In women, loving-kindness meditation linked with marker for longevity

Loving-kindness meditation might slow the aging process in women, based on a small study by researchers at Harvard Medical School.

Loving-kindness is a type of meditation shown to induce positive emotions, help relieve stress and chronic back pain, and potentially ease symptoms of serious mental illness.

In the new study, scientists analyzed white blood cells from 37 adult men and women, of whom 15 had practiced loving-kindness meditation almost every day for at least four years.

The researchers measured length of participants’ telomeres — regions at the end of  chromosomes. Shortened telomeres have been linked in humans to chronic stress, mood disorders and accelerated aging.

The scientists found that women who practiced lovingkindness meditation had significantly longer telomeres than women who did not. But telomere length in men was the same whether or not they practiced loving-kindness.

The results for women remained significant when researchers controlled for differences in body mass index (BMI) and history of depression between meditators and nonmeditators.  (The groups resembled each other in terms of age, gender, race, education level and  history of  trauma.)

Why was the positive result seen only for women? The study’s authors noted that female participants had practiced lovingkindness meditation longer than their male counterparts, although the difference wasn’t statistically significant.

“We could also speculate,” they wrote, “that [loving-kindness] practice leads to greater psychological, and therefore physiological, changes in women because they are able to utilize it better.”

Loving-kindness focuses on emotions, not thoughts, and brain scans of women show they rely more on the “emotional” parts of their brain for performing certain tasks. When women are shown pictures and asked to label and assign emotions, for example, they use their amygdalas more than men do. The amygdala is a brain structure that helps regulate and interpret emotions.

The study’s limitations included its small sample size and the fact that the loving-kindness practitioners also practiced insight meditation. In addition, researchers did not measure participants’ self-reported stress levels, only telomere length.

The study appears in the journal Brain, Behavior and Immunity.

Brain scans help predict treatment effectiveness for social anxiety disorder

Brain scans help predict treatment outcomes for social phobia

By Amy Karon

A new study has taken the first step in using functional magnetic resonance imaging (fMRI) to predict treatment response for social phobia, a chronic, debilitating mental illness that affects almost 7 percent of adults in the United States every year.

Based on these results, the study’s authors hope that brain scans can one day help clinicians select the best treatments for individual patients with social phobia.

The study successfully linked fMRI results to patients’ subsequent response to cognitive-behavioral therapy (CBT), a common treatment for social phobia and other anxiety disorders. Researchers enrolled 39 patients in the Boston, Mass. area who met DSM-IV criteria for social phobia and had not taken psychiatric medications for at least two weeks.

At baseline and after completing 12 sessions of CBT, patients underwent fMRI scans viewing pictures of angry and neutral faces, negative and neutral scenes, and “potent negative” scenes, such as images of sharks.

The researchers found that patients who improved the most after CBT also had the highest baseline levels of fMRI activity in the brain’s higher-order visual cortex, which processes visual information. That finding surprised them, they wrote. They instead had expected to find a link between treatment response and fMRI activity in the amygdala, or in other brain structures associated with emotions, long-term memories, and motivation.

The study’s authors did not speculate on possible reasons for these results. But Dr. Greg Siegle, an associate professor of psychiatry at the University of Pittsburgh, noted in an MIT news release that patients who improved the most from CBT might have been good at segregating visual information, such as pictures of faces. This ability could explain increased baseline fMRI activity in their higher-order visual cortexes.

The investigators next plan to test fMRI’s ability to predict response to medications and other treatments for social phobia.

About social phobia

People with social phobia fear being judged or embarrassed at work or socially.  They know their fear is illogical, but cannot control it.  Simply going to the store can trigger physical symptoms such as trembling, blushing, nausea, and sweating. They often harbor a profound wish to make friends and improve work relationships, but fear shackles them.

Behavioral studies indicate that patients with social phobia may particularly struggle to get better if they have severe symptoms, developed the disorder at an early age, don’t think treatment will work, have unrealistic expectations of their therapist or also have other types of anxiety disorders.

Current treatment options

Studies indicate that counseling therapies such as CBT can ease the symptoms of social phobia for some patients. In a randomized, controlled trial, about 65 percent of patients with social phobia who underwent CBT therapy improved on the Leibowitz Social Anxiety Scale, a common tool for assessing the severity of social phobia.

In another study, 42 percent of patients improved with interpersonal therapy, which focused on changing behaviors such as avoiding social situations. In contrast, only 7 percent of patients improved with no treatment.

Medications such as Paxil (paroxetine), Zoloft (sertraline), Prozac (fluoxetine), Luvox (fluvoxamine) and Effexor (venlafaxine) can also help and are often used in combination with therapy. In a 2005 study, 44 percent of patients with social phobia improved on the Leibowitz scale after taking Effexor for 12 weeks — significantly more than the 30 percent who improved on placebo.

Faith-based healing and disdain for screening: the 2012 GOP platform on mental health

Leaders of the Grand Old Party (and 15,000 journalists) descended on Tampa, Fla. this week for the Republican National Convention. On Tuesday, the GOP adopted a 33,000+ word platform. A closer look shines light on how GOP leaders might set policies for treating serious mental illness, one of the most crucial health problems facing the United States.

The word ‘mental’ appears six times in the GOP platform — not enough make it into this Wordle.

1.  No federal dollars for universal mental health screening programs. Supporters calls these programs a cornerstone of suicide prevention programs, especially for children and teenagers. But the issue has sparked controversy because of concerns about overmedicating children and teenagers, the link between antidepressants and increased risk of suicide in some young people, and ethical dilemmas about screening people if you don’t have resources to treat them (for more, see this excellent overview article from the L.A. Times). The GOP makes its position clear. “We support keeping federal funds from being used in mandatory or universal mental health, psychiatric, or socioemotional screening programs,” it states (p.37).

2. Better treatment for veterans… including faith-based healing? “We must make military and veterans’ medicine the gold standard for mental health care,” the platform holds, but adds, “with military suicides running at the rate of one a day, with post-service medical conditions, including addiction and mental illness, and with the financial stress and homelessness that is often related to these factors, there is an urgent need for the kind of counseling that faith-based institutions can best provide.” (pp. 43-45)

3. Deep cuts and a radical makeover of Medicaid, the single largest U.S. payer for people with mental illness. The platform calls the program ”simply too big and too flawed to manage in its current condition from Washington” (p.23). The solution? Give states block grants, chunks of money they can use with few restrictions to ”improve the quality of care” for people on disability and help poor-but-healthy adults buy private insurance (p.34).

4. An allusion, at best, to mental health parity — the idea that insurance companies should provide the same level of coverage for mental and physical health care. “We believe that all Americans should have improved access to affordable, coordinated, quality healthcare, including individuals struggling with mental illness,” the platform states on page 40.

But it doesn’t say insurance companies should follow parity laws, an omission that could be intentional. Mitt Romney and Paul Ryan want to repeal the Affordable Care Act — which, beginning in 2014, will prohibit companies from denying people health insurance because they have a history of mental illness or substance abuse. Starting the same year, the law will also require most plans to offer mental health coverage as part of their basic benefits packages.

In 2008, Paul Ryan also voted against a mental health parity bill that passed the House 268-148. (Forty-seven Republicans voted for it.) Ryan’s motivations weren’t clear, but the New York Times reported employers and insurance companies fought the bill because it would require mental health insurers to cover every condition listed in the Diagnostic and Statistical Manual of Mental Disorders, from schizophrenia to caffeine intoxication.

Perhaps one of the 15,000 journalists in Tampa will ask GOP leaders to spell out their plans for improving and expanding mental health care and parity. These are questions that politicians in every party and at every level of government should be wrestling with.

Types of borderline personality disorder

Borderline personality disorder is a broad diagnosis.

Media outlets and some psychology websites paint patients with BPD as violent, impulsive, and prone to tumultuous relationships. But in reality, the disorder is far more complex. Its clinical definition includes nine symptoms, of which patients must have at least five. That calculates to 256 different symptom combinations — 256 ways, if you will, to have BPD.

Such diversity of symptoms within a single diagnosis can complicate treatment. That’s distressing, because BPD causes immense suffering and remains difficult to overcome. While some patients benefit from dialectical behavior therapy or medications like mood stabilizers and second-generation antipsychotics, the National Institute for Mental Health estimates that of about 3.8 million U.S. adults with BPD, 4 to 9 percent ultimately commit suicide and thousands are hospitalized every year for self-harming or suicidal behaviors.

A Harvard University analysis of 290 people hospitalized with BPD found that the vast majority did improve substantially over the 16-year study. But remission often took years, longer than for patients with other personality disorders. And full recovery eluded many.

Researchers are trying to refine BPD’s diagnosis, which could help improve treatments and better tailor them to patients’ needs. In a peer-reviewed study published last month, scientists at the University of Pittsburgh used statistical modeling to see which BPD symptoms were most likely to occur together. They found several interesting results. Patients with high levels of anger and aggression were almost always the ones who frantically tried to avoid abandonment. And contrary to popular beliefe, not all patients with BPD reported having  identity problems or feeling chronically empty.

Based on their findings, the researchers categorized BPD into four subtypes:  angry/aggressive, angry/mistrustful, poor identity/low anger, and prototypical (or classic) BPD. But researchers don’t agree yet on how best to subtype BPD. Previous efforts, for example, resulted in categories such as high-functioning internalizing, histrionic, depressive internalizing, and angry externalizing, depending on factors like how likely patients were to act out their feelings, or how prone they were to depressed mood.

Scientists are continuing their efforts to better refine BPD’s diagnosis. The best approaches may combine studies of symptoms, genetics and brain imaging.

Too good to be true?

Screenshot of a search for “Jonah Lehrer” on http://www.newyorker.com.

Heads up, Harvard: A closer look reveals problems with study on yoga for stroke patients

Health news websites — including a Harvard health blog — buzzed last week with news that yoga can help stroke survivors improve their balance and quality of life. But a closer look reveals problems with the study’s design and calls those conclusions into question.

Photo by Joseph Renger.

In the study, e-published last week by the journal Stroke, researchers randomly assigned stroke survivors to one of two groups. One group participated in twice-weekly, hour-long yoga sessions, while the control (or comparison) group didn’t do yoga or any other kind of rehab. The scientists reported that after eight weeks of yoga, patients’ balance improved, they weren’t as afraid of falling, they felt more independent and had better quality of life.

Sounds great, right?

Hang on. Researchers found no significant difference in outcomes between the yoga group and the control group, according to the study. Instead, they based their positive conclusions on a method called within-group comparison: They looked just at the yoga group to see how much participants improved. The problem with this approach is the yoga group could have improved for any number of reasons. Research has showed that simply participating in a study can affect how ill people experience and describe their systems. That’s why the yoga group needed to be compared to the control group — and when the researchers did that, they came up short. An Oxford University statistician called within-group comparisons “conceptually wrong, statistically invalid, and consequently highly misleading.”

Second, the physical therapist who evaluated the study participants knew who did yoga and who didn’t. She even helped out during the yoga sessions. In well designed medical studies, researchers often don’t know the specific theory the study is testing, much less which group a patient was assigned to. Failing to “blind” researchers this way can lead to observer bias – without intending to, the physical therapist could have evaluated the yoga participants differently than the control group.

The final word? Yoga might help stroke survivors, but we can’t conclude that based on this study.

Data visualization fun with Tableau – please give this a like!

Hey, check out this cool visualization on microloan programs my scary smart journalism school classmate, Kate Prengaman, produced using Tableau software (another classmate and I provided some input, but this was her baby). Kate created it for a contest, and if it gets enough ‘likes’ it will win a prize. So please take a second to go check it out, and if you think it’s cool, please click ‘like’ at the bottom.  Thanks!

Update May 1: Just a quick note that the data visualization won first prize in the national Tableau contest — way to go, Kate!