Identification of types of chronic pain patients who will respond to placebo.


Someday doctors may prescribe sugar pills for certain chronic pain patients based on their brain anatomy and psychology. And the pills will reduce their pain as effectively as any powerful drug on the market, according to new research.

Northwestern Medicine scientists have shown they can reliably predict which chronic pain patients will respond to a sugar placebo pill based on the patients’ brain anatomy and psychological characteristics.

“Their brain is already tuned to respond,” said senior study author A. Vania Apkarian, professor of physiology at Northwestern University Feinberg School of Medicine. “They have the appropriate psychology and biology that puts them in a cognitive state that as soon as you say, ‘this may make your pain better,’ their pain gets better.”

There’s no need to fool the patient, Apkarian said.

“You can tell them, ‘I’m giving you a drug that has no physiological effect but your brain will respond to it,'” he said. “You don’t need to hide it. There is a biology behind the placebo response.”

The study was published Sept. 12 in Nature Communications.

The findings have three potential benefits:

Prescribing non-active drugs rather than active drugs. “It’s much better to give someone a non-active drug rather than an active drug and get the same result,” Apkarian said. “Most pharmacological treatments have long-term adverse effects or addictive properties. Placebo becomes as good an option for treatment as any drug we have on the market.”

Eliminating the placebo effect from drug trials. “Drug trials would need to recruit fewer people, and identifying the physiological effects would be much easier,” Apkarian said. “You’ve taken away a big component of noise in the study.”

Reduced health care costs. A sugar pill prescription for chronic pain patients would result in vast cost savings for patients and the health care system, Apkarian said.

How the study worked

About 60 chronic back pain patients were randomized into two arms of the study. In one arm, subjects didn’t know if they got the drug or the placebo. Researchers didn’t study the people who got the real drug. The other study arm included people who came to the clinic but didn’t get a placebo or drug. They were the control group.

The individuals whose pain decreased as a result of the sugar pill had a similar brain anatomy and psychological traits. The right side of their emotional brain was larger than the left, and they had a larger cortical sensory area than people who were not responsive to the placebo. The chronic pain placebo responders also were emotionally self-aware, sensitive to painful situations and mindful of their environment.

“Clinicians who are treating chronic pain patients should seriously consider that some will get as good a response to a sugar pill as any other drug,” Apkarian said. “They should use it and see the outcome. This opens up a whole new field.”

Creationists and conspiracy theorists share the same core process of teleological thinking.

It’s not uncommon to hear someone espouse the idea that “everything happens for a reason” or that something that happened was “meant to be.” Now, researchers reporting in Current Biology on August 20 have found that this kind of teleological thinking is linked to two seemingly unrelated beliefs: creationism, the belief that life on Earth was purposely created by a supernatural agent, and conspiracism, the tendency to explain historical or current events in terms of secret conspiracies or conspiracy theories.

“We find a previously unnoticed common thread between believing in creationism and believing in conspiracy theories,” says Sebastian Dieguez of the University of Fribourg. “Although very different at first glance, both these belief systems are associated with a single and powerful cognitive bias named teleological thinking, which entails the perception of final causes and overriding purpose in naturally occurring events and entities.”

A teleological thinker, for example, will accept as true propositions such as “the sun rises in order to give us light” or “the purpose of bees is to ensure pollination,” he says. “This type of thinking is anathema to scientific reasoning, and especially to evolutionary theory, and was famously mocked by Voltaire, whose character Pangloss believed that ‘noses were made to wear spectacles.’ Yet it is very resilient in human cognition, and we show that it is linked not only to creationism, but also to conspiracism.”

In previous work, Dieguez and colleagues showed that conspiracism wasn’t explained by the tendency to assume that “nothing happens by accident.” They realized that conspiracism isn’t driven by a rejection of the idea that the world is random and complex, but that it still could be linked to the notion that events in the world are actively and purposely fabricated. They also noticed that this looked “striking similar” to creationism. If correct, they reasoned, then conspiracism, like creationism, should be associated with teleological thinking, and both types of beliefs should be correlated with each other.

To find out whether this was the case, the researchers asked more than 150 college students in Switzerland to complete a questionnaire including teleological claims and conspiracist statements, as well as measures of analytical thinking, esoteric and magical beliefs, and a randomness perception task. The survey data showed that the tendency to ascribe function and meaning to natural facts and events was significantly, though modestly, correlated with conspiracist belief scales. Drawing on a large-scale survey of people in France, the researchers also found a strong association between creationism and conspiracism.

To look more closely at this pattern, the researchers next recruited more than 700 people to complete questionnaires online. Those data again confirmed associations among teleological thinking, creationism, and conspiracism. The data also show that those relationships are partly distinct from other variables, including gender, age, analytical thinking, political orientation, education, and agency detection.

“By drawing attention to the analogy between creationism and conspiracism, we hope to highlight one of the major flaws of conspiracy theories and therefore help people detect it, namely that they rely on teleological reasoning by ascribing a final cause and overriding purpose to world events,” Dieguez says. “We think the message that conspiracism is a type of creationism that deals with the social world can help clarify some of the most baffling features of our so-called ‘post-truth era.'”

The researchers say the findings have important implications for science educators and communicators. They may also help in formulating policies to “discourage the endorsement of socially debilitating and sometimes dangerous beliefs and belief systems.”

The researchers are now in the process of assessing the effectiveness of ongoing attempts to educate kids and adolescents about the nature of conspiracy theories and other types of misinformation. They say what’s ultimately needed is a thorough understanding of the factors that contribute to a conspiracist mindset, which is relevant to many beliefs, including global warming denialism and vaccine rejection, and they are developing a general framework to help disentangle the relevant factors.

The findings may help to explain how certain types of misinformation spread so easily aided by social media channels. “It’s possible that content framed in teleological terms are easier to process and spread faster than other types of information, and this could be tested on a much larger scale,” Dieguez says.

Food that helps battle depression

By Elizabeth Bernstein

You’re feeling depressed. What have you been eating?

Psychiatrists and therapists don’t often ask this question. But a growing body of research over the past decade shows that a healthy diet—high in fruits, vegetables, whole grains, fish and unprocessed lean red meat—can prevent depression. And an unhealthy diet—high in processed and refined foods—increases the risk for the disease in everyone, including children and teens.

Now recent studies show that a healthy diet may not only prevent depression, but could effectively treat it once it’s started.

Researchers, led by epidemiologist Felice Jacka of Australia’s Deakin University, looked at whether improving the diets of people with major depression would help improve their mood. They chose 67 people with depression for the study, some of whom were already being treated with antidepressants, some with psychotherapy, and some with both. Half of these people were given nutritional counseling from a dietitian, who helped them eat healthier. Half were given one-on-one social support—they were paired with someone to chat or play cards with—which is known to help people with depression.

After 12 weeks, the people who improved their diets showed significantly happier moods than those who received social support. And the people who improved their diets the most improved the most. The study was published in January 2017 in BMC Medicine. A second, larger study drew similar conclusions and showed that the boost in mood lasted six months. It was led by researchers at the University of South Australia and published in December 2017 in Nutritional Neuroscience.

And later this month in Los Angeles at the American Academy of Neurology’s annual meeting, researchers from Rush University Medical Center in Chicago will present results from their research that shows that elderly adults who eat vegetables, fruits and whole grains are less likely to develop depression over time.

The findings are spurring the rise of a new field: nutritional psychiatry. Dr. Jacka helped to found the International Society for Nutritional Psychiatry Research in 2013. It held its first conference last summer. She’s also launched Deakin University’s Food & Mood Centre, which is dedicated to researching and developing nutrition-based strategies for brain disorders.

The annual American Psychiatric Association conference has started including presentations on nutrition and psychiatry, including one last year by chef David Bouley on foods that support the peripheral nervous system. And some medical schools, including Columbia University’s Vagelos College of Physicians and Surgeons, are starting to teach psychiatry residents about the importance of diet on mental health.

Depression has many causes—it may be genetic, triggered by a specific event or situation, such as loneliness, or brought on by lifestyle choices. But it’s really about an unhealthy brain, and too often people forget this. “When we think of cardiac health, we think of strengthening an organ, the heart,” says Drew Ramsey, a psychiatrist in New York, assistant clinical professor of psychiatry at Columbia and author of “Eat Complete.” “We need to start thinking of strengthening another organ, the brain, when we think of mental health.”

A bad diet makes depression worse, failing to provide the brain with the variety of nutrients it needs, Dr. Ramsey says. And processed or deep-fried foods often contain trans fats that promote inflammation, believed to be a cause of depression. To give people evidenced-based information, Dr. Ramsey created an e-course called “Eat to Beat Depression.”

A bad diet also affects our microbiome—the trillions of micro-organisms that live in our gut. They make molecules that can alter the production of serotonin, a neurotransmitter found in the brain, says Lisa Mosconi, a neuroscientist, nutritionist and associate director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College in New York. The good and bad bacteria in our gut have complex ways to communicate with our brain and change our mood, she says. We need to maximize the good bacteria and minimize the bad.

So what should we eat? The research points to a Mediterranean-style diet made up primarily of fruits and vegetables, extra-virgin olive oil, yogurt and cheese, legumes, nuts, seafood, whole grains and small portions of red meat. The complexity of this diet will provide the nutrition our brain needs, regulate our inflammatory response and support the good bacteria in our gut, says Dr. Mosconi, author of “Brain Food: The Surprising Science of Eating for Cognitive Power.”

Can a good diet replace medicine or therapy? Not for everyone. But people at risk for depression should pay attention to the food they eat. “It really doesn’t matter if you need Prozac or not. We know that your brain needs nutrients,” Dr. Ramsey says. A healthy diet may work even when other treatments fail. And at the very least, it can serve as a supplemental treatment—one with no bad side effects, unlike antidepressants—that also has a giant upside. It can prevent other health problems, such as heart disease, obesity and diabetes.

Loretta Go, a 60-year-old mortgage consultant in Ballwin, Mo., suffered from depression for decades. She tried multiple antidepressants and cognitive behavioral therapy, but found little relief from symptoms including insomnia, crying jags and feelings of hopelessness. About five years ago, after her doctor wanted to prescribe yet another antidepressant, she refused the medicine and decided to look for alternative treatments.

Ms. Go began researching depression and learned about the importance of diet. When she read that cashews were effective in reducing depression symptoms, she ordered 100 pounds, stored them in the freezer, and started putting them in all her meals.

She also ditched processed and fried foods, sugar and diet sodas. In their place, she started to eat primarily vegetables and fruits, eggs, turkey and a lot of tofu. She bought a Vitamix blender and started making a smoothie with greens for breakfast each morning.

Within a few months, Ms. Go says she noticed a difference in her mood. She stopped crying all the time. Her insomnia went away and she had more energy. She also began enjoying activities again that she had given up when she was depressed, such as browsing in bookstores and volunteering at the animal shelter.

Ms. Go’s depression has never come back. “This works so well,” she says. “How come nobody else talks about this?”

How to tell if your child is a future psychopath

By Jane Ridley

Four years ago, Lillyth Quillan cowered behind a padlocked door as her teenage son, taller and stronger than she is, paced back and forth in a rage.

Suddenly he went quiet. “Don’t let me hurt you, Mom,” he said, his voice sounding chillingly calm.

It was the first time the high school freshman had used that particular tone, but he continued to deploy it as he menaced his mom and dad.

“He used the kind of language of abusive husbands — manipulating and controlling,” says Quillan, who had installed locks on every door in her house except her son’s bedroom. “I was terrified of what he was going to do next.”

The boy — whom Quillan chooses to call Kevin in her interview with The Post in reference to the unnerving Lionel Shriver novel “We Need To Talk About Kevin” about a school shooter in upstate New York — was out of control.

After years of cruel and violent behavior plus multiple suspensions and expulsions from school, psychiatrists finally diagnosed the then-14-year-old Kevin with “conduct disorder,” which, in its most extreme form, can be a precursor to psychopathy.

Psychopathy, which is often used interchangeably with the term sociopathy, is believed to affect 1 percent of adults. Key attributes that sociopaths and psychopaths have in common include a disregard for laws, social mores and the rights of others, a failure to feel remorse or guilt and, in some but not all cases, a tendency to violence.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) dictates that people under the age of 18 cannot be labelled psychopaths. However, in 2013 the American Psychiatric Association decided to include the condition “conduct disorder with callous and unemotional traits” for children ages 12 and over.

According to a 2001 report published in the journal American Family Physician, approximately 6 to 16 percent of boys and 2 to 9 percent of girls meet the diagnostic criteria for conduct disorder — only a fraction of which have the “callous and unemotional” label that can potentially lead to psychopathy in adulthood.

More than 50 studies have found that kids with the latter diagnosis are more likely to become criminals or display aggressive, psychopathic traits later in life. It has been reported that Nikolas Cruz, the 19-year-old who allegedly shot and killed 17 people at Marjory Stoneman Douglas High School in Parkland, Fla., last month showed classic signs of the disorder as a child, including abusing animals.

“Psychopaths don’t just appear when they are 20. They are always different from an early age,” Kent Kiehl, a psychology professor at the University of New Mexico and the author of “The Psychopath Whisperer,” tells The Post.

Characteristics to look for — as detailed in the widely used Hare Psychopathy Checklist Youth Version considered by clinicians and researchers to be the “gold standard” in assessing psychopathy — include lack of empathy, lack of guilt and regret, pathological lying, grandiose self-worth and failure to accept responsibility for actions such as fighting and bullying.

“Individuals who score high on those traits are more likely to produce further violence,” adds Kiehl. “If they are sanctioned but continue on the same path, it’s not a perfect indicator, but it’s enough to cause concern.”

Kiehl notes that research has shown that psychopathy is hereditary roughly half of the time. But his own breakthrough was the discovery that the psychopathic brain has a different structure than a “normal” one.

In 2014, he conducted a major study that found at least two abnormalities in the brains of adult psychopaths. There was a lack of gray matter in the section involved in processing emotions, while the area that reacts to excitement and thrills is overactive. Although the research has not been carried out yet, the pattern is likely to also occur in the brains of “callous and unemotional” children. “Brain science has helped us understand what is different about these kids,” adds Kiehl.

At the moment, there is no such thing as a “cure” for psychopathy or conduct disorder. But early intervention can be key for harm reduction, even with children as young as 2 or 3.

Paul Frick, a psychology professor at Louisiana State University and the author of “Conduct Disorder and Severe Antisocial Behavior,” recommends a range of therapies, most of which revolve around rewards systems rather than punishments.

“There are so-called ‘emotion coaching’ techniques that parents and therapists can employ to help children pay attention to the feelings of others,” he explains. “We find that they miss the cues that another child is upset.

“By saying: ‘Can you see how Johnny is feeling?’ [when a toy is snatched from him] and getting them to respond correctly, you can motivate them. You give them a star or a sticker as an incentive.

“Even though it doesn’t come naturally to them, they can learn others’ perspectives.”

Experts can identify a callous and unemotional child when they are as young as 3 or 4. Faced with a crying peer, typically developing children either try to comfort them or take flight. But those with the mental condition remain in place, showing apathy and coldness.

Remarkably, the psychology department at King’s College London has been able to trace the characteristics back to infancy. They tested more than 200 babies at 5 months old, tracking whether they preferred looking at a person’s face or at a red ball. The tots who favored the ball displayed more callous traits two and a half years later.

For Quillan, hindsight is 20/20, but she distinctly recalls the first signs that Kevin had behavioral issues at the age of just 8 months.

“He had teeth and would bite me while he was breast-feeding and he would laugh. He thought it was hilarious. I tried looking very sad and mimicking crying to show it was hurting me, but he would only laugh,” says Quillan, who ended up having to put him on formula.

“It didn’t occur to me until much later that this was a child for whom the amusement of my reaction when he bit me was a greater reward than food.”

Now 18, Kevin, who has had numerous run-ins with police, including for shoplifting, was made a ward of state and no longer lives with his parents. He lives in a residential school for “at-risk” youth in California, where he is on a waiting list to receive treatment, such as therapy, to build empathy.

“Because there is no real treatment for conduct disorder. All you can do is wait for your child to be arrested and enter the juvenile system and hope they get better,” says his 40-year-old homemaker mom.

“Luckily, Kevin is no longer violent and is actually cooperative.”

He is doing so well that he is about to receive his high school diploma, recently won an award for wrestling and has encouraged his mother to tell his story.

Now Quillian, who has no other kids, is focusing on advocacy and encouraging parents facing similar nightmares to hers. Three years ago, she formed a support group for families with kids with CD that has 420 members worldwide. More recently, she launched the Society for Treatment Options for Potential Psychopaths to bring awareness and to campaign for treatment for these children before they cause serious harm.

Adds Quillan: “As every news article came out about Parkland and Nikolas Cruz, I thought: ‘My God, this could easily be one of our kids.’”

Using eye movement to treat stress and other disorders


Over the years, there’s been no shortage of interesting alternatives to typical talk-based psychotherapy. Laughter therapy, sound therapy, horticultural therapy and even wilderness therapy have become popular ways to deal with psychological distress, helping with everything from general anxiety and depression to post traumatic stress disorder (PTSD). These aren’t the only fascinating alternatives, though.

Another form of therapy is Eye Movement Desensitization and Reprocessing (EMDR), which can be an effective method for treating PTSD.

EMDR helps victims of trauma re-process and learn to cope with difficult events by rapidly moving their eyes back and forth, following the movement of a therapist’s finger while concentrating on a distressing memory.

The origins of EMDR
EMDR began practically by accident in 1987, when California psychologist Francine Shapiro was taking a walk in the woods, reports Scientific American.

During her stroll, Shapiro said she was anxious. She soon realized, though, that her anxiety had subsided once she began moving her eyes back and forth while at the same time closely observing and concentrating on her surroundings. Once she discovered that the rapid movement of her eyes brought her to a more relaxed state, she decided to see if rapid eye movement might reduce stress and anxiety in her clients. After finding that the procedure was able to help ease distress in her clients, Shapiro published a study in 1989 on her research, dubbing the practice EMDR.

Since then, EMDR has been used as a treatment for PTSD and various other conditions such as depression, schizophrenia, sexual dysfunction, stress and other anxiety disorders.

EMDR trainer Roger Solomon is a clinical psychologist whose specialty is trauma and grief. He is the police psychologist for the South Carolina Department of Public Safety and a consultant to the trauma programs of the U.S. Senate and several state and federal law enforcement agencies.

“EMDR therapy is guided by the Adaptive Information Processing model,” says Solomon. “This model posits that present problems are the result of past distressing memories that have become ‘frozen’ or stuck in the brain (including the images, thoughts and beliefs, feelings and sensations), thus becoming maladaptively stored in the brain. When there is a reminder (either external or internal), this maladaptively stored information gets triggered and is experienced in the present.”

Based on that premise, EMDR seeks to help people effectively adapt to their lives once trauma has occurred. EMDR gives those who suffer from trauma the possibility of reprocessing traumatic memories, so that the memories are able to become “unstuck” and processed in a way that the traumatized person is able to understand.

EMDR allows for what Solomon sees as the “the transmutation of the perpetual re-experiencing of distressing events with a learning experience that becomes a source of resilience.”

All this takes place by using a simple technique such as moving one’s eyes back and forth, which “stimulates the information processing mechanisms of the brain,” says Solomon. Once the information processing mechanism of the brain is stimulated by following the movements of the therapist’s fingers with the eyes, the traumatized person is able to reprocess the memories that cause distress; it gives them the ability to effectively adapt, learn and understand that he or she has successfully made it through the trauma.


To illustrate, Solomon uses the experience of a war veteran. “A war veteran experiencing a near-death experience in battle may have concluded ‘I am going to die,’ which becomes maladaptively stored in the brain, unable to process,” Solomon says. “When there is a present trigger, the distressing memory including the images, thoughts and beliefs and sensations associated with the event arise and are experienced as nightmares, flashbacks, and other symptoms of PTSD.”

Once the veteran is able to properly reprocess the information after undergoing EMDR, “the veteran can think of the battle event and know, at a felt body level, that ‘I survived, it’s over,’” says Solomon.

Theories behind the inner workings of reprocessing
Psychologists have come up with a number of theories as to how memory reprocessing during EMDR works — and more research is needed to determine the exact process — but here are a few that might explain exactly what’s happening in the brain during EMDR.

The working memory theory: Working memory is our short-term memory. It’s the part of our memory that allows us to store information that we need to reason, learn and comprehend.

“Studies looking at the specific effects of eye movements used in EMDR therapy show a significant reduction of memory vividness and associated emotion” says Solomon. “The working memory theory posits that the working memory system has a very limited capacity. When it is taxed by the competing tasks of holding a memory in mind while moving the eyes, there is a degradation of performance. This results in the distressing memory losing its quality and power.”

It’s almost as if the memory is unable to “keep up” with the reprocessing that occurs while the traumatized person’s eyes are moving back and forth — thus making the memory lose its grip over the person.

REM sleep theory: Rapid Eye Movement sleep (REM) is the stage of sleep in which we dream, and process and store memories.

Solomon explains that it’s “been hypothesized that eye movements stimulate the same neurological processes that take place during REM/dream sleep, which is important in processing and consolidating information.”

It’s possible the EMDR helps a person process a traumatic memory, in much the same way dreaming allows us to process the events of our daily lives while we sleep.

Memory reconsolidation theory: Memory reconsolidation is a process used by therapists to reorder and recode memories once a traumatic memory has been unlocked or accessed.

“Accessing a memory, and updating it with new contradictory information, enables the potential for the original memory to be transformed and reconsolidated, i.e., stored in altered form,” Solomon explains. “This differs from other trauma-focused therapies (e.g. Cognitive Behavioral Therapy) where the underlying mechanism is hypothesized to be habituation and extinction, which are thought to create a new memory, while leaving the original one intact.”

In this instance, the traumatic memory changes and transforms; it doesn’t disappear completely. Here, there aren’t two separate memories — one being the traumatic memory and the other being a memory which is of a peaceful nature. You have one memory which has transformed from trauma into a state of acceptance. This might explain the transmutation aspect of EMDR.

Parasympathetic nervous system theory: The parasympathetic nervous system is the part of our nervous system that helps us calm down and relax. It slows the heart, dilates blood vessels, relaxes the muscles in the gastrointestinal tract, increases digestive juices and decreases pupil size.

As far the relation between the parasympathetic nervous system and EMDR, Solomon says it’s possible that the “eye movements elicit an orienting response which activates the parasympathetic nervous system and lowers arousal.” Simply put, rapid eye movement and EMDR seem to be relaxing. “This theory has support from research showing that eye movement lowers arousal for distressing memories,” says Solomon.

What makes EMDR different

EMDR is based more on how a person reprocesses memories, rather than the strict plan of a therapist.

“The therapist facilitates movement with attuned bilateral stimulation and ‘stays out of the way’ as the distressing memory is shifting in an adaptive direction,” says Solomon. “Clients are able to find their own individualized and creative solutions and perspectives, in ways the clinician may never have thought of.”

A person undergoing EMDR doesn’t have to make themselves as vulnerable as they might during other forms of therapy. Sometimes not showing complete vulnerability makes things less taxing when undergoing treatment.

“The client does not have to describe the memory in detail. Not having to disclose shameful or humiliating moments may make it easier for some clients to engage in the therapeutic process,” Solomon explains.

The fact that EMDR is not a talk-based therapy is unique in that that, “EMDR goes to places where words don’t go and enables the processing of implicit, painful memories and their associated emotions and body sensations that talking alone does not seem to reach,” says Solomon.

EMDR success
When asked about a particular case in which EMDR helped a client overcome trauma, Solomon reflected on his experience with a police officer involved in the tragedy of the Sandy Hook Elementary School shooting:

“A police officer who was one of the first on-scene was very distressed by the images of children killed. For the next two years, he had nightmares and flashbacks, and found it difficult to be around children. He started the EMDR processing with an initial image of a dead child and an associated belief of ‘I’m helpless.’ With processing he realized he did the best he could at the situation. Next he remembered that many police officers from many different agencies started arriving. He realized that these policemen were off duty and coming on their own time to help out. When asked his thoughts/feelings about the incident, he said “UNITY,” and no longer felt distress. This session humbles me as to how the mind can find an adaptive way to deal with a horrible tragedy and I am grateful for EMDR therapy’s ability to help people.”

This is How You Raise Successful Teens, and It Starts When They’re Toddlers With a 3-Part Adaptive Cascade

by Drake Baer, Senior writer at Thrive Global covering the brain and social sciences.

Teachers, parents and policymakers are finally started to realize that academic success depends on more than just “booksmarts,” the kind of fluid intelligence captured by IQ tests and the like. The importance of “soft” or “non-cognitive” skills like grit and emotional intelligence is growing rapidly. But there’s a deeper question here: where do these soft skills come from? According to a new paper in Psychological Science, it’s your mom.

The research team, lead by Lilian Dindo, a clinical psychologist at the Baylor College of Medicine, crossed disciplines and decades to discover what they describe as an “adaptive cascade” that happens in three parts, drawing a line from the relational experiences we have as infants to the academic achievements we have later on. “That having a supportive responsive caregiving environment can actually provide these inner resources that will foster something like effortful control, and that this in turn can actually promote better functioning in school is the new thing here,” she tells Thrive Global.

The first part of that cascade is “secure attachment.” Tots—in this study, one cohort of 9-month olds and another of two-to-three year olds—get strongly influenced by their primary caregivers, implicitly learning how relationships work (often called attachment in the psychology field).

In this study, the mothers rated their children’s security of attachment using a widely used assessment tool. “If a child is distressed and shows distress to a parent and the parent responds to the distress in sensitive and loving and reassuring ways the child then feels secure in their knowledge that they can freely express this negative emotion,” Dindo explained. “Learning in that way is very different than learning that if I express negative emotion then I will be rejected or minimized or ignored or ridiculed. And so the child will learn not to express the negative emotions, to inhibit that negative emotion, or to actually act up even more to try to get that response. Either way they’re learning that expressing this negative emotion will not be responded to in a sensitive or loving way.”

Think of it this way: if you ate at a restaurant and it made you sick, you’d be unlikely to go back; if you expressed hurt and your mom rejected it, you’d minimize that pain next time. Even very early in life, kids are already observing cause and effect.

Step two in the cascade is effortful control, or the ability to delay gratification and inhibit a response to something when it’s in your best interest to do so—it’s the toddler-aged forerunner of things like grit and conscientiousness. In this study, effortful control in toddlers was examined experimentally—for example, in a “snack delay” task where tykes are presented with a cup of Goldfish crackers and instructed to wait to eat them until the experimenter rings a bell—and through parental ratings of how well the kids controlled themselves at home.

Then comes the third part of the cascade: academic achievement. More than a decade after the first experiments, Dindo tracked down the mother-child duos. About two-thirds of each cohort participated in the follow-up, where moms sent in their now 11 to 15-year-old kids’ scores on a couple of academic different standardized tests. The researchers crunched the data from all of the experiments and found quite the developmental chain: secure attachment was associated with effortful control in toddlers, and in turn, effortful control at age 3 predicted better test scores in early adolescence.

While this study doesn’t explain the mechanics of that three-part cascade, Dindo thinks it has to do with how we learn to regard our own inner emotional lives from the way our moms (or primary caregivers) regard us. If mom is soothing and dependable, you learn to consistently do the same for yourself—you learn that you’re going to be okay even if you feel anxious in the moment, like when tackling homework or a test. To Dindo, this shows how coming from a psychologically or emotionally deprived environment can have long-term consequences: if you don’t get the loving attentiveness you need when you’re little, it’s going to be harder to succeed as you grow up.

In very hopeful news though, other studies out this year—like here ( and here ( —show that when parents get attachment interventions, or are coached to be more attentive to their toddlers, the kids’ effortful control scores go up, which should, in turn, lead to greater achievement down the line. Because as this line of research is starting to show, just like plants need sunlight to grow into their fullest forms, humans need skillful love to reach their full potential.

Psychol Sci. 2017 Oct 1:956797617721271. doi: 10.1177/0956797617721271. [Epub ahead of print]

Attachment and Effortful Control in Toddlerhood Predict Academic Achievement Over a Decade Later.

Dindo L, Brock RL, Aksan N, Gamez W, Kochanska G, Clark LA.


A child’s attachment to his or her caregiver is central to the child’s development. However, current understanding of subtle, indirect, and complex long-term influences of attachment on various areas of functioning remains incomplete. Research has shown that (a) parent-child attachment influences the development of effortful control and that (b) effortful control influences academic success. The entire developmental cascade among these three constructs over many years, however, has rarely been examined. This article reports a multimethod, decade-long study that examined the influence of mother-child attachment and effortful control in toddlerhood on school achievement in early adolescence. Both attachment security and effortful control uniquely predicted academic achievement a decade later. Effortful control mediated the association between early attachment and school achievement during adolescence. This work suggests that attachment security triggers an adaptive cascade by promoting effortful control, a vital set of skills necessary for future academic success.

KEYWORDS: academic performance; attachment; effortful control; longitudinal; temperament

PMID: 29023183 DOI: 10.1177/0956797617721271

Tripping on Peyote in Navajo Nation

The peyote cactus, Lophophora williamsii, which contains the psychedelic compound mescaline, serves as a sacrament for members of the Native American Church. Credit: U.S. Fish and Wildlife Service Wikimedia

By John Horgan

In 2002, on assignment for Discover Magazine, I participated in a peyote ceremony of the Native American Church. I’ve been recalling this extraordinary experience lately because I’ve been in contact with the man who arranged it, psychiatrist John H. Halpern, an authority on psychedelics, whom I met while researching my 2003 book Rational Mysticism. Below is the 2003 article I wrote for Discover about the peyote trip, Halpern and the therapeutic potential of psychedelics — John Horgan

Even with several tablespoons of peyote in me, by three in the morning I’m fading. For almost six hours I have been sitting in a tepee in the Navajo Nation, the largest Indian reservation in the United States, with 20 Navajo men, women, and children. They belong to the Native American Church, which has 250,000 members nationwide. Everyone except the four children has eaten the ground-up tops, or buttons, of peyote, Lophophora williamsii. U.S. law classifies the squat cactus and its primary active ingredient, mescaline, as Schedule 1 substances, illegal to sell, possess, or ingest. The law exempts members of the Native American Church, who revere peyote as a sacred medicine.

A barrel-chested man wearing a checked shirt and cowboy boots stands over the cedarwood fire and murmurs a prayer in Diné, the Navajo language. As this roadman, or leader of the service, sprinkles sage on the coals, my eyelids close. I smell the sage and hear it hiss, and I see the roiling geometric patterns, called form constants, generated by compounds such as mescaline. Then the balding white man on my right nudges me and tells me to keep my eyes open. The Navajo might be offended, he whispers, if they think I have fallen asleep. Later, he shakes his head when I lean on an elbow to relieve the ache in my back. Too casual, he says.

My guide to the etiquette of peyote ceremonies is John H. Halpern, a 34-year-old psychiatrist from Harvard Medical School. For five years he has been coming here to the Navajo Nation—27,000 square miles of sage-speckled desert stretching from northern Arizona into New Mexico and Utah—to carry out a study of peyote. Funded by the National Institute on Drug Abuse, the study probes members of the Native American Church for deficits in memory and other cognitive functions. Halpern has brought me here to help me understand him and his mission, which is to provoke a reconsideration of the pros and cons of hallucinogenic drugs, commonly referred to as psychedelics.

Coined in 1956 from the Greek roots for “mind revealing,” the term psychedelic refers to a broad range of drugs that include peyote, LSD, and psilocybin, the primary active ingredient in so-called magic mushrooms. Three decades ago the federal government shut down most research on psychedelics, and the Journal of the American Medical Association warned that they can cause permanent “personality deterioration,” even in previously healthy users. Halpern says this blanket indictment is “alarmist” but agrees that there are documented dangers associated with the recreational use of the drugs. When ingested recklessly in large doses, psychedelics can generate harrowing short-term experiences, and they can precipitate long-term psychopathology in those predisposed to mental illness. Nonetheless, more than 20 million Americans have tried a psychedelic at least once, and 1.3 million are users of the drugs, by far the most popular of which is now MDMA, or Ecstasy. Halpern undertook his peyote research in part to test persistent fears that those who repeatedly use psychedelics run a high risk of brain damage.

While recognizing that psychedelics are toxic substances that should not be treated lightly, Halpern thinks some of the drug compounds could have beneficial uses. “There are medicines here,” he says, that could prove to be “fundamentally valuable.” He hopes the mind-revealing power of psychedelics can be harnessed to help alleviate the pain and suffering caused by two deadly diseases that have long been notoriously resistant to treatment: alcoholism and addiction. More than 12 million Americans abuse alcohol, and another 1 million abuse cocaine or heroin.

Halpern’s conviction that psychedelics might help alcoholics and addicts is based both on research by others and on his personal observations of members of the Native American Church. Although Indians in central and northern Mexico, peyote’s natural habitat, have ingested it for spiritual purposes for thousands of years, only in the last century did this practice spread to tribes throughout North America in the form of rituals of the Native American Church.

All the subjects of Halpern’s research are Navajo, who account for roughly 10 percent of the church’s membership and hold key leadership positions. Even though tribal leaders have banned alcohol from their reservation, alcoholism is still rampant. For the Navajo and other tribes, rates of alcoholism are estimated to be more than twice the national average. Those in the Native American Church say their medicine helps keep them sober and healthy in body and mind, and Halpern suspects they are right.
He first took peyote himself five years ago, shortly after presenting his research plan to leaders of the Native American Church. “It would have been supremely insulting to them if I didn’t try it. So I tried it.” Halpern also hoped that firsthand experience would help him understand how peyote ceremonies might benefit church members. He checked beforehand with the U.S. Drug Enforcement Agency, which told him that it would not object to peyote use by non-Indians for serious scientific, educational, or journalistic purposes. Halpern has participated in five services in all, including the one we both attend, and these experiences have imbued him with respect for the Indians and their faith. When I expressed curiosity about the ceremonies, he said the best way to appreciate them is to participate in one. He warned me that the ceremonies are in no way recreational or fun, and our session in Arizona bears that out.

Like most Native American Church services, this one has been called for a specific purpose—in this case, to help a wife and husband burdened with medical and financial problems, all too common on the reservation. Except for Halpern and me, everyone is a friend or relative of this couple; some have traveled hundreds of miles to be here. The meeting lasts for 10 hours with only a single 10-minute break, and it unfolds in a rhythm of rituals: smoking tobacco rolled in corn husks; singing hymns in Diné or other Native American languages to the pounding of a deerskin drum; eating peyote and drinking peyote tea passed around in bowls, three times in all.

There is a spellbinding beauty in the incantations of the roadman, in the sparks spiraling up from the bed of coals toward the tepee’s soot-blackened roof, in the stoic expression of the elder who adds cedar logs to the fire and rakes the coals into a half circle. But none of the worshippers seems lost in blissful aesthetic reveries. Far from it. For much of the night, the mood is solemn, even anguished. Two people vomit, including the wife. Both she and her husband sob as they confess their fears and yearnings. So do others as they listen, offer prayers, or divulge their own troubles—usually in Diné, but occasionally in English.

The power of these ceremonies, Halpern tells me later, is only partly pharmacological. After all, worshippers usually eat just a few tablespoons of peyote, which amounts to less than 100 milligrams of mescaline—enough to induce a stimulant effect but not full-fledged visions. Peyote, Halpern speculates, serves primarily as an amplifier of emotions aroused by the ceremony’s religious and communal elements. He cannot prove this conjecture yet, nor can he say how or if the putative benefits of these sessions might be achieved by non-Indians in more conventional psychotherapeutic settings. “A lot more work needs to be done to answer such questions,” he says.

His creeping baldness notwithstanding, Halpern looks younger than his age. He can be brash too. During our weekend in Navajo country—where we visit a substance-abuse clinic and meet a Native American Church leader as well as attend the peyote session—he exults in displaying his knowledge of psychedelic chemistry and his talent for mimicry. A nightclub owner once said his impressions were good enough for a stage act, he boasts. (Actually he is good, especially at obscure sitcom characters like Colonel Klink’s irritable commander in Hogan’s Heroes: “Kleenk, you EE-dee-ot!”)

Halpern says he does have “an abrasive, sarcastic side.” But he also has an earnest, idealistic side that comes to the fore when he talks about his upbringing. Raised in a Jewish home in an affluent New York suburb, he was never particularly religious, but he inherited a passion for healing from his psychiatrist father and psychologist mother. They convinced him that “medicine is the highest profession you can have, because it’s such a privilege to work with human beings and to heal them.”
He traces his interest in psychedelics to the early 1990s. Interning at a psychiatric hospital in Brooklyn, New York, he became frustrated that he could not offer better treatments for alcoholic or drug-addicted patients. During a weekend at his parents’ home, he vented to a visiting family friend, Chunial Roy, an Indian-born psychiatrist who had settled in western Canada. Roy recalled that in the 1950s, he did a survey of alcoholism among Indians in British Columbia and found low rates among members of the Native American Church. Roy added that psychedelics such as LSD had once been considered promising treatments for addiction and other disorders.

“I was so fascinated that I did all this research,” says Halpern, who had never taken psychedelics and knew little of their history. He learned that LSD, mescaline, and psilocybin, initially viewed as mimickers of the symptoms of mental illness, came to be seen as potential treatments. From 1950 to the mid-1960s, journals published more than 1,000 papers describing the treatment with psychedelics of 40,000 patients afflicted with alcoholism and various other disorders.

One early advocate of psychedelic therapy was William Wilson, known more familiarly as Bill W., who founded Alcoholics Anonymous in 1935. After observing alcoholics undergoing LSD treatment and taking the drug himself in 1956, Wilson became convinced that it might benefit alcoholics by triggering religious experiences like the one that had helped him stop drinking. The studies that instilled these hopes in Wilson and others were largely anecdotal, lacking controls, or flawed; they were nonetheless suggestive enough, Halpern thought, to merit follow-up investigations.

After Halpern began his residency training at Harvard Medical School in 1996, he found a mentor: Harrison G. Pope Jr., a professor of psychiatry who had investigated marijuana and other psychotropic drugs. Halpern and Pope have coauthored several papers, notably one that considers whether hallucinogens cause permanent neurocognitive damage, as some early critics claimed. “At present,” they wrote, “the literature tentatively suggests that there are few, if any, long-term neuropsychological deficits attributable to hallucinogen use.” They contended that most studies linking psychedelics to neurocognitive toxicity examined too few subjects and did not control adequately for pre-existing mental illness or for consumption of other, more toxic substances, such as amphetamines and alcohol.

It was to help resolve this lingering controversy that Halpern and Pope decided to examine the Native American Church, which offered a large population that consumes a psychedelic substance while avoiding other drugs and alcohol. Halpern and Pope won grants for their project not only from the National Institute on Drug Abuse but also from Harvard Medical School and two private foundations that support research on psychedelics: the Multidisciplinary Association for Psychedelic Studies and the Heffter Research Institute (named after the German chemist who isolated mescaline from peyote and discovered its psychoactive properties in the late 1800s).

Obtaining the cooperation of Native American Church officials turned out to be more difficult. Many disliked the idea of having their faith scrutinized by a scientist, especially a white one. After Halpern gave his pitch to one church gathering, a tribal elder harangued the crowd in Navajo for 20 minutes. Finally he turned to Halpern and, angrily evoking the specter of Christopher Columbus, exclaimed: “1492!” Another difficult moment came during his first peyote session. The roadman kept insisting that Halpern take more peyote, until finally he vomited. Halpern felt that the roadman’s implicit message was, “You want to learn about peyote? I’ll teach you about peyote.”

Halpern persisted, coming to meetings bearing gifts of sweet grass and flat cedar, aromatic herbs prized by Indians. “I was trying to show I took the trouble to learn something about their culture.” He trolled for volunteers for his research by putting up ads in Laundromats and handing out flyers at a flea market in Gallup, New Mexico. (The $100 promised to those who completed the study helped too.)
One church leader who persuaded others in the flock to trust Halpern was Victor J. Clyde, vice president of the Native American Church of North America and an elected state judge. During our trip to the Navajo Nation, Halpern and I visited Clyde in Lukachukai, Arizona, where he lives with his wife and three children. Clyde is compact and broad-shouldered, and he speaks with the tough self-assurance of a former prosecutor.

When I asked what the Native American Church stands to gain from Halpern’s work, Clyde replied that scientific evidence of peyote’s safety should protect church members. Just last year, the Pentagon cited concerns about “flashbacks”—recurrences of a psychedelic’s effects long after it has vanished from the body—in barring servicemen in the Native American Church from sensitive nuclear assignments. Didn’t Clyde ever worry that Halpern’s research might turn up harmful effects? Clyde eyed me momentarily before responding to my question. If peyote was harmful, he said firmly, his people would have noticed by now.

Clyde’s belief that peyote does not harm church members has been corroborated by Halpern’s research. He estimates that he spoke to 1,000 Navajo before finding 210 who met his criteria. The subjects fall into three categories: Roughly one-third have taken peyote at least 100 times but have minimal exposure to other drugs or alcohol; one-third are not church members and have consumed little or no alcohol or drugs; and one-third are former alcoholics who have been sober for at least three months.

Halpern and several research assistants administered a battery of tests—of memory, IQ, reading ability, and other cognitive skills—to the three groups. According to preliminary data that he has presented at conferences, church members show no deficits compared with sober nonmembers and score significantly better than the former alcoholics. Church members also report no flashbacks. With his coauthor Pope, Halpern plans to publish his full results in a peer-reviewed journal this summer, after presenting them to church leaders and Navajo health officials.

Halpern is already anticipating objections to his research—for example, that its significance applies only to one substance used by one ethnic group. “You could in one sense say mescaline is not the same as all these other compounds,” he says. His study nonetheless indicates that psychedelics as a class may not “burn out” the brain. “If we find this group of people that, with these special conditions, aren’t having problems, that does have some relevance for the population at large.”

Halpern also realizes that he may be accused of going native, of becoming so close to his subjects that his objectivity has been compromised. To reduce the risk of bias, he and Pope designed the study to be blind; those who scored the tests given to the Navajo did not know to which group each subject belonged. Moreover, Halpern did not participate in peyote ceremonies with any of his research subjects.
Perhaps the biggest weakness of his and Pope’s research, Halpern acknowledges, is that its design precluded testing to see whether peyote reduces the risk of alcoholism. Halpern would like to see that issue addressed in a follow-up study. An ideal partner for a trial could be the Na’nizhoozhi Center, a substance-abuse clinic in Gallup whose clientele is almost entirely Native American. The center, founded a decade ago, offers conventional therapies and self-help programs, such as Alcoholics Anonymous, as well as various traditional Indian healing ceremonies. These take place in a yard behind the clinic that is large enough for several of the octagonal log cabins known as hogans, sweat lodges, and a tepee for Native American Church sessions. Although peyote is not given to patients during on-site church sessions, staff members encourage some clients to participate in regular peyote ceremonies once they leave the clinic.

The clinic’s records indicate that those who participate in Indian healing ceremonies fare better than those who have participated in Alcoholics Anonymous. Halpern hopes that someday the clinic, perhaps with his help, will rigorously compare the relapse rates of patients who participate in peyote ceremonies versus other treatments. Ideally, to distinguish the effects of peyote per se from those of the ceremony and of church membership, one group of alcoholics could receive peyote in a non-religious setting; another group could receive a placebo.

Halpern would never recommend such a protocol, however, because it would violate precepts of the Native American Church. “Peyote taken the wrong way, they believe, is harmful,” he explains. Out of respect for the church, Halpern would never advocate testing peyote’s effects on non-Indians, either. In this respect, he acknowledges, his affection for church members does influence his role as a researcher.
But there are many other compounds that can be explored as potential treatments for non-Indians. In a 1996 paper, Halpern reviewed scores of studies of the treatment of substance abuse with psychedelics and found tentative evidence that they reduce addicts’ craving during a post-trip “afterglow” lasting a month or two. This effect might be at least partially biochemical; LSD, mescaline, and psilocybin are known to modulate neurotransmitters such as serotonin and dopamine, which play a crucial role in the regulation of pleasure.

One possible candidate for psychedelic therapy would be dimethyltryptamine, or DMT, the only psychedelic known to occur naturally in trace amounts in human blood and brain tissue. DMT is the primary active ingredient of ayahuasca, a tea made from two Amazonian plants. Like peyote, ayahuasca has been used for centuries by Indians and now serves as a legal sacrament for several Brazilian churches. Recent studies of Brazilian ayahuasca drinkers by Charles Grob, a psychiatrist at the Harbor-UCLA Medical Center, and others suggest that ayahuasca has no adverse neurocognitive effects. An advantage of DMT, Halpern says, is that when injected its effects last less than an hour, and so it could be incorporated into relatively short therapeutic sessions.

Halpern already has research experience with DMT. In 1994 he spent six weeks helping Rick Strassman, a psychiatrist at the University of New Mexico, inject DMT into volunteers to measure the drug’s physiological effects. That study showed that DMT is not necessarily benign. Twenty-five of Strassman’s 60 subjects underwent what Strassman defined as “adverse effects,” ranging from hallucinations of terrifying “aliens” to, in one case, a dangerous spike in blood pressure. Strassman’s concerns about these reactions contributed to his decision to end his study early.

An even more controversial candidate for clinical testing is 3,4-methylenedioxymethamphetamine, more commonly known as MDMA or Ecstasy. MDMA is sometimes called an empathogen rather than a psychedelic, because its most striking effects are amplified feelings of empathy and diminished anxiety. Advocates contend that MDMA has therapeutic potential, and several researchers around the world are now administering the drug to patients with post-traumatic stress and other disorders.

Critics point out that MDMA has rapidly become a drug of abuse, with almost 800,000 Americans believed to be users. The drug has been linked to fatal overdoses and brain damage; just last fall, a paper in Science reported that only a few doses of MDMA caused neuropathy in monkeys. To help resolve questions about MDMA’s safety, Halpern and Pope have begun a study of young Midwesterners who claim to take MDMA while shunning other drugs and alcohol.

All drugs pose certain risks, Halpern says. The question is whether the risks are outweighed by the potential benefits for a population. For example, the benefits of giving MDMA to terminal cancer patients to help them cope with their anxiety might outweigh the risks posed to their health. In the same way, DMT or some other psychedelic might be worth giving to alcoholics and addicts who have failed to respond to other treatments.

Halpern also hopes to conduct a brain-imaging study to test his hypothesis that psychedelics reduce craving in addicts by affecting their serotonin and dopamine systems. “It sounds reductionistic,” he says, “but a picture can be worth a thousand words.” An ideal collaborator would be Franz Vollenweider, a psychiatrist at the University of Zurich, who with positron-emission tomography has measured neural changes induced in healthy volunteers by psilocybin and MDMA.

Some psychedelic effects have already been explained in relatively straightforward neural terms. For example, human brain-imaging tests and experiments on animals have shown that mescaline, LSD, and other psychedelics boost the random discharge of neurons in the visual cortex. This neural excitation is thought to induce form constants, the dynamic patterns I saw when I closed my eyes under the influence of peyote, which are also generated by migraines, epileptic seizures, and other brain disorders.
But the effects of hallucinogens will never be reducible to neurochemistry alone, Halpern emphasizes. Decades of research have confirmed the importance of “set and setting”—the prior expectations of users and the context of their experience. The same compound can evoke psychotic paranoia, psychological insight, or blissful communion, depending on whether it is consumed as a party drug in a nightclub, a medicine in a psychiatrist’s office, or a sacrament in a tepee. In the same way, psychedelic treatments may produce different outcomes depending on the setting.

The long-term challenge for researchers, Halpern says, is to determine which settings can exploit the therapeutic potential of hallucinogens while reducing the risk of adverse reactions. In the 1950s and 1960s, psychedelic therapy usually involved a single patient and therapist. In many cases, Halpern believes, psychedelic therapy might work best for couples, families, and friends. “If you take it by yourself, you may have important insights,” he says, “but you’ve lost this other opportunity to learn and grow.”

People might also respond to settings and rituals designed to evoke religious sentiments. Recently various scientists, notably Harold Koenig at Duke University, have reported finding correlations between religiosity—as reflected by church attendance and other measures—and resistance to depression. Ideally, Halpern says, therapists should be able to choose among many different settings to best serve a patient’s needs. One of his favorite proverbs is, “Many paths, one mountain.”

Halpern believes he has benefited from his peyote sessions, albeit in ways difficult to quantify or even describe. Borrowing the term for a compound that boosts the effect of a neurotransmitter, he speculates that peyote serves as a “humility agonist,” counteracting his arrogance by instilling awe and reverence in him. He acknowledges, however, that these emotions might be less a function of the peyote than of the ceremony of the Native American Church.

Reverence is certainly evident in Halpern’s bearing throughout the session we attend together. Although plagued by chronic back pain, he sits straight-backed for hour after hour on the $5 cushion he purchased earlier that day at Wal-Mart. He intently watches every ritual, listens to every song. When the roadman asks everyone to pray for the husband and wife who are the meeting’s focus, Halpern chimes in loudly.

Especially early on, the ceremony seems impenetrably foreign, but its meaning becomes more apparent as the night progresses. At one point the roadman, after offering a long prayer in Diné, turns to the husband and wife and says in English: “You must make more time in your lives for those who care about you.” The rituals, I realize, are just expressions of gratitude for earth, fire, food, and other primordial elements of existence. After each of us sips from a bowl of water passed around the tepee, the roadman carefully pours some water on the dirt floor. Halpern says in my ear, “Think what water means to these desert people.”

As dawn approaches, the mood throughout the tepee brightens. Everyone smiles as the husband and wife embrace and as their two children, who have been sleeping since midnight, wake up blinking and yawning. The wife, coming back into the tepee after fetching a platter of sweet rolls, jokes and laughs with a friend. As we drink coffee and eat the rolls, she thanks us for having sat through this long night with her and her family. “Thank you for letting us join you,” Halpern replies, beaming at her, “and may you and your family enjoy good health.”

Driving out of the Navajo Nation that afternoon, Halpern seems exhilarated, although he has not slept for 36 hours. He howls along with a CD of Native American Church chants and does imitations of Bill Clinton and several Star Trek characters. Outside Shiprock, New Mexico, his expression turns grim as we pass a policeman giving a sobriety test to a wobbly young man. Neither peyote nor any other medicine, Halpern realizes, can cure all those afflicted with alcoholism or addiction. “We don’t have magic pills,” he says drily. If his research on psychedelics yields therapies that can benefit just 10 or 15 percent of the millions struggling with these disorders, he will be more than satisfied. “I’m trying very slowly,” he says, “to put all the pieces in place.”

Fear of financial loss helps people exercise more.

By Morgan Manella

Companies that want their employees to exercise more might want to skip the promise of prizes or pats on the back. Instead, a new study shows, giving someone a financial incentive and then threatening to take it away might work better.

Workplace wellness programs are gaining popularity, and more than 80% of large employers are now using some form of financial incentive to increase physical activity, according a new study published in the Annals of Internal Medicine. This comes after the Centers for Disease Control and Prevention reported that more than half of adults in the United States do not reach the minimum recommended level of physical activity to see benefits to their health.

The study gave 281 people a 7,000 step-a-day goal that they were to keep up during a 13-week challenge. Researchers tested three financial incentive designs.

One group received $1.40 each day that they hit the 7,000-step goal. A second group was entered into a daily lottery, but participants were only eligible to collect a reward if they reached 7,000 steps the day before. The third group was given $42 upfront each month, and $1.40 was taken away each day the goal was not met. The control group received no money but did get some daily feedback.

The researchers found that the possibility of losing money led people to exercise more than the other incentives. It resulted in a 50% relative increase in the average amount of days participants achieved their physical activity goals.

“People are more motivated by losses than gains, and they like immediate gratification,” said study author, Dr. Mitesh Patel, an assistant professor in the Perelman School of Medicine and at the Wharton School at the University of Pennsylvania. “They want to be rewarded today, not next year or far into the future.”

The findings suggest that the way a financial incentive is framed is important to how effective it is — and it can influence the success of health promotion programs, according to the study.

“There is a large body of evidence in behavioral economics that has looked at ways of framing,” Patel said. “It’s the way our brains are wired that we tend to avoid wanting to lose things more than the benefit we get from gaining them. It makes people think like the money is theirs to lose from day one. By having skin in the game, it makes people more motivated, and we think we can leverage that in these types of programs.”

The study participants had an average BMI of 33.2, which classifies a person as obese, according to Patel.

“That is significant because most employers or wellness programs are designed to target people that are already motivated and people that tend to engage,” he said. “We wanted to target overweight and obese people that are more sedentary and have the most to benefit from these programs.”

In most programs, many participants will drop out quickly and only the motivated will stay involved, Patel said.

“In ours, we were pleasantly surprised that 96% stayed,” he said.

He attributes such high engagement rates in this study to the combination of design and technology. “The main takeaway is that the design of the incentive is critical to its success,” he said.

“Our study can help them [wellness programs] to design these incentives in a way that can be more effective and engage employees that have more to benefit, especially those that are obese, and to take into account that simple changes in the way we frame incentives can have a dramatic outcome in how we influence adults to change their behavior.”

Exploring the Biology of Eating Disorders

With the pressure for a certain body type prevalent in the media, eating disorders are on the rise. But these diseases are not completely socially driven; researchers have uncovered important genetic and biological components as well and are now beginning to tease out the genes and pathways responsible for eating disorder predisposition and pathology.

As we enter the holiday season, shoppers will once again rush into crowded department stores searching for the perfect gift. They will be jostled and bumped, yet for the most part, remain cheerful because of the crisp air, lights, decorations, and the sound of Karen Carpenter’s contralto voice ringing out familiar carols.

While Carpenter is mainly remembered for her musical talents, unfortunately, she is also known for introducing the world to anorexia nervosa (AN), a severe life-threatening mental illness characterized by altered body image and stringent eating patterns that claimed her life just before her 33rd birthday in 1983.

Even though eating disorders (ED) carry one of the highest mortality rates of any mental illness, many researchers and clinicians still view them as socially reinforced behaviors and diagnose them based on criteria such as “inability to maintain body weight,” “undue influence of body weight or shape on self-evaluation,” and “denial of the seriousness of low body weight” (1). This way of thinking was prevalent when Michael Lutter, then an MD/PhD student at the University of Texas Southwestern Medical Center, began his psychiatry residency in an eating disorders unit. “I just remember the intense fear of eating that many patients exhibited and thought that it had to be biologically driven,” he said.

Lutter carried this impression with him when he established his own research laboratory at the University of Iowa. Although clear evidence supports the idea that EDs are biologically driven—they predominantly affect women and significantly alter energy homeostasis—a lack of well-defined animal models combined with the view that they are mainly behavioral abnormalities have hindered studies of the neurobiology of EDs. Still, Lutter is determined to find the biological roots of the disease and tease out the relationship between the psychiatric illness and metabolic disturbance using biochemistry, neuroscience, and human genetics approaches.

We’ve Only Just Begun

Like many diseases, EDs result from complex interactions between genes and environmental risk factors. They tend to run in families, but of course, for many family members, genetics and environment are similar enough that teasing apart the influences of nature and nurture is not easy. Researchers estimate that 50-80% of the predisposition for developing an ED is genetic, but preliminary genome-wide analyses and candidate gene studies failed to identify specific genes that contribute to the risk.

According to Lutter, finding ED study participants can be difficult. “People are either reluctant to participate, or they don’t see that they have a problem,” he reported. Set on finding the genetic underpinnings of EDs, his team began recruiting volunteers and found 2 families, 1 with 20 members, 10 of whom had an ED and another with 5 out of 8 members affected. Rather than doing large-scale linkage and association studies, the team decided to characterize rare single-gene mutations in these families, which led them to identify mutations in the first two genes, estrogen-related receptor α (ESRRA) and histone deacetylase 4 (HDAC4), that clearly associated with ED predisposition in 2013 (1).

“We have larger genetic studies on-going, including the collection of more families. We just happened to publish these two families first because we were able to collect enough individuals and because there is a biological connection between the two genes that we identified,” Lutter explained.

ESRRA appears to be a transcription factor upregulated by exercise and calorie restriction that plays a role in energy balance and metabolism. HDAC4, on the other hand, is a well-described histone deacteylase that has previously been implicated in locomotor activity, body weight homeostasis, and neuronal plasticity.

Using immunoprecipitation, the researchers found that ESRRA interacts with HDAC4, in both the wild type and mutant forms, and transcription assays showed that HDAC4 represses ESRRA activity. When Lutter’s team repeated the transcription assays using mutant forms of the proteins, they found that the ESRRA mutation seen in one family significantly reduced the induction of target gene transcription compared to wild type, and that the mutation in HDAC4 found in the other family increased transcriptional repression for ESRRA target genes.

“ESRRA is a well known regulator of mitochondrial function, and there is an emerging view that mitochondria in the synapse are critical for neurotransmission,” Lutter said. “We are working on identifying target pathways now.”

Bless the Beasts and the Children

Finding genes associated with EDs provides the groundwork for molecular studies, but EDs cannot be completely explained by the actions of altered transcription factors. Individuals suffering these disorders often experience intense anxiety, intrusive thoughts, hyperactivity, and poor coping strategies that lead to rigid and ritualized behaviors and severe crippling perfectionism. They are less aware of their emotions and often try to avoid emotion altogether. To study these complex behaviors, researchers need animal models.

Until recently, scientists relied on mice with access to a running wheel and restricted access to food. Under these conditions, the animals quickly increase their locomotor activity and reduce eating, frequently resulting in death. While some characteristics of EDs—excessive exercise and avoiding food—can be studied in these mice, the model doesn’t allow researchers to explore how the disease actually develops. However, Lutter’s team has now introduced a promising new model (3).

Based on their previous success with identifying the involvement of ESRRA and HDAC4 in EDs, the researchers wondered if mice lacking ESRRA might make suitable models for studies on ED development. To find out, they first performed immunohistochemistry to understand more about the potential cognitive role of ESRRA.

“ESRRA is not expressed very abundantly in areas of the brain typically implicated in the regulation of food intake, which surprised us,” Lutter said. “It is expressed in many cortical regions that have been implicated in the etiology of EDs by brain imaging like the prefrontal cortex, orbitofrontal cortex, and insula. We think that it probably affects the activity of neurons that modulate food intake instead of directly affecting a core feeding circuit.”

With these data, the team next tried providing only 60% of the normal daily calories to their mice for 10 days and looked again at ESRRA expression. Interestingly, ESRRA levels increased significantly when the mice were insufficiently fed, indicating that the protein might be involved in the response to energy balance.

Lutter now believes that upregulation of ESRRA helps organisms adapt to calorie restriction, an effect possibly not happening in those with ESRRA or HDAC4 mutations. “This makes sense for the clinical situation where most individuals will be doing fine until they are challenged by something like a diet or heavy exercise for a sporting event. Once they start losing weight, they don’t adapt their behaviors to increase calorie intake and rapidly spiral into a cycle of greater and greater weight loss.”

When Lutter’s team obtained mice lacking ESRRA, they found that these animals were 15% smaller than their wild type littermates and put forth less effort to obtain food both when fed restricted calorie diets and when they had free access to food. These phenotypes were more pronounced in female mice than male mice, likely due to the role of estrogen signaling. Loss of ESRRA increased grooming behavior, obsessive marble burying, and made mice slower to abandon an escape hole after its relocation, indicating behavioral rigidity. And the mice demonstrated impaired social functioning and reduced locomotion.

Some people with AN exercise extensively, but this isn’t seen in all cases. “I would say it is controversial whether or not hyperactivity is due to a genetic predisposition (trait), secondary to starvations (state), or simply a ritual that develops to counter the anxiety of weight related obsessions. Our data would suggest that it is not due to genetic predisposition,” Lutter explained. “But I would caution against over-interpretation of mouse behavior. The locomotor activity of mice is very different from people and it’s not clear that you can directly translate the results.”

For All We Know

Going forward, Lutter’s group plans to drill down into the behavioral phenotypes seen in their ESRRA null mice. They are currently deleting ESRRA from different neuronal cell types to pair individual neurons with the behaviors they mediate in the hope of working out the neural circuits involved in ED development and pathology.

In addition, the team has created a mouse line carrying one of the HDAC4 mutations previously identified in their genetic study. So far, this mouse “has interesting parallels to the ESRRA-null mouse line,” Lutter reported.

The team continues to recruit volunteers for larger-scale genetic studies. Eventually, they plan to perform RNA-seq to identify the targets of ESRRA and HDAC4 and look into their roles in mitochondrial biogenesis in neurons. Lutter suspects that this process is a key target of ESRRA and could shed light on the cognitive differences, such as altered body image, seen in EDs. In the end, a better understanding of the cells and pathways involved with EDs could create new treatment options, reduce suffering, and maybe even avoid the premature loss of talented individuals to the effects of these disorders.


1. Lutter M, Croghan AE, Cui H. Escaping the Golden Cage: Animal Models of Eating Disorders in the Post-Diagnostic and Statistical Manual Era. Biol Psychiatry. 2015 Feb 12.

2. Cui H, Moore J, Ashimi SS, Mason BL, Drawbridge JN, Han S, Hing B, Matthews A, McAdams CJ, Darbro BW, Pieper AA, Waller DA, Xing C, Lutter M. Eating disorder predisposition is associated with ESRRA and HDAC4 mutations. J Clin Invest. 2013 Nov;123(11):4706-13.

3. Cui H, Lu Y, Khan MZ, Anderson RM, McDaniel L, Wilson HE, Yin TC, Radley JJ, Pieper AA, Lutter M. Behavioral disturbances in estrogen-related receptor alpha-null mice. Cell Rep. 2015 Apr 21;11(3):344-50.

CPAP therapy demonstrated to reduce depression in adults with obstructive sleep apnea

A new study shows that depressive symptoms are extremely common in people who have obstructive sleep apnea, and these symptoms improve significantly when sleep apnea is treated with continuous positive airway pressure therapy.

Results show that nearly 73 percent of sleep apnea patients (213 of 293 patients) had clinically significant depressive symptoms at baseline, with a similar symptom prevalence between men and women. These symptoms increased progressively and independently with sleep apnea severity.

However, clinically significant depressive symptoms remained in only 4 percent of the sleep apnea patients who adhered to CPAP therapy for 3 months (9 of 228 patients). Of the 41 treatment adherent patients who reported baseline feelings of self-harm or that they would be “better dead,” none reported persisting suicidal thoughts at the 3-month follow-up.

“Effective treatment of obstructive sleep apnea resulted in substantial improvement in depressive symptoms, including suicidal ideation,” said senior author David R. Hillman, MD, clinical professor at the University of Western Australia and sleep physician at the Sir Charles Gairdner Hospital in Perth. “The findings highlight the potential for sleep apnea, a notoriously underdiagnosed condition, to be misdiagnosed as depression.”

Study results are published in the September issue of the Journal of Clinical Sleep Medicine.

The American Academy of Sleep Medicine reports that obstructive sleep apnea (OSA) is a common sleep disease afflicting at least 25 million adults in the U.S. Untreated sleep apnea increases the risk of other chronic health problems including heart disease, high blood pressure, Type 2 diabetes, stroke and depression.

The study group comprised 426 new patients referred to a hospital sleep center for evaluation of suspected sleep apnea, including 243 males and 183 females. Participants had a mean age of 52 years. Depressive symptoms were assessed using the validated Patient Health Questionnaire (PHQ-9), and the presence of obstructive sleep apnea was determined objectively using overnight, in-lab polysomnography. Of the 293 patients who were diagnosed with sleep apnea and prescribed CPAP therapy, 228 were treatment adherent, which was defined as using CPAP therapy for an average of 5 hours or more per night for 3 months.

According to the authors, the results emphasize the importance of screening people with depressive symptoms for obstructive sleep apnea. These patients should be asked about common sleep apnea symptoms including habitual snoring, witnessed breathing pauses, disrupted sleep, and excessive daytime sleepiness.