Will the real Walter Matweychuk please stand up?

Survey Says Stigma Of Mental Illness Has Declined.

HealthDay (5/6, Dotinga) reported that, according to an online survey commissioned by the American Psychiatric Association and conducted by Harris Interactive, "more than a third of Americans polled believe that the stigma of mental illness has declined and they attribute the change largely to openness by friends, family members, and public figures about their own conditions." Nearly "80 percent of those polled said that such openness on the part of family and friends had had at least a moderate impact on the stigma of mental illness," the survey of "2,285 adults aged 18 and older" found.

'Cuddle hormone' makes men more empathetic

Emma Wilkinson
Health reporter, BBC News

Men are not as 'tuned' in to people's feelings as women

A nasal spray can make men more in tune with other people's feelings, say a team of German and UK researchers.

They found that inhaling the "cuddle hormone" oxytocin made men just as empathetic as women.

The study in 48 volunteers also showed that the spray boosted the ability to learn from positive feedback.

Writing in the Journal of Neuroscience, the researchers said the spray may be useful for boosting behaviour therapy in conditions such as schizophrenia.

Oxytocin is a naturally produced hormone, most well-known for triggering labour pains and promoting bonding between mother and baby.

This study is the latest of several that suggest that intranasal oxytocin seems to 'sensitise' people to become more aware of social cues from other individuals Professor Gareth Leng

But it has also been shown to play a role in social relations, sex and trust.

Study leader Professor Keith Kendrick, a neuroscientist at Cambridge University, said by giving the hormone nasally, it quickly reaches the brain.

In the first part of the study, half the men received a nose spray containing oxytocin and half were given a dummy spray.

They were then shown photos of emotionally charged situations including a crying child, a girl hugging her cat, and a grieving man, and were asked questions about the depth of feeling they had towards the subjects.

Those who had the hormone spray had markedly higher levels of empathy - of a similar magnitude to those only usually seen in women who are naturally more sensitive to the feelings of others.

Neither group were able to accurately guess whether they had received the oxytocin or the dummy spray.

Positive feedback

In a second experiment, the researchers measured "socially motivated learning" where the volunteers were asked to do a difficult observation test and were shown an approving face if they got the answer right and an unhappy face if they got it wrong.

In these types of experiments, people generally learn faster if they get positive feedback but those who had taken the oxytocin spray responded even better to facial feedback than those in the placebo group.

Professor Kendrick said the oxytocin spray may prove to be useful in people with conditions associated with reduced social approachability and social withdrawal, such as schizophrenia.

And other researchers are already looking at its potential use in autism.

"The bottom line is it improved the ability of people to learn when they had positive feedback and that is pretty important because this might help improve the effectiveness of behavioural therapy or even be useful in people with learning difficulties."

Professor Gareth Leng from Edinburgh University said the research used some cleverly-designed tests.

He added there has been a lot of interest recently on oxytocin and social behaviour.

"This study is the latest of several that suggest that intranasal oxytocin seems to 'sensitise' people to become more aware of social cues from other individuals - and more likely to be sympathetic to them."

Mind Over Meds

(an ATB requested article)

By DANIEL CARLAT

April 19, 2010

The New York Times

One day several years ago, I was reaching the end of my first visit with a patient, J.J., who had come to see me for anxiety and insomnia. He was a salesman for a struggling telecommunications company, and he was having trouble managing the strain on his finances and his family. He was sleeping poorly, and as soon as he opened his eyes in the early morning, the worries began. “I wake up with a list of things to worry about,” he said. “I just go through the list, and it seems to get longer every day.”

A psychiatric interview has a certain rhythm to it. You start by listening to what your patient says for a few minutes, without interrupting, all the while sorting through possible diagnoses. This vast landscape of distress has been mapped into a series of categories in psychiatry’s diagnostic manual, DSM-IV. The book breaks down mental suffering into 16 groups of disorders, like mood disorders, anxiety disorders, psychotic disorders, eating disorders and several others. As I listened to J.J. (a nickname that he agreed I could use to protect his privacy), it was clear to me that he had one of the anxiety disorders, but which one? In order to systematically rule in or rule out the disorders, I asked J.J. dozens of questions. “Do you have panic attacks?” “Do you get fearful in crowded situations?” “Have you ever experienced a traumatic event that later caused flashbacks or nightmares?”

Each of J.J.’s answers provided me with a clue, closing off one possibility while opening up others. At its best, when you are working with an intelligent, insightful patient, the process is fun, involving a series of logical calculations, much like working a Sudoku puzzle. Finally, toward the end of the hour, I felt confident that I had arrived at J.J.’s diagnosis. “I think you have what we call ‘generalized anxiety disorder,’ ” I told him. It may start with a defined series of causes, as was true for J.J., but then it spirals outward, blanketing the world with potential threat. J.J. worried about what the future would bring and experienced a predictable series of physical symptoms: insomnia, muscle tension, irritability and poor concentration.

“I’m going to write you a prescription for a medication called Zoloft,” I said, picking up my prescription pad. He asked what was causing his anxiety, and I began one of the stock neurochemical explanations that psychiatrists typically offer patients about low serotonin levels in the brain. The treatment involved “filling up the tank” by prescribing a medication like Zoloft, Celexa or Paxil.

“So Dr. Freud, the causes are all in the brain? Isn’t there some explanation in my childhood?” It was a good-natured tease.

“I specialize in prescribing medications,” I said with a smile. I was a psychopharmacologist and specialized in medication rather than psychotherapy. “I can refer you to a good therapist in the area if you’d like.”

After J.J. left my office, I realized, uncomfortably, that somehow, over the course of the decade following my residency, my way of thinking about patients had veered away from psychological curiosity. Instead, I had come to focus on symptoms, as if they were objective medical findings, much the way internists view blood-pressure readings or potassium levels. Psychiatry, for me and many of my colleagues, had become a process of corralling patients’ symptoms into labels and finding a drug to match.

Leon Eisenberg, an early pioneer in psychopharmacology at Harvard, once made the notable historical observation that “in the first half of the 20th century, American psychiatry was virtually ‘brainless.’ . . . In the second half of the 20th century, psychiatry became virtually ‘mindless.’ ” The brainless period was a reference to psychiatry’s early infatuation with psychoanalysis; the mindless period, to our current love affair with pills. J.J., I saw, had inadvertently highlighted a glaring deficiency in much of modern psychiatry. Ultimately, his question would change the way I thought about my field, and how I practiced.

I originally became interested in psychiatry primarily because of my father: he is a psychiatrist practicing in San Francisco. But there was a darker side to my career choice. My mother suffered severe mental illness, with debilitating depressions and paranoid thoughts. One autumn day during my junior year in college, she committed suicide. Psychiatry then became personal, a way for me to come to terms with her illness.

I majored in psychology at U.C. Berkeley, and at U.C. San Francisco I labored through medical school’s rites of passage in order to qualify for a psychiatric residency. Eventually, on a steamy July day in 1992, I stood on a Boston street, far from home, gazing at Massachusetts General Hospital (known as M.G.H.), where I was about to start my training.

This was a momentous time at M.G.H. Prozac was introduced four years earlier and became the best-selling psychiatric medication of all time. Zoloft and Paxil, two similar medications, were in the pipeline, and many of the key clinical trials for these antidepressants were conducted by psychiatrists at M.G.H. who were to become my mentors. M.G.H. and other top programs were enthralled with neurobiology, the new medications and the millions of dollars in industry grants that accompanied them. It was hard not to get caught up in the excitement of the drug approach to treatment. Psychopharmacology was infinitely easier to master than therapy, because it involved a teachable, systematic method. First, we memorized the DSM criteria for the major disorders, then we learned how to ask the patient the right questions, then we pieced together a diagnosis and finally we matched a medication with the symptoms.

But learning the formal techniques of therapy was like navigating without a compass. While I learned how to form an alliance with my patients and begin a good dialogue, becoming a skillful therapist requires much more practice than busy psychiatry residencies allow.

When my father did his residency at U.C.S.F. in the 1950s, he learned therapy well, because, with few medications available, it was the main treatment psychiatrists could offer their patients. Psychiatric residencies focused on therapy, and many residents extended their training further by enrolling in postgraduate psychoanalytic institutes. When modern medications came on the scene, my father adapted by incorporating them into his therapy practice, as did many of his colleagues. I call this the “golden” generation of psychiatrists, those currently approaching retirement age, who were skilled at offering the full package of effective psychiatric treatments to patients.

The newer generation of psychiatrists, who graduated in the 1980s and afterward, trained in programs that were increasingly skeptical of therapy and that emphasized a focus on medications. M.G.H. was by far the most influential of these modern programs. Graduates of the M.G.H. program and its sister program at nearby McLean Hospital have fanned out throughout the country, becoming chairmen of departments and leaders of the National Institute of Mental Health.

A result is that psychiatry has been transformed from a profession in which we talk to people and help them understand their problems into one in which we diagnose disorders and medicate them. This trend was most recently documented by Ramin Mojtabai and Mark Olfson, two psychiatric epidemiologists who found that the percentage of visits to psychiatrists that included psychotherapy dropped to 29 percent in 2004-5 from 44 percent in 1996-97. And the percentage of psychiatrists who provided psychotherapy at every patient visit decreased to 11 percent from 19 percent.

While it is tempting to blame only the biologically oriented psychiatrists for this shift, that would be simplistic. Other forces are at work as well. Insurance companies typically encourage short medication visits by paying nearly as much for a 20-minute medication visit as for 50 minutes of therapy. And patients themselves vote with their feet by frequently choosing to see psychopharmacologists rather than therapists. Weekly therapy takes time and is arduous work. If a daily pill can cure depression and anxiety just as reliably, why not choose this option?

In fact, during my 15-to-20-minute medication visits with patients, I was often gratified by the effectiveness of the medications I prescribed. For perhaps a quarter of them, medications worked so well as to be nearly miraculous. But over time I realized that the majority of patients need more. One young woman I saw was referred to me by a nurse practitioner for treatment of depression that had not responded to several past antidepressants. She was struggling to raise two young children and was worried that she was doing a poor job of it. Her husband worked full time and was rarely available to help. She cried throughout our initial interview. I started her on Effexor and referred her to a social-worker colleague. She improved initially, but over the years since, her symptoms have waxed and waned. When she reports a worsening of her anxiety or depression, my first instinct is to do one of three things — switch medications, increase her dosage or add another. Over the course of 15 or 20 minutes, this is about all I can offer.

My treatment of this young woman follows the “split treatment” model, but a less charitable description is “fragmented care.” Like the majority of psychiatrists in the United States, I prescribe the medications, and I refer to a professional lower in the mental-health hierarchy, like a social worker or a psychologist, to do the therapy. The unspoken implication is that therapy is menial work — tedious and poorly paid.

But over the past few years, research studies have shown that therapy is just as effective as medications for many conditions, and that medications themselves often work through the power of placebo. In one study, for example, researchers did a meta-analysis of studies submitted by drug companies to the F.D.A. on seven new antidepressants, involving more than 19,000 patients. It turned out that antidepressants are, indeed, effective, because on average patients taking the pills showed a 40 percent drop in depression scores. But placebo was also a powerful antidepressant, causing a 30 percent drop in depression scores. This meant that about three-quarters of the apparent response to antidepressants pills is actually due to the placebo effect.

Nobody knows exactly how the mysterious placebo effect works, but it is clear that it has impacts on the brain that can be seen as clearly as medication effects. In one study conducted by pain researchers at the University of Michigan, subjects were given an ache-inducing injection of saline into their jaws and were placed in a PET scanner. They were then told that they would be given an intravenous pain treatment, but the “treatment” was merely more saline solution, acting as a placebo. The PET scan showed that the endogenous endorphin system in the brains of the subjects was activated. The patients believed so strongly that they were receiving effective treatment that their brains followed suit. Presumably, a corresponding brain change occurs when depressed patients are given placebo pills.

Like placebo, psychotherapy has typically been considered a “nonbiological” treatment, but it has become clear that therapy, like placebo, also leads to measurable changes in the brain. In an experiment conducted at U.C.L.A. several years ago, with subjects suffering from obsessive-compulsive disorder, researchers assigned some patients to treatment with Prozac and others to cognitive behavior therapy. They found that patients improved about equally well with the two treatments. Each patient’s brain was PET-scanned before and after treatment, and patients showed identical changes in their brain circuits regardless of the treatment.

In depression treatment, too, pills and therapy each lead to brain changes, but in this case they appear to be intriguingly distinct. In studies by Helen Mayberg, a professor of psychiatric neurology at Emory University, depressed patients given cognitive behavior therapy showed decreased activity in the frontal lobe, the brain center that might be responsible for the overmagnification of life’s problems that leads to depression in some patients. And they showed increased brain activity in parts of the limbic system, a brain region associated with strong emotion. But Mayberg found that when patients were given medication, their brain activities changed in the opposite direction, stimulating the frontal lobe and damping down the limbic system. “Our imaging results suggest that you can correct the depression network along a variety of pathways,” she said.

Clearly, mental illness is a brain disease, though we are still far from working out the details. But just as clearly, these problems in neurobiology can respond to what have traditionally been considered “nonbiological” treatments, like psychotherapy. The split between mind and body may be a fallacy, but the split between those who practice psychopharmacology and those specializing in therapy remains all too real.

After I saw J.J., I decided that I wanted to try to change my approach to treatment. I gradually began to carve out room in my schedule for longer visits with my patients. I endeavored to do what’s called “supportive” therapy, a technique favored by many therapists and involving basic problem solving and emotional support. It is a bit like what a friend would do for another friend offering advice in times of trouble, but more elaborate and with an accompanying raft of studies endorsing its effectiveness in psychiatry.

When I started to probe my patients, I realized I barely knew most of them. I had exuberantly documented their moods, sleep habits, energy levels and whether they had suicidal thoughts, but I didn’t know what made them tick as people. For example, I had treated Jane (her middle name), a health care administrator in her 40s, for depression and bulimia for many years, focusing on a complicated combination of medications like Effexor, Provigil and Xanax. Then she had a depressive relapse. This time, rather than simply adjusting her medication, I asked her what was going on in her life. I found out that her boss had recently given her an impossible assignment to complete and had berated her when the results were not to his liking. It seemed clear to me that her depression was partly triggered by the fact that she blamed herself for her boss’s poor communication skills and managerial lapses. I encouraged her to question that assumption each time it popped into her mind. Over the next few visits, she improved — relating better to her boss, able to take his criticism with a grain of salt and feeling more confident.

But while my simple therapeutic suggestions were helpful, as Jane and I continued to explore her work issues in detail, she said that she often lacked focus on the job. Knowing that poor concentration can be a symptom of depression, I asked if she associated her distractibility with periods of sadness. But she said there was no such correlation with her moods.

I wondered if she might have an adult version of attention deficit disorder. Indeed, carefully reviewing her years in school, I saw she was always easily distracted but overcame this problem by working extra hard, and managed to achieve good grades. Even now, her job performance was consistently rated as excellent, but the extra work this entailed sapped her energy.

I decided to prescribe her a version of Ritalin, the standard treatment for A.D.D. The next month, she said she felt that this medication had turned her life around. Not only did she feel more focused and productive at work, but she was more apt to get things done at home, which in turn enhanced her mood, indirectly improving her depression.

Is Jane’s story an argument for psychiatrists providing both medication and some sort of psychotherapy? I think it is. This does not mean that dedicated psychotherapists are not crucial — they are, because they can provide the in-depth therapy that psychopharmacologists will never have time to deliver. When our patients need more from us than just medication, however, we should be prepared to provide it. Oddly, managed-care companies discourage us from doing psychotherapy, arguing that it is cheaper to have psychiatrists do 20-minute medication visits every three months and to hire a lower paid non-M.D. for more frequent therapy visits. But the few studies that have analyzed the economics of these arrangements have found that integrated treatment actually saves money. Mantosh Dewan, the chairman of psychiatry at SUNY Upstate Medical University in Syracuse, found that when psychiatrists do both medication and psychotherapy, the overall amount of money paid out by insurance companies is actually less than when the treatment is split between psychiatrists and psychotherapists. When patients see only one provider, they require fewer visits overall.

It may be time to consider whether the term “psychopharmacologist” is actually doing damage to the field of psychiatry. The American Society of Clinical Psychopharmacology defines “psychopharmacology” on its Web site as “the study of the use of medications in treating mental disorders.” But in a recent article, three Harvard psychiatrists (interestingly, two of them from Mass General) have pointed out that no other medical specialty has carved out a separate “pharmacology”subspecialty. Good doctoring, they remind us, involves perfecting all the skills relevant to healing and deploying them when needed.

During my mother’s last months, she isolated herself from her family, so I don’t know what kind of treatment she was receiving before her death. But I do know what kind of treatment I would have hoped for her. She needed medication to combat her paranoia and the emotional pain of her depression. She needed someone who could expertly probe her thought process, in order to understand the fateful logic that led her to conclude that the only solution was to end her own life. She needed treatment that was intensive and exquisitely coordinated.

Such care is not always capable of saving damaged lives. But it is the best that we can do. It’s what we owe our patients — and ourselves.

Daniel Carlat is an associate clinical professor of psychiatry at Tufts University School of Medicine and the publisher of The Carlat Psychiatry Report. His book, “Unhinged: the Trouble With Psychiatry,” will be published in May.

Citation: http://www.nytimes.com/2010/04/25/magazine/25Memoir-t.html

Study: Children of suicide more likely to take own lives

By Elizabeth Landau, CNN

April 21, 2010 3:42 p.m. EDT

Previous research found strong indications of a genetic component to suicide.

STORY HIGHLIGHTS

• Researchers looked at data about Swedish children who lost parents
• Between 7,000 and 12,000 children lose a parent to suicide each year in U.S.
• Developmental, environmental, genetic factors are involved in suicide, experts say
• Studies have found that there may be predisposition toward suicidal behavior in families

(CNN) -- Poet John Berryman. Sylvia Plath's son, Nicholas Hughes. These are prominent examples of people who whose parents died by suicide when they were children and also took their own lives as adults.

A large study has found that people who as children or adolescents lost a parent to suicide are more likely to die the same way. The research will be published in the May issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

"It appears from our results that all factors -- developmental, environmental and genetic -- are important," said lead author Holly Wilcox of Johns Hopkins Children's Center.

Researchers looked at data from Sweden's population registry, examining records of more than 500,000 children, teens and young adults who lost a parent to suicide, illness or accidents. They compared those against nearly 4 million children, teens and young adults with living parents.

They found that Swedes who were children or adolescents when a parent took his or her own life had a three-fold increased risk of dying by suicide themselves. But young adults, in the 18 to 25 age bracket, did not have this higher risk.

"The disruption associated with parental suicide, we think, is greater when someone loses a parent during childhood and adolescence," Wilcox said.

Although the risk of suicide went up for children of people who had taken their own lives, suicide itself is still a relatively rare event, Wilcox said.

In the United States, between 7,000 and 12,000 children lose a parent to suicide each year, the researchers said.

The findings have the caveat that they are attached to a country that provides universal health care and has a higher economic status than many others, Wilcox said.

Still, the study is important in confirming the hereditary risk of suicidal behavior, said Dr. Maria Oquendo, a psychiatrist atColumbia University Medical Center who was not involved in the research.

A study in the same journal in February found that suicide attempts also run in families. In some cases, the children had attempted suicide before the parents did, said Oquendo, co-author of that study.

Oquendo and colleagues found that exposure to suicide -- that is, knowing about a parent's suicide attempt -- could not account for the pattern. This suggests that family members do not imitate suicidal behavior but that there may be predisposition toward it, Oquendo said.

Previous research also has found indications of a genetic component to suicide.

A 2009 study in the Proceedings of the National Academy of Sciences found biological markers for depression. Researchers found that the cortex, the brain's outermost surface, tended to be thinner in people at high risk of developing depression.

Participants had this brain surface thinning before they developed mental problems, the study said. Both children and grandchildren of depressed people had these structural differences in their brains.

Researchers believe that the thinning interferes with the processing of emotional stimuli, meaning people with these abnormalities may benefit from therapy specifically addressing how to respond to social stimuli, co-author Dr. Bradley Peterson, a psychiatrist at Columbia University Medical Center, said when the study was published.

Screening may one day become available for this cortical thinning and may help doctors determine depression risk early on, he said.

Many people mistakenly believe that stress is at the root of suicides; stress can play a role, certainly, but the familial component can determine how people respond to stress, Oquendo said.

"Unless there's something that predisposes you to react to stress in that way, the stress won't precipitate a suicide," she said.

There are opportunities for young people who lose a parent to suicide to be recognized in primary care, Wilcox said. Early identification and treatment of depression could help in suicide prevention, she said.

The surviving parent should also be more sensitive to any psychiatric problems that come up, Wilcox said.

Wilcox's study also found that a child's risk of committing a violent crime went up if he or she had lost a parent, regardless of cause.

Citation: http://www.cnn.com/2010/HEALTH/04/21/suicide.children.hereditary/index.html?npt=NP1

Naps boost memory, but only if you dream

By Denise Mann, Health.com

April 22, 2010 12:56 p.m. EDT

A new finding underscores just how important sleep is to memory and mental function.

(Health.com) -- Sleep has long been known to improve performance on memory tests. Now, a new study suggests that an afternoon power nap may boost your ability to process and store information tenfold -- but only if you dream while you're asleep.

"When you dream, your brain is trying to look at connections that you might not think of or notice when [you're] awake," says the lead author of the study, Robert Stickgold, the director of the Center for Sleep and Cognition at Beth Israel Deaconess Medical Center, in Boston, Massachusetts. "In the dream...the brain tries to figure out what's important and what it should keep or dump because it's of no value."

In the study, Stickgold and his colleagues asked 99 college students to memorize a complex maze on a computer. The researchers then placed the students inside a virtual, 3-D version of the maze and asked them to navigate to another spot within it. After doing this several times, half of the participants took a 90-minute nap while the other half stayed awake and watched videos.

When the students were given the maze test again five hours later, the nappers did better than the students who had stayed awake, even those who had reviewed the maze in their heads. However, the nappers who dreamed about the maze -- one described being lost in a bat cave -- performed 10 times better than the nappers who didn't.

The students who dreamed about the maze did poorly on the test the first time around -- which may not be a coincidence, the researchers say. If a task is difficult for you, your brain seems to know it, and you may be more likely to dream about it than if the task were easier.

"If you're not good at something, and you dream about it, you seem to get better at it -- especially if the information can be used in different situations," says Michael Breus, the clinical director of the sleep division for Arrowhead Health, in Glendale, Arizona, who was not involved in the study.

"The sleeping brain seems to be processing information on one level, but on a higher level it helps evolve your memory network if the information is relevant or helpful in your life experience," adds Breus, who is also the author of "Beauty Sleep."

The study's findings, which appear in the journal Current Biology, underscore just how important sleep is to our memory and mental function.

It doesn't even need to be a deep sleep, as the researchers found when they monitored the brain activity of the students while they slept. Although the deep slumber known as rapid eye movement (REM) is most closely associated with dreaming, the students' dreaming and learning occurred after as little as one minute of non-REM sleep.

Health.com: Turn your bedroom into a sleep haven

The type of learning that occurs while you dream can be illustrated by the classic dream that many people have in which they show up for an exam that they haven't studied for, Stickgold says.

"When you're in school -- especially college -- there's this ongoing sense that you haven't done enough," he says. "Maybe you didn't make it to a lecture, or you had a paper due in three days that you hadn't started, so you're laying down memories that say, 'I haven't done anything that I need to do.'"

When someone has the exam dream (or nightmare), he says, "Your brain is taking the knowledge of what happened to help you behave differently in the future."

You may be able to harness the dream power displayed in the study to perform better in your everyday life, Breus says.

"If you're studying something tough, get the basics down and take a nap. If you dream about it, you will probably understand it better," he says. "Or, go to bed a little earlier the night before, wake up early, review the material, and then take a quick nap to solidify your understanding."

That's good advice, says Dr. Rafael Pelayo, an associate professor of sleep medicine at Stanford University School of Medicine, in Palo Alto, California.

"Instead of cramming, study intensely, catch a nap, and then maybe do some more studying," he says. "A nap may be a good tool to enhance your ability to remember information."

Citation: http://www.cnn.com/2010/HEALTH/04/22/naps.memory.dream.brain/index.html?eref=igoogle_cnn

From Medscape Medical News

Women Calm Down After an Apology, Men Get More Worked Up

Jim Kling

Authors and Disclosures

April 12, 2010 (Seattle, Washington) — Women’s blood pressure returns to normal more swiftly when they receive an apology after an insult, whereas men recover more slowly, new research presented here at the Society of Behavioral Medicine 31st Annual Meeting and Scientific Sessions shows.

Prior studies have shown that forgiveness can influence physiologic reactivity and recovery when people revisit a memory of a past transgression. The aim of the current study was to investigate physiologic effects after a live incident.

For the study, investigators recruited 29 men and 50 women who were tested for levels of forgiving using the Forgiving Personality Inventory. Subjects were asked to perform a serial subtraction task, beginning with 9000 and subtracting 7. They were exposed to multiple interruptions from the experimenter while performing the task. Interjections included statements such as, "Look, you’re too slow and also inaccurate," That can’t be your best," and "You’re obviously not good enough at doing this."

A total of 40 participants received an apology from the experimenter. Those who scored high in forgiveness displayed faster recovery of diastolic blood pressure (DBP) (F _1,70 = 4.88, P < .05) and mean arterial blood pressure (MAP) (F _1,70 = 3.96, P < .05) after the apology.

The effect was most apparent in the immediate aftermath of the apology, when women who scored high in forgiveness had a lower DBP (F _1,23 = 8.75, P < .01) and MAP (F _1,23 = 8.56, P < .01) when compared with low forgiveness women, who had little response to the apology (P > .05).

Women who received an apology recovered faster than women who did not (DBP: F _1,47 = 8.71, P < .01; MAP: F _1,47 = 7.00, P < .01). In men, the effect was reversed. Those who received an apology displayed higher DBP (F _1,26 = 5.13, P < .05) and MAP (F _1,26 = 6.71, P < .05) on recovery than those who received no apology.

The results suggest that people with higher forgiveness levels experience greater attenuation of the cardiovascular stress that can occur as a result of a transgression. However, the beneficial effects of an apology appear to be dependent on sex.

It is premature to say how these findings translate into clinical research, but the difference in men’s and women’s reaction to apologies could potentially be applied to marital therapy, Matthew Whited, PhD, a postdoctoral fellow at the University of Massachusetts Medical School in Worcester, who presented the research, told Medscape Psychiatry. "Even nonverbal communication, such as rolling one’s eyes, affects the physiology [of the other person]."

The study drew praise because it elicits reaction to a real-world situation. "A lot of previous studies ask participants to imagine [a transgression]. It’s hard to go anywhere with that," Kevin S. Masters, PhD, professor of psychology at Syracuse University in New York, said during a discussion period after the presentation. Dr. Masters has considered similar experimental designs, he added, but declined to pursue them for fear of having to navigate an institutional review board. "It turned out I was [too] chicken [to do it]."

Another attendee wondered if the participants could have misinterpreted the interruptions. "In an academic setting, they could have seen it as honest feedback [on their performance]. I think it would be better if the study involved genuine aggression," Kathleen Lawler-Row, PhD, professor and chair of psychology at East Carolina University in Greenville, North Carolina, told Medscape Psychiatry. Nevertheless, she was impressed by the study. "It was a powerful [study] design."

The study did not receive commercial support. Dr. Whited, Dr. Masters, and Dr. Lawler-Row have disclosed no relevant financial relationships.

Society of Behavioral Medicine (SBM) 31st Annual Meeting and Scientific Sessions: Abstract 2C.

Finding love online, despite health problems

By Michael Slenske, Health.com

April 14, 2010 8:19 a.m. EDT

Prescription 4 Love is a dating site for people with special conditions.

Despite -- or perhaps because of -- the economic downturn, the billion-dollar online dating industry has been booming. But not everyone has felt welcome at the party.

While sites like Match.com and eHarmony don't discriminate, they also don't cater to people...who are coping with sexually transmitted diseases, disabilities, or mental health conditions. All of these can make dating -- often an ego-shattering minefield for those in perfect health -- even trickier.

"On bigger dating sites the competition is tremendous," says Jim Houran, PhD, a clinical psychologist and columnist for Online Dating Magazine. "And let's face it, depending on what [the illness] is, it could very well make you uncompetitive in the larger dating pool."

Fortunately, there are a number of alternatives. A new breed of dating sites has emerged to play cupid for people with chronic diseases and disabilities.

Over the past five years, several sites -- such as Prescription4love.com, Nolongerlonely.com, and Cisforcupid.com -- have launched to serve the needs of people with conditions ranging from bipolar disorder to Crohn's disease. Together these sites now boast tens of thousands of members.

In addition to providing their users with a more hospitable environment, these websites defuse the tension over how and when to disclose an illness, which is often an issue for people with diseases and disabilities who venture onto mainstream dating sites.

The stigma of mental illness

People with physical disabilities aren't the only ones who face stigma while dating. People with mental health problems, from chronic depression to schizophrenia, have also benefited from specialized sites.

Jim Leftwich, 39, a college librarian from White Plains, New York, has lived with schizoaffective disorder, a condition that combines features of schizophrenia and mood disorders (such as depression), since 1992. In 2004, after years of brushing up against the harsh realities of the dating scene, Leftwich founded No Longer Lonely, a dating site that caters to the mentally ill.

"I thought to myself, 'There should be something like this out there,' and I was surprised to find there wasn't," says Leftwich. "If you're mentally ill, it's kind of a hostile world out there. I thought by taking down that whole bugaboo of having an illness, making it all open with everyone knowing, it would facilitate things. People would be more trusting and relationships might be more successful."

No Longer Lonely now has 16,000 members and a brand new interface (similar to those of social-networking sites) that allows users to upload poems, art, videos, and blogs. The site has been responsible for more than 20 marriages.

"I find with my clientele, they're more willing to get to know someone remotely and they're more open," he says. "They don't have the same kind of prejudices that people in general tend to have."

Even though most mental illnesses can be controlled with medication, therapy, or a combination of the two, some people still view conditions such as bipolar disorder as a mark of weakness or instability.

"Even in today's enlightened society, where acceptance and diversity are hailed as the right thing to do...mentally ill people tend to be outcasts. It's terrible," says Houran, who is also a former instructor of clinical psychiatry at the Southern Illinois School of Medicine.

"The minute someone knows you have a certain mental disorder, they assume it means that you're not capable of love, or that you're dangerous or unstable. Those are myths. Given the right care, people with mental illnesses and other medical conditions can lead very normal, functioning lives."

Some mental illnesses -- certain mood or personality disorders, for instance -- could cause problems in fledgling relationships, Houran acknowledges. And especially if the relationship progresses to thoughts of marriage and kids, two partners who each have bipolar disorder, for example, could find themselves debating whether it's safe or wise to have children.

However, says Houran, in most cases these considerations aren't enough to forestall a relationship. "Even under the best of circumstances, people still have major relationship challenges," he says.

For Houran, this outgrowth of illness-specific dating sites and services is a boon. "Niche sites are growing in popularity because they allow people with these very specific needs or interests to connect in a way that's not possible on the big dating sites," he says.

"The big dating sites are akin to Wal-Mart. You have a lot of quantity, but that doesn't mean you're going to find people with a lot quality in the way you define it. That being said, niche sites by their very construction tend to be very small. So I always advocate [that] people use both."

Full Article: http://www.cnn.com/2010/HEALTH/04/14/finding.love.online/index.html?eref=igoogle_cnn