PARTNER UP WITH A WORK BUDDY TO MAKE MORE ACCURATE, LESS STRESSFUL DECISIONS

August 27th, 2010

Lawyers have to make a steady stream of decisions every day. These range from the small (whether to interrupt an activity to take a call) to the hugely consequential (whether to reject a final offer of settlement and go to trial). When it comes to making big decisions do you trust yourself above all others and make them alone or do you consult a colleague? If you make them alone you pay a price. What price? You may be sacrificing accuracy without the objectivity a colleague can provide, and you are certainly incurring more stress. When you make decisions alone you are completely responsible for them even though you may be missing something that a colleague might have seen.

The old saying that “two heads are better than one,” turns out to be largely true. In a study published in the August 2010 issue of the journal Science neuroscientists Bahador Bahrami from UCL (University College London) and Chris Frith from Aarhus University, Denmark, explored the relative accuracy of collective vs. solo decision making on a low level perceptual task. The task involved detecting a very weak signal on a computer screen, one that was so weak there could be legitimate disagreement as to whether the signal had occurred or not.

What the researchers found was that for two observers of nearly equal visual sensitivity, two heads were definitely better than one, provided they were given the opportunity to communicate freely about their perceptions. Their accuracy did not depend on getting feedback from the researchers. Simply being told by the researchers which one of them was right did not increase accuracy. But when one observer with good visual sensitivity was paired with another observer with poor visual sensitivity, two heads performed worse than one because the person with poor visual sensitivity influenced the person with better sensitivity to make the wrong decision. The researchers concluded that the optimal conditions for making a perceptual decision (did I actually see something or not?) are having a partner of comparable visual sensitivity and being able to freely discuss your perceptions with each other.

It’s logical to assume that making a complex legal decision would follow the same model. If so, then two heads are better than one provided you select a partner of comparable intellectual capability who is given access to the same information you have, and you communicate freely with each other regarding your perceptions of the data. Following this model of decision making can increase your accuracy and lower your stress at work.

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CHRONIC ALCOHOL DEPENDENT DRINKING DISRUPTS CIRCADIAN RHYTHMS CAUSING INSOMNIA AND DEPRESSION

August 26th, 2010

Human beings have a 24 hour biological rhythm cued by changes in daylight called a circadian rhythm. The mammalian clock that regulates our sleep-wake cycle lies in the suprachiasmatic nucleus of the hypothalamus. Temporary disruption of circadian rhythm by international flights causes a combination of insomnia and fatigue known as jet lag.

Every 24 hours we not only show changes in wakefulness, but also in body temperature, hormone production, brain waves and feeding behavior. Many tissues in our body have circadian clock genes. These genes must be expressed properly in the form of transcription and clock proteins for us to survive. Their appropriate expression is a key for people to sleep well, stay healthy and maintain a good mood. In order to operate properly these genes must have sufficient messenger RNA (ribonucleic acid) to manufacture certain proteins.

It has long been known that people who drink heavily on a chronic basis have problems with insomnia and depression. Researchers Ming-Chyi Huang and collaborators at Taipei Medical University and Taipei City Hospital wanted to know if this was related to depletion of messenger RNA in their circadian clock genes.

The researchers recruited 22 male patients diagnosed with alcohol dependency and 12 healthy control subjects. Study of their blood samples showed markedly lower baseline levels of messenger RNA in the circadian clock genes of the AD patients. The study also showed destruction of normal circadian clock gene expression in the AD patients. Reduced circadian clock expression did not normalize following early alcohol withdrawal treatment. Researcher Sy-Jye Leu said this shows that chronic AD has long term damaging effects on the expression of circadian rhythm genes. Their finds were communicated early on 8/24/10, but will be published in full in the November 2010 issue of Alcoholism: Clinical & Experimental Research.

For alcoholic lawyers in denial it’s important to realize that continuing to drink is tampering with your very genes and altering the basic circadian rhythm that sets the time for normal, healthy changes in sleep, waking, brain waves, hormone production, body temperature and hunger. Research from Dr. Joseph Takahashi of the Howard Hughes Medical Institute came out on July 13, 2010, indicating that chronic disruption of circadian rhythm can cause diabetes by impairing the ability of the pancreas to release insulin.

If you’re a lawyer with an alcohol problem who is still in denial, then it’s high time you sought treatment.

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CURB ELECTRONIC SCREEN USE TO PREVENT BRAIN OVERLOAD AND ENHANCE YOUR RELATIONSHIPS

August 25th, 2010

On 8/24/10 Matt Richtel (the Pulitzer Prize winning technology journalist from the NY Times) spoke on NPR about the hazards of over-use of screens for our brains and our relationships. In the 1960s the only screen in our lives was the TV in our living room, except for occasional trips to the movie theater. Now we not only use computer screens at home and office, but we carry portable screens around with us wherever we go on our mobiles, blackberries and I-pads. They have become ubiquitous.

Screens keep us in touch with supervisors, co-workers, clients, family and friends. They are fun and entertaining. But, says Richtel, we need to think carefully about the costs of using screens in certain situations. When you’re trying to combine one activity with “information jiggling” the result may be failure at both. Texting while driving has been shown to cause a level of impaired reactions equal to being drunk. Even hands free cell phone use while driving can slow reaction time by just enough milliseconds to cause a collision. On my way back from the store this morning to buy milk a young man glued to his cell phone walked in front of my car against a red light and a red “Don’t Walk” signal. Lucky for him I wasn’t using a cell phone too. 

Car shows this year are displaying new models with 10 inch screens on the dash that allow the driver to see restaurant reviews, album covers and a variety of other content. If you feel compelled to buy this sort of car please protect yourself, your car occupants and others on the road by having your passenger read this stuff. Keep your eyes on the road.

Richtel wants us to ask whether our hunger for a constant stream of data in our lives has helped or hurt us. There is abundant research to show that our brains slow down and make more mistakes when processing more than one task. Two is difficult but three is a fiasco according to research published in the April 2010 issue of Science by Etienne Koechlin, a professor at the Ecole Normale Superieure in Paris.

Although people believe they are great at multi-tasking, our brains were not designed to track and digest the sheer amount of information we are getting from screens. If our ancestors had to read and respond to emails on their cells phones while deciding whether or not to run from a saber tooth tiger, we probably wouldn’t be here. Although we don’t have saber tooth tigers anymore, compulsively checking your email and flipping your attention back and forth from email or texting to what you should be focusing on makes it hard to do anything well. How many lawyers have you seen at MCLE seminars scanning and replying to emails on their laptops when they were supposed to be listening to a lecture that could prevent malpractice?

Richtel says you may think you’re spending quality time with your kids while checking and responding to text messages on your phone, but you’re not really present and you’re not really listening to them. He finds it disrespectful. He also worries that parents who do this are teaching their kids to devalue others in the same way. I’ve noticed that these days a play date for 9 year old boys involves both boys sitting faced in opposite directions hunched over their video game players.

To probe the full effects of frequent screen use Richtel accompanied a group of neuroscientists to a very remote corner of Utah on a camping trip. The rule of the expedition was that no one could bring any type of screen be it a PC, hand held device or mobile phone. Half of the group was made of  believers (those who were convinced e-screens were bad for focus and concentration) and half of skeptics (those who thought the value of constant access to information outweighed any problems associated with e-screens).

Richtel says that after 3 days with no e-screens everyone felt more relaxed. Their sense of urgency had faded. They took longer to answer questions. They slept better. When Richtel came home from that trip he banned cell phone use whenever he spent time with his son. He also took himself off Twitter. Simplifying your life in this day may mean eliminating some possessions, but it can also mean less time on e-screens.

As a technology based culture we have crossed a line. There is no going back to the old days. Screens are here to stay and they will continue to play an essential role in our work and home life. There’s no doubt they can be very helpful, especially GPS systems for finding our way while driving to a destination. But, we need to exercise some caution here. Richtel advises that each of us needs to find the line between technology informing us and from technology distracting us, impeding our productivity and even undermining our health. He points to research at Stanford showing the screen use can become addictive and that some heavy users of video games lose the ability to filter out irrelevant information.

Richtel says that many young people feel bored or even socially invisible if their mobile phone isn’t ringing or vibrating with a new text message. Thus they carry around tension until their device springs to life. It’s a sort of Pavlovian response. Just as Pavlov’s dogs waited eagerly for the bell to eat, many teens and twenty somethings wait eagerly for the dopamine blast they get from a ring of their cell phone. This is opposite of mindfulness – a state of relaxed, non-judgmental awareness of the present moment. Mindfulness is associated with mental health and happiness, whereas chronic tension can lead to anxiety and depression.

Richtel says it boils down to the idea of nourishment. Some foods, like Twinkies, are bad for us and others, like broccoli, are good for us. The old belief that all computer use is good for us has been disproven. I think it’s reasonable to say that a lot of the email we scroll through and read is junk, and that we could all live well with fewer text messages. Mental nourishment is one way to address this issue. Another way is through the concept of life balance. What is the best way to spend your time? Do you believe that having an undisturbed conversation with your spouse and kids is important? Do you believe that having an undisturbed walk in the park is important? Do you believe that quiet time for meditation, life reflection, prayer or even napping is important?  Then balance out your life by spending less time on e-screens.

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BERRIES HELP YOUR AGING BRAIN AVOID ALZHEIMER’S DISEASE BY CLEANING DEBRIS AND TOXINS

August 24th, 2010

It has long been known that the polyphenol anti-oxidants found in fresh fruits (especially berries) and in nuts protect the brain from inflammation which can cause degenerative brain disease and from the build-up of arterial plaque which can cause stroke. Now we are hearing of a brand new mechanism by which eating blueberries, strawberries, acai berries and walnuts can protect the brain from degenerative diseases like Alzheimer’s.

The news came at the 240th National Meeting of the American Chemical Society the week of 8/23/10 from Shibu Poulose, Ph.D., where Dr. Polouse presented a research paper on how consuming these berries and walnuts helps the aging brain clean its own  house. Dr. Poulose is a molecular biologist with the Human Nutrition Research Center on Aging in Boston

The human brain is composed of neurons (cell bodies with long myelin sheathed axons that form synapses with adjacent cells) and glial cells or glia. The glia perform many tasks including the removal and recycling of cellular debris and toxic substances that build up in the brain. This process is called autophagy. As the human brain ages the glia become less able to perform this role, and the risk of degenerative brain disease goes up accordingly.

Amyloid precursor protein (APP) is found in brain cell membranes and synapses. It plays a role in the formation and repair of synapses and also in synaptic plasticity (the modification of synapses in response to learning new information or practicing a skill). APP gets broken down into various substances including the protein beta amyloid. One hallmark of Alzheimer’s disease is the build up of excessive amounts of beta amyloid protein in the brain, something which reduces APP formation and eventually kills off brain cells in the hippocampus, the part of the brain which encodes memories.

Could nourishment from eating berries and walnuts re-invigorate aging glia and help them remove and recycle biochemical debris before it accumulates in amounts which cause degenerative brain disease? In prior research Dr. Polouse showed that rats fed for 2 months on diets containing 2% high-antioxidant berry extract showed a reversal of age related deficit in nerve function on tasks involving learning and memory.

In his current research he wanted to find out if berry extract could stimulate the autophagy function of mouse brain glial cells. Dr. Poulose created cultures of living mouse brain cells. When he inserted berry extract in these cultures he found that the berry extract inhibited the action of a protein which shuts down the autophagy process allowing it to proceed in normal fashion. Since the mouse brain and human brain are incredibly similar, the indications are that consuming a diet rich in berries could help prevent degenerative brain diseases like Alzheimer’s. Dr. Poulose recommends eating fruits and vegetables with deep red, orange, or blue color which have plentiful anthocyanin antioxidants.

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HIGH SENSITIVITY TO SOCIAL REJECTION TRIGGERS INFLAMMATORY DISEASE – LEARN TO MODIFY YOUR RESPONSE TO SOCIAL STRESS

August 23rd, 2010

Some people love to speak in public, while others fear it worse than death. Some people are energized by the prospect of a job interview and march in with confidence, while others fear the worst and blow it because they are self-conscious and ill-at-ease. Some people are able to take a “no” in stride and enjoy the dating process, while others make excuses to avoid asking people out and crumble when they reach out and receive a no. 

People in some occupations get ignored or hear “no” more than others. Lawyers are right up there with telemarketers and people selling life insurance or financial investment products. Our legal system is set up to be adversarial. It exists to process disputes between two sides that want different outcomes, hold to different positions and make opposed arguments. Whether it’s a motion, a trial or a negotiation, lawyers constantly hear no. It gets frustrating, irritating and discouraging to keep hearing no from opposing counsel. It can be downright depressing to hear no from a judge or jury. Some lawyers are said to have a “tough hide,” and they are able to shake off rejection and defeat. But not all lawyers are emotionally bullet proof. Some of them are quick to perceive rejection and hate the feeling.

What goes on in the bodies of people who are extra sensitive to social rejection? That’s what psychologist Shelly E. Taylor, Ph.D. and psychoneuroimmunologist George Slavich, Ph.D., at UCLA wanted to find out. They recruited 124 people (54 men and 70 women) and put them throw two stressful social situations. In the first they had to prepare and deliver an impromptu speech and perform difficult mental arithmetic in front of a socially rejecting panel of raters wearing white lab coats. Mouth swabs were taken before and after the test to determine if changes had occurred in two biomarkers for immune system response marked by increased inflammation – greater release of tumor necrosis factor-a and interleukin-6 (IL-6).

In the second test 31 of the participants underwent an MRI brain scan while playing a computerized game of catch with what they believed were two other real people. For the first half of the test the game was between three people, but midway through the game the other two players excluded the participant and played on their own causing the participant to feel rejected.

On MRI some of the subjects showed greatly increased activation of two areas of the brain known to respond to social stress, the dorsal anterior cingulate cortex (ACC) and anterior insula. Those very same subjects showed greater increases in tumor necrosis factor-a and IL-6 as a result of their lab test facing the stern, frowning panel of raters in white lab coats.

Dr. Slavich said this study confirms the very close relationship between mind and body and helps elucidate some of the neurocognitive pathways involved in inflammatory response to social stress. According to Dr. Slavich this is important because frequent or chronic episodes of inflammation in response to the mere perception of social stress can increase the risk for asthma, rheumatoid arthritis, cardiovascular disease and even depression.

Why would the human brain trigger the release of inflammatory proteins via the immune system when it perceives social threat or rejection? Dr. Slavich said that social ostracism in the cave man days meant death because you would have to hunt and defend yourself alone in a world full of dangerous predators and hostile bands of competitors. Thus social ostracism goes hand in hand with anticipation of physical injury and the activation of the immune system before the injury occurred could have some survival value.

What can people do to control their response to situations in which they anticipate or perceive social rejection? Dr. Slavich suggested that you question your belief that people are rejecting you. If there’s no solid evidence it’s true, then you can dismiss the belief and relax your tense mind.  For example if someone doesn’t return your call it’s not necessarily because they don’t like you. It may be that they are away from the office, incredibly busy that week, just plain disorganized or overwhelmed by all the emails and calls they get.  

There are many ways to reduce the negativity and intensity of your response to social stress. Sometimes the answer is skills training. If your greatest fear is public speaking then enrolling in your local Toastmasters club will really help, because Toastmasters has helped tens of thousands of people from all walks of life (including new immigrants with little English) to overcome their fear of public speaking and become confident, effective public speakers. The typical charge to belong is just $100 per year.

In most situations it boils down to your perspective. If your self-esteem is always on the line and it rises or falls with the result of every encounter you have with another person, you’re in deep trouble because none of us can control how other people respond to us and when we attempt to do this we’re perceived as manipulative. If you’re over-focused on something you regard as a defect you won’t be able to connect with others with a feeling of comfort and ease. Do you see yourself as too short, too bald, too fat, too ugly or too something? Do you hate your nose or your accent? Are you terribly self-conscious about the no-name law school you attended or the fact that you have a family member who is much more successful than you?

Are you constantly worried that you might not make partner? Do you evaluate every decision and every interaction with others in terms of how they affect your potential for partnership? Do you live in fear that others may discover something you’re ashamed over? Do you actively try to hide it? Whatever it is (be it a current problem with binge drinking or the imposition of professional reprimand twenty years ago) the fear of discovery is going to make you jittery around others and make you curious as to whether they know your dark secret.

There are two methods for dealing with such anxieties which can free you to interact with others less stressfully. One is to learn self-acceptance. There are many fine books and CDs which teach self-acceptance. I have written a number of blog articles on this topic using such concepts as self-compassion and self-forgiveness. The other method, which I want to talk about here, is self-forgetting – the process of realizing the self is a fiction and letting it go.

Eckhart Tolle (author of The Power of Now) is a leading exponent of self-forgetting in the popular media. While I have certainly enjoyed and gained a lot from reading his books and listening to his lectures on CD, much of my understanding of self-forgetting comes from Tarthang Tulku the Buddhist Lama who founded the Nyingma Institute in Berkeley, CA.

Tarthang Tulku says that the mind clothes itself and renders itself tangible to itself in a purely mind-created projection it calls the self. The self is like a magnet which attracts stories – stories which the mind has spun to make sense of its experiences in the world and stories which others have proffered to mind. Whether you define yourself your own way or you have allowed others to define you (such as your parents, teachers, professors, spouse or boss), either way you are placing narrow, artificial limits on your being and you are shaping the way you perceive and interpret events and situations. Depression is the difference between what you believe you should have accomplished and what you have accomplished.

If your self is a victim in your story than you’re likely to be on guard against rejection, disappointment and victimization. When you meet someone you analyze his every word and scrutinize all his facial micro-expressions for approval/disapproval. If your self is a conquering hero it’s all great until you suffer a long series of small defeats or one big humiliating disaster. As of August 2010 Tiger Woods (arguably the greatest golfer who ever lived) can’t make a golf shot, because the self he constructed with the help of PGA Tour, the press, and his fans has been shattered. Whether you’re a goat or a hero in your own story you’re loading yourself with stress because you’re always waiting for mistreatment and abuse or because you’re always working hard to stay on top.

If you confuse being (the state of existing in the present moment as a being) with having a self, then your focus is not on living in this moment but on how the self is faring (well or ill) and you are lost in tension-riddled comparisons between your self, your past and future selves and other selves. 

Tarthang Tulku recommends daily meditation to release the self and come back into the state of pure being unconditioned by stories about who we are, why we are, what we must do and so forth. He says that meditating in this way leads to compassion for all beings and unity with all beings – a condition of existence in which fear of others (social stress) cannot exist. I have been meditating in this way and making progress along this path.  I commend it you.

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MRI STUDY SHOWS THAT OPTIMISTS AND PESSIMISTS USE THEIR BRAINS DIFFERENTLY

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

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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OBSTRUCTIVE SLEEP APNEA INCREASES THE RISK OF STROKE FOR BOTH GENDERS BUT ESPECIALLY FOR MEN

August 20th, 2010

William Dement, M.D., the Stanford physician who founded the field of sleep medicine, first described obstructive sleep apnea (OSA) in 1976. OSA is a condition in which there are hundreds of episodes of apnea (complete blockage of the airway to the lungs) and/or hypoapnea (partial blockage) during sleep. OSA causes sleep interruption and reduced blood oxygen. OSA results from mechanical collapse of the airway not from a neurologic problem with the motor neurons in the brain or their connections to the muscles of the throat.   

The human airway in the throat is composed of collapsible soft tissue made of muscle and fat. People who are overweight or obese have low muscle tone and extra fat in the walls of their airway putting them at highest risk of airway collapse during sleep. Statistically the risk of OSA goes up with being overweight or obese, smoking, heavy drinking, diabetes, older age and being male.

 The spectrum of severity varies widely from patient to patient as to the number, completeness and duration of nighttime airway collapses that prevent oxygen from getting to the lungs, and from the lungs to the heart and brain. Episodes of airway collapse can last from a few seconds to a few minutes. OSA of any severity is bad for your health. The worse the OSA the worse the health consequences. OSA is associated with increased likelihood of hypertension, heart failure, irregular heartbeats, stroke, daytime sleepiness, sleep-deprived motor vehicle accidents, and diminished quality of life. Severe OSA increases the risk of fatal heart attack by 30% and has been proven to cause tissue death in the brain, especially in the hippocampus which encodes memories.

In some but not all sufferers OSA can cause loud snoring, nighttime restlessness and daytime sleepiness. The vast majority of cases of OSA go undiagnosed, because the sufferers do not see themselves as being at risk and they do not go to a sleep medicine clinic for diagnosis with oximetry (a measurement of blood oxygen) and a polysomnogram (a test which reveals the quantity, quality and continuity of sleep).

In 2002 Terry Young, Ph.D., and colleagues at the Department of Population Sciences, University of Wisconsin gave the following estimates of the incidence of OSA. From 1-5% of all adults in the U.S. have severe OSA which causes  chronic daytime sleepiness. From 1-14% have moderate OSA. From 3-28% have mild OSA. In their article in the American Journal of Respiratory and Critical Care Medicine they call undiagnosed OSA in adults an epidemic and a healthcare crisis. As of 2010 the NIH National Center on Sleep Disorders Research said that more than 12 million Americans have sleep apnea but most are not diagnosed or treated.

The National Heart, Lung, and Blood Institute of NIH sponsored a study called the Sleep Heart Health Study which looked at the relationship between OSA and the risk of stroke. The results of this study were published online on March 25, 2010, and in print in the July 2010 issue of the American Journal of Respiratory and Critical Care Medicine. Dr. Susan Redline, M.D., M.P.H. of Case Western Reserve and her colleagues followed 5,422 participants aged 40 or older with no history of stroke for an average of about 9 years.

At the start of the study each participant performed a standard at-home sleep rest which determined if they had sleep apnea and its severity. During the course of the study 193 participants had a stroke. After adjusting for various cardiovascular risk factors the researchers found that men with sleep apnea had a higher stroke risk than women, that men’s risk of stroke increased with the severity of their apnea and that the only women at significantly increased risk of stroke from apnea were those with the severe form. Men with mild OSA have double the risk of stroke than men without it. Men with moderate to severe OSA have triple the risk of stroke than men without OSA or just the mild version. Dr. Redline speculated that the higher risk of stroke in men resulted from men developing OSA at an earlier age than women and having more cumulative effects.   

How do you know if you have OSA? Some people who have it don’t snore. Some people who snore don’t have it. OSA is only one of many reasons for snoring. Others include sinus congestion, drinking alcohol just before bed and use of sleep medicines. The frequency and intensity of snoring is a clue. If you snore intermittently and it’s not loud enough to send your partner out of the room, it’s much less likely that you have OSA than people who snore like buzz saws all the time. Approximately 80% of “heroic snorers” have OSA. Recently a paper was published saying that men whose eyelids were “rubbery” and tended to roll up and expose the whites of their eyes at night (leaving their eyes dry and irritated in the morning) also tended to have OSA. The only way to know for sure is to be examined by a Board Certified sleep medicine physician.

Are there any treatments for OSA? If the cause is being overweight or obese, then losing weight is crucial. These days the typical treatment during sleep is to wear a mouthpiece or to use a breathing device such as a CPAP machine which forces air down the user’s throat, keeping it open and providing good ventilation. Surgery is also used in some cases. One common technique is the uvulopalatopharyngoplasty which removes or repositions excess tissue from the soft palate and uvula.

Given the increased rate of illness and death from heart attacks and strokes, you don’t want to fool around with OSA. If you have a family history of it, if you are significantly overweight or obese, if you are a heroic snorer whose spouse or partner sleeps in another room, if you’ve been quite sleepy during the day or if you’ve been having irregular heartbeats, then run don’t walk to the nearest sleep clinic.

Lawyers spend many mentally active but physically sedentary hours engaged in reading, writing or talking. They are stuck in offices where it’s much more convenient to have food like pizza delivered. They are also highly stressed so they experience serotonin depletion, increased blood cortisol and a yen for sugary, high fat or fried comfort foods. Plenty of lawyers start their first year of law school with a normal BMI (body mass index) only to wind up overweight or obese by middle age. Some of them smoke, drink alcohol or both to control anxiety or depression. These habits and the changes in their bodies creep up on them and it’s hard for them to acknowledge they’ve put themselves at risk of OSA or that they may already have it. It’s not a pleasant scenario. Indeed it’s downright scary to think about. But, if you’re middle aged or older and you have the risk factors, then it’s time to start facing reality and take good care of yourself by making an appointment with a reputable sleep clinic.

 

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META-COGNITIVE THERAPY BESTS THERAPIST LED SUPPORT GROUP TO HELP ADULTS WITH ADHD

August 19th, 2010

ADHD is a genetic problem of the central nervous system leading to inattentiveness, over-activity and impulsivity. Millions of children have it, yet many cases go undiagnosed and untreated, leading to poor school performance, troubled relationships, impaired self-care and low self-esteem. Although some cases of ADHD spontaneously resolve before adulthood, it often persists into adulthood.

In a research paper published in the April 2006 issue of the American Journal of Psychiatry Ronald C. Kessler,  Ph.D., and colleagues estimated that 4.4% of adults in the U.S. had ADHD, that males were predominant over females, and that symptoms were more subtle and less classic in adults than children making it harder to diagnose. 

There is no doubt that some lawyers have ADHD and that these lawyers have not been diagnosed or treated. Such lawyers have evolved ways to compensate for their ADHD, methods by which they force themselves to sit and concentrate for long periods of time. Doing so costs them enormous amounts of mental energy and places them under enormous stress. This in turn can lead to alcohol or drug abuse, depression and other unwanted outcomes.

Do you have lots of mental barriers to sitting down and concentrating that you must overcome each day? Do you have trouble listening to people and really taking in what they told you? Do you forget to do things you promised to do or committed yourself to doing? Are you easily distracted by extraneous stimuli? Do you often misplace or lose things you need to do your job? These are cognitive symptoms of ADHD.

Do you fidget with hands or feet? Do you talk so much that colleagues, judges, family or friends have to tell you to cool it? While waiting your turn to speak in court do you interrupt others and blurt out even when it annoys the judge? Do you find it torture to sit in a long meeting? Are you always on the go as if driven by a motor? When you vacation with family do they relax while you’re in constant motion exploring every nook and cranny of your new environment? These are hyperactivity-impulsivity symptoms of ADHD.

Traditionally ADHD has been treated with stimulant medications and psychological counseling in children. Adults diagnosed with ADHD take medication, use support groups or both. This year Mary V. Solanto, Ph.D., Associate Professor of Psychiatry and Director of the ADHD Center at the Mount Sinai Medical Center in New York did a study to determine which non-medication treatment was most effective for adults with ADHD.

Dr. Solanto took 88 adult patients from the clinic, each of whom had been rigorously diagnosed as having ADHD. Participants were randomly assigned to meta-cognitive therapy (MCT) group or a control group in which they received supportive psychotherapy. Meta-cognitive therapy uses cognitive-behavioral principles to teach patients skills and strategies in time management, organization, and planning. Part of the therapy is to teach patients how to deal with depressed and anxious thoughts that undermine effective self-management. The support group received the time, attention, and emotional support of the psychotherapist but was not instructed in time management, organization and planning strategies.

After 12 weeks the clinicians found that the patients in the MCT group were significantly more improved than those in the support group. The MCT group also showed greater improvement on self-rating and observer ratings of their symptoms. Dr. Solanto concluded that MCT is an effective non-medication treatment for adult ADHD. Her research was published the August 2010 issue of the American Journal of Psychiatry.

Dr. Solanto’s study provides evidence that you can retrain your brain using MCT and improve symptoms of adult ADHD that cause extra stress in your life on top of the stress you already experience as a lawyer. If you suspect you may have ADHD, then go see a psychiatrist for diagnosis. If you’ve already been diagnosed with ADHD but your symptoms have not improved significantly with medication and/or a support group, this would be the time to look into MCT.

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DEALING WITH THE GUILT THAT GOES WITH BEING DEPRESSED

August 18th, 2010

Being depressed is hard enough. You feel sad, inadequate and worthless. You feel as if nothing you’ve ever done, can do or will do matters. You don’t feel like getting up, eating, getting dressed, going outside, working or playing. You just want to stay in bed and sleep. You’re listless, apathetic and de-energized. But, to make matters worse, people who are severely depressed tend to feel a great deal of guilt. I know this only too well. I know it because I’ve been severely depressed and felt this guilt, and I know it because I have sat in groups of depressed adults who speak of feeling this guilt with shame and pain written all over their faces.

What is a severely depressed person guilty over? How about guilt over not being able to work and earn income. Guilt over not taking care of your client’s cases and leaving your partners or associates to pick up your work load. Guilt over not being an active, involved and competent parent to your children who drives them to/from school, coaches their sports and helps them with homework. Guilt over not being a worthy role model for your kids. Guilt over your kids being ashamed of you when their friends find out their lawyer dad or mom is home depressed.

Then there’s guilt over not doing your share of home chores like grocery shopping, cooking, dish washing, house cleaning, weeding the yard or walking the dog. Guilt over not being a good spouse by supporting, encouraging and validating your partner’s efforts in the world – or by not being attractive, sexy and able to engage in passionate lovemaking. Guilt over needing help from others. There’s even guilt over being depressed in the first place.

Psychologists who treat severely depressed people say that guilt is an obstacle to recovery because guilt is a tool of self-punishment. You can’t get well, become functional again and regain your self-respect if you keep bashing yourself for being such a failure as a result of your depression. So what can you tell yourself to lift the burden of guilt?

It’s crucial to take the long view that depression is not a life sentence, that it will eventually pass if you ride it out instead of harming yourself and that you will be functional again one day. It’s crucial to accept the fact you did not desire to be depressed or invite depression in, but that it just happened and that like it or not you’re going to be depressed for a while and there’s simply no getting around it. It’s crucial to have some compassion for yourself in the midst of all that emotional pain.

Rather than denounce yourself as a pathetic failure for being in pain, it’s so much better to love yourself as would love a hurt baby bird which had fallen from the nest. You can actually say to yourself: “I forgive you for hurting like this instead of working and parenting like you usually do. I love you very much even though you are feeling broken right now. I want what is best for you. I’m on your side. I want you to heal and feel better. I want you to be free of suffering. I want to be happy again.”  

You can also help yourself through the guilt phase of depression by remembering certain basic truths about life. No one is always in a position to serve others. Sometimes life forces us to receive, and being depressed is a time when you must receive help from others to survive, heal and recover. This isn’t a bad thing. Other people can find meaning in life by serving you, so your needs enhance their lives. Without someone to receive, nobody can give.

When you always act the part of the tough-as-nails Marine who is completely self-reliant and detests help from anyone, you’re sending out a message that being vulnerable is bad. When you allow others to serve you, you make it okay for the people you care about (your spouse, kids and friends) to be vulnerable too. When they need help one day, it will be easier for them to receive it. If it’s difficult to open yourself to receiving help from your spouse and kids remember all that you have done for them in the past.

Take some time to think about what would not have been if you had not existed. Yes, you may be immobilized by depression right now, but take some comfort and joy in the fact that you’ve added real value to the world by your existence. Perhaps you’ve had a long, happy marriage. Perhaps you and your spouse have raised some wonderful children who care about other people and make the world a better place. Perhaps you’ve built a solid, ethical law practice which has helped many clients over the years. Perhaps you have mentored young lawyers to have integrity, humanity and professionalism as well as keen legal skills.

Meaning doesn’t have to come from what you do. Meaning can come from the way you are. It can come from how you cope with difficulties and how you relate to others during a period of difficulty. If you’re able to release yourself from guilt, overcome your depression and return to health and function, you become a beacon of hope and a model of resilience to others. You become a teacher. No one can help being struck by depression or feeling guilt as a result of depression. But it is possible to release your guilt and this will aid in your healing.

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