New Tool for Depression – Focus on Positive Future Expectations

For years, I’ve been teaching clients simple frameworks to manage the emotional mind. These frameworks have to be accessible within 1/3rd of a second, before the emotional mind hijacks the rational mind.

A powerful example of this is the framework developed by Phillip Zimbardo at Stanford regarding time perspectives and valence, which is a fancy way of saying that our attention can take you certain places – internal (e.g., monitoring your heart rate, your thoughts) or external (e.g., the room you are in, the people you are with); past, present or future; and/or positive or negative emphasis.

From Ken Pope’s excellent newsletter…

*CNS Neuroscience & Therapeutics* has scheduled an article for publication in a future issue: “Treating Major Depression by Creating Positive Expectations for the Future: A Pilot Study for the Effectiveness of Future-Directed Therapy (FDT) on Symptom Severity and Quality of Life.”

The authors are Jennice S. Vilhauer, Sabrina Young, Chanel Kealoha, Josefine Borrmann, Waguih W. IsHak, Mark H. Rapaport, Narineh Hartoonian, & Jim Mirocha.

Here’s the abstract:

[begin excerpt]

Introduction: This nonrandomized pilot study assesses the efficacy of a new future-oriented form of therapy, known as future-directed therapy (FDT), as a treatment for patients with Major Depressive Disorder (MDD) in a naturalistic hospital-based outpatient psychiatry clinic. The study measured symptom severity of depression and anxiety, in addition to quality of life pre- and posttreatment.

Aims: The study examined a new manualized treatment designed to help people anticipate a more positive future. The intervention consists of twenty 90-min group sessions administered twice a week over 10 weeks. The intervention was compared to depressed patients in the same clinic who enrolled in traditional cognitive-based group psychotherapy. Sixteen patients with MDD completed the FDT intervention as part of their outpatient treatment for depression. Seventeen patients with MDD participated in treatment as usual (TAU) cognitive-based group therapy. The Quick Inventory of Depressive Symptoms, the Beck Anxiety Inventory, and the Quality-of-Life Enjoyment and Satisfaction Questionnaire short form, self-report instruments were administered prior to and immediately after the completion of therapy.

Results: Patients treated with FDT demonstrated significant improvements in depression (P= 0.001), anxiety (P= 0.021) and quality of life (P= 0.035), and also reported high satisfaction with the therapy. Compared to the TAU group, patients treated with FDT showed greater improvements in depressive symptoms (P= 0.049).

Conclusions: FDT may have the potential of becoming an additional treatment option for patients with MDD.

[end excerpt]

On the Cedars-Sinai (where the research was conducted) web site there was the following additional information:

[begin Cedars-Sinai info]

Patients with major depression do better by learning to create a more positive outlook about the future, rather than by focusing on negative thoughts about their past experiences, researchers at Cedars-Sinai say after developing a new treatment that helps patients do this.

While Major Depressive Disorder patients traditionally undergo cognitive-behavior therapy care that seeks to alter their irrational, negative thoughts about past experiences, patients who were treated with the newly-developed Future-Directed Therapy(TM) demonstrated significant improvement in depression and anxiety, as well as improvement in overall reported quality of life, the researchers found.

Results were published recently in the peer-reviewed journal CNS Neuroscience & Therapeutics.

“Recent imaging studies show that depressed patients have reduced functioning in the regions of the brain responsible for optimism,” said Jennice Vilhauer, PhD, study author and clinical director of Adult Outpatient Programs for the Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences. “Also, people with depression tend to have fewer skills to help them develop a better future. They have less ability to set goals, problem solve or plan for future events.”

According to the U.S. Centers for Disease Control and Prevention, an estimated one in 10 American adults meet the diagnostic criteria for depression.

Anand Pandya, MD, interim chair of Cedars-Sinai’s Department of Psychiatry and Behavioral Neurosciences, said, “Future-Directed Therapy is designed to reduce depression by teaching people the skills they need to think more positively about the future and take the action required to create positive future experiences.  This is the first study that demonstrates this intervention intended to increase positive expectations about the future can reduce symptoms of Major Depressive Disorder.”

Depression in Men depressed guys

When people talk only about the negative aspects of their lives, it causes them to focus more attention on what makes them unhappy, Vilhauer said.

“Talking about what makes you unhappy in life doesn’t generate the necessary thinking patterns or action needed to promote a state of thriving and create a more positive future,” Vilhauer said.  “Future-Directed Therapy helps people shift their attention constructing visions of what they want more of in the future and it helps them develop the skills that they will need to eventually get there.”

In the study conducted at Cedars-Sinai, 16 adult patients diagnosed with Major Depressive Disorder attended future-directed group therapy sessions led by a licensed psychologist twice a week for 10 weeks.  Each week, patients read a chapter from a Future-Directed Therapy manual and completed worksheets aimed at improving certain skills, such as goal-setting.  Another group of 17 patients diagnosed with depression underwent standard cognitive group therapy. The study team measured the severity of depression and anxiety symptoms, and quality of life before and after treatment, using the Quick Inventory of Depressive Symptoms, the Beck Anxiety Inventory, and the Quality-of-Life Enjoyment and Satisfaction Questionnaire short form.

Results include:

Patients in the Future-Directed Therapy group experienced on average a 5.4 point reduction in their depressive symptoms on the Quick Inventory of Depressive Symptoms scale, compared to a two point reduction in the cognitive therapy group.

Patients in the Future-Directed Therapy group on average reported a 5.4 point reduction in anxiety symptoms on the Beck Anxiety Inventory, compared to a reduction of 1.7 points in the cognitive therapy group.

Patients in the Future-Directed Therapy group reported on average an 8.4 point improvement in their self-reported quality of life on the Quality of Life Enjoyment and Satisfaction scale, compared to a 1.2 point improvement in the cognitive therapy group.

[end Cedars-Sinai info]

The author note provides the following contact information: Jennice Vilhauer, Ph.D., Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, 8730 W. Alden Drive, Thalians W-101, Los Angeles, CA, USA. Tel.: +(310) 423-2620; Fax: +(310) 423-0114; E-mail:

<vilhauerj@cshs.org>.

Want to Reduce Your Social Anxiety? Increase Your Salt Intake!

For those of you who have seen me speak, teach, or who know me personally, you are well aware that social anxiety is a genetic predisposition that I have learned to manage in my own life. I have learned and teach clients scientifically-proven tools to manage anger and anxiety, such as mindfulness, self-compassion, forgiveness, if-then thinking statements, and more.

Social anxiety is a topic that is very  near and dear to my heart because I have suffered the emotional distress that comes with it.

So I was quite excited to see this study which came out today that shows that higher levels of salt in the diet, while having other negative effects on the body, actually has a positive impact on those of us with social anxiety.

This study demonstrated that higher levels of sodium are associated with increased production of oxytocin (which leads to increased trust, rapport, caring, and connection) and decreased levels of pro-stress hormone angiotensin II. So higher levels of sodium actually decrease the painful feelings of social anxiety!

From an evolutionary perspective this makes tremendous sense. Imagine you are on the plains of Africa, millions of years ago, and you and your tribe are suffering from thirst and dehydration (and sodium levels are rising in the body). In this scenario, an increased level of cooperation and trust is necessary so that everyone in the tribe can get to water and share the water so everyone’s chances of survival increase.

Dying of thirst for connection

Dying of thirst for social connection? Must have oxytocin…

——————————–

Higher Levels of Sodium Reduce Your Response to Stress, Study Shows

ScienceDaily (Apr. 5, 2011) — All those salty snacks available at the local tavern might be doing more than increasing your thirst: They could also play a role in suppressing social anxiety.

New research from the University of Cincinnati (UC) shows that elevated levels of sodium blunt the body’s natural responses to stress by inhibiting stress hormones that would otherwise be activated in stressful situations. These hormones are located along the hypothalamic-pituitary-adrenal (HPA) axis, which controls reactions to stress.
The research is reported in the April 6, 2011, issue of The Journal of Neuroscience, the official journal of the Society for Neuroscience.

“We’re calling this the Watering Hole Effect,” says Eric Krause, PhD, a research assistant professor in the basic science division of UC’s department of psychiatry and behavioral neuroscience and first author of the study. “When you’re thirsty, you have to overcome some amount of fear and anxiety to approach a communal water source. And you want to facilitate those interactions — that way everyone can get to the water source.”

Krause and his team dehydrated laboratory rats by giving them sodium chloride, then exposed them to stress. Compared with a control group, the rats that received the sodium chloride secreted fewer stress hormones and also displayed a reduced cardiovascular response to stress.

“Their blood pressure and heart rate did not go up as much in response to stress as the control group’s, and they returned to resting levels more quickly,” says Krause.

“Also, in a social interaction paradigm with two rats interacting, we found them to be more interactive and less socially anxious.”

Further research, through examination of brain and blood samples from the rats, showed that the same hormones that act on kidneys to compensate for dehydration also act on the brain to regulate responsiveness to stressors and social anxiety.

The elevated sodium level, known as hypernatremia, limited stress responses by suppressing the release of the pro-stress hormone angiotensin II. Conversely, it increased the activity of oxytocin, an anti-stress hormone.

Further research, Krause says, will examine these hormones and neurocircuits to investigate their role in social anxiety disorders and autism, a neurological disorder whose characteristics include social impairment.

Oxytocin deficiency has been implicated in autism in previous studies,” says Krause. “We’d like to investigate the possibility that dysregulation in fluid balance during pregnancy could result in autistic disorders.”

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If you would like a FREE PDF copy of John’s award-winning book on managing anxiety and creating more positive emotions in your life, simply visit www.GuideToSelf.com, click on the yellow book icon in the top left corner of the page, then enter your name and email address on the following page. You will be immediately sent an email and given instant access to your copy of Guide to Self: The Beginner’s Guide to Managing Emotion and Thought.  This award-winning self-help book is filled with the latest in scientifically proven tools and tips to help you manage anxiety, depression and anger. It also is loaded with tips and techniques to teach you cutting-edge ways to insert more positive emotions and thoughts in your life.

To life, love and laughter!

John Schinnerer, Ph.D.

Award-winning author and blogger

Founder Guide to Self, Inc.

Anger Management Coach

San Francisco Bay Area

Danville, CA

Story Source:
The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Cincinnati Academic Health Center, via ScienceDaily and EurekAlert!, a service of AAAS.
________________________________________
Journal Reference:
1. E. G. Krause, A. D. de Kloet, J. N. Flak, M. D. Smeltzer, M. B. Solomon, N. K. Evanson, S. C. Woods, R. R. Sakai, J. P. Herman. Hydration State Controls Stress Responsiveness and Social Behavior. Journal of Neuroscience, 2011; 31 (14): 5470 DOI: 10.1523/JNEUROSCI.6078-10.2011

Does social anxiety disorder respond to therapy? New study says yes

February 14, 2011

When psychotherapy is helping someone get better, what does that change look like in the brain? This was the question a team of Canadian psychological scientists set out to investigate in patients suffering from social anxiety disorder. Their findings are published in Psychological Science, a journal of the Association of Psychological Science.

social anxiety disorder tools

 

Social anxiety is a common disorder, marked by overwhelming fears of interacting with others and expectations of being harshly judged. Medication and psychotherapy both help people with the disorder. But research on the neurological effects of psychotherapy has lagged far behind that on medication-induced changes in the brain.

“We wanted to track the brain changes while people were going through psychotherapy,” says McMaster University Ph.D. candidate Vladimir Miskovic, the study’s lead author.

To do so, the team—led by David Moscovitch of the University of Waterloo, collaborating with McMaster’s Louis Schmidt, Diane Santesso, and Randi McCabe; and Martin Antony of Ryerson University—used electroencephalograms, or EEGs, which measure brain electrical interactions in real time. They focused on the amount of “delta-beta coupling,” which elevates with rising anxiety.

The study recruited 25 adults with from a Hamilton, Ontario clinic. The patients participated in 12 weekly sessions of group cognitive behavior therapy, a structured method that helps people identify—and challenge—the thinking patterns that perpetuate their painful and self-destructive behaviors.

Two control groups—students who tested extremely high or low for symptoms of social anxiety—underwent no psychotherapy.

The patients were given four EEGs—two before treatment, one halfway through, and one two weeks after the final session. The researchers collected EEG measures of the participants at rest, and then during a stressful exercise: a short preparation for an impromptu speech on a hot topic, such as capital punishment or same-sex marriage; participants were told the speech would be presented before two people and videotaped. In addition, comprehensive assessments were made of patients’ fear and anxiety.

When the patients’ pre- and post-therapy EEGs were compared with the control groups’, the results were revealing: Before therapy, the clinical group’s delta-beta correlations were similar to those of the high-anxiety control group and far higher than the low-anxiety group’s. Midway through, improvements in the patients’ brains paralleled clinicians’ and patients’ own reports of easing symptoms. And at the end, the patients’ tests resembled those of the low-anxiety control group.

“We can’t quite claim that psychotherapy is changing the brain,” cautions Miskovic. For one thing, some of the patients were taking medication, and that could confound the results. But the study, funded by the Ontario Mental Health Foundation, is “an important first step” in that direction—and toward understanding the biology of anxiety and developing better treatments.

The work might also alter perceptions of therapy. “Laypeople tend to think that talk therapy is not ‘real,’ while they associate medications with hard science, and physiologic change,” says Miskovic. “But at the end of the day, the effectiveness of any program must be mediated by the brain and the nervous system. If the brain does not change, there won’t be a change in behavior or emotion.”

Provided by Association for Psychological Science

From www.PhysOrg.com

Have a fantastic Valentine’s Day!

Cheers,
John Schinnerer, Ph.D.

Founder Guide to Self, Inc.

Positive psychology of anger management

Turning down the  volume on anger

For your complimentary copy of John’s award-winning self-help book, Guide to Self: The Beginner’s Guide to Managing Emotion and Thought, visit www.GuideToSelf.com and enter your name and email address for instant access to a PDF version! It’s 216 pages of life-altering tools to make the most of your mind.

Mindfulness Training Changes Brain Structure in As Little As Eight Weeks

Mindfulness is a 2500-year-old practice that focuses on the nonjudgmental awareness of thoughts, feelings, sensations and state of mind. Mindfulness is a staple of many positive psychology programs due to it’s wide-ranging positive health benefits. Mindfulness has been shown to be significantly helpful in reducing symptoms of depression, anger, anxiety, obsessive-compulsive disorder and even speeds the healing of physical ailments such as psoriasis. Mindfulness rests on a mountain of research spanning over 30 years demonstrating its effectiveness in such areas.

Mindfulness as resting rocks

Most recently, active participation in an 8-week mindfulness program was shown to make noticeable physical changes in brain areas associated with memory, sense of self, empathy and stress. In a new study coming out in the January 30 issue of Psychiatry Research: Neuroimaging, spearheaded  by Massachusetts General Hospital (MGH) researchers share the results of their study, the first ever to demonstrate mindfulness-produced improvements over an 8-week period in the brain’s grey matter.

Mindfulness – One of the Best Tools Available for Stress, Anxiety, Anger & Depression

“Although the practice of mindfulness is associated with a sense of peacefulness and physical relaxation, practitioners have long claimed that mindfulness also provides cognitive and psychological benefits that persist throughout the day,” says Sara Lazar, PhD, of the MGH Psychiatric Neuroimaging Research Program, the study’s lead author.

Prior studies found structural differences between the brains of experienced mindfulness practitioners and individuals with no history of mindfulness, with thickening of the cerebral cortex in areas associated with awareness and emotional intelligence. But those studies were unable to conclude that those differences were truly produced by the practice of mindfulness.

In this study, magnetic resonance images were taken of the brains of sixteen (16) participants two weeks before and after they took part in the 8-week Mindfulness-Based Stress Reduction (MBSR) Program at the University of Massachusetts Center for Mindfulness. In addition to weekly meetings that included the practice of mindfulness — which focuses on nonjudgmental awareness of thoughts, feelings and sensations — participants received audio files to use for daily guided mindfulness practice. Participants tracked the amount of time they practiced mindfulness each day. A set of MRI brain images were also taken of a control group of people who did not practice mindfulness over the same 8-week period.

Mindfulness, stress management, anger management tools

Mindfulness group participants spent an average of 27 minutes daily practicing mindfulness exercises. Their answers to a mindfulness questionnaire showed significant improvements in mindfulness and meta-cognition compared with pre-study responses.

Physical Changes In Brain Due to Mindfulness Practice

The analysis of brain images found increased grey-matter density in the hippocampus, which is associated with new learning and long-term memory, as well as in brain regions associated with self-awareness and empathy.

Decrease in Stress & the Amygdala

Those who reported a decrease in stress also had a decrease in grey-matter density in the amygdala, which is associated with the presence of anxiety, depression and stress. Interestingly, no such changes were seen in the control group, indicating that the brain changes were not a result of the inevitable passage of time.

“It is fascinating to see the brain’s plasticity and that, by practicing mindfulness, we can play an active role in changing the brain and can increase our well-being, reduce stress and quality of life.” says Britta Hölzel, PhD, first author of the paper and a research fellow at MGH and Giessen University in Germany. “Other studies in different patient populations have shown that mindfulness can make significant improvements in a variety of symptoms, and we are now investigating the underlying mechanisms in the brain that facilitate this change.”

John Schinnerer, Ph.D., Founder of Guide to Self, Inc.

John Schinnerer, Ph.D. is in private practice in Danville, CA teaching clients the latest tools to manage emotions such as anger, anxiety and depression. Using positive psychology, he helps clients achieve happy, thriving, meaningful lives. He graduated summa cum laude from U.C. Berkeley with a Ph.D. in educational psychology. John hosted over 200 episodes of Guide To Self Radio, a prime time radio show on positive psychology, in the San Francisco Bay Area.   He wrote the award-winning book, ‘Guide To Self: The Beginner’s Guide To Managing Emotion and Thought.’ He sits on the Advisory Board of PsychCentral.com, one of the top psychology sites on the web. He may be reached via email at John@GuideToSelf.com.  His award-winning blog on positive psychology, Shrunken Mind is at http://drjohnblog.guidetoself.com. His newest blog on positive psychology and anger management can be found at http://webangermanagement.com.
Story Source:
The above story is reprinted from materials provided by Massachusetts General Hospital.

Journal Reference:
1. Britta K. Hölzel, James Carmody, Mark Vangel, Christina Congleton, Sita M. Yerramsetti, Tim Gard, Sara W. Lazar. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging, 2011; 191 (1): 36 DOI: 10.1016/j.pscychresns.2010.08.006

How Positive Emotion Protects Against Poor Health

How Positive Emotion Protects Against Poor Health in Later Life

The new issue of the journal ‘Current Directions in Psychological Science’ includes an article entitled,
‘Pathways Linking Positive Emotion and Health in Later Life.’

Positive psychology and free online anger management class 

The author is Anthony D. Ong.

The article begins as follows…

‘There is growing empirical evidence that positive emotion protects against poor health outcomes in later life.

Two recent reviews have documented a robust association between positive emotion and improved health (Chida & Steptoe, 2008; Pressman & Cohen, 2005).

Across experimental and large-scale prospective studies, significant aspects of adult health predicted by positive emotion include self- reported health, physiological responses, physical functioning, disease severity, and mortality.

In this article, I review the biobehavioral and psychosocial pathways that may account for the relationship between positive emotion and health in later adulthood.

Although the literature is not without theoretical gaps and methodological inconsistencies (see Pressman & Cohen, 2005, for a discussion), overall, the data suggest that positive emotions have demonstrable health benefits in later life, the net effect of which may be to slow or delay the rate of functional decline in resilience.’

The article concludes like this…

‘Three decades ago, Lazarus, Kanner, and Folkman (1980) suggested that under intensely stressful conditions, positive emotions may provide an important psychological time-out, help to sustain continued coping efforts, and replenish vital resources that have been depleted by stress. Until recently, there has been little empirical support for these ideas. Foundational evidence for the adaptive function of positive emotion is now beginning to accrue, however. Taken together, the available data indicate that there is no single answer to the question of how positive emotion influences health outcomes in later adulthood. Instead, findings suggest that health behaviors, physiological systems, stressor exposure, and stress undoing may be among the key pathways underlying disparities in physical health, psychological well-being, and even longevity in later life.

Future work building on these findings will require greater attention to the interaction between increasing positive emotion and the presence of decreasing resilience with aging. Targeted prevention and intervention strategies that enhance positive emotions, particularly among the most vulnerable, are likely to play an important role in preventing serious physical illness, minimizing the burden of stress, and improving overall functioning in older adults.’

In addition to the reference section, there’s a small bit on ‘Recommended Reading’:

Charles, S.T., & Carstensen, L.L. (2009). Social and emotional aging.
Annual Review of Psychology, 61, 383-409. A comprehensive, highly accessible overview of what is known about socioemotional development.

Fredrickson, B.L. (2003). The value of positive emotions. American Scientist, 91, 330-335. A clearly written review for readers who wish to expand their knowledge on positive emotions.

Ong, A.D., Bergeman, C.S., & Chow, S.M. (2009). Positive emotions as a basic building block of resilience in adulthood. In J. Reich, A. Zautra, & J. Hall (Eds.), Handbook of adult resilience: Concepts, methods, and applications (pp. 81-93). New York, NY: Guilford. A highly accessible overview of what is known about positive emotions and resilience in later life.

Zautra, A.J. (2003). Emotions, stress, and health. New York, NY: Oxford University Press. A thorough, far-reaching theoretical analysis of the relationships between stress, emotions, and health.

The author note provides the following contact information: Anthony D. Ong, Department of Human Development, G77 Martha Van Rensselaer Hall, Cornell University, Ithaca, NY 14853-4401; <ado4@cornell.edu>.

Increasingly, science is proving the necessity of positive emotions (e.g., pride, love, curiosity, interest, passion) for a thriving, meaningful, happy life. Currently, there are more than 70,000 empirical studies looking at these very topics (e.g., self-compassion, mindfulness, love, life satisfaction, curiosity, engagement, the zone, passion, strengths, purpose and meaning) under the umbrella term positive psychology.

For more information on ways to cultivate more positive emotions in your life, visit http://www.GuidetoSelf.com to get a free copy of Dr. John’s award-winning self-help book, ‘Guide to Self: The Beginner’s Guide to Managing Emotion and Thought.’ It has the latest in positive psychology and tools to make you more aware of and ways to create more positive emotions in your life.

Positive emotions are an instrumental part of any top-notch anger management program as well for the same reasons (e.g., they act as a hidden Reset button for negative physiological effects of destructive emotions, they make us feel more connected and they build enduring resources within). For more information on the best anger management programs which include a positive psychology perspective and ways to create more positive emotions in your life, visit Dr. John’s recently developed online anger management course at http://www.webangermanagement.com. There you will find several free videos sharing the latest tools to turn down the volume on anger AS WELL AS the latest tools to turn up the volume on positive emotions.

Happy holidays!!!

To life, love and laughter,

John Schinnerer, Ph.D.
Founder Guide to Self, Inc.
Award-winning author, blogger and mental health coach

Positive psychology - the joy of bubbles

The simple joy of bubbles!

P.S. Also be sure to check out John’s other fantastic blog on free online anger management classes at http://drjohnsblog.wordpress.com.