Posts Tagged Cognitive behavioral therapy

[WEB SITE] What’s the Difference Between CBT and DBT?

Whats the Difference Between CBT and DBT?Cognitive-behavioral therapy (CBT) is one of the most commonly practiced forms of psychotherapy today. It’s focus is on helping people learn how their thoughts color and can actually change their feelings and behaviors. It is usually time-limited and goal-focused as practiced by most psychotherapists in the U.S. today.

Dialectical behavior therapy (DBT) is a specific form of cognitive-behavioral therapy. DBT seeks to build upon the foundation of CBT, to help enhance its effectiveness and address specific concerns that the founder of DBT, psychologist Marsha Linehan, saw as deficits in CBT.

DBT emphasizes the psychosocial aspects of treatment — how a person interacts with others in different environments and relationships. The theory behind the approach is that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family and friend relationships. DBT was originally designed to help treat people with borderline personality disorder, but is now used to treat a wide range of concerns.

DBT theory suggests that some people’s arousal levels in certain situations can increase far more quickly than the average person’s. This leads a person to attain a much higher level of emotional stimulation than normal, and it may take a significant amount of time to return to normal emotional arousal levels.

DBT differs in practice in one important way. In addition to individual, weekly psychotherapy sessions, most DBT treatment also features a weekly group therapy component. In these group sessions, people learn skills from one of four different modules: interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, and mindfulness skills. A group setting is an ideal place to learn and practice these skills, because it offers a safe and supportive environment.

Both CBT and DBT can incorporate exploring an individual’s past or history, to help an individual better understand how it may have impacted their current situation. However, discussion of one’s past is not a focus in either form of therapy, nor is it a differentiation between the two forms (it is completely dependent upon the individual psychotherapist).

Whether cognitive-behavior therapy or dialectical behavior therapy is right for you is a determination best made in conjunction with an experienced therapist. Both types of psychotherapy have strong research backing and have been proven to help a person with a wide range of mental health concerns.

via What’s the Difference Between CBT and DBT?

, , , , , ,

Leave a comment

[WEB SITE] Understanding the Anxious Brain

Post by D. Chloe Chung
“I was so anxious to do what is right that I forgot to do what is right.” – Jane Austin

What’s the deal with anxiety?

You’re giving an important presentation tomorrow for work in front of a big crowd. You know you’re well-prepared, but when you imagine yourself standing at the podium, facing strangers whose eyes are fixed on you, you start to feel nauseated – your palms sweat and your heart hammers in your chest. You’re experiencing acute anxiety, a state of negative emotions and heightened arousal, often accompanied by increased alertness. This definition may sound similar to that of ‘fear’, which is produced as an acute response to immediate threats. There is considerable overlap between the brain circuitry regulating anxiety and fear, but anxiety is distinct from fear because it can be internally triggered or anticipatory – just like when you were merely imagining that presentation for work. Much of our understanding of anxiety stems from what we have learned about how the brain processes and learns fear responses.

What’s going on in your brain when you’re feeling anxious?  

Recent research efforts have emphasized the importance of communication between multiple brain areas in evoking anxiety. One of the established models of the neural circuitry of anxiety proposes that anxiety arises due to active neural communication between brain regions, including the amygdala, a brain structure involved in fear learning. The amygdala (the central extended amygdala [CeA]) sends projections to the bed nucleus of the stria terminalis (BNST), a cluster of nuclei involved in threat monitoring. The amygdala and the BNST also communicate with other brain regions such as the ventral hippocampus (vHPC) and the prefrontal cortex (PFC). According to this model, these four regions are connected by neural projections and work with one another in an orchestrated manner to evaluate whether or not a situation is threatening. The brain activity in this group of regions that we’ll refer to as the ‘anxiety detection’ regions can be either anxiogenic or anxiolytic, meaning they can perpetuate or reduce anxiety, respectively.


Downstream, the motor cortex, regions of the brainstem, and the neuroendocrine system receive, interpret, and evaluate possible anxiety signals from the brain regions involved in anxiety detection. These downstream regions then initiate anxiety responses by triggering defensive and risk-avoiding behaviors and altering biological functions such as heart and respiration rate. Excessive anxiety can occur when the brain’s anxiety pathways misinterpret incoming signals. For instance, repeated exposure to ‘threatening’ situations may cause anxiogenic pathways to become abnormally hyperactive, and therefore more sensitive to threatening stimuli. This can cause an imbalance in the neural circuitry that processes anxiety, shaping the brain to become more reactive and susceptible to experiencing anxiety.

What’s new in anxiety research?

While we know the amygdala (specifically the CeA) is particularly important for anxiety regulation, the exact mechanisms are difficult to disentangle. Recent research has helped to shed light on some of the specific circuitry involved. A recent study in the Journal of Neuroscience used a novel rat model and deleted a gene called ErbB4 –  implicated in various neurological disorders  in a group of amygdala neurons that release somatostatin, a peptide implicated in fear responses. In behavioral tests, rats without this gene exhibited higher anxiety levels, due to increased somatostatin levels in the amygdala. The abnormal activity of somatostatin neurons in the CeA also disrupted the inhibition of somatostatin neurons in the BNST, rendering these neurons hyperactive and ultimately causing heightened anxiety. A peptide called dynorphin has been identified as a key molecular player in this amygdala-BNST anxiety circuit. The authors demonstrated that the amount of dynorphin produced by somatostatin neurons in the amygdala was increased, and led to disinhibition of the BNST, contributing to the induction of anxiety-related behaviors. In other words, both somatostatin and dynorphin work together to play an important role in increased anxiety in mice without ErbB4. The good news is that dynorphin could be a potential target for anxiety treatment.

Another area of anxiety research concerns the stress neuropeptide, corticotropin-releasing factor. It’s known to regulate the BNST’s ability to elicit anxiety, but it was unclear where the corticotropin-releasing factor was coming from until recently. A study published by Pomrenze et al. showed that corticotropin-releasing factor is majorly produced and released by a group of neurons located in the lateral amygdala and the dorsolateral BNST. Using designer drugs that can either inhibit or activate neurons expressing the corresponding receptors via viral transduction, the authors found that neurons that project from the lateral amygdala to the BNST and release corticotropin-releasing factor are critical in mediating anxiety. Removal of these neurons reduced anxiety behaviors, confirming the importance of corticotropin-releasing factor in evoking anxiety responses.

What happens when anxiety interferes with daily life?

Modern life is full of stressors and many people are prone to experiencing intense anxiety at some point in their lives. In fact, anxiety is a part of a normal emotional spectrum and can even be beneficial at times, increasing our vigilance and enabling our survival. However, chronic anxiety can severely interfere with day-to-day living and become pathological, resulting in generalized anxiety disorder (GAD) or other anxiety-related disorders. Anxiety disorders like GAD are common, impacting one in every five adults. Considering how many individuals are affected by pathological anxiety, there is a need for highly effective anti-anxiety drugs or behavioral interventions. It is critical to understand the brain circuitry underlying anxiety to develop effective treatment options for chronic anxiety disorders.

Since anxiety results in heightened arousal, many anxiety medications manipulate neurotransmitters to slow the nervous system down, decreasing arousal. Medications such as selective serotonin reuptake inhibitors (SSRIs) and Buspirone work to increase serotonin in the nervous system, which can, in turn, decrease arousal. Medication options for phobias such as social anxiety tend to decrease the effect of norepinephrine, a neurotransmitter connected to the ‘fight or flight’ fear response. Cognitive-behavioral therapy (CBT) and consulting with certified therapists can also improve anxiety. CBT is a popular and effective strategy that guides individuals to replace anxiety-provoking interpretations of situations with benign ones. For individuals with less severe anxiety symptoms, CBT can sometimes work as well as some medications, depending on the person and the extent of their anxiety. CBT can also be combined with other therapeutic approaches to effectively treat anxiety depending on the severity of symptoms. Regular physical exercise and breathing exercises can also be effective in reducing anxiety symptoms.

Things to remember about anxiety

To manage acute daily anxieties, remembering how the brain circuitry of anxiety works might be helpful – the anxiety regions of the brain first assess whether the situation is threatening or not, and then subsequently trigger the anxiety response. This means that we can practice psychological tricks to aid the brain in better assessing non-threatening situations as just that – non-threatening. Similar to CBT, by taking a step back and evaluating the situation, we can develop habits that lead to new responses and potentially avoid an unnecessary anxiety response in the future. Making an effort to be aware of our anxious thoughts or worries and replacing them with more realistic ones can also be beneficial in helping our brain to relearn our responses to potentially threatening situations. Since the human brain is plastic (i.e. it adapts to changes in our internal and external environments), conscious efforts can result in a shift in the anxiety circuitry. Another key factor in mitigating anxiety is an awareness of the surrounding environment. Anxiety-inducing neural circuitry can be over-activated when we’re repeatedly exposed to certain stressors in our environment, resulting in feelings of anxiety in situations that are not immediately threatening. Hence, eliminating or minimizing such stressors in our environment can help.
Calhoon GG, Tye KM. Resolving the neural circuits of anxiety. Nature Neuroscience (2015) 18(10): 1394-404. DOI: 10.1038/nn.4101.

Ahrens S, Wu MV, Furlan A, Hwang GR, Paik R, Li H, Penzo MA, Tollkuhn J and Li B. A central extended amygdala circuit that modulates anxietyJournal of Neuroscience (2018) 38(24): 5567-5583. DOI: 10.1523/JNEUROSCI.0705-18.2018

Pomrenze MB, Tovar-Diaz J, Blasio A, Maiya R, Giovanetti SM, Lei K, Morikawa H, Hopf FW and Messing RO. A corticotropin releasing factor network in the extended amygdala for anxiety. Journal of Neuroscience (2019) 39(6): 1030-1043. DOI: 10.1523/JNEUROSCI.2143-18.2018

Hofmann SG, Asnaani A, Vonk IJJ, Sawyer AT, and Fang A. The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research (2012) 36(5): 427-440. DOI: 10.1007/s10608-012-9476-1

Kaczkurkin AN, Foa EB. Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in Cinical Neuroscience (2015) 17(3):337-46. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610618/

via BrainPost Life: Understanding the Anxious Brain

, , , , , , , , , , ,

Leave a comment

[Abstract] Treatments for Poststroke Motor Deficits and Mood Disorders: A Systematic Review for the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Stroke Rehabilitation

Abstract

Background: Early rehabilitation after stroke is essential to help reduce disability.
Purpose: To summarize evidence on the benefits and harms of nonpharmacologic and pharmacologic treatments for motor deficits and mood disorders in adults who have had stroke.
Data Sources: English-language searches of multiple electronic databases from April 2009 through July 2018; targeted searches to December 2018 for studies of selective serotonin reuptake inhibitors (SSRIs) or serotonin–norepinephrine reuptake inhibitors.
Study Selection: 19 systematic reviews and 37 randomized controlled trials addressing therapies for motor deficits or mood disorders in adults with stroke.
Data Extraction: One investigator abstracted the data, and quality and GRADE assessment were checked by a second investigator.
Data Synthesis: Most interventions (for example, SSRIs, mental practice, mirror therapy) did not improve motor function. High-quality evidence did not support use of fluoxetine to improve motor function. Moderate-quality evidence supported use of cardiorespiratory training to improve maximum walking speed and repetitive task training or transcranial direct current stimulation to improve activities of daily living (ADLs). Low-quality evidence supported use of robotic arm training to improve ADLs. Low-quality evidence indicated that antidepressants may reduce depression, whereas the frequency and severity of antidepressant-related adverse effects was unclear. Low-quality evidence suggested that cognitive behavioral therapy and exercise, including mind–body exercise, may reduce symptoms of depression and anxiety.
Limitation: Studies were of poor quality, interventions and comparators were heterogeneous, and evidence on harms was scarce.
Conclusion: Cardiorespiratory training, repetitive task training, and transcranial direct current stimulation may improve ADLs in adults with stroke. Cognitive behavioral therapy, exercise, and SSRIs may reduce symptoms of poststroke depression, but use of SSRIs to prevent depression or improve motor function was not supported.
Primary Funding Source: U.S. Department of Veterans Affairs, Veterans Health Administration.

via Treatments for Poststroke Motor Deficits and Mood Disorders | Annals of Internal Medicine | American College of Physicians

, , , , , , , , ,

Leave a comment

[Infographic] COGNITIVE BEHAVIORAL THERAPY Facts

Cognitive behavioral therapy facts - Dr. Axe

, ,

Leave a comment

[WEB SITE] Quiz: What Type of Therapy is Best for You?

Quiz: What Type of Therapy May Be Best for You?

Medically reviewed by psychologist Sarah Schewitz, Psy.D.

Walking into therapy for the first time can feel a little like walking into “The Twilight Zone.” It’s hard to know what to expect and intimidating to think you’ll be sharing so much information with a stranger. Not to mention, each type of therapy has its own guidelines and perspective. And, while the relationship you have with your clinician is perhaps the most important indicator of how well therapy will work for you, not every type of therapy will be a good fit.

Before booking your first therapy session or enrolling in a program, it’s a good idea to find out how your new therapist might meet your needs. After all, you don’t want to be stuck in a room with a counselor whose thoughts on what’s going on for you just don’t jive at all with your experience. Plus, doing a little legwork ahead of time to match the type or types of therapy a counselor uses can help you determine who you might have the best relationship with.

Although some professionals and programs strictly adhere to one type of therapy, many now use several different types of therapy to work with clients. This lets them borrow important skills from each type to better serve your needs. These therapists consider themselves integrative or even eclectic. Keep this in mind as you’re looking for therapist — and taking the following quiz.

This quiz is not professional or medical advice, but simply a way to introduce you to some of the more common types of therapy out there — these are only four of dozens of options. Your results from this quiz will help guide you to what type of therapy may be a good fit for you.

Don’t be worried about answering the questions perfectly. There are no wrong answers. When you are finished with the quiz you will receive your match. For more information on each type of therapy, check below the quiz for more information and where you can find counselors who use those skills in their practice.

Without further ado, visit WEB SITE to TAKE the QUIZ

Cognitive Behavioral Therapy (CBT)

It’s been said what you think is who you are. Just ask Ralph Waldo Emerson, Mahatma Gandhi — or even the Bible. Cognitive behavioral therapy (CBT) borrows a little from this concept: By changing your thoughts, you can also change your emotions and behaviors for a more satisfying life.

In the CBT world, your current thoughts, emotions and behaviors interact with each other. By addressing thoughts that don’t help you, CBT therapists believe you’ll start to experience more well-being. Typically, CBT doesn’t delve way back into your childhood and it’s a format that might include homework, like keeping a log of unhelpful thoughts that might pop into your head that make you feel depressed. It’s skills-based and action-oriented, so this is a good fit if you like to get things done efficiently and in a shorter amount of time — CBT therapy is usually completed in less than 20 sessions.

Because CBT is generally very structured and focuses on concrete, in-the-moment skills, it’s especially helpful if you’re dealing with an anxiety or panic disorder, a specific phobia or obsessive-compulsive disorder (OCD). Many people with depression, suicidal ideation or self-harm, substance use disorders and eating disorders also find CBT helpful. If you live with chronic pain, your treatment team may recommend CBT because it can help you accept the pain you can’t change and learn new coping skills.

You can find CBT therapists through the Association for Behavioral and Cognitive Therapies (ABCT) or Academy of Cognitive Therapy websites.

Dialectical Behavioral Therapy (DBT)

If things feel out of control and super intense — your emotions, relationships, even sometimes your behaviors — dialectical behavior therapy (DBT) is designed with exactly that in mind. This form of therapy focuses on four main areas to help you master your well-being, including mindfulness, distress tolerance, emotion regulation and interpersonal relationships.

DBT was created to treat borderline personality disorder (BPD) and those who struggle with persistent suicidal thoughts or self-harm. One of DBT’s strengths is it gives you a toolbox full of useful life skills so you feel more in control, especially when you didn’t learn those basic emotion regulation or relationship skills earlier in life. DBT is also useful if you’re dealing with other mental health conditions like post-traumatic stress disorder (PTSD), substance use disorders and eating disorders, among others.

There are a couple ways you can do DBT. The traditional, full program includes individual sessions with a DBT therapist, a weekly group skills class and phone coaching between sessions. This can get expensive, so you can also look for a therapist with training to incorporate DBT skills into your regular sessions or participate in just a group skills class.

In whatever context you try DBT, be prepared to work. Studies show DBT can be incredibly effective but you’ll have homework, be expected to track your progress and practice your skills regularly. And know DBT is full of acronyms that might seem overwhelming at first, but soon you’ll be PLEASE-skilling and DEAR MAN-ing like a pro.

To find a DBT therapist near you, search the directories on Behavioral Tech or DBT-Linehan Board of Certification.

Psychodynamic

The premise of psychodynamic therapy is very much based in exploring how the current issues you are dealing with and who you are today originated from your early experiences. By talking through the free associations that come to mind from your past, present, future and dreams, you work with a therapist to find meaning and understanding from your history. These therapists especially focus on their relationship with you, and, traditionally, they use their reactions to you and relationship with you as another tool to help you understand yourself. Relationship is key in psychodynamic formats.

If you’re not a fan of a strict format or homework, are drawn to almost exclusively talk therapy and want to focus on how your past affected you, the more free-flowing nature of psychodynamic therapy may be a good fit for you. Over the years research has shown psychodynamic therapies can help with a variety of mental health conditions, particularly if you’ve experienced trauma.

However, because of the more open format of psychodynamic therapy, if you’re struggling with suicidal thoughts or an active substance use or eating disorder, traditional psychodynamic therapy might not be a good idea. A more structured, skills-based therapy might be needed to make sure you’re safe first. If you still want to work with a psychodynamic therapist in these instances, be sure to ask if they also have training in skills designed to keep you safe during higher-risk times in your life.

Find a psychodynamic therapist near you on Psychology Today.

Interpersonal Psychotherapy (IPT)

If you want to approach your mental health from a well-rounded perspective that takes into account your physical, social, emotional and spiritual health, you might be drawn to interpersonal psychotherapy (IPT). Its major tenant suggests struggles in your interpersonal relationships are directly connected to your mental health symptoms. IPT also believes in the medical model of mental illness, so if you often find yourself comparing dealing with a mental illness to a physical illness, IPT might suit you.

This type of therapy focuses mostly on the present and not on therapy itself, but your life in the real world. IPT is very structured and lasts a set amount of time, usually 12 to 16 sessions. It’s based on attachment — the idea your connections with others is one of the most important aspects of your emotional health. By examining and exploring issues in your current relationships, an IPT therapist works to help you develop stronger connections to reduce your mental health symptoms. This work is done using techniques like role-playing and analyzing how you communicate.

IPT was originally created to treat major depressive disorder and studies also found it’s effective for conditions like anxiety and eating disorders. It’s also helpful when you’re moving through transitions in your life, like a divorce, a move to a new city or a new job. This form of therapy can be used in group therapy settings as well.

You can search for an interpersonal psychotherapist near you on Psychology Today.

If there’s a specific type of therapy you want to try, it may be hard to find a professional in your area that’s affordable and available. If you’re having a hard time finding a local therapist, you’re not alone. You can call the National Alliance on Mental Illness (NAMI) Helpline for assistance finding mental health treatment resources in your area, including therapy and group support. Mental Health America also provides a resource list for other ways you can find referrals and mental health resources.

via Quiz: What Type of Therapy is Best for You? | The Mighty

, , , , , , , ,

Leave a comment

[WEB SITE] VRHealth unveils VR software for hot flashes

The new technology will provide users with an AI guide that will lead them through CBT.

By Laura Lovett, December 12, 2018

Photo credit: VRHealth

 

VRHealth has exclusively unveiled to MobiHealthNews a virtual reality product called Luna that was designed to help patients manage hot flashes.

The new VR product, which can be used by patients going through menopause or chemotherapy treatment, employs cognitive behavioral therapy (CBT). It also gives users a data analysis of their treatment.

When a user puts on the VR headset, they are greeted by an AI trainer called Luna who guides users through CBT and other coping mechanisms. The technology also lets users virtually travel to another environment.

“That trainer you can take to different places. One part of the app is called practice breathing in an environment. It [let’s you] see how you breath,” Eran Orr, CEO of VRHealth, told MobiHealthNews. “Users can actually see the environment and go into a lake or waterfall.”

While the technology will first be given to patients in a hospital setting, Orr said that the idea is for the system to go home with the patients.

“Patients will be introduced to it during chemotherapy or treatment in the hospital and will take [the] headset back home,” he said. “It is an AI that is basically a trainer that follows improvement and can be adjusted automatically.”

The idea for Luna came out of a personal connection. One of the members of the VRHealth team developed the idea for the technology after undergoing chemotherapy for breast cancer and experiencing hot flashes as a side effect.

Orr said that Luna will officially launch in January of 2019 at CES.

Why it matters

Hot flashes, which are often triggered by a hormone drop, are associated with breast cancer chemotherapy and surgery to remove the ovaries as well as menopause, according to the Cancer Treatment Centers of America (CTCA). While women are most likely to experience hot flashes, the CTCA said that men can also experience the condition.

Common treatment options include hormone therapy, antidepressants and other prescription medications, according to the Mayo Clinic. Alternative medicine including meditation, acupuncture and CBT are also used.

VRHealth is pitching this technology as another avenue to treat the condition, and Orr hinted that in yet-to-be-released clinical trials Luna outperformed medications for hot flash treatment.

What’s the trend

VRHealth was in the news in September when it teamed up with Facebook’s Oculus, which makes VR hardware and other related products, on a range of healthcare-focused VR applications to be delivered on the latter’s hardware.

VR as a whole is growing. Many in healthcare are looking to the technology to help with pain, discomfort and anxiety. Clinicians are deploying it in a wide range of settings including obstetricspediatrics and rehabilitation.

On the record 

“We believe VR can be an amazing replacement for opiates or any kind of nonnatural hormone and the most common treatments that have a lot of side effects,” Orr said. “We believe VR could be a good solution.”

via VRHealth unveils VR software for hot flashes | MobiHealthNews

, , , , , , , ,

Leave a comment

[WEB SITE] OCD: Brain mechanism explains symptoms

A large review of existing neuroscientific studies unravels the brain circuits and mechanisms that underpin obsessive-compulsive disorder. The researchers hope that the new findings will make existing therapies more effective, “or guide new treatments.”
doctors looking at brain scans

New research analyzes the brain scans of almost 500 people to unravel the brain mechanisms in OCD.

Obsessive-compulsive disorder (OCD) is a mental health condition that affects more than 2 million adults in the United States.

People with OCD often experience recurring, anxiety-inducing thoughts or urges — known as obsessions — or compulsive behaviors that they cannot control.

Whether it is repeatedly checking if the door is locked or switching lights on and off, OCD symptoms are uncontrollable and can severely interfere with a person’s quality of life.

Treatments for OCD include medication, psychotherapy, and deep brain stimulation. However, not everyone responds to treatment.

In fact, reference studies have found that only 50 percent of people with OCD get better with treatment, and just 10 percent recover fully.

This treatment ineffectiveness is partly down to the fact that medical professionals still do not fully understand the neurological roots of the condition. A new study, however, aims to fill this gap in research.

Scientists led by Luke Norman, Ph.D., a postdoctoral research fellow in the Department of Psychiatry at the University of Michigan (U-M) in Ann Arbor, corroborated and analyzed large amounts of data from existing studies on the neurological underpinnings of OCD.

The scientists published their meta-analysis in the journal Biological Psychiatry.

Studying the brain circuitry in OCD

Norman and colleagues analyzed studies that scanned the brains of hundreds of people with OCD, as well as examining the brain images of people without the condition.

“By combining data from 10 studies, and nearly 500 patients and healthy volunteers, we could see how brain circuits long hypothesized to be crucial to OCD are indeed involved in the disorder,” explains the study’s lead author.

Specifically, the researchers zeroed in on a brain circuit called the “cingulo-opercular network.” This network involves several brain regions that are interconnected by neuronal pathways in the center of the brain.

Studies have previously associated the cingulo-opercular network with “tonic alertness” or “vigilance.” In other words, areas in this brain circuit are “on the lookout” for potential errors and can call off an action to avoid an undesirable outcome.

Most of the functional MRI studies included by Norman and colleagues in their review had volunteers respond to errors while inside the brain scanner.

An analysis of data from the various studies revealed a salient pattern: Compared with people who did not have OCD, those with the condition displayed significantly more activity in brain areas associated with recognizing an error, but less activity in the brain regions that could stop an action.

Study co-author Dr. Kate Fitzgerald of U-M’s Department of Psychiatry explains the findings, saying “We know that [people with OCD] often have insight into their behaviors, and can detect that they’re doing something that doesn’t need to be done.”

She adds, “But these results show that the error signal probably isn’t reaching the brain network that needs to be engaged in order for them to stop doing it.”

The researcher continues using an analogy.

It’s like their foot is on the brake telling them to stop, but the brake isn’t attached to the part of the wheel that can actually stop them.”

Dr. Kate Fitzgerald

“This analysis sets the stage for therapy targets in OCD because it shows that error processing and inhibitory control are both important processes that are altered in people with the condition,” says Fitzgerald.

Findings may boost existing treatments

The researcher also explains how the findings may enhance current treatments for OCD, such as cognitive behavioral therapy (CBT).

“In [CBT] sessions for OCD, we work to help patients identify, confront, and resist their compulsions, to increase communication between the ‘brake’ and the wheels, until the wheels actually stop. But it only works in about half of patients.”

“Through findings like these, we hope we can make CBT more effective, or guide new treatments,” Dr. Fitzgerald adds. The team is currently recruiting participants for a clinical trial of CBT for OCD.

In addition to CBT, Dr. Fitzgerald also hopes that the results will enhance a therapy known as “repetitive transcranial magnetic stimulation” (rTMS).

“If we know how brain regions interact together to start and stop OCD symptoms, then we know where to target rTMS,” she says. “This is not some deep dark problem of behavior,” Dr. Fitzgerald continues.

OCD is a medical problem, and not anyone’s fault. With brain imaging, we can study it just like heart specialists study EKGs of their patients — and we can use that information to improve care and the lives of people with OCD.”

Dr. Kate Fitzgerald

via OCD: Brain mechanism explains symptoms

, , , , , ,

Leave a comment

[WEB SITE] Is There a Science to Psychotherapy?

Neuroscience findings suggest that psychotherapy alters the brain.

Since the decade of the brain, 1990-1999, neuroscience has captured enormous amounts of attention from both the scientific community and the general public. Many books and media reports describe the brain’s basic anatomy and function. There has been a proliferation of neuroscience institutes at universities. In laboratories all over the world, neuroscience has become one of the most exciting and productive branches of inquiry.

Yet not everyone is completely pleased with what neuroscience has to tell us. In particular, some decry neuroscience for trying to delegitimize the “mind.” Going back to the original Cartesian mind-body duality, these critics insist that neuroscience can only go so far by describing the function of neurons and neurotransmitters. What cannot be reached by science, they say, is that ineffable “mind” that constitutes the human spirit. For them, neuroscience is purely an attempt to reduce the complexities and wonders of human experience to brain scan images and electrical recordings from axons and dendrites.

In a new book, Neuroscience at the Intersection of Mind and Brain (Oxford University Press, 2018), one of us (Jack) attempts to allay fears that neuroscience will somehow reduce human experience and creativity to the “mere” workings of the physical brain. There is, in fact, nothing “reductive” about the physical brain. Rather, the brain is a gloriously complex, fascinating, and well-organized structure that constitutes, as neuroscientist Eric Kandel so eloquently put it, “the organ of the mind.”

Biologists versus Psychologists

As a resident in psychiatry in the late 1970s, Jack witnessed the emergence of psychopharmacology as the dominant discipline for academic psychiatry and lived through the often bitter battles between “biologists” and “psychologists.” This may be, in part, where the mistrust of neuroscience began. The biologists believed that their method of treating psychiatric illness—medication—was based on solid science and rejected psychotherapy as unscientific.  They also believed that neuroscience explained why the new psychiatric drugs worked and therefore promoted brain science as the basis for their discipline. Every lecture about depression or schizophrenia in those days began with a picture of a pre- and postsynaptic neuron forming a synapse across which neurotransmitters like serotonin, noradrenaline, and dopamine carried information. The new medications interact with receptors for these neurotransmitters and, it was taught at the time, this explains how they work to treat depression, anxiety, and psychosis.

 Andrew Rybalko/Shutterstock

Source: Andrew Rybalko/Shutterstock

It turns out that the picture of neurons everyone used back then was a vast oversimplification of what a synapse really looks like and that almost nothing we know about neurotransmitters and their receptors actually explains how psychiatric drugs work. But what really bothered the psychologists was the complete dismissal of psychotherapy by the biologists. Years of studying various types of psychotherapy convinced them that indeed they had science on their side. Furthermore, they objected to the biologists’ emphasis on inherited abnormalities as the sole basis for psychiatric illness. Psychologists had always been more interested in the ways that human experience, from birth onwards, shaped personality and behavior.

Over time, many (but thankfully not all) psychologists came to see neuroscience as the branch of science devoted to promoting pharmacology as the only treatment for psychiatric illness and to trying to prove that those illnesses were entirely due to inherited brain abnormalities. Biologists stood with nature; psychologists with nurture.

This fear of neuroscience’s aims is entirely misplaced. Over the last several decades, neuroscience has, in fact, focused a great deal of attention on the biology of experience, elucidating the ways in which what happens to us in life affects the structure and function of the brain. Every time we see, hear, smell, or touch something, learn a new fact, or have a new experience, genes are activated in the brain, new proteins are synthesized, and neural pathways communicate the new information to multiple brain regions.

Neuroscience is not, therefore, synonymous with psychopharmacology, nor does it invalidate the complexities of human experience. It has shown, for example, that early life interactions between a parent and child shape how the brain will function for the rest of a person’s life.

This has tremendous implications for understanding the mechanism of action of psychotherapy if we accept the idea that psychotherapy itself is a form of life experience and therefore capable of changing brain function at molecular, cellular, and structural levels. Here are two examples that illustrate ways in which neuroscience informs psychotherapy.

CBT and the Prefrontal to Amygdala Connection

It is now clear that the expression of conditioned fear is dependent upon an intact, functioning amygdala. Scientists have shown that the amygdala, located in a primitive part of the brain often referred to as the limbic cortex, reciprocally inhibits and is inhibited by a more evolutionarily advanced part of the brain, the medial prefrontal cortex (mPFC). Thus, under circumstances of heightened fear, the amygdala shuts down the ability of the mPFC to exert reason over emotion and initiates a cascade of fearful responses that include increased heart rate and blood pressure and freezing in place. When the mPFC is able to reassert its capacity for logic and reason, it can, in turn, inhibit the amygdala and reduce and extinguish fear.

Cognitive behavioral therapy (CBT) is an evidence-based intervention that is the first-line treatment for most anxiety disorders and for mild, moderate, and in many cases even severe depression. Because the automatic, irrational fears and avoidance behaviors manifested by patients with anxiety disorders and depression resemble the behavior of rodents in Pavlovian fear conditioning experiments, scientists have wondered if CBT works, at least in part, by strengthening the prefrontal cortex to amygdala pathway, thereby reducing amygdala activity. Indeed, many studies have shown that anxious and depressed patients have reduced activity in this pathway and exaggerated amygdala responses to fearful stimuli. Studies have also shown that successful CBT for social anxiety disorder decreases amygdala activation.

Most recently, a group of scientists from Oxford, Harvard, and Berkeley showed clearly that stimulation of the prefrontal cortex in human volunteers both reduced amygdala activation and fear. Maria Ironside and colleagues selected 18 women with high levels of trait anxiety and randomized them to receive either transcranial direct current stimulation (tDCS) to the prefrontal cortex or sham tDCS. The subjects underwent functional magnetic resonance imaging (fMRI) of the brain and performed an attentional load task that tests vigilance to threat. Real, but not sham, tDCS increased activity in the prefrontal cortex, decreased activity in the amygdala, and decreased threat responses.

This study is one example of preclinical and clinical neuroscience coming together to suggest a biological mechanism for the efficacy of a psychosocial intervention. We know that the cognitive portion of CBT strengthens a patient’s ability to assert reason over irrational thoughts and fears and that this decreases amygdala activity in some studies. We know clearly from animal studies that stimulating the prefrontal cortex reduces amygdala activation and potentiates fear extinction. Now we also know that in a group of anxious people, direct stimulation of the prefrontal cortex does exactly the same thing as it does in animal studies and, in addition, reduces anxiety. With this plausible hypothesis for how CBT works, scientists can now push further to see if brain imaging can ultimately help select patients with particularly weak prefrontal to amygdala pathway strength who might be prime candidates for CBT and then to track how they are doing in therapy objectively by repeating the brain imaging studies to see if and when that pathway is strengthened.

Psychoanalysis and Reconsolidation

CBT has been proven effective by many high-quality clinical trials and therefore is a prime candidate for biological studies, but can the same be said for such widely used but not empirically-validated treatments as psychoanalysis and psychoanalytic psychotherapy? In 2011, Jack and his colleague, Columbia psychiatrist and psychoanalyst Steven Roose, proposed that another aspect of fear conditioning—reconsolidation of fear memories—may explain one biological mechanism of action for how psychoanalysis works. In rats, when a conditioned fear memory is reactivated, it temporarily becomes labile and can be completely erased by blocking the biological mechanisms that permit reconsolidation of the memory. Could it be that in psychoanalytic therapies, the patient undergoes a process of reactivating distressing early memories that, once made conscious through the psychoanalytic process, can be manipulated by the therapist’s interpretations? According to this hypothesis, those now altered memories can then be reconsolidated into permanent memory in a less disturbing format.

The theory has been considered since then by many scientists and psychoanalytic theorists and a number of experiments show that the phenomena of labile reactivated memories and blockade of reconsolidation do indeed occur in humans. Blocking reconsolidation of reactivated memories has been shown to be effective in experiments attempting to help addicts overcome the powerful tendency to succumb to subtle cues and resume taking drugs even after successful rehabilitation. Here again, information gained from the basic neuroscience laboratory and from clinical neuroscience studies may help us understand how one aspect of psychoanalysis works to change the brain in ways that are helpful to people suffering with mental illness.

It is not necessary to invoke an ineffable “mind” to explain our unique human characteristics. Understanding the complexity of the human brain is sufficient to reveal how we are able to take what we experience and transform it into scientific theories, poetry, and philosophical ideas. Neuroscience is not superficial or reductionistic and it is not at all in the sole service of psychopharmacology and the genetic explanation for mental disorders. This becomes clear as we recognize the tremendous contributions neuroscientists have made to elucidating basic mechanisms that allow experiences to change the physical structure and function of the brain on a second-by-second basis. Everything we experience during life is translated into events that occur in the brain.

Psychotherapy is a form of life experience that changes the way the brain works, often ameliorating abnormalities caused by adverse experience and stressful life events. So yes, there is a science to psychotherapy, one that can be readily understood by learning about some of the fundamental and fascinating ways our brains work. Neuroscience at the Intersection of Mind and Brain tries to do just that.

via Is There a Science to Psychotherapy? | Psychology Today UK

, , , , ,

Leave a comment

[WEB SITE] OCD: Cognitive behavioral therapy improves brain connectivity

MRI scans show that people diagnosed with OCD who have undergone CBT have intensified connectivity between key brain networks.

Researchers have used brain scans to measure changes in the cerebral activity of people with obsessive-compulsive disorder after undergoing a type of cognitive behavioral therapy. They found that the connectivity of key brain networks is improved, suggesting new targets for therapy.

Obsessive-compulsive disorder (OCD) is a condition marked by inescapable, intrusive thoughts that cause anxiety (hence “obsessive”), and repetitive, ritualistic behaviors aimed at reducing that feeling (hence “compulsive”).

OCD can be a debilitating condition and can severely impair daily functioning. The National Institutes of Mental Health estimate that, in the United States, the yearly prevalence of OCD amounts to 1 percent of the total adult population. Around half of these cases are deemed “severe.”

Treatments for OCD include the administration of selective serotonin reuptake inhibitors and cognitive behavioral therapy (CBT), a type of therapy that aims to improve damaging mind associations.

Researchers from the University of California, Los Angeles – who were led by Dr. Jamie Feusner – have conducted a study aiming to find out whether and how CBT might change levels of activity and network connectivity in the brains of people diagnosed with OCD.

They explain that although the efficacy of CBT in treating OCD has been previously explored, this is likely the first study to use functional MRI (fMRI) to monitor what actually happens in the brains of people with OCD after exposure to this kind of therapy.

The researchers’ findings were recently published in the journal Translational Psychiatry.

Changes in key brain regions following CBT

The team specifically targeted the effects of exposure and response prevention (ERP)-based CBT, which entails exposure to triggering stimuli and encouraging the individual to wilfully resist responding to those stimuli in the way that they normally would.

For the study, 43 people with OCD and 24 people without it were recruited. The results for the two groups were later compared, at which point the 24 individuals without OCD were taken as the control group.

All the participants diagnosed with OCD received intensive ERP-based CBT on an individual basis in 90-minute sessions on 5 days per week, for a total of 4 weeks.

Participants from both groups underwent fMRI. Those diagnosed with OCD, who had received CBT, were scanned both before the treatment period and after the 4 weeks of treatment. Participants from the control group, who did not undergo CBT, also had fMRI scans after 4 weeks.

When the scans of participants with OCD were compared, the results from before exposure to CBT and after it were found to be largely contrasting.

The researchers noticed that the brains of people with OCD exhibited a significant increase in connectivity between eight different brain networks, including the cerebellum, the caudate nucleus and putamen, and the dorsolateral and ventrolateral prefrontal cortices.

 The cerebellum is involved with processing information and determining voluntary movements, while the caudate nucleus and putamen are key in learning processes and controlling involuntary impulses.

The dorsolateral and ventrolateral prefrontal cortices are involved with planning action and movement, as well as regulating certain cognitive processes.

Dr. Feusner and team point out that an increased level of connectivity between these cerebral regions suggests that the brains of the people who underwent CBT were “learning” new non-compulsive behaviors and activating different thought patterns.

He suggests that these changes may be novel ways of coping with the cognitive and behavioral idiosyncrasies of OCD.

The changes appeared to compensate for, rather than correct, underlying brain dysfunction. The findings open the door for future research, new treatment targets, and new approaches.”

Dr. Jamie Feusner

First study author Dr. Teena Moody adds that being able to show that there are quantifiable positive changes in the brain following CBT may give people diagnosed with OCD more confidence in following suitable treatments.

“The results could give hope and encouragement to OCD patients,” says Dr. Moody, “showing them that CBT results in measurable changes in the brain that correlate with reduced symptoms.”

Source: OCD: Cognitive behavioral therapy improves brain connectivity

, , , , ,

Leave a comment

[WEB PAGE] What Is PTSD? – PTSD: National Center for PTSD

What Is PTSD?

PTSD (posttraumatic stress disorder) is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault.

It’s normal to have upsetting memories, feel on edge, or have trouble sleeping after this type of event. At first, it may be hard to do normal daily activities, like go to work, go to school, or spend time with people you care about. But most people start to feel better after a few weeks or months.

If it’s been longer than a few months and you’re still having symptoms, you may have PTSD. For some people, PTSD symptoms may start later on, or they may come and go over time.

What factors affect who develops PTSD?

PTSD can happen to anyone. It is not a sign of weakness. A number of factors can increase the chance that someone will have PTSD, many of which are not under that person’s control. For example, having a very intense or long-lasting traumatic event or getting injured during the event can make it more likely that a person will develop PTSD. PTSD is also more common after certain types of trauma, like combat and sexual assault.

Personal factors, like previous traumatic exposure, age, and gender, can affect whether or not a person will develop PTSD. What happens after the traumatic event is also important. Stress can make PTSD more likely, while social support can make it less likely.

What are the symptoms of PTSD?

PTSD symptoms usually start soon after the traumatic event, but they may not appear until months or years later. They also may come and go over many years. If the symptoms last longer than four weeks, cause you great distress, or interfere with your work or home life, you might have PTSD.

There are four types of symptoms of PTSD (en Español), but they may not be exactly the same for everyone. Each person experiences symptoms in their own way.

  1. Reliving the event (also called re-experiencing symptoms). You may have bad memories or nightmares. You even may feel like you’re going through the event again. This is called a flashback.
  2. Avoiding situations that remind you of the event. You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.
  3. Having more negative beliefs and feelings. The way you think about yourself and others may change because of the trauma. You may feel guilt or shame. Or, you may not be interested in activities you used to enjoy. You may feel that the world is dangerous and you can’t trust anyone. You might be numb, or find it hard to feel happy.
  4. Feeling keyed up (also called hyperarousal). You may be jittery, or always alert and on the lookout for danger. Or, you may have trouble concentrating or sleeping. You might suddenly get angry or irritable, startle easily, or act in unhealthy ways (like smoking, using drugs and alcohol, or driving recklessly.

Can children have PTSD?

Children can have PTSD too. They may have symptoms described above or other symptoms depending on how old they are. As children get older, their symptoms are more like those of adults. Here are some examples of PTSD symptoms in children:

  • Children under 6 may get upset if their parents are not close by, have trouble sleeping, or act out the trauma through play.
  • Children age 7 to 11 may also act out the trauma through play, drawings, or stories. Some have nightmares or become more irritable or aggressive. They may also want to avoid school or have trouble with schoolwork or friends.
  • Children age 12 to 18 have symptoms more similar to adults: depression, anxiety, withdrawal, or reckless behavior like substance abuse or running away.

What other problems do people with PTSD experience?

People with PTSD may also have other problems. These include:

  • Feelings of hopelessness, shame, or despair
  • Depression or anxiety
  • Drinking or drug problems
  • Physical symptoms or chronic pain
  • Employment problems
  • Relationship problems, including divorce

In many cases, treatments for PTSD will also help these other problems, because they are often related. The coping skills you learn in treatment can work for PTSD and these related problems.

Will people with PTSD get better?

“Getting better” means different things for different people. There are many different treatment options for PTSD. For many people, these treatments can get rid of symptoms altogether. Others find they have fewer symptoms or feel that their symptoms are less intense. Your symptoms don’t have to interfere with your everyday activities, work, and relationships.

What treatments are available?

There are two main types of treatment, psychotherapy (sometimes called counseling or talk therapy) and medication. Sometimes people combine psychotherapy and medication.

Psychotherapy for PTSD

Psychotherapy, or counseling, involves meeting with a therapist. There are different types of psychotherapy:

  • Cognitive behavioral therapy (CBT) is the most effective treatment for PTSD. There are different types of CBT, such as cognitive therapy and exposure therapy.
    • One type is Cognitive Processing Therapy (CPT) where you learn skills to understand how trauma changed your thoughts and feelings. Changing how you think about the trauma can change how you feel.
    • Another type is Prolonged Exposure (PE) where you talk about your trauma repeatedly until memories are no longer upsetting. This will help you get more control over your thoughts and feelings about the trauma. You also go to places or do things that are safe, but that you have been staying away from because they remind you of the trauma.
  • A similar kind of therapy is called Eye Movement Desensitization and Reprocessing (EMDR), which involves focusing on sounds or hand movements while you talk about the trauma. This helps your brain work through the traumatic memories.

Medications for PTSD

Medications can be effective too. SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors), which are also used for depression, are effective for PTSD. Another medication called Prazosin has been found to be helpful in decreasing nightmares related to the trauma.

IMPORTANT: Benzodiazepines and atypical antipsychotics should generally be avoided for PTSD treatment because they do not treat the core PTSD symptoms and can be addictive.

Visit Site —> What Is PTSD? – PTSD: National Center for PTSD

, , , , , , , , , ,

Leave a comment

%d bloggers like this: