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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

In the News, Mental Health, Research, Sleep

The importance of screening soldiers for sleep problems to combat mental-health conditions

The importance of screening soldiers for sleep problems to combat mental-health conditions

Watching over

A new report from the RAND Corporation suggests that treating military members’ sleep disturbances early on may be an important step in preventing serious mental-health conditions, including post-traumatic stress disorder, depression, and traumatic brain injury.

The two-year multi-method study examined sleep-related policies and programs across the U.S. Department of Defense and surveyed almost 2,000 veterans from various branches of the military to evaluate their sleep habits. The findings emphasized the negative effects of poor sleep on soldiers’ mental health, daytime impairment and perceived operational readiness; and it outlined interventions for helping identify and prevent sleep problems for service members.

The Huffington Post reports:

The researchers recommended that the military improve screening for sleep disturbance, and develop guidelines for doctors on how to identify and treat sleep disorders in the military. Apps on mobile phones might be one new way to identify and monitor sleep problems so they do not become chronic and debilitating, the researchers said.

Although the new report focused on activity-duty troops, studies show that sleep problems are often missed in veterans as well, [Wendy Troxel, PhD, co-author of the report] said, so there is also a need to develop guidelines for treating this population. In a previous survey of 3,000 veterans, 74 percent had symptoms of insomnia, but only 28 percent had talked with their doctor about it, Troxel said.

The researchers also recommended improving policies and programs to educate military personnel about the importance of sleep, and provide guidance on how to help military members get better sleep.

Previously: Study shows benefits of breathing meditation among veterans with PTSD, The promise of yoga-based treatments to help veterans with PTSD and Using mindfulness therapies to treat veterans’ PTSD
Photo by DVIDSHUB

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

Mental Health, Neuroscience, Rural Health

Seven ways laughter can improve your well-being

Seven ways laughter can improve your well-being

3336353424_df38db0c8a_zEveryone enjoys a good laugh, but who actually makes time for it in their lives? Sure, we like hearing a funny joke, talking to people with a good sense of humor and watching comedies. But few of us take our laughs seriously (no pun intended!) nor do we make a concerted effort to laugh more. But we should! The science of laughter – though still preliminary – suggests that it has tremendous benefits for our health and psychological well-being.

Laughter can improve your relationships. According to a recent study led by research assistant Alan Gray of University College London, the act of laughing can make you more open to new people and can help you build relationships.

Laughter may also boost memory and lower stress. A study by researchers at Loma Linda University found that laughter can sharpen your ability to remember things while also reducing the stress hormone, cortisol, especially in older people.

Laughter may make you more resilient. Ever had nervous laughter in an awkward or difficult situation? That’s because laughter may help you regulate your emotions in the face of challenge, according to a study led by Yale psychologist Erica J. Boothby, PhD.

Laughter can improve your health. A study of diabetic patients by Lee S. Berk, PhD, and Stanley A. Tan, MD, of Loma Linda University found that laughing can lower stress and inflammation and increase good cholesterol. Ever found yourself laughing while telling a joke or funny story? Maybe you were anticipating the ending and laughed your way through the end of the joke? Another study by Berk and Tan suggests that just anticipating a funny event boosted immune function while decreasing stress-related hormones.

Laughter can make you a better learner. When we are trying to learn something new, we usually are pretty serious, but research by Mark Shatz, PhD, and Frank LoSchiavo, PhD, of Ohio University show that a good laugh while learning new material will help you engage with it more!

Laughter can make you more attractive.  Another recent study by Shatz and LoSchiavo shows that humor and playfulness are highly valued traits in potential romantic partners.

Laughter can help you make the world a better place. Why? It’s contagious. At least on the level of the brain, according to research by Sophie Scott, PhD, of University College London.

Emma Seppala, PhD, is associate director of Stanford’s Center for Compassion and Altruism Research and Education and a research psychologist at the School of Medicine. She is also a certified yoga, pilates, breath work and meditation instructor. A version of this piece originally appeared on Psychology Today.
Photo by Arnet Gill

Global Health, Mental Health, Research, Sexual Health, Women's Health

Exploring links between domestic violence, depression and reproductive health

Exploring links between domestic violence, depression and reproductive health

abused womanIt’s no surprise that domestic violence has effects that ripple outward in a victim’s life, beyond physical traces of abuse. Research into just what those effects are can help physicians provide better counseling and treatment, and two new studies show striking correlations between domestic violence, mental illness, and contraception use.

The first study, published in Depression and Anxiety, enrolled a nationally representative sample of more than 1,000 mothers with no previous history of depression, and assessed them over 10 years. It was headed by Isabelle Ouellet-Morin, PhD, researcher at the University of Montreal. Thirty-three percent of the women reported being the victim of violence from their partner, and these women had a twofold increase in their risk of suffering from new-onset depression (after controlling for childhood maltreatment, socioeconomic deprivation, antisocial personality, and young motherhood). Compared with women who had never been victims of violence, women who were abused both in childhood and adulthood were 4-7 times more likely to suffer from depression. The results were similar for psychotic symptoms.

Louise Arseneault, PhD, co-author and professor of developmental psychology at Kings College London, is quoted in PsychCentral:

Health professionals need to be very aware of the possibility that women who experience mental health problems may also be the victims of domestic violence and vice versa. Given the prevalence of depression in these victims, we need to prevent these situations and take action. These acts of violence do more than leave physical damage; they leave psychological scars as well.

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Mental Health, Podcasts, Stanford News

New frontiers for psychiatric illness

New frontiers for psychiatric illness

brain statueI started my recent conversation with Stanford psychiatrist and neuroscientist Amit Etkin, MD, PhD, with the March 24 crash of the Germanwings aircraft. The pilot, now known to have had a history of depression, was on an apparent suicide/homicide mission, killing 150 passengers when he crashed the plane in the French Alps. I wondered, could this tragedy in any way serve as a teachable moment to help de-stigmatize mental illness? Was it possible at all in the midst of a senseless horror to also have any constructive dialogue about mental illness?

I guess I already knew the answer, but Etkin confirmed it. He told me that when a horrendous event occurs like this, someone has to accept blame, and “that already colors the conversation you will have.” It’s not like when an admired public figure discloses a mental disorder and a conversation about mental illness can potentially enlighten the issue.  The sheer tragedy, Etkin said, overwhelms any attempt to educate or lessen the stigma about mental illness.

We went on to talk about the plasticity of the brain and its ability to recover, and a lot about the progress in brain research and why he believes we’re well into a new area of discovery that will reap benefits. And I asked him what Freud would think about this moment in time in psychiatry. Would the father of modern psychiatry see progress in the field if he were transported to today?

Freud, as a clinician, would be disappointed that “we’re not even close to cures now compared to 100 years ago when he lived,” Etkin responded. Freud’s early work, said Etkin,”was to actually try to understand the brain basis with the very, very rudimentary science at the time, of the things he saw clinically. I think that would make him happy – that now there’s a connecting of things grounded in the brain that there wasn’t a couple of decades ago. This is really a relatively new development with brain imaging.”

Etkin does offer great hope and believes the advances in the treatment of mental disorders that are well underway will be transformative in the future:

I think we are now at the point in psychiatry and in neuroscience relative to behavior and emotion where we finally have some of the tools we need to answer the questions that we want to answer and [are] no longer as limited by not having had those tools… Asking questions with the right tools will allow very, very big questions to be answered.

Previously: Study: Major psychiatric disorders share common deficits in brain’s executive-function networkHope for the globby thing inside our skulls, My descent into madness – a conversation with author Susannah CahalanBrain study offers “intriguing clues toward new therapies” for psychiatric disorders and Searching for better PTSD treatments
Related: Brain power: Psychiatry turns to neuroscience
Photograph of a Federico Carbajal Raya sculpture by Victor Vargas Villafuerte

Global Health, Mental Health, Research, Stanford News

Study explores how cultural differences can shape the way we respond to suffering

Study explores how cultural differences can shape the way we respond to suffering

8909380232_a647e15c23_zOur emotions may be a deeply personal experience, but the way we perceive and express our feelings may not be as unique – or random – as we think. According to recent research, culture influences the way some Americans and Germans convey their mood. If this is universally true, it could mean that people of the same culture tend to express their feelings in similar ways.

As this Stanford Report story explains, researchers Jeanne Tsai, PhD, an associate professor of psychology, and Birgit Koopmann-Holm, PhD, a German citizen who earned her doctorate in Tsai’s lab, noticed that Americans of European decent and Germans seemed to differ in the way they express feelings of sympathy:

Americans tend to emphasize the positive when faced with tragedy or life-threatening situations. American culture arguably considers negativity, complaining and pessimism as somewhat “sinful,” [Tsai] added.

Unlike when Americans talk about illness, Germans primarily focus on the negative, Tsai and Koopmann-Holm wrote. For example, the “Sturm und Drang” (“Storm and Drive”) literary and musical movement in 18th-century Germany went beyond merely accepting negative emotions to actually glorifying them.

This seemingly simple observation could have important societal implications, the researchers explain: Studies show that empathy affects our willingness to help someone who is suffering. But, as noted in the article, “until now, Tsai said, no studies have specifically examined how culture shapes ‘different ways in which sympathy, compassion or other feelings of concern for another’s suffering might be expressed.'”

In their study (subscription required, pdf here), published in the Journal of Personality and Social Psychology, the researchers conducted four separate experiments on 525 undergraduate students in the U.S. and Germany to see if Americans accentuate the positive more than Germans do when expressing their condolences. The students were asked how they would feel in a variety of hypothetical situations (such as a scenario where a friend lost a loved one), what feelings they would want to avoid and how they would select and rate sympathy cards.
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Global Health, In the News, Mental Health, Public Health, Research

Study links air pollution with anxiety; calls it a “leading global health concern”

Study links air pollution with anxiety;  calls it a "leading global health concern"

3280739522_c1f8001000_zI often find that natural spaces and fresh air have a calming, balancing effect, and judging by the cultural association between relaxation and the outdoors, I’m not alone. Now some new research backs up the connection. Yesterday, the British Medical Journal published an article linking air pollution with anxiety, as well as an editorial on air pollution’s health effects and another study elaborating on a previously-noted connection between pollution and stroke.

The anxiety study, conducted by researchers at Harvard and Johns Hopkins University, showed a significant connection between exposure to fine particulate pollution and symptoms of anxiety for more than 70,000 older women (mean age of 70 years) in the contiguous United States. Bigger particles appeared to have no effects, interestingly, nor did living close to a major road. The connection was present over a variety of time periods from one month to fifteen years, but was stronger in the short term. This evidence shows a clear need for studies to be done in other demographic groups, and to elaborate on the biological plausibility of the connection.

The stroke article, meanwhile, is a meta-analysis of 103 studies conducted in 28 countries and including 6.2 million events. Researchers found that both gaseous and particulate air pollution had a “marked and close temporal association” with strokes resulting in hospital admissions or death.

As stated in the editorial, particulate air pollution has already been shown to be a contributing factor in a variety of serious health conditions, including a well-supported link to cardiopulmonary diseases, but also diabetes, low birth weight, and pre-term birth. In fact, the World Health Organization estimates that one of every eight deaths is caused by air pollution. The body of research on the topic suggests that pollution may initiate systemic inflammation, thereby affecting multiple organ systems.

With such a broad range of detrimental effects, and because it affects such a significant percentage of the population, air pollution is becoming a top public health concern. As the University of British Columbia’s Michael Brauer, ScD, wrote in the editorial:

The findings of these two studies support a sharper focus on air pollution as a leading global health concern… One of the unique features of air pollution as a risk factor for disease is that exposure to air pollution is almost universal. While this is a primary reason for the large disease burden attributable to outdoor air pollution, it also follows that even modest reductions in pollution could have widespread benefits throughout populations. The two linked papers in this issue confirm the urgent need to manage air pollution globally as a cause of ill health and offer the promise that reducing pollution could be a cost effective way to reduce the large burden of disease from both stroke and poor mental health.

Photo by Billy Wilson

Medical Education, Medicine and Literature, Medicine and Society, Mental Health, Patient Care

Using graphic art to understand the emotional aspects of disease

Using graphic art to understand the emotional aspects of disease

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When it comes to describing the feelings of hopelessness of depression, the fear and anxiety of having an operation or the unrelenting pain of a chronic condition, sometimes words are not enough. But, as some patients have discovered, art can be a powerful medium for portraying and translating these complex emotional experiences. Cartoons can also help future medical professionals empathize with patients and consider their experience from more than a clinical perspective.

An article published last week on the anthropology blog Teaching Culture explores the use of graphic art in medical anthropology courses. It takes its inspiration from Allie Brosh’s comic Hyperbole and a Half, in which she uses a crudely drawn figure to transport readers through the painful inertia and numbness of her depression. I stumbled upon this comic a few years ago when a dear friend was depressed. At the time, I didn’t understand how that could be or what that meant. Brosh’s bizarre, raw, and yes funny, comic resonated not only with what I saw my friend going through, but with my own experience, even though I was not depressed. It enabled me to empathize and to offer her support that was more relevant.

The article also describes a curriculum that incorporates “graphic pathographies” – graphic novels and comics about experiencing illness – into a course for pre-med students. The coursework “examines the multifaceted relations between biomedicine, culture, and the art of care, and places a special emphasis on how creative and humanistic approaches to illness and healing might enrich clinical practice.”

When I asked for his thoughts, Errol Ozdalga, MD, a professor of general medicine involved with the bedside medicine Stanford 25 initiative, commented:

Graphic art is an expression that is probably under-utilized. At Stanford, our guest services offers patients the chance to do guided imagery by expressing their feelings via drawing. Many physicians are unaware this service exists. It’s an opportunity to better understand our patients’ perspectives and promote the importance of connecting to patients among our students.

Previously: Engaging with art to improve clinical skills, Image of the week: a medical-focused manga comic and Stanford nurse’s whiteboard artistry brings cheer to patients, co-workers
Photo by Krystal T

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