Tuesday, May 26, 2009
There was a sign on a door which was advertising a class for Laughing Yoga (which, ironically, the psychiatrist I was working with laughed at with his patients). Apparently, this is a rather large fad. But I had never heard of it, yet many yoga studios and recreational centres offer such courses which use breathing and stretching exercises for purposeful laughing. The laughter is completely intentional on the part of the individual; there are no jokes or other external humorous stimuli.
Laughter yoga was developed by Dr. Madan Kataria in 1995 as an alternative medical treatment for his patients. On his site, he claims laughter yoga is a great aerobic exercise (fine), but he then states that laughter “is the only exercise that impacts positively and directly on your body, mind and emotions,” (not fine. All exercise, as evidenced by many studies, has positive effects in all of those areas).
Though not the only means of healing, laughing does effect the body in a positive way. And you don’t need a class to practice intentional laughing (though the social benefits of practicing in a group setting would be missed).
One study measured the effect of laughter on employees’ self-reported efficacy and found that, “Purposeful laughter is a realistic, sustainable, and generalizable intervention that enhances employees' morale, resilience, and personal efficacy beliefs.”
Another study measured facial movements in depressed subjects using ultrasound markers, which sounded pretty cool to me. Their findings described hypomimia in depressed patients. However, there is a huge limitation in this study in that the stimulus used to provoke laughing was an episode of Mr. Bean. If anything, being forced to watch Mr. Bean for an extended period of time would make me anxious, angry, and depressed.
In an article, Therapy Is Sometimes a Laughing Matter (Psychiatric News, July 4 2008), reporting on a psychiatry-humor workshop, therapeutic laughter was the topic of discussion:
This laughter and play, he [Dunkelblau] said, then generate "mirth or internal good feelings," which in turn have been found to provide (anecdotally or in psychological studies) a plethora of mental and physical benefits: a reduction in stress, anxiety, and depression; an increase in pain tolerance; heightened self-esteem; enhanced creativity and problem solving; improved interpersonal interactions and relationships; a building of group identity; and even an enhancement of memory.
This non-profit site has a great overview of the benefits of laughter and optimism, as well as detailed tips for practicing these things in your daily life.
The Association for Applied and Therapeutic Humor also has a good site (though I find the previous site more user helpful).
Monday, May 25, 2009
On May 1, registration fees for the GRE were raised by $10. In Canada, the GRE general test is now $180 and the Psychology subject test is $150. If you live in the US, there is a fee reduction program you can apply for (see here for info), but I didn’t find anything similar for Canadians. If any Canadian readers know of any GRE subsidies or bursaries, please share.
In light of this information, unless there is any demand for this study guide to continue, this may very well be the last entry. If anyone has any specific questions, they may feel free to contact me.
I’m too lazy to link all of the previous pages, but you can find them in the archives and under the label “GRE”. Page 1 has a link to the official Practice GRE from which this guide is developed.
89. The actor-observer effect is the tendency to attribute our own behaviour mainly to situational causes but the behaviour of others mainly to internal (dispositional) causes. People are much more willing to ascribe a trait to someone else than they are for themselves.
(From: Human Motivation, Weiner)
90. Bem’s gender schema, similar to other schemas, is a set of beliefs and perceptions about men and women which direct how individuals view others and their own behaviours in relation to sexual stereotypes. For example, neutering bulls may be seen as a masculine activity, ‘man’s work,’ and an individual who is performing this task will be judged differently based on their gender. Gender schemas are acquired in childhood through learning and define people’s expectations of gender behaviour based on these acquired categorisations. These schemas are quite often incorrect, particularly in the modern western culture where gender differences are being equalised.
a. A stimulant increases the activity of the CNS and/or the sympathetic nervous system.
b. A psychoactive agent alters brain function by acting on the CNS to induce changes in cognition, mood, perception…
c. An agonist mimics the action of a neurotransmitter therefore producing a similar response.
d. An antagonist opposes the action of a neurotransmitter preventing the neurotransmitter from performing its normal function.
e. An anxiolytic drug reduces anxiety acting as a sort of mild tranquiliser.
92. How information is recalled will depend on how it was encoded during the memorising part of the task. Though no cue is given by the experimenter, the subject has still stored the information into some sort of organised categories. The categories of words given in this example are quite clearly defined so it is not unreasonable to assume the subject will encode the words based on those categories (even if they do not do so deliberately). When asked to recall as many words as possible, the subject will recall one, say ‘apple,’ which will then cue the subject to recall other items from the fruit category. Similarly for the other categories.
This site has a great overview of the different types of memory.
93. Clusters of related facts about people, events, behaviours, etc., are organised for long-term storage into schemas. Remembering requires the use of these determined, general knowledge packages. Because of the general nature on which schemas are built, incorrect recall may occur. For example, you may know that every Tuesday morning you kill a zombie. Later when asked what you did Tuesday morning, you can confidently answer, ‘I beheaded the undead.’ However, if one Tuesday there were no reanimated corpses around to destroy, and you are later asked what you did Tuesday morning, you may still answer, ‘I beheaded the undead,’ simply because that is what you always do.
b. Rote-memory is learning or memorization by repetition, often without an understanding of the reasoning or relationships involved in the material that is learned. (Like the GRE!)
Friday, May 22, 2009
Today is now tomorrow and my bedtime occurred last night. Two hours ago, I sat down to simply check my email before bed. Now, though I am in bed, this article is taking form…
You start a blog so that you can write about some stuff and maybe people will see it or not, but you enjoy the process and it’s just for fun when you have some extra time to kill, and then next thing you know, you are awake in the early am hours of the morning writing an article because Blog X just gained ten more followers and now you have to catch up.
Some symptoms of unhealthy competitive blogging:
• Rejecting social invitations because you have to do a bunch of research for your next piece.
• Pressuring your friends to read your blog so you can get that extra visit.
• Spending hours each week checking your analytics, trying to calculate how accurate the program is, and comparing your numbers to some random average figures you obtained from some random website.
• Feeling inadequate because Blog X has more comments and anger at having your work being ignored.
• Comparing your style of blogging to other sites.
• Comparing yourself to other bloggers. Feelings of resentment and inadequacy because you find their style/input/knowledge/background is more validated than your own and if you had their name/title/education, more people would read your blog as well.
• Calculating the number of posts per week to maximise visits.
• Skipping or missing meals.
• Showing up late for work, calling in sick, using company time to research and write (under the justification that it is somehow related to your work or you deserve more time for yourself anyway).
• Wondering if you will ever catch up to your peers; Giving up, hopelessness.
Is this normal? Probably. Is this healthy? Probably not. The important thing to take into account with this subject or with any obsessive or compulsive behaviour, is how much it is dictating what happens in your day and much anxiety it causes. Being able to take a step back to remind yourself of why you began your blog can help refocus your energy toward your work as work and not your work as competition. The blogoshpere is a big, scary world (they don’t call them trolls because they’re friendly…). But communities and friends are built and support networks are formed. And someone is always reading.
Here are some blogs I found which have also entered into the discourse of competitive blogging:
* The Deon Chronicles has a friendly, competitive blog post.
* flexknowlogy talks about the healthy side of competitive blogging.
* Krentz Quick & Castle Blog talks about comparisons to other bloggers. And bloggers helping each other out.
Tuesday, May 19, 2009
The Body Image Workbook
This is an older book and the language, pictures, and statistics are dated (there is a newer, 2008, edition, but it’s not in the public library system yet), but the book was readable. My biggest criticism is it wasn’t until Step 5 that the reader was expected to challenge their beliefs and behaviours. The previous chapters were informative and likely helpful to anyone working on their self-image. I do think education is a necessary step in recovery, but I believe it should be incorporated into exercises promoting change early on in the process.
The first two Steps were quite laden with negative language. In Step 1, there is a worksheet at the end of the chapter called, “My Needs for Change,” which uses the word ‘need’ repeatedly. To me this implies a fair amount of pressure and judgment. Better language would be using the word ‘can.’ So instead of ‘I need to change…’ statements, one can substitute, ‘In order to…I can…’
Step 2 gives a thorough summary of the ways self image can affect a person including self-esteem, identity, interpersonal anxiety, sexual fulfillment, depression, and eating disorders. There was one exercise in this chapter which subjects were encouraged to immerse themselves in negative thoughts knowing this would elicit unhealthy emotions which I definitely thought should be left out. At least it should have been balanced by an exercise promoting positive thoughts.
Step 3 introduces relaxation and meditation techniques as well as desensitisation strategies, all of which is practised in more detail in the following chapters.
Steps 4 – 7 were the most useful focusing on not only identifying problems, but encouraging behavioural and cognitive changes.
Step 7 introduces mindfulness techniques to be incorporated into every day life. It offers ideas for maintaining well-being such as rewarding oneself and exercise. Also, kudos to the author for not being too shy to use the word ‘masturbating.’
Step 8 provides a summary of one’s progress and change and how to achieve long-term maintenance of new behaviours.
While I found some of the language overly negative, there are times when the author’s well grounded beliefs do come through in the writing, such as in the ‘Final Words of Encouragement’ sections where the author provides a concise summary of the ideas being presented.
Final Rating: If you have a book shelf that needs to be filled and you find this book at a thrift store or in a free bin, go ahead.
Monday, May 18, 2009
After sitting through three early morning lectures at this year’s Society of Biological Psychiatry conference, I had decided I needed a break and was going to skip the Presidential Lecture (this choice was a little bizarre since I had been looking forward to the talk. Monotony breeds indifference). Shortly after making this decision, I ran into my PI (who was a little surprised to see me at a conference I wasn’t registered for. Come for the food, stay for the learning.), who informed me the next speaker was well worth seeing.
The title of the presentation was, “Does a Parasite Know More about Our Brains than We Do?” The presenter was one Robert Sapolsky, a person whom I had been ashamed of by my PI for not worshipping. But after hearing his lecture, I am motivated to purchase one of his books. For those of you who are familiar with Sapolsky, you know he has a very engaging manner of speaking (at one point, he referred to the frontal cortex as the part of the brain that “keeps you from being a serial murder.” Other references were made to Brittney Spears and the urine of grad students).
I myself became way too excited; I swear I almost ran up to the podium to kiss him, when he began talking about parasitic life cycles and how they have very specific ways of manipulate the host’s behaviour in order to ensure their own propagation. At this point, I had to stop to ask myself, “Is it normal for someone to get turned on by parasites?”
I answer, emphatically, YES. Anything that can survive through such elegantly executed means deserves at least some reverence.
Examples of parasitic manipulated host behaviour outlined by Sapolsky were an explanation of a particular barnacle (sacculina) that attaches itself to crabs and then alters the crabs reproductive anatomy and behaviour. When attached to a male crab, the barnacle will sterilise the crab by injecting it with estrogen, which leads to other female adaptations as well. When attached to a female crab, the barnacle causes ovaries to atrophy. The result in both cases is that the crab will engage in nesting behaviour, but will be unable to lay eggs; the crab digs a nest for the parasite.
(There are many more examples, all very interesting and I encourage you to look some of them up).
The talk segued into the life cycle toxoplasma gondii. As you may well know, toxo lives in cat intestines, and it is only in cat intestines that toxo can reproduce. So when a toxo finds itself outside of a cat, in a rodent who came a little to close to a cat’s feces, it needs to finds its way back inside a cat.
This it does by making the rat, instead of deterred by, attracted specifically to cat pheromones, not dog, rabbit, or human smells. The stress responses of the rat are not affected; it can still be conditioned to fear cats.
Parasite ridden rats are cute and all, but, besides fetal damage, toxo also has some effects on humans. It seems that a toxo infected human is at increased risk for schizophrenia. There is some mild neuropsychiatric disinhibition and a person is 2-4 more times likely to die as a result of speeding while driving. As well, treatment with haloperidol eliminated infection induced behaviour.
The hypothesis for these outcomes is because toxo preferentially goes to the amygdala where it blocks the glucocorticoid response of the brain. Toxo contains two genes for tyrosine hydroxylase which is the rate limiting step in the production of dopamine.
For much more detailed descriptions of toxo induced behaviour, check out some of the references.
Also, here's a video interview with Sapolsky.
References: 1, 2, 3, 4, 5
The lovely life cycle chart came from here.
Friday, May 15, 2009
In the May 15 issue of Psychiatric News is an article titled, “Most With Mental Illness Meet Voting Competency Criteria.”
The study paradigm was extremely simplified. The study group was small and did not include the inpatient population or a control group.
“Participants were read descriptions of two candidates and asked to choose one, and to compare the candidates and how choosing one would affect their lives; they were also asked why they would or would not want to vote in the next election for governor...”
“They [the mentally ill] performed equally well on the assessment of comparative reasoning, but had more difficulty describing the impact of their choices on their own lives…”
I think understanding the personal impact of an electoral decision is one that is difficult for any person to grasp. Maybe everyone I know is mentally ill, but the general attitude is that it doesn’t matter whom you vote for because it isn’t going to change an individual’s day-to-day life.
“Moreover, the results did not correlate with cognitive function, intelligence, or severity of symptoms.”
"We have to be leery of efforts to use this instrument for wide-scale screening of people with mental illness," he [Appelbaum] told Psychiatric News. "The Americans With Disabilities Act, among other laws, and probably the Constitution protect the rights of people with mental illness from being treated differently from the rest of the population. We don't screen the general population for their capacity to vote, so in general we shouldn't be screening people with mental illness.”
I don’t have access to full article, but you can find the abstract and a link to the full text at Psychiatric Services.
Wednesday, May 13, 2009
I’m too lazy to link all of the previous pages, but you can find them in the archives and under the label “GRE”. Page 1 has a link to the official Practice GRE from which this guide is developed.
a. Cognitive dissonance theory states that when an elicited behaviour is inconsistent with an individual’s attitude, tension (dissonance) results and either the behaviour or the attitude is changed as a result of this difference between what one believes and what one does.
b. An exchange is when one person gives something to another person in return for something else (money, protection, food).
c. Self-awareness, or self-perception, theory states attitudes are the result of observed behaviours. For example, if you repeatedly buy unicorn figurines, you might infer that you really like unicorns.
d. Social comparison theory explains why people tend to gain or lose happiness when they make comparisons (to people, ideals, past behaviours).
e. Attribution theory deals with the process of how people assign causes/reasons to another person’s behaviours. An example is a person trying to understand why a cat only scratches at the door when that person is sleeping, and never when that person is awake.
a. Meta-analysis is a statistical technique used to compare findings across different research studies based on some common measure in the studies.
b. Multiple regression analysis is used to calculate the relationship between independent and dependent variables. For example, you could take measurements of the sex, weight, colour, sharpness of claws, and annoyingness of a cat and then look to see if claw sharpness is a predictor of annoyingness.
c. Factor analysis is used to calculate the relationship, or correlation, among test scores.
d. Multidimensional scaling allows one to look at similarities or differences between variables with results displayed visually on a graph.
e. Process research examines the underlying dynamics of a variable.
a. Phenylketonuria (PKU) is a genetic disorder in which the body can not break down the amino acid phenylalanine (Phe). If Phe levels are too high, brain damage and mental retardation can occur. Babies are screened for PKU at birth.
b. Korsakoff’s syndrome is a neurological disorder caused by insufficient thiamine (from malnutrition or alcoholism) and results in memory and cognitive deficits.
c. Turner’s syndrome affects females and is characterised by a missing or defective X chromosome. Besides physical abnormalities, girls may have some learning disabilities, though they are not at risk for mental retardation.
d. Down syndrome is also called trisomy 21 and this extra genetic material inherited at conception causes mental retardation.
e. Fetal alcohol syndrome causes mental and physical disabilities in babies who were exposed to alcohol consumed by the mother during pregnancy.
a. Identical twins are very useful in genetics studies since, if they are raised separately, the behavioural and the biological component of events can be separated.
b. and e. Genetic disorders can appear at different periods of a person’s life. Some disorders manifest at birth while others don’t appear until the later adult years.
c. There are many psychiatric (borderline personality disorder) and neurological (brain trauma) disorders which are difficult to treat.
d. This could provide evidence of a genetic disorder, however environmental factors would need to be taken into account, maybe all of the children were raised in a way that predisposes them to violence whereas the others were raised in a more gentle environment.
a. Test norms reflect the average score of the whole testing group. Individual scores are compared to this distribution to determine relative standing.
b. Reliability measures how consistent a test is by looking at whether or not the test produces similar results from different administrations.
c. Validity is an assessment of how well a test measures what it is supposed to measure. Content validity looks at how broadly the test samples span. For example, if you are trying to measure creativity, different types of creativity (artistic, verbal, …) should be included in the measurement.
d. Predictive validity measures the degree to which a test predicts some future outcome. For example, performance on the GRE should correlate with future performance in grad school.
e. Construct validity seeks agreement between a theoretical concept and a specific measuring device or procedure. For example, a researcher designing a new method for screening for depression might spend most of their time working on the definition of depression. Construct validity has two sub-categories: convergent validity is when there is a demonstrated relationship in agreement with the theory and divergent validity is when no relationship is demonstrated among measures which should theoretically not be related.
88. The mode is the most frequently occurring score. The median is the middle point of all the scores. The mean is the average of a set of scores. Also see GRE Study Guide Page 9, #64.
a. Variance is how much the scores in a set of scores differ from each other.
b. The central tendency is the value around which most scores are clustered.
c. Statistical significance means that a test result was unlikely to have occurred by chance. In psychology, p-values of less than 5% are generally considered to indicate significant results. (This kind of relationship validation can be quite crude and misleading if not interpreted in the context of all other known information).
d. Skewness is the asymmetry of a distribution curve. It tells you if the curve, which is normally a centred bell curve, leans to the left or right. A negative skew has few low values and a positive skew has few high values.
e. Dispersion measures, in addition to the mean, other values such as range, deviation, and variation in order to gain a better understanding of the original measured value. For example, if you have a box of a litter of kittens whose mean age is 10 weeks, this means something different from having another box where the cats mean age is 10 weeks but the box contains cats ranging in age from 1 day to 15 years.
Thursday, May 7, 2009
In honour of May being Borderline Personality Disorder Awareness Month,
The American Journal of Psychiatry has a few well written articles on the subject.
In an editorial by Oldham, attention is brought to the amygdala (my favourite brain part) and brain structure and function affecting borderline patients.
It is interesting that, although we now recognize the importance of heritable risk factors
predisposing a patient to develop borderline personality disorder, the evidence-based
core treatment recommended for this disorder is psychotherapy, an intervention
long thought to change the mind but not necessarily the brain. Ironically, we also now
understand that intensive psychotherapy is a form of long-term learning and memory,
which indeed changes the brain. Psychotherapy is thus, at least in part, a biological
treatment. But one important emphasis here is the reference to “long-term.”
It is encouraging and refreshing to hear that attitudes towards BPD patients are shifting from labeling one as a difficult patient to a more empathic understanding of their early traumas and inherent predispositions to relationship instability. It is also encouraging to know that mental health professionals are willing to undertake the lengthy journey of recovery with borderline patients, and in doing so providing them with a stable secure relationship. I think the next step in BPD treatment now is to see if we can find ways to speed up the recovery process. This will of course save governments many dollars, but more importantly, it will save borderline patients possibly years of instability and uncertainty. As well, a more efficient treatment will mean patients will complete their therapy and a therapist will also be able to see more patients. This is an obvious statement, but one we should keep in mind as new treatments, pharmacological and psychotherapeutic, are being developed.
On a slightly related note, we often hear in the world of psychiatry how much opinions have changed. A very good thing indeed, but I myself grow weary of constantly having to defend the efficacy of psychiatric treatments and the tolerance and support of those suffering with mental illnesses; shouldn’t we be beyond that by now? Tireless though it may be, continued vociferous education is critical to the ongoing development of social and professional empathic healing.
Saturday, May 2, 2009
Dietitians do more than review the Canadian Food Guide with you. A dietitian is a nutritional counselor who can aid in educating and supporting a person with unhealthy eating habits into a more nutritional and stable diet. They work with people who only need a small amount of nutritional guidance, to those with more severe disordered eating habits who may not be eligible for an eating disorders program.
A dietitian of course works under the umbrella of nutritional education, but they can offer new ideas and perspectives on what you can do yourself to make your body healthier. Whatever your eating habits are, they will be accepted and treated as any counselor would work with emotional issues; through acknowledgment, goal setting, and working in small steps, they also provide the emotional support of changing how you look at food and your self-image.
Meal planning, grocery shopping, lifestyle complications, and budget eating are all areas in which a dietitian can counsel you.
The Dietitians of Canada site has features such as a recipe analyser which allows you to input a recipe to determine nutritional value and meal planning games, as well as lots of tips and ideas for how to manage a healthy eating lifestyle.
Dial-a-Dietitian is a publicly funded service that offers free telephone access to Registered Dietitians (RD) who will provide an answer to your nutrition and healthy eating questions.
In Greater Vancouver call: 604-732-9191.
In BC call: 1-800-667-3438.
If finances are a concern, the Greater Vancouver Food Bank Society is available for anyone who needs it. And they do have healthy foods such as bread, fruits, and vegetables. Because the food bank considers privacy a priority, the locations of food bank depots are not advertised. To access a food bank location call 604-876-3601.