Saturday, 30 May 2015

Are you anxious to make a decision?

How many of us can genuinely say we find decision-making easy? Sure, when the question is tea or coffee, spots or stripes, wine or mineral water, it's no big deal. But what about when the stakes are higher, like 'should I take that job that pays less but is less stressful' or 'should we leave our friends and move to a new area for a better quality of life'?

MIT researchers have identified a neural circuit that seems to underlie decision-making in situations which combine this positive-negative element, otherwise known as approach-avoidance conflict.

Striosomes are clusters of cells found in the striatum of the brain, a region thought to be involved with anxiety. The researchers tested the hypothesis that these cells are also involved with approach-avoidance decision-making by studying mice.

The mice were placed in a maze and compelled to choose between either strong chocolate and bright light or weaker chocolate and dimmer light. Mice like chocolate and do not like bright light (not so silly) and so the first option was deemed to be 'high cost, high reward' and the second 'low cost, low reward'. Using a technique called optogenetics the researchers were also able to turn cortical input to striosomes on or off.

When the striosome circuit was switched off, the mice began choosing the 'high cost, high reward' option as much as 20% more often than when it was switched on. This suggests that the striosomes may be acting as gatekeepers that limit anxiety, thereby helping in the formation of a decision.

It is hoped that these findings will ultimately help researchers identify new ways to treat psychiatric disorders that often feature anxiety and impaired decision making, such as schizophrenia, depression and bipolar disorder. Commenting on this, Ann Graybiel, an MIT Institute Professor and the paper's senior author said:
"We would so like to find a way to use these findings to relieve anxiety disorder and other disorders in which mood and emotion are affected. That kind of work is a real priority."
I would like them to find a way, too. If diminishing the anxiety associated with decision-making is just a matter of tinkering with my striosomes, then bring it on - it would undoubtedly save me years of procrastination. But perhaps the picture is not quite so simple.

Some would say that decision-making is not an easy thing to do, especially when the stakes are high. Effective decision-making arguably demands a sophisticated interplay between memory, will and intellect, coupled with the ability to 'hold' potent feelings of anxiety, so that conflicting realities may be adequately processed.

This work may be helpful in identifying part of the mechanism involved with decision-making, but meanwhile, I'm going to work on developing my emotional maturity and see how that goes. This seems to me the obvious challenge in 'high cost, high reward' decision-making scenarios. What do you think?

Written by Jacqui Hogan

Friday, 22 May 2015

How much do you love me?

Do you have a penchant for a certain brand of perfume or aftershave? Would you camp out overnight to lay your hands on the latest piece of Apple kit?

One group of researchers has set out to discover whether people feel the same kind of love for brands as they do for people, in a study which says as much about the times we live in, as about the nature of love.

Tobias Langner and his colleagues, writing in Psychology & Marketing in a paper entitled 'Is it really love: a comparative investigation of the emotional nature of brand and interpersonal love', recruited 20 participants on the basis of two criteria:

1. They had to have a consumer brand they felt they 'could not live without'
2. They had to be in a romantic relationship

All were asked to look at images of their beloved brand logo, followed by images of their partner and then images of their closest friend. Their reactions were assessed, first subjectively, using a visual rating tool and then physiologically, using a skin test to detect levels of arousal.

Thankfully, sanity prevailed, and on both the subjective and physiological ratings scales, the participants' love for partners was significantly more intense than for their favourite brand. When probed on the findings in interview, participants maintained that their love of brands was about the tangible benefits imparted (i.e. what they got from the brand), while romantic love was much more altruistic in nature.

We can all breathe a sigh of relief then.

Um, not quite. The study also showed that the level of physiological arousal was equally strong when subjects were shown images of their favourite brand as their favourite friend. And on the subjective rating scale, the brand actually scored higher. You know who your friends are!

Perhaps that's why it's not so uncommon to see people glued to their iPhone or proudly strolling arm in strap with a Prada handbag. Maybe these items are standing in as some kind of partner substitute.

It's difficult to tell with such a small sample size, but if these results are anything to go by, it's a sad indictment of our culture. The day an inanimate object can usurp a human being one calls a friend is a sad day indeed. In truth, relationships with objects have nothing whatever to do with love and everything to do with attachment. Only when we can make the distinction between the two, do we have any hope of truly loving.

Do you, in your daily practice, see certain objects becoming misguided targets for feelings? Or, conversely, do you see human beings becoming the target of behaviours that rightly belong to objects? If so, let us know.

Written by Jacqui Hogan

Friday, 15 May 2015

Let them eat Prozac

The neurotransmitter theory, despite being a theory, has become hard-wired into our understanding of the way depression works. A shortfall in the neurotransmitter serotonin in the synapses between neurones represents a 'chemical imbalance' which leads to the symptoms of depression, right?

Professor David Healy, author of a book published in 2004 entitled 'Let them eat Prozac: the unhealthy relationship between the pharmaceutical industry and depression', challenges this understanding.

He argues in editorial in the latest edition of the British Medical Journal, that the notion that low levels of serotonin are responsible for depression was created by drug companies in the 1980s in response to concerns about patients developing dependence on tranquilisers. To quote from his paper:
"The serotonin reuptake inhibiting (SSRI) group of drugs came on stream in the late 1980s, nearly two decades after first being mooted. The delay centred on finding an indication. They did not have the hoped for lucrative antihypertensive or anti obesity profiles. A 1960s idea that serotonin concentrations might be lowered in depression had been rejected and in clinical trials the SSRIs had lost out to the older tricyclic antidepressants."
According to Healy, the marketing of SSRIs for depression was pursued to solve two problems - the lack of a satisfactory indication and the emerging problem of dependence on tricyclic antidepressants. Launching SSRIs as a viable treatment for depression gave the marketers an indication and the doctors a prescription alternative.

The BMJ article, while challenging 'the received wisdom' on SSRIs, also stresses that serotonin is not irrelevant.

Rather, it focuses on the marketing history of SSRIs and raises general questions about the weight the medical establishment sometimes places on theory over empirical evidence for lives saved or restored function. Professor Healy goes on to say:
"In other areas of life the products we use, from computers to microwaves, improve year on year, but this is not the case for medicines where this year's treatments may achieve blockbuster sales despite being less effective and less safe than yesterday's models."
It's an indisputable fact that, anecdotally at least, many mental health practitioners and patients have observed and experienced clinical benefits with SSRI treatment. And, in a way, perhaps that is the most important point here, notwithstanding the placebo effect.

Nonetheless, it behooves us to understand the historical context for all pharmacological medications, especially in the mental health arena, given the psychosocial implications, reality of side effects and increasing dominance of business interests.

What is your experience of SSRIs, either as a prescriber, witness or patient? We'd love to hear your informed reflections on this vitally important topic.

Written by Jacqui Hogan

Friday, 8 May 2015

These results are not to be sniffed at

If you think that emotions can be contagious, you'd be right. It's well established that feelings of happiness, for example, transfer between individuals through mimicry of facial expressions.

But a new piece of research suggests this is not the only way we influence each others' emotional states. It would appear that feelings can also be spread by chemical means - specifically via the novel route of underarm sweat!

Researchers from the faculty of Social and Behavioural Sciences at Utrecht University recruited 12 men to provide sweat samples. These intrepid fellows attended the lab, rinsed and dried their armpits and then submitted to having pads attached under each armpit. They were then asked to watch videos designed to induce particular emotional states - fear, happiness and neutrality were tested. Following the viewing, the sweat pads were removed and stored in vials.

The 'sniffers' who were recruited to the second half of the study were 36 women. The researchers noted that women were used because the feminine sense of smell is known to be more acute than the masculine, and also because women are more sensitive to emotional triggers than men.

These (arguably more intrepid) subjects were then comfortably seated and asked to place their chins on a chin rest. The sweat samples harvested in the first half of the study were then placed under their noses in a holder attached to the chin rest. Fear, happiness and neutral samples were then presented to them with a five minute break in between.

Facial expression data revealed that women exposed to the 'fear' sweat exhibited greater activity in the medial frontalis muscle, a common feature of fear reactions. Those exposed to the 'happy' sweat showed facial activity of a type related to the 'Duchenne' smile, which is a common feature of happy reactions. The 'neutral' sweat failed to impact on facial muscle activity.

These results, while in need of further testing, seem to point to the existence of some kind of  'chemosignals', which are capable of communicating emotional states between individuals. Psychological scientist, Gun Semin, a senior researcher on the project said of the findings:
"Our study shows that being exposed to sweat produced under happiness induces a simulacrum of happiness in receivers, and induces a contagion of the emotional state. This suggests that somebody who is happy will infuse others in their vicinity with happiness."
So there you have it - the word is out and the gauntlet is laid down. If you're a happy therapist (is there any other kind?) will you take the happy sweat challenge and 'hold' the deodorant, just for a day, to give unhappy patients a break?

I'm kidding of course, but what this study does point to is something that we probably already know - that emotional states are infectious. How we are inevitably affects those around us. What it gives us is a possible mechanism for how the effect may be mediated. But arguably, because it relates to the invisible and mysterious communication that happens between human beings, it is probably much more complex than can ever be fully understood or proven empirically.

Do you have any thoughts on this topic? Have you observed the contagion of emotional states? How do you approach the challenge of emotional containment within the counselling environment? As ever, your thoughts appreciated.

To tap into more of our content, follow us on Twitter @96Harleytherapy

Written by Jacqui Hogan

Friday, 1 May 2015

The latest weapon in the war on mental disorders

With the prevalence of mental disorders at an all-time high in the general population, any measure which promises to alleviate symptoms has to be worthy of attention.

Recently, a woman I know who has spent time in a psychiatric hospital, mentioned, in passing, that she had been greatly helped by a therapist who had followed up her admission with periodic telephone calls.

Which is why this latest piece of research from the Department of Psychiatry and Psychotherapy at University Medicine Greifswald in Germany on the use of so-called 'telemedicine' caught my eye.

The research revolved around testing the concept of following up patients who had been treated in a psychiatric day hospital with periodic telephone calls and personalised text messages. The primary objective was to evaluate the effectiveness of such interventions.

Some 113 patients were randomly assigned to one of three groups - follow-up by telephone only; follow-up by telephone and text and follow-up with the usual aftercare, involving no such intervention. All participants were monitored for six months post-admission and scored for anxiety, depression and somatisation.

The results showed that the greater the extent of 'telemedical' intervention, the greater the level of benefit, with the average anxiety score significantly lowered for the 'phone plus text' group as compared to controls. A similar trend was seen with depression scores, though the results were not statistically significant.

In addition, 75% of patients with the most severe depression at baseline responded significantly more positively to 'phone only' follow-up than to no active intervention.

This led the team to conclude:
"Telemedicine provides a novel option in psychiatric ambulatory care with statistically significant effects on anxiety. A positive tendency was observed for depression, especially in cases with higher symptom load at baseline."
Of course there is no substitute for face-to-face human contact, but this may be one application of technology (if the humble telephone can still be labelled such) which is justified. Though one might wonder at what happens once the phone goes quiet, these results are nonetheless worthy of reflection and perhaps even further exploration.

Have you experienced therapeutic success with so-called 'telemedicine', without even realising you were trail-blazing this new frontier? Or, like the woman to whom I referred, have you experienced personal benefit from the application of such technique? With depression and anxiety running at such a high ebb in the culture, we welcome feedback on all your experiences.

Written by Jacqui Hogan