Problem-Solving Therapy (PST)

Problem-Solving Therapy (PST) is a well-established form of cognitive-behavioural therapy (CBT) with a substantial body of research evidence supporting its theory and practice.  It was developed in the early 1970s by behaviour therapists seeking to design a general-purpose set of strategies for helping clients to enhance their creative problem-solving abilities.  We now know that Problem-Solving Therapy (PST) is particularly effective in helping people who suffer from depression, and it tends to be combined with assertiveness training and other therapeutic approaches.

The goal of Problem-Solving Therapy isn’t merely to help you solve your own problems but to make you a more skilled ans self-confident problem-solver in general.  Problem-solving is traditionally divided into five main component skills, which can be taught and practised in therapy sessions,

1. Problem Orientation.  Your mind-set or attitude toward problems, i.e., seeing problems as a normal part of life, as challenges to be overcome rather than overwhelming threats, and a willingness to approach them in a systematic and timely manner.
2. Problem Definition.  The ability to define problems and corresponding goals accurately and objectively, without unhelpful assumptions or emotive language, i.e., to stick to the key facts and pinpoint what it is that makes the situation a problem.
3. Generating Alternatives.  The ability to look at things from different perspectives and creatively brainstorm an exhaustive list of potential solutions, i.e., to identify all of the available options.
4. Decision-Making.  The ability to prioritise the best solutions and evaluate them from all the relevant perspectives, i.e., in terms of both short and long-term consequences and the effect upon yourself and other people.  The ability to identify the best solution or combination and to develop a realistic plan of action.
5. Solution Implementation.  The ability to test your action plan out in the real world, putting it into practice and evaluating the outcome, in an “experimental” manner.  The ability to adapt plans or employ “backup plans” where appropriate and to repeat the problem-solving process where problems remain unresolved.

Source: http://londoncognitive.com/about-problem-solving/

CBT Psychotherapy Best For Anxiety Disorders

A University of Houston researcher has found that patients suffering fromanxiety disorders showed the most improvement when treated with cognitive-behavioral therapy (CBT) — in conjunction with a “transdiagnostic” approach, which allows therapists to use one kind of treatment no matter what the anxiety.

The problem up to now, according to Peter Norton, Ph.D., an associate professor in clinical psychology and director of the Anxiety Disorder Clinic at the University of Houston, has been that each anxiety disorder — such aspanic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social anxiety disorder, and phobias — has had a targeted treatment.

The transdiagnostic approach recognizes that many overlapping dimensions exist among these anxiety disorders. It suggests that thinking about anxiety disorders as a whole from a behavioral dimension and/or psychological dimension perspective may yield important insights into these disorders.

Norton, who says the specific treatments aren’t all that different from each other, has shown that a combination of CBT with the transdiagnostic approach has proven more effective than CBT combined with other types of anxiety disorder treatments, such as relaxation training.

“The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been an important breakthrough in understanding mental health, but people are dissatisfied with its fine level of differentiation,” he said. The DSM uses a categorical approach to classifying mental disorders, including anxiety concerns.

“Panic disorders are considered something different from social phobia, which is considered something different from PTSD. The hope was that by getting refined in the diagnosis we could target interventions for each of these diagnoses, but in reality that just hasn’t played out.”

Norton’s research began 10 years ago when he was a graduate student in Nebraska and found he couldn’t get enough people together on the same night to run a group session for social phobia.

“What I realized is that I could open a group to people with anxiety disorders in general and develop a treatment program regardless of the artificial distinctions between social phobia and panic disorder, or obsessive-compulsive disorder, and focus on the core underlying things that are going wrong,” said Norton.

He says cognitive-behavioral therapy, which has a specific time frame and goals, is the most effective treatment as it helps patients understand the thoughts and feelings that influence their behaviors. The twist for him was using CBT in conjunction with the transdiagnostic approach.

The patients receiving the transdiagnostic treatment showed considerable improvement, especially with treating comorbid diagnoses, a disease or condition that co-exists with a primary disease and can stand on its own as a specific disease, like depression. Anxiety disorders often occur with a secondary illness, such as depression or substance and alcohol abuse, he noted.

“What I have learned from my past research is that if you treat your principal diagnosis, such as social phobia, you are going to show improvement on some of your secondary diagnosis,” he said. “Your mood is going to get a little better, your fear of heights might dissipate. So there is some effect there, but when we approach things with a transdiagnostic approach, we see a much bigger impact on comorbid diagnoses.”

“In my research study, over two-thirds of [co-existing] diagnoses went away, versus what we typically find when I’m treating a specific diagnosis such as a panic disorder, where only about 40 percent of people will show that sort of remission in their secondary diagnosis,” he continued.

“The transdiagnostic treatment approach [appears to be] more efficient in treating the whole person rather than just treating the diagnosis… then treating the next diagnoses.”

Norton notes the larger contributions of the studies are to guide further development and interventions for how clinical psychologists, therapists and social workers treat people with anxiety disorders. The data collected will be useful for people out on the front lines to effectively treat people to reduce anxiety disorders, he said.

Source: University of Houston

CBT, pharmacologic interventions decrease depressive symptoms in cancer patients

Despite guidelines recommending screening for depression in cancer patients, it’s been unclear whether interventions designed to treat this depression are effective. A study by the University of Colorado Cancer Center and other institutions, published in theJournal of the National Cancer Institute, changes that. This meta-analysis of 10 studies encompassing 1362 patients shows that especially cognitive behavioral therapy and pharmacologic interventions decrease depressive symptoms in cancer patients.

“In the past, we had looked at interventions as a whole – most of which were designed to help cancer patients cope generally with stress but not specifically with depression – and found moderate effects. This study shows not only that interventions specific to depression in cancer patients can improve symptoms, but shows which interventions are likely to offer the most benefit,” says Kristin Kilbourn, PhD, CU Cancer Center investigator and assistant professor of psychology at the University of Colorado Denver.

The recent study is the culmination of a five-year effort during which Kilbourn and collaborators combed the literature for studies that met stringent criteria specifying that studies were randomized control trials in which cancer patients reported a significant number of depressive symptoms prior to starting the intervention.

“Still, many questions exist,” Kilbourn says. “For example, which interventions are best in early cancers versus metastatic disease? Do we find similar effectiveness if patients were diagnosed with depression before their cancer? And which interventions are most effective with different cultural and ethnic subpopulations?” Likewise, Kilbourn hopes further study will explore the durability of gains patients experience with these interventions.

Finally, “This study supports the notion that screening for depression in cancer patients is important because if we could identify people early in the process and intervene, we now know definitively that we can affect the trajectory of this depression,” Kilbourn says.

Source: University of Colorado Denver

Middle-Aged Women Who Were Child Abuse Victims at Increased Risk for Heart Disease, Diabetes

ScienceDaily (July 11, 2012) — Middle-aged women who report having been physically abused as children are about two times more likely than other women their age to have high blood pressure, high blood sugar, a larger waistline and poor cholesterol levels, according to a new study published by the American Psychological Association.

These women are diagnosed as having metabolic syndrome which, according to previous research, places them at an increased risk of developing heart disease and Type 2 diabetes. This link between physical abuse and metabolic syndrome persisted beyond traditional risk factors, suggesting physical abuse is a unique factor in women’s cardiovascular health, according to the study. It is the first study to show that a history of childhood physical abuse is related to the development of metabolic syndrome in women at mid-life, according to the authors. It was published online in the APA journal Health Psychology.

“Our research shows us that childhood abuse can have long-lasting consequences, even decades later, on women’s health and is related to more health problems down the road,” said study co-author Aimee Midei, MS, from the University of Pittsburgh.

Participants in the study were 342 women, 113 black and the remainder white, from the Pittsburgh area. They were between the ages of 42 and 52 when the study began. Each completed a childhood trauma questionnaire that assessed past physical, emotional and sexual abuse. Approximately 34 percent of the participants reported experiencing some type of childhood abuse.

Metabolic syndrome was identified by measuring the women’s waist circumference, cholesterol levels, blood pressure and fasting glucose levels annually during the seven-year study. Other traditional risk factors for metabolic syndrome were also assessed, such as smoking, physical activity, menopause, alcohol use, depressive symptoms and childhood and adult socioeconomic status. At baseline, 60 women were diagnosed with metabolic syndrome and 59 more were identified over the course of the study.

Results showed that physical abuse was strongly associated with metabolic syndrome, even after controlling for ethnicity, age, menopause and other traditional risk factors. Sexual abuse and emotional abuse were unrelated to metabolic syndrome, according to the findings.

The authors further examined individual components of the metabolic syndrome and found that physical abuse was particularly associated with larger waist circumference and fasting glucose, both of which are precursors to Type 2 diabetes. “It’s possible that women with histories of physical abuse engage in unhealthy eating behaviors or have poor stress regulation,” said Midei. “It appears that psychology plays a role in physical health even when we’re talking about traumatic incidents that happened when these women were children.”

Childhood Trauma Linked to Adult Smoking for Girls

ScienceDaily (July 12, 2012) — Adverse childhood experiences (ACEs) can stay with us for life. New research published in BioMed Central’s open access journal Substance Abuse Treatment, Prevention, and Policy explains how these events can be tied up with adult smoking patterns, especially for women, and suggests that treatment and strategies to stop smoking need to take into account the psychological effects of childhood trauma.

ACEs can range from emotional, physical, and sexual abuse to neglect and household dysfunction and affect a large range of people. In one of the largest studies of ACEs survey over 60% of adults reported a history of at least one event.  ACEs are thought to have a long term effect on the development of children and can lead to unhealthy coping behaviour later in life.

Since psychiatric disorders, including depression and anxiety, are known to increase the risk of smoking, researchers across the USA collaborated to investigate the effects of psychological distress on the relationship between ACE and current adult smoking. The ACE questionnaire was completed by over 7000 people, about half of whom were women.

Even after adjusting the data for factors known to affect a person’s propensity for smoking, such as their parents smoking during the subject’s childhood, and whether or not they had drunk alcohol in the previous month), women who had been physically or emotionally abused were 1.4 times more likely to smoke. Having had a parent in prison during childhood doubled chances of women smoking.

Psychological distress increases the chances that any person (male or female) will smoke. Dr Tara Strine, who led this study commented, “Since ACEs increase the risk of psychological distress for both men and women, it seemed intuitive that an individual experiencing an ACE will be more likely to be a tobacco cigarette smoker. However,  in our study, ACEs only to increased the risk of smoking among women.  Given this, men who have experienced childhood trauma may have different coping mechanisms than their female counterparts.”

Dr Strine continued, “Our results show that, among women, an underlying mechanism that links ACEs to adult smoking is psychological distress, particularly among those who have suffered emotional or physical abuse or physical neglect as a child. These findings suggest that current smoking cessation campaigns and strategies may benefit from understanding the potential relationship between childhood trauma and subsequent psychological distress on the role of smoking particularly in women.”

Oxycontin Formula Change Has Many Abusers Switching to Heroin

ScienceDaily (July 11, 2012) — A change in the formula of the frequently abused prescription painkiller OxyContin has many abusers switching to a drug that is potentially more dangerous, according to researchers at Washington University School of Medicine in St. Louis.

The formula change makes inhaling or injecting the opioid drug more difficult, so many users are switching to heroin, the scientists report in the July 12 issue of the New England Journal of Medicine.

For nearly three years, the investigators have been collecting information from patients entering treatment for drug abuse. More than 2,500 patients from 150 treatment centers in 39 states have answered survey questions about their drug use with a particular focus on the reformulation of OxyContin.

The widely prescribed pain-killing drug originally was thought to be part of the solution to the abuse of opioid drugs because OxyContin was designed to be released into the system slowly, thus not contributing to an immediate “high.” But drug abusers could evade the slow-release mechanism by crushing the pills and inhaling the powder, or by dissolving the pills in water and injecting the solution, getting an immediate rush as large amounts of oxycodone entered the system all at once.

In addition, because OxyContin was designed to be a slow-release form of the generic oxycodone, the pills contained large amounts of the drug, making it even more attractive to abusers. Standard oxycodone tablets contained smaller amounts of the drug and did not produce as big a rush when inhaled or injected.

Then in 2010, a new formulation of the drug was introduced. The new pills were much more difficult to crush and dissolved more slowly. The idea, according to principal investigator Theodore J. Cicero, PhD, was to make the drug less attractive to illicit users who wanted to experience an immediate high.

“Our data show that OxyContin use by inhalation or intravenous administration has dropped significantly since that abuse-deterrent formulation came onto the market,” says Cicero, a professor of neuropharmacology in psychiatry. “In that sense, the new formulation was very successful.”

The researchers still are analyzing data, but Cicero says they wanted to make their findings public as quickly as possible. The new report appears as a letter to the editor in the journal. Although he found that many users stopped using OxyContin, they didn’t stop using drugs.

“The most unexpected, and probably detrimental, effect of the abuse-deterrent formulation was that it contributed to a huge surge in the use of heroin, which is like OxyContin in that it also is inhaled or injected,” he says. “We’re now seeing reports from across the country of large quantities of heroin appearing in suburbs and rural areas. Unable to use OxyContin easily, which was a very popular drug in suburban and rural areas, drug abusers who prefer snorting or IV drug administration now have shifted either to more potent opioids, if they can find them, or to heroin.”

Since the researchers started gathering data from patients admitted to drug treatment centers, the number of users who selected OxyContin as their primary drug of abuse has decreased from 35.6 percent of respondents before the release of the abuse-deterrent formulation to 12.8 percent now.

When users answered a question about which opioid they used to get high “in the past 30 days at least once,” OxyContin fell from 47.4 percent of respondents to 30 percent. During the same time period, reported use of heroin nearly doubled.

In addition to answering a confidential questionnaire when admitted to a drug treatment program, more than 125 of the study subjects also agreed to longer phone interviews during which they discussed their drug use and the impact of the new OxyContin formulation on their individual choices.

“When we asked if they had stopped using OxyContin, the normal response was ‘yes,'” Cicero says. “And then when we asked about what drug they were using now, most said something like: ‘Because of the decreased availability of OxyContin, I switched to heroin.'”

These findings may explain why so many law enforcement officials around the country are reporting increases in heroin use, Cicero says. He compares attempts to limit illicit drug use to a levee holding back floodwaters. Where the new formulation of OxyContin may have made it harder for abusers to use that particular drug, the “water” of illicit drug use simply has sought out other weak spots in the “levee” of drug policy.

“This trend toward increases in heroin use is important enough that we want to get the word out to physicians, regulatory officials and the public, so they can be aware of what’s happening,” he says. “Heroin is a very dangerous drug, and dealers always ‘cut’ the drug with something, with the result that some users will overdose. As users switch to heroin, overdoses may become more common.”

Funding for this research comes from the Denver Health and Hospital Authority, which provided an unrestricted research grant to fund the Survey of Key Informants’ Patients (SKIP) Program, a component of the RADARS (Researched Abuse, Diversion and Addition-Related Surveillance) System.

Moderate Drinking May Reduce Risk of Rheumatoid Arthritis

ScienceDaily (July 10, 2012) — Moderate consumption of alcohol is associated with a reduced risk of developing rheumatoid arthritis, suggests a study published on the British Medical Journalwebsite.

The results show that women who regularly consume more than three alcoholic drinks a week for at least 10 years have about half the risk of developing rheumatoid arthritis compared with non-drinkers.

After adjusting for factors such as age, smoking and dietary habits, women who reported drinking more than three glasses of alcohol per week in both 1987 and 1997 had a 52% reduced risk of rheumatoid arthritis compared with never drinkers at both assessments.

These findings add to a growing body of evidence that long term moderate alcohol consumption is not harmful and may protect against a chronic disease like rheumatoid arthritis, say the authors. However, they stress that the effect of higher doses of alcohol on the risk of rheumatoid arthritis remains unknown.

Rheumatoid arthritis is a chronic inflammatory joint disorder that usually develops between the ages of 40 and 50. About 1% of the world’s population is affected — women three times more often than men. Some studies have shown that drinking alcohol is associated with a lower risk of rheumatoid arthritis, whereas others have found no association.

The relation between alcohol intake and rheumatoid arthritis remains controversial. So a team of researchers based in Sweden set out to analyse this association among 34,141 Swedish women born between 1914 and 1948.

Detailed information about alcohol consumption, diet, smoking history, physical activity and education level was collected in 1987 and again in 1997.

Participants were followed up for seven years (Jan 2003 to Dec 2009) when they were aged 54-89 years, during which time 197 new cases of rheumatoid arthritis were registered.

The age-standardized rate of rheumatoid arthritis was smaller among women who drank more than four glasses of alcohol a week (7 per 10,000 person years) than among women who drank less than one glass a week (9.1 per 10,000 person years) as reported in 1997.

After adjusting for factors such as age, smoking and dietary habits, women who reported drinking more than three glasses of alcohol per week in both 1987 and 1997 had a 52% reduced risk of rheumatoid arthritis compared with never drinkers at both assessments.

One standard glass of alcohol was defined as approximately 500 ml beer, 150 ml of wine or 50 ml of liquor.

The reduced risk was similar for all three types of alcoholic drink.

Further analyses made little difference to the results, supporting the theory that a moderate amount of alcohol may be a protective factor for rheumatoid arthritis. The authors suggest that this is most likely to be due to alcohol’s ability to lower the body’s immune response.

This is relevant because rheumatoid arthritis is an autoimmune disease — it causes the immune system, which usually fights infection, to attack the cells that line the joints.

Revisiting LSD as a Treatment for Alcoholism

ScienceDaily (Mar. 8, 2012) — Several decades ago, a number of clinics used LSD to treat alcoholism with some success. But until now, no research has pulled together the results of these trials to document exactly how effective LSD was. Now a new meta-analysis of randomized controlled trials of the drug, available in the Journal of Psychopharmacology, published by SAGE, provides evidence for a clear and consistent beneficial effect of LSD for treating alcohol dependency.

Teri Krebs and Pål-Ørjan Johansen are both affiliated with the Department of Neuroscience at the Norwegian University of Science and Technology (NTNU), Trondheim, Norway. During research fellowships at Harvard Medical School, Boston, USA, they spotted a gap in the understanding of lysergic acid diethylamide’s (LSD’s) potential for alcoholism treatment. No researcher had ever performed a quantitative meta-analysis of previous clinical trials using the drug.

Krebs and Johansen set out to independently extract data from previous randomized, controlled clinical trials, pooling their results. They identified six eligible trials, all carried out in the late 1960s and early 1970s. These included 536 participants, the vast majority of whom were male in-patients enrolled in alcohol-focused treatment programs. Individuals with a history of schizophrenia or psychosis were excluded from the original trials. The control conditions included low-dose LSD, stimulants, or non-drug control conditions. Each trial used clearly defined treatment-independent and standardized methods to assess outcomes on alcohol misuse.

While the experiments varied in the dosage used and the type of placebo physicians administered to patients, LSD had a beneficial effect on alcohol misuse in every trial. On average, 59 percent of LSD patients and 38 percent of control patients were improved at follow-up using standardized assessment of problem alcohol use. There was also a similar beneficial effect on maintained abstinence from alcohol. The positive effects of a single LSD dose — reported both in these and in other, non-randomized trials — lasts at least six months and appears to fade by 12 months.

Regarding the lasting effects of the LSD experience in alcoholics, investigators of one trial noted, “It was rather common for patients to claim significant insights into their problems, to feel that they had been given a new lease on life, and to make a strong resolution to discontinue their drinking.” And investigators of another trial noted, “It was not unusual for patients following their LSD experience to become much more self-accepting, to show greater openness and accessibility, and to adopt a more positive, optimistic view of their capacities to face future problems.”

LSD interacts with a specific type of serotonin receptors in the brain, which may stimulate to new connections and open the mind for new perspectives and possibilities, Krebs explains. LSD is not known to be addictive or toxic to the body, but the LSD has striking effects on imagination, perception, and memories and can elicit periods of intense anxiety and confusion.

“Given the evidence for a beneficial effect of LSD on alcoholism, it is puzzling why this treatment approach has been largely overlooked,” says Johansen. The authors suggest a number of reasons for this: many of the individual trials did not have enough patients to confidently conclude that there was a beneficial effect of LSD, but when pooled together the trials shows a clear and consistent effect; trial authors expected unrealistic results from a single dose of LSD and tended to discount moderate or short-term effects and; earlier non-randomized clinical trials reporting promising results but had methodological problems, creating the misunderstanding that well-designed studies did not exist or failed to find a beneficial effect. Finally, the complicated social and political history of LSD meant that obtaining regulatory approval for clinical trials became laborious, although national and international drug control measures have never banned treatment development or medical use of LSD.

Its unusual for a psychiatric medication to have a positive treatment effect lasting for several months after a single dose. Krebs and Johansen suggest that repeated doses of LSD coupled with modern, evidence-based alcohol relapse prevention treatments might provide more sustained results. They also note that plantbased psychedelics such as mescaline and ayahuasca which are used by Native Americans to promote mental health and sustained sobriety, merit further investigation for alcoholism treatment.

Discovery of Brain’s Natural Resistance to Drugs May Offer Clues to Treating Addiction

ScienceDaily (Mar. 8, 2012) — A single injection of cocaine or methamphetamine in mice caused their brains to put the brakes on neurons that generate sensations of pleasure, and these cellular changes lasted for at least a week, according to research by scientists at the Salk Institute for Biological Studies.

Their findings, reported March 7, 2012 in Neuron, suggest this powerful reaction to the drug assault may be a protective, anti-addiction response. The scientists theorize that it might be possible to mimic this response to treat addiction to these drugs and perhaps others, although more experiments are required to explore this possibility.

“It was stunning to discover that one exposure to these drugs could promote such a strong response that lasts well after the drug has left the body,” says Paul Slesinger, an associate professor in the Clayton Foundation Laboratories for Peptide Biology. “We believe this could be the brain’s immediate response to counteract the stimulation of these drugs.”

Scientists are trying to better understand the brain’s response to psychoactive drugs in hopes of finding new ways to prevent and treat addiction. This research has become especially important as the number of deaths due to drug abuse now exceeds those due to car accidents, with more than 37,000 people dying from drugs in 2009, according to the Centers for Disease Control and Prevention. Slesinger and Christian Lüscher, a long-time collaborator at the University of Geneva, have been investigating the cellular changes in the brain that occur with drug abuse.

Dopamine is a primary neurotransmitter used in the brain’s reward pathway — generally speaking, the activity of dopamine neurons in the reward pathway increases in response to rewards, such as sex, food and drugs. Psychostimulants, such as methamphetamine and cocaine, co-opt this pathway and alter the brain’s response to dopamine. Understanding the neuroadaptations that occur in the reward pathway in response to drugs of abuse may lead to the development of a treatment for drug addiction.

Previous research has shown that use of cocaine and methamphetamine in mice enhances excitatory connections to dopamine neurons. While most research has focused on these excitatory neurons, Slesinger and his colleagues looked at neurons that inhibit dopamine transmission, and found that one injection of cocaine or methamphetamine produces a profound change in the function of these inhibitory GABA neurons. These neurons were not able to control how they fired, so they would release more than the usual amount of inhibitory neurotransmitter.

“This persistent change in the inhibitory neurons occurs simultaneously with enhancement of excitatory inputs, indicating a possible compensatory mechanism that could be protective during exposure to drugs,” Slesinger says.

The Salk researchers identified a change in the biochemical pathway in inhibitory GABA neurons that led to this protective effect. It involved a change in the activity of a protein, known as a phosphatase, which controls the levels of a receptor known to be important for controlling the electrical activity of the GABA neuron.

“This particular pathway — involving a GABA type B receptor and a particular type of potassium channel — was affected by psychostimulants in these inhibitory neurons,” Slesinger says. “We noticed a dramatic reduction in the strength of this signaling pathway, which we showed was due to a decrease in the activity of the GABA_B receptor and the potassium channel on the neuron’s membrane surface.”

“If we could tap into this pathway — enhance the ability of inhibitory neurons to control the activity of dopamine neurons — we might be able to treat some types of drug addiction,” Slesinger says.

What is not known is how long the drug response lasts — this study only looked at the brains of mice at two time points, 24 hours and seven days, after drug use — and why addiction ultimately develops with chronic drug use. These are questions Slesinger and his colleagues are now investigating.

The study’s two lead authors are Claire Padgett, a former postdoctoral researcher in the Slesinger laboratory, and Arnaud Lalive, a doctoral student at the University of Geneva, who is working in the laboratory of Christian Lüscher, also a co-author. Other participating investigators include: Michaelanne Munoz, of the University of California San Diego; Stephen Moss and colleagues from Tufts University School of Medicine; Rafael Luján, from the Universidad de Castilla-La Mancha in Albacete, Spain; and investigators from Hokkaido University School of Medicine in Sapporo, Japan; University College in London; and AstraZeneca in Cheshire, United Kingdom.

The study was funded by the National Institute on Drug Abuse, the National Institute of Neurological Disorders and Stroke, Catharina Foundation and the Spanish Ministry of Education and Science.

The Principles of Reality Therapy

There are several basic principles of reality therapy that must be applied to make this technique most successful.

• Focus on the present and avoid discussing the past because all human problems are caused by unsatisfying present relationships.
• Avoid discussing symptoms and complaints as much as possible since these are often the ineffective ways that clients choose to deal with (and hold on to) unsatisfying relationships.
• Understand the concept of total behavior, which means focus on what clients can do, directly act, and think. *Spend less time on what they cannot do directly such as changing their feelings and physiology. Feelings and physiology can be changed indirectly, but only if there is a change in the acting and thinking.
• Avoid criticizing, blaming and/or complaining and help clients do the same. By doing this, they learn to avoid these extremely harmful external control behaviors that destroy relationships.
• Remain non-judgmental and non-coercive, but encourage people to judge all they are doing by the Choice Theory axiom: Is what I am doing getting me closer to the people I need? If the choice of behaviors is not getting people closer, then the therapist works to help the client find new behaviors that lead to a better connection.
• Teach clients that legitimate or not, excuses stand directly in the way of their ability to make needed connections.
• Focus on specifics. Find out as soon as possible who clients are disconnected from and work to help them choose reconnecting behaviors. If they are completely disconnected, focus on helping them find a new connection.
• Help them make specific, workable plans to reconnect with the people they need, and then follow through on what was planned by helping them evaluate their progress. Based on their experience, therapists may suggest plans, but should not give the message that there is only one plan. A plan is always open to revision or rejection by the client.
• Be patient and supportive but keep focusing on the source of the problem: disconnectedness. Clients who have been disconnected for a long time will find it difficult to reconnect. They are often so involved in the harmful behavior that they have lost sight of the fact that they need to reconnect. Help them to understand Choice Theory and explain that whatever their complaint, reconnecting is the best possible solution to their problem.

CBT, Supportive Therapy Equally Effective for Bipolar

A recent study has found that cognitive behavioral therapy (CBT) and supportive therapy are equally effective in treating the symptoms of bipolar disorder.

Researchers, led by Thomas D. Meyer, PhD, at Eberhard Karls Universität in Tübingen, Germany, wanted to investigate the effectiveness of currently available treatments for the disorder.

Bipolar disorder is a mental illness in which the sufferer experiences extreme and abnormal mood swings, from manichighs to potentially dangerous lowdepression. Over five million people in the United States suffer from bipolar — about 1.6 percent of the population.  It is the sixth leading cause of disability worldwide, and causes significant stress on families and relationships.

Earlier studies have proven that CBT is an effective treatment for the disorder, but these studies did not compare CBT to other types of treatments.

The randomized controlled trial included 76 patients with bipolar I or bipolar II. Patients were given either CBT or supportive therapy for 20 sessions over nine months. The participants were then followed for up to two years.

Both CBT and supportive therapy are psychoanalytic therapies that teach the patient to increase healthy thought processes and behaviors and decrease upsetting thoughts and behaviors.

CBT uses a systematic method to achieve this goal, whereas supportive therapy reinforces and supports the positive, healthy thoughts and behaviors.

The results show that the participants had equal amounts of symptom improvement regardless of the type of treatment. Relapse was also similar for patients in both therapy types.

During the 33 months of the study, 64.5 percent of the participants relapsed regardless of the type of therapy. Relapsing was associated with having bipolar II, the number of previous episodes, and the number of sessions attended before the relapse.

The researchers conclude that both therapies share some characteristics such as mood monitoring and educational components.

These factors might explain the overall benefits of these types of treatments and why they had equally positive effects.

This study was published in Psychological Medicine.

Source: Psychological Medicine 

Why Current Strategies for Fighting Obesity Are Not Working

ScienceDaily (July 3, 2012) — As the United States confronts the growing epidemic of obesity among children and adults, a team of University of Colorado School of Medicine obesity researchers concludes that what the nation needs is a new battle plan — one that replaces the emphasis on widespread food restriction and weight loss with an emphasis on helping people achieve “energy balance” at a healthy body weight.

In a paper published in the July 3 issue of the journal Circulation, James O. Hill, PhD. and colleagues at the Anschutz Health and Wellness Center take on the debate over whether excessive food intake or insufficient physical activity cause obesity, using the lens of energy balance — which combines food intake, energy expended through physical activity and energy (fat) storage — to advance the concept of a “regulated zone,” where the mechanisms by which the body establishes energy balance are managed to overcome the body’s natural defenses towards preserving existing body weight. This is accomplished by strategies that match food and beverage intake to a higher level of energy expenditure than is typical in America today, enabling the biological system that regulates body weight to work more effectively. Additional support for this concept comes from many studies showing that higher levels of physical activity are associated with low weight gain whereas comparatively low levels of activity are linked to high weight gain over time.

“A healthy body weight is best maintained with a higher level of physical activity than is typical today and with an energy intake that matches,” explained Hill, professor of pediatrics and medicine and executive director of the Anschutz Health and Wellness Center at the University of Colorado Anschutz Medical Campus and the lead author of the paper. “We are not going to reduce obesity by focusing only on reducing food intake. Without increasing physical activity in the population we are simply promoting unsustainable levels of food restriction. This strategy hasn’t worked so far and it is not likely to work in the future.

As Dr. Hill explains, “What we are really talking about is changing the message from ‘Eat Less, Move More” to ‘Move More, Eat Smarter.’ ”

The authors argue that preventing excessive weight gain is a more achievable goal than treating obesity once it is present. Here, the researchers stress that reducing calorie intake by 100 calories a day would prevent weight gain in 90 percent of the adult population and is achievable through small increases in physical activity and small changes in food intake.

People who have a low level of physical activity have trouble achieving energy balance because they must constantly use food restriction to match energy intake to a low level of energy expenditure. Constant food restriction is difficult to maintain long-term and when it cannot be maintained, the result is positive energy balance (when the calories consumed are greater than the calories expended) and an increase in body mass, of which 60 percent to 80 percent is usually body fat. The increasing body mass elevates energy expenditure and helps reestablish energy balance. In fact, the researchers speculate that becoming obese may be the only way to achieve energy balance when living a sedentary lifestyle in a food-abundant environment.

Using an exhaustive review of the energy balance literature as the basis, the researchers also refuted the popular theory that escalating obesity rates can be attributed exclusively to two factors — the change in the American diet and the rise in overall energy intake without a compensatory increase in energy expenditure. Using rough estimates of increases in food intake and decreases in physical activity from 1971 to 2000, the researchers calculated that were it not for the physiological processes that produce energy balance, American adults would have experienced a 30 to 80 fold increase in weight gain during that period, which demonstrates why it is not realistic to attribute obesity solely to caloric intake or physical activity levels. In fact, energy expenditure has dropped dramatically over the past century as our lives now require much less physical activity just to get through the day. The authors argue that this drop in energy expenditure was a necessary prerequisite for the current obesity problem, which necessitates adding a greater level of physical activity back into our modern lives.

“Addressing obesity requires attention to both food intake and physical activity, said co-author John Peters, PhD., assistant director of the Anschutz Health and Wellness Center. “Strategies that focus on either alone will not likely work.”

In addition, the researchers conclude that food restriction alone is not effective in reducing obesity, explaining that although caloric restriction produces weight loss, this process triggers hunger and the body’s natural defense to preserve existing body weight, which leads to a lower resting metabolic rate and notable changes in how the body burns calories. As a result, energy requirements after weight loss can be reduced from 170 to 250 calories for a 10 percent weight loss and from 325 to 480 calories for a 20 percent weight loss. These findings provide insight concerning weight loss plateau and the common occurrence of regaining weight after completing a weight loss regimen.

Recognizing that energy balance is a new concept for to the public, the researchers call for educational efforts and new information tools that will teach Americans about energy balance and how food and physical activity choices affect energy balance.

Childless Women With Fertility Problems at Higher Risk of Hospitalization for Psychiatric Disorders

ScienceDaily (July 2, 2012) — While many small studies have shown a relationship between infertility and psychological distress, reporting a high prevalence of anxiety, mood disorders and depressive symptoms, few have studied the psychological effect of childlessness on a large population basis. Now, based on the largest cohort of women with fertility problems compiled to date, Danish investigators have shown that women who remained childless after their first investigation for infertility had more hospitalisations for psychiatric disorders than women who had at least one child following their investigation.

The results of the study were presented July 1 at the annual meeting of ESHRE (European Society of Human Reproduction and Embryology) by Dr Birgitte Baldur-Felskov, an epidemiologist from the Danish Cancer Research Center in Copenhagen.

Most studies of this kind have been based on single clinics and self-reported psychological effects. This study, however, was a nationwide follow-up of 98,737 Danish women investigated for infertility between 1973 and 2008, who were then cross-linked via Denmark’s population-based registries to the Danish Psychiatric Central Registry. This provided information on hospitalisations for psychiatric disorders, which were divided into an inclusive group of “all mental disorders,” and six discharge sub-groups which comprised “alcohol and intoxicant abuse,” “schizophrenia and psychoses,” “affective disorders including depression,” “anxiety, adjustment and obsessive compulsive disorder,” “eating disorders,” and “other mental disorders.”

All women were followed from the date of their initial fertility investigation until the date of psychiatric event, date of emigration, date of death, date of hospitalisation or 31st December 2008, whichever came first. Such studies, said Dr Baldur-Felskov, could only be possible in somewhere like Denmark, where each citizen has a personal identification number which can be linked to any or all of the country’s diagnostic registries.

Results of the study showed that, over an average follow-up time of 12.6 years (representing 1,248,243 woman-years), 54% of the 98,737 women in the cohort did have a baby. Almost 5000 women from the entire cohort were hospitalised for a psychiatric disorder, the most common discharge diagnosis being “anxiety, adjustment and obsessive compulsive disorders” followed by “affective disorders including depression.”

However, those women who remained childless after their initial fertility investigation had a statistically significant (18%) higher risk of hospitalisations for all mental disorders than the women who went on to have a baby; the risk was also significantly greater for alcohol/substance abuse (by 103%), schizophrenia (by 47%) and other mental disorders (by 43%). The study also showed that childlessness increased the risk of eating disorders by 47%, although this was not statistically significant.

However, the most commonly seen discharge diagnosis in the entire cohort (anxiety, adjustment and obsessive compulsive disorders) was not affected by fertility status.

Commenting on the study’s results, Dr Baldur-Felskov said: “Our study showed that women who remained childless after fertility evaluation had an 18% higher risk of all mental disorders than the women who did have at least one baby. These higher risks were evident in alcohol and substance abuse, schizophrenia and eating disorders, although appeared lower in affective disorders including depression.

“The results suggest that failure to succeed after presenting for fertility investigation may be an important risk modifier for psychiatric disorders. This adds an important component to the counselling of women being investigated and treated for infertility. Specialists and other healthcare personnel working with infertile patients should also be sensitive to the potential for psychiatric disorders among this patient group.”

New Brain Receptor for Drug ‘Fantasy’ Identified

ScienceDaily (July 2, 2012) — Researchers are closer to understanding the biology behind GHB, a transmitter substance in the brain, best known in its synthetic form as the illegal drug fantasy.

In the 1960s, gamma-hydroxybutyric acid (GHB) was first discovered as a naturally occurring substance in the brain. Since then it has been manufactured as a drug with a clinical application and has also developed a reputation as the illegal drug fantasy and as a date rape drug. Its physiological function is still unknown.

Now a team of researchers at the Department of Drug Design and Pharmacology at the University of Copenhagen has shown for the first time exactly where the transmitter substance binds in the brain under physiologically relevant conditions. The results have recently been published in the Proceedings of the National Academy of Sciences.

“We have discovered that GHB binds to a special protein in the brain — more specifically a GABA_A-receptor. The binding is strong even at very low dosage. This suggests that we have found the natural receptor, which opens new and exciting research opportunities, in that we have identified an important unknown that can provide the basis for a full explanation of the biological significance of the transmitter,” says Laura Friis Eghorn, PhD student.

Illegal use and possible antidote

Fantasy is also used as a so-called date rape drug, because in moderate amounts it has sedative, sexually stimulating and soporific effects. The compound is also abused for its euphoric effect, but in combination with alcohol, for example, it is a deadly cocktail that can lead to a state of deep unconsciousness or coma.

“GHB is registered for use as a drug to treat alcoholism and certain types of sleep disorders, but the risk of abuse presents difficulties. In the long-term, understanding how GHB works will enable us to develop new and better pharmaceuticals with a targeted effect in the brain, without the dangerous side-effects of fantasy,” explains Laura Friis Eghorn, Department of Drug Design and Pharmacology.

Fantasy is an extremely toxic euphoriant, because the difference between a normal intoxicating dose and a fatal dose is so small. A better understanding of the biological mechanisms behind GHB-binding in the brain will benefit research into a life-saving antidote for this drug. Today there is no known antidote.

Statistics from Denmark in 2010 show that 8-10 percent of young people who frequent night clubs have had experience with Fantasy. However, since the drug is often also used in private for its sedative effect, it is difficult to estimate the extent of abuse.

Researchers on a targeted fishing expedition

The new research findings are the result of a collaboration between researchers at the University of Sydney in Australia and medicinal chemists at the Faculty of Health and Medical Sciences:

“Our chemist colleagues designed and produced special ligands — that are mimics of GHB in several variations. This enabled us to go on a targeted fishing expedition in the brain. We have slowly found our way to the receptor, which we have also been able to test pharmacologically. In itself, it is not unusual to find new receptors in the brain for known compounds. However, when we find a natural match rooted in the brain’s transmitter system, the biological implications are extremely interesting,” explains Petrine Wellendorph, associate professor and head of the responsible research group that produced the pioneering results.

Painkiller Abuse Linked to Depression, Suicide in College Students

ScienceDaily (June 11, 2012) — Non-medical prescription drug use by college students is a growing trend on most campuses, according to the U.S. Department of Education’s Higher Education Center for Alcohol, Drug Abuse and Violence Prevention. Due to this trend, Western Illinois University Department of Health Sciences Assistant Professor Amanda Divin and her colleague, Keith Zullig, an associate professor in the West Virginia University School of Public Health, recently conducted and published a study that explores non-medical prescription drug use and depressive symptoms in college students.

Divin and Zullig utilized data from the fall 2008 American College Health Association National College Health Assessment (ACHA-NCHA), a national research survey that addresses seven areas of health and behavior of college students, one of which is alcohol, tobacco and other drug use. The sample used for the study (from the ACHA-NCHA data) contained 26,600 randomly selected college students from 40 campuses in the U.S. The student respondents were asked about their non-medical prescription drug use (including painkillers, stimulants, sedatives and antidepressants) and mental health symptoms within the last year.

According to Divin’s and Zullig’s results, approximately 13 percent of the college-student respondents reported non-medical prescription drug use, with those who reported feeling hopeless, sad, depressed or considered suicide being significantly more likely to report non-medical use of any prescription drug. The results also showed this relationship was more pronounced for females who reported painkiller use. The study — which is titled, “The association between non-medical prescription drug use, depressive symptoms, and suicidality among college students” — will appear in the August 2012 issue of Addictive Behaviors: An International Journal.

“Because prescription drugs are tested by the U.S. Food and Drug Administration and prescribed by a doctor, most people perceive them as ‘safe’ and don’t see the harm in sharing with friends or family if they have a few extra pills left over,” Divin explained. “Unfortunately, all drugs potentially have dangerous side effects. As our study demonstrates, use of prescription drugs — particularly painkillers like Vicodin and Oxycontin — is related to depressive symptoms and suicidal thoughts and behaviors in college students. This is why use of such drugs need to be monitored by a doctor and why mental health outreach on college campuses is particularly important.”

Divin and Zullig believe the results suggest that students are self-medicating their psychological distress with prescription medications.

“Considering how common prescription sharing is on college campuses and the prevalence of mental health issues during the college years, more investigation in this area is definitely warranted,” Divin added. “Our study is just one of the many first steps in exploring the relationship between non-medical prescription drug use and mental health.”

Mothers’ Teen Cannabinoid Exposure May Increase Response of Offspring to Opiate Drugs

ScienceDaily (June 5, 2012) — Mothers who use marijuana as teens — long before having children — may put their future children at a higher risk of drug abuse, new research suggests.

Researchers in the Neuroscience and Reproductive Biology section at the Cummings School of Veterinary Medicine conducted a study to determine the transgenerational effects of cannabinoid exposure in adolescent female rats. For three days, adolescent rats were administered the cannabinoid receptor agonist WIN-55, 212-2, a drug that has similar effects in the brain as THC, the active ingredient in marijuana. After this brief exposure, they remained untreated until being mated in adulthood.

The male offspring of the female rats were then measured against a control group for a preference between chambers that were paired with either saline or morphine. The rats with mothers who had adolescent exposure to WIN-55,212-2 were significantly more likely to opt for the morphine-paired chamber than those with mothers who abstained. The results suggest that these animals had an increased preference for opiate drugs.

The study was published in the Journal of Psychopharmocology and funded by the National Institutes of Health.

“Our main interest lies in determining whether substances commonly used during adolescence can induce behavioral and neurochemical changes that may then influence the development of future generations,” said Research Assistant Professor John J. Byrnes, the study’s lead author, “We acknowledge that we are using rodent models, which may not fully translate to the human condition. Nevertheless, the results suggest that maternal drug use, even prior to pregnancy, can impact future offspring.”

Byrnes added that much research is needed before a definitive connection is made between adolescent drug use and possible effects on future children.

The study builds on earlier findings by the Tufts group, most notably a study published last year in Behavioral Brain Research by Assistant Professor Elizabeth Byrnes that morphine use as adolescent rats induces changes similar to those observed in the present study.

Other investigators in the field have previously reported that cannabinoid exposure during pregnancy (in both rats and humans) can affect offspring development, including impairment of cognitive function, and increased risk of depression and anxiety.

Wisdom Comes With Age, At Least When It Comes To Emotions

ScienceDaily (June 12, 2008) — A University of Alberta researcher in collaboration with researchers from Duke University has proven that wisdom really does come with age, at least when it comes to your emotions.

A study conducted by Dr. Florin Dolcos, assistant professor of psychiatry and neuroscience in the Faculty of Medicine & Dentistry, identified brain patterns that help healthy older people regulate and control emotion better than their younger counterparts. The study identified two regions in the brain that showed increased activity when participants over the age of 60 were shown standardized pictures of emotionally challenging situations.

“Previous studies have provided evidence that healthy older individuals have a positivity bias — they can actually manage how much attention they give to negative situations so they’re less upset by them,” said Dr. Dolcos, a member of the Alberta Cognitive Neuroscience Group, which brings together researchers from the University of Alberta to explore how the brain works in human thought, including issues like perception, attention, learning, memory, language, decision-making, emotion and development. “We didn’t understand how the brain worked to give seniors this sense of perspective until now.”

During the study, younger and older participants were asked to rate the emotional content of standardized images as positive, neutral or negative, while their brain activity was monitored with a functional magnetic resonance imaging (fMRI) machine, a high-tech device that uses a large magnet to take pictures inside the brain. The older participants rated the images as less negative than the younger participants. The fMRI scans helped researchers observe this reaction in the senior participants. The scans showed increased interactions between the amygdala, a brain region involved in emotion detection, and the anterior cingulate cortex, a brain region involved in emotion control.

According to Dr. Dolcos, “These findings indicate that emotional control improves with aging, and that it’s the increased interaction between these two brain regions that allows healthy seniors to control their emotional response so that they are less affected by upsetting situations.”

The study, published in the journal Neurobiology of Aging, was performed under the co-ordination of Dr. Roberto Cabeza and in collaboration with Ms. Peggy St. Jacques, both of Duke University where Dr. Dolcos received his training in brain imaging research.

This research may have clinical implications. “If we can better understand how the brain works to create a positivity bias in older people, then we can apply this knowledge to better understand and treat mental health issues with a negativity bias, such as depression and anxiety disorders, in which patients have difficulty coping with emotionally challenging situations,” Dolcos said.

Dr. Florin Dolcos’s current research projects are funded by grants from the U.S.-based National Alliance for Research on Schizophrenia and Depression (NARSAD), the Canadian Psychiatric Research Foundation (CPRF), the University Hospital Foundation (UHF) in Edmonton and the University of Alberta.

Secret to Successful Aging: How ‘Positivity Effect’ Works in Brain

ScienceDaily (July 14, 2011) — Whether we choose to accept or fight it, the fact is that we will all age, but will we do so successfully? Aging successfully has been linked with the “positivity effect,” a biased tendency towards and preference for positive, emotionally gratifying experiences. New research published in Biological Psychiatry now explains how and when this effect works in the brain.

German neuroscientists studied this effect by using neuroimaging to evaluate brain engagement in young and old adults while they performed a specialized cognitive task that included supposedly irrelevant pictures of either neutral, happy, sad or fearful faces. During parts of the task when they didn’t have to pay as much attention, the elderly subjects were significantly more distracted by the happy faces. When this occurred, they had increased engagement in the part of the brain that helps control emotions and this stronger signal in the brain was correlated with those who showed the greatest emotional stability.

“Integrating our findings with the assumptions of life span theories we suggest that motivational goal-shifting in healthy aging leads to a self-regulated engagement in positive emotions even when this is not required by the setting,” explained author Dr. Stefanie Brassen. “In addition, our finding of a relationship between rostral anterior cingulate cortex activity and emotional stability further strengthens the hypothesis that this increased emotional control in aging enhances emotional well being.”

“The lessons of healthy aging seem to be similar to those of resilience, throughout life. As recently summarized in other work by Drs. Dennis Charney and Steven Southwick, when coping with extremely stressful life challenges, it is critical to realistically appraise the situation but also to approach it with a positive attitude,” noted Dr. John H. Krystal, the Editor ofBiological Psychiatry.

Lifespan theories explain that positivity bias in later life reflects a greater emphasis on short-term rather than long-term priorities. The study by Dr. Brassen and colleagues now provides another clue to how the brain contributes to this age-related shift in priorities.

This makes aging successfully sound so simple — use your brain to focus on the positive.

Moderate Doses of Alcohol Increase Social Bonding in Groups

ScienceDaily (June 29, 2012) — A new study led by University of Pittsburgh researchers reveals that moderate amounts of alcohol — consumed in a social setting — can enhance positive emotions and social bonding and relieve negative emotions among those drinking.

While it is usually taken for granted that people drink to reduce stress and enhance positive feelings, many studies have shown that alcohol consumption has an opposite effect. In a new paper titled “Alcohol and Group Formation: A Multimodal Investigation of the Effects of Alcohol on Emotion and Social Bonding,” research shows that moderate doses of alcohol have a powerful effect on both male and female social drinkers when they are in a group.

The paper is published online inPsychological Science.

According to the researchers, previous alcohol studies testing the impact of alcohol on emotions involved social drinkers consuming alcohol in isolation rather than in groups.

“Those studies may have failed to create realistic conditions for studying this highly social drug,” said Michael A. Sayette, lead author and professor of psychology in Pitt’s Kenneth P. Dietrich School of Arts and Sciences. “We felt that many of the most significant effects of alcohol would more likely be revealed in an experiment using a social setting.”

Sayette and his colleagues assembled various small groups using 720 male and female participants, a larger sample than in previous alcohol studies. Researchers assessed individual and group interactions using the Facial Action Coding System (FACS) and the Grouptalk model for speech behavior.

They concluded that alcohol stimulates social bonding, increases the amount of time people spend talking to one another, and reduces displays of negative emotions. According to Sayette, the paper introduces into the alcohol literature new measures of facial expression and speech behavior that offer a sensitive and comprehensive assessment of social bonding.

Sayette and eight colleagues took special care in the methods they employed to form the groups. Each participant was randomly assigned to a group of three unacquainted “strangers.” Each group was instructed to drink an alcoholic beverage, a placebo, or a nonalcoholic control beverage. Twenty groups representing each gender composition (three males; one female and two males; two males and one female; and three females) were assigned to the three different beverage scenarios. Group members sat around a circular table and consumed three drinks over a 36-minute time span. Each session was video recorded, and the duration and sequence of the participants’ facial and speech behaviors were systematically coded frame by frame.

Results showed that alcohol not only increased the frequency of “true” smiles, but also enhanced the coordination of these smiles. In other words, alcohol enhanced the likelihood of “golden moments,” with groups provided alcohol being more likely than those offered nonalcoholic beverages to have all three group members smile simultaneously. Participants in alcohol-drinking groups also likely reported greater social bonding than did the nonalcohol-drinking groups and were more likely to have all three members stay involved in the discussion.

“By demonstrating the sensitivity of our group formation paradigm for studying the rewarding effects of alcohol,” said Sayette, “we can begin to ask questions of great interest to alcohol researchers — Why does alcohol make us feel better in group settings? Is there evidence to suggest a particular participant may be vulnerable to developing a problem with alcohol?”

The new research sets the stage for evaluation of potential associations between socioemotional responses to alcohol and individual differences in personality, family history of alcoholism, and genetic vulnerability.

Additional Pitt researchers on the project were Pitt graduate students in psychology Kasey Creswell, John Dimoff, and Catharine Fairbairn and professors of psychology Jeffrey Cohn, John Levine, and Richard Moreland. Other researchers included Bryan Heckman, a graduate student in psychology at the University of South Florida, and Thomas Kirchner, a research investigator at the Schroeder Institute for Tobacco Research and Policy Studies.

The study was funded by a grant from the National Institute on Alcohol Abuse and Alcoholism.

New Vaccine for Nicotine Addiction

ScienceDaily (June 27, 2012) — Researchers at Weill Cornell Medical College have developed and successfully tested in mice an innovative vaccine to treat nicotine addiction.

In the journal Science Translational Medicine, the scientists describe how a single dose of their novel vaccine protects mice, over their lifetime, against nicotine addiction. The vaccine is designed to use the animal’s liver as a factory to continuously produce antibodies that gobble up nicotine the moment it enters the bloodstream, preventing the chemical from reaching the brain and even the heart.

“As far as we can see, the best way to treat chronic nicotine addiction from smoking is to have these Pacman-like antibodies on patrol, clearing the blood as needed before nicotine can have any biological effect,” says the study’s lead investigator, Dr. Ronald G. Crystal, chairman and professor of Genetic Medicine at Weill Cornell Medical College.

“Our vaccine allows the body to make its own monoclonal antibodies against nicotine, and in that way, develop a workable immunity,” Dr. Crystal says.

Previously tested nicotine vaccines have failed in clinical trials because they all directly deliver nicotine antibodies, which only last a few weeks and require repeated, expensive injections, Dr. Crystal says. Plus, this kind of impractical, passive vaccine has had inconsistent results, perhaps because the dose needed may be different for each person, especially if they start smoking again, he adds.

“While we have only tested mice to date, we are very hopeful that this kind of vaccine strategy can finally help the millions of smokers who have tried to stop, exhausting all the methods on the market today, but find their nicotine addiction to be strong enough to overcome these current approaches,” he says. Studies show that between 70 and 80 percent of smokers who try to quit light up again within six months, Dr. Crystal adds.

About 20 percent of adult Americans smoke, and while it is the 4,000 chemicals within the burning cigarette that causes the health problems associated with smoking — diseases that lead to one out of every five deaths in the U.S. — it is the nicotine within the tobacco that keeps the smoker hooked.

A New Kind of Vaccine

There are, in general, two kinds of vaccines. One is an active vaccine, like those used to protect humans against polio, the mumps, and so on. This kind of vaccine presents a bit of the foreign substance (a piece of virus, for example) to the immune system, which “sees” it and activates a lifetime immune response against the intruder. Since nicotine is a small molecule, it is not recognized by the immune system and cannot be built into an active vaccine.

The second type of vaccine is a passive vaccine, which delivers readymade antibodies to elicit an immune response. For example, the delivery of monoclonal (identically produced) antibodies that bind on to growth factor proteins on breast cancer cells shut down their activity.

The Weill Cornell research team developed a new, third kind — a genetic vaccine — that they initially tested in mice to treat certain eye diseases and tumor types. The team’s new nicotine vaccine is based on this model.

The researchers took the genetic sequence of an engineered nicotine antibody, created by co-author Dr. Jim D. Janda, of The Scripps Research Institute, and put it into an adeno-associated virus (AAV), a virus engineered to not be harmful. They also included information that directed the vaccine to go to hepatocytes, which are liver cells. The antibody’s genetic sequence then inserts itself into the nucleus of hepatocytes, and these cells start to churn out a steady stream of the antibodies, along with all the other molecules they make.

In mice studies, the vaccine produced high levels of the antibody continuously, which the researchers measured in the blood. They also discovered that little of the nicotine they administered to these mice reached the brain. Researchers tested activity of the experimental mice, treated with both a vaccine and nicotine, and saw that it was not altered; infrared beams in the animals’ cages showed they were just as active as before the vaccine was delivered. In contrast, mice that received nicotine and not treated with the vaccine basically “chilled out” — they relaxed and their blood pressure and heart activity were lowered — signs that the nicotine had reached the brain and cardiovascular system.

The researchers are preparing to test the novel nicotine vaccine in rats and then in primates — steps needed before it can be tested ultimately in humans.

Dr. Crystal says that, if successful, such a vaccine would best be used in smokers who are committed to quitting. “They will know if they start smoking again, they will receive no pleasure from it due to the nicotine vaccine, and that can help them kick the habit,” he says.

He adds that it might be possible, given the complete safety of the vaccine, to use it to preempt nicotine addiction in individuals who have never smoked, in the same way that vaccines are used now to prevent a number of disease-producing infections. “Just as parents decide to give their children an HPV vaccine, they might decide to use a nicotine vaccine. But that is only theoretically an option at this point,” Dr. Crystal says. “We would of course have to weight benefit versus risk, and it would take years of studies to establish such a threshold.”

“Smoking affects a huge number of people worldwide, and there are many people who would like to quit, but need effective help,” he says. “This novel vaccine may offer a much-needed solution.”

The study was funded by the National Institutes of Health, the National Foundation for Cancer Research, and the Malcolm Hewitt Wiener Foundation.

The Cornell Center for Technology Enterprise and Commercialization, on behalf of Cornell University, has filed patent applications on the work described in this study.

Other study co-authors are Dr. Martin J. Hicks, Dr. Jonathan B. Rosenberg, Dr. Bishnu P. De, Dr. Odelya Pagovich, Dr. Jian-ping Qiu, Dr. Stephen M. Kaminsky, Dr. Neil R. Hackett, and Dr. Stefan Worgall from Weill Cornell Medical College, and Dr. Colin N. Young and Dr. Robin L. Davisson from Cornell University.