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LEARN TO REGULATE YOUR CRAVINGS FOR CIGARETTES, ALCOHOL OR DRUGS

Tuesday, September 7th, 2010

Addiction to substances damages people’s health and careers. Cigarette smoking causes more than 400,000 deaths per year (more than all deaths from illicit drugs and alcohol combined). Alcohol consumption causes 75,000 deaths per year. The CDC estimates that 35,000 of these deaths come from cirrhosis of the liver, cancer and other diseases linked to excessive drinking while 40,000 come from car crashes and other mishaps. Experts on addiction agree that what drives addictions is craving not fear of painful withdrawal symptoms. Can people learn to effectively control their cravings for a substance?

The answer is yes. We all know people who have mastered their craving and permanently given up smoking, illicit drug use or alcoholic drinking. Some of them used a twelve step group. Some used meditation or other relaxation techniques. And, some of them took up running or other intense exercise. What do these people have in common? One thing they have in common is full awareness of the terrible long term consequences of giving into their cravings, and a strong conscious commitment to overcome their cravings and break free of addiction so they can lead healthier, happier, longer lives.

What else do they have in common? That’s what a group of neuroscientists led by psychology professor Kevin Ochsner, Ph.D., of Columbia University wanted to find out. Dr. Ochsner’s group did brain scans of a group of smokers who had been taught cognitive strategies to control their craving for cigarettes, especially to think about the long term consequences of smoking. Their paper was published in the August 3, 2010 online issue of the Proceedings of the National Academy of Sciences.

The smokers who had been taught to control their cravings showed increased activity in the parts of the brain associated with rational thought and cognitive control over emotions (the dorsomedial, dorsolateral and ventrolateral prefrontal cortex). They also showed decreased activity in the parts of the brain associated with craving for substances, reward-seeking and addiction (the ventral striatum, subgenual cingulate, amygdale and ventral tegmentum). Co-author Hedy Krober, assistant professor psychiatry at Yale School of Medicine, said “This shows that smokers can indeed control their cravings, they just need to be told how to do it.”

What Dr. Krober is talking about here is not the same thing as the silly “just say no” campaign during the Regan years. Lawyers who are dependent on cigarettes, illicit drugs or alcohol to relieve the many stresses of law practices aren’t going to quit because someone tells them to just say no. The fact is that the stresses will continue, the temptations to indulge will continue and you will continue to be surrounded by lawyers who do indulge. However, you can enroll in a program which teaches cognitive strategies to control your cravings and gradually teach your brain to control your cravings as it strengthens the command circuit running from the prefrontal cortex to the subcortical dopamine producing and receiving areas.

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SCIENTIFIC LINKAGE OF SOCIAL REJECTION AND PHYSICAL PAIN PUTS THE INCIVILITY CRISIS IN A NEW LIGHT

Thursday, September 2nd, 2010

When someone disturbs, annoys or otherwise ill-treats you, do you call him a “pain,” a “pain in the neck,” or a “pain in the ass?” Is there any truth to these expressions? The answer is yes according to C. Nathan DeWall, Ph.D., an Assistant Professor of Psychology at the University of Kentucky, and Gregory Webster, Ph.D., at the University of Florida. In the July 2010 issue of Psychological Science they published their research into the connection between social rejection and physical pain. Remarkably taking the equivalent of a Tylenol for 3 weeks reduced self-reported social pain from being rejected.

The researchers conducted two experiments. In the first one volunteers took either a 1,000 mg. acetaminophen pill or a placebo pill every day and kept a diary in which they reported their social pain. The subjects who took the acetaminophen reported substantially less social pain.

In the second experiment volunteers took either a 2,000 mg. acetaminophen pill or a placebo pill everyday for 3 weeks. At the end of the 3 week period all participants played a computer game designed to elicit feelings of social rejection while a functional MRI scanner monitored their brain activity. The MRI showed that acetaminophen reduced neural responses to social rejection in brain regions associated with distress from social pain (the anterior cingulate cortex) and from physical pain (the insula). 

This simple yet remarkable experiment showed that a drug designed to reduce physical pain managed to reduce the pain of social rejection. Dr. DeWall says the study shows that social and physical pain centers may overlap in the brain and rely on some of the same behavioral and neural mechanisms. Dr. Webster said the experiment showed that the physical and social or emotional pain systems are inherently linked and it makes sense, because if someone is hurting you, you want to know about it and get away.

What does this mean for us? Clearly the old saying “sticks and stones may break my bones but names will never hurt me” isn’t true. When lawyers exchange rude, insulting language which conveys contempt they aren’t just “pissing each other off” (to use another bodily expression) they are causing each other social, and perhaps also, physical pain. Do you live with headaches, neck aches, stomach aches or other aches which have no apparent cause? These could be coming from your law practice.

In life we get back what we give. It’s called karma. When you’re unreasonable and downright hostile to other lawyers, they will treat you the same way. If you’re reasonable and civil to other lawyers, they will act the same towards you. One way guarantees social stress, muscle tension, and very possibly physical ailments, while the other invites peace and calm even in the midst of strong disagreements over legal issues. You get to choose the way.

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MRI STUDY SHOWS THAT OPTIMISTS AND PESSIMISTS USE THEIR BRAINS DIFFERENTLY

Sunday, August 22nd, 2010

Do you consider yourself an optimist or pessimist? An optimist is someone who is hopeful and confident that things will turn out well. He has a sense of personal power and expects to obtain a favorable outcome from his efforts. An optimist does not view failure as sign that he is defective or that the universe is against him. When he meets with defeat he regards it as a temporary setback and he looks for new strategies to succeed.

A pessimist is someone who sees and anticipates the worst in people and situations. He assumes things are likely to go badly. When they do go badly he takes this as a confirmation of his negative view that failure and frustration are a permanent and pervasive condition of his existence. When things go well he assumes the good times will not last. Rock bottom pessimism (what Martin Seligman called “learned helplessness”) is the belief that nothing you can do to help yourself or improve your situation matters because it’s doomed to fail.

Nobody I know is a pure optimist or pure pessimist. People tend to incline more one way than the other. Which way you incline has a huge impact on your health, longevity, career, family relationships and social relationships. Psychiatrist George Vaillant, M.D., (author of Aging Well) and psychologist Martin Seligman (author of Learned Optimism) say that optimists tend to have more friends, higher levels of happiness, better health and greater longevity than pessimists. 

Although pessimists call optimists frivolous Pollyannas the optimists I know are not naïve simpletons. Far from it. They are realistic optimists who would not hand their money over to a Bernard Madoff to invest, but would extend themselves to raise money to eradicate a disease or volunteer to tutor underprivileged children from bad neighborhoods (things that a pessimist would call long shots). Optimists are motivated by positive reward, rather than avoidance of worst case scenarios. A new study by Richard A. Anderson, Ph.D., the James G. Boswell Professor of Neuroscience at Caltech, confirms this on a neurological level. The study was published in the August 2010 issue of PLoS Biology.

Dr. Anderson recruited a group of adult subject to perform a complex task while under a functional MRI brain scanner. He wanted to find out how the motivation of the participants affected the degree to which the part of their brain called the posterior parietal cortex (PPC) was activated. The PPC is the part of the brain that transforms sensory stimuli into movement plans. It lies between the parts of the brain that control vision and movement. Using a trackball the subjects had to move a cursor to a number of memorized locations on a computer screen in a predetermined order. The subjects were given 1 second to memorize the sequence, 15 seconds to plan their movements and then only 10 seconds to perform the task.

In each trial the subjects were presented with opportunities for monetary gain or loss. For instance in one trial completing the task successfully would net the subject $5 while failure cause him to lose $1. In another trial success would earn $1 while failure would cost $5. Following all trials, the subjects were interviewed about how well they thought they did. All of them did poorly with regard to accurately recollecting their performance. People either had exaggerated perceptions of how well they did or exaggerated perceptions of how poorly they did.

The most interesting finding was how the perceptions of the subjects affected the activation of their PPC. Subjects who are optimists and believe they are doing well put out the most effort, and exhibit the largest increase in PPC activity, for the largest reward. Subjects who are pessimists and believe they are doing poorly put out the most effort, and exhibit the largest increase in PPC activity, to avoid the largest loss. Dr. Anderson concluded that the process of planning and action are influenced both by our subjective – but often incorrect – idea of how well we are doing, as well as by our perspective on potential gain and loss. Optimists are motivated by gain while pessimists are motivated by loss avoidance.

This is a fascinating study on a neuroscience level and a life philosophy level. Martin Seligman said that pessimism might be helpful to lawyers in spotting places where a deal could go sour, but it’s not a good recipe for a happy life. If you’re an optimist that’s great, but what if you’re a pessimistic lawyer who is making a good living but is subjectively unhappy, even depressed? Think about the fact that neurons which fire together wire together. Every time you act based solely on loss avoidance, you’re missing a chance to see and act on opportunities for reward which could increase your health and happiness.

I am not advocating that you become a frivolous Pollyanna and that you ignore blatant risks to yourself and your law clients when making decisions, something which could trigger malpractice. I am suggesting that you take some time to think about how your mind operates, to ask yourself if you’re happy or depressed, and (if you’re depressed) to think about moving from the strongly pessimistic zone into the mildly optimistic zone and give it a trial run. If you spend more time in the optimistic zone you will change your brain and become more motivated by reward than by loss avoidance. You will see people and situations more positively. That’s not a bad thing at all.

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INTEGRATIVE BODY MIND TRAINING REDUCES STRESS, ANGER AND DEPRESSION WHILE INCREASING RESTFUL ALERTNESS AND LEARNING CAPACITY

Saturday, August 21st, 2010

Integrative body mind training (IBMT) is a specific mind relaxation technique which incorporates aspects of traditional meditation practice, but can be learned in a matter of days rather than years. It helps users achieve a high degree of mind-body awareness within a state of restful alertness. A coach guides trainees in posture and balanced breathing while providing mental imagery and soothing music conducive to mind-body harmony in the Taoist tradition. Trainees are helped to keep their minds focused on the present moment instead of allowing their minds to switch rapidly back and forth between past and future.

IBMT was developed during the 1990s by Dr. Yi-Yuan Tang of the Dalian University of Technology in China. Dr. Tang is a distinguished researcher and professor in China where he works to link traditional meditation with modern neuroscience. He designed IBMT to serve as an easy, effective way to improve  self-regulation in cognition, emotion and social behavior.

Dr. Tang became a Visiting Professor at the University of Oregon in Eugene to work on IMBT with psychologist Michael Posner, Ph.D. In 2007 they did a pilot study on Chinese students. After 20 minutes of IMBT training over 5 days these students had lower blood cortisol levels than a control group while taking a mental math test. They also showed lower levels of tension, anger and depression.

In 2009 they did a second study involving 86 students at Dalian University of Technology. The study showed that students trained in IMBT for 20 minutes a day over 5 days showed physiologic changes consistent with reduced tension. Their brain waves went from a state of high arousal (beta) to a state of restful alertness (alpha). Heart rate and skin conductance were lowered. Breathing shifted from rapid, shallow chest breathing to slower, deeper belly breathing.

In the 2009 study Dr. Tang and Dr. Posner used SPECT scanning (which measures blood flow patterns in the brain). SPECT scans of the  participants who used IBMT displayed extra blood flow to the right anterior cingulate cortex (ACC). The ACC is an important area of the frontal lobes which helps regulate cognition by controlling where we place our attention and by resolving conflicts between new and old information. It also plays a role in emotional self-control and is capable of inhibiting fear messages from subcortical parts of the brain like the amygdale which can lower our stress level. Extra blood and oxygen helps the ACC function more efficiently and effectively.

Dr. Posner is no lightweight. He is an expert on the brain networks which underlie attention who is currently a Professor Emeritus at the Institute of Neuroscience at the university. Dr. Posner often uses brain imaging in his research. He has published book chapters and articles on the role of genetics, environment and training on the development of the neural networks of attention. He has frequently teamed up with the world’s best known cognitive neuroscientist Michael S. Gazzaniga, Ph.D., who currently heads the SAGE Center for the Study of Mind at U.C. Santa Barbara. He just won a National Science Medal.

On August 21, 2010, Dr. Posner was interviewed about IBMT on Science Friday produced by National Public Radio. During the broadcast he discussed his latest study on IBMT at the University of Oregon. For this study he recruited 45 USO students (28 males and 17 females). Twenty-two participants received IBMT while 23 were in a control group which received the same amount of general instruction in relaxation. The participants underwent a relatively new form of brain MRI called Diffusion Tensor Imaging (DTI) at the Robert and Beverly Lewis Center for Neuroimaging.

 The processing areas of the brain in the gray matter and subcortical areas are clusters of neurons of like type. They communicate with each other through tracts of white matter composed of myelinated axons. A brain criss-crossed with dense, healthy thickets of myelinated axons functions very efficiently and is said to have high connectivity. A brain with low connectivity has fewer myelinated axons to hook up its processing areas. 

DTI helps neuroscientists look at the connectivity of a person’s brain in specific regions. DTI measures the time it takes water molecules to diffuse across myelinated bundles of axons in the brain (its white matter tracts). The less white matter in a given area the quicker the water molecules travel. The more white matter in a given area the slower the water molecules travel.

Using DTI Dr. Posner discovered that changes in the brain connectivity of the IBMT group began after 6 hours of training and became clear by 11 hours. He believes the changes represent a reorganization of white matter tracts or an increase in the myelin coating around them. Deficits in activation of the ACC have been associated with attention deficit disorder, dementia, depression, schizophrenia and many other disorders. Increased activation of the ACC through IMBT would appear to be highly desirable. During his interview Dr. Posner was asked if any of the students doing IMBT had suffered harm and he said no – they either displayed no change or positive change, and he emphasized that gains in ACC connectivity should help people learn more efficiently.  

During the interview Dr. Posner said he and Dr. Tang plan to continue to study IMBT and that right now it is not commercially available in the U.S. However, I did find Dr. Tang’s website at http:www.yi-yuan.net and when I clicked the services button it said that persons interested in finding an IMBT trainer in China or the U.S. should email yiyuanbalance@hotmail.com Lawyers who are struggling with stress, anxiety or depression may wish to try this email.  

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HIGH FAT DIET IMPAIRS DOPAMINE SIGNALING IN THE BRAIN AND REDUCES MOTIVATION

Wednesday, August 4th, 2010

On the level of neurotransmitters, the human motivation to undertake action comes largely from the transmission (signaling) of dopamine. In July 2010 neuroscientist Mitchell F. Roitman, Ph.D., an Assistant Professor of Psychology at the University of Illinois in Chicago, announced the results of his research into the effect of a high fat diet on dopamine signaling in the brains of rats. He plans to publish his research in a prestigious journal within the next month or so.

Dr. Roitman fed one group of rats a high fat, high cholesterol diet and another group a normal diet. Using a specialized machine which measures dopamine production and re-uptake in the brains of living rats, he found that the rats fed a high fat diet produced significantly less dopamine than the control group. Because this created a shortage of dopamine in the synaptic space between the brain cells of the high-fat diet rats, the amount of dopamine re-uptake by their brain cells decreased to preserve what little dopamine was available. In the rats on a high fat diet, less brain dopamine caused decreased dopamine signaling with a decrease in behavioral motivation.

Parkinson’s patients (who suffer from decreased dopamine) are able to speak or move once they get going, but have difficulty initiating activity. In human beings dopamine shortage is associated with decreased motivation, passivity and depression. A number of drug companies are working right now to develop an anti-depressant which would reverse depression by increasing dopamine transmission.

We already know that a high fat diet contributes to diabetes, high blood pressure, heart attacks and strokes, all of which impair brain function. Dr. Roitman’s work is  important, because it shows one new mechanism by which a high fat diet impairs brain function, and adds to the reasons we already have to reduce our consumption of unhealthy fat. Dr. Roitman said his work puts questions marks around our cultural stereotype that obese people are lazy. It could be that the extra fat in their diet actually saps their motivation to move and exercise by impairing dopamine signaling in their brains.

The take home message is that it’s high time to decrease your daily consumption of unhealthy fat from refined and processed foods containing lots of sugar, high fructose corn syrup and partially hydrogenated fat. When you consume fat do your best to eat healthy fats like Omega 3s from cold water fish, nuts, nut butters, and seeds, and oils like extra virgin olive oil, flax oil, avocado oil, walnut oil, coconut oil or sesame seed oil. Keep your brain primed with enough dopamine to initiate the activities that keep you healthy and happy.

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INTRAVENOUS KETAMINE CAUSES IMMEDIATE IMPROVEMENT IN TREATMENT-RESISTANT BIPOLAR PATIENTS

Tuesday, August 3rd, 2010

Four percent of Americans suffer from bipolar disorder which is characterized by very long periods of depression alternating with brief episodes of mania. The majority of bipolar patients are treated with lithium, anti-convulsants like valproate (depakote), anti-psychotics and conventional anti-depressants. Some patients with bipolar depression do not respond at all to these drugs and they are called treatment-resistant. When a bipolar patient suddenly enters a severe depression and he is started on medication, there is typically a lag of a week before the depression responds. This is problematic because of the increased risk of suicide during the lag period. Bipolar disorder is the psychiatric disorder with the highest mortality rate.

Ketamine is a hydrochloride salt compound used as an anesthetic and analgesic agent. In 2006 it was accidentally discovered that ketamine infusion at a sub-anesthetic dose immediately (within a matter of minutes) improved depression when it was administered to a group of patients suffering from complex regional pain syndrome and associated depression. Following this discovery a small number of off-label studies were done in which bipolar patients with treatment-resistant depression showed rapid improvement after being infused with ketamine. This was an exciting finding because the ability to rapidly reverse depression in such bipolar patients was something new that had never been achieved.

Ketamine is a glutamate antagonist which means it blocks the brain receptors for glutamate. Glutamate is the most prevalent excitatory neurotransmitter in the human brain. The receptors for glutamate are called NMDA receptors. Post-mortem research has shown that NMDA receptors in the hippocampus are abnormal in humans with bipolar disorder. The current theory for the effectiveness of ketamine in reversing severe depression in bipolar patients is that it blocks NMDA receptors. The FDA has not yet approved ketamine for use as an anti-depressant agent, but studies continue.

The latest study on ketamine use in relieving depression for bipolar patients with treatment resistant depression was published in the August 2010 issue of the Archives of General Psychiatry. The study was conducted by Dr. Nancy Diazgranados and her colleagues at the Mood Disorders Research Unit of the National Institute of Mental Health (NIMH). Dr. Diazgranados recruited 18 male and female subjects aged 18-65 who had been diagnosed with Bipolar I or Bipolar II without psychotic features and whose depression had resisted standard drug treatment. All subjects were in good general health and free of substance use for the past three months. None were judged at risk of suicide.  However, all subjects were currently experiencing a major depression; all subjects had failed a trial of at least one anti-depressant prior to coming to NIMH; and all subjects had failed a four week trial of either lithium or valproate while at NIMH for the study.

While the subjects were maintained at therapeutic levels of lithium or valproate, they were randomly chosen to receive one intravenous infusion of either ketamine hydrochloride (0.5 mg/kg) or placebo (saline solution) on 2 test days 2 weeks apart. This was a double-blind study in which neither the subjects, nor the investigators knew which subjects got the ketamine and which got the placebo. The Montgomery-Asberg Depression Rating Scale was used to rate subjects at baseline and at 40, 80, 110, and 230 minutes and on days 1, 2, 3, 7, 10, and 14 post-infusion

Within 40 minutes, depressive symptoms significantly improved in the subjects receiving ketamine as compared with placebo. This improvement remained significant through day 3. The drug difference effect size was largest at day 2. When compared to baseline at days 7, 10, and 14, there was no significant difference in the mood of the patients. As with prior studies the use of one sub-anesthetic IV dose of ketamine produces rapid relief of severe depression limited to a period of two to three days. Seventy-one percent of subjects responded to ketamine and 6% responded to placebo at some point during the trial. One subject receiving ketamine and 1 receiving placebo developed manic symptoms. Ketamine was generally well tolerated. The most common adverse effect was dissociative symptoms, only at the 40-minute point.

Dr. Diazgranados’ conclusion was that a single IV dose of ketamine caused “robust and rapid antidepressant effects” in patients with treatment-resistant bipolar depression. Thus ketamine is not a cure for treatment-resistant bipolar depression, but it does create a window for psychiatric intervention that gives standard drug treatments time to work.

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TRAIN YOUR BRAIN USING OPEN FOCUS EXERCISES TO DIFFUSE STRESS AND RELIEVE ANXIETY OR DEPRESSION

Monday, July 26th, 2010

The human brain is an electro-chemical organ which produces a small but measurable amount of electric current in the form of gamma, beta, alpha, delta and theta waves. Each wave type has a range of frequencies associated with different types of mental activities. The brain does not emit any one wave type in pure form. At any given moment it emits a mix of two or more wave types. The predominant wave type can vary s with the part of the brain being measured. EEG brain wave patterns vary depending on whether a person is awake and actively concentrating, awake and resting, falling asleep, in deep slow wave sleep or dream (REM) sleep; in a fearful, tense and fight-flight state; in a calm, meditative state; or in states of consciousness affected by such things as sexual arousal or consumption of alcohol or drugs. Mental illnesses and alcoholism show distinctive brain wave patterns.

Neuropsychologist Les Fehmi, Ph.D., is an expert in the link between brain waves and stress reduction. After doing his post-doctoral work at the UCLA Brain Research Institute, he became a pioneer in neurofeedback therapy. Neurofeedback is a method of helping individuals reduce stress levels and anxiety symptoms by gaining control over their central nervous system using EEG biofeedback. In 1969 Dr. Fehmi co-founded the Biofeedback Society of America which later became the Association for Applied Physiology and Biofeedback. During the 1970s Dr. Fehmi used neurofeedback on hundreds of patients. He had them sit at a desk wearing a headband with a nest of electrodes attached to their scalp while they watched their EEG displayed in real time on a screen. They were asked to control their brain waves without being told how to do so, since nobody quite knows how this can be done. If they did not make the desired changes they were notified by bleeping noises and flashes of light.

Dr. Fehmi’s approach to neurofeedback was twofold. First he wanted patients to learn to synchronize their brain waves across their entire brains, because the brain operates most efficiently, effectively and under the least stress when brain cells in different brain regions are firing together (synchronously) in the same wave pattern. Second he wanted his patients to reduce beta (the highest frequency, most energetic brain waves in the range of 13-50 hertz) and increase the amount of their alpha waves (in the range of 8-12 hertz). At the higher end of beta frequency people show great mental effort, high mental energy expenditure, anxiety and tensed muscles. A college student taking an important exam who does not know the material and a driver who blares his horn and screams angrily after being cut off are in high beta. In the alpha frequency people are in a relaxed but alert state where they can observe and deal with the world without intense effort. Meditation puts people in an alpha state. You can also move from beta to alpha by closing your eyes.

During the 1970s Dr. Fehmi noticed an interesting phenomenon while treating his patients. All of them went through a difficult break-in period using neurofeedback where no matter how hard they tried they could not get the results they wanted. They couldn’t synchronize their brain waves or reduce beta and increase alpha frequencies. It was only when they gave up and were on the verge of quitting the training that they succeeded. It was only when they concluded that no amount of trying would succeed and they let go of trying, that they effortlessly brought their brain waves under conscious control. Dr. Fehmi concluded that to be successful in neurofeedback his patients had to give up their effortful orientation to the task.

This led Dr. Fehmi to realize that the how of attention (how we pay attention to something) is much more important than the what (the content of our attention). He began taking physiological measurements of people attending in effortful (beta) and relaxed (alpha) fashion. He found that effortful attention triggers the sympathetic nervous system with the adrenalized fight-flight response and over-reactivity;  whereas relaxed attention triggers the parasympathetic nervous system which keeps people calm and at ease. Dr. Fehmi also found that people learn information more quickly, more accurately and with much less effort in a relaxed mode of attention. People who approach tasks in an effortful way have greater difficulty and progress more slowly.

After years of studying attention Dr. Fehmi came up with different categories of attention. Narrow focus refers involves intense effortful attention associated with high beta waves. A person using narrow focus shrinks the aperture of his attention to one object (be it a person, thing or  idea) while pushing all other objects into the background and excluding them from consciousness insofar as possible. Open focus refers to a diffuse form of attention in which the person’s aperture of attention is wide open. In open focus a person remains aware of the object he’s attending to, but he is  simultaneously aware of his internal sensations, feelings and ideas, the objects in his environment along with their sounds, sights and smells; and the space in, around and between external objects.

Objective focus refers to a state of scientific detachment from the object of attention which is looked at as a wholly separate and distinct entity. It is accompanied by a high degree of self-consciousness, analysis and judgment. Immersed focus refers to a form of attention in which the observer experiences the object of attention from within, yield to it and joins with it. It is accompanied by sensations of union, pleasure and love and marked by a loss of self-consciousness and judgment.

According to Dr. Fehmi the most prevalent form of attentional style in our society is the narrow-objective kind. It can manifest as an obsessive-compulsive focus on a psychological or environmental object or as a denial of and shift of attention away from such an object. This kind of attention limits our awareness and stimulates fear and anxiety by separating us from our inner guidance system (our sensations, feelings, emotions, and intuitions) and from other people. Lawyers engage in the narrow-objective style of attention nearly all the time. They frequently focus on ideas, words and word meanings to the exclusion of their own physical sensations and feelings and their inner sense of what others are feelings. Dr. Fehmi says that people who are stuck in this mode of attention show awkwardness, lack of smoothness and fluidity in dealing with others and a tendency toward anxiety, worry, panic and rigidity.

Narrow-objective attention is a creature of the left brain. Our cave dwelling ancestors used it when they were out hunting or foraging and they had to scan their environment with utmost vigilance and urgency to spot predators like saber tooth tigers. Children in our day learn to use narrow-objective attention when they are told to stop day dreaming, focus on their homework and prove to their parents and teachers that they know their academic material. This amps up their nervous system. As children or as adult lawyers we can get stuck in this amped up state of great cognitive intensity which rigidifies one’s thinking and one’s muscles. Open states of attention act as a gear shifter that can take us out of this mental and physiological state in which we are stuck in over-drive. They allow us to get the best performance out of our brains and feel so much better.
Although narrow-objective attention has its uses, the problem (says Dr. Fehmi) is that we are addicted to it and we use it in many situations where it is more of a hindrance than a help. Narrow-objective focus is useful when learning the parts of the human body, but not when figuring out why a patient is dizzy or depressed. Narrow-objective focus is  useful in learning the notes to a music score but not when playing your part during a symphony orchestra performance. Narrow-objective focus may have some use during  sexual foreplay but not when making love. The key is in developing attentional flexibility so you can make use of all forms of attention at the appropriate time. Developing this flexibility helps release the psycho-physiological stress stored up through habitual use of narrow-objective attention.

When we stop excluding parts of our experience, open up our focus and allow our attention to equally and simultaneously spread out, we experience a softening of goal-directed behavior, a release of energy and a greater sense of wellbeing. The addiction to narrow-objective focus causes us to miss out on many opportunities to use open-diffused and open-immersed attention which are associated with the right brain and which give us a broader big-picture view which sparks creativity, empathy and spirituality. When the right brain is engaged sensory experiences become more fresh, vivid,  captivating, and satisfying. Our brains were designed to be multi-modal, which means they were designed to take in and integrate information from all five senses. We learn best and enjoy life most when we use our minds in a multi-modal fashion. Dr. Fehmi says that a life lived with open focus takes us away from tension, rigidity, anxiety and fatigue to ease, flexibility, efficiency, energy, productivity, spontaneity and creativity.

So how do we get there? You can either seek a solution to your problems in the content of your lived experience (memories of the past), which Dr. Fehmi says won’t work, or you can change your style of attention to open focus. When patients come to Dr. Fehmi for help he can give them neurofeedback, open focus exercises or both. The neurofeedback route is more expensive and requires multiple visits to his office in Princeton, New Jersey, to use the EEG machine.

Patients using neurofeedback benefit by producing more alpha than beta all over the brain and by harmonizing their production of alpha so the various parts of their brain emit alpha in unison like a choir. This allows information to pass through the brain more rapidly, fluidly and completely and allows for the greatest possible integration of information. It enables thinkers, artists, musicians and athletes to reach their peak performance. If you want to try this therapy your insurance might cover it, for instance if the presenting complaint was headache or insomnia. If you can’t make it to Princeton where Dr. Fehmi’s Princeton Biofeedback Center is located, you can go to his website at www.openfocus.com to find links to people he has trained in various parts of the country.

Open focus exercise therapy is inexpensive and can be done at home or at the office behind closed doors. You can do it with a CD. In 2007 Dr. Fehmi came out with The Open Focus Brain published by Trumpeter Books. It contains a companion CD with open focus exercises as well as written exercises after each chapter. I have tried the open focus exercises on CD and found them quite helpful. They put me in the same relaxed, tranquil and mildly euphoric state of mind that meditation does. Like meditation these exercises give me renewed mental clarity and extra energy. Open focus exercises and meditation both involve learning to accept rather than fight one’s sensations, feelings and ideas. In his book Dr. Fehmi talks about curing pain by turning into it, rather than running from it and trying to push it away. Whether you allow the imagined physical space around your pain or the space of your awareness to enter it and fuse with it, either way it will dissolve. The same holds true for negative thoughts and fears.

Based on his work with many thousands of patients Dr. Fehmi says that open focus work can become second nature after you do the exercises enough, and it can not only reduce your stress and anxiety, but help you with self-realization. Chronic stress breeds depression, substance abuse, insomnia, fatigue and stress-related disorders like asthma, allergies, rashes and psycho-somatic pain syndromes. When these have been cleared up, and your brain is working in alpha and firing synchronously, you can expect to experience renewed energy, productivity, enhanced relationships and improved performance in your work, sports, leisure and artistic activities.

Although open focus work is compatible with, and can be done simultaneously with, meditation, I know from experience that some people who could benefit from both modalities are not going to become long term meditators. Why? Some people don’t like sitting for prolonged periods of time in silence in the hope of reducing stress, improving mental clarity and gaining wisdom and compassion. They find listening to their own interior mental chatter intolerable – or they complain of distracting noises, physical pain or discomfort, boredom, restlessness, frustration, lack of progress and a host of other problems. Meditation isn’t for everyone. For these people open focus could be a safe, drug-free method of reducing stress, anxiety and depression while enhancing their performance of and enjoyment of their work and other activities.

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STATINS PROTECT YOUR HEART BUT MAY CONTRIBUTE TO DEPRESSION AND DEMENTIA

Monday, June 28th, 2010
The statins (drugs like Zocor, Mevacor and Lipitor) are the most heavily prescribed cholesterol lowering drugs on earth. They bring in 25 billion dollars annually from worldwide sales. The theory for prescribing them is that statins reduce arterial clogging, hypertension and heart disease by reducing cholesterol (a waxy textured mixture of fats) in the blood. They do this by inhibiting the function of HMG-CoA reductase, a key enzyme responsible for the biosynthesis of cholesterol. The problem with statins is that they work too well. They tip the balance of cholesterol from too high to too low.
Although depression is the product of multiple causes, one known cause is insufficiency of serotonin in the brain, and the sole purpose of America’s best selling anti-depressant drugs (like Prozac and Zoloft) is to raise the amount of brain serotonin by blocking its re-uptake after it is secreted. Amitabha Chattopadhyay, Ph.D., of the Centre for Cellular and Molecular Biology in Hyderabad, India, has shown in the laboratory that the receptors for serotonin in brain cell membranes need a certain minimal amount of cholesterol to function and that long term use of statins impairs the function of these receptors by lowering cholesterol too much.
Dr. Chattopadhyay reported his research in the June 3, 2010 issue of Biochemistry. He placed animal cells called Chinese Hamster Ovary cells, which had been cloned to express human serotonin receptors, into a test tube. When he subjected these cells to mevastatin he observed that over time they ceased to function properly. But when he added cholesterol to the test tube the function of the serotonin receptors was restored to normal. Dr. Chattopadhyay concluded that chronically low levels of cholesterol in the brain from long term use of a statin drug could cause anxiety and depression in a heart patient.
I note that Dr. Chattopadhyay is an American trained chemist and internationally respected expert in cell membranes. The journal of Biochemistry, one of 34 peer reviewed journals put out by the American Chemical Society, was voted one of the most 100 influential journals in their fields during the last 100 years by the Special Libraries Association. This study is an important one. It suggests that taking a statin undermines the benefit of taking an SSRI anti-depressant. Having more sertonin in your brain from an SSRI won’t help if your cholesterol starved serotonin receptors aren’t working.  If you suffer from depression and your doctor has prescribed a statin or you are considering going on a statin, please talk to your doctor about this study. While protecting your heart health is an absolute necessity, you don’t want to do it in a way that causes you depression or increases the depression you already have. Your doctor may have a solution.
Regarding statins and dementia, American neurosurgeon Larry McCleary
has written in The Brain Trust Program that statins block the production of an important anti-oxidant called CQ-10 which is found in the human brain. Dietary sources of CQ-10 are liver, salmon, nuts, soy and canola oil. Lab research shows that high concentrations of CQ-10 are protective against Alzheimer’s disease, Parkinson’s disease and ALS. Dr. McCleary says that most people are deficient in CQ-10 and should take a daily CQ-10 supplement. He has expressed concern that taking a statin could expose people to increased risk of degenerative brain disease with dementia. If you are taking a statin you should discuss this with your doctor along with the idea of taking a CQ-10 supplement.
My father has been taking a statin for years, and his cholesterol levels are very good. He is quite healthy at age 85, and we are going to fly to New Jersey in mid-July 2010 to celebrate this milestone birthday with him. Clearly statins have done him good.
But my father was never prone to depression (which means he wasn’t born with a serotonin-deficiency problem) and we have no known cases of Alzheimer’s disease in our family tree, so his risk levels for depression and Alzheimer’s were quite low. The risk level for depression, dementia or both, for a person taking a statin on a long term basis would presumably be quite different for someone with a family history of these problems, or someone already suffering from depression. Such at-risk people should be concerned about increasing their risk by long term statin use.

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MINDFULNESS: STAY AWARE OF YOUR OWN SUGGESTIBILITY

Saturday, June 26th, 2010
Lawyers falsely believe they are the captain of their cognitive ship. They think they make their own decisions and are able to detect and resist influences on their decision making which come from circumstances or from other people. A variety of studies have come out showing that most of our decision making occurs beneath conscious awareness and that our decisions are frequently influenced by what other people say, how other people act or how other people manipulate circumstances. A lot of this information is presented in Kluge by Gary Marcus and How We Decide by Jonah Lehrer, but new studies along these lines come out every day. Here are two.
In June 2010 Michelle VanDellen of the University of Georgia and co-author Rick Hoyle at Duke University published their research in the online edition of the journal Personality and Social Psychology Bulletin concerning how an individual’s level of self-control is influenced by others. By doing five studies over two years with hundreds of volunteers they learned that self-control and lack of self-control are both contagious and both are spread by social networks.
In the first study volunteers who were asked to think about a friend with good self-control persisted longer on a handgrip test than volunteers asked to think about a friend with bad self-control. In the second, volunteers who watched a person choose a carrot instead of a cookie off a plate were more likely to choose a carrot than volunteers who watched a person choose a cookie. In the third, volunteers were asked to list the names of friends with good or bad self-control. While they performed a computerized test measuring self-control, the name of a friend was flashed too fast to read but enough to subliminally bring the name to mind. The volunteers exposed subliminally to the name of a friend with good self-control showed better self-control on the test than those exposed to the name of a friend with poor self-control. In the fourth, volunteers were asked to write an essay about a friend with good or bad self-control. In a later test of self-control the volunteers who wrote about a friend with good self-control did better on a test measuring self-control than those who wrote a friend with bad self-control. In the fifth test, volunteers asked to write an essay about a friend with good self-control were much faster at identifying words related to self-control (like achieve, discipline and effort) than volunteers asked to write about a friend with poor self-control.
Van Dellen concluded that although we are all responsible for actions, our level of self-control is subject to influence by watching or even thinking about how other people exercise self-control. She said that whether we eat a second cookie and whether we go to the gym or skip it depends in part on what sort of people are in our social network. While reading this study my mind immediately jumped to William Golding’s Lord of the Flies, a book I discussed last night with my nine year old son. In that book British school boys who had been trained in self-discipline were marooned on a deserted island and in a very short time they split up into tribes. The boys in the tribe with violent leaders prone to scapegoating and harming others quickly stepped in line and abandoned self-restraint. Only the boys who made a conscious effort to stay true to civilized values were able to preserve self-control.
In the June 2010 issue of Science researchers Joshua M. Ackerman of MIT, John A. Bargh of Yale, and Christopher C. Nocera of Harvard, showed that people are influenced by their sense of touch when they make supposedly rational decisions. They took 86 adult volunteers and had them bargain with a salesperson over a new car with a sticker price of $16,500. The volunteers who sat on the hard, wooden chairs wanted an average of $896.50 more for the car. The ones who sat on the soft, comfy chairs were willing to pay an average of $1,243.60 extra for the car. They then asked 54 passers-by to evaluate a job candidate by reading the person’s resume which was attached to a clipboard. Some clipboards weighed .75 pounds while others weighed 4.5 pounds. People holding the heavier clipboard evaluated the same job candidate as overall better and more serious than people holding the lighter clipboard.
Mindfulness is non-judgmental awareness of what is going on inside you and around you in the present moment. When you are mindful, and you  take account of the people and circumstances that could be influencing your perceptions and choices, you are more able to make decisions which truly reflect your values, principles and goals. When you are mindless (meaning you are just reacting to people and circumstances without objectivity) you are vulnerable to all kinds of influences, including how much self-control your friends or colleagues do or don’t exercise, what sort of seat you’re sitting on and how heavy a clipboard you’re holding when you review written material.
These research papers are a wake up call to all of us that it pays to be more mindful. When John A. Bargh was interviewed on NPR on June 25, 2010 there was a discussion about a new trend in sales, where the new car salesman works the deal out with the customer while he is seated on the soft car seat behind the steering wheel instead of sitting on the hard wooden chair in the salesman’s cramped office. This technique nets dealerships a better sales price because softer seat makes buyers softer in negotiations.
So next time you have to make a decision, take a breath, relax, and take stock of your surroundings and your train of thought, before you pull the trigger. You will reap the benefit of making smarter, more informed choices for yourself, your clients and your family, and you will have less to regret after your decisions are final.

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REDUCE DEPRESSION BY BULKING UP YOUR ANTERIOR CINGULATE CORTEX WITH MEDITATION

Friday, June 4th, 2010

A cingulate is a curved bundle of nerves. The anterior cingulate cortex (ACC) is a collar shaped bundle of nerves that surrounds the corpus callosum within the frontal lobes of the human brain. The dorsal (top) portion of the ACC is involved with the cognitive function of monitoring task completion. The dorsal ACC helps us pay attention to where we are directing our attention and facilitates learning. It is stimulated by novelty and some neuroscientists believe it plays a role in error detection. The ventral (bottom) portion of the ACC has connections with many key brain areas. These are the amygdala (the brain’s fear alarm); the hypothalamus (which regulates appetite, sleep, and sex drive, and which also triggers the secretion of the stress hormones adrenalin and cortisol via the pituitary when the amygdala signals the approach of a threat); the nucleus accumbens (which uses dopamine to create the experiences of reward and pleasure); and the insula (the brain’s empathy center).

The ACC is situated between the frontal lobes (the seat of rational thought,  impulse control, self-image and self-esteem) and the subcortical limbic areas (the seat of our emotions, passions and drives). Working as a whole the ACC helps integrate thought with feeling as well as attention with motivation. The ventral ACC is extremely rich in serotonin transporters.

Although depression is a highly complex phenomenon with multiple causes, it appears that the ACC is involved. One study of depressed people using MRI found that depressed people had a smaller ACC than non-depressed volunteers. This study was published by Ramin S. Hastings of the New York Psychiatric Institute and colleagues in the March 2004 issue of Neuropharmacology.

Helen Mayberg. M.D. is a Board Certified neurologist who trained in neurology at  Columbia University and trained in nuclear medicine at Johns Hopkins. She has used PET scans to delineate brain activity in the neural circuits she believes play a role in causing depression. Dr. Mayberg has shown that the ventral ACC (also known as Broadmann’s Area 25) is hyperactive in depressed patients. She describes it as “a gate left open.” By that she means that negative, depressive emotions coming from the limbic area are allowed to flow freely across Area 25 in depressed patients and overwhelm the frontal lobes causing dark mood.

In February 2005 (just before she went to work at Emory University) Dr. Mayberg performed an experimental treatment on six seriously depressed patients at a clinic associated with Toronto University. She referred to these patients as being “terminally depressed,” since they had spent years in treatment with psychotherapy, anti-depressant medication and even electro-convulsive therapy, but had not gained any remission of their symptoms. Dr. Mayberg used a technique called DBS (deep brain stimulation) by inserting electrodes connected to a battery with adjustable current into Area 25 of their brains. All patients reported feeling better when the electric current pulsed into Area 25. Four of the six patients have achieved long term recovery from their depression by continuing to use DBS. Dr. Mayberg concluded that DBS had reduced and normalized the activity of their ventral ACC which effectively closed the gate between their negative emotions and their frontal lobes.

Dr. Mayberg continued her trials of DBS for treatment-refractory depressed patients. On February 19, 2009, the FDA approved the use of DBS for treatment of chronic, severe obsessive-compulsive disorder. Medtronic, Inc., the company which received the approval announced it would start a multi-center, randomized clinical trial of DBS for treatment-resistant depression.

If you’re a person who tried everything but failed to improve his depression without DBS, then wearing electrodes in your head and carrying around battery on your belt will be acceptable. On the other hand, what if you could significantly reduce your depressive symptoms through daily meditation? Wouldn’t that preferable?

There can be little doubt that forms of meditation devoted to increasing inner peace and tranquility or compassion and loving-kindness help relieve depression. One of the key factors in producing depression is high blood cortisol induced by chronic stress. Once you become depressed, the depressed state of mind keeps your cortisol level high because depressed people feel helpless, hopeless, and blameworthy, and they verbally attack themselves.

In September 1991 R. Sudsuang and colleagues in the Department of Physiology and Anatomy, Faculty of Medicine, Chulalongkorn University in Bangkok, Thailand, published a paper in Physiology & Behavior showing that 52 males aged 20-25 who  meditated regularly had significantly lower blood cortisol and blood pressure then 30 males in the same age group who did not meditate.

Zen meditation has been associated with decreased sensitivity to emotional and physical pain. In February 2010 Joshua A. Grant and colleagues in the Department of Physiology at the Universite de Montreal published a paper in a special issue of the APA Journal Emotion exploring the relationship of Zen meditation, cortical thickness and pain sensitivity. The researchers recruited 17 Zen meditators and 18 non-meditators. They measured pain sensitivity by applying a heated plate to the calf of the participants and followed by measuring brain volume with structural MRI. They determined that the Zen meditators were significantly less sensitive to pain and that consequent to years of meditation they had substantially thicker gray matter in their dorsal ACC, parts of their hippocampus and their insula – all areas involved in pain regulation.

Richard Davidson, Ph.D. is a neuroscientist who has been meditating every day since 1974 (while pursuing his Ph.D. at Harvard University) and has been a personal friend of the Dalai Lama since 1992. He is known all over the world for his work on how meditation physically changes the structure and function of our brains along with our emotional lives – in particular how meditation makes use of the neuroplasticity of our brains to make us more empathic, compassionate, and loving human beings. Dr. Davidson runs the Lab for Affective Neuroscience at the University of Wisconsin where he has done many groundbreaking studies using MRI on meditating Buddhist monks.

In one well known paper in 2003 Dr. Davidson teamed up with Jon Kabat-Zinn to study the effect of eight weeks of meditation on non-meditators. As reported in Volume 65 of Psychosomatic Medicine, the eight weeks led to increased subjective feelings of wellbeing, increased brain activation of the left frontal cortex (which is associated with feelings of wellbeing) and increased immune function with increased resistance to the flu virus.

Dr. Davidson has studied the ACC. In the July 28, 2000 issue of Science Dr. Davidson and colleagues used functional brain scans to analyze the brains of 500 people with difficulty regulating emotion including 41 murders. They found that murders had little or no activity in the orbito-frontal cortex (OFC) and ACC with heightened activity in their amygdala (which sounds the fear alarm in response to potential threats). The OFC is supposed to constrain violent impulses, while the ACC mediates between the OFC and the amygdala and is supposed to help resolve decisions about how to respond to threat. These individuals became overwhelmed by the neural messages of threat/fear/defend from the amygdala, because their OFC and ACC were not functioning normally.

Based on the work of Dr. Mayberg and Dr. Davidson it appears that abnormalities in ACC function (hyperactivity or no activity) are associated with depression or violence. This makes sense since depression is a form of violence directed at the self. Further violence and depression are both mental states of great agitation, unhappiness and suffering associated with inability to regulate one’s emotions.

Meditation can thicken and strengthen your ACC, and help you regulate your emotions and decrease your sensitivity to emotional and physical pain. It can make you less reactive and more even-keeled. If you haven’t  tried it, start today. Begin exploring various forms of meditation taught in community and find one that works for you.

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