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Seven Questions for Daniel Amen

February 4, 2009 in Blogs, Psychology Today by Psychology Today

The Seven Questions project welcomes renowned brain expert and bestselling author Daniel Amen. You may have seen him preach his message of change on PBS , on bookshelves or at professional conferences. He’s not simply suggesting you can change your attitude or behavior, he actually believes you can change your brain. In an effort to illuminate the various clinical approaches to psychotherapy, this series asks the same seven questions to influential authors, theorists and policymakers. Dr. Amen, a revered and sometimes controversial figure in popular psychiatry is our honored guest today. Daniel G. Amen (MD, Oral Roberts University, 1982) is a psychiatrist, brain imaging specialist and the CEO and medical director of Amen Clinics , Inc. (ACI) in Newport Beach and Fairfield, California, Tacoma, Washington and Reston, Virginia. ACI has the world’s largest database of functional brain scans related to psychiatric medicine, now totaling nearly 50,000 scans, and the clinics have seen patients from 75 countries. Dr. Amen is an Assistant Clinical Professor of Psychiatry and Human Behavior at the University of California, Irvine School of Medicine. No stranger to the public sphere, Dr. Amen is one of the hardest working and most diverse MD’s out there, sharing his wisdom in nutrition columns , on the Men’s Health Q & A forum and even paid a visit to  The View  to discuss brain-based gender differences. Dr. Amen is the author of 22 books , including two New York Times bestsellers, Change Your Brain, Change Your Life and Magnificent Mind at Any Age . He has also written and produced two highly successful specials for public television. His method employs a balanced approach to treating mood, attention and relational problems. A review of Magnificent Mind  states: "Dr. Amen has rendered the growing trend of not treating the whole person, and of using prescription medicine as the first or only choice for mental and physical health, completely obsolete." Dr. Amen shares his opinions on psychotherapy with us today. As a psychiatrist who believes in : "using the least toxic, most effective treatments for our patients, … from natural supplements, medications, dietary interventions and targeted forms of psychotherapy," I knew he’d contribute some unique thoughts to the discussion. For example, his answer to Q3 is an important reminder that many psychological symptoms can have a biological etiology. Please enjoy Dr. Amen’s responses to the Seven Questions. Seven Questions for Daniel Amen: 1. How would you respond to a new client who asks: "What should I talk about?" His or her biggest concerns. A good history is so critical to the therapeutic process. It starts with someone’s concerns and then expands from there. I take a bio-psycho-social-spiritual approach to my patients and want them to talk to me about all of these issues. 2. What do clients find most difficult about the therapeutic process? Being confused as how to help themselves. Most people who see me want to be better, but the therapeutic process is so foreign to them. I think they need very clear direction on how to be most effective in using the process. 3. What mistakes do therapists make that hinder the therapeutic process? The biggest mistake I see is that they rarely consider the brain. I often say psychiatrists are the only medical specialists that never look at the organ they treat. How crazy is that! How do we know unless we look? We call people who have brain damage personality disordered? We call people with toxic exposure resistant to treatment? We think of depression as a singular illness, when it has many types, like chest pain. We need to do much better and it will start when we really take brain function seriously. 4. In your opinion, what is the ultimate goal of therapy? Better brain function. I am convinced therapy goes much faster, and patients are better able to do their own lives when you help your patients have better brain function. 5. What is the toughest part of being a therapist? Not having enough information to be helpful. 6. What is the most enjoyable or rewarding part of being a therapist? Helping people change their lives in a positive way. I have so many stories of how when a person’s brain is better that they become more effective, more loving, more passionate … that it brings me joy on a regular basis. 7. What is one pearl of wisdom you would offer clients about therapy? Think about the brain, how to improve it and you will be more effective in all you do. ——– My gratitude to International Psychoanalysis , The Library of Economics and Liberty , Introductory Psychology Resources , Psychlinks Online and the American Psychological Association for blogging about or linking to the Seven Questions. There’s even a European magazine named  Charaktery asking seven questions to influential Polish psychotherapists. My goal was to get people talking about psychotherapy so it’s nice to see interest from such diverse venues. © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Seven Questions for Daniel Amen

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Antidepressants and Suicide: WHO Scientists Weigh In

February 4, 2009 in Blogs, Psychology Today by Psychology Today

On the question of new antidepressants and suicide, the evidence we have has been synthesized, and the results are in : the medications prevent suicides in adults, and especially in the elderly. For children and adolescents, we simply don’t know – and the gap in our knowledge has had dangerous effects. World Health Organization scientists based in Italy and Canada have re-analyzed data on over 200,000 patients with depression treated with serotonergic antidepressants, or SSRIs. With a pool this large, the researchers were able to look past ideation to actual attempts or completed suicides. The study found a strong protective effect for adults, including young adults, aged 18 to 25, and the elderly, over age 65. The medications decreased the risk of suicide by over 40 per cent in adults aged 18 to 64, and by over 50 per cent in older patients. These results are striking, especially in the light of earlier FDA summaries that found a neutral effect for non-elderly adults and a negative effect for young adults. But the FDA reports were based on research not designed to investigate suicidality, and the data were skewed conservatively, that is, in ways that might over-identify suicidal behavior. The new analysis is more clear-cut; it moves the line of high risk down from age 25 to age 18. What happens below age 18 is uncertain. Both the FDA summary and yesterday’s analysis found a marked increase in suicidality in depressed adolescents treated with SSRIs. (Unless I’m reading the data wrong, the risk for youth looks to be almost double on medication.) But as an accompanying editorial indicates, a large body of research points in the opposite direction. For instance, examining all youth suicides (42 deaths) over a five-year period, Danish pathologists found that none of the adolescents had been on SSRIs. In many countries, studies have found that low SSRI prescribing levels correlate with high youth suicide rates. Decreased SSRI prescribing since the FDA issued its "black box" warning has been associated with increased rates of suicide in adolescents. And some of the studies (including ones in the current WHO analysis) that have demonstrated an increase in suicidality are poorly controlled, so that the young people on SSRIs may be more seriously ill than those in the comparison group. We need to settle this issue: As regards risk of suicide, do SSRIs help or harm depressed adolescents? The editorial assessing the WHO study contains these disturbing sentences: "Alarmingly, concerns about the risk of suicide in youth have led not only to fewer SSRI prescriptions without substitution of alternative medications or psychotherapies, but also to a decrease in predicted rates of diagnosis of mood disorders. Since a decrease in the rate of true depression is improbable, clinicians may be avoiding making this diagnosis to avoid the dilemma of whether to prescribe antidepressants to children or adolescents." This worry was one that experts raised when the FDA was considering its action – that a warning, however carefully worded, might cost lives. (I should note that on balance I favored the black box warning.) As the editorial indicates, "in youth, suicide appears to occur most commonly among those with untreated mood disorders." My own impression – I discuss it in Against Depression – is that antidepressants simply work less well in children, and for reasons that accord well with the prevailing neurobiological theories of mood disorder. But when the medications do appear to help, are they dangerous? The new study again raises special worries about Paxil and also Effexor in young patients. Incidentally, two of the WHO researchers on the new study, Andrea Cipriani and Corrado Barbui, were also authors of the widely publicized recent summary analysis that rated the relative merits of antidepressants. As in the prior report, in the new one Zoloft looks especially safe, at least in adults. © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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by Vaughan

NeuroPod on pheromones, neural nets, fMRI and sleep

February 4, 2009 in Blogs, Mind Hacks by Vaughan

The latest Nature Neuropod neuroscience podcast has just hit the net, with a great selection of discussions and interviews covering everything from pheromones and sexual attraction to the impact of poor quality sleep on memory. This final section on an intriguing and recently published study found that even mild disturbance that didn’t wake the sleeper but knocked them out of deeper sleeper into the shallower sleep stages could still disrupt the retention of material learned the previous day. However, as I am remarkably tired myself I need as much deep sleep as I can get, so I shall leave the rest of the podcast as a voyage of discovery. Enjoy! Link to Neuropod home page with audio. mp3 of latest podcast.

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NeuroPod on pheromones, neural nets, fMRI and sleep

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Tracing memories [Neurophilosophy]

February 2, 2009 in Blogs, Brain & Behaviour by BrainAndBehaviour

During the first half of the twentieth century, the American psychologist Karl Lashley conducted a series experiments in an attempt to identify the part of the brain in which memories are stored. In his now famous investigations, Lashley trained rats to find their way through a maze, then tried to erase the memory trace – what he called the “engram” – by making lesions in different parts of the neocortex. Lashley failed to find the engram – no matter where he made a lesion, his experimental animals were still able to find their way through the maze. As a result, he concluded that memories are not stored in a discrete area of the brain, but rather were distributed throughout it. This led Lashley to devise his principle of Mass Action, which states that most behaviours involve the integrated actions of the whole cerebral cortex.    Subsequently, the pioneering work of Brenda Milner, who worked with the amnesic patient known as H.M. , implicated the hippocampus as being crucial for memory formation. We now know that the frontal cortex is also involved, and it is currently thought that new memories are transferred to there for long-term storage. A new study now provides some evidence that memory recall becomes increasingly dependent upon the frontal cortex, and other areas of the brain, with time.   Read the rest of this post… | Read the comments on this post…

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The Ritalin Generation [The Frontal Cortex]

February 2, 2009 in Blogs, Brain & Behaviour by BrainAndBehaviour

I came of age in the Ritalin generation, which meant that plenty of my classmates in elementary school went to the nurse’s office for their little dose of drug. At the time, I remember being jealous of these kids, who not only got to miss 10 minutes of instruction but got to have a real, genuine medical affliction. (I was one of those confused children who, for a brief period, thought it would be awesome to have braces and/or a big cast on my arm.) In retrospect, I can appreciate the complexities of the ADHD debate. On the one hand, ADHD is a real syndrome, with identifiable neural correlates. For instance, in November 2007, a team of researchers from the National Institute of Mental Health and McGill University uncovered the specific deficits of the ADHD brain. The disorder turns out to be a developmental problem: the brains of kids with ADHD develop at a significantly slower pace than normal. This lag was most obvious in the prefrontal cortex, which is a brain area that’s crucial for things like directed attention and impulse control. (On average, their frontal lobes were three and a half years behind schedule.) And yet, I often wonder about the medical treatments we’ve come to rely on for the treatment of ADHD. Ritalin (aka methylphenidate) is a potent, psychoactive drug. We prescribed it to millions of kids with little knowledge of the long-term consequences. While I know Ritalin can be effective – I’ve seen it perform wonders on my elementary school friends, not to mention all the undergraduates who juiced their attention with crushed pills – there are many uncertainties concerning its long-term application. A new PNAS paper by scientists at the National Institute for Drug Abuse (NIDA) makes this clear. I’m forced to clip from the press release, as the paper itself isn’t out yet: Investigators funded by the National Institute on Drug Abuse (NIDA) have shown that the medication methylphenidate (Ritalin), which is commonly prescribed to treat attention-deficit hyperactivity disorder (ADHD), can cause physical changes in neurons in reward regions of mouse brains; in some cases, these effects overlapped with those of cocaine. Both methylphenidate and cocaine are in the class of drugs known as psychostimulants. While methylphenidate is widely prescribed, this study highlights the need for more research into its long-term effects on the brain. These research findings will be published February3 in Proceedings of the National Academy of Sciences. “Studies to date suggest that prescribed use of methylphenidate in patients with ADHD does not increase their risk for subsequent addiction. However, nonmedical use of methylphenidate and other stimulant medications can lead to addiction as well as a variety of other health consequences,” said NIDA Director Dr. Nora Volkow. “This study highlights the fact that we know very little about how methylphenidate affects the structure of and communication between brain cells.” The researchers exposed mice to 2 weeks of daily injections ofcocaine or methylphenidate, after which reward areas of the brain were examined for changes in dendritic spine formation, which is related to the formation of synapses and the communication between nerve cells; and the expression of a protein, delta Fos B, which has been implicated in the long-term actions of addictive drugs. Both drugs increased dendritic spine formation and the expression of delta Fos B; however, the precise pattern of their effects was distinct. It differed in the types of spine saffected, the cells that were affected, and the brain regions. In some cases, there was overlap between the two drugs; further, in some cases, methylphenidate produced greater effects than cocaine–for example, on protein expression in certain regions. It’s worth noting, though, that previous studies found no link between stimulant treatment for ADHD and drug abuse. The takeaway from this latest study is NOT that Ritalin is just a fancy brand of cocaine, or that delta Fos B is a gene uniquely turned on by amphetamines or illicit drugs. (It seems to be part of the BDNF pathway, which is why its expression leads to the growth of dendritic spines.) Rather, it’s that we really don’t know how stimulants like Ritalin influence fundamental pathways in the brain. Thanks for the tip, Dave! Read the comments on this post…

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The Ritalin Generation [The Frontal Cortex]

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Your brain on football – it’s not pretty [Neuron Culture]

January 27, 2009 in Blogs, Brain & Behaviour by BrainAndBehaviour

CNN has a fascinating and rather frightening story about the toll football (or the concussions acquired playing it) take on the brain : But today, using tissue from retired NFL athletes culled posthumously, the Center for the Study of Traumatic Encephalopathy (CSTE) is shedding light on what concussions look like in the brain. The findings are stunning. Far from innocuous, invisible injuries, concussions confer tremendous brain damage. That damage has a name: chronic traumatic encephalopathy (CTE). CTE has thus far been found in the brains of five out of five former NFL players. On Tuesday afternoon, researchers at the CSTE will release study results from the sixth NFL player exhibiting the same kind of damage. “What’s been surprising is that it’s so extensive,” said Dr. Ann McKee, a neuropathologist at the Veterans Administration Hospital in Bedford, Massachusetts, and co-director of the CSTE. “It’s throughout the brain, not just on the superficial aspects of the brain, but it’s deep inside.” CSTE studies reveal brown tangles flecked throughout the brain tissue of former NFL players who died young — some as early as their 30s or 40s. McKee, who also studies Alzheimer’s disease, says the tangles closely resemble what might be found in the brain of an 80-year-old with dementia. The study’s limitation to brains of athletes who died young probably creates a selection bias toward more heavily damaged brains. But still. There were some alarming photos I couldn’t manage to swing over. Story’s definitely worth a look . h/t: BoingBoing Read the comments on this post…

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Your brain on football – it’s not pretty [Neuron Culture]

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by Vaughan

Neuroimaging, before the invention of television

January 27, 2009 in Blogs, Mind Hacks by Vaughan

Neuroscience textbooks often suggest that the ability to image the structure of the brain in living patients started in the 1970s with the introduction of the CT scanner. What they tend to forget is that brain surgeon Walter Dandy was already neuroimaging patients as early as 1918. We think of x-rays as only being useful for getting pictures of bones but soft tissue does show up on an x-ray. The images rely on certain bits of the body having a higher density and therefore blocking more of the rays falling on the photographic plate. Bones are obviously very dense so show up well but look at this image of a hand x-ray. You can clearly see the difference between bone, flesh and air. What you can’t see is any difference in the soft tissue. The crucial difference that struck Walter Dandy was the possibility of distinguishing flesh and air on an x-ray. Knowing that the brain is surrounded by cerebrospinal fluid ( CSF ), which also fills internal spaces called the ventricles , he decided to simply replace the fluid with air and x-ray the patient. He published his first results in 1918. He described how he drilled a hole in the skull of a patient and carefully removed the CSF from the ventricles and replaced it with air. Now known as ventriculography, one of the images he took is illustrated on the top left. For the first time, you could clearly see the ventricles in a living patient. During the procedure, he noted that some of the air has escaped the ventricles and was occupying the space between the skull and the brain. The following year he published another study where he deliberately filled this space with air as well, so the surface of the brain was surrounded by the gas and so could show up on an x-ray. The bottom left image shows the result of this, and you can see it clearly shows some of the ‘trenches’, the cerebral sulci , on the surface of the brain. Now called pneumoencephalography, the procedure was immensely useful, but, extremely unpleasant. In his 1918 article he noted that the patient’s reaction “was characterized by a rise of temperature, nausea, vomiting, and increased headache”. Furthermore, it takes weeks, if not months, for the CSF to be replaced by the body, leaving the patient in a debilitated and fragile state. However, it was used throughout the 20th century and the research literature is peppered with the results of this early neuroimaging research. Link to 1918 paper on imaging of the ventricles. Link to 1919 paper on imaging the brain surface.

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Ironic Thoughts [The Frontal Cortex]

January 22, 2009 in Blogs, Brain & Behaviour by BrainAndBehaviour

I know, I know, you’re probably sick of me prattling on about metacognition . If so, then feel free to skip this post. I’ve got a new article in the latest Seed (it’s a particularly good issue, I think, although it’s not yet online) on the virtues and vices of thinking about thinking: The game only has one rule, and it’s a simple one: Don’t think about white bears. You can think about anything else, but you can’t think about that. Ready? Close your eyes, take a deep breath, and banish the animals from your head. You just lost the game. Everyone loses the game. As Dostoevsky first observed, in Winter Notes on Summer Impressions: “Try to avoid thinking of a white bear, and you will see that the cursed thing will come to mind every minute.” In fact, whenever we try to not think about something, be it white bears or a broken heart, that something gets trapped in the mind, stuck in the recursive loop of self-consciousness. The brain backfires; our attempt at repression turns into an odd fixation. This human frailty has profound consequences. Dan Wegner, a psychologist at Harvard, refers to the failure as an “ironic” mental process. Whenever we establish a mental goal⎯such as trying to not think about white bears⎯the goal is accompanied by an inevitable follow-up thought, as the brain checks to see if we’re making progress. The end result, of course, is that we obsess over the one thing we’re trying to avoid. Wegner argues that this ironic twitch is responsible for all sorts of afflictions, from anxiety disorder (we get anxious whenever we think about not getting anxious) to insomnia, which can occur when the drowsy brain checks to see if we’ve fallen asleep (and so we wake up). The mind is a disobedient machine. Although these perverse thoughts can be irritating⎯⎯wouldn’t it be nice to be able to fall asleep at will, like a cat?⎯they also reveal an essential feature of the human mind, which is that it doesn’t just think: it constantly thinks about how it thinks. We’re insufferably self-aware, like some post-modern novel, so that the brain can’t go for more than a few seconds before it starts calling attention to itself, reflecting on its own contents, thoughts and feelings. This even applies to thoughts we’re trying to avoid, which is why those white bears are so inescapable. The technical term for this is metacognition, and it’s a rather surreal skill. Imagine that M.C. Escher drawing of a hand drawing a hand, or a video camera making a movie of itself: The cortex is the same way, as it constantly transforms the subject at the center of consciousness⎯you⎯into yet another object contemplated by consciousness. Of course, like all things meta, the process can quickly spiral out of control. When a mind thinks about metacognition, it’s thinking about how it thinks about how it thinks. And so on. I then go on to discuss the benefits of metacognition… Read the comments on this post…

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by Vaughan

The cutting edge of robotics

January 22, 2009 in Blogs, Mind Hacks by Vaughan

Singularity Hub has reviewed the best commercial and research lab robots from 2008 and has videos of each and every one. It’s a fantastic collection that has everything from exoskeletons, to violin playing humanoids, to ultra-lightweight robots that fly by flapping gossamer-thin wings. The most curious is probably the robot self-reassembling chair or maybe the robo-shapes from the ISI Polymorphic Robotics Laboratory. Anyway, a fascinating collection and great to see how AI and mechanical engineering are being applied to create the latest in cutting-edge robotics. Link to ‘A Review of the Best Robots of 2008′ videos.

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Learning Should Be Fun

January 19, 2009 in Blogs, Mind Hacks by Vaughan

Learning can and should be fun. This is not just a moral position, but a scientific one too. When you learn a new thing, or get a surprise, there is a shot of a chemical messenger in your brain called dopamine . Dopamine is famous among neuroscientists for its involvement in the reward and motivation systems of the brain. You won’t be surprised to learn that the reason addictive drugs are addictive is that they hack the reward circuitry that dopamine is intimately involved in. Perhaps the most addictive drug, cocaine, directly increases the amount of dopamine at work in your brain. Learning something new triggers a chemical release of the same kind as cocaine, albeit in a much more subtle manner. As methods of getting your kicks you can perhaps compare it to the difference between walking up a hill yourself or being strapped to a rocket and blasted up — slower, harder work, but a lot more sustainable and you’re in a better state to enjoy the view when you get there! The reason for this electro-chemical connection between learning and drugs of reward is that our brains have obviously been designed to find learning fun . One of the many negative things about the misconception that education is about transmitting content is the idea that any fun you have is taking time away from proper learning, and that ‘proper learning’ shouldn’t be fun. Rather than fun being a relief from learning, or a distraction from it, for most of our history, before school, learning had to be its own motivation. Brains that learnt well had more offspring, and so learning evolved to be rewarding. In lots of teaching situations we focus on the right and wrong answers to things, which is a venerable paradigm for learning, but not the only one. There is a less structured, curiosity-driven, paradigm which focusses not on what is absolutely right or wrong, but instead on what is surprising. A problem with rights and wrongs is that, for some people, the pressure of being correct gets in the way of experiencing what actually is . You can try this for yourself, either in any teaching you do, or any learning. Often we will get blocked at a particular stage in our learning. A normal response is to try harder, and to focus more on what we’re doing right, and what we’re doing wrong. Sometimes this helps, but sometimes it just digs us further into our rut. The way out of the rut is to re-focus on experiencing again. I’ll give you an example from one of the two things I know best about teaching — aikido, the japanese martial art. Aikido involves some quite intricate throws and grappling moves. Often a student is so intent on getting through the move, and on trying hard to get it right, that they become completely stuck, repeatedly doing something that doesn’t work, and usually too fast. Even if you say or show explicitly the correct movement, they can’t seem to get it. In this situation, one teaching technique I use, inspired by the ‘Inner Game’ writings of Timothy Gallway , is to tell the student to stop trying to do the move correctly, and instead do it deliberately wrong. “Try pushing over this way to the left”, I’ll say, “Now try the opposite over to the right. Now try high, or low. Which is easiest?”. By removing the obligation to get the move correct I hope to give permission to the student to just experience the effect they are having on their partner’s balance. Once they can tune into this they can figure out for themselves what the right thing to do is, without me having to tell them. However you do it, if you can get out of the rut of right and wrong you free up a natural capacity for experience-led, curiosity-driven learning. Soon you’ll be flying along again, experiencing the learning equivalent of the jogger’s high, and all thanks to that chemical messenger dopamine and a brain that’s evolved to find things out for itself, and feel good while doing it. Part of a series. #1 Learning Makes Itself Invisible Cross-posted at schoolofeverything.com Image: jogging on the beach by Naama

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