Temptation
Have you ever given in to temptation? Have you ever had a moment of weakness when that jelly donut seemed just too irresistible or you felt that it was about time to tell someone what you REALLY thought?
Sad to say I am sure that we are all guilty of that at some time or other.
What we are talking about here is self-regulation, our ability to inhibit impulses, make decisions, persist at difficult tasks and to control our emotions. We know that our ability to self-regulate is highly variable. It becomes more difficult if we are tired, stressed or working with people who drain us emotionally. There is evidence that our abilities to self-regulate can fatigue in just the same way that a muscle can get tired. It’s like having a limited amount of money, and when it’s gone it’s gone. One of the main factors that help to keep self-regulating is our level of resilience.
It is interesting that when we give in to the temptation to do something unwise, we are often unaware of it at that moment. It is only later that we feel regret.
There is some interesting new research from the University of Kentucky, that was conducted by two psychologists Suzanne Segerstrom and Lise Solberg Nes. Their work suggests that there may be a biological indicator to tell us when we are working hard at resisting temptation and consequently when we are vulnerable to doing things that we hadn’t meant to.
They hypothesized that there would be a link between variations in heart rate – heart rate variability (HRV) – and self-regulation. HRV is emerging as a very interesting tool for examining the health of the autonomic nervous system, and if disturbed, it can be a harbinger of many highly undesirable health problems. The researchers’ reasoning was that many of the same brain structures involved in self-regulation are also involved in the control of HRV.
They did a two-part study to test their hypothesis. In the first experiment participants were told that they were going to take part in test on the “physiology of food preference.” They were instructed to fast for three hours before starting the procedure. Then their HRV was monitored while they were presented with a tray of cookies, candy and carrots. The “temptation” was to give in to eating the tastier but the less healthy snack of cookies and candy.
HRV was considerably higher when people were working to resist temptation (eating carrots rather than cookies and chocolate) than when they were not. This suggested that HRV was mirroring the attempt at self-regulation.
In part two of the experiment, after resisting or giving into temptation, the experimenters had the participants attempt to complete difficult anagrams, some of which were impossible to solve. The authors measured how long participants persevered at the anagrams. As predicted, those who had exerted high self-regulation by resisting the candy and cookies were more likely to give up earlier on the task. They didn’t have any more self-control to give.
People with naturally higher levels of HRV were likely to try longer at the anagram task, whether or not they had given into “temptation.”
Now the “temptation” in this study wasn’t much, but the implications are important. There are many people – particularly those with addictions and some kinds of personality disorder – who have major problems with self-regulation. HRV feedback could turn out to be a useful way of helping people realize that their self-control may be about to fail.
It is also important to know that self-regulation is finite, but can be built by building an individual’s resilience (1,2,3,4,5).
By the way, if you have never given in to temptation, would you PLEASE share your secret?
“Watch and pray, that ye enter not into temptation: the spirit indeed is willing, but the flesh is weak.”
–The Bible: Matthew 26:41
“A silly idea is current that good people do not know what temptation means. This is an obvious lie. Only those who try to resist temptation know how strong it is…. A man who gives in to temptation after five minutes simply does not know what it would have been like an hour later. That is why bad people, in one sense, know very little about badness. They have lived a sheltered life by always giving in.”
–C. S. Lewis (British Scholar and Novelist, 1898-1963)
“What makes resisting temptation difficult for many people is they don’t want to discourage it completely.”
–Franklin P. Jones (American Businessman, 1887-1929)
“Temptation is an irresistible force at work on a moveable body.”
Henry Louis (H.L.) Mencken (American Writer and Editor, 1880-1956)
Cortisol and Cigarette Smoking
There is an interesting study from London that may help us devise some new strategies for helping people stop smoking.
Cortisol levels decline after people stop smoking, and this decline has been linked to smoking relapse.
The researchers examined 112 smokers trying to quit using 15-mg nicotine patches. They measured salivary cortisol levels and reports of stress, withdrawal, and urges before quitting smoking and up to 6 weeks of abstinence among abstinent smokers using the patch. Thirty participants both remained abstinent and provided cortisol samples at all measurement times.
The fall in cortisol is greater among heavier smokers and may predict who will start smoking again. People with the lowest cortisol levels were more likely to relapse and to experience withdrawal symptoms, the urge to smoke and subjective stress.
This shows us once again that the cortisol system is complex and implicated in many different functions. Those adverts that tell us that we should block cortisol to lose weight are way off the mark. Even if the products could block cortisol, they may have other behavioral effects. The findings from this study are also interesting from the point of view of continuing claims that chronic fatigue and a load of other symptoms can be a result of “adrenal fatigue.”
Try as we might, we have still not been able to find much credible evidence that adrenal fatigue is a real phenomenon. I am an endocrinologist and I’ve reviewed the research literature in great detail, but I am not yet convinced.
And we would expect that the toxins in cigarette smoke would lower cortisol, and that it should rise if people quit. Not the other way around.
“A drug is neither moral nor immoral — it’s a chemical compound. The compound itself is not a menace to society until a human being treats it as if consumption bestowed a temporary license to act like an asshole.”
–Frank Zappa (American Composer, Guitarist, Satirist and Song Writer, 1940-1993)
Hormones, Addictions and Mood
People working with mental illness have been for years now been puzzled by two observations. The first is that mood disorders and schizophrenia follow quite different trajectories in men and women. Women tend to be more vulnerable to mood disorders and if they get schizophrenia it tends to be less severe and to have fewer “negative” symptoms, such as flat, blunted or constricted affect and emotion, poverty of speech and lack of motivation until after menopause. We have looked at some of the reasons for the different rates of mood disorder, in terms of relationships and social pressures, but there must also be a biological component. The second puzzle is that women are more vulnerable to addictive drugs in the days before they ovulate.
New research published in the Proceedings of the National Academy of Sciences may provide part of the answer to both puzzles.
Colleagues at the National Institute of Mental Health (NIMH), a component of the National Institutes of Health (NIH), have conducted a fascinating imaging study that has shown that fluctuations in levels of sex hormones during women’s menstrual cycles affect the responsiveness of the reward systems in the brain.
The reward system circuits include the:
- Prefrontal cortex, which has key roles in thinking, planning and in the control of our emotions and impulses
- Amygdala, which is involved in rapid and intense emotional reactions and the formation of emotional memories
- Hippocampus, which is involved in learning, memory and navigation
- Striatum that relays signals from these areas to the cerebral cortex
It has been known for some time that neurons in the reward circuits are rich in estrogen and progesterone receptors. However, how these hormones influence reward circuit activity in humans has remained unclear.
The researchers used functional magnetic resonance (fMRI) imaging to examine brain activity of 13 women and 13 men while they performed a task that involved simulated slot machines. The women were scanned while they did the task, both before and after ovulation.
When anticipating a reward, in the pre-ovulation phase of their menstrual cycles the women showed more activity in the amygdala and frontal cortex. When women were actually winning prizes, their reward systems were more active if they were in the phase of their menstrual cycle preceding ovulation. This phase of the cycle is dominated by estrogen, compared to postovulatory phase when estrogen and progesterone are both present. When winning, the main systems that became active were in the parts of the brain involved in pleasure and reward.
The researchers also demonstrated that the reward-related brain activity was directly linked to levels of sex hormones. Activity in the amygdala and hippocampus was in directly linked to estrogen levels, regardless of where a woman was in her cycle. When women won prizes during the post-ovulatory phase of the cycle, progesterone modulated the effect of estrogen on the reward circuit.
Men showed a different activation profile from women during both anticipation and delivery of rewards. Men had more activity in the striatum during anticipation compared with women. On the other hand, women had more activity in a frontal cortex when they won prizes.
This research could have a number of important implications. The most obvious is that it confirms what many women know already: they are more likely to take addictive substances or to engage in pleasurable – but perhaps impulsive or risky – behaviors just before they ovulate.
It is not difficult to imagine why this might have developed during evolution.
“Coming to terms with the rhythms of women’s lives means coming to terms with life itself, accepting the imperatives of the body rather than the imperatives of an artificial, man-made, perhaps transcendentally beautiful civilization. Emphasis on the male work-rhythm is an emphasis on infinite possibilities; emphasis on the female rhythms is an emphasis on a defined pattern, on limitation.”
–Margaret Mead (American Anthropologist and Writer, 1901-1978)
Ohrwurm
I often think that I’m a lucky fellow to be bilingual in English and German. There are some priceless words in German that just don’t translate. It’s one of the reasons that so many books and papers translated from German become nonsensical when back translated. That is, translated from German into English and then back into German again.
There are some wonderful examples in the medical and psychiatric literature. English speaking psychiatrists are taught about “Schneider’s First Rank Features.” Which is a massive misquotation. And some of the collected works of Carl Jung are “interesting” in English.
There is a lovely German word – Ohrwurm – that can best be translated as “ear worm,” though in German it has a rather richer sense. The term was popularized by James Kellaris, a professor of marketing at the University of Cincinnati, to describe a song stuck in one’s head. Particularly an annoying one. I’m sure that we’ve all had them: some song or tune that you just can’t get out of your head.
Mark Twain wrote in a short story about an annoying ”jingling rhyme” that became indelibly lodged in the author’s mind until he passed the curse along to another hapless victim!
I first saw this research being talked about three years ago, in an article on the BBC website. At the time Professor Kellaris described the ohrwurm as "A cognitive itch is a kind of metaphor that explains how these songs get stuck in our head."
Kellaris has identified three major influences on whether or not a song stays stuck in your brain:
- Repetition:
- Musical simplicity:
- Incongruity: This one is very interesting and gives us another clue about why ohrwurms form. When a song does something unexpected, it can also spark a cognitive “itch.” Kellaris cites examples like the irregular time signatures of Dave Brubeck’s "Take Five" or the song "America" from West Side Story. Unpredictable melodic patterns or an unexpectedly articulated individual note can have the same impact.
Marketers and writers of pop songs are very interested in understanding how and why some tunes just get stuck in our heads. There have been some songwriters and producers who have created a load of ohrwurms. You may remember the string of hits produced by Mike Stock, Matt Aitken and Pete Waterman in the late 1980s and early 1990s. There is even some brain imaging work going on to try and unlock the mechanisms responsible.
The best cures for a nagging ohrwurm appear to be to listen to the whole tune or song. And at the same time to think of something annoying. It can also go away with the simple technique of gently tapping the side of your hand: it is sometimes a manifestation of psychological reversal.
One of the reasons for being interested in ohrwurms, is that it is interesting to find out why things get stuck in our heads. Understanding the lowly ohrwurm may have some important implications for understanding PTSD and some kinds of addiction.
So what’s you best or most irritating ohrwurm?
“I was in yoga the other day. I was in full lotus position. My chakras were all aligned. My mind is cleared of all clatter and I’m looking out of my third eye and everything that I’m supposed to be doing. It’s amazing what comes up, when you sit in that silence. "Mama keeps whites bright like the sunlight, Mama’s got the magic of Clorox 2.”
Ellen DeGeneres (American Actor and Comedian, 1958-)
Methamphetamine
We have been seeing some of the terrible consequences of methamphetamine abuse.
Where I live it is normally called and sold as "Crystal meth," and it is the worst type of drug that I have ever seen: and I’ve seen most things over a busy career during which I’ve consulted in many countries.
Apart from the personal cost, there can be few things more devastating to a family than discovering a loved one destroying their life with this highly addictive group of compounds.
I thought that you may be interested in a resource published a couple of months ago on PsychiatricResourceForum.blogs.com.
There is also another article on the same blog about some of the new principles of helping the recovery of people with chronic mental illness. But interestingly, many of the same principles apply when helping people with addictions.
These are very useful resources. Though designed for healthcare professionals, they will, I think, be of value to anyone who comes into contact with drug using people.
And that is far more of us than most people ever realize.
Using Yoga: Some Measurable Effects in People with Alcohol Dependence
I was very interested to see a quite well designed pilot study which seems to show some clear antidepressant and hormonal effects (reduction in cortisol and increase in prolactin levels) in alcohol dependent individuals who could be persuaded to practice something called Sudarshana Kriya Yoga (SKY). This technique involves rhythmic hyperventilation at different rates.
Studies like this are difficult to perform, and this one was not perfect. It only involved males, and the study will inevitably be skewed by the kinds of people participating. The study involved quite a bit of time, and so the subjects had to be motivated. Some people still dropped out of the study, and their data should have been included in the analysis. They also had more than just the breathing exercises: they got a whole treatment package. It will be interesting to see how long the effects last. We’re always interested to see how many people remain abstinent at one year.
One of the odd things was that the investigators measured the hormone prolactin. It is so named because its primary role is to promote lactation. It has at least 300 hundred other functions in the human body, and has at least ten major control systems. It is a little surprising that it should rise, since it normally goes up when people are stressed. However, I might have an explanation. As far as I can see, the techniques used in the study are pretty straightforward yogic pranayama. Hyperventilation slightly alkalinizes the blood. That would change the rate of firing in the reticular activating system of the brain stem, and could of itself be responsible for the elevated prolactin levels. Had I been designing the study, I would have measured arterial pH: it would have helped answer several questions.
Though not perfect, this study is a good piece of pilot data, and should stimulate further research into the use of these techniques for helping a very difficult problem.
I was interested to find out more about the technique. SKY was devised by a spiritual guru – Sri Sri Ravi Shankar – of the Art of Living Foundation in Bangalore, India. He has established a Foundation that seems to be engaged in a number of charitable activities. I have known a great many spiritual teachers; each has been criticized and controversial, and Shankar is no exception. I’m not in a position to judge whether or not it is justified.
All that I can say for now is that he has devised a technique rooted in the Indian classics, that seems to help some selected patients with an otherwise tough problem. And that is a good start.
Mel's Madness
In the midst of all the furor about Mel Gibson and his self-admittedly foul behavior while under the influence of alcohol, an important point has been missed: when someone is drunk or brain damaged, is their behavior just disinhibition? Are they behaving this way because they’ve lost the cerebral censor that normally maintains our social demeanor? The Romans certainly thought so: in banqueting halls they would have roses carved into columns and the ceiling. The rose – the symbol of secrets – was a reminder to be discrete when alcohol might begin to lossen the tongue.
When the frontal lobes are on strike, does our “true” personality emerge? Or can alcohol, drugs and brain injury produce brand new behaviors that are not just totally out of character, but predictable by the drug or type of injury?
The answer is a mixture of the two. I know a man who is in the running for the Nobel Prize in medicine. But a couple of years ago it was all over the press when he shattered the arm of an innocent man in the middle of an alcohol-fueled frenzy. Was it the alcohol? Yes, I’m sure that it was. But the scientist has had a very long history of anger problems and of bullying younger colleagues. The alcohol was the catalyst to behavior that he normally keeps in check, but which was just waiting to come out of its cage. I’ve treated hundreds of alcohol abusing people, and the amiable ones far outnumber the violent ones. And the majority of the violent ones had also been violent when not drinking.
Some drugs and chronic alcohol abuse can produce stereotyped hallucinations and behaviors. Some alcoholic people really do see bugs and pink elephants, and there are many other examples of predictable perceptual and behavioral disturbances with drugs and with brain injuries.
Students of the healing arts learn that damage to certain regions of the brain is associated with specific behavioral and emotional consequences. This teaching goes back more than a century, and generations of students have been told that, “Damage here causes depression, and damage here causes mania, and over there a lesions will damage one type of language.” Yet for three decades we have known that much of this teaching is fictitious. I was taught brain localization by some of the finest neurologists in the world, and yet each would admit the inaccuracy of their methods. A new study from Brisbane, Australia supports that nihilism. The investigators examined 61 consecutive people admitted to a stroke unit. “Strokes” are either vascular blockage or bleeds affecting the brain.
They could find no significant relationship between the side or location of a lesion and the development of post-stroke depression. But the kinds of people that they were before the stroke had a big impact: pre-morbid neuroticism and a past history of mental disorder were important predictors of depression following stroke.
So why all the fuss about Mel? Because people are asking if deep down inside he really has been harboring some of the dark, mean spirited thoughts that he expressed to the police, and that the alcohol was the catalyst and not the creator of his diatribe.
“The intoxication of anger, like that of the grape, shows us to others, but hides us from ourselves. We injure our own cause in the opinion of the world when we too passionately defend it.”
— Charles Caleb Colton (English Clergyman and Author, c.1780-1832)
Technorati tags: Mel Gibson Alcohol abuse Pre-morbid personality Brain
Helping to Prevent Suicide
Unless you work in psychology or psychiatry, you may not know that in the United States, there are considerably more suicides each year than there are murders.
Though there is sometimes little warning that someone might be about to harm themselves, in the majority there have been some warning signs.
The American Association of Suicidology expert consensus panel has just published a mnemonic to help professionals and the general public recognize some of the major risk factors. You can find a brief article with a link here.
Here is the whole mnemonic:
I Ideation
S Substance abuse
P Purposelessness
A Anxiety
T Trapped
H Hopelessness
W Withdrawal
A Anger
R Recklessness
M Mood changes
This is only a first attempt at an evidence-based summary of some of the major risk factors, and the sensitivty and specificity of the list is still quite low. But If awareness of some of these warning signs and risk factors saves even a single life, this post will have been worthwhile.
Technorati tags: Suicide Depression Self-harm
Sun Bed Addiction
One of the most pernicious claims of some purveyors of medical misinformation is that there is no connection between exposure to sunlight and skin cancer.
I just saw that repeated by someone on an infomercial promoting his latest book. The person speaking was a marketer with, I understand, no scientific or medical training. The fact is that exposure to ultraviolet light has been shown to damage DNA in cells grown in culture in the laboratory, and the pattern of damage is exactly what we predict would cause cells to become malignant.
There are protocols for transforming normal cells into malignant ones using ultraviolet light alone. We also know from epidemiological studies that exposure to sunlight is linked to the development of skin cancer. The best predictors are both the number of hours exposed, and the number of times that the skin has been burned. Despite this information, there was a 300 percent increase in the number of indoor tanners in the United States between 1986 and 1996.
So why do people continue to use sun beds? Apart from vanity, there is now increasing evidence of another factor. Earlier this year investigators from the University of Minnesota published a study suggesting that the over-use of indoor tanning by adolescents could be addictive. The age at initiation of usage, the frequency of use and the relationship between use and difficulty in quitting indoor tanning are consistent with other potentially addictive behaviors taken up during adolescence.
Now a team from Wake Forest University in North Carolina has published a small study in which they showed that in four of eight frequent tanners, giving them the opioid antagonist naltrexone caused them to experience symptoms very much like those that we associate with drug withdrawal. I recently came across a case of a young person who was tanning obsessively, at least once a day. It turned out that she also had a substance abuse problem. Though this study is small and preliminary, it certainly seems to fit with clinical observations.
We already knew that ultraviolet light can elevate mood: it has been known for many years that in people with bipolar disorder, they are more likely to become manic as the days become longer and they are exposed to more sunlight. There is also some evidence that ultraviolet light may elevate testosterone levels, which is one of many possible reasons why some people report increased libido while vacationing at the beach. (I feel sure, gentle reader, that you can come up with a long list of other reasons for that observation…)
Technorati tags: utltraviolet light, sun bed, mood
Addiction, Learning and Genes
Many of us have been mourning the death of George Best at the age of just 59. Arguably one of the most skillful players ever to kick a soccer ball, he finally succumbed to the slow suicide of alcohol abuse. Yet in the midst of all the opinion pieces that have tried to unravel the reasons for his alcohol abuse, all seem to have missed out on something very important. It has been missed because so many people have become wedded to the simple notion that there is one cause for one problem.
We have all seen so many television programs on which people have tearfully recounted the traumas that have befallen them, and we are then told that their current problems, whether of addiction, or of an inability to trust, or of serial infidelity, are all the result of having learned these behaviors, usually in childhood. So a person becomes an alcoholic because they saw their father drinking. An awful lot of therapy, and self-help is based upon that faulty premise. Why is it faulty? Because these people also share the same genes, and because, try as we might, we cannot reduce the whole of human behavior to ONLY learning, or ONLY genes. Most of the genes in the brain do not so much force you into behaving in a certain way; they instead predispose you to the way that you will handle something in your immediate environment.
So in the case of George Best, virtually all the tributes have said that the poor man become an alcoholic because he could not deal with all the fame, adulation and pressure that accompanied becoming soccer’s first real superstar. And doubtless, those were factors. But there is something else: his mother also died of complications of alcoholism, when she was 58 years old. Her drinking was attributed to watching her son succeed and then crash and burn. Possibly. But it is far more likely that it happened because they were both genetically predisposed to alcoholism.
When we try to understand a problem like this, it is essential not just to focus on the obvious cause: stress, or trauma, but also to look at the physical predisposition to reacting to the stress or trauma. Some people can be assailed by the most dreadful events, and come out smiling, while others have their lives ruined. It is also essential to look at the social context. George Best was brought from Belfast to Manchester when he was only 15 years old, and went home after two days because he was so homesick. He was persuaded to return to Manchester, and everyone tried to create a surrogate family for him, but it was obviously very difficult for him. It is also important to know that alcohol and substance abuse can cause havoc in the subtle systems of the body. That is why, when we treat people suffering form these illnesses, we encourage them to do some work, like Qigong or Yoga, to strengthen their subtle systems. Finally there is often a spiritual component to these problems. It is no coincidence that “spirits” as in alcohol and “spirit” as in spirituality, come from the same Latin root, in recognition of the ancient worship of the god Bacchus. Bill Wilson and Bob Smith recognized this link when they founded Alcoholics Anonymous in 1935. Many people who have struggled with addictions have been able to achieve sobriety once they discover and acknowledge the spiritual aspect of their lives, or in some cases that their substance abuse has been a reaction to a deep spiritual hunger.
Newsweek has an excellent article on the progress being made in our understanding of the physical components of addiction. The article highlights the complexity of the illness and the extraordinarily high relapse rates of sufferers.
There is only one quibble that I have with the article, and that is that it perpetuates the idea that substances of abuse hijack the “reward systems” of the brain. The reason why this is not quite correct is that it is a bit of a misnomer to talk about “reward systems.” These days we prefer to talk about salience systems. What does this mean? If something pleasurable happens to you, then the dopamine and GABA systems of the brain are indeed stimulated. And it appears that in substance abusers this system does not respond properly. So that they self-medicate because they have a form of sensory deprivation in these systems and that is the only way to get the dopamine levels that they need. But we now learn that dopamine also rises in the self same regions of the brain in response to threat. So what this system is doing is deciding what is salient, or important in the environment, and then focusing on and responding to it. It is these salience systems that seem to be under some genetic control, and can predispose someone to becoming a substance abuser.
Technorati tags: George Best alcoholism energy medicine
