The Science of Emotion (Harvard Medicine)

8/13/2019 The Science of Emotion (Harvard Medicine)

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Anger Management

Scientists probe the nature of wrath in the hope of devising cures

by ELIZABETH DOUGHERTY

Joson/Getty Images

WHEN EMOTIONAL BRAKES FAIL

Depression and anger often go hand in hand

Flares and flashes. Outbursts and eruptions. The words used to describe anger tend to be olcanic. Andscience may e!plain why.

"hen an angry feeling coincides with aggressie or hostile behaior# it also actiates the amygdala# an

almond$shaped part of the brain associated with emotions# particularly fear# an!iety# and anger.

This finding is one in a series from studies led by %arin %ougherty# an &M' associate professor of psychiatry

at Massachusetts General &ospital# that aim to uncoer why anger attac(s occur in patients with ma)or

depressie disorder. 'ome of these patients e!perience angry flare$ups that are inappropriate to the situation

and out of character for the indiidual. *+eople will yell or throw things#, says %ougherty. *"e wanted to

inestigate the mechanisms behind those reactions.,


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For these patients# angry outbursts usually stop when the depression ends. -nderstanding this lin( could

proide aluable insights into these disorders and their treatment.

%ougherty began in by inestigating healthy people with no signs of depression and no history of angry

episodes. &e employed positron emission tomography imaging to e!amine which regions of the brain engage

during angry moments. 'ub)ects simulated angry moments by recalling the moments in their lies when they

felt rage. *0ou can try to spar( anger by showing upsetting pictures# for e!ample#, says %ougherty. *1ut the

response isn2t as robust. The best way to induce emotion is through autobiographical scripts.,

%uring angry recollections# the amygdala fired. At the same time# a part of the orbital frontal corte!# )ust aboe

the eyes# also engaged# putting the bra(es on emotion. *&ealthy people e!perience anger#, says %ougherty#

*but they can suppress it before acting on it.,

In depressed people who are prone to anger attac(s# this neurological bra(e fails to engage. In another study#

%ougherty found that in people with ma)or depressie disorder and anger attac(s the orbital frontal corte! did

not actiate. 3ather# actiity in the amygdala increased and angry outbursts ensued. More recently# %ougherty

used functional magnetic resonance imaging to achiee a more fine$grained e!amination of the timing of the

amygdala2s actiation during angry moments.

4ow %ougherty is applying these research techni5ues to e!amine what happens in the brain during treatment

for anger and depression using drugs or cognitie behaioral therapy to better understand how treatments wor(

mechanistically. -ltimately he hopes this wor( will gie clinicians better insights into which treatment options

might be best for patients.

STICKS AND STONES

Verbal abuse injures young brains

6eryone feels anger. Traffic snarls# unsympathetic colleagues# playground bullies7 we all hae our triggers.The problems start when anger boils oer into hostility and aggression# behaiors that cause harm.


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T&6 8I%' A36 4OT A99 3IG&T: Martin Teicher# pictured aboe# has documented the damage that parental erbal abuse

wrea(s on the brains of their children.

3ose 9incoln/&arard 4ews Office

According to research from Mc9ean &ospital# seemingly harmless anger may cause inisible damage to the

brains of young children. Martin Teicher# an &M' associate professor of psychiatry at Mc9ean# has found that

erbal abuse from parents and peers causes changes in deeloping brains tantamount to scarring that lasts into

adulthood.

Teicher began his inestigations by e!amining the effects of se!ual abuse# physical abuse# and harsh corporeal

punishment on young brains. In ;


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More recently# Teicher found that peer erbal abuse>whether teasing# belittling# or disparaging words>can

cause similar damage. *8ids often hear many negatie things from their peers#, he says.

Teicher2s latest research suggests that parental and peer erbal abuse may affect children differently

throughout deelopment. "hen e!perienced during early childhood# erbal abuse can lead to somati?ation# the

translation of emotions into physical illness. %uring middle school# it can increase the li(elihood of drug abuse#

an!iety# and depression. In high school# it can lead to increased anger and hostility.

*The e!pression of a lot of anger can be pathogenic#, Teicher says. *@hildren especially suffer when anger is

ented. Openly e!pressed negatie# raw# and intense emotion is hard for many people to witness and can leae

scars., That is# children2s brains seem to turn down the olume on abusie words# images# and een pain. The

result is diminished integrity in these sensory pathways.

Teicher is now inestigating the effects of witnessing domestic iolence. 6arly findings suggest that all

sensory systems may be ulnerable to iolence7 abuse that is heard may damage regions distinct from those

in)ured by abuse that is seen or felt. &is wor( as a whole suggests that anger may desere more attention from

psychiatry.

*"e2e really focused on depression and an!iety as (ey emotions#, he says. *1ut anger is a big problem. It2s a

problem when we e!press it too much and when we e!press it too little.,

THE SOUND OF THE FURY

Turn off your phones. And televisions. And game consoles...

6eryone# from children to great$grandparents# uses electronic media# and media use will only grow moreperasie. At least# that2s how Michael 3ich 2# an &M' associate professor of pediatrics at @hildren2s

&ospital 1oston# sees it.

0et since the earliest days of teleision# electronic media has been a blame$ta(er. In the fifties# people worried

that teleision would turn children into delin5uents. Today# parents fear that iolent moie scenes and game

scenarios will breed anger# aggression# and iolence. These accusations against media# 3ich beliees# come

down to alues$based arguments# not scientific eidence.

In the fifties# people worried that teleision would turn children into delin5uents. Today# parents fear that iolent moie scenes


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and game scenarios will breed anger# aggression# and iolence.

6ri( %ungan/'toc(.chng

In an effort to drill down to media2s true effects# 3ich has launched a longitudinal surey study. *"e2re trying

to create the media e!posure e5uialent of the Framingham &eart 'tudy#, he says. The pilot study# now in its

third wae of data collection# inoles an ethnically and socioeconomically dierse group of ;B middle$

school students from Manchester# 4ew &ampshire.

3ich began the inestigation with computer$based self$interiews to understand each child2s typical media

use# health behaiors and health status. For one wee(# participants carry a +alm +ilot and ideo camcorder#

soon to be replaced by a smartphone# which they are randomly signaled to use during wa(ing hours to capture

their locations# companionship# media use# focus of attention# and emotional state. After completing the =C$

5uestion form>which# gien the media adeptness of the young participants# usually ta(es less than < seconds

>participants ma(e a 5uic( DB


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3ich aims to better understand the ways media affect people2s health and intends to share this information

through his online parenting column# As( the Mediatrician. *In a way# urging responsible media consumption

is li(e promoting food safety and traffic safety#, he says. *0ou don2t want to lecture people# but to gie them

facts so they can ma(e informed decisions.,

ALIEN THERAPY

A video game trains angry children to keep their cool

+eewE +eew peewE Missed that alienE +eewE +eewE Oh# noE Just shot a good guy. +eewE +eew peewE

@ourtesy of Joseph Gon?ale?$&eydrich

"elcome to 3AG6 @ontrol 3egulate and Gain 6motional @ontrol# a shoot$2em$up ideo game designed# as

its name suggests# to teach anger management. This counterintuitie game>the (ind often blamed for

reinforcing behaiors that celebrate anger>wor(s. The (ey elementH "hen players2 heart rates rise# indicating

the emotional arousal that can lead to anger# their guns start shooting blan(s. For adolescents who respond to

minor stresses with angry and dangerous outbursts# the game may be an alternatie to pharmaceutical

interentions such as antipsychotics. In addition# says Joseph Gon?ale?$&eydrich# an &M' assistant professorof psychiatry at @hildren2s &ospital 1oston and leader of the 3AG6 @ontrol pro)ect# the game may enhance

the effectieness of behaioral therapy.

-nli(e traditional biofeedbac( training# in which people learn to calm themseles by disengaging from reality#

3AG6 @ontrol re5uires players to stay internally calm during an intense and frustrating actiity. In this game#


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players must destroy googly$eyed aliens falling down the screen without harming the affable snails that s5uish

past.

*"e (new this type of game would force the (ids to ma(e decisions constantly while still (eeping their arousal

in chec(#, says Jason 8ahn# an &M' instructor in psychiatry who built and helped design the prototype. *+lus

it would be something they would wantto play., The game# modeled after 'pace Inaders# targets children

aged eight and up.

The researchers combine game play with behaioral therapy that teaches such anger management techni5ues

as deep breathing. The game also seres as an icebrea(er for therapists. *The game proides patients with an

opportunity to tal( about their actions and feelings in the conte!t of the game rather than haing to reisit

uncomfortable# demeaning topics such as past bad behaior#, says +eter %ucharme# a clinical social wor(er at

@hildren2s &ospital 1oston who is inoled in the pro)ect. *+racticing the game lets them e!perience

mastering the s(ills presented in therapy. This in turn allows them to open up about their difficulties.,

%uring the early stage of testing the game# the researchers recruited children who were inpatients in a

psychiatric unit. *The alternatie treatment for these (ids would be antipsychotic drugs# which hae a host of

side effects and don2t get at the root of the problem#, says Gon?ale?$&eydrich. *0ou don2t learn to control

your aggression by ta(ing antipsychotics.,

A recent trial of the game compared patients receiing the normal course of treatment with those receiing

psychotherapy coupled with game play. Gon?ale?$&eydrich cautions that the study was small# and that a

larger# randomi?ed controlled trial has started. At the same time# he says# *The game interention had a

profound effect. The (ids reported feeling less angry.,

THEMS FIGHTIN WORDS

erotonin and dopamine drive aggression in fruit flies

3aised in isolation# he had no role models. &e had neer een witnessed a fight. 0et when he stepped into thering# he had all the moes. &e postured# lunged# and bo!ed# dancing li(e Muhammad Ali and )abbing li(e

'ugar 3ay.

&ow did he feel when he faced his first foeH AngryH FrightenedH It is a 5uestion for the ages# for our ictorious

pugilist is a fruit fly.

*"e don2t (now when flies are angry#, says 6dward 8rait?# the George +ac(er 1erry +rofessor of

4eurobiology at &M'# who studies fruit$fly aggression. *"e can2t as( the animals how they feel.,


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@OM6 O-T '"I4GI4G: 6dward 8rait?s research team has found that during half$hour fights# fruit flies aerage ;

encounters of seconds each. The s(irmishing flies moe so 5uic(ly that the researchers need slow$motion instant replay to

score them.

Arlindo/istoc(photo.com

"hat 8rait? canas(# howeer# is what dries this innate aggressie behaior. 'uch research# although it does

not translate directly to human anger# can proide insights into hostility and bullying. 8rait? saw similar

unlearned# unpracticed fighting instincts in lobsters# ma(ing the 5uestion about hardwired anger een more

curious. &e selected flies as a model for teasing out the genetics# though# because flies can be bred rapidly and

raised in complete isolation.

8rait? has found that flies show aggressie behaiors when they face competition for resources# such as food

or a mate. At first# they all fight the same way# but oer time# winners and losers emerge. *9osing flies deelop

a loser mentality#, says 8rait?. They fight less aggressiely against opponents they2e lost to before and# een

though they approach new foes with gusto# they tend to (eep losing.

6en bullies# the ictors who (eep pic(ing fights and winning# will lose their competitie adantage after )ustone loss.

In recent wor(# 8rait? bred flies with *tunable, aggression. In these transgenic flies he can selectiely turn on

and off neurons that contain serotonin and dopamine to determine what roles these neurons play in aggression#

fight intensity# and the creation of pec(ing orders.

'erotonin# he found# is crucial for fight intensity. "ithout it# flies will not do battle with gusto. %opamine

appears to inhibit aggression: In its absence# flies fight at higher intensity leels. 8rait? and colleagues plan to

isolate the specific neurons inoled and wor( out the circuitry that goerns these behaiors.

"hile it2s tempting to relate such findings to humans and their mood disorders# 8rait? aoids such e5uations.

*"e are after general principles of how these neural circuits wor(# and some of the chemicals are the same

across species#, he says. *1ut the details of the circuitry are going to be completely different.,

!li"abeth Dougherty# a former science writer at H$# is now a freelance science writer and novelist living in

central $assachusetts.


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The @hill of Fear

Dread requires only a tenth of a second to take root

by ANN MARIE MENTING

Ocean/@orbis

Acopse can bec(en# with its dappled leaes and songbird trills. 1ut linger past twilight# and tree# bush# andanimal assume different dimensions. Trun(s thic(en and loom# bushes snatch at clothing# and the rustlings and

s(itters of feather and claw magnify. 0ou become unsettled# unnered. 0ou run.

0ou do this because you2re afraid. 6en without direct eidence of danger# you2re compelled to flee# to protect

yourself. "hy this compulsionH It2s the wor( of your amygdala# a tiny almond$shaped structure in your brain.

'ensory signals alert it7 in turn# it triggers a cascade of actiity# deluging your body with messages that widen

your eyes# pric( your ears# accelerate your heart# 5uic(en your breathing# wrench your stomach# moisten your

palms# and launch a full$body# organ$clenching# corpuscle$filling chill. 0ou run 5uite simply because feargrips you.

*0ou could call the amygdala a releance detector#, says 4ouchine &ad)i(hani# an &M' associate professor of

radiology who speciali?es in capturing the actiity of the brain as it reacts to fear$proo(ing stimuli. *In less

than


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The good news is that# should the terror proe benign# you2ll not long be in fear2s thrall. For while your

amygdala is proiding surial insurance by spurring action# sensory clues are also traeling to your prefrontal

corte!. The amygdala2s action buys you additional milliseconds# during which you might glimpse a light#

stumble upon a traeled road# or receie other sensory stimuli that your prefrontal corte! will use to temper the

initial response. 0ou will calm# completing an arc of reaction that has been (ey to mammalian surial througheons.

Inestigating what dries that arc of reaction spurs much of today2s research into the molecular mechanisms of

the fear response. &M' scientists are proiding tantali?ing insights by e!plaining how we decipher danger in

the ga?es or body moements of others# by informing treatments for conditions such as post$traumatic stress

disorder# and een by proiding clues to the gender$based underpinnings of human response to fear.

FEAR FACTORS

A ;


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reported on their inestigation of one aspect of facial e!pression>the ga?e>and its role in communicating

danger. They found that while a direct ga?e from a fear$filled face triggers actiity in fear$response regions of

the brain# the response is not as comple! as that elicited by a fear$filled face in which the eyes are aerted. A

direct ga?e signals an interaction between participants who (now themseles to be non$threatening. 1ut an

aerted ga?e# *pointing with the eyes#, as the researchers call it# flags a possible enironmental danger andspar(s actiity in brain regions s(illed at reading faces# interpreting ga?es# processing fear# and detecting

motion.

In other research# &ad)i(hani found that the brain can recogni?e happy and fearful e!pressions in body

moements. A fearful posture>hands held open and in front of the body li(e shields# for e!ample>actiates

brain regions that oersee emotion# ision# and action# while postures of happiness>arms loosely held from

the body as if opened to embrace>spur actiity only in ision$processing regions.

These physical communications of actual or perceied danger offer one aenue to deeloping a conditioned

fear# a learned response founded upon emotion and impressed so firmly within memory that it remains actie

for a lifetime.

RAISING THE DREAD

According to the 4ational Institute of Mental &ealth# roughly million people in the -nited 'tates hae

mental illnesses that inole persistent# outsi?ed fear responses to seemingly ordinary stimuli. A door slam

becomes a gun2s report to a shattered combat eteran# for e!ample# while smo(e from burning leaes might

trigger smell$based memories of pyres for a genocide surior. Among the an!iety disorders lin(ed to

conditioned fear responses is one that2s much in the news: post$traumatic stress disorder.


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Kadim 1olsha(o


For more than a decade# Kadim 1olsha(o# an &M' associate professor of psychiatry and director of Mc9ean

&ospital2s @ellular 4eurobiology 9aboratory# has e!plored fear$drien disorders by inestigating their

molecular bases in the brains of rats. One early finding from his laboratory showed that learned fear changes

the way the animals2 brains operate# offering a mechanism for conditioned fear2s persistence.

1olsha(o and colleagues taught rats to associate a harmless stimulus# a tone# with a painful eent# a shoc( to

their feet. The researchers found that neurons in the rodent amygdala e!hibited remar(able sensitiity to the

tone# so much so that the neurons continued to fire after the stimulus was remoed. This sensitiity# (nown as

long$term potentiation# is important to memory ac5uisition. It is normally modulated by glutamate# a chemical

that is released into the synaptic spaces between neurons when a message is being passed# but then is

deactiated to preent message oer$e!pression. 1olsha(o2s team showed that the amygdala2s heightened

sensitiity was the result of too much glutamate# either because the clean$up process failed or# as the

researchers postulated# because production of the chemical went into oerdrie.

Other studies by 1olsha(o and colleagues identified two proteins essential to the innate and learned fear

responses. "hen the researchers bloc(ed production of one of the proteins# stathmin# fear$conditioned mice

were less able to recall the learned fear>and lost the ability to recogni?e dangers that normally would hae

(ic(ed their innate fear response into high gear. 1loc(ing the gene that produced a protein (nown as transient

receptor potential channel =# normally found in high concentrations in the amygdala# decreased the rodents2

neurons2 sensitiity to cholecysto(inin# a neuropeptide released when the innate fear response is triggered or a

learned fear is recalled.


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These insights are welcomed by 3oger +itman# an &M' professor of psychiatry# and Mohammed Milad# an

&M' assistant professor of psychiatry. 1ased at Massachusetts General &ospital# these researchers see( to

tease out treatments for people with an!iety disorders such as post$traumatic stress disorder.

LOCATION, LOCATION, LOCATION

*0ou can neer completely abolish a learned fear#, says +itman. *9earned fears are deep and may strengthen

by reconsolidating after recall. One way to help patients diminish the impact of an an!iety$producing memory

is to guide them to form a new memory that inhibits# or e!tinguishes# e!pression of the fearful memory during

any recall attempt.,

3oger +itman

John 'oares

Or# as +itman and colleagues discoered seeral years ago# people might be helped to stae off a fear$filled

memory by preenting it from consolidating in the first place. In a controlled study of patients entering Mass

General2s emergency department after traumatic e!periences>assaults or car accidents# for e!ample>+itman

proided some participants with a placebo and others with propranolol# a drug that bloc(s the effects of the

hormone adrenaline. At follow$up interiews participants listened to audiotapes of their own accounts of their

trauma the day it occurred. +ropranolol recipients had wea(er physical responses to the tapes than placebo

users# who showed physical signs of the stirring of their fearful memory despite time2s passage.

3eplicating these results has proen difficult# howeer# so +itman and colleagues hae shifted their focus to

reactiating traumatic memories in people with post$traumatic stress disorder and then administering an anti$

stress drug to try to wea(en the memory2s reconsolidation.


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3eliing a fear# een a trauma$induced one# is not necessarily pathologic# Milad points out. 3ecalling the

source of high emotion or in)ury can sere as a safeguard# a warning that our brains can tap as needed. In

addition# time often softens the intensity of response.

*'ay you2re in a car accident#, Milad adds. *It occurs at a particular intersection at the same time a certain

song is playing on the radio. For a period following that accident# wheneer you go through that intersection or

hear that song# you will re$e!perience at some leel your initial fear. If oer time nothing horrible happens to

re(indle your memory# your conditioned response to either stimulus will lessen until the fear is e!tinguished.

This e!tinction doesn2t erase the initial learned fear7 instead# it leads to forming a new memory# a Lsafety

memory.2 The learned fear>the neuronal connections that the e!perience formed within your amygdala and

between your amygdala and certain cortical structures>remains.,

For some# the trauma neer lessens. In people with post$traumatic stress disorder# Milad and +itman hae

found that two brain regions inoled in e!tinction# the hippocampus and a region of the prefrontal corte!#

function at a lesser capacity# while actiity in the amygdala and the dorsal anterior cingulate# a region inoled

in cognition and motor control# rachets up. These findings may e!plain the unending rawness that trauma$

induced fears bring to people with the disorder.

X FACTOR

Other research by these inestigators suggests that hormones and biological cycles may play significant roles

in fear learning and e!tinction.

*Although some data suggest that estrogen actually enhances fear learning#, says Milad# *other studies suggest

the opposite# that it reduces fear and an!iety. -nfortunately# the area is underinestigated. An!iety disorders#

for e!ample# are twice as high in women>and we can2t say precisely why.,


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Mohammed Milad

John 'oares

The researchers2 wor( does proide intriguing clues# howeer. They hae found that women with higher

estrogen leels showed stronger actiation of the entromedial prefrontal corte!# a brain region (ey to fear

control. These high$estrogen women were good at e!tinguishing fear. "hen the researchers repeated the study

in rats and manipulated estrogen leels# they found that bloc(ing estrogen impaired the animals2 ability to

control fear. 3eintroducing estrogen caused the rats to behae as if they felt safe.

@uriously# the researchers found that men2s ability to control fear was a(in to that of high$estrogen women.

&ow does it )ibe# then# that women hae twice the prealence of an!iety disordersH

*"e don2t (now#, says Milad# *but the speculation is that estrogen alone doesn2t ma(e you a super$

e!tinguisher. It may be the lac( of the hormone that puts a woman at higher ris(. If a woman2s estrogen is

high# she controls fear in a way comparable to men# but if her estrogen dips# as it would during a normal

menstrual cycle# she may be at a higher ris( for fear ac5uisition following a trauma or another emotion$laden

incident.,

'uch studies by Milad and others highlight a growing interest in finely parsing the mechanisms of fear

ac5uisition and e!tinction in humans. Fundamentally# though# our response to fear remains basic# a primitie

emotion essential to our surial and a core response that unifies our species.

*The amygdala is the amygdala#, says Milad. *"hether it2s in Taipei or in @edar 3apids# it2s still a (nee$)er(

response to danger.,

Ann $arie $enting is Associate !ditor of Harvard $edicine.


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The %epths of %espair

Medicine tackles melancholia with new tools and understanding

by ELIZABETH DOUGHERTY

+i!onaut/istoc(photo.com

TUNING OUT SORROW

Deep%brain stimulation offers hope for depression

'ome people with depression hae tried eerything>behaioral therapy# antidepressants# sleep depriation#electroconulsie therapy>to no aail.

4ow deep$brain stimulation is showing promise for people whose condition is refractory. The therapy# already

used in some +ar(inson2s patients to control tremors# inoles implanting electrodes in a region of the brain

found to be actie during sadness$induction studies.


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T&3O"I4G A 9IF69I46: %arin %ougherty has found that deep$brain stimulation can offer hope to those with intractable

depression.


%arin %ougherty# an &M' associate professor of psychiatry at Massachusetts General &ospital# was principal

inestigator of a study of fie of the world2s first fifteen implantations eer attempted to control depression.

The procedure# initial studies of which began at Mass General in ;


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processing as fear or anger. *Our findings indicate that while other emotions hae primitie surial alue#,

8illgore says# *sadness appears to be more of a social emotion.,

istoc(photo.com

8illgore arried at this conclusion after inestigating whether the subliminal suggestion of sadness triggers

actiity in the brain2s amygdala# a region lin(ed with unconscious# surial$related responses# such as the

startle refle! and the fight$or$flight response. In this study# 8illgore showed adult participants faces wearing

sad e!pressions. 6ach sorrowful isage appeared for ;< milliseconds before 8illgore mas(ed it with one whose

e!pression was neutral. "hile iewing the sad faces# participants had no conscious awareness of them#

8illgore found. -nli(e angry# frightened# and happy e!pressions# which in earlier research had all produced

spi(es in amygdala actiity# the subliminal sad e!pressions elicited no such response.

In ;


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1ernard 9elle/istoc(photo.com

*"e want to personali?e treatment in psychiatry#, he says# by giing psychiatrists the tools to find the best

path to recoery for each patient. The science is not there yet# he adds# but it may be soon.

A decade ago# +i??agalli2s laboratory discoered that a region of the brain called the rostral anterior cingulate

corte! shows eleated actiity among people who# though not yet treated for depression# would go on to

respond to the treatment months later. This biomar(er for eleated actiity identified C percent of eentual

responders7 its absence was lin(ed with C percent of eentual nonresponders. More than a do?en studies hae

since replicated this finding.

*The ne!t challenge#, +i??agalli says# *is to find a more treatment$specific predictor., &e is part of a group of

researchers who recently receied funding to do )ust that. A 4ational Institute of Mental &ealth grant supports

si! sites nationally# including Mc9ean &ospital# where +i??agalli is the principal inestigator# and

Massachusetts General &ospital. The inestigators will recruit


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-4%63 +36''-36: 3andy Auerbach has found that teens who receie little support from their parents and classmates are more

li(ely to be susceptible to stress$triggered depression.

John 'oares

*The presence of stress isn2t enough# and neither is the presence of ulnerability#, he says. *It2s the interaction

of these two ris(s that conerge and pae the path to sadness and depression.,

Auerbach2s research aims to tease out depression2s genesis by studying the interplay of stress with such

ulnerabilities as low self$esteem# dysfunctional attitudes# self$referential processing# and a perceied lac( of

control in the face of aderse eents. &e focuses on adolescents because ;< percent of people in this age group

e!perience a depressie episode# and most will relapse in adulthood.

Auerbach recently e!amined the relationship between social support and stress and the deelopment of

depression among adolescents. &e found that young people with little support from parents and classmates are

more li(ely to e!perience depressie symptoms in the face of stress. A lac( of friends and supportie peers#

howeer# did not contribute to ris( for depression. This wor( appeared in the May ;


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!li"abeth Dougherty# a former science writer at H$# is now a freelance writer.


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The 9oo( of 9oeLoves many splendors begin with empathy and attachment

by DAVID CAMERON

+ainting: *+air of 9oers#, by +al '?inyei Merse +hoto by Alfredo %agli Ori/The Art Archie/@orbis

"hen second grader Jac5ueline Olds arried home from school one afternoon in ==# she found theatmosphere charged with e!citement. &er parents pointed to a headline on the front page of the$ontreal tar:

*McGill opens ast new research field with brain Lpleasure area2 discoery.,

Olds# now an &M' associate clinical professor of psychiatry at Massachusetts General &ospital# had only

ague notions bac( then of what her father# James Olds# then a postdoctoral researcher at McGill -niersity#

did during the day# yet she (new it had something to do with the brains of rats.

The elder Olds had )ust published a paper in theJournal of )omparative and 'hysiological

'sychologydescribing how the rat brain was suffused with desire when a particular region of it was

electronically stimulated. The rat would do whateer it could to relie the cerebral oltage regardless of cost#

li(e a )ilted loer see(ing intimacy anew# or a gambler circling bac( to the roulette wheel. James Olds2s

discoery of the brain2s *pleasure center, has held up for more than half a century# and no scientific discussion

on the phenomenon of human loe can aoid it.


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Most of us# een those disciplined to interpret the world through the lens of eidence$based science# can2t help

but imagine loe as a ghost in the machine. 't. +aul2s famous meditation on the patience and (indess of loe#

recited in a seemingly nonstop wedding loop# personifies loe as an entity embodying what we crae most in

others. 9oe as a spiritual alue has so permeated "estern culture that een a science$drenched modern fable

li(e the film!ternal unshine of the potless $indcouldn2t help but bust it out of its neurophysiologicsheathing.

1ut the scientific eidence is unmista(able: "hateer this thing called loe is# we humans need it. %eep

attachments to others>and the pleasure$center stimulation those lin(s cause>are as ital to our bodies and

minds as food and sleep. Their absence carries catastrophic ris( to our health and well$being.

I FEEL YOUR PAIN

"hile many drugs# including antibiotics and certain chemotherapies# gradually lose effectieness oer time#

one treatment has manifested a steady rise in potency during the past few decades: the placebo.

@arl Marci


Much to the e!ation of pharmaceutical companies trying to get antidepressants and pain medications

approed for use# clinical trials conducted oer the years hae reealed the increasing power of the placebo

effect. Our efforts to understand that trend throws light on the healing power of doctor/patient connectedness.


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@arl Marci 2# an &M' assistant professor of psychiatry at Massachusetts General &ospital# began paying

attention to the placebo effect in the early


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that animate faces to form beaming smiles flare the nanosecond you glimpse a @heshire grin. *Our brains are

so wired for empathy#, Marci says# *that there2s ?ero lag time.,

As far as the placebo effect goes# Marci suggests that one e!planation for its steady rise is the increasing

comple!ity of clinical trials. The tighter the regulations# the more interactions patients hae with a team of

proiders. The deeper human interaction that presumably results may help e!plain the increase in the placebo

effect.

"hich leads us bac( to the brain2s pleasure center# or reward center. 6mpathy triggers dopamine and

serotonin# neurochemicals associated with the reward center2s con)oined twin# the brain2s emotion center. If# as

the scientific literature indicates# mere laughter stimulates the reward center# how much more stimulating

would be the act of immersing yourself in the world of anotherH

From an eolutionary perspectie# this ma(es perfect sense. *&uman babies hae the most postnatal neuronal

growth of any species#, says Marci. *"ithout empathy# there is no attachment# and attachment is essential for

surial.,

GOOD CHEMISTRY

"hat happens when empathy is absentH "hile Marci2s model is the doctor/patient relationship# 8arlen 9yons$

3uth# an &M' associate professor of psychology at @ambridge &ealth Alliance# studies the physiological

effects of human interactions in a relationship far more primordial: the one between mothers and infants.

"ithin the field of deelopmental psychology# 9yons$3uth is a leading e!pert on attachment# with a particular

focus on attachment gone wrong. *In a sense#, she says# *I2m most interested in what happens when loe goes

awry.,

6mpathy and mirroring of the infant2s states by the parent is a powerful regulator of normal deelopment# says

9yons$3uth. The biomar(er she uses to measure the 5uality of a mother$infant relationship is cortisol. This

steroid hormone has a number of functions# such as increasing blood sugar and helping the body metaboli?e

fats and carbohydrates. It is also released in response to stress to help the body mobili?e to meet a challenge.

0et too much cortisol can lead to health problems.

@ombat soldiers in particular are li(ely to e!perience long periods of e!treme stress. 'uch prolonged stress(eeps the hormone )ac(ed up# but the human organism2s capacity to tolerate such a powerful chemical is

limited# so an emergency system clic(s in and dams the hormone2s flow. This chec( can result in an indiidual

who goes through life with a blunted stress response system and attenuated emotional engagement.

4ormal cortisol leels and stress responses are essential for healthy attachment# says 9yons$3uth. "hen a

mother2s cortisol leels are normal# she acts as an e!ternal regulator by being attuned to her baby2s fear and


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discomfort and acting to reliee these negatie states. As a result# the baby e!periences minimal stress. 1ut

when a mother2s cortisol response is blunted# her ability to act as an attuned e!ternal regulator for the infant

may fail.

*"e still hae much wor( to do to understand this model of attachment#, says 9yons$3uth. *1ut our research

has shown that mothers whose interactions with their infants are the most disrupted hae the lowest cortisol

leels., 'he and her colleague 1)arne &olmes hae also obsered that the infants of low$cortisol mothers

present with low cortisol leels as well. "hen low$cortisol infants are stressed# though# their cortisol leels fly

off the charts. *These babies lac( the ability to modulate their stress responses#, 9yons$3uth says. 1ecause

antisocial children and adults also show blunted cortisol responses# low cortisol leels among mothers with

ery young infants set off alarm bells about these babies2 future deelopment.

Infants reared in orphanages may be most at ris( for blunted stress responses and associated disturbances in

their ability to form deep emotional bonds. As Megan Gunnar and her colleagues at the -niersity of

Minnesota hae shown# many children adopted from orphanages show abnormally low hormone leels similar

to those of combat eterans and antisocial adults. 1ut instead of acting antisocial# some of these children

e!hibit what 9yons$3uth calls indiscriminate friendliness. They lac( the *stranger danger, instinct that is

recogni?ed as a healthy component of early deelopment. Indiscriminate behaior often persists throughout

childhood# een after adoption into healthy and stable homes.

*The wor( that @harley Neanah has done at Tulane is pointing to a possible critical period for the formation of

attachment bonds#, says 9yons$3uth. *%espite good care later# unless responsie care is proided before the

end of toddlerhood# blunted cortisol and attachment problems can persist.,

LONELY HEARTS CLUB


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Jac5ueline Olds and 3ichard 'chwart?

John 'oares

3ichard 'chwart? has the distinction of being both an &M' associate clinical professor of psychiatry at

Mc9ean &ospital and the husband of Jac5ueline Olds# the psychiatrist whose father discoered the brain2s

reward center. Together 'chwart? and Olds hae cared out a niche as e!perts in the study not only of loe and

marriage# but of loneliness as well.

They had already written one boo( on loneliness when a -niersity of @hicago surey found# in ;


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Angeles. In this study# researchers found that chronic loneliness alters the e!pression of a networ( of genes

associated with inflammation. *If we (now that loneliness affects our immune response#, 'chwart? says# *it2s

not surprising that it would happen at the leel of %4A e!pression.,

As therapists# 'chwart? and Olds constantly encounter patients who suffer from chronic loneliness# yet most

are hesitant to label it as such. As diagnoses go# depression and an!iety are less embarrassing. 1ut it2s hard to

oerestimate the psychic pain that loneliness can cause. Thin( of the nibbling feelings you had as a child or an

adultE when you suspected you were being purposely left out. Then try to imagine the pain of ostracism or#

ta(en to e!tremes# the outright torture of solitary confinement.

*Few higher mammals are solitary#, obseres 'chwart?. *&umans are relatiely helpless as indiiduals in the

natural world. +art of what ma(es us so powerful is that we2e banded together in small groups. And part of

the pain of loneliness is the recognition that without other people we simply can2t surie.,

4or surprisingly# loneliness and substance abuse often go hand in hand. *Many drugs# particularly stimulants#

trigger the dopaminergic reward center#, Olds says. *1ut we now (now that social connectedness and the

feeling of being loed also actiate that same reward center. If you lac( the relationships needed to stimulate

that part of your brain# you2ll li(ely find it in a drug.,

1lanche %u1ois2s legendary line inA treetcar ,amed Desire# *I hae always depended on the (indness of

strangers#, is eolutionarily and neurologically true. 6mpathy and attachment are at the core of human

relatedness# and a small section of our prefrontal corte! dries us to find it one way or another. "ithout it#

we2re lost.

*Attachment to others#, says Olds# *is the original reward.,

David )ameron is the Director of cience )ommunications at Harvard $edical chool.

The Science of Emotion (Harvard Medicine)

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