Humans have been making music ever since they realized that tapping two sticks together could create an engaging beat. Music can foster feelings of joy, unleash our creativity, and is often a key feature of our most enjoyable social gatherings. Ever versatile, music can set the tone for romance or relaxation, and can impel us to move our bodies, whether for exercise or self-expression.

In the mid-twentieth century, music therapy emerged as a discipline, and the development of modern technologies has since shed new light on how music can change the structure and function of the brain, improve mood, and help us recover after a stroke.

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Music and the Brain

One thing we have learned is that music is processed by a number of different areas of the brain, including ones involved in spoken language. Learning to play music changes the structure of our brains in a way that is somewhat analogous to how physical exercise tones our muscles and makes us stronger and more dexterous. A number of studies with healthy and clinical samples have shown temporary cognitive benefits associated with listening to pleasant music, including improved information processing speed, reasoning, attention and memory, and creativity.

In some studies, verbal material that was presented in a musical context was learned and recalled better than spoken verbal material. Music therapy has also helped people who have had strokes to improve their gait, mood, speech, social interactions, and to reduce visual neglect.

Music Therapy and Visual Processing

Visual neglect is the inability to recognize objects in part of the visual field due to lesions in the visual cortex. Specifically, a lesion in one hemisphere produces neglect in the opposite visual field (so a stroke in the left visual cortex would result in one being unable recognize objects in the right visual field, and vice versa). In one study of stroke patients experiencing visual neglect, listening to pleasant music resulted in both better mood and a statistically significant improvement in their ability to describe the color and shape of geometric objects presented via computer. No such effects were observed when patients sat in silence or when they were presented with music that they did not like.

Further examination with functional magnetic resonance imaging (fMRI) confirmed that listening to pleasant music activated a number of different brain areas, including those involved in visual processing.

Memory, Attention, and Mood

The same team conducted another study, this time with 60 patients who had recently suffered a stroke. Participants were randomly assigned to one of three groups: a music group, an audio book group, or a control group receiving neither intervention. All groups otherwise received standard medical treatments. Those in the two audio groups were allowed to select either the music or audio books of their choice and were asked to listen for an hour daily for two months, and then more on their own after the intervention period ended.

Listening to music was associated with greater recovery of verbal memory and focused attention in the music group versus the other two. Furthermore, the music group participants had significantly less depression and confusion than those in the control group. This benefit was seen within the first three months of listening.

The act of listening to music has been associated with a number of benefits, including on mood, cognition, and physical functioning in healthy people and in clinical samples, such as those who have suffered a stroke.

Those in the music group reported that listening helped them relax, increased their motor activity, and improved their moods. In both the music and audio book groups, participants said the experiences provided positive stimulation. Preliminary imaging results suggest that listening to music following a stroke may result in observable changes to the structure and function of the brain that enhance recovery.

The researchers speculate that the short-term cognitive benefits of music therapy post-stroke may be related to effects on the brain’s reward system and effects on the neurotransmitter dopamine, but the long-term effect is more likely due to improvements in mood somehow impacting improvements in verbal memory and attention. Music may also mitigate the negative effects of stress on the brain and body, and impact other neurotransmitters that play a role in recovery.

The act of listening to music has been associated with a number of benefits, including on mood, cognition, and physical functioning in healthy people and in clinical samples, such as those who have suffered a stroke. Although we are still learning about how and why music helps, it is worth making time for music to move your body, engage your mind, and soothe your soul.

References:

1. American Music Therapy Association: http://www.musictherapy.org
2. Thaut, M., & McIntosh, G. (2010). How Music Helps to Heal the Injured Brain. Therapeutic Use Crescendos Thanks to Advances in Brain Science. Cerebrum. http://dana.org/news/cerebrum/detail.aspx?id=26122
3. Sarkamo, T., & Soto, D.  (2012). Music listening after stroke: Beneficial effects and potential neural mechanisms. Ann. N.Y. Acad. Sci., 1252, 266–281.

Contrary to what we may think, getting older is actually not all that bad. There may be financial and emotional challenges, and health conditions may change the way we live. But according to an abundance of research, older people have lower levels of negative affect, or disposition, than younger people. To better understand why this is, Amanda J. Shallcross of the Department of Psychology at the University of Denver recently led a study that looked at acceptance. She believes that acceptance to negative life events weakens the negative reactions to those events and causes them to impact a person’s affect less. In other words, as we age we are more accepting of things and, ultimately, less unhappy.

Shallcross used the emotional states of anger, anxiety, and sadness to explore her theory. She evaluated 340 participants ranging in age from 21 to 73 years old and subjected them to a stress-inducing experiment designed to cause negative affect. She measured their responses to the induction at the time of the experiment and several more times over the next six months. She found that the older individuals had more acceptance of the stressful condition and responded with less anger and anxiety than the younger participants. However, she did not find lower levels of sadness in the older participants.

These results suggest that as people age they learn to accept conditions in their lives. Perhaps anger and anxiety no longer serve their goals of forming intimate relationships, maintaining family bonds and social networks. They may alter their emotional responses to events in order to secure those relationships. As for sadness, Shallcross believes that older individuals may actually benefit from acceptance there as well. Because they experience more adversity, loss, and life challenges as they age, older individuals should have higher levels of sadness than younger individuals. But in this study, their sadness was equal to the younger participants. Again, Shallcross believes that this was the result of acceptance. “This skill may decrease levels of sadness to remain on par with those of younger individuals,” said Shallcross. “Thereby, net levels of sadness remain constant across age groups.” Overall, these findings demonstrate that acceptance is an important skill for maintaining a positive well-being. And most importantly, people do not have to wait until they are old to acquire that skill. It can be learned at any age.

Reference:
Shallcross, A. J., Ford, B. Q., Floerke, V. A., and Mauss, I. B. (2012). Getting better with age: The relationship between age, acceptance, and negative affect. Journal of Personality and Social Psychology. Advance online publication. doi: 10.1037/a0031180

While not everyone’s experience is the same, when people have a major depressive episode, generally the world looks, feels, and is understood completely differently than before and after the episode. During a major depressive episode, the world can literally seem like a dark place. What was beautiful may look ugly, flat, or even sinister. The depressed person may believe loved ones, even their own children, are better off without them. Nothing seems comforting, pleasurable, or worth living for. There’s no apparent hope for things ever feeling better, and history is rewritten and experienced as confirmation that everything has always been miserable, and always will be.

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When this reality shift happens, it’s difficult to remember or believe what seemed normal before the episode. What the person believes during the episode seems absolutely real, and anything that conflicts with it is as unbelievable as a memory or message telling him or her that the sky is purple. For example, if the person is unable to feel love for a spouse, and someone reminds the person that he or she used to feel that love, the person may firmly believe he or she had been pretending to himself/herself and others—though at the time he or she really felt it. The person can’t remember feeling the love, and can’t feel it during the episode, and thus concludes he or she never felt it. The same process happens with happiness and pleasure. Attempts to tell the person that he or she used to be happy, and will feel happy again, can cause the person to feel more misunderstood and isolated because he or she is convinced it’s not true.

Even if nothing was wrong before the episode, everything seems wrong when it descends. Suddenly, no one seems loving or lovable. Everything is irritating. Work is boring and unbearable. Any activity takes many times more effort, as if every movement requires displacing quicksand to make it. What was challenging feels overwhelming; what was sad feels unbearable; what felt joyful feels pleasureless—or, at best, a fleeting drop of pleasure in an ocean of pain.

Major depression feels like intense pain that can’t be identified in any particular part of the body. The most (normally) pleasant and comforting touch can feel painful to the point of tears. People seem far away—on the other side of a glass bubble. No one seems to understand or care, and people seem insincere. Depression is utterly isolating.

There is terrible shame about the actions depression dictates, such as not accomplishing anything or snapping at people. Everything seems meaningless, including previous accomplishments and what had given life meaning. Anything that had given the person a sense of value or self-esteem vanishes. These assets or accomplishments no longer matter, no longer seem genuine, or are overshadowed by negative self-images. Anything that ever caused the person to feel shame, guilt, or regret grows to take up most of his or her psychic space. That and being in this state causes the person to feel irredeemably unlovable, and sure everyone has abandoned or will abandon him or her.

It’s difficult to describe all of this in a way that someone who’s never experienced it can make sense of it. I can’t emphasize enough that when this happens, what I am describing is absolutely the depressed person’s reality. When people try to get the person to look on the bright side, be grateful, change his or her thoughts, or meditate, or they minimize or try to disprove the person’s reality, they are very unlikely to succeed. Instead, they and the depressed person are likely to feel frustrated and alienated from one another. I do believe cognitive therapy has an important place, but generally not in the throes of a major depressive episode.

Support for People with Depression

So what does a person whose reality has shifted in this way need? Please keep in mind that I am talking about a major depressive episode—severe depression that has lasted more than two weeks. I would take a different approach for someone with milder depression, or one that is a response to a terrible loss.

For some people in a major depression, psychotropic medication works and is the only thing that works. The same could be said for electroshock treatment, though it’s not for everyone. Many people will emerge from major depression in time, though episodes seem to make more episodes more likely, so if medication works to end the episode, it’s usually prudent to take it. Nutrition, acupuncture, and other body-based treatments as well as therapy can help without the side effects of medication.

What Loved Ones Can Do

Loved ones can gently hold and show love and commitment to the depressed person, try not to take on the person’s reality, but also not argue with him or her about it. They can also gently remind the person that depression causes his or her perspective on everything to change, and he or she is unable to think outside of depression mode at the moment. It is a time for the person to avoid making decisions, or avoid doing anything significant that requires a nondepressed perspective. If this is a repeated experience for this person, it can be helpful to discuss all of this between episodes so he or she is more prepared when caught in the quicksand.

As someone who loves a person with depression, it can be emotionally difficult or stressful at times to support that person. It can be beneficial to focus on your own needs and self-care, and to reach out for help if you need it such as seeking the support of a counselor or therapist.

Depression coupled with severe anxiety represents an often-debilitating psychiatric condition. Treatment is frequently a challenging proposition, marked by repeated trial and error. No two people are alike, and reactions to specific medications run the gamut from successful remission of symptoms to no effect whatsoever. In other cases, side effects may be so severe that someone is forced to discontinue a medication.

Severe mood issues and constant worry often lead to pronounced physical symptoms. Severe anxiety, for example, is well known to cause gastrointestinal complaints. Unfortunately, many of the most commonly prescribed antidepressant medications have stomach upset or nausea as one of their known side effects.

Sinequan (doxepin) is an older variety of antidepressant medication that has fallen out of favor because of its broad side effect profile. However, at low doses, these side effects mostly disappear. A pair of case studies demonstrated that a standard antidepressant such as Zoloft (sertraline), combined with low doses of Sinequan, offered noticeable improvements to both depression and anxiety without stomach upset. Both of these individuals had tried and failed with nearly every antidepressant and anti-anxiety medication on the market. Side effects or lack of noticeable benefit was the consistent result, regardless of treatment method.

Even combination treatments proved ineffective. Studies have shown that repeated non-remission of severe depression predicts a negative outcome. Therefore, discovering an effective treatment in these difficult cases is especially important.

Based on previous research findings, attending physicians in these case studies surmised that Sinequan would reduce or eliminate gastrointestinal symptoms at low doses. In the absence of nausea and stomach upset, the patients would be less inclined to discontinue their antidepressant regimen. Furthermore, the low dosage would avoid the most troubling of Sinequan’s side effects, such as drowsiness, weakness, and dry mouth. At regular doses, Sinequan has been known to cause nausea. The dosages in these case studies, however, were far below standard prescription levels.

For the people involved, remission of their gastrointestinal symptoms was instrumental in alleviating both their depression and anxiety. Further research will determine if low-dose Sinequan is applicable in a wider range of cases. The primary concern is with the safety of the medication, particularly in elderly patients or those with a long history of unsuccessful treatment.

References:

1. Doxepin – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved March 28, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000668/
2. MacLean, L., & Ahmedani, B. (2011). Sertraline and Low-Dose Doxepin Treatment in Severe Agitated-Anxious Depression With Significant Gastrointestinal Complaints:Two Case Reports. The primary care companion to CNS disorders, 13(4). Retrieved March 28, 2012, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219524/?tool=pmcentrez

Everyone has experienced a “gut feeling” at one time or another, but not everyone voices his or her feelings. Implicit attitudes, or gut feelings, tend to guide our behaviors. However, our explicit attitudes, the way in which we give voice to our emotions, are not always aligned with our implicit attitudes. In fact, research has shown that there is quite a gap between implicit and explicit attitudes. Societal expectations and conformity could have something to do with this, causing people to stifle their true feelings in order to be socially accepted. But so could our moods. Jeffrey R. Huntsinger of the Department of Psychology at Loyala University in Chicago believes our explicit attitudes more closely reflect our implicit attitudes when we experience anger.

In an attempt to determine if anger closes the gap between implicit and explicit attitudes, Huntsinger recently conducted a study involving three separate experiments. Huntsinger assessed the association between implicit and explicit attitudes of participants after they experienced angry, sad, and neutral emotional cues. He found that anger resulted in a more authentic explicit manifestation of implicit attitudes than neutral or sad moods. Huntsinger believes anger is like happiness, which causes a similar effect, in that both happiness and anger increase confidence. People who are sure of their emotional states will be more likely to voice their true opinions, their gut feelings, than those who are less sure of themselves. When they doubt their implicit attitudes and are less confident in themselves, as is the case in moments of sadness, people are less likely to exhibit their authentic attitudes in explicit ways.

“Although this research concerned the influence of anger on agreement between implicit and explicit attitudes, these results have implications beyond this particular domain of inquiry correspondence,” Huntsinger said. In particular, the appraisals associated with anger may be associated with other emotions, such as disgust. Each of these unique emotions also influences approach and avoidance behaviors. All of these factors should be explored in more depth in future research in order to capture a more comprehensive picture of what draws our implicit and explicit attitudes closer together and what drives them apart.

Reference:
Huntsinger, J. R. (2012). Anger enhances correspondence between implicit and explicit attitudes. Emotion. Advance online publication. doi: 10.1037/a0029974

Depression makes it difficult to function in daily life, but adding discrimination to the equation makes it even more troublesome.

A new study in the journal The Lancet stated that out of the 1,082 adult participants with major depressive disorder, 79% reported that they have experienced discrimination. People who experienced discrimination while depressed had more depressive episodes, social difficulties, and issues finding and keeping a job. They also were less likely to reveal a diagnosis of depression.

These results suggest that more works needs to be done in the area of preventing discrimination and eliminating stigma. Discrimination can prevent people with depression, who may be worried about disclosing their diagnosis, from getting the help they need. While getting a job and growing social networks can help fight depression symptoms, those pursuits become more challenging in the face of discrimination.

How, specifically, does discrimination affect people with depression? How can the general public be more understanding? And what options do people with depression have? Mental health experts and other professionals have some answers.

Dr. David Sack, CEO of Elements Behavioral Health and Promises Treatment Centers, said by email that sensitivity toward people with depression often is lacking.

“The most common example has to do with intolerance toward peers/friends/relatives that comes from not understanding that depression is a disease that the individual cannot simply will themselves out of,” he said.

Sack said a supervisor might question an employee’s motivation and commitment due to symptoms of depression, even if those symptoms don’t reflect how the employee really is.

“How often have we heard that this or that person claims that they are depressed just so they can get time off from work or won’t have to take responsibility for mistakes they’ve made?” Sack said.

Although many people know the basics of depression thanks to widespread awareness initiatives, prejudice, bias, and stigma still are rampant.

Viola Drancoli, a clinical psychologist, said in an email that friends and family members of people with depression might exhibit discriminatory behavior with them because they may feel drained from being around someone who expresses sadness, pessimism, irritability, and a lack of motivation.

This could push someone with depression into isolation. A person with depression might prefer being alone so he or she doesn’t have to attempt to hide feelings from others.

“The social isolation often starts a vicious cycle in which the (client’s) negative outlook on life is reaffirmed, they feel let down by family and friends, and symptoms may worsen,” Drancoli said. “This is especially dangerous for individuals who have suicidal ideations and need support and monitoring.”

Drancoli said it’s important for family and friends to be supportive. She suggests volunteering to help out with chores that might be difficult for someone with depression to complete when he or she is struggling to function, as well as patiently listening without judgment. Loved ones can gently encourage a person with depression to exercise as well, as this has been shown to boost mood.

People with depression who believe they have been discriminated against have the law on their side. Sack said that discrimination against people with any disabilities, including mental issues such as depression, is forbidden by the Americans with Disabilities Act. The civil rights law, enacted in 1990, defines disability as “a physical or mental impairment that substantially limits a major life activity.” Some states have additional laws against discriminatory behavior.

“An individual who is concerned about discrimination at work will want to speak with their supervisor or the director of human resources first,” Sack said. “Most companies have strong policies to promote fairness and nondiscrimination.”

Justine Lisser, a senior attorney advisor in the Office of Communications & Legislative Affairs at the U.S. Equal Employment Opportunity Commission, said by email that if an employer has at least 15 employees, it must abide by the ADA. Employers need to provide “reasonable accommodations” for people with disabilities, as long as the employer isn’t deeply burdened as a result.

“For example, if a person with depression is hired for a position that requires an 8 a.m. start time, but due to the effects of (antidepressant) medication the person could not start until 10 a.m., it would be a reasonable accommodation to permit the employee with depression to start at 10 a.m., assuming that it would not cause an undue hardship for the employer,” Lisser said.

The EEOC has successfully enforced employee discrimination laws in a few cases involving people with mental health issues. In one case, a sales associate at a video retailer experienced harassment because of his social anxiety disorder and depression. His employer was ordered to pay $70,000 to settle the discrimination suit, according to an EEOC press release from March 2012.

Sports generally are viewed as harmless pursuits, a source of social interaction and bonding, exercise, and stress relief. But in recent years, highly publicized incidents of fan violence have raised concerns about the culture surrounding sports. The vicious 2011 beating attack on Bryan Stow at Dodger Stadium in Los Angeles is just one such example. Alcohol-fueled fights and skirmishes are increasingly common at all levels of competition, from playgrounds to professional leagues. Most people who have attended a sporting event have witnessed at least one example of an out-of-control fan.

What’s behind this surge in violence? The problem may not be the nature of sports themselves, but rather the way society treats sports in conjunction with personal factors. A closer look at some factors that may contribute to fan violence:

Overidentification

For many sports fans, their teams of choice become a proxy for their own identities. Overidentifying personally with a favorite team may be a contributing factor to sports violence. A person who watches a favorite team lose, or witnesses an unfavorable referee call, may behave as if he or she has personally suffered. The advent of Facebook and other social media, as well as message boards and other gathering places for fans, may make it difficult to disengage from favorite teams or let go of bad memories. These platforms also provide more access to inflammatory views from rival teams’ fans, fueling deep feelings of loyalty, protectiveness, and anger that boil to the surface amid the emotional current of a live game.

Alcohol

Alcohol plays a significant role in many fan altercations. At National Football League games in 2011, more than 7,000 fans were ejected for inappropriate or violent behavior. Some fans spend all morning and afternoon tailgating and drinking with friends before watching the event and then celebrating—or grieving—afterward. People often are intoxicated before even entering a venue. The feelings of deep loyalty and anger that many fans feel can be exacerbated by alcohol consumption.

Hypermasculine Culture

Despite years of progress toward gender equality, many men feel pressured to meet expectations of traditionally masculine behavior. Sports can be a significant platform for masculine identity, and people who identify with hypermasculine culture may be more likely to attend sports events. Combined with adrenaline, overidentification, and ready access to fans with opposing allegiances, some men may be inclined to be violent when exposed to triggers. Likewise, women in hypermasculine environments that promote disrespectful or violent behavior may also be more inclined to engage in it.

Sociological Factors

Certain people are at a greater risk of engaging in violent behavior. People who have experienced a recent stress such as job loss, the death of a loved one, or a perceived humiliation are already on edge and more likely to react emotionally. Many people attend sporting events to alleviate stress. However, when a favored team loses, a person is heckled, or a person loses a significant bet associated with a game’s outcome, stress may explode into rage.

Group Dynamics

Millions of people attend sporting events every year, and the vast majority never commit a violent act. When 100,000 people pack a stadium, though, the odds are high that a number of them are under the influence of alcohol. Combine this with an emotional, hypermasculine environment and exposure to opposing sentiment, and you’ve created a recipe for fan violence. Proactive measures such as reporting inappropriate behavior immediately, limiting alcohol intake, and actively encouraging sportsmanship among peer groups, can help address an increasingly challenging threat to our enjoyment of sporting events.

References:

1. Aguirre, B. E. (2008). Sports fan violence in North America. Contemporary Sociology: A Journal of Reviews, 37(2), 157-158. doi: 10.1177/009430610803700235
2. Associated Press. (2012, May 31). Witnesses describe violent scene. ESPN. Retrieved from http://espn.go.com/los-angeles/mlb/story/_/id/7991565/witnesses-depict-violent-scene-bryan-stow-beating
3. Handwerk, B. (n.d.). Sports riots: The psychology of fan mayhem. National Geographic. Retrieved from http://news.nationalgeographic.com/news/2005/06/0620_050620_sportsriots.html

Let’s face it: Every woman on the planet knows about hormonal cycles. They’re difficult to ignore. Most men, on the other hand, are taught from the time they are born that being manly means denying anything in us that might be viewed as “feminine.” I still remember the taunts when I was a kid. “What’s the matter with you, Diamond, you throw like a girl.” Or, “Look, he’s going to cry, just like a little girl.”

It’s no wonder guys grow up convinced that we’re not “hormonal.” But is that true? Many of us know intellectually that we have hormones. We know we’ve got testosterone. Many of us have a vague idea that we also have estrogen coursing through our bloodstream—a fact we’d like to ignore. Hormonal cycles? That sounds too “fem” for many of us to even contemplate.

Midlife Hormonal Changes

I first began to recognize that there might be more going on inside me when I began doing research on andropause, or male menopause, in the early 1990s. I was seeing changes going on with midlife men at my health clinic that seemed similar to what I saw with women going through menopause. Many of the men were having “night sweats” and “hot flashes.” Others were on an emotional rollercoaster, up one minute and down the next. Some were having unexplained joint pain, and others were having problems becoming aroused or having intercourse.

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I began interviewing midlife men and women to find out what they were experiencing. Most of the men thought the idea that they were “hormonal” was ridiculous. Most of the women had a different view. “Well, it’s about time you guys finally figured out you’re hormonal,” one woman told me. Eventually, I interviewed more than 1,000 men and women, and 30,000 filled out a questionnaire I developed. The results were published in my books, Male Menopause, in 1997, and Surviving Male Menopause: A Guide for Women and Men, in 2000.

Do Men Have Hormonal Cycles?

Although most of us now accept that women and men have “male” and “female” hormones, it is more difficult to accept that men also have hormonal cycles. According to endocrinologist Dr. Estelle Ramey, professor at Georgetown University Medical School, “The evidence of them may be less dramatic, but the monthly changes are no less real.” But if men do have hormonal cycles, why don’t they recognize or talk about them? Dr. Ramey believes it is because men respond to their cycles in a way that is a function of their “culturally acquired self-image. They deny them.” This denial is the main reason she believes the largely male scientific and medical communities have taken so long to recognize hormonal cycles in men.

Winifred Cutler is one of the world’s leading experts on hormonal cycles. She has published more than 35 scientific papers, is co-inventor on five patents, and has authored eight books, including Love Cycles: The Science of Intimacy. “Now it is known that men show a hormonal rhythm,” she says. “A rhythm I call the hormonal symphony of men.”

A cycle might last a few minutes, a day, a week, a month, a season, a year, or a lifetime. When we go to sleep, our testosterone levels rise hour by hour until, by the time we awaken, they are at their highest (morning erections, anyone?). By the early and late morning, our levels typically level off and begin to decline. By late afternoon, our testosterone is usually at its lowest ebb. No wonder it’s more difficult for me to get up for the “afternoon delight” my wife thinks is wonderful, while I’m more interested in a morning romp.

Men’s hormones cycle throughout the year. In studies conducted in the United States, France, and Australia, it was found that men secrete their highest levels of sex hormones in October and their lowest levels in April. There was a 16% increase in testosterone levels from April to October and a 22% decline from October to April. Interestingly, although Australia, for example, is in its springtime when France and the United States are in their autumn, men in all three parts of the world showed a similar pattern of peaks in October and valleys in April.

Men also have monthly hormonal cycles, though there are some interesting differences and similarities between women’s and men’s cycles. Women’s monthly cycles are more predictable and synchronous. Women who live in close proximity find that their monthly cycles begin to align. Men’s cycles seem to be more unpredictable and individual. A study of young men showed that the majority had a discernible cycle of testosterone with repeating rises and falls, but each man who did show a cycle had a cycle unique to himself.

“Testosterone levels oscillate every 15 to 20 minutes in men, and also follow daily, seasonal, and annual rhythms,” says Theresa L. Crenshaw, author of The Alchemy of Love and Lust. “The morning highs, daily fluctuations, and seasonal cycles whip men around. Think about the moment-to-moment impact of testosterone levels firing and spiking all over the place during the day and what this must be doing to a man’s temperament. Men who so strongly need to feel in control are in fact in much less control than they realize. No wonder they can be so, well, testy!”[fat_widget_right]

I suspect that we’d all be better off if we recognized that men, like women, have our own challenges dealing with our hormones. The great philosophers tell us to “know thyself.” Knowing and accepting our hormonal cycles may be the most important knowing we can have about what it means to be a man.

This is the second in a series of articles designed to explore some of the issues and concerns that arise around what is currently called Asperger’s syndrome, which will soon be incorporated into the broader spectrum of autism disorder when the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is published in 2013.

Emotional intelligence (EI) is generally understood to be a person’s ability to identify and assess his or her emotional state, as well as the emotional state of others. It is not related to the kind of intellectual capability or intelligence typically assessed by IQ tests. Rather, it corresponds to a person’s ability to relate to others, work in groups, read between the lines in conversation, and interpret behaviors and moods displayed by others. It also relates to an individual’s understanding and regulation of those qualities within. High emotional intelligence provides a sort of shorthand for smooth interpersonal relations and communication.

Emotional intelligence is related to theory of mind. (See my previous blog, titled Asperger’s Syndrome: Theory of Mind.) The better able you are to imagine the world from another person’s point of view, the more likely you are to score high on a measurement of emotional intelligence. Persons with high EI are able to anticipate what someone might do in reaction to certain circumstances or statements. They are able to empathize with unspoken sadness because they are able to interpret an event in ways another person is likely to interpret it, given what they know about that person. They are able to avoid certain topics of conversation because they can predict which subjects might be problematic for another person. They understand the concept of conversational finesse. High EI is at the very heart of diplomacy.

A person with Asperger’s syndrome experiences the world in a very different way. With a tendency to take conversations and events literally, the emotional subtext often is unseen. This can lead to behavior that appears inappropriate at best, heartless or cruel at worst.

Imagine, for example, not being able to understand why the death of a beloved pet is still a sensitive issue for your friend even several years after the pet has passed away. Imagine saying something such as, “But that cat has been dead for two years!” And then imagine the reaction of your friend, who in that moment is feeling sad about the loss, feeling it as strongly as if he or she had lost the pet yesterday. Your friend is not likely to react well. Your words might sound intentionally cold, uncaring, and thoughtless. But when your friend does not respond favorably, you are confused. What do you do now? You made a simple statement of fact, and now your friend is upset with you.

This is the experience of challenged emotional intelligence. This is commonly the experience of a person with Asperger’s. Anxiety soars as the person wonders what he or she did wrong, what he or she failed to understand, or what was missed.

With therapy, a person with Asperger’s can learn to decode some of what seems mysterious in the realm of emotional intelligence. It is possible to discern intellectually what may not come naturally emotionally. For example, to use the above scenario as a basis of conversation in a therapy session might help a person with Asperger’s see that there are different ways of responding to the death of a pet, and that the person’s own, seemingly logical way may not be the way others respond to something as essentially emotional as the loss of a pet.

Learning that there is such variability helps a person with Asperger’s navigate the complex emotional undertones of daily life. It also helps relieve the free-floating anxiety that can accompany conversations and events, both familiar and unfamiliar, because it broadens the range of expectations and softens the likelihood of inadvertent blunders.

Emotional intelligence is a challenge for individuals with Asperger’s, but it is also a fruitful topic for exploration in therapy because it is so central to most interactions with others, both in social and in intimate contexts.

One of the most common methods for assessing the behavioral and emotional state of a child is a parental report. This type of evaluation usually comprises a parent’s observation and evaluation of the child’s feelings, mood states, and behaviors over a period of time. But just how accurately do parents gauge the emotional temperature of their children? That was the question at the center of a recent study conducted by C. Emily Durbin of the Department of Psychology at Michigan State University. Because parental reports can vary quite dramatically from reports obtained by other observers, such as teachers, counselors, and classmates, Durbin wanted to determine what factors, if any, skewed parents’ perceptions.

Durbin chose to focus on the effects of maternal depression on parental reports. She based her decision on the fact that other conditions, such as alcoholism, parental anxiety, and family distress, have been shown to influence maternal reports. Durbin extended the existing research and compared mothers’ reports with those of unbiased observers on a sample of 190 children ranging from 3 to 6 years old. Participants were instructed to rate levels of sadness, fear, happiness, surprise, and anger in the children after they completed 10 emotion-inducing tasks. Durbin found that the mothers with a history of depression or anxiety tended to rate their children as less happy than mothers with no such history. Additionally, these same mothers viewed their children as overly fearful, and rated girls as sadder than boys. This could be a result of maternal sensitivity to emotions such as fear and sadness. However, the outcome showed a significant disparity between observers’ ratings and those of the mothers with a psychological history. “These mothers may have greater difficulty setting aside their perceptions of the child’s typical emotional adjustment to focus solely on rating the behavior the child is currently exhibiting,” Durbin said. Although the sample size was limited to young children and did not contain a large number of mothers currently exhibiting depressive symptoms, the results warrant further investigation. Durbin believes it is essential to expand this research to include older children, comparison to other assessment tools, and evaluation of other aspects of childhood development.

Reference:
Durbin, C. Emily, and Sylvia Wilson. Convergent validity of and bias in maternal reports of child emotion. Psychological Assessment 24.3 (2012): 647-60. Print.

Dialectical behavior therapy (DBT) is a comprehensive, evidence-based treatment approach used to treat individuals with a wide variety of issues, including relationship conflict, anxiety, depression, bipolar, self-injury, eating issues, and substance abuse. Developed in the 1980s by psychologist Marsha M. Linehan for the treatment of borderline personality disorder and chronic suicidality, this method has since been adapted and utilized to help clients with much less severe issues. The therapy can help clients who exhibit extreme emotional reactions, helping them develop self-acceptance while also learning coping skills to better regulate their emotions and handle distress. DBT uses both individual therapy sessions and group skills training, as well as telephone coaching between sessions.

The DBT model combines a behavioral therapy approach with eastern mindfulness practices. In one sense, the term dialectical refers to the goal of synthesizing the extreme opposites inherent in the rigid “black and white” thinking of many clients who have trouble regulating their emotions. “Dialectical” also applies to the core DBT principle of practicing acceptance strategies while implementing change strategies, in the process of reducing and modifying self-destructive behaviors.

This type of therapy is very support-oriented; it helps clients identify their strengths, build new skills, and increase their self-esteem. DBT focuses on cognitive issues by indentifying destructive thought patterns and replacing them with more neutral and accepting internal dialogues. It is designed to be a nonjudgmental collaboration, with the therapist and client working together to increase emotional awareness and understanding, minimize negative thought patterns and behaviors, and develop new coping and problem-solving skills.

The four modules of dialectical behavior therapy:

• Core mindfulness: The first of the four primary modules of DBT, this concept involves learning to observe one’s emotions, describe those emotions, and fully participate in present experiences. This skill forms the foundation for the other three modules, and is derived largely from eastern practices of living in the moment.
• Interpersonal effectiveness: The second core component of DBT teaches clients assertiveness skills and strategies to ask for what they need, set boundaries and say no when appropriate, and deal more effectively with interpersonal conflict.
• Distress tolerance: The third module entails clients developing nonjudgmental acceptance of themselves as well as their current situation. The focus is on learning to accept the present reality and to tolerate crises, and making use of strategies such as distraction, self-soothing, and improving the moment. Practicing these skills will increase the client’s ability to tolerate challenging events and environments.
• Emotion regulation: The final module of DBT consists of three main goals: to understand one’s emotions, reduce emotional vulnerability, and decrease emotional suffering. With this in mind, some of the specific skills taught in DBT include identifying and labeling emotions as well as evaluating: events that prompt the emotion, interpretations that trigger the emotion, how the emotion is experienced, how the emotion is expressed behaviorally, and the aftereffects of the emotion.

In the case of adolescent treatment, Dr. Alec Miller has adapted Dr. Linehan’s model to incorporate parents attending skills training groups with their teens. There is an additional module, “walking the middle path,” which focuses on helping parents and their children understand each other’s viewpoints and reduce conflict and invalidation.

The five functions:

Dialectical behavioral therapy was designed to fulfill five primary functions:

• Enhance behavioral capabilities: DBT helps clients develop important life skills that help them regulate emotions, experience the present moment, improve interpersonal interactions, and better tolerate distressing situations.
• Improve motivation to changes: DBT supports clients’ motivation to change by tracking and reducing detrimental behaviors, thereby increasing quality of life.
• Generalize capabilities to other environments: In order for the client to make progress, the skills learned in therapy must transfer to a wide variety of situations. This is accomplished through homework assignments and practicing skills. Telephone consultations also can be valuable in helping clients utilize these skills in their daily lives.
• Support client and therapist capabilities: DBT aims to maintain and build the capabilities of therapists through continued training and consultation-team meetings.
• Enhance therapist motivation: The DBT model encourages the use of support, validation, feedback, and encouragement between therapists to avoid burnout and improve their effectiveness.

Stages of treatment:

The course of DBT generally flows through three stages:

• Stage 1: This stage is primarily focused on eliminating or reducing serious behaviors, including self-injury, suicidal thinking, and aggression. Behaviors that interfere with therapy also are addressed, such as missing appointments and not returning phone calls.
• Stage 2: The client strives to increase quality of life and experience emotions in a less intense manner. The client continues to eliminate or decrease destructive behaviors, and address other issues or situations that are interfering with daily life, such as past trauma.
• Stage 3: The client is experiencing increased feelings of completeness, self-respect, and love.

Who can benefit:

Though DBT originally was developed to treat more severe issues, such as borderline personality disorder, suicidal behaviors, and self-harm, the treatment has become a widely respected method for treating clients who exhibit the following, much milder traits and issues:

• Difficulty with emotional regulation
• A high level of reactivity, with a slow return to baseline
• Impulsiveness with a tendency toward self-destructive behaviors
• An inclination toward extreme thinking, unable to perceive a middle ground
• A lack of sense of self, tending to feel incomplete or empty
• A history of instability in relationships, and difficulty with interpersonal interactions
• Extreme sensitivity, accompanied by rapid mood swings, anxiety, and depression
• Fears of abandonment and trouble with intimate relationships

Dialectical behavior therapy has proven to be a very effective tool to help people manage intense emotions, change negative thought patterns, and decrease self-destructive behaviors. Individual therapy sessions focus on current detrimental behaviors in the client’s life, while group sessions involve learning skills from the four modules: mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation.

People who drink coffee usually crave it first think in the morning. Similarly, individuals who enjoy a glass of wine or a cocktail after a long day of work may have physiological cravings during peak happy hour times. And according to a new study conducted by Lydia A. Shrier of Harvard Medical School’s Department of Pediatrics and the Division of Adolescent/Young Adult Medicine at Boston’s Children Hospital, young adults who crave marijuana also do so at specific times of the day. Persistent cravings are associated with high levels of relapse, regardless of the substance. People who crave sweets, alcohol, cocaine, or other substances tend to report that obsessions of cravings for their substance are what preceded their most recent relapse. Some reports suggest that the majority of individuals who receive treatment for drug addiction have cravings when they abstain. This is a primary symptom of withdrawal in drug and alcohol addiction and can lead to eventual relapse. To better understand what causes or increases cravings, Shrier gathered information from 41 young adult marijuana users over a period of 2 weeks.

The participants were cued six times a day, and they recorded where they were, who they were with, their level of desire to use, the availability of marijuana, and mood. Shrier discovered that even though the participants had all been selected because of their current drug use, just over half of them reported any desire or craving for marijuana during the study period. Of those who did, location, companionship, and time were critical triggers. For instance, the participants had more cravings when they were with friends than when they were with parents. Additionally, cravings were more common in the evening than in the morning. The participants in this study may have been engaging in more social activities in the evening and more academic or job-related activities in the morning. This would explain the increase in reported cravings during evening hours, a time that is often viewed as more social. Shrier said, “The association between times of day and increased desire suggests that intervention strategies recommending alternative activities be focused on vulnerable times.” She believes that marijuana use may decrease if individuals are able to reduce their desire for marijuana, especially in situations when cravings are strongest.

Reference:
Shrier, L. A., Walls, C. E., Kendall, A. D. , Blood, E. A. (2012). The context of desire to use marijuana: Momentary assessment of young people who frequently use marijuana. Psychology of Addictive Behaviors. Advance online publication. doi: 10.1037/a0029197

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