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Mental Health, Research, Science, Technology

Fear factor: Using virtual reality to overcome phobias

Fear factor: Using virtual reality to overcome phobias

3493601806_7f5512fe6d_zPast research has shown that virtual reality can be effective in treating phantom limb syndrome, helping smokers kick their nicotine habit, easing patients’ pain and reducing post-traumatic stress disorder symptoms, among other things. Now a pair of engineering students at Santa Clara University in California are exploring the potential of the technology to assist individuals in overcoming their fear of heights and other anxiety-related conditions.

The design duo behind the project are undergrads Paul Thurston and Bryce Mariano. The students partnered with Kieran Sullivan, PhD, a psychology professor at Santa Clara, to develop a simulation tool that guides patients through a controlled virtual environment populated with phobia-triggering features. More details about the system were provided in this recent university story:

They started with a fear of heights simulation. As the patient takes in a 360-degree view from atop a building, the therapist can alter the virtual height and the resultant view—backing off or increasing exposure as needed according to the patient’s emotional response. While the team stresses that their tool is for use by trained therapists, not for sufferers to use on their own, Thurston notes that just knowing you can take the goggles off while immersed in the experience may make this form of treatment more approachable for some.

“Another aspect of our project that has been very important to us is to keep it affordable as well as accessible for future development,” said Mariano. “By using economical hardware and developing the simulation using the Unity Game Engine, which is 100 percent free and readily available, we hoped to create a platform that would allow others to easily pick up the project where we left off and continue expanding on the library of simulations to treat the widest possible range of phobia patients.”

Previously: From “abstract” to “visceral”: Virtual reality systems could help address pain and Can behavioral changes in virtual spaces affect material world habits?
Via CBS San Francisco
Photo by Amber Case 

Behavioral Science, Events, Mental Health, Research, Videos

Stanford bioengineer uses his experience in Iraq to improve research of TBI and PTSD

Stanford bioengineer uses his experience in Iraq to improve research of TBI and PTSD

777423808In 2012, President Obama issued an Executive Order calling for better prevention, diagnosis and treatment of traumatic brain injury (TBI), post-traumatic stress disorder (PTSD) and other mental health conditions. Third-year doctoral student Russell Toll is one of many who is doing research in these areas, and he brings a unique perspective to his work: He’s both a bioengineer and an Army combat veteran.

In 2006, Toll was in charge of a combined tank and infantry platoon stationed in the Diyala River Valley, about an hour northeast from Baghdad, Iraq.

His unit deployed with 14 tanks; they came back with four. Within 15 months, 28 men in his batallion were killed and 132 were severely wounded. A third of his men earned the Purple Heart and his unit — the 1-12 CAV in the 1st Cavalry Division — earned the Valorous Unit Citation for extraordinary heroism.

Now, Toll is working with his graduate advisor, Amit Etkin, MD, PhD, an assistant professor in the Department of Psychiatry and Behavioral Sciences, to identify biomarkers associated with TBI and PTSD. Toll and Etkin will discuss their work at the West Coast preview of the film “Searching for Home: Coming Back from War” next Saturday, June 20, at Stanford’s Cubberley Auditorium.

Recently, I spoke with Toll to learn more about his experience in Iraq and his research.

How did your experience in Iraq inform your understanding of PTSD?

As a platoon leader, all of your thoughts and efforts are focused on keeping your unit safe and getting them home. Only after you get home and decompress do you realize how much [weight] you were carrying.

This is a common experience for many soldiers and people that have lived through a traumatic experience.

At what point in your military career did you become interested in bioengineering and research on TBI and PTSD?

The pivotal point was in 2009 when I visited Walter Reed [National Military Medical Center] to check in on my men. The care they received at the center was excellent, but some of the equipment and technology that was being used to diagnose and treat them seemed like it hadn’t changed since Vietnam.

When I returned to my hotel room at night, I found myself drawing up ways we could address this problem on the backs of napkins. I have a bachelors degree in systems engineering from West Point, and I decided to apply these skills as a graduate student in bioengineering.

What was it like to come to Stanford after spending 15 months in Iraq?

It was a stark transition from the Army to Stanford; I felt like I had just climbed off the tank and stepped straight into systems biology. It sounds funny, but in a way I was able to apply my military training to my graduate studies: I developed cooperative relationships with the “indigenous experts” so I could get help from my classmates. As evidenced by my friends, I’m good at surrounding myself with excellent people. Their tutoring, coaching and friendship — especially that of Shrivats Iyer — was a major reason I was able to make it this far.

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

Keeping an even keel: Stanford surgery residents learn to balance work and life

Keeping an even keel: Stanford surgery residents learn to balance work and life

med students in sailboat

Residency is one of the most intense times in a surgeon’s training, and it can take a toll physically and mentally on newly minted medical school graduates as they learn to cope.

To help them counter that stress, Stanford’s Department of Surgery started the Balance in Life Program for its residents. The program, and one of its team-building exercises – a sailing lesson in one of the world’s best sailing spots, the San Francisco Bay – were highlighted in a recent Inside Stanford Medicine story.

As described in the piece, the program is dedicated to the memory of Greg Feldman, MD, a former chief surgical resident at Stanford who committed suicide in 2010. The program provides basics like easy-to-access healthy meals, group therapy sessions and social activities, and Ralph Greco, MD, the program’s director said of it:

A lot of people would argue with the notion that such a program is necessary… I know our day of sailing may raise some eyebrows, but our faculty decided that we should do whatever we could to give these young people the tools they need to help them deal with the vicissitudes of life and medicine through the rest of their careers.

The article also notes that the program attracts residents interested in work-life balance to Stanford:

“The fact that we have this Balance in Life Program is great for recruitment of like-minded individuals,” [resident Micaela Esquivel, MD,] said. “I can tell medical students considering us that they would be hard-pressed to find another program that cares enough about their well-being to offer what we do.”

Previously: A call to action to improve balance and reduce stress in the lives of resident physicians, Surgeon offers his perspective on balancing life and work, Program for residents reflects “massive change” in surgeon mentality and New surgeons take time out for mental health
Photo by Norbert von der Groeben

Health and Fitness, Mental Health, Public Health

Not just for kids: A discussion of play and why we all need to do it

Not just for kids: A discussion of play and why we all need to do it

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All work and no play makes everyone a dull boy. Recognizing this, the California-based National Institute for Play focuses on shining light on the importance of the practice of play in everyday life. BeWell@Stanford recently spoke with its founder and president, Stuart Brown, MD, who here talks about play’s role in human function:

Play is a survival drive that is necessary for adaptation, flexibility and social learning. Play helps us belong in the community, develop the ability to suppress unwanted urges, and regulate our emotions.

He goes on to talk about play’s importance for adults in particular:

Most people tend to think that play is confined primarily to childhood, and my sense of the paleo-anthropological design of being human is that we are neotenist creatures.  We are designed to be juveniles until we die and that is part of our primate design as Homo sapiens. When we honor that design, we tend to be less violent, more communal and healthier.

Taking time off to play does not mean you shirk your responsibilities, or that you aren’t a good parent or a good productive citizen. In fact, it’s just the opposite: your level of agitation drops when you get playful, which tends to increase perseverance and mastery. Play has a real payoff.

Brown also speaks about the importance of play in childhood development, and how we can learn about play’s impact on behavioral patterns from other animals such as social rats. Lastly, he provides advice as to how to reconnect with the childlike fun of play and incorporate it into adult life.

The piece is an intriguing conversation that might make readers slow down, think about their life, and remember that fun isn’t just for kids.

Alex Giacomini is an English literature major at UC Berkeley and a writing and social media intern in the medical school’s Office of Communication and Public Affairs.  

Previously: Workaholics vs work engagement: The difference is playExercise and relaxation techniques may help ease social anxiety, study finds and Exercise may boost heart failure patients’ mental and physical health
Photo by kilgarron

Behavioral Science, Ethics, Events, Medicine and Society, Mental Health

Anger: The most evil emotion or a natural impulse?

Anger: The most evil emotion or a natural impulse?

5846841745_f2f620c5d3Anger isn’t good for your health. It spikes your heart rate, exacerbating heart conditions and anxiety. It leaves an ugly residue, a sensation of unease and aggression and it can lead to violence against others or oneself.

But in the west, we have an uneasy relationship with this powerful emotion, said Owen Flanagan, PhD, co-director of the Center of Comparative Philosophy at Duke University and speaker at the annual Meng-Wu lecture hosted by the Stanford Center for Compassion and Altruism Research and Education last week.

In the United States and Europe, some anger is considered justified, even necessary for healing after one is wronged, Flanagan said. It’s natural, just a part of our constitution. An appropriate amount of anger is expected, a sign that you care. Flipping out because your barrista took too long making your latte? Probably not okay. But yelling at a driver who rear-ended you while texting? Certainly.

Not in Asia, Flanagan said. There, in accordance with Buddhist traditions, anger is right up there with hatred as the worst emotion, something that should be eliminated as soon as it arises.

Flanagan said he and other academic colleagues posed a question to the Dalai Llama several years ago: If you find yourself in a public place with a very bad person, like Hitler, before the atrocities have started, what should you do? Westerners would say anger was AOK, as was perhaps even murder. After conferring with his colleagues, the Dalai Llama said yes, murdering Hitler would be justified to prevent a very bad karmic causal chain. But anger? Absolutely not.

One could argue that even Hitler’s behavior was a byproduct of his genes, his upbringing, the surrounding society, Flanagan told the audience.

Flanagan said he still hasn’t figured out his own views toward anger. “Anger is a destructive emotion, but it might be a necessary emotion. I’m still not sure about that.”

But in the U.S., we don’t always live in accordance with our own traditions, Flanagan said. “We give ourselves sloppy permissions all over the place to be very angry people. That’s something that’s just not good.”

To counter anger, Flanagan offers several tips, drawn from both western and eastern traditions. First, embrace an emotion that is incompatible with anger, such as gratitude. Or reflect on your own insignificance and the transitory nature of the harm: This too will pass. “Astronomy is a good antidote to taking yourself too seriously,” Flanagan said.

In a longer term, Seneca suggests that it helps to “live among people who teach the children that anger is always bad.”

But is it even possible to completely eliminate anger? Some argue no, even babies express a form of frustration or discontent that could be a sign of inner anger. Or, we could all be conditioned by society, learning to be angry as soon as we’re born.

Previously: Bright lights breed stronger emotions, study finds, Is it possible to control one’s emotions? and Study suggests emotions may trump mind in matters of self-control while meditating
Photo by katmary

Medical Education, Medical Schools, Mental Health, Stanford News

A call to action to improve balance and reduce stress in the lives of resident physicians

A call to action to improve balance and reduce stress in the lives of resident physicians

4086639111_a7e7a56912_zIn November of 2010, those in Stanford’s general surgery training program experienced an indescribable loss when a recently graduated surgical resident, Greg Feldman, MD, committed suicide. His death wound up being a call to action that brought about the Balance in Life program at Stanford, according to program founder Ralph S. Greco, MD.

With the Balance in Life program now in its fourth year, Greco; chief surgical resident Arghavan Salles, MD, PhD; and general surgery resident Cara A. Liebert, MD, have learned much about the daily stresses that resident physicians face. In a recent published JAMA Surgery opinion piece they wrote:

As physicians, we spend a significant amount of time counseling our patients on how to live healthier lives. Ironically, as trainees and practicing physicians, we often do not prioritize our own physical and psychological health.

A recent national survey found that 40% of surgeons were burnt out and that 30% had symptoms of depression. Another study reported that 6% of surgeons experienced suicidal ideation in the preceding 12 months. Perhaps most startling, there are roughly 300 to 400 physicians who die by suicide per year—the equivalent of 3 medical school graduating classes.

Greco, Salles and Liebert explain that the Balance in Life program is specifically designed to help resident physicians cope with these stresses by addressing the well-being of their professional, physical, psychological and social lives. To accomplish this goal, the program offers mentorship and leadership training activities; dining and health-care options that are tailored to the residents’ busy schedules and needs; confidential meetings with an expert psychologist; and social events and outdoor activities that foster support among residents.

The authors concede that the program may not fix every stressful problem that their residents face, but it does let the residents know that their well-being is important and valued. “This may be the most profound, albeit intangible, contribution of Balance in Life,” the authors write.

Although the program (and the JAMA article) is geared for people in the medical field, it’s not much of a stretch to see how its core principles can apply to any work setting. Learning how to manage stress and reach out to colleagues for support is a valuable skill and, as the authors write, to provide expert care for others you must first take good care of yourself.

Previously: After work, a Stanford surgeon brings stones to lifeSurgeon offers his perspective on balancing life and workProgram for residents reflects “massive change” in surgeon mentality, New surgeons take time out for mental health and Helping those in academic medicine to both “work and live well”
Photo by Gabriel S. Delgado C.

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

Green roofs are not just good for the environment, they boost productivity, study shows

Green roofs are not just good for the environment, they boost productivity, study shows

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Boosting productivity can be as simple as looking at a grassy roof for just forty seconds, conclude researchers at the University of Melbourne. It’s been shown that contact with nature can relieve stress and improve concentration and mood, but this is one of the first studies to see if novel urban manifestations of greenery can have the same effect.

The study, published in the Journal of Environmental Psychology and led by Kate Lee of Melbourne’s Green Infrastructure Research Group, involved giving students a mindless computer task to do in a city office building with a brief break spent looking at a picture of either a lush green roof or bare concrete roof. Those who looked at the green one made significantly fewer mistakes and showed better concentration in the second half of the task. The study was based on the idea of “attention restoration” through microbreaks lasting under a minute, which happen spontaneously throughout the work day.

Lee is quoted in a press release:

We know that green roofs are great for the environment, but now we can say that they boost attention too. Imagine the impact that has for thousands of employees working in nearby offices… It’s really important to have micro-breaks. It’s something that a lot of us do naturally when we’re stressed or mentally fatigued. There’s a reason you look out the window and seek nature, it can help you concentrate on your work and to maintain performance across the workday.

Certainly this study has implications for workplace well-being and adds extra impetus to continue greening our cities. City planners around the world are switching on to these benefits of green roofs and we hope the future of our cities will be a very green one.

She and her team next plan to see if city greening makes people more helpful and creative, as well as productive.

Previously: Nature is good for you, right? and Out of office auto-reply: Reaping the benefits of nature
Photo by Jeremy Reding

Medical Education, Medical Schools, Mental Health, SMS Unplugged

Free from school

Free from school

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category

Editor’s note: After today, SMS Unplugged will be on a limited publishing schedule until September.

girls running

Summer. It beckons with strawberry warm rays of sunlight, afternoons spent splashing in a pool, and the joys of watermelon-flavored popsicles. We, second-year medical students around the country, look out our windows and see children, newly freed from school, frolicking in the playground next door – and feel miserable. For this is the time when we are experiencing the worst of medical school.

We have completed the pre-clinical curriculum, some of us barely crawling across the finish line. We have spent weeks cramming for the USMLE, an exam described in no softer terms than “the most important exam you will take in your life.” And we are becoming familiar with a new kind of anxiety as we prepare to enter clinics for the first time. Or, rather, my classmates are – I chose to take time off between second and third year.

In the midst of Stanford-high expectations for our professional performance, we are seldom taught exactly how to take care of ourselves. I knew that I needed to change something halfway through second year when I found myself outlining a novel instead of studying during finals week. I nearly failed two exams. But I was happy.

I felt satisfied.

And so, I set about finding a way to incorporate more of writing into my medical school experience. Stanford has funding called Medical Scholars, which is set aside for every medical student to take a year off to work on a significant project or research experience. Their office willingly helped me apply for and receive this funding to work on my novel full-time for a year. I can’t imagine this level of support for an artistic endeavor from any other medical school. And so very soon, I too will be frolicking in the grass, newly freed from school.

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Autism, Mental Health, Neuroscience, Research, Science, Stanford News, Stem Cells

Brain cell spheres in a lab dish mimic human cortex, Stanford study says

Brain cell spheres in a lab dish mimic human cortex, Stanford study says

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Mental disorders like autism and schizophrenia are notoriously difficult to study at the molecular level. Understandably, people are reluctant to donate pieces of living brain for study, and postmortem tissue lets researchers see the structure, but not the function, of the cells.

Now researchers in the laboratories of psychiatrist Sergiu Pasca, MD, and neurobiologist Ben Barres, MD, PhD, have found a way to make balls of cells that mimic the activity of the human cortex. They use a person’s skin cells, so the resulting “human cortical spheroid” has the same genetic composition as the donor. The research was published in Nature Methods yesterday.

According to our release:

Previous attempts to create patient-specific neural tissue for study have either generated two-dimensional colonies of immature neurons that do not create functional synapses, or required an external matrix on which to grow the cells in a series of laborious and technically difficult steps.

In contrast, the researchers found they were able to easily make hundreds of what they’ve termed “human cortical spheroids” using a single human skin sample. These spheroids grow to be as large as 5 millimeters in diameter and can be maintained in the laboratory for nine months or more. They exhibit complex neural network activity and can be studied with techniques well-honed in animal models.

The researchers, which include neonatology fellow Anca Pasca, MD, and graduate student Steven Sloan, hope to use the technique to help understand how the human brain develops, and what sometimes goes wrong. As described by Barres:

The power and promise of this new method is extraordinary. For instance, for developmental brain disorders, one could take skin cells from any patient and literally replay the development of their brain in a culture dish to figure out exactly what step of development went awry — and how it might be corrected.

The research is starting to garner attention, including this nice article from Wired yesterday. Pasca’s eager to note, however, that he’s not working to create entire brains, which would be ethically and technically challenging, to say the least. But simply generating even a few of the cell types in the cortex will give researchers a much larger canvas with which to study some devastating conditions. As Pasca notes in our release:

I am a physician by training. We are often very limited in the therapeutic options we can offer patients with mental disorders. The ability to investigate in a dish neuronal and glial function, as well as network activity, starting from patient’s own cells, has the potential to bring novel insights into psychiatric disorders and their treatment.

Previously: More than just glue, glial cells challenge neuron’s top slot and Star-shaped cells nab new starring role in sculpting brain circuits
Photo of spheroid cross-section by Anca Pasca

Events, Mental Health, Sexual Health, Stanford News, Women's Health

Women’s health experts tackle mood disorders and sexual assault

Women's health experts tackle mood disorders and sexual assault

3131235412_fa7f528735_zEarlier this week I reported from the Women’s Health Forum, held on Monday for the sixth year running. The hardest part about attending the event was deciding which among all the interesting talks to attend.

Among the many sessions, the two that most piqued my interest focused on women’s mental health. Katherine (Ellie) Williams, MD, spoke about mood disorders related to the menstrual cycle, and Laraine Zappert, PhD, discussed the psychological impact of sexual assault. Both are from the school’s Department of Psychiatry and Behavioral Sciences.

Williams’ talk began with a cartoon of a dishwasher bursting with dishes, clothes, a phone, a vacuum – above a caption quip about PMS. The out-of-control energy of the sketch conveys the affective thundercloud often associated with women and their “hormones.” Williams identified three periods when this thundercloud may be an actual mood disorder, as opposed to “normal” fluctuations: pre-menstrual, perinatal, and perimenopausal.

Technically speaking, “PMS” is about physical symptoms and is fairly common, whereas pre-menstrual dysphoric disorders (PMDDs) is all about mood and affects less than 5 percent of women. The disruption happens in the luteal phase of a woman’s cycle, usually the two weeks after ovulation – this is a big chunk of time we’re talking about, nearly 50 percent! Treatments for disorders in all periods include exercise, acupuncture, and diet supplements, and pharmaceuticals like certain birth control pills and antidepressants (which interestingly work differently for women with PMDD than for people in general – when taken only during that luteal phase, they have fast onset time and cause no withdrawal symptoms).

Researchers are learning more about how to predict and prevent cycle-related mood disorders, and increasingly it is clear that life context plays a major role. Stressful life events, interpersonal conflicts, marital tension, and previous mental-health instabilities (from being a perfectionist to having suffered childhood abuse or major depressive breakdowns) are the primary risk factors. This knowledge means clinical practitioners have to think much more broadly about how to help women, particularly in terms of prevention, Williams said.

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