The emotional, mental, and physical impact of our symptoms and stress can be savage. And the only way to find relief is to understand how our stress and relaxation responses work. Let’s do it…
‘…we become even more vulnerable to many types of emotional and physical illnesses when we believe we have little or no control over stress.’ Dr. Gregg D. Jacobs
Some years ago I was looking for information regarding drug-free insomnia treatment and bumped into a great book.
Say Good Night to Insomnia was written by Gregg D. Jacobs, PhD, who developed the first drug-free program that proved more effective than meds.
Where we’re going
The book includes valuable information regarding how our stress and relaxation responses work. And that’s where we need to go.
To maximize learning, we’ll handle it in two parts. Let’s take care of our stress response in this piece and we’ll take a look at our relaxation response in part two.
Off with us…
Our stress response
Our stress response (SR), aka fight/flight response, is a collection of involuntary physiological changes that occur when we’re faced with threatening or stressful circumstances.
Simply, it pushes our bodies into a state of arousal and preparation.
By the way, it’ll be helpful to read up on the hypothalamic-pituitary-adrenal axis (HPA axis). Don’t let the med-speak spook you, it’s interesting.
Stress response in action
Okay, here’s what happens when our SR is triggered…
Pumping of stress hormones such as cortisol and adrenaline (epinephrine) to activate our nervous system and put us on edge.
Increased heart rate, blood pressure, and respiration to ramp up physical strength and energy.
Heightened visual and hearing acuity, and faster brain waves, to enhance alertness and mental reactions.
Decreased blood flow to the stomach and extremities, and increased blood flow to the brain, muscles, heart, and lungs to support fight/flight.
Increased muscle tension. Interesting, this is an evolutionary mechanism that allowed our cave-dwelling ancestors to assess danger and remain immobile so they weren’t seen by predators. It also prepared them for fight/flight and protected them from injury by creating “body armor.”
Increased sweating to cool the body.
Increased blood sugar levels to reduce fatigue and increase energy.
Maybe you’ve experienced one or more of these and were distressed because you didn’t know why it was happening. Could be your SR was crankin’ beneath conscious awareness.
I mean, let’s not forget how sensitive those of us with a mood or anxiety disorder can be to our internal and external environments.
“All this stuff, all this stimulation. No wonder I constantly pump adrenaline.”
“Yikes! 12 Signs You’re Overstimulated” addresses exactly that. Even gets into something known as a “highly sensitive person” (HSP). Give it a read sometime.
Now, granted, we aren’t facing the physical threats experienced by our ancestors. However, we’re still up to our eyeballs in personal stressors, which are often frequent and chronic.
Just think about your relationships, work, family, schooling, and finances.
But there’s more
On top of that, we’re responsible for juggling social and environmental stressors. Jacobs emphasizes the decline of the family, noise pollution and overcrowding, a constant sense of time pressure, and exposure to rapidly increasing amounts of information and global events via computers and mass communication.
It isn’t a news flash that our brains don’t distinguish between physical, personal, and social/environmental stressors. Stress is stress.
There’s a problem
So now we’re faced with a problem…
We can’t avoid stress and we can’t toss aside our SR’s physical arousal by fighting or fleeing. That’s because fighting and fleeing aren’t socially acceptable responses to stressful situations.
As Jacobs wisely observes, if your boss fires you, slugging her or running away aren’t good choices..
Suffice it to say, many of us are left with chronic, inappropriate, and excessive SR activation. And it can happen so frequently during any given day that it becomes automatic.
The stress-illness connection
Those who have an automatic – unconscious – SR may find themselves in the midst of what Jacobs refers to as the stress-illness connection.
The idea that an over-the-top SR can generate physical health problems is well-accepted. Jacobs puts things in perspective by pointing out that 50-80% of all complaints brought to a physician’s office are stress-related.
Consider these…
Muscle problems: Chronic tension, headache, neck and back pain
Cardiovascular issues: Increased blood pressure and cholesterol, chest pain, irregular heartbeat, increased risk of cardiovascular disease
Compulsive behavior problems: Substance use, gambling, consumption of pornography
Infertility
PMS
Not only are these manifestations of a hair-on-fire SR, they become stressors in and of themselves, leading to additional SR activity and unhealthy cycling.
I mean, where does it all end?
Drivers of the stress-illness connection
According to Jacobs, studies implicate the following stressors as notable drivers of the stress-illness connection…
Marital conflict, separation, divorce
Loneliness
Job loss and unemployment
Academic examinations
Death of a loved one
Caring for an incapacitated loved one
To wrap things up on the stress-illness connection, this from Dr. Jacobs…
… life without stress would be a life without challenge, adaptation, and growth. Stress becomes a problem when it is excessive and chronic. As research consistently documents, we become even more vulnerable to many types of emotional and physical illnesses when we believe we have little or no control over stress.
No arguments here.
On to the relaxation response
That’ll do it for the stress response. Do you see how important it is to get it squared away before we leap into the relaxation response?
Makes sense that relief is tough to come by if we aren’t fully briefed on our adversary.
Would you bare your soul to a robot or bond with a chatbot? How ‘bout trusting a machine learning diagnosis? Artificial intelligence and mental health: fantastic things are happening. Here’s the latest…
…a Vanderbilt University Medical Center study revealed that machine learning predicted whether a person will take their life with 80% accuracy.
The Age of Artificial Intelligence is upon us. And if it’s managed responsibly it can be marvelous.
There are an abundance of artificial intelligence applications up and running, and emotional and mental health is on the list.
Here’s the latest…
Background
“AI In Mental Health: Opportunities And Challenges In Developing Intelligent Digital Therapies,” written by Bernard Marr, appeared on Forbes recently.
Mr. Marr is a world-renowned business and tech futurist and influencer, as well as a best-selling author.
We’re going to rely upon his hard work and knowledge to get us where we need to go.
Let’s roll…
Definitions
Before we get to the goods, we need to handle some key definitions…
Artificial intelligence
A field of science concerned with building computers and machines that can reason, learn, and act in a way that would normally require the intelligence of humans or that involves data whose scale exceeds what humans can analyze.
Algorithm
A well-defined, in sequence computational technique that accepts a value or a collection of values as input and produces the output(s) needed to solve a problem.
Machine learning
A branch of artificial intelligence and computer science that focuses on the use of data and algorithms to imitate the way humans learn, gradually improving its accuracy.
Chatbot
A computer program that simulates human conversation to solve problems and answer questions. Modern chatbots use technologies, such as artificial intelligence and machine learning.
Artificial intelligence and mental health: Applications
I’m guessing you’ve been exposed to the artificial intelligence (AI) hype. Have you ever wondered if AI could somehow come to your emotional and mental rescue? Maybe you’ve had visions of healing similar to our featured image.
Let’s see if we can get you some answers…
Artificial intelligence therapists
Chatbots are on the rise and they’re offering advice, symptom coping assistance, and a communication conduit during treatment.
And catch this, they can pick up on keywords during a conversation that can trigger a referral and direct contact with a human emotional and mental health (EMH) professional.
Marr offers Woebot as an example of a therapeutic chatbot. It gets to know the user’s personality and adapts to it. And it can even talk the user through quite a few therapies and exercises frequently used to manage a variety of conditions.
Marr goes on to mention the chatbot, Tess. It offers free 24/7 on demand emotional support and can be used to help with anxiety and panic attacks in the moment.
Wearables
Wearables up the AI treatment ante. They don’t wait around for action on the users part. Since they’re worn, and their sensors are constantly interpreting body signals, they give an immediate heads up if something merits a look-see.
Marr uses Biobeat as an example. Sleeping patterns, physical activity, variations in heart rate and rhythm – they’re all tracked and used to assess the user’s mood and cognitive state.
The data is compared with aggregated and anonymized data from other users to provide warnings when intervention may be necessary.
Diagnosing and predicting outcomes
AI, specifically machine learning, can be used to analyze a user’s medical and behavioral data, voice recordings collected from phone calls to intervention services, and more to flag warning signs of problems before they progress to an acute stage.
For instance, Marr mentions a review of studies conducted by IBM and the University of California. The review found that where AI was used to parse various data sources, machine learning could predict and classify mental health problems – including suicidal thoughts, depression, and schizophrenia – with “high accuracy.”
“Come on, Bill, it all sounds too good to be true. What’s the catch?”
Taking things to the extreme, a Vanderbilt University Medical Center study revealed that machine learning predicted whether a person will take their life with 80% accuracy.
And research is currently being conducted at the Alan Turing Institute that’s examining ways of using large-scale datasets from individuals who have not shown symptoms of EMH issues to predict who is likely to develop them during their lifetimes.
And if that isn’t enough, AI has been used to predict cases where patients are more likely to respond to cognitive behavioral therapy (CBT), therefore being less likely to require meds.
Improving patient outcomes
If you’ve wrestled with an EMH disorder, nobody has to tell you that sticking to a treatment regimen can be challenging.
AI can be used to predict when the user is likely to slip into non-compliance and either issue reminders or alert their healthcare providers to enable manual interventions.
Personalized treatments
Research is underway involving leveraging AI to create personalized treatments for a number of mental health conditions. It’s been used to monitor symptoms and reactions to treatment to provide insights that can be used to adjust individual treatment plans.
And how ‘bout this? A University of California, Davis study focused on creating personalized treatment plans for children suffering from schizophrenia based on computer vision analysis of brain images.
Artificial intelligence and mental health: Challenges
Let’s wrap things up by talking about work that needs to be done.
Okay, you may be saying to yourself, “Come on, Bill, it all sounds too good to be true. What’s the catch?” Well, not really “catches,” but there are challenges that are being addressed.
Marr talks about AI bias. He’s referring to inaccuracies or imbalances in the datasets used to train algorithms that could perpetuate unreliable predictions or social prejudice.
For instance, when it’s known that EMH issues are more likely to go undiagnosed among ethnic groups with poorer access to healthcare, algorithms that rely on this data may also be less accurate at diagnosing those issues.
And then there’s the fact that diagnosing EMH issues often requires more subjective judgment on the part of clinicians compared to diagnosing physical conditions.
Are you on board?
Quick note before we say goodbye. Lots in the works regarding AI and psychotropic medications – recommendations, prescribing, and development.
Well, that’ll do it. Man, I broke a sweat writing this one – so much information, so much learning. And a big thank you to Bernard Marr, by the way.
How do you feel about it?
The Age of Artificial Intelligence has begun. And emotional and mental health is along for the ride. The big question is, are you on board?
Humans have sought relationships with deities from the beginning of time. Makes you wonder if we’re wired for it. Have you ever heard of the “God Spot?” Do we really have one? Let’s take a look…
Dr. Ferguson wants to pursue ways in which the findings can assist in understanding the role of spirituality and compassion in clinical treatment.
Poking around for content ideas last week, it jumped out of the screen: The “God Spot.”
If you were traipsing around the online psych world and saw it, what would be your reaction?
Well, I was hooked and had to learn more. And after jumping from article to article, I found what I was looking for…
“Researchers Identify Brain Circuit for Spirituality”
Brigham and Women’s Hospital posted a Research Brief entitled “Researchers Identify Brain Circuit for Spirituality,” dated July 1, 2021. It announced the results of a study completed by their Center for Brain Circuit Therapeutics.
A neural circuit for spirituality and religiosity derived from patients with brain lesions appeared in the June 29, 2021 edition of Biological Psychiatry. The study team leads were Michael Ferguson, PhD and Michael D. Fox, MD, PhD.
Background
The Brief begins by pointing out that more than 80% of people around the world consider themselves religious or spiritual. Curious thing is, research on the neuroscience of spirituality and religiosity has been sparse.
It goes on to state that the functional neuroimaging used in previous studies rendered a spotty and often inconsistent picture of spirituality. However, the new and advanced approach to mapping spirituality and religiosity used in their study delivered on the mark and fascinating results.
The bottom-line
Speaking of those results, here’s the gist. Dr. Ferguson, Dr. Fox, and team used lesion network mapping to identify a specific brain circuit that serves as a neural underlay for spirituality and religiosity.
Dr. Ferguson…
Our results suggest that spirituality and religiosity are rooted in fundamental, neurobiological dynamics and deeply woven into our neuro-fabric. We were astonished to find that this brain circuit for spirituality is centered in one of the most evolutionarily preserved structures in the brain.
Are you wondering what the structure is? Hang in there.
How did they do that?
So how did the team come up with the goods? They used data from another study in which 88 patients completed the Temperament and Character Inventory (TCI) before and after brain tumor resection – occurring in various places throughout the brain.
The TCIs spiritual acceptance subscale is a validated measure of spirituality and religiosity.
Interesting: 30 patients reported a decrease in spiritual belief, 29 reported an increase, and 29 reported no change.
The periaqueductal gray
Periaqueductal gray
Makes sense that the brain lesions in patients with changes in spiritual belief would be mapped. And when they were, the brain circuit for spirituality was found to be centered in the periaqueductal gray (PAG).
The PAG is a column of cells that stretches 14 millimeters/.5 inches in the midbrain portion of the brainstem. You can see its approximate location in the image.
The PAG plays a major role in pain modulation, fear conditioning, defensive behaviors, altruistic behaviors, and unconditional love. Given its size, think about how incredible that is.
Is the PAG the “God Spot?” If you want it to be, sure. All I know is the discovery is huge.
Are there other players?
Key brain structures
The brain circuit for spirituality may be centered in the PAG, but are there other players?
Of particular note, a 2012 University of Missouri-Columbia study suggested the frontal-parietal brain circuit (located in the cerebrum) is related to spiritual-religious experiences.
The authors went on to speculate that “selflessness,” associated with decreased right parietal lobe functioning, is the primary neuropsychological foundation for spiritual transcendence – having less focus on self, which makes one more capable of focusing on things beyond.
Keep in mind, the PAG (located in the midbrain) is anatomically connected to the prefrontal cortex, our executive functioning center, and other brain structures. And though certain parts of the brain may play a dominant role, they all work together to facilitate spiritual experiences.
What’s next?
The study may be completed, but the Brigham and Women’s team isn’t finished.
They want to see if they can replicate the study results across a variety of spiritual and religious backgrounds.
And how ‘bout this? Dr. Ferguson wants to pursue ways in which the findings can assist in understanding the role of spirituality and compassion in clinical treatment.
Dr. Ferguson…
Only recently have medicine and spirituality been fractionated from one another. There seems to be this perennial union between healing and spirituality across cultures and civilizations.
I’m interested in the degree to which our understanding of brain circuits could help craft scientifically grounded, clinically-translatable questions about how healing and spirituality can co-inform each other.
Please keep up the good work.
A “God Spot?”
Humans have sought and embraced relationships with deities from the beginning of time. And 80% of us consider ourselves to be religious or spiritual. It really does make the case for common wiring.
You were pretty sure you had it. Still, it was good to get the diagnosis. Are you looking for more restless legs syndrome info? Maybe cause, treatment? Here’s what you need to know…
Dopaminergic agents: These drugs, which increase dopamine in the brain, can reduce symptoms of RLS when taken at night.
If you or someone you care about has restless legs syndrome, you know how troublesome it can be.
You also know it doesn’t get the attention it deserves.
We started a two-part series on restless legs syndrome last week. In part one we defined it, reviewed its symptoms, and who’s more likely to have it.
Now it’s on to cause and treatment…
What causes restless legs syndrome
Like most of the conditions we discuss, the cause of restless legs syndrome (RLS) is unknown. That means we have to turn to triggers and scientific supposition to connect the dots.
If someone is experiencing RLS-like symptoms and any of the following are going on, the dots are connecting…
Family history of RLS
Parkinson’s disease/dopamine imbalance
Neuropathy
Sleep deprivation and other sleep conditions, such as sleep apnea
Pregnancy or hormonal changes, especially in the last trimester
Use of alcohol, nicotine, and caffeine
Iron deficiency, even without anemia
Using medications, such as some anti-nausea drugs, antidepressants that increase serotonin, antipsychotics, medications that contain older antihistamines
End-stage renal disease and hemodialysis
What’s in the works?
Lots of mystery, supposition, and dot connecting going on when it comes to the cause of RLS. It’s terribly frustrating. But what can I say? It’s the brain.
The good news is the National Institute of Neurological Disorders and Stroke (NINDS) is funding a lot of fantastic research.
“Yeah, participating in a clinical trial is a great way to help the cause. Good idea, doc.”
Included: investigating changes in the brain’s signaling pathways with an emphasis on dopamine, discovering genetic relationships, studying the role of endothelial cells in the regulation of cerebral iron metabolism, using advanced MRI to measure chemical changes in the brain’s arousal system, testing non-drug therapies, such as a non-invasive nerve stimulation device to use during sleep.
If you’re dealing with it, you know that’s the kind of attention RLS deserves.
How is restless legs syndrome treated?
There is no treatment that directly addresses RLS. So to secure relief we have to focus upon contributing medical conditions, lifestyle habits, and self-care.
Medications
Let’s start with medical conditions – reference the “triggers” above. Here are medications frequently used in the treatment of RLS…
Iron supplements: Check with your physician first.
Anti-seizure drugs (anticonvulsants): The first-line prescription drugs for those with RLS. The U.S. Food and Drug Administration (FDA) approved gabapentin enacarbil (Horizant, Regnite) for the treatment of moderate to severe RLS. Other anti-seizure drugs, such as pregabalin (Lyrica), can decrease sensory disturbances and nerve pain.
Dopaminergic agents: These drugs, which increase dopamine in the brain, can reduce symptoms of RLS when taken at night. Ropinirole (Requip), pramipexole (Mirapex), and rotigotine (Neupro) are FDA-approved to treat moderate to severe RLS. Levodopa (L-Dopa) plus carbidopa (Lodosyn) may be effective, but can only be used intermittently.
Opioids: Drugs such as methadone (Dolophine, Methadose), codeine, hydrocodone (Hysingla ER, Zohydro ER), or oxycodone (OxyContin, Roxicodone) are sometimes prescribed to treat individuals with more severe symptoms of RLS who do not respond well to other medications.
Benzodiazepines: They are anticonvulsants. Medications such as clonazepam (Klonopin) and lorazepam (Ativan) are generally prescribed to treat anxiety, muscle spasms, and insomnia; and can help individuals get more restful sleep.
Lifestyle habits and self-care
Lifestyle habits and self-care have a major impact on distress. The following often provide relief for those with mild to moderate RLS…
Avoid or decrease the use of alcohol, nicotine, and caffeine
Change or maintain a regular sleep pattern
Moderate, regular exercise
Massage the legs or take a warm bath
Apply a heating pad or ice pack
Use foot wraps specially designed for people with RLS or vibration pads to the back of the legs
Aerobic and leg-stretching exercises of moderate intensity
With creativity, we can come up with more.
The attention it deserves
That’ll do it for our series. Restless legs syndrome makes life challenging for tens of millions worldwide. If you or someone close to you has it, that isn’t front page news.
No cause, no cure. So quality management options will have to hold us over as research continues.
But there’s plenty of hope because restless legs syndrome is finally getting the attention it deserves.
To get the full scoop on restless legs syndrome, be sure to read part one.
Like our friend with his doc, if your interested in participating in a clinical trial for RLS, or any other disorder, start with NIH Clinical Trials and You. When you’re ready to find a trial, visit ClinicalTrials.gov.
Would you like to read more Chipur mood and anxiety info and inspiration articles? Head to the titles.
Bill White is not a physician and provides this information for educational purposes only. Always contact your physician with questions and for advice and recommendations.
You’ve been having strange sensations in your legs and overpowering urges to move them. You can’t even sleep anymore. “Do I have restless legs syndrome?” Here’s what you need to know…
Do you think there’s a relationship between RLS, depression, and anxiety? Sure is. And one incites the other.
Restless legs syndrome can turn lives upside down.
If you’re one of the tens of millions struggling, or think you may be, here’s what you need to know. In fact, there are so many need to knows that we’ll go with a two-part series.
Let’s get after defining restless legs syndrome, reviewing its symptoms, and who’s more likely to have it. And we’ll come back in part-two with causes and what to do about it.
Off with us…
What is restless legs syndrome?
Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is a neurological disorder characterized by unpleasant or uncomfortable sensations in the legs and an irresistible urge to move them. It can also affect other parts of the body.
The occurrence rate of RLS in North America and Europe is 7-10%. It’s believed to be quite a bit lower in Middle Eastern and East Asian countries.
What are the symptoms of restless legs syndrome?
Here are the primary symptoms – characteristics – of RLS…
Sensations – aching, crawling, tingling, itching, throbbing, pain, burning, tugging – that typically begin after being inactive and sitting for extended periods of time.
Relief of discomfort with movement of the legs (or other affected body part). Keeping them in motion may minimize or prevent the sensations. It may come down to pacing the floor or constant movement while sitting.
Worsening of symptoms at night with a distinct symptom-free period early in the morning.
Difficulty falling and staying asleep, which can worsen with a reduction of sleep due to events or activity.
With moderately severe RLS, symptoms may only occur once or twice a week, but often result in significant delay of sleep onset with some disruption of daytime functioning.
Periods of remission may occur for weeks or months, especially during the early stages of the disorder. But not only are they likely to reappear, they can become worse over time.
By the way, can you see why RLS is considered both a sleep and movement disorder?
Severe cases
“I love this show, but enough’s enough. It’s time to see the doc.”
Some 3% of RLS cases are considered severe, which means intense and persistent symptoms occur more than twice a week.
In addition to sensations and movement, mental distress, insomnia, and daytime sleepiness may present. And since RLS is worse when resting, those with severe cases may avoid daily activities that involve long periods of sitting.
But that’s not all. Sufferers of severe RLS are more apt to isolate socially and experience frequent daytime headaches, compromised memory, impaired concentration, and libido issues.
Do you think there’s a relationship between RLS, depression, and anxiety? Sure is. And one incites the other.
Who is more likely to have restless legs syndrome?
Just like our specialty, the mood and anxiety disorders, the root cause of RLS is unknown. When that’s the case, triggers help us identify who’s more likely to have a disorder.
Let’s take a look…
Family history of RLS
Neuropathy
Sleep deprivation and other sleep conditions, such as sleep apnea
Use of alcohol, nicotine, and caffeine
Pregnancy or hormonal changes, especially in the last trimester. In most cases, symptoms disappear within four weeks post-delivery.
Parkinson’s disease
Medications, such as anti-nausea drugs, antipsychotics, antidepressants that increase serotonin, cold and allergy medications that contain older antihistamines (e.g., chlorphenamine, doxylamine, hydroxyzine)
Iron deficiency, even without a diagnosis of anemia
End-stage renal disease and hemodialysis
Heads up, right?
Come on back for part two
That’ll do it for part one. Whether you know you have restless leg syndrome or you’re considering the possibility, the information will lend you a hand.
If you’re interested in participating in a clinical trial for RLS, or any other disorder, start with NIH Clinical Trials and You. When you’re ready to find a trial, visit ClinicalTrials.gov.
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