Meditation is the simple practice of making the mind calm, and silent, and bringing your thoughts to one point. In other words, meditation can be defined as making mind free from agitation, turning attention away from distracting thoughts and focusing on the present moment. Some individuals incorporate meditation as part of religious practice, and others do not. Yoga, for example, is one approach to meditation that has spiritual roots, and the same is true of contemplative prayer in Christian and Jewish traditions. Zen meditation, deriving from Buddhism, also has spiritual aspects.

Christian writer Phil Fox Rose says, "The promise of a devoted spiritual life, of which meditation is an invaluable part, is serenity...that in everyday life you will not be anxious, restless or irritable; and that in good times you will be fully alive to enjoy them."

After practicing meditation for even a few weeks, what many people notice is that mindfulness becomes a part of everyday life. In other words, we become more mindful in every activity. We focus more clearly, we think and speak more in terms of the present moment, and we act with greater compassion and clarity.

Meditation produces many benefits. I have noticed that my meditation practice improves concentration, strengthens the mind and leads to multiple health benefits: lowering blood pressure, reducing emotional distress , diminishing anxiety attacks, and improving my relationships.

The Wake Forest study now shows that meditation each day could be better in relieving pain than taking morphine. Similar studies at Duke and Harvard point to similar findings.

In their study, the lead researcher, Dr. Fadel, examined the brain scans of individuals who had been trained to use relaxation and breathing techniques to cope with the pain. After studying the brain scans, his team noticed that the study subjects who meditated regularly had calmer brain scans. They saw a 27 percent reduction in pain intensity and 44 percent less emotional pain in group of volunteers who actually practiced mindfulness meditation.

Along with many others, I believe that such findings prove that mindfulness meditation can produce different patterns of brain activity to suppress the feeling of pain.
Based on the study results, the scientists believe 20-minute a day meditation practice could be added to conventional pain relief methods for better and quicker relief. The study focused on volunteers who were pain free, so the question remains as to whether individuals with more serious pain problems can achieve similar results. The study findings are reported in the Journal of Neuroscience.

Another study from the Department of Psychiatry at Duke University Medical Center shows that mindfulness meditation can protect against depression. There are now hundreds of scientific papers on mindfulness. A Harvard Medical School study showed promising results in pain relief: "Recently, it has been demonstrated that pain can also be attenuated by mindfulness….Mindfulness practitioners and controls received unpleasant electric stimuli in the functional magnetic resonance imaging scanner during a mindfulness and a control condition. Mindfulness practitioners, but not controls, were able to reduce pain unpleasantness by 22% and anticipatory anxiety by 29% during a mindful state."

Let me know if you discover new findings in this exciting area of research!

 
A Dab Rig Sold Online

What are Dabs and How are They Made?
Dabs are concentrated doses of cannabis that are made by extracting THC and other cannabinoids using a solvent like butane or carbon dioxide, resulting in sticky oils also commonly referred to as wax, shatter, budder, and butane hash oil (BHO). While it's possible to extract non-psychoactive compounds like CBD, THC is what's behind the potent effects of dabs, making them the fastest and most efficient way to get really, really medicated. Terpenes, or the aromatic oils that give cannabis flavor, can also be extracted, although it can be difficult to preserve these volatile compounds in the extraction process.


From http://leafly.com

What are the Concerns Surrounding Dabbing? 
Here's what the Leafly website says about dabbing: "Let’s start with the bad news first: dabbing can be dangerous. Actually, it’s the extraction that can be dangerous.The process can be tricky, but thanks to online forums and videos, many amateur "scientists" think they have mastered the technique enough to try it on their own. In cases when things go well, the product is probably still pretty poor. When things go bad, houses blow up. When I worked out in rural Texas, people were getting blown up when cooking methamphetamine in their kitchens. Today, there are other ways (like extracting cannabis oil) that apparently can get you blown up as well.

"Another side effect of these home extraction experiments is “dirty” oil that may contain chemical contaminants that could present health hazards to consumers. If the concern is butane, the dangers are most likely minimal since it already occurs in everyday products such as scent and flavor extracts. Whether or not the equipment used in the extraction process is adding additional contaminants is a more viable issue. When done correctly, these extras can be avoided, so as is the case with growing cannabis, it’s best to leave it to those who know what they’re doing.

"One of the most unsettling facts about dabs is that thanks to the super-concentrated power of BHO, for the first time it seems possible to “overdose” on cannabis. While still not lethal, taking more than your personal limit of dabs can lead to uncomfortable highs and, in some cases, passing out. After all of the chanting that “you can’t overdose on marijuana,” concentrates could be undermining advocates’ message of safety. There have also been reports of more intense withdrawal symptoms for dabbers, but again, the information is limited."

For more on recent research on potential problems with marijuana, see my previous post (scroll down here on the blog) "Update on Marijuana Research."


• Craving for drugs
• Diarrhea
• Large pupils
• Yawning
• Abdominal pain
• Chills and goose bumps (the origin of the phrase "cold turkey")
• Nausea and vomiting
• Body aches
• Agitation and severe negative moods

A list of symptoms doesn't capture the agony of opioid withdrawal.
The syndrome is intensely unpleasant, and people will do almost anything to avoid it.

Opioid withdrawal lasts from hours to several days -- and sometimes weeks -- depending on how long and how much a person has used their drug of choice. After the intense initial symptoms subside, some physical and mental discomfort may persist for weeks.

Medications for Opioid Withdrawal
Opioid withdrawal is difficult to endure, and is a major reason for relapse and continued prescription drug abuse. Medications are used to prevent symptoms of opioid withdrawal during detox, easing the person out of physical dependence:

Methadone is a long-acting opioid drug. It activates the same opioid receptors as narcotics, effectively eliminating withdrawal symptoms. Providing the correct dose of methadone prevents opioid withdrawal symptoms and eases drug craving but it does not provide the euphoria. The dose can be slowly tapered off, freeing the person from physical dependence without withdrawal symptoms. Methadone is the most effective known treatment for narcotic addiction.

Buprenorphine and Naloxone (Suboxone) is a newer combination drug that helps for detox from prescription opioid addiction. Buprenorphine activates opioid receptors, reducing drug craving and preventing withdrawal. Naloxone helps prevent misuse of the medication.

Clonidine is a blood pressure medicine that acts on the brain. Clonidine reduces the effects of the "fight or flight" response, which is over-activated during opioid withdrawal. However, clonidine does nothing to reduce drug craving, and is mostly ineffective when used alone.

"Rapid detox" programs claim to accelerate the process of detox and opioid withdrawal by giving large doses of opioid blocking drugs. Some programs place an addict under general anesthesia during the detox process. These programs have not proven to be more effective than traditional methods of detox, and may be more dangerous.

Maintenance Therapy After Detox
Completing detox subdues the physical effects of narcotic addiction and opioid withdrawal. But experts say psychological and social factors are the main drivers that push addicts back to using. Stress and situations that remind the brain of the drug's pleasure are common triggers.

When drug cravings strike, they can be impossible to resist. Most people who go through detox and short-term counseling will relapse to prescription drug abuse.

Studies show that the chances of beating narcotic addiction are better with long-term maintenance therapy with either methadone or buprenorphine paired with naloxone (Zubsolv, Bunavail, Suboxone) . These drugs are used during the maintenance phase of treatment. People on these drugs are still opioid-dependent, but they are often freed from their destructive drug addiction. They can return to work, drive without impairment, and function normally in society. Naloxone has also been combined with oxycontin ( Targiniq ER ) to deter abuse by snorting or injecting the drug. A person can still become addicted by taking it orally, however.

Methadone is the best-studied, most effective method of recovery from narcotic addiction. Suboxone, while newer, has gained wide acceptance as maintenance therapy.

Some people have a high rate of relapse when maintenance therapy is stopped, and so they remain on the medicines for decades. In others, maintenance therapy is tapered off over months to years.

Naltrexone (ReVia, Vivitrol) is an opiate receptor-blocking medication used in maintenance therapy for narcotic addiction. Unlike methadone and Suboxone, naltrexone does not activate receptors at all, so it does not reduce opioid withdrawal or craving. However, because naltrexone blocks opiate receptors, a person won't get high if he or she uses drugs while taking the medicine. The drug is usually ineffective by itself, because people can simply stop taking it and get high shortly after.

Counseling and 12-Step Programs
Narcotics Anonymous (NA) is an international network of community-based meetings for those recovering from drug addiction. Modeled after Alcoholics Anonymous (AA), NA is a 12-step program with a defined process for overcoming narcotic addiction.

NA is an abstinence-based program. In principle, NA is opposed to the use of maintenance therapy. Methadone Anonymous is a 12-step program that acknowledges the value of methadone or Suboxone in recovery from narcotic addiction. Methadone Anonymous has caught on in California, but I don't know much about meetings in Texas. If you have information about Methadone Anonymous meetings, contact me.

Most of us who are experts in the field recommend participation in a 12-step program or other form of counseling. Therapy can take place as an outpatient, or in a residential facility. I discuss the value of 12 Step Programs on my FAQ page.

Tags: Addiction, Drug Abuse, Painkillers, addiction psychiatry

"What we have today is not the weed we used to smoke in the 1960's."

In a recent report researchers found that the concentration of THC sold on the streets in Denmark has tripled to an average of 28 percent in the last 20 years.
Attitudes toward marijuana are also rapidly changing. In the 1960s surveys found a mere 12 percent supported marijuana legalization—now, more than 50 percent are in favor. Over the past decade recreational/medicinal use of cannabis was legalized in the District of Columbia as well as in Alaska, Colorado, Oregon and Washington State; 19 other states also permit the use of the drug for medical purposes. As more states and countries, such as Canada and the U.K., consider following suit, advocates and critics are engaging in heated debates about the potential risks and rewards—particularly in light of the increasing prevalence of highly potent marijuana. But the evidence is nebulous—even within the scientific community, there is lack of consensus about how much harm marijuana can do to users’ brains and mental health.

In addition to THC, the other major component of marijuana that has caught the attention of researchers is cannabidiol (CBD), which scientists have linked to antipsychotic properties. Not only do THC and CBD have opposing effects, cannabis with higher THC content tends to contain lower amounts of CBD. “The relationship between CBD and THC is unique, in that the biological process required to make THC antagonizes the generation of CBD,” says Matthew Hill, a cannabinoid neuropharmacologist at the University of Calgary.

Damage to the brain?

In an article published last month in Psychological Medicine, researchers conducted a neuroimaging study to assess the effects of cannabis use on the corpus callosum, the largest collection of white matter in the brain containing fibers that facilitate communication between the two hemispheres. They found that this structure was negatively affected in those who used high potency cannabis—strains high in THC and low in CBD—compared with those who used lower strength bud or did not use at all. Moreover, the changes were similar in both those with and without previous episodes of psychosis. However, the researchers assert that they did take other drug usage into account.

Previous studies have demonstrated the importance of these confounding factors when interpreting marijuana’s effects on the brain. For example, a 2014 study in The Journal of Neuroscience reported that marijuana use was associated with changes in brain structures associated with reward processing. This effect was dose-dependent, meaning the more cannabis someone used, the more changes became apparent in their brains. In a subsequent study, published in 2015 in the same journal, another group of researchers found that once variables such as alcohol use, gender and age were controlled for, the differences between users and nonusers disappeared.

Marijuana madness?

In a study published earlier this year in Lancet Psychiatry the same group of researchers at King’s College found that using cannabis, and THC specifically, can produce acute psychotic symptoms, and some researchers suggest it increases the risk of developing schizophrenia. The link between marijuana and psychosis, however, has been a matter of heated debate in the scientific community. Researchers have argued that there are sufficient grounds to doubt the causality of this link. There are two alternative possibilities: being predisposed to schizophrenia may increase the likelihood for cannabis use or a third variable may make it more likely for people to use marijuana and develop schizophrenia. For example, previous studies have suggested that schizophrenia and cannabis share both genetic and demographic risk factors, such as low socioeconomic status.

Critics also point to the fact that all the studies to date have been correlational. But this does not immediately dismiss the possibility that causation is possible. After all, although there was a strong correlational link between smoking and cancer, it took a study of more than 30,000 British doctors to confirm causality.

According to Haney, the odds ratio—the likelihood that an exposure will lead to a certain outcome—of marijuana causing psychosis are much lower than those for smoking and cancer. “There is also an association with tobacco smoking and schizophrenia that is much stronger [than cannabis use],” Haney says. “If this relationship is causal, it is a tiny effect, which might explain why there hasn't been a dramatic upsweep in rates of schizophrenia in recent years.”

Both Haney and Evins agree that it is biologically plausible that marijuana, particularly at a young age, could increase the likelihood of negative psychiatric outcomes. The developing brain has an abundance of cannabinoid type 1 (CB1) receptors, where THC binds to exert its effects, in the prefrontal cortex, a key brain area impacted by schizophrenia. “I don't think it's a good idea for young children to be smoking marijuana at all because of their developing brains but I am extremely cautious about pinning it all on marijuana when there is a potential for many other explanations,” Haney says.

To truly determine whether marijuana causes such effects, scientists would need to track changes that occur in a large number of individuals before and after they use a drug over a long period of time. An effort to conduct this type of study is currently underway—the National Institutes of Health recently funded the multicenter Adolescent Brain Cognitive Development Study, which plans to recruit 10,000 children before they start drug use, and follow them for 10 years to assess the short-and long-term effects of using marijuana, tobacco and other drugs.

Teenagers and young adults at risk?

Cannabis has been found to impair cognitive functions such as memory and is increasingly being considered an addictive substance, especially in adolescents. There are still many questions that remain to be answered but strict regulation and lack of funding pose large barriers to conducting the required studies. The U.S. Drug Enforcement Administration still classifies marijuana in its most restrictive “Schedule I” category, which puts tight regulations on researchers who want to study its effects.

A New Zealand study found that persistent cannabis users show neuropsychological decline from childhood to midlife. These scientists found that frequent and persistent marijuana use starting in adolescence was associated with a loss of an average of 8 IQ points measured in mid-adulthood. Significantly, in that study, those who used marijuana heavily as teenagers and quit using as adults did not recover the lost IQ points.

Users who only began using marijuana heavily in adulthood did not lose IQ points. These results suggest that marijuana has its strongest long-term impact on young users whose brains are still busy building new connections and maturing in other ways. The endocannabinoid system is known to play an important role in the proper formation of synapses (the connections between neurons) during early brain development, and a similar role has been proposed for the refinement of neural connections during adolescence. If confirmed by future research, this may be one avenue by which marijuana use during adolescence produces its long-term effects. (For details see: Meier MH, Caspi A, Ambler A, et al. Persistent cannabis users show neuropsychological decline from childhood to midlife. Proc Natl Acad Sci USA. 2012;109:E2657-2664.)

The ability to draw definitive conclusions about marijuana’s long-term impact on the human brain from past studies is often limited by the fact that study participants use multiple substances, and there is often limited data about the participants’ health or mental functioning prior to the study. Over the next decade, the National Institutes of Health is planning to fund a major longitudinal study that will track a large sample of young Americans from late childhood (before first use of drugs) to early adulthood. The study will use neuroimaging and other advanced tools to clarify precisely how and to what extent marijuana and other substances, alone and in combination, affect adolescent brain development.

Scientists agree the highly potent marijuana may be better to avoid. Aside from potential long-term harm, receiving a high dose of THC can be especially risky for first-time users who are more likely to experience adverse effects such as panic or anxiety attacks. But even knowing the potency of a product, consumers might not always get what they ask for.

Because of competing laws at the state and federal level, the quality of regulation varies largely between states and regions. Although THC potency labeling is mostly required for both medical and recreational products, it is not always accurate—a study published this June in JAMA The Journal of the American Medical Association revealed that of the 75 edible marijuana products (from 47 different brands) researchers assessed only 17 percent accurately labeled their THC content.

The article states: "Edible cannabis products from 3 major metropolitan areas, though unregulated, failed to meet basic label accuracy standards for pharmaceuticals. Greater than 50% of products evaluated had significantly less cannabinoid content than labeled, with some products containing negligible amounts of THC. Such products may not produce the desired medical benefit.

"Other products contained significantly more THC than labeled, placing patients at risk of experiencing adverse effects.5,6 Because medical cannabis is recommended for specific health conditions, regulation and quality assurance are needed.

"A limited number of cities, dispensaries, and products were included. Because no source lists all dispensaries, and many products are not labeled with cannabinoid content, a true random sample was not possible and the results may not be generalizable. However, this study illustrates the variability in label accuracy for edible cannabis products within 2 of the largest medical cannabis markets in the United States."

Across labs and in homes, marijuana remains a highly debated issue. Marijuana is an extremely polarizing topic among scientists, as these articles demonstrate. My own view is that marijuana is not likely to cause someone to suffer a schizophrenic illness, but clearly what we have today is not the weed we smoked in the 1960's.

Tags: Addiction, Drug Abuse, Marijuana, Cannabis

“We speak of bullshit artists and spin doctors. To call it
artistry implies originality, innovation and creativity.”
– Philosopher Harry Frankfurt

Most participants could detect bullshit statements, and could easily differentiate mundane phrases from truly profound phrases. But some had difficulty weeding out the pseudo-profound from actually profound motivational statements. A full 27 percent gave bullshit statements a score of 3 or more.

What made them more prone to believing the bullshit was profound? To test that, the researchers followed the initial experiments by doing cognitive testing on the participants to assess their intelligence, and asked about spiritual leanings, views on conspiracy theories and alternative medicine.

They found that people who were less analytic and had lower cognitive ability were more prone to confuse the bullshit for the profound. That wasn’t all; those people were “more likely to hold religious and paranormal beliefs, and are more likely to endorse complementary and alternative medicine.”

In short, it looks like Carl Sagan’s intuition was right. Critical thinking may be your best defense against bullshit.
 
The Father Of Bullshit Studies

Why is it worth developing ways to study bullshit empirically in the lab? It’s the next step in a field that has taken off thanks to a seminal text that turned out to be a watershed: Dr. Frankfurt’s “On Bullshit“. Originally published in an obscure journal article in 1986, underground buzz led Princeton University Press to publish it as a small book in 2005. It reached No. 1 on The New York Times Bestseller List, spending 27 weeks there. Today, the book has been cited over 600 times.

“It was a concept I was using quite freely but I didn’t really know what it meant,” Dr. Frankfurt, now an emeritus professor of philosophy at Princeton University, said in a phone interview. “As an analytical philosopher, it’s my job to clarify and illuminate concepts like that.”

We need to study bullshit because we seem to have a higher tolerance for it than for lying, he argues. “We may seek to distance ourselves from bullshit, but we are more likely to turn away from it with an impatient or irritated shrug than with the sense of violation or outrage that lies often inspire,” he noted in his original article. For some reason, it doesn’t seem to violate our expectations of polite society.

Perhaps our tolerance is already explained by how we talk about it. “We speak of bullshit artists and spin doctors,” Dr. Frankfurt told me. “To call it artistry implies originality, innovation and creativity.”

The book’s unlikely success could probably be chalked up to both the ubiquity of the concept in our daily lives and its profanity. The word itself carries power. “It was very provocative to see a book by an Ivy League professor dealing with such a topic,” he told me. “I made the topic respectable in a way.”

That power to provoke also struck Pennycook. “There is force behind the word "bullshit" that implies, ‘We’re not OK with this,’ ” he said. “I think we should be forceful with our labels.”

The study authors specifically looked at “pseudo-profound bullshit.” That may sound redundant, but, as the authors note, it is only one type of bullshit. Thinking quickly, you can easily come up with other examples of bullshit. For me, the card game characterized by bluffing and “bullshitting your way through” comes to mind, and particular situations (like college, an interview or life itself.) Others have written about various types: pomposity or fanaticism, pseudoscientific nonsense or academic writing which has no regard for meaning.

To test the pseudo-profound sort, the researchers needed to be able to create bullshit— at will. It turns out, that’s the easy part. Profound-sounding but ultimately meaningless sentences are everywhere on the Internet. There’s the Twitter hashtag #cosmicconsciousness or wisdomofchopra.com. They also included quotes from the New Age Bullshit Generator, which is a load of fun.
(I hope you weren’t planning on getting anything else done today besides wasting time on fake pseudo-profound, new age tweets. You’re welcome.)

To explain how a psychology paper about bullshit ends up on a health blog: It is worth noting that the two bullshit generators for this paper were both inspired by quotations from Chopra, who is a physician. I’ve never read any of his books, so I cannot say whether his writings are bullshit, but profound-sounding misinformation is unfortunately all too common in health and medicine. Think about the late-night infomercials selling diet pills or vitamins. The wary health consumer should always be on the lookout for bullshit.

An interesting footnote: “On Bullshit” was translated into at least 16 languages. Dr. Frankfurt recalled that for some of them, like French, Russian, Portuguese and Hebrew, no exact equivalent for the term “bullshit” could be found, so they used the term “bullshit” spelled out in their own alphabet.

“I don’t understand how languages can get along without it,” he said. “It’s not as if the phenomenon is unknown to them.”

Tags: drug abuse, alcoholism

Fifty-six percent of all working parents say the balancing act is difficult, and those who do are more likely to say that parenting is tiring and stressful, and less likely to find it always enjoyable and rewarding. For example, half of those who said the work-family balance was not difficult said parenting was enjoyable all the time, compared with 36 percent of those who said balance was difficult.

In her 1989 book The Second Shift, the sociologist Arlie Russell Hochschild described the double burden employed mothers face because they are also responsible for housework and child care. Last year she said that despite some changes in society, the workplace had not changed enough to alleviate the problems. In another widely praised book, All Joy and No Fun, the journalist Jennifer Senior described how little had improved: Working parents face similar stresses, but they are now exacerbated by the expectations of modern parenthood and shared by fathers, too.

Senior draws on the psychologist Daniel Kahneman’s distinction between the “experiencing self” that exists in the present moment and the “remembering self” that constructs a life’s narrative. “Our experiencing selves tell researchers that we prefer doing the dishes — or napping, or shopping, or answering emails — to spending time with our kids. But our remembering selves tell researchers that no one — and nothing — provides us with so much joy as our children. It may not be the happiness we live day to day, but it’s the happiness we think about, the happiness we summon and remember, the stuff that makes up our life-tales.” She talks about parents’ pride in their children, not only in their accomplishments but even in their basic development as human beings, their growth into kindness and generosity. “Kids may complicate our lives,” she writes. “But they also make them simpler. Children’s needs are so overwhelming, and their dependence on us so absolute, that it’s impossible to misread our moral obligation to them. We bind ourselves to those who need us most, and through caring for them, grow to love them, grow to delight in them, grow to marvel at who they are.”

Tags: psychiatry, Family Therapy

In his book Mindful Work, David Gelles (New York Times reporter) makes a good case for mindfulness: "One of the most surprising and promising trends in business today is the rise of mindfulness in the workplace. At first, the notion of yoga and meditation in the office seems like the province of Silicon Valley startups where employees bring their dogs to work and play football in the lobby. But in recent years, mindfulness has gone mainstream. Many of America’s largest companies, such as General Mills, Target, Google, and Aetna, have built extensive programs to foster mindful practices among their workers. This is because—as employees and employers are discovering, and psychologists and cognitive scientists have confirmed—mindfulness has tangible benefits. For workers, meditation lowers stress, increases mental focus, and alleviates depression. For companies, a more mindful workforce is more productive."

1. Don’t foist it on anyone
Nobody loves a noodge who is intent on telling you what’s wrong with you and what you have to do to fix it. While you may feel that someone who is telling you how stressed out they are would benefit from meditation, it’s better to bide your time and let them ask you about it. Resist the urge to gush about your new favorite thing.
An exception: There’s nothing wrong with suggesting it to your employer. It’s not as awkward to bring it up in an organizational context. You’re not really imposing on anyone. You can talk about the science, about how lots of successful organizations are using it (See David Gelles’ Mindful Work), and suggest someone to contact. If possible, it’s good to note that any successful mindfulness program must be voluntary.
2. It’s not about stopping thinking or clearing the mind
Lots of people have picked up the truly crazy idea that meditation somehow vacuums out your head and makes you into a brainless zombie. Let people know that it’s about focusing the mind, not blanking it out. Emphasize that it’s an inherent, innate ability, a skill, not a gauzy, zoned-out place to drift off to.
3. It’s not just another damn thing on a to-do list to not do
People are naturally afraid to take on yet another self-improvement project to feel guilty about. Their life probably has a few exercise machines they’re not using, books they’re not reading, and club memberships going unused. Let them know that there are lots of ways to fit meditation into their existing life, and that it might actually help them use time better.
4. Let them know it’s hard, but not too hard
There’s no point in blathering on about how simple and easy it is, because if someone tries it for even five minutes, one of their first thoughts will be, “I cannot do this.” Staying with your breath in the moment can just seem impossible. Let people know this, but let them know it does get better.
5. If you can tell someone is interested, find out why, and listen
There’s a great New Yorker cartoon where a woman tells her lunch companion, “I’ve only been gluten-free for a week, but I’m already really annoying.” The essence of proselytizing and preaching is talking at, not with, someone. It’s important to hear what someone has to say and be ready to learn. It also sends the authentic message that mindfulness is about being continually curious about the mind—your own and everyone else’s.
6. Remind them about what really is annoying: the ceaseless voice in your head
 When you talk about the nattering voice in the head, you get right into the heart of people’s internal lives, which they may or may not have considered before. If you point out that most of our internal dialogue is negative and self-referential, most people will recognize that in themselves. The notion of having a tool to better manage that will seem appealing.
7. Stick with what you know and be honest
What could hurt about telling someone here’s what I’ve done and what it’s done for me. It makes no promises and it allows you to have a real human discussion at eye level, rather than elevate yourself onto the pedestal of “great and learned meditator.”

Tags: meditation, mindfulness

Yeah I’m out that paper, no more chasing med records
Writing so illegible, that I’ll be HIPAA foreva
Bought the new software, and though we use it here
I can’t use it over there, different systems everywhere
I used to chart on paper, all of my verbals recorded
Mix up with the ward clerk, turned “diluted” to “dilaudid”
Switched me to that EMR, meaningless abuse, G
Now catch me at the nurses station mashin’ that F2 key
Notes used to be our story, narrative, but yo
Replaced with copy paste, now a bloated ransom note
Me, I’m at that bedside, focused like a laser beam
On the patient, naw come on, I’m treatin’ the computer screen
8 dozen warnings, click check boxes
Alarm fatigue, vaseline conflicts with doxy??
Nurses they be burned out, we could use some OT
Tell by our wrist guards that we most definitely on
EHR, crappy software some vendor made us,
there’s nothing you can do, stuck with EHR,
best practice pop ups will tire you,
complain and they’ll fire you,
we need a new chart new chart new chart
(you’re welcome, they built you a turd doc!)
Catch me on the phone with IT beggin’ tech support
Shoot, it’s like IT and me be stuck in 1994
Innovation all around, but it ain’t in healthcare
Internet and apps for you, but we get ancient software
Welcome to that EHR, Go Live and it don’t stop
Uncle Sam promoted it, but gone is the interop
CMS, EMS, PMS, holla back
For doctors it ain’t fair, these vendors act like they all kinda wack
8 million stories, out there docs can’t take it,
after this disaster half of y’all won’t make it
How to train your Dragon: “hotmail” isn’t “Hot Male”
If some be saying it’s epic we sayin’ it’s epic fail
Electronic silo, team not talking
Paperless they say, but whole trees we droppin’
Props to case management
Long live the RT
Long live the pharmacist, whole team definitely hates
EHR, just a glorified billing platform,
with some patient stuff tacked on,
give us a new chart, ICD-10’s a disaster,
meet your new robot master,
we need a new chart, new chart, new chart
(this chart wack, welcome to the apocalypse doc)
Tech should bind us, connect, not blind us,
to the reason why we care,
Patient’s face reminds us
Designs like Epocrates, that tap the app agilely
Then magically the team works, let’s bite the Apple, Steve
Caught up in the in-box, now you’re in-sane
Good docs gone mad, the clinic’s filled with them
Nursing, they the heart of everything
Data entry got ‘em hurtin’, life starts when the shift ends
10 years of school, graduated to the OR
Mommy busts a Whipple she deserves a better damn chart
Autocorrect turning Chantix into Champion
Patient needs a sleeper, 30 clicks for a Ambien
EHR, crappy software some vendor made us,
there’s something you CAN do,
give us a new chart,
stand up and make our voices heard,
let doctors be doctors,
we need a new chart new chart new chart
(Stand up, the whole team)

The disease of addiction can develop in people despite their best intentions or strength of character. Drug addiction is insidious because it affects the very brain areas that people need to "think straight," apply good judgment and make good decisions for their lives. No one wants to grow up to be a drug addict, after all.

The addiction study cited above has some limitations. The results are based on participants' self-reporting, so the study may suffer from reporting bias. However, researchers found that based on urine testing, under-reporting of drug use was low. Additional limitations: not everyone in the clinic waiting rooms agreed to participate, which could impact the study's generalizability; there was some attrition during the study, though the 75 percent participation rate at follow-up compares to other studies of low income patients and drug use; and the three month follow up was relatively short.

There is a need for larger trials to gauge the QUIT program's effectiveness, but based on these findings the project appears to have the potential to fill an important gap in care for patients who use drugs, particularly in low-income communities, Gelberg said.

Read the entire report and article by clicking here.

Tags: intervention, primary care, psychiatry, addiction

Tags: adderall , stimulants, ADHD, education

Tags: meditation, mindfulness, recovery, 24 Hour Book

Discover if you're at risk of job burnout — and what you can do
when your job begins to affect your health and happiness.

Job burnout can result from various factors, including:
• Lack of control. An inability to influence decisions that affect your job — such as your schedule, assignments or workload — could lead to job burnout. So could a lack of the resources you need to do your work.
• Unclear job expectations. If you're unclear about the degree of authority you have or what your supervisor or others expect from you, you're not likely to feel comfortable at work.
• Dysfunctional workplace dynamics. Perhaps you work with an office bully, you feel undermined by colleagues or your boss micromanages your work. These and related situations can contribute to job stress.
• Mismatch in values. If your values differ from the way your employer does business or handles grievances, the mismatch may eventually take a toll.
• Poor job fit. If your job doesn't fit your interests and skills, it may become increasingly stressful over time.
• Extremes of activity. When a job is always monotonous or chaotic, you need constant energy to remain focused — which can lead to fatigue and job burnout.
• Lack of social support. If you feel isolated at work and in your personal life, you may feel more stressed.
• Work-life imbalance. If your work takes up so much of your time and effort that you don't have the energy to spend time with your family and friends, you may burn out quickly.

You may be more likely to experience job burnout if:
• You identify so strongly with work that you lack a reasonable balance between your work life and your personal life
• You try to be everything to everyone
• You work in a helping profession, such as health care, counseling or teaching
• You feel you have little or no control over your work
• Your job is monotonous

Ignored or unaddressed job burnout can have significant consequences, including:
• Excessive stress
• Fatigue
• Insomnia
• A negative spillover into personal relationships or home life
• Depression
• Anxiety
• Alcohol or substance abuse
• Heart disease
• High cholesterol
• Type 2 diabetes, especially in women
• Stroke
• Obesity
• Vulnerability to illnesses

Don't let a demanding or overwhelming job undermine your health.

Remember, if you think you may be experiencing job burnout, don't ignore your symptoms. Consult your doctor or a mental health provider to identify or rule out any underlying health conditions.If you're concerned about job burnout, take action. To get started:

• Manage the stressors that contribute to job burnout. Once you've identified what's fueling your feelings of job burnout, you can make a plan to address the issues.
• Evaluate your options. Discuss specific concerns with your supervisor. Perhaps you can work together to change expectations or reach compromises or solutions. Is job sharing an option? What about telecommuting or flexing your time? Would it help to establish a mentoring relationship? What are the options for continuing education or professional development?
• Adjust your attitude. If you've become cynical at work, consider ways to improve your outlook. Rediscover enjoyable aspects of your work. Recognize co-workers for valuable contributions or a job well done. Take short breaks throughout the day. Spend time away from work doing things you enjoy.
• Seek support. Whether you reach out to co-workers, friends, loved ones or others, support and collaboration may help you cope with job stress and feelings of burnout. If you have access to an employee assistance program (EAP), take advantage of the available services.
• Assess your interests, skills and passions. An honest assessment can help you decide whether you should consider an alternative job, such as one that's less demanding or one that better matches your interests or core values.
• Get some exercise. Regular physical activity, like walking or biking, can help you to better deal with stress. It can also help get your mind off work and focus on something else.
• Pay attention to your use of alcohol, pills, or other "stress relievers." Although booze and drugs can provide temporary relief, neuroscience tells us that the misuse of alcohol or intoxicants is bad for your brain. It's better to get proper help from a qualified professional.

Tags: mindfulness, veterans, psychiatry, psychotherapy

• Healthline, By R. Sam Barclay, July 9, 2015

  Should a Worker Be Fired for Using Medical Marijuana at Home?

• USA Today, By Liz Szabo, July 8, 2015

  Advocates Push to Expand Use of Medications to Treat Addiction

• PBS NewsHour, By Catherine Woods, June 27, 2015

  Virtual Reality Shows How Dangerous it is to Drive Drunk and Stoned

• Nature, By Katherine Bourzac, June 25, 2015

  Neuroscience: Rewiring the Brain

• Nature, By Maia Szalavitz, June 24, 2015

  Genetics: No More Addictive Personality

• Nature, By Cassandra Willyard, June 24, 2015

  "Pharmacotherapy: Quest for the Quitting Pill"

• USA Today, By Trevor Hughes, June 23, 2015

  Study Analyzes How Much Pot Impairs Drivers

• TIME, By Eliza Gray, June 23, 2015

  "How Much Does Marijuana Impact Your Driving?"

• Science News, By Kate Baggaley, May 05, 2015

  "Designer Drugs Hit Dangerous Lows to Bring New Highs"

1) PRECONTEMPLATION STAGE

"It isn't that we can't see the solution. It's that we can't even see the problem for what it is."

Pre-contemplators usually show up in therapy because of pressures from others: spouses, employers, parents, and courts. They resist change. When their problem comes up, they change the topic of conversation. They place responsibility for their problems on factors such as genetic makeup, addition, family, society, destiny, the police. They explain how little they actually use or drink, and they complain that no one gives them credit when they cut down or even abstain for a short time. They feel hopeless and demoralized, and they are often defensive, angry, and frankly illogical in their thinking.

2) CONTEMPLATION STAGE

"I want to stop feeling so stuck. I am tired of all the hassles and of other people intruding in my life."

Contemplators admit that they have a problem and begin to think about solutions. Contemplators struggle to understand their problems, to see its causes, and wonder about possible solutions. Many contemplators have indefinite plans to take action within the next few months. They know where they want to do, and they have ideas (some good, some not so good) about how to get there.

"You know your destination, and maybe even how to get there, but you're not ready to go…yet."

Contemplators tell themselves that someday they are going to change. When contemplators are trying to reach the preparation stage of change, their thinking is clearly marked by two changes.

First, they begin to think more about the future than the past.

The end of contemplation stage is a time of anticipation and anxiety. Relapse is common when individuals reach this stage. They are fearful of what will happen next. Support from family and friends may be exhausted. Even though they have made considerable effort, things often don't get easier — not yet.

Between stage 2 and 3: A decision is made. People conclude that the negatives of their behavior outweigh the positives. They choose to change their behavior. They make a commitment to change. This decision represents an event, not a process.

3) PREPARATION STAGE

Most people in the preparation stage are planning to take action and are making the final adjustments before they begin to change their behavior. Usually they have not resolved their ambivalence. A part of them wants to get well, but as the Zen saying puts it, "The mind is a barrel of wild monkeys," and they often go back and forth about taking action.

4) ACTION STAGE

The time for action does not come on with a blinding flash of light. There is no burning bush. Gradually the person overtly modifies his or her behavior and his or her surroundings. At this point the make the move for which they have been preparing. This is a critical point, and it requires the greatest commitment of time and energy.

Change is visible to others. Others can see the difference in attitude, honesty and commitment. Small changes sometimes matter the most.

5) MAINTENANCE STAGE

Change never ends with a single action. One old saying in Alcoholics Anonymous is that without a strong commitment to maintenance, there will surely be relapse, usually to the pre-contemplation or contemplation stage.

THE IMPORTANCE OF PROCESSES

Processes are selected activities that are regularly initiated to effect change. There are nine important ones chosen by therapists as distinct areas of consideration and useful tools in personal transformation.

1. Consciousness-raising: Increasing knowledge about yourself and your problem.

2. Social liberation: Considerations in the external environment that can contribute to helping change, i.e.: no smoking areas, lo-cal menu items, advocacy groups.

3. Emotional arousal: Increased awareness through depth of feeling from natural events or dramatic intervention, psychodrama.

4, Self-reevaluation: A thoughtful and emotional reappraisal of yourself as regards your problem, weighing the pros and cons of changing.

5. Commitment: Acknowledging that you are the only one who can respond, speak and act for yourself.

6. Countering: Planning for and substituting healthy responses for unhealthy ones, action oriented.

7. Environmental control: Restructuring your personal environment so that the probability of a problem-causing event is reduced.

8. Rewards: Affirmation of desirable behavior by self or others as contrasted with and better than any type of punishment for problem behavior.

9. Helping relationships: Receiving care, support and assistance from significant people in your life.

For more information about the stages of change, see the book Changing for Good by James Prochaska.

Mindfulness-based cognitive therapy aims to change the way people think and feel about their experiences. How we think affects how we feel. And the use of mindfulness practice is relatively easy for most people. Just 10-15 minutes two or three times daily makes a difference. The current study compares MBCT with maintenance antidepressant medication for reducing the risk of relapse in depression. The results are encouraging.

The study aimed to establish whether MBCT is superior to maintenance antidepressant treatment in terms of preventing relapse of depression. Although the findings show that MBCT isn't always more effective than maintenance antidepressant treatment in preventing relapse of depression, the results, combined with those of previous trials, suggest that MCBT may offer similar protection against relapse or recurrence for people who have experienced multiple episodes of depression, with no significant difference in cost.

"Mindfulness gives me a set of skills which I use to keep well in the long term. Rather than relying on the continuing use of antidepressants mindfulness puts me in charge, allowing me to take control of my own future, to spot when I am at risk and to make the changes I need to stay well." — Study Participant

MBCT builds on the insight that when people with a history of depression experience even a brief period of feeling low they tend to be especially vulnerable to negative thinking. That negative thinking is often accompanied by what’s known as “processing biases”: worrying about past problems, for example, or returning to unpleasant memories. Thinking like this raises the risk of a full-blown depressive episode.

MBCT focuses on helping people to become more aware of these thoughts and feelings, and thus better able to gain distance from them. As its founders put it: “We discover that difficult and unwanted thoughts and feelings can be held in awareness, and seen from an altogether different perspective – a perspective that brings with it a sense of warmth and compassion to the suffering we are experiencing.”

Tags: mindfulness, psychotherapy, psychiatry, recovery

I am an old-timer, and when my generation trained in psychiatry virtually all of us planned on being psychotherapists who were well educated in the use of medication as an adjunct to talk therapy. All psychiatrists I knew back then had been in psychotherapy themselves; personal therapy was considered part of becoming a competent clinician: "Physician, know thyself."

If a psychiatrist has a limited vocabulary, and can't conjugate nouns and verbs, how can they possibly communicate with patients?

Research shows that when psychotherapy and medication are both available, the combination is synergistic. It's like saying 1 + 1 = 3. Today, however, fewer than 10% of psychiatrists are trained and skilled in psychotherapy. My opinion is that this is why a good psychiatrist is very hard to find. I have been teaching young psychiatrists for over thirty years, and I have been a training director in one of our finest medical schools, and I can say with authority that many psychiatrists coming out today get failing grades when it comes to important skills like writing, speaking, and communicating clearly. I'm talking about basic errors in English grammar, syntax, and sentence structure — the stuff most people should learn by the time they enter high school! If a psychiatrist has a limited vocabulary, and can't conjugate nouns and verbs, how can they possibly communicate with patients? This is one reason that psychiatrists today are, in general, poor psychotherapists with little interest in what talk therapy has to offer.

Writing in a medical chart is similar to text messaging. It's easy, and grammar doesn't count. In fact, the modern electronic medical record discourages thoughtful writing, just like text messaging does. A good psychiatrist should not only speak well and write well. A good psychiatrist should be a superior thinker and communicator. Every doctor should have a big sign on the wall behind the chair where the patient is sitting: "DOCTOR, YOUR PATIENT IS TRYING TO TELL YOU SOMETHING!"

Here's Dr. Friedman again: "With few exceptions, every major class of current psychotropic drugs — antidepressants, antipsychotics, anti-anxiety medications — basically targets the same receptors and neurotransmitters in the brain as did their precursors, which were developed in the 1950s and 1960s."

"Sure, the newer drugs are generally safer and more tolerable than the older ones, but they are no more effective."

Prescribing a pill is easier and cheaper than offering the patient psychotherapy. Psychiatrists are paid more to prescribe pills than to counsel with patients. It is understandable, then, that the incentive is to see five patients in a single clinic hour. This saves insurance companies a lot of money. Many insurance companies will not even pay for psychotherapy with a qualified psychiatrist. And think about this: if a patient doesn't like the psychiatrist, there are fewer repeat or return visits. The winners are the insurance companies.

Dr. Friedman is also critical of trends in research, not because they are wrong, but because of simplistic logic. "The doubling down on basic neuroscience research" he says, "seems to reflect the premise that if we can unravel the function of the brain, we will have a definitive understanding of the mind and the causes of major psychiatric disorders." He points to an editorial in May in one of the most respected journals in our field, JAMA Psychiatry, emphasizing the brain but not mentioning the mind, the complexity of mental illness, or anything about how psychotherapy scientifically helps the brain. Friedman believes that "an undertaking as ambitious as unraveling the function of the brain would most likely take many years. Moreover, a complete understanding of neurobiology is unlikely to elucidate the complex interactions between genes and the environment that lie at the heart of many mental disorders."

"Anyone who thinks otherwise should remember the Decade of the Brain, which ended 15 years ago without yielding a significant clue about the underlying causes of psychiatric illnesses."
—Professor and Psychiatrist Richard Friedman

Dr. Friedman's article generated a number of replies, including this one from Christopher Lukas, a noted author:

"Over the years, I have had talking therapy for my depression and post-traumatic stress disorder, and I don’t believe I would be alive were it not for those sessions. I have also taken a whole range of medications for depression and find that psychotherapy outweighs the benefits of any of those drugs.

"Some psychiatrists and some patients think that drugs are better because they work like aspirin: Take two and call me in the morning. But, as Dr. Friedman pointed out, and as I have experienced, other patients find doses of talking therapy can work well if we’re patient and if we understand that many emotional problems may take time to go away.

"Persistence, willingness to give yourself over to the process and willingness to change therapists if the talk isn’t helping you: These are key to talk therapy’s benefits."

The comments by Lukas remind me of something I pointed out to a patient just last weekend. Asking about Alcoholics Anonymous, she wanted to know what it takes to succeed in finding sobriety through AA. "An easy way to think about it," I said, is to remember the three letters H-O-W." The old AA acronym stands for "honesty, open-mindedness, and willingness."

Another writer, who is a physician herself, also agreed with Dr. Friedman:

"For the past 30 years psychotherapy has been given short shrift as drug therapy has become the treatment of choice. There are many reasons for this, but the most powerful are economic.

"Doctors can manage medication for many more patients in a day than they can treat with psychotherapy. More important, pharmaceutical companies, which profit from the drug sales, support research, thus providing funds to psychiatry departments that receive no similar support for psychotherapy research. Sadly, in the past generation or two there has been a huge loss in professional expertise as fewer psychiatry residency programs provide top-notch psychotherapy education and supervision.

"Twenty-eight years ago I went to medical school planning a career in child psychiatry. My interest had been primed by fascinating conversations I’d heard in high school between my father, a psychoanalyst, and his colleagues. My medical school psychiatry rotation was a disappointment. There was no attempt to solve the riddles of patients’ emotions and behavior, only the adjustment of medication doses to treat symptoms. Still wanting to solve puzzles, I chose a career in radiology.

"When my father died, I was tremendously moved to hear some of his patients who attended his funeral tell me how the treatment he provided had profoundly changed their lives. Psychotherapy should be an integral part of psychiatric training."

Since I do both — I am a psychotherapist who prescribes medication when appropriate — it's understandable that I agree with Dr. Friedman. It's also true that I practice this way because that approach provides the best care for the brain, the mind, and the whole person.

Tags: New York Times , medication, psychotherapy, psychiatry

Tags: adderall , ritalin, ADHD

Tags: Children

Tags: Overdose Deaths

Tags: medicare, benzodiazepines, addiction

Tags: psychiatry, suicide, mental health, veterans

Tags: lymphatic system, brain, neuroscience, research

Tags: daniel amen, mri scans, brain scans, pseudoscience, quackery

Tags: Children, brain, drug abuse, socioeconomic status

Tags: texas holdem, Computers

Tags: Opiates, Overdose Deaths, pain pills, addiction treatment

Now comes Aviva Rutkin, writing in New Scientist that human poker professionals are taking on artificial intelligence (and the strongest poker playing computer built to date), and they are playing for real money. Here's the story.

Computer scientists have already made some progress, at least with simpler forms of the game. But the version being played at the Pittsburgh tournament, called Heads Up No Limit Texas Hold 'em, is "a completely different beast", says pro player Vanessa Selbst. "There's much more human elements and game strategies to employ, so it's a much more complex game." What's more, there are no betting limits, so the computer also has to take into account how much players might stake on each game.

Competing in Pittsburgh is Claudico, a program created at Carnegie Mellon University. Claudico taught itself poker skills by playing trillions of games in search of some kind of optimal strategy. Whatever it has picked is pretty good: last year, Claudico beat all 13 other computer competitors at no-limit poker in the annual contest run by the Association for the Advancement of Artificial Intelligence.

Computers have a few edges over humans, says graduate student Noam Brown, part of the team behind Claudico. For example, a computer can switch randomly between various betting strategies, which may confuse human opponents.

On the other hand, Claudico is slow to pick up on and adapt to people's playing styles – something that many pro players do with ease. "One of our big concerns is that the human will be able to identify weaknesses that Claudico has and exploit them," says Brown.

Because Claudico taught itself to play, even the team that built it don't quite know how it picks its moves. "We're putting our faith in Claudico. It knows much better than we do what it's doing."

Algorithms like those used to play poker could be valuable for other kinds of problems characterised by imperfect information. They could suggest optimal locations for military resources in a war, for example. Rival AIs could also be tasked to negotiate with each other over insurance rates or handle legal squabbles. "In society, sometimes you see one side getting screwed over because someone has more lawyers or more information or more resources at their disposal," says Brown. "Something like this can really level the playing field."

The winner of the poker tournament won't be crowned until the event ends on 7 May. Eric Jackson, a software engineer who creates poker bots as a hobby, is cautiously optimistic that Claudico can win. As we went to press, the pros and Claudico were neck and neck.

Even if AI triumphs, it won't mean programmers have conquered the game. "Beating humans decisively would be a landmark, but it wouldn't mean the end of work on poker," says Jackson. "We still don't know what the perfect strategy is."

The original article by Aviva Rutkin can be found online here.

Tags: poker, texas holdem, artificial intelligence, gambling

Tags: TBI, traumatic brain injury, Center for BrainHealth

Tags: Kevin McCauley M.D.

The brain changes as we get older, and in some ways it works better as we get older.

How is it possible for older people to function better even as their brains slow? “The brain begins to compensate by using more of itself,” explains Dr. Bruce Yankner, professor of genetics and co-director of the Paul F. Glenn Laboratories for the Biological Mechanisms of Aging at Harvard Medical School. He notes that MRIs taken of a teenager working through a problem show a lot of activity on one side of the prefrontal cortex, the region we use for conscious reasoning. In middle age, the other side of the brain begins to pitch in a little. In seniors, both sides of the brain share the task equally. The cooperative effort has a payoff. “Several studies suggest that seniors who can activate both sides of the brain actually do better on tasks, while those who can’t do worse,” Dr. Yankner says.

If you’ve found that it’s a little harder to carry on a conversation while searching your bag for your keys, MRI studies offer some clues. They show that in younger people, the area of the brain used to do a task goes dark immediately once the task is completed, while in older people it takes longer to shut down. As a result, it’s harder for the older brain to take on several tasks, because not only do you need to use more of the brain for any single task, but the brain also has a harder time letting go of a task. So even after you fish out your keys, you may have trouble getting back into the conversation.
What about the moments when you find yourself driving down the street without any recollection of having passed the last few blocks? Or the times you’ve locked the car door with your keys in the ignition? On those occasions your brain may have slipped into the default mode, which controls processes like remembering and daydreaming that are not required for a directed task. Imaging studies show that interconnected regions of the brain dubbed the “default network” grow more active with age, indicating that as we age we spend more time daydreaming.

THE GOOD NEWS ABOUT "THE MORE MATURE" BRAIN

At The Center for BrainHealth, as at Harvard, we are discovering that the more mature brain actually has advantages over its younger counterpart. These findings came as a surprise to many people, who were accustomed to seeing “senior moments”—groping for the right word or taking longer to articulate your thoughts—as a sign that the brain was on the skids. Yet even in professions where youth is valued, testing has shown that maturity has advantages.

For example, in a study of air-traffic controllers and airline pilots, those between ages 50 and 69 took longer than those under 50 to master new equipment, but once they had, they made fewer mistakes using it. (Keep this in mind when you’re trying to conquer a new computer program or adapt to a new car!) The mastery that comes with maturity is due to changes in your glands as well as your brain. Declining levels of testosterone—even in women—result in better impulse control. The end of the hormonal roller coaster of menopause may also contribute to emotional stability. After midlife, people are less likely to have emotional issues like mood swings and neuroses that interfere with cognitive function.

Most importantly, the wealth of knowledge from decades of learning and life experience enables you to better assess new situations. At midlife, most people are more adept at making financial decisions and getting to the heart of issues than they were when they were younger.

In most people, these abilities improve with age:

Inductive reasoning. Older people are less likely to rush to judgment and more likely to reach the right conclusion based on the information. This is an enormous help in everyday problem solving, from planning the most efficient way to do your errands to managing your staff at work.

Verbal abilities. In middle age, you continue to expand your vocabulary and hone your ability to express yourself.

Spatial reasoning. Remember those quizzes that require you to identify an object that has been turned around? You are likely to score better on them in your 50s and 60s than you did in your teens. And you may be better at some aspects of driving, too, because you are better able to assess the distance between your car and other objects on the road.

Basic math. You may be better at splitting the check and figuring the tip when you’re lunching with friends, simply because you’ve been doing it for so many years.

Accentuating the positive. The amygdala, the area of the brain that consolidates emotion and memory, is less responsive to negatively charged situations in older people than in younger ones, which may explain why studies have shown that people over 60 tend to brood less.

Attaining contentment. Years ago, researchers were surprised to find that people seem to be more satisfied with their lives as they age, despite the losses that accumulate with passing years. This is probably because they tend to minimize the negative, accept their limitations and use their experience to compensate for them, and set reasonable goals for the future. Dr. Yankner notes that this trait may be innate, because it is prevalent even in the United States and other Western nations, which tend to value youth over age.

Tags: aging brain, mental health, psychiatry

Psychiatrists dropping our of private insurance networks
Many respondents reported dropping out of private insurance networks, resulting in more consumers having to pay out of pocket for mental health care. In 2007, the Maryland Psychological Association published a white paper titled, “Access to Care in the State of Maryland.” Their survey found that 44% of mental health professionals listed in the managed care networks were unreachable, and that the average wait time for an appointment with a psychiatrist was 25 days.
In the same April 2015 article, attorney Colleen Coyle, general counsel for the American Psychiatric Association, said that "in many instances health plans advertise provider networks that appear to offer users of behavioral health services a wide range of option for access to care, but in reality those networks may be much "thinner" than consumers are led to believe.

Insurance false advertising is fraud
"In my view, that is fraud," Coyle said. The insurer is promoting a provider list that it knows is not reflective of the access to care that patients will really have. I don't think it's innocent at all."
She goes on to say that insurance plans are constantly looking at their providers and and claims "because that's how they target which providers to audit and whether they are going to challenge the claim."
John McIntyre, M.D., a past president of the American Medical Association, said: "Many insurers, in an attempt to hold down costs, employ very narrow or shallow networks that are inadequate to provide necessary medical care. But patients don't know that when they sign up."

The detailed report from The Maryland Mental Health Association is available online here.

Tags: access to care, network adequacy, psychiatrist hard to find

• the extent and nature of the person’s problems;
  • the appropriateness of treatment;
• the competence and skill of clinical staff;
  • the availability of additional services; and
  • the quality of interaction between the person and the treatment providers.
  

Tags: addiction treatment, addiction, addiction medicine

Tags: mindfulness meditation, brainhealth, relaxation

Tags: brain, psychiatry, new scientist

Tags: CBT, Cognitive behavioral therapy, psychotherapy

Tags: teens, SMART Training, brain performance institute

An excellent video of one of Roy's lectures is on my media page.

We try to control ourselves in all sorts of ways: eating right, exercising, avoiding drugs and alcohol, studying more, working harder, spending less. Baumeister says that the practical significance of all this is enormous. He says: "Most of the problems that plague modern individuals in our society — addiction, overeating, crime, domestic violence, sexually transmitted diseases, prejudice, debt, unwanted pregnancy, educational failure, underperformance at school and work, lack of savings, failure to exercise — have some degree of self control failure as a central aspect."

Baumeister goes on to say that two main traits that seem to produce an immensely broad range of benefits: intelligence and self-control. However, psychology has not found much one can do to produce lasting increases in intelligence. On the other hand, self-control can be strengthened, and the study of self-control is a rare and powerful opportunity for psychology to make a palpable and highly beneficial difference in the lives of ordinary people.

For example, in his research he has found that people perform relatively poorly on tests of self-control when they have engaged in a previous, seemingly unrelated act of self-control: "For instance, in a study in my lab, we invited some students to eat fresh-baked chocolate-chip cookies, and asked others to resist the cookies and munch on radishes instead. Then we gave them impossible geometry puzzles to solve. The students who ate the cookies worked on the puzzles for 20 minutes, on average. But the students who had resisted the tempting cookies gave up after an average of eight minutes."

"Such studies suggest," he continues, "that some willpower was used up by the first task, leaving less for the second. The pattern is opposite to what one would expect based on priming or activating a response mode. So we began to think that some kind of limited resource is at work: It gets depleted as people perform various acts of self-control. Over time, we have begun to link this resource to the folk notion of willpower."

Making decisions seems to use up our willpower. After making decisions, people perform worse at self-control. Conversely, after exerting self-control, decision-making shifts toward simpler and easier processes. That can lead people to make poorer decisions, or to avoid making choices at all. Apparently, decision making depletes the same resource as self-control.

One of Baumeister's examples of willpower depletion: "A dieter may easily avoid a doughnut for breakfast, but after a long day of making difficult decisions at work, he has a much harder time resisting that piece of cake for dessert. Another example might be losing your temper. Normally, you refrain from responding negatively to unpleasant things your romantic partner says. But if one day you’re especially depleted — maybe you’re trying to meet a stressful work deadline — and the person says precisely the wrong thing, you erupt and say the words you would have stifled if your self-control strength was at full capacity. What do you call this process? My collaborators and I use the term “ego depletion” to refer to the state of depleted willpower. Initially, we called it “regulatory depletion” because the first findings focused purely on acts of self-regulation. When it emerged that the same resource was also used for decision-making, we wanted a broader term that would suggest some core aspect of the self was depleted. We borrowed the term “ego” from Freudian theory because Freud had spoken about the self as being partly composed of energy and of processes involving energy."

In his book, Baumeister explains that some people imagine that self-control or willpower is something you only use once in a while, such as when you are tempted to do something wrong. The opposite is true. Research indicates that the average person spends three to four hours a day resisting desires. Self-control is used for other things as well: controlling thoughts and emotions, regulating task performance and making decisions. Most people use their willpower many times a day, all day. And toward the end of the day, there is less gas in the tank.

We now know that people can improve their self-control even as adults. As with a muscle, it gets stronger from regular exercise. So engaging in some extra self-control activities for a couple weeks produces improvement in self-control, even on tasks that have no relation to the exercise activities. The exercises can be arbitrary, such as using your left hand instead of your right hand to open doors and brush your teeth. Or they can be meaningful, such as working to manage money better and save more. The important thing is to practice overriding habitual ways of doing things and exerting deliberate control over your actions. Over time, that practice improves self-control. As people deplete willpower, they became increasingly likely to give in to desires they might otherwise have resisted. This was true for all manner of desires: desires to sleep, to eat, to have sex, to play games, to spend money, to drink alcohol or smoke cigarettes.

One of the best features of Roy Baumeister's work, particularly his book on willpower, is that he is easy to read, accessible to those of us not trained in clinical research or adept at deciphering scientific papers.

Tags: Willpower, psychology, addiction

The word "cocaine" had different connotations as well. In the 1860s, for instance, a substance termed "cocaine" was advertised by a Boston company as a topical treatment to prevent hair loss.

Over time these words – "alcohol", "cocaine" and others, including "drugs" and" intoxicated" – became more closely associated with substance use, abuse and addiction in American popular culture.

"'Alcoholism' made its debut in the lexicon around 1900, associated almost exclusively with 'crime' and 'dreams' – coincidentally around the time that Sigmund Freud's The Interpretation of Dreams was published," Recovery.org notes. "However, the association with crime was soon eclipsed by concern over 'chronic' alcoholism and 'death'/'deaths' related to alcoholism, which ballooned in the 1920s during the height of the prohibition movement." Documentarian Ken Burns echoes this in his series, Prohibition. One of the tragic unintended consequences of the nationwide crackdown on alcohol was an increase in dangerous, unregulated spirits — leading to 1,000 deaths a year.

Tags: addiction treatment, psychiatry, psychology

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Tags: placebo, genetics, medication

Tags: meditation, mindfulness, addiction treatment, relapse, psychotherapy

What people in addiction recovery notice, usually right away, is the strong similarity between the findings of positive psychology research and the guiding principles of twelve step recovery.

Positive emotions include a wide range of feelings, not just happiness and joy. Included are emotions like excitement, satisfaction, pride and awe, amongst others. These emotions are frequently seen as connected to positive outcomes, such as longer life and healthier social relationships.

Engagement refers to involvement in activities that draws and builds upon one’s interests. Mihaly Csikszentmihalyi explains true engagement as flow, a feeling of intensity that leads to a sense of ecstasy and clarity. The task being done needs to call upon higher skill and be a bit difficult and challenging yet still possible. Engagement involves passion for and concentration on the task at hand and is assessed subjectively as to whether the person engaged was completely absorbed, losing self-consciousness.

Relationships are all important in fueling positive emotions, whether they are work-related, familial, romantic, or platonic. We receive, share, and spread positivity to others through relationships. They are important in not only in bad times, but good times as well. In fact, relationships can be strengthened by reacting to one another positively. It is typical that most positive things take place in the presence of other people.

Meaning is also known as purpose, and prompts the question of “Why?” Discovering and figuring out a clear “why” puts everything into context from work to relationships to other parts of life. Finding meaning is learning that there is something greater than you. Despite potential challenges, working with meaning drives people to continue striving for a desirable goal. The three criteria are that it 1) contributes to well-being, 2) is pursued for its own sake, and 3) is measured independently of the other elements of PERMA.

Accomplishments are the pursuit of success and mastery. Unlike the other parts of PERMA, they are sometimes pursued even when it does not result in positive emotions, meaning, or relationships. Accomplishment can activate the other elements of PERMA, such as pride under positive emotion.Accomplishments can be individual or community based, fun or work based.

The five domains are valuable to consider when "the program isn't working," because taking personal inventory usually comes down to looking at what's going on inside these categories. The five elements were sifted out of research on thousands of individuals who were interviewed on the broad topic of happiness.

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• Analgesia (feeling no pain)
• Sedation
• Euphoria (feeling high)
• Respiratory depression (shallow or slow breathing)
• Small pupils
• Nausea, vomiting
• Itching or flushed skin
• Constipation
• Slurred speech
• Confusion or poor judgment

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• Effective psychiatrists demonstrate a sophisticated set of interpersonal skills, including verbal fluency, perceptiveness of others, emotional intelligence, expressiveness, warmth, and acceptance. Given these gifts, the most effective psychiatrists are those who are first excellent physicians, well trained in medicine, competent to practice at the highest levels.

• Effective psychiatrists are inquisitive, questioning, and seeking new knowledge constantly. They embrace science while at the same time possessing the humility to know how little we really know.

• Patients of effective psychiatrists feel understood, trust the psychiatrist, and believe the psychiatrist can help. The psychiatrist creates these conditions in the first moments in both speech and action. In the initial contacts, patients are very sensitive to cues of acceptance, understanding, and expertise. Although these conditions are necessary throughout therapy, they are most critical in the initial interaction to ensure engagement in the therapeutic process.

• Effective psychiatrists are able to form a working alliance with a broad range of patients. The working alliance involves the therapeutic bond, but also importantly agreement about the task of goals of therapy. The working alliance is described as collaborative, purposeful work on the part of the patient and the psychiatrist. The effective psychiatrist builds on the patient’s initial trust and belief to form this alliance and the alliance becomes solidly established early in therapy.

• Effective psychiatrists provide an acceptable and practical explanation for the patient’s distress. The patient wants an explanation for his or her symptoms or problems. There are several considerations involved in providing the explanation. First, the explanation must be consistent with the healing practice. On the medical side, the explanation is biological, and in psychotherapy the explanation is psychological. Second, the explanation must be acceptable and compatible with the patient’s attitudes, values, culture, and worldview. Third, the explanation must provide a strategy by which the patient can overcome difficulties and solve life’s problems. These three factors together make for a strong therapeutic alliance.

• The effective psychiatrist provides a treatment plan that is consistent with the explanation provided to the patient. Once the patient accepts the explanation, the treatment plan will make sense and patient compliance will be increased. The treatment plan must involve healthy actions—the effective psychiatrist promotes healing by replacing failed strategies with effective strategies. At the same time, strong defenses will replace weak defenses, and healthy practices will replace self-defeating behaviors.

• The effective psychiatrist is influential, persuasive, and convincing. The psychiatrist presents the explanation and the treatment plan in a way that convinces the patient that the explanation is correct and that following through with the treatment will benefit the patient. This process leads to patient hopefulness, increased expectancy for mastery, and healthy actions. These characteristics are essential for forming a strong working alliance.

• The effective psychiatrist is honest and authentic. Authenticity refers to communication to the patient that the psychiatrist truly wants to know how the patient is doing. The best psychiatrists tend not to use checklists, scales, and paper measures. Instead, they talk and listen openly and honestly.

• The effective psychiatrist is flexible and will be patient if resistance to the treatment is apparent or the patient is slow to make progress. Although the effective psychiatrist is persuasive, persuasion can be a process that takes time. The good psychiatrist pays attention, takes in new information, test hypotheses about the patient, and is willing to be wrong. A good psychiatrist will seek second opinions, refer to other specialists, and even take calculated risks such as trying a new approach or a newly released medication.

• The effective psychiatrist does not avoid difficult material in therapy. Doctor and patient must use such difficulties therapeutically. We all tend to avoid material that is difficult. The effective psychiatrist senses avoidance is taking place and does not collude to avoid the material. Instead, the psychiatrist will discuss the difficult material and address difficult problems. Sometimes conversations can be difficult, and at times the relationship between doctor and patient can be strained, but this is part of the work of therapy. The good psychiatrist can use skill, experience, and compassion to overcome these barriers to recovery.

• The effective psychiatrist communicates hope and optimism. Sometimes this is easy to do, and sometimes it’s difficult. The working partnership must maintain hope and optimism in the face of chronic illness, relapses, lack of consistent progress, and many other difficulties. Effective psychiatrists acknowledge these issues and still communicate hope that the patient will achieve realistic goals in the long run. This communication is not blind faith or Pollyanna optimism, but rather a firm belief that together the psychiatrist and patient will work successfully. At the same time, effective psychiatrists mobilize patient strengths and resources to facilitate the patient’s ability to solve his or her own problems. The best doctors know that the patient, through his or her work, is responsible for therapeutic progress, creating a sense of mastery.

• Effective psychiatrists are aware of the patient’s characteristics and context. This is a tall order with many categories: culture, race, ethnicity, spirituality, sexual orientation, age, physical health, motivation for change, and beyond. Furthermore, the effective psychiatrist is aware of how his own background, personality, and beliefs figure into the relationship.

• The effective psychiatrist is aware of his or her own psychological process and does not inject his or her own material into the therapy process unless such actions are deliberate and therapeutic.

• The effective psychiatrist is aware of the best research evidence related to the particular patient, in terms of treatment, problems, and social context. It is very important to understand the biological, social, and psychological basis of the patient’s problem.

• The effective psychiatrist seeks always to improve, always to be a student. Hippocrates said, “The life so short, the craft so long to learn,” and truer words were never spoken.

• Finally, the good psychiatrist must possess both humility and a sense of humor. We will never know enough, or be wise enough, to have all the answers. We cannot take ourselves too seriously, lest we become arrogant, prideful, and set ourselves apart from those who have graced us with the privilege of being socially sanctioned healers.

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Psychiatry as a medical specialty is a vast—and often uncharted—territory. The basic education of a psychiatrist is highly scientific and technical. The first two years of medical school are purely basic science: anatomy, physiology, biochemistry, microbiology, and so on. The last two years include brief exposure to psychiatry and psychology, but most of the time is devoted to medicine, surgery, ob-gyn, and pediatrics. Internship and residency years in psychiatry involve patient care, but the psychiatrist’s true education begins after graduation. As the venerable Dr. Eugene Stead used to tell us at Duke, “Medical school is where you stay until you’re old enough to learn how to be a doctor.” The education of the good psychiatrist is a process that lasts a lifetime.

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