Problems

Transcendental Meditation has dramatic benefits for those with PTSD

  • A month of practicing Transcendental Meditation daily resulted in 80% of military veterans with PTSD having their symptoms reduced to below the clinical level.

A pilot study involving 41 military veterans and 5 active-duty soldiers diagnosed with clinical levels of PTSD has found that one month of transcendental meditation produced dramatic benefits, with 37 (80%) having their symptoms reduced to below the clinical level, and 40 having a clinically significant decrease of more than 10 points.

A test 90 days later also showed that PTSD symptoms continued to improve, and a further three individuals had dropped to below the clinical level.

The participants learned the standard Transcendental Meditation technique, which is practiced 20 minutes twice a day. Those who practiced twice a day had greater benefits than those who practiced once a day.

The study follows on from two earlier studies involving Congolese refugees, who found a significant benefit after just 10 days of Transcendental Meditation.

Note that this is only a preliminary study, with no controls, and the participants were self-selected, responding to media advertising (89 responded — only those with clinical levels of PTSD were included in the study). However, the results certainly appear dramatic, and previous research has shown that Transcendental Meditation has a positive benefit for many of the conditions associated with PTSD, such as high anxiety, insomnia, depression, and high blood pressure.

https://www.eurekalert.org/pub_releases/2018-01/muom-vwl011018.php

Full text of the paper is available at https://academic.oup.com/milmed/article/183/1-2/e144/4781643

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Sleep helps process traumatic experiences

  • A finding that sleeping after watching a trauma event reduced emotional distress and traumatic memories is intriguing in light of the theory that PTSD occurs through a failure of contextual processing.

A laboratory study has found that sleeping after watching a trauma event reduced emotional distress and memories related to traumatic events. The laboratory study involved 65 women being shown a neutral and a traumatic video. Typically, recurring memories of certain images haunted the test subjects for a few days (these were recorded in detail in a diary). Some participants slept in the lab for a night after the video, while the other group remained awake.

Those who slept after the film had fewer and less distressing recurring emotional memories than those who were awake. This effect was particularly evident after several days.

 One of the reasons for this benefit is thought to be that the memory consolidation processes that happen during sleep help contextualize the memories. This is interesting in view of the recent theory that PTSD is associated with a deficit in contextual processing.

However, I'd note that there is conflicting evidence about the effects of sleep on negative memories (for example, see http://www.memory-key.com/research/news/sleep-preserves-your-feelings-about-traumatic-events).

https://www.eurekalert.org/pub_releases/2016-12/uoz-shp121316.php

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Individual cognitive processing therapy had better PTSD improvement

  • A large randomized study has found that cognitive processing therapy works better when administered on an individual basis, but that regardless, it is only successful about half the time.

A randomized clinical trial of 268 active-duty personnel seeking treatment for PTSD has found that individual sessions of cognitive processing therapy were twice as effective as group sessions.

Participants were assigned to CPT in either 90-minute group sessions or 60-minute individual sessions twice weekly for six weeks. PTSD severity was reduced significantly more in those receiving individual treatment, however improvements were maintained during the six-month follow-up in both groups. Depression and suicidal ideation also improved equally with both forms of CPT.

However, even among those receiving individual CPT, some 50% still had PTSD and clinically significant symptoms.

https://www.eurekalert.org/pub_releases/2016-11/tjnj-icp112116.php

Full paper available at https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2587076

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Brain changes seen in veterans with PTSD after mindfulness training

  • A small study found mindfulness training had an observable effect on the brains of PTSD sufferers.

A pilot study involving 23 military veterans with PTSD found that those who received mindfulness training showed reduced PTSD symptoms, and brain changes that suggest a greater ability to shift and control attention. Mindfulness training was given to 14 veterans, while the other 9 received ‘control’ group support. Both groups were given brain scans before and after the treatment program.

The initial scan showed that, even during rest, veterans’ brains showed unusual activity in regions involved in responding to threats and other external dangers. After practising mindfulness, the default mode network was not only more active, but also showed stronger connections with the executive network, which is involved in controlling attention. PTSD is associated with reduced executive functioning.

Moreover, veterans responded well to the training, with more of that group sticking with the therapy, compared with the comparison psychotherapy group.

The researchers emphasize, however, that people with PTSD interested in this should seek out providers trained specifically in PTSD care, as mindfulness sessions can sometimes trigger symptoms such as intrusive thoughts to flare up.

http://www.eurekalert.org/pub_releases/2016-04/uomh-bcs033016.php

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Is PTSD a failure of context processing?

  • A new theory suggests a single dysfunction, in the processing of context, could underlie the multiple symptoms and characteristics of PTSD.

An interesting new theory for PTSD suggests that the root of the problem lies in context processing problems.

Context processing allows people and animals to recognize that a particular stimulus may require different responses depending on the context in which it is encountered. So, for example, a lion in the zoo evokes a different response than one encountered in your backyard.

Context processing involves the hippocampus, and its connections to the prefrontal cortex and the amygdala. Research has shown that activity in these brain areas is disrupted in those with PTSD.

The idea that a disruption in this circuit can interfere with context processing can explain most of the symptoms and much of the biology of PTSD. Previous models have focused on one aspect of the disorder:

  • on abnormal fear learning, which is rooted in the amygdala
  • on exaggerated threat detection, which is rooted in a network involving the amygdala, the anterior cingulate cortex and insula
  • on executive function and emotion regulation, which is mainly rooted in the prefrontal cortex.

The researchers suggest that a deficit in context processing would lead PTSD patients to feel "unmoored" from the world around them, unable to shape their responses to fit their current contexts. Instead, their brains impose an "internalized context", one that always expects danger.

This type of deficit, arising from a combination of genes and life experiences, may create vulnerability to PTSD in the first place.

The researchers are now testing their model.

https://www.eurekalert.org/pub_releases/2016-10/uomh-wrg100716.php

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Size of hippocampus associated with PTSD therapy benefits

  • Size of that key memory region, the hippocampus, appears to be not simply a risk factor for PTSD, but also key to whether sufferers will respond positively to exposure therapy.

Following previous research showing that having a smaller hippocampus is associated with increased risk of PTSD, a study involving 40 participants with PTSD and 36 trauma-exposed healthy controls has found that those PTSD patients who responded to the treatment had larger hippocampi compared to those who didn’t benefit from the therapy.

The participants were evaluated at baseline and after 10 weeks, during which time the PTSD group had prolonged exposure therapy.

The study found that both the resilient controls and the 23 patients with PTSD who responded to treatment had greater hippocampal volume at the beginning of the study than the 17 non-responders.

The findings add to growing evidence that the hippocampus is key to distinguishing between cues that signal safety and those that signal threat.

http://www.eurekalert.org/pub_releases/2016-05/cumc-sob051216.php

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Menstruation doesn't change how your brain works

  • A largish study for its type indicates that hormonal changes during the menstrual cycle have no impact on working memory, multitasking ability, or cognitive bias.

A study involving 88 women, some of whom had endocrinological disorders, has found that, while some hormones were associated with changes across one menstrual cycle in some of the women taking part, these effects didn't repeat in the following cycle. In other words, there was no consistent effect of hormonal changes on cognition. This is not to say that some individuals might not be consistently affected, just that it doesn’t appear to be a general rule.

While the number of participants isn’t huge, it is considerably larger than is common in these sort of studies. The replication across two cycles is particularly important, since if the researchers had settled for just looking at one cycle, they would have concluded that there was an effect on cognition — as several studies have previously concluded. This more rigorous study suggests that earlier findings should be regarded with caution.

The study followed the women through two menstrual cycles. For the first cycle, 88 women participated; 68 women were re-assessed for a second cycle, to rule out practice effects and false-positive chance findings. Visuospatial working memory, attention, cognitive bias and hormone levels were assessed at four consecutive time-points across both cycles.

Of the initial 88, 58 had no endocrinological problems, 13 were diagnosed with endometriosis, 16 with polycystic ovary syndrome (PCOS) and one woman with hyperprolactinemia. Additionally, 12 women presented with obesity. Women were excluded if they were using oral contraceptives, had been pregnant or breastfeeding within the past 6 months, were using medication or had surgery which might interfere with endocrine parameters, had severe psychiatric or general diseases, worked irregular shifts, had menstrual or ovulation disorders except those investigated in the study, or showed any additional abnormality in hormonal parameters. Mean age was 30. Data from the subset of healthy women were also analyzed separately, confirming no difference in the findings. I would have liked the researchers to mention how the 68 women in the replication were selected, but I assume, after all their emphasis on methodological rigor, that they would have been careful to make sure there was no bias in that selection.

It should be noted, however, that the cognitive testing wasn’t exhaustive by any means — it’s possible that other cognitive aspects might be affected by hormonal changes. However, attention and working memory are the areas generally accused, and most likely to be noticed by an individual.

Of course, that’s the thing about attention and working memory — they’re very sensitive to a host of factors, including sleep quality and stress. So, we often notice that we’re not working at top gear, and we’re likely to look around for reasons. If we’re women, and it’s our period or just before it, we’re quite likely to attribute the reason to that. And it may be true in an indirect way — if we have pain, or sleeplessness, or are stressed, for example. What this study tells us, is that the changes in hormonal levels don't seem to consistently affect cognition.

https://www.eurekalert.org/pub_releases/2017-07/f-mdc062717.php

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Chemo-brain: prevalence, why it happens, and how to help

  • The largest study to date of chemo-brain shows that 45% of women with breast cancer report it's a substantial problem for months after chemotherapy.
  • A rat study suggests an effect of chemotherapy on dopamine and serotonin may be partly responsible.
  • Better cognitive function, and improved mood, are linked to frequent moderate-to-vigorous physical exercise among breast cancer survivors.
  • A new cognitive-behavioral treatment program has been trialed with positive results.

Chemo-brain common among women with breast cancer

A study involving 581 breast cancer patients and 364 healthy age-matched people (mean age 53) has found that women with breast cancer reported significantly greater cognitive difficulties for up to six months after chemotherapy. Cognitive difficulties were evaluated using FACT-Cog, an assessment that examines a person's own perceived impairment as well as cognitive impairment perceived by others.

Compared to healthy controls, the FACT-Cog scores of women with breast cancer were 45% lower at outset. This difference increased substantially after chemotherapy (see graph). The first assessment after chemotherapy was at 4.8 months, with the second 6 months after that (i.e, nearly a year after chemotherapy). Patients were also much more likely to report significant cognitive decline from diagnosis to the first post-chemotherapy assessment (45.2% vs 10.4% of the controls), and from prechemotherapy to second post-chemotherapy assessment (36.5% v 13.6%).

Having more anxiety and depressive symptoms at the outset, and having lower cognitive reserve (assessed by a reading score), were significantly associated with lower scores.

Those who received hormone therapy and/or radiation treatment after chemotherapy had similar cognitive problems to women who received chemotherapy alone.

Chemobrain a product of dysfunction in dopamine & serotonin release?

A rat study suggests one reason for chemo-brain is an effect of chemotherapy on the neurotransmitters dopamine and serotonin. Both of these are important for both mood and cognition.

After giving carboplatin (commonly used with breast, bladder, colon and other cancers) to rats over four weeks, researchers found that the release and uptake of both dopamine and serotonin in their brains became impaired, although overall levels didn’t change. The rats also showed impaired cognition.

Exercise helps memory for breast cancer survivors

A role for dopamine and serotonin in chemo-brain is consistent with findings that anxiety and depression are risk factors for chemo-brain. No surprise then, that a study has found that physical exercise helps improve cognition in breast cancer survivors.

The study used self-reported data from 1,477 breast cancer survivors, as well as from accelerometers worn by 362 of the women. It found that breast cancer survivors who did more moderate or vigorous physical activity (including brisk walking, biking, jogging, or an exercise class) had fewer subjective memory problems.

Higher levels of physical activity were associated with lower levels of fatigue and distress, and higher levels of physical confidence. The researchers suggest that exercise reduces subjective memory problems via these factors.

Cognitive-behavioral therapy may help

A cognitive-behavioral therapy called "Memory and Attention Adaptation Training" (MAAT), which helps cancer survivors to increase their awareness of situations where memory problems can arise and to develop skills to either prevent memory failure or to compensate for memory dysfunction, has been trialed in a small randomized study involving 47 Caucasian breast cancer survivors. The patients were an average of four years post-chemotherapy.

The participants were either assigned to eight visits of MAAT (30 to 45 minutes each visit) or supportive talk therapy for the same length of time. Both treatments were delivered over a videoconference network between health centers.

MAAT participants reported significantly fewer memory problems as well as improved processing speed two months after treatment. They also reported much less anxiety about cognitive problems.

https://www.eurekalert.org/pub_releases/2017-01/uorm-caw010317.php

http://www.eurekalert.org/pub_releases/2016-05/acs-ih052516.php

http://www.futurity.org/exercise-breast-cancer-memory-1200372-2/

http://www.eurekalert.org/pub_releases/2016-05/w-ctm050216.php

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[4253] Janelsins MC, Heckler CE, Peppone LJ, Kamen C, Mustian KM, Mohile SG, Magnuson A, Kleckner IR, Guido JJ, Young KL, et al. Cognitive Complaints in Survivors of Breast Cancer After Chemotherapy Compared With Age-Matched Controls: An Analysis From a Nationwide, Multicenter, Prospective Longitudinal Study. Journal of Clinical Oncology [Internet]. 2016 ;35(5):506 - 514. Available from: http://dx.doi.org/10.1200/JCO.2016.68.5826

[4254] Kaplan SV, Limbocker RA, Gehringer RC, Divis JL, Osterhaus GL, Newby MD, Sofis MJ, Jarmolowicz DP, Newman BD, Mathews TA, et al. Impaired Brain Dopamine and Serotonin Release and Uptake in Wistar Rats Following Treatment with Carboplatin. ACS Chemical Neuroscience [Internet]. 2016 ;7(6):689 - 699. Available from: http://dx.doi.org/10.1021/acschemneuro.5b00029

[4255] Phillips SM, Lloyd GR, Awick EA, McAuley E. Relationship between self-reported and objectively measured physical activity and subjective memory impairment in breast cancer survivors: role of self-efficacy, fatigue and distress. Psycho-Oncology [Internet]. 2016 :n/a - n/a. Available from: http://onlinelibrary.wiley.com/doi/10.1002/pon.4156/abstract

[4256] Ferguson RJ, Sigmon ST, Pritchard AJ, LaBrie SL, Goetze RE, Fink CM, A. Garrett M. A randomized trial of videoconference-delivered cognitive behavioral therapy for survivors of breast cancer with self-reported cognitive dysfunction. Cancer [Internet]. 2016 ;122(11):1782 - 1791. Available from: http://onlinelibrary.wiley.com/doi/10.1002/cncr.29891/abstract

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Concrete thinking may reduce the power of traumatic memories

  • Focusing on concrete details when experiencing a traumatic event may, oddly enough, protect you more from the power of those memories, than if you tried to distance yourself from what you are experiencing.

Can you help protect yourself from the memory of traumatic events? A new study suggests that, by concentrating on concrete details as you live through the event, you can reduce the number of intrusive memories later experienced.

The study, aimed particularly at those who deliberately expose themselves to the risk of PTSD (e.g., emergency workers, military personnel, journalists in conflict zones), involved 50 volunteers who rated their mood before watching several films with traumatic scenes. After the first film, they rated their feelings. For the next four films, half the participants were asked to consider abstract questions, such as why such situations happened. The other half were asked to consider concrete questions, such as what they could see and hear and what needed to be done from that point. Afterward, they gave another rating on their mood. Finally, they were asked to watch a final film in the same way as they had practiced, rating feelings of distress and horror as they had for the first film.

The volunteers were then given a diary to record intrusive memories of anything they had seen in the films for the next week.

Both groups, unsurprisingly, saw their mood decline after the films, but those who had been practicing concrete thinking were less affected, and also experienced less intense feelings of distress and horror when watching the final film. Abstract thinkers experienced nearly twice as many intrusive memories in the following week.

The study follows previous findings that emergency workers who adopted an abstract processing approach showed poorer coping, and that those who processed negative events using abstract thinking experienced a longer period of low mood, compared to those using concrete thinking.

Further study to confirm this finding is of course needed in real-life situations, but this does suggest a strategy that people who regularly experience trauma could try. It is particularly intriguing because, on the face of it, it would seem like quite the wrong strategy. Distancing yourself from the trauma you're experiencing, trying to see it as something less real, seems a more obvious coping strategy. This study suggests it is exactly the wrong thing to do.

It also seems likely that this tendency to use concrete or abstract processing may reflect a more general trait. Self-reported proneness to intrusive memories in everyday life was significantly correlated with intrusive memories of the films. Perhaps we should all think about the way we view the world, and those of us who tend to take a more abstract approach should try paying more attention to concrete details. This is, after all, something I've been recommending in the context of fighting sensory impairment and age-related cognitive decline!

Abstract thinking certainly has its place, but as I've said before, we need flexibility. Effective cognitive management is about tailoring your style of thinking to the task's demands.

http://www.eurekalert.org/pub_releases/2016-05/uoo-tdc050516.php

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Diabetes & MCI linked in middle age

September, 2014

A large study has found that mild cognitive impairment occurred twice as often in older adults diagnosed with type 2 diabetes.

A German study involving 1,936 older adults (50+) has found that mild cognitive impairment (MCI) occurred twice as often in those diagnosed with type 2 diabetes.

Analysis of 560 participants with MCI (289 with amnestic MCI and 271 with non-amnestic MCI) and 1,376 cognitively normal participants revealed that this was only observed in middle-aged participants (50-65), not in older participants (65-80). Interestingly, there was a gender difference. Middle-aged women showed a stronger association between diabetes and amnestic MCI, while middle-aged men showed a stronger association with non-amnestic MCI.

http://www.eurekalert.org/pub_releases/2014-09/ip-dma090214.php

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Winkler, A., Dlugaj, M., Weimar, C., Jöckel, K.-H., Erbel, R., Dragano, N., & Moebus, S. (2014). Association of diabetes mellitus and mild cognitive impairment in middle-aged men and women. Journal of Alzheimer’s Disease: JAD, 42(4), 1269–1277. http://doi.org/10.3233/JAD-140696

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