Why Placebos Work Wonders

From Weight Loss to Fertility, New Legitimacy For 'Fake' Treatments

Wall Street Journal, In the Lab, January 3, 2012

Say "placebo effect" and most people think of the boost they may get from a sugar pill simply because they believe it will work. But more and more research suggests there is more than a fleeting boost to be gained from placebos.
A particular mind-set or belief about one's body or health may lead to improvements in disease symptoms as well as changes in appetite, brain chemicals and even vision, several recent studies have found, highlighting how fundamentally the mind and body are connected.

It doesn't seem to matter whether people know they are getting a placebo and not a "real" treatment. One study demonstrated a strong placebo effect in subjects who were told they were getting a sugar pill with no active ingredient.

Placebo treatments are sometimes used in some clinical practices. In a 2008 survey of nearly 700 internists and rheumatologists published in the British Medical Journal, about half said they prescribe placebos on a regular basis. The most popular were over-the-counter painkillers and vitamins. Very few physicians said they relied on sugar pills or saline injections. The American Medical Association says a placebo can't be given simply to soothe a difficult patient, and it can be used only if the patient is informed of and agrees to its use.

Researchers want to know more about how the placebo effect works, and how to increase and decrease it. A more powerful, longer-lasting placebo effect might be helpful in treating health conditions related to weight and metabolism.

Hotel-room attendants who were told they were getting a good workout at their jobs showed a significant decrease in weight, blood pressure and body fat after four weeks, in a study published in Psychological Science in 2007 and conducted by Alia Crum, a Yale graduate student, and Ellen Langer, a professor in the psychology department at Harvard. Employees who did the same work but weren't told about exercise showed no change in weight. Neither group reported changes in physical activity or diet.

Patients in a recent study were treated with placebos for an induced asthma attack. They reported feeling just as good as when they received an active treatment with albuterol.

Another study, published last year in the journal Health Psychology, shows how mind-set can affect an individual's appetite and production of a gut peptide called ghrelin (GREL-in), which is involved in the feeling of satisfaction after eating. Ghrelin levels are supposed to rise when the body needs food and fall proportionally as calories are consumed, telling the brain the body is no longer hungry and doesn't need to search out more food.

Yet the data show ghrelin levels depended on how many calories participants were told they were consuming, not how many they actually consumed. When told a milkshake they were about to drink had 620 calories and was "indulgent," the participants' ghrelin levels fell more—the brain perceived it was satisfied more quickly—than when they were told the shake had 120 calories and was "sensible."

The results may offer a physiological explanation of why eating diet foods can feel so unsatisfying, says Ms. Crum, first author on the study. "That mind-set of dieting is telling the body you're not getting enough."

Studies across medical conditions including depression, migraines and Parkinson's disease have found that supposedly inert treatments, like sugar pills, sham surgery and sham acupuncture, can yield striking effects. A 2001 study published in Science found that placebo was effective at improving Parkinson's disease symptoms at a magnitude similar to real medication. The placebo actually induced the brain to produce greater amounts of dopamine, the neurotransmitter known to be useful in treating the disease.

At times, a weaker placebo effect might be desired. In trials of experimental drug treatments for dementia, depression and other cognitive or psychiatric conditions, where one patient group takes medication and the other takes a sugar pill, it can be difficult to demonstrate that the medicine works because the placebo effect is so strong.

With depression, an estimated 30% to 45% of patients—or even more, in some studies—will respond to a placebo, according to a review published in December in Clinical Therapeutics. An additional 5% of patients were helped by an antidepressant in cases of mild depression, and an additional 16% in cases of severe depression. (The clinically meaningful cutoff for additional benefit was 11%.)

Fertility rates have been found to improve in women getting a placebo, perhaps because they experience a decrease in stress. A recent randomized trial of women with polycystic ovarian syndrome found that 15%, or 5 of 33, got pregnant while taking placebo over a six-month period, compared with 22%, or 7 of 32, who got the drug—a statistically insignificant difference. Other studies have demonstrated pregnancy rates as high as 40% in placebo groups.

Ted Kaptchuk, director of Harvard's Program in Placebo Studies and the Therapeutic Encounter, and colleagues demonstrated that deception isn't necessary for the placebo effect to work. Eighty patients with irritable bowel syndrome, a chronic gastrointestinal disorder, were assigned either a placebo or no treatment. Patients in the placebo group got pills described to them as being made with an inert substance and showing in studies to improve symptoms via "mind-body self-healing processes." Participants were told they didn't have to believe in the placebo effect but should take the pills anyway, Dr. Kaptchuk says. After three weeks, placebo-group patients reported feelings of relief, significant reduction in some symptoms and some improvement in quality of life.

Why did the placebo work—even after patients were told they weren't getting real medicine? Expectations play a role, Dr. Kaptchuk says. Even more likely is that patients were conditioned to a positive environment, and the innovative approach and daily ritual of taking the pill created an openness to change, he says.

Do placebos work on the actual condition, or on patients' perception of their symptoms? In a study published last year in the New England Journal of Medicine, Dr. Kaptchuk's team rotated 46 asthma patients through each of four types of treatment: no treatment at all, an albuterol inhaler, a placebo inhaler and sham acupuncture. As each participant got each treatment, researchers induced an asthma attack and measured the participant's lung function and perception of symptoms. The albuterol improved measured lung function compared with placebo. But the patients reported feeling just as good whether getting placebo or the active treatment.

"Right now, I think evidence is that placebo changes not the underlying biology of an illness, but the way a person experiences or reacts to an illness," Dr. Kaptchuk says.

Placebo can be more effective than the intended treatment. In a trial published in the journal Menopause in 2007, 103 women who had menopausal hot flashes got either five weeks of real acupuncture, or five weeks of sham acupuncture, where needles weren't placed in accepted therapeutic positions. A week after treatments ended, only some 60% of participants in both groups reported hot flashes—a robust immediate placebo effect. Seven weeks post-treatment, though, 55% of patients in the sham acupuncture group reported hot flashes, compared with 73% in the real acupuncture group.

Corrections & Amplifications
An earlier version of this article said that a study in the journal Health Psychology about appetite and the gut peptide ghrelin was published earlier this year.

http://online.wsj.com/article/SB10001424052970204720204577128873886471982.html?mod=e2tw

The nocebo effect

13 NOV, 2011, tags: Neuroscience, Science writing, Science communication, Wellcome Trust Science Writing Prize, Nocebo effect, hypochondria, Professor Irene Tracey

by Wellcome Trust

Can anxious thoughts harm you? Penny Sarchet, winner of the professional scientists category in the 2011 Wellcome Trust Science Writing Prize, discusses the nocebo effect in her prize-winning essay. 

Can just telling a man he has cancer kill him? In 1992 the Southern Medical Journal reported the case of a man who in 1973 had been diagnosed with cancer and given just months to live. After his death, however, his autopsy showed that the tumour in his liver had not grown. His intern Clifton Meador didn’t believe he’d died of cancer: “I do not know the pathologic cause of his death,” he wrote. Could it be that, instead of the cancer, it was his expectation of death that killed him?

This death could be an extreme example of the “nocebo effect” – the flip-side to the better-known placebo effect. While an inert sugar pill (placebo) can make you feel better, warnings of fictional side-effects (nocebo) can make you feel those too. This is a common problem in pharmaceutical trials and a 1980s study found that heart patients were far more likely to suffer side-effects from their blood-thinning medication if they had first been warned of the medication’s side-effects. This poses an ethical quandary: should doctors warn patients about side-effects if doing so makes them more likely to arise?

The nocebo effect can also be highly infectious. In 1962, 62 workers at a US dressmaking factory were suddenly stricken with headaches, nausea and rashes, and the outbreak was blamed upon an insect arriving from England in a delivery of cloth. No insect was ever found, and “mass psychogenic illnesses” like these occur worldwide, usually affecting close communities and spreading most rapidly to female individuals who have seen someone else suffering from the condition.

Until recently, we knew very little about how the nocebo effect works. Now, however, a number of scientists are beginning to make headway. A study in February led by Oxford’s Professor Irene Tracey showed that when volunteers feel nocebo pain, corresponding brain activity is detectable in an MRI scanner. This shows that, at the neurological level at least, these volunteers really are responding to actual, non-imaginary, pain. Fabrizio Benedetti, of the University of Turin, and his colleagues have managed to determine one of the neurochemicals responsible for converting the expectation of pain into this genuine pain perception. The chemical is called cholecystokinin and carries messages between nerve cells. When drugs are used to block cholecystokinin from functioning, patients feel no nocebo pain, despite being just as anxious.

The findings of Benedetti and Tracey not only offer the first glimpses into the neurology underlying the nocebo effect, but also have very real medical implications. Benedetti’s work on blocking cholecystokinin could pave the way for techniques that remove nocebo outcomes from medical procedures, as well as hinting at more general treatments for both pain and anxiety. The findings of Tracey’s team carry startling implications for the way we practise modern medicine. By monitoring pain levels in volunteers who had been given a strong opioid painkiller, they found that telling a volunteer the drug had now worn off was enough for a person’s pain to return to the levels it was at before they were given the drug. This indicates that a patient’s negative expectations have the power to undermine the effectiveness of a treatment, and suggests that doctors would do well to treat the beliefs of their patients, not just their physical symptoms.

This places a spotlight on doctor-patient relationships. Today’s society is litigious and sceptical, and if doctors overemphasise side-effects to their patients to avoid being sued, or patients mistrust their doctor’s chosen course of action, the nocebo effect can cause a treatment to fail before it has begun. It also introduces a paradox – we must believe in our doctors if we are to gain the full benefits of their prescribed treatments, but if we trust in them too strongly, we can die from their pronouncements.

Today, many of the fastest-growing illnesses are relatively new and characterised solely by a collection of complaints. Allergies, food intolerances and back pain could easily be real physiological illnesses in some people and nocebo-induced conditions in others. More than a century ago, doctors found they could induce a hay fever sufferer’s wheezing by exposure to an artificial rose. Observations like these suggest we should think twice before overmedicalising the human experience. Our day-to-day worrying should be regarded as such, not built up into psychological syndromes with suites of symptoms, and the health warnings that accompany new products should be narrow and accurate, not vague and general in order to waive the manufacturer’s liability.

As scientists begin to determine how the nocebo effect works, we would do well to use their findings to manage that most 21st-century of all diseases – anxiety.

Penny Sarchet

This is an edited version of Penny’s original essay. 

Exercise for Life: Easier Than You Think Sandra A. Fryhofer, MD From Medscape Internal Medicine: Medicine Matters Posted: 12/23/2011

The topic: You do have time to exercise, according to a new study in Lancet.^[1] Here's why it matters.
Everybody knows exercise is or would be good for them. It helps your heart. It maintains your mind. It relieves stress. But how much is enough? The general recommendation for adults is at least 150 minutes total each week.^[2] That's slightly more than 20 minutes a day, which is 20 minutes more than many people claim they have.
A new study in Lancet obliterates that excuse.^[1] Conducted in Taiwan, the study followed more than 400,000 people for more than 8 years. Participants kept exercise diaries and self-reported weekly exercise as inactive, low, medium, high, or very high. It turns out that even the low average, which was 15 minutes of exercise a day, reduced mortality, with a 10% decrease in cancer death, 14% decrease in death overall, and an average increase of 3 years of life. Whereas even a low amount of exercise is good, more is better. Each additional 15 minutes of daily exercise -- half an hour total -- produced an additional 1% decrease in cancer death and an additional 4% decreased risk for death overall. Participants who could not find 15 minutes to spare and did not exercise at all had a 17% higher death risk compared with even the low exercise group.
This is an observational study, but its bottom line is that just 15 minutes a day -- 105 minutes a week -- of moderate-intensity physical activity is all it takes to reap major benefits. A little bit of exercise can do a lot of good, and some is always better than none.

References

1. Wen CP, Wai JP, Tsai MK, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet. 2011;378:1244-1253. Epub 2011 Aug 16. Abstract
2. Office of Disease Prevention & Health Promotion, U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans Summary Accessed December 13, 2011.

The BBC Stress Test - Results All in the Mind, BBC Radio 4, 20.12.11

The BBC Stress test was launched in June with BBC Lab UK, with the aim of answering one of the big questions in mental health - what is the cause of mental illness? More than 32,000 Radio 4 listeners took part, making this one of the largest studies of its kind in the world. The early results are in and Peter Kinderman, professor of clinical psychology at the University of Liverpool, tells Claudia Hammond what the findings reveal about the origins of mental health problems and the most effective coping strategies.

Extract from Claudia Hammond’s interview with Professor Peter Kinderman:

Peter Kinderman (PK): …we set out to find people who may or may not be stressed and then to look at what the causes of their mental health difficulties, their wellbeing were.

Claudia Hammond (CH): So what conclusions have you drawn about these bigger questions, about what causes mental health problems?

PK: The first thing to say is that we were testing out a theory that we had first expressed back in 2005 and we were looking at whether psychological factors were the consequence of high levels of stress, or whether they tended to cause high levels of stress. We’re still doing the analysis, so we’ve got a little bit of work still left to do, but it looks very much to us as if a family history of mental health problems, stressful life events, negative life events that you have experienced, and deprived social circumstances tend to make people ruminate and also blame themselves more for the negative events in their lives. And it’s that combination of self-blame and rumination that seems to be related to high levels of stress, and not as it might have been, the other way around.

CH: Ceri [one of the listeners who completed the ‘stress’ survey] mentioned that she often had a tendency to blame herself and that she would ruminate to an extent. How were you able to unpick what causes what in this, and how much it’s the events that have happened, how much it’s whether people blame themselves later, how much it’s whether they ruminate?

PK: Statistically, what we were looking at is how much of somebody’s stress levels were explained by different combinations of the different variables. So we were particularly interested in whether self-blame was more of a predictor than rumination. In fact, rumination seemed to be slightly more important than self-blame. But both self-blame and rumination were much more important than any of the other variables to be honest. So life events themselves were related to levels of stress, but they seemed to be related to stress only when people tended to ruminate or blame themselves. If you didn’t ruminate and didn’t blame yourself, then your levels of stress were much lower, even if you’d experienced many negative events in your life.

CH: So did you find that if people had many negative life events in the past, for example, difficult times growing up, if they then don’t ruminate a lot, are they then OK?

PK: Yes, basically what happened was that negative life events and very negative childhood events involving abuse were both related to mental health problems. But it seemed to be self-blame and rumination that were the pathway to those mental health problems. In scientific terms, very little of the variants was explained by the negative life events outside of the pathway through self-blame and rumination.  

CH: I see what you mean – so they can have those events, but if they don’t ruminate and self blame, they might be OK later on?

PK: Yes. And that’s important for another reason, which is it also suggests that if people are able to get a handle on rumination and self-blame, and to be honest, those other psychological processes such as where you place your attention, how your memory works, what you think about yourself, your self-concept. If people were to be able to get a handle on those psychological variables, then they might be able to improve their levels of stress and wellbeing. 

CH: Jan and Ceri were talking about rumination and their levels of stress there. What do you really mean by rumination? Does this mean worrying about those life events that happened in the past, those bad things that happen to people, or worrying more generally about everyday things?

PK: Well it can be both. It can be people having things going round and round in their heads about things that are coming up in the future. A typical example is someone who’s not sleeping because they’ve got a job interview the next day, and then thinking about what’s going to happen. It’s also people going over and over things that have happened in the past, ruminating about things that have happened, and they can’t shake these things out of their head. Interestingly, Jan made a distinction between productive and unproductive rumination, and I think that’s very important. We should plan for the future and we should reflect on the past: the question is to judge when it’s becoming unproductive and whether it’s just repetitive thoughts going round and round in our head.

CH: So you’re not saying all introspection is bad?

PK: I think introspection is good, but I think you need to be in control of it to the extent that it’s still useful to you, so you’re thinking about the future and preparing for it, rather than having thoughts about the ‘dreadful’ thing that’s coming up unproductively buzzing around in your head.

CH: So does this have implications for how psychological therapies should be shaped? I mean should they change to focus more on rumination and self-blame? Could you just look at those two things and make a difference?

PK: What I was doing was quite specifically testing out the question of whether psychological factors were causal of mental health problems, or whether they were the consequence of mental health problems. And I think that, although it’s only one study and other people will have other interpretations of it, I think it demonstrates that for this sample, rumination was a factor which caused mental health problems, in this sample.

CH: So it’s a bigger factor than say biological factors that people might think about?

PK: It was a much bigger factor than biological factors directly, although biological factors were related to your tendency to self blame. Everything was related to everything else, and it’s still quite difficult to tease that out. The important thing I think is that it gives an opportunity for people who are experiencing stress, who do feel as if their wellbeing is less than it should be, that there are things that can be done about that that don’t involve going back to the past and reversing the negative things that have happened but dealing with the consequences now, dealing with people’s tendency to ruminate, dealing with their tendency to self blame. And like I say, there will be other things like a tendency to jump to conclusions, how you evaluate your performance, what your self-concept is like, and a range of other psychological processes, that this experiment, amongst others, seems to demonstrate are important in determining how stressed you are.

CH: So these are your initial results. What are you going to be doing next?

PK: Well, one of the important things is to tease out the relationships between these variables in much more detail. So, for instance, one thing we have not yet analysed, but I think might be important, is the relationship between the two big explanatory factors: self-blame and rumination. It might be the case that rumination, if you don’t blame yourself for the events that have happened in your life, might be quite benign. It might be that it’s a particular combination of a tendency to ruminate and a tendency to blame yourself that’s particularly pernicious. Doing that analysis will take some time, it’s quite complicated. And so far we have tried it on three different computers and none of them have a big enough memory, so we need to increase the computing power.

CH: Because your sample is just too big – too many listeners you see.

PK: Yes, our sample is fantastically big.

CH: So if you found out that it was the self-blame that really mattered more, then in therapy you could just ignore rumination and teach people somehow not to blame themselves so much?

PK: Yes, I mean I think that Jan illustrated that a little bit when she said she tends to ruminate but she puts on the radio, and that’s OK. If you’re ruminating about toast, if you’re ruminating about what you might have for breakfast tomorrow morning, that might be easy to live with; if you’re ruminating about all of the mistakes you’ve made in your life and why you’re a bad person, that might cause you a great deal of stress.

CH: Listening to the radio as therapy – that’s what we like to hear. Professor Peter Kinderman. And the stress test is still there if you want to find out how you deal with stress. It takes about 20 minutes, it’s completely confidential, and you’ll find a link to it on the All in the Mind page of the Radio 4 website.   

(The programme can be downloaded from the Radio 4 website.)

Sacred Salubriousness: Why Religious Belief Is Not the Only Path to a Healthier Life New research on self-control explains the link between religion and health December 19, 2011, Scientific American Mind and Brain newsletter

Ever since 2000, when psychologist Michael E. McCullough, now at the University of Miami, and his colleagues published a meta-analysis of more than three dozen studies showing a strong correlation between religiosity and lower mortality, skeptics have been challenged by believers to explain why—as if to say, “See, there is a God, and this is the payoff for believing.”
In science, however, “God did it” is not a testable hypothesis. Inquiring minds would want to know how God did it and what forces or mechanisms were employed (and “God works in mysterious ways” will not pass peer review). Even such explanations as “belief in God” or “religiosity” must be broken down into their component parts to find possible causal mechanisms for the links between belief and behavior that lead to health, well-being and longevity. This McCullough and his then Miami colleague Brian Willoughby did in a 2009 paper that reported the results of a meta-analysis of hundreds of studies revealing that religious people are more likely to engage in healthy behaviors, such as visiting dentists and wearing seat belts, and are less likely to smoke, drink, take recreational drugs and engage in risky sex. Why? Religion provides a tight social network that reinforces positive behaviors and punishes negative habits and leads to greater self-regulation for goal achievement and self-control over negative temptations.
Self-control is the subject of Florida State University psychologist Roy Baumeister’s new book, Willpower, co-authored with science writer John Tierney. Self-control is the employment of one’s power to will a behavioral outcome, and research shows that young children who delay gratification (for example, forgoing one marshmallow now for two later) score higher on measures of academic achievement and social adjustment later. Religions offer the ultimate delay of gratification strategy (eternal life), and the authors cite research showing that “religiously devout children were rated relatively low in impulsiveness by both parents and teachers.”
The underlying mechanisms of setting goals and monitoring one’s progress, however, can be tapped by anyone, religious or not. Alcoholics Anonymous urges members to surrender to a “higher power,” but that need not even be a deity—it can be anything that helps you stay focused on the greater goal of sobriety. Zen meditation, in which you count your breaths up to 10 and then do it over and over, the authors note, “builds mental discipline. So does saying the rosary, chanting Hebrew psalms, repeating Hindu mantras.” Brain scans of people conducting such rituals show strong activity in areas associated with self-regulation and attention. McCul­lough, in fact, describes prayers and meditation rituals as “a kind of anaerobic workout for self-control.” In his lab Baumeister has demonstrated that self-control can be increased with practice of resisting temptation, but you have to pace yourself because, like a muscle, self-control can become depleted after excessive effort. Finally, the authors note, “Religion also improves the monitoring of behavior, another of the central steps of self-control. Religious people tend to feel that someone important is watching them.” For believers, that monitor may be God or other members of their religion; for nonbelievers, it can be family, friends and colleagues.
The world is full of temptations, and as Oscar Wilde boasted, “I can resist everything except temptation.” We may take the religious path of Augustine in his pre-saintly days when he prayed to God to “give me chastity and continence, but not yet.” Or we can choose the secular path of 19th-century explorer Henry Morton Stanley, who proclaimed that “self-control is more indispensable than gunpowder,” especially if we have a “sacred task,” as Stanley called it (his was the abolition of slavery). I would say you should select your sacred task, monitor and pace your progress toward that goal, eat and sleep regularly (lack of both diminishes willpower), sit and stand up straight, be organized and well groomed (Stanley shaved every day in the jungle), and surround yourself with a supportive social network that reinforces your efforts. Such sacred salubriousness is the province of everyone—believers and nonbelievers—who will themselves to loftier purposes.

ABOUT THE AUTHOR(S)

Michael Shermer is publisher of Skeptic magazine (www.skeptic.com). His new book is The Believing Brain.

Dreaming Takes the Sting out of Painful Memories, Research Shows

ScienceDaily (Nov. 23, 2011) — They say time heals all wounds, and new research from the University of California, Berkeley, indicates that time spent in dream sleep can help us overcome painful ordeals.

UC Berkeley researchers have found that during the dream phase of sleep, also known as REM sleep, our stress chemistry shuts down and the brain processes emotional experiences and takes the edge off difficult memories.
The findings offer a compelling explanation for why people with post-traumatic stress disorder (PTSD), such as war veterans, have a hard time recovering from distressing experiences and suffer reoccurring nightmares. They also offer clues into why we dream.
"The dream stage of sleep, based on its unique neurochemical composition, provides us with a form of overnight therapy, a soothing balm that removes the sharp edges from the prior day's emotional experiences," said Matthew Walker, associate professor of psychology and neuroscience at UC Berkeley and senior author of the study to be published on Nov. 23, in the journal Current Biology.
For people with PTSD, Walker said, this overnight therapy may not be working effectively, so when a "flashback is triggered by, say, a car backfiring, they relive the whole visceral experience once again because the emotion has not been properly stripped away from the memory during sleep."
The results offer some of the first insights into the emotional function of Rapid Eye Movement (REM) sleep, which typically takes up 20 percent of a healthy human's sleeping hours. Previous brain studies indicate that sleep patterns are disrupted in people with mood disorders such as PTSD and depression.
While humans spend one-third of their lives sleeping, there is no scientific consensus on the function of sleep. However, Walker and his research team have unlocked many of these mysteries linking sleep to learning, memory and mood regulation. The latest study shows the importance of the REM dream state.
"During REM sleep, memories are being reactivated, put in perspective and connected and integrated, but in a state where stress neurochemicals are beneficially suppressed," said Els van der Helm, a doctoral student in psychology at UC Berkeley and lead author of the study.
Thirty-five healthy young adults participated in the study. They were divided into two groups, each of whose members viewed 150 emotional images, twice and 12 hours apart, while an MRI scanner measured their brain activity.
Half of the participants viewed the images in the morning and again in the evening, staying awake between the two viewings. The remaining half viewed the images in the evening and again the next morning after a full night of sleep.
Those who slept in between image viewings reported a significant decrease in their emotional reaction to the images. In addition, MRI scans showed a dramatic reduction in reactivity in the amygdala, a part of the brain that processes emotions, allowing the brain's "rational" prefrontal cortex to regain control of the participants' emotional reactions.
In addition, the researchers recorded the electrical brain activity of the participants while they slept, using electroencephalograms. They found that during REM dream sleep, certain electrical activity patterns decreased, showing that reduced levels of stress neurochemicals in the brain soothed emotional reactions to the previous day's experiences.
"We know that during REM sleep there is a sharp decrease in levels of norepinephrine, a brain chemical associated with stress," Walker said. "By reprocessing previous emotional experiences in this neuro-chemically safe environment of low norepinephrine during REM sleep, we wake up the next day, and those experiences have been softened in their emotional strength. We feel better about them, we feel we can cope."
Walker said he was tipped off to the possible beneficial effects of REM sleep on PTSD patients when a physician at a U.S. Department of Veterans Affairs hospital in the Seattle area told him of a blood pressure drug that was inadvertently preventing reoccurring nightmares in PTSD patients.
It turns out that the generic blood pressure drug had a side effect of suppressing norepinephrine in the brain, thereby creating a more stress-free brain during REM, reducing nightmares and promoting a better quality of sleep. This suggested a link between PTSD and REM sleep, Walker said.
"This study can help explain the mysteries of why these medications help some PTSD patients and their symptoms as well as their sleep," Walker said. "It may also unlock new treatment avenues regarding sleep and mental illness."
Other co-authors of the study are UC Berkeley sleep researchers Justin Yao, Shubir Dutt, Vikram Rao and Jared Saletin.

http://www.sciencedaily.com/releases/2011/11/111123133346.htm

Therapy in the Air Focused attention on breathing can boost mood By Tori Rodriguez | Scientific American Mind and Brain, November 29, 2011

Feeling tense? Paying attention to your breathing for a few minutes could soothe your nerves. Practicing such mindful breathing regularly may even lead to better mental health, according to two recent studies.
In an experiment reported in May in the International Journal of Psychophysiology, researchers at Toho University School of Medicine in Japan taught healthy subjects to breathe deeply into their abdomen. After subjects maintained attention on breathing this way for 20 minutes, they had fewer negative feelings, more of the mood-boosting neurotransmitter serotonin in their blood, and more oxygenated hemoglobin in the prefrontal cortex, an area associated with attention and high-level processing.
Another study, in the April issue of Cognitive Therapy and Research, looked at depression symptoms. Investigators at Ruhr University Bochum in Germany asked healthy participants to stay in mindful contact with their breathing—maintaining continual awareness without letting their mind wander. During the 18-minute trials researchers asked the subjects frequently whether they were succeeding in doing so. Those who were able to sustain mindful contact with their breathing reported less negative thinking, less rumination and fewer of the other symptoms of depression.
“In my opinion, the cultivation of mindfulness through breathing meditation helps to prevent depression,” says study author Jan M. Burg, although he cautions that this interpretation goes beyond the findings of his research. Mindfulness, Burg explains, may allow people to disengage from dysfunctional rumination, a central risk factor for depression.
Anyone can try a bit of this technique on the fly. Simply sit up comfortably and breathe naturally. Focus your attention on your breath, feeling it in detail—in the nasal cavity, the chest and the abdomen. If you notice your mind wandering, try to redirect your attention to your breathing—it is important, Burg says, not to criticize yourself during this process. At first it might be difficult to stay focused, but with some practice you should be able to hit the mark these studies showed to be beneficial, about 20 minutes. And once you have the hang of it, even a few minutes of mindful breathing can help you become more calm and collected before a high-stakes meeting or any other stressful situation.