Showing posts with label research. Show all posts
Showing posts with label research. Show all posts

Questions Work Magic: How They Change the Brain

Quick - What does a lemon taste like?

I know what a lemon tastes like. Tell me something else instead:

What just happened inside your mouth?

David Hoffeld asks another one: Want to know what your brain does when it hears a question?

His article from the website FastCompany.com explores the neurological consequences of hearing a question. Questions temporarily hijack the brain. Did you immediately think about lemons? First, serotonin is released, causing the brain to relax. Next you get a hit of dopamine. The question takes over your thought processes while you think about the answer. The technical term is instinctive elaboration.

The hijacking doesn't last forever. The person who was asked the question can choose to ignore it, can argue against it, can go off on a tangent - though for people with ADHD or bipolar disorder, a question that interrupts our train of thought may cause us to derail.

But Hoffeld cites a number of research studies that document when you ask somebody whether they are going to do something, you increase the probability that they will do it - buy a car, vote in an upcoming election, even donate blood.

Questions not only alter your perception. They can even alter your chemistry. Chances are, when you read the lemon question, you started to salivate.

Why Writing Bar Tales of Costa Rica is Good for my Mental Health

Mindfulness


Mayo Clinic describes mindfulness as a type of meditation in which you focus on being intensely aware of what you are sensing and feeling in the moment, without interpretation or judgment. Practicing mindfulness involves breathing methods, guided imagery, and other practices to relax the body and mind and help reduce stress.

For some of us, these meditation exercises, "close your eyes, focus on your breath..." are difficult, frustrating, and stress inducing. Particularly for people with a trauma history or ADHD, mindfulness can be a land mine.

For others, the whole enterprise sounds like woo-woo mental health. Add some essential oils and affirmations - who needs therapy or, God forbid, medication?

But there's more to mindfulness than nonsense.

The same Mayo Clinic article identifies several mindfulness practices. Three could be taken as basic concepts:

  • Pay attention
  • Live in the moment
  • Accept yourself

How does that work out irl - in real life?

Let me tell you about my recent five week stay in Costa Rica. First, the back story:


Prozac Monologues

My first book, Prozac Monologues, began with a hypomanic episode during an earlier trip to Costa Rica. I wrote a series of comedic monologues in an effort to not be mindful. The monologues danced around the memory of a recent Prozac-induced traumatic experience. It began with a bizarre thought, and moved on to some other weird stuff: dissociation, thought broadcasting, paranoia, and the like. 

Years later, once I was correctly diagnosed with bipolar disorder, I added edgy essays about that experience and everything I learned about bipolar disorder while trying to figure out what the hell happened to my brain. Like many memoirs, Prozac Monologues is a hybrid of my story and my issue. Sheila Hamilton's podcast, Beyond Well, captures it. Here's the linkIt's also a great read and now available on audio.

Bar Tales of Costa Rica

So what about Bar Tales of Costa Rica? My second book is exactly what the title promises: the stories I heard while sitting in bars in Costa Rica. That sounds like a very different book. Am I a genre hopper?

Yes and no.

via GIPHY


Bar Tales is about a milieu, a place and the people in it. It is not about mental illness. There are passing references to my own. But that's not the point. No references to research. No descriptions of recovery strategies. Stories heard in bars - it's a very different book.

Still, it is a sequel. It picks up where the monologues left off. In the first book, my wife Helen and I thought about moving to Costa Rica. Several months later, we did buy a little house in Playas del Coco. Didn't quite move there, but we spend several weeks there every year.


That's where I continued to work on Prozac Monologues. It's also where I gathered my bar tales, most of them at my sister's hotel and restaurant, the Pato Loco, which means "crazy duck." Other sites included El Bohío (referenced in the first book), Pacifico Beach Club, Coco Palms, and Soda Navidad.

You could call the second book a segue to the first. I turn a corner. That would be a right turn that leads me out of my neighborhood Los Canales, on to the Boulevard de Iguanas, and over to a whole new cast of characters: Patricia, Bruce, Andy, Sydney, Monique and André. Bar Tales is about their stories.



So why is this book good for my mental health?

As I am polishing these tales for publication in the spring of 2024, I spent several weeks in Coco for research. Research.

I wasn't sitting in bars, gathering tales - though inevitably a couple got added to the collection. This time I was gathering sensations. Physical sensations.

Trauma and Sensations

Sensations - these are at the heart of my mindfulness technique.

  • The person who has experienced trauma sometimes gets stuck in the past, reliving a loop of troublesome sensations. And let me tell you - being suicidal, as I was, is traumatic.
  • Or, in the face of current strife and stress, that person might dissociate - disconnect from present anxiety by going numb.
  • Or, based on deeply rooted thought patterns about bad things that happened in the past, the person faces the future with dread, anticipating - and pre-experiencing - a repeat of negative experiences.

Each of these are ways that we lose or escape the here and now. I think of here and now as my worst subject.

The thing is - here and now is where joy lives.

Let me repeat that.

Here and now is where joy lives.

So my research, gathering sensations, experiences in the present, kept me anchored in here and now.

And it filled me with joy.

What color are the rooster's feathers? - bronze head and breast, black legs, wings of teal and red.

What sound do the geckos make? - chk, chk, chk. How about the howler monkey? muffler dragging on concrete!

What do mangoes smell like when they are sitting in the field near my house in the hot sun? - like a fortified sweet wine.

What does carne en salsa taste like? Beef stewed in a rich vegetable sauce with hints of smoke when Juan cooks it all day in an iron pot over a wood fire under the mango tree.

What does it feel like to walk in the surf? Caressing waves, then grit in my sandals.

I walked around town with my phone in my hand, making voice memos, describing these sights, sounds, smells, tastes, and sensations. My mind fixed on the present, there was no room there for regrets about the past or anxiety about the future.

Health Benefits of Mindfulness

Mindful meditation has been demonstrated to reduce anxiety, depression, stress, pain, insomnia, and high blood pressure.

There are many ways to do mindfulness. A review of literature published in Clinical Psychology Review, Effects of Mindfulness on Psychological Health, summarizes the context of mindfulness practice in its Eastern and Western versions and its application in a variety of psychological treatments.

What I offer here is one simplified self-help practice for addressing panic and anxiety, a disciplined version of what I called my research:

Focus on your environment.

  • Name five things that you see right now
  • Name four sounds that you hear
  • Name three things that you feel
  • Name two things that you smell
  • Name one thing that you taste
Yeah, don't get hung up on remembering whether it's three feelings or three smells. I don't remember the order of the sensations and made it up.

The point is to redirect the catastrophizing brain, to pull it into the here and now. Remember - here and now is where joy lives.

This practice isn't the cure all to my mental health issues. And I doubt it will cure yours. But it gives our poor brains, exhausted by the three alarm fires that usually occupy them, a break. It turns down the temperature and lets a different input in.

And that's a good thing.

There's That Squirrel Again! How Do I Know if I Have ADHD?

There is a reason why I haven't posted in months. My latest diagnosis -- ADHD -- Attention Deficit Hyperactivity Syndrome -- the adult version.

I have a fistful of posts in my draft file that were never finished before they seemed beside the point. That is not an unusual state for me. Many years ago my brilliant brain was unable to write the doctoral thesis for which I had already conducted extensive field research and had a thorough outline. Periodically I would write whole chapters in my head. But when the laptop was in front of me...

via GIPHY

I was stuck.

We'll see how this post goes.

Diagnosis

Wait a minute. Don't I have bipolar disorder? Where did this new diagnosis come from? What are the chances a person could have both?

Beyond the DSM: Three Ways to Manage Other Issues of Bipolar Disorder

Medication is approved for a mental illness if it reduces symptoms, the symptoms listed in the Diagnostic and Statistical Manual (DSM).

Did you know that there is more to bipolar disorder than: 

an episode of depression 

elevated or irritated mood, inflated self-esteem, decreased need for sleep, pressure to keep talking, flight of ideas, distractibility, increase in goal-directed activity, psychomotor agitation, and excessive involvement in pleasurable or risky activities?

These are merely the outward and visible signs of what is happening inside the brain. These are how the doctor can tell that you have bipolar disorder.

But even after you suppress these symptoms, you still have a variety of neurological dysfunctions that affect your thinking, your energy metabolism, and your health.

Psych meds do not address all these other issues. They are a piece of treatment, an important piece. But suppressing symptoms, while it relieves the anxieties of those around you, does not fix your life.

Does Music Therapy Help People with Bipolar Disorder? Maybe Not

Non-pharmaceutical approaches to mental illnesses are great. I mean, who wouldn't like to pop a pill without the side effects?

I eagerly clicked on the link: Music therapy for bipolar disorder: Can it help? from the newsletter, Medical News Today, hoping to find the playlist that would soothe the savage beast. The article reported on two studies, both pretty small, N<30. I guess music therapy doesn't attract the big bucks in research land. Spoiler alert: I did not find the magic playlist.

The first study compared people with bipolar in a euthymic state (stable, not depressed, not manic) with healthy controls. They listened to music that typically produces wonder and joy. The healthy controls felt wonder and joy. The bipolar participants felt... tense. The researchers surmised that the negative emotions in bipolar participants has to do with difficulties in emotional regulation, part of the executive dysfunction.

The music disrupted an equilibrium, perhaps, which healthy controls found exhilarating, but bipolar people found simply disruptive? -- That's my conjecture.

Ritual, Stress, and Surviving a Pandemic Thanksgiving

Human beings are pattern-seeking creatures. Place us in an absurd situation, we feel stress. We respond by ritual behavior, or clinging to biases, or even inventing an explanation. Does this sound like anything happening around you for the last several months?

Some of these responses serve us better than others. Biases preserve energy by saving us the time it takes to make case by case evaluations. But they also can be mistaken and rob us of original insights.

Invented explanations are how we manage the terror of acknowledging any bad thing that is out of our understanding or control. Why did Daddy hit me--again? Who is to blame for all these fires lately? How could my candidate have lost? We tell ourselves a story that makes sense of the event, relieving the pain of uncertainty, and thus gaining control over our emotions.

Diagnosing Bipolar - Doing Better to Prevent Suicide

How can I be a better psychiatrist for you?

Frankly, I was gobsmacked by that question. It came in response to reading my book, Prozac Monologues: A View from the Edge. The book is a comedic memoir of misdiagnosis and a self-help book for bipolar. It is both uproariously funny and brutally frank about my suicidal episodes, usually at the same time.

There are two directions to go with that question. This particular psychiatrist cares about both.

What kind of behaviors and qualities could he display that would make the relationship more helpful? Honestly, not all psychiatrists are interested in this question. I don't do relationships; I use psychopharmacology to treat psychiatric disorders, a psychiatrist once told me. Well, that had the benefit of clarifying things.

How can I improve my diagnostic skills? Nevertheless just about any psychiatrist wants to get the answer to the puzzle right, even the ones who treat patients as no more than a puzzle.

Major Depression and World Bipolar Day

Your diagnosis is major depression. So what does World Bipolar Day have to do with you?

I mean, what a relief to just have major depression, right? Isn't bipolar another level of crazy? Well. . .

First, a reality check. Whatever level of crazy you are now, you can call it whatever you want, your mental health struggles will not get worse if your diagnosis changes. Actually, you might get better. I'll get back to that.

Neuroscientifically Challenged - Check it out

Yay! When I found a new (to me) website, Neuroscientifically Challenged, I rewrote the resource section of the book. Given that Prozac Monologues is in proofreading stage, my project manager was not as pleased as I was. But it's now a better book.

Mark Dingman started blogging in 2008 as a way to explore his interest in neuroscience. That interest morphed into a PhD program, then a new career, and now his continued work on a website where he can learn, draw, teach, and talk about his favorite topic, the brain. Take my eclectic blog, focus on the brain part, turn it into a genuine resource, call it Neuroscientifically Challenged.

The website features two-minute videos each with a bite of information. Okay, Dingman has to talk kind of fast to get it done in two-minutes, but really, what do you want? Here is a sample:

New Year's Resolution - Eat Chocolate! Or Maybe Not...

Long time readers may know of my over-a-decade-long effort to get the sugar monkey off my back. I can report that I am reasonably  successful. I don't know if it has made an ongoing difference to my mood. But a shared dessert at a restaurant will get my arthritic shoulder burning. So I keep it up.

Or maybe I have taken it too far. It's all about costs and benefits, you know. And recent research suggests maybe I should lighten up, or rather, darken up.

Chris Aiken of Bipolar Not So Much fame, also Wake Forest University School of Medicine and The Carlat Psychiatry Report, says to my sugar fast, Not so fast. At least as far as dark chocolate goes.

People With Schizophrenia Who Recover

Among the top five factors that limit recovery for people with mental illness:

The false belief that it's all about the medication.

Medication indeed is part of mental illness recovery. It's a bigger part for some mental health issues (like schizophrenia) than others. And its effectiveness varies from drug class to drug class.

I created a bit of a twitter storm when somebody tweeted: Please quote this tweet with a thing that everyone in your field knows and nobody in your industry talks about because it would lead to general chaos.

To which I responded: Antipsychotics cause loss of brain matter.

 Last week's post described the research study that demonstrated that claim. The study was led by Nancy C. Andreasen, MD of the University of Iowa Carver College of Medicine. One should not reject antipsychotics on the basis of the study. They do what they are supposed to do. They reduce the positive symptoms (like, psychosis) that cause so much suffering. Payoffs and price tags. But they don't do the whole healing.

I continue this week with a broader picture, the what else of recovery in schizophrenia. This post was first published in 2013 with the title:

Fabulous People with Schizophrenia

The Brain Science of Caffeine

It's Pumpkin Spice Latte Season -- what better time to pour a cup of Caffeine: Neurological and Psychiatric Implications? It's the next up in my PsychiatricTimes.com Appreciation Month.

Sergi Ferré, MD, PhD offers this continuing education course for doctors and other health care providers. The goal of this activity is to provide an understanding of the mechanisms involved in the innervating effects of caffeine and the impact that caffeine may have on psychiatric disorders.

So settle in to learn about your favorite beverage.

Disclaimer: Though I have read the thing many times and looked up many big words, I cannot honestly say that I have satisfied all of the learning goals. Specifically, I cannot:
  • Explain the adenosine-dependent modulation of striatal dopamine and glutamate neurotransmission
nor
  • Describe the adenosine-dependent modulation of glutamate neurotransmission in the amygdala.
Good thing I don't need the grade.

Nevertheless, I gleaned a few fun facts which I will share with you.

Caffeine is the most commonly consumed psychotropic drug in the world, used primarily for its psychostimulant properties on the central nervous system. Yes, I think we already knew that, but it's nice to begin with a softball.

Describing Negative Emotions and Depression


Negative emotion differentiation (NED) refers to the ability to identify and label discrete negative emotions.

Are you the mom who says to your tantruming toddler, Use your words? That's good parenting in so many ways. Well actually, I found it quicker to turn the critter over and hold him up by his ankles, so he could ponder his universe from a different perspective. You could call that reframing. But that technique is more difficult to execute on a teenager.

Here is the latest reason why Use your words is good for your kid: the folk who get paid to come up with new things to research have discovered a relationship between teenagers and words. The more words they have to describe precisely their negative emotions, the less risk they have to develop depression in the face of high stress. And conversely:

Results suggest that low NED is primarily depressogenic in the context of high stress exposure.

That's from "The perils of murky emotions: Emotion differentiation moderates the prospective relationship between naturalistic stress exposure and adolescent depression,"  by Star, Hershenberg, Shaw, Li, and Santee.

That's what I'm here for. I find cool stuff in the scientific research world and translate it into English for you, dear reader. The more words you have for negative emotions = the less depression you get when stressed.

I'm all over this. I use words like my sister uses broken bits of tile, to turn loss into beauty. There's a bit of Mama's good china that hit the floor in this photo of the tabletop coming together in my sister's workshop:


So one of the things that pleases me about this research study is that I have discovered a new word, depressogenic: causing or tending to cause depression.

Google doesn't recognize euthymigenic. I made it up: creating or sustaining a normal, tranquil mental state or mood. In a sentence: Turning the broken bits of our lives, turning our losses into beauty is euthymigenic. My sister does this with tile. I do it with words. 

Here's an excerpt from Prozac Monologues: What If It's More Than Depression?

The DSM has its checklists. People with depression have poetry. 

People with diabetes discuss about their diet, their feet, their retinas. They check glucose levels. Put two diabetics at a table, they compare numbers.

People with depression talk in metaphor. We talk about the cloud, the curtain, the weight, the darkness. When it goes away, we say, “It lifted!” That lift is a physical sensation, actually, of lightness or elevation...

If I could just find the right words, maybe I could break the spell...

See, I always knew that increasing my vocabulary would help me. Turns out increasing my kid's will help him, too.

cartoon from memedroid.com
photos from the Pato Loco, Coco, Costa Rica by the author

Bipolar and Cortisol

Y'all know about Bipolar as the mood disorder of Up and Down.  You have seen the movies, watched the soap operas and dramas.  The medications promise to reduce the number of trips around the loop de loop.

That's important, because what goes up must come down, and the fall can be mighty.  But there is more to is that that.

In a person with bipolar, a whole series of mis-timings and misalignments in our internal and external cycles results in a failure to maintain balance.  The list includes: dysregulation of hormones, neurotransmitters, and immune system; irregularities in communication between brain cells and within brain cells; and wonky wiring among the networks that connect the thinking, feeling, and evaluating parts of the brain.

In other words,


Over the next few weeks, I will sample this list, especially the items that are true all the time, even when not on that roller coaster.

Dysregulation of cortisol is one of my favorites, to use the term loosely.  Cortisol is the get-up-and-go hormone.  It gets you out of bed in the morning and manages energy throughout the day in response to stress.

Antidepressants and Suicide: Defending Prozac

It amazes me how many research scientists seem to have flunked statistics.  Or ought to have.  Me, I majored in the liberal arts.  But at Reed, even those who took Science for Poets would be required to rewrite some of the scientific papers I have read on the subject of antidepressants.

So the vocabulary terms for the week are observer bias and confounding variables.  No worries -- lots of pictures.

Clinical Experience in Defense of Prozac

Let's say you are a doctor treating 100 patients with severe depression.  You give them all antidepressants.  It seems irresponsible not to, doesn't it.  Thirty of them get better.  Fifteen do not make a follow-up appointment.  You switch the fifty-five who are still trying to another antidepressant.  Another fifteen get better.  And another fifteen do not make a follow-up appointment.

Over the course of a year, you get up to fifty whose depression is remission and ten who are still struggling.  You don't know what happened with the forty who are no longer seeing you. They couldn't afford treatment; they didn't like your face; they couldn't find parking; they got worse on your medication. You have no idea.  But you have fifty patients who think you saved their lives.  You feel pretty good about yourself, don't you.

Hearts Beat As One

It is common knowledge that we can slow our heart rate by slowing our breathing. Breathe is arguably the most important tool in the whole recovery toolbox for relieving stress and staying in the here and now. The folks in Sweden have taken this data a step further, into building community for common action.

Having taken a leave of absence just as DSM-5 was published, I have a backlog of posts on diagnosis to write. But let's break it up, shall we? This one gets filed under both recovery and political action.

It would take researchers from outside of the United States to think of examining the physiology of a group activity. Swedes, with their solid background in hymn singing, did just that, using group singing as a stand-in for group action.

Introducing Allen Frances

Allen Frances was the editor of the DSM-IV, first published in 1990.  He is now the fiercest critic of its next major revision, the DSM-5.  For over three years, he has been blogging weekly to this end at Psychology Today.  This week I will summarize his steady drumbeat.  I hope soon to publish an open letter to him.

Frances' complaint in a nutshell is that the DSM-5 creates fad diagnoses and changes criteria of older diagnoses to medicalize a whole range of normal behavior and miseries.  The link lists these problem diagnoses and a number of the following points, in an article published all over town last December.

These issues have been discussed widely, in public and private circles.  I am not qualified to address each point, though I did give a series over to one of them, the bereavement exclusion.  The best of the batch, if I do say so myself, is Grief/Depression III - Telling the Difference, which got quoted in correspondence among the big boys.

Thomas Insel - Toward a New Understanding of Mental Illness




Cutting this guy's budget is like telling Orville and Wilbur Wright to take the month off.

Why the Poor Give More

The article that inspired this post is titled Why the Rich Don't Give to Charity.  But I figure, language has power, and why reinforce behavior that I would rather see changed?

Before you go off in a huff, let me tip my hand -- I acknowledge and will discuss both the exceptions and free will.

The short answer to any of these questions, why the poor give more, why the rich don't give, and why some rich do is -- mirror neurons.  Three weeks ago I reported on these in Mirror Neurons - They Change Everything, along with a youtube featuring V.S. Ramachandran.  Here is the promised expansion on the theme.

Statistics on Giving

Ken Stern reports in The Atlantic Magazine that the top 20% of Americans donate 1.3% of their income.  The bottom 20% donate 3.2%.  He asks, What's up with that?

Paul Piff - Higher Social Class Predicts Increased Unethical Behavior

Guns and Death, Death and Guns

I have a friend, a young mother of two toddlers, whose New Years resolution is to get her license to carry.  This series is for her.  Live long and prosper, dear one!

My Next Series -- Facts About Firearms

I have a plan.  No, not that kind of plan.  Well, yes, I do.  But that is not the plan I mean right now.  I plan to do a series about firearms.  It is my intent to provide facts, just facts.  There are a lot of facts out there about firearms.  A lot of nonsense is disguised as facts.  But genuine facts are available, and more useful than our impressions for making sound decisions.

I am not going to write about my opinions about firearms, because, well really, who cares about my opinions.

Keeping Track of How People Die

Firearms are a cause of death, which means that the US Centers for Disease Control keeps track of them.  Wait, wait -- it doesn't keep track of the firearms, just the deaths.

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