emotion were also engaged during improvisation.

As someone who has done a lot of brain imaging, and has spent many hours inside scanners, this whole piece of work is dazzling from a technical point of view. The hardy musicians had to lie on their backs with their heads and torsos inside the scanner and their knees bent upward. They had to use a plastic keyboard, which was shortened to fit inside the scanner and which rested on their knees. A mirror placed over the volunteers' eyes, together with the headphones, helped the musicians see and hear what they were playing.

Just thinking about it makes me queasy.

“Words are the children of reason and, therefore, can't explain it. They really can't translate feeling because they're not part of it. That's why it bugs me when people try to analyze jazz as an intellectual theorem. It's not. It's feeling.”
--Bill Evans (American Jazz Pianist, 1929-1980)

“Jazz tickles your muscles, symphonies stretch your soul.”
--Paul Whiteman (American Musician and Bandleader, called the King of Jazz for popularizing a musical style that helped to introduce jazz to mainstream audiences during the 1920s and 1930s, 1890-1967)

“Jazz music is an intensified feeling of nonchalance.”
--Françoise Sagan (French Novelist and Dramatist, 1935-2004)

Overcoming Rejection

I am sure that most of us have faced some form of rejection at some time or other in our lives. People with high self-esteem seem better able to take rejection in their stride, but usually only if it is “earned.” Simply trying artificially to build your self-esteem rather than having built it on a platform of past achievement, will probably not work very well.

New research in the journal Psychological Science from UC Berkeley indicates that this does not mean that people with low self-esteem are doomed to respond defensively to criticism and rejection. The key seems to be that people who are better at controlling their impulses are less vulnerable to rejection. 

There were 38 female and 29 male participants in the study. The first completed the Rosenberg self-esteem scale, one of the most widely used self-esteem measure in the social sciences. They then completed a questionnaire on their ability to focus on tasks at hand without distraction. The subjects were arranged into two groups - low self-esteem and normal-to-high self-esteem – based on their scores on the Rosenberg scale.

Each of the volunteers then viewed images showing positive, neutral, negative and rejection themes while being subjected to sporadic loud noises. A startle probe measured the force of their eye-blinks in response to the abrupt sounds. Eye blinks are a good measure of the startle response and correlate fairly well with the activation of the “fight or flight” reaction.

As anticipated, all the participants blinked more strongly when the loud noise was paired to such negative images as dead animals or mutilated bodies. However, the people with low self-esteem blinked more forcefully in response to pictures portraying themes of rejection loneliness and alienation. Paintings with negative themes or acceptance themes, such as lovers embracing, did not elicit the same response in low self-esteem people.

In other words the powerful was in which rejection activates the threat system in people with low self-esteem suggests that their fear of rejection runs extremely deep and engages neurological systems involved in reacting to a threat.

On the other hand, those with low self-esteem who scored higher for attention control, which included the ability to focus, were able to modulate their immediate reactions to rejection. 

Some previous work has suggested that self-esteem is part of a primitive emotional warning system that warns us if we are in danger of being socially excluded. While the evolutionary function of this detection system was originally intended to motivate people to stay socially connected, the constant anticipation of rejection can create problems, with the system being triggered by the merest whiff of rejection. They may become hypersensitive and have a brain that generates a cascade of defensive reactions if they sense any kind of disapproval.

Although this is a small study, the evidence is that rather than teaching self-esteem skills, the solution for them might be to improve their abilities to focus, concentrate and regulate their internal states.

In other words develop some specific forms of self-control and resilience.

For many people this may be the most effective way of helping them to cope with disappointment and maintain close relationships.




“No man is free who is not master of himself.”
--Epictetus (Phrygian-born Greek Stoic Philosopher, c.A.D.55- c.A.D.135

“It is not the mountain we conquer but ourselves.”
--Sir Edmund Hillary (New Zealand Mountaineer and Explorer, 1919-

“Mind control is not one's birthright. The successful few owe their success to their perseverance.”
--Ramana Maharshi (Indian Hindu Mystic and Spiritual Teacher, 1879-1950

“The cyclone derives its powers from a calm center. So does a person.”
--Norman Vincent Peale (American Cleric, Writer and Self-Help Expert, 1898-1993)

Meditation, Stress and Self-Regulation

There is progressively more evidence that meditation can have measurable effects on behavior and the brain. The trouble is that some of the results have conflicted, mainly because of the different types of meditation and different measurement protocols. So I was very interested to see some new research in this week’s issue of the Proceedings of the National Academy of Sciences, by a team of researchers from China collaborating with renowned experts at the University of Oregon, who have developed an approach for neuroscientists to study how very brief meditation training might improve a person's attention and response to stress.

The study itself was done with undergraduate students in China. The experimental group received five days of meditation training using a technique called integrative body-mind training (IBMT), which was developed in China n the early 1990s.

IBMT is a rapid mental training method that aims at inducing a state of alert restfulness using breathing and guided imagery.

The control group received five days of relaxation training. Before and after training both groups took tests involving attention and reaction to mental stress.

The experimental group showed greater improvement a test of attention that was designed to measure peoples’ ability to resolve conflict among stimuli. Subjects were stressed by doing mental arithmetic.

At the beginning of the experiment both groups showed an elevated release of cortisol following the mathematical task, but after training the experimental group showed less cortisol release. This probably indicates an improvement in stress regulation. The experimental group also showed lower levels of anxiety, depression, anger and fatigue than the control group.

The next stage in the research will involve direct measurements of brain function.

Although IBMT is described as a form of meditation, it may be inducing something slightly different from, say, Zen meditation. The important point is that it is possible to produce measurable physiological changes in just five days, and this will make it much easier to examine the dynamic effects of hypnosis, relaxation and this technique on brain function.

I would also be grateful for any readers who have more information abut the precise details of IBMT, and whether training in the precise techniques is available outside China.

I shall keep you posted as new data emerge.

“Peace can be reached through meditation on the knowledge which dreams can give. Peace can also be reached through concentration upon that which is dearest to the heart.”
--Patanjali (Indian Philosopher said to be the Compiler of the Yoga Sutras, Dates Unknown)

“Through meditation and by giving full attention to one thing at a time, we can learn to direct attention where we choose.”
--Eknath Easwaran (Indian-American Spiritual Teacher, Professor and Author, 1910-1999)

“Meditation is not to escape from society, but to come 
back to ourselves and see what is going on. Once there is 
seeing, there must be acting. With mindfulness, we know 
what to do and what not to do to help.”
--Thich Nhat Hahn (Vietnamese Buddhist Monk, 1926-)

“A meditator keeps his mind open every second. He is constantly investigating life, investigating his own experience, viewing existence in a detached and inquisitive way. Thus, he is constantly open to truth in any form, from any source, an at any time.”
--Henepola Gunaratana (a.k.a. Bhante G., Sri Lankan Buddhist Monk, 1927-)

Who’s In Charge of Your Brain?

There has been a lot of discussion in the neuroscience community about the way in which different circuits in the brain are integrated. We know that the right and left sides of the brain normally operate together, and that most of the time the three major systems of the brain: reptilian, limbic and neocortical regions work together. However, we have also speculated that one of the causes for some neurological, psychological and psychiatric illnesses might be a result of “disconnections” between different regions of the brain. The idea that some brain regions may be uncoordinated goes back more than a hundred years, but was resurrected and developed quite brilliantly in the 1960s by one of my mentors, the late Norman Geschwind, who was one of the three smartest people that I ever met.

Now there is some new research that may have important implications for neurology and psychology.

Colleagues from Washington University School of Medicine in St. Louis have found strong evidence that there is not one but two complementary commanders in charge of the brain. It is rather like having two captains in charge of the same ship.

The two captains are networks of brain regions that do not consult each other but still work toward a common purpose: the control of voluntary, goal-oriented behavior. These behaviors include a vast range of activities from walking and talking, reading and deciding on a course of action. There are yet other systems that control behaviors that are usually involuntary such as control of the pulse rate or digestion.

Last year the researchers found that there are 39 brain regions that consistently became active before the brain goes to work on a task. They did this through functional magnetic resonance imaging (fMRI) scans that follow the oxygenation of the blood. As a region of the brain is activated, blood flow increases and we can work out which brain regions are contributing to a mental task. One of the keys to our mental capacity is the ability to recruit different parts of the brain as we need them. The previous research suggested that these brain regions create task sets: plans for using the specialized talents of various brain regions to achieve a goal. Let me give you an example.

Read the word: CAT

You can do many things with that word: make a mental image of a cat, read it aloud, make rhymes or lists of words and so on. And each of those activities involves a different set of circuits in the brain. The person with good powers of attention and concentration is able to mobilize and coordinate more of his or her mental resources than the person who is less focused on a task.

In this new study the researchers used a different brain scanning technique called “resting state functional connectivity MRI.” Volunteers were asked to relax while their brains are scanned instead of working on a task.

They then used graph theory, a branch of mathematics that visually graphs relationships between pairs of objects to work out how different brain regions are coordinated. This mathematical technique is rather like the party game Six Degrees of Kevin Bacon, in which you use paired connections to go from one actor or actress to another until you've identified a chain of connections linking Kevin Bacon and another actor, actress or movie that wasn't immediately obvious.

They were able to identify pairs of brain regions where blood oxygen levels rose and fell roughly in synch with each other, implying that the regions most likely work together. What they found was two separate systems. Each system had multiple connections to other regions in its own team, but they never connected to regions on the opposite team.

Having established the existence of two control networks, the next task was to work out their roles. One network - the “cinguloopercular network" - was linked to a "sustain" signal. It turns on when you start doing a task and stays constant while you do it. When you are finished it switches off.

The second is the frontoparietal network that is consistently active at the start of mental tasks and during the correction of errors.

In some senses this is not too much of a surprise. Many systems of the body have multiple control systems. I have often talked about the scores of systems involved in the control of body weight, which means that a dietetic approach directed at only one system is doomed to failure. If the body thinks that it is starving other systems jump in to slow your metabolism, reduce your activity level and make you crave certain foods.

Another good example is body temperature. Your temperature is regulated by several independent factors including your sweat glands, metabolism and activity level. If one of them goes wrong, other systems will try and compensate. When one controlling factor goes awry, others can try to compensate. The controls of your weight and body temperature are known as complex adaptive systems, and they are found not only in biology, but also in ecology, economics and atmospheric dynamics. We study them using an approach called network dynamics.

The findings may help our efforts to understand the effects of brain injury and develop new strategies to treat such injuries.

They may also help us understand problems like goal-directed behavior and human motivation.

If only one of the two systems has agreed that you need to go out and exercise, it may help us design new strategies to help you and explain why some approaches to, say, diet and exercise, are more effective than others.

Groundbreaking stuff!

Biofeedback for Tension Headaches

Tension headaches are common and can cause a great deal of pain and distress. They can also be hellish hard to treat.

Medicines do not always help, so I have since the 1970s been interested in anything else that could help. In 1982 my boss gave me the money to set up a biofeedback laboratory at Charing Cross Hospital in London, and it turned out that this form of treatment helped around a third of people with tension headaches. Most experts have assumed that biofeedback helps by reducing muscle tension, though I have never been so sure: not everyone with tension headache has increased muscle tone, and many simply reported that they felt less stressed and more in control of their lives.

So it was very interesting to see some new research (NR10) presented yesterday at the 2007 Annual Meeting of the American Psychiatric Association in San Diego, California.

Researchers from Ingok Ja-Ae Hospital in Chungbuk Eumseong, South Korea looked at the efficacy of biofeedback assisted autogenic training for chronic tension headaches.

They examined 35 people aged 20-40 with chronic tension headaches. 17 had treatment as usual, and 18 received 8 sessions of biofeedback. The researchers used some standard measures of headache. Both groups improved, but the people who had biofeedback showed a greater improvement using a simple visual analog scale.

But this is what was interesting: people who had biofeedback had a significant improvement in their levels of anxiety and depression. The reductions of anxiety correlated with the improvements in headache, while biofeedback had no impact on the electrical activity of the muscles in the head and neck. This is an important finding, since it suggests that biofeedback may be helpful with other problems in which anxiety is an issue. There are few problems that are only physical or only psychological: there will almost always be a psychological component in anyone who suffers from chronic pain.

I recently discussed the use of a particular form of biofeedback that seems to help many people with attention-deficit/hyperactivity disorder (ADHD). The treatment seems to help attention itself, but it would also be very helpful if it reduces anxiety, since excessive worrying is a common issue in ADHD.

I shall keep you updated on the use of biofeedback as more research is published.

The most important conclusion from all this work is that it confirms that the mind has extraordinary powers over the body.

And that is incredibly encouraging for all of us.

Non-pharmacological and Lifestyle Approaches to Attention-Deficit/Hyperactivity Disorder: 6. Biofeedback

It seems odd that hyperkinetic children and adults with attentional problems should be able to stop long enough to try yoga, meditation of biofeedback. Yet there is good evidence that they can and they do, and that all three modalities can be helpful.

Today we are going to look at the use of a specific form of biofeedback.

Neurofeedback is a form of behavioral training that is aimed at developing skills to help people self-regulate the activity of their brains.

The first attempts to use biofeedback in children with behavioral problems took place in the early 1980s, following some interesting work on using it to control epilepsy, headaches and an array of other problems. Several good quality neurofeedback studies have been published over the last ten years.

In neurofeedback training, people are taught to control specific aspects of electrical brain activity. They are hooked up to machine that records electric impulses from the brain – a form of electroencephalograph (EEG) and they are given immediate feedback and positive reinforcement, usually using a visual display.

In frequency training, people are asked to increase or decrease the activity of different EEG frequency bands. To learn to regulate their level of cortical excitability they are trained to generate and regulate slow cortical potentials (SCPs). Slow cortical potentials are slow event-related direct-current shifts of the EEG.

With a little practice, almost anyone can learn the basic techniques, and as they do, they constantly improve their ability to regulate their attention, thoughts, moods and reactions. Many young people with attention-deficit hyperactivity disorder (ADHD) look at it like a game, and quickly become engaged with it.

Studies of neurofeedback have shown some specific effects on attention and memory processes. The key point is that the improvements in performance are maintained once the person is engaged in real-life activities. The techniques can be used to help healthy people perform better as well as helping people with problems.

Several studies have shown that children with ADHD had improvements in behavioral and cognitive variables after both frequency (e.g., theta/beta) training and SCP training. Some of the improvements have been sustained for six months. It has also been possible to show improvements in some neurophysiological measurements. Most studies have been done in children with ADHD, and in most other things were done as well. For instance the children were kept on medications, or children were given other types of exercises to reinforce what they were learning.

There has been some good brain imaging research that has shown that neurofeedback in children with ADHD normalizes the functioning of the anterior cingulate cortex, the key neural substrate of selective attention

There is also another type of feedback training. There is evidence that the level of activity in a classroom containing hyperactive boys can be reduced using feedback about the level of activity together with positive reinforcement. Some recent research has produced preliminary data in which investigators used a device that combines a beeper and actigraphy technology for measuring, monitoring, and modifying motor excess in children. The feedback reduced the activity level of seven out of nine hyperactive boys.

There remain a lot of unanswered questions about biofeedback in the treatment of ADHD. In an excellent review article, John Gruzelier and Tobias Egner from London pointed out that neurofeedback had grown and been widely adopted with little in the way of research to back it up. However their own work has shown that the technique can help improve cognition, and they provided the first evidence of conscious control over the ratio of alpha and theta waves in the brain. They also showed that the technique could lead to remarkable improvements in artistic aspects of music performance, which were equivalent to two class grades in conservatory students.

The evidence for biofeedback is growing, and since it is non-invasive ad may be associated with a number of other improvements in mood and cognition, it will likely bean important option for some people with ADHD.

Marijuana and Psychosis

A number of my friends and colleagues in London have shown how cannabis (marijuana) may trigger a psychotic illness. A team at the Institute of Psychiatry gave healthy volunteers the active ingredient tetrahydrocannabinol (THC).

They then recorded reduced activity in an area of the brain called the inferior frontal cortex that keeps inappropriate thoughts and behaviors in check. The inferior frontal cortex is part of the self-regulatory systems of the brain that stop us swearing inappropriately, and help us to realize that people are not looking at or spying on us. In other words the inferior frontal cortex checks the environment and stops us jumping to conclusions that could lead to paranoia.

The THC was given to healthy volunteers who had not abused marijuana. The effects were short-lived, but more sever in some people than others, suggesting a genetic vulnerability.

In another study from Yale University, THC was given intravenously. Even at fairly low doses, 50% of healthy volunteers began to show symptoms of psychosis. As expected, people who had a previous history of psychosis were particularly vulnerable to the effects of THC.

A separate study has shown that one of these ingredients - cannabidiol (CBD) - has the potential to dampen down psychotic symptoms, and could perhaps form the basis of new treatments.

Whenever people start talking about the possible association between psychiatric problems and using marijuana, there are always loads of people who protest, “But I’ve used it for years and it’s never done me any harm.”

They may be right, but that objection misses four important points:

1. People vary in their sensitivity to marijuana. Mental illness is the result of both genes and environment. Somebody who is very stressed but has no known genetic predisposition may run into trouble, while somebody with strong genetic loading and a minimal amount of stress can get very ill very quickly. And that stress can be anything from marijuana to abuse. There is also a lot of variation in how people respond to specific types of stressors
2. If people have already had some psychological trouble, marijuana can be like pouring gasoline on a fire
3. The age at which marijuana is used is all important. There seem to be “critical periods” in brain development, when marijuana can be particularly risky. There is a strong correlation between the number of times someone uses it under the age of eighteen and their subsequent risk of developing psychosis later in life. This relationship does not seem to hold with regular cigarettes, alcohol or any of the other street drugs looked at so far, suggesting that this is not just a matter of young people who are self-medicating. We cannot prove “causality” any more than we can “prove” that cigarette smoking causes lung cancer. Trying to prove a single cause for an illness is a tricky business. There are some examples, for instance illnesses caused by a single gene, but they are few and far between
4. The marijuana available today is very different from the anemic material that was available in the 1960s and 1970s. Today’s is far powerful

This research provides the strongest evidence yet that modern marijuana can have a significant impact on the brain. Proving a long-term effect would be extremely difficult: it would be neither ethical nor feasible to stimulate long-term psychosis in volunteers.

But clearly if something has an active effect in inducing the symptoms of psychosis after one dose, it would not be at all surprising if repeated use could induce a chronic problem, particularly if someone is genetically predisposed.

Temptation

Have you ever given in to temptation? Have you ever had a moment of weakness when that jelly donut seemed just too irresistible or you felt that it was about time to tell someone what you REALLY thought?

Sad to say I am sure that we are all guilty of that at some time or other.

What we are talking about here is self-regulation, our ability to inhibit impulses, make decisions, persist at difficult tasks and to control our emotions. We know that our ability to self-regulate is highly variable. It becomes more difficult if we are tired, stressed or working with people who drain us emotionally. There is evidence that our abilities to self-regulate can fatigue in just the same way that a muscle can get tired. It’s like having a limited amount of money, and when it’s gone it’s gone. One of the main factors that help to keep self-regulating is our level of resilience.

It is interesting that when we give in to the temptation to do something unwise, we are often unaware of it at that moment. It is only later that we feel regret.

There is some interesting new research from the University of Kentucky, that was conducted by two psychologists Suzanne Segerstrom and Lise Solberg Nes. Their work suggests that there may be a biological indicator to tell us when we are working hard at resisting temptation and consequently when we are vulnerable to doing things that we hadn’t meant to.

They hypothesized that there would be a link between variations in heart rate – heart rate variability (HRV) - and self-regulation. HRV is emerging as a very interesting tool for examining the health of the autonomic nervous system, and if disturbed, it can be a harbinger of many highly undesirable health problems. The researchers’ reasoning was that many of the same brain structures involved in self-regulation are also involved in the control of HRV.

They did a two-part study to test their hypothesis. In the first experiment participants were told that they were going to take part in test on the "physiology of food preference." They were instructed to fast for three hours before starting the procedure. Then their HRV was monitored while they were presented with a tray of cookies, candy and carrots. The “temptation” was to give in to eating the tastier but the less healthy snack of cookies and candy.

HRV was considerably higher when people were working to resist temptation (eating carrots rather than cookies and chocolate) than when they were not. This suggested that HRV was mirroring the attempt at self-regulation.

In part two of the experiment, after resisting or giving into temptation, the experimenters had the participants attempt to complete difficult anagrams, some of which were impossible to solve. The authors measured how long participants persevered at the anagrams. As predicted, those who had exerted high self-regulation by resisting the candy and cookies were more likely to give up earlier on the task. They didn’t have any more self-control to give.

People with naturally higher levels of HRV were likely to try longer at the anagram task, whether or not they had given into “temptation.”

Now the “temptation” in this study wasn’t much, but the implications are important. There are many people – particularly those with addictions and some kinds of personality disorder – who have major problems with self-regulation. HRV feedback could turn out to be a useful way of helping people realize that their self-control may be about to fail.

It is also important to know that self-regulation is finite, but can be built by building an individual’s resilience (1,2,3,4,5).

By the way, if you have never given in to temptation, would you PLEASE share your secret?

“Watch and pray, that ye enter not into temptation: the spirit indeed is willing, but the flesh is weak.”
--The Bible: Matthew 26:41

“A silly idea is current that good people do not know what temptation means. This is an obvious lie. Only those who try to resist temptation know how strong it is....  A man who gives in to temptation after five minutes simply does not know what it would have been like an hour later. That is why bad people, in one sense, know very little about badness. They have lived a sheltered life by always giving in.”
--C. S. Lewis (British Scholar and Novelist, 1898-1963)

“What makes resisting temptation difficult for many people is they don't want to discourage it completely.”
--Franklin P. Jones (American Businessman, 1887-1929)

“Temptation is an irresistible force at work on a moveable body.”
Henry Louis (H.L.) Mencken (American Writer and Editor, 1880-1956)

Thinking Speed, Mood and Optimism

There’s a very interesting article at the Mixing Memory blog. It’s one of the blogs that I highlight in the “What I’m reading” section. The articles highlights some recent research by Emily Pronin and Dan Wegner from Princeton and Harvard respectively, entitled "Manic Thinking: Independent Effects of Thought Speed and Thought Content on Mood.”

It’s about an intriguing issue. People who have a manic illness have an acceleration of thinking processes together with elevated mood and energy level. Mania is also associated with racing thoughts grandiose or creative ideas, fast, uninterruptible speech, aimless pacing, irritability and an over-involvement in pleasurable activities, together with a loss of impulse control.

It may sound great, and initially people are often very happy to be manic. But after a while it can give way to exhaustion or the realization that some of their choices have been unwise. I once knew someone who was driving a brand new BMW – that she could definitely not afford – at over 120 miles an hour, the wrong way down Interstate 95. That’s when the police became involved, and they immediately realized that she was not a villain, but a very sick person who could have killed herself and a ton of other people.

The researchers they had a group of college undergraduates read a series of 58 emotion-inducing statements out loud, and to do it at either a fast or slow pace. The statements are emotionally neutral at the beginning and then become progressively more emotionally positive or negative. The idea is that reading a series of progressively more positive or negative statements will affect the reader's mood. The letters in the statements were presented one at a time, either for 40 milliseconds per letter ("fast thinking" condition) or 170 milliseconds per letter ("slow thinking"). A pilot study indicated that the 40 milliseconds per letter reading time were about twice the normal reading speed for college undergraduates and 170 milliseconds were about half the normal speed. The time between statements also varied, with only 320 milliseconds between statements in the "fast condition" and 4 seconds between statements in the "slow condition."

After reading all 58 statements, the participants were asked to answer a series of questions designed to assess their mood, energy level, feelings of power, creativity and inspiration. There were also questions to evaluate "grandiosity or inflated self-esteem," together with their own perceptions of their speed of thought.

Subjects in the "fast thought" condition reported faster thought speeds than those in the "slower" condition. As predicted, faster thought speeds affected mood and mania-related feelings, participants in the fast thought condition reported being happier, had higher energy levels, experienced greater senses of power and creativity, and higher levels of grandiosity (though self-esteem did not differ between conditions). What is important, is that these effects were independent of the mood manipulation (positive or negative statements). Here is a graph from the paper presenting the effects of slow and fast thinking as a function of the type of sentence:

This study has some important implications. Thinking more quickly produces elevations of mood and self-perception that can smetimes be similar to those of very mild mania. I have seen this happen frequently when people have been up all night: the bright lights of morning and a few cups of coffee make them appear mildly manic. For a time they do in fact impress with their creativity and mastery not only of details, but of the “Big picture.” But as time goes on, much of their thinking turns out to be not altogether logical.

The study also raises the possibility that some manic symptoms may be produced by thinking. There is an old term from the psychoanalytic literature called "manic defense," in which people use manic-like symptoms to protect themselves - or more accurately their ego structures - when under stress.

I have spent most of my life with people who think very quickly and accurately. Most also express themselves very well: both succinctly and fluently. But all have also known the importance of stopping for a while after a brainstorming session, so that we can see if our ideas have really born fruit, or if they just seemed a good idea at the time.

There is no question that moving and speaking more quickly can elevate our mood. It is no surprise that it has little impact on self-esteem. It is becoming more and more clear that self-esteem follows from genuine achievement. Boosting artificially is difficult, with one exception: when people have every reason to have decent self-esteem, but instead they keep feeling bad, as if they have a kind of leaky bucket as my friend the psychiatrist Stephen Preas calls it.

I remember an experiment in which an investigator was experimenting with ether. During one of his sessions he had a deeply felt mystical experience in which he was sure that he suddenly understood the whole of nature and reality. He immediately wrote it down so that he could show the world The Secret.

When he came back down to earth, he looked at what he had written, “The world is like a fish...”

“The world that we have created is a product of our thinking. It cannot be changed without changing our thinking.”
--Albert Einstein (German-born American Physicist and, in 1921, Winner of the Nobel Prize in Physics, 1879-1955
)

“Some would sooner die than think. In fact, they often do.”
--Bertrand Russell (Welsh Mathematician, Philosopher, Pacifist and, in 1950, Winner of the  Nobel Prize in Literature, 1872-1970)

“Most people can't think, most of the remainder won't think, the small fraction who do think mostly can't do it very well. The extremely tiny fraction who think regularly, accurately, creatively, and without self-delusion. In the long run, these are the only people who count.”
--Robert Heinlein (American Writer, 1907-1988)

Rethinking Cancer

Over the last thirty years, there has been a gradual change in the way in which we conceptualize biological processes. Although the lion’s share of research is still dedicated to biochemical processes involving DNA, RNA and the cell membrane, other important concepts are being quite widely accepted. They include:

• Fetal imprinting
• Epigenetic control
• Self-organization
• Self-regulation
• Coherence over time
• Information exchange with the environment
• Symbiosis
• Morphogenesis

One way of thinking about this is to describe cells, organs and bodies as coherent information-rich processes. And when things go wrong, it is because these processes have gone awry. Information medicine is designed to bring the system back into coherence and harmony.

I have spoken before Integrated Medicine and in the next posting I am going to talk more about the difference between Integrated, integrative and integral medicine. But at this point suffice to say that Integrated Medicine is information medicine based on an understanding of these principles.

Several years ago I presented a paper at a closed meeting where I introduced the term “adult dysmorphogenesis,” to describe the way in which some disease processes – such as arteriosclerosis, arthritis and Alzheimer’s disease - could be better understood not as degenerative conditions, but as deranged information systems. These in turn disrupted the normal self-organizing principles of the body that lead it to constantly correct and repair itself. Part of my reasoning was that we were constantly seeing apparently irreversible conditions like broken down joints being repaired by information medicines like acupuncture and homeopathy.

With that background I was very interested to read an important paper in the journal Theoretical Biology and Medical Modelling.

The paper begins by highlighting three odd observations:

1. Throughout the animal kingdom cancer hardly ever occurs in tissues that have a strong ability to regenerate
2. In animals in which cancer occurs frequently, its incidence rises with age. If it occurs in a young animal it usually occurs in a tissue that has already been damaged
3. In animals that have a strong ability to regenerate and repair organs, these mechanisms remain fairly efficient throughout life. In animals with weak regenerative and repair mechanisms, they tend to become less efficient with age.

The authors propose that when an organ is damaged it receives a signal to start undertaking repairs. The cancer cell is the one cell in an organ that is able to respond to the signal telling it to start to proliferate. It is the one cell that is trying to restore function. So simply removing a cancer might not work if the organ remains damaged: new tumor cells would simply keep emerging.

This paper is a good complement to another in the same journal. This one is a bit more mathematical, but also views cancer as a dynamic systems problem.

Ideas like this have come and gone before, but I have not seen them so well presented before, and they open up some new ways of thinking about a set of problems that is altogether too common.

Moving away from thinking that cancers are all simply the result of mutated or messed up DNA toward the idea that they may owe just as much to the environment in which they grow makes very good sense.

Curing Chronic Pain: Its All Done with Mirrors

There is a fascinating new approach to treating chronic pain. 

The story goes back two years, to the publication of important research from a team at the Royal National Hospital for Rheumatic Diseases, in Bath in England. They wrote a paper in which they tried to link joint pain in neurological conditions. They wanted to see how the pain of rheumatoid arthritis, fibromyalgia and complex regional pain syndrome might relate to phantom limb pain (PLP) experienced by many amputees.

They suggested that in each condition there is reorganization in the sensory regions of the cerebral cortex. And it is this reorganization that generates pain and an altered body image. It seems to be just the same in rheumatology patients as has previously been hypothesized for amputees with PLP; that is a motor/sensory conflict. The body and the sense don’t match and it hurts. Their initial research indicated that something incredibly simple: using a mirror could help people correct of this conflict. They were able to show that a mismatch between motor output and sensory input creates sensory disturbances, including pain, in rheumatology patients and also in healthy volunteers.

In a second paper the investigators were able to show that doing a movement while looking at a distorting mirror could quickly induce uncomfortable symptoms in fit healthy people.

For over two decades, David Blake - the senior author of this research - has championed the idea that there is an important neurological component in inflammatory arthritis. It all started with a simple observation that has puzzled generations of clinicians: why is it that joint involvement in inflammatory arthritis is so often symmetrical? It isn’t surprising if both hips get arthritis: they will likely both have been subjected to a lot of wear and tear. But why should arthritis involve the second joint of the index finger in both hands? It has always looked as if this might imply some neurological contribution.

The idea is that although pain may have originated in inflamed joints, it is maintained and exacerbated by the nervous system. This fits with a fact that has been known to acupuncturists for centuries and has been replicated in pain clinics around the world. If you can interrupt what we call the pain cycle - constant chronic pain that feeds on itself and gets progressively worse – then you may often see pain relief for weeks or months, or sometimes even indefinitely. It is quite common for chronic pain to have had a clear physical precipitant, but to be maintained by key regions in the brain.

This new research strongly supports these observations, implies that the successful treatment of chronic rheumatological pain may involve a neurological approach, and offers a brand new therapeutic option.

“The speaker is only a mirror. Where you can see yourself. When you recognize yourself clearly, you can put aside the mirror.”--Jiddu Krishnamurti (Indian Spiritual Teacher, 1895-1986)

“Perception is but a mirror, not a fact. What I look on is my state of mind reflected outward.”--A Course in Miracles

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.)

Food, Reward and Weight Gain

There's a short review with a link to an online research paper that you might find interesting.

Although the paper has to do with the mechanisms of weight gain in people with schizophrenia, many of the same principles apply to many people with weight problems. The systems of the brain involved in salience - deciding what is important in the environment - appear to be disrupted.

Gene-Jack Wang at the Brookhaven National Laboratory has discovered that the brains of morbidly obese people seem constantly to be turned toward finding food: The regions of the brain connected to the mouth lips and tongue are overly active, and, like the addicts who get the biggest rush from drugs, they seem to have fewer dopamine receptors in the reward systems. Perhaps like the addict, the morbidly obese eat to compensate for an underactive dopamine system.

In Healing, Meaning and Purpose, we coined the term, “Salience Disruption Syndrome,” to describe a group of problems that are normally thought of as separate entities, but which are inextricably linked. They include not just over-eating, but:

• Impulse control disorders
• Substance abuse disorders
• Pathological gambling
• Pathological shopping
• Attention deficit with ot without hyperactivity
• Bipolar disorder

The list is a long one and the reason for highlighting it is that we have been able to devise new treatments based on this new principle of a disruption in salience. If there is interest, I shall post some more about the methods that we have devised.

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-_

People Dangerous to Your Health

I found a terrific blog with the title “Warning: Bores and buffoons may endanger your health.”

Our ability to self-regulate is a limited resource that fluctuates markedly, depending on our prior use of willpower, tiredness, stress and our personal resilience.

A new study by a team lead by Professor Eli Finkel of Northwestern University has shown that poor social coordination impairs self-regulation. What does this mean? If you are forced to work or interact with difficult individuals you may be left mentally exhausted and far less able to do anything useful for a significant period of time. In other words, draining social dynamics, in which an individual is trying so hard to regulate his or her behavior, can impair success on subsequent unrelated tasks.

In the research, volunteers were asked to work in pairs to maneuver an icon around a computer maze, with one volunteer giving the instructions, the other moving the joystick. Those operating the joysticks were actors, primed to respond to instructions in slow, stupid, inefficient and generally irritating ways. What was interesting was that the effects were not mediated through participants' conscious processes: they were almost entirely going on below the level of conscious awareness.

There is extensive literature on the consequences of social conflict. But until now, very little research has been conducted on the effects of ineffective social coordination. That has been a big gap in the research literature, particularly given the fact that most of the higher systems in our brains are dedicated to social functions, and since the earliest days of our hunter-gatherer ancestors, tasks requiring social coordination have been the norm. In our day-to-day activities we have to cooperate with other people. Ineffective social coordination consumes a great deal of mental resources and has high costs for subsequent self-regulation. This is so important, because self-regulation is essential to living life well. It is also essential to the existence of a well functioning society.

What to do with this new information?

Identify people who drain you. If you need to work with them, do it in short bursts, and give yourself plenty of time outs.

And continue to build your resilience.

There's also one other piece, that we'll look at another time. Some people may also drain your energy directly. You may have come across "energy" or "psychic vampires." They really do exist, though there is nothing supernatural about them, and they don't have fangs or an aversion to garlic. In another post I'll show you some techniques for dealing with those people as well.

The researchers have done us a great service by putting the entire paper on the departmental website. Access is free.