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Understanding Critical Components of the Brain’s Stress Circuitry

Study identifies how the PVT interacts with other brain areas during stress

 • Science Update

Everyone feels stressed from time to time. While people often learn to deal with stress in a healthy, adaptive way, sometimes people respond to stress in a maladaptive way, which can put them at greater risk for developing mental illnesses. Now, a new study conducted by researchers at the National Institute of Mental Health (NIMH) has revealed more about the organization and function of a brain structure that may serve a key role in linking stress detection to the development of adaptive behaviors. The study, published online June 18, 2018, appears in Nature Neuroscience.

The paraventricular nucleus of the thalamus (PVT) is a brain structure that has been identified as a player in emotional processing, learning, and in adaptive responses to stress. Although knowledge of the role of this brain structure in stress responses is growing, researchers are still working to understand how this structure is organized and how it connects with other parts of the brain.

The PVT has a unique place in the brain, receiving inputs from brain areas that make it sensitive to both environmental cues as well as to internal bodily signals. The dual nature of these inputs has led some to hypothesize that the PVT may serve as a critical link in the brain, helping to integrate information about environmental stressors and internal physiological states to guide behavior. In this study, NIMH IRP researchers investigated the cellular and circuit mechanisms by which stressors impact PVT function. To do this, the researchers examined the contribution of different neurotransmitter systems in the PVT. They found that, during stress, dopamine (a major modulator of brain function) triggered a reduction in inhibition of the PVT. Notably, the disinhibition produced by dopamine made the PVT more sensitive to aversive outcomes.

“A stressful event typically leads to an increase in our sensitivity to new stressors, which suggests that a ‘stress memory’ center exists in the brain,” said study author Mario Penzo, Ph.D., chief of the Unit on the Neurobiology of Affective Memory at the NIMH. “Previously, scientists speculated that the PVT may be such a center. We now have evidence that indicates this is indeed the case. Our results suggest that stress-induced changes of the PVT circuit may promote susceptibility to future stressors.”

A surprising observation made by the researchers was that the stress-induced disinhibition of the PVT by dopamine was brought about through input from the locus coeruleus (LC). The LC is a small structure of the mammalian brainstem that is involved in physiological responses to stress and panic, but that it is primarily thought to do so via the release of the neurotransmitter norepinephrine. According to lead study author B. Sofia Beas, Ph.D., a postdoctoral fellow in the NIMH Unit on the Neurobiology of Affective Memory, the uncovering of dopaminergic modulation of the midline thalamus by the LC was unexpected and remarkable.

“Our finding that the LC, which is primarily known as a hub for norepinephrine, is the main source of dopamine to the midline thalamus is outstanding, given that this region is normally thought of as a norepinephrine center and not as a dopaminergic one,” said Beas. “This finding also emphasizes the intricacies of the neurotransmitter systems and challenges how they are defined in the nervous system”

While the researchers know that the PVT plays a role in stress processing, they are currently working to better understand how modulation there impacts downstream structures that are also involved in emotional processing and adaptive responding.

The findings help clarify the structural and functional roles of an important piece of the brain’s stress circuity and provide a platform for future research into how the brain responds to and is impacted by, stress.

An overlay image of the PVT showing the terminals from the locus coeruleus (red) and the neurons that project to the nucleus accumbens (green).

An overlay image of the PVT showing the terminals from the locus coeruleus (red) and the neurons that project to the nucleus accumbens (green). Image credit: B. Sofia Beas, Mario A. Penzo, and Nature Neuroscience.

Reference

Beas, B. S., Wright, B. J., Skirzewski, M., Leng, Y., Ho Hyun, J., Koita, O., … Penzo, M. A. (2018). The locus coeruleus drives disinhibition in the midline thalamus via a dopaminergic mechanismNature Neuroscience, 21, 963–973.

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You are not alone in feeling lonely!

Global health service company Cigna (NYSE: CI) released results from a national survey in June 2018 exploring the impact of loneliness in the United States. The survey, conducted in partnership with market research firm, Ipsos, revealed that most American adults are considered lonely. Nearly half of Americans report sometimes or always feeling alone (46 percent) or left out (47 percent).

From the Cigna report we learn the following:

• One in four Americans (27 percent) rarely or never feel as though there are people who really understand them.

• Two in five Americans sometimes or always feel that their relationships are not meaningful (43 percent) and that they are isolated from others (43 percent).

• One in five people reports they rarely or never feel close to people (20 percent) or feel like there are people they can talk to (18 percent).

• Americans who live with others are less likely to be lonely (average loneliness score of 43.5) compared to those who live alone (46.4). However, this does not apply to single parents/guardians (average loneliness score of 48.2) — even though they live with children, they are more likely to be lonely.

• Only around half of Americans (53 percent) have meaningful in-person social interactions, such as having an extended conversation with a friend or spending quality time with family, on a daily basis.

• Generation Z (adults ages 18-22) is the loneliest generation and claims to be in worse health than older generations.

• Social media use alone is not a predictor of loneliness; respondents defined as very heavy users of social media have a loneliness score (43.5) that is not markedly different from the score of those who never use social media (41.7).

There are some good suggestions for combating loneliness, but a lack of confidence could be the real reason why you are not interacting with others. Loneliness is a feeling and not a fact. It starts with you, not the world around you. If you are lacking the self-confidence to speak to others freely, I strongly suggest seeing a psychotherapist to work on the negative beliefs you have about yourself.

Most of the time we are our own worst enemies and assumptions will bring you nowhere. You will never know what you are missing out on if you do not take a leap of faith and start a conversation with someone you would like to get to know a little better. All healthy relationships started with a simple “hello”.

Here are a few simple but effective ways to combat loneliness…

1. Reach out to others. Just remember – it’s all about taking a chance. Everybody has to go through the same process of saying hello and standing a chance to either walk away with a new friend’s phone number or feeling like a total failure and even more lonely. But each time you puck up the courage to say hello you learn, become stronger and wiser and stand a chance to win a new friend. So worth it!

2. Stop the self-deflating thoughts. You and you alone think that you are a loser or unworthy or silly or whatever you tell yourself. We are not mind-readers and there is no way you can know for sure what people are thinking about you. And really? Who cares? What they think about you does not matter at all. There is a lid for every pot out there and if you keep your head high and stay positive and keep trying, you will meet your match.

3. Focus on others and focus less attention on yourself. What you give may come back to you.

4. Find others who have common interests. But ensure that these are your true interests. Remember, you are the most important person here. Don’t pretend to like something just to impress someone or be accepted into the “cool crowd”.

 5. Always show up when meeting with others. Don’t stand people up. You would not like it if someone stood you up or made you wait. Do to others what you want done to yourself.

6. Be interested in other people. Listen to what they are saying and doing. Take the focus off of you. People love talking about themselves and if they notice that you are a good listener, they will love hanging out with you.

7. Be kind. Some people are rude but most people will respond to kindness. Being mean, rude and a jerk will earn you a reputation you don’t want.

8. Find a group with whom to connect such as church groups, exercise groups, music groups, Alcoholics Anonymous, sewing or baking groups or folks who simply gather for coffee.

Talking, listening, kindness, showing interest in others, participating and helping others will help you in overcoming loneliness and build your self-confidence. Do it for yourself, not for other’s sake. You will soon start to develop long-lasting healthy relationships.

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Suicide: How You Can Make a Difference

 • Science Update

The recent deaths of high-profile public figures and a new Centers for Disease Control and Prevention (CDC) report on rising suicide rates have brought the topic of suicide into everyday conversations. It’s important to know some facts and to know what to do if you think someone might be at risk for self-harm. A crisis can pass with time and the most important thing is to stay safe through the crisis and get help.

5 Action Steps for Helping Someone in Emotional Pain

  • Ask: “Are you thinking about killing yourself?” It’s not an easy question but studies show that asking at-risk individuals if they are suicidal does not increase suicides or suicidal thoughts.
  • Keep them safe: Reducing a suicidal person’s access to highly lethal items or places is an important part of suicide prevention. While this is not always easy, asking if the person has a plan and removing or disabling the lethal means can make a difference.
  • Be there: Listen carefully and learn what the individual is thinking and feeling. Findings suggest acknowledging and talking about suicide may, in fact, reduce rather than increase suicidal thoughts.
  • Help them connect: Save the National Suicide Prevention Lifeline’s number in your phone so it’s there if you need it: 1-800-273-TALK (8255). You can also help make a connection with a trusted individual like a family member, friend, spiritual advisor, or mental health professional.
  • Stay Connected: Staying in touch after a crisis or after being discharged from care can make a difference. Studies have shown the number of suicide deaths goes down when someone follows up with the at-risk person.

The Facts

CDC reported that nearly 45,000 people died by suicide in 2016, it is the third leading cause of death among those age 10-34, and the 10th leading cause of death overall. The suicide death rate has increased in the US since 1999, however, it is still a relatively rare event resulting in approximately 15 deaths for every 100,000 people.

Suicide is Complicated

There is no single cause of suicide, it is linked to mental health conditions and stressful life experiences. It’s important to reach out and talk honestly with anyone going through a difficult time.

Many stressful situations contribute to suicide among those with and without known mental health conditions. Some of the most significant contributing factors include:

  • Relationship problems
  • A crisis that occurred in the past two weeks or that is expected in the next two weeks
  • Substance use problems
  • Physical health problems
  • Job or financial problems
  • Criminal or legal problems
  • Loss of housing

The Warning Signs

These are the most common signs that someone is in emotional distress. If you are concerned, take the 5 Action Steps listed above.

  • Feeling like a burden
  • Being isolated
  • Increased anxiety
  • Feeling trapped or in unbearable pain
  • Increased substance use
  • Looking for a way to access lethal means (e.g., a firearm or pills)
  • Increased anger or rage
  • Extreme mood swings
  • Expressing hopelessness
  • Sleeping too little or too much
  • Talking or posting about wanting to die

A Community Effort

Suicide is a growing public health problem and the solution will take a community effort. This CDC factsheet highlights how everyone—from states, employers, and schools to the news media and friends—can have an impact on suicide prevention.

Action Steps for News Media

Research shows that the media can influence suicide rates by the way they report on suicide. Evidence suggests that when the media tells stories of people positively coping in suicidal moments, more suicides can be prevented.

For best practices for safely and accurately reporting on suicide, please see
Recommendations for Reporting on Suicide.

More Information

If you or someone you know need immediate help, call the National Suicide Prevention Lifeline (NSPL) at 1-800-273-TALK (8255). The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889.

The free service is available 24 hours a day, 7 days a week. All calls are confidential. Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency.

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Children and the Use of Complementary Health Approaches

What’s the Bottom Line?

How much do we know about complementary health approaches for children?

We know a lot about the usage rates of complementary health approaches for children but little about their effects and safety.

What do we know about the effectiveness of complementary health approaches for children?

Studies have looked at many complementary health approaches for children with different conditions, but the evidence generally isn’t strong enough to show what works and what doesn’t.

What do we know about the safety of complementary health approaches for children?

Many complementary approaches haven’t been tested for safety in children.

In the past, children were often excluded from research studies due to special protections, and findings from studies of adults were applied to children. Today, the National Institutes of Health requires that children be included in all studies unless there are scientific and ethical reasons not to.

Patterns in the Use of Complementary Health Approaches for Children

The 2012 National Health Interview Survey (NHIS) included a comprehensive survey on the use of complementary health approaches by almost 45,000 Americans, including more than 10,000 children aged 4 to 17. The survey found that 11.6 percent of the children had used or been given some form of complementary health product or practice, such as yoga or dietary supplements, during the past year.

The most frequently used approaches for children were natural products (fish oil, melatonin, and probiotics), and chiropractic or osteopathic manipulation.

For children, complementary health approaches were most often used for back or neck pain, other musculoskeletal conditions, head or chest colds, anxiety or stress, attention-deficit hyperactivity disorder (ADHD) or attention-deficit disorder (ADD), and insomnia or trouble sleeping.

10 Most Common Complementary Health Approaches Among Children-2012: follow link for full description

Diseases/Conditions for Which Complementary Health Approaches Are Most Frequently Used Among Children-2012: follow link for full description

Other studies show that children in the United States who use or are given complementary health approaches vary in age and health status. For example:

  • About 10 percent of infants are given teas or botanical supplements, usually for fussiness or stomach problems.
  • About 40 percent of children aged 2 to 8 are given dietary supplements containing vitamins or minerals. However, that age group generally eats a nutritionally adequate diet.
  • Teens are particularly likely to use products that claim to improve sports performance, increase energy levels, or promote weight loss.
  • Children with chronic medical conditions, including anxiety, musculoskeletal conditions, and recurrent headaches, are more likely than other children to use complementary health approaches, usually along with conventional care.

What the Science Says About the Safety and Side Effects of Complementary Health Approaches for Children

  • Dietary supplements result in about 23,000 emergency room visits every year. Many of the patients are young adults who come to the emergency room with heart problems from taking weight-loss or energy products. One-fifth of the visits are children; most of whom took a vitamin or mineral when unsupervised. (Child-resistant packaging isn’t required for dietary supplements.)
  • Some dietary supplements contain contaminants, including drugs, chemicals, or metals.
  • Children’s small size, developing organs, and immature immune system make them more vulnerable than adults to having allergic or other adverse reactions to dietary supplements.
  • Some products may worsen conditions. For example, echinacea is a type of ragweed so people sensitive to ragweed may also react to echinacea.
  • Do not rely on asthma products sold over-the-counter and labeled as homeopathic, the U.S. Food and Drug Administration (FDA) warns. Homeopathic remedies and dietary supplements are not evaluated by the FDA for safety or effectiveness.
  • Biofeedback, guided imagery, hypnosis, mindfulness, and yoga are some of the mind and body practices that have the best evidence of being effective for children for various symptoms (such as anxiety and stress) and are low-risk. However, spinal manipulation, a common complementary approach, is associated with rare but serious complications.

More to Consider

  • Make sure that your child has received an accurate diagnosis from a licensed health care provider.
  • Educate yourself about the potential risks and benefits of complementary health approaches.
  • Ask your child’s healthcare provider about the effectiveness and possible risks of approaches you’re considering or already using for your child.
  • Remind your teenagers to talk to their health care providers about any complementary approaches they may use.
  • Do not replace or delay conventional care or prescribed medications with any health product or practice that hasn’t been proven safe and effective.
  • If a health care provider suggests a complementary approach, do not increase the dose or duration of the treatment beyond what is recommended (more isn’t necessarily better).
  • If you have any concerns about the effects of a complementary approach, contact your child’s health care provider.
  • As with all medications and other potentially harmful products, store dietary supplements out of the sight and reach of children.
  • The NCCIH Web site offers safety tips on dietary supplements and mind and body practices for children and teens.
  • Tell all your child’s health care providers about any complementary or integrative health approaches your child uses. Give them a full picture of what you do to manage your child’s health. This will help ensure coordinated and safe care.

Selecting a Complementary Health Practitioner

If you’re looking for a complementary health practitioner for your child, be as careful and thorough in your search as you are when looking for conventional care. Be sure to ask about the practitioners –

  • Experience in coordinating care with conventional healthcare providers.
  • Experience in delivering care to children.
  • Education, training, and license. For more information on credentialing, see the NCCIH Web site or visit my terms and conditions page here.

You can also read more about kid’s life coaching here.