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Advice for young docs from psychiatrist David Spiegel: Find a mentor and pursue your passion

Spiegel in office - smallThe takeaway from Stanford David Spiegel‘s recent lunchtime discussion, part of the Psychiatry and Behavioral Science Grand Rounds, was simple: You can’t make it on your own; accept, welcome and offer assistance. To succeed as an academic psychiatrist, it isn’t necessary to come from a line of psychiatrists, as Spiegel, MD, does, he said.

But junior physicians do need mentors, those who know the formal and informal rules of the system and who are willing to make time and lend a hand, a practice Spiegel attributed to his mentor, Irvin Yalom, emeritus professor of psychiatry and behavioral sciences.

Spiegel said that early in his career, he would initially get discouraged when papers or grants would be rejected. Then, he came across a statistic that few hockey players make it out of their first year in the National Hockey League with all of their teeth. It was an “a-ha” moment for the second-generation psychiatrist (Spiegel’s parents were both psychiatrists). Despite hard work, even the best scientists encounter challenges and adversity.

Now, Spiegel is the Jack, Lulu and Sam Willson Professor and a professor of psychiatry and behavioral sciences. He directs the Stanford Center on Stress and Health and is also medical director for the Stanford Center for Integrative Medicine.

Spiegel offered additional advice to the 80-or-so people who gathered to hear him: Disregard convention and explore your interests. “You will do your best work if you’re doing something you’re passionate about,” he said.

Despite the prevalence of psychotherapy, and then of community psychiatry, Spiegel said he stuck by his interest in hypnosis, despite its poor reputation. By conducting statistically sound studies, he developed a body of work demonstrating that hypnosis has real, replicable benefits. This work stood up to critical skeptics and helped secure his tenured position at Stanford, Spiegel said.

Stanford then, and now, has accepted work that expands the bounds of disciplines, as long as it stands up to scientific scrutiny, Spiegel said. “Do whatever the hell you want to do, but be scientific and empirical about it. If you can demonstrate it works, fine,” Spiegel said. He concluded with this parting phrase: “Data rocks!”

Previously: “Tranceformation:” David Spiegel on how hypnosis can change your brain’s perception of your body, Starting a new career in academic medicine? Here’s a bible for the bedside: The Academic Medicine Handbook, Exploring the science of hypnosis with Stanford’s David Spiegel and Stanford psychiatrist David Spiegel’s path west
Photo by L.A. Cicero

Behavioral Science, In the News, Mental Health, Neuroscience, Research, Science

Inside the brain of optogenetics pioneer Karl Deisseroth

Inside the brain of optogenetics pioneer Karl Deisseroth

brain-494152_1280Lighting the brain,” a recent New Yorker profile, offers insight into the brain of Karl Deisseroth, MD, PhD, the well-known innovator of both optogenetics and CLARITY. (Optogenetics is a genetic engineering feat that allows researchers to control neurons in living animals using light. CLARITY is a technique that makes individual neural connections visible.)

Deisseroth, readers of the article learn, is a guy who shows up to his leading scientific laboratory wearing jeans and a t-shirt and who doesn’t let a little fender bender tweak his mood.

Yes, he’s brilliant. His ability to instantly memorize information morphed into a “circus act” of sorts when he was in elementary school. He began medical school at age 20. But, he’s also driven and hard working. When optogenetics encountered early resistance and doubt after its initial publication in 2005, Deisseroth “began working furiously,” the article states. Into work before 6 a.m., Deisseroth slaved over his brainchild often until 1 a.m., his wife, Michelle Monje, MD, PhD, reported.

It took a few more papers — and demonstrations of the applicability of optogenetics to examine real diseases — for the scientific community to catch on. But then, like a contagion of scientific glee, optogenetics rocked the neuroscience community.

Monje realized its popularity at a recent scientific conference:

“People were stopping us at the airport asking to take a picture with him, asking for autographs,” she said. “He can’t walk through the conference hall—there’s a mob. It’s like Beatlemania. I realized, I’m married to a Beatle. The nerdy Beatle.”

For more on the “nerdy Beatle,” and the science behind both optogenetics and CLARITY, check out the article for yourself. It’s well worth your brain power.

Previously: Stanford’s Karl Deisseroth awarded prestigious Albany Prize, Lightning strikes twice: Optogenetics pioneer Karl Deisseroth’s newest technique renders tissues transparent, yet structurally intact and New York Times profiles Stanford’s Karl Deisseroth and his work in optogenetics
Image by Tumisu

Behavioral Science, In the News, Neuroscience, Research

Embrace your stress: From enemy to friend

Embrace your stress: From enemy to friend

2204059683_09eb09601b_zStress isn’t evil, health psychologist Kelly McGonigal, PhD, emphasized on KQED’s Forum on Friday. “Just a few years ago, that would have sounded like nonsense. But now, thanks in part to several appearances coinciding with the publication of her book, “The Upside of Stress,” McGonigal is making in-roads on the “stress-as-boogeyman” narrative.

By embracing stress, accepting it as your body’s natural response to events, people can live longer and even channel their stress into a productive form, she said.

“One way to think about stress is that it’s energy and you get to decide what the right thing to do with that energy is,” McGonigal said.

Just as top performers and athletes capture the momentum of stress to improve their performance, all of us can learn to relate to stress in a way that leaves us wiser and stronger, she explained.

Stress can also be a catalyst to strengthen relationships: “It’s part of the brain’s  and body’s motivation to help you connect with others and help you strengthen social bonds.”

During rough patches, it can also be immensely helpful to maintain the perspective that life is teaching you a lesson that will leave you stronger, McGonigal told listeners.

Previously: Tend and befriend — helping you helps me, Resolution check-in with a Stanford psychologist, one week into the new year and Exploring the costs and deaths associated with workplace stress
Image by bottled_void

Behavioral Science, Events, Mental Health, Stanford News

From suffering to compassion: Meditation teacher-author Sharon Salzberg shares her story

From suffering to compassion: Meditation teacher-author Sharon Salzberg shares her story

20150416-CCARE-Sharon Salzberg-0434Mediatation master and author Sharon Salzberg showed her recent Stanford audience that she could field even the toughest questions about the nature of compassion.

“What about the beheadings in the Middle East?” one audience member called out. Is it really possible to feel compassion for the perpetrators?

“It’s not easy,” Salzberg admitted. “But I also think it’s possible and important… Hatred will never cease with hatred.”

For models and proof it can be done, there are examples of great leaders who have suffered deeply such as Aung San Suu Kyi, Nelson Mandela, Desmond Tutu and the Dalai Lama, Salzberg and James Doty, MD, pointed out.

Salzberg joined Doty, the director of the Stanford Center for Compassion and Altruism Research and Education, at a Conversation on Compassion last week on campus.

She had a tough start in life; her parents separated when she was 4 years old and her mother died soon after. Yet it was through suffering that she gained the motivation, and experience, to pursue the study of meditation, she said.

After taking an Asian philosophy course — on a whim — at the State University of New York at Buffalo, Salzberg traveled to India in 1970 to experience Buddhism firsthand. “The course completely changed my life,” she told the audience. She said she was attracted by the Buddha’s acknowledgment of the existence of suffering.

“Like many people, mine was a family system where this was never spoken about,” Salzberg said. “Buddha’s saying right out loud, ‘Suffering is a part of life,’ you don’t have to feel isolated or abhorrent.”

Salzberg went on to co-found one of the first meditation centers in the United States, the Insight Meditation Society in Massachusetts.

Her conversation at Stanford was informal: Doty confessed he had spilled coffee on the business shirt he planned to wear, and the pair fielded questions from the audience throughout the talk.

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Behavioral Science, Mental Health, Research

Type of verbal therapy could reduce PTSD risk among trauma victims

Type of verbal therapy could reduce PTSD risk among trauma victims

217849066_f011b26437_zTurning on the bedroom light can knock the teeth out of all kinds of terrors. This same concept – seeing things as they are, not as we fear them to be – also forms the basis for many therapies used to treat the estimated 5.2 million people living in the U.S. with post-traumatic stress disorder (PTSD). Now, research shows that treating a victim of trauma with a certain type of therapy within six hours of the event – when most memories are formed – can reduce his or her risk of developing PTSD.

In the study, researchers from King’s College London and the University of Oxford investigated the effect of two treatments: “updating” therapy, where the patient talks about traumatic memories to update them with more factual information, and “exposure” therapy where the patient revisits the source of fear to decrease its emotional effect. These two techniques were applied to 115 participants after they watched six film clips containing real-life footage of humans and animals in distress.

The researchers found giving the participants “information about the fate of the films’ protagonists” (i.e., using the updating technique) significantly reduced the occurrence of fearful feelings, and it reduced these intrusive thoughts better than the exposure treatment and no treatment at all.

As psychologist and lead author Victoria Pile, PhD, explains in a press release, this study is important because there are currently no established therapies to help victims of trauma fend off PTSD. And, she said, “this research implies that finding out what actually happened as soon as possible after the trauma might change the way the memory is stored and so limit the devastating effects of PTSD.”

The researchers note that these findings could be especially helpful for people who are routinely exposed to traumatic situations, such as emergency service workers, military personnel and people working in conflict zones.

Previously: Study shows benefits of breathing meditation among veterans with PTSDExamining the scientific evidence behind experimental treatments for PTSDUsing mindfulness therapies to treat veterans’ PTSD and In animal study, sleep deprivation after traumatic events lowers risk of PTSD symptoms
Image by Capture Queen

Behavioral Science, Cardiovascular Medicine, Patient Care, Research, Stanford News

A little help from pharmacists helps a-fib patients adhere to prescriptions

A little help from pharmacists helps a-fib patients adhere to prescriptions

TurakhiaIt’s not always easy to take drugs as prescribed — life often gets in the way of taking a pill at the same time each day. And it’s relatively easy to ignore the tiny printing on a medication container, to rationalize why that doesn’t apply to you, or how a few exceptions certainly wouldn’t hurt.

Except sometimes precise prescription adherence is important. And that’s the case for a new class of blood thinners such as dabigatran that are used to treat atrial fibrillation.

With these twice-daily oral drugs, “even missing a few doses can lead to acute events such as stroke,” said Mintu Turakhia, MD. Along with other researchers, Turakhia was puzzled when he learned that patients weren’t adhering very well to these drugs. It seemed surprising because the drugs didn’t require frequent blood tests like warfarin, the traditional blood thinner used to treat atrial fibrillation.

Digging into the data, Turakhia and his team found that adherence varied by treatment site, not by individual patient. How odd, they thought. To figure out what was going on, “we rolled up our sleeves and looked at what each site was doing,” Turakhia said.

My colleague explained the result of the researchers’ work, which appears today in the Journal of the American Medical Association, in a release:

At the sites with the highest patient adherence, there was usually a pharmacist actively educating patients on medication adherence, reviewing any possible drug interactions, and following up to make sure patients were taking the medication when they were supposed to and that prescriptions were being refilled on time…

“We’re suggesting that greater structured management of these patients, beyond the doctor just prescribing medications for them, is a good idea,” Turakhia said. “Extra support, like that provided in the VA anticoagulation clinics with supportive pharmacist care, greatly improves medication adherence.”

Previously: One label fits all? A universal schedule for prescription drugs, Raising awareness about the importance of taking medications properly and Study highlights increased risk of death among patients with atrial fibrillation who take digoxin
Photo of Turakhia by Norbert von der Groeben

Behavioral Science, Complementary Medicine, Mental Health, Stanford News

Stanford law professor uses behavioral psychology to promote stress reduction in students

Stanford law professor uses behavioral psychology to promote stress reduction in students

6145155310_258dc36f9e_zGoing back to school inspired Stanford law professor Joseph Bankman, JD, with more than new perspectives on his legal work. Through his experience in the Palo Alto University/Stanford School of Medicine joint PsyD (doctor of psychology) program, Bankman thought of a way to connect what he was learning about behavioral psychology with what he sees everyday in his students. He started a program that offers first-year law students an emotional health seminar using cognitive behavioral therapy (CBT) to help them positively respond to situations that induce stress and anxiety.

Stanford News has the story, in which Bankman is quoted:

I have all these brilliant students whom I can help by giving them some useful knowledge and improving their analytical skills. But, as I came to realize over the years, if they crash and burn it will not be because they lack these necessary skills.  It will be because they lack emotional resilience to cope with the stresses and challenges of a demanding professional career.  Like millions of others, they need help with anxiety and, for some, depression.

The two-hour course includes an introduction to the principles of CBT and some simple exercises, and it has been offered on a voluntary basis for the past two years. Student response has been overwhelmingly positive: in one course, 100 percent said it should be offered again, and many reported that the benefits extended past school and into their personal lives.

In the news report, Bankman says he is observing a new focus on the emotional well-being of students in both research and  institutions, and he hopes the trend will continue.

Previously: A conversation with Scott Stossel, author of My Age of Anxiety, Benefits of mindfulness program for med students, Reframing reactions could reduce symptoms of social anxiety disorder, Stanford study shows and A closer look at depression and distress among medical students
Photo by Tulane Public Relations

Behavioral Science, Complementary Medicine, Events, Stanford News

His Holiness the 17th Karmapa discusses the nature of compassion

20150317-CCARE-17th-Karmapa-7343When he was taken from his village in eastern Tibet at age 7 after being identified as a religious leader, His Holiness the 17th Karmapa didn’t have aspirations to become a world-renowned spiritual leader. “My first thought was this new position would give me many more opportunities to play and many more friends to play with,” His Holiness said Tuesday, in one of his first appearances on a two-month tour of the United States.

Now 29, he certainly attracted many “friends” Tuesday; fans and followers packed Stanford’s sizable Memorial Hall for the evening talk. Though his English is quite good, His Holiness used an interpreter to tell tales of his childhood and escape to India at age 14 and to share his thoughts on the nature of compassion and hopes for the protection of the environment.

He told the audience that he learned about compassion early, while living with his parents and siblings in a one-room tent made of yak hair. Every morning, his parents prayed — “May all sentient beings be happy” — again in the evening, they prayed. And they taught him about the interdependence of all beings — even insects could not be smashed. “I really feel I was raised in a mandala, or circle, of compassion and love,” he said.

Even the way his parents gave him up, letting him leave to pursue his future as a spiritual leader, was altruistic, His Holiness said. “They embraced the idea the Karmapa would accomplish great, excellent benefits for the world.”

His Holiness said he has come to learn that compassion is all about thinking about the feelings, and interests, of others. “It’s all about developing a sense of responsibility in relation to the reality of interdependence,” he said, before elaborating:

 I think what compassion involves is not just looking at our own situation, but considering  the state or reality of other sentient beings, those similar to us and those dissimilar to us… and developing a concern for those people.

Compassion involves realizing that our experience of happiness and suffering is the same as everyone else’s. Compassion has this component of awareness to it and knowledge that everyone is wanting to be happy and free of suffering.

For example, His Holiness said he is hoping to teach others in Himalayan monasteries about the importance of caring for the environment. “Compassion means becoming more involved,” he said.

He explained that his passion for the environment stems from his experience growing up in rural Tibet, which he said was beautiful and unaffected by development or pollution. “If I were to return to Tibet, the sad thought occurs to me that maybe things wouldn’t be as beautiful as I remember,” he said.

Though there’s much work to do to protect the environment, and “the actions of one individual are not going to be enough,” he said he still believes “it’s really important for individuals to take up the cause.”

The event was sponsored by the Center for Compassion and Altrusim Research at Stanford and was followed by a Q&A session with James Doty, MD, center founder and director.

Previously: The Dalai Lama talks business, compassion and happiness, Dalai Lama and Stanford researchers explore the science of compassion and altruism and Buddhist teacher Jack Cornfield on practicing “sensitivity to now”  
Photo by Christopher Wesselman

Behavioral Science, In the News, Medicine and Society, Research

Research prize for helping make mice comfy – and improving science

Research prize for helping make mice comfy - and improving science

OLYMPUS DIGITAL CAMERAA Stanford researcher has won accolades for a research paper that could help ease the lives of millions of laboratory mice – and improve the outcomes of research studies.

Joseph Garner, PhD, an associate professor of comparative medicine, and his colleagues observed that mice are routinely housed in cold conditions, which put stress on the animals. The mice compensate with physiologic changes that can skew the results of laboratory studies. For instance, temperature has been shown to affect immune function and tumor development in mice, among other factors. So cold stress in mice raises concerns not only for animal welfare but also for science.

Garner and his colleague, Briana Gaskill, PhD, proposed a simple solution: Give the animals some nesting material, and they’ll build a cozy home to regulate their temperatures. These comfy mice would be more physiologically comparable to humans, making them better research subjects, the researchers said. But one obstacle to adopting this simple solution was the question of how much nesting material is enough? In their prize-winning experiment, the researchers asked the mice how much nesting material they needed to give up a warm cage for a cold cage with a nest. The scientists found that between 6 and 10 grams of nesting material could effectively reduce cold stress in the animals – a standard now starting to be adopted in labs around the world.

The paper, published in 2012 in PLoS One, won a high commendation recently from the National Centre for the Replacement, Refinement & Reduction of Animals in Research, a leading, UK-based scientific organization that supports research which aims to minimize the need for animals in research and improve animal welfare.

The group said that the research results “have the potential to positively impact the welfare of millions of laboratory mice all over the world.”

Garner and Gaskill both traveled to London to receive the prize.

Previously: Stanford students design “enrichments” for lions, giraffe and kinkajou at the San Francisco Zoo, Nesting improves mouse well-being, could aid research studies and Stanford researcher’s easy solution to problem of drug testing in mice
Photo, which originally appeared in Stanford Medicine magazine, by Brianna Gaskill

Behavioral Science, Complementary Medicine, Events, Research, Stanford News

Tend and befriend — helping you helps me

Tend and befriend — helping you helps me

7005743072_b8c1acb3d0_kHelping others helps you. That’s not new news — perhaps you’ve heard it from your mother or your priest or your great-uncle Joe for your entire life. But what is new is the firm biological basis of that old adage — the connections between altruism, caring and neuroscience. Health psychologist and Stanford lecturer Kelly McGonigal, PhD, drove that point home hard last week at a talk sponsored by the Stanford Center for Compassion and Altruism Research and Education.

The event kicked off with a meditation tailored to open hearts and minds outward — for participants to consider others as well as themselves. Even that five-minute exercise was enough to spur the release of oxytocin, sometimes called the “love hormone,” McGonigal said. It “fine tunes our social instincts,” she explained. It dampens fear, making it easier to help others and even improving one’s ability to read facial expressions.

“We can create this biology by choosing to have a social response to stress,” McGonigal told the audience. The academic term is “tend and befriend,” coined by UCLA psychologist Shelley Taylor, PhD. Rather than making her aggressive, Taylor and her colleagues found they softened when stressed, becoming more caring and pro-social.

A series of studies have demonstrated the power of the tend and befriend response. Urban teens who volunteer alleviate their own biological stress. Adults who contribute to charity are more resilient in the face of major life events. People feeling a time crunch — too much to do, too little time — can alleviate the feeling by spending time on others. And the list goes on.

“There’s something about this tend and befriend mindset that seems to create physical resilience,” McGonigal said.

Evolutionarily, the instinct makes sense in the event of a disaster, she said. “I have it so you all will survive if there’s an emergency. My having the tend and befriend instinct is mostly about you.”

Perhaps one of the most relevant illustrations of the tend and befriend response — and a lesson for adopting it — comes from study that just came out this week, McGonigal said. Two researchers asked 150 middle-age adults to tell the story of their lives. The stories from the mentally healthiest participants shared a similar theme: Personal suffering inspired them to do something to transform the suffering of others into something positive. They transformed their suffering from a negative into a positive.

“Helping others increases the chemistry of hope and courage and dampens fear and despair,” McGonigal said.

Previously: Ask Stanford Med: Stanford health psychologist Kelly McGonigal taking questions on willpower, Stanford health psychologist Kelly McGonigal discusses how stress shapes us and Why stress might not be so bad
Photo by David Hodgson

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