Cognitive Behavioral Therapy as Possible Treatment for Anxiety-Depression Comorbidity

According to the National Institute of Mental Health (NIMH), anxiety is the most common mental

illness in the United States, affecting 40 million adults, nearly 18% of the U.S. population. Additionally, the NIMH reported that 10.2 million adults are affected by symptoms of major depression. That being said, it is highly critical that work be done to identify the nature of these diseases and how best to help those suffering.

Dr. Stewart Shankman recently came to Loyola University Chicago to talk to neuroscience students about anxiety and depression. Dr. Shankman spoke about a recent study, A Psychological Investigation of Threat and Reward Sensitivity in Individuals With Panic Disorder and/or Major Depressive Disorder, in which Gorka et al. (2013) broke down the relationship between anxiety disorders, depressive disorders, and anxiety-depression comorbidity. It is generally thought that the main component of anxiety is a heightened sensitivity to predicted/unpredicted threats, and the major component of depression is a reduced sensitivity to reward. Threat anticipation associated with anxiety was measured via the NPU-threat paradigm in which participants were either not exposed to an aversive stimulus, exposed to a predicted adverse stimulus, or exposed to an unpredicted adverse stimulus. The operational definition of sensitivity to threat was startle response. The sensitivity to reward associated with depression was measured via a virtual slot task in which participants pressed a button that had the potential to result in the winning of money. The operational definition of sensitivity to reward was an asymmetrical frontal EEG reading. Four different groups of participants complete both of these tasks: panic disorder (PD) only, major depressive disorder (MDD) only, comorbid panic disorder and major depressive disorder, and control participants. Results showed that PD, regardless of MDD, was uniquely associated with a heightened startle response to both predicted and unpredicted adverse stimuli. Additionally, MDD, regardless of PD, was uniquely associated with frontal EEG asymmetry while the participants anticipated the possible money reward. Interestingly, the results did not suggest that anxiety-depression comorbidity is simply an amplification of these disorder specific characteristics. The paper concluded that anxiety-depression comorbidity may be better characterized as higher levels of general distress and negative temperament associated with anxiety and depression respectively.
These findings suggest that treatment of anxiety-depression comorbidity should not simply consist of anxiety treatment and depression treatment. In a recent study, Randomized Controlled Trial of Group Cognitive Behavioral Therapy for Comorbid Anxiety and Depression in Older Adults, Wuthrich and Rapee (2013) found group CBT as an effective means to treat anxiety-depression comorbidity. The group CBT utilized in the study consisted of various interventions such as psychoeducation, cognitive restructuring, and graded exposure. The graded exposure consisted of components typically used to treat anxiety and components typically used during activity scheduling to treat depression. This success of blending anxiety and depression interventions into a unique treatment for anxiety-depression comorbidity confirms Gorka et al. (2013)'s finding that comorbidity is not simply anxiety and depression that co-occur as two separate disorders. These studies draw important attention to the nature of anxiety and depression and how the millions of people suffering from these disorders can be helped.

Resources:

Shankman, S. A., Nelson, B. D., Sarapas, C., Robison-Andrew, E. J., Campbell, M. L., Altman, S. E., ... & Gorka, S. M. (2013). A psychophysiological investigation of threat and reward sensitivity in individuals with panic disorder and/or major depressive disorder. Journal of abnormal psychology, 122(2), 322.

Wuthrich, V. M., & Rapee, R. M. (2013). Randomised controlled trial of group cognitive behavioural therapy for comorbid anxiety and depression in older adults. Behaviour research and therapy, 51(12), 779-786.

http://www.nimh.nih.gov/health/statistics/prevalence/any-anxiety-disorder-among-adults.shtml

Picture: http://www.thesmarterbrain.net/break-the-link-between-depression-and-anxiety/

The Workings of Nicotine: Scientific Interplay with Physiological Dependence

Tobacco addiction is best considered a chronic disease, with most smokers requiring repeated interventions over time before achieving permanent abstinence. Nicotine, the major addictive substance in tobacco, activates nicotinic receptors (nAChRs) to initiate a series of adaptive changes at the cellular and circuit levels in brain, particularly the ventral tegmental area (VTA). Disregarding the countless ads and initiatives taken to bringing the detrimental effects of cigarette smoking to light, it may seem not understandable to some as to why certain people are not able to “kick” the habit and put it down for once. Having a father who has smoked since he was 16, I have always wondered if the extent of his addiction to smoking was truly something that could be given up for the sake of his health and others around him. In search for understanding in the addiction of millions over the world, I looked at the scientifically achieved findings of Dr. McGehee along with another supplemental article that slightly correlated with the information he was able to obtain through experimentation.

Interestingly enough, though nicotine has many negative factors, when looking into an article written titled Can Nicotine Be Good for you, it was noted that certain patients had felt as though nicotine presented positive psychiatric effects. Surprisingly, the positively felt affects of nicotine ranged greatly, especially having influence on cognition, mood, attention, and even memory. It was reported that patients with mental disabilities had also taken to smoking at much higher rates, expressing that nicotine had ameliorated certain symptoms.

            Found to correlate in the studies presented forth by University of Chicago’s speaker Daniel S.McGehee at Loyola University’s Neuroscience Seminar on February 23^rd, it was noted that nicotine was able to facilitate long term potentiation in the VTA dopamine neurons by increasing glutamate release via activation of specific terminals, suggesting that nicotine played a strong role in the pre-synaptic contributing in LTP. In his publishing, Nicotine Potentiation of Excitatory Inputs to Ventral Tegmental Area Dopamine Neurons, he further went on the express the much more complex findings of nicotine influence on excitatory synaptic strength. Correlating well with the article mentioned before, the nicotine-induced changes in the VTA were expressed in his findings bringing in light to the brain chemistry of those who rely heavily on the highly induced effects that nicotine brings forth.

With the article I read and Dr. McGehee’s findings presenting a scientific interplay, explaining the chemistry behind the physiological need for nicotine for some, I was able to better understand the daily implications of intake of nicotine that smokers might go through. With increased advancement in looking to mimic or block those regulated excitatory signals put forth by nicotine, the world of health-care has been constantly working towards finding replacements for cigarettes in things like nicotine gum or patches. With continued effort and consideration of findings like these, there is a bright, potential future in alleviating the addictions of smokers, looking to potentially eradicate the detrimental effects.

Article Source: http://www.nytimes.com/2016/03/06/opinion/sunday/can-nicotine-be-good-for-you.html
Speaker Source: Mao, Danyan, Keith Gallagher, and Daniel S. McGehee. “Nicotine Potentiation of Excitatory Inputs to VTA Dopamine Neurons.” The Journal of neuroscience : the official journal of the Society for Neuroscience 31.18 (2011): 6710–6720.PMC. Web. 30 April. 2016
Image Sources: https://static01.nyt.com/images/2016/03/06/opinion/sunday/06fels/06fels-master768.jpg

https://s3.amazonaws.com/lowres.cartoonstock.com/health-beauty-nicotine_patches-smokers-cigarette-craving-crave-forn2203_low.jpg

VENs: A Hidden Gem?

Thomas Edison. Benjamin Franklin. Albert Einstein. These individuals have been categorized as being geniuses. It makes one wonder if there are geniuses lurking among us today. According to some recent studies, a new category of geniuses have emerged: Super-agers. In her presentation, Tamar Gefen spoke at Loyola University Chicago about the research her fellow colleagues and her were conducting regarding Super-agers. Super-agers are individuals who are of at least 80 years of age but, seem to have the memory capacity of individuals between the ages of 50-65.  From an experimental study they conducted, Dr. Gefen mentioned that Super-agers performed substantially better in memory oriented tasks in comparison to individuals who were of the same age group. With the difference in memory performance despite the similar age between the groups, researchers performed MRI studies to determine if differences existed within the brain between the groups. 

Researchers found that in comparison, Super-agers had greater thickness in their anterior cingulate cortex as well displayed a thicker cingulate cortex overall. According to Dr. Gefen, the surprising discovery was that the researchers found that Super-agers had an enormous abundance of VENs, von Economo neurons, within their brains. It has been found that VENs enable the thickness of the cingulate cortex which may give rise to the intellectual superiority of Super-agers.

However, there has been limited research done in regards to the role of VENs within humans. There has been studies done to see if VENs are found in other species. In fact, along with humans, ape species, four cetacean species, African and Indian elephants seem to have VENs as well. When observing the brains of African elephants that were obtained from the Cleveland Metroparks Zoo, it was found that VENs were abundant in their frontoinsular cortex and anterior cingulate cortex.  Researchers found that species with large-brains often had a high concentration of VENs. One plausible explanation is that due to their large size, VENs allow for “rapid transmission of information over long distances”.

Not only are VENs found within species that have large brains but, these species tend to have a high level of intelligence. Thus, is it possible that VENs and intelligence are interlinked? Do Super-agers have exceptional memories due to a high concentration of VENs ? With further investigation on the role of VENs, it is hoped to be able to answer these questions one day.

Works Cited

Picture 1:

https://www.google.com/search?q=superagers&rlz=1C1TSNP_enUS497US497&espv=2&biw=1517&bih=714&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjQtsKs_rTMAhXBUyYKHaPqDloQ_AUIDCgA&dpr=0.9#tbm=isch&q=smart+old+people&imgrc=M1u3u1aDyzAYUM%3A

Picture 2: 

https://www.google.com/search?q=superagers&rlz=1C1TSNP_enUS497US497&espv=2&biw=1517&bih=714&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjQtsKs_rTMAhXBUyYKHaPqDloQ_AUIDCgA&dpr=0.9#tbm=isch&q=african+elephant&imgrc=EdFsv9LYLDmCjM%3A

Article:

http://onlinelibrary.wiley.com/doi/10.1002/ar.20829/pdf

Melody and Memory: How music can induce an emotional response that helps memory formation

Imagine you are driving and get stuck in traffic. You start to feel annoyance with the people around you, regardless of the fact that they have no control of the situation any more than you do. To calm yourself, you turn on the radio and hear a song you can’t recall the name of, but sing along to the words anyways. The words come to you easily, despite not knowing the exact details of the song. This is a form of implicit memory. You can’t recall the exact details, but you can sing the song or at least hum the melody.

            In recent years, the study of implicit memory has come to the forefront, specifically in regards to memory disorders. One form of evidence that implicit memory plays a frequent role in an individual’s recognition memory utilizes the emotional response of the individual. In an article on memory and music, it was theorized that music can act as a therapy for people suffering from dementia. Dementia is a form of memory disorder that varies from individual to individual. It is suggested that music can help memory retrieval and cognition. Implicit memory can be triggered from an emotional tie to a specific song or melody that can trigger a specific memory, which is explicit memory recognition, or can elicit an emotional response. This emotional response is reminiscent of a memory, and it becomes an implicit memory.

            It is also suggested that music can help cognitive functioning as well as memory before and during a memory decline that is onset from dementia. Learning to play an instrument is a good way to help memory formation. This is because learning to play an instrument is a way of acquiring a skill or habit that will form implicit memories since habits and skills do not require conscious awareness.

            The use of music in recognition memory, specifically implicit memory, is a way of emotionally arousing an individual in order to trigger a memory response without conscious awareness. Dr. Ryals of Northwestern University studied the behavioral aspect of implicit memory by using trigger words. These specific words elicit an emotional response that arouses the participant. This triggers implicit memory in a free recall test that uses both emotional and neutral words. His behavioral study examines this idea of variable retrieval, which can also be described as a “tip-of-the-tongue” state. The results of the study suggest that implicit memories, which are also variable retrieval memories, can be triggered when an individual is emotionally aroused.

            Both Dr. Ryal’s study and the article on music and memory suggest similar ideas of implicit memory recognition. Emotional responses and arousals can be used to help individuals who have, or are predisposed to have, dementia or Alzheimer’s disease. By forming more implicit memories, individuals will be able to retain those happy memories and feelings.

http://previews.123rf.com/images/yadvigagr/yadvigagr1211/yadvigagr121100001/16259600-man-silhouette-with-brain-and-heart-Stock-Vector-music.jpg

References

Ryals, A.J., Voss, J.L. The outer limits of implicit memory. (2015). The Wiley Handbook on the Cognitive Neuroscience of Memory. 1. 44-59.

http://www.abc.net.au/radionational/programs/allinthemind/tapping-into-the-connections-between-music-and-the-brain/7288328

Memory Capacity in the Elderly

The article “Morphometric and Histologic Substrates of Cingulate Integrity in Elders with Exceptional Memory Capacity” by Tamar Gefen, Melanie Peterson, Steven T. Papastefan, Adam Martersteck, Kristen Whitney, Alfred Rademaker, Eileen H Bigio, Sandra Weintruab, Emily Rogalski, M.-Marsel Mesulam, and Changiz Geula was used in a talk given by Tamar Gefen. This study focuses on a group of 80 plus individuals that display episodic memory functioning of someone between the ages of 50-65. These unique individuals are referred to as “SuperAgers.” An experiment was conducted with two control groups: middle agers (50-65 years old) and cognitively average elderly (same age as SuperAgers) and one experimental group: SuperAgers. With using the MRI, scientists were able to analysis each individual’s scans and come to certain conclusions about SuperAgers. They found that these individuals displayed the same or greater thickness as the middle-aged control in their anterior cingulate cortex. Compare to the cognitively average elders, the SuperAgers also displayed a thicker cingulate cortex. They also found that SuperAgers had an abundance of VENs, which enhance the thickness of the cingulate cortex. Scientists came to the conclusion that this thickness may contribute to the preservation of cognitive and intellectual functioning in individuals who are 80 years or older in age. These findings lead scientists to believe that there could be possible biological factors to resistance for age-related diseases.

            The article, “Forget about Forgetting: Elderly know more, use it better” from Science Daily also focused on memory capacity in the elderly. This article believes that older people are slower because they retain a lot more information compared to younger people. They used the example of a computer database; if you keep adding more and more files to a database, the slower the computer will work. Similarly, if an elderly person cannot remember someone’s name, it might have to do with the fact that in the past couple of decades there have been more diverse names. Therefore, since there has been a remarkable increase in the number of names used, there are significantly more names for the elderly to remember. Even a computer would have a difficult time locating a name in today’s time with the increasing diversity and number of people. To support this claim that the elderly are slow because of the amount of information they have acquired over their lifetime, scientists performed a “paired-associate learning” test. They compared results from younger people to the elderly and found that the elderly took longer because they were sorting through what is a nonsense pair and what pairs connected whereas younger counterparts were not able to do this. This proves that older people are not weak or slow but actually know more than we think.

            Both of the articles discussed, “Morphometric and HIstologic Substrates of Cingulate Integrity in Elders with Exceptional Memory Capacity” and “Forget about Forgetting: Elderly know more, use it better” explore memory capacity in different ways. Gefen believes there is a biological reasoning for why some older people have excellent memory. Her research focused on how the anterior cingulated gyrus thickness and VENs contributes to the memory of the elderly. On the other hand, the article from Science Daily took a less biological approach. They believed that age does not mean one’s memory is weak, but rather they are slower because they have acquired so much information over the span of their lives. Even though both articles view memory capacity in the elderly in different ways, they both contribute to the overall progression to understand how the human brain functions as people age.
https://www.sciencedaily.com/releases/2014/01/140120090415.htm
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