Archive for July, 2011
Many people want to remain mentally (as well as physically) fit, so that they can perform well at school and at work. A controversial way to improve focus and mental functioning is to take a “smart pill” — the slang term for using prescription stimulants such as amphetamine (Adderall) or methylphenidate (Ritalin, Concerta) to try to boost mental functioning rather than to treat a problem like attention deficit hyperactivity disorder. One survey of U.S. college students found that 7% had used prescription stimulants in an effort to improve academic achievement, for example. But there are nonpharmacological ways to boost mental performance. Jeff Brown, a cognitive behavioral psychologist at Harvard Medical School, and Mark Fenske, a neuroscience researcher at the University of Guelph in Ontario, Canada, have described a set of strategies for remaining mentally sharp even under trying circumstances. In their book, The Winner’s Brain: Eight Strategies Great Minds Use to Achieve Success, Drs. Brown and Fenske outline an approach they derive from well-known psychotherapies and discoveries in neuroscience. The strategies they suggest can be applied in the clinic, the classroom, and the workplace. Once thought to be as hard-wired as a computer, the brain’s neural circuitry is now understood as an ever-changing landscape. The ability of individual neurons to form new synaptic connections in response to novel experiences or environmental challenges is known as brain plasticity, and it underlies learning and memory. Although brain processing speed tends to slow down with age, the brain remains plastic throughout life. The challenge for people is to take advantage of this inborn gift. Preliminary neuroimaging studies suggest that the way people use their minds may alter neural circuitry, and in some cases build brain tissue. It’s important to remember, though, that the research usually involves only small numbers of participants. It also detects patterns and associations that are determined after taking images of multiple brains and then averaging the results. Individual brain activity might vary somewhat from a particular norm, just as height and weight do. For that reason, it is not currently possible in the clinic — nor is it likely to be for a long time — to take an individual “brain snapshot” and say with certainty what type of mental activity is going on. Even so, these patterns of brain activity provide the basis for clinical advice to challenge the brain constantly, so that it will continue to form new connections. Drs. Brown and Fenske review eight strategies that people can try in everyday life to challenge their brain, learn to focus, and think more productively. The strategies incorporate principles used in cognitive behavioral therapy (CBT), a mainstay of psychotherapy that helps patients to reframe situations and learn more productive ways of coping. Other elements come from positive psychology, a relatively new clinical slant that identifies and builds on people’s strengths rather than trying to correct weaknesses. A brief discussion of several “winner’s” strategies will provide a flavor of the approach that Drs. Brown and Fenske advocate. Motivation. Identifying a goal is usually the easy part; it’s achieving it that’s hard. Drs. Brown and Fenske offer several suggestions for ways to spark and maintain motivation. For example, when procrastination is a problem, the issue may be that the task at hand seems too big to accomplish. The authors suggest that people first envision or “map” the multiple steps necessary for reaching an ultimate goal, and then concentrate on achieving each step. Although focusing on such mundane, incremental tasks may seem boring, neuroscience research suggests that commitment to mastering a craft can feel rewarding. Furthermore, this kind of immersion can help a person achieve a state of heightened concentration and pleasure that Dr. Mih�ly Cs�kszentmih�lyi, a leading thinker in the positive psychology field who is now at Claremont Graduate University, has described as “flow.” A small but intriguing study by researchers at the National Institutes of Health, for example, involved professional jazz musicians. Using functional magnetic resonance imaging (fMRI) to scan the brain in action, the investigators found that when the musicians improvised, they displayed interesting patterns of brain activity. During creative improvisations, the medial prefrontal cortex, an area of the brain involved in the integration of information to support complex goals and aspirations, became more active. Simultaneously, the dorsolateral prefrontal cortex, which is often involved in inhibiting behavior and monitoring thinking, became less active. Limbic areas associated with anxiety also quieted. This study may provide a glimpse of the brain “in flow,” as the musicians used skills they’d already mastered — playing notes — in new and creative ways. Focus. It’s often difficult to get any work done while at work. Offices are full of distractions: colleagues who need help or just want to talk, phone calls, e-mails that need answering, meetings, and so on. The day, and people’s attention, can become fragmented. The typical response — multitasking — can take a toll on the brain. In a study of 14 participants who underwent fMRI, researchers at Vanderbilt University found that when people try to juggle two tasks at once, a bottleneck occurs in information processing. The posterior lateral prefrontal cortex, a part of the brain that is involved in decision making, delayed one task until the other was complete. Another study, by researchers at the University of California, Los Angeles, involved 14 participants (mean age 26) who were asked to learn a task under two conditions. They learned one task without any distractions. Then they learned another task while listening to, and trying to count, a series of beeps. Not surprisingly, their ability to recall how to do the task later on was much better when they learned it without distraction. Preliminary research suggests that maintaining focus, on the other hand, might help build brain tissue. Researchers at Massachusetts General Hospital conducted MRI studies of people who regularly practice meditation, and found that compared with controls, they had more gray matter (brain cells) in areas associated with attention and sensory processing. Drs. Brown and Fenske offer practical tips for fostering focus, even in distracting environments. Some may seem obvious, yet few people remember to do them: turn off the cell phone or e-mail, for example. Other tips — such as taking a break or taking a walk — may seem counterintuitive, but do work; shifting from what they call a “hunt it down and kill it” intensity to a more relaxed approach can actually improve ability to focus. Memory. Drs. Brown and Fenske encourage people to understand that memory can be used proactively, as a way to prepare for the future, not just remember the past. In fact, one of the evolutionary reasons for memory was to provide people with a way to apply lessons learned in the past to current problems or challenges. In practical terms, Drs. Brown and Fenske suggest that people actively acquire the types of memory that will enable them to perform more efficiently or with more confidence. One example is that of an airline pilot, who drills repeatedly in simulated emergency situations in order to prepare for the possibility of a crash landing. Several studies suggest that such repetitive practice at a particular task or skill might build brain tissue. One frequently cited study involved London cab drivers. Researchers from University College, London, used MRI scans to compare brains of the cab drivers with those of controls. They found that part of the hippocampus (an area of the brain responsible for navigation and spatial relations) was larger in the cab drivers than in controls. The more experience a cab driver had (as indicated by how long he’d held the job), the larger the hippocampus. In another brain imaging study, researchers at Beth Israel Deaconess Medical Center found that the motor cortex in 32 professional musicians (including both pianists and string musicians) was larger than in 32 matched controls with no musical training. Findings such as these suggest that there is some brain basis for the old adage, “practice makes perfect.” The idea is to both practice something physically and use imagery repeatedly, thereby gaining skills and confidence that help to improve performance. This approach is one that can be applied in the classroom, the boardroom, or the courtroom. It’s also important for people to remember to take care of their brains, even while finding new mental challenges every day. The basics of brain care consist of three things that are also good for the rest of the body: sleep, exercise, and nutrition. Sleep. Neuroimaging and neurochemistry studies suggest that a good night’s sleep helps foster both mental and emotional resilience, while chronic sleep disruptions set the stage for negative thinking and emotional vulnerability. Exercise. Evidence is growing that physical exercise — always known to be good for the body — also benefits the brain. Aerobic exercise in particular appears to improve several aspects of cognition and brain functioning, both in children and adults. Nutrition. Several large epidemiological studies have suggested that particular diets — such as those emphasizing vegetables and heart-healthy oils — may also help people maintain cognitive ability. Although such studies do not prove cause and effect, and the research on nutrition is more preliminary than it is for exercise or sleep, the results do provide support for the idea that what people put in their mouths may affect what they do with their minds. If nothing else, a healthy diet is necessary for physical health — which in turn helps the brain function optimally. http://www.health.harvard.edu/newsletters/Harvard_Mental_Health_Letter/2010/May/cultivating-a-winners-brainRead Full Post | Make a Comment ( None so far )
Everyone experiences pain at some point, but in people with depression or anxiety, pain can become particularly intense and hard to treat. People suffering from depression, for example, tend to experience more severe and long-lasting pain than other people.
The overlap of anxiety, depression, and pain is particularly evident in chronic and sometimes disabling pain syndromes such as fibromyalgia, irritable bowel syndrome, low back pain, headaches, and nerve pain. For example, about two-thirds of patients with irritable bowel syndrome who are referred for follow-up care have symptoms of psychological distress, most often anxiety. About 65% of patients seeking help for depression also report at least one type of pain symptom. Psychiatric disorders not only contribute to pain intensity but also to increased risk of disability.
Researchers once thought the reciprocal relationship between pain, anxiety, and depression resulted mainly from psychological rather than biological factors. Chronic pain is depressing, and likewise major depression may feel physically painful. But as researchers have learned more about how the brain works, and how the nervous system interacts with other parts of the body, they have discovered that pain shares some biological mechanisms with anxiety and depression.
Shared anatomy contributes to some of this interplay. The somatosensory cortex (the part of the brain that interprets sensations such as touch) interacts with the amygdala, the hypothalamus, and the anterior cingulate gyrus (areas that regulate emotions and the stress response) to generate the mental and physical experience of pain. These same regions also contribute to anxiety and depression.
In addition, two neurotransmitters — serotonin and norepinephrine — contribute to pain signaling in the brain and nervous system. They also are implicated in both anxiety and depression.
Treatment is challenging when pain overlaps with anxiety or depression. Focus on pain can mask both the clinician’s and patient’s awareness that a psychiatric disorder is also present. Even when both types of problems are correctly diagnosed, they can be difficult to treat. A review identified a number of treatment options available when pain occurs in conjunction with anxiety or depression.
Various psychotherapies can be used on their own to treat pain in patients with depression or anxiety, or as adjuncts to drug treatment.
Cognitive behavioral therapy. Pain is demoralizing as well as hurtful. Cognitive behavioral therapy (CBT) is not only an established treatment for anxiety and depression, it is also the best studied psychotherapy for treating pain. CBT is based on the premise that thoughts, feelings, and sensations are all related. Therapists use CBT to help patients learn coping skills so that they can manage, rather than be victimized by, their pain. For example, patients might attempt to participate in activities in order to improve function and distract themselves from focusing on the pain.
Relaxation training. Various techniques can help people to relax and reduce the stress response, which tends to exacerbate pain as well as symptoms of anxiety and depression. Techniques include progressive muscle relaxation, yoga, and mindfulness training.
Hypnosis. During this therapy, a clinician helps a patient achieve a trance-like state and then provides positive suggestions — for instance, that pain will improve. Some patients can also learn self-hypnosis.
In one study, investigators asked 204 patients with irritable bowel syndrome to complete self-assessment questionnaires before, immediately after, and up to six years following hypnosis training. They found that 71% of participants reported the technique reduced both gastrointestinal distress and levels of depression and anxiety.
Exercise. There’s an abundance of research that regular physical activity boosts mood and alleviates anxiety, but less evidence about its impact on pain.
The Cochrane Collaboration reviewed 34 studies that compared exercise interventions with various control conditions in the treatment of fibromyalgia. The reviewers concluded that aerobic exercise, performed at the intensity recommended for maintaining heart and respiratory fitness, improved overall well-being and physical function in patients with fibromyalgia, and might alleviate pain. More limited evidence suggests that exercises designed to build muscle strength, such as lifting weights, might also improve pain, overall functioning, and mood.Read Full Post | Make a Comment ( None so far )
Mental health problems affect many employees — a fact that is usually overlooked because these disorders tend to be hidden at work. Researchers analyzing results from the U.S. National Comorbidity Survey, a nationally representative study of Americans ages 15 to 54, reported that 18% of those who were employed said they experienced symptoms of a mental health disorder in the previous month.
But the stigma attached to having a psychiatric disorder is such that employees may be reluctant to seek treatment — especially in the current economic climate — out of fear that they might jeopardize their jobs. At the same time, managers may want to help but aren’t sure how to do so. And clinicians may find themselves in unfamiliar territory, simultaneously trying to treat a patient while providing advice about dealing with the illness at work.
As a result, mental health disorders often go unrecognized and untreated — not only damaging an individual’s health and career, but also reducing productivity at work. Adequate treatment, on the other hand, can alleviate symptoms for the employee and improve job performance. But accomplishing these aims requires a shift in attitudes about the nature of mental disorders and the recognition that such a worthwhile achievement takes effort and time.
Symptoms of common problems — such as depression, bipolar disorder, attention deficit hyperactivity disorder (ADHD), and anxiety — are all described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). But symptoms tend to manifest differently at work than they do at home or in other settings.
Although symptoms may go unnoticed, the economic consequences are tangible. Studies assessing the full work impact of mental health disorders often use the World Health Organization (WHO) Health and Work Performance Questionnaire, which not only asks employees to report how many days they called in sick, but also asks them to assess, on a graded scale, how productive they were on the days they actually were at work. The results are measured in days out of work (absenteeism) and lost productivity (“presenteeism”).
In one study examining the financial impact of 25 chronic physical and mental health problems, researchers polled 34,622 employees at 10 companies. The researchers tabulated the amount of money the companies spent on medical and pharmacy costs for employees, as well as employees’ self-reported absenteeism and lost productivity, using the WHO questionnaire.
When researchers ranked the most costly health conditions (including direct and indirect costs), depression ranked first, and anxiety ranked fifth — with obesity, arthritis, and back and neck pain in between.
Many of the studies in this field have concluded that the indirect costs of mental health disorders — particularly lost productivity — exceed companies’ spending on direct costs, such as health insurance contributions and pharmacy expenses. Given the generally low rates of treatment, the researchers suggest that companies should invest in the mental health of workers — not only for the sake of the employees but to improve their own bottom line.
Depression is the mental health disorder that has been best studied in the workplace, partly because it is so common in the general population. One survey of a nationally representative sample reported that about 6% of employees experience symptoms of depression in any given year.
Although the DSM-IV lists low mood as the defining symptom of depression, in the workplace this disorder is more likely to manifest in behaviors — such as nervousness, restlessness, or irritability — and in physical complaints, such as a preoccupation with aches and pains. In addition, employees may become passive, withdrawn, aimless, and unproductive. They also may be fatigued at work, partly as a result of the mood disorder or because they are having trouble sleeping at night. Depression may also impair judgment or cloud decision making.
Researchers who analyzed employee responses to the WHO questionnaire found that workers with depression reported the equivalent of 27 lost work days per year — nine of them because of sick days or other time taken out of work, and another 18 reflecting lost productivity. Other research has found that employees with depression are more likely than others to lose their jobs and to change jobs frequently.
Part of the problem may be lack of treatment. In one study, only 57% of employees with symptoms of major depression said they had received mental health treatment in the previous 12 months. Of those in treatment, fewer than half — about 42% — were receiving treatment considered adequate, on the basis of how consistent it was with published guidelines about minimal standards of care. The researchers estimated that over all, when lack of treatment or inadequate treatment was taken into account, only about one in four employees with major depression received adequate treatment for the disorder.
Bipolar disorder is typically characterized by cycling between elevated (manic) and depressed moods. In a manic phase, employees may appear highly energetic and creative, but actual productivity may suffer. And during full-blown mania, a person may become self-aggrandizing or disruptive, flout workplace rules, be overly aggressive, and make mistakes in judgment (such as overspending a budget). During the depressive phase, an employee may exhibit depressive symptoms as described above. Although mania may be more noticeable at work, the research suggests that the depressive phase of bipolar disorder can impair performance more than the manic phase.
One nationally representative study estimated that about 1% of American employees suffer from bipolar disorder in any year. Based on employee responses to the WHO questionnaire, the researchers estimated that employees with bipolar disorder lost the equivalent of about 28 work days per year from sick time and other absences, and another 35 in lost productivity. The authors note that although bipolar disorder may be more disabling to employees on an individual level, the cost to employers is still less than that attributed to depression, because the latter is more common in the population.
In a departure from findings about treatment rates for other mental health disorders, about two-thirds of employees with bipolar disorder said they had received treatment for it. But the likelihood of receiving adequate care depended on the type of clinician they saw. Only about 9% of those who sought care from general practitioners received care in keeping with published guidelines for bipolar disorder, compared with 45% of those who sought care from mental health professionals.
Anxiety disorders in the workplace may manifest as restlessness, fatigue, difficulty concentrating, and excess worrying. Employees may require constant reassurance about performance. Sometimes, as with depression, physical symptoms or irritability may be noticeable.
Anxiety disorders affect about 6% of the population at some point in life, but typically go undiagnosed for 5 to 10 years. And only about one in three individuals with a diagnosed disorder receives treatment for it. At the same time, the studies suggest that people with anxiety disorders are more likely than others to seek out medical care — but for problems like gastrointestinal distress, sleep disturbances, or heart trouble rather than for anxiety.
It is probably not surprising, then, that anxiety disorders cause significant work impairment. Generalized anxiety disorder, for example, results in work impairment (as measured by sick days and lost productivity) similar to that attributed to major depression.
ADHD is often considered a problem only in childhood, but it also affects adults. An international survey in 10 countries (including the United States) estimated that 3.5% of employees have ADHD. In the workplace, symptoms of ADHD may manifest as disorganization, failure to meet deadlines, inability to manage workloads, problems following instructions from supervisors, and arguments with co-workers.
Workplace performance — and the employee’s career — may suffer. Studies estimate that people with ADHD may lose 22 days per year (a combination of sick days and lost productivity), compared with people without the disorder. In addition, people with ADHD are 18 times as likely to be disciplined for behavior or other work problems, and likely to earn 20% to 40% less money than others. They are also two to four times as likely as other employees to be terminated from a job.
Treatment rates among employees with ADHD are especially low. In the United States, for example, only 13% of workers with ADHD reported being treated for this condition in the previous 12 months.
The literature on mental health problems in the workplace suggests that the personal toll on employees — and the financial cost to companies — could be eased if a greater proportion of workers who need treatment were able to receive it. The authors of such studies advise employees and employers to think of mental health care as an investment — one that’s worth the up-front time and cost.
Most of the research on the costs and benefits of treatment has been done on employees with depression. The studies have found that when depression is adequately treated, companies reduce job-related accidents, sick days, and employee turnover, as well as improve the number of hours worked and employee productivity.
But the research also suggests that treatment for depression is not a quick fix. Although adequate treatment alleviates symptoms and improves productivity, one study found that in the short term, employees may need to take time off to attend clinical appointments or reduce their hours in order to recover.
To overcome barriers to accessing care, and to make it more affordable to companies, the National Institute of Mental Health is sponsoring the Work Outcomes Research and Cost Effectiveness Study at Harvard Medical School. The researchers have published results from a randomized, controlled trial of telephone screening and depression care management for workers at 16 large companies, representing a variety of industries.
During the two-phase study, mental health clinicians employed by an insurance company identified workers who might need treatment, provided information about how to access it, monitored adherence to treatment, and provided telephone psychotherapy to those workers who did not want to see a therapist in person. The outcomes of 304 workers assigned to the intervention were compared with 300 controls, who were referred to clinicians for treatment but did not receive telephone support.
The researchers found that workers assigned to the telephone intervention reported significantly improved mood and were more likely to keep their jobs when compared with those in the control group. They also improved their productivity, equivalent to about 2.6 hours of extra work per week, worth about $1,800 per year (based on average wages) — while the intervention cost the employers an estimated $100 to $400 per treated employee. The researchers are conducting additional research on how to improve access to mental health care in the workplace, and to quantify costs and benefits for employers.Read Full Post | Make a Comment ( None so far )
We all know congressional negotiators are trying to balance party and ideology, principle and pragmatism. But negotiators are people, too, and psychology has some useful things to say about the ongoing debt-ceiling standoff. Here are some key ideas to keep in mind.
CHOICES: Behavioral economists find that people tend to make much better decisions about their future selves, rather than their present selves. Ask the alcoholic whether he is ready to give up booze next year and he’ll find it easy to say yes. Ask him right now to walk by the bar and he’ll balk. The same phenomenon shows up all the time for people who aren’t alcoholics.
We can forsake dessert a year from now and we can decide to become better savers a year from now, but right now, we grab tasty bites from the dessert tray and spend like there’s no tomorrow. The same principle applies to the budget standoff.
Asking Congress to think about what the shape of budget cuts should be in the future will likely yield a more productive conversation, where legislators aren’t biased as much by current threats and temptations, says Richard Thaler, a University of Chicago economist, and the author of Nudge. “Congress would be better off spending a week dancing the hokey-pokey than debating the debt limit.”
DEADLINES: At the same time, it’s useful to have deadlines. If we told Congress to fix the budget deficit two years from now, they have no immediate incentive to act. Thaler suggests that one way to get Congress to act is to take advantage of the human tendency to pay undue importance to current threats and temptations.
“Suppose that we say that if the budget isn’t reduced, Congress isn’t paid anymore,” he said. “Or worse yet, suppose they lose their parking spots if the deficit isn’t reduced two years from now. All of a sudden you’re going to see all kinds of self control adopted.”
THE NEGOTIATING TABLE: Who sits around the negotiating table can make a big difference to how negotiations turn out. Psychologists have found that when groups are predominantly male, individuals tend to act in increasingly aggressive ways. They take bigger risks. They show off.
“Any place in which there are more men than women, the men are becoming more aggressive with each other and are competing with each other to attract women,” says Vladas Griskevicius, a psychologist at the University of Minnesota.
Griskevicius has found that cities in which men outnumber women have the highest amount of consumer debt — the result, he believes, of men buying expensive stuff to show off. Most of us don’t think the same dynamics affect professional settings, but Griskevicius finds in experiments that when men are surrounded by other men, their behavior changes without their awareness.Read Full Post | Make a Comment ( None so far )
Until the early 1990s, most research on substance abuse and dependence focused on men. That changed once U.S. agencies began requiring federally funded studies to enroll more women. Since then, investigators have learned that important gender differences exist in some types of addiction. (For a brief explanation of how we’re defining these terms, see below.)
Terminology matters. Addiction specialists use the following words in specific ways.
Addiction. The term does not appear in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), but incorporates elements of both substance abuse and dependence. Addiction involves craving for a particular substance, inability to control its use, and continued use despite negative consequences.
Dependence. According to the DSM-IV, people who are dependent on a substance exhibit at least three of the following symptoms or behaviors over a period of time, typically for a year or longer: greater tolerance for the substance, withdrawal symptoms, ongoing desire to quit using, loss of control over use, preoccupation with the substance, less focus on other meaningful activities or commitments, and continuing use in spite of negative consequences.
Abuse. The DSM-IV uses this term to describe people who use a substance excessively on a regular basis, in spite of incurring legal problems, endangering themselves, jeopardizing relationships, or falling through on major responsibilities. But they do not yet show signs of dependence — such as a psychological compulsion or physical need to use the substance.
Men are more likely than women to become addicts. In 2008, the U.S. National Survey on Drug Use and Health found that 11.5% of males ages 12 and older had a substance abuse or dependence problem, compared with 6.4% of females.
But in other respects, women face tougher challenges. They tend to progress more quickly from using an addictive substance to dependence (a phenomenon known as telescoping). They also develop medical or social consequences of addiction faster than men, often find it harder to quit using addictive substances, and are more susceptible to relapse. These gender differences can affect treatment.
Alcohol is the most commonly abused substance in the United States. About 7% to 12% of women abuse alcohol, compared with 20% of men. But research also suggests that since the 1970s, this gender gap has been narrowing, as drinking by women has become more socially acceptable.
This trend is concerning because women develop alcohol dependence more quickly than men do. Alcohol-related problems such as brain atrophy or liver damage also occur more rapidly in women than in men.
Several biological factors make women more vulnerable to the effects of alcohol. First, women tend to weigh less than men, and — pound for pound — a woman’s body contains less water and more fatty tissue than a man’s. Because fat retains alcohol while water dilutes it, a woman’s organs sustain greater exposure.
In addition, women have lower levels of two enzymes — alcohol dehydrogenase and aldehyde dehydrogenase — that break alcohol down in the stomach and liver. As a result, women absorb more alcohol into the bloodstream.
Psychotherapy, self-help groups, and medications are all available to help people stop drinking. Although investigators once believed that women are not as likely as men to recover from alcohol dependence, the most recent research and analyses suggest the situation is complicated.
A large federal study of alcohol dependence in both men and women, the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) trial, concluded that drug therapy and a specialized behavioral therapy helped patients of both sexes abstain from drinking.
After four months, about three in four study participants who received naltrexone (ReVia, Vivitrol) or behavioral therapy plus medical management were either abstinent or drinking moderately. By the end of one year, overall rates of abstinence among these study participants were still significantly better than at the start of the study. (Acamprosate [Campral], another drug tested, proved no better than placebo.) Overall, men and women responded equally well to treatment.
A comprehensive review of the literature concluded that, although women with alcohol problems were less likely to enter treatment, once they began treatment they were just as likely as men to recover. Both this review and another concluded that programs that provided perinatal care, child care, and other family services would better enable women to enter treatment.
Women-only treatment programs are generally no more effective than mixed-gender programs for alcohol dependence. However, some subgroups of women — such as those with a history of trauma or abuse, or who have other psychiatric disorders — are more likely to recover in gender-specific treatment programs that address these factors.
Nearly 71 million Americans ages 12 and older — about 35% of men and 23% of women — said they smoked tobacco (most often cigarettes) in 2008.
Female smokers face more health risks than male smokers; they may be more likely to develop lung cancer, for example, and are twice as likely to have a heart attack. But the research suggests that women find it more difficult than men to quit smoking, and are more likely to start smoking again even if they do quit.
The reasons for this are not clear, although studies have found that female smokers are more responsive to environmental cues and triggers (such as wanting to light up a cigarette when drinking alcohol), while male smokers are more responsive to the biological effects of nicotine. This suggests — and preliminary research confirms — that nicotine replacement therapy may not work as well in women as it does in men.
A meta-analysis of 14 placebo-controlled studies concluded that although both women and men were more likely to quit smoking while using a nicotine patch, women were less likely than men to do so. About 20% of men quit for six months using the patch, compared with nearly 15% of women; with a placebo patch, roughly 10% of both sexes quit.
Other stop-smoking medications, such as bupropion (Zyban) and varenicline (Chantix), do not rely on nicotine replacement. Varenicline interacts with nicotine receptors in the brain to reduce craving while also blocking the pleasurable effects of nicotine. Bupropion is an antidepressant that helps reduce the desire to smoke, although it’s not yet clear how it works in the brain to reduce craving. The limited research available suggests that these medications might be equally effective for both sexes, at least in the short term.
Counseling used in conjunction with medication boosts the chance of quitting for both men and women. Given that women are more responsive than men to environmental cues that may trigger a relapse, it makes intuitive sense that using cognitive behavioral therapy to help them resist such cues would help. Unfortunately, this has not been studied in the research setting, so it’s impossible to say for sure.
About half of female smokers say they are afraid they will gain weight if they stop smoking. Although the usual advice is to exercise or count calories while kicking the habit, this may be impractical and only ensure that the effort to stop smoking will fail. A preliminary study suggests that it may be more productive to help women learn to accept any weight gain as a reasonable trade-off for the improved health that comes from smoking cessation.
Finally, studies find that kicking the habit is especially tough for women during the menstrual cycle’s luteal phase (which begins mid-cycle, just after ovulation). Preliminary research suggests that women who time their quit date to occur during the follicular phase (which begins after menstruation and ends at ovulation) are more likely to abstain from cigarettes for a longer period than women who quit during the luteal phase.
One theory is that the increase of estrogen levels during the follicular phase decreases anxiety and improves mood, helping a woman cope better with the challenges of smoking cessation.
The evidence is mixed about gender differences in addiction to illicit drugs or prescription medicines.
Stimulants. Men and women are about equally likely to use and abuse stimulants such as cocaine and methamphetamine. But gender differences do exist. For example, women report first using cocaine at younger ages than men. Preliminary evidence in people and in animals also suggests that women more quickly develop dependence on stimulants, and are more prone to relapse after quitting the habit.
As with nicotine, hormonal fluctuations may increase cocaine cravings during certain times of the menstrual cycle. Preliminary evidence also suggests that women may experience more intense craving than men do when exposed to cues that remind them of cocaine.
Opioids. Women are more likely than men to receive prescriptions for opioids, perhaps because they are more likely to suffer from chronic pain conditions such as fibromyalgia. Women are more likely than men to visit emergency rooms because they abused opioids, suggesting (although not proving) that they suffer more medical consequences.
While medications are available to treat opioid dependence, few studies have examined gender differences in treatment response.
Marijuana. Men are nearly three times as likely as women to report smoking marijuana on a daily basis. Although preliminary research suggests that women might suffer more adverse medical effects, and progress more quickly to dependence, the only consensus so far is that more research is needed about gender differences in marijuana use.Read Full Post | Make a Comment ( None so far )
A new study from the University of Southern California finds that among dual wage earners, the spouse who does the most housework has elevated levels of cortisol, the primary stress hormone.
USC researchers looked at how male and female spouses recover from the burdens of work and how the couples balance their housework and leisure activity time.
The report is found in the Journal of Family Psychology.
In the study, researchers followed 30 double-income households. The couples were a median age of 41 and the families had at least one child between the ages of eight and ten.
The results paint a pessimistic picture of marriage, said lead author Dr. Darby Saxbe, a postdoctoral fellow in the USC Dornsife College Psychology Department.
“Your biological adaptation to stress looks healthier when your partner has to suffer the consequences – more housework for husbands, less leisure for wives,” Saxbe said.
For both husbands and wives, doing more housework kept cortisol levels higher at the end of the day. In other words, doing chores seemed to limit a spouse’s ability to recover from a day of work.
For wives, cortisol profiles were healthier if husbands spent more time doing housework. For husbands, in contrast, having more leisure time was linked with healthier cortisol level – but only if their wives also spent less time in leisure.
“The result shows that the way couples spend time at home – not just the way you spend time, but the way your partner spends time as well – has real implications for long-term health,” Saxbe said.
Cortisol levels can affect sleep, weight gain, burnout and weakened immune resistance.
One of Saxbe’s earlier studies focused on marital relationships, stress and work. Her research found that more happily married women showed healthier cortisol patterns, while women who reported marital dissatisfaction had flatter cortisol profiles, which have been associated with chronic stress.
Men’s marital satisfaction ratings, on the other hand, weren’t connected to their cortisol patterns.
“The quality of relationships makes a big difference in a person’s health,” Saxbe said. “Dividing up your housework fairly with your partner may be as important as eating your vegetables.”
Source: University of Southern CaliforniaRead Full Post | Make a Comment ( None so far )
Character — what Webster’s defines as “the complex of mental and ethical traits often individualizing a person” — has long been almost universally agreed to be a stable fixture. People believe that it is formed at an early age through learning and experience, and that it becomes internalized and solidified into a deep-seated disposition that guides their actions over the course of their lives. In fact, the word character itself comes from an ancient Greek term referring to the marks impressed indelibly upon coins to tell them apart. And since that time, the term has been used to describe the supposed indelible marks pressed upon humans’ minds and souls that “reveal” their true nature. Character is the currency we employ to make judgments about people — to determine who is good and who is flawed, who is worthy and who is not, who is saved and who is damned. Character, quite simply, is who we are, like it or not. Everyone believes this to be a fact; even The Complete Idiot’s Guide to Understanding Ethics says that character traits are fixed, deeply ingrained features of personality.
But if this view is correct, some things just don’t add up. If character is stable, how could Mark Sanford and others like him fool so many people for so long? How could they have concealed their moral shortcomings from their families, friends, colleagues, and communities year after year? It’s hard to imagine that most people are capable of such an elaborate ruse. As Tom Davis, one of Sanford’s closest friends for thirty years, put it: “I’ve known Mark, and the opinion I’ve formed of him, I never would have expected something like this. This is not in character for Mark Sanford.” Virginia Lane, one of Jenny’s close friends, echoed the view: “Mark’s the last person on the planet we thought this would happen to.” And Jenny herself was the most shocked of all: “I always believed that Mark and I had no secrets. After all of these years in the public eye, our lives were open books to one another, let alone the public.” “It never occurred to me that he would do something like that,” she said upon reflection. “The person I married was centered on a core of morals.”
But in a way, our responses to situations like these aren’t entirely logical or fair. Should a single moral failing erase a lifetime of good behavior? Why does a single transgression seem to give us license to brand someone with the indelible mark of a marred character? One explanation is that because these single events are so shocking and so memorable (not to mention so beaten to death by the media), they eclipse all else. But if you buy that view, then why isn’t the reverse true? Why doesn’t a single good deed, even a memorable one, ever seem to be seen as a mark capable of defining a person’s true colors? Ever heard of Farron Hall, the homeless alcoholic who lived under a bridge in Winnipeg, and who in May 2009 risked his own life by jumping into the Red River in a heroic attempt to save a drowning teen? Probably not. That’s because despite risking his life to save a total stranger, he was never hailed as a role model, never awarded a medal of honor or invited on the talk show circuit to discuss his moral bona fides. Instead, he was patted on the back by local officials and quickly forgotten. In society’s eyes, this one good act wasn’t nearly enough to redeem Hall from a lifetime of “degenerate behavior.”
It seems that wolves may masquerade as sheep, but sheep just don’t masquerade as wolves. We rarely view one good act as proof someone had good character all along, yet most of us are ready and willing to do the reverse. Those marked as “bad” can do something nice now and again and our opinion of them doesn’t change, but all it takes for a person of seeming high virtue is one slip for us to claim that his or her character is inherently flawed.
This double standard may not be fair, but it’s also not particularly surprising. As work by the psychologist Paul Rozin has shown, humans possess a fundamental tendency to accentuate the negative. Drop a fly into a bowl of delicious soup and the soup suddenly becomes inedible. Yet placing a drop of delicious soup in a bowl of dead flies hardly makes for a tasty treat. This may be an extreme example, but the point is that, rational or not, for the mind any sign of contamination — physical or moral — is hard to ignore.
History has borne this tendency out over and over. In one particularly egregious example, during the nineteenth and early twentieth centuries it was accepted in many southern states that a single drop of “black blood” in one’s ancestry rendered one legally black, therefore tainting and making one ineligible for all the civil rights that applied at the time, whereas the reverse didn’t apply. In short, the things we deem “bad” consistently seem to hold more weight than those we deem “good.”
This very fact provides a bit of a problem for the commonly held view of character as a stable phenomenon. Think of it this way: if you believe that character is fixed, you have to accept that an instance of behaving “out of character” is one of two things: (1) an aberrant event (like Hall’s heroic act) or (2) a window into the person’s “true” and yet hidden nature (like Sanford’s indiscretion). But in reality, which one we choose seems to depend on whether the person in question was a “saint” or “sinner” to begin with.
An even bigger problem for the fixed view of character is that acting “out of character” isn’t a freak occurrence or something restricted to the famous few. As we’ll see throughout this book, it’s actually much more commonplace than most people think. There lurks in every one of us the potential to lie, cheat, steal, and sin, no matter how good a person we believe ourselves to be. Combine these two problems, and the view of character as a stable fixture begins to crumble.
This is not to say that character doesn’t exist or that our behavior is completely unpredictable. A random system like that wouldn’t make any sense either. If the mind worked that way, our social world would be chaos — our actions at any moment in time would be reduced to a simple roll of the dice. No, character exists. It just doesn’t work the way most people think.
Reprinted from Out of Character by David DeSteno and Piercarlo ValdesoloRead Full Post | Make a Comment ( None so far )
It can happen to anyone, at any time, in any place — in public bathrooms, on trains, in schools, even in your own backyard. You’re never safe. For Mark Liberman, a linguist at the University of Pennsylvania, it happened at the gym. “There was a young woman on the treadmill next to mine who was talking on her cell phone, and I was doing my best to tune it out, but she kept saying the same sentence over and over and over again. It was something like, ‘He’s arriving tomorrow.’ I think she must have said it like ten or twelve times.”
This is a classic case of cell phone annoyance. Liberman couldn’t ignore the broken record on the treadmill next to him, and that was annoying. Why? Maybe it was annoying because talking on a cell phone when you’re in a public space is rude.
Why is it rude? Lauren Emberson, a psychology graduate student who studied this, has an answer. “I think the reason why is that we can’t tune it out. We find it more rude than someone having a conversation around us because our attention is drawn in and that makes us irritated that we can’t be doing the other things or thinking about the other things that we want to. That’s why it seems intrusive.”1
It’s an interesting idea: what we find rude is what we cannot ignore. In terms of cell phone conversations, Liberman points out that some will be harder to ignore than others — louder conversations will be more annoying, and the content of certain conversations may be more attention grabbing.
If you think it’s juicy content that keeps people tuned in to others’ cell calls, however, think again. The most mundane cell phone conversation, as Liberman found out at the gym, can be the hardest to ignore. “It was maddening because I couldn’t figure what could be going on that was causing her to repeat the same thing over and over again,” Liberman says. “It wasn’t in itself very interesting; what was attention-getting was the unexpected fact of repetition. What was the conversational setting that would lead to this?”
This perfectly embodies Emberson’s theory of what makes a cell phone conversation — which she and her coauthors dub a “halfalogue” — annoying. The repetition of the girl on the treadmill was annoying because it was distracting. It was distracting because, try as we might — and we do try — we can’t even imagine how that conversation would make any sense.
The neighborhoods nearest to the campus of the University of British Columbia at Vancouver are expensive — too expensive for students, says Emberson, who was a student there and didn’t live near campus. She lived a forty-five-minute bus ride away, which translated to a lot of commuting, which translated to a lot of reading.
When Emberson was in college, cell phones were just starting to get popular. She didn’t have one, and they annoyed her, especially on the bus. She wanted to read her essays on the philosophy of mind, but she found herself distracted by her bus-mates’ conversations. “Being an academic, I couldn’t stop at just being irritated,” she recalls. “I started thinking, ‘Why was I irritated?’ I couldn’t tune it out, and I used to think it was because I was nosy. But I actually didn’t want to listen. I felt myself forced to, almost. For most people, that’s not enough to go and do a study about it.” It was for Emberson, though, who is now at Cornell University. She devised a study to test her hypothesis on why cell phone conversations are so irritating.
Everyone is annoyed by something. Many of us are annoyed by lots of things. Most of these annoyances have more to do with our personal sensitivities — our neuroses, our upbringings, our points of view — than any objective “annoying” quality. Other annoyances are so powerful, however, that they transcend race, gender, age, and culture. At the top of the list is that most convenient of modern conveniences, the cell phone — at least, when someone else is talking on it.
Researchers at the University of York have shown that cell phone chatter is particularly annoying compared to conversations in which listeners can hear both sides.3 You don’t need to have a special sensitivity, it’s not a matter of taste, it doesn’t have to remind you of something, and it’s not an intrinsic feature of the human voice. Cell phone conversations are different. Could there be something about this annoyance that taps into the essence of our humanness?
Emberson has a theory. “It actually happened to fit into my emerging worldview about how we respond to information around us,” she says. Her view is that when we hear half a conversation, such as when someone is talking on a cell phone, “our brains are always predicting what’s going to happen next, based on our current state of knowledge — this is how we learn about the world, but it also reflects how we are in the world. When something is unexpected, it draws our attention in, our brains tune into it because we’re this information-seeking, prediction-loving cognitive system — this is the idea.”
Although cell phones are fairly new, halfalogues aren’t a new annoyance. More than a century ago, Mark Twain railed against them. Twain was a man, let it be said, who found no shortage of annoyances in life, and American literature is all the richer for it. In 1880 — just four years after Alexander Graham Bell first exhibited his telephone at the Centennial Exposition in Philadelphia — Twain wrote an essay called “A Telephonic Conversation,” in which he stated,
Consider that a conversation by telephone — when you are simply sitting by and not taking any part in that conversation — is one of the solemnest curiosities of this modern life. Yesterday I was writing a deep article on a sublime philosophical subject while such a conversation was going on in the room. . . . You hear questions asked; you don’t hear the answer. You hear invitations given; you hear no thanks in return. You have listening pauses of dead silence, followed by apparently irrelevant and unjustifiable exclamations of glad surprise or sorrow or dismay. You can’t make head or tail of the talk, because you never hear anything that the person at the other end of the wire says.4
As Twain put it, you “can’t make head or tail of the talk,” and Emberson thinks this is the root of why cell phone conversations so effectively capture our attention — and subsequently annoy us. When you hear only half of a conversation, it’s hard to predict when the person will start talking again and what that person is going to say when he does open his mouth.
Part of the recipe for what makes something annoying seems to be its level of unpredictability. Completely random stimuli, we can tune out. We also have an easier time ignoring something that is steady, stable, and routine. But things that have some pattern, like the rhythm of a conversation, but are not predictable — grab our attention, whether we want them to or not.
Speech, especially, reels us in. You might think that when you’re having a conversation with someone your brain is focused on listening, on taking in what that person is saying and processing the information he’s imparting. You probably think you’re absorbing his words like a sponge and possibly preparing your response. In fact, your brain is focused on guessing what the person is going to say next. You may be able to finish your spouse’s sentences, but your mind wants to finish everyone’s sentences.
Humans are always trying to predict speech, says Liberman. It relates to an idea called “theory of mind,” which suggests that people can’t help themselves from trying to read into what other people are thinking. “It’s also pretty much automatic,” he wrote on his blog Language Log.5 “If you’re not
autistic, you can’t stop yourself from reading your companions’ minds any more than you can stop yourself from noticing the color of their clothes.” This applies to conversations, too, he says: if you’re listening to half of a conversation, “then filling in all this theory of mind stuff does seem to be unavoidable.”
Humans are pretty good at filling in the blanks. One experimental paradigm that tests our brains’ ability to predict language has to do with verbal shadowing. “The task is to listen to someone speaking and repeat what they say as soon as possible after they say it,” says Liberman. “There used to be people who would go on variety shows because they could do it almost as fast as the person was talking. They hardly seemed to be behind them at all. But everyone can do this to some extent with a lag of a few tenths of a second.”
As the speech becomes more unpredictable — or what Liberman calls “word salad — just random words spoken in sequence — the shadowing lag is very long compared to semantically incoherent but syntactically well-formed, nonsense material.” The shadowing rate gets better and better as the structure and the content of the speech become more coherent.
Theories about how our brains prefer predictability show up in music research, too. “What we know from a biological perspective is that the best surprise is no surprise,” says musicologist David Huron. “Large parts of your brain are oriented toward predicting what’s going to happen next. There are excellent biological adaptive reasons why brains should be so oriented toward what’s going to happen. An accurate prediction is rewarded by the brain. It’s one of the reasons why in music we have very predictive rhythms. The thing to say about music is that it’s incredibly repetitive.”
Emberson tested the idea that halfalogues distract us more than dialogues or monologues do by asking people to listen to half of a cell phone conversation while performing a task that required paying attention. To make the cell phone conversations as realistic as possible, Emberson and her colleagues gathered Cornell undergrad roommates, brought them to the lab, and recorded them chatting to one another on their phones. Then the researchers asked them to sum up the conversations in monologues. This provided the researchers with halfalogues, dialogues, and monologues to play to listeners.
Listeners were asked to perform two tasks: The first was to keep a mouse cursor on a dot that was moving around a computer screen — which requires constant monitoring. The other was to hold four letters in memory and hit a button any time one of the letters popped up on the screen and refrain from hitting that button when another letter popped up. These tasks required monitoring and decision making. “Both demand a great deal of attention, but in very different ways,” says Emberson. “We wanted to know if there was an attentional effect for the different types of speech.”
The distraction of the conversations caused an effect, the researchers reported in the journal Psychological Science.6 During the mouse tracker task, people started to make more errors in the moments after the halfalogue recommenced. “When the person starts talking, your attention is really drawn in,” says Emberson. “It’s really automatic.” The errors occurred in the 400 milliseconds after the audible speech restarted. It almost seemed reflexive.
Would any blast of random noise derail us? To make sure the effect was specifically caused by understandable speech, Emberson filtered the halfalogue so that it was garbled. She says it sounded like someone talking underwater. You could tell it was speech, but you couldn’t make out the content. In that case, the distracting effects went away. When the halfalogue speech was incomprehensible, people didn’t screw up the task.
When people performed the letter-matching task, Emberson found that people did worse when they were hearing a halfalogue compared with a dialogue or a monologue, which may suggest that we’re more distracted by halfalogues generally. Emberson interprets the findings to mean that “there’s a cost when you can’t predict the succession of speech.”
Liberman generally agrees with the theory that halfalogues are more distracting than dialogues or monologues: “It’s extremely well-established, something that Emberson and company have assumed; when you’re getting lower-quality information coming in, you’re having to work harder to understand and reconstruct it.” Liberman is more cautious about whether the increased cognitive load from unpredictable content is solely responsible for the decrease in performance on the attention tasks.
That brings us to our second ingredient in the recipe for what’s annoying. Whatever it is — a buzzing mosquito, a pestering child, a dripping faucet, or half of a cell phone conversation — it has to be unpleasant. Not horrible, not deadly, just mildly discomfiting. Whether halfalogues are distracting because they’re rude or rude because they’re distracting, it’s rare to listen to someone else’s cell phone conversation and enjoy it. Some things are inherently unpleasant — the sound of fingernails on a chalkboard probably falls in this category — and others are more unique to the individual. Some people find being stuck in traffic unpleasant; others don’t seem to mind a bit.
Overheard cell phone conversations point to a third and final ingredient in the perfect recipe for annoyance: the certainty that it will end, but the uncertainty of when. To be annoyed requires some impatience on your part. The conversation could be finished in a few more seconds, or maybe it will stretch on for another hour — it’s the knowledge that the unpleasantness will come to an end soon that gives a particular situation an edge, a sense of urgency. That is, your annoyance is related to your sense of optimism. Your hope that it will be over amplifies every additional second that you have to put up with it.
Annoyance is probably the most widely experienced and least studied of all human emotions. How do we know that? We don’t really. There is no Department of Annoying Studies or annoyingologists. There are no data, no measurements of how many people are annoyed or how annoyed people are, no investigations into what makes people annoyed, and no systematic looks at how people cope with annoyance. In fact, if you talk to psychologists, practitioners of a scientific discipline that one would think would have grappled with annoyance, you get the feeling that there might not be such a thing as annoyance at all.
So we set out to try to understand this feeling by mining the science in every field. There’s no dearth of relevant research. A vast literature exists on anger, aversion, acoustics, social anthropology, and chemical irritants, but few scientists have thought about these things in terms of how they help explain annoyance. That’s what this book sets out to do. Buzzing flies, car alarms, skunk odors, bad habits, terrible music, idiotic employers, recalcitrant spouses, and more. Tell people you’re writing a book on the annoyingness of modern life, and you’ll soon realize what a tetchy species we humans are.
Cell phones aside, the trouble with cataloging annoyances is that there seem to be few universals in what we find unpleasant. You may like the smell of aftershave, whereas it annoys your spouse. Pleasures can become pet peeves. You may find your spouse’s way of using a knife cute when you first get together and god-awfully annoying after twenty years of marriage. The experience of annoyance is so subjective, so context dependent, that it’s hard to nail down. This may be why researchers don’t tend to think of annoyance as a separate emotion. “From my perspective, annoyance is mild anger,” says James Gross, a psychologist at Stanford University. “And there’s a huge literature on anger.” Paul Rozin, a psychologist at the University of Pennsylvania, warns, “You have to be careful to distinguish annoyance from aversion.” “It’s hard to distinguish annoyance from frustration,” says University of Florida psychologist Clive Wynne.
Emotions are sometimes plotted on a chart with positive/negative on one axis and arousal/calm on the other axis. “Annoyance would be arousal-negative. But it’s a subtle one, isn’t it?” asks Dr. Randolph Nesse, a psychiatrist and the director of the Evolution and Human Adaptation Program at the University of Michigan. “It’s not quite rage. It’s not quite anger. It doesn’t fit real nicely on those valences.” Annoyance seems to be its own thing. It’s possible that defining annoyance is as difficult as Justice Potter Stewart found defining pornography to be: “I know it when I see it.” Knowing it when you see it, however, isn’t always good enough. In some lines of work, you need to be an expert in being annoying just to get through the day.
Excerpted from Annoying: The Science of What Bugs Us by Joe Palca and Flora Lichtman.Read Full Post | Make a Comment ( None so far )
All children and adolescents act out occasionally, but those with conduct disorder consistently behave in unusually aggressive ways — sometimes resulting in property damage or physical injury. Examples of such behavior include stealing from parents, threatening schoolmates to extract pocket change, breaking windows in cars, and setting fires. Although children with conduct disorder may have normal intelligence, they tend to disrupt or skip classes and fall behind in school. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), the criteria for conduct disorder consist of 15 behaviors that fall into four broad categories. Editors of the DSM-V, now undergoing review, have not proposed any changes in these criteria. Conduct disorder involves a persistent and repetitive pattern, beginning at an early age, of impulsive, aggressive, and deceitful behavior that violates basic social rules and the rights of others. It may include any of the following: aggression toward people or animals that threatens or causes physical harm burglary, vandalism, and other behavior that causes property loss or damage deceitfulness or theft serious rule violations such as truancy, staying out late at night, or running away from home. Conduct disorder is more common — or at least more frequently diagnosed — in boys. Community studies suggest that 2% to 16% of boys and 1% to 9% of girls have conduct disorder. Complicating diagnosis and the research on prevalence, however, is the fact that children diagnosed with conduct disorder often have additional psychiatric conditions. For example, at least 50% of youths with conduct disorder have attention deficit hyperactivity disorder (ADHD). Also common are co-occurring mood disorders, anxiety, post-traumatic stress disorder, and learning problems. It’s important to understand what problem (or combination of problems) underlies the difficult behaviors seen in children with conduct disorder. Subtypes and risk factors The DSM-IV describes two subtypes of conduct disorder based on age at diagnosis. Childhood-onset conduct disorder is diagnosed when the child exhibits at least one of the behaviors listed in the DSM-IV before age 10. The adolescent-onset type applies if the child had no symptoms of conduct disorder before age 10, but in any 12-month period afterward exhibits at least three symptomatic behaviors. Aside from age of onset, the two subtypes differ in other ways. Childhood onset. In children as young as 2 (although usually they are 5 or 6), the first signs of conduct disorder are unusual irritability, impulsive behavior, or defiance. On the basis of such early behaviors, clinicians initially may diagnose affected children with ADHD or oppositional defiant disorder. Youths diagnosed with childhood-onset conduct disorder tend to have more persistent and severe symptoms than those diagnosed in adolescence. They are also more likely than those diagnosed as adolescents to have poor family and peer relationships, and to develop antisocial personality disorder in adulthood. Adolescent onset. Youths diagnosed with conduct disorder after age 10 tend to be less aggressive than those with the childhood-onset form, and their peer relationships are closer to normal. When they do act out, it is usually in the company of aggressive peers, such as gang members. They are also less likely than those with childhood-onset conduct disorder to meet criteria for co-occurring ADHD, although some do. They are far less likely than those with childhood-onset conduct disorder to develop antisocial personality disorder as adults. Risk factors. As with other psychiatric disorders, it is likely that conduct disorder develops when a child who is genetically vulnerable encounters a stressful environment. Children with conduct disorder are often brought up in poor families and disintegrating neighborhoods, with little access to interventions that might help. Family dysfunction also likely contributes. In the typical scenario, a child is born with a tendency toward irritability, impulsiveness, or fearlessness. These temperamental qualities are aggravated in a family environment characterized by rejection, neglect, physical or emotional abuse, brutal or erratic discipline, or constant changes in caregivers. The child’s behavior worsens in response to this stress, provoking maladaptive responses from parents, teachers, and other children — only making the problem worse. Working with families A review identified 16 psychosocial treatments that are likely to be effective for disruptive behavior in children and adolescents. The review defined such behavior broadly, looking at interventions targeted to reduce aggression, disruptive classroom behavior, or delinquent behavior. The authors included studies involving youths with oppositional defiant disorder or conduct disorder, but excluded those with autism or ADHD. Most of the effective interventions involved parents or other caregivers as well as the child. One popular approach is known as parent management training, which focuses on helping parents to better manage the child’s behavior. Parents learn to issue and enforce stable rules, negotiate compromises with older children, reward good behavior, and substitute sensible discipline for inconsistent punishments. Therapists model the behavior and guide the parents in rehearsing it. A related model is known as behavioral family therapy. Therapists using this approach not only work with parents to modify a child’s behavior, but also help them learn stress-reduction techniques, understand how a child’s temperament can affect behavior, and recognize their own ways of thinking about the child’s behavior. A few examples of effective programs, designed for youths of different ages, follow. Helping the Noncompliant Child. This model is most appropriate for children ages 3 to 8 (preschool and elementary school age). Therapists usually see parents and children together during 10 weekly 60- to 90-minute sessions. Therapists coach parents about how to reward positive behavior, give clear instructions, and provide time-outs after bad behavior. The larger goal is to improve interactions between parent and child. Parent Management Training, Oregon Model. This program helps parents learn to supervise children closely, place limits, enforce structure, and encourage youths to engage in positive activities rather than spending time with deviant peers. Length of therapy depends on the family’s needs, and usually involves a combination of in-person meetings and telephone coaching. Research suggests this program is effective for children ages 3 to 12. Multisystemic therapy. This therapy is used mainly to treat adolescents who are antisocial and delinquent. It combines strategies from cognitive behavioral therapy, parent management training, and various family therapies. Multisystemic therapy is based on the assumption that antisocial behavior has different causes in different youths and must be managed and treated individually. Depending on the adolescent, the program may concentrate on behavior, family discipline, school performance, or gangs and other forms of peer pressure. Therapy usually combines in-person meetings at home or school with phone consultations, and lasts three to five months. Multiple randomized controlled studies have concluded that this therapy is effective at reducing delinquent behavior and drug use, and at preventing incarceration or hospitalization. Other options Medications and other therapies tend to be less effective, but may be helpful for some children. However, a particularly popular approach, boot camp, is actually counterproductive. Individual psychotherapy. Children and adolescents with conduct disorder tend to resist individual therapy. They may be defensive because they have been forced to see a mental health professional, and the mask of insolence and bravado can be difficult to penetrate. At other times, children with conduct disorder conceal their difficulties because they would rather be considered bad than admit to weakness or suggest in any way that they need help. Asked to talk about themselves and their behavior, they may lie, deny, and change the subject. For all these reasons, individual therapy is likely to be insufficient as a single treatment, although it may help some youths benefit from other interventions. Group psychotherapy. This may be helpful for young children, but not for adolescents. For example, young children with conduct disorder may best learn social skills and problem-solving techniques in groups. Proceeding step by step, using games and stories that gradually approach real-life situations, the therapist teaches children how to exercise self-control, see other people’s points of view, anticipate their reactions, and understand the consequences of their own actions. Boot camps. Although still commonly recommended, the long-term research suggests that forcing youths with conduct disorder to attend military-style boot camps or rugged wilderness camps is usually ineffective and may even aggravate their problems. Weaker youths may follow and learn from the stronger, admiring them for their willingness to be aggressive, take chances, break rules, and defy authority. Even when youths’ behavior improves temporarily in a controlled and restrictive environment, the change does not necessarily hold when they have to face an unpredictable and indifferent outside world. Long-term data suggest that youths who attend boot camps have high arrest rates as adults. Medications. The American Acad emy of Child and Adolescent Psychiatry recommends that medications not be used for conduct disorder when it is the only diagnosis. Medications may be helpful for co-occurring disorders, such as ADHD. For serious violence, mood swings, and temper tantrums, clinicians sometimes recommend antipsychotic medications, anticonvulsants, or mood stabilizers — but there is little evidence to support use of these drugs. Remaining questions. There is some evidence that longer-term programs are more effective, and academic support may be especially beneficial. Most of the methods evaluated in controlled studies have been pilot programs rather than standard clinical practice. Because these programs often seem effective only as long as they continue, many experts think it would benefit both children and their communities to treat conduct disorder more intensively and for a longer time. http://www.health.harvard.edu/newsletters/Harvard_Mental_Health_Letter/2011/MarchRead Full Post | Make a Comment ( None so far )
Two environmental accidents in different parts of the world — along with media and public reaction to them — have dramatically illustrated some of the basic psychological principles of risk perception. In 2010, the Deepwater Horizon oil spill sent millions of gallons of oil into the Gulf of Mexico. In 2011, the Fukushima Daiichi nuclear power plant in Japan — damaged after a devastating earthquake and tsunami — leaked radiation into the atmosphere.
These incidents dominated news coverage for weeks and created widespread anxiety, even in people living miles away and not directly affected. For example, news that potassium iodide pills could help prevent radiation-induced thyroid cancer sparked a run on pharmacy supplies in the United States, thousands of miles away from the disaster, even when there was no evidence of increased radiation exposure.
Factors affecting perception
Risk perception is rarely entirely rational. Instead, people assess risks using a mixture of cognitive skills (weighing the evidence, using reasoning and logic to reach conclusions) and emotional appraisals (intuition or imagination). After reviewing the research, risk expert David Ropeik identified 14 specific factors that affect perception of danger:
Trust. When people trust the officials providing information about a particular risk — or the process used to assess risk — they tend to be less afraid than when they don’t trust the officials or the process.
Origin. People are less concerned about risks they incur themselves than the ones that others impose on them. This helps explain why people often get angry when they see someone talking on the cell phone while driving — and yet think nothing of doing so themselves.
Control. Perceived control over outcomes also matters. This helps explain why someone is not afraid of driving a car — even though automobile crashes kill thousands of people each year — but may be afraid of flying in an airplane.
Nature. Dangers in nature — such as sun exposure — are perceived as relatively benign, whereas man-made harms — nuclear power accidents or terror attacks — are more menacing.
Scope. Cataclysmic events, capable of killing many people at the same time, are scarier than chronic conditions — which may kill just as many people but over a longer period. That helps explain why a tsunami or earthquake feels scarier than heart disease or diabetes.
Awareness. Saturation media coverage of high-profile disasters raises awareness of particular risks more than others. Likewise, an event that hits close to home, such as having a friend diagnosed with cancer, heightens risk perception.
Imagination. When threats are invisible or hard to understand, people become confused about the nature of the risk, and the event becomes scarier.
Dread. Events that invoke dread — such as drowning or being eaten alive — scare people more than those that do not.
Age affected. Risks are more frightening when they affect children. Asbestos in a school building, for example, may bother people more than asbestos in a factory.
Uncertainty. Events inspire more fear when officials don’t communicate what is known — or when the risks are simply unknown. In the Deepwater Horizon spill, for example, officials could more easily estimate the amount of oil spewing into the ocean than they could predict what effect that would have on wildlife and fisheries.
Familiarity. Novel risks are perceived to be more dangerous than more familiar threats. That’s why West Nile virus may be perceived as more of a risk to health than not testing a smoke detector regularly.
Specificity. Victims who are publicly identified evoke a greater emotional reaction than those who remain nameless and faceless.
Personal impact. Risks that affect people personally are more frightening than those that affect strangers.
Fun factor. Engaging in risky behavior may not seem that way if it involves pleasure. Some examples are drug taking, unsafe sex, and high-risk sports.
Risk in perspective
There is no question that people living in the direct vicinity of high-profile disasters suffer mentally as well as physically. Hurricane Katrina, for example, was followed by an increase in psychiatric disorders, substance abuse, and domestic violence among people living in the areas affected.
For people who are affected indirectly by reading media reports, however, the real danger is heightened or exaggerated perception of risk that may not have a solid basis in fact. Keeping the risk in perspective will help prevent needless anxiety or counterproductive coping strategies.Read Full Post | Make a Comment ( None so far )
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