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January 2007
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March 2007

Birth Stories, Natural and Medicated

Julie Dearborn, a writer for the Chicago Tribune, wrote about the birth of her second son, and the article inspired many other women to tell their stories. Dearborn opted for natural childbirth, even though she gave birth in a hospital with a 90-percent epidural rate.

She wrote,

But then it dawned on me: I just had to muster enough courage to push until my insides exploded. When I did, my 9.2-pound, 22-inch baby boy found his way out.

My husband and I rejoiced, happy that I’d been able to deliver the baby on my own terms, but even more grateful that he was healthy. In the end, that was all that really mattered.

Many of the women who responded with their own stories chose to have epidural pain relief, as well as pitocin, the artificial oxytocin used to stimulate contractions. These women are honest about not wanting to experience the pain -- or deciding during labor they couldn't stand the pain.

Every woman is different and every labor is different. I think it must be extremely difficult to have natural childbirth in the hospital without a midwife or doctor who is extremely experienced in the maneuvers and techniques to reduce pain and speed labor.

Many of the women who had epidurals reported being conscious and active during their labor despite the meds.

Oxytocin Meets Home Design

The intense interest in oxytocin continues, reaching even the real estate and design magazines.

In a story from Inman News, Katherine Salant makes the case that today's mania for huge houses with master suites, kids' private entertainment centers and separate bathrooms is bad for us and bad for society.

She writes,

Anytime you are with people you are close to and trust, your brain releases oxytocin. This reinforces the brain's bonding circuits and you feel calmer, explained Louann Brizendine, a professor of psychiatry at the University of California in San Francisco and the author of "The Female Brain." When teenaged girlfriends chatter endlessly, they literally feel better because oxytocin is surging in their brains, she said.

To get the benefits of oxytocin's calming effect and what Brizendine calls "body time," however, "you have to be in the same place, see and sense the other person, and breathe the same air," she said.

The bigger the house and the more rooms inside, she says, the more opportunity family members have to spread out -- and avoid each other. Salant also covers the way the social brain develops after birth, in response to the nurturing and interaction we get.

I'm not sure her thesis holds so true. Even mothers and fathers who dwell in McMansions likely spend about the same amount of facetime with their babies as do the denizens of one-bedroom apartments. Certainly, we need continuous social interaction. By the time the kids are old enough for their own computers, TVs and phones, they're probably getting whatever oxytocin they can from friends -- including boyfriends or girlfriends, since kids start dating at 11 or 12.

Still, no matter what size your domicile is, it probably is good advice to make sure the family gathers regularly to breathe the same air and look at each others' faces.

Inside the Loneliness Lab

Hawkley_lab_staff Jia Cheng winds sticky metallic tape several times around my neck, and then again around my waist. She's about to hook me up to a battery of sensors that will track how I respond to the embarrassment of making mistakes in front of a stranger.

In John Cacioppo and Louise Hawkley's loneliness lab, the University of Chicago researchers chart the merest twitch of a muscle, an extra drop of blood to a section of the brain and the delay of a heartbeat to understand how being with people -- or being cut off from them -- changes the chemical brew that animates the mind.

Cacioppo and Hawkley don't think of it as the loneliness lab, of course. The official name for this facility is a social neuroscience laboratory, and the two professors, along with their project managers, Jeanine Pilat, Zach Johnson and Jia Cheng, examine endocrine, immunological, autonomic, and central nervous system processes and how they change from day to day as we navigate the sometimes difficult waters of relationship.

They've found that loneliness is a state of the body, as well as the mind. While everyone experiences bouts of loneliness and periods when circumstances take them out of their circle of support, loneliness can become an emotional and physical habit.

Their monitoring setup looks like a music recording studio: racks of hardware with sliders and knobs, a row of video monitors. But this rig is recording the music of human emotion, as expressed in the peaks and pulses of electrical activity.

Hawkley_at_door_1 The heart of the lab is an enclosed room behind a forbiddingly solid door. Its four inches of thickness block out sound, while copper lining the jamb and the edge of the door snag stray electrical impulses that could interfere with the delicate sensors inside.

The monitoring room is as pleasantly nondescript as a dentist's waiting room, except for the huge flat panel TV screen. It has a nicely upholstered wing chair, a coffee table with a few magazines and a side chair. The only indication of its function is a snake of cables coming through the wall behind the armchair.

Cheng attaches the end of each magnetic strip stuck to my body to a sensor, straps a blood pressure cuff to my left arm and then straps another monitor to my wrist to follow my pulse. Then, the fun begins. Zach Johnson, another project manager, enters the room, sits on the chair at my left and gives me a no-nonsense look. He tells me I'll perform a mental subtraction test, and he'll judge my performance. I've read about this test, designed to turn up the heat, so I'm not too alarmed about my performance -- but still, I'm not looking forward to the math.

The first couple sets seem relatively easy, but by the fourth round my brain is seriously tired. I have trouble remembering the number I'm supposed to subtract, and sometimes my mind just stalls. What is 738 minus 7? All the time, the sensing equipment is monitoring changes in my physical state.

I breathe a sigh of relief when the last round comes, and three is the number I need to subtract. (Evidently, this puts me at barely average in my math ability; testers adjust the difficulty as the test progresses to make sure it's stressful enough. Some people need to be asked to serially subtract 17 to become stressed.)

My test isn't exactly "fair," because I know what the game is, so I don't have the same kind of performance anxiety someone else might experience. But the point of the study isn't to determine any individual's reaction pattern. Instead, Cacioppo and Hawkley are looking for patterns. Do people who are lonelier, for example, become stressed sooner? Do they exhibit more stress trying to subtract 8 from 1,297 than do those who say they have many people they can turn to?

They've already found strong evidence that lonely people can spiral into a vicious circle of disconnection and illness. Cortisol -- the chemical that keeps us alert and helps us cope with stress, seems to be a culprit.

Cortisol is the yang to oxytocin's yin. The body needs a little boost to get it going after sleep, so the brain typically sends out a little jolt of cortisol as we wake  up. This cortisol awakening response, or CAR, is part of a daily ebb and flow that keeps us alert and able to cope with whatever comes our way. The cortisol level peaks in the first 30 to 45 minutes after awakening, and then drops over the course of the day, reaching its lowest point around midnight.

But how high those peaks and how low those troughs are a part of each person's chemical signature. Stressed-out folks often show a higher CAR; people suffering from chronic fatigue or fibromyalgia may have less variation in their daily cortisol levels.

The question is, do the body's cortisol tides contribute to these conditions, or are they the result of them? A study Cacioppo and Hawkley did with Emma Adam of Northwestern University and Brigitte Kudielka of the University of Trier showed that one day's emotional experiences set the next day's endocrine tone.

They sent 156 older adults home with bags full of plastic tubes and multi-page questionnaires. The participants spit into the tubes three times a day, and they also filled answered dozens of questions that exhaustively catalogued their days, from whether they ate junk food to whether they got support from the person who's closest to them, from a pet or from God.

It turned out that one bad day can lead to another one -- at least, when it comes to the cortisol awakening response. People who reported feeling overwhelmed, sad, threatened or lonely had higher CARs the following day. (This study didn't look at whether the subjects felt less unhappy on the second day, thanks to the extra cortisol.)

In the short term, the extra jolt of cortisol after a bad day may get us over the hump. In the long run, though, it turns into a killer. Among the elderly people Cacioppo and Hawkley study, there's a clear link between loneliness, high cortisol and chronic high blood pressure.

These studies are helping to illuminate the link between body, mind and emotion. Clearly, loneliness -- and its debilitating effects -- isn't just in the mind. Says Hawkley, "That's pretty clear evidence of psychology pushing physiology."

Photos: Zach Johnson, Jia Cheng, Jeanine Pilat and Louise Hawkley in the Social Neuroscience Lab; Hawkley opens the door to the monitoring room.

Oxytocin and Delayed Ejaculation

Anxiety Insights reproduces the abstract of a study showing a link between oxytocin and the common  problem of delayed ejaculation in men taking SSRIs for depression or other reasons.

According to the review of animal studies by scientists at Utrecht University, the gradual onset of delayed ejaculation may be caused by desensitization of certain receptors on oxytocin neurons.

SSRIs increase the amount of serotonin available to the brain. The abstract explains,

The increased serotonin levels induce oxytocin release via activation of 5-HT(1A) receptors, and this might compensate for the inhibitory actions of serotonin on sexual behavior. Chronic treatment with fluoxetine and paroxetine desensitizes 5-HT(1A) receptors on oxytocin neurons, and that might in part determine the onset of delayed ejaculation.

A Traumatic Story

This brutally honest account shows how violence not only destroys a childhood but continues to cause harm throughout life. Meera Atkinson writes,

Even if survivors finally see the connection between their past and present symptoms, it doesn't guarantee others will extend compassion: if we ignore our past, no one knows; if we discuss it, we risk being seen as malingerers, as people who live in the past — which is, in a sense, exactly what we do, if not consciously.

For Atkinson, understanding how early trauma interferes with the brain's development was a first step to healing.

Another Oxytocin Patent

The race is on to set patent claims on oxytocin therapies.

The latest is a patent application filed by Steven Quay of Nastech on using oxytocin to treat the symptoms of autism spectrum disorder, as well as similar maladies.

According to the application, oxytocin is effective in reducing social withdrawal, eye contact avoidance, repetitive  behaviors, anxiety, attention deficit, hyperactivity, depression, loss of  speech, verbal communication difficulties, aversion to touch, visual difficulties, comprehension difficulties, and sound and light  sensitivity.

Nastech, which assigned the patent to Atossa Healthcare, a related company, has another application in the works for a long-acting oxytocin nasal spray. (See the "Oxytocin Therapies" category for more.)

Anti-Vasopressin as Antidepressant

French pharmaceutical company Sanofi-Aventis is testing SSR149415, a drug that blocks vasopressin receptors in the limbic system, for use in treating generalized anxiety disorder. In rats, the compound reduced the negative effects of stress. SSR149415 acts specifically on vasopressin B receptors, or V1b, which are located in the brain.

Vasopressin, a close cousin of oxytocin, seems to be involved in learning and social memory. While men and women both produce vasopressin, testosterone increases the brain’s receptivity to it, just as estrogen increases the effects of oxytocin.

The drug seems to reduce anxiety and have antidepressant effects without impairing motor activity or messing up sleep patterns.

Scientists think SSR149415 acts on vasopressin receptors in the neurons in the amygdala, septum, hippocampus, or hypothalamus, regions that are associated with the integration and processing of stressful stimuli.

Oxytocin Primer

The Beauty Brains has a good overview of oxytocin -- what it does, when and how it's produced. And they've very kindly linked to this blog!

Beauty Brains is the work of two cosmetic chemists who answer questions about beauty products, demystifying and sometimes debunking product claims. As someone who loves to browse the cosmetics aisles of the drugstore, I really enjoy their site.

They're also fellow members of Indy Science Blogs, a group of scientists, academics, journalists and science nerds. There's always something new and unexpected from our group, so if you haven't checked this out yet, well, go there!

Scanning the Brains of Those Who Run from Love

He's cool. Cold. An iceberg. We all know people who don't need people.

Whether they flit from one relationship to another, remain mysteriously aloof, or eschew love for a higher purpose, these folks seem immune to the pains pangs and joys of love.

David Chun wants to know how their brains work.

Chun is a graduate student working in the Adult Attachment Lab at UC Davis. The lab is headed by Phil Shaver, who, building on the pioneering work of John Bowlby and Mary Ainsworth, is one of the preeminent psychologists studying attachment. ("Attachment in Adulthood," a book by Shaver and Mario Mikulincer, is in press.)

While we intuitively feel that, somehow, our mothers reach out from our childhoods to influence adult behavior, Shaver and his students are charting exactly how that happens.

Chun is one of a new generation of psychologists who are using the tools of neuroscience to discover how mothering shapes the way the brain works. They’re finding just how deeply engrained is the way we approach relationships: How we love -- or why we can't -- seems to be etched into the circuits of the brain.

His work is exciting and important, because he's using analytical, quantitative tools to examine what so far have only been theories of psychology.

The question Chun is trying to answer is, "Are there differences in brain functioning between individuals with different attachment styles?" This research question is a lifelong adventure; Chun has started by looking at the brains of people who are high in what psychologists call avoidance.

The theory of attachment proposed by Bowlby and Ainsworth, and further developed by Shaver and others, identifies four different attachment styles -- the way we tend to approach close relationships with others. These styles were based on observations of young children with their mothers; Chun is one of many researchers elucidating how we bring what we learned about getting what we needed from Mommy to our lovers and mates.

Chun is looking at "avoidant" people, those who try to protect themselves from rejection by shutting the door on intimacy. Their motto is, "You can't hurt me if you can't get near me."

Researchers have discovered something fascinating: This tends to work.

We may suspect that these social icicles are seething volcanoes of emotion inside. In Casablanca, when Bogie watches Ingrid Bergmann walk out of his life forever and then heads back to his bar for a nightcap, we assume he's dying inside.

But when Chun looks at the brains of these icebergs, they seem to be doing fine, thank you very much, as long as their defenses go unchallenged.

To find the avoidant types he wants to put under the fMRI scanner, Chun gives them a standard questionnaire designed to uncover attachment styles. Avoidant people tend to agree with statements like, "I prefer not to show a partner how I feel deep down." Anxious people, on the other hand, agree with statements like, "I worry that romantic partners won’t care about me as much as I care about them."

Chun built his research on two concepts. First, it's really hard not to think about something when someone tells you not to. It's the classic, "Don't think about a white bear" conundrum. The more you try not to think about that bear, the more it lumbers through your thoughts.

Second, you can reliably tell just how anxious someone is by measuring the conductivity of her skin. The more it conducts electricity, that is, the higher the galvanic response, the more she's fretting.

Another of Shaver’s students, Chris Fraley, did some studies showing that avoidant defenses work pretty well. Fraley, now a faculty member at the University of Illinois, hooked people up to sensors that measured their skin conductance. He asked them to think about a painful breakup with a boyfriend or girlfriend, and measured their anxiety. Then, he told them not to  think about the breakup.

People who'd scored as anxious on the questionnaire couldn't stop thinking about their exes; they got even more anxious. But the avoidant subjects chilled. They seemed to be able to control their feelings.

Chun is comparing the brain activity of avoidant women with the brain activity of those who are very anxious in relationships, always worrying that friends and lovers won’t be there when they need them.

As a test subject lies under the scanner, Chun asks her to think about a boyfriend who broke up with her. Next, Chun gives her a Stroop test. This research tool, presented on a computer screen, cycles through emotionally neutral words like "book" or "table." Words are presented in different colors, and the subject is asked to name the color of the word, instead of reading the word. Occasionally, the Stroop test slips in a loaded word like "abandoned," words that reinforce the sad memory of a breakup.

In the scanner, Chun sees the areas of the brain that process these emotions glow as more blood travels to them.

When anxious people see the negative words, they're a bit slower to name the color, because they can’t help thinking about the meaning of the word. But those sad words don’t slow down the avoidant people at all.

Next, he gives the test subject a "cognitive load," a mental task designed to interfere with  emotional defenses. In Chun's study, they're asked to remember a seven-digit number while seeing the words and trying to name their colors.

What he hopes to see is that, as the brains of avoidant individuals struggle to remember the number, their defenses will break down, and they'll be slower to name the colors of the emotionally loaded words in the Stroop test. (This has already been shown outside the scanner in lab studies by Chun’s colleagues.)
As he watches this process under fMRI, he may be able to see exactly where in the brain these avoidant people push those hurtful thoughts -- and how those areas of the brain come to life when the defenses are interrupted.

Previous fMRI studies have shown increased activity in the anterior cingulate cortex, a part of the brain scientists believe is used for monitoring and responding to conflict. When the ACC detects conflict, they hypothesize, it sends a message to the prefrontal cortex, or PFC, the part of the brain that regulates conflict and inhibition. You could say that the ACC is the part of the brain that senses the conflict, while the prefrontal cortex takes a controlled  approach to fixing the problem.

In other words, avoidant people may have learned to apply the intellect directly to a hurt without feeling it.

Chun's hypothesis is that the avoidant loners will show less activity in the ACC and more in the prefrontal cortex when they encounter the loaded words.
In other words, avoidant people have learned to apply the intellect directly to a hurt without feeling it.

"We think that maybe these avoidant people have a strong need to be in control," Chun says. "They are good at emotion regulation," the process by which we calm ourselves  down when we need to. "So, perhaps they do recruit more activity in the prefrontal cortex."

Chun is betting that, under the high cognitive load, these avoidant types will show increased activity in the feeling ACC, because the thinking prefrontal cortex is busy remembering the number and can’t take charge.

He thinks that other emotional areas of the brain, including the amygdala, the hypothalamus, and the hippocampus will be more active when stressful words appear under the cognitive load. He's not sure whether this will include the hypothalamus, the seat of oxytocin, but he says he wouldn't be surprised.

Interview: Dafna Lender, Theraplay Institute

Dafna Lender is training director and clinical coordinator for the Theraplay Institute, an organization that trains teachers, social workers and psychotherapists. Theraplay provides a structure for activities that help heal kids' attachment problems.

HUG: First, tell me how you got involved with Theraplay.

Lender: My involvement began when I was working in a foster care agency that had a residential component. Most kids had been adopted previously or been in a nuclear family, and their history of abuse, neglect, separation, loss and trauma had caused them to disrupt the place they had been in.

We found these kids were still unprepared after two years with us to go into a family. We were looking for some sort of method or therapy model that would help. I was sold from the beginning, and it was transformative for me, too. I felt I had hit on what I needed for the clients I was working with.

HUG: I've been hearing more in the news about reactive attachment disorder, and about failed adoptions. Is this problem increasing, or is there simply more awareness?

Lender: We have had a huge influx of parents who call us with these problems in the last ten or fifteen years, as societal problems get worse, and funding for social services diminishes -- and foreign adoptions become more common. There also is increased awareness of attachment issues. I definitely think it's a phenomenon that's increasing in size with not enough resources.

HUG: I've been distressed by some parents' accounts of adoptions that didn't work out. The parents seem not to understand how deeply messed up these kids are.

Lender: Parents do try very hard, and the lack of resources and support from the child welfare system or adopting agency can leave adoptive parents really depressed, resentful or despairing. They may feel like they're going crazy. An attachment therapist would help the parent put the child's behavior's into context so that the parent does not feel that they have gone crazy or are bad people. The attempt in the attachment community is to say it's not all the child's fault, but not the parents' fault either.

The child is projecting all this non-conscious trauma onto the parent. Most trauma that happens to kids is out of their awareness, because either it happened before they were verbal and therefore have no recollection of it, or they're defended against it, because it was such a horrible experience.

The only way for a parent or therapist to interact or give healing to these kids is to not to take it personally. That's a very difficult feat and requires a great deal of work on the parents' part and a great deal of support from a therapist. If parents sound callous, it could be because they have not received this help.

HUG: Do you buy the diagnosis of reactive attachment disorder, or RAD? There's no mention of this disorder on the Theraplay website.

Lender: There are a lot of problems with the diagnosis. There's a lot of overlap with other diagnoses, and no criteria that are discreet from others. Other people have talked clinically about attachment issues in terms of both severity and features that are more on a continuum, and that is more helpful clinically.

HUG: You work with both mother and father, if available. What about the idea that mother is primary regulator of brain and affect development in the first years?

Lender: That's definitely the case, but we don't work with kids during that period of time. Parents typically bring kids in toward the end of their second year, or before they start preschool. After the first year, the father is important typically -- although this is a stereotype -- in providing high levels of positive affect. This is important in being able to regulate high arousal, enjoyment, joy, interest and excitement. A child needs that just as much, so he doesn’t go berserk if he's waiting in line for the playground, for example. It also wards against depression and creates a great bond. So we love to focus on both parents.

HUG: There's an emphasis in Theraplay on certain special moments of connection that lead to change. Can you talk a little bit about this?

Lender: Those are called "now moments" or "moments of meeting" in the psychotherapy literature. It has to do with when two people are spontaneously sharing an idea, and they know that. It's an expansive moment, when we shared something that was meaningful. For example, when we're playing bubbles, and it pops right on the tip of the child's nose. There's a moment where he's startled, and then thinks it's funny, and I laugh too, and it's amplified. It's not something planned by me, it has to just happen.

HUG: Theraplay was developed for the Head Start program. Is there a change in the client base in the past few years?

Lender: In the last few years, there's been an increase in the severity of the abuse and neglect, the number of placements, and the rising awareness of the effects of drugs and alcohol in utero. On a parallel stream, there's also more and more focus on autism and early diagnosis, and we're known for that, as well.

Theraplay is a registered service mark of The Theraplay Institute, 3330 Old Glenview Rd, Wilmette, IL,