Posts Tagged anxiety

[WEB SITE] UC study explores how low risk stress reduction treatments may benefit epilepsy patients

Patients with epilepsy face many challenges, but perhaps the most difficult of all is the unpredictability of seizure occurrence. One of the most commonly reported triggers for seizures is stress.

A recent review article in the European journal Seizure, by researchers at University of Cincinnati Epilepsy Center at the UC Gardner Neuroscience Institute, looks at the stress-seizure relationship and how adopting stress reduction techniques may provide benefit as a low risk form of treatment.

The relationship between stress and seizures has been well documented over the last 50 years. It has been noted that stress can not only increase seizure susceptibility and in rare cases a form of reflex epilepsy, but also increase the risk of the development of epilepsy, especially when stressors are severe, prolonged, or experienced early in life.

“Studies to date have looked at the relationship from many angles,” says Michael Privitera, MD, director of the UC Epilepsy Center and professor in the Department of Neurology and Rehabilitation Medicine at the UC College of Medicine. “The earliest studies from the 1980s were primarily diaries of patients who described experiencing more seizures on ‘high-stress days’ than on ‘low-stress days.'”

Privitera and Heather McKee, MD, an assistant professor in the Department of Neurology and Rehabilitation Medicine, looked at 21 studies from the 1980s to present–from patients who kept diaries of stress levels and correlation of seizure frequency, to tracking seizures after major life events, to fMRI studies that looked at responses to stressful verbal/auditory stimuli.

“Most all [of these studies] show increases in seizure frequency after high-stress events. Studies have also followed populations who have collectively experienced stressful events, such as the effects of war, trauma or natural disaster, or the death of a loved one,” says Privitera. All of which found increased seizure risk during such a time of stress.

For example, a 2002 study evaluated the occurrence of epileptic seizures during the war in Croatia in the early 1990s. Children from war-affected areas had epileptic seizures more often than children not affected by the war. Additionally, the 10-year follow up showed that patients who had their first epileptic seizure during a time of stress were more likely to have controlled epilepsy or even be off medication years later.

“Stress is a subjective and highly individualized state of mental or emotional strain. Although it’s quite clear that stress is an important and common seizure precipitant, it remains difficult to obtain objective conclusions about a direct causal factor for individual epilepsy patients,” says McKee.

Another aspect of the stress-seizure relationship is the finding by UC researchers that there were higher anxiety levels in patients with epilepsy who report stress as a seizure precipitant. The researchers suggest patients who believe stress is a seizure trigger may want to talk with their health care provider about screening for anxiety.

“Any patient reporting stress as a seizure trigger should be screened for a treatable mood disorder, especially considering that mood disorders are so common within this population,” adds McKee.

The researchers report that while some small prospective trials using general stress reduction methods have shown promise in improving outcomes in people with epilepsy, large-scale, randomized, controlled trials are needed to convince both patients and providers that stress reduction methods should be standard adjunctive treatments for people with epilepsy.

“What I think some of these studies point to is that efforts toward stress reduction techniques, though somewhat inconsistent, have shown promise in reducing seizure frequency. We need future research to establish evidence-based treatments and clarify biological mechanisms of the stress-seizure relationship,” says Privitera.

Overall, he says, recommending stress reduction methods to patients with epilepsy “could improve overall quality of life and reduce seizure frequency at little to no risk.”

Some low risk stress reduction techniques may include controlled deep breathing, relaxation or mindfulness therapy, as well as exercise, or establishing routines.

Source: UC study explores how low risk stress reduction treatments may benefit epilepsy patients

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[WEB SITE] 17 Things People With Chronic Illness Mean When They Say ‘I’m Tired’

Everyone has said “I’m tired” at one point or another. But those deceptively simple words can have so many meanings. Without knowing the extent of the exhaustion someone with chronic illness is feeling when they say they’re people may think your “tiredness” can be cured by a nap or early night, like theirs, not understanding the support you really need in that moment.

So we asked our Mighty community with chronic illness to reveal what they might actually mean when they say, “I’m tired.” It’s important for the people in your life to understand the challenges you’re dealing with and the empathy and kindness that can help you get through them.

 

Here’s what our community told us:

1. “Most people who are healthy don’t understand that ‘I’m tired’ is a very shortened phrase for us. When I actually admit to friends and family that I feel bad or am tired that means so much. That means I can no longer mask the symptoms I deal with on a daily basis and I need a little compassion to get through the next few hours or sometimes days.”

2. “When I say ‘I’m tired,’ I mean my body hurts to the point I can’t explain to a ‘normal’ person how bad it hurts. It means mentally, emotionally and physically I do not want to keep going. When I say ‘I’m tired’ I’m giving myself permission for a second to stop fighting my illness and to be vulnerable. When I say ‘I’m tired’ I’m trusting you enough to show you how I really feel before I get ready to get up and keep fighting again.”

3. “I don’t want to stop helping you, but I’m pretty sure I’m going to crumble if I do one more thing. So, just smile and nod as I go sit down and put my brace on.”

4. “Just sitting in a chair is exhausting. I just want to be able to melt into the floor because I don’t have the energy to hold myself up. I’m not sleepy, I’m exhausted!”

5. “When I say ‘I’m tired’ it means I don’t want to talk about it right now. It means I’m tired of the fight my body is constantly in against itself, I’m tired of being positive, I’m tired of pushing through the pain, I’m tired of never-ending procedures and continuous doctor appointments that tend to only discover new problems. I know everything will be OK and my faith will get me through this, but right now ‘I’m tired’ and don’t have the energy or the will to put that much effort in to finding the good in my situation.”

6. “‘I’m tired’ is code for: I’ve hit the exhaustion wall/power-off button; I don’t have the energy to explain the systemic overload my body and mind are experiencing; I need to be alone; I’m sorry I can’t do that for you right now, but I’m incapable of even doing that for myself.”

7. “Most of the time it actually means, ‘I know you mean well, but please give me some space. I’d like to be alone.’ Predominantly this is when I really am absolutely exhausted and have zero energy to consider those around me.”

8. “I’m mentally exhausted from having to keep it together on the surface at work, when what I really want to do is scream out loud with the pain. The majority of my day is spent ticking down the clock so I can go home and curl up and just be in pain out loud.”

9. “Half the time it means I don’t have any reason for feeling the way I do emotionally, mentally, or physically, but I feel I need to give one. The other half of the time it’s that I’m at my breaking point and there’s not enough rest or time away in the world to bring me out of it.”

10. “It’s usually my go-to response for pain, exhaustion, anxiety, everything. It’s easier than trying to explain something ‘normal’ people will never understand. Tiredness is something everyone can comprehend on some level.”

11. “I want, no need, to collapse right here. I’m in so much pain I want to cry, but it isn’t socially acceptable to do that. I can’t think straight enough to know my own name, let alone what I should be doing right now!”

12. “When I say I’m tired I mean I can’t keep smiling and acting as if nothing was happening. My whole day I try to show my best, I pretend to be the same person I was before the pain started. When I’m tired I cannot pretend anymore, I have to be who I am now.”

13. “I’m emotionally drained. But I don’t want to appear weak or go into details. Saying, ‘I’m just tired’ is simpler sometimes.”

14. “I say ‘I’m tired,’ but what I mean is I am fatigued beyond exhaustion, I can barely function, I feel like I haven’t slept in days, my body and mind ache for restful rest!”

15. “When I say I am tired, it means wherever I am could make a good place to lay down and hopefully sleep. The concrete floor over there? Yeah that looks like an amazing place.”

16. “I’m out of spoons. Of juice. Of battery. I physically cannot muster the energy needed to complete the task(s) being asked of me.”

17. “I’ll stare off into the brain fog and when someone notices, auto respond, ‘I’m just tired.’ It’s so much easier not to have to explain something you know they likely don’t understand. My being tired can’t be fixed. Take a nap, cured. If only it were that simple.”

Source: 17 Things People With Chronic Illness Mean When They Say ‘I’m Tired’ | The Mighty

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[Abstract] Systematic review: Predicting adverse psychological outcomes after hand trauma

Abstract

Study Design

Systematic review.

Introduction and Purpose of the Study

After traumatic hand injury, extensive physical and psychological adaptation is required following surgical reconstruction. Recovery from injury can understandably be emotionally challenging, which may result in impaired quality of life and delayed physical recovery. However, the evidence base for identifying high-risk patients is limited.

Methods

A PROSPERO-registered literature search of MEDLINE (1946-present), EMBASE (1980-present), PsychInfo, and CINAHL electronic databases identified 5156 results for studies reporting psychological outcomes after acute hand trauma. Subsequent review and selection by 2 independent reviewers identified 19 studies for inclusion. These were poor quality level 2 prognostic studies, cross sectional or cohort in design, and varied widely in methodology, sample sizes, diagnostic methods, and cutoff values used to identify psychological symptoms. Data regarding symptoms, predisposing factors, and questionnaires used to identify them were extracted and analyzed.

Results

Patients with amputations or a tendency to catastrophize suffered highest pain ratings. Persisting symptom presence at 3 months was the best predictor of chronicity. Many different questionnaires were used for symptom detection, but none had been specifically validated in a hand trauma population of patients. Few studies assessed the ability of selection tools to predict patients at high risk of developing adverse psychological outcomes.

Discussion and Conclusion

Despite a limited evidence base, screening at 3 months may detect post-traumatic stress disorder, anxiety, depression, and chronic pain, potentially allowing for early intervention and improved treatment outcomes.

Source: Systematic review: Predicting adverse psychological outcomes after hand trauma – Journal of Hand Therapy

 

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[WEB SITE] Cognitive Behavioral Therapy Benefits & Techniques

In today’s society, doctors and psychiatrists are quick to prescribe psychotropic drugs that often come with dangerous side effects for any disorder that stems from thought patterns. But what if I told you there was a better, safer way to manage and treat stress and brain disorders? Enter cognitive behavioral therapy.

According to the National Association of Cognitive Behavioral Therapists, cognitive behavioral therapy (often just called CBT) is a popular form of psychotherapy that emphasizes the importance of underlying thoughts in determining how we feel and act. Considered to be one of the most successful forms of psychotherapy to come around in decades, cognitive behavioral therapy has become the focus of hundreds of research studies. (1)

CBT therapists work with patients to help them uncover, investigate and change their own thought patterns and reactions, since these are really what cause our perceptions and determine our behaviors. Using CBT therapists offers patients valuable perspective, which helps improve their quality of life and manage stress better than patients simply “problem-solving” tough situations on their own.

Something that might surprise you about CBT: A core principle is that external situations, interactions with other people and negative events are not responsible for our poor moods and problem in most cases. Instead, CBT therapists actually view the opposite as being true. It’s, in fact, our own reactions to events, the things we tell ourselves about the events — which are within our control — that wind up affecting our quality of life.

This is  great news — because it means we have the power to change. Through cognitive behavioral therapy, we can learn to change the way we think, which changes the way we feel, which in turn changes the way we view and handle tough situations when they arise. We can become better at intercepting disruptive thoughts that make us anxious, isolated, depressed, prone to emotionally eating and unwilling to change negative habits.

When we can accurately and calmly look at situations without distorting reality or adding additional judgments or fears, we’re better able to know how to react appropriately in a way that makes us feel happiest in the long run.


Proven Benefits of Cognitive Behavioral Therapy

A 2012 meta-analysis published in the Journal of Cognitive Therapy and Researchidentified 269 studies that supported the use of CBT for the following problems: (2)

  • substance abuse disorders
  • schizophrenia and other psychotic disorders
  • depression and dysthymia
  • manic depression/bipolar disorder
  • anxiety disorders
  • somatoform disorders
  • eating disorders
  • sleep disorders, including insomnia
  • personality disorders
  • anger and aggression
  • criminal behaviors
  • general stress and distress due to general medical conditions
  • chronic fatigue syndrome
  • muscle pains and tension
  • pregnancy complications and female hormonal conditions

Researchers found the strongest support for CBT in treating anxiety disorders, somatoform disorders, bulimia, anger control problems and general stress. After reviewing 11 review studies comparing improvement rates between CBT and other therapy treatments, they found that CBT showed higher response rates than the comparison treatments in seven of the 11 reviews (more than 60 percent). Only one of 11 reviews reported that CBT had lower response rates than comparison treatments, leading researchers to believe that CBT is one of the most effective therapy treatments there is.

Here are some of the major ways cognitive behavioral therapy benefits patients from different walks of life:

1. Lowers Symptoms of Depression

Cognitive behavioral therapy is one of the best-known, empirically supported treatments for depression. Studies show that CBT helps patients overcome symptoms of depression like hopelessness, anger and low motivation, and lowers their risk for relapses in the future.

CBT is believed to work so well for relieving depression because it produces changes in cognition (thoughts) that fuel vicious cycles of negative feelings and rumination. Research published in the journal Cognitive Behavioral Therapy for Mood Disordersfound that CBT is so protective against acute episodes of depression that it can be used along with, or in place of, antidepressant medications. CBT has also shown promise as an approach for helping handle postpartum depression and as an adjunct to medication treatment for bipolar patients. (3)

2. Reduces Anxiety

According to work published in Dialogues in Clinical Neuroscience, there’s strong evidence regarding CBT treatment for anxiety-related disorders, including panic disorders, generalized anxiety disorder, social anxiety disorder, obsessive compulsive disorder and post-traumatic stress disorder. Overall, CBT demonstrates both efficacy in randomized controlled trials and effectiveness in naturalistic settings between patients with anxiety and therapists. (4)

Researchers have found that CBT works well as a natural remedy for anxiety because it includes various combinations of the following techniques: psycho-education about the nature of fear and anxiety, self-monitoring of symptoms, somatic exercises, cognitive restructuring (for example disconfirmation), image and in vivo exposure to feared stimuli (exposure therapy), weaning from ineffective safety signals, and relapse prevention.

3. Helps Treat Eating Disorders

The Journal of Psychiatric Clinics of North America reports that eating disorders provide one of the strongest indications for cognitive behavioral therapy. CBT has been found to help address the underlying psychopathology of eating disorders and question the over-evaluation of shape and weight. It can also interfere with the maintenance of unhealthy body weights, improve impulse control to help stop binge eating or purging, reduce feelings of isolation, and help patients become more comfortable around “trigger foods” or situations using exposure therapy. (5)

Cognitive therapy has become the treatment of choice for treating bulimia nervosa and “eating disorders not otherwise specified” (EDNOS), the two most common eating disorder diagnoses. There’s also evidence that it can be helpful in treating around 60 percent of patients with anorexia, considered to be one of the hardest mental illnesses to treat and prevent from returning.

4. Reduces Addictive Behaviors and Substance Abuse

Research has shown that CBT is effective for helping treat cannabis and other drug dependencies, such as opioid and alcohol dependence, plus helping people quit smoking cigarettes and gambling. Studies published in the Oxford Journal of Public Health involving treatments for smoking cessation have found that coping skills learned during CBT sessions were highly effective in reducing relapses in nicotine quitters and seem to be superior to other therapeutic approaches. (6) There’s also stronger support for CBT’s behavioral approaches (helping to stop impulses) in the treatment of problematic gambling addictions compared to control treatments. (7)

5. Helps Improve Self-Esteem and Confidence

Even if you don’t suffer from any serious mental problems at all, CBT can help you replace destructive, negative thoughts that lead to low self-esteem with positive affirmations and expectations. This can help open new ways to handle stress, improve relationships and increase motivation to try new things. The Psychology Tools website provides great resources for using CBT worksheets on your own to work on developing affirmative communication skills, healthy relationships and helpful stress-reducing techniques. (8)

Facts About Cognitive Behavioral Therapy

  • CBT was originally created to help people suffering from depression, but today it’s used to improve and manage various types of mental disorders and symptoms, including: anxiety, bipolar disorder, post-traumatic stress disorder, obsessive compulsive disorder, addictions and eating disorders. (9)
  • CBT techniques are also beneficial for just about everyone else, including people with no form of mental illness but who have chronic stress, poor moods and habits they’d like to work on.
  • The term cognitive behavioral therapy is considered a general term for a classification of therapeutic approaches that have similarities, including: rational emotive behavior therapy, rational behavior therapy, rational living therapy, cognitive therapy and dialectical behavior therapy.
  • To date, more than 332 medical studies and 16 quantitative reviews have examined the effects of CBT. Interestingly, more than 80 percent of these studies were conducted after 2004. (10)
  • Studies have found that in people who have completed CBT programs and then undergone brain scans, CBT is actually capable of positively changing physical structures in the brain. (11)
  • CBT can work quickly, helping patients feel better and experience lessened symptoms within a short period of time (several months, for example). While many forms of therapy can take many months or even years to become very helpful, the average number of CBT sessions clients receive is only 16.
  • CBT often involves the patient completing “homework” assignments on their own between therapy sessions, which is one of the reasons benefits can be experienced so quickly.
  • In addition to homework being done by the patients while they’re alone, cognitive behavioral therapists also use instructions, questioning and “exposure therapy” during sessions. CBT is very interactive and collaborative. The therapist’s role is to listen, teach and encourage, while the patient’s role is to be open and expressive.
  • One of the biggest advantages for patients is that CBT can be continued even after formal sessions with a therapist are over. Eventually, formal therapy ends, but at this point the clients can continue to work on exploring CBT concepts, using techniques they’ve learned, journaling and reading to help prolong benefits and manage symptoms.

How Cognitive Behavior Therapy Works

CBT works by pinpointing thoughts that continuously rise up, using them as signals for positive action and replacing them with healthier, more empowering alternatives.

The heart of CBT is learning self-coping skills, giving patients the ability to manage their own reactions/responses to situations more skillfully, change the thoughts they tell themselves, and practice “rational self-counseling.” While it definitely helps for the CBT therapist/counselor and patient to build trust and have a good relationship, the power really lies in the patient’s hands. How willing a patient is to explore his or her own thoughts, stay open-minded, complete homework assignments and practice patience during the CBT process all determine how beneficial CBT will be for them.

Some of the characteristics that make cognitive behavioral therapy unique and effective include:

  • Rational approach: CBT theory and techniques are based on rational thinking, meaning they aim to identify and use facts. The “inductive method” of CBT encourages patients to examine their own perceptions and beliefs to see if they are in fact realistic. In CBT, there is an underlying assumption that most emotional and behavioral reactions are learned. Many times with a CBT therapists’s help, patients learn that their long-held assumptions and hypotheses are at least partially incorrect, which causes them unnecessary worrying and suffering. (12)
  • Law of entropy and impermanence: CBT rests on scientific assumptions, including the law of entropy, which is essentially the fact that “if you don’t use it, you lose it.” We always have the power to change how we feel because our feelings are rooted in our brains’ chemical interactions, which are constantly evolving. If we break cycles of thought patterns, our brains will adjust for the better. MRI scans show the human brain creates and sustains neural synapses (connections) between frequent thoughts and emotions, so if you practice positive thinking your brain will actually make it easier to feel happier in the future.
  • Accepting unpleasant or painful emotions: Many CBT therapists can help patients learn how to stay calm and clear-headed even when they’re faced with undesirable situations. Learning to accept difficult thoughts or emotions as being “simply part of life” is important, because this can help stop a vicious cycle from forming. Often we get upset about our tough feelings and add on even more suffering. Instead of adding self-blame, anger, frustration, sadness or disappointment to already-tough feelings, CBT teaches patients to calmly accept a problem without judgment in order to not make it even worse.
  • Questioning and expressing: Cognitive behavioral therapists usually ask patients many questions in order to help them gain a new perspective, see the situation more clearly and realistically, and help them undercover how they really feel.
  • Specific agendas and techniques: CBT is usually done in a series of sessions that each have a specific goal, concept or technique to work with. Unlike some other forms of therapy, sessions are not simply for the therapist and patient to talk openly without an agenda in mind. CBT therapists teach their clients how to better handle difficult thoughts and feelings by practicing specific techniques during sessions that can later be applied to life when they’re most needed.

Cognitive Behavioral Therapy vs. Other Types of Psychotherapy 

CBT is a type of psychotherapy, which means it involves open talking between patient and therapist. You might have heard of several other forms of psychotherapy in the past and are wondering what makes CBT stand apart. Many times there is some overlap between different forms of psychotherapy. A therapist might use techniques from various psychotherapy approaches to help patients best reach their goals and improve (for example, to help someone with a phobia, CBT might be coupled with exposure therapy).

According to the National Alliance on Mental Illness, here is how CBT differs from other popular forms of therapy: (13)

  • CBT vs. Dialectical Behavior Therapy (DBT): DBT and CBT are probably the most similar therapeutic approaches, however DBT relies more heavily on validation or accepting uncomfortable thoughts, feelings and behaviors. DBT therapists help patients find balance between acceptance and change by using tools like mindfulness guided meditation.
  • CBT vs. Exposure Therapy: Exposure therapy is a type of cognitive behavioral therapy that’s often used to help treat eating disorders, phobias and obsessive-compulsive disorder. It teaches patients to practice using calming techniques and small series of “exposures” to triggers (things that are most feared) in order to become less anxious about the outcome.
  • CBT vs. Interpersonal Therapy: Interpersonal therapy focuses on the relationships a patient has with his or her family, friends, co-workers, media and community to help evaluate social interactions and recognize negative patterns (such as isolation, blame, jealousy or aggression). CBT can be used with interpersonal therapy to help reveal underlying beliefs and thoughts driving negative behavior toward others.

Ways to Practice Cognitive Behavioral Therapy Techniques on Your Own

  • Identify your current obstacles: The first step is to identify what’s really causing you stress, unhappiness and unease. Maybe you’re feeling resentful toward someone, fearful of failure or worried about being rejected socially in some way. You might find that you have persistent anxiety, symptoms of depression or are struggling to forgive someone for a past event. Once you can recognize this and become more aware of your primary obstacle, then you have the power to start work on overcoming it.
  • Try “thought recording”: You can use a journal or even record your own voice on a tape recorder to help you identify recurring destructive thoughts you frequently tell yourself. Ask yourself questions to dig deeper and form connections you weren’t previously aware of. Then reread your entries as if you were not yourself, but a good friend. What advice would you give yourself? What beliefs of yours can you notice aren’t very accurate, only making matters worse and not overall helpful?
  • Form patterns and recognize your triggers: Think about what types of situations make you most likely to feel anxious, upset, critical or sad. Start to form patterns of behaving in certain ways or experiencing certain things (for example, maybe drinking too much alcohol or gossiping behind someone’s back) and how they leave you feeling, so you can start breaking the cycle.
  • Notice how things are always changing: Feelings come and go constantly (called impermanence), so knowing that fear, anger or other strongly unplesant emotions are only temporary can help you stay calm in the moment.
  • “Put yourself in their shoes”: It’s important to try and view situations as rationally, clearly and realistically as possible. It helps to consider other people’s perspectives, question your assumptions, and see if there’s something important you might be missing or ignoring.
  • Thank yourself and be patient: Even though CBT works quickly for many people, it’s an ongoing process that’s essentially lifelong. There’s always ways to improve, feel happier, and treat others and yourself better, so practice being patient. Remind yourself there is no finish line. Give yourself credit for putting effort into facing your problems directly, and try to view “slip-ups” as inevitable parts of the journey and learning process.

Final Thoughts on Cognitive Behavioral Therapy

  • CBT techniques are also beneficial for just about everyone else, including people with no form of mental illness but who have chronic stress, poor moods and habits they’d like to work on.
  • Some of the major ways cognitive behavioral therapy benefits patients from different walks of life includes lowering symptoms of depressions, reducing anxiety, treating eating disorders, reduces addictive behaviors and substance abuse, and helps improve self-esteem and confidence.
  • You can practice cognitive behavioral therapy by identifying your current obstacles, trying thought recording, forming patterns and recognizing your triggers, noticing how things are always changing, putting yourself in others’ shoes, and thanking yourself and being patient.

Source: Cognitive Behavioral Therapy Benefits & Techniques – Dr. Axe

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[ARTICLE] When neutral turns significant: brain dynamics of rapidly formed associations between neutral stimuli and emotional contexts – Full Text

Abstract

The ability to associate neutral stimuli with motivationally relevant outcomes is an important survival strategy. In this study, we used event-related potentials (ERPs) to investigate brain dynamics of associative emotional learning when participants were confronted with multiple heterogeneous information. Participants viewed 144 different objects in the context of 144 different emotional and neutral background scenes. During each trial, neutral objects were shown in isolation and then paired with the background scene. All pairings were presented twice to compare ERPs in response to neutral objects before and after single association. After single pairing, neutral objects previously encoded in the context of emotional scenes evoked a larger P100 over occipital electrodes compared to objects that were previously paired with neutral scenes. Likewise, larger late positive potentials (LPPs) were observed over parieto-occipital electrodes (450–750 ms) for objects previously associated with emotional relative to neutral contexts. The LPP – but not P100 – enhancement was also related to subjective object/context binding. Taken together, our ERP data provide evidence for fast emotional associative learning, as reflected by heightened perceptual and sustained elaborative processing for neutral information previously encountered in emotional contexts. These findings could assist in understanding binding mechanisms in stress and anxiety, as well as in addiction and eating-related disorders.

Introduction

One important survival strategy is to perceive fluctuating changes that occur in contiguous environments in order to readjust the momentary motivational relevance of incoming information. This ability allows developing flexible and adaptive responses based on the history of contingencies encountered by the individual (Miskovic & Keil, 2012). In this sense, it has been observed that a previously neutral stimulus (conditioned stimulus; CS+) continuously associated with an aversive event (unconditioned stimulus; UCS) acquires motivational relevance, compared to a neutral stimulus (CS−) unpaired with a UCS or associated with a non-emotional UCS, a process called associative learning. Traditionally, a large number of pairings between few and/or simple CS+ and a strongly aversive UCS have been used in learning paradigms to generate strong associations (Lissek et al., 2006). However, rather than single, unambiguous and/or isolated CS/UCS pairings, we are constantly confronted with multiple different events that imply associations between neutral and moderately relevant stimuli. Thus, the use of paradigms involving ‘weak’ ambiguous situations (e.g. less salient UCS, multiple complex pairings and/or few contingencies CS/UCS) would provide a better understanding of the underpinnings of associative learning (Lissek et al., 2006; Beckers et al., 2013; Steinberg et al., 2013b; Hur et al., in press). In the present study, we investigated the role of UCS heterogeneity on the formation of associations using electrophysiological correlates of associative learning for multiple neutral events paired with multiple emotional contingencies (emotional scenes).

Recent studies from Junghöfer and colleagues (e.g. Pastor et al., 2015; see Steinberg et al., 2013b, for review) used the so-called MultiCS conditioning, in which multiple CSs+ (e.g. pictures of different faces) were associated with emotionally relevant UCSs (e.g. aversive and appetitive sounds, electric shocks), while other CSs− remained unpaired or were associated with neutral events. Brain activation was measured using electro- and magnetoencephalography (EEG, MEG) during these conditioning procedures. After multiple pairings, CSs+ compared to CSs− evoked enhanced neural activity at prefrontal and sensory cortical regions during earlier (< 300 ms; Bröckelmann et al., 2011; Steinberg et al., 2012, 2013a; Rehbein et al., 2014, 2015) and later stages of processing (> 300 ms; Pastor et al., 2015), irrespective of contingency awareness. These results suggest the existence of a rather automatic learning mechanism that rapidly transfers the emotional properties of the UCS to CSs, leading to a facilitated perceptual and a more elaborated processing of the CS+.

Nevertheless, these studies have only used highly salient UCS. Therefore, it is unclear whether such associative learning processes also occur in the presence of less intense emotional events – i.e., reproducing daily interactions – or whether the formation of associations is exclusively facilitated in survival-specific contexts (Öhman & Mineka, 2001). It is also unclear whether the acquired motivational significance leading to neural response enhancement for emotion-associated stimuli occurs rapidly after one single pairing (e.g. Morel et al., 2012; Rehbein et al., 2014), or whether more than one repetition is needed to form such associations (e.g. Steinberg et al., 2012). While most of the electrophysiological conditioning studies have used aversive cues as UCS (see Miskovic & Keil, 2012, for review), it has recently been observed that pleasant information can also serve as effective, intrinsically motivating UCSs (Schacht et al., 2012; Steinberg et al., 2013a; Blechert et al., 2016; see Martin-Soelch et al., 2007, for neuroimaging findings). Both aversive and appetitive conditioning processes likely not only contribute to various disorders, such as trauma- and stress-related disorders, but also to substance abuse and eating-related disorders (e.g. Martin-Soelch et al., 2007; Pape & Pare, 2010). Thus, more evidence regarding the effect of valence on associative conditioning is needed.

In the present study, we therefore investigated brain dynamics of associative emotional learning when participants viewed neutral objects in the context of different emotionally arousing (both pleasant and unpleasant) and neutral background scenes. Object and scene presentation occurred always in the same order; first objects were presented in isolation (CS) and then a picture scene was added as background (see Fig. 1). Pairings were presented in two consecutive blocks, allowing to compare the processing of CS+ objects – paired with emotional scenes – and CS− objects – paired with neutral scenes, before (first block) and after single pairing (second block). Based on previous EEG and MEG conditioning studies (see Miskovic & Keil, 2012, for review), we predicted enhanced processing of neutral cues previously paired with emotional contexts, irrespective of valence, relative to cues previously paired with neutral contexts at different stages of processing. Because both perceptual and sustained elaborative processing have been found to be enhanced for stimuli associated with CS+, we predicted enhanced positivity for the CS+ compared with the CS− at (a) earlier (P100) and (b) later stages of processing [late positive potential (LPP)].

Figure 1. Schematic view of the stimulus presentation during the first and the second associative learning blocks. When an object was seen during the first block, the object/background association has not yet taken place, and when the object was seen in the second block, object and background scene have been associated once. [Correction added on 19 Aug 2016, after original online publication: Figure 1 has been corrected.]

Continue —> When neutral turns significant: brain dynamics of rapidly formed associations between neutral stimuli and emotional contexts – Ventura-Bort – 2016 – European Journal of Neuroscience – Wiley Online Library

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[ARTICLE] A structured multicomponent group programme for carers of people with acquired brain injury: Effects on perceived criticism, strain, and psychological distress. – Full Text HTML

Abstract

Objectives

The purpose of this study was to examine whether a brief structured multicomponent group programme for carers of people with acquired brain injury (ABI) was effective in reducing carer distress, strain, and critical comments between carer and person with an ABI compared to a waiting list control condition.

Design

Waiting list controlled study. Pre- and post-test design with outcomes measured at induction, at the end of the intervention, and at the 3-month follow-up.

Methods

One hundred and thirteen carers took part in the study: 75 carers in the intervention group and 38 in the waiting list control group (2:1 ratio). All participants completed assessments of caregiver strain (Caregiver Strain Index), perceived criticism towards and from the person with an ABI (Perceived Criticism Scale), and psychological distress (Hospital Anxiety and Depression Scale). The person with an ABI was also assessed on the Functional Independence Measure/Functional Assessment Measure.

Results

Using an intention to treat analysis, there were significant effects of group (intervention vs. waiting list control) at the 3-month follow-up on carers’ perceptions of stress and strain resulting from caring, and perceptions of criticism received by the carer from the person with an ABI. A subsequent per-protocol analysis showed an additional reduction at 3 months in levels of criticism expressed towards the person with an ABI by the carer. There was no significant effect of the intervention on psychological distress.

Conclusions

The structured multicomponent carers programme showed beneficial effects in terms of reducing carer strain and in the reduction of elements of perceived criticism at the 3-month follow-up; however, it did not significantly affect psychological distress in carers, suggesting the need for additional support for this group of carers.

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Continue —> A structured multicomponent group programme for carers of people with acquired brain injury: Effects on perceived criticism, strain, and psychological distress – Fortune – 2015 – British Journal of Health Psychology – Wiley Online Library

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[WEB SITE] How stress increases seizures for patients with epilepsy – Medical News Today

It is well known that stress can increase the frequency and severity of seizures for patients with epilepsy. Now, researchers have shed light on why this is, and they may have even found a way to stop it.

Researchers have shed light on why stress increases seizure frequency for patients with epilepsy.

Published in the journal Science Signaling, the researchers reveal how epilepsy alters the way brain reacts to stress to cause seizures.

Epilepsy is a neurological disorder characterized by recurrent seizures, which are sudden surges of electrical activity in the brain.

According to the Epilepsy Foundation, around 1.3-2.8 million people in the United States have epilepsy. Each year, around 48 in every 100,000 Americans develop the condition.

Stress and anxiety are well-established triggers for seizures among people with epilepsy, and studies have shown that reducing stress may lower seizure risk for those with the condition.

While neurologists recommend that patients with epilepsy avoid stressful situations as a way of avoiding stress-induced seizures, it is not always possible to do so, highlighting the need for a therapeutic alternative.

However, because scientists have been unclear about how stress causes seizures, such a treatment has proven difficult to find.

Now, Michael O. Poulter, Ph.D., of the University of Western Ontario in Canada, and colleagues believe they may have moved a step closer to fulfilling this need.

Stress-induced seizures caused by increased activity in piriform cortex

For their study, the researchers focused on analyzing the activity of corticotropin-releasing factor (CRF) in the brains of rats with and without epilepsy.

CRF is a neurotransmitter – a chemical that enables communication between nerve cells – that regulates the behavioral response to stress.

The researchers assessed how CRF affected the piriform cortex of the rodents, which is a region of the brain in which seizures are known to occur among humans with epilepsy.

Among rats without epilepsy, the researchers found that CRF reduced activity in the piriform cortex of the brain. Among rats with epilepsy, however, they found CRF did the opposite, increasing activity in the piriform cortex.

“When we used CRF on the epileptic brain, the polarity of the effect flipped; it went from inhibiting the piriform cortex to exciting it,” explains Poulter. “At that point we became excited, and decided to explore exactly why this was happening.”

On further investigation, the team found that CRF altered neuronal signaling in the brains of rats with epilepsy.

Specifically, they found that CRF activated a protein called regulator of G protein signaling protein type 2 (RGS2), which changed communication between nerve cells in the piriform cortex to increase the occurrence of seizures.

The researchers say their findings suggest it may be possible to prevent stress-induced seizures in patients with epilepsy by blocking CRF.

“We are very excited about this possibility for treating epilepsy patients.”

Michael O. Poulter, Ph.D.

Furthermore, the researchers say their findings may have implications for other neurological disorders, such as depression and schizophrenia; these conditions might trigger neurochemical processes that increase severity of symptoms.

Learn how a derivative of cannabis could help treat childhood epilepsy.

Source: How stress increases seizures for patients with epilepsy – Medical News Today

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[ARTICLE] Anxiety — Is There an App for That? Considering Technology, Psychiatry, and Internet-Assisted Cognitive Behavioral Therapy – Full Text PDF

Abstract

Across Western countries, more than a third of people will have a mental health disorder over their lifetime; mood and anxiety disorders are the most common. The effectiveness of psychological interventions is well established. Cognitive Behavioural Therapy (CBT), for example, is as effective for mild and moderate anxiety as medica‐ tions; combined psychopharmacology and CBT is superior to either modality alone, suggesting a synergistic effect. However, CBT requires a major investment of time and resources. Thus, in public systems, CBT has limited availability and is subject to long waiting times; primary-care physicians and psychiatrists may not offer CBT.

Can technology address the deficiency of psychological interventions for mental illness? Internet therapies (including smart phone apps) have been developed, offering CBT and other psychological interventions. In this chapter, we focus on Internet-assisted CBT (ICBT).

ICBT allows patients to receive ongoing CBT with easier and quicker access, at reduced cost, and with increased convenience over traditional CBT. We review evidence from randomized trials and meta-analyses, which strongly support the use of ICBT in clinical practice, especially in combination with ongoing therapist support. We consider government experimentation with ICBT, with a particular focus on Australia. We also present a case demonstrating the clinical application of ICBT. Finally, with an eye to the future, we will look at potential research questions.

Full Text PDF

 

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[WEB SITE] Could High-Powered Infrared Light Help Reverse TBI Damage?

Published on August 27, 2015

NILTaaA possible treatment for traumatic brain injury (TBI) could be the use of a specific high-powered, near-infrared light (NIR), a new study suggests.

The study was published recently in the journal Neuropsychiatric Disease and Treatment, according to a media release from the Neuro-Laser Foundation.

Study co-authors Theodore Henderson, MD, PhD from the Neuro-Laser Foundation and Dr Larry Morries and Paolo Cassano of Massachusetts General suggest that a specific high-powered, near infrared light (NIR) can possibly re-energize damaged brain cells after penetrating the skin and skull, per the release.

In their study, which occurred from 2011 to 2013, the research team administered 10 transcranial applications of high-power NIR over the course of 2 months to 10 study participants who were diagnosed with chronic mild-to-moderate TBI. Using a Class IV laser and pulsed light, each treatment took less than 60 minutes, the release explains.

Continue —> Could High-Powered Infrared Light Help Reverse TBI Damage? – Physical Therapy Products

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[WEB SITE] 5 Things Every TBI Survivor Wants You to Understand

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March is National Brain Injury Awareness Month, and as promised, I am writing a series of blogs to help educate others and bring awareness to traumatic brain injuries (TBI).

1. Our brains no longer work the same.

We have cognitive deficiencies that don’t make sense, even to us. Some of us struggle to find the right word, while others can’t remember what they ate for breakfast. People who don’t understand, including some close to us, get annoyed with us and think we’re being “flaky” or not paying attention. Which couldn’t be further from the truth, we have to try even harder to pay attention to things because we know we have deficiencies.

Martha Gibbs from Richmond, VA, suffered a TBI in May of 2013 after the car she was a passenger in hit a tree at 50 mph. She sums up her “new brain” with these words:

Almost 2 years post-accident, I still suffer short-term memory loss and language/speech problems. I have learned to write everything down immediately or else it is more than likely that information is gone and cannot be retrieved. My brain sometimes does not allow my mouth to speak the words that I am trying to get out.

2. We suffer a great deal of fatigue.

We may seem “lazy” to those who don’t understand, but the reality is that our brains need a LOT more sleep than normal, healthy brains. We also have crazy sleep patterns, sometimes sleeping only three hours each night (those hours between 1 and 5 a.m. are very lonely when you’re wide awake) and at other times sleeping up to 14 hours each night (these nights are usually after exerting a lot of physical or mental energy).

Every single thing we do, whether physical or mental, takes a toll on our brain. The more we use it, the more it needs to rest. If we go out to a crowded restaurant with a lot of noise and stimulation, we may simply get overloaded and need to go home and rest. Even reading or watching tv causes our brains to fatigue.

Toni P from Alexandria, VA, has sustained multiple TBI’s from three auto accidents, her most recent one being in 2014. She sums up fatigue perfectly:

I love doing things others do, however my body does not appreciate the strain and causes me to ‘pay the price,’ which is something that others don’t see.  I like to describe that my cognitive/physical energy is like a change jar. Everything I do costs a little something out of the jar.  If I keep taking money out of the jar, without depositing anything back into the jar, eventually I run out of energy. I just don’t know when this will happen.  Sometimes it’s from an activity that seemed very simple, but was more work then I intended. For me, like others with TBIs, I’m not always aware of it until after I’ve done too much.

Continue —>  5 Things Every TBI Survivor Wants You to Understand | Amy Zellmer.

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