It is a fact of life that in any sort of relationship with others, we risk being neglected, abused, rejected, lied to, or betrayed in some other way. Whether due to minor or major transgressions, each of us has been confronted with the tension around whether to forgive someone who has hurt us. And whether one is more inclined to crave “an eye for an eye” rather than to “turn the other cheek,” it is not uncommon to believe forgiving another is contingent on that person’s remorse or apology. Yet, the guilty party may never feel guilt or take any responsibility whatsoever. If this is the case, you may wonder what is to be gained by forgiveness. To answer this question, we must also look at the risks of not forgiving.

The Risks of Holding on to Anger

Research over the past two decades has found that ongoing anger, resentment, and hostility are linked to poorer physical and mental health. It can feel extremely difficult to move through these emotions and develop compassion or pity for those who have wronged us or hurt someone we love. Yet, reaching a place of forgiveness can free one from a virtual prison of negative thoughts and burdensome emotions, which typically only prolong the feelings of anger and suffering generated by the original offense.

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The Benefits of Forgiveness

The benefits of being able to forgive are many. Developing forgiveness has been associated with decreased stress, anxiety, and depression, and increased feelings of well-being. Some studies have found a relationship between dispositional or trait forgiveness and life satisfaction. One study to date has found trait forgiveness is linked to better relationships with others.

To date, the research is limited on the benefits of state forgiveness—or forgiveness in response to a current interpersonal hurt. A recent study examined the potential mental health benefits of practicing state forgiveness, as well as what factors contributed to the relationship between forgiveness and well-being. Specifically, 11 participants affiliated with either Buddhist, Muslim, new religious movements (NRM), or secular/atheist groups were recruited who met the criteria of having practiced forgiveness in response to an interpersonal hurt. The types of hurts were related to parental love deprivation, hurt by romantic partners, and feelings of neglect within the context of work relationships. Participants were then administered an in-depth, semi-structured interview inquiring about the above.

Despite the benefits of forgiveness, it can be difficult to cultivate, particularly when the offense results in lasting or severe harm, when the offender refuses to take responsibility, or when the relationship and the offenses are both ongoing.

The interviews revealed three themes related to the perceived negative effects of refusing to forgive on mental health. Specifically, refusing to forgive another impacted how participants felt emotionally; had negative effects on mental health, including on cognitive abilities (such as the ability to think clearly); and led to both social and psychological barriers to their own growth (feeling unable to move forward). Among other things, participants reported unforgiveness contributed to feelings of anger, guilt, or bitterness, left them feeling drained, and could lead to carrying bitterness into subsequent relationships. One participant stated he had experienced feelings of “darkness,” depression, and suicidal thoughts. He said forgiveness led to alleviation of his depressive symptoms and desire to self-harm, and resulted in greater personal happiness. Others said forgiving another led to greater feelings of spiritual transformation, inner peace, joy, personal empowerment, and meaning. In addition to these benefits, several participants said their relationships improved after adopting an attitude of forgiveness.

There appeared to be no obvious distinctions in these themes on the basis of religious or spiritual affiliation.

Barriers to (and Facilitators of) Forgiveness

The study participants acknowledged there were factors that made it either easier or more difficult to forgive those who had hurt them. Barriers included feelings of powerlessness; if the offender refused to acknowledge the offense; if participants ruminated on the hurtful act; having a desire for revenge; ongoing transgressions by the offending party; and physical proximity to the offender.

Yet, these same respondents also said certain other factors facilitated forgiveness. These included feeling a sense of connectedness with others; focusing on the positive qualities of the offender or relationship; beliefs about being of benefit to others; engaging in meditation, self-observation or prayer; feelings of empathy for the offender; persistent effort (by the offender) to repair the situation; and talking to and support from friends.

The Bottom Line

The researchers concluded that the study participants experienced benefits largely from applying inner transforming strategies such as those mentioned above but without necessarily expecting a change in external conditions (i.e., the offender or the relationship with the offender). This strategy or approach appeared to lead to greater levels of forgiveness and mental well-being.

It’s worth noting this study was conducted with a small sample of people who were selected precisely because they had been able to forgive personal hurts. The message that forgiveness is healthier and more rewarding than holding on to anger, bitterness, and desire for revenge is worth paying attention to, however.

How to Cultivate Forgiveness

Despite the benefits of forgiveness, it can be difficult to cultivate, particularly when the offense results in lasting or severe harm, when the offender refuses to take responsibility, or when the relationship and the offenses are both ongoing. What follows are some thoughts on how to cultivate forgiveness while maintaining feelings of safety and healthy boundaries.

1. Forgiving someone does not mean you need to allow that person to continue hurting you. You can release anger, bitterness, and the desire for vengeance while still setting limits. The limits, which will look different depending on the relationship, can range from severing a relationship altogether to limiting contact and setting guidelines for whatever contact you wish to maintain.
2. Mindfulness has been shown to have a number of benefits related to good mental health and can help foster self-compassion. Self-compassion means treating yourself with the same kindness, consideration, and acceptance you afford others. Self-compassion has also been shown to increase compassion for others—which can help you get to a place of forgiveness.
3. Remember you cannot heal another person, nor can you make them kinder, more self-aware, or more empathic. That said, you are also not responsible for the choices others make. Remembering these things can help you detach from the need to change others or how they feel about you.

Reference:

Akhtar, S., Dolan, A., & Barlow, J. (2017). Understanding the relationship between state forgiveness and psychological wellbeing: A qualitative study. Journal of Religion and Health, 56(2), 450–463.

Affirmations are positive statements that are often used to combat negative self-perceptions or enhance focus on personal goals. Affirmations also tend to foster the expectation of success. Often, affirmations address a specific concern or fundamental self-talk theme. As an example, someone struggling with weight concerns may have frequent, albeit self-defeating thoughts such as, “I am never going to be able to lose/gain weight” or “My body is my enemy.”

Self-critical, pessimistic statements can make it more difficult to stick with goals, especially during the expectable minor setbacks most people experience on the road to success. In essence, habitual negative self-statements can erode self-confidence and become self-fulfilling prophecies of failure.

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How Affirmations Can Be Employed in Daily Life

Affirmations can serve as an important tool for staying on track and staving off feelings of discouragement. To use the previous example, an affirmation to address anxiety or pessimism around weight concerns could be, “Each day, I am one step closer to achieving my healthiest weight.” If the negative self-talk is more generalized or self-critical, one might create an affirmation such as, “I partner with my body in keeping myself well.” An affirmation that is counter to negative feelings or beliefs related to exercise is, “It feels wonderful to eat well and move my body.”

Again, a productive affirmation is specifically related to a positive goal; the opposite of what the negative self-talk says; and helps one imagine a successful outcome.

Affirmations Present and Future

Although affirmations are commonly phrased in the present tense (to foster a feeling of these statements already being true), affirming statements can also be combined with guided or self-directed imagery to focus on future success. This technique is actually used in hypnosis and self-hypnosis, and is referred to as “future progression.” Future progression imagery involves creating the multisensory experience of being in that moment when one has already achieved a future goal, even though the actual imagery is happening within oneself, in the present moment.

How Affirmations Work

Although crafting affirmations can be straightforward, recent research has found affirmations effectively increase feelings of well-being and improve the likelihood of making good choices. As you’ve probably noticed, when under stress, most people are more vulnerable to self-doubt or feeling overwhelmed in general. Affirmations appear to work by reminding us of personal resources beyond what we notice when we are discouraged. Relatedly, affirmations seem to help us to reflect on our core values and draw upon the positive personal experiences we’ve had.

Affirmations and the Brain

Several different brain regions are thought to be involved in the benefits seen related to engaging in affirmations. For example, in previous studies, the ventral striatum and the ventral medial prefrontal cortex have been linked to assigning a positive value to something (such as achieving a goal) and viewing it as a reward. Increased activity in the medial prefrontal cortex and posterior cingulate cortex have been linked to focusing on one’s personal strengths. In addition, self-affirmations may work in part by engaging the anterior cingulate cortex and the ventrolateral prefrontal cortex to regulate emotions (staving off negative emotions, or remaining more objective) when faced with difficult situations.

In a recent study, researchers sought to shed light on the brain activity of 67 sedentary participants during a self-affirmation task. For this study, the participants first were asked to rank a list of eight values, such as creativity, relationships with loved ones, religious values, and so forth.

Although crafting affirmations can be straightforward, recent research has found affirmations effectively increase feelings of well-being and improve the likelihood of making good choices.

One week later, while undergoing functional magnetic resonance imaging (fMRI), those in the affirmation condition were asked to reflect on their highest-ranked value. Those in the control condition were asked to reflect on the value they’d ranked lowest out of the eight. In each condition, participants were directed to recall a time in the past that was positively associated with the value they were focusing on (having fun with family and friends, for example), and then imagine a time in the future when they would also experience something positive related to that same value. In both affirmation and control groups, participants were also presented with past- and future-oriented statements related to everyday, emotionally neutral events such as charging a cell phone.

Participants in both groups were then exposed to health-related messages encouraging increased physical activity and decreased sedentary behavior. The team also looked at brain activity in regions linked to positive valuation and reward, self-related processing (such as positive self-worth), and emotion regulation.

The team found that those in the affirmation condition displayed significantly greater activity in the positive valuation and reward network (ventral striatum [VS] and ventral medial prefrontal cortex [VMPC]) when engaging in the affirmation as opposed to imagining the everyday scenario. The VS and VMPC are associated with expecting and receiving some type of reward. The reward can be something primary, such as food, or abstract, such as something personally meaningful. Increased activity in these areas was also associated with decreased sedentary behavior going forward. Furthermore, the team’s findings suggest affirmations may have an even stronger effect on brain-related activity, as this pertains to future decisions (as opposed to past events).

Although their study did not directly address this question, the researchers speculated, based on data from other studies, that affirmations that are prosocial and self-transcendent are more strongly linked to later positive behaviors than those affirmations that are primarily self-serving.

Another finding from this study was that future-oriented affirmations activated the medial prefrontal cortex and posterior cingulate cortex. These brain regions are associated with self-insight, reflecting on one’s preferences and motivations, and imagining personally relevant future as well as remembering past events. Increased activity in the MPFC specifically is associated with imagining positive, but not negative, future events.

To summarize, previous research has shown links between positive affirmations and increased activity in brain areas linked to positive self-worth, viewing an outcome as positive and rewarding, and the ability to regulate one’s emotions. In this most recent study, affirmations that were consistent with participants’ personal values and focused on imaging having positive experiences related to these values at a future time were linked to positive changes in behavior one month later.

How to Incorporate Affirmations Into Your Life

There are a number of easy, free-to-low-cost ways to use affirmations to help you make positive change. A quick internet search will reveal an abundance of audio programs featuring positive affirmations and imagery, but you can also make your own. Here are some suggestions:

1. Set aside some quiet time to engage in this exercise.
2. Write a list of some goals that you’d like to achieve. Make the list simple, specific, and concrete.
3. Pick one goal to start. You are probably more likely to stick with a goal that is consistent with your personal values rather than one someone else sets for you.
4. Note any negative thoughts you tend to have when you try to focus on your goal.
5. For each negative statement, write a positive statement that is the opposite of the negative self-talk. Make the statements short and to the point.
6. Even if the goal is for some time in the future, write the positive statements as if they are already true (e.g., “I enjoy moving my body and feeling healthy” or “Each day, I feel stronger, happier, and healthier.”).
7. Recall a specific time in your life when each statement rang true for you. Remember, it’s not about recalling a time when things were perfect.
8. For each affirmation, vividly envision the future goal as already being true. Imagine how your body feels, envision how your life or health will have changed, and how terrific it feels to have achieved something meaningful to you. Use as many of your senses as you can to engage in this imagery.
9. Repeat each individual affirmation, silently or out loud. Breathe.
10. Set aside a few minutes to meditate on your affirmations each day. You can even record yourself saying each positive statement, and play this back to yourself.

Reference:

Cascio, C. N., O’Donnell, M. B., Tinney, F. J., Lieberman, M. D., Taylor, S. E., Strecher, V. J., & Falk, E. B. (2016). Self-affirmation activates brain systems associated with self-related processing and reward and is reinforced by future orientation. Social Cognitive and Affective Neuroscience, 11(4), 621–629.

Schizophrenia is a chronic, severe mental health condition thought to result from some combination of genetic and environmental factors. Imbalances in brain chemicals, such as dopamine and glutamate, also seem to play a role in schizophrenia.

Schizophrenia is diagnosed both by “positive” symptoms—among them hallucinations, delusions, and other disordered thinking—as well as “negative” symptoms such as reduced expression of emotion and speaking less. People who have this condition also may experience difficulties with cognitive functions such as decision making, planning, paying attention, and working memory.

There has been a great deal of talk about the role of gut flora, also known as the “microbiome,” and mental health. It may sound surprising, but severity of symptoms in depression, anxiety, autism, and now schizophrenia have been linked to imbalances in the gastrointestinal (GI) tract. More recent research has suggested a relationship between activity of the immune system, increased inflammation, the presence of food sensitivities, and imbalances in the GI tract in the presentation of schizophrenia.

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What’s the Gut Got to Do with It?

During the normal birth process, our GI tracts are populated with “good” bacteria (by moving down the mother’s vaginal canal). This, our diets, stress levels, and other factors subsequently affect our gut bacteria and our overall health, as well as our brain development.

Gut bacteria help regulate proteins and other substances that influence the brain’s development. One substance, “brain-derived neurotrophic factor” or BDNF, impacts the brain’s ability to develop new neurons and remain adaptable (referred to as neuroplasticity).

Our gut environment also appears to affect receptors in our brains. Receptors may be thought of as the equivalent of a keyhole on the surface of a neuron. Brain chemicals are like the “keys” that are designed to fit in a specific type of receptor. Once such type of receptor, the NMDA, is a type of glutamate receptor involved in, among other things, plasticity (or adaptability) of neurons related to memory and other functions. An unbalanced microbiome (gut bacteria, or flora) can lead to under-functioning NMDA receptors and variations in BDNF that may contribute to the production of schizophrenia symptoms.

Structural damage to the GI tract in people with schizophrenia has been linked to developing antibodies to brain cells in the hippocampus, amygdala, and frontal cortex. These brain areas are involved in working memory, emotion, motivation, decision making, and logical thinking—all of which may be impaired in people with schizophrenia.

Dr. Kaitlyn Nemani and colleagues reviewed the literature on the role of the gut in schizophrenia. Their review found that imbalances in the microbiome may be linked to structural damage in the gut, inflammation, and the development of autoimmune disorders. People who have schizophrenia, as well as their relatives, have been found to have a greater incidence of autoimmune disorders than people who either do not have or are not related to someone with schizophrenia.

In addition, structural damage to the GI tract in people with schizophrenia has been linked to developing antibodies to brain cells in the hippocampus, amygdala, and prefrontal cortex. These brain areas are involved in working memory, emotion, motivation, decision making, and logical thinking—all of which may be impaired in people with schizophrenia.

Gut flora imbalances may also play a role in increased sensitivity to gluten (a protein found in grains) and casein, which is the main protein found in milk and milk products. A growing body of research has found a relationship between gluten sensitivity that is not due to celiac disease and symptoms of both schizophrenia and autism.

Finally, imbalances in gut flora are linked to obesity and insulin resistance, both of which are linked to diabetes. People who have schizophrenia have an increased risk for these types of metabolic imbalances, and antipsychotic medication can further induce weight gain that can lead to metabolic problems and diabetes.

Novel Therapies to Balance the Gut

Dr. Nemani and colleagues suggest some nontraditional therapies that may complement existing medication and psychotherapy approaches for treating schizophrenia. These include:

1. Dietary changes. Although the evidence has been mixed, there is some data and also anecdotal reports suggesting that a subset of people who have schizophrenia benefit from avoiding gluten-containing foods (i.e., wheat, rye, barley, and other grains). Data regarding the impact of a casein-free diet on schizophrenia symptoms are lacking, but if your current treatment regimen provides insufficient relief, or you have GI symptoms that appear to worsen after consuming dairy, it may be worth going dairy-free for a few weeks to see if this improves your symptoms.
2. Antimicrobials. Minocycline (a form of tetracycline) is under investigation as an adjunct treatment in people with schizophrenia. It is thought to reduce inflammation and enhance glutamate neurotransmission.
3. Probiotics. Probiotics, or supplements containing “good bacteria,” may help balance gut flora and have been shown to positively impact mood, digestion, immunity, and weight. There does not appear to be risk associated with taking probiotics.

The last type of novel therapy discussed by the authors is fecal transplantation, or transplanting the fecal bacteria from someone with a healthy microbiome to a person who has a gut imbalance. Although this is considered a cutting-edge GI treatment for those who have inflammatory bowel disease, the authors conclude that a better understanding of the microbiome in those with schizophrenia is needed to know if this therapy is warranted.

As always, consult with your medical team when considering new therapies, conventional or complementary, such as those described above.

References:

1. Celiac Disease Foundation. (n.d.). Sources of Gluten. Retrieved from https://celiac.org/live-gluten-free/glutenfreediet/sources-of-gluten/
2. National Institute of Mental Health. (2016). Schizophrenia. Retrieved from http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
3. Nemani, K., Ghomi, R. H., McCormick, B., & Fan, X. (2015). Schizophrenia and the gut-brain axis. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 56, 155-160.

Self-compassion is one of those terms that has gained popularity of late but remains misunderstood by many. Self-compassion comes down to treating yourself as you would treat someone else you care about—with kindness, understanding, and the awareness that everyone is human, imperfect, but still inherently worthy.

Dr. Kristin Neff at the University of Texas at Austin was the first person to operationalize, or create a way to define and measure, the idea of self-compassion. She and other researchers since have found three essential components to self-compassion. These are self-kindness, common humanity—which refers to understanding the things we criticize ourselves about are both universal and part of being human—and mindfulness.

Mindfulness, at its most basic level, refers to present-moment, nonjudgmental awareness. The practice of mindfulness has been linked to numerous mind-body benefits, including the ability to notice the thoughts and feelings that tend to cause us suffering—without holding them close, pushing them away, or automatically identifying with them.

Although many of us could identify people we believe would benefit from taking a closer and perhaps more constructively critical look at themselves, there is a large subgroup of people who tend to be overly self-critical. This can come in the form of unfair comparisons, such as, “I’ll never be as good as so-and-so,” to frequent catastrophizing (“I’ve really messed up, and now my life is ruined for good!”), to conditional self-worth (“I’ll be okay/worth something/lovable only when I am [insert criterion here]”).

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Why We Self-Criticize

I’ve noticed a tendency toward chronic or constant self-criticism in those whose parents praised only exceptional behavior (leading to the belief, “If I’m not the best, I am the worst”), spent a lot of time fault-finding, or, in extreme cases, were abusive. If the inner stream of criticism sounds uncannily like the critical statements someone else used to tell you, take note. That’s useful information if you decide to pursue therapy.

Among the many downsides to constant self-criticism: it can leave one either overly vulnerable to feeling criticized—even in response to constructive feedback—and can also lead to projecting self-criticism onto others (and becoming hyper-critical in general). In addition, self-criticism erodes self-esteem and can leave one feeling depressed, anxious, or hopeless.

Why We Resist Self-Compassion

Often people resist the idea of self-compassion because they believe self-criticism is a necessary tool that protects them from “slacking off,” being a “bad” person, or otherwise becoming something they associate with personal failure (“fat,” “alone,” “lazy,” “unlovable,” etc.). People may also feel counter-identified with a parent or other family member who exhibited undesirable qualities, and thus, the self-critical voice may feel necessary to avoid winding up like that person. Similarly, they may worry that without being self-critical, they will fail to take responsibility for the things they do, and perhaps will lack compassion for others (because of the self-indulgence they associate with self-compassion).

The good news is the research on self-compassion has found that the practice is associated with being more compassionate with others, greater altruism, and greater likelihood to forgive others.

The good news is the research on self-compassion has found the practice is associated with being more compassionate with others, greater altruism, and greater likelihood to forgive others. In addition, self-compassion has been linked to being more likely to take responsibility for one’s own actions, greater happiness, increased motivation, and greater self-worth.

Some simple ways to enhance self-compassion include the following:

1. Ask yourself, “Is the way I am thinking about myself the way I would respond to a close friend or other loved one?” If the answer is no, imagine how you would treat others who found themselves in a similar situation. What would you say? What recommendations would you make? How would you offer comfort? How would you help this person reframe their take on things?
2. Write down the answers to the above questions. Now, viewing yourself from the perspective of the observer, speak to yourself in the same compassionate tone, using the language you would use with someone you care about.
3. Remember you, like everyone else, are human. Humans are imperfect, yet born with inherent worth. Most of the things you have suffered over are universal in some way.
4. Remind yourself of the truisms. Mistakes are one of the ways in which we learn. Challenges present opportunities to grow stronger. No one is perfect.
5. Practice mindfulness daily. Set aside time for formal practice, such as breath awareness, and strive to be present for your life in general—however it is in this moment.

References:

1. Breines, J. G., & Chen, S. (2012). Self-compassion increases self-improvement motivation. Social Psychology Bulletin, 38, 1133-1143.
2. Germer, G. K., & Neff, K. D. (2013). Self-compassion in clinical practice. Journal of Clinical Psychology: In Session, 69, 856–867. Retrieved from http://self-compassion.org/wp-content/uploads/publications/germer.neff.pdf
3. Neff, K. D., & Pommier, E. (2012). The Relationship between Self-compassion and Other-focused Concern among College Undergraduates, Community Adults, and Practicing Meditators. Self and Identity, 1-17 (iFirst article). Retrieved from http://self-compassion.org/wp-content/uploads/publications/Neff.Pommier.pdf

Borderline personality (BP) is estimated to affect between 1.5% and 6% of people in the United States. Core features of BP include black-and-white, all-or-nothing thinking, intense, rapidly shifting emotions and difficulties with emotion regulation, challenges in relationships and with self-image, and a tendency toward impulsivity. All of these can exacerbate distress, decrease coping, and make it harder to function socially, at work, and in general. Furthermore, the prevalence of BP in people with chronic pain is significantly greater than in the general population (30%) and is linked to increased pain severity and poorer coping with pain.

Non-suicidal self-injury is a tool frequently used by those with borderline personality in an effort to decrease emotional pain and induce calm. Those who have BP often report both the absence of pain and an increase in well-being or feelings of euphoria when engaging in self-harm, both of which may reinforce the tendency to continue self-harming as a way of coping.

The Pain Paradox

The relationship between pain, self-injury, and BP is complex. Between 70% and 80% of those diagnosed with BP engage in self-injury to distance themselves from painful emotions and distressing thoughts. On the surface, it is perplexing that BP predisposes individuals to not only higher pain tolerance in the face of acute (short-duration) and self-inflicted pain, but lower pain tolerance, as well as greater pain severity and poorer coping, in response to chronic (ongoing) pain.

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The Overlap of Emotional and Physical Pain

Contrary to popular belief, there is no one “pain center” in the brain; multiple brain structures are responsible for the experience of pain. A complex and multifaceted experience, “pain” refers to sensing the location of discomfort, assessing pain severity, registering the quality of pain (e.g., piercing, hot, throbbing, intermittent, etc.), linking to memories related to pain, the emotional response to pain, beliefs one has about the potential for coping with pain, and the ability to devise and follow through with a plan for pain management, among others.

The current and rapidly growing body of research on pain has found that distressing cognitive responses, such as catastrophizing (“I can’t handle this pain; I’m never going to get better!”) and emotional responses, such as depression and anxiety, can worsen both pain severity and coping, as well as challenge one’s ability to stick with a pain management plan that may require patience, persistence, and possibly a temporary increase in pain severity (such as with physical therapy).

This relationship among thoughts, feelings, and physical sensations and their related brain structures is not one-directional: physical pain tends to increase distressing thoughts and emotions and impair coping; distressing thoughts and feelings and poor coping strategies are linked to worsening physical pain. Relatedly, employing adaptive coping, such as taking good care of one’s body via a healthy diet, exercise, and stress management program, and treating any issues related to anxiety or depression, can improve pain and general well-being.

The Brain and Self-Harm as Self-Medication

Borderline personality is associated with increased rejection sensitivity and a tendency to personalize others’ intentions and emotional states. This is thought to occur in part due to over-activation of the amygdala, a small, almond-shaped structure deep in the brain, and under-activation of the anterior cingulate cortex, or ACC.

The amygdala is involved in the experience of intense, often unpleasant emotions, such as anger and fear, as well as emotional memories. The ACC is involved in, among other things, decision making and regulating emotions. Recent research has found that BP is linked to having less gray matter density in the ACC and more in the amygdala, as well as decreased activity in the ACC and increased activity in the amygdala in response to viewing fearful or angry faces.

Theoretically, in response to perceived social rejection, the ACC should help assess the situation, turn down the volume on intense, negative emotions (calm down the amygdala), and help make a “rational” decision about how to handle the situation. This process is compromised in people with borderline personality. Emotional distress due to social pain is a frequent trigger of self-harm in those with BP.

Repeatedly self-harming is thought to stimulate the release of the body’s opioid and cannabinoid receptors, leading to feelings of increased well-being, relaxation, and euphoria. You may be familiar with the effects of exogenous cannabinoids and opioids (those from a source outside of the body). Opioid pain medications are exogenous opioids, and marijuana contains exogenous cannabinoids (the most well known of which is THC). Both substances can prompt feelings of pleasant detachment, pain relief, and euphoria, among other effects.

Self-harm has also been found to increase the predominance of theta brainwaves, which are associated with light sleep, deep meditation, and dissociation, or feeling disconnected from one’s thoughts and feelings. Other studies have found that those with a history of repetitive self-injury had lower cerebrospinal fluid levels of two neuropeptides (proteins) that are associated with analgesia (pain reduction): beta-endorphin and met-enkephalin. It is unclear if low levels of these neuropeptides result from severe childhood trauma, a biological predisposition, or some combination of these. Thus, self-injury appears to prompt the body to release pain-relieving chemicals and induce a trance-like state that blunts physical and emotional pain.

Challenges in Treating Pain

It remains an unfortunate truth that most medical and mental health professionals generally receive minimal or no education about diagnosing and treating chronic pain unless they pursue specialized postgraduate treatment in this area. Imaging, blood tests, and physical exams frequently fail to isolate a cause for many pain syndromes, which can leave both patients and providers feeling frustrated or on the defensive. In the absence of physical evidence for pain, providers may conclude that a person is reporting pain in an effort to gain attention or assistance from others, referred to as “secondary gain.” Providers may also conclude that overwhelming emotions are the sole cause of physical pain.

There is no definitive answer for why borderline personality would be so much more prevalent in people with chronic pain than in the general population.

Although some people do manufacture or exaggerate reports of pain, and emotional distress can be experienced via physical symptoms, the picture is typically more complex for most of those in pain. Furthermore, advances in genetics, immunology, endocrinology, and brain imaging are revealing biological correlates of many pain syndromes once thought to be purely psychogenic (caused by the mind), such as phantom limb pain, irritable bowel syndrome, chronic fatigue/myalgic encephalomyelitis, and fibromyalgia.

Providers who are not well informed about pain can leave pain sufferers both without a plan for pain management and vulnerable to feeling unheard and invalidated. In addition, those who react dismissively to reports of pain and distress are likely to trigger feelings of rejection and abandonment, particularly in those with borderline personality, who are already more vulnerable to these feelings. Overwhelming painful emotions may worsen pain and decrease the ability to manage it.

Why Is Borderline Personality Common in People with Chronic Pain?

There is no definitive answer for why borderline personality would be so much more prevalent in people with chronic pain than in the general population. Because pain is a complex, mind-brain-body phenomenon, one hypothesis is that pain that feels random or beyond one’s control may induce feelings of depression, hopelessness, helplessness, anger, and anxiety—all of which amp up pain. Invalidation by ill-informed providers is more likely to elicit poor coping, particularly in those who may struggle with coping already.

Reports of increased severity of pain and other bodily symptoms in those with BP are correlated with greater levels of anxiety and depression. When researchers have statistically controlled for anxiety and depression in those who have both BP and pain, symptom severity has been similar to that of those without BP.

Another possible explanation for the greater prevalence of BP in chronic pain is that when under significant and prolonged stress, everyone is vulnerable to psychological regression, or using earlier ways of coping that are not adaptive in adulthood. Factors associated with BP, such splitting or black-and-white thinking, emotional instability, impulsivity, and greater emotional intensity, may become more prominent when dealing with the ongoing stressor of chronic pain. Furthermore, because many who have borderline personality experienced trauma or neglect at a developmental stage prior to being able to express feelings verbally, regulate their emotions, or negotiate relationships skillfully, the regression prompted by pain may be both retraumatizing and leave those with BP or BP traits feeling unable to process overwhelming emotions directly. This distress may be acted out in interpersonal relationships with providers and others. In addition, unexpressed distress may be somatized, or experienced as bodily pain. This does not mean that a person cannot have an actual chronic pain condition and also somatize; the relationship between the two is often difficult to tease apart.

Finally, as stated above, clinicians unfamiliar with chronic pain may respond in a way that reactivates the experience of invalidation that is thought to be an important factor in developing BP.

Although there is no definitive conclusion as of yet about the reasons for the pain paradox in borderline personality, it appears to be the result of a complex relationship among the following: a biological predisposition to greater emotional pain, and a higher pain threshold for acute pain but a lower tolerance for chronic pain; the analgesic effects of self-harming; and the feelings of helplessness and rejection often inherent in the processes of seeking treatment for chronic pain. For those with BP, self-harming may serve what feels like an essential function in relieving emotional pain; yet, the ongoing and intense stress of chronic pain can overwhelm coping resources and diminish the ability to cope with either pain or the social, medical, and interpersonal challenges that accompany it.

References:

1. Ducasse, D., Courtet, P., & Olie, E. (2014). Physical and social pains in borderline disorder and neuroanatomical correlates: A systematic review. Current Psychiatry Reports, 16, 443.
2. Magerl, W., Burkart, D., Fernandez, A. Schmidt, L. G., & Treede, R. (2012). Persistent antinociception through repeated self-injury in patients with borderline personality disorder. Pain, 153, 575-584.
3. Mayo Clinic News Network: Irritable Bowel Syndrome. Retrieved from http://newsnetwork.mayoclinic.org/discussion/mayo-clinic-researchers-find-genetic-clue-to-irritable-bowel-syndrome/
4. Minzenberg, M. J., Fan, J., New, A. S., Tang, C. Y., & Siever, L. J. (2008). Frontolimbic structural changes in borderline personality disorder. Journal of Psychiatric Research, 42(9), 727-33.
5. National Alliance on Mental Illness (NAMI) – Borderline Personality Disorder. Retrieved from http://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder
6. Niedtfeld, I., Schulze, L., Kirsch, P., Herpertz, S. C., Bohus, M., & Schmahl, C. (2010). Affect regulation and pain in borderline personality disorder: a possible link to the understanding of self-injury. Biological Psychiatry, 68, 383-391.
7. University of Maryland: Chronic Fatigue Syndrome. Retrieved from http://umm.edu/health/medical/reports/articles/chronic-fatigue-syndrome
8. Light, K. C., White, A. T., Tadler, S., Iacob, E., & Light, A. R. (2012). Genetics and gene expression involving stress and distress pathways in fibromyalgia with and without comorbid chronic fatigue syndrome. Pain Research and Treatment. Retrieved from http://www.hindawi.com/journals/prt/2012/427869/

There’s a good reason why more than 16 million people have viewed Harvard professor Amy J. Cuddy’s TED Talk: “Your Body Language Shapes Who You Are.” In it, Dr. Cuddy describes findings that seem to be both commonsensical and revolutionary all at once; even two minutes of adopting a powerful stance can change both one’s physiology and behavior. Over time, acting as if one is confident and powerful can positively impact self-concept, or the way we view ourselves.

Other research has shown that people who feel powerful tend to have a greater sense of agency, better cognitive function, adopt more expansive body language, and are more willing to take action than those who feel less powerful. People who feel disempowered tend to adopt more contractive or protective postures. During her talk, Cuddy shows photographs of the iconic Wonder Woman stance (i.e., hands on hips, feet apart, head erect, and gaze confident) as one example of a power pose. She contrasts this with images of protective postures (i.e., limbs in toward body or crossed, shoulders forward, chin tucked). In effect, feeling powerful leads one to take up more space, both literally and psychologically. Furthermore, powerful people tend to have higher baseline levels of testosterone, lower baseline levels of cortisol (a stress hormone), and reduced cortisol reactivity to stressors.

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In their study, Dr. Cuddy and colleagues hypothesized that adopting high-power poses would lead to increased testosterone, decreased cortisol, and higher risk tolerance. They randomized 42 men and women into two groups, where they would be posed in either high or low power positions by an experimenter for a total of two minutes. Power poses were characterized by expansiveness (taking up more space) and openness (limbs open versus closed or crossed; the specific poses used can be viewed in their article).

Cortisol and testosterone levels were measured before and after the poses. Participants’ willingness to engage in risk taking was measured via a gambling task, and subjective feelings of power were measured by self-report.

The team found that their hypotheses were confirmed: Just two minutes of high-power posing was associated with a statistically significant increase in testosterone and decrease in cortisol. High-power posers also reported feeling more powerful and “in charge” than low-power posers. Furthermore, they were more likely to view a game of risk as an opportunity to win rather than to lose. In contrast, those who had adopted low-power poses for two minutes had significant decreases in testosterone, increases in cortisol, reported feeling less powerful, and were more likely to avoid risk, viewing it as an opportunity to lose.

Why is this important?

Aside from the subject distress associated with feeling powerless, persistently elevated stress hormone levels are linked to increased incidence of stress-related illnesses, including immune issues and hypertension. In addition, if we feel chronically at a disadvantage, we are likely to act in accordance with this belief, avoiding situations because we view ourselves as less likely to navigate them successfully.

In her talk, Dr. Cuddy equated personal power with feeling more confident in one’s ability to “win,” and thus, greater willingness to take chances that may result in some reward. She also noted the difference between male and female business students’ body language and levels of class participation (men tend to participate more, and adopt power poses more frequently; women as a group participate less often, despite the fact their grades depend on participation). Cuddy attributed this difference at least in part to the fact women are socialized differently from men; my interpretation of this is that, in general, women are encouraged to be nice, and discouraged from taking up too much space, physically or otherwise.

It is intriguing to wonder what the long-term benefits could be of consciously adopting more powerful, self-confident body language, particularly if one feels stressed, discouraged, or down. It certainly seems worth trying. If you do this, please let me know what you think.

Be well!

The winter solstice is nigh upon us, and marks the shortest, darkest day of the year. The term solstice is derived from the Latin words for “sun” and “to stand.” On December 21, the sun’s high point in its daily path will be at the southernmost point for the year. The next day, it will begin its journey northward, each day becoming a little bit lighter. But for a few days before and after this period, the changes will be so slight that the sun’s high point will appear to stand still, even though powerful change is taking place.

The solstice also officially marks the beginning of winter. Seeds planted in the spring have yielded their harvest, and although we now commence celebration and feasting, the solstice serves as a celestial reminder that soon we must allow for stillness, reflecting on the past year before beginning anew in the next.

At times, the urge to resist going within can be strong. We may try to distract ourselves; parties and libations and presents serve this purpose quite effectively. Setting aside time for reflection enables us to make meaning of our year, however. And once we understand what has transpired, we can better decide what it is we hope to create in the coming year. If we allow it, this can be a time of grieving those we have lost, as well as celebrating their gifts and memories that remain. Similarly, it can be a time of gratitude for our accomplishments or the opportunities we have been given, as well as a time for identifying what we would like to do differently going forward.

Ideally, if we are brave enough, as we take stock of our lives we can create space to allow ourselves to fully experience the feelings we have, without fighting or judging them. We can breathe through them. It is this process that can help us to then release these feelings sufficiently to move forward—the equivalent of surveying what one’s plantings have yielded, appreciating the harvest for whatever it was, and deciding whether we hope to harvest the same or something different the next time around.

[fat_widget_left]A reflective period need not—and should not—be a time to be unduly harsh with ourselves, but rather to be lovingly honest. Firm yet forgiving. After all, endless rumination and self-recrimination keeps us trapped in a past we cannot change, and no one benefits from this. An attitude of self-forgiveness can liberate us from old patterns or ways of being that we likely adopted for a reason, but that do not serve us nor adequately reflect who we are and who we’d like to be.

What an incredible gift to give ourselves.

Activities that facilitate going within include meditation, setting aside time for silence, being in nature, and engaging in a creative activity, among others. If you find it difficult to quiet your mind at first, move your awareness to your breath, observing it as if you were observing the waves of the ocean, leaves blowing off into the distance, or clouds drifting across the sky. As you do so, you may wish to ask yourself the following questions. Allow your answers to be honest.

1. What do I really want each aspect of my life (e.g., family, work, romance, creativity, spirituality, health) to be like in the coming year?
2. How much effort am I wiling to put into making positive change?
3. What tool or support will I draw upon to help me when things feel difficult (e.g., conscious breathing, meditation, psychotherapy, friends/family, religious community)?
4. How will I accept the things that I may be unable to change—my best efforts notwithstanding?
5. How will I know when I have achieved positive change (what will this look like specifically)?
6. Can I commit to loving myself as I am now—the only way I will ever be in the present moment—even as I plan for and work toward change?

Write down what you discover. Periodically, take your list out and fine-tune as needed. Decide when you will begin making concrete steps toward your goals. These are the seeds you will sow. Visualize yourself continuing to grow and learn, and do the things that matter to you and give your life meaning. This is how you will till the soil, plant your seeds, and care for them. Every day, celebrate your life—this is what you will harvest.

A happy holiday season, and a peaceful, healthy New Year to all!

Humans have been making music ever since they realized that tapping two sticks together could create an engaging beat. Music can foster feelings of joy, unleash our creativity, and is often a key feature of our most enjoyable social gatherings. Ever versatile, music can set the tone for romance or relaxation, and can impel us to move our bodies, whether for exercise or self-expression.

In the mid-twentieth century, music therapy emerged as a discipline, and the development of modern technologies has since shed new light on how music can change the structure and function of the brain, improve mood, and help us recover after a stroke.

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Music and the Brain

One thing we have learned is that music is processed by a number of different areas of the brain, including ones involved in spoken language. Learning to play music changes the structure of our brains in a way that is somewhat analogous to how physical exercise tones our muscles and makes us stronger and more dexterous. A number of studies with healthy and clinical samples have shown temporary cognitive benefits associated with listening to pleasant music, including improved information processing speed, reasoning, attention and memory, and creativity.

In some studies, verbal material that was presented in a musical context was learned and recalled better than spoken verbal material. Music therapy has also helped people who have had strokes to improve their gait, mood, speech, social interactions, and to reduce visual neglect.

Music Therapy and Visual Processing

Visual neglect is the inability to recognize objects in part of the visual field due to lesions in the visual cortex. Specifically, a lesion in one hemisphere produces neglect in the opposite visual field (so a stroke in the left visual cortex would result in one being unable recognize objects in the right visual field, and vice versa). In one study of stroke patients experiencing visual neglect, listening to pleasant music resulted in both better mood and a statistically significant improvement in their ability to describe the color and shape of geometric objects presented via computer. No such effects were observed when patients sat in silence or when they were presented with music that they did not like.

Further examination with functional magnetic resonance imaging (fMRI) confirmed that listening to pleasant music activated a number of different brain areas, including those involved in visual processing.

Memory, Attention, and Mood

The same team conducted another study, this time with 60 patients who had recently suffered a stroke. Participants were randomly assigned to one of three groups: a music group, an audio book group, or a control group receiving neither intervention. All groups otherwise received standard medical treatments. Those in the two audio groups were allowed to select either the music or audio books of their choice and were asked to listen for an hour daily for two months, and then more on their own after the intervention period ended.

Listening to music was associated with greater recovery of verbal memory and focused attention in the music group versus the other two. Furthermore, the music group participants had significantly less depression and confusion than those in the control group. This benefit was seen within the first three months of listening.

The act of listening to music has been associated with a number of benefits, including on mood, cognition, and physical functioning in healthy people and in clinical samples, such as those who have suffered a stroke.

Those in the music group reported that listening helped them relax, increased their motor activity, and improved their moods. In both the music and audio book groups, participants said the experiences provided positive stimulation. Preliminary imaging results suggest that listening to music following a stroke may result in observable changes to the structure and function of the brain that enhance recovery.

The researchers speculate that the short-term cognitive benefits of music therapy post-stroke may be related to effects on the brain’s reward system and effects on the neurotransmitter dopamine, but the long-term effect is more likely due to improvements in mood somehow impacting improvements in verbal memory and attention. Music may also mitigate the negative effects of stress on the brain and body, and impact other neurotransmitters that play a role in recovery.

The act of listening to music has been associated with a number of benefits, including on mood, cognition, and physical functioning in healthy people and in clinical samples, such as those who have suffered a stroke. Although we are still learning about how and why music helps, it is worth making time for music to move your body, engage your mind, and soothe your soul.

References:

1. American Music Therapy Association: http://www.musictherapy.org
2. Thaut, M., & McIntosh, G. (2010). How Music Helps to Heal the Injured Brain. Therapeutic Use Crescendos Thanks to Advances in Brain Science. Cerebrum. http://dana.org/news/cerebrum/detail.aspx?id=26122
3. Sarkamo, T., & Soto, D.  (2012). Music listening after stroke: Beneficial effects and potential neural mechanisms. Ann. N.Y. Acad. Sci., 1252, 266–281.

As I sat to write my end-of-the-year complementary and alternative medicine blog post, I questioned the wisdom of discussing prayer for healing, as prayer remains one of the most hotly debated CAM therapies. For many people, prayer is a meaningful part of their daily lives; for others, it may be engaged in more out of duty than beliefs. And for some, prayer is simply a practice in which other people engage.

Regardless, according to a large-scale survey by the National Institutes of Health, approximately 43% of Americans say they pray to improve their health, and about 24% indicated asking others to pray on their behalf. In the scientific community, however, the topic of prayer can be as polarizing as many of the other issues and events that marked 2012.

What’s the Evidence?

The research evidence for whether intercessory prayer (prayer on behalf of another for the purpose of healing) can improve mood, heal wounds, or enhance other health-related outcomes has been subject to much scrutiny and harsh debate. The quality of the research has been variable, as have the results. There are also many who believe it is inappropriate to test whether prayer can affect change. Yet prayer for healing, specifically, remains one of the most commonly used CAM “techniques.”

Several prayer studies have found positive effects, whereas others have found prayer to make no difference with regard to health (or even be associated with slightly poorer outcomes). Many have pointed out, not incorrectly, the tendency for the prayer research to create more questions than it answers. Researchers in both the “pro” and “against” camps regarding prayer agree that one challenge in evaluating this type of intervention is that it is not possible to completely rule out whether those in the control or “no prayer” group have in fact also received prayers from loved ones or clergy during the study period. If those in the “no-intervention” group are prayed for, and prayer does have an effect, theoretically this would make it difficult or impossible to tell the difference between one group and another. Thus, even if prayer for others could help them heal, we would be unlikely to detect this effect in a research situation described above.

Of course, no study can answer whether there is, in fact, a God or other divine organizing principle; if He or She answers study-related or other prayers; or whether religious affiliation of the one praying has any impact on the outcome.

Why Pray, Then?

The question of whether prayer should be studied, or if it has any efficacy as a tool for healing, will not be answered here. Regardless of the scientific evidence available, people who pray will likely continue to do so for themselves and others. Prayer brings millions of people comfort, and helps them feel connected to others as well as to something greater than themselves. Thus, given the time of year, and especially in light of the events of recent months, it seems relevant and important to mention it here.

As someone who has engaged in research, I know that my questions may never be adequately answered by the data, and yet, as a human being, I admit that when I or someone I care about has been ill or experienced significant difficulty, I have very much appreciated and at times solicited prayers, healing intentions, and “good vibes.” Over the years, I have also worked with many medically ill children and adults, and I can say that prayer is very common in the hospital setting and elsewhere, even when it is not obvious.

Perhaps there is a difference between private prayer for oneself, a loved one, or for one’s community, as compared to prayer for a stranger identified only by a study ID number, at least with regard to the meaning it has for us. Although I am not a religious person, on occasion I have prayed for my clients, although I have never prayed with any of them. At these times, when I have prayed for or hoped on someone’s behalf, or tried to visualize a positive outcome, I have often felt a sense of connection with something greater than myself—whether this is evidence of the divine or simply a sense of knowing I am part of a caring community, or a benefit I receive simply from striving to do good in some way, I cannot say for certain. And at those times, I am not really sure that finding “proof” matters all that much anyway.

Whatever your beliefs, my wish for us all in the coming year is to treat each other with respect, kindness, and compassion. If you do pray, among other things, pray for peace.

Goodwill to all!

References:

1. Davis, J. L. (2006). Can prayer heal? http://www.webmd.com/balance/features/can-prayer-heal
2. Mind and body: Do music, imagery, touch, or prayer improve cardiac care? (2006). Harvard Men’s Health Watch; 11, 6-7. http://www.health.harvard.edu/newsletters/Harvard_Mens_Health_Watch/2006/December/Mind_and_body_Do_music_imagery_touch_or_prayer_improve_cardiac_care
3. More than one-third of U.S. adults use complementary and alternative medicine, according to new government survey(2004). http://nccam.nih.gov/news/2004/052704.htm

Binaural beat technology (BBT) was discovered in the early 1800s and first described in the popular literature in the early 1970s. In the last four decades, binaural beat audio programs have been touted as tools for reducing stress, improving sleep, enhancing concentration, and even fostering altered states of consciousness. In the ‘70s and ‘80s, BBT audiotapes were primarily found in more esoteric venues, such as New Age bookstores, health food emporia, and retreat centers dedicated to consciousness exploration. One such center, the Monroe Institute in Virginia, is well known for their use of Hemi-Sync recordings, which feature BBT.

Today, BBT has become more commonplace, as one can download MP3s and smartphone applications in a matter of moments. Although the prevalence and popularity of such products has waxed and waned, several studies examining the potential usefulness off BBT have been conducted with a variety of populations.

What is BBT?
The term “binaural beat” refers to the brain’s tendency to hear the difference between two similar tones that are played in opposite ears as one new tone.  Our ears hear tones in terms of hertz (Hz), or cycles (the number of times a wave repeats itself) per second. Beats played at frequencies that are characteristic of brain wave frequencies are both audible and thought to facilitate alterations in our predominant brain-wave state.

Types of Brain Waves and Their Associated States
At any given time, our predominant brain wave may be in the frequency associated with deep sleep or deep trance (delta; 1-4 Hz), meditation (theta; 4-8 Hz), relaxed awareness or daydreaming, (alpha; 8-12 Hz), a state of relaxed focus (low-beta, or sensorimotor rhythm [SMR]; 12-15 Hz), alert mental activity/concentration (mid-beta; ~15-18 Hz), anxiety (high-beta; >18 Hz), or high-level information processing (gamma; >30 Hz). Gamma brain-wave states appear to be the least well researched. There is no “best” state to be in; however, at different times we will understandably want to be able to shift into one that is appropriate to the task at hand, whether sleeping, working on a project, or relaxing.

What Type of BBT for Which Conditions?
It has been hypothesized that a number of conditions, including chronic stress, chronic and postoperative pain, migraines and other headaches, problems with attention/concentration or learning, and insomnia, to name a few, reflect an imbalance or irregularity in brain-wave states. The deliberate use of BBT to change the predominant brain-wave state is referred to as brain-wave entrainment (BWE). BWE is not limited to BBT, but discussion of other methods is outside the scope of this article. However, a 2008 review of the BWE literature found that delta stimulation was associated with improvement in migraines and other headaches and reduction in short-term stress. A single session of alpha stimulation was associated with stress reduction in some settings, but not for those undergoing root canal. Alpha stimulation was also linked to pain relief. Beta improved attention, reduced short-term stress, alleviated headaches, reduced behavioral problems, and improved performance on measures of overall intelligence. An alpha-beta protocol improved verbal skills performance and attention, and a beta-gamma protocol showed improved arithmetic skills in children who had learning disabilities or attention-deficit hyperactivity. Most of these studies examined photic stimulation (presented via flashing lights) or combined photic and BBT entrainment rather than BBT alone. Thus, it is difficult to draw a definitive conclusion about the specific utility of BBT from this review.

BBT as a Potential Tool for Reducing Anxiety and Pain
The results of a small pilot study published in 2007 found that listening to an hour-long program emphasizing delta BBT for 60 days was associated with a decrease in self-reported trait anxiety and an increase in quality of life among eight healthy adults. The level of dopamine (an excitatory neurotransmitter) was also decreased significantly and may be related to the decrease in trait anxiety scores. Interestingly, the team assessed changes in the level of growth hormone because the BBT’s producer claimed that listening would increase these levels. Growth hormone decreases with age, and thus, an increase would be considered a potentially beneficial outcome; yet, listening to this BBT program was associated with a significant decrease in growth hormone. Both the reasons for this result and it’s implications are unclear.

Perhaps two of the more intriguing studies about BBT were the following trials with patients undergoing surgery. The first is a 2005 double-blind, randomized controlled trial in which 108 patients undergoing general anesthesia for elective surgeries received either a BBT plus music audio, the same music without BBT, or no intervention other than standard care for a 30-minute period prior to their operations. The BBT audio featured a progressively slowing beat that ended with 10 minutes of delta. No adverse events were noted, and although initial state anxiety scores were higher in the BBT group (prior to the intervention), the most significant decrease in anxiety was also in the BBT group—even after adjusting for the fact that participants in this group on average had higher initial anxiety. Listening to music alone was also associated with a significant decrease in anxiety, but this decrease was of a lesser magnitude than that of the BBT group. This study showed that an inexpensive, one-time intervention of short duration was beneficial despite the stress characteristic of undergoing surgery.

The other study was a randomized controlled trial of 60 patients about to have surgery with general anesthesia. Twenty patients were assigned to each of three conditions: a Hemi-Sync BBT program, listening to the music of their choosing, or listening to a blank audiocassette for 30 minutes prior to surgery. None of the participants was offered any sedative premedication. Stereo headsets from all groups of participants were removed before the patients entered the operating room but were replaced and the respective audio programs restarted after the induction of anesthesia. Headsets were discontinued at the conclusion of surgery. The researchers found that using the Hemi-Sync programs resulted in significantly less intraoperative use of fentanyl (a very potent, synthetic opiate pain medication), lower self-reported pain scores several hours after the surgery, and being discharged from the hospital sooner. Unfortunately, the specific frequency of BBT was not described in this article.

Anecdotally, several months ago I went for my first-ever root canal and noticed considerable anxiety at the thought of having a very sensitive tooth drilled (even with anesthetic). On the way to the endodontist’s office, I listened to both a guided imagery program designed specifically for medical procedures in which one must remain awake (available via HealthJourneys.com) and also to a free delta BBT program (Napuru) I’d downloaded for my iPhone. The delta tones were played against a backdrop of ocean waves. My subjective experience was that the BBT and imagery, combined with mindfulness practice before and during the root canal, reduced my anxiety significantly and enabled me to get through what seemed like an eternity of loud drilling. I cannot say what the most “active” ingredient in this integrative approach was; however, the point is that this nondrug, inexpensive, easy-to-use adjunct was effective for me.

BBT has been around for decades and is now readily and inexpensively available. There are some data to suggest that it may be helpful for relieving anxiety in general and in the context of a stressful event. There is also some evidence that BBT or other methods of brainwave entrainment may help with pain, concentration, headaches, and other issues, and serious risks or side effects have not been reported. The current research does not definitively answer the question of whether there would be a dose-response effect or a benefit from listening to BBT more regularly versus listening once; however, this seems plausible. More research needs to be done to better elucidate whether BBT could be used as an independent therapeutic tool, however. Additionally, assuming BBT is effective, one should not drive or perform tasks requiring sharp focus when listening to delta, theta, or alpha tones, as these may induce a very relaxed state.

For More Information:

1. Dabu-Bondoc, S., Vadivelu, N., Benson, J., Perret, D.,  Kain, Z. N.  (2010). Hemispheric Synchronized sounds and perioperative analgesic requirements. Anethesia & Analgesia, 110(1), 208-210.
2. Huang, T. L., Charyton, C. (2008). A comprehensive review of the psychological effects of brainwave entrainment. Alternative Therapies in Health and Medicine, 14(5), 38-50.
3. Padmanabhan, R., Hildreth, A. J., Laws, D. (2005). A prospective, randomised, controlled study examining binaural beat audio and pre-operative anxiety in patients undergoing general anesthesia for day case surgery. Anesthesia, 60, 874-877.
4. Wahbeh, H., Calabrese, C., Zwickey, H. (2007). Binaural beat technology in humans: A pilot study to assess psychologic and physiologic effects. The Journal of Alternative and Complementary Medicine, 13(1), 25-32.

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