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Real life is the game that – literally – everyone is playing. But it can be tough. This is your guide.

Basics

You might not realise, but real life is a game of strategy. There are some fun mini-games – like dancing, driving, running, and sex – but the key to winning is simply managing your resources.

Most importantly, successful players put their time into the right things. Later in the game money comes into play, but your top priority should always be mastering where your time goes.

Childhood

Life begins when you’re assigned a random character and circumstances:

The first 15 years or so of life are just tutorial missions, which suck. There’s no way to skip these.

Young adult stage

As a young player, you’ll have lots of time and energy, but almost no experience. You’ll find most things – like the best jobs, possessions and partners – are locked until you get some.

This is the time to level up your skills quickly. You will never have so much time and energy again.

Now that you’re playing properly, your top priority is to assign your time as well as possible. Every single thing you do affects your state and your skills:

This may sound simple, but the problem is you won’t always know what tasks to choose, and your body won’t always obey your commands. Let’s break it down.

How to obey your own commands

Many players find that when they choose to do something – say “go to the gym” – their body ignores them completely.

This is not a bug. Everybody has a state, which you can’t see directly, but looks something like this:

If your state gets too low in one area, your body will disobey your own instructions until your needs are met. Try studying when you’re exhausted and hungry, and watch your concentration switch to Twitter.

Your willpower level is especially important. Willpower fades throughout the day, and is replenished slightly by eating, and completely by a good night’s sleep. When your willpower is low, you are only able to do things you really want to.

Every decision you have to make costs willpower, and decisions where you have to suppress an appealing option for a less appealing one (e.g. exercise instead of watch TV) require a lot of willpower.

There are various tricks to keep your behaviour in line:

1. Keep your state high. If you’re hungry, exhausted, or utterly deprived of fun, your willpower will collapse. Ensure you take consistently good care of yourself.
2. Don’t demand too much willpower from one day. Spread your most demanding tasks over multiple days, and mix them in with less demanding ones.
3. Attempt the most important tasks first. This makes other tasks more difficult, but makes your top task more likely.
4. Reduce the need to use willpower by reducing choices. If you’re trying to work on a computer that can access Facebook, you’ll need more willpower because you’re constantly choosing the hard task over the easy one. Eliminate such distractions.

A key part of playing the game is balancing your competing priorities with the state of your body. Just don’t leave yourself on autopilot, or you’ll never get anything done.

Choosing the right tasks

Choosing the right tasks at the right time is most of the game. Some tasks mostly affect your state, e.g.

Others mostly affect your skills:

You need to put time into things that ensure a healthy state – like food and sleep – to keep your willpower high. And then you need to develop your skills with what you have left.

Some skills are more valuable than others. Good ones can open up whole paths like a tech tree:

Others are dead ends:

Combinations of skills are the most effective. It’s very hard to max out one skill to be the best – in fact, that’s often impossible. But it’s much easier to get pretty decent at lots of related skills that amount to something bigger, e.g.

See how psychology just helped you become both rich and attractive? You should study that.

Where you live

Your environment has a constant impact on your stats, skills, and your chances of levelling up.

It’s possible to play the game well almost anywhere, but it’s a lot easier in certain places. If you’re female and in the wrong country, for example, you can’t unlock many achievements.

The odds of anyone being born in their optimal location are virtually zero, so research your options, and consider moving early. Location is a multiplier to all of your skills and states.

Finding a partner

Attraction is a complex mini-game in itself, but mostly a byproduct of how you’re already playing. If you have excellent state and high skills, you’re far more attractive already. A tired, irritable, unskilled player is not appealing, and probably shouldn’t be looking for a relationship.

Early in the game it can be common to reject and be rejected by other players. This is normal, but unfortunately it can drain your state, as most players don’t handle rejection or rejecting well. You’ll need to expend willpower to keep going, and willpower is replenished by sleep, so give it time.

80% of finding someone comes down to being your most attractive self, which – like so much in life – just means putting your time in the right places. If you’re exercising, socialising, well nourished and growing in your career, you will radiate attraction automatically. The remaining 20% is simply putting yourself in places where you can meet the right people.

Money money money

Later in the game you’ll have to manage a new resource called ‘money’. Most players will find money increases throughout the early game, but that this actually introduces more problems, not less.

The most important rule of money is never to borrow it, except for things that earn you more back. For example, education or a mortgage can be worthwhile (but are not necessarily so, depending on the education or the mortgage). Borrowing to buy new shoes is not.

Depending on your financial ambitions, here are a few strategies to bear in mind:

1. Not fussed about money. The low-stress strategy: simply live within your means and save a little for a rainy day. Be sure to make the best of all the time you save though, or you’ll regret it.
2. Well off. Choose a career and environment carefully, and be prepared to move often to move up. You’ll need to invest heavily in matching skills, which will cost you time, and be careful not to abuse your state or you’ll burn out.
3. Mega rich. Start your own business. It’s almost impossible to get rich working for someone else. Riches do not come from work alone, they come from  owning things – assets – that pay back more than they cost, and your own company is a powerful asset you can create from scratch. Compound your winnings into more assets, and eventually they can remove your need to work at all.

Later life

Your options change as the game progresses. Marriage and children will reduce your time and energy, and introduce more random elements into the game (“Emergency diaper change!”). This makes it harder to develop yourself as quickly.

Older characters usually have more skills, resources and experience, unlocking quests that were previously impossible, like “owning a house”, or “writing a (good) novel”.

All players die after about 29,000 days, or 80 years. If your stats and skills are good, you might last a little longer. There is no cheat code to extend this.

At the start of the game, you had no control over who you were or your environment. By the end of the game that becomes true again. Your past decisions drastically shape where you end up, and if you’re happy, healthy, fulfilled – or not – in your final days there’s far less you can do about it.

That’s why your strategy is important. Because by the time most of us have figured life out, we’ve used up too much of the best parts.

Now you’d best get playing.

Article from:  http://oliveremberton.com

The Trouble With Mirror Neurons

When researchers discovered neurons in monkey brains that fired when an action was performed or observed, they were dubbed “mirror neurons.” And they quickly became the go-to explanation for empathy. Decades later, says Sharon Begley, the evidence that human beings have them is sketchy at best.

Illustration by Gavin Potenza

By Sharon Begley

In 1992, scientists at Italy’s University of Parma announced the genuinely exciting discovery that certain neurons in the premotor cortex of macaques fire under two quite different conditions: when the monkeys execute a specific action like reaching for food and when they merely observe an experimenter performing that action. Until then, the textbook wisdom in neuroscience had been that brain cells execute an action or observe one—not both. The Parma find seemed to show that “cells in the motor system fire when I see you make a movement, and they’re the same ones that fire when I make that movement,” according to neuroscientist Marco Iacoboni of the University of California, Los Angeles. “We didn’t think the brain was organized this way.” In 1996, these cells got their intriguing moniker, reflecting that the neurons “mirrored” observed behavior by firing as if the observer were not just seeing the action but also executing it.

It was like a starter’s pistol had gone off in the neuroscience lounge.

The discovery of mirror neurons would launch a “revolution” in understanding empathy and cooperation, predicted one researcher. Mirror neurons were “the driving force” behind the “great leap forward” in brain evolution, claimed another. They “will provide a unifying framework and explain a host of mental abilities that hitherto remained mysterious,” asserted a third, calling these cells “the neurons that shaped civilization.” Other researchers asserted that mirror neurons spurred the development of language (the human analogue of the monkeys’ premotor region is Broca’s area, which is involved in producing spoken language) and of theory of mind, our ability to infer what someone thinks, believes, or feels. Broken mirror neurons were invoked to explain autism, which is characterized by an inability to intuit others’ feelings and state of mind. One scholar invoked mirror neurons to argue for the superiority of face-to-face diplomacy, which, he said, allows negotiators “to transmit information and empathize with each other.”

The media piled on. Popular stories have invoked mirror neurons to explain everything from crying at movies to selfless acts of heroism and why hospital patients feel better when they have visitors.

To some neuroscientists, it was all a bit much. After giving a speech at the University of California, Davis, in 2010, I had dinner with members of the psychology department, and innocently asked about mirror neurons. From the collective eye roll, you’d think I’d asked about creationism. And as the number of scientific papers on mirror neurons approached 800 in 2012, Christian Jarrett of the British Psychological Society called them “perhaps the most hyped topic in neuroscience.” Psychology professor Morton Ann Gernsbacher of the University of Wisconsin told me recently, “Mirror neuron theory is being used as an explanation for many phenomena in social cognition without the claims being supported with actual data.”

Let’s try to separate wheat from chaff.

Do humans have mirror neurons? Given the similarities between our brains and monkeys’, we should. But clear evidence has been hard to come by, mostly because the most direct test—using electrodes to detect the firing of individual neurons to be sure the same ones fire during observing an action and executing it—is too invasive to be ethically done on healthy volunteers. In 2010, however, Iacoboni and his colleagues piggy-backed on epilepsy surgery, in which such electrodes are temporarily implanted into patients’ brains. Result: certain neurons fired when the patients both observed (on a laptop) and performed grasping actions and facial gestures.

Unfortunately, the study used only 21 patients and has not been independently confirmed. Also, the purported mirror neurons were not where monkeys’ neurons are but, among other places, in regions involved in memory. That raised concerns that the neurons firing during both observation and execution were involved in remembering the action, and thus not true mirror neurons. As a 2013 review put it, research results “cannot yet furnish conclusive proof” that humans have them.

If we do, can mirror neurons cause us to feel other people’s emotions and therefore underlie empathy? Here’s the logic: the mirror circuitry that’s activated during both the performance and observation of an action is probably wired into the circuitry that “knows” the goal of that action, Iacoboni told me, since “actions come with intentions. Mirror neurons activate meaning or intention circuits from within. It’s deeper than cognitive understanding.” Similarly, the circuitry that produces smiles, frowns, or other expressions seems to be connected to circuits that encode the associated feeling (hence the common experience of feeling a little happier if you make yourself smile). Since mirror circuitry fires at the sight of someone else making a face, that would trigger the same “feeling” circuits as are tripped when we make the face. Presto: A mechanism for inferring what another person feels.

Skeptics point out, however, that we don’t need to perform an action in order to understand why someone is doing it or what it feels like. I understand my husband’s goal when he removes an outlet plate and starts pulling out wires even though my own motor neurons have never rewired a circuit. “We’re able to understand many actions— and the goals of those actions—which we’ve never executed ourselves,” Gernsbacher argued. “And there are people who can decipher the emotion in facial expression without being able to make the expressions themselves” due to brain damage or other disability. That suggests a mirror system, even if we have one, is not necessary for empathy or theory of mind.

Many scientific papers promise “evidence for mirror neuron dysfunction in autism,” but only some are confirmed by other labs. Even fewer use bulletproof methodology. Some of the autism/ mirror-neuron studies, for instance, used neuroimaging to measure brain activity when people with autism executed movements on their own or imitated gestures in a picture. The region suspected of harboring human mirror neurons showed less activity, compared to normally developing participants, during the imitation task.

But it’s not clear that imitating has much to do with autism, Gernsbacher and other critics point out. “Many studies have found that neither autistic children nor autistic adults have any difficulty understanding the intention of other people’s actions,” as would be predicted by the mirror-neurons/ autism hypothesis, she said. “The bulk of brain imaging studies fail to support it.”

Mirror neurons were indeed a paradigm-changing discovery. From the observation that some premotor neurons fire when action is observed rather than performed, however, it is quite a leap to empathy, autism, and the rest. It’s natural to root for the human brain to have as many cool components as possible, and enticing to think that one of them offers a simple and elegant answer to the question of what make us human. But even if it turns out that we don’t have these nifty mirror neurons, it doesn’t make us any less empathetic. We just lack a simple neurological explanation for it.

Tomorrow’s sociologists will have a field day studying how claims about mirror neurons became part of the popular culture even as neuroscientists became skeptical of the unbridled exuberance. It’s a great case study of how once a scientific notion takes hold in the popular mind, it’s hard to jam it back into Pandora’s box.

Sharon Begley is the senior health and science correspondent at Reuters, author of Train Your Mind, Change Your Brain, and coauthor with Richard Davidson of The Emotional Life of Your Brain.

Article originally published on www.mindful.org

This 2011 study looks at the effects of craniosacral therapy on fibromyalgia patients, showing that “at 6 months after a 25-week treatment period, patients in the intervention group showed a significant improvement in their levels of state anxiety, trait anxiety, pain, quality of life and Pittsburgh sleep quality index.”

Influence of Craniosacral Therapy on Anxiety, Depression and Quality of Life in Patients with Fibromyalgia

Guillermo A. Matarán-Peñarrocha, ^{1 ,*} Adelaida María Castro-Sánchez, ² Gloria Carballo García, ³ Carmen Moreno-Lorenzo, ¹ Tesifón Parrón Carreño, ⁴ and María Dolores Onieva Zafra ⁵

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This article has been cited by other articles in PMC.

Abstract

Fibromyalgia is considered as a combination of physical, psychological and social disabilities. The causes of pathologic mechanism underlying fibromyalgia are unknown, but fibromyalgia may lead to reduced quality of life. The objective of this study was to analyze the repercussions of craniosacral therapy on depression, anxiety and quality of life in fibromyalgia patients with painful symptoms. An experimental, double-blind longitudinal clinical trial design was undertaken. Eighty-four patients diagnosed with fibromyalgia were randomly assigned to an intervention group (craniosacral therapy) or placebo group (simulated treatment with disconnected ultrasound). The treatment period was 25 weeks. Anxiety, pain, sleep quality, depression and quality of life were determined at baseline and at 10 minutes, 6 months and 1-year post-treatment. State anxiety and trait anxiety, pain, quality of life and Pittsburgh sleep quality index were significantly higher in the intervention versus placebo group after the treatment period and at the 6-month follow-up. However, at the 1-year follow-up, the groups only differed in the Pittsburgh sleep quality index. Approaching fibromyalgia by means of craniosacral therapy contributes to improving anxiety and quality of life levels in these patients.

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1. Introduction

There is an increasing interest in the role of psychological factors in fibromyalgia, and studies have been published on associated psychological variables, psychopathological explanations, assessment instruments and psychological intervention programs [1, 2]. Suhr (2003) considered psychological factors to be important for understanding the subjective and objective cognitive disorders of fibromyalgia patients [3]. Various investigations have centered on the relationship of fibromyalgia with pain, depression, anxiety and quality of life. The Copenhagen declaration in 1992 described psychological patterns frequently associated with fibromyalgia, such as anxiety and depression, and there is a growing interest in this aspect among professionals of different fields [4]. Nevertheless, many authors consider that psychological factors are more frequently the result than the cause of pain and disability in fibromyalgia, and this issue remains controversial [4].

Some symptoms of fibromyalgia are similar to those observed during depression, and antidepressants have been administered to fibromyalgia patients to treat sleep disorders and pain symptoms [4]. Review of the literature on the association between fibromyalgia and depression reveals two divergent research lines. Hudson and others [5] believe that a direct association cannot be established between fibromyalgia and depression, whereas Gruber and others (1996) [6] propose a common etiology for fibromyalgia and depression. Significant differences in psychological state between patients with fibromyalgia and depression were reported in a study on fibromyalgia, pain intensity and duration and psychological alterations; the results of depression and anxiety questionnaires indicated that the somatic expression of depression differed between the two patient groups [7]. The relationship between depression and fibromyalgia remains controversial. Although antidepressants can reduce pain and fatigue in fibromyalgia, the effects of these drugs vary in degree and duration among patients [7].

Various authors have indicated that patients with fibromyalgia are more depressed than healthy controls and that their perception of psychological distress or depression is similar to that of depressed patients [8, 9]. Moreover, levels of psychological distress (depression, anxiety) have been correlated with cognitive findings in both groups of patients (fibromyalgia and depression) [10–12].

Garland [13] observed a higher degree of anxiety in fibromyalgia patients than in healthy controls or other groups of patients with painful disease, for example, rheumatoid arthritis. Anxious individuals usually have a respiratory dysfunction that generates more work in the upper chest, and the resulting minimum diaphragmatic activity may exacerbate symptoms in patients with fibromyalgia or chronic fatigue syndromes. Although anxiety is known to be an immediate symptom of hyperventilation, it is controversial whether or not hyperventilation and anxiety in patients with fibromyalgia result from a broader alteration. In this context, Peter et al. [14] reported that education to reduce the effects of hyperventilation can reduce fibromyalgia symptoms, including pain, fatigue and emotional distress.

Dysfunction of the autonomic nervous system may explain the different clinical manifestations of fibromyalgia. The hyperactive sympathetic nervous system of these patients becomes incapable of responding to different stressing stimuli, which would explain the continuous tiredness and the morning rigidity of these patients [15]. Likewise, incessant sympathetic activity may explain the sleeping disorders, anxiety, pseudo Raynaud’s phenomenon, dry syndrome and intestinal irritability [2, 15]. The other defining characteristics of fibromyalgia such as diffuse pain, painful sensitivity to palpation and paresthesia may also be explained by “sympathetically maintained pain”. This neuropathic pain is characterized by a perception of pain regardless of the presence of stimuli, accompanied by paresthesias and allodynia, which are characteristic of patients with fibromyalgia [16].

Patients frequently report sleeping disorders as well as depression, and both factors are known to have a strong association with cognitive disruption [17, 18] and to play an important role in the reduced quality of life reported by fibromyalgia patients. There is a high prevalence of sleeping problems in this population. In many cases, pain and fatigue disappear with sleep. However, paradoxically, patients with fibromyalgia awake with intensified muscle rigidity, pain and marked fatigue [19, 20]. Shaver et al. [21] described a vicious circle of pain, poor sleep, fatigue and increased pain in overt fibromyalgia. Bigatti et al. [22] concluded that sleep predicts subsequent pain in these patients but may be related to depression due to pain and physical dysfunction.

The quality of life of patients with fibromyalgia is especially impaired in relation to physical function, intellectual activity and emotional state, influencing their working capacity and social relationships [23]. Backman [24] affirmed that psychosocial factors are related to two dimensions of experience: psychological (cognitive, affective) and social (interacting with others, performing daily activities). According to this author, psychosocial factors influence the perception of pain, which in turn influences psychological wellbeing and social participation.

Various studies have demonstrated the efficacy of biofeedback acupuncture to reduce pain symptoms in fibromyalgia [25–28]. However, we could find no studies that address the effects of manual therapy on the autonomic nervous system or the possible benefit of this type of alternative therapies as a complement to pharmaceutical treatment of hyperautonomic alterations and derived disorders (anxiety and depression). With this background, the objective of this study was to determine the effects of craniosacral therapy on anxiety, depression, pain, sleep quality and quality of life in fibromyalgia patients up to 1-year post-treatment.

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2. Methods

2.1. Setting and Participants

Patients with fibromyalgia syndrome undergoing pharmaceutical therapy were recruited from among members of the Almeria Fibromyalgia Association with clinical records at the Torrecárdenas Hospital Complex (Almeria, Spain). Inclusion criteria were: diagnosis of fibromyalgia (by rheumatology specialist), age of 16–65 years and agreement to attend afternoon therapy sessions. Exclusion criteria were: presence of physical disease, psychological disease, infection, fever, hypotension or skin disorders or respiratory alterations that would limit the application of the treatments.

Out of the 376 patients in the accessible population, 351 were subjected to a randomization procedure to recruit a sample of 119 patients. Out of these 119 patients, 15 were excluded, and the remaining 104 were randomly assigned by means of a balanced stratified assignment to an intervention (n = 52) or placebo (n = 52) group. The groups were balanced for type of medication received, sex and age, using a stratification system that generates a sequence of letters (from a table of correlatively ordered permutations) for each category and combination of categories. Informed consent was obtained from all participants according to the ethical criteria established in the Helsinki declaration, modified in 2000, for the performance of research projects. In Spain, current legislation for clinical trials is gathered in the Real Decreto 223/2004 February 6, 2004. This project was approved by the research commissions of the University of Almeria and of the Torrecárdenas Hospital Complex (Almeria)-Servicio Andaluz de Salud (Andalusian Healthcare Service).

Twenty-one patients were under treatment with muscle relaxants, 32 with antidepressants, 46 with anxiolytics, 59 with anti-inflammatories, 36 with corticoids and 84 with analgesics.

2.1.1. Measurements

The following instruments were used to measure anxiety, depression and quality of life in study participants:

 

1. Visual analogue scale (VAS) for pain [29]: This scale assesses the intensity of pain and degree of alleviation experienced by the patient (0 = no pain, 10 = unbearable pain) [30].
2. Short form-36 health survey (SF-36) for quality of life: The SF-36 survey evaluates dimensions of functional state, emotional wellbeing and health. Functional state dimensions are: physical function (10 items), social function (two items), role limitations due to physical problems (four items) and role limitations due to emotional problems (three items); emotional wellbeing dimensions are: mental health (five items), vitality (four items) and pain (two items); and health dimensions are: general health perception (five items) and change in health over time (one item—not included in final score) [31].
3. Pittsburgh Sleep Quality Index (PSQI): This questionnaire comprises 24 questions, 19 for subjects and 5 for individuals living with them. It yields scores for: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of hypnotic medication and daily dysfunction. Each component is scored on a scale of 0 to 3 (0 = no problem, 3 = severe problem), yielding an overall score range of 0–21 [32].
4. Assessment of the depression index (Beck depression inventory): The Beck inventory is a self-applied questionnaire of 21 items that assesses a broad spectrum of depressive symptoms. It gives weight to the cognitive component of depression, with symptoms in this area representing around 50% of the total questionnaire score. Out of the 21 items, 15 refer to ecological-cognitive symptoms, and six to somatic-vegetative symptoms [33]. The score for each item ranges from 0–3 (from least to greatest severity), giving an overall score range of 0–63 points [34].
5. State Trait Anxiety Inventory (STAI): This 40-item questionnaire measures trait anxiety and state anxiety. For the trait anxiety scale (20 items), subjects describe how they feel in general, and for the state anxiety scale (20 items), how they feel at the present time. A score is obtained for each scale [35].

 

2.1.2. Procedure

In this experimental, longitudinal double-blind clinical trial, the intervention group was formed by 43 patients and the placebo group by 41. Before the treatments, initial assessments of anxiety, depression, pain, sleep and quality of life were performed in all patients [36]. Women of childbearing age were assessed the day after their menstrual period ended. These assessments were repeated at 30 min, six months and 1 year after the last session of the 25-week treatment program.

2.2. Intervention

The intervention group underwent a craniosacral therapy protocol, with two weekly sessions of 1h for 25 weeks. The treatment was carried out by an expert craniosacral therapist with the patient in prone position. This therapy consists of applying very mild manual traction on cranial bones in flexion or extension stages of the craniosacral cycle. The aims were to contribute to re-establishing the normal movement of cranial bones and to intervene in the autonomic nervous system by releasing bone and membranous restrictions [37]. Craniosacral therapy procedures were: still point (occipital), compression-decompression of temporomandibular joint, decompression of temporal fascia, compression-decompression of sphenobasilar joint, parietal lift, frontal lift, scapular waist release and pelvic diaphragm release [37–40].

The placebo group underwent two weekly 30-min sessions of sham ultrasound treatment in which the disconnected probe (4 cm in diameter) was applied to the cervical area (10 min), lumbar region (10 min) and both sides of the knees (10 min). The sham treatment was performed with the patient in prone position. The screen of the ultrasound was covered to ensure that the patient was unaware that the equipment was disconnected.

Both patient groups were instructed not to change their pharmacological treatment during the 25-week study period.

2.3. Statistical Analysis

The SPSS package (version 17.0) was used for the data analyses. After performing descriptive statistics of variables at baseline, the Kolmogorov–Smirnof test was applied to evaluate the normal distribution of variables. Continuous data were expressed as means ± SD. A paired t-test was used to examine changes in scores between baseline and follow-up examinations. Inter-group differences in variables were analyzed by using repeated-measures analysis of variance. Relationships between demographic variables (sex and age group), aggravating factors, work activity, diseases related to fibromyalgia syndrome, VAS pain score, dimensions of the SF-36 health survey for quality of life, dimensions of the Pittsburgh sleep quality index, total Beck depression inventory score and state and trait anxiety scores were evaluated by calculating Pearson correlation coefficients. A 95% confidence interval (CI) (α = 0.05) was considered in all tests.

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3. Results

During the study, 9 patients withdrew from the intervention group and 11 from the placebo group. Reasons for withdrawal were death of spouse, start of another type of treatment, change in pharmacologic therapy during treatment period, and missing sessions due to acute pain crisis and forgetfulness. The final study sample comprised 84 patients (81 females) aged 34–63 years with a mean age of 49.08 ± 14.17 years (Figure 1). There were no differences in baseline demographic characteristics between the intervention group (n = 43) and placebo group (n = 41) (Table 1). The groups did not differ significantly in state anxiety (P < .320), trait anxiety (P < .269) or VAS (P < .239) scores but differed in all dimensions of the SF-36 questionnaire with the exception of vitality.

Figure 1

Flow of participants in the study. None of the 84 participants reported adverse effects.

Table 1

Baseline and demographic characteristics of study groups.

In the whole study population, there were significant correlations at baseline between age and physical role (r = 0.412; P = .008), vitality and general health (r = 0.433; P = .005), habitual sleep efficiency and social function (r = 0.319; P = .045) and between mental health and emotional role (r = 0.346; P = .029), sleep duration (r = 0.485; P = .001) and habitual sleep efficiency (r = 0.328; P = .039).

3.1. At 35 Weeks after Intervention

At 35 weeks, the intervention group showed significant improvements in state anxiety (P < .029) and trait anxiety (P < .042) versus baseline scores. No changes were observed in the placebo group. The groups differed significantly in trait anxiety (P < .045). Depression scores did not differ significantly between groups or with respect to baseline values (Figure 2).

Figure 2

Comparisons between study groups in levels of depression, anxiety and pain. *P = .05 (95% CI). Values are presented as means.

VAS-measured pain improved significantly in the intervention group versus baseline (P < .035) and differed between groups (P < .041). The intervention group also showed significant improvement in physical function (P < .024), physical role (P < .020), body pain (P < .043), general health (P < .039), vitality (P < .041) and social function (P < .029). The placebo group showed no significant changes versus baseline in SF-36 questionnaire dimensions. The groups differed in physical function (P < .009), physical role (P < .019), body pain (P < .036), general health (P < .048), vitality (P < .046) and social function (P < .028) (Table 2). The intervention group showed a significant overall improvement in Pittsburgh sleep quality index score (P < .043), and the groups differed significantly in the sleep duration (P < .042) and sleep disturbance (P < .040) items (Table 3).

Table 2

Differences in quality of life (SF-36 questionnaire) between study groups.

Table 3

Differences between study groups in Pittsburgh sleep quality index score at baseline and after therapy.

In the intervention group, significant correlations were found between trait anxiety and Beck depression inventory score (r = 0.374; P = .027), overall SF-36 score and VAS score (r = 0.431;P = .015), and between physical role and VAS score (r = 0.564; P = .021), body pain (r = 0.378; P = .016) and mental health (r = 0.385; P = .024).

3.2. Six Months Post-Intervention

No significant intra-group or inter-group differences were found in state anxiety, depression or pain with respect to baseline. The intervention group showed a significant improvement (versus baseline) in physical function (P < .041). The placebo group showed no differences (versus baseline) in any SF-36 questionnaire item. The groups differed significantly in physical function (P < .049) and vitality (P < .050). The groups also differed significantly in sleep duration (P < .039), habitual sleep efficiency (P < .047) and sleep disturbance (P < .045) (Table 4).

Table 4

Differences between study groups in Pittsburgh sleep quality index at 6 months and 1 year after treatment.

In the intervention group, correlations were found between overall SF-36 questionnaire score and VAS score (r = 0.331; P = .048) and between trait anxiety score and Beck depression score (r = 0.323; P = .045).

3.3. One Year Post-Intervention

At 1 year, the intervention group showed a significant improvement (versus baseline) in sleep duration (P < .040), habitual sleep efficiency (P < .044) and daily dysfunction (P < .039) (Table 4). No significant differences in anxiety, depression, pain or quality of life were found between groups or with respect to baseline values.

In the intervention group, trait anxiety was correlated with Beck depression score (r = 0.311; P= .047).

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4. Discussion

We examined the efficacy of craniosacral treatment on anxiety, depression and quality of life in patients with fibromyalgia. At 6 months after a 25-week treatment period, patients in the intervention group showed a significant improvement in their levels of state anxiety, trait anxiety, pain, quality of life and Pittsburgh sleep quality index.

In comparative studies, patients with fibromyalgia have higher levels of depression in comparison to other patients with chronic diseases. Bennet [41] found that 30% of patients with fibromyalgia present with depression at the first consultation and 60% at some time in their clinical history. These patients reported a diffuse non-localized pain that tended to increase their level of depression.

Recent investigations have not considered depression to be a primary symptom of fibromyalgia, establishing that the degree of depression measured by the Beck questionnaire is closely related to the level of pain suffered by the patient [42, 43]. Nonetheless, a variable percentage of fibromyalgia patients (30–70%) suffer depression, which is also present to some degree in any chronic disease that courses with pain [44]. In multicenter studies, symptoms of major depression appear in 22–68% of patients affected by fibromyalgia, anxiety in 16% and simple phobias in 12–16% [45]. It has not been established whether these psychological disorders are secondary to predominant fibromyalgia symptoms or are primary symptoms of the fibromyalgia syndrome itself, regardless of the remaining symptoms [46–48].

Quality of life results showed a significant post-therapeutic improvement in the physical role, body pain and social function of the intervention group. These findings are consistent with multidisciplinary studies in patients with fibromyalgia, which have underlined the importance of motivation in achieving the participation of patients in the different therapy programs [49–52].

The improvement in physical function achieved by our craniosacral therapy protocol was similar to that obtained by aerobic exercise programs in combination with other exercise modalities and educational programs [53, 54]. Likewise, the improvement obtained in the majority of SF-36 dimensions was similar to that achieved after a 3-month hydrotherapy program, which obtained a 40% reduction in the “body pain” dimension, although the mechanisms underlying this improvement have not been elucidated [55, 56].

The improvement in the SF-36 questionnaire of quality of life shown by intervention group patients was lesser than their improvement in VAS score. This may be explained by the greater sensitivity of the “body pain” dimension of the SF-36 to detect painful changes in comparison to the VAS. Redondo et al. [56] also reported significant differences in the results obtained by these two measures of body pain.

At the end of the treatment period, the intervention and placebo groups differed significantly in overall Pittsburgh subjective sleep quality index score and in habitual sleep efficiency and sleep disturbance items. However, at one month after therapeutic intervention, significant differences were also found in sleep latency and duration. These results are in agreement with those published by Hains and Hains [57], who also found significant differences in sleep quality at one month after a spinal compression and manipulation protocol despite finding no changes in fatigue or pain immediately after the treatment. An improvement in sleep quality persisted for 1 year after a 20-session course of manual therapy involving conjunctive tissue manipulation [58]. The release of fascial restrictions may improve sleep quality by correcting visceral fascial dysfunction and thereby favoring the secretion of platelet serotonin. A study of the gut neurological system found that a high proportion of fibromyalgia patients had intestinal disorders, probably due to neuro-endocrinal causes, which may affect serotonin secretion [59].

Studies on the effects of aerobic exercise programs in fibromyalgia patients found no significant difference in the number of nights per week with sleep disturbances [60–62]. However, multidisciplinary therapeutic programs were reported to significantly improve anxiety, depression, wellbeing and sleep quality [43].

One of the limitations of the study was the inability to study 25 of the 376 patients in the accessible population before the randomized selection of the study group, due to incompatibility with their work schedules. A further limitation is related to the disparity between males and females diagnosed with fibromyalgia, which may be conditioned by the cultural setting. It is also possible that subjects with less severe pain were able to improve more rapidly.

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5. Conclusions

The present study shows that craniosacral therapy improves the quality of life of patients with fibromyalgia, reducing their perception of pain and fatigue and improving their night rest and mood, with an increase in physical function. Our craniosacral therapy protocol also reduces anxiety levels, partially improving the depressive state. This manual therapy modality must be considered as a complementary therapy within a multidisciplinary approach to these patients, also including pharmaceutical, physiotherapeutic, psychological and social treatments.

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Article taken from:  http://www.ncbi.nlm.nih.gov

This is an article I wrote in February for Shine Holistinc’s blog.

Do you suffer from anxiety, palpitations or panic attacks which can set your heart rate spiraling in such an alarming fashion? If so, there’s a potentially welcome alternative to traditional courses of treatment, which might involve drugs or psychotherapy – and it’s so gentle, it’s commonly recommended for pregnant mums.

IS A NEW MODEL OF MEDICINE EMERGING?

Termites.  Lots of them.  Over two million in fact.  And not just any termite – Macrotermes michaelseni to be precise.  Not your normal subject matter for Holistic Therapist Magazine, and I am guessing that unless I explain myself quickly, you will be turning to the horoscope blog!  So what is so special about these termites?

A TERMITE’S HOME IS HIS AIR CONDITIONING SYSTEM….

Actually there is probably very little special about M michaelseni. However, it just so happens that one very particular aspect of their lives has been studied in great depth.  Their homes.  Sitting some ten feet high on the arid plains of southern Africa, the mounds of M. michaelseni stand like Sorting Hats (as per Harry Potter and the Philosopher’s Stone) made out of clay.  Each mound is home to upwards of two million termites but surprisingly the actual ‘nest’ occupies a relatively small part of the structure, typically a sphere around three or four feet in diameter just below ground level.  The rest of the structure proves itself to be a rather remarkable feat of architectural engineering.

Within the dome structure there lies an intricate series of chambers and tunnels.  Some of these chambers are where the termites ‘farm’ a particular species of fungus which they use to digest wood and grass, releasing the nutrients needed to feed the colony.  Think the inner chambers of a ruminant’s stomach and you are not far off the mark.  But it is not even that that I find so remarkable.  What really gets my juices flowing here is the discovery that most of the structure above the ground serves one very important function.  Air-conditioning.  Both the termites and the fungi they harvest thrive within a very precise range of temperature and humidity; much of the research on the termites and their homes has shown that the mound structure serves to provide both of these with amazing precision.  What’s more, these mounds are ‘self-healing’.

What the researchers have found is that, through this intricate series of tunnels and chambers, the colony can effectively control the flow of air through the whole nest.  Not only does this control the environment within the nest – the humidity in the nest is maintained at around 90 per cent for example, which is no trivial achievement in the arid desert – but it also ensures that oxygen reaches the inner sanctum of the colony and carbon dioxide is passed to the outside for elimination.  So an air conditioning system that breathes as well!  One researcher called these mounds the lungs of the termite colony and just as much a living part of the colony as the termites themselves.

Almost by accident through the research, something rather clever was observed with these colonies.  When one of these mounds was damaged, then very quickly the mound was repaired.  But these repairs were not random.  Whatever was damaged would be repaired  not only to restore the integrity of the nest but also to restore fully its function as a lung and air conditioning system.  When damage occurred, the behaviour of the termites in the nest would change and levels of activity would increase:  Termites on other duties such as farming would be mustered to nest repairing.  Some termites would be engaged in repairing the breach, others would be sealing tunnels deep within the nest to protect them from the harsh temperatures and humidity of the outside whilst others would be rebuilding chambers in a way that restored the breathe-ability of the nest.  In one extreme study the whole mound above ground was destroyed and yet within ninety days the whole thing had been rebuilt.  And the new structure was just as effective at breathing and air-conditioning as the old.

When describing what they saw, the researchers found it very easy to humanize the termites and their behaviour.  It was as if the termites ‘knew’ what to do when the mound was destroyed. It was as if they worked to a ‘plan’, a plan that ‘understood’ how air-conditioning works.  They seemed to be ‘organised’ in a way that clearly assigned duties to individuals.  The problem is we are talking termites here.  Termites are, in the evolutionary scale of things, primitive organisms with very limited neural circuitry and yet here the researchers were claiming these insects could ‘know’, ‘plan’, ‘understand’ and ‘organise’.  We know it would be fruitless to try to find the neural structures within an individual termite that confer these behavioural traits.  But in a sense that was the first step these researchers took as they assumed that in some way, all of these nest building and repairing behaviours were vested with the Queen.

At the heart of every colony of termites there is the Queen.  Larger than all the others, she has privileged status – many of the worker termites tend to her, bring her food and ensure her chamber is kept clean.  It is tempting therefore to assume that somehow she is the brains of the outfit.  It would be easy to suggest that the mustering of the workers to repair the nest is at her command.  However, the researchers quickly dispelled this idea – if you take the Queen away from the colony, rather than becoming a rudderless collective of individuals, the colony can just as effectively and just as quickly repair a damaged nest.  Of course if you think about it, attributing the organising and planning behaviour to the Queen would not really be a solution as the neural circuits of the Queen are little different from those of a worker.  If we struggle to find the neural basis of the termite behaviour in the workers, we would struggle just as much to find such a basis in the Queen.  In fact, calling her a ‘Queen’ is more than a little misleading – it would seem to impart to her some sort of rank and control over the colony in the same way that a monarch might have exerted such influence in human society.  The Queen in such colonies should perhaps be considered more as a reproductive machine hidden away at the centre of the colony with little influence over the day-to-day activity of the colony.  Very definitely a queen with a small ‘q’!

The clever bit from the researchers was to hypothesize that the termites’ behaviour is vested not within each termite, but is instead a collective characteristic of the two million termites lacting together.  But how do you go about proving this?  Well, and you have to remember (from Part One of this article) that I am a Biophysicist so such things excite me, you have to get a computer, probably quite a powerful one, and model the behaviour of a colony of two million termites.  And that is just what the researchers did.

Whilst I would love to delve into some of that detail here, I shall acquiesce to the mostly non-mathematical bent of my audience here.  However, it is probably sufficient at this point to summarise their computer modelling.  What they showed was that even if you model termites as very simple organisms working at a purely reflex level (that is, they show simple responses to simple stimuli) a collective of two million termites can show some rather clever behaviour if you allow for one very important feature – feedback.

NO TERMITE IS AN ISLAND

No termite is an island.  Although they do not have the trappings of language as you or I would perceive, the behaviour of one termite is very much influenced by the behaviour of termites around them.  The possible actions of a termite are quite limited.  A ‘worker’ termite for example might be concerned with just four simple simple actions;  1) collecting dirt to make a mud pellet, 2) mixing this mud pellet with pheromone, a form of chemical messaging substance, 3) transporting this pellet and 4) depositing this pellet.  A trigger for starting such a sequence of actions could be detecting a temperature rise in their local environment, as may be the case when the nest structure has been compromised.  However, what the researchers found was that the frequency of the actions that followed was controlled by the activity of termites around them.  If a neighbouring termite had deposited its pellet in one particular location, then other termites were more likely to do the same in that same location.  Also, responding to changes in pheromone levels left in the pellets of others could influence the behaviour of termites even if they did not come into direct contact with each other.  There was interaction resulting from communication with neighbours and from trails of pheromones left by others and all of this led to feedback.

Now, if you model upwards of two million termites with similar simple behaviour patterns but with the ability to detect and respond to changes in their environment, the ability to interact with their neighbours and the ability to respond to feedback then, remarkably, computer simulations of termite mounds were able to self-heal in a way very similar to the real thing.  Inflict damage to a computer simulated mound and within similar time frames, these virtual mounds would be restored and restored in a way indistinguishable from the original.  Just as real termites seemed to be able to ‘know’, ‘plan’, ‘understand’ and ‘organise’ so these computer simulated colonies exhibited the same traits.

So what has all of that to do with well-being, placebos, and models of health and illness?  Let me recap the story so far.  You may remember from Part One of this article I was proposing that the extant reductionist/mechanist approaches to medicine are running out of steam.  Up to now we have worked with models of medicine that define us by the molecules of which we are made.  If we ‘go wrong’ or become ill, then it is a matter of finding the molecules or chemical processes that go wrong, find a method of correcting those molecules or chemical processes and then we shall be healed.  Most of our currently prescribed (conventional) drugs and procedures are derived from this model and in fairness, this model has given us great successes in managing many medical conditions.

MODELS OF ILLNESS OR MODELS OF HEALTH AND WELL-BEING

So what has all of that to do with well-being, placebos, and models of health and illness?  Let me recap the story so far.  You may remember from Part One of this article I was proposing that the extant reductionist/mechanist approaches to medicine are running out of steam.  Up to now we have worked with models of medicine that define us by the molecules of which we are made.  If we ‘go wrong’ or become ill, then it is a matter of finding the molecules or chemical processes that go wrong, find a method of correcting those molecules or chemical processes and then we shall be healed.  Most of our currently prescribed (conventional) drugs and procedures are derived from this model and in fairness, this model has given us great successes in managing many medical conditions.

However, you may recall that I started to question the reductionist/mechanist model of health by looking at placebos and the placebo effect.  I gave examples of drugs where the effectiveness seemed to depend on the beliefs of the patient and the prescribing practitioner as much if not more than the molecular components of the drug.  I also described a case where the colour of a drug changed what sort of conditions it treated.  Remember, the prevailing model of health is that if you find the chemical reaction that goes wrong in an illness and develop a drug to correct that, then you have your treatment.  This model has no latitude for the beliefs of the patient or those of the prescribing practitioner.

Let me now give you an alternative model of health and well-being, that model being the one encompassed within Traditional Chinese Medicine (TCM).  Before I describe this model, we should perhaps mention one immediate difference between this and the prevailing Western model.  The Western model I have examined so far is a model of illness; the Chinese model I am going to discuss now is a model of health and well-being.  This is pretty fundamental.  The former is concerned with fixing things when they have gone wrong, the latter is concerned with maintaining and where necessary restoring things back to the ‘equilibrium’ of good health and well-being.

The full philosophy of Chinese Medicine is extensive and way beyond the scope of this article but allow me to distill some of the key concepts here.  Of the many concepts of Chinese medicine, one of the most central is the idea of Qi (pronounced chee).   This concept is both simple and yet also profound.   Often translated as ‘life force’, Qi is the stuff that pervades all of the processes within our bodies.  It warms, lifts, transforms and holds things in place; it controls the shape and flow of our thoughts, emotions and feelings.  Qi ultimately determines how we interact mentally, physically and emotionally with the outside world.  In many senses, it defines who we are and defines those characteristics that make each one of us unique.  Qi is not however a substance we can distill – you cannot have a bucket-full of Qi – but rather it is defined by its effects or the footprints it leaves.

Just like blood and lymph flow through vessels, so Qi conceptually flows through our bodies within channels known as meridians.  The Chinese concept of pathology is critically dependent on this flow of Qi.  When this flow is smooth and controlled, then we could consider ourselves as healthy and balanced.  But where we show signs or symptoms of illness, then those symptoms would be attributed to an interruption in the smooth flow of Qi somewhere in the meridian system in our body.

According to the philosophy there are many meridians within this Qi-flow network and each of the principal ones is named after an organ of the body (Small Intestine, Liver and Kidney to name three).  Whilst each meridian has a connection with the organ from which it derives its name, the pathway of the whole meridian is often far-removed from the location of the actual organ.  And yet, manipulation of the Qi anywhere on these meridians can still bring about benefits to the associated organ.  Manipulation of the shoulder for example, can bring about changes to the Qi flow in the Small Intestine as that particular meridian flows through the rotator cuff of the shoulder.  An interruption to the flow of Qi through the Small Intestine meridian (say) would have specific ‘signs’ and signs that would be different to interruptions in other meridians.  Some of these would be physical and related to the function of the small intestine as we would understand it in Western physiology.  Other signs would not.  For example, as we saw above, pain and dysfunction in the shoulder could be related to a disturbed flow of Qi through the Small Intestine meridian but also with issues such as discernment and joy.  In the Chinese philosophy, all the meridians and their linked organs are associated with physical conditions, emotions and mental states that Western medicine would not acknowledge.

Diagnosis and treatment of symptoms is then a matter of identifying where the Qi flow has been disturbed and taking steps to restore that smooth flow.  However, the smooth flow of Qi may be disturbed and yet we do not exhibit symptoms of illness that Western medicine would acknowledge.  In such instances, the signs of this imbalance would be rather more subtle, perhaps changes to those linked emotions, feelings and behaviours.  However, practitioners of TCM would still treat such individuals to restore balance and well-being before illness sets-in.  Remember, the Chinese model is a model of health and well-being, not just of illness.

This balance between the physical body, the emotions and our mental being is central to the Chinese model.  And it is a reciprocal balance too.  Imbalance in one can lead to imbalance in the others – disturb the emotions and then the physical body can be impacted but similarly, disturb the physical body and then the emotions may be affected.  It is also reciprocal when considering treatment – if you treat the physical body, it may also bring about improvement to any disturbed emotions and similarly, if you treat disturbed emotions, that too could bring about improvements in the physical body.

Now of course, this inter-relationship between the physical body and the emotions is not at all alien to holistic therapists.  How often have we as holistic therapists offered a sympathetic ear to our clients whist delivering our treatment modality and been able to transform how our client feels on many levels?  But it is exactly this inter-relationship between the physical, mental and emotional that is missing from the Western reductionist/mechanist approach to illness.  With the Chinese model there is absolutely no problem in accounting for the Prozac findings (discussed in Part 1) – if the prescribing therapist or the receiving patient believes they are receiving a drug that will help deal with anxiety and depression, then that can be enough to bring relief to symptoms.  And just as the meridians are linked to certain emotions so they are also linked to colours.  It is just a natural extension of this idea that could account for how the same pill could have different benefits for the receiving patient depending on the colour of the sugar coating (also discussed in Part 1).

Of course, the Western medical model will struggle with all of this.  For example, the shoulder is, according to the reductionist/mechanists, a mechanical structure with mechanical parts.  If there is pain and dysfunction in the shoulder it is because these components have failed at a mechanical level and need a mechanical solution.  Nothing to do with the small intestine or the emotions.  What is more, no matter how much a reductionist/mechanist dissects the shoulder, her or she shall find no physical trace of Qi, meridians or links to the small intestine.  The death blow to the Chinese model?  Not at all and this is where I believe termites can help.

Remember our self-healing termite colony?  Damage the home of two million termites and said termites will repair their home to near perfection, their new repaired home being as good functionally as the old one.  However, when these colonies were examined, there was no ‘planning department’, there was no central organiser and there was no master plan being conveyed and managed to the workforce.  The repair process was a phenomenon that emerged from the interaction of the two million termites and their response to their local environment.  Although an individual behaved in a relatively simple and predictable manner, two million individuals behaved in a way that was not predictable by simply scaling-up the behaviour of individuals. Multiply the behaviour of one termite by two million and you get far less than the real behaviour of a real colony.  The colony behaved as if there was a planning department or central controller but none of these structures physically existed in a dissected nest.  Similarly, none of these attributes nor even traces of them could be found in any single termite.

What if I were to modify those last few sentences and instead say that our bodies behave as if there are Qi and meridians but that neither of these things are actual physical structures.  None of these attributes or even their building blocks are to be found in the dissection of one cell, one tissue or one organ.  What if I were instead to suggest that Qi and meridians are phenomena that emerge from the interaction and feedback between the millions and millions of molecules within us but which are not predictable from merely observing these components in isolation?  It is now sounding very much like our termite colony.  In light of these emergent phenomena, observing our molecular components in a test tube gives little insight to how these molecules behave within a complex interacting system.  Have the reductionist/mechanists therefore missed something?  I believe they have.

The area of emergent phenomena in complex interacting systems is more generically known as Emergence and is one of the new exciting topics of mathematics and science – you may remember that I am a biophysicist so such things are very likely to excite me!  The termite study I described at the start of this article is just one example but there are so so many more.  Not just termites, but ants, bees, electricity networks in the US, crowd behaviour and even gene expression from our DNA are all now being reconsidered in the light of this new form of mathematics.

The key feature of every Emergent system is that it has qualities not directly traceable to the system’s components, but rather to how those components interact with each other on a large scale.  The whole is greater than the sum of its parts.  Critically for our reductionist/mechanists, these emergent properties are in a sense ephemeral as they disappear if the system is disassembled.  Put the components of your system in a test tube and those emergent properties are no longer there to be observed.

Computer modelling, as we saw with the termite colonies, is now giving us great insights into some of these systems but we are still only able to model some of the very simplest of these systems.

In a sense the conventional medical fraternity already accepts some types of emergent phenomena.  Conscious thought, emotions and memory are examples of phenomena that emerge from the complex interaction of millions of nerve cells within our brains.  The study of one neuron in isolation does not lead us to predict these macroscopic phenomena.  They only exist in the complex assembly of many neurons.  The state of ‘living’is similarly something that emerges from the almost countless chemical and electrical interactions and feedback loops within our bodies.  Perhaps life too is an emergent phenomenon.

Of course, the ancient Chinese knew nothing about emergent phenomena or computer modelling but equally they were not hidebound by the belief that, when it comes to living systems, every attribute has to be dissected and physically located.  It did not matter to them that they could not find a meridian or capture a bucket full of Qi.  They created a model that fitted observation and created constructs that were consistent with those observations.  In a sense I have to be careful what I am saying here.  I am not saying that meridians and Qi don’t exist, I am just saying that if we take a reductionist/mechanist approach you will not find them in the debris left by dissecting us.  What I certainly am saying is that if I cannot locate these phenomena physically then that alone is not going to be a show-stopper.

If for one moment we imagine that the Chinese were to have created a philosophy to account for the healing of termite colonies, then that philosophy may well have described ‘planning departments’ and ‘central controllers’.  It would not have mattered to them if none of these structures could be found in a dissected nest.   The colony behaved as if those structures existed.  And, as interaction and feedback between the termites is essential for the healing of the nest, such a Chinese philosophy may have then described the importance of nurturing the well-being of the whole termite colony to bring about that self-healing.  It is all sounding familiarly holistic now.

So how would I draw parallels between the problem of modern medicine running out of steam introduced in Part 1 and these self-healing termite colonies?   Well, I would liken many reductionist/mechanist drugs to coming along with a trowel and pasting new mud where the existing mud in a termite colony has been damaged.  This will ‘fix’ the nest by external intervention and may give lasting results.  However the most robust solution would be to nurture all the termites in the nest so that they can get on with the job of self-healing.  This would produce a repair that is organic and from within.  An enduring ‘holistic’ solution and one more akin to most alternative or complementary therapy approaches.  And what of placebos?  Remember I described cases where if the prescribing practitioner or the patient believes they are receiving a drug, they are healed even if they in fact were receiving a placebo.  In this instance, the sugar pill placebo would be (for our termite colony) like external intervention but rather than putting mud on the trowel you would have dry sand which on its own is not up to the job of repairing the walls but perhaps looks convincingly like it would.  However, if the person holding the trowel believes this will fix the nest and they are able to convey this belief to the termites in a way that nurtures the feedback loops between the members of the colony, then the self-healing properties of the nest will still be boosted thereby bringing about a long term repair to the nest anyway but from within.

So if we are being fooled by placebos, perhaps we should be changing your models of health and well-being!

I hope you have enjoyed reading this article.  If you would like to read more about the fascinating area I would point you to three books that stimulated me into writing this article: Smart Swarm by Peter Miller, The Science Delusion by Rupert Sheldrake and Bad Science by Ben Goldacre.

Article taken from: www.holistictherapistmagazine.com

DON’T BE FOOLED BY PLACEBOS

PART 1

  Medicine used to be easy.  Through (conventional) medicine we have successfully eradicated many once commonplace and potentially fatal illnesses.  At our disposal we now have a veritable army of drugs to ease pain, make us immune to diseases and thwart the progress of degenerative conditions.  We have surgical techniques that can mend and replace parts of us that wear out or become damaged due to illness.  Yet all is not well in this Utopia of Man conquering disease and illness.

As I write this article (May 2013) a new strain of Bird Flu, H7N9, is beginning to stir the Worldwide medical community amid fears that this could be the ‘big one’.  Thirty years on from its first appearance, HIV still does not have a robust cure.  It is commonplace to hear that hospital wards are closed due to anti-biotic resistant infections.  Drugs are becoming increasingly expensive to produce – we are never far from a heartstring-pulling story of some new ‘wonder’ drug being available and yet too expensive to be prescribed to patients.  We are living longer than ever before, but as a consequence we are exposing ourselves to an increasing number of conditions as our bodies and our body chemistry wear out.

Proponents of conventional medicine will argue that it is just a matter of time – drugs for the currently incurable WILL be found, we just need more time.  All we need is more time to get inside the agents that cause these conditions, more time to delve ever deeper into their biochemistry, more time to improve our understanding of our own physiology and then modern medicine will prevail once more.

What I would like to argue in this article is that our current conventional ways of thinking of health are perhaps running out of steam and now need to make room for other ways of thinking.  What I shall then argue is that some of these ‘other ways‘ are not new at all – not new because other branches of science have already learnt to embrace these methods and not new because many alternative models of health and well-being have been adopting these approaches for, in some cases, millennia.

THE CLOCKWORK MODEL OF THE WORLD

“My name is Phil Nuttridge and I have a degree in Biophysics”.

Whilst that may not be your usual sort of confessional statement, I think it is going to be an important one here.  Biophysics is a wonderful subject (of course I am going to say that), which transcends traditional boundaries between the physics of the material world and the diversity of living systems. As a graduate of Biophysics I find it quite natural to inject a bit of mathematical thinking into any discourse on living systems, in particular models of health and wellbeing. Whilst that may be alien territory for most of my intended audience here, I am asking your forgiveness in advance for doing just that in this article. Please take it on trust that the journey is worth it!

Let me take you back to physics a la Seventeenth Century.  The great scientists of that time such as Galileo and Kepler were making significant in-roads into our understanding of the physical universe.  A little while earlier, Copernicus had radically changed things by putting the Sun at the centre of our part of the cosmos; what Galileo and Kepler did then was to deduce the physical laws governing the motion of these celestial bodies.  Their legacy was to give us the idea of a clockwork universe – understand the laws of planetary motion sufficiently and then you can ‘crank the handle’ of this clockwork universe to predict where the planets will be at any point in the future.

To the Human mind, there is something very satisfying about this.  Being able to disassemble the components of the world around us, understand the laws controlling the  behaviour of those components and then reassemble them to understand the ‘whole’ is surely testament to Man’s supremacy of the world around him?

The clockwork model of the world very successfully unlocked our understanding of many aspects of the physical world around us and not just the movement of the cosmos.  For nearly two centuries it ruled supreme.  Its proponents were, and indeed still are, hailed as the ‘greats’ of the early scientific movement.  However, by the early twentieth century Einstein and his contemporaries were beginning to challenge the supremacy of the clockwork model.  Observations were stacking-up that just did not fit with a clockwork world.  At first it was the observations that were challenged rather than the clockwork model as, after all, the clockwork model had been so successful for so long.  It took some of the greatest scientific minds of the twentieth century to formulate a robust challenge to the clockwork model and spawn what we now call modern physics.  A century on, and modern physics embraces the strange world of strings, bosons, quanta and uncertainty.

What I would like to argue is that current medical thinking is now at a similar turning point.

Back in the Seventeenth century the success of the clockwork model, led to its extension to other aspects of the world around us.  The philosopher Descartes is attributed as the founder of the clockwork or mechanical model of the human body.  He was the first to consider living things as little more than automata or mechanical machines the components of which would one day be sufficiently understood in sufficient detail so that all aspects of the ‘human condition’ would be explained.  Although we have perhaps watered-down our thinking a little in the intervening centuries, particularly in respect of us being little more than automata, this mechanical approach still dominates medical thinking today.

Let me rephrase the Descartes model and instead call it the reductionist/mechanist model of medicine.  By reductionist/mechanist I mean an approach that assumes if we know enough about how the individual cellular components and chemicals inside a living system work (the ‘reductionist’ bit), then we can scale-up this knowledge and understand how living organisms such as you and I function as a whole (the ‘mechanist’ bit).  Medical techniques based on reductionist/mechanist principles rely heavily on drugs that work at the molecular level and whose benefits are then scaled-up to whole human beings in a similar manner.

I am not inherently against reductionism.  Reductionism has given us great insights into the workings of many aspects of the human body.  Those parts that can be considered as mechanical (joints, heart valves, eyes and ears for example) respond well to the mechanical type treatments that reductionism would offer.  Much of the sphere of my own work as a Manual Therapist relies on what we have learnt about muscle and joint function at a reductionist level and as such responds well to methods developed on the back of reductionist/mechanist research.

Also, for us humans, reductionism/mechanism is intuitive – you show me a little boy or girl who has not dismantled a toy (probably a brother’s or sister’s favourite toy) in order to ‘understand’ better how it works.  It is part of the human psyche to disassemble something to understand better how it is assembled and how that assembly operates.  What I am arguing for is that when something is imbued with the quality we call ‘life’,  then that object can no-longer be considered as a purely mechanical object, merely the sum of its mechanical components.  There are characteristics of living things that cannot be disassembled, that cannot be found in the disassembled components or deduced from reassembling those components.  When it comes to living things, the whole is most definitely greater than the sum of its parts.

But maybe even that latter part (the bit about the whole being greater than the sum) is in our psyche too.  When I wrote that previous paragraph, I just added the bit about ‘a brother’s or sister’s favourite toy’ as a bit of humour.  Actually, now I have thought about it, perhaps it was more than that.  Perhaps we do intuitively understand that once something has been disassembled and reassembled it is no longer the same.  As a child, we would rather take apart something that is not precious to us because we know that when we reassemble it, it is not truly the same as it was.  And what is true of inanimate toys, is of course certainly going to be true of living things.

So if I am suggesting that reductionist/mechanist models of medicine are running out of steam, what might the alternatives look like.  For me, the opposite of reductionism in medicine shall equate to the body of holistic alternative and complementary therapies.  The existence of such holistic approaches to health is often to the annoyance of the conventional medical fraternity.  The reductionist approach to medicine has not yet found robust explanations to how all or possibly any of these approaches work (or is it because the medical fraternity have not been looking for explanations, something I shall explore later) and it is an essential part of the reductionist ideal that if no explanation can be found at the molecular or reduced level, then such approaches cannot work.  For example, if a reductionist cannot measure or understand how an acupuncturist’s needle affects the chemical functioning of a molecule or an individual cell, then that same reductionist cannot extrapolate-up the benefits of acupuncture on a whole human being.  Often any holistic therapy benefits observed in patients will be dismissed by the medical fraternity because they do not have a reductionist explanation of how they could work.  Seeing is not believing – apparently.

THE BLUEPRINT OF LIFE

One of the holy grails of reductionist medical research is that one day we should understand to such a great level of detail the body’s molecular functioning that we should then be able to ‘design’ drugs at a molecular level to deal with any ailment.  Unlock the destiny of every molecule in the human body and how that destiny is impacted by illness, we then unlock the detail of how to overcome any illness that can beset us, or so the story goes.  The centre-piece of this was the creation of the Human Genome Project.

On June 26 2000, President Bill Clinton took to the stage on the publication day of the first draft of the Human Genome Project.  This project, started in 1990 and with a (then) budget of over $3 billion, was created to map every chemical genetic instruction of the human genome.  I shan’t get too technical here, but essentially within our 46 chromosomes and the DNA contained therein, are the chemical instructions used to create each one of us (this is of course in the words of the reductionist fraternity).  Once we had the technology to delve into this, it became the ‘space race‘ of the medical world to elucidate all of these instructions and create the complete map of how a human being is made.  President Clinton told us:

“We are here today to celebrate the completion of the first survey of the entire human genome.  Without a doubt this is the most important, most wondrous map ever produced by mankind.  It will revolutionise the diagnosis, prevention and treatment of most, if not all human diseases.  Humankind is on the verge of gaining immense, new power to heal”

I don’t know about you, but 13 years on, I feel I am still waiting for this immense new power to heal!

So what went wrong?  Before I get on my reductionist versus holistic approach hobby horse, here are some interesting statistics.   At the start of the Human Genome Project it was anticipated that there would be around 100,000 genes in our genome.  Disappointingly the number turned out to be only around 23,000.  If you are a reductionist/mechanist, this is fundamentally troubling.  If the genome is truly the repository for the biochemical instructions to make us, then of course there needs to be enough instructions to account for the complexity of a human being.  Whilst 23,000 instructions may seem a lot, consider by comparison that there are 26,000 genes in a sea urchin’s genome and 38,000 in some species of rice!  A parallel project to map the genome of chimpanzees and compare it to our genome, set-out to discover the biochemical (reductionist) prerequisites that make us different from chimpanzees.  When the project completed, the chimpanzee genome was found to be so similar to our own that the director of the chimpanzee project concluded: ‘We cannot see in this why we are so different from chimpanzees’.  Unlocking every molecule and the instructions to create those molecules is perhaps going to be less revealing than we thought.

Such a dead end has to be fundamentally troubling to the reductionist/mechanist fraternity.  Unlocking the genome is the ultimate pathway available to reductionists – there are no deeper levels to explore beyond that.  If that level of reductionism fails to deliver an understanding that leads to a ‘new power to heal’ then maybe reductionism itself cannot deliver this new power.

At the danger of repeating myself, let me make one final comparison with my earlier discourse on the clockwork model of the cosmos.  The use of the Human Genome has a parallel to where physics was before the turn of the 20th century.  Mechanists up to that time thought of the cosmos as being like a clockwork model, working according to precise and immutable laws and rules.  If we just knew enough about the starting conditions to feed-into these laws and rules we could thereby predict everything about the future of the cosmos.  Similarly, if we could map-out the details of the mechanical wheels and cogs of the human body as encoded in our genome, then in a similar clockwork fashion we could understand the workings of the human body in health and in illness.  Physics, when it reached its crisis point, adapted and embraced the strange new world of quantum mechanics.  Perhaps medicine has to find a similar new strategy.

As I said earlier, I am not against reductionist/mechanist medicine as it DOES work in many situations, much of the time.  What I am arguing is that, just like the clockwork mechanics of the cosmos, medicine is now facing challenges and observations that just don’t quite fit the model and that force us to rethink where medicine is heading in the twenty-first century.

SO WHAT’S THE EVIDENCE?

So what are these observations that challenge conventional medical thinking?  To my mind  (of course) these are many and various.  My thrust here though will be a look at the role of placebos in medicine.

I would imagine that most of my intended audience here are familiar with the concept of the placebo.  In fact, I suspect many of the alternative and complementary therapists reading this may have had their modalities of treatment dismissed as nothing more than the placebo effect wrapped-up in non-scientific mumbo-jumbo (or is it just me smarting from that one?).

The Wikipedia definition of a placebo is:

….a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient. Sometimes patients given a placebo treatment will have a perceived or actual improvement in a medical condition, a phenomenon commonly called the placebo effect.

Already I am getting a bit animated.  Just consider that – a treatment that is medically ineffectual that will have a perceived or actual improvement in a medical condition.  If a treatment gives an improvement in a medical condition, can you still honestly call it medically ineffectual?  Perhaps I can be assertive here a recast that part of the definition in terms of my foregoing discussions.  A placebo is then a treatment that does not fit the reductionist/mechanist approach to medicine and yet in some cases brings about improvement in a medical condition.  Now that makes me feel a bit happier.  And what about ‘actual’ versus ‘perceived’ improvement in a condition?  If a patient perceives an improvement in his or her condition, is that not an improvement?  And so, if the placebo effect brings about an improvement in a medical condition, does that not make it an effective treatment?

The placebo (in the strict sense that is intended to deceive a recipient) is the mainstay of the Randomised Clinical Trial (RCT), the main route through which drugs or procedures are tested before being prescribed.  In a RCT patients are exposed either to the drug/procedure being tested or a placebo; in the most robust RCTs neither the prescribing practitioner nor the patient knows whether the treatment being administered is the ‘real’ one or the placebo.  Such RCTs are known as double blind. If you are a reductionist/mechanist then the interpretation of such trials is clear – if the drug or procedure being tested is effective, then those patients receiving it shall show significantly better improvements in their conditions than those receiving the placebo.  If the placebo and the drug perform equally well, then there is no case for the effectiveness of the drug/procedure being tested.

Unfortunately, what gets in the way are peoples’ emotions, beliefs and hopes.  Now that is VERY troubling for the reductionists/mechanists.  If we have drugs and procedures developed and working at the reductionist and mechanical level, then the mechanistic model just has no latitude to allow for these touchy-feely concepts.  Allow me to present some of the evidence of this.

Firstly let us look at Prozac.  Worldwide sales of Prozac are huge – $2 billion annually at one estimate.  Because it is ‘out there’ we would expect therefore that RCTs testing its effectiveness would show that it is significantly better than a placebo.  At first glance the results of the RCTs would indeed suggest that.  However there is a problem.  Prozac has well-documented side effects such as nausea and insomnia.  As such, a practitioner prescribing Prozac in a RCT may very quickly be able to determine whether they are indeed prescribing Prozac or the placebo.  Remember, one of the key aspects of a robust RCT is that neither practitioner nor patient know if they are using the real drug.  Ask the patient if they experienced either side effect and bam, you know or at least strongly suspect whether it was indeed Prozac that was prescribed.  This is known as ‘breaking the blind’.  Of course in a reductionist/mechanist model that should make absolutely no difference to the outcome.  However, the stats do not support that.  Making no allowance for ‘breaking the blind’, Prozac does indeed out-preform a placebo.  However, if you eliminate data where the prescribing practitioner successfully deduced that they were in fact prescribing Prozac, then Prozac barely out-performs the placebo.  Pitch Prozac against a placebo that also causes nausea and vomiting and again there is little difference between the real drug and the placebo.

If Prozac works at a reductionist/mechanist level, then how can the practitioner knowing which is being prescribed make a difference? Can it really be that the prescribing practitioner’s  beliefs and hopes make a difference to the effectiveness of a treatment?

Let me throw another example at you.  In the late Naughties, analysis showed that placebos are becoming increasingly effective in clinical trials, particularly in the United States.  Let me be clear here – I am not just saying that in clinical trials since the start of this century the gap between the drugs being tested and placebos has narrowed (which is certainly true) but more specifically that placebos perform better now against a range of medical conditions than ever they did before.  What is more, this effect is more noticeable in the United States.

The reason that has been suggested for this is also testament to the success of the pharmaceutical industry.  Since 1997 drug companies in the United States have been able to market their products directly to their ‘consumers’, the American people.  Thanks to the power of the marketing machines of the pharmaceutical industry, Americans now see images of happy, healthy, smiley people and it is all thanks to the latest wonder drugs.  The American populace therefore has a heightened expectation from the output of drug companies – put these people in clinical trials and even if they are receiving the placebo, their belief in the power of drugs can make those placebos work more effectively than ever before.

So, we have evidence that the hopes and expectations of practitioners and patients alike can make profound differences to the effectiveness of treatment.  No reductionist/mechanist model of medicine I know of can account for that.

Let me give you one more example to challenge the accepted model of medicine.  Clinical trials of the drug Oxazepam have shown that it is more effective at treating anxiety when the pills are dyed green and yet more effective at treating depression when dyed yellow.  The same chemical compound targeting the same biochemical pathways but its effect depending on its colour?  Unless we are suggesting that the dyes being used are the ‘active’ ingredient, then this again has to be very troubling to the reductionist/mechanists.

So how do we make sense of this and what other models of medicine are available to account for this?

I shall address both of these questions in the second part to this article.  I shall look at how some exciting new developments in mathematics might be showing the future direction for medicine and how some of the most ancient philosophies of health and well-being have been embracing such thinking for millennia.

Article taken from: www.holistictherapistmagazine.com