Full Title: Cognitive Behavioral Therapy and Schizophrenia: A Survey of Clinical Practices and Views on Efficacy in the United States and United Kingdom

Research has shown that cognitive-behavioral therapy (CBT) is effective in the treatment of schizophrenia (Wykes et al. in Schizophr Bull 34(3):523-537, 2008). The majority of this research has been conducted in the United Kingdom (Beck and Rector in Am J Psychother 54:291-300, 2000) where the National Health Service recommends that CBT be delivered to all people with schizophrenia (NICE in Schizophrenia: core interventions in the treatment and management of schizophrenia in primary and secondary care (update). http://www.nice.org.uk/Guidance/CG82/NiceGuidance/pdf/English , 2009). In contrast, the corresponding American Psychiatric Association guidelines describe CBT as an adjunctive technique that "may benefit" patients (Lehman et al. in Am J Psychiatry 161:1-56, 2004, p. 35). Anecdotal evidence also suggests a difference between UK and US clinicians' use of and views on CBT with schizophrenia (Tarrier in Clinical handbook of psychological disorders: a step-by-step treatment manual. Guilford, New York, 2008). In the present study 214 clinicians in the UK and US completed an internet survey examining this apparent discrepancy. UK and US participants were equally aware that empirical research supports the efficacy of CBT with schizophrenia. However, UK participants were more likely to practice CBT, rated CBT effectiveness more highly, and were more optimistic about the chances of recovery. These findings suggest fundamental differences in the attitudes and practices of UK and US clinicians.

Community Ment Health J. 2009 Jul 25. Kuller AM, Ott BD, Goisman RM, Wainwright LD, Rabin RJ. Massachusetts School of Professional Psychology, 221 Rivermoor Street, West Roxbury, MA, 02132, USA, andrew_kuller@mspp.edu.

Participants of low and high hypnotic susceptibility were tested on a temporal order judgement task, both with and without hypnosis. Judgements were made of the order of presentation of light flashes appearing in first one hemi-field then the other. There were differences in the inter-stimulus intervals required accurately to report the order, depending upon which hemi-field led. This asymmetry was most marked in hypnotically susceptible participants and reversed when they were hypnotised. This implies not only that brain activity changes in hypnosis, but also that there is a difference in brain function between people of low and high hypnotic susceptibility. The latter exhibited a faster-acting left hemisphere in the waking state, but faster right when hypnotised.

Conscious Cogn. 2009 Nov 7. Naish PL. Dept. of Psychology, The Open University, Briggs Building, Walton Hall, Milton Keynes MK7 6AA, United Kingdom.

by Mark Gorkin, LICSW

One Small Step for Employee-Management-Community Consensus Building: Affirming the Purpose, Participation and Power of Admin Professionals

One of the challenges for an Organizational Development Consultant is getting management and employees on the same page, if not singing from the same sheet of music. Sometimes you don't need management to generate static. Status distinctions within the employee ranks may exacerbate in-house tensions. For example, in one government directorate, scientists and IT folks were called "professional" staff while the clerical/administrative personnel were labeled "support" staff. (On a retreat, I quickly changed the nomenclature: all were professional staff; some were scientific, others were administrative.)

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AIMS: To determine whether definable subtypes exist within a cohort of patients listening to music with regard to their physiological patterns and to compare whether associated factors vary between subjects in groups with different profiles. BACKGROUND: The intensive care unit (ICU) is one of the most stressful environments for patients among various clinical settings in a hospital. ICU patients are not only compromised by illness but also faced with a wide range of stressors. DESIGN: A repeated-measures design was conducted with one music group. METHOD: One hundred and one patients were recruited in three intensive care units in Hong Kong. There were two main outcome variables: demographic characteristics and physiological outcomes. RESULTS: A cluster analysis yielded two clusters. Patients in cluster 1 typically experienced relatively low therapeutic effects from listening to music. There were more males, of a younger age but more educated and employed than patients in cluster 2, and they represented 41.6% of the total respondents. Cluster 2 comprised almost 58.4% of this study sample and they reported high therapeutic effects of music. There were more females in this group as well as more older people and they mainly used a ventilator in the intensive care unit. CONCLUSION: Our study shows that music may have a more positive effect on groups of patients whose profile is similar to that of the patients in cluster 2, than for patients such as those in cluster 1. A clear profile may help health professionals to design appropriate care therapy to target a specific group of patients to improve their physiological outcomes. RELEVANCE TO CLINICAL PRACTICE: The implication of this study is that music therapy should be provided to patients as a relaxation technique if they are willing to accept it, and the selection of music should be based on their preferences. Information should be given to patients so that they can understand how music therapy works and they should be encouraged to focus their attention on listening to the music to maximise its benefits.

J Clin Nurs. 2009 May;18(9):1250-7. Epub 2008 Sep 4. Chan MF, Chung YF, Chung SW, Lee OK. Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore. nurcmf@nus.edu.sg

Pat Ogden, PhD, is the founder and director of the Sensorimotor Psychotherapy Institute, an internationally recognized school that specializes in training psychotherapists in somatic/cognitive approaches for the treatment of trauma, developmental and attachment issues. She is a co-founder of the Hakomi Institute, served on the faculty of The Naropa University in the Somatic Psychology and Contemplative Psychology departments from 1985 to 2005, and lectures internationally.

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Yoga and meditation can alleviate stress, anxiety, mood disturbance, and musculoskeletal problems, and can enhance cognitive and physical performance. Professional musicians experience high levels of stress, performance anxiety, and debilitating performance-related musculoskeletal disorders (PRMDs). The goal of this controlled study was to evaluate the benefits of yoga and meditation for musicians. Young adult professional musicians who volunteered to participate in a 2-month program of yoga and meditation were randomized to a yoga lifestyle intervention group (n = 15) or to a group practicing yoga and meditation only (n = 15). Additional musicians were recruited to a no-practice control group (n = 15). Both yoga groups attended three Kripalu Yoga or meditation classes each week. The yoga lifestyle group also experienced weekly group practice and discussion sessions as part of their more immersive treatment. All participants completed baseline and end-program self-report questionnaires that evaluated music performance anxiety, mood, PRMDs, perceived stress, and sleep quality; many participants later completed a 1-year followup assessment using the same questionnaires. Both yoga groups showed a trend towards less music performance anxiety and significantly less general anxiety/tension, depression, and anger at end-program relative to controls, but showed no changes in PRMDs, stress, or sleep. Similar results in the two yoga groups, despite psychosocial differences in their interventions, suggest that the yoga and meditation techniques themselves may have mediated the improvements. Our results suggest that yoga and meditation techniques can reduce performance anxiety and mood disturbance in young professional musicians.

Appl Psychophysiol Biofeedback. 2009 Aug 6. Khalsa SB, Shorter SM, Cope S, Wyshak G, Sklar E. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, khalsa@hms.harvard.edu.

by Joe Rubino, PhD

Studies show that high self-esteem is the #1 ingredient essential for developing happiness, fulfillment, rich relationships, and overall success in life. In the life of every child, usually sometime between birth and age 6, something happens to have the child doubt him or herself. Someone says or does something that has the child believe that he or she is flawed, unlovable, not worthy, imperfect.

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Full Title: Mind-Body Treatments for the Pain-Fatigue-Sleep Disturbance Symptom Cluster in Persons with Cancer

CONTEXT: Co-occurring pain, fatigue, and sleep disturbance comprise a common symptom cluster in patients with cancer. Treatment approaches that target the cluster of symptoms rather than just a single symptom need to be identified and tested. OBJECTIVE: To synthesize evidence regarding mind-body interventions that have shown efficacy in treating two or more symptoms in the pain-fatigue-sleep disturbance cancer symptom cluster. METHODS: A literature search was conducted using CINAHL, Medline, and PsychInfo databases through March 2009. Studies were categorized based on the type of mind-body intervention (relaxation, imagery/hypnosis, cognitive-behavioral therapy/coping skills training [CBT/CST], meditation, music, and virtual reality), and a preliminary review was conducted with respect to efficacy for pain, fatigue, and sleep disturbance. Mind-body interventions were selected for review if there was evidence of efficacy for at least two of the three symptoms. Forty-three studies addressing five types of mind-body interventions met criteria and are summarized in this review. RESULTS: Imagery/hypnosis and CBT/CST interventions have produced improvement in all the three cancer-related symptoms individually: pain, fatigue, and sleep disturbance. Relaxation has resulted in improvements in pain and sleep disturbance. Meditation interventions have demonstrated beneficial effects on fatigue and sleep disturbance. Music interventions have demonstrated efficacy for pain and fatigue. No trials were found that tested the mind-body interventions specifically for the pain-fatigue-sleep disturbance symptom cluster. CONCLUSIONS: Efficacy studies are needed to test the impact of relaxation, imagery/hypnosis, CBT/CST, meditation, and music interventions in persons with cancer experiencing concurrent pain, fatigue, and sleep disturbance. These mind-body interventions could help patients manage all the symptoms in the cluster with a single treatment strategy.

J Pain Symptom Manage. 2009 Nov 7. Kwekkeboom KL, Cherwin CH, Lee JW, Wanta B. School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA.

WEBWIRE – Monday, December 28, 2009

Study in Nature Neuroscience uncovers possible basis of short-term memory

CLEVELAND - Ben W. Strowbridge, PhD, associate professor of neuroscience and physiology/biophysics, and Phillip Larimer, PhD, a MD/PhD student in the neurosciences graduate program at Case Western Reserve University School of Medicine, are the first to create stimulus-specific sustained activity patterns in brain circuits maintained in vitro.

Their study, entitled, "Representing information in cell assemblies: Persistent activity mediated by semilunar granule cells" will be published in the February 2010 issue of Nature Neuroscience and is currently available online.

Neuroscientists often classify human memory into three types: declarative memory, such as storing facts or remembering specific events; procedural memory, such as learning how to play the piano or shoot basketballs; and working memory, a type of short-term storage like remembering a phone number. With this particular study, Strowbridge and Larimer, were interested in identifying the specific circuits that could be responsible for working memory.

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Full Title: The existential experiences of receiving soft tissue massage in palliative home care--an intervention

BACKGROUND: Soft tissue massage is currently used in palliative care for the relief of anxiety and pain. Only few studies have focused on patients' deeper experience of receiving the massage. AIM: The purpose of this study was to explore how patients with cancer in palliative home care experienced soft tissue massage. MATERIALS AND METHODS: Twenty-two patients received soft tissue massage (hand or foot) nine times over a period of 2 weeks. Each session lasted for 25 min. Following the last massage session, a qualitative interview was conducted. The analysis was performed using a hermeneutic approach. FINDINGS: Soft tissue massage generated feelings of existential respite with perceptions of being released from illness for a while. Two categories constituted the basis of the experiences: (1) "an experience of thoughtful attention" and (2) "a sensation of complete tranquility" resulting in the overarching theme "A time of existential respite." CONCLUSION: The patients experienced the massage to give meaning and to be important as it generated feelings of an inner respite. RELEVANCE TO CLINICAL PRACTICE: Soft tissue massage appears to be an appreciated source of support to dying patients in palliative home care. The method is easy to comprehend and relatively short (25 min) which may imply that it is a suitable complement in nursing care for this patient group.

Support Care Cancer. 2009 Sep;17(9):1203-11. Epub 2009 Jan 28. Cronfalk BS, Strang P, Ternestedt BM, Friedrichsen M. Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden. berit.cronfalk@ki.se

by Marta Luzim, MS

Healing our childhood awakens the unconscious hunger for the love of our mother and father. We cannot be in the present until we satisfy the loneliness of the child's deep craving to be loved, seen and cherished. This is where romantic loves begins. Children believe that their parents are the perfect gods, all knowing and all loving. The trauma that comes from the first sting of rejection, criticism and abandonment in our youths carries on into our adult relationships. It is our parent's validation of our existence that gives us a sense of meaning, purpose and worthiness. As adults we remain frozen in the past, searching for the perfect mother or father in our intimate relationships to fulfill the child who felt unloved and forgotten.

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Full Title: Homeopathic Individualized Q-potencies versus Fluoxetine for Moderate to Severe Depression: Double-blind, Randomized Non-inferiority Trial

Homeopathy is a complementary and integrative medicine used in depression, The aim of this study is to investigate the non-inferiority and tolerability of individualized homeopathic medicines [Quinquagintamillesmial (Q-potencies)] in acute depression, using fluoxetine as active control. Ninety-one outpatients with moderate to severe depression were assigned to receive an individualized homeopathic medicine or fluoxetine 20 mg day(-1) (up to 40 mg day(-1)) in a prospective, randomized, double-blind double-dummy 8-week, single-center trial. Primary efficacy measure was the analysis of the mean change in the Montgomery & Asberg Depression Rating Scale (MADRS) depression scores, using a non-inferiority test with margin of 1.45. Secondary efficacy outcomes were response and remission rates. Tolerability was assessed with the side effect rating scale of the Scandinavian Society of Psychopharmacology. Mean MADRS scores differences were not significant at the 4th (P = 0.654) and 8th weeks (P = 0.965) of treatment. Non-inferiority of homeopathy was indicated because the upper limit of the confidence interval (CI) for mean difference in MADRS change was less than the non-inferiority margin: mean differences (homeopathy-fluoxetine) were -3.04 (95% CI -6.95, 0.86) and -2.4 (95% CI -6.05, 0.77) at 4th and 8th week, respectively. There were no significant differences between the percentages of response or remission rates in both groups. Tolerability: there were no significant differences between the side effects rates, although a higher percentage of patients treated with fluoxetine reported troublesome side effects and there was a trend toward greater treatment interruption for adverse effects in the fluoxetine group. This study illustrates the feasibility of randomized controlled double-blind trials of homeopathy in depression and indicates the non-inferiority of individualized homeopathic Q-potencies as compared to fluoxetine in acute treatment of outpatients with moderate to severe depression.

Evid Based Complement Alternat Med. 2009 Aug 17. Adler UC, Paiva NM, Cesar AT, Adler MS, Molina A, Padula AE, Calil HM. Department of Psychobiology, Universidade Federal de São Paulo, R. Napoleão de Barros, 925 São Paulo, SP 04024-002, Brazil. hmcalil@psicobio.epm.br.

The reduction of elevated polyamine (PA) levels in biological fluids of cancer patients were known to be correlated with remission following diverse therapeutic treatments. In this study, altered urinary PA levels from three different cancer cases were monitored at different intervals during the long-term weekday acupuncture treatments. Nine urinary PA levels from 16 normal and three cancer patients with different types were measured by gas chromatography-mass spectrometry in selected ion monitoring mode as N-ethoxycarbonyl-N-pentafluoropropionyl derivatives. Their levels measured at three follow-up stages for each patient were then normalized to the corresponding normal group means and plotted into star symbol patterns. Large alterations of PA levels were observed for each patient. Each normalized concentration displayed elevation of the PA levels in multiples (0.0-57.7) of the respective normal mean values. The normalized PA values were transformed into distorted star patterns which were characteristic of each follow-up stage and of cancer type.

Amino Acids. 2009 Jul;37(2):407-13. Epub 2008 Aug 20. Paik MJ, Kuon D, Cho J, Kim KR. Metabolomic Analysis Laboratory, Institute for Neuroregeneration and Stem Cell Research, School of Medicine, Ajou University, Suwon 443-721, Republic of Korea.

Full Title: Cognitive behavioral stress management effects on psychosocial and physiological adaptation in women undergoing treatment for breast cancer

BACKGROUND: A diagnosis of breast cancer and treatment are psychologically stressful events, particularly over the first year after diagnosis. Women undergo many demanding and anxiety-arousing treatments such as surgery, radiation and chemotherapy. Psychosocial interventions that promote psychosocial adaptation to these challenges may modulate physiological processes (neuroendocrine and immune) that are relevant for health outcomes in breast cancer patients. METHODS: Women with Stages 1-3 breast cancer recruited 4-8 weeks after surgery were randomized to either a 10-week group-based cognitive behavioral stress management (CBSM) intervention or a 1-day psychoeducational control group and completed questionnaires and late afternoon blood samples at study entry and 6 and 12 months after assignment to experimental condition. RESULTS: Of 128 women initially providing psychosocial questionnaire and blood samples at study entry, 97 provided complete data for anxiety measures and cortisol analysis at all time points, and immune assays were run on a subset of 85 of these women. Those assigned to a 10-week group-based CBSM intervention evidenced better psychosocial adaptation (lower reported cancer-specific anxiety and interviewer-rated general anxiety symptoms) and physiological adaptation (lower cortisol, greater Th1 cytokine [interleukin-2 and interferon-gamma] production and IL-2:IL-4 ratio) after their adjuvant treatment compared to those in the control group. Effects on psychosocial adaptation indicators and cortisol appeared to hold across the entire 12-month observation period. Th1 cytokine regulation changes held only over the initial 6-month period. CONCLUSIONS: This intervention may have facilitated a "recovery or maintenance" of Th1 cytokine regulation during or after the adjuvant therapy period. Behavioral interventions that address dysregulated neuroendocrine function could play a clinically significant role in optimizing host immunologic resistance during a vulnerable period.

Brain Behav Immun. 2009 Jul;23(5):580-91. Epub 2008 Sep 20. Antoni MH, Lechner S, Diaz A, Vargas S, Holley H, Phillips K, McGregor B, Carver CS, Blomberg B. Department of Psychology, University of Miami, Coral Gables, FL 33124, USA. ntoni@miami.edu

The Irritable bowel syndrome (IBS) is a highly prevalent functional disorder with a remarkable clinical and economic impact. Several pathogenetic factors of IBS are discussed and summarised within a bio-psycho-social model. Data from published hypnotherapeutic interventions with approximately 800 patients show long-lasting symptom relief. The underlying mechanisms of action are not well understood. Nine mechanism studies show influences of hypnosis on colorectal sensitivity, colorectal motility and mental strain (anxiety, depression, maladaptive cognitions). Results are often contradictory and effects of hypnosis on several of the proposed pathogenetic factors are not examined at all. This paper reviews previous studies on hypnotherapy in IBS patients with a focus on symptom relief and mechanisms of action.

Z Gastroenterol. 2009 Nov;47(11):1153-9. Epub 2009 Nov 6. Hefner J, Rilk A, Herbert BM, Zipfel S, Enck P, Martens U. Abteilung Innere Medizin VI, Psychosomatische Medizin und Psychotherapie, Universität Tübingen. jochen.hefner@t-online.de

This is an excellent Discovery Channel video. The hypnotist is Seth-Deborah Roth, CRNA, who is an Institute member and an expert in medical hypnotherapy.

It brings up several interesting concepts. First, does the effectiveness of hypnotherapy require a trance state. In the video three people are tested for suggestibility using a type of EEG machine. The belief that trance is equal to reduced brain wave frequency is proposed by biofeedback. technician. Second, they presuppose that there is a relationship between suggestibility and trance state. While there may be a correlation at times, this is not a requirement. Hypnosis is a process of bypassing resistance. This may or may not happen in a trance state.

Of course, the TV program unfortunately full of the typical media lingo. The announcer frequently uses the term "going under" to signify a trance state. Most reputable hypnotists avoid that phrase, which is one that too often misleads and scares members of the public.

Nevertheless, I did appreciate that they "busted" the concept that a person can be forced to do something that is suggested while in a hypnotically-induced trance.

posted by Tim Brunson, PhD

The purpose of this study was to determine the effect of music on peer awareness in preschool age children with developmental disabilities. Specifically, this study sought to find which combinations of musical and play elements produced the longest durations of sustained attention towards peers and the highest frequency of alternating attention from peer to peer. Nine children between the ages of 2 and 6 who had been diagnosed with a developmental disability participated in the study. Each participant completed 4 small group sessions with the researcher and 2 other research participants. During each session, the children participated in activities targeting peer awareness that incorporated musical and play elements. Behavioral data were recorded representing the children's sustained and alternating attention towards peers. Results indicated that children sustained attention towards peers for the longest durations and alternated attention from peer to peer at the highest frequencies during activities that utilized a musical object within a nonmusical or play-based context.

J Music Ther. 2009 Spring;46(1):53-68. Sussman JE. University of Missouri-Kansas City, USA.

Lino Stanchich is a Licensed Nutritionist, Kushi Institute Certified Macrobiotic Educator and Counselor, and Licensed Massage and Bodywork Therapist with over 40 years experience. He is a respected author and teacher of the macrobiotic diet, philosophy, and lifestyle, along with energy exercises (Chi Kung), shiatsu massage, Do-In self-massage, and Conscious Eating Techniques. Mr. Stanchich received the prestigious Aveline Kushi Award, from Michio Kushi in 2006.

As a former faculty member of the Kushi Institute, Lino currently serves on the K.I. Summer Conference faculty, both in the U.S.A. and Europe. He is a member of the Kushi Institute Macrobiotic Educators Association.

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Yoga represents a fascinating mind-body approach, wherein body movements (asana), breathing exercises (pranayama) and meditation are integrated into a single multidimensional practice. Numerous beneficial mental and physical effects have been classically ascribed to this holistic ancient method. The purpose of the present study has been to examine the effects of long-term yoga practice on Subjective Sleep Quality (SSQ) and on several hormonal parameters of the hypothalamus-pituitary-adrenal (HPA) axis. Twenty-six subjects (16 experimental and 10 controls) were recruited to be part of the study. Experimental subjects were regular yoga practitioners with a minimum of 3 years of practice. Blood samples for the quantification of adrenocorticotropic hormone (ACTH), cortisol and dehydroepiandrosterone sulphate (DHEA-S) were drawn from all subjects. Likewise, the Pittsburgh Sleep Quality Index (PSQI) was employed to assess SSQ. As statistical analysis, Mann-Whitney U-test was performed. The yoga group displayed lower PSQI scores and higher blood cortisol levels than control subjects. Therefore, it can be concluded that long-term yoga practice is associated with significant psycho-biological differences, including better sleep quality as well as a modulatory action on the levels of cortisol. These preliminary results suggest interesting clinical implications which should be further researched.

Biol Psychol. 2009 Jul;81(3):164-8. Epub 2009 Apr 1. Vera FM, Manzaneque JM, Maldonado EF, Carranque GA, Rodriguez FM, Blanca MJ, Morell M. Department of Psychobiology and Methodology, Faculty of Psychology, University of Malaga, Campus de Teatinos, Malaga, Spain. pvera@uma.es

by Anne Arsenault

They say "You are what you eat", so we can also say that your mental health is affected by what you eat. If your blood sugar is all over the place, then your moods will be too. If you are eating foods devoid of B Vitamins and Omega 3 Fats, then Depression can set in. If your liver and arteries are clogged from high fat foods, then you will feel sluggish and grouchy. Your brain is very much affected by what you eat and how you digest it.

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BACKGROUND: Pain is a major issue after burns even when large doses of opioids are prescribed. The study focused on the impact of a pain protocol using hypnosis on pain intensity, anxiety, clinical course, and costs. METHODS: All patients admitted to the ICU, aged >18 years, with an ICU stay >24h, accepting to try hypnosis, and treated according to standardized pain protocol were included. Pain was scaled on the Visual Analog Scale (VAS) (mean of daily multiple recordings), and basal and procedural opioid doses were recorded. Clinical outcome and economical data were retrieved from hospital charts and information system, respectively. Treated patients were matched with controls for sex, age, and the burned surface area. FINDINGS: Forty patients were admitted from 2006 to 2007: 17 met exclusion criteria, leaving 23 patients, who were matched with 23 historical controls. Altogether patients were 36+/-14 years old and burned 27+/-15%BSA. The first hypnosis session was performed after a median of 9 days. The protocol resulted in the early delivery of higher opioid doses/24h (p<0.0001) followed by a later reduction with lower pain scores (p<0.0001), less procedural related anxiety, less procedures under anaesthesia, reduced total grafting requirements (p=0.014), and lower hospital costs per patient. CONCLUSION: A pain protocol including hypnosis reduced pain intensity, improved opioid efficiency, reduced anxiety, improved wound outcome while reducing costs. The protocol guided use of opioids improved patient care without side effects, while hypnosis had significant psychological benefits.

Burns. 2009 Oct 30. Berger MM, Davadant M, Marin C, Wasserfallen JB, Pinget C, Maravic P, Koch N, Raffoul W, Chiolero RL. Service of Intensive Care Medicine & Burns Centre, University Hospital (CHUV), Lausanne, Switzerland.

by Joyce-Anne Locking

Human nature, as described in Wikopedia, the online enclyclopedia, is the concept that there are a set of characteristics, including ways of thinking, feeling and acting that all human beings have in common. It is also human nature, I might add, to expect some abundant form of reward for the work we provide.

There are conditions that apply to the flow of natural rivers of wealth. It is said that money flows back to us if we follow our heart, for example. Millions of books have been written about the topic of how to make money. This is not the reward I intend to explore in this article, however. My topic might better be described as payment in psychic dollars. What I mean to say is "invisible pay" might turn out to be far more valuable than other, more obvious forms of remuneration.

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This paper describes an observational study describing how Tactile Massage (TM) was integrated into Swedish clinical medical care, the impact of this initiative suggests a foundation for future research. Subjects completed three questionnaires pre- and post-tactile massage. These were: Sense of Coherence (SOC), an enlarged Health Index (HI) and the Borg CR10 scale. RESULTS: A convenience sample of forty-three subjects (37 women and 6 men) were referred to TM treatment for a range of problems including for pain, sleep disorders, inability to move, headache and tense body. Patients received 10 TM treatments, each lasting approx. 1h in length. The enlarged HI questionnaire indicated that eleven out of fourteen parameters were significantly affected according (p-values between 0.0015 and <0.001). These included energy, mood, tiredness, sleep, pain, movement, health, general health and physical health. Pain reduction was also significantly reduced using the Borg CR10 scale (p<0.001). CONCLUSION: TM seems to affect several dimensions of health, and this should be explored more fully in future research.

Complement Ther Clin Pract. 2009 Aug;15(3):158-60. Andersson K, Törnkvist L, Wändell P. Center for Family and Community Medicine, Karolinska Institutet, SE-141 83 Huddinge, Sweden. katarina.andersson5@comhem.se

This paper describes the successful outcome of homeopathic treatment in a case of resistant livedoid vasculopathy (LV). LV is a rare disease characterized by chronic recurrent and painful ulceration of the lower limbs, frequently associated to atrophie blanche (AB), probably due to procoagulant conditions. Most literature reports single or very few cases; response to treatment is difficult, even resistant. This patient suffered LV for 7 years before seeking homeopathic treatment; ulcers recurred frequently, at intervals less than 3 months, in spite of continual use of pentoxyfilline. Configuration of signs and symptoms strongly pointed out to the prescription of homeopathic remedy Sepia succus that promptly elicited significant improvement of LV and the patient's overall state (non suppressive treatment). Considerations are made on the value of single case reports and the reliability of prescriptions grounded on consistent signs and coherence among the manifold features of individual disease.

Homeopathy. 2009 Jul;98(3):165-8. Waisse-Priven S, Jurj G, Lima Thomaz LC, Tierno SA, Filho WL, Sos AB. Associação Paulista de Homeopatia, São Paulo, Brazil. silvia.priven@gmail.com

Full Title: Acupuncture for the treatment of hot flashes in breast cancer patients, a randomized, controlled trial

Acupuncture has been used to treat the problem of hot flashes in healthy postmenopausal women. The object of this study was to investigate the efficacy of acupuncture in women with breast cancer suffering from hot flashes as a result of anti-oestrogen medication. In a prospective, controlled trial, 59 women suffering from hot flashes following breast cancer surgery and adjuvant oestrogen-antagonist treatment (Tamoxifen) were randomized to either 10 weeks of traditional Chinese acupuncture or sham acupuncture (SA). Mean number of hot flashes at day and night were recorded prior to treatment, during the treatment period as well as during the 12 weeks following treatment. A validated health score (Kupperman index) was conducted at baseline, at the end of the treatment period and at 12 weeks following treatment. During the treatment period mean number of hot flashes at day and night was significantly reduced by 50 and almost 60%, respectively from baseline in the acupuncture group, and was further reduced by 30% both at day and night during the next 12 weeks. In the sham acupuncture group a significant reduction of 25% in hot flashes at day was seen during treatment, but was reversed during the following 12 weeks. No reduction was seen in hot flashes at night. Kupperman index was reduced by 44% from baseline to the end of the treatment period in the acupuncture group, and largely maintained 12 weeks after treatment ended. No corresponding changes were seen in the sham acupuncture group. Acupuncture seems to provide effective relief from hot flashes both day and night in women operated for breast cancer, treated with Tamoxifen. This treatment effect seems to coincide with a general health improvement measured with the validated Kupperman index.

Breast Cancer Res Treat. 2009 Jul;116(2):311-6. Epub 2008 Oct 7. Hervik J, Mjåland O. Pain Clinic, Vestfold Hospital, Tonsberg, Norway. jill.hervik@siv.no

Full Title: BOLD signal in insula is differentially related to cardiac function during compassion meditation The brain and the cardiovascular system influence each other during the processing of emotion. The study of the interactions of these systems during emotion regulation has been limited in human functional neuroimaging, despite its potential importance for physical health. We have previously reported that mental expertise in cultivation of compassion alters the activation of circuits linked with empathy and theory of mind in response to emotional stimuli. Guided by the finding that heart rate increases more during blocks of compassion meditation than neutral states, especially for experts, we examined the interaction between state (compassion vs. neutral) and group (novice, expert) on the relation between heart rate and BOLD signal during presentation of emotional sounds presented during each state. Our findings revealed that BOLD signal in the right middle insula showed a significant association with heart rate (HR) across state and group. This association was stronger in the left middle/posterior insula when experts were compared to novices. The positive coupling of HR and BOLD was higher within the compassion state than within the neutral state in the dorsal anterior cingulate cortex for both groups, underlining the role of this region in the modulation of bodily arousal states. This state effect was stronger for experts than novices in somatosensory cortices and the right inferior parietal lobule (group by state interaction). These data confirm that compassion enhances the emotional and somatosensory brain representations of others' emotions, and that this effect is modulated by expertise. Future studies are needed to further investigate the impact of compassion training on these circuits.

Neuroimage. 2009 Sep;47(3):1038-46. Epub 2009 May 5. Lutz A, Greischar LL, Perlman DM, Davidson RJ. Laboratory for Functional Brain Imaging and Behavior, Waisman Center, University of Wisconsin, 1500 Highland Avenue, Madison, WI 53705, USA. alutz@wisc.edu

Full Title: Does the form or the amount of exposure make a difference in the cognitive-behavioral therapy treatment of social phobia?

Exposure is considered to be an essential ingredient of cognitive-behavioral therapy treatment of social phobia and of most anxiety disorders. To assess the impact of the amount of exposure on outcome, 30 social phobic patients were randomly allocated to 1 of 2 group treatments of 8 weekly sessions: Self-Focused Exposure Therapy which is based essentially on prolonged exposure to public speaking combined with positive feedback or a more standard cognitive and behavioral method encompassing psychoeducation, cognitive work, working through exposure hierarchies of feared situations for exposure within and outside the group. The results show that the 2 methods led to significant and equivalent symptomatic improvements which were maintained at 1-year follow-up. There was a more rapid and initially more pronounced decrease in negative cognitions with the Self-Focused Exposure Therapy, which included no formal cognitive work, than with the more standard approach in which approximately a third of the content was cognitive. In contrast, decrease in social avoidance was more persistent with standard cognitive-behavior therapy which involved less exposure. The results indicate that positive cognitive change can be achieved more rapidly with non cognitive methods while avoidance decreases more reliably with a standard approach rather than an approach with an exclusive focus on exposure.

J Nerv Ment Dis. 2009 Jul;197(7):507-13. Borgeat F, Stankovic M, Khazaal Y, Rouget BW, Baumann MC, Riquier F, O'Connor K, Jermann F, Zullino D, Bondolfi G. Department of Psychiatry, University of Lausanne, Lausanne, Switzerland. francois.borgeat@umontreal.ca

Introduction. Hypnosis is not only intrinsically interesting, but it can be used instrumentally as a powerful tool to investigate phenomena outside its immediate domain. In focusing on instrumental hypnosis research, we first sketch the many contributions of hypnosis across a range of areas in experimental psychopathology. In particular, we summarise the historical and more recent uses of hypnosis to create and explore clinically relevant, temporary delusions. Methods. We then describe in detail the steps that hypnosis researchers take in constructing a hypnotic paradigm to map the features and processes shared by clinical and hypnotic delusions, as well as their impact on information processing (including autobiographical memory). We illustrate with hypnotic versions of mirrored-self misidentification, somatoparaphrenia, alien control, and identity delusions. Results. Finding indicate that hypnotic analogues can produce compelling delusions with features that are strikingly similar to their clinical counterparts. These similarities encompass phenomenological features of delusions, delusional resistance to challenge, and autobiographical memory during delusions. Conclusion. We recognise important methodological issues and limitations of such hypnotic analogues, including: indexing response (behaviour vs. experience), alternative explanations (e.g., social compliance), the need for converging data, the need for close and continuing dialogue between the clinic and the laboratory, and generalisability of the findings.

Cogn Neuropsychiatry. 2009 Oct 28:1-31. Cox RE, Barnier AJ. Macquarie Centre for Cognitive Science, Macquarie University, Sydney, Australia.

Margaret Lee Lyles, known as "Marge" to most, was a busy massage therapist when, in 1992, she discovered she had a malignant tumor. She opted for natural healing without chemotherapy or radiation. Six months after the diagnosis however, Marge contracted hepatitis-A virus, causing the tumor to regain size and forcing her to choose a lumpectomy to spare her life.

In her third year of recovery, her doctor encouraged her to practice the "Reiki" healing method to strengthen her immune system. Today, in her mid-seventies, the author maintains her remission from cancer with a strong enthusiasm for living. She does not claim Reiki cured her cancer but definitely feels it is largely responsible for her current state of wellness.

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The purpose of this study was to examine the effect of background music and song texts to teach emotional understanding to children with autism. Participants were 12 students (mean age 11.5 years) with a primary diagnosis of autism who were attending schools in Japan. Each participant was taught four emotions to decode and encode: happiness, sadness, anger, and fear by the counterbalanced treatment-order. The treatment consisted of the four conditions: (a) no contact control (NCC)--no purposeful teaching of the selected emotion, (b) contact control (CC)--teaching the selected emotion using verbal instructions alone, (c) background music (BM)--teaching the selected emotion by verbal instructions with background music representing the emotion, and singing songs (SS)--teaching the selected emotion by singing specially composed songs about the emotion. Participants were given a pretest and a posttest and received 8 individual sessions between these tests. The results indicated that all participants improved significantly in their understanding of the four selected emotions. Background music was significantly more effective than the other three conditions in improving participants' emotional understanding. The findings suggest that background music can be an effective tool to increase emotional understanding in children with autism, which is crucial to their social interactions.

J Music Ther. 2009 Spring;46(1):15-31. Katagiri J. The Florida State University, USA.

by Randy Herron, SPHR

Think about the people who work for you. Do any of them need to improve performance? Should you have had a discussion with one or two of them within the last 60 days? Is there a gap between their performance, the job description and your expectations? Think of the one who needs this discussion the most... the one with the most significant gap between actual performance and your expectations (P/E gap).

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BACKGROUND: Between 75-90% of nursing home (NH) residents with dementia develop behavioral symptoms (BSD) which may be associated with a stress response. Therapeutic touch has been shown to decrease restlessness in NH residents, however the mechanism is unknown. The purpose of this randomized controlled trial (RCT) was to examine the effect of therapeutic touch on BSD and basal cortisol levels among NH residents with dementia. PARTICIPANTS AND METHODS: Using a double blind experimental interrupted time series ABAB design, 65 participants were assigned to one of three groups. The experimental group received therapeutic touch with contact on the neck and shoulders delivered twice daily for 3 days (administered over 2 separate treatment periods); the placebo group received a mimic treatment identical in appearance, and the control group received routine care. Study outcomes were BSD, measured by the modified Agitated Behavior Rating Scale (mABRS), and salivary cortisol levels, measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: 64 residents, aged 67-93 years (M = 85.5, SD = 5.50), completed the study. Restlessness was significantly reduced in the experimental group compared to the control group (p = 0.03). There was a significant difference in morning cortisol variability among groups across time periods (<0.0001). Findings suggest that therapeutic touch may be effective for management of symptoms like restlessness coupled with stress reduction. At a time when cost containment is a consideration in health care, therapeutic touch is an intervention that is non-invasive, readily learned, and can provide a non-pharmacologic alternative for selected persons with BSD. Copyright 2009 S. Karger AG, Basel.

Forsch Komplementmed. 2009 Jun;16(3):181-9. Epub 2009 Jun 5. Woods DL, Beck C, Sinha K. School of Nursing, University of California Los Angeles, CA 90095-6919, USA. lwoods@sonnet.ucla.edu

by Brenda J. Crawford-Bee

Detoxification of the body has been around for centuries, as far back as Ancient Egypt. Body detox or body cleansing became popular in recent centuries during the 19the century, but fell out of favor in the early 20th century. Detoxification, ridding the body of toxins, is a treatment in alternative medicine, and abandoned my mainstream medicine.

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Full Title: No Change in Rectal Sensitivity After Gut-Directed Hypnotherapy in Children With Irritible Bowel Syndrome

OBJECTIVES:Gut-directed hypnotherapy (HT) has recently been shown to be highly effective in treating children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS). This study was conducted to determine the extent to which this treatment success is because of an improvement in rectal sensitivity.METHODS:A total of 46 patients (aged 8-18 years) with FAP (n=28) or IBS (n=18) were randomized to either 12 weeks of standard medical therapy (SMT) or HT. To assess rectal sensitivity, a pressure-controlled intermittent distension protocol (barostat) was performed before and after the therapy.RESULTS:Rectal sensitivity scores changed in SMT patients from 15.1+/-7.3 mm Hg at baseline to 18.6+/-8.5 mm Hg after 12 weeks of treatment (P=0.09) and in HT patients from 17.0+/-9.2 mm Hg to 22.5+/-10.1 mm Hg (P=0.09). The number of patients with rectal hypersensitivity decreased from 6 of 18 to 0 of 18 in the HT group (P=0.04) vs. 6 of 20 to 4 of 20 in the SMT group (P=0.67). No relationship was established between treatment success and rectal pain thresholds. Rectal sensitivity scores at baseline were not correlated with intensity, frequency, or duration of abdominal pain.CONCLUSIONS:Clinical success achieved with HT cannot be explained by improvement in rectal sensitivity. Furthermore, no association could be found between rectal barostat findings and clinical symptoms in children with FAP or IBS. Further studies are necessary to shed more light on both the role of rectal sensitivity in pediatric FAP and IBS and the mechanisms by which hypnotherapy results in improvement of clinical symptoms.Am J Gastroenterol advance online publication, 27 October 2009; doi:10.1038/ajg.2009.613.

Am J Gastroenterol. 2009 Oct 27. Vlieger AM, van den Berg MM, Menko-Frankenhuis C, Bongers ME, Tromp E, Benninga MA. Department of Pediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands.

by Tim Brunson, PhD

Trichotillomania, which is also referred to as trich or TTM, is an impulse control disorder, which involves recurrent hair pulling, resulting in a noticeable loss of hair. It includes compulsive and habitual pulling of eye lashes, eye brows, head hair, and pubic hair. Tension before the act and feelings of pleasure immediately thereafter are typical affect conditions. The obvious hair loss results in increased anxiety and often may lead to an avoidance of social situations and even intimate relationships. Reduced self-esteem is also a factor. Hypnotherapy is a valid clinical intervention for trich treatment.

The pervasiveness of trich is unknown. One study indicated that 11% of surveyed college students reported symptoms. 92 to 93% of sufferers are female. Scalp hair puling (80%) is the most prevalent form of trich. This is followed by lash pulling (46%) and brow pulling (43.5%).

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Full Title: The culture of massage therapy: valued elements and the role of comfort, contact, connection and caring

OBJECTIVE: To explore the attributes of the therapy encounter valued by repeat users of health-related massage therapy. DESIGN: A qualitative design with telephone focus group methodology was used. A total of 19 repeat users of massage therapy participated in three telephone focus groups where audiotaped semi-structured interviews were conducted. SETTING: Telephone focus group with massage clients from a range of provincial and urban regions in New Zealand. MAIN OUTCOME MEASURES: Summary of reported themes of the massage experience. Data were thematically analysed using the general inductive approach. RESULTS: Six valued elements of the massage encounter (time for care and personal attention, engaging and competent therapist, trust partnership, holism and empowerment, effective touch and enhancing relaxation), four modulators (comfort, contact, connection and caring) and two themes relating to adding experiential value (enjoyment, escapism) characterize the massage therapy culture. CONCLUSIONS: The culture of massage therapy care incorporates a number of characteristics that are congruent with the complementary and alternative medicine approach to health. In addition, massage specific factors were identified. The humanistic aspects of the therapy encounter valued by clients offer insight into the growing use of massage therapy and the success of massage therapy outcomes.

Complement Ther Med. 2009 Aug;17(4):181-9. Smith JM, Sullivan SJ, Baxter GD. Massage Department, Southern Institute of Technology, Private Bag 90114, Invercargill 9840, New Zealand. jo.smith@sit.ac.nz

by Nanci Trivellato

and Nelson Abreu

Among poorly understood topics in medicine and behavioral studies is so-called psychological contamination, that is, the transmission of attitudes through mental influence or the imitation reflex. Although this process is well-known among psychiatrists, psychologists, and sociologists, many of these professionals do not consider its bioenergetic aspect.

You may have observed how, if a person yawns, sneezes, laughs, or cries others in the room may follow suit. This effect is more powerful in large crowds, like a live sporting or entertainment event, where individuals may feel an unusual level of emotion and hundreds to thousands simultaneously laugh, cry, or feel connected to the same artist or athlete. Another example can be found in charged political events where a small fight can propagate into a chaotic situation resulting in vandalism and even lynching involving many people who are otherwise peaceful by themselves.

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OBJECTIVE: To evaluate the response to homeopathic treatment in a public homeopathic clinic of all patients attending between September 1998 until December 2005, and to analyze homeopathic practice. METHODS AND SETTING: Longitudinal observational study in a homeopathic clinic based in a public hospital in Lucca, Italy. Data relating to patient details, clinical diagnosis, remedy prescribed, potency of dosage, prescription strategy and identification of the case as acute-chronic-recurrent were analyzed. Clinical response was assessed by the Glasgow Homeopathic Hospital Outcome Score. RESULTS: Overall 74% of patients reported at least moderate improvement. Outcomes were better with longer treatment duration and younger age of patients. Respiratory, followed by dermatological and gastrointestinal pathologies responded best, psychological problems relatively poorly. CONCLUSIONS: Homeopathic therapy is associated with improvement in a range of chronic and recurring pathologies. Certain characteristics of patient and pathology influence the outcome.

Homeopathy. 2009 Jul;98(3):142-8. Rossi E, Endrizzi C, Panozzo MA, Bianchi A, Da Frè M. Homeopathic Clinic, ASL 2 Lucca, Tuscany Regional Homeopathic Reference Centre, Italy. omeopatia@usl2.toscana.it

Full Title: Symptom management for irritable bowel syndrome: a pilot randomized controlled trial of acupuncture/moxibustion

The purpose of this pilot study was to assess the effect of an individualized traditional Chinese medicine (TCM) acupuncture and moxibustion (Acu/Moxa) treatment on symptom control in patients with irritable bowel syndrome (IBS) in a preliminary, randomized, sham/placebo-controlled trial. Twenty-nine men and women with IBS were randomized to either individualized Acu/Moxa (treatment group) or sham/placebo Acu/Moxa (control group). All subjects were assessed by a diagnostic acupuncturist for a TCM evaluation and individualized point prescription. Only those subjects assigned to the experimental group received the individually prescribed treatment. The diagnostic acupuncturist did not administer treatments and was blind to treatment assignments. All subjects kept a symptom diary for the duration of the study, enabling measurement of symptom frequency, severity, and improvement. The Clinical Global Impression Scale was administered preintervention to establish baseline severity and on completion of the 4-week, eight-session treatment intervention. After 4 weeks of twice-weekly Acu/Moxa treatment, average daily abdominal pain/discomfort improved whereas the control group showed minimal reduction. This between-group difference adjusted for baseline difference was statistically significant. The intestinal gas, bloating, and stool consistency composite score showed a similar pattern of improvement. The findings indicate that Acu/Moxa treatment shows promise in the area of symptom management for IBS.

Gastroenterol Nurs. 2009 Jul-Aug;32(4):243-55. Anastasi JK, McMahon DJ, Kim GH. Columbia University School of Nursing, New York, NY 10032, USA. jka8@columbia.edu

Background Although increases in obesity over the past 30 years have adversely affected the health of the U.S. population, there have been concomitant improvements in health because of reductions in smoking. Having a better understanding of the joint effects of these trends on longevity and quality of life will facilitate more efficient targeting of health care resources.

Methods For each year from 2005 through 2020, we forecasted life expectancy and quality-adjusted life expectancy for a representative 18-year-old, assuming a continuation of past trends in smoking (based on data from the National Health Interview Survey for 1978 through 1979, 1990 through 1991, 1999 through 2001, and 2004 through 2006) and past trends in body-mass index (BMI) (based on data from the National Health and Nutrition Examination Survey for 1971 through 1975, 1988 through 1994, 1999 through 2002, and 2003 through 2006). The 2003 Medical Expenditure Panel Survey was used to examine the effects of smoking and BMI on health-related quality of life.

Results The negative effects of increasing BMI overwhelmed the positive effects of declines in smoking in multiple scenarios. In the base case, increases in the remaining life expectancy of a typical 18-year-old are held back by 0.71 years or 0.91 quality-adjusted years between 2005 and 2020. If all U.S. adults became nonsmokers of normal weight by 2020, we forecast that the life expectancy of an 18-year-old would increase by 3.76 life-years or 5.16 quality-adjusted years.

Conclusions If past obesity trends continue unchecked, the negative effects on the health of the U.S. population will increasingly outweigh the positive effects gained from declining smoking rates. Failure to address continued increases in obesity could result in an erosion of the pattern of steady gains in health observed since early in the 20th century.

Susan T. Stewart, Ph.D., David M. Cutler, Ph.D., and Allison B. Rosen, M.D., Sc.D. From the Harvard University Interfaculty Program for Health Systems Improvement, Boston (S.T.S.); the Department of Economics, Harvard University (D.M.C.), and the National Bureau of Economic Research (S.T.S., D.M.C., A.B.R.) -- both in Cambridge, MA; and the Departments of Internal Medicine and Health Management and Policy, University of Michigan Schools of Medicine and Public Health, Ann Arbor (A.B.R.).