Jayne Jubb

With Christmas and the ‘Festive Season’ rapidly approaching, it seems that every year there is increasingly more focus on the amounts of food we buy, make and consume. In the days leading up to Christmas our local Amsterdam supermarket looks as though there is going to be a famine because people are pilling up their trolleys as if there will not be a tomorrow.

When did it all get so crazy? How did it all get so crazy?

I decided to delve into the research around getting addicted to food….

In the United States more than two thirds of the population is overweight or obese, and that proportion continues to rise, even as public awareness of the importance of healthy eating is at an all-time high. Before we Europeans start to get too comfortable on our increasing posteriors, know that the same problem is occurring here too. Most people have a good idea of what a healthy diet looks like, so why is eating (less) such a difficult process? It turns out that every decision we make about eating is influenced by mental and physiological forces that are often outside of our awareness and control.

The path to gluttony looks something like the following. We start with the occasional experience of eating too much— say five handfuls of salted nuts instead of two, or a larger-than-normal portion of dessert, before realising we are uncomfortably full. The way a particular food looks, tastes and feels in our mouth can trick our brain into eating well past necessity from an energy standpoint, and modern foods (think: processed, packaged goods) are especially effective at this deception. The brain response to high-sugar, high-fat foods is much stronger than to foods found in nature. The food industry amps up those responses to a point where our brain is really going to react.

New research is revealing that those occasional bouts of overeating and eating for pleasure, rather than out of hunger, can push us further down the path to gluttony, priming our brain to want that hedonistic experience more and more. Humans who overeat may develop the same patterns of neural activity in areas of the brain associated with rewarding experiences as drug addicts do, and many rodent studies have found that eating high-sugar or high-fat diets prompt cycles of craving and withdrawal along with brain changes similar to those that accompany drug addiction. For many people, these brain changes lead to addiction-like behaviours with certain foods — for instance, consistently consuming more than they intended to or feeling regret and shame after many meals.

Although the concept of food addiction is still controversial, many scientists now believe that considerably more than half the population struggles with its symptoms, in large part because of the widely-available high-sugar, high-fat foods. We may not all be equally at risk or equally vulnerable, but the fact that we’re all in this environment makes us all vulnerable to some degree.

The good news is that knowing how our surroundings push us toward gluttony, we can push back, psyching ourselves into eating less and feeling better. We’re battling an environment that is completely cueing us to eat all the time. The goal is to eat more foods that are minimally processed. Keep that bowl of fruits and vegetables on the counter, the pack of almonds in your purse. In other words, be a glutton for nourishment instead of punishment.

Oops, I Ate the Whole Bag

Eating is at once a great pleasure and a dire necessity. Early studies in the mid-20th century largely focused on the necessity component: scientists successfully teased out how our body regulates our appetite in response to changing energy demands. For instance, when a casual runner starts training for a marathon, s/he needs to consume more calories daily to power her muscles over those longer distances, so his/her appetite increases. This internal regulation is the product of a complex system of hormones and neurotransmitters that make us feel hungry when we need more energy and sated when we have enough in the tank. Past attempts to develop drugs for weight control focused on these appetite mechanisms, but many researchers now feel that was a mistake.

Pioneering neuroscientist food addiction researchers say that they “don’t want people to not eat; we want them to not eat only for pleasure”. By shifting the focus to the hedonistic aspect of eating, scientists in the past two decades have uncovered many additional psychological and neural mechanisms that contribute to overeating—not only in one sitting, when a food’s taste and texture influence our desire to keep eating, but also in the long term, when addiction-like behaviors can set in.

When we bite into, for example, a crisp (chips in Dutch, potato chip in American), the sensory experience is immediate and intense: crunchy, salty, rich. The desire for those crisps depends more on these sensory qualities than the need for sustenance; you will stop eating them when you are tired of putting crunchy, salty things in your mouth. Scientists call that halting point “sensory-specific satiety,” and research has shown that it has nothing to do with metabolic satiety, which is the feeling of “fullness” that signals the body has consumed enough energy. We have all heard the advice to eat slowly, so your body has a chance to sense when it is full—but that takes at least 20 minutes, which is far longer than we typically spend on a snack or a light meal. Sensory-specific satiety theoretically happens a lot sooner, in minutes or even a few bites, explains nutritional scientists.

According to research in the 1990s, sensory-specific satiety is processed in the orbitofrontal cortex, a region of the brain just behind the brow involved in sensory integration, reward processing and decision making. Neurons in that region respond strongly when we first taste a food, and the response gets weaker with each subsequent bite. When a different food is introduced, neuron activity jumps back to the high initial levels, instigating a response that can spur us to eat more even if we are full, as long as the next bite has a radically different sensory profile than what we had previously eaten. In other words, there is always room for dessert. This work suggests that you can reduce your intake by limiting your choices. Try to avoid having a variety of foods in one meal; avoid the ‘smorgasbord’ type buffet.

Over time, on the other hand, you may need some variety to get around another fattening phenomenon. In the first long-term study of sensory-specific satiety published in 2012, nutritional scientists asked 118 study participants to eat either chocolate, hazelnuts or crisps (potato chips) every day for 12 weeks. Afterwards the participants were slower to reach sensory-specific satiety when eating their assigned snack food. The familiar banality of the food, the authors speculate, seems to prevent it from becoming unpalatable. As a result, people robotically consume it. So although it may be wise to stick to one or two foods at every meal, do not eat the same foods day in and day out, or you may gradually eat more, perhaps without knowing it.

Studies on sensory-specific satiety also reveal that the flavour profile of the food you eat makes a dramatic difference in how much of it you want in one sitting. People reach this type of satiety much more quickly when they eat foods that have complex, intense or unfamiliar flavours, as opposed to mild or one-note taste profiles. So if your goal is to eat less without really thinking about it, choose spicy and rich over bland and light: a fiery curry instead of your go-to chicken soup, extra-dark rather than milk chocolate, Granny Smith apples—or better yet, a fruit you have not tried before—over Golden Delicious. The more exciting the flavour, the quicker you will feel satisfied.

When Indulgence Triggers Compulsion

The occasional episode of overeating, in theory, should not be problematic for our body to handle. We should simply feel full longer, as our body waits for the energy it just consumed to get used up before prompting us to eat again. Unfortunately, our survival-focused brain has other ideas. Bingeing was probably useful in our evolutionary past, when food was scarce and our ancestors needed to eat as much as possible after they came across a berry patch or brought down a fresh kill on the hunt. Yet our food environment is quite different today. Now that you can open the refrigerator or go to a supermarket, this response is absolutely unnecessary. But your brain is still operating in a way that is producing a rewarding response. The obese rats had fewer receptors for the neurotransmitter dopamine, which signals pleasure, in the striatum, a brain area activated by rewarding stimuli. Fewer receptors suggest a lowered sensitivity to a substance such as food, an effect that may motivate an animal to consume more to get the same “high.” Similar decreases in dopamine receptors are seen in overweight people, as well as rodents and humans addicted to cocaine and heroin.

Being surrounded by a large variety of extremely delicious food plays a key role in triggering this rewarding brain response in some people. Studies on the rodent equivalent of a nearby open-all-hours supermarket—unlimited access to a variety of high-sugar, high-fat foods—find that this food environment makes rats start eating compulsively. For example, in 2010 neuroscientists reported that rats that could eat whenever they wanted from a buffet of highly palatable foods ate more and more over time, became obese, and showed a disruption of the reward function in their brain compared with control rats fed normal amounts.

Another risk factor for overindulging is, well, having over-indulged. That is, once a person has binged, the behaviour can trigger more of the same. In a study published in 2011 rats bred to be prone to binge eating were compared with those bred to be resistant. As expected, the binge eaters ate uncontrollably when given access to unlimited food, even crossing a metal plate that gave them a foot shock to get to that food. The binge-resistant rats refused to cross the plate—until the researchers began feeding them a cyclic diet of massive amounts of food followed by very little food. These rats then began overeating when given the chance and even endured the shock to get to the food. Being willing to endure pain to get to a desired substance is a hallmark of addiction.

If humans are like rats, then dieters who break a strict diet with a binge may be putting themselves at risk for addiction. The cycle of caloric restraint followed by overindulgence could make the brain even more sensitive to food cues. The psychology of this binge-restrict pattern might rset people up to have an addictive response. Other work suggests that frequently eating extremely palatable food high in sugar and fat may trip a kind of trigger for overeating in the nucleus accumbens, a brain site that evolved to direct us toward things that were evolutionarily advantageous. In previous work, scientists had seen that rats would frantically binge after injections into their nucleus accumbens of a drug that mimicked the neurotransmitter gamma-amino-butyric acid (GABA). Researchers became curious about whether this phenomenon was relevant to ordinary eating behaviour. In a study published very recently it was shown that a high-sugar, high-fat diet prompts the nucleus accumbens of rats to be hypersensitive to GABA. In addition, it was found that injecting endogenous opioid peptides, known pleasure molecules, into the nucleus accumbens induced the same hypersensitivity as the palatable diet. The findings explain how a diet consistently high in sugar and fat can prompt overeating: the repeated rushes of opioid peptides that accompany habitual consumption of pleasurable food sensitise the nucleus accumbens so that a small surge of the omnipresent GABA could bring on a binge. If you eat a little bit and the on switch is sensitised, you might lose con- trol and not be able to stop…..

Sugar Withdrawal?

In 2006 at Brighton Hospital, a substance abuse treatment center in Michigan, then training director John Hopper was noticing something strange about his patients. Many of them had recently had bariatric surgery, such as a gastric by-pass, to lose weight. They had shed kilos—but became saddled with another heavy weight: a drug or alcohol addiction, many for the first time in their lives. Hopper decided to investigate further investigate. In 2010 it was reported that 2 to 6 percent of the hospital’s clients had had bariatric surgery—a rate at least 100 times higher than in the general population, suggesting that something about bariatric surgery puts people at risk for addiction. It is now believed that bariatric surgery removed these patients’ ability to feed their addiction to food— and so they replaced food with a different “drug.” These are middle-aged men and women, of modest or good socioeconomic status, suddenly eating pills or drinking boxes of wine, totally out of control….

In the reverse phenomenon, recovering drug and alcohol addicts tend to gain a lot of weight— as if replacing their drug with food. And it has long been known that food and drugs compete for the same reward systems in the brain, bolstering the argument that food has addictive qualities similar to those of drugs. Some data also suggest that sugars and fats can induce withdrawal: the distress, cravings and pain that can occur when an individual suddenly stops habitually consuming drugs or alcohol. For example, in a study published in 2012 fed rats a high-fat, sugary diet for six weeks. When they abruptly returned the rats to their normal fare, the rodents became anxious, displaying fearful behaviour such as avoiding open areas. They also showed increased motivation to get to either high-fat or high-sugar food: they were willing to press a lever more times to obtain a sugar or fat pellet. In the rats’ brain, the scientists also found elevated levels of certain chemicals characteristic of drug withdrawal. In other experiments, the researchers showed that not all fats lead to these withdrawal signs in rats. The monounsaturated fats present in olive oil and avocados seem to be far less problematic than the saturated types prevalent in butter, red meat and many processed foods. Food addiction is apparently distinct from obesity.

Many food addicts have a normal weight, and the rats in the study displayed withdrawal symptoms without becoming obese. In addition, some obese people are not food addicts. To separate those who might be addicted from those who just tend to gain weight, a food addiction scale was created:

Though intriguing, the idea of food addiction remains unproved. Not all criteria for drug addiction apply when the putative addictive substance is food. We need food to survive in a way we do not need recreational drugs. For example, irritability, lethargy and a tendency to seek out the substance in its absence are not signs of pathology when it comes to food. We may, after all, just be hungry. As a result, experts need to agree on an adjusted definition of addiction in this case. And unlike drugs, food in general cannot be defined as an addictive substance; scientists still need to tease out which foods or ingredient combinations are the most likely to lead to addiction.

Nevertheless, experts agree that certain foods trigger what are clearly addiction-like behaviours in some people. And the food addiction concept is gaining momentum in the face of accumulating data supporting it and new thinking about obesity. In June the American Medical Association officially recognised obesity as a disease. Many experts think acceptance of food addiction cannot be far behind. Some say that if society were to embrace the idea that sugary, fatty foods are dangerous enough to be taxed, regulated and avoided the way cigarettes are today, we would have a better chance of reversing the obesity epidemic.

For now we can use the lessons from recent research to put ourselves on a fitter path. To enlist sensory-specific satiety as an aid, choose flavourful or unusual foods and carefully regulate the amount of food choice you give yourself at any given sitting—and over time. In addition, realise that just walking past a vending machine at work or sitting down in front of the television can trigger a craving. Make sure you are aware of and avoid situations where you are conditioned to eat. A lot of people eat when they are bored or stressed, so instead of turning to food at those times, train your brain to want a more beneficial reward, such as taking a walk. And when you do find yourself unable to resist the junk food— at a party for instance—go ahead and have some but keep your portions moderate. Your small indulgence may prevent a far bigger fall off the wagon.

References:

◆ Further Developments in the Neurobiology of Food and Addiction: Update on the State of the Science. Nicole M. Avena, Jessica A. Gold, Cindy Kroll and Mark S. Gold in Nutrition, Vol. 28, No. 4, pages 341–343; April 2012.

◆ Long-Term Consumption of High Energy-Dense Snack Foods on Sensory-Specific Satiety and Intake. Siew Ling Tey et al. in American Journal of Clinical Nutrition, Vol. 95, No. 5, pages 1038–47; May 2012.

◆ “I Didn’t See This Coming”: Why Are Postbariatric Patients in Substance Abuse Treatment? Patients’ Perceptions of Etiology and Future Recommendations. Valentina Ivezaj, Karen K. Saules and Ashley A. Wiedermann in Obesity Surgery, Vol. 22, No. 8, pages 1308– 1314; August 2012.

◆ Salt, Sugar, Fat: How the Food Giants Hooked Us. Michael Moss. Random House, 2013.

◆ Food Addiction? Special issue of Biological Psychiatry, Vol. 73, No. 9; May 1, 2013.

I love it when science catches up with what we ‘know’ from natural medicine. Recently several studies have caught my attention in which ‘treating the mind’ relieves physical symptoms.

Gastritis and Anxiety

People with gastritis—a blanket term for stomach and intestinal discomfort, including heartburn, nausea and abdominal pain— are nearly twice as likely as the general population to suffer from anxiety and mood disorders, according to a study published in the January Journal of Psychiatric Research. But even in patients with no known mental issues, psychotherapy improves gut health, as research published online in February in the Asian Journal of Psychiatry showed. Study participants with indigestion who received 16 weeks of a therapy aimed at helping them identify and correct dysfunctional interpersonal patterns, called core conflictual relationship theme (CCRT) psychotherapy, saw improvements in all their gastrointestinal symptoms—and their mental health—which lasted for at least a year.

Ulcers and Depression

Renee Goodwin, professor of psychology at Queens College and the City University of New York and co-author of the January gastritis study, and her colleagues are currently researching the relation between ulcers and depression and anxiety. Preliminary data, Goodwin says, suggest that patients treated for depression were much less likely to have an ulcer 10 years later, compared with those who were not treated.

Tinnitus and Stress

Tinnitus, or persistent ringing in the ears, affects 50 million Americans. A study published online in January in Quality of Life Research found that about half of tinnitus sufferers also have mental disorders, confirming the findings of previous research. A 2012 study found that emotional stress more strongly predicts tinnitus than other known risk factors, perhaps because the emotion-processing areas of the brain are closely connected to its auditory systems. A small study in the January Mindfulness found that reducing stress with mindful meditation alleviated tinnitus symptoms and lowered sufferers’ perceived handicap.

Asthma and Depression

Research has hinted at a relation between asthma and depression. In a study published online in Psychosomatic Medicine last year, scientists found that a third of asthma patients also suffer from depression and that those individuals were more likely to have an asthma-related visit to the accident & emergency department over the yearlong study period. The findings suggest that treating depression could make asthma attacks less severe for patients who have both conditions.

Migraine and Panic Disorder

A meta-analysis published in the January Headache: The Journal of Head and Face Pain determined that migraine sufferers are almost four times as likely as nonsufferers to have panic disorder, an anxiety condition characterized by disabling panic attacks. Patients who have both conditions experience more negative effects from migraine, including more frequent attacks and increased disability. Todd Smitherman, a psychologist at the University of Mississippi and co-author of the paper, says there is a “dire need” for studies investigating whether treating panic disorder can reduce the frequency or severity of migraines.

Self-esteem, or a person’s overall sense of self-worth, is generally considered to be critical to healthy functioning. Its darker side, however, has been largely overlooked. The quest for greater self-esteem can leave people feeling empty and dissatisfied. Recent research bolsters the case. Even when we achieve goals we anticipate will make us feel good about ourselves, high self-esteem may still elude us because self-esteem that is dependant on success is fragile.

It turns out that having self-esteem, as a fairly stable personality trait, does have a few modest benefits. High self-esteem also has drawbacks, however, and is mostly irrelevant for success. Further the pursuit of self-esteem is clearly detrimental to well-being. When people chase after a stronger sense of self-worth, it becomes their ultimate goal, leading them to sacrifice other aspirations, such as learning or doing what is good for others.

The hunt for self-esteem through a focus on achievement makes us emotionally vulnerable to life’s inevitable travails and disappointments. It also causes us to engage in behaviours that can actually harm our chances of success, our competence and our personal relationships. A far better way to bolster your sense of self-worth is, ironically, to think about yourself less. Compassion toward others and yourself, along with a less self-centered perspective on your situation, can motivate you to achieve your goals while helping you weather bad news, learn from your mistakes and fortify your friendships.

Rocky Road

Scientists define self-esteem as the amount of value people place on themselves—an inherently subjective assessment. Researchers typically measure this value using self-report scales, including statements such as “I take a positive attitude toward myself,” indicating a positive evaluation of oneself, or “All in all, I am inclined to feel that I am a failure,” denoting a more negative self-appraisal. Someone with a highly favourable overall self-evaluation has high self-esteem; a person who judges himself or herself unfavorably has low self-worth.

Back in the 1980s, many academic psychologists, policy makers and others became concerned about low self-esteem among the populace. They argued that solving this problem would create more productive citizens and lead to fewer social ills such as crime and school failure. The self-esteem movement began. Schools and other institutions poured resources into interventions designed to raise self-esteem, particularly in children. These programs typically centred on lots of positive feedback—irrespective of performance—and exercises in which individuals expounded on their positive qualities. In “I Love Me” lessons, for example, students were encouraged to complete the phrase “I am …” with positive words such as “beautiful” or “gifted.” Those performing below grade level were taught to focus on their potential rather than their shortcomings. In 1986, for example, California allocated $245,000 a year to its Task Force to Promote Self-Esteem and Personal and Social Responsibility, under the assumption that the money would be repaid through lower rates of crime, welfare dependency, unwanted pregnancy, drug addiction and school failure.

Yet even as the self-esteem movement gained momentum, scientific research began to undermine some of its major assumptions. For one, the data did not show that many of us suffer from low self-esteem. On the contrary, most of us already feel pretty good about ourselves. In a study published in 1989 psychologist Roy Baumeister found that the average American’s self-esteem score is well above the conceptual midpoint of self-esteem scales—the point that denotes a moderate or decent view of the self. It would seem that most Americans have decided that they are above average.

What is more, our egos seem to be expanding, not contracting. In a study published in 2008 psychologists concluded that high school students like themselves more now than they did in the 1970s, even though they do not see themselves as more competent than previous generations did. That is, the students do not consider themselves better at math, music, sports or other activities than adolescents did in the past, but they think more highly of themselves anyway.

While documenting a plethora of self-esteem, researchers began to discount its importance. In a comprehensive review of the literature published in 2003 Baumeister stated that people with high self-esteem perform only slightly better academically and at work than do those with low self-esteem. Likewise, self-esteem is only weakly related to children’s popularity in school and tenuously tied to the quality of a person’s relationships in general. It also has little effect on how likely someone is to be violent or engage in risky behaviours such as smoking and drug use.

High self-esteem does have some benefits. It seems to make people more persistent. Those with high self-esteem also reported feeling happier and less depressed. Yet whether high self-esteem causes pleasant feelings, or vice versa, remains unclear.

High self-esteem seems to have at least one serious drawback: difficulty in seeing your own short-comings. A great deal of research conducted for several decades shows that people with high self-esteem tend to have unrealistically positive views of themselves. They think they are more attractive, successful, likable, smart and moral than others do—and are unaware of their deficits or incompetence. When they get negative feedback, they tend to be defensive, blaming the test or the messenger, rather than owning up to a mistake or deficiency. In this way, high self-esteem can impede learning and growth and impair personal relationships. When it comes to your brain surgeon (or spouse, for that matter), most of us would most likely prefer that person to have a realistic view of his or her abilities and a willingness to learn from mistakes—rather than high self-esteem.

“I Didn’t Try Hard”

The studies Baumeister analysed measured the trait of self-esteem with questions that get people to reflect about themselves in general, over time. When people are asked to indicate how they feel “right now” or “today,” self-esteem scores can fluctuate dramatically in response to events. These ups and downs affect motivation, because boosts to self-esteem feel good and drops feel lousy. Like mice looking for crumbs of cheese while steering clear of the mousetrap, people look for opportunities to inflate their self-esteem and avoid situations that could lower it.

One way to get those increases is to succeed or excel; likewise, we can try to avoid the drops by circumventing failure. Because we cannot succeed at everything, people tend to invest their self-esteem in one or a few traits or endeavours, say, academics, sports or beauty. These contingencies of self-esteem represent the areas in which people’s self-worth is on the line; they are worthy if they succeed and worthless if they fail. In 2003 a questionnaire was developed assessing such contingencies as academic success, appearance, others’ approval and moral virtue. People who base their self-esteem on academics, for example, say that their self-esteem goes up when they get good grades but that they feel worthless, anxious and ashamed when their grades are poor.

People who become so personally invested in certain domains are highly motivated to succeed in those realms, which often leads them to work hard. For example, Crocker and Luhtanen found that students whose self-esteem is contingent on academics report studying more than do students who depend less on such reports. On the other hand, putting your self-worth at the mercy of achievement in this way creates emotional vulnerability to setbacks. Even the most successful people sometimes fail or fall short, even at what they do best. Trading off occasional feelings of worthlessness for motivation and the highs of achievement might seem reasonable. Yet the exchange is not even: dips in self-esteem following setbacks appear to be much larger than the increases stemming from success.

In a study published in 2002 Crocker asked 37 university students applying for post-graduate education to fill out a questionnaire to assess how much they based their self-worth on their academic track record, personal appearance, and love of family and friends, among other areas. These students then completed measures of their self-esteem twice a week during the two-month season of post-graduate course admissions. It was found that students whose self-esteem was tightly bound to their academic success experienced small boosts on days when they received an acceptance notice but large drops on days they were rejected. For them, the pain of failure far outweighed the joy of success. The students whose self-esteem did not depend on academic performance experienced markedly less extreme fluctuations in their self-worth; they were better able to weather the storm of positive and negative feedback. Studies show that a similar vulnerability afflicts those whose self-esteem is contingent on appearance or career achievement.

In addition, an uptick in self-esteem is short-lived. Research shows that changes in self-esteem typically do not last more than a few days. Even after major accomplishments, self-esteem quickly returns to its average level. As a result, they are a relatively transient source of happiness. The instability that results from ups and downs of self-esteem, on the other hand, has significant costs to our mental health. In particular, it can lead to symptoms of depression. For example, the fluctuations in self-worth experienced by the post-graduate course applicants were associated with increases in depressed mood, feelings of hopelessness and helplessness, disruptions in appetite and sleep, and loss of motivation.

Perhaps the most pernicious cost of basing self-esteem on achievement is that it can sometimes lead people to focus on avoiding failure rather than reaching for success—a mind-set that can increase the chances of falling short. For example, to protect their self-esteem, people may create excuses for poor performance such as “I didn’t try hard” or “I was tired, sick or upset,” believing that such explanations suggest they could have done well under other circumstances. Yet to work, the excuse must be believable, so a person may stay up late before a test so that the “tired” excuse will be valid in the event they do badly or put off studying until the last moment so they can claim they were underprepared. Social psychologists have coined the phrase “self-handicapping” to describe such behaviour.

Pursuing self-esteem also undermines intrinsic motivation, the type driven by interest in the task itself. Psychologists Edward Deci and Richard Ryan have argued that contingent self-esteem is a form of ego involvement, in which people focus on how successes and failures reflect on the self. Their research, conducted over several decades, shows that individuals who are ego-involved do things such as studying and exercising because they feel that they have to, rather than because they want to. This sense of obligation and pressure takes away the satisfaction that can come from working hard at something difficult.

Personal relationships also suffer from the quest for self-esteem. People focused on boosting their own self-esteem tend to put their own needs before those of others. Because they are preoccupied with questions about their own value, their friends, family and acquaintances serve mainly as potential sources of validation or invalidation, making their interactions with others ultimately all about themselves.

Not all contingencies of self-esteem are equally damaging. Staking self-esteem on personal values such as religious faith or virtue seems to have fewer negative consequences than letting it ride on traits or skills such as appearance or prowess at math that others can measure or judge. The reasons for this discrepancy are not fully understood, but it may result from the fact that those who are driven to prove that they are virtuous or faithful to a religion may be more likely to engage in helpful, collaborative or philanthropic activities that others appreciate. Nevertheless, all such contingencies leave us somewhat vulnerable to the consequences of letting our self-esteem depend so heavily on the particulars that define us.

The Greater Good

Although the pursuit of self-esteem has many negative consequences, it also serves an important purpose: motivating us to action. Without the urge to prove our worth, might we turn into slackers? Fortunately, we can adopt another approach. Instead of focusing on our own status, we can focus on others or the collective good. For example, an individual might work just as hard at the office, but with the primary goal of contributing to the team’s mission or supporting his or her family rather than earning individual recognition. Goals directed at being constructive, supportive and responsive to others lead to feelings of connectedness, closeness to others, social support and trust, as well as reduced feelings of conflict, loneliness, fear and confusion.

Compassionate goals appear to engender a sense of worth and connectedness without the devastating drops that come after feedback suggestive of failure. In a study published in 2011 Crocker examined the consequences of compassionate goals in first year university students and their same-sex roommates. Every roommate rated the extent to which they had compassionate goals such as “be supportive of my roommate” and “be aware of the impact my behaviour might have on my roommate’s feelings”; they also answered a self-esteem questionnaire at the beginning and end of the semester and each week in between. In addition, participants rated their regard for their roommate, how responsive they viewed themselves as being to their roommate’s needs and how responsive they perceived their roommate to be to their own needs.

Students with compassionate goals were more receptive to their roommates’ needs, according to both the student and the roommate. Their roommates noticed and responded in kind, creating a virtuous cycle that solidified the relationship. Furthermore, the more responsive students were, the more their self-esteem increased during the three-month semester. Their roommates’ self-esteem also rose, suggesting that having compassion for others may be an effective strategy for boosting self-esteem over the long run. In contrast, the roommates who were primarily concerned with what their roommates thought about them were less responsive to their roommates, a pattern of behaviour that undermined their self-esteem and that of their roommate.

You can be compassionate toward yourself and others. If you find yourself upset by a mistake or downfall, self-compassion can make for a softer landing for your fall. People with self-compassion treat themselves kindly, as they would a close friend. They are patient with themselves, nonjudgmental and understanding of their own imperfections, according to work by psychologist Kristin. They also avoid harsh self-critiques or negative generalisations about self-worth following one negative experience. Self-compassion helps you accept life’s inevitable setbacks as simply part of what it means to be human. It allows you to see failure as a learning opportunity rather than a threat, something that can motivate you to work toward your goals.

Compassion for the self seems to be linked to compassion for others. In an experiment, research participants were asked to write a note designed to make a friend feel better after causing a minor car accident. Those participants then rated themselves as higher in self-compassion than participants who recalled a fun time or read about others’ suffering.

A further way to reduce an obsession with the self, and the problems that fixation generates, is to use a technique called self-distancing. Using this strategy, you see yourself from the perspective of a third-party observer, the proverbial “fly on the wall,” rather than from inside your own head. In a 2012 study psychologist Ethan Kross asked participants, on each of seven nights, to consider and answer questions about emotional events that had occurred during the previous day. In addition to noting the frequency, intensity and duration of the episodes, the subjects rated to what extent they had adopted a self-immersed versus distanced perspective when reflecting on each one. Those who adopted the distanced viewpoint recovered more rapidly from their negative feelings but also experienced briefer positive emotions than those who adopted the more self-centred outlook. The results suggest that creating mental distance from an emotional situation buffers us from the slings and arrows of fortune.

Another means of alleviating the sting of self- evaluation is self-affirmation, in which people restore their feelings of worth following negative feedback by reflecting on a value in a different realm that is important to them. For example, if someone gets drooped from a sport’s team, she might protect her self-esteem by, say, writing a paragraph about why science is personally meaningful to her or by simply donning a white lab coat. Such behaviours can temper the unpleasant emotions that accompany a critical evaluation. And recent work suggests that this kind of affirmation works best if the value transcends you. For example, thinking about how science can create a better world for all of us has a larger payoff than focusing on how science can win you wealth or status.

All these alternatives to pursuing self-esteem reduce the tendency to judge the self. By focusing on others, having self-compassion or adopting a distanced view of yourself, you can work toward your goals without constant self-evaluation and self-criticism. If we were to design a new self-esteem movement, it would teach people to reduce focus on the worth of the self altogether because any action designed to enhance self-esteem is destined to have, at best, temporary benefits and most likely will fail because such actions are motivated by a toxic preoccupation with self-judgment.

Helping others may make you feel good about yourself but only if you let go of what this means about you. If you are wondering, “Do I have worth?” “Do I have value?” the answer is not yes, no or maybe. The answer is simpler: change the subject ;=)

References:

◆Does High Self-Esteem Cause Better Performance, Interpersonal Success, Happiness, or Healthier Lifestyles? R. F. Baumeister, J. D. Campbell, J. I. Krueger and K. D. Vohs in Psychological Science in the Public Interest, Vol. 4, No. 1, pages 1–44; 2003.

◆The Curse of the Self: Self-Awareness, Egotism, and the Quality of Human Life. Mark R. Leary. Oxford University Press, 2007.

◆Transcending Self-Interest: Psychological Explorations of the Quiet Ego. Edited by Heidi A. Wayment and Jack J. Bauer. American Psychological Association, 2008.

◆Crocker Laboratory: http://faculty.psy.ohio-state.edu/crocker/lab/ index.php

◆Learning as Leadership: http://learnaslead.com

◆Letting Go of Self-Esteem. J. Crocker and J. J. Carnevale.Scientific American Mind, vol. 24, nr. 4, Sept/Oct 2013 pages 26-33.

September brings with it another acamdemic year – a time when the children go back at school, universities start up again, and people go back to work after the summer break. Each year at this time I notice the whiff off ‘wanting to learn’ wafting around in my surroundings. Not just my own curiosity but those of other people around me. It seems that the end of summer and the start of Autumn heralds cooler indoor days and time to embark on something new.

In spite of all the learning done in educational institutions, one thing we typically never study is the art of studying itself. In this month’s On the Border, I have combed through some of the scientific literature on learning techniques to identify the two methods that work best.

Education generally focuses on what you study, such as maths, the elements of the periodic table or how to conjugate verbs. But learning how to study can be just as important – and with lifelong benefits. It can teach you to pick up knowledge faster and more efficiently and allow you to retain information for years rather than days.

Cognitive and educational psychologists have developed and evaluated numerous techniques, ranging from re-reading to summarising to self-testing, for more than 100 years. Some common strategies markedly improve student achievement, whereas others are time-consuming and ineffective. Yet this information does not seem to be making its way into the classrooms and lecture theatres. Teachers today (even neuroscience and psychology professors!) are not being told which learning techniques are supported by experimental evidence, and students are not being taught how to use the ones that work well.

Both methods help learners of various ages, abilities and levels of prior knowledge—and they have been tested in a classroom or other real-world situation. Learners can use the methods to master a variety of subjects, and they also result in long-lasting improvements in knowledge and comprehension. Perfect!

1.SELF-TESTING: Quizzing Yourself Gets High Marks

HOW IT WORKS:

Unlike a test that evaluates knowledge, practice tests are done by students on their own, outside of class. Methods might include using flash cards (physical or digital) to test recall or answering the sample questions at the end of a textbook chapter. Although most students prefer to take as few tests as possible, hundreds of experiments show that self-testing improves learning and retention.

In one study, undergraduates were asked to memorise word pairs, half of which were then included on a recall test. One week later the students remembered 35 percent of the word pairs they had been tested on, compared with only 4 percent of those they had not. In another demonstration, undergraduates were presented with Swahili-English word pairs, followed by either practice testing or review. Recall for items they had been repeatedly tested on was 80 percent, compared with only 36 percent for items they had restudied. One theory is that practice testing triggers a mental search of long-term memory that activates related information, forming multiple memory pathways that make the information easier to access.

WHEN DOES IT WORK?

Anyone from pre-schoolers to fourth-year medical students to middle-age adults can benefit from practice testing. It can be used for all kinds of factual information, including learning words in foreign languages, making spelling lists and memorising the parts of flowers. It even improves retention for people with Alzheimer’s disease. Short, frequent exams are most effective, especially when test takers receive feedback on the correct answers.

Practice testing works even when its format is different from that of the real test. The beneficial effects may last for months to years— great news, given that durable learning is so important.

IS IT PRACTICAL?

Yes. It requires modest amounts of time and little to no training.

HOW CAN I DO IT?

Students can self-test with flash cards or by using the Cornell system: during in-class note taking, make a column on one edge of the page where you enter key terms or questions. You can test yourself later by covering the notes and answering the questions (or explaining the keywords) on the other side.

RATING:

High utility. Practice testing works across an impressive range of for- mats, content, learner ages and retention intervals.

2. DISTRIBUTED PRACTICE: For Best Results, Spread Your Study over Time

HOW IT WORKS:

Students often “mass” their study—in other words, they cram. But distributing learning over time is much more effective. In one classic experiment, students learned the English equivalents of Spanish words, then reviewed the material in six sessions. One group did the review sessions back to back, another had them one day apart and a third did the reviews 30 days apart. The students in the 30-day group remembered the translations the best. In an analysis of 254 studies involving more than 14,000 participants, students recalled more after spaced study (scoring 47 percent overall) than after massed study (37 percent).

WHEN DOES IT WORK?

Children as young as age three benefit, as do undergraduates and older adults. Distributed practice is effective for learning foreign vocabulary, word definitions, and even skills such as mathematics, music and surgery.

IS IT PRACTICAL?

Yes. Although text-books usually group problems together by topic, you can intersperse them on your own. You will have to plan ahead and overcome the common student tendency to procrastinate……

HOW CAN I DO IT?

Longer intervals are generally more effective. In one study, 30-day delays improved performance more than lags of just one day. In an Internet-based study of trivia learning, peak performance came when sessions were spaced at about 10 to 20 percent of the retention interval. To remember something for one week, learning episodes should be 12 to 24 hours apart; to remember something for five years, they should be spaced six to 12 months apart. Although it may not seem like it, you actually do retain information even during these long intervals, and you quickly re-learn what you have forgotten. Long delays between study periods are ideal to retain fundamental concepts that form the basis for advanced knowledge.

RATING:

High utility. Distributed practice is effective for learners of different ages studying a wide variety of materials and over long delays. It is easy to do and has been used successfully in a number of real-world classroom studies.

References:

◆ Ten Benefits of Testing and Their Applications to Educational Practice. H. L. Roediger III, A. L. Putnam and M. A. Smith in Psychol- ogy of Learning and Motivation, Vol. 55: Cognition in Education. Edited by Jose P. Mestre and Brian H. Ross. Academic Press, 2011.

◆ Interleaving Helps Students Distinguish among Similar Concepts. D. Rohrer in Education- al Psychology Review, Vol. 24, No. 3, pages 355–367; September 2012.

◆ Using Spacing to Enhance Diverse Forms of Learning: Review of Recent Research and Implications for Instruction. S. K. Carpenter, N. J. Cepeda, D. Rohrer, S.H.K. Kang and H. Pashler, ibid., pages 369–378.

◆ When Is Practice Testing Most Effective for Improving the Dura- bility and Efficiency of Student Learning? K. A. Rawson and J. Dunlosky, ibid., pages 419–435.

◆ What Works, What Doesn’t. J. Dunlosky, K. A. Rawson, E. J. Marsh, M. J. Nathan and D. T. Willingham. Scientific American Mind, vol. 24, nr. 4, Sept/Oct 2013 pages 47-53.

◆“Improving Students’ Learning with Effective Learning Techniques: Promising Directions from Cognitive and Educational Psychology,” on which this story for Scientific American Mind is based, at the Association for Psychological Science’s Web site: www.psychologicalscience.org

Traditionally psychologists have attributed negative body image to pictures in the media of unusually thin or beautiful people with whom the rest of us compare our own physique. In June 2011 the American Medical Association released a statement that urged advertisers to stop the use of digitally altered photographs after researchers found links among exposure to mass media, negative body image and disordered eating.

The impact of distorted body image is widespread. Almost half of adolescent girls report being dissatisfied with their appearance, and the number of males reporting serious body image dissatisfaction is also on the rise (although the exact number of males thousands suffer from a clinical body image disturbance such as an eating disorder or body dysmorphic disorder, in which people cannot stop thinking about minor or imaginary “flaws” in their appearance.

Yet the question remains: Given that everyone is exposed to images of presumably perfect bodies, why don’t we all have serious trouble with body image? Research indicates that various biological and environmental factors must come together to create a problem. One of the more recently studied, and perhaps biggest biological contributors, is difficulty with interoception. Interoception informs us of emotions, pain, thirst, hunger and body temperature. People vary on how well they receive such cues. A deficit in this internal sense plays a leading role in the development of anorexia, bulimia and body dysmorphic disorder. Identifying this sensory defect as a major contributor to these ailments suggests new treatments that could speed recovery.

Internal Difficulties

We know whether we are full or hungry, hot or cold, itchy or in pain when receptors in the skin, muscles and internal organs send signals to a region of the brain called the insula. This small pocket of neural tissue is nestled in a deep fold of the brain’s external layer near the ears. It cultivates an awareness of the body’s internal state and, in doing so, plays an important role in self-awareness and emotional experience. Interoceptive data combine in the insula with external information about the body. This region will, for example, connect the sharp pain we experience when touching a hot stove with the red welt that appears on our palm. This integration forms our body image—that is, what we think we look like.

The greater the contribution from interoception as opposed to external, visual cues, the better a person’s body image. A runner with good interoception, say, might focus on the steady thud of her heart and the jolt of her feet against pavement, cues she might use to guide the speed and length of her run. By paying attention to how her body is functioning, the runner feels good about it no matter its exact proportions. A runner with poor interoception, on the other hand, might be thinking about whether onlookers notice the jiggling of her thighs. Because she has little internal input to anchor her sense of self, she can become overly concerned with small visual details, potentially resulting in a diminished body image. Someone with body dysmorphic disorder also lacks this sense of self, inadvertently causing him to focus more on what his nose looks like than how his nose feels on his face.

Distorted body image—known formally as body dysmorphia—can range from mild worries about whether these jeans make one’s bum look fat to an almost delusional misinterpretation of body size and shape as seen in anorexia nervosa and body dysmorphic disorder. People can also have misconceptions in the reverse direction: In a 2010 study almost one in 10 obese adults thought their weight was normal. One explanation for the positive distortion in body shape in these individuals is poor interoception.

In 2004 neuroscientists developed a way to easily and reliably measure this internal experience. Healthy subjects were asked to try to count their heartbeats without taking their pulse while researchers electronically monitored their heart rate. The investigators found that the people whose guesses were closest to their real heart rates also scored highest on other measures of interoceptive awareness, such as questionnaires and brain scans of insula activity.

These heartbeat tests correlated well with how people judged other physiological changes, like feelings from their stomachs. Even those who are good at sensing their internal state do not know they have this talent because they have no way to compare themselves with others. As a result, most people who take the heartbeat test are at least somewhat surprised by their score. (To take the heartbeat test yourself, see the FREEBIE section)

Image Issues

The score does matter. Differences between women in interoceptive skill predict their level of body satisfaction. In a study last year, 214 college-age females were given tests for psychological problems ranging from social anxiety to disordered eating. They found that those who scored lower on measures of interoceptive ability had not only higher levels of body dissatisfaction but also more symptoms of eating disorders than those who were more in tune with their body.

People with anorexia have problems interpreting hunger and fullness cues. Someone with damaged interoception may not be able to physically sense her weight loss and so persists in thinking her body weight is normal or high even as she becomes emaciated. In anorexia patients, these difficulties extend to all areas of interoception: when they perform the heartbeat task, they typically do worse than people without the disorder.

In a study published in 2008 it was found that 28 anorexic women were about 68 percent accurate in sensing their heart rate compared with a 77 percent accuracy rate for women who did not have an eating disorder. This result represents a significant difference in interoceptive ability. Besides being worse at interoception, the anorexic women also had more psychological problems, such as depression and anxiety, lower body weights and significantly higher body dissatisfaction. (Virtually all the imaging studies done in anorexia patients have involved women because of the low number of males diagnosed with the illness.)

Underlying the interoceptive issues of anorexic individuals may be an unresponsive insula. In a study published in 2005 functional MRI was used to scan the brains, at rest, of 12 women who had recovered from anorexia nervosa. They found diminished blood flow—suggesting lower activation—in the insula of these women relative to 11 control subjects who had never had anorexia. An fMRI study published in 2003 had shown similar results. Both studies suggest that recovered anorexics are relatively slow to process interoceptive information, a bottleneck that likely leads to less input to their brain about their body and may complicate the recovery process.

Outside Influences

In addition to interpreting internal cues at rest, the insula typically responds with a burst of activity when a person is looking at a picture of herself. When normal, healthy women see photographs of themselves, blood rushes to the insula, suggesting that the picture enhances a person’s experience of what it is like to be inside her own body.

In anorexic women, however, the insula remains mute, even when prodded by such images. In a study published in 2008, researchers asked 10 anorexic women and 10 other females to view photographs of themselves and of others while in an MRI machine. Although seeing images of themselves caused a boost in insula activity in the healthy women, no such increase in activity appeared in the anorexic women (see MRI images below).

This finding hints that anorexics lack the ability to link external cues about their appearance to internal knowledge of their body, which was likely minimal in the first place. (The differences disappeared when the women looked at pictures of other people: in both groups, the insula was quiet.)

Compounding the problem, deficiencies in interoception may make your body image more vulnerable to other visual influences. In a 2011 study 46 female college students were tested using an unusual type of visual cue: a rubber hand. In what is known as the rubber hand illusion, a person can be made to feel as if a rubber hand is part of his body by having him place both hands on a table and blocking his view of the left hand with a cardboard divider. Immediately to the right of the divider, an experimenter places a lifelike rubber hand. Then he or she gently strokes both the person’s left hand and the rubber one with a small paintbrush. After a minute or two, many people begin to believe that the rubber hand is their real hand. Amazingly, the temperature of the left hand also drops significantly, suggesting that the brain loses ownership of the real left hand and gains ownership of the rubber hand.

Based on the results of the heartbeat test, the women were split into two groups: those with high scores—the group average was better than 80 percent—and those whose scores were below 50 percent. They found that the females with lower bodily awareness could more easily be fooled into thinking that a rubber hand was part of their body. Similarly, researchers think media images of thin women will have an outsize effect on those who lack internal awareness. People with good interoception, with their solid sense of themselves, would be less affected by seeing someone skinnier or, by some standards, more attractive than they are.

People with body dysmorphic disorder may have an additional perceptual problem. Evidence suggests they have visual-processing abnormalities that distort what they see. This distortion probably combines with low interoception to create a particularly poor body image.

Those who lack a keen awareness of their internal state also seem to be easily swayed by the opinions of others. They may evaluate their goals and attributes based on how they think others perceive them rather than by their own standards. In a study in 2004 scientists asked adult women with body dysmorphic disorder to recall specific memories from childhood. The researchers found that these women were significantly more likely to relate personal experiences as if they were happening to someone else. Instead of describing an event using a first-person perspective (for instance, “I saw …”), the patients with body dysmorphic disorder told the story as if they were a narrator in a novel (“this happened …”). Building better interoceptive awareness, then, could not only improve body image, it could also bolster a fragile sense of self.

Minding the Body

One way to increase your internal sense is to practice mindfulness, a mental mode characterized by attending fully to the present moment without elaboration or judgment. In numerous studies in the past decade researchers have found that incorporating mindfulness training into cognitive-behaviour therapy and other treatments for eating disorders and body dysmorphic disorder has diminished symptoms and enhanced quality of life. Training people to closely heed their current, ongoing physical sensations may improve their interoception, scientists theorize.

Recent studies have tested yoga as a potential therapy for eating disorders. Certain forms of yoga, such as hatha or vinyasa yoga, encourage the participant to focus on both their breathing and the different bodily sensations produced by each pose—practices central to mindfulness.

In 2010 clinical psychologists assigned 27 adolescents receiving outpatient eating disorder treatment to eight weekly hour-long yoga sessions. The researchers hoped that by focusing their attention on the yoga poses and their own body, the adolescents would decrease their obsessions with food and weight.

The strategy seemed to work. At the start of treatment, these adolescents were so disconnected from their body that they had trouble balancing on one foot. After eight weeks of yoga, the teens had gained enough interoceptive skills to easily find their balance. They also showed greater improvements in all areas of eating disorder psychopathology, including body dysmorphia, than did 27 similarly afflicted youth who did not take yoga. It appears that yoga helps to give the young people a way to be more in tune with their body.

References:

Functional Neuroimaging in Early-Onset Anorexia Nervosa. B. Lask et al. in International Journal of Eating Disorders, Vol. 37, S49–S51; 2005. Discussion on pages S87–S89.

Randomized Controlled Clinical Trial of Yoga in the Treatment of Eating Disorders. T. R. Carei, A. L. Fyfe-Johnson, C. C. Breuner and M. A. Brown in Journal of Adolescent Health, Vol. 46, No. 4, pages 346–351; April 2010.

Just a Heartbeat Away from One’s Body: Interoceptive Sensitivity Predicts Malleability of Body-Representations. M. Tsakiris, A. Tajadura-Jiménez and M. Costantini in Proceedings of the Royal Society B, Vol. 278, pages 2470–2476; August 22, 2011.

Inside the Wrong Body. C. Arnold. Scientific American Mind (May/June 2012), Vol. 23, pages 36-41.

The Dalai Lama is reknown for his interest in neuroscience. When I stumbled across this very recent article by top neuroscientist Christof Koch about his experience with the Dalai Lama, I knew that I had to share this with you all. So here it is, cut & pasted without apology straight into my newsletter :=)

“Knowledge can be communicated, but not wisdom. One can find it, live it, do wonders through it, but one cannot communicate and teach it.”

This line from Herman Hesse’s 1922 novel Siddhartha came unbidden to me during a recent weeklong visit to Drepung Monastery in southern India. His Holiness the Dalai Lama had invited the U.S.-based Mind and Life Institute to familiarize the Tibetan Buddhist monastic community living in exile in India with modern science. About a dozen of us—physicists, psychologists, brain scientists and clinicians, leavened by a French philosopher—introduced quantum mechanics, neuroscience, consciousness and various clinical aspects of meditative practices to a few thousand Buddhist monks and nuns. As we lectured, we were quizzed, probed and gently made fun of by His Holiness, who sat beside us [see photograph; Christof Koch is the suited man by the Mac laptop]. We learned as much from him and his inner circle—such as from his translator, Tibetan Jinpa Thupten, who has a doctor- ate in philosophy from the University of Cambridge, and from the French monk Matthieu Ricard, who holds a Ph.D. in molecular biology from the Pasteur Institute in Paris—as they and their brethren from us.

What passed between these representatives of two distinct intellectual modes of thinking about the world were facts, data—knowledge. That is, knowledge about the more than two-millennia-old Eastern tradition of investigating the mind from the inside, from an interior, subjective point of view, and the much more recent insights provided by empirical Western ways to probe the brain and its behavior using a third-person, reductionist framework. What the former brings to the table are scores of meditation techniques to develop mindfulness, concentration, insight, serenity, wisdom and, it is hoped, in the end, enlightenment. These revolve around a daily practice of quiet yet alert sitting and letting the mind settle before embarking on a specific program, such as “focused attention” or the objectless practice of generating a state of “unconditional loving-kindness and compassion.” After years of daily contemplative exercise—nothing comes easily in meditation—practitioners can achieve considerable control over their mind.

Twelve years of schooling, four years of college and an even longer time spent in advanced graduate training fail to familiarize our future doctors, soldiers, en- gineers, scientists, accountants and politicians with such techniques. Western universities do not teach methods to enable the developing or the mature mind to become quiet and to focus its considerable powers on a single object, event or train of thought. There is no introductory class on “Focusing the Mind.” And this is to our loss!

From introspection, we are all familiar with the mental clutter, the chatter that makes up our daily life. It is a rapid fire of free associations, of jumping from one image, speech fragment or memory to the next. Late-night lucubrations are particularly prone to such erratic zigzagging. Focusing on a single line of argument or thought requires deliberate, laborious and conscious effort from which we flee. We prefer to be distracted by external stimuli, conversations, radio, television or newspapers. Desperate not to be left alone within our mind, to avoid having to think, we turn to our constant electronic companions to check for in-coming messages.

Yet here we had His Holiness, a 77-year-old man, who sat during six days, ramrod straight for hours on end, his legs tucked under his body, attentively following our arcane scholarly arguments. I have never experienced a single man, and an entire community, who appeared so open, so content, so happy, constantly smiling, yet so humble, as these monks who, by First World standards, live a life of poverty, deprived of most of the things we believe are necessary to live a fully realized life. Their secret appears to be mind control.

Among the more extreme cases of mind control is the self-immolation of the Vietnamese Buddhist monk Thich Quang Duc in 1963 to protest the repressive regime in South Vietnam. What was so singular about this event, captured in haunting photographs that are among the most readily recognized images of the 20th century, was the calm and deliberate nature of his heroic act. While burning to death, Duc remained throughout in the meditative lotus position. He never moved a muscle or uttered a sound, as the flames consumed him and his corpse finally toppled over.

I am filled with utter bewilderment in the face of this singular event and would have found it difficult to accept as real, were it not captured in the testimony of hundreds of onlookers, including jaundiced journalists with their cameras.

Brain Basis of Mind Control

A step toward a brain-based explanation of this extraordinary phenomenon comes from a recent scanning experiment by Fadel Zeidan, Robert C. Coghill and their colleagues at the Wake Forest School of Medicine. Fifteen volunteers were recruited to lie in a scanner while a small metal plate was attached to their right calf. As its temperature varied from pleasant (near body temperature) to painful (49 degrees Celsius), subjects had to rate both pain intensity and pain unpleasantness of the noxious stimulus. Predictably, the hot probe triggered increased hemodynamic activity in structures that are known to be involved in pain processing, such as the primary and secondary somatosensory cortices that represent the leg, as well as more frontal structures, the anterior cingulate cortex and the insula. Subsequently, the volunteers underwent four days of 20 minutes’ daily practice of mindfulness meditation involving focused attention or the Buddhist mind-calming practice called shamatha. In the latter, the practitioner focuses attention on the changing sensations of her breath, noting thoughts, pictures and memories as they arise from their inner source, but without any emotional engagement. This exercise frees her to quickly disengage from them to return attention to monitoring her breathing.

Practicing mindfulness during the noxious stimulation reduced the unpleasantness of the pain by a whopping 57 percent and its intensity by 40 percent. And this after only minimal training (four times the 20 minutes). Of course, it is a far cry from attenuating the unthinkable agony of burning to death, but still. Mindfulness exerts its effect by promoting a sense of detachment and by reducing the subjectively experienced saliency of the heated metal plate. Yet how does it work in the brain?

Pain-related activity in the primary and secondary somatosensory cortices was reduced by the meditation. Those subjects who experienced the greatest reduction in the intensity of their pain had the largest increase of activity in their right insula and both sides of their anterior cingulate cortices. Subjects with the greatest reduction of the unpleasantness of the pain—which is what most people care about— exhibited the greatest activation of regions in the orbitofrontal cortex and the largest reduction in the thalamus (gating the incoming sensory information).

Think of mindfulness, think of all meditations, as mental skills to control emotions and to shape the impact that external events, such as sight, sound or heat, have on the sensory brain. Select prefrontal regions in the practitioner’s brain reach all the way down to the thalamus to reduce the flood of incoming information from the periphery, leading to a lessening of the pain. These skills to steer the mind are not magical, otherworldly or transcendental. They can be learned by sufficiently intensive practice. The only question is whether our instruments are always sufficiently sensitive to pick up their footprints in the brain.

In 2008 Richard J. Davidson and his group at the University of Wisconsin– Madison published a classic study with the active participation of Ricard and other Buddhist monks. The cognitive scientists fitted skullcaps with 128 electro-encephalographic (EEG) electrodes to the heads of eight long-term Buddhist practitioners and 10 student volunteers. The former were asked to attain a state of “unconditional loving-kindness and compassion” (a form of meditation that does not focus on a single object and is sometimes referred to as “pure compassion”), whereas the volunteers thought about somebody he or she deeply cared about and then tried to generalize these feelings to all sentient beings.

The onset of meditation in the monks coincided with an increase in high- frequency EEG electrical activity in the so-called gamma band (spanning 25 to 42 oscillations a second), which was synchronized across the frontal and parietal cortices. Such activity is thought to be the hallmark of highly active and spatially dispersed groups of neurons, typically associated with focusing attention. Indeed, gamma activity in these monks is the largest seen in nonpathological conditions and 30 times greater than in the novices. The more years the monks had been practicing meditation, the stronger the (normalized) power in the gamma band.

More important, even when the monks were not meditating, but simply quietly resting, their baseline brain activity was distinct from that of the students. That is, these techniques, practiced by Buddhists for millennia to quiet, focus and expand the mind—the interior aspect of the brain—had changed the brain that is the exterior aspect of the mind. And the more training they had, the bigger the effect.

Yet knowing about meditation and its effect on the brain is not the same as benefiting from it and not the same as achieving wisdom. So just like the young Siddhartha in Hesse’s novel, I left the monastic community richer in knowledge about a different way to look at the world but continuing to strive.

It is quite incredible that even though scientists have been studying strokes for decades, the only intervention available is a drug that breaks up blood clots, and only a small number of patients benefit from it. Brain damage is unfortunately inevitable in most cases. However, new research in rat studies has shown that they were saved from brain damage after a stroke when neuroscientists simply touched their whiskers or played sounds in their ear.

The new research offers the tantalising possibility of a low-tech, inexpensive treatment that could be dispensed immediately, anywhere, and by anyone. Although translating these interventions into human treatments means overcoming significant hurdles, the revolutionary finding has invigorated a field fraught with dead ends and lackluster results.

Stumped for Treatments

A stroke happens when a sudden loss of blood causes a part of the brain to stop working. The blood shortage may arise from either of two main causes: a blood clot or a hemorrhage. More than three quarters of strokes are clot-based or ischemic; the rest are hemorrhagic, in which a blood vessel bursts inside the brain. In both types, cells downstream of the clot or eruption are cut off from the vital supply of nutrients and oxygen.

The lack of treatments for stroke certainly is not for lack of research efforts. More than 1,000 compounds have been studied in animal models, but the dozens that have gone on to human clinical trials have all failed except one. Tissue plasminogen activator (tPA), the only treatment for stroke approved by the Food and Drug Administration, attempts to unblock a clogged blood vessel by breaking up the clot. It must be given in the first couple of hours after stroke, turning treatment into a game of beat the clock. Although tPA is potentially lifesaving for someone having an ischemic stroke, the clot-busting drug would spell disaster for someone with a hemorrhagic stroke, where clots must form to stop the bleeding. To make sure the wrong people do not get tPA, patients must undergo a brain scan before receiving the medication—a time-consuming step that delays treatment, disqualifying most patients.

Clot busters are one of the two main types of treatments that researchers have attempted to develop over the years. The other is neuroprotective agents, which employ a wide variety of brain-saving strategies, including dampening electrical activity and halting signaling molecules within brain cells. The wide range of approaches speaks to the complexity of the processes at work in the stroke-damaged and recovering brain. When brain cells go too long without access to oxygen-rich blood, catastrophe ensues: the balance of charged particles inside and outside cells is upset, a harmful amount of calcium flows into cells, and electrical activity runs rampant, leading to a dangerous state called excitotoxicity. Next, cell membranes break down, and free radicals—reactive particles that damage cells and DNA—build up. These events trigger programmed cell death, during which genetic material and cellular structures are destroyed. Even surviving cells surrounding the affected area are in danger; the sudden flood of oxygen and nutrients that follows a successful dissolution of a clot can further skew the delicate ecosystem of the brain and spread the damage wider.

Researchers have attempted to develop neuroprotective drugs aimed at certain elements of these destructive cascades, with little success thus far. Still, experts are hopeful; early failures could have been because of poor guesses about dosage or time frames. Efforts aimed at neuroprotection continue today; for example, a clinical trial called FastMag, headed by clinical stroke expert Jeffrey Saver of U.C.L.A., is in its final stages. In this trial, ambulance personnel give patients an injection of magnesium ions in an attempt to quell the brain’s hyper-excitability immediately after a stroke.

Stroke experts agree that the best form of neuroprotection is to restore blood flow to the area cut off by the stroke—and fast. To that end, an epiphany of sorts hit researchers when they realised that blood vessels in the brain look more like a connected matrix of loops than like a tree with branches. Vessel structure is more like the streets of a large busy city: when there is a lorry parked in the middle of a road so that you can’t get through, then you try to take another road. Figuring out how to get blood rerouted through these existing networks in the brain could very well be the key to keeping cells alive—but until now, researchers had no idea how to harness this network.

Recruiting Nearby Blood Vessels

Serendipitously, neuroscientists at U.C. Irvine discovered that the brain’s blood vessel supply might be at the beck and call of the very neurons it serves, providing a built-in defense against stroke. Five years ago Frostig, who studies neuroplasticity at U.C. Irvine, had set out to test whether rats that were allowed to actively explore a natural environment might recover better after a stroke. ‘Enriched environments’ or ‘enriched experiences’ have been found to improve brain health and function in many settings, particularly in rehabilitation. To mimic the occurrence of a stroke, Frostig and his team cut the middle cerebral artery (MCA), a major blood supply route, in an anesthetised rat. Immediately after cutting the MCA, they wanted to get a baseline measure of stroke-damaged brain activity, so they used a mechanical device to wiggle one of the rat’s whiskers and simultaneously gauged the activity of the corresponding neurons in the cortex. They expected this baseline activity to be utterly destroyed by the stroke, and they hoped it might improve over time as the rat recovered.

Instead, during the stroke and a day later, the neurons looked and acted completely normal. Frostig was shocked; even the most promising therapeutic agents typically provide just marginal defense against stroke in lab animals. Only half-joking, he asked postdoctoral fellow Christopher Lay whether he was sure he had cut the artery. But after the result held up in 30 animals, they realised that something important was going on. The neurons were completely protected. Eventually the researchers concluded that by stimulating that single whisker immediately after stroke, they had prevented any stroke-related brain damage.

Once Frostig and his team were convinced their results were real, they looked for signs of damage, and they looked hard. They first reported in 2010 that they could find no difference between the brains of rats with a wiggled whisker and control rats that had no interruption to their blood supply. A staining technique revealed no damage; brain imaging showed functional blood flow to the affected area; even direct recordings of the neurons activated by whisker movement showed the area was electrically active and healthy. And the animals behaved normally on waking. But the rats were protected only when they were stimulated within an hour or two of the stroke—any later, and they actually suffered worse damage than unstimulated rats.

The time window seems to be critical. In subsequent research published in 2011, it was confirmed that timing—not duration or pattern—of stimulation is key. Past the three-hour mark, stimulation does more harm than good. It is not yet known what is the underlying cause of this three-hour switch. Although other animal studies have revealed that some molecules are destructive early in an attack but required for remodeling and recovery at later stages, many questions remain.

So why does wiggling a whisker save the brain? Frostig suspected that the sensory experience activates the very cortex that was deprived of blood flow. The key issue is neuronal activity. This flurry of activity and its attendant demand for oxygen recruited an alternative blood supply. Along with two other major arteries, the MCA supplies blood to the cerebral cortex, its trunk splitting into progressively smaller branches. At their tips, the fine branches of these vascular trees interconnect with one another, forming a vast network. Blood does not normally flow through these loops, but Frostig’s investigation using advanced brain imaging showed that after the stroke the rats’ neuronal activity indeed recruited blood via these alternative routes. When Frostig sealed off the MCA network’s collateral branches—in addition to cutting their supply trunk—no amount of stimulation could save the cortex.

Researchers do not yet know how, exactly, neuronal activity evokes the change in blood flow. Current research is investigating non-neuronal cells called astrocytes, which are closely coupled to blood vessels in the brain and seem to be involved in signaling for oxygen and nutrients. In the meantime, Frostig and his colleagues are investigating whether other types of sensory input can protect the brain as well. He has more recently found that auditory stimuli—bursts of white noise—also protected from stroke, though not as completely as whisker stimulation. This is probably because whereas whisker stimulation “tickles” much of the blood-starved cortex, sound activates only the auditory cortex at the edge of the affected area.

A Much Needed Breakthrough

Moving from rodents to humans is a challenge for any therapy, and experts, including Frostig, are cautious about predicting a future of sensory-stimulated recovery for people. But hope-starved stroke researchers cannot help but be enthusiastic. The beauty is that it’s cheap and nontoxic! And the treatment remains effective even as Frostig’s group has systematically expanded testing to address some of the differences between the response of humans and lab rats. The team has made sure that awake and anesthetised animals are protected because an estimated 70 percent of strokes occur in awake people. In his 2012 paper, Frostig’s team showed that elderly rats were protected as well as the juvenile animals commonly used in lab research; in humans, age is the number-one risk factor for stroke. Furthermore, the protection held up in rats that got sensory stimulation by exploring their environment and whose whiskers had been removed— a good thing for whiskerless humans.

Most important, by studying ischemic attack in the territory of the brain supplied by the MCA, Frostig is investigating the conditions that account for the vast majority of human strokes.

One big challenge for this treatment to overcome is that humans do not have an exact analogue to the barrel cortex, the area in a rat’s brain dedicated to sensing whisker movements. This area is huge in rats; in humans, the closest equivalent would be the cortical real estate dedicated to the fingers and lips. Because the relative size of our sensory cortex is much smaller than that of rats, Frostig predicts sensory stimulation of more than one type might be required. “Sing to them, stroke their hands, their face—while you’re calling the ambulance,” Frostig says. Engaging someone in whatever stimulation possible might increase the chance of activating—and thereby protecting—more cortex. As for that ambulance ride, which itself is noisy, it alone may not help, because ambulance personnel do not necessarily make a point of actively engaging a patient. Taking sensory stimulation to that next level, such as by caressing the patient’s face and hands, might make all the difference.

Frostig’s work shows promise for circumventing some of the other inherent problems in stroke treatment, too. Sensory stimulation is unlikely to be derimental to someone with a hemorrhagic stroke, eliminating the need for time-consuming brain scans. If the treatment indeed reroutes blood flow, it could aid in the delivery of therapeutic drugs, including tPA—a major challenge in stroke treatment today. And the new finding underscores the importance of timing. People who miss the critical window for treatment, for instance, because they wake up from a night’s sleep having had a stroke, might benefit from little or no stimulation at all—no sirens wailing, no medical team barking orders, no constant barrage of questions and tests.

Human trials based on Frostig’s work are still far away—first the idea needs to be tested in larger animals such as monkeys or pigs. It could be years before we know if sensory stimulation can do for people even a fraction of the good it does for rats. But as the quest continues for clot busters and neuroprotectants, for new techniques and technology, stroke experts across the board agree that fresh ideas are welcome.

So if you find your in a situation with someone who is having a stroke, go ahead and sing to them, caress their hands and face; if nothing else, they will feel comforted at a scary time. And you might just save their brain.

See you again in July!

References:

◆ Update of the Stroke Therapy Academic Industry Roundtable Pre­ clinical Recommendations. Marc Fisher et al. in Stroke, Vol. 40, No. 6, pages 2244–2250; June 2009.

◆ Understanding and Augmenting Collateral Blood Flow during Ischemic Stroke. Gomathi Ramakrishnan, Glenn A. Armitage and Ian R. Winship in Acute Ischemic Stroke. Edited by Julio César García Rodriguez. InTech, 2012.

◆ A Rat’s Whiskers Point the Way toward a Novel Stimulus­Dependent, Protective Stroke Therapy. Ron D. Frostig, Christopher C. Lay and Melissa F. Davis in Neuroscientist. Published online October 9, 2012.

◆ For the warning signs and symptoms of stroke, see the American Stroke Association Web site: www.strokeassociation.org/STROKEORG/ WarningSigns/Stroke­Warning­Signs_UCM_308528_SubHomePage.jsp

◆ A Magic Touch for Stroke Prevention? S. Sutherland in Scientific American Mind, Vol. 24, number 3, pages 48-53.

Imagine you get nine hours of sleep every night, squeeze in long naps whenever you can, and yet every waking hour is a blur of exhaustion, poor focus and longing for the next time your head will hit the pillow. That is the reality for people with primary hypersomnia, a poorly understood, rare condition of constant sleepiness and tiredness.

The theory in sleep science has been that unexplained sleepiness is caused by underactive brain regions involved in wakefulness and attention. This view has done little to provide relief for many of the chronically tired. Yet the opposite hypothesis—that the body might be producing a natural brake or sedative—has been controversial. Now scientists at Emory University have found just such a sedative in patients with primary hypersomnia, providing hope for the weary and perhaps even pointing to a new type of sleep-aid drug.

The researchers discovered the sleep-promoting substance in the patients’ cerebrospinal fluid, the watery liquid that cushions the brain and surrounds the spinal cord. In a study appearing in Science Translational Medicine last November, the researchers demonstrated that the compound enhances the activity of the same signaling pathway in the brain that is spurred on by sedatives such as the commonly prescribed benzodiazepines Valium and Ambien. The pathway involves gamma-aminobutyric acid (GABA), which is a neurotransmitter that acts a brake on attention and focus.

The researchers took spinal fluid from 32 patients with primary hypersomnia and applied it to human cells while measuring their electrical activity. They found the spinal fluid increased GABA receptor activity dramatically by some 84 percent, when GABA was also present (as it is in the brain). Spinal fluid from unaffected individuals enhanced GABA receptor activity, too, though to a lesser extent. There the boost was closer to 36 percent—similar to the effect produced by patients’ spinal samples after researchers removed the natural sedative.

The compound’s chemical identity remains a mystery; the researchers have determined that it is probably a small protein (called a peptide). Future work will focus on identifying and perhaps even synthesizing the substance, to act as a sleep aid for people with insomnia.

For the permanently sleepy, this recent work offers hope. Because their internal sedative acts in the brain like Valium, the investigators reasoned that its action could be blocked by flumazenil, a drug given intravenously to treat benzodiazepine overdoses.

In seven patients suffering from hypersomnia, flumazenil did restore alertness and reaction times for several minutes to a few hours, depending on the dose. For one of these patients—a woman who has managed to obtain an ongoing supply of the drug in tablet and cream forms—that relief has lasted four years.

Getting enough flumazenil to treat multiple individuals with hypersomnia may be tricky—the entire North American supply would be enough for only four hypersomniacs at the doses likely needed to maintain alertness all day, every day. Even so, Emory researchers have begun initial trials exploring the possibility of using flumazenil, or another drug similar to it, to awaken those people who have to live with the ‘nightmare’ of internal sedation.

References:

B. Rye et al.. Modulation of Vigilance in the Primary Hypersomnias by Endogenous Enhancement of GABA_A Receptors. Science Translational Medicine 2012, volume 4, number 161, 161ra151

A. Anderson. An Internal Sedative. Scientific American Mind 2013, volume 24, number 1, 12-13.

More than half the world’s population now lives in a large city, and by 2050 that figure will very likely jump to two thirds. China’s megacities in particular are fueling the trend, with more than 10 million new residents every year. Historically, urbanisation has brought about stupendous changes—the Renaissance, the industrial revolution, globalisation. Yet this urban migration represents one of the most dramatic environmental shifts human beings have ever undertaken. So we might be tempted to ask: How are we adapting to our new surroundings?

At first glance, trading green fields for grey grids would seem to be a trade up. City slickers have, on average, more money, better food and greater access to health care than country folk. On the flip side, though, recent studies indicate that memory and attention can suffer in urban environments, and psychologists have long known that city life takes an emotional toll. Urbanites are more likely to suffer from anxiety and depression, and the risk of schizophrenia increases dramatically among people raised in a city. Some researchers have calculated that children born in cities face twice, if not three times, the risk of developing a serious emotional disorder as compared with their rural and suburban peers.

These statistics may not surprise harried rush-hour commuters, but they are also not easily explained. Epidemiologists have ruled out the most obvious answers—namely, that people at risk for developing emotional disorders are more drawn to urban areas. Instead certain aspects of metropolitan life appear to incline the brain toward mental illness. A number of possible culprits are now under investigation, among them noise, pollution and social pressure, in both the form of greater competition and weaker community ties.

Several inquiries suggest that this last factor, social stress, is especially harmful. Research at the Central Institute of Mental Health in Mannheim, Germany, corroborates this view and provides the first neurobiological mechanism to explain it. In a series of studies, evidence has found that the social strain of urban living engages specific stress circuits in the brain—circuits known to go wrong in mood disorders and other mental illnesses. Perhaps by understanding this mechanism and its role in the development of psychiatric conditions, ways can be found to intervene and make cities more livable.

Stress in the City

Many studies have confirmed the link between social strain and mental illness. In 2010 Stanley Zammit and his colleagues at Cardiff University in Wales traced the origins of schizophrenia in 200,000 individuals in Sweden. They found an array of contributing factors, all of which were increasingly potent in more urban environments. In general, though, people who perceived themselves as isolated—immigrants, for example—were at significantly greater risk. Such research is invaluable but relies on a rough measurement: the frequency of clinically diagnosed psychiatric patients. To look for more subtle connections between the pressure of city life and emotional instability, magnetic resonance imaging (MRI) has been used.

In 2011, the brain activity of 32 German college students, who hailed from big cities, towns or countryside was measured. As the recruits performed a series of brainteasers, the researchers deliberately stressed them out. For example, while inside the scanner, each volunteer saw a false performance meter, which indicated that they were doing poorly compared with everyone else. At the same time, one of the researchers urged them to try harder otherwise they were told that they would ruin the experiment. It worked. Not only did was an elevated heart rate, blood pressure and level of stress hormones in the participants detected, but after the test—when they were told what the scientists had done—they confirmed that they had indeed felt pressured.

As expected, this stressful experience activated many areas in the brain. Astonishingly, though, one particular region, the amygdala, whose activity under pressure exactly matched the subjects’ house address: the more urban their home environment, the more engaged their amygdala became. This cherry-size structure, deep within the temporal lobe, serves as a danger sensor of sorts, prompting the “fight or flight” response. It also modulates emotions such as fear. In this study, the amygdala seemed almost impervious to stress among villagers and was only moderately active among those from small towns. For big city residents, stress kicked it into overdrive.

The German scientists had not expected such a strong correlation, and so they repeated the experiment, placing 70 additional test subjects under slightly different stress conditions. Again, they saw the same pattern. In each experiment, they could readily identify city residents by brain scan alone: urban life had marked all of them with telltale hyperactivity in the amygdala. This finding revealed at least one way in which city stress can lead to mental illness. An amygdala in high gear is also observed in patients suffering from depression and anxiety. Not all urbanites succumb to mood disorders, of course, but the researchers concluded that chronic overstimulation of this brain region puts some people at a higher risk.

The very same mechanism may play at least a small role in prompting violent behaviour. Violence is not a psychiatric diagnosis per se; it results from an exceedingly complex interplay of factors. Even so, data from the U.S., Germany and elsewhere confirm that violence is a bigger problem in cities, and several lines of inquiry link violent behaviour with overstimulation of the amygdala.

Urban Upbringing

The German researchers wanted to follow up on another important observation—namely, the increased risk for schizophrenia in people born and raised in cities. They analysed the same subjects described above and quantified their early urban exposure using a simple score: they assigned three points for each year they had lived in a city as a child, two for each year in a town and one for each year of country living. Again, they found one specific brain region—the perigenual anterior cingulate cortex (pACC)—whose activity levels under stress reflected the city score. Subjects who spent the most time growing up in cities showed the highest levels of pACC activity under pressure. A second experimental group of 70 students showed the same correlation between pACC activation and urban upbringing.

This finding was not a total surprise. The pACC and the amygdala are closely interconnected. Studies indicate that the pACC serves to inhibit activity in the amygdala. If the pACC is damaged through chronic stimulation during a city upbringing, it might then fail to quell an overactive amygdala in an urban adult. If the same adult were sheltered from social strain, this deficit might never surface. Infact, giving brainteasers to a control group, without any pressure, no association was found between childhood environment and activity in the amygdala or pACC.

Additional research supports this idea. Various researchers—including Tsutomu Takahashi of Toyama University in Japan—have found structural changes in the pACC in patients with schizophrenia. Notably, these alterations also manifest among those who are at an increased genetic risk of the disease developing, before they exhibit any psychiatric symptoms.

Lean on Me

All these studies reveal that the longer a person lives in a city, the less communication occurs between their amygdala and pACC. Genes and other factors then steer city dwellers closer to developing schizophrenia, anxiety, depression or violent tendencies. Fortunately, scientists have found mechanisms that strengthen feedback between these two brain regions. In 2011 Lisa Feldman Barrett and her colleagues at Massachusetts General Hospital reported that the volume of the amygdala increases with the size of a person’s circle of friends. It has also been found that the hormone vasopressin—which, among other roles, is released during moments of bonding—reduces activity in areas of the cingulate cortex, including the pACC, and boosts feedback to the amygdala.

These studies highlight the well-documented fact that a close network of friends and family can insulate us from the most damaging effects of stress, but this is not the whole story. A lack of green space, noise and other environmental factors may also contribute to pACC and amygdala dysfunction. Such research could have far-reaching consequences: Almost a third of schizophrenia cases might be avoided if more people were born in a rural setting. Herein lies a paradox: we cannot act on this insight without urbanizing the countryside. But we can try to design our cities so that they promote emotional well-being. In this way, we might take aim at the real goal of psychiatry, which is to prevent serious emotional disorders, not just treat them.

References:

5-HTTLPR Polymorphism Impacts Human Cingulate-Amygdala Interactions: A Genetic Susceptibility Mechanism for Depression. Lukas Pezawas, Andreas Meyer-Lindenberg, Emily M. Drabant, Beth A. Verchinski, Karen E. Munoz, Bhaskar S. Kolachana, Michael F. Egan, Venkata S. Mattay, Ahmad R. Haririand Daniel R. Weinberger in Nature Neuroscience, Vol. 8, No. 6, pages 828–834; June 2005.

City Living and Urban Upbringing Affect Neural Social Stress Processing in Humans. Florian Lederbogen, Peter Kirsch, Leila Haddad, Fabian Streit, Heike Tost, Philipp Schuch, Stefan Wüst, Jens C. Pruessner, Marcella Rietschel, Michael Deuschle and Andreas Meyer-Lindenberg in Nature, Vol. 474, pages 498–501; June 23, 2011.

The Stress of Crowds. Alla Katsnelson in Scientific American, Vol. 305, No. 3, page 18; September 2011.

Neural Mechanisms of Social Risk for Psychiatric Disorders. Andreas Meyer-Lindenberg and Heike Tost in Nature Neuroscience, Vol. 15, No. 5, pages 663–668; May 2012.

Mounting Evidence Shows How City Living Can Harm Our Mental Health. Andreas Meyer-Lindenberg in Scientific American Mind Vol. 24, number 1, pages 59-61; March/April 2013.

Romantic relationships can begin anywhere. When Cupid’s arrow strikes, you might be anywhere. My own romance with Sjoerd started with some hilarious double-entendre Dutch-language mistakes, together with an incident in the gas cyclinder storage cupboard (well, better than a bike shed, even if we are in Holland!). Sometimes, however, Cupid seems to have emigrated…so instead of waiting for him to get back to work, people are increasingly joining online-dating sites to assert some control over their romantic lives.

For millennia cultures have invented practices to fulfill the evolutionary requirements of mating and reproduction. In the Western world today, individuals are largely expected to identify romantic partners on their own, a process that can consume significant time, effort and emotional energy. The ability to hunt for dates online offers singles a sense of control over a seemingly random process and grants them access to hundreds, potentially thousands, of eligible mates.

The unprecedented opportunity to pursue romance beyond one’s social circles and neighbourhood haunts has developed into a huge money-making industry. Most online-dating sites work in this way: users create profiles describing themselves and then search a Web site for possible romantic partners according to various criteria—within a town or city, for example, or perhaps by educational levels, age range or religion. Some sites attempt to play the role of matchmaker and use mathematical algorithms to suggest pairings between users, whereas other services give their customers free rein.

Two decades ago almost no couples met online, whereas now it is the second most common way to find a partner, trailing slightly behind connecting through friends. Rather than dabbing on perfume or after-shave and preparing for a night on the town, singles can peruse potential partners while drinking their morning cup of coffee, during meetings at work or when lying in bed for 10 minutes before nodding off. In short, online services have fundamentally altered the dating landscape.

The changes are not all constructive, however. Critical assumptions lurk in the mechanisms of online dating. One supposition is that people are good judges of which qualities described in an online profile will appeal to them in person. A second premise is that comparing multiple potential partners side by side is an effective way to evaluate compatibility. A third is that having many options allows people to make good decisions about their romantic future. Several lines of scientific work suggest that none of these guesses is likely to be true.

This disconnect between the assumptions underlying online dating and the realities of human psychology often yields dissatisfaction. Users may invest tens of hours every month in browsing profiles and only rarely arrange a date. They may contact dozens of users and hear back only from a small fraction of them. They may set up dates with individuals who seem perfect “on paper” only to learn on the first date that as a pair they have no chemistry.

For online daters, what follows is a ‘science-based survival guide’. For others, it will be a look at how today’s dating methods offers reveal insights into the human psyche.

Set Limits for Yourself

Online dating is almost nothing like a typical night out on the town (or ‘on the pull’ as we used to say in Northern England). At a bar, a man might size up the room before letting his gaze settle on the thirtysomething brunette with the welcoming smile and the serious eyes. If he approached her and managed to strike up a conversation, he could take in her nonverbal cues–such as her gestures, posture and scent—as he tried to make her laugh.

If he were instead reading her profile on an online-dating site, he would have learned that she plays board games on the weekends, works as a pastry chef and loves horror movies. A connoisseur of art-house films, he might have already dismissed her for her questionable taste.

With the carrot of romance always dangling a mere mouse click away, the temptation to scan—and quickly dismiss—dozens of profiles is strong. We all value having options, but too many can produce choice overload, undermining our ability to make good decisions. In a famous illustration of this effect, supermarket shoppers encountered a tasting booth that displayed either six or 24 flavors of jam. Although shoppers were more likely to stop at the display with the larger array of jams than the booth with the smaller selection, they were 10 times more likely to purchase an item from the smaller group than the larger. Presumably the larger choice paralysed them with indecision.

Similarly, several studies in the romantic domain suggest that people become overwhelmed as the number of online-dating profiles they browse grows larger. In a recent study, participants viewed either four or 20 such profiles. Those considering the larger set were more prone to misremembering information in them. In a second experiment, as the number of profiles grew from four to 24 to 64, users increasingly switched from time-consuming choice strategies that attend to and integrate multiple cues to more frugal strategies that examine few elements and do not combine them effectively.

No studies have investigated how satisfied online daters are with their choices after considering small versus large numbers of profiles, but other research suggests that exposure to numerous options leads to low satisfaction with a given choice. Those who selected one chocolate out of six, for example, thought the treat tasted significantly better than did participants who picked their chocolate from an array of 30. By analogy, online daters choosing from a small rather than a large batch of potential partners are more likely to enjoy the person with whom they end up sharing a candlelit dinner.

These cognitive biases are hard but not impossible to counteract. Remain aware of how many profiles you have scanned in a browsing session and impose a time limit. View profiles in manageable clusters and consider reaching out to, say, one out of every 20 users. Keep in mind that behind the profile is a flesh-and-blood person, with nuance and depth that is easily lost online.

Monitor Your Mind-set

People also tend to evaluate romantic prospects differently depending on how they encounter them. Many studies in nonromantic domains have demonstrated that people frequently prioritise different qualities when they compare multiple options side by side—referred to as a joint evaluation mind-set—than when they size up one specific possibility in isolation, known as a separate evaluation mind-set.

A study of new first-year university students explored this idea in the context of their accommodation assignments. Before learning which one of 12 student houses they would be randomly assigned to, the students tended to predict that physical features, such as the building’s location and the size of its rooms, would strongly influence their future happiness. None of these attributes ultimately predicted their well-being. Instead experiential qualities—such as the relationship with one’s roommate and the social atmosphere of the student house—far outweighed any of the lodgings’ physical characteristics.

One explanation for this discrepancy between expectation and reality is that the new students were in a joint evaluation mind-set when making the predictions and in a separate evaluation mind-set when living in the assigned student house. Before moving in, they were more sensitive to unimportant physical variations simply because those differences were easy to judge. Browsing profiles of potential romantic partners is also likely to trigger a joint evaluation mind-set and cause users to overvalue qualities that are easy to assess but unlikely to determine compatibility. Indeed, profiles are chock-full of details that tend to be largely unrelated to the hard-to-discern, experiential characteristics that promote relationship well-being. Levels of education or physical attractiveness can be easily assessed through a profile, for example, whereas rapport and attraction are best evaluated face-to-face.

Engaging in joint evaluation can also strengthen so-called assessment mind-sets and undermine locomotion mind-sets. When in an assessment mind-set, a person critically evaluates a specific option against available alternatives. A person in a locomotion mind-set focuses on a certain selection, such as a desirable mate, and pursues it vigorously. To be sure, all dating involves some degree of assessment. The side-by-side evaluation of countless online-dating profiles, however, seems to invoke a strong assessment mind-set regarding the general pool and a weak locomotion mind-set with respect to any single person. One way to ward off a problematic mind-set is to take a moment to imagine what it might be like to talk to any profilee face-to-face. Mentally simulating a social interaction is likely to make you less critical and more motivated to consider possible ways you might be compatible. As with managing choice overload, do not waste time comparing a profile with too many others.

Cast a Wide Net

Studies suggest that online daters typically aim too high. They contact the most objectively desirable individuals at massively higher rates than others. In a real-world dating scenario, attendees at a party would not all strive to mob one attractive individual, which is effectively what happens online, because these daters cannot see how much attention a person is already receiving. These highly sought-after people are the least likely to respond to e-mails, and both the deluged daters and the pursuers can experience frustration as a result.

Part of the problem appears to stem from the attitudes that daters adopt, intentionally or not, when on these sites. In one 2010 study Rebecca Heino of Georgetown University and her colleagues described online dating as “relationshopping.” The metaphor of shopping is apt. Much like hunting for size 42 leather shoes online, online daters seek partners by searching through profiles using attributes such as income and hair colour, as opposed to arguably more important factors, such as a sense of humor or rapport. One online dater illustrated the shopping mentality as follows: “You know, ‘I’ll take her, her, her’—like out of a catalogue.” A second online dater agreed: “I can pick and choose; I can choose what size I want, it’s like buying a car, what options am I looking for.”

This checklist mentality underscores our lack of self-knowledge when it comes to romance. In one experiment, research participants who evaluated an online dater’s written profile expressed more attraction toward a person whose description was rigged to match their own idiosyncratic preferences. After a brief live interaction, however, the participants’ ideals no longer predicted romantic interest. These experiments tell us a few things. First, daters by and large think they covet the same people. Further, we are bad at predicting what we will find attractive in real life. Last, the easy accessibility of profiles may exacerbate these tendencies by encouraging us to evaluate potential partners in an ineffectual manner.

Rather than reaching out to the most desirable people “on paper,” consider looking for more idiosyncratic features that are likely to appeal to some daters more than others. More important, get away from profiles as soon as you can and do not expect too much from them in the first place. Stay open-minded about whom you might end up falling for—and who might love you back.

Communicate with Care

Online-dating sites include easy methods, such as e-mail and online chat functions, for users to communicate with prospective dates. In fact, dating hopefuls must converse through one of these methods before switching to a personal e-mail account or arranging for a telephone call. If these interactions go well, the romance seekers typically agree to meet in person in short order.

Unfortunately, many matches never get the chance to blossom. One reason is that not all profiles on a site represent paying or active users. In addition, responses to initial overtures can be few and far between. In one recent study, men replied to one out of four messages they received through a dating site, and women replied to one in six. More promisingly, this study found no evidence that eager responses were a turnoff; the faster the reply, the more likely that reciprocal communication continued. If you sense a spark, don’t play hard to get.

Putting some effort into the initial e-mail can also pay off. A linguistic analysis of 167,276 initial e-mails sent by 3,657 online daters revealed that the messages more likely to receive a response were characterised by less use of the pronoun “I” and of leisure words such as “movie” and by higher use of the pronoun “you” and of social-process words such as “relationship” and “helpful.”

At this stage, the incipient relationship is still fragile. Do not wait too long to set up a date. Most of the pairings that start communicating outside the dating site’s messaging systems meet face-to-face within a month, frequently within a week, according to two studies from 2008. Doing so is wise, as research shows that although a small amount of emailing or chatting online can increase attraction when two daters meet, too much of it tends to instill overly specific expectations.

Ultimately there is something that people must assess face-to-face before a romantic relationship can begin. Scholars are still working to identify exactly what that something is, but it appears to reside at the intersection of experiential attributes, chemistry and gut-level evaluations. Some emotional reactions could even be based on sensory experiences, such as smell, that cannot be gleaned any other way. Meeting in person also serves as an important reality check before intimacy progresses: people are less likely to misrepresent their observable attributes in a real-world setting as compared with online correspondence.

Don’t Bet on Matching Algorithms

Several high-profile dating sites promise to match users with an especially compatible individual using a ‘proprietary matching algorithm’. Unfortunately, these companies have so far failed to offer convincing evidence supporting this claim. Sp please consider this limitation before investing the sometimes considerable money required to join such services.

To their credit, dating-site algorithms can probably discern which people have an increased risk of experiencing relationship problems by assessing individual differences such as neuroticism and a history of substance abuse. Evidence that some people are better at sustaining intimacy than others is strong and unequivocal. By assessing these types of characteristics, online-dating sites can in principle screen out the relationally challenged more efficiently and effectively than a human can. This is a potentially useful service, as long as you are not one of the unlucky folks who gets eliminated!

This filtering service, however, yields far less than what algorithm-based matching sites typically promise their users. They pledge to identify potential mates who are particularly compatible with their customers—even soul mates—a claim that is hard to swallow for two simple reasons. No matching site has mustered any scientifically compelling evidence that its algorithm is effective. Second, decades of research on relationships suggest that the most important determinants of a relationship’s fate emerge only after the pair have met—factors such as the way the couple navigates interpersonal conflict, responds to unpredictable events or shares good news. Because matching sites have demonstrated insufficient ambition or creativity, their approaches are based solely on qualities of individuals that can be known prior to meeting in person. As a result, these algorithms are poorly equipped to predict whether strangers on a date will linger over dessert or quickly demand the check. Discerning whether two people will live happily ever after is even further out of reach.

Particularly exasperating is the fact that these matching sites could so easily test whether their algorithm actually works. If the proprietors would reveal their secret sauce, scientists could test its validity by randomly assigning online daters to one of four experimental conditions. In the wait-list control group, participants would experience no intervention. A placebo-control group would consist of subjects who believe they are being matched by the site’s algorithm but are actually matched at random. Daters in a relationship-aptitude control group would be paired with people who tend to be good at relationships in general and are not, say, especially neurotic. Last, individuals in an algorithm group would view profiles selected by the site’s matching technology.

If the members of the fourth group experienced romantic outcomes superior to those of the participants in the other three groups, then we would have evidence that the algorithm is effective. It seems suspicious than no site has so far done so—or allowed independent scholars to perform the study on its behalf. Until matching sites that claim to use science actually conduct minimally adequate experiments, online daters should think twice before paying a large amount of money for such services.

Know What Works

Some aspects of online-dating services are marvelous. They open up access to potential sources of romance that might never otherwise be available to their clients. They can transcend geographic and social-network boundaries to an unprecedented degree. These benefits may be especially powerful for those people who need it the most—including those who are socially anxious, have struggled to find like-minded partners or have recently moved to a new city.

Even though our decision making falters under trying conditions, it is worth noting that we are actually quite skilled at deducing certain personality characteristics from sparse amounts of information. Past research demonstrates that people can accurately assess a broad range of facts about others based on a brief exposure to their photographs. For example, when study participants viewed snapshots of the faces of chief executive officers from Fortune 1000 companies, their ratings of those CEOs’ leadership ability correlated strongly with the companies’ profits. What people cannot discern from an image, however, is how compatible they might be with the individual pictured. This capability also so far eludes online-dating sites, unfortunately.

In general, however, online-dating sites present a unique opportunity to bring happiness into the world. The industry is still in its infancy, which is probably one reason it contains so many flaws. As these services increasingly incorporate the best relationship science, they will evolve and improve. When wielded with skill and structure, these tools can help millions of ‘free-and-singles’ find love.

References:

Formal Intermediaries in the Marriage Market: A Typology and Review. Aaron C. Ahuvia and Mara B. Adelman in Journal of Marriage and Family, Vol. 54, No. 2, pages 452–463; May 1992.

When Choice Is Demotivating: Can One Desire Too Much of a Good Thing? Sheena S. Iyengar and Mark R. Lepper in Journal of Personality and Social Psychology, Vol. 79, No. 6, pages 995–1006; December 2000.

Sex Differences in Mate Preferences Revisited: Do People Know What They Initially Desire in a Romantic Partner? Paul W. Eastwick and Eli J. Finkel in Journal of Personality and Social Psychology, Vol. 94, No. 2, pages 245–264; February 2008.

Dating in a Digital World. Eli J. Finkel, Paul W. Eastwick, Benjamin R. Karney, Harry T. Reis and Susan Sprecher. Scientific American Mind (September/October 2012), Vol. 23, 26-33.

Matching and Sorting in Online Dating. Guenter J. Hitsch et al. in American Economic Review, Vol. 100, No. 1, pages 130–163; March 2010.

Intimate Relationships. Thomas N. Bradbury and Benjamin R. Karney. W. W. Norton, 2010.

I always smile enormously when science starts to catch up with what the healing-therapy-natural medicine community has been doing.

So this month I share with you the latest scientific findings on mindfulness and EMDR.

Mindfulness to Reduce Social Anxiety

Many people who suffer the pain, depression and negative health effects associated with social anxiety or loneliness do not respond to common therapy tactics or drugs. Two new studies offer hope from an unlikely source: rather than focusing on your relationships with others, turn inward for relief.

Mindfulness meditation—which has been around for well over 2,000 years—has many forms, but an extensive body of research supports the effectiveness of one training program in particular. Mindfulness-Based Stress Reduction (MBSR) is an eight-week program developed in 1979 by a U.S. physician. Initially created to help patients suffering from chronic pain, the program has been found to reduce symptoms of stress, depression and anxiety, even among people with cancer and HIV.

In one of the new studies, published in the October 2012 Brain, Behavior, and Immunity, 55- to 85-year-old adults were randomized to either receive MBSR or be put on a waiting list for the program. The loneliness of the participants who received MBSR decreased after training, whereas the loneliness of the wait-listed control subjects increased slightly. MBSR also reduced inflammation—the cause of loneliness-related health risks such as heart attack or stroke—as measured by levels of stress proteins and proinflammatory gene expression.

The other study, published online in August 2012 in Social Cognitive and Affective Neuroscience, found that MBSR reduced negative emotions in people with social anxiety disorder.

Mindfulness training teaches people to be fully attentive to their present experience in a nonjudgmental way, which is believed to help reduce the rumination common to mood disorders. A mindful perspective teaches people how to apply a brake between a single lonely thought and what could be a resulting chain of distressing thoughts and feelings.

Recent research supports the effectiveness of EMDR

Imagine you are trying to put a traumatic event behind you. Your therapist asks you to recall the memory in detail while rapidly moving your eyes back and forth, as if you are watching a high-speed Ping-Pong match. The sensation is strange, but many therapists and patients swear by the technique, called eye movement desensitization and reprocessing (EMDR). Although skeptics continue to question EMDR’s usefulness, recent research supports the idea that the eye movements indeed help to reduce symptoms of post-traumatic stress disorder (PTSD).

Much of the EMDR debate hinges on the issue of whether the eye movements have any benefit or whether other aspects of the therapeutic process account for patients’ improvement. The first phase of EMDR resembles the start of most psychotherapeutic relationships: a therapist inquires about the patient’s issues, early life events, and desired goals to achieve rapport and a level of comfort. The second phase is preparing the client to mentally revisit the traumatic event, which might involve helping the person learn ways to self-soothe, for example. Finally, the memory processing itself is similar to other exposure-based therapies, minus the eye movements. Some experts argue that these other components of EMDR have been shown to be beneficial as part of other therapy regimens, so the eye movements may not deserve any of the credit. New studies suggest, however, that they do.

In a January 2011 study in the Journal of Anxiety Disorders, for example, some patients with PTSD went through a session of EMDR while others completed all the components of a typical EMDR session but kept their eyes closed rather than moving them. The patients whose session included eye movements reported a more significant reduction in distress than did patients in the control group. Their level of physiological arousal, another common symptom of PTSD, also decreased during the eye movements, as measured by the amount of sweat on their skin.

One of the ways EMDR’s eye movements are thought to reduce PTSD symptoms is by stripping troubling memories of their vividness and the distress they cause. A study in the May 2012 Behaviour Research and Therapy examined the effectiveness of using beep tones instead of eye movements during EMDR. The researchers found that eye movements outperformed tones in reducing the vividness and emotional intensity of memories.

Those studies relied on self-reports of symptom severity, however, so researchers at Utrecht University in the Netherlands sought more objective confirmation of a change in vividness by also measuring participants’ reaction times to fragments of a previously viewed picture. The work, published online in July 2012 in Cognition and Emotion, compared two groups of participants who had committed one detailed picture to memory. When asked to recall the picture and focus on it mentally, one group was instructed to perform eye movements. That group had slower reaction times to the familiar picture fragments in a subsequent memory test, and subjects reported that the vividness of the recalled pictures had decreased.

These studies and others from the past several years have helped validate EMDR—so much so that the American Psychiatric Association, the International Society for Traumatic Stress Studies, and the Departments of Defense and of Veterans Affairs have deemed it an effective therapy.

Yet how it works remains unclear. Chris Lee, a psychologist at Murdoch University in Australia and co-author of the January 2011 study, says a common theory is that EMDR takes advantage of memory reconsolidation: every time we recall a memory, it is changed subtly when we file it away again. For instance, parts of the memory may be left out, or new ideas and feelings are stored alongside of it. Making eye movements during recall, Lee explains, may compete with the recollection for space in our working memory, which causes the trauma memory to be less intense when recalled again.

The experiments show that negative autobiographical memories are very rich in sensory detail, and by pairing them with eye movements, they lose this sensory richness. People describe that the memories become less vivid and more distant, that they seem further in the past and harder to focus on. What follows after this distancing is a reduction in the associated emotional levels. This means in summary: the traumatic memory stays, but its power has been diminished.

Practicing meditation might make you sick from colds less often, and botox treatments that prevent facial muscles from registering negative emotions and could help depression. Have I gone completely mad? Not in the least! The latest scientific research reveals both of these to be true.

Meditate Away Your Cold

To stop or get rid of your next (winter) cold, try meditating or exercising now. A new study from the University of Wisconsin–Madison found that adults who practiced mindful meditation or moderately intense exercise for eight weeks suffered less from seasonal ailments during the following winter than those who did not exercise or meditate.

The study appeared in the July issue of Annals of Family Medicine. Researchers recruited about 150 participants, 80 percent of them women and all older than 50, and randomly assigned them to three groups. One group was trained for eight weeks in mindful meditation; another did eight weeks of brisk walking or jogging under the supervision of trainers. The control group did neither. The researchers then monitored the respiratory health of the volunteers with biweekly telephone calls and laboratory visits from September through May—but they did not attempt to find out whether the subjects continued meditating or exercising after the initial eight-week training period.

Participants who had meditated missed 76 percent fewer days of work from September through May than did the control subjects. Those who had exercised missed 48 percent fewer days during this period. The severity of the colds and flus also differed between the two groups. Those who had exercised or meditated suffered for an average of five days; colds of participants in the control group lasted eight. Lab tests confirmed that the self-reported length of colds correlated with the level of antibodies in the body, which is a biomarker for the presence of a virus.

The big news in this is that mindfulness meditation training appears to work in preventing or reducing the length of colds!

Botox Fights Depression

A common complaint about wrinkle-masking Botox is that recipients have difficulty displaying emotions on their faces. That side effect might be a good thing, however, for people with treatment-resistant depression.

In the first randomised, controlled study on the effect of botulinum toxin—known commercially as Botox—on depression, researchers investigated whether it might aid patients with major depressive disorder who had not responded to antidepressant medications. Participants in the treatment group were given a single dose (consisting of five injections) of botulinum toxin in the area of the face between and just above the eyebrows, whereas the control group was given placebo injections. Depressive symptoms in the treatment group decreased 47 percent after six weeks, an improvement that remained through the 16-week study period. The placebo group had a 9 percent reduction in symptoms. The findings appeared in May in the Journal of Psychiatric Research.

Study author Axel Wollmer, a psychiatrist at the University of Basel in Switzerland, believes the treatment “interrupts feedback from the facial musculature to the brain, which may be involved in the development and maintenance of negative emotions.” Past studies have shown that Botox impairs people’s ability to identify others’ feelings, and the new finding adds more evidence: the muscles of the face are instrumental for identifying and experiencing emotions, not just communicating them.