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Behavioral Science

Behavioral Science, Cardiovascular Medicine, Neuroscience, Research, Stanford News

Scientists zero in on brain’s sigh-control center

Scientists zero in on brain's sigh-control center

sighWhy do we sigh?

(Sigh…) How should I know? Don’t I already have enough on my mind?

As we all well know, sighing is a long, deep involuntary inhalation accompanying sensations of yearning, sadness, relief, boredom, exhaustion, or (see above) exasperation. Fewer of us know (at least I didn’t, but now I do!) that the typical person also sighs spontaneously about every five minutes or so.

If you’re a mouse, you do it much more often – as much as 40 times per hour. (Nobody said it would be easy, little mousie.)

Those spontaneously sighs (and all the other ones), it’s thought, may be helping to keep our half-billion or so alveoli – the tiny sacs through which our lungs exchange oxygen and carbon dioxide with the atmosphere that surrounds us – pumped up and operating efficiently.

That could be, at least in part, why we sigh. But Mark Krasnow, MD, PhD, Stanford biochemist and molecular biologist and Howard Hughes Medical Institute Investigator, has figured out how.

In a series of experiments described in a Nature study, Krasnow’s team, along with colleagues at Stanford and UCLA, painstakingly employed genetic, pharmacological and surgical techniques to map out a precise set of nerve circuits in the brain that are essential to the act of sighing. They showed that a sigh results when inhalation-initiating nerve impulses generated rhythmically within these circuits double up: One impulse effectively laps another and rides piggyback on top of it, producing a deeper, drawn-out inhalation.

The experiments were performed in mice. But the brain circuits involved are sufficiently ancient that our common ancestors no doubt had them, too – and therefore we (probably) do, too, or at least very similar ones.

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Behavioral Science, Big data, Neuroscience, Research, Stanford News

What were you just looking at? Oh, wait, never mind – your brain’s signaling pattern just told me

What were you just looking at? Oh, wait, never mind - your brain's signaling pattern just told me

headI’ve blogged previously (here, here and here) about scientific developments that could be construed, to some degree, as advancing the art of mind-reading.

And now, brain scientists have devised an algorithm that spontaneously decodes human conscious thought at the speed of experience.

Well, let me qualify that a bit: In an experimental study published in PLOS Computational Biology, an algorithm assessing real-time streams of brain-activity data was able to tell with a very high rate of accuracy whether, less than half a second earlier, a person had been looking at an image of a house, an image of a face or neither.

Stanford neurosurgical resident Kai Miller, MD, PhD, along with colleagues at Stanford, the University of Washington and the Wadsworth Institute in Albany, NY, got these results by working with seven volunteer patients who had recurring epileptic seizures. These volunteers’ brain surfaces had already been temporarily (and, let us emphasize, painlessly) exposed, and electrode grids and strips had been placed over various areas of their brain surfaces. This was part of an exacting medical procedure performed so that their cerebral activity could be meticulously monitored in an effort to locate the seizures’ precise points of origin within each patient’s brain.

In the study, the volunteers were shown images (flashed on a monitor stationed near their bedside) of houses, faces or nothing at all. From all those electrodes emanated two separate streams of data – one recording synchronized brain-cell activity, and another recording statistically random brain-cell activity – which the algorithm, designed by the researchers, combined and parsed.

The result: The algorithm could predict whether the subject had been viewing a face, house, or neither at any given millisecond. Specifically, the researchers were able to ascertain whether a “house” or “face” image or no image at all had been presented to an experimental subject roughly 400 milliseconds earlier (that’s the time it takes the brain to process the image), plus or minus 20 milliseconds. The algorithm correctly nailed 96 percent of all images shown in the experiment. Moreover, it made very few lousy guesses: only one in 25 were rotten calls.

“Although this particular experiment involved only a limited set of image types, we hope the technique will someday contribute to the care of patents who’ve suffered neurological imagery,” Miller told me.

Admittedly, that kind of guesswork gets tougher as you add more viewing possibilities – for instance, “tool” or “animal” images. So this is still what scientists call an “early days” finding: We’re not exactly at the point where, come the day after tomorrow, you’re walking down the street, you randomly daydream about a fish for an eighth of a second, and suddenly a giant billboard in front of you starts flashing an ad for smoked salmon.

Not yet.

Previously: Mind-reading in real life: Study shows it can be done (but they’ll have to catch you first), A one-minute mind-reading machine? Brain-scan results distinguish mental states and From phrenology to neuroimaging: New finding bolsters theory about how brain operates
Photo by Kai Miller, Stanford University

Behavioral Science, Mental Health, Pediatrics, Research, Stanford News

Stanford ingenuity + big data = new insight into the ADHD brain

Stanford ingenuity + big data = new insight into the ADHD brain

ask-the-brainAttention-focusing brain networks interact more weakly than usual in kids with attention deficit hyperactivity disorder, new Stanford research shows.

The research, published online today in Biological Psychiatry, is part of an ongoing effort to figure out how the brain differs from normal in people with ADHD. The disorder is both serious and common: It’s characterized by impulsiveness, hyperactivity and difficulty paying attention, and it has been diagnosed in more than 6 million U.S. children.

The new study focused on a particular set of linked brain regions called the salience network. From our press release:

“A lot of things may be happening in one’s environment, but only some grab our attention,” said Vinod Menon, PhD, a professor of psychiatry and behavioral sciences and the study’s senior author. “The salience network helps us stop daydreaming or thinking about something that happened yesterday so we can focus on the task at hand. We found that this network’s ability to regulate interactions with other brain systems is weaker in kids with ADHD.”

The research could lead to better diagnostics for ADHD, Menon said. That’s a big deal because, right now, diagnosis is based on subjective assessment of a child’s behaviors, and the threshold of behavior considered sufficient for diagnosis varies quite widely. Doctors worry about the risks of diagnosing ADHD in kids who don’t have it, or who actually suffer from a different psychiatric problem, and also about missing children who really should get a diagnosis.

But prior efforts to find an ADHD biomarker have been hampered by weak science. Many papers reporting brain-scan features of ADHD have not withstood attempts to replicate their findings.

The new study is different: Not only did Menon’s team find that their analysis could distinguish ADHD patients from controls with brain scans, it did so in three independent data sets. The data, from an open-source database of fMRI scans called the ADHD-200 Consortium, was collected using a different MRI scanner and slightly different clinical assessments at each site.

“We could use biomarkers developed from one site — New York — to classify ADHD children in another site, Beijing,” Menon said. The biomarkers also worked for the data from the third study site, which was Portland, Oregon. The fact that the findings held for all three sites gives an important level of real-world assurance that they’re meaningful.

More research is still needed to investigate whether brain scans can distinguish children with ADHD from those with other psychiatric conditions. But Menon thinks the work is on track to making a practical difference for better ADHD diagnostics.

Previously: A visual deluge may provide clues to ADHD treatment, Scientists reveal link between dopamine receptor subtype and ADHD diagnosis and Study finds many teachers, doctors mistaking immaturity for ADHD
Photo by Thomas Hawk

Behavioral Science, Neuroscience, Research, Stanford News

Like or dislike? Brain scans reveal source of initial preferences

Like or dislike? Brain scans reveal source of initial preferences

3228273137_020ba1b3c1_oJust seconds into an interview with a potential babysitter, I had already formed a slightly unfavorable opinion. She had excellent reviews — five stars across the board. She was polite and paid attention to my baby. Why didn’t I like her?

Well, I may not consciously know, but perhaps the answer lies deep in my brain, new research from Stanford’s Department of Psychology suggests.

A team led by Jeanne Tsai, PhD, associate professor of psychology, showed volunteers faces that varied by gender, ethnicity and emotion and monitored their reactions using functional magnetic resonance imaging (fMRI), a recent Stanford News article details:

In the study, Tsai and her colleagues examined whether cultural values could drive neural responses and preferences for different positive facial expressions – like excited versus calm faces…

“Within cultures, European Americans responded similarly to excited and calm faces, but Chinese showed greater activity in the ventral striatum in response to calm versus excited expressions,” Tsai said.

The ventral striatum is part of the brain involved in emotional responses, particularly those related to the anticipation of pleasure. “This pattern held regardless of the ethnicity or gender of the face,” Tsai added.

This finding reflects the cultural preference in China for calm expressions, Tsai said, and it could have implications for employment decisions as well as mate selection.

Previously: Hidden memories: A bit of coaching allows subjects to cloak memories from fMRI detector, Thinking about “culture” as part of global well-being and From phrenology to neuroimaging: New finding bolsters theory about how brain operates
Photo by Dar’ya Sip

Behavioral Science, Neuroscience, Podcasts

Advice for changing health behavior: “Think like a designer”

Advice for changing health behavior: "Think like a designer"

When listening to our latest 1:2:1 podcast, featuring a conversation with Kyra Bobinet, MD, MPH, two things jumped out at me. First, Bobinet, an expert in design thinking and behavioral change who says she “leads by my curiosity,” has a very cool personal story, and second: We shouldn’t be so hard on ourselves when we struggle to make positive health changes. In short, it’s not us – it’s a design flaw.

The interests of Bobinet, CEO and founder of a design firm using neuroscience to change behavior, can be traced back to medical school, when she was exposed to a program that taught health education in juvenile hall. “I became fascinated by the behavioral patterns of gang members who had violent pasts and came in and out of the system,” she says. These gang members vowed to stay out of jail when they were released but yet “two days later they were immersed” in their old lives and back in trouble. “Why is that happening? And how is that different than me saying I don’t want to eat french fries during Lent but then doing so the second day?” she wonders aloud.

Not long after, an experience with a patient wound up changing the trajectory of her career. During residency she saw a man with gout who had taken meth just three days prior. Bobinet had only ten minutes in clinic with him, and he only mentioned the drug use during the tail end of their conversation, before she had a chance to probe into it. “He changed my life,” she says. “I was so interested in the behavior that led to the medical condition – I [realized I] didn’t want to write prescriptions for the condition anymore, I wanted to focus on the behavior.” She went on to public health school from there.

In the podcast, Bobinet, who also teaches courses on patient engagement and empowerment in the Stanford AIM Lab with Larry Chu, MD, goes on to talk a lot more about behavior and what she has learned through extensive research of patients and caregivers. She talks about her new book, Well Designed Life, which lays the groundwork for those looking to design the changes they want to see in their life, and she offers more advice and words of encouragement for people who are struggling to, say, stay on a diet or quit smoking. “Think like a designer,” she says. Your failed attempt at making positive change “was just a version, just a protoptype… That was something that didn’t work – but it’s not you, it’s the design… And you have to redesign what will grab your attention now.”

Previously: Designing behavior for better health

Behavioral Science, Mental Health, Patient Care

Take it from me: To improve compliance with psychiatric meds, we must educate patients

Take it from me: To improve compliance with psychiatric meds, we must educate patients

We’ve partnered with Inspire, a company that builds and manages online support communities for patients and caregivers, to launch a patient-focused series here on Scope. Once a month, patients affected by serious and often rare diseases share their unique stories; this month’s column comes from mental health advocate Gabe Howard.

3926259585_5f265f6683_zWhenever I give a speech to psychiatric practitioners, I start by giving the group index cards and pens and asking them to write down their most important goal for their patients.

Answers like “be med-compliant,” “miss fewer appointments,” and “follow my instructions” are always the most popular. Patients’ answers are much different. They write “live well,” “go to Hawaii,” or “get back to work.” This exercise serves as a reminder to physicians that taking medication is not a final goal, but a step toward the ultimate goal of living well.

It’s important to realize that patients aren’t failing to take their medication as prescribed because they are incompetent, lazy, or intentionally self-sabotaging. Patients often skip doses or skew directions because they are scared of something, often due to a misunderstanding.

They may misunderstand the prescription instructions or the way the drugs work and this misinformation quickly becomes fact in a patient’s mind. They may already be confused by their diagnosis and lack knowledge about their condition.

Once I understood how difficult it was to find the correct combination of medications, I felt much more hopeful.

More often than not, patients suffer from side effects or even a perceived moral failure by taking psychiatric medications. I’m surprised that many clinicians aren’t aware of the stigma patients feel about taking medication. They believe it means they are “less of a man,” “not capable of being a good mother,” or other such nonsense. Psychiatric medications are often first prescribed to people in their early 20s who are not used to taking medication. Most 20-somethings are still in the “I’m invincible” phase.

I believe this can be remedied with education.

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Addiction, Behavioral Science, Neuroscience

Decisions, decisions: How evolution shaped our decision-making

Decisions, decisions: How evolution shaped our decision-making

Research in neuroscience, psychology, business and economics tells us that a plethora of influences can alter the decisions we make. The author explored some of these factors in a Worldview Stanford course and wrote about them in a Stanford story package, Decisions, Decisions. This post is the last in a series on what she learned. 


Our brains evolved to get the reward now and worry about consequences later. That, according to Stanford’s Keith Humphreys, PhD, is in part why addiction treatment programs so often fail.

“An alcoholic person will always choose the swift and certain rewards of a drink now over the possible threat of punishment at some future time,” he says.

In my story about how evolution shaped our decisions, I describe a program that allows people with drunken driving arrests to keep driving as long as they prove twice a day that they are sober:

Punishment is mild – a night in jail – but swift and certain if they are caught with alcohol in their bloodstream. And, according to a 2013 study, repeat offenses were down 12 percent where that policy was in effect.

Humphreys said he’d written about this program, to some skepticism. But when he explained evolutionary theory to an assembled group of law enforcement and lawyers he was surprised at how receptive they were.

“The rest of the conference everyone kept telling me that they had never thought about the neurological basis of why addicted offenders do what they do and why criminal justice systems which ignore this reality fail over and over again,” he said.

The story has more about a new initiative within the Stanford Neurosciences Institute in which Humphries and other faculty members are hoping to use neuroscience to influence addiction policies.

Previously: Decisions, decisions: How group dynamics alters decisionsKeith Humphreys: Drug-addiction treatment programs for military families are outdated and “24/7 Sobriety” program may offer a simple fix for drunken driving
Photo from Shutterstock

Behavioral Science, Mental Health, Pediatrics, Stanford News

Beyond behavior: Stanford expert on recognizing and helping traumatized kids

Beyond behavior: Stanford expert on recognizing and helping traumatized kids

beyond_behavior_fullWhen Victor Carrion, MD, was a pediatric psychiatry fellow in the mid-1990s, he had an “a-ha” moment about some of his poorly behaved patients that set the trajectory of his career. These kids had been traumatized, and the adults around them didn’t recognize it.

He described what happened for my feature story in Stanford Medicine magazine:

“Kids were coming to see me with little notes from their teachers that said, ‘This child has ADHD. Please place on Ritalin,’” Carrion says. Chuckling slightly, he recalls his half-facetious reaction to these missives: “Wow: A diagnosis has been made; there’s a treatment plan; there’s not much for me to do here.”

But after carefully obtaining life histories for several patients, he realized that although some had ADHD, many others had been traumatized by such experiences as abuse, neglect or witnessing violence in their homes or communities. Their reactions — a triad of self-protective behaviors that experts summarize as “freeze, fight or flee” — were being misinterpreted as ADHD’s signature inattentiveness, hyperactivity, aggression and poor cooperation.

Childhood trauma, Carrion realized, was very poorly understood. People assumed kids were more resilient in the face of trauma than adults (they’re not), that you could deal with trauma by ignoring it (no) or that children traumatized before they had the vocabulary to describe what was going on would simply forget what had happened (no again). He wanted to understand what was really going on.

Now, 20 years later, his work and that of many other trauma experts across the country clearly shows we can’t afford to ignore the long shadow cast by early-life abuse, neglect, violence and other instability. “We need to address trauma because it impacts health, period,” Carrion told me. “Not just mental health; it impacts physical health as well.”

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Behavioral Science, Palliative Care, Stanford News

Stanford physician highlights the “never-ending battle” of PTSD

Stanford physician highlights the "never-ending battle" of PTSD

VJ Periyakoil, MD, a palliative care physician at Stanford, first met Mr. M, a 78-year-old veteran with heart failure, in the remaining few weeks of his life – when he was wheelchair bound and tethered to an oxygen cylinder. She asked him about his condition, his pain levels, and his military service, but he would share little at first. He vehemently denied having PTSD, with his wife simply saying, “He doesn’t like to talk about war.”

Mr. M’s medical records showed he had chest pain and trouble sleeping, but he just shrugged and refused any pain medicine. Over his next few weeks in the hospital, as Periyakoil grew to know her patient better and he grew to trust her more, the veteran began talking with Periyakoil about his war wounds, and he revealed a heart-wrenching tale.

Periyakoil writes about Mr. M in a perspective piece published today in the New England Journal of Medicine, telling readers:

Even if the war they fought is long over, many veterans are perpetual prisoners of an ongoing inner war that rages silently in their heads. Men and women on active duty may be forced to commit actions that directly conflict with their ethical and moral beliefs. Their stoicism and “battlemind” may serve them well as long as their psychological defenses are intact. At the end of life, however, their previous coping strategies may crumble, especially if they’re taking mind-altering medications to relieve pain. Many may even prefer to bear severe pain and avoid pain medications, which make them fuzzy-headed and can unleash war-related nightmares and flashbacks.

What unfolds in the piece is a the tale of a brave solider, still on active combat duty battling the mental wounds of war daily the best he knows how: “The nights were pretty bad for him. He was hyper alert but exhausted, and he often prowled the hospital hallways on his electric scooter all night long,” she writes.

On one of those nights, while Periyakoil was treating the weeping ulcers on his ankles, Mr. M told her about the pivotal event from the war, the one that haunted him at night, keeping him from closing his eyes to sleep:

Finally, Mr. M looked straight into my eyes and said softly, “The girl was pregnant. I noticed it after… you know … as I was cleaning my knife. Whenever I close my eyes, I see her face, that split second when she understood what was about to happen. I cannot get it out of my head.”

The story continues:

After several minutes of companionable silence, he asked, “VJ, am I going to hell for killing two innocents?” Without waiting for a response, he continued, “Well, I’m going to find out soon enough.”

As a nationally recognized leader in geriatrics and palliative care, Periyakoil, is both a researcher and a clinician. But this piece is a reminder of just how important her work with patients is. She said she’s telling the story of Mr. M in honor of both Veteran’s Day and the memory of the many veterans with similar stories who she has treated over the years.

Previously: Examining the scientific evidence behind experimental treatments for PTSDThe promise of yoga-based treatments to help veterans with PTSDHow a Stanford physician became a leading advocate for palliative care and Are veterans with PTSD at higher risk for medical illnesses?

Behavioral Science, Neuroscience, Stanford News

Decisions, decisions: How group dynamics alters decisions

Decisions, decisions: How group dynamics alters decisions

Research in neuroscience, psychology, business and economics tells us that a plethora of influences can alter the decisions we make. The author explored some of these factors in a Worldview Stanford course and wrote about them in a Stanford story package, Decisions, Decisions. This post is part of a series on what she learned. 

Are you a leader? A follower? Are you charismatic? Knowledgeable? All of these factors will alter your role in a group, and eventually the decisions that the group makes.

Lindred Greer, PhD, with the Stanford Graduate School of Business, studies the way power structures effect group decisions. “If you put people with high power together, it’s a clash of egos like no other,” she said. “They are busier maintaining power than in making good decisions.”

In her work, she has found that hierarchical teams make faster decisions, but teams of equals produce the most creative solutions. Ultimately, the pressure is on the group leader to figure out what kind of decision is needed and to make sure the group functions effectively.

“The leader really does have the onus to be the most competent person in the room and we always forget that,” she said.

There’s more in my story about the qualities that make a good leader and the perils of choosing a bad one.

Previously: Decisions, decisions: How emotions alter our decisionsDecisions, decisions: The way we express a decision alters the outcome and Decisions, decisions: How our decision making changes with age
Video courtesy of Worldview Stanford

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