Virtual Reality for Reducing Pain

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Falling Through the Cracks in Pain Management

Pain and Opioids

Chronic pain is debilitating, and it can cause patients to “fall through the cracks”. Health care institutions struggle to find ways to create “nets” and catch these patients. Pain medications include opioids which are used to treat chronic pain. Opioids often fail to treat the patient’s primary medical condition. As time goes by, patients tend to be unsatisfied with the results.

Also, there is a good chance that some of these types of pain medications will be abused. In fact, pain medicines such as opioids are part of the United States opioid crisis. According to the Centers for Disease Control (CDC), every day, more than 115 people in the United States die after overdosing on opioids. (CDC/NCHS, 2017) The opioids include prescription drugs, including fentanyl, and synthetic street drugs such as heroin.

It is estimated that the total economic burden of prescription opioid misuse in the United States is $78.5 billion a year which includes the costs in health care, lost productivity, addiction therapy, and criminal justice involvement. (Florence, Zhou, Lou, & Xu, 2013)

Pain and Mindfulness Meditation

To overcome pain, another task which demands higher controlled attention must be pitted against it.

Other forms of therapies were introduced to manage chronic pain.

One such therapy is known as mindfulness meditation. Mindfulness meditation is: “the intentional self-regulation of attention from moment to moment”. (Goleman & Schwartz, 1876) This method has been used for quite some time. A study done in mindfulness meditation by Dr. Kabat-Zinn has reported that 65% of patients have exhibited a reduction of pain by more than 33% and about 50% of patients have reported a reduction of pain by 50% over a 10-week period of therapy. (Kabat-Zinn, 1982)

Some studies performed in mindfulness meditation have reported patients with strong feelings of anger towards their pain condition while others report some anxiety while undergoing mindfulness therapy. la Cour and Petersen point out that meditation therapy requires a learning curve for the patient to access the more important personal “inner space”. (la Cour & Petersen, 2015) This can be an exciting learning experience of discovery for some patients while other patients may see this as a constant battle that in itself can be a painful experience.

The next question to consider therefore is to find out which patients benefits the most from mindfulness meditation and which are not, and then find out what other therapies we can use in these patients.

Enter Virtual Reality: Pain and Attention

Recall a recent injury. Ever wonder why after a trauma or injury has occurred, there seems to be a delay in which actual pain is produced? Pain has to first gain access to consciousness and demands central attentional resources by interrupting all other current brain processes such as worry, fear, or desire. It does so easily because of its noxious nature. (Eccleston, 1995) Pain, therefore, can be considered as a controlled task. To overcome pain, another task which demands higher controlled attention must be pitted against it.

The characteristics of pain such as intensity, quality, and/or pattern affect the probability of capturing attention. In chronic pain, for example, the characteristics of the pain and its intensity are important for pain processing. This may explain the reason why there are “good” days and “bad” days for patients with sciatica, multiple sclerosis, and other causes of chronic pain. Persistent pains with unpredictable sensory qualities that fluctuate in intensities are more likely to be processed. (Eccleston, 1995)

Finding the perfect distractor with the ability to interrupt persistent pain stimulus processing is key to coping. Virtual reality (VR) systems offer computer-generated sensory inputs that involve sight, sound, and touch. These inputs make it essentially difficult for the brain to ignore especially if the VR program is immersive. Immersive VR is an experience that gives a perfect illusion to the patient that is in the virtual world. The strength of the illusion of the presence of the virtual world reflects the amount of attention drawn into the virtual environment. (Hoffman, Doctor, Patterson, Carrougher, & Furness III, 2000)

Virtual reality may not replace the conventional pain management anytime soon. Once the patient comes out of VR, they will soon feel pain once more. Pharmacologic therapy remains the mainstay of pain management. But the problem of using pharmacologic treatment for pain remains a challenge. Undermedication is a problem of pain management failure. But higher doses of opioids poses a serious risk such as respiratory failure and encephalopathy. Therefore, the application of pain relief using VR may be for the use of procedural pain management such as minor surgical procedures, wound cleaning and debridement, and escharotomy in burn victims.

References

CDC/NCHS. (2017). National Vital Statistics System, Mortality. (US Department of Health and Human Services, CDC) Retrieved May 21, 2018, from CDC Wonder, Atlanta GA: https://wonder.cdc.gov/

Eccleston, C. (1995). Chronic pain and distraction: an experimental investigation into the role of sustained and shifting attention in the processing of chronic persistent pain. Behav Res Ther, 33(4), 391-405. doi:10.1016/0005-7967(94)00057-Q

Florence, C., Zhou, C., Lou, F., & Xu, L. (2013). The economic burden of prescription opioid overdose, abuse, and dependence in the United States. Med Care, 54(10), 901-906. doi:10.1097/MLR.0000000000000625

Goleman, D., & Schwartz, G. (1876). Meditation as an intervention in stress activity. J Consult Clin Psychol, 44, 456-466. doi:10.1037/0022-006X.44.3.456

Hoffman, H. G., Doctor, J. N., Patterson, D. R., Carrougher, G. J., & Furness III, T. A. (2000, March 1). Virtual reality as an adjunctive pain control during burn wound care in adolescent patients. Pain, 85(1-2), 305-309. doi:10.1016/S0304-3959(99)00275-4

Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psych, 4, 33-47. doi:10.1016/0163-8343(82)90026-3

la Cour, P., & Petersen, M. (2015, April 2). Effects of mindfulness meditation on chronic pain: a randomized control trial. Pain Medicine, 16(4), 641-652. doi:10.1111/pme.12605

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How the Brain Perceives Colors?

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Color vision is the ability to distinguish different wavelengths of electromagnetic radiation. Color vision relies on a brain perception mechanism that treats light with different wavelengths as different visual stimuli (e.g., colors). Usual color insensitive photoreceptors (the rods in human eyes) only react to the presence or absence of light and do not distinguish between specific wavelengths.

We can argue that colors are not real—they are “synthesized” by our brain to distinguish light with different wavelengths. While rods give us the ability to detect the presence and intensity of light (and thus allow our brain to construct the picture of the world around us), specific detection of different wavelengths through independent channels gives our view of the world additional high resolution. For instance, red and green colors look like near identical shades of grey in black and white photos.

An animal with black and white vision alone won’t be able to make a distinction between, let’s say, a green and red apple, and won’t know which one tastes better before trying them both based on color. Evolutionary biologists believe that human ancestors developed color vision to facilitate the identification of ripe fruits, which would obviously provide an advantage in the competitive natural world.

Why certain wavelengths are paired with certain colors remains a mystery. Technically, color is an illusion created by our brain. Therefore, it is not clear if other animals see colors the same way we see them. It is likely that, due to shared evolutionary history, other vertebrates see the world colored similarly to how we see it. But color vision is quite common across the vast animal kingdom: insects, arachnids, and cephalopods are able to distinguish colors.

What kind of colors do these animals see?

Human color vision relies on three photoreceptors that detect primary colors—red, green, and blue. However, some people lack red photoreceptors (they are “bichromates”) or have an additional photoreceptor that detects somewhere between red and green colors (“tetrachromates”). Obviously, having only 3 photoreceptors doesn’t limit our ability to distinguish other colors.

Each photoreceptor can absorb a rather broad range of wavelengths of light. To distinguish a specific color, the brain compares and quantitatively analyses the data from all three photoreceptors. And our brain does this remarkably successfully—some research indicates that we can distinguish colors that correspond to wavelength differences of just 1 nanometer.

This scheme works in largely the same way in most higher vertebrate animals that have color vision. Although the ability to distinguish between specific shades varies significantly between the species, with humans having one of the best color distinguishing abilities.

However, invertebrates that have developed color vision (and vision in general) completely independently from us demonstrate remarkably different approaches to color detection and processing. These animals can have a exceptionally large number of color receptors. The mantis shrimp, for instance, has 12 different types of photoreceptors. The common bluebottle butterfly has even more—15 receptors.

Does it mean that these animals can see additional colors unimaginable to us? Perhaps yes. Some of their photoreceptors operate in a rather narrow region of light spectrum. For instance, they can have 4-5 photoreceptors sensitive in the green region of the visual spectrum. This means that for these animals the different shades of green may appear as different as blue and red colors appear to our eyes! Again, the evolutionary advantages of such adaptations are obvious for an animal living among the trees and grasses where most objects, as we see them, are colored in various shades of green.

Researchers tried to test if a more complicated set of visual receptors provide any advantages for animals when it comes to the distinguishing between main colors. The findings show that this is not necessarily the case, at least not for the mantis shrimp. Despite the impressive array of receptors detecting light in a much broader part of the electromagnetic spectrum compared to humans, the shrimp’s ability to distinguish between colors that great in comparison to us. However, they determine the colors fast. This is probably more important for practical purposes, as mantis shrimps are predators. A large number of photoreceptors allows for their quick activation at specific wavelengths of light and thus communicate directly to the brain what specific wavelength was detected. In comparison, humans have to assess and quantify the signals from all three photoreceptors to decide on a specific color. This requires more time and energy.

Apart from employing a different number of photoreceptors to sense light of specific wavelengths, some animals can detect light that we humans are completely unable to see. For example, many birds and insects can see in the UV part of the spectrum. Bumblebees, for instance, have three photoreceptors absorbing in the UV, blue, and green regions of the spectrum. This makes them trichromates, like humans, but with the spectral sensitivity shifted to the blue end of the spectrum. The ability to detect UV light explains why some flowers have patterns visible only in this part of the spectrum. These patterns attract pollinating insects, which have an ability to see in this spectral region.

A number of animals can detect infrared light (the long wavelength radiation) emitted by heated objects and bodies. This ability significantly facilitates hunting for snakes that are usually looking for small warm-blooded prey. Seeing them through IR detecting receptors is, thus, a great tool for slow-moving reptiles. The photoreceptors sensitive to IR radiation in snakes are located not in their eye but in “pit organs” located between the eyes and nostrils. The result is still the same: snakes can color objects according to their surface temperature.

As this brief article shows, we humans can see and analyze only a small portion of the visual information available to other creatures. Next time you see a humble fly, think about how different it perceives the same things you are both looking at!

References:

Skorupski P, Chittka L (2010) Photoreceptor Spectral Sensitivity in the Bumblebee, Bombus impatiens (Hymenoptera: Apidae). PLoS ONE 5(8): e12049. doi: 10.1371/journal.pone.0012049

Thoen HH, How MJ, Chiou TH, Marshall J. (2014) A different form of color vision in mantis shrimp. Science 343(6169):411-3. doi: 10.1126/science.1245824

Chen P-J, Awata H, Matsushita A, Yang E-C and Arikawa K (2016) Extreme Spectral Richness in the Eye of the Common Bluebottle Butterfly, Graphium sarpedon. Front. Ecol. Evol. 4:18. doi: 10.3389/fevo.2016.00018

Arikawa, K., Iwanaga, T., Wakakuwa, M., & Kinoshita, M. (2017) Unique Temporal Expression of Triplicated Long-Wavelength Opsins in Developing Butterfly Eyes. Frontiers in Neural Circuits, 11, 96. doi: 10.3389/fncir.2017.00096

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Is Social Media the Bad Guy? Redefining Beauty in a Digital World

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We’re living in an age of hyper-connectivity where social media is being widely used by almost every age group in the world. It’s connected people from all corners of the planet and given us the opportunity to have global conversations about practically any subject, event, or news piece.

However, many mental health and behavioral experts believe that social media has had a negative impact on the psychological well-being of those who use it because it gives people the illusion of being popular based solely on how many “likes” and “friends” they have on their profiles.

Psychologists have also observed that social media exacerbates the tendency for frequent users to develop a skewed impression of the world which is seldom accurate or healthy. Young girls and women, for example, may develop unrealistic standards when it comes to their looks and bodies based on what they see on social media.

But instead of labeling social media as the bad guy, I see it as a double-edged sword. The eventual effect that it has on your life really comes down to how you use it and for what purpose. The Internet is a neutral and open platform that levels the playing field when it comes to having access to knowledge that could help us live healthier, productive, and more fulfilling lives.

If anyone wants to avoid the negative impact that social media could have on her self-image, they need to become more conscious of their media diet. If they follow social media accounts and blogs run by people and institutions that are shallow and appearance-focused, such as Instagram models and celebrity fashion and gossip related profiles, it can hurt them if they aren’t mindful of its probable impact on them, especially on a subconscious level.

The negative impact of social media can be avoided if people are guided towards adopting a more empowering and all-encompassing standard of beauty which includes all aspects of being—intellect, aspirations, passions, talents and her morals.

In this way, they will be naturally drawn towards developing an identity that isn’t solely based on outward appearances but on character—this, in turn, will influence the use of social media for noble purposes that will expand the mind and provide a platform to express creative potential and to make a difference. In other words, we need to take an inside-out approach when it comes to combating the potentially harmful effects of social media, or any other forms of media.

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VIDEO: How Facebook Preys on Our Mental Health

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In an ironic turn, the recent controversy surrounding Facebook and Cambridge Analytica eclipsed another controversy brewing months before. As 2017 came to close, the million-dollar question surrounding the company was, Does Facebook make us depressed?

Back in December, even Facebook itself posted an article on its official blog, titled, Hard Questions: Is Spending Time on Social Media Bad For Us? The post cites a number of studies that prove spending time on Facebook can threaten well-being.

One study from the University of San Diego and Yale found that people who clicked on four times as many links or liked twice as many posts as the average person reported decreased mental health in a survey. A broader study found that increases in “likes clicked,” “links clicked,” or “status updates” was associated with decreases in mental health.

But though these studies might prove that Facebook brings us down, they don’t ask the important question of how Facebook brings us down. For a more thorough dive into what truly addict us to the site, ultimately leaving us feeling unsatisfied, check out this video, which explains the subject in depth:

The video presents arguments from two former employees, Sean Parker and Chamath Palihapitiya, who claim that Facebook was designed to prey on its users’ neurochemical reward systems. Dopamine, the chemical released in the brain during certain activities, such as exercising, finishing tasks at work, and finding food, has also been found to surge during social interactions. The brain desires cooperation and connection, so it sends reward signals in the form of dopamine when this cooperation or connection occurs. It could be something as simple as carrying a couch up a flight of stairs with a friend, or as profound as telling your partner you love her.

Because the brain cannot distinguish between, an interaction in real life and one on Facebook in terms of dopamine release, these rewards systems are integral to Facebook’s interface. Even the little red notification, or the ping sound we’ve all become accustomed to, produce a similar dopamine release.

The key insight in the video is that Facebook knows these dopamine hits are essential to their business model, the main driving force bringing people back to the site over and over and over again. Knowing this, they’ve ramped up notifications over the years, spiking our dopamine levels for something as mundane and uninteresting as someone having gone “live” a few hours ago, or a belated birthday, or even just to tell you that you haven’t posted in a while.

What happens, then, is a uniquely modern phenomenon. Your brain is rewarding you with dopamine for a successful social interaction, but in reality, no genuine connection has occurred, creating a disconnect between the chemical reward system in your brain and your actual lived experience.

Obviously, Facebook can depress its users in a number of ways. People often assume others’ lives are happier than theirs because of how their friends present themselves online. Teen brains are now trained to be distracted based on the interface alone. But this feeling, the dopamine hit followed by immediate disappointment with the reality of a meaningless notification, seems central to the deflating feeling Facebook can produce.

References

Shakya, H., & Christakis, N. (2017). Association of Facebook Use With Compromised Well-Being: A Longitudinal Study. American Journal Of Epidemiology. doi: 10.1093/aje/kww189

Verduyn, P., Lee, D., Park, J., Shablack, H., Orvell, A., & Bayer, J. et al. (2015). Passive Facebook usage undermines affective well-being: Experimental and longitudinal evidence. Journal Of Experimental Psychology: General, 144(2), 480-488. doi: 10.1037/xge0000057

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Mental Health is Not Just the Absence of Mental Illness

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In an increasingly globalized and mediatized world, in which mental illness is one of society’s most discussed cultural artifacts, Colleen Patrick Goudreau’s words ring out: “If we don’t have time to be sick, then we have to make time to be healthy”.

With the prevalence of mental health problems, it is clear why. Mental health issues are one of the leading causes of the overall disease burden globally, according to the World Health Organisation. One study reported that mental health is the primary source of disability worldwide, causing over 40 million years of disability in 20 to 29-year-olds.

Compared to previous generations, mental illness is now said to surpass the effects of the Black Death. The root causes of the unprecedented rise in people directly affected by mental illness, and the cost of this, can be considered across at least three levels of analysis.

If we don’t have time to be sick, then we have to make time to be healthy.

Colleen Patrick Goudreau

At the first level of analysis, the root cause of mental illness is an amalgamation of heredity, biology, environmental stressors, and psychological trauma.

Notions of specific genes being responsible for illness have been supplanted by those of genetic complexity, where various genes operate in concert with non-genetic factors to affect mental illness. That is, health-relevant biology and mental health impact each other in a complex interplay, which is inherently social.

Despite the importance of understanding the social underpinnings of biological risk factors for mental illness, there is a relative paucity of research investigating this topic. Research that does exist, is nevertheless engrossing. For example, one study, of many, found that social isolation leads to increased risk of coronary heart disease. Since low levels of social integration are related to higher levels of C-reactive protein, a marker of inflammation related to coronary heart disease, social integration is posited to be a biological link between social isolation and coronary heart disease.

Moreover, social support affects physical perception. In a landmark study, researchers demonstrated that people accompanied by a supportive friend or those who imagined a supportive friend, estimated a hill to be less steep when compared to people who were alone.

Mental health, like physical health, is more than the sum of functioning or malfunctioning parts.

At the second level of analysis, the complex bio-social interplay scaffolding mental illness points to the fundamentally chemical underpinnings of human thinking and emotion.

With recent advances in neuroscience like Clarity, we are now able to make the brain optically transparent, without having to section or reconstruct it, in order to examine the neuronal networks, subcellular structures, and more. In short, we can examine mental illness from a biological perspective.

The depth and complexity of the bio-social root of mental illness, however, paints a more nuanced picture than discussed thus far. With such pioneering work, there is an increasingly popular assumption that the brain is the most important level at which to analyze human behavior.

In this vein, mental illness perpetuates itself by virtue of the fact that people often consider it to be biologically determined. In turn, a ‘trait-like’ view of mental illness establishes a status quo of mental health stigma by reducing empathy. Such explanations overemphasize constant factors such as biology and underemphasize modulating factors such as the environment.

At the third level of analysis, the obsession with seeing mental health in terms of mental illness reveals the fallible assumption that mental health is simply the absence of mental disorder. However, the problematic landscape of mental health draws on a far wider set of working assumptions. That is, mental health, like physical health, is more than the sum of the functioning or malfunctioning parts. It is an overall well-being that must be considered in light of unique differences between physical health, cognition, and emotions, which can be lost in a solely global evaluation.

So, why do we as a society ponder solving mental illness, which should have been targeted long ago, far more than we consider improving mental health? In part, because when we think of mental health, we think of raising the mean positive mental health of a population, more than closing the implementation gap between prevention, promotion, and treatment.

Cumulatively, social environments are the lubricating oil to biological predispositions, which influence mental health, such that mental health and physical health should be considered holistically. In this vein, national mental health policies should not be solely concerned with mental disorders, to the detriment of mental health promotion.

It is worth considering how mental health issues can be targeted using proactive behavioral programs. To achieve this, it is pivotal to involve all relevant government sectors such as education, labor, justice, and welfare sectors.

In a diverse range of existing players, many nonprofits’, educational institutions’, and research groups’ efforts contribute to the solution landscape of mental health promotion. In Ireland, for example, schools have mental health promotional activities such as breathing exercises and anger management programs. Nonprofits around the world are increasingly seeing the value of community development programmes and capacity building (strengthening the skills of communities in so they can overcome the causes of their isolation). In addition, businesses are incorporating stress management into their office culture.

We think of raising the mean positive mental health of a population, more than closing the implementation gap between prevention, promotion and treatment.

The pursuit to empower people to help themselves joins up these social ventures to teach us that promoting mental health is optimized when it is preventative, occurring before mental illness emerges, and when it is linked to practical skills within a community. Furthermore, these social ventures exemplify how different types of efforts (government, nonprofit, business etc.) cater to different populations, from children to corporates.

While these social ventures bring hope to the future and underscore the importance of sustainable change, there are still too few programs effectively targeting people, who want to maximize already existent positive mental health not just to resolve or cope with mental health issues. If we continue to take such pride in our successful problem finding and solving of mental illness that we ignore mental illness prevention and mental health promotion, we are at risk of increasing the problem we are trying to solve.

References

Heffner, K., Waring, M., Roberts, M., Eaton, C., & Gramling, R. (2011). Social isolation, C-reactive protein, and coronary heart disease mortality among community-dwelling adults. Social Science & Medicine, 72(9), 1482-1488. doi: 10.1016/j.socscimed.2011.03.016

Lozano, R., Naghavi, M., Foreman, K., Lim, S., Shibuya, K., & Aboyans, V. et al. (2012). Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet, 380(9859), 2095-2128. doi: 10.1016/s0140-6736(12)61728-0

Schnall, S., Harber, K., Stefanucci, J., & Proffitt, D. (2008). Social support and the perception of geographical slant. Journal Of Experimental Social Psychology, 44(5), 1246-1255. doi: 10.1016/j.jesp.2008.04.011

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Skype, text or Facebook? Using technology to get most out of your long-distance relationship

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Our world is getting smaller and we are all getting farther apart.

No, this isn’t a prelude to a discussion on how technology has turned us into antisocial zombies. On the contrary, in an increasingly connected world each of us has more opportunities to work in, travel to, and meet people from different places around the globe than ever before. This means there are that many more of us falling in love with people who live far away from us—in different cities, countries, continents and, maybe one day, planets?

Alternatively, some of us have fallen in love with the girl/boy next door only to find ourselves separated from the love of our lives due to their/our work commitments. In any case, few of us are strangers to being a partner in a long-distance relationship (LDR).

While there is a healthy amount of research that looks into how couples communicate with each other within a relationship, there is, surprisingly, not that much about how couples in long-distance relationships keep the flame burning.

For many of us, LDRs are a ‘test’ to see how strong a relationship is and if it can sustain itself in the face of adversity. Sure, there was a time when the only means couples in an LDR had to stay in touch was through fortnightly letters written by hand or expensive phone calls with unclear network reception. But today, with a spectrum of communication mediums literally at our fingertips, this ‘test’ is not nearly as challenging as it once was.

In a study conducted by Hampton et al. (2018) the authors set out to find out which mediums were used the most by couples in LDRs and which were the most effective at maintaining relationship satisfaction. They had a straightforward hypothesis: couples in LDRs who communicated with each other more frequently would report greater relationship satisfaction. To this hypothesis they added a caveat: not all means of communication are created equal, and some, such as Skype, may be more beneficial to relationships than others.

The researchers surveyed 588 participants in LDRs that asked them questions about how frequently they used different kinds of communication, how satisfied they were with the communication in their relationship, and how satisfied they were with their relationship overall.

Perhaps unsurprisingly, text messages were the most frequently used means of communication in LDRs. However, Skype was the only communication medium where the researchers could discern association with relationship satisfaction. Partners who spent more time video chatting via Skype did indeed report greater levels of satisfaction with their relationship. When it came to communication satisfaction, it was the use of Skype as well as picture messaging that came out on top. As for Facebook, Twitter, and Snapchat? They had close to no impact on either relationship or communication satisfaction. In fact, Facebook use was associated with lower levels of relationship satisfaction. That’s something worth thinking about.

What is surprising about this study is that the humble telephone call displayed little to no relation with communication satisfaction or relationship satisfaction, quite unlike its video counterpart, Skype, revealing that being able to see your partner is a core component to maintaining a healthy relationship even when apart.

Based on this study, it seems clear that a mode of communication that involves a visual component—as Skype and picture messaging do—is an effective indicator of relationship satisfaction. The researchers suggest this is due to the presence of non-verbal as well as audio cues resulting in greater communication satisfaction and thereby more satisfaction with the relationship overall. So if you’re in an LDR, the more you talk to your partner over Skype (with the camera on), the more satisfied you will be with your relationship. Then again, if you’re in an LDR, you probably already knew that.

Reference:

Hampton, A.J., Rawlings, J., Treger, S., Sprecher, A. (2017) Channels of Computer-Mediated Communication and Satisfaction in Long-Distance Relationships. Interpersona, 2017, Vol. 11(2), 171–187, doi: 10.5964/ijpr.v11i2.273

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Asperger’s Syndrome: Hallmark of Genius, or Just Another Form of Autism?

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Isaac Newton, Albert Einstein, Charles Darwin—what unites these three exceptional individuals? It is widely accepted that all three were geniuses, but there is something else. These days, neuroscientists believe that all three suffered from a specific neurological disorder called Asperger’s syndrome.

The whole definition of the term “neurological disorder” implies that something is going wrong in the brain. However, there is a growing recognition of the fact that when it comes to the processes in our brain, “going wrong” does not necessarily mean “going bad”. Our brain is too complicated a mechanism to be interpreted in simplistic terms. Some neurological disorders produce a peculiar state of mind often associated with high artistic and scientific achievements.

Asperger’s Syndrome (AS) is a developmental and neurological disorder that is often associated with symptoms of social withdrawal, motor clumsiness, and impaired communication skills. The Diagnostic and Statistical Manual of Mental disorders (DSM-5) classified AS in the same category as Autism Spectrum Disorder (ASD). It is often referred to as ‘High-functioning’ Autism (HFA), as individuals with AS are more intellectually capable and show less severe abnormalities compared to ASD subjects.

The story of AS and autism started in the 1940s, when two Viennese Scientists, Leo Kanner and Hans Asperger, described a syndrome observed in some children, with the unique characteristics of social isolation, impaired communication skills, and restrictive and obsessive interests. Both scientists used the term ‘autistic’ in their reports. While Kanner’s syndrome was published right away in 1943, Asperger’s report was written in German and remained undiscovered until 1991 when it reappeared in Uta Frith’s textbook Autism and AS.

Research and publications on Asperger’s syndrome reached its peak during 2000-2012. Different research groups proposed a set of criteria for AS diagnosis. While several of these criteria were overlapping, WHO’s International Classification of Diseases and Disorders set the following key characteristics that can be diagnostic for Asperger’s Syndrome:

  • Qualitative social impairment involving dysfunctional social adaptivity, impaired non-verbal communication for interaction and lack of social reciprocity.
  • Restrictive pattern of interest, motor clumsiness, repetitive behavior, and extreme obsessiveness to specific rituals.
  • AS patients must show age-specific, normal cognitive and linguistic development.

Interestingly, the father of Asperger Syndrome, Hans Asperger, described AS patients to be characteristically distinct from ASD subjects. He characterized them as intellectually-able, abstract-loving, and even overachieving in some specific cognitive domains.

Decades after Asperger’s observation, recent studies have also found that AS patients often demonstrate high verbal IQ, strong grammatical skills and they often outperform others in fluid reasoning although they are reported to show a delayed reaction time with poor performance IQ, specifically in symbol coding and processing speed.

Surprisingly, AS is more common than classical autism. Epidemiological surveys report that about 4 out of every 10,000 children are autistic whereas about 25 out of 10,000 children are diagnosed with AS. AS is more common in boys than girls. No scientific explanation behind this observation exists at present.

Like with many other syndromes, no single specific cause is responsible for AS. Rather, a milieu of factors is associated with its development.

Children diagnosed with AS show a genetic pattern, like in autism, where at least one of the parents (most often the father) is diagnosed with AS or at least have some hallmark AS characteristics. The relatives of AS children are known to have anxiety or depression related disorders.

An important causal factor behind the development of AS might be the altered level of neurotransmitters. In AS patients, higher levels of N-Acetyl Aspartate/Choline (precursor of acetylcholine) intake and increased dopamine levels were reported, suggesting an overall altered dopaminergic neurotransmitter composition in major areas of the brain. Intranasal injection of oxytocin, a neuropeptide, was shown to improve facial emotion recognition abilities in AS patients.

Apart from alterations in neurotransmitter levels, neuroimaging studies show that there are structural changes in major areas of the brain that could be associated with the development of Asperger’s Syndrome. Altered grey and white matter volumes were observed in major brain regions, and an abnormal thickness of the hippocampus, amygdala, and anterior cingulate cortex was reported to be the major contributing factor for dysregulated cognitive functions in AS.

Some researchers also proposed that environmental factors can contribute indirectly to the development of AS. Viral or bacterial infection and smoking during pregnancy particularly increases the risk factor, although no concrete evidence supporting these views was found.

Due to the substantial number of overlapping similarities between Asperger’s Syndrome and Autism, it is very easy to confuse one with the other.

Studies in recent decades showed differences between AS and ASD on both quantitative and qualitative levels. The AS subjects displayed age-specific or earlier verbal development, meticulous speech ability, higher desire for social reciprocation, and supreme imagination compared to ASD patients.

On a cognitive level, AS subjects are more perceptive, they possess superior verbal performance and visual-spatial ability compared to ASD patients.

But the major limitations of these studies is the huge variability within the study groups and contradictions in the data patterns, as with age, the distinction between AS and ASD significantly reduces. It is particularly difficult to categorize AS from other disorders as there are no known biomarkers specific to AS only.

As there is not sufficient evidence of distinguishable characteristics for AS that can class the syndrome as ‘one biologically and clinically diagnosed entity’, the DSM-V in 2013 revised and categorized Asperger’s Syndrome as another variant of ASD. Although this decision was criticized by the scientific community, most of the researchers agreed that there is a need to conduct more studies that could help in distinguishing AS from other ASDs.

The most general misconception about Asperger’s syndrome or, as a matter of fact, about autism spectrum disorders in general, is that they develop because of poor parenting and a lack of bonding between parents and their child. This concept was even termed as ‘Refrigerator Mother’ to describe cold and distant parenting. But this notion was challenged from the 1960’s when research on these neurological disorders started to grow and scientists found that it is not parenting, but rather the genetic and neurological makeup of the child that is responsible for these syndromes. Even today, the belief that neurodevelopmental disorders are caused by a traumatic childhood are common. The reality, however, is more complicated than our guesses based on limited information.

References

Barahona-Correa, J. B. and C. N. Filipe (2015) A Concise History of Asperger Syndrome: The Short Reign of a Troublesome Diagnosis. Front Psychol 6: 2024. doi: 10.3389/fpsyg.2015.02024

Faridi, F. and R. Khosrowabadi (2017) Behavioral, Cognitive and Neural Markers of Asperger Syndrome. Basic Clin Neurosci 8(5): 349-359. doi: 10.18869/nirp.bcn.8.5.349

Weiss, E. M., B. Gschaidbauer, et al. (2017) Age-related differences in inhibitory control and memory updating in boys with Asperger syndrome. Eur Arch Psychiatry Clin Neurosci 267(7): 651-659. doi: 10.1007/s00406-016-0756-8

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