Category: Neuroscience

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A Brain Stimulation Device May Power Healing

90Cognition, Cognitive Stimulation Therapy, Environment, Featured news, Health, Neuroscience February, 18

Source: UCI Research at flickr, Creative Commons

Promising new treatments for neurological disorders are aimed at transforming disease management through neuroplasticity—the brain’s ability to alter its structure and function to adapt to changes in the environment. Leading-edge research is investigating how technological solutions can enhance neuroplasticity, boosting recovery from neurological damage.

In September 2016, Helius Medical Technologies announced positive results for its pilot study using a brain stimulation device to treat pediatric Cerebral Palsy (CP). CP affects muscle control due to injury or malformation of the brain. For the study, some participants received standard physiotherapy, while others received standard physiotherapy along with 20 minutes of brain stimulation with Helius’s experimental device.

Those who received brain stimulation showed improvements in muscle spasms and gross lower limb motor function, over those who did not. And, there were improvements in quality of life, social status, and cognitive function. One explanation is that the brain stimulation device heightens the brain’s natural ability to heal, producing enhanced benefits from physiotherapy.

This new method of brain stimulation is termed cranial nerve non-invasive neuromodulation (CN-NINM). A successful feasibility study was done for the treatment of Multiple Sclerosis (MS), and studies are underway for Parkinson’s disease, brain injury, and stroke. Participants are reporting improvements in mental health and wellbeing, such as greater mental clarity and increased energy. And benefits may extend to other neurological conditions as well.

The brain stimulation device used in these studies comes from decades of work by researchers at the University of Wisconsin-Madison, in the Tactile Communication and Neurorehabilitation Laboratory (TCN Lab). The team named the device the Portable Neuromodulation Stimulator (PoNS). The PoNS consists of a small array of electrodes that transfer an electrical current to the patient’s tongue, activating areas of the brainstem and cerebellum. Researchers theorize that this activation induces a sequence of activity that spreads through the brain.

In his book, The Brain’s Way of Healing, researcher and psychiatrist Norman Doidge explains how brain stimulation enhances neuroplastic healing. Doidge says an underlying cause of symptoms in neurological disorders is a dysregulation of electrical activity in the brain. He explains the sequence of activity caused by the PoNS may help the brain balance the electrical activity in its networks of brain cells. Balancing promotes rest and relaxation of these cells, allowing further stimulation alongside appropriate rehabilitative therapy. Stimulation reactivates dormant or dysregulated brain cells, and reintegrates them into functioning networks. Taken together, these changes make an ideal state for neuroplastic healing to take place.

Doidge shares a story about Broadway singer Ron Husmann’s remarkable recovery, which Doidge attributes to neuroplastic healing. Multiple Sclerosis led Ron to lose control of his bladder, mobility, and singing voice. Devastated by the loss of his voice and feeling he had nothing to lose, Ron travelled to the TCN Lab. He spent two weeks in intensive speech therapy, accompanied by brain stimulation with the PoNS device. By the end of his stay, Ron was singing and dancing again.

Brain stimulation and modulation are not new. They are central to established, FDA-approved treatments, such as deep brain stimulation (DBS), for neurological disorders. But, an important difference between the PoNS device and deep brain stimulation is that DBS is a highly invasive treatment. It involves the insertion of an electrode into the patient’s brain, and introduces several possible risks, including infections and strokes. And so, DBS is only used as a last resort. But the PoNS is non-invasive and presents few risks. Plus, the effects of the PoNS appear to continue even after the stimulation ends, whereas the benefits of DBS tend to end when stimulation is turned off.

Reported side effects for treatment by the PoNS, though, include increased salivation, mild headaches, and jaw pain. To reduce side effects, researchers teach participants swallowing and relaxation techniques that manage saliva and tension in the jaw.

Although early evidence for the PoNS device is impressive, skeptics point out that the number of participants used in the studies is small, which reduces confidence in reported outcomes. And although the team at the TCN Lab has shown that the PoNS increases activity in key brain areas, theories on how, precisely, it contributes to healing are still unclear.

Still, the PoNS shows promise as an addition to rehabilitation programs, and as a way of promoting physical and mental health. This technology is one to watch.

–Stefano Costa, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Brain Stimulation Device Powers Healing

70Cognition, Cognitive Stimulation Therapy, Environment, Featured news, Health, Neuroscience February, 18

Source: UCI Research at flickr, Creative Commons

Promising new treatments for neurological disorders are looking to transform disease management through neuroplasticity—the brain’s ability to alter its structure and function to adapt to changes in the environment. Leading-edge research is investigating how technological solutions can enhance neuroplasticity, boosting recovery from neurological damage.

In September 2016, Helius Medical Technologies announced positive results for its pilot study using a brain stimulation device to treat pediatric Cerebral Palsy (CP). CP affects muscle control due to injury or malformation of the brain. For the study, some participants received standard physiotherapy, while others received standard physiotherapy along with 20 minutes of brain stimulation with Helius’s experimental device.

Those who received brain stimulation showed improvements in muscle spasms and gross lower limb motor function, over those who did not. And, there were improvements in quality of life, social status, and cognitive function. One explanation is that the brain stimulation device heightens the brain’s natural ability to heal, producing enhanced benefits from physiotherapy.

This new method of brain stimulation is termed cranial nerve non-invasive neuromodulation (CN-NINM). A successful feasibility study was done for the treatment of Multiple Sclerosis (MS), and studies are underway for Parkinson’s disease, brain injury, and stroke. Participants are reporting improvements in mental health and wellbeing, such as greater mental clarity and increased energy. And benefits may extend to other neurological conditions as well.

The brain stimulation device used in these studies comes from decades of work by researchers at the University of Wisconsin-Madison, in the Tactile Communication and Neurorehabilitation Laboratory (TCN Lab). The team named the device the Portable Neuromodulation Stimulator (PoNS). The PoNS consists of a small array of electrodes that transfer an electrical current to the patient’s tongue, activating areas of the brainstem and cerebellum. Researchers theorize that this activation induces a sequence of activity that spreads through the brain.

In his book, The Brain’s Way of Healing, researcher and psychiatrist Norman Doidge explains how brain stimulation enhances neuroplastic healing. Doidge says an underlying cause of symptoms in neurological disorders is a dysregulation of electrical activity in the brain. He explains the sequence of activity caused by the PoNS may help the brain balance the electrical activity in its networks of brain cells. Balancing promotes rest and relaxation of these cells, allowing further stimulation alongside appropriate rehabilitative therapy. Stimulation reactivates dormant or dysregulated brain cells, and reintegrates them into functioning networks. Taken together, these changes make an ideal state for neuroplastic healing to take place.

Doidge shares a story about Broadway singer Ron Husmann’s remarkable recovery, which Doidge attributes to neuroplastic healing. Multiple Sclerosis led Ron to lose control of his bladder, mobility, and singing voice. Devastated by the loss of his voice and feeling he had nothing to lose, Ron travelled to the TCN Lab. He spent two weeks in intensive speech therapy, accompanied by brain stimulation with the PoNS device. By the end of his stay, Ron was singing and dancing again.

Brain stimulation and modulation are not new. They are central to established, FDA-approved treatments, such as deep brain stimulation (DBS), for neurological disorders. But, an important difference between the PoNS device and deep brain stimulation is that DBS is a highly invasive treatment. It involves the insertion of an electrode into the patient’s brain, and introduces several possible risks, including infections and strokes. And so, DBS is only used as a last resort. But the PoNS is non-invasive and presents few risks. Plus, the effects of the PoNS appear to continue even after the stimulation ends, whereas the benefits of DBS tend to end when stimulation is turned off.

Reported side effects for treatment by the PoNS, though, include increased salivation, mild headaches, and jaw pain. To reduce side effects, researchers teach participants swallowing and relaxation techniques that manage saliva and tension in the jaw.

Although early evidence for the PoNS device is impressive, skeptics point out that the number of participants used in the studies is small, which reduces confidence in reported outcomes. And although the team at the TCN Lab has shown that the PoNS increases activity in key brain areas, theories on how, precisely, it contributes to healing are still unclear.

Still, the PoNS shows promise as an addition to rehabilitation programs, and as a way of promoting physical and mental health. This technology is one to watch.

–Stefano Costa, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Parkinson’s Takes its Toll on Family Caregivers

00Caregiving, Family Dynamics, Featured news, Health, Neuroscience, Parenting, Stress January, 18
Source: Lesia Szyca, Trauma and Mental Health Report Artist, used with permission

Her hands and legs trembled, she could no longer drive. Cognitively, she declined. Her balance was affected, and she often fell. My grandmother Anna (name changed) had Parkinson’s Disease. It took over her life.

As a vibrant and independent woman, Anna had always been eager to help her family. Then, as the disease progressed, roles began to shift, and younger family members had to care for her.

Anna battled Parkinson’s Disease (PD) for more than 15 years. A degenerative neurocognitive condition, it is caused by a gradual loss of dopamine producing cells in the brain that worsens over time leading to tremors, cognitive impairment, and emotional changes.

To date, there is no cure, so a combination of medication and therapy is the only treatment. Anna battled this debilitating illness with no chance of recovery.

As she declined, so did her capacity to be self-sufficient. Her motor abilities drastically decreased, and her memory continued to diminish. She required supervision the majority of the day, and was unable to perform her favorite activities, such as baking, making crafts, sewing, and gardening.

Before Anna was admitted to a long-term facility in 2015, caring for her became a full-time job shared by my mother, my sisters, and grandfather. For my mother Charlotte (name changed), seeing her mother’s deterioration was particularly difficult. Unexpectedly shouldering the role of primary caregiver took a toll:

“At times on my own, I would go in the shower and cry. At other times too, the circumstances made me short and impatient with people. I would be intolerant and lose my temper due to the frustration.”

A study by Laurence Solberg and colleagues examined the emotional and mental health of adult children who are primary caregivers to ill parents. In administering a survey to identify stress levels, the researchers found that caregivers had heightened levels of negative feelings, such as anxiety, while caring for a parent. They found that being a caregiver of an elderly, sick parent adversely affected personal health. However, caregivers balancing the needs of an ill parent with those of their own children did not experience elevated stress compared to individuals without children.

But my own mother’s experience was different. She found it demanding to balance caring for an ill parent and caring for her own children.

“If you only have to balance an elderly parent and a job, it’s much easier than if you also have a family. With children, there’s additional responsibility. Anna required some priority, but I couldn’t lose focus on my children.”

When researchers Caroline Kenny and colleagues examined the experiences of family caregivers, many expressed distress over feeling unprepared for the role. My mother felt the same:

“We didn’t know how to properly care for Anna. We didn’t know how to lift her correctly, or how to deal with her frustration. On top of having the responsibility of caring for her, we had the added stress of not knowing how to handle her properly.”

And finding time for herself was not easy for my mother either. Solberg’s research supports this predicament: three quarters of caregivers reported decreased time for personal hobbies and interests. Charlotte said:

“I do think these responsibilities cause you to neglect your usual pastimes. I went from work to Anna’s home to my home. There wasn’t time for myself.”

In a study by Vasiliki Orgeta and colleagues, published in the International Psychogeriatrics Journal, the authors reported on the importance of social support for coping with the strain of becoming a caregiver.

For me, it was painful to see my grandmother’s decline alongside my own mother’s struggle to care for her. But consistent with Orgeta’s findings, I’ve found that relying on friends and family, and my social support system, has helped alleviate the anxiety of seeing my family in distress.

No one’s experience is the same; people cope in their own ways. For my mother, the situation has been heartbreaking:

“Seeing a person who is loving and vibrant, such a nurturing mother, become a person who is not nurturing anymore, not strong, whether emotionally or physically, is agonizing. It’s a part of life, but it’s hard to accept.”

–Alyssa Carvajal, Contributing Writer, The Trauma and Mental Health Report. 

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Rape Victims’ Reactions Misunderstood by Law Enforcement

40Depression, Featured news, Law and Crime, Neuroscience, Post-Traumatic Stress Disorder, Trauma January, 18

Source: Richard George Davis, used with permission

In 2008, 18-year-old Marie reported being raped at knifepoint in her apartment. Confronted by the police with allegations that she was lying, she conceded under pressure that the rape may have been a dream. Then, after being aggressively interrogated about her story, she finally admitted to making it up. She was subsequently charged with false reporting.

The report, however, was not false. In June 2012, Marc O’Leary pleaded guilty to 28 counts of rape and was sentenced to 327½ years in prison, including 28½ years for the rape of Marie.

Rape is unlike most other criminal offences. The credibility of the victim is often on trial as much as the guilt of the assailant, despite the fact that false rape accusations are rare (only an estimated 2-8% of cases are fabricated).

Sergeant Gregg Rinta, a sex crimes supervisor at the Snohomish County Sheriff’s Office in Washington, deemed that what happened to Marie was “nothing short of the victim being coerced into admitting that she had lied about the rape.” Rinta recounted in an external report of the department’s handling of the case how Marie was subjected to “bullying and hounding”, as well as threats of jail time and withdrawal of housing assistance.

Steve Rider, the commander of Marie’s criminal investigation, considers her case a failure. In an interview conducted by ProPublica and The Marshall Project, he explained:

“Knowing that she went through that brutal attack—and then we told her she lied? That’s awful. We all got into this job to help people, not to hurt them”

The seed of doubt was planted when the police received a phone call from Marie’s former foster mother Peggy and another foster mother, Shannon. One of their biggest issues was that Marie was calm while describing the attack, rather than upset.  Shannon stated:

“She called and said, ‘I’ve been raped. there was just no emotion. It was like she was telling me that she’d made a sandwich.”

Peggy remembers:

“I felt like she was telling me the script of a Law & Order story. She seemed so detached and removed emotionally.”

Hearing these accounts from those closest to Marie led the police to distrust her story, and the situation unfolded from there. In rape cases, a judgment of legitimacy often focuses on the victim’s reaction during and following the event instead of on the assailant’s behaviour.

Clinical psychologist Dr. Rebecca Campbell spoke about the neurobiology of sexual assault in a talk to the National Institute of Justice. She explained that victims are flooded with high levels of opiates during a rape—chemicals in the body intended to block physical and emotional pain, but which can also dull the victims’ feelings:

“The affect that a victim might be communicating during the assault and afterward may be very flat, incredibly monotone—like seeing no emotional reaction, which can seem counterintuitive to both the victim and other people.”

This misperception contributes to sexual assault cases not going to trial. Of rape cases that are reported, 84% are never referred to prosecutors or charged; 7% are charged but later dropped; 7% get a plea bargain; 1% are acquitted; and only 1% are ever convicted.

Dr. Campbell identifies part of this problem as the police misunderstanding victims’ reactions as they recount their trauma. Based on this confusion, police officers make assumptions about the legitimacy of what they hear and often discourage victims from seeking justice. Officers may even secondarily victimize them.

Secondary victimization is defined by Dr. Campbell as “the attitudes, beliefs and behaviors of social system personnel that victims experience as victim blaming and insensitive. It exacerbates their trauma, and it makes them feel like what they’re experiencing is a second rape.”

On average, 90% of victims are subject to at least one secondary victimization in their first encounter with the justice system. Victimization includes discouraging victims from pursuing the case, telling them it’s not serious enough, and asking about their appearance or any actions that may have provoked the assault.

These incidents have a profound effect on victims, as conveyed by Dr. Campbell, with many reporting feeling depressed, blamed, and violated. In fact, 80% feel unwilling to seek further help. As a result, many rape victims withdraw their complaint. To make matters worse, only 68% of rape cases are reported in the first place.

Sharing information on the neurobiology of trauma could be a powerful tool in educating police officers who don’t understand victims’ reactions. Evidence of the neurobiological changes that lead to flat affect or what appear to be huge emotional swings after an assault may help police better serve this population.

Furthermore, normalizing a range of reactions from rape victims, rather than accepting preconceived notions, may lead to a safer and more effective environment for reporting sexual assault. Knowledge about trauma can also serve to inform public discourse about sexual assault, as well as help victims to see their own reactions with compassion.

–Caitlin McNair, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report. 

Copyright Robert T. Muller.

This article was originally published on Psychology Today

1 A blood test to diagnose depression-118138414119886042cd33f08a35cf742e1cc5c5

A Blood Test to Diagnose Depression?

00Addiction, Depression, Featured news, Neuroscience, Psychiatry, SSRIs March, 16

Source: Andrew Mason on Flickr

Researchers at the Feinberg School of Medicine at Northwestern believe it may be possible to diagnose depression using a blood test. According to Eva Redei, a professor of psychiatry at the university, previous studies with lab animals have identified 26 markers in the blood (called biomarkers) that are associated with depression.

With human subjects, Redei identified nine biomarkers that differed between depressed and non-depressed individuals. The biomarkers signify a difference in gene expression associated with depression and allowed Redei to identify all those suffering from Major Depressive Disorder (MDD) in a sample of 66 adults.

Further, Redei was able to use biomarkers to identify adults with MDD who benefited from Cognitive Behavioural Therapy (CBT).  When depression symptoms were improving, some of the original biomarkers that helped to identify depressed individuals disappeared in blood samples.

If replicable, these findings would have major implications for the future of mental health diagnosis. Patients sometimes seek the attention of a primary care physician when they have concerns about depression. Unfortunately, such physicians are not as equipped or experienced as psychiatrists and psychologists in diagnosing and treating depression. This increases the time between when individuals begin to experience symptoms and when they are able to receive treatment. On average, an official depression diagnosis can take between 2 to 40 months.

At the same time, untreated depression has severe risks. “The longer depression is not treated, the more difficult it is to treat,” says Redei. “There’s also a higher chance of suicide, and adverse effects in the person’s work environment, home environment, [and] social structure.”

Untreated depression usually worsens over time, and to cope, patients may succumb to addiction, self-injury, and reckless behaviors such as having unprotected sex and drunk driving. Risk of suicide also goes up the longer depression remains untreated.

Using a test such as this to identify depression could reduce some of the stigma tied to the disorder and bridge the gap between mental and physical health. Depression affects the whole person, body and mind. A test such as this underscores that connection.

Does it all sound too easy?

Perhaps.  New biological findings in mental illness have a way of promising a whole lot more than they deliver.

Nowhere is this seen more than in the area of depression (Anyone out there remember Peter Kramer’s 1993 classic, Listening to Prozac?)  Decades of research on SSRI’s, once hailed as revolutionary, are increasingly showing just how modest, indeed disappointing, the medication’s effects actually are.

So a healthy dose of skepticism is in order.

This study is one of the first in its category. Depression is an exceptionally complex disorder that can only be partially understood in terms of biology. For the above implications to be substantiated, many studies with larger sample sizes must replicate the findings.

In fact, a much larger study that looked for genetic associations with MDD in over 6,000 individuals (of whom 2,000 were diagnosed with MDD) found little to no genetic links.

Further, even if blood sampling were used to diagnose depression, it would not account for the social and environmental components of the disorder. It is possible that increased reliance on biological factors could lead to increased numbers of people being misdiagnosed and forced to suffer alone due to the narrow diagnostic scope that blood tests would provide.

Still, Redei’s research does show promise. She hopes that using blood tests to diagnose depression will help expedite the otherwise lengthy process. But she does not feel that current diagnostic practices should be replaced. Instead, the combination of blood tests and self-report evaluations of symptoms may be key to early diagnosis in the future.

Although further research is needed, the hope is that blood tests may eventually help clinicians with the question of which treatment may be most effective for which client. “I think this opens the possibility to begin to look at whether there are biomarkers that may be able to predict response to a behavioral treatment like cognitive behavioral therapy, pharmacotherapy and other forms of treatment,” says co-author David Mohr.

Redei’s research responds to the very real need for more efficient and effective methods of diagnosing depression.  And it opens doors to new ways of understanding the disorder and its identifying characteristics.

– Alessandro Perri, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Nasal Spray May Prevent PTSD, Study Finds

Nasal Spray May Prevent PTSD, Study Finds

00Ethics and Morality, Featured news, Law and Crime, Memory, Neuroscience, Post-Traumatic Stress Disorder, Therapy, Trauma January, 16

Source: Stan Dominguez on Flickr

The emotional connection between a memory and an event can be powerful. A child rescued from a house fire or a soldier returning from Afghanistan may be plagued by flashbacks that elicit guilt, fear, and anxiety. These associations may disrupt daily functioning, causing social isolation, difficulty sleeping, and paranoia—all symptoms of Post-Traumatic Stress Disorder (PTSD).

Traditionally, PTSD has been treated with counseling and cognitive behavioural therapy, as well as psychiatric medications. Now, new research by biochemistry professor Esther L. Sabban and colleagues at New York Medical College is exploring how to stop the negative emotional association from being formed in the first place. They developed a nasal spray that, when administered before, during, or after crises, may do just that.

The spray contains Neuropeptide Y (NPY) which, at low levels, is associated with reduced negative emotional processing of events. Increased NPY in the amygdala and hippocampus—structures of the brain involved in processing memory and emotional responses—is associated with decreased anxiety, fear, and depression resulting from stressful situations.

Sabban and colleagues found that, when inhaled, the peptide acts as a neurotransmitter that has an immediate effect on the brain and prevents the development of PTSD symptoms in rats. In their study, rats were first subjected to stress by being immobilized, forced to swim, and exposed to chemicals which made them lose consciousness. Thirty minutes before or after the stress, some rats were given NPY. After seven days, rats that received NPY had lower levels of anxiety, decreased avoidant behaviour, and fewer startle responses.

Similar results were obtained when the spray was administered a week after the stressful event.

If effective for people, the spray might benefit those with high-risk jobs or those who help others during emergencies. By reducing negative emotional processing of a traumatic event, victims and responders might have a weaker emotional reaction to the memory, limiting the subsequent development of PTSD symptoms.

But there are many questions as well as practical impediments.

Professor Evelyn Tenanbaum of Albany Law School outlines a number of legal and ethical issues that using this spray might have. She argues that blunting the emotional impact of such an event could hinder a victim’s ability to impact a judge or jury in criminal trials. Social change may also be more difficult as the emotional stories of trauma victims often act as catalysts.

Informed consent before administration must also be considered. Victims need to know they may no longer be a reliable witness to a crime and that their memory of the incident may become unclear. Informed decisions may be hard to make during crisis situations.

It is also important to remember that the spray has only been tested on animal populations. NPY purportedly severs ties between emotion and memory; it is unclear what this would mean for humans. Would individuals be left feeling neutral regarding the traumatic event?

A lack of emotion may leave some victims confused or depressed in an entirely different way. Philosophical counselor Elliot Cohen writes how some individuals may become depressed over not feeling guilt, even if they were not personally responsible for the event’s occurrence. And, some victims find their traumatic histories become vital parts of their identities. Personal experiences, memories, and feelings about painful events inform how we see ourselves. What does blunting memory do to a person’s sense of who they are?

NPY’s unpredictable effects on human emotion require much research. If effective, the spray might be a powerful tool for preventing PTSD in some.

Still for others, a painful memory may be preferable to none at all.

– Anjali Wisnarama, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Patients with Misophonia require help and understanding

Patients with Misophonia require help and understanding

10Empathy, Featured news, Happiness, Loneliness, Neuroscience, Relationships, Social Life November, 15

Source: Rick&Brenda Beerhorst on Flickr

Some people find the sound of nails on a chalkboard or the rumbling of a snoring spouse irritating, but what if the sound of someone breathing sent you into a fit of rage?  This is a reality for many sufferers of misophonia.

Only recently garnering attention from researchers, misophonia is a condition where individuals have a decreased tolerance for certain sounds.  Chewing, coughing, scratching, or pen clicking can provoke an immediate aggressive response.  Verbal tantrums are common and in severe cases, sufferers may even physically attack the object or person causing the noise.

“I turn my eyes to face the source of the noise and feel myself glaring at that person in rage,” misophonia sufferer Shannon Morell explains to The Daily Record.  “The only thing I can think about is removing myself from the situation as quickly as possible.”

Many sufferers begin to structure their lives around their struggle with the disorder and avoid triggers by socially isolating themselves.  Public spaces like restaurants or parks are readily avoided and in extreme cases, eating or sleeping in the same room as a loved one can feel impossible.  Even establishing or maintaining relationships is very challenging.

Misophonia can interfere with academic and work performance.  In a study by PhD candidate Miren Edelstein at the University of California in San Diego, patients reported trouble concentrating in class or at work due to distraction from trigger noises.  In some cases, students may resort to isolating themselves, taking their courses online.

David Holmes tells The Daily Record that he finds refuge in using headphones (whenever possible) to block out external noises while at work.

The cause of misophonia is currently believed to be neurological, where the patient’s limbic (emotional) and autonomic nervous systems are more closely connected with the auditory system.  This may be why hearing a disliked sound elicits an emotional response.  Aage Moller, a neuroscientist at the University of Texas, describes it as a complication in how the brain processes auditory stimuli.

Research shows that misophonia usually develops at puberty and tends to worsen into adulthood.

But misophonia is still greatly misunderstood.  There is a lack of research examining its causes or possible treatments.  There is no cure, and some critics even wonder if misophonia should be considered a disorder at all, arguing instead that it’s just a personality quirk.

While it seems there is little help available for people with the disorder, Misophonia UK, an organization dedicated to providing information and support to misophonia sufferers, outlines a number of interventions.

Tinnitus Retraining Therapy (TRT) involves teaching patients how to slowly build sound tolerance, while Cognitive Behavioural Therapy (CBT) focuses on changing negative attitudes that can contribute to the severity of the disorder.  In some cases, hypnosis can be used to relax individuals.  Breathing techniques are also taught so patients can learn to sooth themselves when hearing their trigger noises.

Keeping a diary to record feelings and providing education to loved ones are also strategies recommended by Misophonia UK.  Support groups and online forums like UK Misophonia, Selective Sound Sensitivity, and Misophonia Support also provide a way for sufferers to share their experiences and interact with others.

Researchers in the Department of Psychiatry at the University of Amsterdam say that DSM classification may be necessary to pave the way for more recognition and research on the disorder, and that if misophonia is not regarded as a distinct psychiatric condition, it should at least be viewed as part of Obsessive Compulsive Spectrum Disorder (OCSD).

The prevalence of misophonia is currently not documented, and it seems few seek help.  Suffers of misophonia can only do so much on their own before the disorder starts intruding on their lives.

– Anjali Wisnarama, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

empathy sand sculpture_1

I Feel Your Pain: The Neuroscience of Empathy

00Empathy, Featured news, Neuroscience, Relationships, Stress April, 15

Source: Empathy Sand Sculpture/photopin

“I saw you doubling over and it felt like a shot right through me. I didn’t see any blood and there was nothing that scared me. Just you, in your misery, and a horrible sensation…I could feel your pain.”

This was my mother’s explanation for fainting while watching the doctor treating me in the operation room.

While fainting from another person’s pain may be uncommon, it brings into view an interesting aspect of human experience: the ability to relate to and feel the sensations of others.

Empathy is understanding and experiencing emotions from the perspective of another, a partial blurring of lines between self and other. We put ourselves in the shoes of others with the intention of understanding what they are going through, we employ empathy to make sense of their experiences.

Pain empathy takes the concept of empathy to the next level, describing physical sensations occurring to others. The concept has been portrayed in the form of sympathetic pregnancy, men reporting symptoms similar to those of their pregnant partners.

A subset of motor command neurons, mirror neurons are thought to be responsible for these sensations, firing in our brain when we perform an action, or when we observe someone else perform an action. These neurons can make you feel like you know what the other person is feeling. Witnessing someone getting hit by a ball, you feel a twinge of pain too.

Originally discovered in primates, mirror neurons have been used to explain how humans relate, interact, and even become attached.

Mirror neurons connect us to others. Neuroscientist Vilayanur Ramachandran, at the University of California, has described mirror neurons as dissolvers of physical barriers between people (he even nicknamed them Gandhi neurons), explaining that it is our skin receptors that prevent us from getting confused and thinking we are actually experiencing the action.

Though not entirely responsible for empathy, mirror neurons do help us detect when another person is angry, sad or happy, and allow us to feel what the person is feeling as if we were in their place.

Ramachandran suspects that mirror neuron research will lead to understanding purported mind reading abilities, which may in fact have an organic explanation, such as a strong empathic occurrence in which one’s emotional/physical sensations are experienced by the other.

Mirror neurons are important in learning and language acquisition. Through imitation, vicarious learning allows for the construction of culture and tradition.

When malfunctioning, mirror neurons may have a big impact. Individuals diagnosed with autism have difficulty with empathy. And as Ramachandran suggests, it is indeed mirror neuron dysfunction that is involved in autism.

The discovery of mirror neurons also helps us rethink other concepts, such as human evolution. Ramachandran says that mirror neurons are what make culture and civilization possible because they are involved in imitation and emulation. In other words, historically, to learn to do something, we have adopted another person’s point of view, and for that we’ve used mirror neurons.

Empathy allows for intimacy and closeness, and mirror neurons provide evidence that humans are biologically inclined to feel empathy for others. More than just an abstract concept, empathy seems rooted in our neurological makeup.

My mother fainted because she couldn’t endure my pain. Perhaps my suffering triggered great anxiety that her body was unable to manage. Or maybe she physically felt my pain.

Mirror neurons are the interface that joins science and humanities. The connection allows us to reconsider concepts like consciousness, the self, even the emergence of culture and civilization.

Indeed, it’s not surprising that Ramachandran compares the discovery of mirror neurons in psychology, to the discovery of DNA in biology.

– Contributing Writer: Noam Bin Noon, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

4522309210_a703f7ed0b_o

Forgetting PTSD: How Genes Affect Memory

00Fear, Featured news, Genetics, Memory, Neuroscience, Post-Traumatic Stress Disorder, Therapy, Trauma April, 15

Source: Jared Rodriguez // Flickr

Memory can be a double edged sword. It holds our identities, our relationships, our histories. But when memory holds our most unspeakable stories, it can become a painful burden.

Sufferers of PTSD live with this reality. Many cannot forget. Recent studies have found that a gene, called tet1, plays a central role in forgetting such traumatic experiences.

Massachusetts Institute of Technology researcher, Andrii Rudenko, found that when people with normal levels of this gene experience a traumatic event, the triggers to traumatic responses become extinct over time. For example, if you were bitten by a dog after walking past a neighbour’s house, you may be reluctant to walk by that same house again. And if you continued to walk past the house and nothing happened, eventually the association with being bitten and walking past that house would become extinct –you would no longer fear walking past the house. However, people with PTSD do not form these new associations, and would continue to fear walking past the neighbour’s house.

Currently, one of the most effective treatments for PTSD is exposure therapy, where patients learn new associations by being exposed to the triggers of PTSD in safe environments. This can include practicing driving on a driving simulator for someone who is afraid to drive due to a motor vehicle accident. Over time, patients begin to learn that driving is not as dangerous as they came to believe.

The tet1 gene aids in the expression of genes in the brain that help people form new memories and cover up old ones. However, when a person has low levels of this gene, old and traumatic memories are not masked.

In Rudenko’s study, mice were conditioned to fear a particular cage using electric shocks. When the electric shock was taken away and the mice were placed in the cage, the mice with normal levels of the tet1 gene lost their fear of the cage, while the mice with low levels of the tet1 gene continued to fear as before.

A process called DNA methylation blocks the expression of the promoter genes that are responsible for forming new memories. The methylation process is lowered by tet1 and other tet proteins in areas of the brain that are important for forming memories, including the hippocampus and the cortex.

Simply put, the more tet proteins, the more expression of promoter genes and memories formed. Conversely, even though low levels of the tet1 gene make learning new things difficult, it has been hypothesized that fear responses are so strong that tet2 and tet3 proteins can compensate for the demethylation processes of tet1 proteins. Therefore, memories are formed during strong responses to fear or traumatic events, but with a lack of tet1 proteins, new memories are not formed to replace the old memories, and chronic PTSD is the result.

Li-Huei Tsai, director of MIT’s Picower Institute for Learning and Memory, told MIT news that “if there is a way to significantly boost the expression of these genes, then extinction learning is going to be much more active.” That is, if we can find a way to boost the expression of the tet1 gene, then people’s traumatic memories will be covered up by new memories quicker.

Memory extinction, prefrontal lobotomies, and other psychosurgeries have been a topic of popular film and literature. It’s not surprising that questions on how these findings may be applied to PTSD treatment have raised eyebrows.

According to Tsai, “What happens during memory extinction is not erasure of the original memory.” Instead, new memories and associations can be formed and old ones forgotten. In the case of the mice, the mice with the higher levels of the tet1 gene begin to learn that the cage is safe, and forget that it was once dangerous. In Rudneko’s view, “association with safety is rebuilt.”

Manipulating tet1 proteins in the brain and combining exposure therapy may bring new PTSD treatment possibilities. This method might even be used to assess a person’s genetic predisposition to PTSD. One imagines a possible screening tool for applicants to jobs with exposure to highly stressful events, like police officers.

This research is still in its infancy. Yet it shows promise for those who, despite their best efforts, can’t find a way to forget.

– Contributing Writer: Andrew McColl, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit:Jared Rodriguez // Flickr

This article was originally published on Psychology Today

Brain Trauma, feature2

Coping With Traumatic Brain Injury

30Anxiety, Child Development, Cognition, Depression, Empathy, Environment, Featured news, Health, Memory, Neuroscience, Productivity, Sleep, Sport and Competition, Trauma February, 15

Source: Shine In Your Crazy Diamond//Flicker

Traumatic brain injuries (TBI) contribute to many deaths each year, and can lead to the development of secondary mental health problems.  The Centre for Disease Control has reported that approximately 1.7 million TBIs occur every year, and individuals with a TBI commonly suffer cognitive impairments and developmental delays.

The Trauma & Mental Health Report recently spoke with Tricia Williams, a clinical neuropsychologist at Holland Bloorview Kids Rehabilitation Hospital, who works with children who have different forms of TBI.  Williams explained how to improve child development and mental health for individuals coping with a TBI.

Q:  What are the most common injuries that lead to the development of a TBI?

A:  A TBI is caused when an external mechanical force, such as a blow to the head or a concussive force causes harm to the head or body.  Motor vehicle accidents are the leading cause of TBIs.

Other common injuries include falls (which are common in young children and infants), sport injuries, concussions, horseback riding, interpersonal violence (fighting, gun shots, physical hits to the head by person/object,) and war related injuries.

Q:  How is a TBI diagnosed?

A:  Professionals in emergency services diagnose a TBI in the acute state at the time of injury.  They assess the severity of the injury by checking eye responses, verbal responses, motor responses, and mobile ability.  CT scans are initially performed to rule out bleeding and swelling, and then an MRI may be performed as follow up.  Amnesia is another way to diagnose a TBI. The degree of memory loss prior to the event, and difficulty forming new memory can provide more information about the injury. The duration of loss of consciousness can also affect the severity of the injury, which may be ranked as either mild, moderate, or severe.

Q:  What is involved in rehabilitation following a TBI?

A:  In the acute state, the TBI is managed medically, including neurosurgical intervention.  Once stabilized at the hospital, children move on to rehabilitation.  An assessment of physical, functional, and speech abilities are conducted, and occupational therapists and speech and language pathologists then work with the children. Neuropsychological assessments are conducted after the acute state to help children transition back to school.  The children continue with follow-up visits to monitor the impact of the injury on developing cognitive skills.

Q:  As a clinical neuropsychologist, what is your role with patients who have a TBI?

A:  Children are seen as inpatients at the hospital after the injury, and are also seen as outpatients after they have transitioned home.  They can be followed for many years after the injury.  Typically, they are seen during transitional periods such as the transition from primary school to high school.  A thorough assessment of the child’s skills (IQ, memory and learning, language, processing speed, executive functioning, academic skills, visual and motor skills, socio-emotional status) are conducted and compared to previous testing to assess the child’s progress and developing difficulties.

Q:  What daily activities can become difficult for an individual with a TBI?

A:  Activities that can be difficult depend on the nature and severity of the injury, the stage of recovery, and how well they have been supported.  Common complaints across all injuries include:  keeping up with class, forgetfulness, difficulty paying attention, and becoming easily fatigued, overwhelmed, and frustrated.  Because these activities can be challenging, continued support from their physicians and neuropsychologists as well as family support is very important during the recovery process.

Q:  How can secondary mental health symptoms develop from a TBI?

A:  Depression is a common outcome, and can develop as a reaction to the injury or to neurochemical changes in the brain.  Anxiety is also a common reaction to the injury, because if the child is old enough to understand what has happened, they might expect it to happen again.  This is common for children who developed a TBI as a result of a sports injury.  Children can also be anxious about their academic achievement and about performing well in school.  It is important to make patients aware of potential secondary mental health symptoms. But, individuals with a TBI can also have a greater appreciation of life, as they see themselves as survivors.

Q:  What advice can you offer someone with TBI?

A:  Be patient with yourself and try to normalize your emotional variability.  It’s important to ask for and accept help, and to find the balance between accepting what has happened and moving on.  Individuals should keep in mind that while there are variable outcomes, full recovery is possible.  Finding a “new normal” for oneself without becoming centered on the injury is extremely important.

Q:  Do you have any further suggestions for coping with a TBI?

A:  Here is a list of helpful tips:

  • Take additional time on activities as needed
  • Manage fatigue (with exercise/relaxation, sleep)
  • Ask for repetition of key information and written outlines of key terminology
  • Repeat back what people tell you to ensure you are understanding
  • Use your phone or equivalent to make dictated notes and reminders with regularly scheduled playback times
  • Break down (or ask someone to help you break down) larger tasks into smaller manageable parts
  • Choose the time of day when you are most able to accomplish tasks that require more obvious mental effort and sustained attention
  • Recognize the signs that you are losing attention/productivity or becoming overwhelmed and take a break
  • Exercise can help relieve tension, improve sleep and attention
  • Seek out a quiet room to complete work or practice techniques as needed
  • Social support is extremely helpful

Traumatic brain injuries (TBI) contribute to many deaths each year, and can lead to the development of secondary mental health problems.  The Centre for Disease Controlhas reported that approximately 1.7 million TBIs occur every year, and individuals with a TBI commonly suffer cognitive impairments and developmental delays.

The Trauma & Mental Health Report recently spoke with Tricia Williams, a clinical neuropsychologist at Holland Bloorview Kids Rehabilitation Hospital, who works with children who have different forms of TBI.  Williams explained how to improve child development and mental health for individuals coping with a TBI.

Q:  What are the most common injuries that lead to the development of a TBI?

A:  A TBI is caused when an external mechanical force, such as a blow to the head or a concussive force causes harm to the head or body.  Motor vehicle accidents are the leading cause of TBIs.

Other common injuries include falls (which are common in young children and infants), sport injuries, concussions, horseback riding, interpersonal violence (fighting, gun shots, physical hits to the head by person/object), and war related injuries.

Q:  How is a TBI diagnosed?

A:  Professionals in emergency services diagnose a TBI in the acute state at the time of injury.  They assess the severity of the injury by checking eye responses, verbal responses, motor responses, and mobile ability.  CT scans are initially performed to rule out bleeding and swelling, and then an MRI may be performed as follow up.  Amnesia is another way to diagnose a TBI. The degree of memory loss prior to the event, and difficulty forming new memory can provide more information about the injury. The duration of loss of consciousness can also affect the severity of the injury, which may be ranked as either mild, moderate, or severe.

Q:  What is involved in rehabilitation following a TBI?

A:  In the acute state, the TBI is managed medically, including neurosurgical intervention.  Once stabilized at the hospital, children move on to rehabilitation.  An assessment of physical, functional, and speech abilities are conducted, and occupational therapists and speech and language pathologists then work with the children. Neuropsychological assessments are conducted after the acute state to help children transition back to school.  The children continue with follow-up visits to monitor the impact of the injury on developing cognitive skills.

Q:  As a clinical neuropsychologist, what is your role with patients who have a TBI?

A:  Children are seen as inpatients at the hospital after the injury, and are also seen as outpatients after they have transitioned home.  They can be followed for many years after the injury.  Typically, they are seen during transitional periods such as the transition from primary school to high school.  A thorough assessment of the child’s skills (IQ, memory and learning, language, processing speed, executive functioning, academic skills, visual and motor skills, socio-emotional status) are conducted and compared to previous testing to assess the child’s progress and developing difficulties.

Q:  What daily activities can become difficult for an individual with a TBI?

A:  Activities that can be difficult depend on the nature and severity of the injury, the stage of recovery, and how well they have been supported.  Common complaints across all injuries include:  keeping up with class, forgetfulness, difficulty paying attention, and becoming easily fatigued, overwhelmed, and frustrated.  Because these activities can be challenging, continued support from their physicians and neuropsychologists as well as family support is very important during the recovery process.

Q:  How can secondary mental health symptoms develop from a TBI?

A:  Depression is a common outcome, and can develop as a reaction to the injury or to neurochemical changes in the brain.  Anxiety is also a common reaction to the injury, because if the child is old enough to understand what has happened, they might expect it to happen again.  This is common for children who developed a TBI as a result of a sports injury.  Children can also be anxious about their academic achievement and about performing well in school.  It is important to make patients aware of potential secondary mental health symptoms. But, individuals with a TBI can also have a greater appreciation of life, as they see themselves as survivors.

Q:  What advice can you offer someone with TBI?

A:  Be patient with yourself and try to normalize your emotional variability.  It’s important to ask for and accept help, and to find the balance between accepting what has happened and moving on.  Individuals should keep in mind that while there are variable outcomes, full recovery is possible.  Finding a “new normal” for oneself without becoming centered on the injury is extremely important.

Q:  Do you have any further suggestions for coping with a TBI?

A:  Here is a list of helpful tips:

Take additional time on activities as needed
Manage fatigue (with exercise/relaxation, sleep)
Ask for repetition of key information and written outlines of key terminology
Repeat back what people tell you to ensure you are understanding
Use your phone or equivalent to make dictated notes and reminders with regularly scheduled playback times
Break down (or ask someone to help you break down) larger tasks into smaller manageable parts
Choose the time of day when you are most able to accomplish tasks that require more obvious mental effort and sustained attention
Recognize the signs that you are losing attention/productivity or becoming overwhelmed and take a break
Exercise can help relieve tension, improve sleep and attention
Seek out a quiet room to complete work or practice techniques as needed
Social support is extremely helpful

– Contributing Writer: Janany Jayanthikumar, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit: Shine In Your Crazy Diamond//Flickr 

This article was originally published on Psychology Today