Forging a Connection Between “Doing” and “Feeling”: How Behavioral Activation Therapy Can Alleviate Depression

 

By Lauren Tanabe, PhD

 

A few weeks ago, I stumbled across a short description of a recent study published in The Lancet out of the University of Exeter: researchers found that behavioral activation (BA) therapy works as well as cognitive behavioral therapy as therapeutic intervention for depression. Cognitive behavioral therapy (CBT) has been previously shown to be as effective as antidepressants.

 

According to the Society of Clinical Psychology, depression may cause people to “disengage from their routines and withdraw from their environment.” Over time, this isolating avoidance behavior can intensify depression as people “lose opportunities to be positively reinforced through pleasant experiences, social activity, or experiences of mastery.” Behavioral activation therapy aims to alter the patient’s avoidance behavior by increasing exposure to “sources of reward.” As well as by helping people to understand the connection between their behavior and their mood.

 

In lay-terms, activity will influence how you feel. If you sit at home alone, this may worsen depression. If you coax yourself to engage in some kind of social activity, or to work towards a goal (chores, hobby, work), this may lessen depression symptoms.

 

This seems straightforward enough. When I first learned of the study, scrolling through a blurb in Scientific American entitled, Depressed? Do What You Love, I must admit, I audibly scoffed, Really? We need a study to tell us this? At the time, it seemed rather obvious and mostly common-sense that doing what you love would lead to feelings of happiness (or if not happiness, a lessening of depression). I reached out to the lead author on the study, Dr. David Richards of Exeter University and proceeded to pose question after skeptical question. Dr. Richards patiently and thoroughly answered each one. I was most curious about how he would respond to one question in particular:

 

Some might say that it’s not surprising that doing what you enjoy can ward off depression. Why do we need a study to tell us this?

 

“If it were that obvious, then why would we have got to the point of recommending complex therapies like CBT [cognitive behavioral therapy] which focus on changing the way we think? Or why wouldn’t people have figured it out for themselves? … BA is not just doing what you enjoy. It is increasing the opportunities for positive reinforcement and reducing avoidance caused by aversive experiences. Depression is self-reinforcing and before you know it you can find yourself in a position where you cannot see a way out, just by having started on what at the time seemed like a sensible path of avoiding things you don’t like. Although there is an element of the common sense to BA that you suggest, in actual fact people often get stuck and what BA does is help them make some important connections between activity and mood which then leads to a personalised programme of re-activation …

 

As I read his email, my emotions ranged from incredulous to enlightened.  I mulled over his words in the following days. Perhaps, like most who suffer from depression, I want to believe that I am actively doing what I can to wriggle my way out of its clutches. Especially since it often takes an inordinate amount of effort and cognitive calisthenics for me to admit to myself (or anyone else) that I need help in the first place. I’ve painstakingly evaluated my thoughts and actions with a therapist and I know in great detail why I’m depressed. I’ve finally filled that antidepressant prescription, that old, familiar frenemy I hate to get in touch with again, after so many independent years. These actions should be enough to cure me. And yet, each morning, as I wash down my pill, vicious thoughts gnaw into me for being weak, followed by the washing over of a listless acceptance in the belief that I am broken, followed by the eking seepage of a meek hope. That tiny bit of hope – that these tyrannical thoughts will dissipate and I’ll finally be free – carries me through the day. The daily ritual of self-flagellation even (especially) for seeking help is simply exhausting. So, maybe there is something more I could be doing to help myself.

 

Dr. Richards went on to write, “Western tradition often stresses that if we are ‘ill’ we must cure the sickness inside us before taking our place in the world again. What BA does is tell people that they do not need to do this. So although you might think that is common sense, you would be surprised at how many people are applying a ‘fix me first’ principle and are surprised by the BA rationale …”

 

Behavioral activation therapy highlights a subtle, yet significant, shift in how treatment for depression is viewed, in general. A common analogy used in describing this type of therapy is that it works from the “outside-in” rather than the “inside-out.” That is, if you’re depressed you don’t wait to feel better and then participate in fulfilling activities (a common and somewhat intuitive strategy). Rather, the participation in meaningful work will alter your outlook and mitigate the depression. This, I could relate to.

 

I could recall myriad examples of times when I knew that sitting on the couch and binge-watching bad TV or going to bed at 7 pm was not going to lead to fulfillment of any kind, and much more likely just make me feel worse about myself, but I did it anyway. Why? Likely a strange dichotomy of wanting to make myself feel better from a quick-fix of escapism coupled with a twisted hatred of myself – I couldn’t possibly excel at anything other than existing as a gluttonous zombie, so why bother? And then, of course, there is not wanting to be a burden to others or to bring them down. Practicing self-imposed isolation in order to avoid becoming the archetypal “Debbie Downer” feels necessary to preserve relationships and save face.

 

But, clearly, this approach doesn’t work for most. It certainly didn’t for me.

 

The Exeter study was a well-controlled, randomized analysis of over 400 men and women who either received CBT or BA therapy. One year after treatment, both groups reported at least a 50% reduction in symptoms and were equally likely to experience remission. Both groups also contained some participants already taking antidepressants (ADs).

 

I asked Dr. Richards if he thought that being on medication could make someone more receptive to the therapy. He did not believe so, “We stratified the randomisation to ensure both groups had the same likelihood of being on ADs. The key thing is that for most of them, the drugs had not worked, evidenced by the fact that they had been on them for a considerable while before starting BA. We chose this because this is the reality of clinical services – psychological therapists have to work with patients who are on tablets as well as undergoing therapy. It’s the real world.”

 

The real world is replete with people suffering from depression (approximately 350 million worldwide). Of those, many do not have access to adequate treatment. According to the study, BA therapy is a more cost-effective option (about 20% less expensive than CBT), as treatment can be delivered by less specialized health workers. This is important. Wide-scale treatment options are critical, especially in low income countries where the treatment gap can be as much as 80 – 90%.

 

When I first read about BA, I mistakenly thought the goal was to do what makes you happy. But this is not the case. I asked Dr. Richards about this: “It’s not at all about making you happy. It’s about the function of behaviour in the short- and long-term. People learn to see the connection between activity and mood and choose activities where their experience is that this will be a more positive experience – achieving things, reducing avoidance.”

 

When asked why he believes BA therapy works, Dr. Richards responded, “It is because what we do has a profound connection with how we feel. Experiencing this connection is the core.”

 

I think I’ll be adding aspects of BA therapy to my current repertoire. As much as I sometimes want to avoid others, I’ll make the extra (albeit sometimes painful) effort to socialize with friends and to engage in tasks that “rational me” knows will lead to fulfillment (even if “depressed me” fights it). It will be a slow process, but no better time than the new year to forge new habits, new behaviors, and hopefully, resurrect a happier version of myself.

Happy Science: Turn That Frown Upside Down

 

By Lori Bystrom, PhD

Although 2016 may have been rough for some, most of us are still optimistic about 2017. We all want to start the New Year happy. Fortunately, more and more businesses, institutions, and even countries and cities are focusing on happiness. Companies, such as Happy City in Bristol, England, aim to keep people content. The Center for Health and Happiness at Harvard is gaining a lot of interest (see The Atlantic  article). Many countries and cities are being ranked based on happiness (check out the happy planet index). And just look at the United Arab Emirates, which appointed its first “minster for happiness” early in 2016. All of this sounds wonderful and promising, but what about the happiness of scientists?

 

I am not sure that many people would equate “science” with “happiness.” As an academic scientist, I recall happy moments of scientific discovery, but those are memorable partly because they are rare. I particularly recall one glorious moment during the last month of a project — after many failures and nearly passing out — when I was finally able to get publishable results. Oh how long I waited for that happy day!  More often, however, the scientific work environment can be tough, especially in academia, with little positive feedback, low pay, and competitive/high pressure work. This is all compounded with constant trials and tribulations of everyday science, all of which can take a toll on the mental health of scientists.

 

It may seem grim to view scientific work as so difficult, but this does not stop many scientists from loving science. In fact, I think science would probably be very boring if amazing results were so easy to achieve all the time (well, it would be a little bit exciting). I think many scientists would agree that there is something appealing about the challenge of discovering and exploring the unknown in order to reach that happy eureka moment. That being said, though, science research does not need to be as depressing as it is. This is to say: there is much that could be done to make scientists less unhappy.

 

So what can be done to make or keep scientists more content with their job? More money is always nice, of course, but this is not always the answer, nor is it always feasible. There are, however, other approaches that may improve work conditions for scientists. Here are a few ideas for promoting happiness in the lab, especially for academic scientists.

Listen to all; respect all

This may seem obvious, but this was often a major problem in the labs where I have worked.  I think it is always good to listen to what everyone has to say about a project. I have witnessed people at all levels in the academic institution fail to encourage this kind of healthy discourse. Everyone should have a voice. Not only that, but scientific discovery comes in many shapes and forms. Even a young scientist may see something that a more experienced scientist might not, because they are too lost in the detail. Different perspectives may help shed light on problems that initially seem too complex to solve.

 

Excluding people from intellectual discussion hinders the creative flow in research and leads to unhappy scientists. Most researchers would like to provide some feedback about projects in the lab.  Scientists should not be treated like robots. This   only makes scientists angry. And once a few colleagues are upset, they are liable to take it out on everyone else, leading to a lab infested with unhappy scientists.

 

Define and communicate expectations

All mentors should have their students and/or employees define what kind of expectations they have of each other at the beginning of a project. These expectations should be reviewed over time, as they will likely change. You may not see eye to eye with your mentor, but they are also not mind readers. This is why expectations from both sides should be reviewed. And if you are not a good match then it is better to find out early.

 

In addition to short-term goals, both mentor and mentee should also define their long-term goals. Not everyone wants to go to medical school, be a PI/advisor, or stay in the lab, and therefore scientists should work on projects that are relevant to their long-term and short-term interests. Furthermore, if you need advice you should ask, and if someone asks for advice, you should respond. No one has a crystal ball and so dead silence does not help anyone. Ultimately, good communication prevents miscommunication and an unhappy lab environment.

 

Aim to achieve little goals

It is not reasonable for everyone in a lab to expect to be the first author on a paper in a high-ranking journal after a short stint in research (I have had many summer students expect this!) For this reason, I think it is important for scientists to aim for small goals, especially at the beginning of a project or career. By starting out small you can build a strong foundation for a big project. For students that are new to a particular field of science, or even science at all, it may be good  for them to work on projects already in progress by developing small and relevant side projects, as well as providing them small incentives (e.g., name on poster or something that they can put on their CV). This way there is less confusion in the lab and the outcome of the project is more likely to keep everyone happy.

 

More senior scientists can also benefit from taking on smaller projects within or outside of their own research. This can help because many scientists may not see the light at the end of the tunnel when their project is not working as planned. In such an eventuality, having smaller projects on the side allows them to take a break from their main project by using their expertise in small doses to help other projects, especially those close to being finished. This, in turn, may help them better visualize their problem, keep their publication record up, and boost their morale.

 

Keep everything organized and transparent

I think organization is crucial in a lab. This not only pertains to cleaning the lab space, decluttering lab supplies and maintaining instruments, but also to finances. It would be nice if someone at the institution other than the PI had to deal with this. Unfortunately, this is not usually the case. It is a lot to ask that one person manage research, lab drama, and also lab finances. I find that academic scientists (myself included) are not trained how to do this very well. Therefore, it may be good if everyone in the lab sat down and discussed what is needed for various projects in order to make sure the money is well spent. If financial conditions are becoming a problem in lab — as they often are, even in the most prosperous labs — it may also be good to have everyone write a budget for their project. Transparency about the financial situation of the lab also helps people understand the state of the lab (and perhaps the mood of their PI/boss), and may encourage scientists to think again about paying extra for something not necessary (do we really need pink pipettes?). A lab that is organized and financially transparent helps prevent unnecessary stress and avoids a lot of unnecessary resentment.

 

Don’t forget to socialize… and take a break!

I know that I could not have survived my lab experiences without the support of other fellow scientists. I found that lunchtime was something I looked forward to every day because not only could I eat (nom nom), but I could vent about experiment problems, laugh, or learn from other colleagues. I think all mentors should encourage this and celebrate any scientific achievement with some kind of social event, even if it only occurs during lab meeting. A friendly and social environment makes for happier scientists.

 

Additionally, overworking scientists leads to less efficient and productive work. Before a big deadline is about to approach, it might be good for scientists to take a few hours off to recompose themselves. This might be a good time to take a walk or eat a nice dinner. Otherwise, if there is no time for that it might be good to take a longer vacation after the deadline is over so you can come back more refreshed and ready to tackle more challenging moments in science. I know I have denied myself vacations many times because I thought maybe if I just kept on working I would get the data I needed sooner. Unfortunately, this often led to less productive work. This is why it might be good to enforce that all researchers take vacations, especially after stressful periods.

 

Perhaps in the future, there will be organizations to help manage the happiness of scientists, although I am not holding my breath for something like this to appear anytime soon. Maybe the first step, however, is acknowledging that there is a lot of unnecessary unhappiness in the lab and that we should try to do something about it. The future of science will be better if we keep scientists smiling 🙂

Meditation and Science – Crossing Pathways

 

By Jesica Levingston Mac leod, PhD

Good news (as of February 22, 2016): finally science is starting to explain how mindful meditation can be good for your health. Last month, a study published in the Biological Psychiatry journal proved that  mindfulness meditation combines the default state network (a network of interacting brain regions known to have activity highly correlated with each other)  with a region known to be important in top-down executive control at rest (the left dorsolateral prefrontal cortex), which in turn is associated with improvements in Interleukin -6 levels. Interleukin-5 is  a marker of inflammatory disease risk. They recruited 35 jobless adults, who were separated in 2 groups: one group  was immersed in a 3-day intensive residential mindfulness meditation and the other group in a relaxation training program.  Blood samples and a resting state scan test were taken before and after the  program. The key findings indicated that  mindfulness meditation training, and not relaxation training, increased posterior cingulate cortex  resting state functional connectivity with left dorsolateral prefrontal cortex (region important in top-down executive control). According to this study “these pre-post training alterations  statistically explained 30% of the overall mindfulness meditation training effects on Interleukin-6 at follow-up after 4 months“. In healthy men, elevated levels of Interleukin-6 are related to  increased risk of future Myocardial infarction, for example heart attack.

 

More than 9 years ago I read a study that completely changed my point of view about meditation. I am very lucky to have an open-minded meditation-practicing mother who taught me the basic techniques when I was very young, but as a researcher I did not connect the power of meditation with any “biological” or scientifically proved alteration. Many people meditate to reduce psychological stress and health problems, but my mother taught me to meditate to reach a nirvana-like moment of peace and clarity. We focused on the moment – not searching for fixing any problem – and just enjoyed the experience.

 

Meditation can be defined in psychological terms as the practice of disciplining one’s attention in an effort to attain a certain state of mind. There are two different types of meditation: spiritual (known for the presence of mantras and thoughts about God and God’s attributes) and secular meditation independent of any religious motivation. In the study that changed my view of this practice, Wacholtz and Pargament (1, 2) studied how these 2 types of meditation helped people deal with pain. They asked the participants to meditate for 20 minutes each day over a period of 2 weeks. One group was told to practice spiritual meditation and a second group would practice secular meditation. A third group of people were asked to not meditate as a control. Then, the researchers performed the simple “please introduce your hand in this cold ice water and try to hold it there as long as you can” method. How long could the participants keep their hand in this very uncomfortable situation? Well, the “spiritual” group had greater decreases in anxiety and more positive mood, spiritual health, and spiritual experiences, plus they tolerated pain almost twice as long as the other two groups. Of course, just meditation gave the participants a better tolerance to the -2C water. In 2008 they published another study where they showed that spiritual meditation was more effective than secular meditation at reducing the severity of migraines in chronic patients.

 

Recently, a variety of studies are proving that meditation is an effective treatment for stress and pain. For example in Nature Review NeurologyJensen et al. reviewed a number of publications on this very topic. First of all, they note that meditation is not an invasive therapy, moreover they conclude that the “evidence indicates that mindfulness meditation has both immediate and long-term effects on cortical structures and activity involved in attention, emotional responding and pain”.

 

On the other hand, a meta analysis published this year by Goyal et al. in JAMA Internal  Medicine (they included 47 trials with 3515 participants) found that mindfulness meditation programs had moderate evidence of improved anxiety, depression and pain. They detected low evidence of improved stress/distress and mental health-related quality of life, and low evidence of no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight. In conclusion, they found no evidence that meditation programs were better than any active treatment, like medicine or workout.

 

Let’s face it: the happiest guy in the world, Dr. Matthieu Ricard (yes, he has a PhD in molecular biology), meditates often as the basis of his awesomeness, so let’s follow his example… or in scientific language: he has being proving his hypothesis with 100% success, and we can reproduce his experiment at any time in our own lives.

To find a meditation group near you and more information check the free mediation info website.

This post was originally published on June 4, 2014. 

4 Ways to a Happier Postdoc

 

By Florence Chaverneff, PhD

Chances are, if you have been a postdoctoral fellow for a little while, you have at some point or another (unless it is constantly) felt like the ‘Desperate man’ in this painting by Gustave Courbet. So, in the aim of trying to help and save you from pulling your hair out of your head, here are a few pointers gathered both from personal experience and that of friends and co-workers which I hope will help you cruise through this particular phase of your career and make the most of it, whichever your next step.

1. Prepare your next step

Certainly, as a postdoctoral fellow, most of your efforts should be concentrated on making advances on your project(s) and getting fabulous data worthy of a 30+ impact factor journal. Equally as important, you should start thinking as early as possible about what your next step should be. If you’re not planning on staying in academia to pursue a tenure track position, which, according to statistics should be the case for about 85% of you, you will need to have a plan B. Some sectors are more popular or should I say, more intuitive as a career alternative (think pharma and biotech sectors). But you shouldn’t limit yourself to those areas, as a whole array of attractive options is available to a postdoctoral fellow seeking to transition outside of academia. What these alternatives are and how to figure out which ones fit(s) you best, as well as how to land a job will be the subject of a future post. Utilize the resources available to you at your current institution as much as you can. If you are as lucky as I am, your university will have a very active office of postdoctoral affairs that organizes a plethora of events aimed at helping fellows with their ‘individual development plan’, a term I only learnt about quite recently I’m afraid to admit.You don’t want to be a postdoc forever. No, really, you don’t. Knowing what’s coming next undoubtedly will help you tackle with poise the many challenges you will be facing during this period. As a side note, international postdocs intending on pursuing their career in the U.S. should also plan on acquiring permanent residency while in academia.

2. Manage your stress

Start to realize that most of the stress you experience is self-imposed. So, make it easy on yourself and go to yoga. Free yoga if you can, cause, you know… Naturally, your PI will most likely be starving for data from everyone in the lab, including you, and knowingly or not, also constitute a sizeable source of stress. Just remember one thing. Your advisor is a whole lot more stressed than you are. And that might have to do with the fact that he/she NEEDS data. No data, no publications. No publications, no grant. No grant, no money. And, well, no money, no lab. It is visibly in everyone’s interest to keep the lab. You know the not so old adage, so I’m not going to repeat it. So, learn to deal with your advisor. This might require a good deal of social and emotional intelligence from you. Developing such skills to the point where they become automatic will be essential throughout your career in dealing effectively with bosses and co-workers. You might find it useful to get acquainted with personality tests such as the well-renowned and widely-used Myers-Briggs. This is a great tool to learn about yourself, of course, but also to use as a complement to social and emotional intelligence to successfully interact and work with any personality type.

3. Ask for help

Another great source of frustration in the professional life of a postdoc is dealing with experiments that either simply fail, are not reproducible, do not yield statistically significant results, or even, contradict your working hypothesis, without even mentioning all kinds of other mishaps that are likely to happen along the way. The best way to deal with these issues is to talk them through with your labmates. They might have great insights about things you wouldn’t think of or notice because you are so involved in your project and experiments. So, don’t hesitate to ask for help. It is not a sign of weakness!

4. Enjoy your free time

Finally, by all means, try and manage a proper work-life balance. I mentioned yoga earlier, but really, anything that floats your boat and takes you out of the lab, not just outside the door, but literally outdoors. Too many postdocs I have encountered spend most of their awake time in the lab, the rest being spent eating, grocery shopping or doing house chores. If that sounds fun to you, I’m not sure what to tell you. In the opposite case, try and make time to spend on your favorite activity, be it sports, playing guitar or painting. And hang out with your friends and family. Working 24/7 is plain unhealthy and unproductive. So if you feel like you don’t have the time, it most likely is because you’re not managing your time properly. Then, I recommend you learn about time management, be it in a course, a book or on the internet. Also, instead of spending long incubation periods chatting with labmates or surfing the web to whatever websites you favor, do something productive, like catching up on your reading, planning your next experiments, analyzing data…There is plenty to be done and lots of options to pick from. If your project is simply extremely labor-intensive, find yourself an eager undergrad to help lighten the workload. In addition to saving you precious time, you will get practice in mentoring and teaching.

I hope these few tips will help you be a happier postdoc!