Tuesday, January 24, 2012

Substance abuse and alexithemia

In substance use disorders (SUD), alexithymia rates of up to 67% have been reported, but evaluations of therapy in alexithymic SUD patients are scarce. Group cognitive behaviour therapy (CBT) was relatively successful in high-scoring alexithymic SUD patients, but alexithymia was associated with a lower attrition rate and with a larger Addiction Severity Index (ASI) alcohol composite score at follow-up.

From a clinical point of view the Authors of this study were interested in the predictive value of alexithymia at baseline on recovery. They hypothesized a negative relation of alexithymia with outcomes, which would be a strong argument for addressing alexithymia at intake and adjusting therapy for highly alexithymic patients. A total of 187 abstinent SUD inpatients were assessed at baseline by the Dutch version of the Toronto Alexithymia Scale (TAS-20) and the European ASI (EuropASI) at baseline and 3-month follow-up after an inpatient CBT as usual (CBT-TAU group) or CBT with shared decision making intervention (SDMI) (CBT-SDMI group).

All patients have been diagnosed according to the DSM-IV-TR as having 1 or more substance-related disorders. The mean score on the TAS-20 at baseline was 55.7 (SD = 11.3). According to the cutoff score, 36.9% were highly alexithymic and 33.2% were low scoring alexithymics. Highly alexithymic patients had fewer years of education [p =0.05] and were more often unemployed [p = 0.05] than low-scoring alexithymics.

Highscoring alexithymics showed more problems in the ‘work, income and education’ [p= 0.04] and ‘psychiatry’ domains [p<0.001]. The mean time of treatment (in days) for highly alexithymic patients (116.0, SD = 58.9) was not different from that for low scoring alexithymics [p = 0.26], and also the rate of completers was similar between high- (50.7%) and low-scoring alexithymics [p=0.41]. Fifty-four percent of the high-scoring, and 45.7% of the low-scoring alexithymics were abstinent at follow-up [p=0.41].

As concerns the Europ-ASI, differences between baseline high- and low-scoring alexithymic patients were found for the ‘work, income and education’ domain in the CBT-SDMI group, and for the ‘family and social relations’ and ‘drugs’ domains in the CBT-TAU group.

Overall, highly alexithymic patients improved on the EuropASI change scores at least equally well as low-scoring alexithymic patients, and alexithymia as a continuous score was predominantly positively associated with these change scores.

The results of this study show that highly alexithymic SUD patients can profit from CBT with or without SDMI, and that the degree of alexithymia is not negatively related to resulting outcomes. Limitations of this study were the absence of systematic urine or blood samples to confirm abstinence, and not having performed multimethod alexithymia assessments with an observer scale included.

However, in answering the question on whether a highly alexithymic SUD patient should be treated differently at the beginning of treatment, the Authors made use of the two extremes of categorical classification of alexithymia. As highly alexithymic SUD patients performed very well and alexithymia was associated with the treatment outcomes, CBT may be used in this population even if patients present alexithymic features at intervention entry.


values for auction


'“As culture changes, it affects our brains, and as our brains change, that affects our culture. You can’t separate the two,” Berns says. “We now have the means to start understanding this relationship, and that’s putting the relatively new field of cultural neuroscience onto the global stage.”


Monday, January 23, 2012


'Gerard Manley Hopkins invented the word “inscape” to denote intrin­sic form, the pattern of essential characteristics both in single objects and (what is more interesting) in objects in a state of relation to each other, and the word “instress” to denote the experiencing of the perception of inscape, the apperception of inscape.' Denise Levertov

Elbow the night will always win

Friday, January 20, 2012

Brain behaiviour and addiction

Harvard scientists have developed the fullest picture yet of how neurons in the brain interact to reinforce behaviors ranging from learning to drug use, a finding that might open the door to possible breakthroughs in the treatment of addiction.
The finding is the result of a year-long effort by a team of researchers led by associate professor of Molecular and Cellular Biology Naoshige Uchida to examine a brain process known as reward prediction error. Thought to be a key component of learning, prediction error was long believed to be the product of dopamine neurons firing in response to an unexpected “reward,” thus reinforcing the behavior that led to the reward.
But Uchida and colleagues from Harvard and Beth Israel Deaconess Medical Center report in the Jan. 18 issue of Nature that reward prediction error is actually the product of a complex interplay between two classes of neurons – one that relies on dopamine and an inhibitory class of neuron that uses the neurotransmitter GABA.
“Until now, no one knew how these GABA neurons were involved in the reward and punishment cycle,” Uchida said. “What we believe is happening is that they are inhibiting the dopamine neurons, so the two are working together to make the reward error computation.”
Before Uchida and his team could prove that GABA neurons are involved in the computation, however, they had to be sure what type of cells they were observing.
The challenge in studying either dopamine or GABA neurons is that the two cell types are intermingled in a relatively small area of the brain, making it difficult for researchers to definitively know which type they are observing. Ultimately, researchers developed an elegant solution to the problem.
Researchers genetically altered the neurons in two groups of mice – one for the dopamine neurons, the other for GABA neurons – to fire when hit by a pulse of laser light. Once researchers were certain they were measuring the correct type of neuron, they used electrodes to measure whether and when the neurons fired in response to expected and actual rewards.
The results, Uchida said, showed that while firing of dopamine neurons signaled reward prediction error, firing of GABA neurons signaled an expected reward. Taken together, GABA neurons help dopamine neurons calculate reward prediction error.
The finding is particularly important, Uchida said, because it sheds new light on how behaviors can be reinforced, either through normal brain function, or by damaging the way the two types of neurons interact.
“What happens with drug abuse is that many drugs, such as opioids and cannabinoids, target the GABA neurons,” he said. “What we are hypothesizing is that, by inhibiting those GABA neurons, you can lose this feedback cycle, so you keep getting reinforcing signals from the dopamine neurons.
“This is a new way of thinking about addiction in general,” Uchida continued. “Based on this theory, I believe you may be able to develop new theories or treatments for addiction.”

Saturday, January 14, 2012


Via zenhabits

‘Everything is practice.’ ~Pele
Post written by Leo Babauta.
When we learn a martial art, or ballet, or gymnastics, or soccer … we consciously practice movements in a deliberate way, repeatedly. By conscious, repeated practice, we become good at those movements.
Our entire lives are like this, but we’re often less conscious of the practice.
Each day, we repeat movements, thought patterns, ways of interacting with others … and in this repeated practice, we are becoming (or have already become) good at these things. If you constantly check Facebook or Twitter, that is practice, and you are forming that habit, though it’s usually not with too much awareness.
When you smoke, or eat junk food, or speak rudely to others, or put yourself down internally, this is something you are practicing to be good at. You may already be good at these things.
What if, instead, we practiced consciously, deliberately, and became good at the things we really want to be good at?
What if you first, above all skills, learned to be more aware of what you are practicing? What if constant conscious action is the skill you became good at?
If you could learn to take conscious action, you could learn to practice other things you want to be good at, rather than the ones you don’t.

What Are You Practicing?
Ask yourself these things throughout the day, to practice conscious action:
• Do I want to practice rushing through my morning, or can I wake a little earlier and simplify my morning routine so that I practice a slow, enjoyable morning ritual?
• Do I want to practice leaving dirty dishes out, or can I practice washing my bowl when I’m done with it?
• Do I want to practice leaving clothes strewn about, or papers lying on the counter, or can I take a few seconds to put them where they belong?
• Do I want to speak angrily to my kids or spouse, or can I speak to them with kindness and compassion?
• Do I want to practice complaining and self-pity, or can I practice gratitude?
• Do I want to practice rushing and being busy, or can I practice simplifying and going slowly?
• Do I want to practice eating fried foods, sugary foods, salty junk food snacks, fast foods … or can I practice eating whole foods, vegetables and fruits, nuts and beans and seeds?
• Do I want to practice surfing time-wasting sites, or can I practice clearing away distractions and creating?
• Do I want to practice watching mindless entertainment, or can I practice moving my body and exerting myself in activity?
• Do I want to practice smoking, or can I learn a healthier way to deal with stress?
• Do I want to practice shopping, or can I practice giving?
These are only examples … your life will show you what you’ve been practicing, and you can decide what you might rather practice instead. Or you might be completely happy with what you’ve been practicing.
Some ideas for creative practice from Ali Edwards.
How to Practice
The first step is always awareness. When you are conscious of what you are doing, you can decide whether this is an action or thought pattern you want to practice, or if there’s an alternative you’d rather be good at.
As you go through your day, practice this awareness. It’s the first skill, and it’s the most important one. Be aware, without feeling guilty or angry at yourself, of what you’re doing and thinking. You will forget to this, but remind yourself. You might wear a rubber band around your wrist, or carry a talisman, or make tally marks on a slip of paper each time you remember.
As you get good at conscious action, start to practice those actions and thought patterns you want to be good at. Start to notice the ones you’d really rather not be good at, and see if you can deliberately practice other actions and thought patterns.
As you consciously, deliberately repeat these things, you’ll get better at them. It takes a lot of repetition to get good at a skill, but you’ve got time.
Important Conclusions
You won’t be able to change all your habits at once, and I’m not implying that you should try. The habit you’re really changing is consciousness, and practice. Other habits will be difficult to change, especially if you’re trying to change all of them, but it’s OK if you mess up. Give yourself permission to make mistakes without guilt, and instead just deliberately practice again, and again.
If something is too hard, and you can’t get it right no matter how many times you practice, you can try it in smaller steps. If you can’t quit smoking, try not smoking once, and instead relieving stress through walking or doing some pushups or meditation or self-massage. If you can’t quit junk food, just replace one snack with a fruit, or add a tasty veggie to your dinner.
I’d like to emphasize that this isn’t about perfection. There is no perfect way of life, and you don’t need to strive to be perfect every moment of the day. I believe you’re already perfect. This is just about conscious action, which is a useful skill to have.
Remember that we become good at what we repeatedly do, and what we do repeatedly can be done consciously. It’s when we’re conscious that we are truly alive.
‘If you want others to be happy, practice compassion. If you want to be happy, practice compassion.’ ~Dalai Lama
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Mike Snider's Formal Blog and Sonnetarium View Technorati Cosmos
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