J Pediatr Psychol. 2009 Oct;34(9):1030-9. Epub 2009 Mar 13.
Hipwell AE, Keenan K, Marsland A.
Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, 3811 O'Hara St, Pittsburgh, PA 15213, USA. hipwellae@upmc.edu
OBJECTIVE: To examine the association between biological stress regulation and somatic complaints in young girls prior to the onset of clear psychopathology such as somatization disorder. METHODS: Salivary cortisol, heart rate variability (HRV), and negative mood were assessed in 48 12-year-old girls in response to the Trier Social Stress Test for Children (TSST-C). Parent and child report on the Children's Somatization Inventory was used to identify girls with high and low somatic complaints. RESULTS: Girls with high levels of somatic complaints had significantly higher initial levels of cortisol, which decreased over time, and showed a trend for a more limited HRV in response to the TSST-C than girls with low levels of somatic complaints. CONCLUSIONS: High levels of cortisol and possibly low HRV among girls with somatic complaints may interfere with flexibility in responding to typical psychosocial stressors, which may increase vulnerability to the onset of somatic illnesses in females.
http://www.ncbi.nlm.nih.gov/pubmed/19286887?dopt=Abstract
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Exposure to stressful events during development has consistently been shown to produce long-lasting alterations in the hypothalamic-pituitary-adrenal (HPA) axis, which may increase vulnerability to disease, including posttraumatic stress disorder and other mood and anxiety disorders. Recently reported genetic association studies indicate that these effects may be mediated, in part, by gene×environment interactions involving polymorphisms within two key genes, CRHR1 and FKBP5. Data suggest that these genes regulate HPA axis function in conjunction with exposure to child maltreatment or abuse. In addition, a large and growing body of preclinical research suggests that increased activity of the amygdala-HPA axis induced by experimental manipulation of the amygdala mimics several of the physiological and behavioral symptoms of stress-related psychiatric illness in humans. Notably, interactions between the developing amygdala and HPA axis underlie critical periods for emotional learning, which are modulated by developmental support and maternal care. These translational findings lead to an integrated hypothesis: high levels of early life trauma lead to disease through the developmental interaction of genetic variants with neural circuits that regulate emotion, together mediating risk and resilience in adults. Depression and Anxiety Depression and Anxiety 26:984-992, 2009. Published 2009 Wiley-Liss, Inc.
| Charles F. Gillespie, M.D. Ph.D. 1, Justine Phifer, B.A. 1, Bekh Bradley, Ph.D. 1 2, Kerry J. Ressler, M.D. Ph.D. 1 3 4 * |
1Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
2Atlanta Veterans Affairs Hospital, Atlanta, Georgia
3Yerkes National Primate Research Center, Emory University, Atlanta, Georgia
4Howard Hughes Medical Institute, Chevy Chase, Maryland
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http://www3.interscience.wiley.com/journal/122596389/abstract?CRETRY=1&SRETRY=0
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KEYWORDS
Cortisol • immune • inflammatory • PTSD • trauma
CONCLUSIONS. Current studies suggest an excess of inflammatory actions of the immune system in individuals with chronic PTSD. High levels of inflammatory cytokines have also been linked to PTSD vulnerability in traumatized individuals. There is also evidence that excessive inflammation is in part due to insufficient regulation by cortisol.
PRACTICE IMPLICATIONS. An excess of inflammatory immune activity may contribute to health declines in individuals with PTSD, and treating PTSD symptoms may reduce these risks.
http://www3.interscience.wiley.com/journal/122609114/abstract
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Cereb Cortex. 2009 Oct;19(10):2479-84. Epub 2009 Feb 4
Shansky RM, Hamo C, Hof PR, McEwen BS, Morrison JH.
Department of Neuroscience Mount Sinai School of Medicine, New York, NY 10029, USA. shansky@gmail.com
Chronic stress exposure has been reported to induce dendritic remodeling in several brain regions, but it is not known whether individual neural circuits show distinct patterns of remodeling. The current study tested the hypothesis that the projections from the infralimbic (IL) area of the medial prefrontal cortex (mPFC) to the basolateral nucleus of the amygdala (BLA), a pathway relevant to stress-related mental illnesses like depression and post-traumatic stress disorder, would have a unique pattern of remodeling in response to chronic stress. The retrograde tracer FastBlue was injected into male rats' BLA or entorhinal cortex (EC) 1 week prior to 10 days of immobilization stress. After cessation of stress, FastBlue-labeled and unlabeled IL pyaramidal neurons were loaded with fluorescent dye Lucifer Yellow to visualize dendritic arborization and spine density. As has been previously reported, randomly selected (non-FastBlue-labeled) neurons showed stress-induced dendritic retraction in apical dendrites, an effect also seen in EC-projecting neurons. In contrast, BLA-projecting neurons showed no remodeling with stress, suggesting that this pathway may be particularly resilient against the effects of stress. No neurons showed stress-related changes in spine density, contrasting with reports that more dorsal areas of the mPFC show stress-induced decreases in spine density. Such region- and circuit-specificity in response to stress could contribute to the development of stress-related mental illnesses.
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October 2007 13:03 A new commentary in the Oct. 10 edition of the Journal of the American Medical Association explores whether psychological stress leads to disease and concludes that the link is likely. The authors, who say consistent results across different kinds of studies suggest that stress plays a causal role in disease, looked at four diseases. “The evidence from studies of depression and heart disease is most convincing. The HIV/AIDS data are a little weaker. The evidence for stress playing a role in cancer isn't all that good, even though there is supporting evidence from studies of animals,” said lead author Sheldon Cohen. Cohen and colleagues want more time, thought and dollars invested to explore whether interventions designed to reduce stress influence health.
“The existing evidence linking stress to health is impressive,” said Cohen, a psychology professor at Carnegie Mellon University. “What we need now is to find out what actually works to reduce stress,” he added. “After that we'd like to see randomized controlled trials to determine if these stress-reducing strategies translate to less disease.” The commentators are all psychologists who study the interplay of biology and behavior on the body. Cohen says it would be unethical to expose someone to ongoing stress that might cause them permanent harm, so gold-standard evidence from randomized experimental studies is not available. Still, there is convincing confirmation from prospective cohort studies, natural experiments, animal studies and brief laboratory tests on humans. Cohen says the evidence adds up. In studies of people exposed to brief, acute stress, researchers have documented changes in the way the body functions. “That approach looks for the effect of stress on body systems related to disease — things like heart rate, blood pressure or changes in immune function — but we don't necessarily know that such changes would lead to disease,” Cohen said. Researchers have also noted associations between stress and disease in prospective studies. In those investigations, the stress levels of participants are measured; then investigators follow them to see if the participant groups who experienced the most stress are also the people with develop the highest rates of death and disease. “The problem with that approach is there could be environmental or personality characteristics that influence both why a person is stressed and why they developed a disease,” Cohen said. In natural experiments, investigators track the health and death rates of people who experience stressors that are beyond their control (such as death in the family or a natural disaster). Since the subjects do not cause the stressful event, these studies are not subject to the alternative explanations that plague prospective studies. Repeated, sustained stress could throw off everything from metabolism to resting heart rate to the body's response to infection and inflammatory insults, Cohen and colleagues write. Stress might also increase the risk of disease because, “stressed people smoke more and sleep less; they don't have healthy diets; they exercise less,” Cohen said. Michael Irwin is a physician who studies the interaction of the brain, behavior and immunity. He echoes the call for more research on stress and diseases. “This suggestion is critical as most of the data are correlations. Intervention studies are needed to show that stress amelioration impacts psychological and physical health outcomes. Randomized controlled trials are the ‘backbone' of evidenced-based medicine and are needed to change how doctors counsel their patients,” said Irwin, a professor at the University of California, Los Angeles. Both Cohen and Irwin have observed changing attitudes about the influence of stress on health. “My experience with doctors is that they do believe in the association between stress and disease, and they tell their patients to try and reduce their stress,” Cohen said.
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by National Institute of Health (NIH), 06/28/03
For thousands of years, people believed that stress made you sick. Up until the nineteenth century, the idea that the passions and emotions were intimately linked to disease held sway, and people were told by their doctors to go to spas or seaside resorts when they were ill. Gradually these ideas lost favor as more concrete causes and cures were found for illness after illness. But in the last decade, scientists like Dr. Esther Sternberg, director of the Integrative Neural Immune Program at NIH's National Institute of Mental Health (NIMH), have been rediscovering the links between the brain and the immune system.
The Immune System and the Brain
When you have an infection or anything that causes inflammation such as a burn or injury, many different kinds of cells from the immune system stream to the site. Dr. Sternberg likens them to soldiers moving into battle, each kind with its own specialized function. Some are like garbage collectors, ingesting invaders. Some make antibodies, the "bullets" to fight the infectious agents; others kill invaders directly. All these types of immune cells must coordinate their actions, and the way they do that is by sending each other signals in the form of molecules that they make in factories inside the cell.
"It turns out that these molecules have many more effects than just being the walkie-talkie communicators between different kinds of immune cells," Dr. Sternberg says. "They can also go through the bloodstream to signal the brain or activate nerves nearby that signal the brain."
These immune molecules, Dr. Sternberg explains, cause the brain to change its functions. "They can induce a whole set of behaviors that we call sickness behavior… You lose the desire or the ability to move, you lose your appetite, you lose interest in sex." Scientists can only speculate about the purpose of these sickness behaviors, but Dr. Sternberg suggests that they might help us conserve energy when we're sick so we can better use our energy to fight disease.
These signaling molecules from the immune system can also activate the part of the brain that controls the stress response, the hypothalamus. Through a cascade of hormones released from the pituitary and adrenal glands, the hypothalamus causes blood levels of the hormone cortisol to rise. Cortisol is the major steroid hormone produced by our bodies to help us get through stressful situations. The related compound known as cortisone is widely used as an anti-inflammatory drug in creams to treat rashes and in nasal sprays to treat sinusitis and asthma. But it wasn't until very recently that scientists realized the brain also uses cortisol to suppress the immune system and tone down inflammation within the body.
Stress and the Immune System
This complete communications cycle from the immune system to the brain and back again allows the immune system to talk to the brain, and the brain to then talk back and shut down the immune response when it's no longer needed.
"When you think about this cross-talk, this two-way street," Dr. Sternberg explains, "you can begin to understand the kinds of illnesses that might result if there is either too much or too little communication in either direction."
According to Dr. Sternberg, if you're chronically stressed, the part of the brain that controls the stress response is going to be constantly pumping out a lot of stress hormones. The immune cells are being bathed in molecules which are essentially telling them to stop fighting. And so in situations of chronic stress your immune cells are less able to respond to an invader like a bacteria or a virus.
This theory holds up in studies looking at high-levels of shorter term stress or chronic stress: in caregivers like those taking care of relatives with Alzheimer's, medical students undergoing exam stress, Army Rangers undergoing extremely grueling physical stress, and couples with marital stress. People in these situations, Dr. Sternberg says, show a prolonged healing time, a decreased ability of their immune systems to respond to vaccination, and an increased susceptibility to viral infections like the common cold.
Some Stress is Good
People tend to talk about stress as if it's all bad. It's not. "Some stress is good for you," Dr. Sternberg says. "I have to get my stress response to a certain optimal level so I can perform in front of an audience when I give a talk." Otherwise, she may come across as lethargic and listless.
But while some stress is good, too much is not good. "If you're too stressed, your performance falls off," Dr. Sternberg says. "The objective should be not to get rid of stress completely because you can't get rid of stress - stress is life, life is stress. Rather, you need to be able to use your stress response optimally."
The key is to learn to move yourself to that optimal peak point so that you're not underperforming but you're also not so stressed that you're unable to perform. How much we're able to do that is the challenge, Dr. Sternberg admits. This may not be possible in all situations, or for all people, because just as with the animals Dr. Sternberg studies, some people may have a more sensitive stress response than others.
"But your goal should be to try to learn to control your stress to make it work for you," Dr. Sternberg says. "Don't just think of getting rid of your stress; think of turning it to your advantage."
Controlling the Immune Response
Problems between the brain and the immune system can go the other way, too. If for some reason you're unable to make enough of these brain stress hormones, you won't be able to turn off the immune cells once they're no longer needed.
"There has to be an exit strategy for these battles that are being fought by the immune system and the brain provides the exit strategy through stress hormones," Dr. Sternberg says. "If your brain can't make enough of these hormones to turn the immune system off when it doesn't have to be active anymore, then it could go on unchecked and result in autoimmune diseases like rheumatoid arthritis, lupus, or other autoimmune diseases that people recognize as inflammation."
Dr. Sternberg says that there are several factors involved in these autoimmune conditions. There are many different effects that the brain and its nervous system can have on the immune system, depending on the kinds of nerve chemicals that are being made, where they're being made, what kind of nerves they come from, and whether they're in the bloodstream or not. Still, at least part of the problem in these diseases seems to involve the brain's hormonal stress response.
"So if you have too much stress hormone shutting down the immune response, you can't fight off infection and you're more susceptible to infection," Dr. Sternberg concludes. "Too little stress hormones and the immune response goes on unchecked and you could get an inflammatory disease."
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Jim Robbins wrote an excellent article a few years ago which was published in Psychology Today. It serves as a nice example even today. It includes information on electroencephalographic biofeedback or neurofeedback, a natural treatment for conditions such as epilepsy, depression, insomnia and closed head injuries. Information on researches that testify to the effectiveness of neurofeedback; How neurofeedback works; Example of a neurofeedback session.
Click Wired for Miracles? to read the original work.
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The trends in brain health - and the public's growing demand for it - is demonstrated in a recent article written by Alvaro Fernandez for the May-June 2009 Issue of Aging Today, the bimonthly publication of the American Society on Aging: Public Libraries: Community-Based Health Clubs for the Brain.
Libraries now are focusing more on health and wellness promotion in order to engage older adults, and cognitive health, or brain fitness, is becoming a significant component of that promotion. And now, recent demographic and scientific trends are converging to fundamentally transform the role of libraries in our culture.
Society is quickly grasping the dangers of the effects of stress. The demand for proactive solutions is growing exponentially. The only question is, who will provide those solutions?
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The great misconception within the chiropractic profession lies in the gap between what we believe and what we say. We have allowed our dialog regarding our “spinal talk” to define Chiropractic as a physical application, and with this the public now sees our role in health in a very limited perspective.
The very basic fundamental principle of chiropractic is centered on the power of the nervous system to control body function and therefore the state of health. The gap between our “spine talk” and this basic principle has created a major dilemma for the profession both from outside (limitation of scope of practice) and inside (complete lack of connection between the adjustment and neurological response) the profession.
Could it be that we have abandoned the fight to verify chiropractic? I know that this question will generate letters stating that Chiropractic does not need verification but that is simply not true! Resting on the laurels of “results” as verification does nothing to support “why” it gets them. Understanding the “WHY” will allow us to improve the quality of care. It seems that we have simply decided that there is no acceptable scientific proof of “WHY” the Chiropractic adjustment can generate changes in the neurophysiology. The science of today has become our friend. Today we can show and connect the adjustment to neurophysiological responses. Objective neurological outcomes are available for the first time in 114 years. Our truth has been revealed! The catch is that it isn’t quite the way we thought it worked.
So this truth will require a shift in our understanding and most importantly, our explanation talk! The “spinal talk” needs to change, which will include our view of the use of old analysis systems which applied to the spinal presentation, such as x-rays and static sEMG instruments. These are technologies of the 20th century and today new 21st Century technology offers much more valuable information when it comes to Neurologically Based Chiropractic™. (NBC)
So the first application of this new world of Chiropractic starts with the question, “Do you really believe what you say?” If you say that the primary focus of Chiropractic is the nervous system, then every step you take and everything you say must start and end with that concept. Your intake information, your history form, your examination and most importantly of all, your care program must be centered on a neurological foundation.
It is time for us to step up to the plate here. Every other health profession has adapted as new information has dictated the need to grow. Every other health care profession has become more focused on their specific application. Not so with Chiropractic and we have to ask why? We have attached nutrition, decompression, acupuncture, laser therapy, spinal biomechanics, herbal therapy, and a host of others not so well defined. It seems like anything but the neurological connection!
So let’s look at some of the changes required for implementation of Neurologically Based Chiropractic.
The Intake form
We recommend that all of the essential information including basics such as name, phone number, address etc be done by the CA over the phone. No real change here - next that the CA be trained to also record information such as: chief area of complaint, onset, duration, complications, previous incidents, etc on that first contact calls as well. This will save the DC hours of time during the consultation, and is a tried and true set of Chiropractic Equity Offices Inc procedures. CAs will tend to balk at this at first but once they learn how, it will take no more time than having them explain the forms once the patient is in the office.
The intent of this procedure is to keep the DC’s energies in the adjusting room and not expended listening to some story about the Second World War injury during the consultation. The new Intake form and procedures (including dialog) are part of the NeuroInfiniti Workbooks. Time saving for the DC is HUGE!
Establishing the role of the Nervous system in the patient physical complaint
This is the link we have been missing for the last 50 years. It is about dealing with the “Cause” rather than symptoms. While we have been well taught in the medical system of “symptom recording” at college, we need to redirect the patients to “why” they are having these problems. The vast majority (over 90%) of patients have had their complaint on previous occasions so it is easy to talk about a new approach, seeing that the problem continues to return. The simple question of, “Do you think there would be benefit for us to look at the cause of your problems rather than just keep working on the symptoms?” is worth its weight in gold.
Once the patient states that they would like to address the cause, you can now talk about NBC™ and it makes sense. The Gap is gone! IT IS THAT EASY!!
We also have a wonderful chart called the “BioChart™ in which the patient establishes the link between their presenting problem challenges and nervous system function. It is also a great neurologically based new patient referral tool.
The Neurological Examination
This is where most DCs have a challenge. It is about the amount of time it takes to do an examination. My question is what are you doing (or not) in your current examination and what information do you gather that applies to your care program? Time for truth!
Are you ready for one of my secrets to building my 180 PVA practice? Perhaps not yet! I’ll give you a hint, it has a lot to do with my examination.
If you are still doing orthopedic exams or medical neurological exams or postural exams or static sEMG/thermal exams and calling that a foundation for Chiropractic care, you better be prepared to support these actions. Good luck!!! Science and “compliance” in practice billing have left these procedures behind.
We teach CAs how to do the NeuroInfiniti “Stress Response Evaluation” (SRE), a true neurological function analysis which directly applies to chiropractic practice. This means that the time it takes for the DC to do the exam is zero! We have the full office procedures including: forms, scripts and timing for this type of practice. It is that easy!
Next I will write about interpretation of neurological findings for Chiropractic practices and outlining Chiropractic care programs based on Duration, Frequency, and Intensity.
Stay tuned
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EEG Biofeedback and Autism
EEG biofeedback therapy for youngsters with autism is a new frontier. ACN is collecting related anecdotal reports; studies have not yet been done. The treatment is being utilized primarily for higher functioning autistics, as the subject must be able to engage his or her attention in a specialized computer program during each session. Autistic children are often adverse to having monitor wires placed on their heads during sessions, though reports. suggest this reluctance can sometimes be overcome with creativity and patience. We share two case report summaries to convey the effort required for this approach, as well as the positive results that can occur. While all autistic children undergoing EEG biofeedback training may not have similar results, it appears to be an area worthy of exploration. Report from an EEG therapist:
Note: Dr. Siegfried Othmer, director of EEG Spectrum, has taken a special interest in the use of EEG biofeedback for autistic children. Editor: This 8-year-old subject attends a special school where he works with an individual classroom aide most of the day and receives physical and occupational therapy. Prior to EEG biofeedback training, in spite of drug interventions of Buspar and Prozac, he remained unable to focus on tasks, adverse to many textures, foods, and sensations, as well as highly hyperactive and impulsive. Speech was usually a repetition of things he had heard; it was rapid, loud, and difficult to understand. His mother described him as: “irritable and grumpy; doesn’t like to be touched, and often takes off without notice, requiring a lot of chasing.”
Adapted from therapist’s log:
First Month: Initially, as soon as electrodes were put on H., he pulled them off He’s very sensitive to touch. An old set of electrodes were sent home so he could get used to them. After that we gave him small things to hold to keep his hands occupied. Mom said he liked to hold his guinea pig (!) so we let him bring that in for several sessions. We were then able to keep the elec- trodes on for the entire session. Sometimes we played classical music in the background. Sessions were held three times a week. Mom had not informed the school that she was try- ing biofeedback. He began focusing better, and was more responsive to verbal cues. After eight sessions, the teacher reported that H. had his best day ever. Four sessions af- ter that, his teacher commented that it was like having a different child at school-and he seemed much more cheerful. Between sessions 12 and 28: H. began to work on school assignments at home with Mom for the first time. Speech was easier to understand. He took his first math and spelling tests and did relatively well. He continues to progress in these subjects. H. has improved in listening skills and is more compliant with parents. After almost one year: Sessions were reduced to twice a week, then weekly. To date, a total of 98 sessions have been given
Positive effects noted by parent:
Medications have been reduced by half
Previous “memorized” speech has been replaced by some original thought; expresses ideas and asks questions.
Speech used to be too rapid to understand. It is now slower and more distinct.
Loud outbursts are now infrequent and softer. Asks for hugs and will initiate touch; less sensitive to light, sound, and textures.
Interacts with siblings and can do some group work at school for the first time.
Responds more appropriately to parental directions.
Improved balance and gross motor control
Energy level has decreased from severe hyperactivity to a more normal level.
More awareness of feelings, emotions, and humor Tolerates changes in his environment better than before.
Mood more stable and positive
(No negative effects reported.)
Joy Lunt, R.N.
EEG Spectrum Northshore
Northbrook, IL
The therapist commented: “In March of this year, H. celebrated his birthday by having a party at a video arcade. This is a place he could not have tolerated previously. Mom reported that he loved it, interacted with the other kids, waited his turn for games, and was not overwhelmed by the noise and activity. What a test!” Report from an EEG therapist: I have just completed 40 sessions of EEG biofeedback training with an 8-year-old boy. The family traveled here and stayed in town for one month for intensive therapy. The subject is a relatively high-functioning autistic. His vocabulary is limited, but memory is good.
Positive effects observed by mother:
Less ritualistic
More imaginative in play
Improved socialization within family
Began reciting the news from TV programming (this was progress).
Better language association Engaged in watching an activity from afar for the first time.
Throughout training he demonstrated mood swings between and within sessions. Getting him to engage was a challenging task.
Negative effects observed by mother:
More whining and crying Became more impatient (perhaps because more aware).
The parents are happy with the training results and have placed an order to acquire the instrument for thei long-term use at home. Kenneth Kang
EEG Spectrum Affiliate
Singapore
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