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!

Can brain training make you smarter?

I’m a master procrastinator, which is why I usually ban myself from computer and video games. But a few days ago I succumbed to temptation in the form of Lumosity.com, whose dozens of online brain training exercises purport to “improve brain health and performance” and “enhance memory, attention and creativity.”

Oops. I told myself I’d try Lumosity because I was sick of losing my keys, but now I’ve spent more hours than I care to confess playing the site’s addictive brain games. Taxes? Housework? Who cares? I’d rather try to remember whether Robert, Richard or Ryan ordered the chicken wings, cheeseburger or chicken salad, or solve falling math problems before they dissolve into a lake.

Turns out I’m not alone. Lumosity.com reports having recruited more than 20 million users since its inception in 2007, including almost 9 million unique visitors last January. That’s a lot of other people hankering to sharpen their face-name recall or remember where they left their cell phone (Inside a clothes drawer? On a shelf at the grocery store? In my case, yes and yes.)

The site’s popularity is no surprise. Besides its alluring games, Lumosity entices users by tracking their scores over time and showing how they stack up against other players. Since I started using the site, my “brain performance index” — Lumosity’s measure of cognitive power — has nearly doubled and I now outscore more than half of users in my age group. When else in adult life can you improve that much in five days?

But whether such gains translate to meaningful real-life abilities is debatable. In a much-cited study published in the journal Nature, 11,430 volunteers aged 18 to 60 who played brain training games for six weeks got better at playing the games, but showed no significant change in their ability to reason, retrieve words or shapes from short-term memory, or correctly associate one word or concept with another.

In a 2010 study, 11,400 people showed no significant improvements in various cognitive tests after an average of 25 brain training sessions. Experimental groups 1 and 2 played one of two types of brain training games, while the control (comparison) group searched the internet to answer a series of obscure questions. Notice that the control group also improved slightly, but not significantly, casting further doubt on the legitimacy of brain training games. Source: Putting Brain Training to the Test. Nature. 2010 Jun 10;465(7299):775-8.

It’s important to note, though, that the Nature study didn’t help answer a central question: whether brain training might help slow or reverse age-related cognitive decline. That’s because the researchers tested 18 to 60 year old volunteers with normal brain function, not older people with mild cognitive impairment.

But since 2010, when that research was published, no other major study has shown that brain exercises help people function better in everyday life. Indeed, as McGill University neuroscientists pointed out in a lengthy review published last month in the journal Brain and Cognition, there’s little evidence showing that getting better at one cognitive task through brain training helps people improve in other areas, or that brain training boosts healthy older people’s overall cognitive function. So far, most studies have been hampered by small sample sizes and design limitations. A PLoS One study published in March 2012, for example, reported that older people who played Nintendo’s Brain Age outperformed Tetris players on tests of thinking speed and executive functioning (the ability to organize and plan, manage time and make reasoned decisions). But the study included only 32 participants and assessed neither real-world tasks nor memory, one of the brain functions most susceptible to aging, stress and depression.

Does that mean there’s no value in using websites like Lumosity? Not necessarily. As the McGill authors noted, brain training games won’t hurt you and may have a helpful placebo effect, inspiring users to pay better attention to the world around them, focus more when making decisions, or engage in other activities that stimulate the mind. And brain training may also hold promise for more specific types of disabilities, such as attention-deficit hyperactivity disorder or impaired cognitive performance after a stroke.

For me, Lumosity has reinforced a couple of ideas. First, my husband’s right when he says I’m good at solving problems, but not always at paying attention. In fact, my Lumosity scores mirror his observation exactly. I’m dubious whether brain training can make me slow down and focus in the kitchen, where I’m prone to burns because my mind jumps ahead of my fingers, but sometimes just knowing you need to slow down and compensate for a weakness can help. And second, sleep really does make a difference in brain function. When I’ve slept five hours, I score lower on the exercises no matter how much coffee I drink. It’s a good reason to sign off Lumosity, wrap up this post and climb into bed — until tomorrow, when that tax deadline looms even nearer.

Garden your troubles away

The songbirds returned about a month early here in south-central Wisconsin, and in honor of spring, I’m updating a post from last year about gardening’s mental health benefits.

I hope this spring brings you fresh energy and many happy hours outside on — and in! — the earth.

Photo by Laura Berman.

When you’re stressed, when you go to the garden, you feel different.
It helps you hold onto life.
– Southeast Toronto resident, 2007 study on health benefits of community urban gardening

Summer’s finally here in south-central Wisconsin, ushered in by one of the coldest springs we’ve had in years. Though I grumbled about trudging through snow flurries on May 1, our garden loved the cool, wet weather. Now, in mid-June, Red Russian kale stands tall in raised beds, its smooth curled leaves jostling with green cabbages, Di Cicco broccoli and Early Snowball cauliflower. The heirloom tomatoes I grew from seed back in February are beginning to flower, and pea vines climb a trellis so fast I swear I can see them move.

When I’m in my garden, life’s troubles crumble away with the rich black soil between my fingers. I’m fully in my body, out of my head, my worries banished. My garden is my church, my time there sacred.

We 21st-century humans so often find ourselves adrift in technologies that wall us off even as they keep us connected. Our gardens are antidotes to that, places where we abandon the filters of cell phones and computers and contact life directly, sensually, touching and smelling plants and bugs and worms and the billions of microorganisms that make garden soil so rich. Biologist E.O. Wilson spoke to these feelings with his biophilia hypothesis, the idea that humans have an “innately emotional affiliation… to other living organisms.”

While far scarcer than studies on psychotherapy or psychiatric medications, research on gardening’s health benefits has found that working with plants can ease mental suffering. There’s even a term for this process — horticultural therapy. As we tend our gardens, sowing seeds, watering, pulling weeds, pruning and, months later, harvesting, so too we sow seeds of patience, hope and optimism within ourselves. A 2008 paper in Nursing Times called such hope “an intrinsic requirement of gardening,” and key to how this activity heals.

Gardening as a therapy for mental illness hasn’t been thoroughly researched, but what has been published shows promise. A paper from 2011 summarized two studies in which patients with depression who gardened for 12 weeks felt better at the end of the intervention and three months later (note that both studies lacked control groups, so we don’t know how much the patients might have improved on their own). In the United Kingdom, a program called Rethink Green Growers helps people with mental illness ranging from mild depression to schizophrenia grow their own food on land plots in Wiltshire, Somerset and Dorset. The program organizers say gardening not only gets the patients out of bed and into the sunshine, but  helps them connect with each other and eat healthier diets — which, in turn, further stabilizes their moods.

Horticultural therapy isn’t only being used as adjunctive treatment for mental illness. A 2005 study found gardening reduced stress in patients undergoing cardiac rehabilitation, and a study of patients with dementia found that gardening twice weekly for six weeks helped them interact more with others.

I’ll sign off for now — my garden beckons. How has gardening helped you feel better?  Please share your experiences! (And read more from a wonderful blog called The Storied Mind!)

Reduce anxiety by learning to accept life’s uncertainties

Life so often bucks and plunges beyond our control. Its pleasures and rewards can evaporate in an instant, demolished by a car accident, a pink slip, a friend’s betrayal.

Image by Luca Z.

By the time we reach adulthood, most of us have seen firsthand how damningly unsure life can be. But knowing this is one thing. Accepting it is another.

Though we all struggle at times to make peace with life’s unexpected twists and turns, studies show that people with high levels of anxiety — including conditions like panic disorder, generalized anxiety disorder, obsessive-compulsive disorder and social phobia — tend to have a much harder time accepting uncertainty than others. (A study published last month also found some association between intolerance of uncertainty and hypochondria, or chronic, unfounded health concerns.)

This connection makes sense when you think about it. Excessive worry can be a subconscious attempt to control life — to try to prevent mishaps by imagining and trying to sidestep everything that could go wrong.

People who can’t tolerate uncertainty may develop counterproductive behaviors, too, like refusing to delegate tasks, re-reading every email before sending it, and triple-checking their work, even on small projects. They may constantly ask friends or family members for reassurance. In severe cases, they may fear the unexpected so much that they avoid routine activities, like driving, meeting new people or traveling.

Of course, such efforts to control life usually don’t work. They just confine us to ever-shrinking comfort zones, reducing our potential and stifling both learning and pleasure. What’s more, chronic, unrelenting anxiety and tension have been linked to a host of emotional and physical health problems, from insomnia and digestive problems to a weakened immune system and even heart attacks.

Learning to accept uncertainty can significantly reduce anxiety. But how to do it? Changing ingrained beliefs takes time and sustained effort. Here’s what the research shows helps:

- Cognitive behavioral therapy helps anxious people learn to identify distorted, negative thoughts and replace them with more realistic ones. For example, someone who lives in a safe neighborhood but constantly worries he’ll be assaulted can learn to identify this thought as “fortune telling” and replace it with a more realistic one, such as, “It’s very unlikely I’ll be attacked, and I can reduce the risk further by keeping my head up and looking around when I walk.” Or someone who constantly overworks herself because she fears negative feedback can notice the underlying beliefs that drive her behavior, such as, “If someone criticizes me, it means I’m a bad person,” and respond with healthier self-talk, such as, “I don’t need to be perfect. Constructive criticism is useful and can help me grow, and I get to decide whether or not I agree with others’ feedback.” Group cognitive behavioral therapy can also help people with social phobias better tolerate uncertainty, according to a small study published this month.

- Whether you do it on your own or as part of therapy, seeking out situations you’ve habitually avoided is one of the best ways to teach yourself that you can tolerate uncertainty and solve problems on your feet when they arise. This process usually involves a gradual immersion into a new experience: If you’d like to one day feel able to travel internationally by yourself, perhaps you start by spending a day alone in a city within driving distance. And if you’d like to meet new friends, but you fear rejection, you might experiment with smiling at strangers and silently wishing them well, and then, once you’re comfortable with that, practice striking up a conversation.

- Mindfulness meditation can be a powerful tool for learning to accept uncertainty. Simply sitting and feeling your breath — the interplay between long and short inhalations and exhalations — reveals life’s mercurial essence. And noticing habitual thoughts helps you choose how you’ll respond to them. By cultivating an alert but passive attitude in meditation, you can begin, breath by breath and thought by thought, to relinquish the need to control life — and taste the profound peace that comes with letting go.