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Events, Medicine X, Mental Health, Stanford News, Technology

Medicine X spotlights mental health, medical team of the future and the “no-smartphone” patient

Medicine X spotlights mental health, medical team of the future and the “no-smartphone” patient

Larry_ChuInnovative thinkers and thought leaders engaged in using emerging technologies to enhance health-care delivery and advance the practice of medicine will gather here in early September for Stanford Medicine X.

As Lloyd Minor, MD, dean of the School of Medicine, comments in a release today, Larry Chu, MD, associate professor of anesthesia at Stanford and executive director of the conference, “has made this the go-to event for e-patients, physicians and innovators who want to get together to map out the future of health care.” Chu also notes that the conference  “has distinguished itself through a singular commitment to inclusivity and by finding new ways to bring every voice and perspective into important conversations about health care.”

Now in its third year, Medicine X is building on this inclusive spirit by exploring a variety of new themes during its 2014 program. More from our release:

This year’s program will spotlight the relationship between physical and mental well-being with three breakout panels. Psychologist Ann Becker-Shutte, PhD, will moderate a session on how mental health affects overall health. A conversation about emerging technologies in mental health will be led by Malay Gandhi, managing director of Rock Health, a business accelerator for health-care technology startup companies. Additionally, patient advocate Sarah Kucharski will direct a discussion about depression caused by chronic disease and about coping through online communities.

“Mental health is imperative to address in the overall conversation about the future of health care,” said Chu. “We need to be thinking about the health of the whole person, not just a patient’s individual symptoms or disease.”

The three-day event will also feature panels on what the medical team of the future may look like; how patients with chronic diseases can use self-tracking tools to improve their health and support one another; ways for the pharmaceutical industry to partner with patients in the drug discovery and clinical trial process; and opportunities to connect with “no-smartphone” patients — those who don’t have the access or resources to fully engage with health-enhancing technologies.

Keynote speakers for this year’s conference, being held Sept. 5-7, include Daniel Siegel, MD, clinical professor of psychiatry at the University of California-Los Angeles; Barron Lerner, MD, PhD, professor of medicine and population health at New York University School of Medicine; and Charles Ornstein, a Pulitzer Prize-winning journalist and senior reporter at ProPublica.

For information about the program or to  register the Medicine X website. Last year’s conference sold out, and space is limited for this year’s event.

Previously: Medicine X Live! to host Hangout on design thinking for patient engagement, Quite the reach: Stanford Medicine X set record for most number of tweets at a health-care conference, Videos from Medicine X now available and “You belong here”: A recap of Stanford Medicine X
Photo of Larry Chu by StanfordMedicineX

More news about Stanford Medicine X is available in the Medicine X category.

In the News, Mental Health, Research

How are flight attendants affected by plane disasters?

How are flight attendants affected by plane disasters?

airplaneA few nights after the recent plane crash in Ukraine, I ran into an acquaintance who was heading to Europe later in the week. “It feels weird to fly,” she told me, comparing it to how she felt about boarding a plane for the first time after the 9/11 attacks 13 years ago. I could relate: During my first post-9/11 flight, I was jittery and uneasy the entire way from San Francisco to Minneapolis. (It didn’t help that I was flying alone, in the darkened cabin of a red-eye.)

If plane crashes and tragedies like the one in Ukraine can leave passengers feeling unsettled (or worse), how might they affect people who take to the skies on an almost daily basis? In a piece on The Atlantic yesterday, writer Rebecca Rosen reported on the work of Jeffrey M. Lating, PhD, a professor of psychology at Loyola University Maryland who has studied this issue. Rosen writes:

For flight attendants who worked at American Airlines on 9/11, the rates [of PTSD] were… just over 18 percent. This number is so high, Lating says, it is comparable to the rates seen among people living south of Canal Street in Manhattan, the neighborhoods closest to Ground Zero.

Lating and his colleagues found no statistical difference in probable PTSD rates between West Coast flight attendants and East Coasters, who were much more likely to have known the flight attendants killed on 9/11. For flight attendants, it seems that the trauma they experience following a crash comes not only from the loss and tragedy itself, but also from a deep sense of vulnerability. A follow-up study in 2006 found similarly high rates of probable PTSD at another airline, further suggesting that “it didn’t matter what airline you worked for,” says Lating. “The virulent factor in this was, ‘I wonder if I could possibly be next.’ ”

Those fears can make just doing one’s job as a flight attendant incredibly challenging. Many suffering from PTSD try to avoid sights and triggers that recall the initial trauma. But for flight attendants, those reminders are unavoidable, part of the work itself. To have to work through that anxiety, all the while servicing others and maintaining a sense of calm on a flight— “you could imagine how uncomfortable that would be,” Lating say

Previously: 9/11: Grieving in the age of social media and What 9/11 has taught us about PTSD
Photo by epsos.de

Behavioral Science, Health and Fitness, Mental Health, Research

Exercise and relaxation techniques may help ease social anxiety, study finds

Exercise and relaxation techniques may help ease social anxiety, study finds

TrishWardMeditationPicPhysical exercise and relaxation techniques are common forms of stress-relief. Now, a new study has found that both may help people with social anxiety perceive their surroundings as less threatening environments.

Researchers from Queen’s University in the U.K. conducted two experiments measuring anxiety in participants. In both experiments, the participants were shown point-of-light displays describing a human but not indicating which way the stick figure was facing or whether it appeared to be approaching or receding. Facing-the-viewer bias, a possible biological protective mechanism, may lead people to assume the figure is approaching and posing a threat. And, according to the study, people who are more anxious may place their attention on more threatening stimuli, thereby increasing anxiety.

The researchers tested two means of altering participants’ perception of threat when looking at the stick-figure displays. From a release:

“We wanted to examine whether people would perceive their environment as less threatening after engaging in physical exercise or after doing a relaxation technique that is similar to the breathing exercises in yoga (called progressive muscle relaxation),” researcher [Adam Heenan, a PhD candidate,] said in a statement. “We found that people who either walked or jogged on a treadmill for 10 minutes perceived these ambiguous figures as facing towards them (the observer) less often than those who simply stood on the treadmill. The same was true when people performed progressive muscle relaxation.”

“This is a big development because it helps to explain why exercising and relaxation techniques have been successful in treating and mood and anxiety disorders in the past,” Heenan said.

The research was published in PLOS ONE.

Previously: Research brings meditation’s health benefits into focusAh…OM: Study shows prenatal yoga may relieve anxiety in pregnant womenStudy reveals initial findings on health of most extreme runners and The remarkable impact of yoga breathing for trauma
Photo courtesy of Trish Ward-Torres

Health Disparities, LGBT, Mental Health, Patient Care, Stanford News

Stanford med student discusses his documentary on LGBT vets’ health

Stanford med student discusses his documentary on LGBT vets' health

doublelifeWhen Stanford anesthesiologist Audrey Shafer, MD, welcomed attendees to a screening of “The Camouflage Closet“ on campus recently, she noted the artistic accomplishments and service work of the film’s director, Michael Nedelman. (And also mentioned he was “a Stanford medical student in his spare time.”) Nedelman, who will be entering his third year here, conducted a project with nine LGBT veterans, all patients at the Veterans Affairs Palo Alto Health Care System, exploring their experiences of trauma and recovery.

Nedelman and his collaborators engaged in a community-based participatory method of film-making, allowing participants to tell their stories through art as a path toward empowerment. The participants were provided with cameras to document their stories; they also had a say in the editing process. And while the project was neither officially sanctioned research nor therapy, many of the participants found the process therapeutic. Christine Stout-Holmes said this in the film about sharing her story:

It’s healing. It makes me feel like, “Hey, I don’t have to be agoraphobic.” “Hey, I don’t have to isolate.”

Of course, I feel fists beating me on my back, but I know that that’s not now. And I know that what I’m doing now is going to benefit clinicians, and vets, and hopefully artists, and young girls to know that every story is important.

Since the film’s premiere last June, it has screened at the National Queer Arts Festival, the 31st annual Gay and Lesbian Medical Association conference, and at universities, film festivals and VA hospitals across the U.S. and in Mexico.

Below, Nedelman answers questions about his work.

You have a BA in film studies from Yale. How did you decide to attend med school, and have your interests in art and medicine always intersected?

It took me a while to understand exactly how my interests in art and medicine intersected, but it turned out they had a common ancestor in my love of story.

A few years out of college, I was working at Mount Sinai in New York City on both clinical research and documentary film studies. Whether or not there was a camera in the room, I loved hearing people’s stories, and turning those stories into something meaningful. But in a medical context, I also saw the opportunity to get involved in these stories – to reach past the lens and make a tangible difference.

Combining the two wasn’t really a new concept, though. My first major work in college was a photography project addressing preventable blindness in South India. As with “The Camouflage Closet,” I loaned out cameras to rural vision clinic patients who were able to document their restored sight through images that were important to them. But I had no idea that hyphenating doctor-filmmaker was even an option until I discovered, and later met with, filmmakers like Maren Grainger-Monsen, MD, and Gretchen Berland, MD. Something clicked when I figured out that patient care and digital media could go hand-in-hand.

What are some of the issues faced by this population that you’re most interested in exploring through storytelling?

Some of the issues I found most compelling are not just the unique challenges faced by some individuals (e.g. witch hunts of the pre-DADT – “Don’t Ask, Don’t Tell” – era, increased rates of military sexual trauma, barriers to accessing care), but also the creativity and strength that come from their recovery narratives. Alongside some of the heavier moments in the film, there’s some humor, too. I think I personally learned a lot from the veterans’ resilience, and how their pride – for being LGBT, and for being veterans – factors into their personal growth.

What do you hope viewers will take away from your film?

I hope viewers will come out of the film with a desire to learn more about the unique challenges, types of trauma, and sources of resilience among a previously silenced community. I think there’s a lot to identify with in the film, whether or not you identify as LGBT or a veteran, and there’s a lot to be said for turning empathy into action. This is partly why we also created an accompanying educational resource that summarizes previous research, evidence-based suggestions for culturally relevant care, and resources for clinicians and veterans.

The veterans were excited that clinicians and providers would see and learn from their work. But at the end of the day, I wonder if some of them might have answered this question a little differently. Something we often heard among the vets was, “Even if just one other veteran out there sees this and knows they aren’t alone, we’ve accomplished what we came here to do.”

Previously: Documentary on LGBT veterans’ PTSD, trauma and recovery premieres tomorrow and Photography and storytelling may help poor women with HIV cope with their illness
Film still from “The Camoflauge Closet” courtesy of Michael Nedelman

Aging, Mental Health, Research, Stanford News

Everyday conversations may help older adults bounce back from hardship

JapaneseLadyAs a fan of obituaries, oral histories and encounters with people who have had long lives, I was delighted to come across a humanities study finding that conversation is good for the subjects of the stories, too. Yoshiko Matsumoto, PhD, a Stanford professor of Japanese language and linguistics, has been studying conversations of older people, who, with long lives, have faced challenges such as health problems and losses of loved ones. Her research documents which types of conversation play a particularly important role in supporting the subjects’ well-being and can provide family members and care providers “potential tools for building resiliency following change.”

More from a recent Stanford Report article:

Matsumoto’s most recent work specifically focuses on older women’s discourse about the illness or death of their husbands, with particular attention to conversations that also include humor and laughter. “These instances are not uncommon in my data, although they are a surprising combination,” Matsumoto says.

Matsumoto’s linguistic analyses of more than 60 hours of recorded conversations illustrate that there is in fact a structure to such discourse. Her findings suggest that by reframing a serious story through an ordinary, or “quotidian,” perspective, the women she studied infused their dialogue with cathartic smiles.

In one instance, a woman jokingly described how she used to chide her husband about his smoking and drinking habits – the very cause of his death. Matsumoto notes that by shifting the narrative perspective from somber to the ordinary, the speaker helped everyone involved regain the feeling of normality.

Previously: Depression, lifestyle choices shown to adversely affect memory across age groups, Helping older adults live independently using mobile-health technology and How social media and online communities can improve clinical care for elderly patients
Photo by Debs

Medical Apps, Mental Health

Smartphone app detects changes in mental health patients’ behavioral patterns in real time

texting_070214In an effort to improve diagnosis, treatment and monitoring for mental health patients, researchers have developed a smartphone application that detects changes in patients’ behavioral patterns and transmits them to medical professionals in real time. PsychCentral reports on researchers’ findings showing the app can provide useful insights to health-care providers about patients’ daily activity and mood:

Researchers conducted two clinical trials in which the application was installed on the smartphones of 20 patients suffering from bipolar, unipolar/depressive, or schizoaffective disorders, as well as on the phones of 20 healthy participants.

Over the course of six months, the app acquired data from patients’ phones and sent the information to distant computers, where advanced algorithms analyzed the data to detect changes in patients’ sleep, communication, mobility, and vocal patterns.

The researchers further developed a visualization system that displayed the summarized information to psychiatrists, providing them with instant insight into the behavioral trends of their patients.

Psychiatrists in the trials reported that the system has already positively affected their interaction with patients, offering a useful objective “window” into the patient’s daily routine.

Patients have full control over who is allowed to access the app and information it collects. The system does not acquire or record the content of calls or texts and any identifying parameters of the patient or of his contacts are irreversibly masked and are obviously not used, according to a release.

Photo by jDevaun

Behavioral Science, Mental Health, Stanford News

Using mindfulness-based programs to reduce stress and promote health

Using mindfulness-based programs to reduce stress and promote health

JamesLeeIn a Stanford BeWell Q&A, Mark Abramson, DDS, the founder and facilitator of Mindfulness-Meditation Based Stress Reduction programs at Stanford Hospital & Clinics and the Stanford School of Medicine, discusses the origins of such practices and how they can be applied in health settings and other areas such as business and education. Abramson leads an eight-week mindfulness meditation course through Stanford’s Health Improvement Program.

From the Q&A:

What is Mindfulness-Based Stress Reduction?

Mindfulness-Based Stress Reduction was originated by Jon Kabat-Zinn, [PhD,] who applied the traditional meditation practice of mindfulness (defined here as non-judgmental awareness) to medical centers. He created an eight-week treatment program for medical illnesses as well as general stress issues. In his program, he used a combination of mindfulness meditation, body awareness, and yoga to assist people with pain and a range of conditions and life issues. MBSR is now a common part of the treatment regimen in many hospital settings.

Meditation looks easy, but can be quite difficult. What is the simplest way to get started?

There are two phenomena that make meditation difficult. The first is the expectation people have that they’re going to go into a mystical, magical place where the mind shuts off and they will be in a special state. This expectation has ruined people’s practice more than anything else. Mindfulness is really just observing yourself through your natural senses — such as your taste, hearing, smelling and feeling. Even the thoughts you have are observable experiences.

The second difficulty is the habitual tendency for our minds to go off on tangents. It is difficult to stay focused; we slip away and we come back. I try to see that as part of the practice.

Previously: Med students awarded Schweitzer Fellowships lead health-care programs for underserved youthA campus-wide call to pause and reflect, Learning tools for mindful eating and Stress, will-power top reasons why Americans fail to adopt healthy habits
Photo of James Lee by Emily Hite

Aging, Health and Fitness, Mental Health, Neuroscience

Depression, lifestyle choices shown to adversely affect memory across age groups

Depression, lifestyle choices shown to adversely affect memory across age groups

IMG_0140Have trouble remember where you put your keys? Forgetting the names of familiar faces? A lack of physical activity, depression, high blood pressure and a variety of other health factors could be to blame, according to findings recently published in PLOS ONE.

In the study, researchers at the University of California, Los Angeles and the Gallup organization surveyed more than 18,000 people about memory and lifestyle choices previously shown to increase the risk of Alzheimer’s disease and dementia. PsychCentral reports:

Depression, low levels of education, physical inactivity, and high blood pressure increased the likelihood of memory complaints in younger adults (ages 18–39), middle-aged adults (40–59), and older adults (60–99), the researchers found.

Depression was the strongest single risk factor for memory complaints in all age groups.

Having just one risk factor significantly increased the frequency of memory complaints, regardless of age, according to researchers. Memory complaints rose when the number of risk factors increased.

Overall, 20 percent of those polled had memory complaints, including 14 percent of younger adults, 22 percent of middle-aged adults, and 26 percent of older adults.

For younger adults, stress may play more of a role, and the ubiquity of technology — including the Internet and wireless devices, which can often result in constant multi-tasking — may impact their attention span, making it harder to focus and remember.

Researchers hope the findings, and follow-up studies, better identify how health choices made earlier on may impact cognitive function at a later age and lead to interventions to lower the risk of memory loss.

Previously: Newly identified protein helps explain how exercise boosts brain health, Exercise may protect aging brain from memory loss following infection, injury, Stanford biostatistician talks about saving your aging brain and Exercise may be effective in treating depression
Photo by bibliojojo

Mental Health, Podcasts

10% happier? Count me in!

10% happier? Count me in!

harrisDan Harris, author of 10% Happier – How I Tamed the Voice in My Head, Reduced Stress Without Losing My Edge, and Found Self-Help that Actually Works (whew, now that’s a mouthful) acknowledges that he’s not a new-agey spiritual kind of guy who you’d naturally find wandering in the tranquil waters of meditation. And across the phone line, when talking to him for my latest 1:2:1 podcast, I can tell. It’s clear he’s an Alpha Male who’s risen to the top in broadcast network news (co-anchor of Nightline and the weekend editions of Good Morning America) by not being laid back. So he might just be the right guy to take the world of meditation out of the “om” and bring it to a new audience. When I told him I thought he might be doing for mediation what Richard Nixon did for China – normalizing it – he laughed and said, “I love the analogy. It’s probably more flattering than I deserve, but it’s cool nonetheless.”

The success of 10% Happier is not something Harris envisioned. As he was writing it he kept telling his wife it was never going to find an audience: “No one is going to read it.” Yet he’s managed to spin out a wonderful tale about the life of a mega-skeptical agnostic journalist finding  peace, happiness and yes, fulfillment, in the land of self-help and meditation. Well, maybe not total serenity. He did have that little spat with a New York City taxi driver last week that caused his wife to remind him that he still has more steps to climb to reach the Zen state of Fudoshin. Nonetheless, Harris is happier no matter what the percentage; you get the distinct impression that he sees a lot more sunshine out there than rain. And who wouldn’t want that?

Harris thinks his worrier gene was inherited from his father, Dr. Jay Harris who he calls “a gifted wringer of hands and gnasher of teeth.” His mother, Dr. Nancy Lee Harris, was much more in the Zen mode: “…slightly mellower about her equally demanding medical career.” (Both his parents are alums of the Stanford School of Medicine.)

Interestingly, Harris tells me he believes that emerging science linking the practice of meditation to a wide range of physical and psychological advantages may lead to the next big public-health revolution. “Say that again,” I asked. “You think that meditation will lead to a revolution?” With no lack of uncertainty he replied:

Yeah, I do. As I’ve said, the science is really still in its early phases, but the science is really compelling. It shows… that this whole, almost laughably long list of benefits from lower blood pressure to boosted immune system to reduced release of the stress hormone cortisol, and then the neuroscience is just truly sci-fi.

When we wrapped up the podcast, Harris spoke highly about the groundbreaking work being done here at Stanford by neurologist James R Doty, MD. Doty is leading his own revolution in neurology and created the Center for Compassion and Altruism Research and Education (CCARE), to stimulate a rigorous multi-disciplinary scientific effort at understanding the neural, mental, and social bases of compassion and altruism.

Previously: Research brings meditation’s health benefits into focus, How being compassionate can influence your health, Study shows meditation may alter areas of the brain associated with psychiatric disorders and Ommmmm… Mindfulness therapy appears to help prevent depression relapse
Photo in featured entry box by J E Theriot

Events, Mental Health, Public Health, Research, Stanford News, Women's Health

Promoting healthy eating and a positive body image on college campuses

Promoting healthy eating and a positive body image on college campuses

IMG_2764rtshEncouragement to focus on physical appearance in our culture often fuels negative body image and eating disorders. College students can be particularly susceptible to body image issues, and a past survey shows that eating disorders among college students have risen to affect 10 to 20 percent of women and four to 10 percent of men.

To create a social environment where healthy eating and a positive body image are the norm, Connie Sobczak and Elizabeth Scott established The Body Positive initiative in 1996. The program provides youth and adults with tools and strategies to overcome self-destructive eating and exercise behaviors. This past year, the women worked with a group of Stanford students and staff members to change cultural beliefs of beauty and health on campus.

In celebration of the student-led movement, The Body Positive is hosting an event at the Stanford Women’s Center this Sunday. During the event, attendees will be able to view students’ art, hear them sing and speak out in celebration of their authentic beauty and learn more about their projects to support positive body attitudes. Below Scott discusses The Body Positive model, research at Stanford to measure the effectiveness of the approach, and ways that parents, educators and others can support young adults in developing a healthy body image.

What is it about the college experience that leads students be so critical of their body image and to struggle with eating disorders?

Students report many messages in the college environment that promote a preoccupation with body image and dieting — two risk factors in the development of an eating disorder. In the student community at college, there are a plethora of messages questioning students’ ability to trust their own bodies and promoting the idea that everyone can, and should, transform the size and shape of their bodies to meet a very slender ideal. Both men and women are susceptible to these messages. Women, however, are also trained to be ashamed of their appetites and ambitions and to shrink themselves and their passions. These messages are strengthened by peers who are also afraid that they are not okay as they are, especially freshman who are separated from their family and out in the world alone for the first time feeling uncertain about how to take care of themselves.

What motivated you and Connie to launch The Body Positive?

We founded The Body Positive to prevent eating disorders by teaching youth and adults to experience self-love, inhabit their unique beauty, and listen to the voice of wisdom within to guide sustainable, joyful self-care. Ultimately, our work is about freeing all people to pursue their life purpose and passions. Connie survived an eating disorder and then lost a sister to body hatred. She was motivated to change the world so her daughter, and all children, could grow up loving themselves and seeing beauty in their unique bodies. I was overwhelmed by the suffering of the people I was seeing as a new therapist in my practice in Marin County. I was shocked (and still am) to see so many young people suffering with body hatred and eating disorders and losing years of their lives. Being a social worker and an activist, I was motivated to transform the culture so that people could let go of the fruitless pursuit of transforming their bodies.

What advice can you offer to help parents, educators or others in establishing a social climate where healthy eating, a positive body image and excellent self-care are the norm?

Learn the Body Positive competencies! Learn to cultivate mercy for your impermanent and ever-changing body. Be a role model of self-love, especially to your children. Learn to be generous with yourself and develop peaceful, sustainable self-care behaviors so that you can gently return to balance when you are out of balance. Explore the ways your ancestors are represented in the natural size and shape of your body and celebrate those amazing survivors instead of fighting them. Trust the authority of your own body and test everyone else’s ideas about how you should take care of it against your own experience, like a true scientist. If you do all this you will be a great role model for others and that is the best way to create body positive community.

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