Brain Blogger » Psychology & Psychiatry http://brainblogger.com Health and Science Blog Covering Brain Topics Sat, 22 Nov 2014 12:00:34 +0000 en-US hourly 1 http://wordpress.org/?v=4.0.1 Psychotherapy for Paranoid Schizophrenia http://brainblogger.com/2014/10/27/psychotherapy-for-paranoid-schizophrenia/ http://brainblogger.com/2014/10/27/psychotherapy-for-paranoid-schizophrenia/#comments Mon, 27 Oct 2014 11:00:04 +0000 http://brainblogger.com/?p=17296 Often psychotherapy is not considered to be effective with individuals dealing with schizophrenia spectrum disorders. But a cognitive-relational psychotherapy approach helps form a warm, trusting and detached relationship, conveys an understanding and concern for one’s client, and involves the therapist telling that individual their own empathic views about what that individual is dealing with.

Often clinicians assume that psychotherapy does not work well with persons manifesting what are called “thought disorders” – conceived to be irrational, unrealistic and factually inaccurate. Again, clinicians fail to understand, empathically, the circumstances of the psychotic individual. It should be noted that schizophrenics deal with non-normative experience that, in terms of hallucinations, is visceral in nature. This experience entrenches them in delusions based on hallucinations that are highly convincing.

One idea that may help schizophrenics is reflected in this line from a poem I wrote: “May you walk beyond the empty sudden blindness of existence.” To schizophrenics in crisis and even those not in crisis, the future may seem to be extremely uncertain and perhaps treacherous. They may perceive both the mental and the material worlds as incredibly dangerous. And in many ways, they are dangerous, due to the amount of suffering experienced by the paranoid schizophrenic that seems to her to be inflicted on her by these worlds.

No knowledge about knowledge

A non-epistemological stance regarding no knowledge about knowledge may help a schizophrenic replace her delusions. Essentially, the non-epistemological view represents deconstruction of knowledge with an assertion that relies on the fact that all “knowledge” is subjective. While schizophrenics have subjective views regarding their own knowledge, and although this may be communicated to them, they may be able to understand, in a similar sense, that nobody really has any kind of certain knowledge.

In terms of non-epistemology, it may not be possible to live in the world on these terms. Moreover, it may not be possible to tolerate an awareness that anything may happen to us at any time that will catapult us into crisis. The sudden death of a loved one may be an example of this.

Typically, we reside in faith that things will go normally and as planned, and they generally do so. However, the schizophrenic lacks such faith. If the therapist can communicate to the schizophrenic that she should try to get as comfortable as possible with simply “not knowing,” this may help the schizophrenic. There is a basis for “not knowing” that corresponds to everyone’s subjective experiences of the world, and this is reflected in all individuals’ perspectives on the mental and the material worlds. Realistically, it might be more threatening to the schizophrenic to “not know”, as opposed to clasping her delusional beliefs.

In terms of addressing the idea of “not knowing” with the paranoid schizophrenic, the psychotherapist may say the following: “Nobody knows what the future may bring. If you buy a lottery ticket, even if the chances are small, you may win the lottery. If you have sex, even with birth control, you may become a parent. Most events in are life happen by chance. You don’t really know what will happen, even if you fear with certainty that bad things will happen to you. Your condition of schizophrenia really causes you to suffer mostly because of your fear of bad things happening to you, rather than these things actually happening to you. Maybe the thing you should fear in your life is the fear itself. By realizing that you do not know what the future will bring, you may feel safer.”

Context matters?

Another aspect of dealing with schizophrenia is encompassed in the idea, stated by Ralph Ellison in The Invisible Man: “If you don’t know where you are, you don’t know who you are.”

This statement implies that one needs to know her context in order to know her self and her identity. Often schizophrenics fail to know their contexts. They have confused and distorted ideas about context, based on the fact that their contexts, in their minds as well as in the material world, may reflect delusions and hallucinations. This leads to ambiguity as perceived by the schizophrenic in her mental and material environments as threatening, simply because the schizophrenic may be dealing with non-normative experience.

The clinician may convey to the schizophrenic the idea of not knowing her context by stating: “It’s hard to know what you think of yourself when you don’t really know what you are dealing with in the world. This may be what causes you to be afraid of the world. And this means that you are afraid of both your voices in your mind, (for example), and the people outside in the world.”

The schizophrenic may adhere to her delusional beliefs due to the fact that she, as well as virtually everyone else in the world, thinks that knowing one’s context allows them to be safer than they would be if they did not “know what they know”, even when “knowing what they know” may be delusional. Again, the assertion that the client does not really know what her worlds signify can replace delusional ideas.

One way of communicating this idea to a paranoid schizophrenic would be constituted by saying: “You might think that being a schizophrenic makes people prejudiced towards you, and it may, but also the world we live in makes you into a schizophrenic. Your context in the world – and how the world views you – may be determined by the situation that you are in. You may believe that this is false, that you really know more than other people about the world, but you still do not know what you are in the world, perhaps because believing you are schizophrenic may be unacceptable and may not make sense to you. Nevertheless, you do not know for certain what the world is. That is why it is scary. And you don’t know who and what you really are, because you may believe one thing and others believe differently.”

Treating life as normal

Another idea for dealing with hallucinations and delusions stems from a novel by Carrie Fisher, Postcards from the Edge, which states the idea that: “Perhaps if we treat life as normal, a sense of normalcy will follow.”

This idea is highly salient to dealing with one’s hallucinations and delusions. The schizophrenic may be perhaps traumatized by her experience, but treating life as normal may lead to a gradually acquired feeling of safety.

The idea embedded in this statement from Fisher reflects the advantages of the act of challenging the delusions of a schizophrenic by the schizophrenic. Living one’s life normally in terms of habits and faith in the normative view of reality may allow the schizophrenic to experience the decay of her fears, her paranoia and her delusions. Not obsessing about one’s hallucinations and delusions, by trusting life to proceed normally, combats the punitive experience of schizophrenia and paranoid schizophrenia, in particular.

It should be noted that the ideas contained within this article represent an intellectualized framework of how the clinician or the psychotherapist may approach therapy with a paranoid schizophrenic. They may also be applicable to those who are high functioning, but may be suffering to an extreme extent.

A belief in the scientific bases for the effectiveness of psychiatric medications may be a belief that can be cultivated or even spontaneously adhered to by the schizophrenic. Nevertheless, non-normative experience may lead to non-normative thought, and the deep communication by an empathic therapist who is able to accurately imagine and recapitulate to the schizophrenic what she is dealing with may be in some sense curative.

I have applied these ideas to psychotherapy with paranoid schizophrenics with some success. One client, a paranoid schizophrenic, was struck by the idea that “if you don’t know where you are, you don’t know who you are.” She asked for a restatement of that idea based upon the connection she had established with it. Another schizophrenic stated humorously that he wanted to write a book entitled, The Fallacy of Truth.” He was able to understand a non-epistemological stance. Lastly, one client tried diligently to treat her life as normal and routine even though she was hyper-vigilant and paranoid. The trauma that she experienced precluded her from entirely benefiting from this perspective, but she became extremely high functioning.

Overall, these ideas for psychotherapy, from a cognitive relational perspective, may be of some help to some people, especially paranoid schizophrenics. However, it should be noted that the different types of schizophrenia may correspond with different interventions and treatment.

Image via Diez Artwork / Shutterstock.

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Comparing the 5 Theories of Emotion http://brainblogger.com/2014/10/22/comparing-the-5-theories-of-emotion/ http://brainblogger.com/2014/10/22/comparing-the-5-theories-of-emotion/#comments Wed, 22 Oct 2014 11:00:19 +0000 http://brainblogger.com/?p=17415 Emotions seem to dominate many aspects of our lives. But what exactly are emotions?

The word first appears in our language in the mid-16th century, adapted from the French word émouvoir, which literally means, “to stir up”. However, one can find precursors to the word emotion dating back to the earliest known recordings of language. When searching for a definition, Hockenbury describes an emotion as “a complex psychological state that involves three distinct components: a subjective experience, a physiological response, and an expressive response.”

Researchers have long studied how and why people experience emotion and a number of theories have been proposed. In order to compare and contrast these theories of emotion it is helpful to first explain them in terms of the interactions between their components: an emotion-arousing stimulus, a response of physiological arousal, a response of cognitive appraisal, and the subjective experience of emotion.

According to the James-Lange theory, initially proposed by James and around the same time also by Lange, the stimulus leads to the arousal that leads to the emotion. The sound of a gun shot, for example, leads to the physiological responses like rapid heart rate and trembling that lead to the subjective experience of fear. On the other hand, according to the Cannon-Bard theory, proposed first by Cannon and later extended by Bard, the stimulus leads to both the arousal and the emotion. The sound of a gun shot, for example, leads both to the physiological responses like rapid heart rate and trembling and to the subjective experience of fear.

The two most well-known cognitive theories are the two-factor and the cognitive-mediational theories of emotion. According to the two-factor theory, proposed by Schachter and Singer, the stimulus leads to the arousal that is labelled using the cognition that leads to the emotion. The sound of a gunshot, for example, leads to the physiological responses like rapid heart rate and trembling that are interpreted as fear and lead to the subjective experience of fear.

According to the cognitive-mediational theory, proposed by Lazarus, the stimulus leads to the personal meaning arrived at using cognition that leads to both the arousal and the emotion. The sound of a gunshot, for example, is interpreted as something potentially dangerous and leads to both the physiological responses like a rapid heart rate and trembling and the subjective experience of fear.

Finally, according to the facial feedback theory, emotion is the experience of changes in our facial muscles. In other words, when we smile, we then experience pleasure, or happiness. When we frown, we then experience sadness. It is the changes in our facial muscles that cue our brains and provide the basis of our emotions. Just as there are an unlimited number of muscle configurations in our face, so to are there a seemingly unlimited number of emotions. The sound of a gunshot, for example causes your eyes to widen, your teeth clench and your brain interprets these facial changes as the expression of fear. Therefore, you experience the emotion of fear.

By breaking them down in this way, one can already notice the differences and similarities between the different theories, as one can clearly identify the components that exist in each theory and the order in which they occur. As can be seem from the above, the James-Lange and Cannon-Bard theories are fundamentally similar in that they both involve the same three components but different in how they handle the timing of when arousal and emotion occur. They differ from the two cognitive theories in that both of them do not explicitly acknowledge any role of cognition.

Regarding the similarities, the sequence of the three components in both the James-Lange and two-factor theories and in both the Cannon-Bard and cognitive-mediational theories is the same, the fundamental difference between the two theories comprising each pair being the addition of a cognition component at some point in the sequence in the cognitive theories.

References

Hockenbury & Hockenbury (2007). Discovering Psychology: Fourth Edition. New York: Worth Publishers, Inc.

JAMES, W. (1884). II.—WHAT IS AN EMOTION ? Mind, os-IX (34), 188-205 DOI: 10.1093/mind/os-IX.34.188

Lazarus, R. S. (1991). Emotion and adaptation. New York: Oxford University Press.

Myers, D. G. (2004). Theories of Emotion. Psychology: Seventh Edition, New York, NY: Worth Publishers.

Image via Elnur / Shutterstock.

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Poor Social Judgment – An Aspect of Schizophrenia http://brainblogger.com/2014/10/12/poor-social-judgment-an-aspect-of-schizophrenia/ http://brainblogger.com/2014/10/12/poor-social-judgment-an-aspect-of-schizophrenia/#comments Sun, 12 Oct 2014 11:00:40 +0000 http://brainblogger.com/?p=17244 There are three components that generally typify an individual emerging with schizophrenia: alienation, introversion and divergent thinking. Together, these characteristics diminish the schizophrenic individual’s capacity for exercising good judgment in social situations.

Alienation

People with emerging schizophrenia are generally socially impaired and isolated. As stated by Burns (2006), “premorbid developmental and social impairments have been well documented in adult schizophrenia.” People with schizophrenia tend to be unpopular and uninvolved in primary and secondary school, and they may also be more introverted than their peers.

The mentally ill are possibly the most alienated members of our society. Research suggests that social isolation (i.e. limited social interaction with other children) and poor or disrupted interpersonal relations during childhood, teen and early adult years appear to increase an individual’s risk for future development of schizophrenia-spectrum disorders. It is quite possible that social isolation is causally implicated in the presentation of schizophrenia, instead of simply being correlated with psychosis as a separate characteristic. It is obvious that social isolation is a consequence of schizophrenia.

Introversion

Introversion may also accompany psychosis, and it too may be inexorably intertwined with alienation and psychosis. Divergent thinking has been noted to be descriptive of individuals that may be more self-involved, at least in terms of their thinking processes. Jung noted that introverts solve their problems in their own minds, as opposed to extroverts who rely on the external world and interaction with other people in solving problems.

As stated by Rugu (2013), “one is predominantly introverted if his interest and attention generally turn inward, toward his own thoughts and feelings; if his interest and attention are generally directed outward, toward other people and external stimuli, he is predominantly extroverted.” Clearly, however, there exists a continuum between introversion and extraversion, with most individuals falling between the two extremes. Nevertheless, most schizophrenics are probably more introverted than they are extroverted, and the social isolation that may accompany their introversion may be extreme.

Divergent thinking

In previous articles, I’ve suggested that schizophrenic individuals tend to be divergent thinkers. Divergent thinking has been noted to rely on perceiving more details in the in the mental and the material worlds than what might emerge from what may be called dogmatic thinking, and it should be understood that there exists worlds that are constituted by the material and the non-material.

While people with schizophrenia may be more imaginative than non-mentally ill individuals, the creativity implicit in their thought processes may not be productive in a positive sense, specifically because they may lack the quality of convergent thinking, involving analytic reasoning and logic. Schizophrenics may have more details at their disposal with which to construct their world-views, but they may not be able to construct their world-views in a meaningful way. Divergent thinking characterizes perhaps all forms of schizophrenia. It may be most obvious in the paranoid schizophrenic, but the results of this type of thinking, when convergent thinking is lacking in the individual, can be seen disorganized schizophrenic individuals.

Divergent thinking accompanies social isolation due to the fact that this type of thinking leads to unique ideas, whether these are good ideas or bad ideas, and whether these ideas are practically applicable to problems in the material and mental worlds. Because divergent thinking is a quality that characterizes schizophrenic individuals as well, it might be said, again, that divergent thinking is a correlate of schizophrenia and it may result in alienation. Alienation, divergent thinking, and introversion all may be amalgamated as causes of the psychotic presentation. In combination, these characteristics allow for the synergy between isolation and introversion, compounded by the influence of divergent thinking, perhaps without the convergent thinking which would permit solutions to problems related to social interaction.

The synergy between alienation, introversion and divergent thinking may all equally form part of the personality of the schizophrenic individual. This personality will be dysfunctional in meeting the interpersonal needs of the schizophrenic individual, due to the nature of intrapersonal self-involvement reflected in alienation, introversion and divergent thinking.

Social judgment

Ultimately, it is social judgment that is compromised by these three characteristics. The schizophrenic’s essential and paramount battle may be to ameliorate the effects of stigma, a consequence of implicit societal attitudes that are a reaction to the schizophrenic’s hapless and unintended nonconformity.

Without social judgment, the schizophrenic may have no means of negotiating social relationships, she may be unable to understand how others view her, and she may lose contact with others in the material world. This loss of real world social contact, then, exacerbates the condition of schizophrenia.

Schizophrenia can be viewed as a vicious cycle caused by alienation, introversion and divergent thinking. Social skills training would be an intervention that might serve to assist schizophrenics in dealing with stigma. This type of training might allow them to approach new acquaintances with knowledge of appropriate disclosure of their condition – disclosure that may demonstrate a social awareness of how their illness is viewed by others. Equipped with an understanding, however limited, of the role of stigma in terms of their interactions with others, people with schizophrenia may be better able to interact in the material world.

References

Burns J (2006). The social brain hypothesis of schizophrenia. World psychiatry : official journal of the World Psychiatric Association (WPA), 5 (2), 77-81 PMID: 16946939

Image via everst / Shutterstock.

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Treating Children and Teens Diagnosed with Schizophrenia http://brainblogger.com/2014/09/24/treating-children-and-teens-diagnosed-with-schizophrenia/ http://brainblogger.com/2014/09/24/treating-children-and-teens-diagnosed-with-schizophrenia/#comments Wed, 24 Sep 2014 11:00:11 +0000 http://brainblogger.com/?p=17114 In this article, I will focus on treatment considerations regarding the diagnosis of schizophrenia in children and adolescents. This article on assessment of schizophrenia concerns the nature of psychological tests that evaluate the prevalence of schizophrenic symptoms in an individual child or adolescent. These specific tests, which rely on interview and self-report, are described as potentially useful in formulating a diagnosis of schizophrenia by a qualified clinician.

There are several treatment strategies for helping one’s child or adolescent cope with a diagnosis of schizophrenia. These avenues to treatment may include psychiatric medication, individual therapy, behavioral intervention, such as a token economy, and family therapy.

Medications for psychotic illnesses have revolutionized the treatment for schizophrenia and psychotic disorders of all types. While some parents may be reluctant to medicate their child for very good reasons, medication nevertheless may be an extremely important piece of a configuration of treatment strategies. The fact is that medication has evolved since the times when medication was viewed by some as “psychiatric straight jacket”. 

While past antipsychotics have been termed “major sedatives”, newer, atypical antipsychotics increase cognitive organization, and, in conjunction with other medications, such as appropriately prescribed antidepressant and mood stabilizing medication, these medications may help the child or adolescent. For this reason, the use of medication should be considered as treatment for children and adolescents who manifest schizophrenic symptoms. It might make them feel better, and it might increase their subjective well-being.

While medication seems to be the treatment of choice for psychotic disorders, other interventions bear scrutiny. Sometimes clinicians underestimate the value of psychotherapy in treating schizophrenia. The reality exists that even the most well-intended parents will have difficulty dealing with their schizophrenic child. However, if a child therapist treats a child, she may have more success in diminishing the overt symptoms of schizophrenia in a child, precisely because she is not one of the child’s parents.

A therapist can be warm and detached, simultaneously. While these two characteristics may seem dichotomous, they can be combined by a therapist so that she does not forfeit her objectivity, but nevertheless nurtures the child. The element of emotional detachment in a therapist is crucial for both parties. One can see that parents and their youths may lack detachment from each other to an extent that creates negative feelings in both the parents and their children. This is why bringing the child in for individual therapy may be crucial to the child’s or the adolescent’s well-being. If nothing else, the therapist might serve as a trusted and caring adult or role model. This type of relationship clearly will benefit the child or adolescent who becomes involved in individual therapy. It should be noted that therapy of any modality, relational, behavioral or eco-systemic, will likely benefit the child or adolescent.

One intervention that relies on the principles of behaviorism is the token economy. A token economy can be described as a system of positive and negative reinforcement by which a child may earn and lose privileges as a result of his behavior. This means that the child essentially enters into a contract with the facilitator of the token economy, who would likely be his parent. The contract between the child and his parent would specify what the child may gain or lose privileges, contingent on whether he did his chores or his homework, as examples. As such, the child may earn one hour of playing video games, as an example, in return for completing his homework.

If the rewards are meaningful to the child, and the system of the token economy seems fair to the child, the token economy will work to change maladaptive behavior. Note, also, that the rules of the token economy may be determined before it is implemented, and the child’s or adolescent’s feelings, as well as his parents’ feelings, should not enter into what and when rewards will be forthcoming. This allows for some detachment, on the part of both the child and the parent, which will assist the process entailed by the token economy, overall.

Family therapy is efficacious in treating the schizophrenic child or adolescent for several reasons. Clearly, by means of family therapy, the schizophrenic child or adolescent will feel supported by her parents in terms of the concern that they demonstrate in gathering together in an effort to help the client, who is the identified patient. Moreover, the family can be guided and monitored by the therapist in such a way that the family members can express their feelings about the issues surrounding the impact of the diagnosis on the family without angering other family members. Lastly, the therapist will be able to normalize the experience of family members, thus clarifying their expectations about living with the diagnosis of the child or adolescent.

Overwhelmingly, however, it is the support of the schizophrenic individual by her family members as evidenced by the choice to engage in family therapy that will have the greatest positive therapeutic effect on that individual. He will know that his family cares about him.

The diagnosis of schizophrenia regarding a child or adolescent is incredibly difficult for the entire family to endure. However, this may be the case largely because the parents do not know how to negotiate the process of beginning with observation of odd behavior in their child, then seeking an assessment for a schizophrenic diagnosis, and culminating in treatment for all family members to help them deal with the situation.

No one expects to have a schizophrenic child. The anger, sadness and grief associated with this diagnosis are extreme. However, parents should note that their child may feel this anger and sadness and grief more poignantly than they do. The odd, confusing and inappropriate behavior of their child or adolescent may be compounded simply because he has received this diagnosis, and he is likely to be treated differently by family members as a result of this diagnosis.

The appropriate behavior of the schizophrenic individual’s family members is crucial to dealing well with this diagnosis. Perhaps the discussion by this writer has in some way illuminated the path for the families of schizophrenic children and adolescents so that they will be able to cope effectively with this diagnosis that need not equate with tragedy.

Image via Nikola Solev / Shutterstock.

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The Relationship Between Depression and Arthritis http://brainblogger.com/2014/08/08/the-relationship-between-depression-and-arthritis/ http://brainblogger.com/2014/08/08/the-relationship-between-depression-and-arthritis/#comments Fri, 08 Aug 2014 11:00:35 +0000 http://brainblogger.com/?p=16947 Both arthritis and depression are common in the United States, with age and obesity trends likely to increase the number of people who suffer from both conditions simultaneously.

Studies have repeatedly demonstrated an association between arthritis symptoms and major depression. Of concern, research has shown that among patients with both conditions, the result is not merely the sum of the suffering and disability associated with each independent illness; when depression coincides with arthritis, studies have found that the conditions are multiplicative rather than additive, amplifying each other.

Arthritis and depression are but one example of the increasingly frequent overlap between medical and behavioral health, and evidence suggests that treating depression reduces arthritis-related healthcare expenditures, increases compliance with arthritis treatment plans, and alleviates physical symptoms.

The Arthritis Problem
According to the CDC’s 2013 Morbidity and Mortality Weekly Report, one in five adults in the United States has physician-diagnosed arthritis. For the past 15 years, arthritis has been the most common cause of disability among U.S. adults. Ten years ago, just under 10 percent of U.S. adults, approximately 19 million people, said their activities of daily living were limited by this chronic condition. The number is projected to reach 25 million by 2030.

In older populations, arthritis is widespread: by age 65, at least a third of people in the U.S. have osteoarthritis, and the majority, approximately 80 percent, experience degenerative changes or joint disease. The costs associated with this are enormous: The American Academy of Orthopedic Surgeons (AAOS) reported an estimated annual cost for medical care to treat arthritis and joint pain of $281.5 billion in 2004. Prescription drugs accounted for 23 percent of the expenditures.

The Depression Problem
The Morbidity and Mortality Weekly Report also notes that depression is more common among people with chronic diseases such as diabetes, asthma, cancer, and arthritis. Citing the Behavioral Risk Factor Surveillance System (BRFSS) survey conducted from 2006 to 2008, 9 percent of U.S. adults, of any health status, met the criteria for depression.

Depressive symptoms have been identified as an independent risk factor for all-cause mortality. A study by Wells et al. found an association between depression and disability where the effects of depression were comparable to several major medical conditions.

When Arthritis and Depression Overlap
When arthritis and depression overlap, studies have shown a synergism resulting in worse suffering and disability than that which would be associated with each condition independently. A 1998 study found that osteoarthritis-related knee pain was associated with depression. Other studies demonstrate worse outcomes, lack of adherence to treatment plans, and increased cost of care in patients suffering from both illnesses.

In addition to increased use of pain medication, a bidirectional relationship exists between the two conditions: Yohannes and Canton describe how the fatigue that accompanies depression results in activity avoidance, which decreases muscle conditioning, resulting in increasing arthritis pain while also leading to social isolation, thereby perpetuating depression. They also note that “a previous history of depression is a better predictor of utilizing healthcare than the severity of osteoarthritis symptoms,” which implies that the financial burdens of arthritis could be mitigated to some extent by addressing coinciding depression.

While osteoarthritis is the most common form of arthritis, another form, rheumatoid arthritis, shows an even more significant link with depression. The National Institute of Mental Health (NIMH) Catchment Area program reports that the lifetime prevalence of psychiatric disorders among patients with rheumatoid arthritis is 63 percent. “Indeed,” state the researchers, “approximately 20 percent of patients with RA are found to have current major depression with potential impact on RA symptoms.”

Devellis and Devellis summarize the implications of these studies, stating that “helping arthritis patients obtain relief from their depression promises both to mitigate the added risk associated with depression and to enable the patient and physician to manage the arthritis itself more effectively. A first step to optimal treatment may simply be an awareness of the role that depression can play in the course of arthritis and its treatment.” Primary care physicians could screen arthritis patients for depression and refer them for treatment.

Treatment
The long term effects of medication, as well as interactions between medications, should be cause for concern among patients afflicted with multiple conditions. Non-steroidal anti-inflammatory and other drugs for arthritis are associated with gastrointestinal issues, renal toxicity, and other side effects.

Breedveld notes that among American adults over the age of 35 with osteoarthritis, 41 percent were also receiving pharmacotherapy for hypertension. As other chronic diseases join the mix of arthritis and depression, the potential for activity-limiting, undesirable medication side effects increases. According to the CDC, 57 percent of those with heart disease also have arthritis, and 52 percent of diabetics have arthritis.

The CDC’s Arthritis Program recommends self-management education and physical activity programs, noting that some of the barriers to self-management through physical activity include lack of time, competing responsibilities, lack of motivation, difficulty finding an enjoyable activity, and fear of exacerbating pain or further damaging joints. Barriers to treating depression often include cost of drugs, side effects, stigma, and the patient-provider relationship.

Studies have shown that older people with osteoarthritis could benefit from combination therapy utilizing medication and cognitive behavioral therapy, however copays are frequently a barrier to treatment for elderly patients on a fixed income. Consistent with the CDC’s recommendations, Yohannes and Canton concluded that self management techniques, medical information, assistance with pain coping skills, and exercise would be beneficial. Cognitive behavioral therapy has been used to cultivate the belief that the patient is equipped to effectively cope with the condition, resulting in increased activity and improvement in depressive symptoms. Aerobic exercise programs have decreased depression in adults with arthritis.

Depression exacerbates the manifestations of joint disease. Recognition of this relationship by family members and providers can lead to better support for the increasing number of people suffering from overlapping medical and behavioral health issues. Counseling, education, and exercise programs have shown the potential to mitigate symptoms and reduce health care spending while improving quality of life and daily functioning.

References

Agarwal P, Pan X, & Sambamoorthi U (2013). Depression treatment patterns among individuals with osteoarthritis: a cross sectional study. BMC psychiatry, 13 (1) PMID: 23607696

Behnam, B. (2013). The Frequency and Major Determinants of Depression in Patients with Rheumatoid Arthritis Turkish Journal of Rheumatology, 28 (1), 32-37 DOI: 10.5606/tjr.2013.2599

Breedveld, F. (2004). Osteoarthritis–the impact of a serious disease Rheumatology, 43 (90001), 4-8 DOI: 10.1093/rheumatology/keh102

Current Depression Among Adults, 2006-2008. (2010). Morbidity and Mortality Weekly Report

Parmelee PA, Harralson TL, McPherron JA, & Schumacher HR (2013). The structure of affective symptomatology in older adults with osteoarthritis. International journal of geriatric psychiatry, 28 (4), 393-401 PMID: 22653754

Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation – United States, 2007-2009. Morbidity and Mortality Weekly Review, 59(139).

Yohannes AM, & Caton S (2010). Management of depression in older people with osteoarthritis: A systematic review. Aging & mental health, 14 (6), 637-51 PMID: 20686976

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Reading Your Psychotherapist’s Mind http://brainblogger.com/2014/07/27/reading-your-psychotherapists-mind/ http://brainblogger.com/2014/07/27/reading-your-psychotherapists-mind/#comments Sun, 27 Jul 2014 11:00:20 +0000 http://brainblogger.com/?p=16895 I am a clinical social worker and faculty member in psychology and community counseling. I came across a provocative article in the New York Times, Wellness section, entitled “What the Therapist Thinks About You”. I am sharing my clinical experience of sharing my notes with the clients I treat.

Mental health patients do not have the ready access to office visit notes that, increasingly, other patients enjoy. But as discussed in the article, Mr. Baldwin is among about 700 patients at Beth Israel Deaconess Medical Center who are participating in a novel experiment.

Within days of a session, they can read their therapists’ notes on their computers or smartphones. The hope is that this transparency will improve therapeutic trust and communication.

The Department of Veterans Affairs, which began making medical and mental health records available online last year, is only just beginning to study the effect of this on mental health patients.

The Beth Israel project grew out of OpenNotes, a program by Dr. Delbanco and his colleagues that made physicians’ notes accessible to 22,000 patients at three institutions. A 2011 study showed that patients responded positively and became more involved in their care.

Mindful of any pitfalls, the Beth Israel psychiatrists have offered notes initially to only 10 percent of patients.

I have been sharing my clinical notes with clients for years now, with no discernible negative effects. However, I do so only at the next session as a review of our last session. I never post them in any electronic format, so as to preserve respect, confidentiality and privacy. I do not trust the safety of electronic information.

I have been doing this for a number of reasons, some I will discuss here.

For one, I believe that all healthcare recipients are entitled to an accurate recording of their care. Secondly, I believe that this approach also solidifies the therapeutic alliance, which is critical to effective care. Thirdly, it reinforces therapeutic momentum and keeps the client and clinician focused on the objectives and goals of the treatment.

So in my experience, the benefits outnumber the liabilities. I’m certain that some clinicians will disagree with the essential premise of this article; and I welcome robust discussion.

Reference

J. Hoffman (2014). What The Therapist Thinks About You. New York Times, July 7.

Leveille SG, Walker J, Ralston JD, Ross SE, Elmore JG, & Delbanco T (2012). Evaluating the impact of patients’ online access to doctors’ visit notes: designing and executing the OpenNotes project. BMC medical informatics and decision making, 12 PMID: 22500560

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Self-Help for Schizophrenics http://brainblogger.com/2014/07/18/self-help-for-schizophrenics/ http://brainblogger.com/2014/07/18/self-help-for-schizophrenics/#comments Fri, 18 Jul 2014 11:00:22 +0000 http://brainblogger.com/?p=16867 In spite of the existence of stigma, the first crucial step in dealing with schizophrenia is acceptance by that individual that he or she has a mental illness.

This acceptance will allow him to deal more effectively with his life and move on with a lifestyle that is perhaps different from that of an ordinary person. Acceptance of one’s mental illness and the life task modifications that are involved in existing as a schizophrenic in the world are essential to dealing with schizophrenia with a modicum of success. Noteworthy is the fact that denial of having a mental illness is likely to be a significant step toward delusional thinking, and acceptance of having a mental illness is a step toward sanity.

At this point, it’s worth addressing the fact that there has been a fair amount of criticism directed at me for labeling and pathologizing those who have perceptual differences in the articles I’ve written so far for this website. Much of this criticism has described my articles as “reductionistic” and “stigmatizing”. By no means do I intend to denigrate schizophrenics or those with perceptual differences. Rather, these articles represent efforts to illuminate schizophrenia, and they have been intended to help the individuals suffering from the condition of schizophrenia.

Many of the suggested treatments for mental illness have reflected traditional approaches. But I believe in the importance of self-help. This article is intended to offer helpful advice, not only to schizophrenics, but to their treatment providers, as well.

Although not usually construed as a self-help related behavior, taking one’s prescribed medication is also an important aspect of self-help. Medication has been empirically studied from the perspective of science, amounting to predicting and controlling behavior by means of medication. There are a multitude of very reliable studies that have been done, equating with the efficacy of medication in treating schizophrenia and myriad other diagnosed conditions, such as depressive, anxiety and bipolar disorders.

Often schizophrenics wax delusional in that they feel that taking medication makes them mentally ill, or that stopping their medication will make them sane, or that taking medication is synonymous with being mentally ill, and they should throw their pills away. They may discontinue taking their prescribed medications as a direct result of their delusional stance, or they may discontinue their medication use simply because they do not like the side-effects of medications.

Accepting psychiatric treatment by taking prescribed medications and attending appointments with one’s psychiatrist are perhaps the single most important aspects of self-help that a person with schizophrenia can enact. The use of medication to treat diagnosed psychiatric conditions may be reductionistic, but taking medication might also lead to subjective well-being on the part of the mentally ill individual.

Mental illness, and schizophrenia in particular, entails social isolation. Stigma to a great extent causes this type of alienation, and combating alienation from others is essential in dealing with mental illness. This can be achieved by attending group therapy or support groups. Speaking to other schizophrenics about one’s symptoms and participating in dialogue about mental illness aids one in seeing one’s own problems in the experience of others.

For example, revealing to other mentally ill people one’s delusional ideation, and then asking others how they think it feels to think these thoughts, is a way of reaching for a union with others. Even though they may or may not agree with one’s expression of one’s delusional framework, group therapy or support groups may allow one to feel less isolated. Moreover, the realities of dealing with poverty or childcare, experienced by the mentally ill, may allow one to feel less alienated, as well. Just talking to others and getting out of one’s internal ruminations about one’s psychosis is helpful to the mentally ill individual. As a consequence, seeking interpersonal activity is an extremely important aspect of self-help regarding mental illness and schizophrenia.

In addition to relational activity, vocational activity – whether this involves paid or voluntary employment – is extremely helpful to those dealing with mental illness. Freud said that happiness resides in love and work. In addition to meaningful relationships, work is essential in providing an individual with feelings of self-worth. Many individuals who suffer from serious mental illness are currently engaging in vocational activities, more so than in past decades. These include peer support specialists, who are consumers of mental health services who work in the mental health system, often assisting other consumers with their positive treatment related activities. Even filling the roles of greeters at large stores can help some mentally ill individuals by providing with both relational and vocational activity.

One should remember that it is often not the status entailed by a particular job that is important to job success. Success in vocational activities relies on whether the individual, in this case, one with schizophrenia, fits the niche of that job. Often, the atmosphere of one’s workplace and how the individual feels while he is working will determine her success or her failure. For example, the atmosphere of a fast food restaurant may be too fast-paced for a mentally ill person. This type of stress may lead to failure for the schizophrenic almost inevitably.

The individual schizophrenic should perhaps start slowly by first volunteering at a work venue, where he feels comfortable, for a minimal period of time each week. Then, as he gains confidence, gradually works toward a goal of what he seeks in terms of vocational success. One should realize, however, that a schizophrenic should not exaggerate or minimize what one foresees as his ability in this regard. One must proceed at a slow pace and a exercise a trial and error approach to succeeding in work.

Overall, there are many avenues to better psychological health regarding schizophrenia. These include but are not limited to the use of psychiatric medication. Discovering these avenues may be approached sensibly in terms of understanding the needs that all people have in their lives, and, as mentally ill individuals, trying to modify their approach to fulfilling needs that are universal.

“Love” and “work” are concepts that represent needs for all people. We all need relational and vocational activity in order to combat interpersonal alienation and proceed in activity that gives us a sense of purpose. We all need vocational activity in order to feel worthwhile. We all need relationships with others who perceive us as we are.

Often, the mentally ill stray from the productive avenues of life, due to the fact that no one thinks that they can participate in love and work. Perhaps their symptoms cause a lack of fulfillment of these fundamental needs, even while this lack of need fulfillment may cause their symptoms. The purposes of love and work should be sought with persistence and faith in one’s own ability to fulfill needs in this regard. But first, the mentally ill individual should accept her mental illnesses and accept her use of psychiatric medication.

Lastly, the mentally ill should not embrace or reject the label of schizophrenia without reservation. The danger of stigma and usefulness of this diagnosis should be navigated using good judgment and self-awareness. No one can define what a mentally ill individual may be able to accomplish, and the diagnostic label of “schizophrenia” is not a self-fulfilling prophecy. Ultimately, it is largely to the schizophrenic’s lack of self-esteem, entailed by stigma that is accepted, ambivalently or not so, that determines whether stigma has any power.

One should not allow the terms for mental illness to define them. Stigmatizing labels may make one angry, defensive and degraded, but the word “schizophrenia” has no power. Labels can amount to name-calling by people who have the psychological sophistication of children. Perhaps that is why this author will not acknowledge stigma even to the extent of not using these labels that clearly seem reductionistic.

The choice to be stigmatized by a label is a decision made by the individual who is mentally ill, and the choice to be limited by a diagnosis may be their choice, as well.

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Psychosis – The Brain’s Inner Conflict http://brainblogger.com/2014/06/30/psychosis-the-brains-inner-conflict/ http://brainblogger.com/2014/06/30/psychosis-the-brains-inner-conflict/#comments Mon, 30 Jun 2014 15:08:26 +0000 http://brainblogger.com/?p=16596 Sensation is a function of the five senses: taste, smell, touch, vision and sound. Sensory organs convert stimulation into experiences that can be described as meaningful by means of neural receptors that send sensory information to the brain. Thus, the brain interprets sensory information as experience as meaningful. The human brain experiences the absorption of energy as meaningful in terms of the senses involving taste, smell, touch, sight and hearing.

Perception is different. It is the process by which the brain organizes and interprets sensory information, shaped by learning, expectation and attention. Perception also affects how we understand sensory information and give it meaning by using memory and emotion. Although sensation and perception work together to create meaningful human experience, they are separate processes, implicating separate functions.

Perception results in consciousness of the material world. Although sensory perception allows us to maintain information about the world gathered by the five senses, intellectual perception allows one to comprehend information. This differs from ordinary perception. Intellectual perception allows one to extrapolate from sensory experience and reason about it analytically and abstractly.

Thinking about sensory experience involves Piaget’s conceptualized abilities of assimilation and accommodation. Assimilation involves fitting objects or concepts into categories. For example, we might place an “apple” and an “orange” into the category of “fruit”. An example of accommodation involves the creation of a new category that cannot be assimilated into the category of “fruit” by creating a category for “vegetables” when one is first introduced to a vegetable, such as “cabbage”. The concepts of assimilation and accommodation are the basic tools by which knowledge is created and comprehended.

It is obvious that the processes of thought and knowledge about the world are much more complex than is signified by these examples. Sensory stimulation, sensory experience, sensory perception and categorization of concepts, intellectual perception, and meta-cognition or thinking about thinking are amalgamated except perhaps by philosophy’s attempts to disseminate such knowledge in a rational way. It is obvious in an intuitive way that thought processes rely on various ways of thinking, feeling and sensing.

A baby is born with sensory perception. She responds with emotion to pain and pleasure. Emotion represents a form of perception. Some of our emotions are virtually instinctive and innate. Other emotions depend on memory and learning that combine with sensory and intellectual perception to create the various ways we feel about and experience the world. In short, we construct our understanding of the world.

People, generally, do not create consistent worldviews, and it is blatantly clear that cognitive errors are rampant in the minds of virtually all individuals. Even speaking of consciousness, a state that all people know by experience, may baffle most people. Cognitive error can be comprehended as afflicting all individuals who do not have belief systems that are interconnected logically and consistently. It may not be possible to achieve a belief system that is logically consistent in terms of a worldview.

Cognitive dissonance — the mental stress experienced by someone who holds more than one contradictory, conflicting idea in their minds — stems from cognitive error that is skewed by emotion to create views that an individual, when made aware of this dissonance and corresponding error, attempts to modify by changing his views or reinterpreting his experience.

For example, the “just-world hypothesis” is a cognitive bias that is comprised of the view that an individual’s actions always result in ethically fair consequences, such that good deeds are rewarded and bad actions are punished. When information contrary to this assumption is revealed to an individual, the individual may change his views to make them compatible with his assumption of the just-world hypothesis, such that he may maintain that the individual who is punished for good deeds in fact deserved his punishment.

It should be noted that paranoid psychotic individuals have views that represent amalgamations of experience involving sensation, perception, emotion and thought or thought about thought. Psychotic individuals have the misfortune of enduring pseudo-sensory experience in the form of hallucinations. This experience is as visceral and real to them as is the experience of the five senses that most people endure. Hallucinated experience cannot simply be dismissed as “white noise” because it is said to be unreal — it persists in the mind of the schizophrenic, and, especially in terms of auditory hallucinations, it has immediate meaning in that the schizophrenic “hears” verbal material in what should be the safe sanctuary of her own mind.

Nevertheless, we distinguish between the mentally ill and the non-mentally ill with either/or mentalities, such that it is assumed that a person is either mentally ill or not so, when in fact all people make cognitive errors. While cognitive dissonance is experienced by all people who misinterpret sensory and perceptual experience, the mentally ill are punished for such misinterpretation. If there exists any reason to challenge the attributions of the mentally ill that are entailed by stigma, this should be the most salient one. The ideation of the psychotic mentally ill is comprehensible, and, if it is viewed as such, the stigma regarding mental illness may be diminished. In fact, a lack of stigmatization of the mentally ill might paradoxically allow them to release over-valued ideas.

It is the paranoia of the psychotic mentally ill person that creates a vigilance by which that individual responds to hallucinations and delusions, and vigilance creates a sensitivity to reinforcement of delusional material. Paranoia fuels psychotic ideation because it implicates an intolerance for ambiguity that corresponds with fear. Clearly, if the psychotic individual does feel safe or safer, she may express less of a need to speculate, perhaps endlessly, about the world-view that is unwillingly owned by her.

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The Family of Schizophrenia http://brainblogger.com/2014/06/25/the-family-of-schizophrenia/ http://brainblogger.com/2014/06/25/the-family-of-schizophrenia/#comments Wed, 25 Jun 2014 11:00:56 +0000 http://brainblogger.com/?p=16718 The improvement of the condition of schizophrenia is strongly linked to family involvement in the life of the schizophrenic. Family members can ease the difficulties of this serious mental illness in ways that people outside the family system cannot.

Due to the fact that family members may be in close contact with their schizophrenic father, mother, sister or brother or child, they are better able to monitor the behavior of the schizophrenic. They know this family member, and they may be able to ascertain the causes of the schizophrenic’s negative behavior. This closer understanding may allow them to intervene even before negative symptomatic behaviors emerge.

The psychotic fragmentation of the schizophrenic may occur at any time, particularly in response to aspects of the environment and the material world that can be monitored and controlled. Family members are more likely to recognize the deterioration of their schizophrenic family member if they are living with them. Being able to monitor medication compliance, for example, is a positive aspect of effectively managing the mental illness of the schizophrenic, and this monitoring becomes more possible if the family lives in close proximity to the schizophrenic person. It should be noted that the schizophrenic may have just as much to gain by living independently, even though the close relationships with his family members may be compromised as a result.

Even when family members do not live with the affected person, however, regularly seeing the schizophrenic offers lots of benefits. More than any other people in the schizophrenic’s perhaps sparse constellation of relationships, her family members may be able to understand the continuity of the schizophrenic’s life before and after the emergence of her mental illness. Even though it may be jarring to witness such behavioral changes, family members can be of immense service to the schizophrenic. This is due to the fact that, in spite of the realities of aberrant behavior on the part of the schizophrenic individual, the family members might stigmatize the schizophrenic to a lesser degree.

Another way that families can help their schizophrenic relative is by helping that person to access consistent and reliable psychiatric services. Also, families can aid crisis intervention. Relatives are likely to know when their schizophrenic member is a danger to herself, to others, or is gravely disabled. They serve a valuable function in this regard.

In addition, schizophrenics may suffer from extremes of alienation and subjectively punitive self-involvement. Families can help minimize the damage to self of the schizophrenic that this entails. Most importantly, families can make the schizophrenic feel loved, accepted and valued.

Essentially due to stigma, schizophrenics feel extremely alienated from the world of other people. Moreover, the traumatic effects of stigma regarding mental illness can be more or less eliminated by the family’s acceptance of that individual, although this may not be an easy task. The metamorphosis of the mentally ill individual, from someone who may seem psychologically healthy to a person labeled as a schizophrenic, can mean that individual transforms into someone unrecognizable. The struggle to accept oneself and be acceptable to others in terms of serious mental illness may be terrifying to the schizophrenic. The rage and grief associated with the onset of serious and chronic mental illness, for both the schizophrenic and her family, may be extreme.

Family members may be able to bypass some of what seems to be a tragedy for the troubled individual and themselves by educating themselves about mental illness and the diagnosis of schizophrenia. The difficulties of the schizophrenic and the subsequent difficulties of the family in dealing with this diagnosis may seem like a life sentence in terms of its chronic nature. In addition, the problems of the schizophrenic are cyclic: biochemistry causes auditory hallucinations, the appearance of hear voices that no one else hears leads to stigma, and stigma causes the schizophrenic to retreat physically and psychologically from others, leading to greater isolation and greater self-involvement within the mind of the schizophrenic.

The schizophrenic may act out, and the family may respond by not understanding her behavior, which further alienates the schizophrenic in a way that makes her terrified that she can no longer be understood by anyone, even herself. For that reason, the person labeled as unrecognizable may act out in unacceptable ways. This means that the family may be compelled to re-evaluate and realign their values in terms of their efforts to accept their family member.

Overwhelmingly, the mentally ill family member wants to feel loved. The fear and terror that any family deals with as a consequence of such a diagnosis is intense. No one thinks that they are going to be a schizophrenic when they grow up. The tragedy of this diagnosed condition is enormous and devastating. Family involvement and acceptance, in particular, may ameliorate much of this tragedy. In fact, these qualities might even make the circumstances of the diagnosis of schizophrenia tolerable, for both the schizophrenic and her family.

A female schizophrenic client of mine once shared a story with me which amounted to an intervention on the part of her family members. She spoke of how her siblings came to speak with her and talked about her with a psychiatric social worker at a hospital where this client was staying after a severe and life-threatening breakdown. They simply came – all of her siblings – and this was enough to make the schizophrenic feel that her life was valued. She felt loved based upon her families concern for her. She had never experienced this kind of validation.

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Maternal Depression More Frequent After Postpartum Period http://brainblogger.com/2014/06/05/maternal-depression-more-frequent-after-postpartum-period/ http://brainblogger.com/2014/06/05/maternal-depression-more-frequent-after-postpartum-period/#comments Thu, 05 Jun 2014 11:00:41 +0000 http://brainblogger.com/?p=16637 Postpartum depression has many negative consequences for the mother and her child, and society is right to promote awareness of this condition. But now, a study of new mothers indicates that depression is more common four years after childbirth than at any point during the postpartum period.

Pregnancy and childbirth are emotionally and physically wrenching experiences and the overwhelming fatigue, anxiety, irritability, and sadness are seemingly part and parcel to the role of a new mother. When these symptoms are severe or long-lasting, the ability of a mother to care for her child or herself can be impaired. This, of course, leads to many significant negative effects on a mother’s relationships, the child’s cognitive and emotional development, and the ability of the mother and child to form appropriate bonds. Thankfully, because of increased attention surrounding postpartum depression in the last decade, practitioners (and friends and family members) are better equipped to recognize this type of depression and offer effective treatments for most new moms who suffer from postpartum depression.

In the new study, Australian moms completed questionnaires in early pregnancy, at 3, 6, 12, and 18 months, and at 4 years postpartum to assess mental health and relationship status. Of the more than 1500 women surveyed, 14.5% reported depressive symptoms at 4 years after childbirth, which was higher than at any of the time points tested within the first year after childbirth.

Women who had only one child at the 4-year point were twice as likely to have depressive symptoms compared to women who had additional children within the 4-year time period (22.9% vs. 11.3%). The strongest predictor of depression at 4 years was an earlier diagnosis of depression, either during pregnancy or in the first year postpartum. The women at the highest risk for depression at 4 years after childbirth were the same as those at highest risk for postpartum depression: young mothers, mothers who had experienced significant life changes or stressful events, mothers who had low income, and mothers who were victims of abuse.

The symptoms associated with depression in new moms – fatigue, anxiety, irritability, and sadness, to name a few – are the same emotions experienced by most moms with four-year-olds. The prevalence of women with depressive symptoms in this study is higher than the prevalence in the general population, but, again, this is an already tired and stressed out group of women. (Frankly, the Edinburgh Postnatal Depression Scale – the scale used in this study – could easily identify depressive symptoms in moms of elementary school kids, teenagers, or even young adults.) But, as with maternal depression during the postpartum period, maternal depression at any time during a child’s life can have negative consequences for the mother and child.

The need for postpartum depression screening and treatment is warranted, but so is the need for life-long maternal mental health screening and treatment. Many factors in a mother’s life affect her mental health, which has direct effects on her child. Assessment of maternal mental and physical health should begin as early in the prenatal period as possible and it should not stop at the last postnatal physician visit: it should continue throughout her life.

A mother’s fears and anxieties change as her child grows – as do her reasons for being tired and sad – and mothers in the immediate postpartum period are not the only ones who need support. If mental health screenings accommodated different stages of parenting, we could more widely and accurately assess maternal mental health.

And, lest we forget the fathers – men, too, experience postpartum depression, albeit at a much lower rate than women. But, fathers experience stress and exhaustion related to parenting just as mothers do, and ensuring the mental health of all family members will lead to happier, healthier children.

References

Agnafors S, Sydsjö G, Dekeyser L, & Svedin CG (2013). Symptoms of depression postpartum and 12 years later-associations to child mental health at 12 years of age. Maternal and child health journal, 17 (3), 405-14 PMID: 22466717

Fihrer I, McMahon CA, & Taylor AJ (2009). The impact of postnatal and concurrent maternal depression on child behaviour during the early school years. Journal of affective disorders, 119 (1-3), 116-23 PMID: 19342104

Thombs BD, Arthurs E, Coronado-Montoya S, Roseman M, Delisle VC, Leavens A, Levis B, Azoulay L, Smith C, Ciofani L, Coyne JC, Feeley N, Gilbody S, Schinazi J, Stewart DE, & Zelkowitz P (2014). Depression screening and patient outcomes in pregnancy or postpartum: A systematic review. Journal of psychosomatic research, 76 (6), 433-446 PMID: 24840137

Woolhouse, H., Gartland, D., Mensah, F., & Brown, S. (2014). Maternal depression from early pregnancy to 4 years postpartum in a prospective pregnancy cohort study: implications for primary health care BJOG: An International Journal of Obstetrics & Gynaecology DOI: 10.1111/1471-0528.12837

Woolhouse H, Gartland D, Perlen S, Donath S, & Brown SJ (2014). Physical health after childbirth and maternal depression in the first 12 months post partum: results of an Australian nulliparous pregnancy cohort study. Midwifery, 30 (3), 378-84 PMID: 23619027

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The Self-Help Industry Helps Itself to Billions of Dollars http://brainblogger.com/2014/05/23/the-self-help-industry-helps-itself-to-billions-of-dollars/ http://brainblogger.com/2014/05/23/the-self-help-industry-helps-itself-to-billions-of-dollars/#comments Fri, 23 May 2014 11:00:22 +0000 http://brainblogger.com/?p=16530 Self-improvement represents a $10 billion per year industry in the U.S. alone. In addition to high revenues, self-help also has a high recidivism rate, with the most likely purchaser of a self-help book being the same person who purchased one already in the last 18 months. This begs the question of how much good these self-help books and seminars are doing for consumers. If they are so effective at solving our problems, why do they usually result in a continuing stream of self-help purchases?

Self-help books are frequently followed by a train of formulaic subsequent manuals for happiness, weight loss, success, money, or spirituality by the very same authors, fueling the 6.1% average annual growth rate projected by Marketdata Enterprise Inc. The New Statesman’s Barbara Gunnell forecasts a secure future for positive psychology, noting that “never has an age been so certain that it deserves not just freedom from distress, but positive well-being” and that “the worried well with a belief in their right to feel good are a lucrative market.” Furthermore, the credentials of self-help authors are uneven, and research has documented the noticeable absence of empirical evidence supporting the advice so copiously pumped out to the masses.

The origins of the self-help genre have been attributed to Victorian phrenologist George Combe’s The Constitution of Man (1828), followed by Ralph Waldo Emerson’s Compensation. Dale Carnegie, famous for his books How To Win Friends and Influence People (1936) and How to Stop Worrying and Start Living still holds a top-ranking spot on Amazon.com to this day.

In the 1950s and 60s, Abraham Maslow “proclaimed the supremacy of the self-actualizing person, who realizes the fullness of his or her nature – without doing harm to others, or course – and lives as happily as one can on earth,” notes Algis Valiunas. Among the more modern offerings, Tony Robbins has raked in $80 million in a year and John Gray’s New York Times best-seller Men Are From Mars, Women Are From Venus “outsold almost every other book in the known universe except the Bible” claims Valiunas in The New Atlantis. In his particularly eloquent and scathing commentary, “The Science of Self-Help,” Valiunas points out that “this is the scientific fruit of those who consider themselves not only the wisest of our time but evidently the wisest of all time,” with teaching that is “sensible, unexceptional. It is also obvious and insipid. Accept imperfection and pain. Do some jogging. Slow down and count your breaths.”

Credentials of Self-Help Authors and Recurring Themes Among Best-Sellers

Norah Dunbar and Gordon Abra conducted a survey of current self-help literature, with 2 aims: first, to determine whether the people advising the masses had the appropriate credentials to do so, and second, to identify common themes among top selling self-help books.

Using Amazon.com to identify the most popular self-help authors by searching terms including “marriage”, “relationships”, and “communication,” the researchers identified 31 authors. Among them, two were medical doctors and 19 held doctorates, mostly PhDs in psychology, with two in linguistics or education. Seven held a master’s degree in social work, counseling psychology/family therapy, or theology, with one in film studies. Two authors had no formal education, and one had a bachelor’s degree in Home Economics. “All degrees were from accredited institutions except one. Gray’s degree is from the unaccredited and now defunct Columbia Pacific University,” state Dunbar and Abra.

Another component of this query was whether the authors of popular self-help books used research published in academic journals to support their advice. The majority did not, relying solely or primarily on anecdotal evidence: “Few of the popular authors are basing their opinions about communications on empirically-tested research findings. Fewer than 20% had based their findings on a sustained program of research and less than half had published even one article in peer-reviewed journals or books.”

With regard to overarching themes, the researchers identified five. The first was the use of banking or financial metaphors and analogies, such as “love bank”, “account balances”, “relationship bank account,” and other references amounting to debits and credits to relationship satisfaction. Chapman, author of The Five Love Languages (and all the subsequent variations thereof, such as the singles edition, men’s edition, and so on), is quoted: “I am convinced that keeping the emotional love tank full is as important to a marriage as maintaining the proper oil level is to an automobile. Running your marriage on an empty ‘love tank’ may cost you even more than trying to drive your car without oil.”

A second theme dealt with creating buckets or types in which to neatly categorize people, where the reader is supposed to find their category and follow the advice tied to that category or type. For example, dichotomous types were found in Gray’s Men Are From Mars, Women Are From Venus (male and female) and in Lerner’s book, which the researchers say “places women into two types: ‘bitches’ and ‘nice ladies.’” A third commonality was the step format, where the authors offered simple steps to implement solutions. They note that seven seems to be the “magic number” of steps, with The Seven Principles for Making Marriage Work, The Proven 7-Step Program for Saving Your Marriage, and The 7 Habits of Highly Effective People.

A fourth common element was emphasis on childhood for past models, where childhood experiences were major determinants of current relationship behavior. The fifth theme involved offering the reader exercises to complete.

A Lack of Evidence

Bibliotherapy is clearly cheaper than counseling. There is minimal risk to the consumer who invests in one book. Financially, self-help books are accessible to a greater number of people than life coaches and counselors, and there is arguably more anonymity in a book purchase than a relationship with a local therapist. This can be especially appealing to people with stigmatizing problems.

However, it’s difficult to test the effectiveness of these books. Researchers Norah Dunbar and Gordon Abra cite Rosen, stating that two main conclusions that can be drawn from bibliotherapy literature: “First, techniques applied successfully by a therapist are not always self-administered successfully,” and “second, the therapeutic value of a self-help book can only be determined by testing the specific instructions to be published under the conditions in which they are to be given. The fact that people are free to read all or only part of a particular book, and follow the book’s advice to varying degrees makes it difficult to evaluate the effectiveness of self-help books for their therapeutic value.”

Corporate Self-Help

In addition to the typical female, middle-class, educated consumer buying the majority of self-help products, the corporate wallet has opened up to the happiness and success industry. In recent Securities and Exchange Commission filings, publicly traded Franklin Covey, whose mission is “enabling greatness in people and organizations everywhere,” warns shareholders of the risks of an “intensely competitive” industry with easy entry by new competitors. Franklin Covey sells training and consultancy on topics including leadership, execution, productivity, sales performance, customer loyalty, and educational improvement. In the New Statesman’s article, “The Happiness Industry,” a psychologist challenges whether the best interests of workers are served where corporations are paying the bills of coaches and consultants.

Egalitarianism versus Reality

In additional to the presumption of autonomy, there seems to be a certain egalitarian assumption underlying the demand for self-help: that the end result being sought is attainable to virtually all. Counters Valiunas: “Beauty, size, strength, health, energy, disposition, verbal or spatial or mathematical or emotional intelligence, ability in music or painting or oratory simply are not parceled out equally- and in any chosen activity, not even a single-minded devotion or expert training and wholesome diet can ensure that all will come out even in the end. Natural inequalities will always make for differences between one person and the next, and these differences will always be cause for unhappiness.”

However, Valiunas praises Malcolm Gladwell’s Outliers, which instead of offering quick five or seven step fixes or dropping people into buckets such as genius and non-genius, suggests that years of hard work and deliberate practice can lead to self-improvement. “That does not mean everyone will be above average, as the old joke goes. It does mean that the average should rise, and everyone willing to put in the work be able more fully to realize his potential, if not necessarily his dreams.” However dreams of the perfect relationship, the perfect career, and the perfect weight continue to sell off the shelves.

References

Dunbar, N. and Abra, Gordon (2006). Popular Self-Help Books on Communications in Relationships: Who’s Writing them and What Advice Are They Giving? Paper presented at the annual meeting of the International Communication Association, Dresden International Congress Centre, Dresden, Germany, Jun 16, 2006. http://citation.allacademic.com/meta/p_mla_apa_research_citation/0/9/0/8/7/pages90873/p90873-1.php

Gunnell, B. (6 September 2004). The Happiness Industry. New Statesman.

Valiunas, A. (2010). The Science of Self-Help. The New Atlantis: A Journal of Technology and Society.

Van Wyhe, J. George Combe Phrenologist and Natural Philosopher (1788-1858). The Victorian Web.

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Deliberately Forgetting Memories – Easy for Some http://brainblogger.com/2014/04/20/deliberately-forgetting-memories-easy-for-some/ http://brainblogger.com/2014/04/20/deliberately-forgetting-memories-easy-for-some/#comments Sun, 20 Apr 2014 14:18:27 +0000 http://brainblogger.com/?p=16007 We have all had memories that, at some point in time, we wished we could forget. Many newly published studies highlight the neurological and molecular mechanisms behind choosing to forget and suggest why disrupting this process may lead to unhealthy aging and serious mental disorders. It seems, that to some degree, one does find eternal sunshine in a spotless mind.

Our autobiographical memories are integral to both making sense of the past and making predictions for the future, as well as providing an understanding of who we are as individuals. Having a lack of control over autobiographical memory retrieval and which memories enter our conscious awareness is debilitating for those suffering from clinical conditions such as depression, phobia or post-traumatic stress disorder. Conversely, research suggests that possessing the ability to deliberately choose which autobiographical memories we retain, may be pivotal to our mental health, well-being and sense of self.

The existence of memory repression, a Freudian concept, where unwanted memories are forgotten by pushing them into the unconscious, has remained controversial for more than a century. In recent years, however, research has centred upon a “think/no-think” paradigm, providing proof-of-principle that it is possible to train people to systematically forget previously learned material. The idea is simple; participants memorize word pairs and are then shown the first word and asked to either recall the second word or consciously try to avoid thinking about it.

fMRI studies identified two separate mechanisms for the forgetting of unwanted memories, suppression and substitution, involving two separate neural pathways. Brain activity was observed while participants who had previously learned associations between pairs of words tried to forget the memories by either recalling alternative memories (substitution) or blocking them out (suppression). For memory suppression, the hippocampus, which is the key player in remembering past events, is inhibited by the dorsolateral prefrontal cortex, thus inhibiting memory retrieval. Substituting memories, on the other hand, activates specific areas of the prefrontal cortex which are involved in consciously willing our attention to focus on specific memories in the presence of distracting unwanted ones.

So, we can actively forget using at least two different neural mechanisms of mnemonic control, but how relevant is forgetting random words to real life situations? Well the buck doesn’t stop there. The think/no-think task was extended into the realms of autobiographical memory, revealing that training people to not think about a memory results in a loss of specific details about that memory. When asked to recall a memory they had previously tried to intentionally forget, the main gist of the story remained. However, about 11 per cent less detail was recalled on average. Interestingly, for the never-been-depressed student subjects, the intentional memory loss effect was stronger for negative autobiographical memories, with positive memories being retained more strongly, despite trying to forget them.

However, the most recent addition to the think/no-think research looked at individual differences in forgetting, over both short and long time periods. Researchers were able to predict which students were most likely to be successful “forgetters” 12 to 13 months after the think/no-think training, based on how well they were able to forget immediately after training. This indicates that obtaining ‘the eternal sunshine of a spotless mind’ by forgetting negative memories at will may be easier for some than others, giving them the ability to forget more successfully for longer. This may indicate that these individuals are less likely to suffer rebound effects from traumatic experiences.

Hot off the press is new evidence that shows how memory loss is actively regulated at the molecular level. The study drew attention to a protein in a model organism for neural development, the nematode Caenorhabditis elegans, called musashi (MSI-1). In MSI-1 mutants, where expression of the protein is prevented, memory loss was inhibited. This memory loss inhibition brought about by MSI-1’s absence, caused an increase in the levels of a protein complex called Arp2/3, which is involved in the growth of dendritic spines and in establishing strong synapses.

The researchers presented a model for the active forgetting of memories, where MSI-1 regulates neuroplasticity and de-stabilizes neural connections associated with the memory by inhibiting levels of Arp2/3. This subsequently reduces the size, complexity and activity of the associated synapses. The existence of human MSI-1 homologues, indicates that actively choosing to forget a memory may also involve musashi regulated de-stabilization of neural connections associated with that memory in humans.

It’s likely that future research will attempt to characterize the precise mechanisms involved in humans and may result in the development of drugs for the prevention of abnormal memory loss in diseases such as Alzheimer’s and Parkinson’s. On the flip side, such research may also prove useful in the treatment of depression and post-traumatic stress disorder, where there is therapeutic value in improving our ability to forget. Nonetheless, we are someway off the development of Eternal Sunshine-esque technologies for complete and specific erasure of unwanted memories.

References

Addis DR, Leclerc CM, Muscatell KA, & Kensinger EA (2010). There are age-related changes in neural connectivity during the encoding of positive, but not negative, information. Cortex; a journal devoted to the study of the nervous system and behavior, 46 (4), 425-33 PMID: 19555933

Anderson MC, & Green C (2001). Suppressing unwanted memories by executive control. Nature, 410 (6826), 366-9 PMID: 11268212

Hadziselimovic N, Vukojevic V, Peter F, Milnik A, Fastenrath M, Fenyves BG, Hieber P, Demougin P, Vogler C, de Quervain DJ, Papassotiropoulos A, & Stetak A (2014). Forgetting Is Regulated via Musashi-Mediated Translational Control of the Arp2/3 Complex. Cell, 156 (6), 1153-66 PMID: 24630719

Noreen S, & MacLeod MD (2014). To think or not to think, that is the question: individual differences in suppression and rebound effects in autobiographical memory. Acta psychologica, 145, 84-97 PMID: 24309017

Noreen S, & Macleod MD (2013). It’s all in the detail: intentional forgetting of autobiographical memories using the autobiographical think/no-think task. Journal of experimental psychology. Learning, memory, and cognition, 39 (2), 375-93 PMID: 22686849

Image via Jack Cobben / Shutterstock.

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Executive Pathologies – The Relationship Between CEO Narcissism and Fraud http://brainblogger.com/2014/04/16/executive-pathologies-the-relationship-between-ceo-narcissism-and-fraud/ http://brainblogger.com/2014/04/16/executive-pathologies-the-relationship-between-ceo-narcissism-and-fraud/#comments Wed, 16 Apr 2014 15:19:18 +0000 http://brainblogger.com/?p=16292 Research suggests an association between CEO personality traits and fraudulent behavior. Narcissism has been linked to manipulation of financial results, which has implications for the executive selection process, board oversight, and the structuring of executive compensation packages.

The celebration of financial misconduct in movies like The Wolf of Wall Street tends to focus on the enthralling aspects of the perpetrator’s personality, rather than the economic woe that ensues for other, less glamorous stakeholders such as the average investor or the employee who loses his or her job in the wake of a scandal.

The Committee of Sponsoring Organizations report Fraudulent Financial Reporting 1998-2007: An Analysis of U.S. Public Companies analyzed 347 fraudulent financial reporting occurrences investigated by the SEC from 1998 to 2007, and found CEO and/or CFO involvement in 89 percent of the cases, with the CEO specifically implicated in 72 percent of those cases.

The report also found that the magnitude of losses from financial misstatement and misappropriation has been on the rise: 300 of the cases together resulted in over $120 billion in losses.

Fraud Behavior

Allegedly, one of the first instances of financial statement fraud at a publicly traded company occurred in the 1600s at the British East India Company. Economist Adam Smith, in his 1776 Inquiry into the Nature and Causes of the Wealth of Nations, mentioned shareholders suffering from the effects of fraud as well. Fraud is everywhere. More than 80 percent of respondents to a 2012 FINRA national survey on Financial Fraud and Fraud Susceptibility in the United States indicated that they had been solicited to participate in a potentially fraudulent offer. Of concern, many Americans appear to be unable to discern signals of potential fraud, such as unreasonable rates of return or “fully guaranteed” investments. Accounting scandals also show the failure of auditors to detect or report financial results fraud by executives.

Models explaining factors contributing to fraud behavior have evolved from the fraud triangle, consisting of three points that criminologist Cressey proposed must be present at the same time: pressure, opportunity, and rationalization. Wolf and Henderson later stretched Cressey’s fraud triangle into a fraud diamond by adding a fourth element: capability, suggesting that capability is what allows the fraudster to identify and take advantage of deficiencies in internal controls and effectively cover up misconduct.

Studies and surveys demonstrate that financial fraud is a slippery slope, with “accidental fraudsters” transitioning into “predators.”  When pressure, opportunity, and rationalization combine, Cressey’s fraud triangle explains unethical behavior by a seemingly normal person, the “accidental fraudster”. However, once the criminal mindset takes hold, pressure and rationalization fade into the background, and the remaining condition of opportunity is all that is required for the predatory fraudster. The desensitization that occurs after committing fraud and which leads to more fraudulent behavior has been noted in fraud literature.

“Managing earnings” is often a euphemistic way of referring to deliberate or fraudulent manipulation of financial results to change the picture of a company’s financial position prior to presentation to board members or shareholders by exploiting gray areas in accounting on how and when revenue and expenses are recognized. It’s relatively easy to turn losses into a profit on the books by estimating and recording more revenue in a particular time period.

Researchers have proposed that “financial statement fraud perpetrators often appear to start as accidental fraudsters by managing earnings, trying to buy time for their organization until conditions improve. But sooner or later, managing earnings gives way to financial reporting fraud, and the accidental fraudster becomes a predator.”

Executive Involvement

Studies show little correlation between income level and fraud. The tendency to compare one’s social status to that of other people, as well as a culture of competition, have been cited in surveys as potential motives for financial fraud committed by otherwise affluent CEOs. Coleman offered that wealth and success, rather than being goals, become entrenched in the individual’s sense of identity.

The “pressure” component of Cressey’s fraud triangle, therefore, may come in the form of internal pressure to preserve one’s image rather than external financial pressure.  Among high profile cases, often the CEOs who committed fraud did so for payoffs which seem trivial relative to their very generous legitimate compensation packages. This seems to suggest that personality and other factors contribute to financial fraud behavior by CEOs.

The role of CEO Narcissism

The DSM-IV definition of narcissism encompasses “a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration and a lack of empathy, beginning by early adulthood and present in a variety of contexts.” While Kets de Vries notes that “a solid dose of narcissism is a prerequisite for anyone who hopes to rise to the top of an organization”, and others have suggested that all leadership is inherently narcissistic to some degree, narcissism can be viewed on a sliding scale. Certain levels of narcissistic traits in leadership have been categorized as constructive, having a positive effect on an organization, whereas other more extreme forms of narcissism have had destructive effects on companies and their stakeholders. Dysfunctional, high levels are categorized as Narcissistic Personality Disorder, the prevalence of which is estimated to be between 0.7 to 1 percent of the population.

The “narcissistic paradox” refers to the seeming contradiction where narcissists lack self-confidence and self-esteem and overcompensate by representing themselves as superior to other people. According to Rijsenbilt and Commandeur, “In order to protect themselves from being criticized, narcissistic people constantly look for affirmation and tend to ignore the feelings, words, and behaviors of others and therefore cultivate underdeveloped feelings of empathy.” Investigators of CEO narcissism have expressed the idea that financial reporting, due to its frequent and periodic nature, serves as a regular source of affirmation of the CEO’s greatness.

A study by Chatterjee and Hambrick found a “strong indication” of an association between “large annual fluctuations in accounting returns” and CEO narcissism. In Accounting as a Facilitator of Extreme Narcissism, Amernic and Craig propose that accounting is a choice tool for narcissistic CEOs, allowing them to “construct a narrative about the corporation and themselves using financial accounting measures.” Pointing out that the general public perceives accounting to be rigid, objective, and scientific, when in fact accounting rules are often subjective and malleable, they “suggest that many narcissistic CEOs make accounting policy choices and earnings management decisions to maintain a positive sense of self, defend their egos, and preserve self-esteem.”

Measures of CEO performance often reside in the accounting world, namely financial metrics such as earnings per share (EPS), return on investment (ROI), and net income. Since narcissistic CEOs view these as a reflection of self and personal accomplishment, they are inclined to manipulate them by exercising their power over accounting policies and procedures. These same metrics also serve as a basis for compensation for many CEOs, so there are significant monetary rewards to be reaped from artificially rosy financial ratios.

Several aspects of accounting which appeal to narcissistic CEOs have been described by Amernic and Craig: financial reports regarded as personal report cards, the fact that accounting measures are “amenable to refraction and distortion by them,” and that a company’s financial reporting, “which can produce unflattering self-images, can be tailored easily to reflect a picture of financial performance that is more flattering and ego-satisfying for a CEO.” The perception of accounting by the general public as something more objective and neutral than it really is, as well as the “social patina of presumed external auditor independence” are also cited as reasons accounting manipulation appeals to narcissist CEOS.

A 2013 study by Rijsenbilt and Commandeur followed up on previous research suggesting that narcissists have a propensity to set unrealistic or unattainable goals as a result of the constant “intense need to have their superiority continually reaffirmed.” Using a sample of 953 S&P 500 CEOs from all industries, they found a positive relationship confirming the influence of CEO narcissism on fraud. The researchers used proxies for narcissism, such as the size of the CEOs’ photos in annual reports (2 pages of photos of the CEO alone, rather than with a team, were worth a maximum of 12 points), number of biography lines in the Marquis Who’s Who database, the “Idi Amin phenomenon” of holding multiple titles signaling a consolidation of power, whether the CEO was also chairman of the board, and perquisites. The resulting narcissism score was used in conjunction with the SEC’s Accounting and Auditing Enforcement Releases which name CEOs and their involvement in financial misstatement or fraud.

Implications

Narcissistic CEOs, largely ignoring the long term interests of shareholders and employees, may engage in high risk and unethical behaviors which jeopardize organizations.

Studies have linked aggressive merger and acquisition behavior with the propensity to commit financial fraud, and found that executives at high growth firms are more likely to engage in such behavior. The destructive effects of their behavior include tremendous economic damage to multiple stakeholders, including employee job loss and loss of investor money and confidence. Firms with fraud activity are more likely to declare bankruptcy.

The body of literature surrounding narcissism and accounting fraud has implications for the executive screening process, board oversight, auditors, and the design of executive compensation packages. Amernic and Craig propose that understanding narcissism offers insight into CEO involvement in unethical financial reporting practices. Boards and audit committees should pay attention to CEO personality traits and power consolidation. CEO involvement in the auditor selection process also warrants scrutiny. Research demonstrates that the personalities and pathologies of leadership have the capacity to greatly impact various stakeholders.

References

Amernic, J., & Craig, R. (2010). Accounting as a Facilitator of Extreme Narcissism Journal of Business Ethics, 96 (1), 79-93 DOI: 10.1007/s10551-010-0450-0

Boyle, D., Carpenter, B., and  Hermanson, D. (2012). CEOs, CFOs, and Accounting Fraud. The CPA Journal.

Dorminey, J., Fleming, A., Kranacher, M., & Riley, R. (2012). The Evolution of Fraud Theory Issues in Accounting Education, 27 (2), 555-579 DOI: 10.2308/iace-50131

Financial Fraud and Fraud Susceptibility in the United States: Research Report from a 2012 National Survey. FINRA Investor Education Foundation.

Fraudulent Financial Reporting 1998-2007: An Analysis of U.S. Public Companies. (2010). Committee of Sponsoring Organizations of the Treadway Commission http://www.coso.org/documents/COSOFRAUDSTUDY2010_001.PDF

Rijsenbilt, A., & Commandeur, H. (2012). Narcissus Enters the Courtroom: CEO Narcissism and Fraud Journal of Business Ethics, 117 (2), 413-429 DOI: 10.1007/s10551-012-1528-7

Zona, F., Minoja, M., & Coda, V. (2012). Antecedents of Corporate Scandals: CEOs’ Personal Traits, Stakeholders’ Cohesion, Managerial Fraud, and Imbalanced Corporate Strategy Journal of Business Ethics, 113 (2), 265-283 DOI: 10.1007/s10551-012-1294-6

Image via Gajus / Shutterstock.

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Empathy and Stress – Women Are the Stronger Sex http://brainblogger.com/2014/04/13/empathy-and-stress-women-are-the-stronger-sex/ http://brainblogger.com/2014/04/13/empathy-and-stress-women-are-the-stronger-sex/#comments Sun, 13 Apr 2014 11:30:12 +0000 http://brainblogger.com/?p=16255 I learned many of life’s great lessons while watching Audrey Hepburn movies with my grandmother. To this day, I cannot hear the word “empathy” without being reminded of the first time I heard that word in the movie Funny Face. Empathy is difficult to study, owing to its many dimensions and facets, but it is essential to human interaction. And new evidence suggests that women may be better at it than men.

In the movie, Audrey Hepburn plays Jo, a shy bookkeeper who wants to spend her days studying the theories of empathicalism. When Fred Astaire (as Dick Avery) asks her about her philosophy, she explains: “Sympathy is to understand what someone feels; empathy is to project your imagination so that you can actually feel what the other person is feeling; you put yourself in the other person’s place.”

Recently, researchers examined empathy in males and females under stressful conditions. When the men were stressed, they were less able to engage in socially appropriate and empathetic interactions with other people; men became more egocentric when stressed. Women, on the other hand, were more empathetic toward others when they themselves were under stress.

For the study, which is published in the journal Psychoneuroendocrinology, the participants were placed in moderately stressful situations in a laboratory, including speaking in public with little preparation or performing mental arithmetic tasks, that mimicked the type of stress humans can encounter on a daily basis. Once stressed, the participants were asked to imitate movements, recognize emotions, or make a judgment about the perspective of another person. Stress worsened the men’s performances in all three areas, but the women’s scores improved.

Stress seems problematic when we are acutely dealing with a challenging situation, but stress actually has a positive function: it makes us recruit additional resources when faced with a difficult situation. We can either reduce the internal load of the stress or seek external support to cope with the stress. The authors of the current study suggest that the easiest response to stress is to become more egocentric and self-centered, which reduces the internal emotional and cognitive workload. And, the more egocentric a person is, the less empathetic he or she becomes.

The fact that women were more empathetic when stressed might be explained in two ways (though neither theory has been proven). First, women may have a keen understanding that the better they interact with other people, the more external support they receive. Therefore, women are more likely to expend emotional energy when interacting with other people and apply appropriate social strategies, even when they are stressed – something akin to catching more flies with honey than with vinegar.

Additionally, the hormone oxytocin may play a role in social behaviors. We already know that oxytocin is important in relationship building, pair bonding, and maternal behaviors, but in one study, under stressful conditions, women had higher levels of oxytocin than men.

Empathy involves emotional, autonomic, cognitive, and regulatory processes. Some information is known about which regions of the brain are involved in empathy, but the timing and sequencing of the activities are unclear. Empathy could even be partly attributed to misinterpretation of perceptual information. People with mental illness and those who have suffered stroke or other brain injury can lose some empathetic abilities. It is clear that we do not understand the “how” of empathy, but the “why” and “what” are pretty obvious. Empathy is a necessary part of human interaction. In order to work and socialize and cooperate with other people, we must be able, at least sometimes, to put ourselves in their shoes – take on their perspective, feel what they feel, and act the way they act. Sometimes, we will be stressed, but we still need to do it. (Men – listen up!)

This current study provides no direction for how to use these findings to improve our own social interaction; it is merely a report of interesting results that remind us of the differences between men and women when it comes to what the professionals call “prosocial behavior.” That is, empathy is just one of the behaviors in which we need to engage to benefit other people and society at large, and women seem to have the upper hand in this case.

References

Balconi M, & Bortolotti A (2012). Empathy in cooperative versus non-cooperative situations: the contribution of self-report measures and autonomic responses. Applied psychophysiology and biofeedback, 37 (3), 161-9 PMID: 22419515

Cowan DG, Vanman EJ, & Nielsen M (2014). Motivated empathy: The mechanics of the empathic gaze. Cognition & emotion PMID: 24568562

Mahayana IT, Banissy MJ, Chen CY, Walsh V, Juan CH, & Muggleton NG (2014). Motor empathy is a consequence of misattribution of sensory information in observers. Frontiers in human neuroscience, 8 PMID: 24567713

Thirioux B, Mercier MR, Blanke O, & Berthoz A (2014). The cognitive and neural time course of empathy and sympathy: An electrical neuroimaging study on self-other interaction. Neuroscience PMID: 24583040

Tomova, L., von Dawans, B., Heinrichs, M., Silani, G., & Lamm, C. (2014). Is stress affecting our ability to tune into others? Evidence for gender differences in the effects of stress on self-other distinction Psychoneuroendocrinology, 43, 95-104 DOI: 10.1016/j.psyneuen.2014.02.006

Tran US, Laireiter AR, Schmitt DP, Neuner C, Leibetseder M, Szente-Voracek SL, & Voracek M (2013). Factorial structure and convergent and discriminant validity of the E (Empathy) scale. Psychological reports, 113 (2), 441-63 PMID: 24597440

Yeh ZT, & Tsai CF (2014). Impairment on theory of mind and empathy in patients with stroke. Psychiatry and clinical neurosciences PMID: 24521285

Image via Lorimer Images / Shutterstock.

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Markers for Melancholy http://brainblogger.com/2014/03/07/markers-for-melancholy/ http://brainblogger.com/2014/03/07/markers-for-melancholy/#comments Fri, 07 Mar 2014 12:00:00 +0000 http://brainblogger.com/?p=16108 Depression involves, in part, dysfunctions in the perception of, response to, and interpretation of emotions. Research is now focusing on biomarkers that are involved in the pathophysiology of depression, which may lead to improved treatments.

Several parts of the brain, including the prefrontal cortex, hippocampus, amygdala, striatum, and insula, work together to regulate emotions, and people with depression exhibit altered structure and function of these areas. Many direct and indirect factors lead to these alterations, including chronic exposure to stress and genetic influences.

For the better part of a century, depression has been approached as a deficiency in specific neurotransmitters in the brain. Pharmacological treatments for depression have relied on increasing the release or blocking the destruction of these neurotransmitters, including dopamine, norepinephrine, and serotonin. Still, these therapies are only able to induce remission in approximately half of patients with depression, leaving many patients suffering and in need of help.

The drive for new treatment options has allowed researchers to focus on neuron density in regions of the brain that are involved in emotions. They have discovered that the body’s response to stress has a significant impact on the generation and destruction of neurons and that inflammatory mediators play a critical role in this response. Scientists and mental health professionals stress that, while these new theories are promising for expanding our understanding of depressive and mood disorders, all of the theories – both new and old – are interconnected and the integration of the theories will provide the most meaningful progress in the treatment of mental health.

We are still a long way away from completely defining the pathophysiology of depression, but screening for compounds or biomarkers that are influential in the disease could assist in the clinical diagnosis of depression and help identify new classes of treatments. Biomarkers like magnesium and proinflammatory cytokines including tumor necrosis factor alpha, interleukin-6, and interleukin-1 beta could reflect biological changes that occur during depression, and compounds such as ketamine and anti-inflammatory agents could moderate the effects of the biological changes.

New treatments that are being considered for depression include reduced response to stress, restoration of the appropriate balance of neurotransmitters, and neuronal generation and regulation in the hippocampus, pituitary gland, and adrenal glands. For example, stress ultimately leads to the release of glucocorticoids in the brain, and suppressing its release or modifying its binding to glucocorticoid receptors in the brain may improve depressive symptoms. Corticotropin-releasing hormone antagonists or dexamethasone are likely candidates for treatment in this case. The removal of part of the adrenal gland has also been proposed. But, a holistic treatment plan that involves cognitive and behavioral stress management techniques is also appropriate.

Changes in treatment for depression are by no means imminent, but the map we are creating of how the mind works will eventually guide the future of mental health care.

References

Dunjic-Kostic B, Ivkovic M, Radonjic NV, Petronijevic ND, Pantovic M, Damjanovic A, Poznanovic ST, Jovanovic A, Nikolic T, & Jasovic-Gasic M (2013). Melancholic and atypical major depression–connection between cytokines, psychopathology and treatment. Progress in neuro-psychopharmacology & biological psychiatry, 43, 1-6 PMID: 23200828

Hannestad J, DellaGioia N, & Bloch M (2011). The effect of antidepressant medication treatment on serum levels of inflammatory cytokines: a meta-analysis. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 36 (12), 2452-9 PMID: 21796103

Martin C, Tansey KE, Schalkwyk LC, & Powell TR (2014). The inflammatory cytokines: molecular biomarkers for major depressive disorder? Biomarkers in medicine PMID: 24524646

Murck H (2013). Ketamine, magnesium and major depression–from pharmacology to pathophysiology and back. Journal of psychiatric research, 47 (7), 955-65 PMID: 23541145

Rao, M and Alderson, JM. (2014). Dissecting melancholia with evidence-based biomarker tools. Current Psychiatry, 13(2):41-48, 57.

Image via Artaporn Puthikampol / Shutterstock.

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