Tag Archives: Cognitive behavioral therapy

Sunday Reading: The New Science of Mind

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How much do you know about the brain? consisting of 100 billion neurons that each can connect to from 1000-10000 others, it hides the secrets of our being, and the path to enlightenment. The most fascinating feat of this grey-wrapped supercomputer, is how it can be influenced by the world around us. This means that we have a structured lied out for us, but its malleable and we can choose how we want the end-result, to look. It is something like having a template for a house. You know how it shall look (at least four walls, some windows and rooms) but you can choose the painting, the material and the size of the difference rooms. You can also decide what shall be inside it. The possibilities for ourselves does not become narrower the more we study the brain, be just learn how we can use the knowledge to our maximum. Interested ? If so, I recommend spending a couple of minutes on the following text from New York times:

 

 

The New Science of Mind

 

 

 

Recent newspaper articles have argued that psychiatry is a “semi-science” whose practitioners cannot base their treatment of mental disorders on the same empirical evidence as physicians who treat disorders of the body can. The problem for many people is that we cannot point to the underlying biological bases of most psychiatric disorders. In fact, we are nowhere near understanding them as well as we understand disorders of the liver or the heart.

But this is starting to change.

Biology of depression

Consider the biology of depression. We are beginning to discern the outlines of a complex neural circuit that becomes disordered in depressive illnesses. Helen Mayberg, at Emory University, and other scientists used brain-scanning techniques to identify several components of this circuit, two of which are particularly important.

One is Area 25 (the subcallosal cingulate region), which mediates our unconscious and motor responses to emotional stress; the other is the right anterior insula, a region where self-awareness and interpersonal experience come together.

These two regions connect to the hypothalamus, which plays a role in basic functions like sleep, appetite and libido, and to three other important regions of the brain: the amygdala, which evaluates emotional salience; the hippocampus, which is concerned with memory; and the prefrontal cortex, which is the seat of executive function and self-esteem. All of these regions can be disturbed in depressive illnesses.

In a recent study of people with depression, Professor Mayberg gave each person one of two types of treatment: cognitive behavioral therapy, a form of psychotherapy that trains people to view their feelings in more positive terms, or an antidepressant medication. She found that people who started with below-average baseline activity in the right anterior insula responded well to cognitive behavioral therapy, but not to the antidepressant. People with above-average activity responded to the antidepressant, but not to cognitive behavioral therapy. Thus, Professor Mayberg found that she could predict a depressed person’s response to specific treatments from the baseline activity in the right anterior insula.

What does this show us?

These results show us four very important things about the biology of mental disorders. First, the neural circuits disturbed by psychiatric disorders are likely to be very complex.

Second, we can identify specific, measurable markers of a mental disorder, and those biomarkers can predict the outcome of two different treatments: psychotherapy and medication.

Third, psychotherapy is a biological treatment, a brain therapy. It produces lasting, detectable physical changes in our brain, much as learning does.

And fourth, the effects of psychotherapy can be studied empirically. Aaron Beck, who pioneered the use of cognitive behavioral therapy, long insisted that psychotherapy has an empirical basis, that it is a science. Other forms of psychotherapy have been slower to move in this direction, in part because a number of psychotherapists believed that human behavior is too difficult to study in scientific terms.

Genetics and psychiatric disorders

ANY discussion of the biological basis of psychiatric disorders must include genetics. And, indeed, we are beginning to fit new pieces into the puzzle of how genetic mutations influence brain development.

Crocheted chromosome 7...my favorite chromosome and the first one I learned to identify!

Chromosone nr 7

Most mutations produce small differences in our genes, but scientists have recently discovered that some mutations give rise to structural differences in our chromosomes. Such differences are known as copy number variations.

People with copy number variations may be missing a small piece of DNA from a chromosome, or they may have an extra piece of that DNA.

Matthew State, at the University of California, San Francisco, has discovered a remarkable copy number variation involving chromosome 7. An extra copy of a particular segment of this chromosome greatly increases the risk of autism, which is characterized by social isolation. Yet the loss of that same segment results in Williams syndrome, a disorder characterized by intense sociability.

 

This single segment of chromosome 7 contains about 25 of the 21,000 or so genes in our genome, yet an extra copy or a missing copy has profound, and radically different, effects on social behavior.

The second finding is de novo point mutations, which arise spontaneously in the sperm of adult men. Sperm divide every 15 days. This continuous division and copying of DNA leads to errors, and the rate of error increases significantly with age: a 20-year-old will have an average of 25 de novo point mutations in his sperm, whereas a 40-year-old will have 65. These mutations are one reason older fathers are more likely to have children with autism and schizophrenia.

Our understanding of the biology of mental disorders has been slow in coming, but recent advances like these have shown us that mental disorders are biological in nature, that people are not responsible for having schizophrenia or depression, and that individual biology and genetics make significant contributions.

The result of such work is a new, unified science of mind that uses the combined power of cognitive psychology and neuroscience to examine the great remaining mysteries of mind: how we think, feel and experience ourselves as conscious human beings.

Mind and matter work together

This new science of mind is based on the principle that our mind and our brain are inseparable. The brain is a complex biological organ possessing immense computational capability: it constructs our sensory experience, regulates our thoughts and emotions, and controls our actions. It is responsible not only for relatively simple motor behaviors like running and eating, but also for complex acts that we consider quintessentially human, like thinking, speaking and creating works of art. Looked at from this perspective, our mind is a set of operations carried out by our brain. The same principle of unity applies to mental disorders.

In years to come, this increased understanding of the physical workings of our brain will provide us with important insight into brain disorders, whether psychiatric or neurological. But if we persevere, it will do even more: it will give us new insights into who we are as human beings.

 

 

Eric R. Kandel, a professor at the Mortimer B. Zuckerman Mind Brain Behavior Institute at Columbia, a senior investigator at the Howard Hughes Medical Institute and a recipient of the 2000 Nobel Prize in Physiology or Medicine, is the author of “The Age of Insight: The Quest to Understand the Unconscious in Art, Mind and Brain, From Vienna 1900 to the Present.”

 

 

Just A Spoonful of Stress Hurts the Medicine

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Spoonful

Spoonful

A brand new study has been completed by a team of neuro-scientists at New York University with findings that point to the limits clinical techniques have over helping people manage their emotions even under the influence of mild stress. The study’s findings appear in the journal Proceedings of the National Academy of Sciences document how even mild stress can undermine therapies designed to keep emotions in check.

“In other words, what you learn in the clinic may not be as relevant in the real world when you’re stressed,” says Elizabeth Phelps, the study’s senior author and a professor in NYU’s Department of Psychology and Center for Neural Science.

The study’s main intent was to determine whether cognitive restructuring techniques, such as encouraging patients to change their thinking or approach toward a situation in order to change their emotional response, would hold up in the real world where everyday stress occurs.

If you would like to know particular details of the study, please write me personally and I will gladly provide you with them, but the main points are that the study was designed as a two-day experiment in which participants were taught cognitive strategies, collectively titled cognitive-behavioral therapy to use to decrease conditioned fear. They were exposed to the fear conditioning on the first day. They were also taught strategies for combating the fear that was produced on that first day.

On day two they were put in a situation where they were expected to rely on the fear-combatting-strategies in the ‘real world situation” they were placed in, AFTER having been exposed to a mild level of stress.

The participants in the ‘stress group’ were not able to reproduce or use the techniques to combat fear they had been taught the previous day. The ‘control group’ the participants who were not subjected to a mild level of stress, on the other hand, employed the techniques they were taught.

Brain

Brain

The study linked to findings that show cognitive techniques used to control fear rely on regions of the pre-frontal cortex that have been proven to be functionally impaired by mild stress. This is what the study’s authors believe is the cause of the inability to learn to employ the fear decreasing techniques. But do not lose hope, because with practice or after longer intervals of cognitive training, the strategies may become more habitual and less sensitive to the effects of stress, according to the authors.

I am rephrasing here, but it seems that for some people, it will most likely never be a rational, natural type of reaction to fear and anxiety. These people will have to work harder and longer to turn these methods into habits in order for them to be effective for them. But, it can be done and the more studies that are funded to research emotion study, the more readily methods will be found to work with a variety of people in more individual and accurate ways that work best for them.

ABOUT THE AUTHOR:
Judy is a licensed clinical social worker and has worked extensively as a counselor with children, adolescents, couples and families. Judy’s professional experience in the mental health field along with her love of writing, provide insight into real-life experiences and relationships. Her fresh voice and down-to-earth approach to living a happier, more meaningful life are easy to understand and just as easy to start implementing right away for positive results!

Bird’s Eye View-Eliminate Energy Thefts!

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first posted on my blog: https://marinazet.wordpress.com/     Thank you Free Psychology-I’m happy to share my ideas!

It’s it the nature of humans: we try to analyze and interpret certain situations and behaviors of other people we interact with every day. This makes perfect sense and is important in order to get an orientation in the world/ system we live in. Besides, our brain loves order and rationality.

Unfortunately, our brain also tends to overinterpret things a lot as we are not purely rational species but are also driven by our emotions and feelings. One of our strongest feelings, for exampel, is anxiety-if we fear losing something, we act more emotionally than rationally. We can easily misinterpret situations in such a state of mind and overlook important aspects. A good example are relationships. Men and women often get stuck in what I call a “toxic relationship”-both are not satisfied with the other partner any longer, even after long discussions (let it be because of a shift of needs or change of personality traits) but decide to stay together and accept the discontentment because of the fear of being alone. The emotion of anxiety hinders our brain to think rationally and assess the situation and possible outcomes of our actions in a realistic way.

Another good example is an unsatisfying job. A completely rational person would see that their Your Fear is 100% dependent on you for its survival | Anonymous ART of Revolutioncurrent job is strictly monotonic, isn’t fulfilling and/or is very stressful and steals valuable time of their life. A completely rational person would not only realize that but also take actions in order to change the situation instead of staying in the same miserbale position for years and years. A person on the other hand who is driven by fear, would stay in that position-probably for the rest of their working life out of pure fear to get unemployed for a longer period of time and lose all their savings. If you fear, you get stuck!

Another fact is that most people have horror scenarios in their head and hate risk. We tend to create worst case scenarios when we encounter risk and change instead of seing the possibilities. That’s because people would rather eliminate the risk of loss rather than keeping the possibility of gain.
Having said this, I belive I found a technique for myself which can be helpful for others, too to overcome the risk of misinterpretation and bad decisions stemming from negative emotions.

I called it the Bird’s Eye View. When you see the whole situation and take a step back from the problem, you see more than when you look very close at it.

1. Ask yourself the question: is this problem relevant right now, is it relevant in a month, a year? If it’s only a short-term problem it doesnt deserve tremendous, time-consuming long-term planning before making a decision.

2. Are you in charge of the problem- can you influence it? Many times we spend hours and hours lamenting about things we can’t change-the weather, our tax bill, the success of our .favorite football team…nevertheless, it doesn’t stop us to wrap our head around it a hundert times. Is it worth your energy? As a business graduate, I would say the alternative costs are simply too high to complain about things you can’t change. Realize and let go ot these energy thefts – knowing that these things aren’t wasting your time and energy is very fulfilling.

3. Be aware of the costs, possibilities and risks! Know the emotions which are involved! When you know which emotions are involved in certain situations you can assess them and see problems from a more realistic way without the cloudy fog of confusing emotions in it. If you know that fear is the prevailing emotion, you can ask yourself-what is the real cost and risk if I initiate the change anyways? What is the wors-case scenario and is it really unchangeable afterwards? Breaking risk down to worse-case scenarios and contrast them with opportunities, often reveal that the main reason for our fear are not the possible bad outcomes but simply the fear of change.

Anticipated fear is oftentimes worse than the manifestation of that fear.

The best treatment

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Biomarker Could Point the Way Past Trial-and-error Inefficiencies – NIH-funded Study

Press Release • June 12, 2013

 

Pre-treatment scans of brain activity predicted whether depressed patients would best achieve remission with an antidepressant medication or psychotherapy, in a study funded by the National Institutes of Health.

“Our goal is to develop reliable biomarkers that match an individual patient to the treatment option most likely to be successful, while also avoiding those that will be ineffective,” explained Helen Mayberg, M.D., of Emory University, Atlanta, a grantee of the NIH’s National Institute of Mental Health.

Mayberg and colleagues report on their findings in JAMA Psychiatry, June 12, 2013.

“For the treatment of mental disorders, brain imaging remains primarily a research tool, yet these results demonstrate how it may be on the cusp of aiding in clinical decision-making,” said NIMH Director Thomas R. Insel, M.D.

Currently, determining whether a particular patient with depressionwould best respond to psychotherapy or medication is based on trial and error. In the absence of any objective guidance that could predict improvement, clinicians typically try a treatment that they, or the patient, prefer for a month or two to see if it works. Consequently, only about 40 percent of patients achieve remission following initial treatment. This is costly in terms of human suffering as well as health care spending.

Mayberg’s team hoped to identify a biomarker that could predict which type of treatment a patient would benefit from based on the state of his or her brain. Using a positron emission tomography (PET) scanner, they imaged pre-treatment resting brain activity in 63 depressed patients. PET pinpoints what parts of the brain are active at any given moment by tracing the destinations of a radioactively-tagged form of glucose, the sugar that fuels its metabolism.

They compared brain circuit activity of patients who achieved remission following treatment with those who did not improve.

Activity in one specific brain area emerged as a pivotal predictor of outcomes from two standard forms of depression treatment:cognitive behavior therapy (CBT) or escitalopram, a serotonin specific reuptake inhibitor (SSRI) antidepressant. If a patient’s pre-treatment resting brain activity was low in the front part of an area called the insula, on the right side of the brain, it signaled a significantly higher likelihood of remission with CBT and a poor response to escitalopram. Conversely, hyperactivity in the insula predicted remission with escitalopram and a poor response to CBT.

Among several sites of brain activity related to outcome, activity in the anterior insula best predicted response and non-response to both treatments. The anterior insula is known to be important in regulating emotional states, self-awareness, decision-making and other thinking tasks. Changes in insula activity have been observed in studies of various depression treatments, including medication, mindfulness training, vagal nerve stimulation and deep brain stimulation.

“If these findings are confirmed in follow-up replication studies, scans of anterior insula activity could become clinically useful to guide more effective initial treatment decisions, offering a first step towards personalized medicine measures in the treatment of major depression” said Mayberg.

Right anterior insula

If a patient’s pre-treatment resting brain activity was low in the front part of the insula, on the right side of the brain (red area where green lines converge), it signaled a significantly higher likelihood of remission with CBT and a poor response to escitalopram. Conversely, hyperactivity in the insula predicted remission with escitalopram and a poor response to CBT. Picture shows PET data superimposed on anatomic MRI scan data.

Source: Helen Mayberg, M.D., Emory University

Insula activity graph

Brain PET scans prior to treatment predicted whether a patient’s depression would best respond to an antidepressant or a psychotherapy. Higher resting activity in the right front insula identified cognitive behavior therapy non-responders (CBT NR) and patients who achieved remission with escitalopram (sCIT REM). Conversely, lower activity in that brain area signaled remission with cognitive behavior therapy (CBT REM) and a poor response to escitalopram (sCIT NR). Each circle or square represents a patient in the study. Most patients in each group clustered either above or below the dotted line demarcating high and low activity, indicating that the insula may hold promise as a biomarker of brain states associated with differential response to these treatments.

Source: Helen Mayberg, M.D., Emory University

Reference

Toward a neuroimaging treatment selection biomarker for major depressive disorder. JAMA Psychiatry. McGrath CL, Kelley MD, Holzheimer III PE, Dunlop BW, Craighead WE, Franco AR, Craddock RC, Mayberg HS. June 12, 2013, JAMA Psychiatry

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