Mood disorders, depression, brain chemistry relationship to weight loss and sleep disorders - Psychotherapist Review and Commentary

Townsend Letter for Doctors and Patients,  April, 2004  by Robert A. Anderson

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Low back pain-hypnosis

Fifteen adults 18-43 years of age with chronic low back pain (mean duration 4 years) were found to be moderately/highly hypnotizable based on the modified 11-point Stanford Hypnotic Susceptibility Scale. Somatosensory event-related potential correlates of noxious electrical stimulation were evaluated during attend (control) and hypnotic analgesia conditions at anterior frontal, midfrontal, central, and parietal brain regions. Significant brain inhibitory processing was evidenced in different brain locations (p<.05 - p<.001) compared to the control condition. Hypnotic analgesia led to highly significant mean reductions in perceived sensory pain and distress (p<.001). Participants were then shown to develop self-efficacy through the successful transfer of newly learned skills of experimental pain reduction to reduction of their own chronic pain; within 3 sessions, they reported chronic pain reduction, increased psychological well-being, and increased sleep quality. In 60% the pain was totally gone and in 80% the distress was totally gone by the end of the 3rd session. Hypnotic analgesia is an active process that requires inhibitory effort, dissociated from conscious awareness, in which the anterior frontal cortex participates in a topographically specific inhibitory feedback circuit that cooperates in the allocation of thalamocortical activities. The development of "neurosignatures of pain" can influence subsequent pain experiences, and may be expanded in size and easily reactivated.

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Crawford HJ et al. Hypnotic analgesia: 1. Somatosensory event-related potential changes to noxious stimuli and 2. Transfer learning to reduce chronic low back pain. Int J Clin Exp Hypn 1998 Jan; 46(1):92-132.

Comment: This study suggests that hypnosis and other psychological interventions need to be introduced early as adjuncts in medical treatments for onset pain before the development of chronic pain. Pain control and sleep quality were significantly improved. Chronic pain is one of the leading reasons why patients seek medical care. The commonest conventional medical responses are prescriptions for analgesics and psychotropics. The disadvantages of these classes of drugs are the potential for addiction with analgesics and for undesirable alteration of mood and mental clarity with psychotropic medicines. Use of behavioral approaches such as hypnosis used here bypasses these hazards and empowers patients to be more fully in charge of their own awarenesses and internal voluntary controls. My own personal coping with chronic low back pain from a congenital spondylolisthesis has been enhanced most of all with regular meditation and associated programmable imagery. While some mystery about these "soft" processes remains, they are far more powerful than most practitioners would think, and these approaches are grossly underused in medical care.

Insomnia/stress

Fifteen adult insomniacs <40 were studied for activity of the "stress system" (hypothalamic-pituitary-adrenal axis and the sympathetic nervous system). A baseline night of measurements showed mean sleep latency to be 41 minutes. Mean disturbances were 7% in stage 1 sleep, 66% in stage 2 sleep, 23% in REM sleep and 3% in slow-wave sleep. Each subject then spent 3 nights in the sleep lab. 24-hour urinary free cortisol values were correlated with total wake time (p=.05). Catecholamine metabolites (DHPG--dihydroxyphenylglycol, and DOPAC--dihydroxyphenylacetic acid) were positively correlated with the percentage of stage 1 sleep disturbance (p<.05) and wake time after sleep onset (p<.05). Growth hormone was not significantly correlated.

Vgontzas AN et al. Chronic Insomnia and Activity of the Stress System: A Preliminary Study. J Psychosom Res 1998 Jul; 45(1):21-31

Comment: Stress, as evidenced by cortisol and catecholamine output, was significantly correlated with aspects of insomnia. Cortisol levels appear to be throttled back at night in healthy individuals. Perception of stress, elevated night-time cortisol output, blunted immune responses and poor sleep are associated phenomena which tend to move together. Poor sleep then becomes an additional stress and the cycle is ratcheted up one notch. So, better handling of stress, and behavioral approaches for enhancement of sleep can both interrupt this vicious cycle. The behavioral approaches which improve stress handling and efficacious sleep also are markedly successful in favorably modulating serious illnesses such as heart disease (see below).

Myocardial ischemia/stress management

One hundred seven patients with coronary artery disease and myocardial ischemia documented during mental stress testing or ambulatory electrocardiographic monitoring, were randomly assigned to a 38-month program of stress management training with patients living at a distance from the facility forming a nonrandom, usual care control group. The training consisted of sixteen 1.5-hour weekly sessions of cognitive education with graded task assignments of monitoring irrational internal autonomic thoughts, generating alternative interpretations of situations and unrealistic thoughts, progressive relaxation and >2 sessions of EMG biofeedback. Myocardial ischemia was reassessed following treatment, and patients were contacted annually for up to five years to document cardiac events, including death, nonfatal MI, and cardiac revascularization procedures. Twenty-two patients (21%) experienced at least one cardiac event during a mean follow-up period of 38 months. Stress management was associated with a relative risk of 0.26 v. usual care controls (p=0.04). The stress management subjects experienced weight loss (p=.02), decreased severe ventricular wall movement (p<.004), reduced ischemia induced by mental stress and less ambulatory ischemia.