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Mental Health

Cardiovascular Medicine, Men's Health, Mental Health, Research, Women's Health

Examining how mental stress on the heart affects men and women differently

Examining how mental stress on the heart affects men and women differently

stress_womanPast research has shown that stress, anger and depression can increase a person’s risk for stroke and heart attacks. Now new findings published in the Journal of the American College of Cardiology show that cardiovascular and psychological reactions to mental stress vary based on gender.

In the study (subscription required), participants with heart disease completed three mentally stressful tasks. Researchers monitored changes in their heart using echocardiography, measured blood pressure and heart rate, and took blood samples during the test and rest periods. According to a journal release:

Researchers from the Duke Heart Center found that while men had more changes in blood pressure and heart rate in response to the mental stress, more women experienced myocardial ischemia, decreased blood flow to the heart. Women also experienced increased platelet aggregation, which is the start of the formation of blood clots, more than men. The women compared with men also expressed a greater increase in negative emotions and a greater decrease in positive emotions during the mental stress tests.

“The relationship between mental stress and cardiovascular disease is well known,” said the study lead author Zainab Samad, M.D., M.H.S., assistant professor of medicine at Duke University Medical Center, Durham, North Carolina. “This study revealed that mental stress affects the cardiovascular health of men and women differently. We need to recognize this difference when evaluating and treating patients for cardiovascular disease.”

Previously: Study shows link between traffic noise, heart attack, Ask Stanford Med: Cardiologist Jennifer Tremmel responds to questions on women’s heart health and Study offers insights into how depression may harm the heart
Photo by anna gutermuth

Mental Health, Research, Technology

How social media can affect your mood

How social media can affect your mood

Facebook_10314A close friend engages in a yearly media detox, where for a period of time he limits his time and activity spent on the Internet. He only answers e-mails requiring an immediate response, spends few minutes reading current news and avoids engaging in social media, shopping online or perusing gossip and entertainment sites. Another friend goes on annual eight-day meditation retreats and turns off her phone for her entire stay. Both report that these periodic breaks significantly improve their moods.

Past research supports their personal experience and shows that while many of use social media to feel connected to others, it can also leave us feeling frustrated, lonely and depressed.

A study (subscription required) recently published online in the journal Computers in Human Behavior offers context to these earlier findings and suggests that when we are feeling blue we use social media sites, such as Facebook, to find friends that are also having a bad day, suffered a setback or going through a tough time in their lives.

During the experiment, researchers gave participants a facial emotion recognition test and randomly told them their performance was “terrible” or “excellent” to put them in positive or negative moods. The individuals were than asked to review profiles on a new social networking site. The profiles used dollar sign or heart icons to make users appear successful and attractive or unattractive and unsuccessful. All profile photos were blurred and the status updates were relatively mundane and similar in tone. PsychCentral reports:

Overall, the researchers found that people tended to spend more time on the profiles of people who were rated as successful and attractive.

But participants who had been put in a negative mood spent significantly more time than others browsing the profiles of people who had been rated as unsuccessful and unattractive.

“If you need a self-esteem boost, you’re going to look at people worse off than you,” [Silvia Knobloch-Westerwick, PhD, co-author of the study] said.

“You’re probably not going to be looking at the people who just got a great new job or just got married.

“One of the great appeals of social network sites is that they allow people to manage their moods by choosing who they want to compare themselves to.”

Previously: Ask Stanford Med: Answers to your questions on the psychological effects of Internet use and Elderly adults turn to social media to stay connected, stave off loneliness
Photo by Paul Walsh

Behavioral Science, Events, Mental Health

Learning to forgive with Fred Luskin, PhD

283888330_71b4084e22The long, wooden conference table was surrounded by 12 women, including me. We giggled a bit: Where were the men?

“All over the world, it’s almost always women,” said the first and only man to enter the room, Fred Luskin, PhD, the instructor of a four-week “Forgive for Good” class (presented by the Stanford Health Improvement Program) and founder of a movement to forgive – for your own health. He looked every bit the professor — gangly, with disheveled hair and a shirt sporting an equation.

“Even in northern Ireland?,” one woman asked.

“Even in northern Ireland,” Luskin responded.

I came to watch, to record as an observer, just as I have covered hundreds of events in the past. But in Luskin’s class, everyone must forgive. Even journalists.

It hurt to darken my laptop and separate my fingers from its well-worn keys. I bristled during the initial relaxation session, where we were directed to focus on our breathing. He’s saying things and I’m missing them! Grrrrrr. My heart raced.

“You can’t forgive if you don’t relax,” Luskin said. “You have to quiet down and open.”

I tried to pretend I was in yoga class. I took in a breath. Open. Breathe. Then, the relaxation session was over and I relaxed, once again reunited with my trusty Mac.

But then, as Luskin was mentioning that many women had taken his classes to forgive their ex-husbands – “There’s lots of terrible ex-husbands running around,” he joked – I looked around the table. Here were 11 women, driven to spend four evenings letting go of a hurt that was tearing them up inside. Instantly, my aggravation slipped away. My teensy anger was nothing compared to the real wrongs of the world.

“It’s quick and difficult to be a human being,” Luskin said. “You don’t get a do-over.”

Grieving and suffering are normal, he said. Yet make sure the harm doesn’t dampen the rest of your life. A jerk cuts you off on the freeway? Fume for a second, but one exit later it should be forgotten, Luskin said. A drunk driver leaves you crippled? That takes a bit longer, maybe five years. Dreadful childhood? No one in their 50s should still be stewing about their harsh lot.

“Life is very challenging,” Luskin said. “Do you want to spend years holding on to your part of that challenge? Or can you accept your portion of portion of pain?”

Once the grieving is done, stop talking about the hurt, Luskin said. “We used to call this shut-up therapy…  Just shut up and stop driving yourself nuts.”

Then, he said, you can love again, without hiding your heart. That’s a message worth parting from my computer.

Previously: Practicing forgiveness to sustain healthy relationships, A conversation with Stanford psychologist Fred Luskin on forgiveness and its health benefits and Teaching children the importance of forgiveness
Image by Ian Burt

Addiction, Bioengineering, Mental Health, Neuroscience, Stanford News, Stroke

Neuroscientists dream big, come up with ideas for prosthetics, mental health, stroke and more

Neuroscientists dream big, come up with ideas for prosthetics, mental health, stroke and more

lightbulbs

So there you are, surrounded by some of the smartest neuroscientists (and associated engineers, biologists, physicists, economists and lawyers) in the world, and you ask them to dream their biggest dreams. What could they achieve if money and time were no object?

That’s the question William Newsome, PhD, asked last year when he became director of the new Stanford Neurosciences Institute. The result is what he calls the Big Ideas in Neuroscience. Today the institute announced seven Big Ideas that will become a focus for the institute, each of which includes faculty from across Stanford schools and departments.

In my story about the Big Ideas,I quote Newsome:

The Big Ideas program scales up Stanford’s excellence in interdisciplinary collaboration and has resulted in genuinely new collaborations among faculty who in many cases didn’t even know each other prior to this process. I was extremely pleased with the energy and creativity that bubbled up from faculty during the Big Ideas proposal process. Now we want to empower these new teams to do breakthrough research at important interdisciplinary boundaries that are critical to neuroscience.

The Big Ideas are all pretty cool, but I find a few to be particularly fascinating.

One that I focus on in my story is a broad collaboration intended to extend what people like psychiatrist Robert Malenka, MD, PhD, and psychologist Brian Knutson, PhD, are learning about how the brain makes choices to improve policies for addiction and economics. Keith Humphreys, PhD, a psychiatry professor who has worked in addiction policy and is a frequent contributor to this blog, is working with this group to help them translate their basic research into policy.

Another group led by bioengineer Kwabena Boahen, PhD, and ophthalmologist E.J. Chichilnisky, PhD, are working to develop smarter prosthetics that interface with the brain. I spoke with Chichilnisky today, and he said his work develop a prosthetic retina is just the beginning. He envisions a world where we as people interface much more readily with machines.

Other groups are teaming up to take on stroke, degenerative diseases, and mental health disorders.

One thing that’s fun about working at Stanford is being able to talk with really smart people. It’s even more fun to see what happens when those smart people dream big. Now, they face the hard work of turning those dreams into reality.

Previously: This is your brain on a computer chip, Dinners spark neuroscience conversation, collaboration and Brain’s gain: Stanford neuroscientist discusses two major new initiatives
Photo by Sergey Nivens/Shutterstock

Mental Health, Neuroscience, Technology

What email does to your brain

What email does to your brain

man yellingUpdated 10-2-14: A follow-up post, with tips on how to manage your inbox, can be found here.

***

10-1-14: Have you ever been in a situation in which you were feeling great until you received an email out of the blue that completely upset your day? How does it feel to receive 30 such emails first thing in the morning? There’s a reason why: Research shows that just looking through your inbox can significantly increase your stress levels (see research described here).

Why is this? Let’s start by defining stress. Stress is the experience of having too great a task to accomplish with too few resources to meet the demand. In the past, for our ancestors, this stress might have looked like meeting a hungry wild animal in the jungle. Today, however, it takes on a much more simple, yet equally powerful form: an inbox. Email overload is just another way in which we experience that there is too great a task (the huge list of to-dos) to handle. In the study mentioned above, email overload had a lot to do with the stress response as measured psychologically and physiologically through heart rate, blood pressure and a measure of cortisol (the “stress hormone”).

Is it just the amount of emails that lead to stress though? There’s another element that we are forgetting. The emotional impact of each email. Think about it: Usually, in our email-less past, we would experience maybe one highly emotional event a day or maybe two or three at the most, e.g. a confrontation with a colleague, perhaps a spat with a spouse, and/or a phone call from an angry neighbor. Our stress response is evolved to handle and recover from a small number of stressful situations but not a whole host of them. Unless we live in unusually extreme situations such as warzones, for example, our life usually doesn’t have frequent and sequential stressors thrown at us.

Today, however, just sitting down at our desk to check our email with a cup of coffee can bring on a deluge of emotional assailants. Between 30-300 different emotional stimuli are delivered to you within the span of minutes. From an email from your boss asking you to complete a task urgently, to a passive-aggressive message from a family-member, to news from a colleague that he’s out sick and you have to take over his workload. One hour of email can take you through a huge range of emotions and stressors. Sure, you can get happy emails too – photos of your nephews, someone’s marriage announcement – but unfortunately, research on the negativity bias shows that our brain clings more to the negative and they don’t always balance out.

That’s when our emotional intelligence is impacted. We know that when our stress response is activated, the parts of our brain that respond with fear of anxiety tend to take over, weakening our ability to make rational choices and to reason logically this study). You may be stressed; what’s more, your own ability to respond appropriately is impacted. We know that our emotions impact the way we act. You’re going to reply with a different tone if you’re upset (even at someone other than your email recipient) than if you’re not.

Have you ever pressed “send” only to regret it moments later? Don’t blame yourself. Research shows that getting depleted because you have too much on your plate reduces your self-control. For example, it can make you take more risks when maybe you should be more cautious (e.g. this study). It’s harder to have a say over our impulses when there’s just too much going on. As in too many emails, with too many different messages leading to increased stress and emotional overload.

When you’re doing a million emails – all about different topics and requesting you for different things, you are, by definition in a situation of overwhelmed multitasking. And multitasking, research shows, leads to lower productivity and makes you lose a lot of time out of our day!

So what’s the answer to the assailment of email on our lives?

Before you contemplate moving to a farm, selling your smartphone on Ebay, raising chickens and goats and cutting technology out of your life forever despite your love of selfies – WAIT, there’s a solution. Think about it – email didn’t exist 10 years ago! That means that there is a way to undo the madness. I’ll share a number of tips in my next post… Stay tuned.

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 her website.

Photo by bark

Medical Education, Medical Schools, Mental Health, Stanford News, Surgery

New surgeons take time out for mental health

New surgeons take time out for mental health

rope webI spent a recent morning watching about 30 Stanford surgical residents take time off from their operating rooms to participate in a series of team-building games out on the alumni lawn on campus. These are busy, dedicated professionals who are passionate about their work, so getting them to take time off is hard. “I can tell you a surgical resident would rather be in the operating room than anywhere else on earth,” Ralph Greco, MD, a professor of surgery, told me as he sat on a nearby bench watching the residents play games.

In a story I wrote about the games, I describe how the Balance in Life program, which sponsored the day’s event, was founded following the suicide of a former surgical resident, Greg Feldman, MD. Greco, who helped build the program, was committed to doing whatever he could to prevent any future tragedies like Feldman’s, as I explain in the piece:

“The residency program was just rocked to its knees,” he said, remembering back to the death in 2010 of the much-loved mentor and role model for  many of the surgical residents and medical students at the time. Feldman died after completing his surgical residency at Stanford and just four months into his vascular surgery fellowship at another medical center. “It was a very frightening time,” Greco said. “Residents were questioning whether they’d made the right choices.”

Today, the Balance in Life program includes, among other thing, a mentorship program between junior and senior residents, group therapy time with a psychologist and a well-stocked refrigerator with free healthy snacks. Residents themselves, like Arghavan Salles, MD, who participated in the ropes course, plan and coordinate activities:

“Some people think this is kind of hokie,” said Salles, who was one of a group of residents who helped found the program along with Greco following Feldman’s death. “Surgery is a super critical field,” Salles said. She paused to instruct a blind-folded colleague: “Step left! Step left!” “You face constant judgment in everything you do and say,” she added. “Everyone is working at the fringes of their abilities. They’re stressed.”

While writing this story, my co-workers suggested I read a September editorial in the New York Times that brought the issue into sharp focus. Spurred by the suicides two weeks prior of two second-year medical residents who jumped to their deaths in separate incidents in New York City, Pranay Sinha, MD, a medical resident at Yale-New Haven Hospital wrote about the unique stresses of new physicians:

As medical students, while we felt compelled to work hard and excel, our shortfalls were met with reassurances: ‘It will all come in time.’ But as soon as that MD is appended to our names in May, our self-expectations skyrocket, as if the conferral of the degree were an enchantment of infallibility. The internal pressure to excel is tremendous. After all, we are real doctors now.

Pranay’s message was similar to the one promoted by Stanford residents during the games: The key to battling new physician stress is realizing that you are not alone, that your colleagues are there to support you. “It sounds touchy feely to say that we care,” Salles told me. “But at the end of the day, if we want to have better patient care, we need to take care of each other too.”

Previously: Using mindfulness interventions to help reduce physician burnout and A closer look at depression and distress among medical students
Photo by Norbert von der Groeben

Mental Health, Research, Stanford News

Study shows benefits of breathing meditation among veterans with PTSD

Study shows benefits of breathing meditation among veterans with PTSD

man meditating - smallEarlier this year, Emma Seppala, PhD, associate director of Stanford’s Center for Compassion and Altruism Research and Education and a research psychologist at the the medical school, wrote on Scope about her work using breathing meditation to help veterans with PTSD. One of her studies, involving 21 male veterans of the Afghanistan and Iraq wars who were taught a set of breathing techniques from the Sudarshan Kriya Yoga practice, has now been published.

A recent Stanford Report article provides more details on the research, which found that the breathing techniques “resulted in reduced PTSD symptoms, anxiety and respiration rate” among study participants. The piece also highlights Seppala’s surprise that the meditation appeared to have a lasting effect:

“It is unusual to find the benefits of a very short intervention – one-week, 21 hours total – lasting one year later,” she said. One year after the study, the participants’ PTSD scores still remained low, suggesting that there had been long-lasting improvement.

When the scientists asked the veterans whether they had continued practicing at home, a few had but most had not. The data showed that whether or not they had practiced at home, it did not hinder meditation’s long-term benefits.

One reason, Seppala suggested, is that Sudarshan Kriya yoga retrained the veterans’ memories.

Before the breathing meditation training, participants reported re-experiencing traumatic memories frequently and intensely, Seppala said. Afterward, they reported that the traumatic memories no longer affected them as strongly or frequently.

The study appears in the in the Journal of Traumatic Stress.

Previously: The remarkable impact of yoga breathing for trauma, The promise of yoga-based treatments to help veterans with PTSD, Using mindfulness therapies to treat veterans’ PTSD, As soldiers return home, demand for psychologists with military experience grows, Stanford and other medical schools to increase training and research for PTSD, combat injuries and Can training soldiers to meditate combat PTSD?
Photo by Sebastien Wiertz

Chronic Disease, Medical Education, Medicine X, Mental Health, Parenting, Stanford News

Medicine X explores the relationship between mental and physical health: “I don’t usually talk about this”

Medicine X explores the relationship between mental and physical health: "I don’t usually talk about this"

standing o at MedX - smallThis year, Medicine X examined the relationship between physical and emotional well-being with three breakout panels. Psychologists and ePatients came together in two of the sessions to discuss depression in chronic illness and coping through online communities, as well as the topic of mental health and the whole person.

The conversations centered on five themes: how the uncertainty, fear and overall stress of living with a chronic illness, or being a caregiver, can lead to depression and anxiety; why patients’ desire to be empowered can prevent them from seeking help; why eliminating the stigma associated with mental health conditions is so important; the need to better integrate the training of future doctors and mental-health professionals; and ways patients can identify that they may need mental health services and how to find them.

Ann Becker-Schutte, PhD, a Kansas City-based psychologist who participated in both panels, told the audience, “Living with any of these illnesses, whether it’s rare or well-known, requires a lot of work. There is a burden of gilt, fear and shame that are all rolled into one. It’s not unusual for anyone facing these conditions to get tired and just say ‘I’m done’.”

Sarah Kucharski, a Medicine X ePatient advisor diagnosed with depression, anxiety and fibromuscular dysplasia, gave the audience insight into how depression can take over – explaining that she was shocked to learn during a therapy session that a recent string of major life events (getting married, having bypass surgery and buying a house) had elevated her score on the Holmes and Rahe Stress Scale to roughly 500. “I had no ideas that such things had a rating or that they could be cumulative,” she said. “As a result, I try to be more cognizant and slow down.”

Other ePatients spoke candidly and courageously about some for their darkest moments, with many saying it was challenging to discuss their experiences with depression and anxiety outside their inner circles. ”I don’t usually talk about this,” said Hugo Campos, an ePatient with an implantable cardiac defibrillator in his chest. “This will be particularly difficult to admit in public.”

Campos opened up about the severe depression he encountered during the month following a procedure to implant into his chest a cardiac defibrillator, which shocks the heart to control life-threatening arrhythmias and prevent sudden cardiac arrest. Since the device was implanted preventatively, he felt that by having the surgery he had somehow failed himself and continued to be unsure if the device was necessary. There was also anxiety and fear about the device spontaneously shocking him. He turned to his online community to learn how to cope with these feelings. “I felt I would be better of speaking with my peers online, rather than a professional who did not have an implantable device and didn’t know what I was going through,” he explained.

Scott Strange, who was diagnosed with Type 1 diabetes in 1970 and also struggles with chronic depression, also turned to the Internet for support. “My journey to acceptance started when I found my online community. Until I found them, I never really faced it.”

Strange talked about growing up with the knowledge that not properly monitoring his glucose and insulin levels could be fatal. He also addressed the shame and exhaustion that results from “busting your rear end and trying to do everything your doctor says” and not seeing an improvement in your health.

While some turned to their patient communities online, others turned to someone outside of their social networks. When the demands of being a caregiver began to overwhelm Erin Moore, the mother of a four-year-old son with cystic fibrosis (CF) and three other children, she opted not to discuss it with someone well-versed with her situation. “Initially I sought help outside of the CF community because I was aware of how many people rely on me for my strength and I didn’t want to admit a weakness.”

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In the News, Mental Health, Public Safety

Will a steel net under the Golden Gate Bridge deter would-be jumpers?

Will a steel net under the Golden Gate Bridge deter would-be jumpers?

Golden Gate BridgeThe Bridge Rail Foundation estimates that there have been almost 1,600 suicide deaths from the Golden Gate Bridge since it opened in 1937, and the San Francisco’s Golden Gate Bridge Board of Directors recently approved $76 million in funding to install a 20-foot-wide steel net to deter suicide jumpers.

In a piece on the Washington Post’s Wonkblog, Stanford’s Keith Humphreys, PhD, examined the effectiveness of bridge barriers on suicide prevention, writing that “a half century of experience and evidence supports an optimistic view.” He highlights several small studies before writing:

Because suicide by jumping is a mercifully rare event, most studies of barriers have small samples, making findings unstable and the difference between the Toronto study and other research unsurprising. Statistically, a more reliable result would come from combining the findings across all prior studies.  When Dr. Jane Pirkis of the University of Melbourne led such a “meta-analysis” in 2013, she and her colleagues found that on average barriers reduce suicides by 86% at the barrier site, and that jumping suicides at other nearby sites rise by 44%.  The net benefit is a 28% decrease in suicides by jumping per year.

Dr. Pirkis’ findings bode well for the success of San Francisco’s suicide barrier, which is expected to be installed in about three years.  Even if the net has only the average level of effectiveness, it would have saved a life a month in 2013 alone, as well as sparing the families of the deceased years of mental and emotional anguish.

Jen Baxter is a freelance writer and photographer. After spending eight years working for Kaiser Permanente Health plan she took a self-imposed sabbatical to travel around South East Asia and become a blogger. She enjoys writing about nutrition, meditation, and mental health, and finding personal stories that inspire people to take responsibility for their own well-being. Her website and blog can be found at www.jenbaxter.com.

Previously: Stanford researcher examines link between sleep troubles and suicide in older adults and Stanford’s Keith Humphreys on Golden Gate Bridge suicide prevention: Get the nets

Behavioral Science, Chronic Disease, Mental Health, Neuroscience, Research, Stanford News

Can Alzheimer’s damage to the brain be repaired?

Can Alzheimer's damage to the brain be repaired?

repair jobIn my recent Stanford Medicine article about Alzheimer’s research, called “Rethinking Alzheimer’s,” I chronicled a variety of new approaches by Stanford scientists to nipping Alzheimer’s in the bud by discovering what’s gone wrong at the molecular level long before more obvious symptoms of the disorder emerge.

But Stanford neuroscientist Frank Longo, MD, PhD, a practicing clinician as well as a researcher, has another concern. In my article, I quoted him as saying:

Even if we could stop new Alzheimer’s cases in their tracks, there will always be patients walking in who already have severe symptoms. And I don’t think they should be forgotten.

A study by Longo and his colleagues, which just went into print in the Journal of Alzheimer’s Disease, addresses this concern. Longo has pioneered the development of small-molecule drugs that might be able to restore nerve cells frayed by conditions such as Alzheimer’s.

Nerve cells in distress can often be saved from going down the tubes if they get the right medicine. Fortunately, the brain (like many other organs in the body) makes a number of its own medicines, including ones called growth factors. Unfortunately, these growth factors are so huge that they won’t easily cross the blood-brain barrier. So, the medical/scientific establishment can’t simply synthesize them, stick them into an artery in a patient’s arm and let them migrate to the site of brain injury or degeneration and repair the damage. Plus, growth factors can affect damaged nerve cells in multiple ways, and not always benign ones.

The Longo group’s study showed that – in mice, at least -  a growth-factor-mimicking small-molecule drug (at the moment, alluded to merely by the unromantic alphanumeric LM11A-31) could counteract a number of key Alzheimer degenerative mechanisms, notably the loss of all-important contacts (called synapses) via which nerve cells transmit signals to one another.

Synapses are the soldier joints that wire together the brain’s nerve circuitry. In response to our experience, synapses are constantly springing forth, enlarging and strengthening, diminishing and weakening, and disappearing.They are crucial to memory, thought, learning and daydreaming, not to mention emotion and, for that matter, motion. So their massive loss — which in the case of Alzheimer’s disease is a defining feature – is devastating.

In addition to repairing nerve-cells, the compound also appeared to exert a calming effect on angry astrocytes and  microglia, two additional kinds of cells in the brain that, when angered, can produce inflammation and tissue damage in that organ. Perhaps most promising of all, LM11A-31 appeared to help the mice remember where things are and what nasty things to avoid.

Previously: Stanford’s brightest lights reveal new insights into early underpinnings of Alzheimer’s, Stanford neuroscientist discusses the coming dementia epidemic and Drug found effective in two mouse models of Huntington’s disease
Photo by Bruce Turner

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