The Emperor’s New Klotho, Or Something More?

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Unzipping The Genes Of Aging?

Klotho is an enzyme encoded in humans’ genes—specifically, in the KL gene.

It’s found throughout all living parts of the human body (and can even circulate about in its hormonal form, or come to rest in its membranaceous form), and its subgroups are especially found:

  • α-klotho: in the brain
  • β-klotho: in the liver
  • γ-klotho: in the kidneys

Great! Why do we care?

Klotho, its varieties and variants, its presence or absence, are very important in aging.

Almost every biological manifestation of aging in humans has some klotho-related indicator; usually the decrease or mutation of some kind of klotho.

Which way around the cause and effect go has been the subject of much debate and research: do we get old because we don’t have enough klotho, or do we make less klotho because we’re getting old?

Of course, everything has to be tested per variant and per system, so that can take a while (punctuated by research scientists begging for more grants to do the next one). Given that it’s about aging, testing in humans would take an incredibly long while, so most studies so far have been rodent studies.

The general gist of the results of rodent studies is “reduced klotho hastens aging; increased klotho slows it”.

(this can be known by artificially increasing or decreasing the level of klotho expression, again something easier in mice as it is harder to arrange transgenic humans for the studies)

Here’s one example of many, of that vast set of rodent studies:

Suppression of Aging in Mice by the Hormone Klotho

Relevance for Alzheimer’s, and a science-based advice

A few years ago (2020), an Alzheimer’s study was undertaken; they noted that the famous apolipoprotein E4 (apoE4) allele is the strongest genetic risk factor for Alzheimer’s, and that klotho may be another. FGF21 (secreted by the liver, mostly during fasting) binds to its own receptor (FGFR1) and its co-receptor β-klotho. Since this is a known neuroprotective factor, they wondered whether klotho itself may interact with β-amyloid (Aβ), and found:

❝Aβ can enhance the ability of klotho to draw FGF21 to regions of incipient neurodegeneration in AD❞

~ Dr. Lehrer & Dr. Rheinstein

In other words: β-amyloid, the substance whose accumulation is associated with neurodegeneration in Alzheimer’s disease, is a mediator in klotho bringing a known neuroprotective factor, FGF21, to the areas of neurodegeneration

In fewer words: klotho calls the firefighters to the scene of the fire

Read more: Alignment of Alzheimer’s disease amyloid β-peptide and klotho

The advice based on this? Consider practicing intermittent fasting, if that is viable for you, as it will give your liver more FGF21-secreting time, and the more FGF21, the more firefighters arrive when klotho sounds the alarm.

See also: Intermittent Fasting: What’s the truth?

…and while you’re at it:

Does intermittent fasting have benefits for our brain?

A more recent (2023) study with a slightly different (but connected) purpose, found results consistent with this:

Longevity factor klotho enhances cognition in aged nonhuman primates

…and, for that matter this (2023) study that found:

Associations between klotho and telomere biology in high stress caregivers

…which looks promising, but we’d like to see it repeated with a sounder method (they sorted caregiving into “high-stress” and “low-stress” depending on whether a child was diagnosed with ASD or not, which is by no means a reliable way of sorting this). They did ask for reported subjective stress levels, but to be more objective, we’d like to see clinical markers of stress (e.g. cortisol levels, blood pressure, heart rate changes, etc).

A very recent (April 2024) study found that it has implications for more aspects of aging—and this time, in humans (but using a population-based cohort study, rather than lab conditions):

The prognostic value of serum α-klotho in age-related diseases among the US population: A prospective population-based cohort study

Can I get it as a supplement?

Not with today’s technology and today’s paucity of clinical trials, you can’t. Maybe in the future!

However… The presence of senescent (old, badly copied, stumbling and staggering onwards when they should have been killed and eaten and recycled already) cells actively reduces klotho levels, which means that taking supplements that are senolytic (i.e., that kill those senescent cells) can increase serum klotho levels:

Orally-active, clinically-translatable senolytics restore α-Klotho in mice and humans

Ok, what can I take for that?

We wrote about a senolytic supplement that you might enjoy, recently:

Fisetin: The Anti-Aging Assassin

Want to know more?

If you have the time, Dr. Peter Attia interviews Dr. Dena Dubal (researcher in several of the above studies) here:

Click Here If The Embedded Video Doesn’t Load Automatically

Enjoy!

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    Antidepressants: Personalization Is Key! Find the right antidepressant for you. Science shows they can correct neurochemical imbalances, help tackle other factors, and have varying side effects. Learn more here.

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  • How White Is Your Tongue?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s Q&A Day at 10almonds!

    Have a question or a request? We love to hear from you!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    ❝So its normal to develop a white sort of coating on the tongue, right? It develops when I eat, and is able to (somewhat) easily be brushed off❞

    If (and only if) there is no soreness and the coverage of the whiteness is not extreme, then, yes, that is normal and fine.

    Your mouth has a microbiome, and it’s supposed to have one (helps keep the conditions in your mouth correct, so that food is broken down and/but your gums and teeth aren’t).

    Read more: The oral microbiome: Role of key organisms and complex networks in oral health and disease

    The whiteness you often see on a healthy tongue is, for the most part, bacteria and dead cells—harmless.

    Cleaning the whiteness off with your brush is fine. You can also scrape off with floss is similar if you prefer. Or a tongue-scraper! Those can be especially good for people for whom brushing the tongue is an unpleasant sensation. Or you can just leave it, if it doesn’t bother you.

    By the way, that microbiome is a reason it can be good to go easy on the mouthwash. Moderate use of mouthwash is usually fine, but you don’t want to wipe out your microbiome then have it taken over by unpleasantries that the mouthwash didn’t kill (unpleasantries like C. albicans).

    There are other mouthwash-related considerations too:

    Toothpastes and mouthwashes: which kinds help, and which kinds harm?

    If you start to get soreness, that probably means the papillae (little villi-like things) are inflamed. If there is soreness, and/or the whiteness is extreme, then it could be a fungal infection (usually C. albicans, also called Thrush), in which case, antifungal medications will be needed, which you can probably get over the counter from your pharmacist.

    Do not try to self-treat with antibiotics.

    Antibiotics will make a fungal infection worse (indeed, antibiotic usage is often the reason for getting fungal growth in the first place) by wiping out the bacteria that normally keep it in check.

    Other risk factors include a sugary diet, smoking, and medications that have “dry mouth” as a side effect.

    Read more: Can oral thrush be prevented?

    If you have any symptoms more exciting than the above, then definitely see a doctor.

    Take care!

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  • Will there soon be a cure for HIV?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Human immunodeficiency virus, or HIV, is a chronic health condition that can be fatal without treatment. People with HIV can live healthy lives by taking antiretroviral therapy (ART), but this medication must be taken daily in order to work, and treatment can be costly. Fortunately, researchers believe a cure is possible.

     In July, a seventh person was reportedly cured of HIV following a 2015 stem cell transplant for acute myeloid leukemia. The patient stopped taking ART in 2018 and has remained in remission from HIV.

    Read on to learn more about HIV, the promise of stem cell transplants, and what other potential cures are on the horizon.

    What is HIV?

    HIV infects and destroys the immune system’s cells, making people more susceptible to infections. If left untreated, HIV will severely impair the immune system and progress to acquired immunodeficiency syndrome (AIDS). People living with untreated AIDS typically die within three years.

    People with HIV can take ART to help their immune systems recover and to reduce their viral load to an undetectable level, which slows the progression of the disease and prevents them passing the virus to others.

    How can stem cell transplants cure HIV?

    Several people have been cured of HIV after receiving stem cell transplants to treat leukemia or lymphoma. Stem cells are produced by the spongy tissue located in the center of some bones, and they can turn into new blood cells.

    A mutation on the CCR5 gene prevents HIV from infecting new cells and creates resistance to the virus, which is why some HIV-positive people have received stem cells from donors carrying this mutation. (One person was reportedly cured of HIV after receiving stem cells without the CCR5 mutation, but further research is needed to understand how this occurred.)

    Despite this promising news, experts warn that stem cell transplants can be fatal, so it’s unlikely this treatment will be available to treat people with HIV unless a stem cell transplant is needed to treat cancer. People with HIV are at an increased risk for blood cancers, such as Hodgkin lymphoma and non-Hodgkin lymphoma, which stem cell transplants can treat.

    Additionally, finding compatible donors with the CCR5 mutation who share genetic heritage with patients of color can be challenging, as donors with the mutation are typically white.

    What are other potential cures for HIV?

    In some rare cases, people who started ART shortly after infection and later stopped treatment have maintained undetectable levels of HIV in their bodies. There have also been some people whose bodies have been able to maintain low viral loads without any ART at all.

    Researchers are studying these cases in their search for a cure.

    Other treatment options researchers are exploring include:

    • Gene therapy: In addition to stem cell transplants, gene therapy for HIV involves removing genes from HIV particles in patients’ bodies to prevent the virus from infecting other cells.
    • Immunotherapy: This treatment is typically used in cancer patients to teach their immune systems how to fight off cancer. Research has shown that giving some HIV patients antibodies that target the virus helps them reach undetectable levels of HIV without ART.
    • mRNA technology: mRNA, a type of genetic material that helps produce proteins, has been used in vaccines to teach cells how to fight off viruses. Researchers are seeking a way to send mRNA to immune system cells that contain HIV.

    When will there be a cure for HIV?

    The United Nations and several countries have pledged to end HIV and AIDS by 2030, and a 2023 UNAIDS report affirmed that reaching this goal is possible. However, strategies to meet this goal include HIV prevention and improving access to existing treatment alongside the search for a cure, so we still don’t know when a cure might be available.

    How can I find out if I have HIV?

    You can get tested for HIV from your primary care provider or at your local health center. You can also purchase an at-home HIV test from a drugstore or online. If your at-home test result is positive, follow up with your health care provider to confirm the diagnosis and get treatment.

    For more information, talk to your health care provider.

    This article first appeared on Public Good News and is republished here under a Creative Commons license.

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  • Pain Clinics Made Millions From ‘Unnecessary’ Injections Into ‘Human Pin Cushions’

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    McMINNVILLE, Tenn. — Each month, Michelle Shaw went to a pain clinic to get the shots that made her back feel worse — so she could get the pills that made her back feel better.

    Shaw, 56, who has been dependent on opioid painkillers since she injured her back in a fall a decade ago, said in both an interview with KFF Health News and in sworn courtroom testimony that the Tennessee clinic would write the prescriptions only if she first agreed to receive three or four “very painful” injections of another medicine along her spine.

    The clinic claimed the injections were steroids that would relieve her pain, Shaw said, but with each shot her agony would grow. Shaw said she eventually tried to decline the shots, then the clinic issued an ultimatum: Take the injections or get her painkillers somewhere else.

    “I had nowhere else to go at the time,” Shaw testified, according to a federal court transcript. “I was stuck.”

    Shaw was among thousands of patients of Pain MD, a multistate pain management company that was once among the nation’s most prolific users of what it referred to as “tendon origin injections,” which normally inject a single dose of steroids to relieve stiff or painful joints. As many doctors were scaling back their use of prescription painkillers due to the opioid crisis, Pain MD paired opioids with monthly injections into patients’ backs, claiming the shots could ease pain and potentially lessen reliance on painkillers, according to federal court documents.

    Now, years later, Pain MD’s injections have been proved in court to be part of a decade-long fraud scheme that made millions by capitalizing on patients’ dependence on opioids. The Department of Justice has successfully argued at trial that Pain MD’s “unnecessary and expensive injections” were largely ineffective because they targeted the wrong body part, contained short-lived numbing medications but no steroids, and appeared to be based on test shots given to cadavers — people who felt neither pain nor relief because they were dead.

    Four Pain MD employees have pleaded guilty or been convicted of health care fraud, including company president Michael Kestner, who was found guilty of 13 felonies at an October trial in Nashville, Tennessee. According to a transcript from Kestner’s trial that became public in December, witnesses testified that the company documented giving patients about 700,000 total injections over about eight years and said some patients got as many as 24 shots at once.

    “The defendant, Michael Kestner, found out about an injection that could be billed a lot and paid well,” said federal prosecutor James V. Hayes as the trial began, according to the transcript. “And they turned some patients into human pin cushions.”

    The Department of Justice declined to comment for this article. Kestner’s attorneys either declined to comment or did not respond to requests for an interview. At trial, Kestner’s attorneys argued that he was a well-intentioned businessman who wanted to run pain clinics that offered more than just pills. He is scheduled to be sentenced on April 21 in a federal court in Nashville.

    According to the transcript of Kestner’s trial, Shaw and three other former patients testified that Pain MD’s injections did not ease their pain and sometimes made it worse. The patients said they tolerated the shots only so Pain MD wouldn’t cut off their prescriptions, without which they might have spiraled into withdrawal.

    “They told me that if I didn’t take the shots — because I said they didn’t help — I would not get my medication,” testified Patricia McNeil, a former patient in Tennessee, according to the trial transcript. “I took the shots to get my medication.”

    In her interview with KFF Health News, Shaw said that often she would arrive at the Pain MD clinic walking with a cane but would leave in a wheelchair because the injections left her in too much pain to walk.

    “That was the pain clinic that was supposed to be helping me,” Shaw said in her interview. “I would come home crying. It just felt like they were using me.”

    ‘Not Actually Injections Into Tendons at All’

    Pain MD, which sometimes operated under the name Mid-South Pain Management, ran as many as 20 clinics in Tennessee, Virginia, and North Carolina throughout much of the 2010s. Some clinics averaged more than 12 injections per patient each month, and at least two patients each received more than 500 shots in total, according to federal court documents.

    All those injections added up. According to Medicare data filed in federal court, Pain MD and Mid-South Pain Management billed Medicare for more than 290,000 “tendon origin injections” from January 2010 to May 2018, which is about seven times that of any other Medicare biller in the U.S. over the same period.

    Tens of thousands of additional injections were billed to Medicaid and Tricare during those same years, according to federal court documents. Pain MD billed these government programs for about $111 per injection and collected more than $5 million from the government for the shots, according to the court documents.

    More injections were billed to private insurance too. Christy Wallace, an audit manager for BlueCross BlueShield of Tennessee, testified that Pain MD billed the insurance company about $40 million for more than 380,000 injections from January 2010 to March 2013. BlueCross paid out about $7 million before it cut off Pain MD, Wallace said.

    These kinds of enormous billing allegations are not uncommon in health care fraud cases, in which fraudsters sometimes find a legitimate treatment that insurance will pay for and then overuse it to the point of absurdity, said Don Cochran, a former U.S. attorney for the Middle District of Tennessee.

    Tennessee alone has seen fraud allegations for unnecessary billing of urine testing, skin creams, and other injections in just the past decade. Federal authorities have also investigated an alleged fraud scheme involving a Tennessee company and hundreds of thousands of catheters billed to Medicare, according to The Washington Post, citing anonymous sources.

    Cochran said the Pain MD case felt especially “nefarious” because it used opioids to make patients play along.

    “A scheme where you get Medicare or Medicaid money to provide a medically unnecessary treatment is always going to be out there,” Cochran said. “The opioid piece just gives you a universe of compliant people who are not going to question what you are doing.”

    “It was only opioids that made those folks come back,” he said.

    The allegations against Pain MD became public in 2018 when Cochran and the Department of Justice filed a civil lawsuit against the company, Kestner, and several associated clinics, alleging that Pain MD defrauded taxpayers and government insurance programs by billing for “tendon origin injections” that were “not actually injections into tendons at all.”

    Kestner, Pain MD, and several associated clinics have each denied all allegations in that lawsuit, which is ongoing.Scott Kreiner, an expert on spine care and pain medicine who testified at Kestner’s criminal trial, said that true tendon origin injections (or TOIs) typically are used to treat inflamed joints, like the condition known as “tennis elbow,” by injecting steroids or platelet-rich plasma into a tendon. Kreiner said most patients need only one shot at a time, according to the transcript.

    But Pain MD made repeated injections into patients’ backs that contained only lidocaine or Marcaine, which are anesthetic medications that cause numbness for mere hours, Kreiner testified. Pain MD also used needles that were often too short to reach back tendons, Kreiner said, and there was no imaging technology used to aim the needle anyway. Kreiner said he didn’t find any injections in Pain MD’s records that appeared medically necessary, and even if they had been, no one could need so many.

    “I simply cannot fathom a scenario where the sheer quantity of TOIs that I observed in the patient records would ever be medically necessary,” Kreiner said, according to the trial transcript. “This is not even a close call.”

    Jonathan White, a physician assistant who administered injections at Pain MD and trained other employees to do so, then later testified against Kestner as part of a plea deal, said at trial that he believed Pain MD’s injection technique was based on a “cadaveric investigation.”

    According to the trial transcript, White said that while working at Pain MD he realized he could find no medical research that supported performing tendon origin injections on patients’ backs instead of their joints. When he asked if Pain MD had any such research, White said, an employee responded with a two-paragraph letter from a Tennessee anatomy professor — not a medical doctor — that said it was possible to reach the region of back tendons in a cadaver by injecting “within two fingerbreadths” of the spine. This process was “exactly the procedure” that was taught at Pain MD, White said.

    During his own testimony, Kreiner said it was “potentially dangerous” to inject a patient as described in the letter, which should not have been used to justify medical care.

    “This was done on a dead person,” Kreiner said, according to the trial transcript. “So the letter says nothing about how effective the treatment is.”

    Over-Injecting ‘Killed My Hand’

    Pain MD collapsed into bankruptcy in 2019, leaving some patients unable to get new prescriptions because their medical records were stuck in locked storage units, according to federal court records.

    At the time, Pain MD defended the injections and its practice of discharging patients who declined the shots. When a former patient publicly accused the company of treating his back “like a dartboard,” Pain MD filed a defamation lawsuit, then dropped the suit about a month later.

    “These are interventional clinics, so that’s what they offer,” Jay Bowen, a then-attorney for Pain MD, told The Tennessean newspaper in 2019. “If you don’t want to consider acupuncture, don’t go to an acupuncture clinic. If you don’t want to buy shoes, don’t go to a shoe store.”

    Kestner’s trial told another story. According to the trial transcript, eight former Pain MD medical providers testified that the driving force behind Pain MD’s injections was Kestner himself, who is not a medical professional and yet regularly pressured employees to give more shots.

    One nurse practitioner testified that she received emails “every single workday” pushing for more injections. Others said Kestner openly ranked employees by their injection rates, and implied that those who ranked low might be fired.

    “He told me that if I had to feed my family based on my productivity, that they would starve,” testified Amanda Fryer, a nurse practitioner who was not charged with any crime.

    Brian Richey, a former Pain MD nurse practitioner who at times led the company’s injection rankings, and has since taken a plea deal that required him to testify in court, said at the trial that he “performed so many injections” that his hand became chronically inflamed and required surgery.

    “‘Over injecting killed my hand,’” Richey said on the witness stand, reading a text message he sent to another Pain MD employee in 2017, according to the trial transcript. “‘I was in so much pain Injecting people that didnt want it but took it to stay a patient.’”

    “Why would they want to stay there?” a prosecutor asked.

    “To keep getting their narcotics,” Richey responded, according to the trial transcript.

    Throughout the trial, defense attorney Peter Strianse argued that Pain MD’s focus on injections was a result of Kestner’s “obsession” with ensuring that the company “would never be called a pill mill.”

    Strianse said that Kestner “stayed up at night worrying” about patients coming to clinics only to get opioid prescriptions, so he pushed his employees to administer injections, too.

    “Employers motivating employees is not a crime,” Strianse said at closing arguments, according to the court transcript. “We get pushed every day to perform. It’s not fraud; it’s a fact of life.”

    Prosecutors insisted that this defense rang hollow. During the trial, former employees had testified that most patients’ opioid dosages remained steady or increased while at Pain MD, and that the clinics did not taper off the painkillers no matter how many injections were given.

    “Giving them injections does not fix the pill mill problem,” federal prosecutor Katherine Payerle said during closing arguments, according to the trial transcript. “The way to fix being a pill mill is to stop giving the drugs or taper the drugs.”

     

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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    This story can be republished for free (details).

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

    This article first appeared on KFF Health News and is republished here under a Creative Commons license.

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  • Oscar contender Poor Things is a film about disability. Why won’t more people say so?
  • Vibration Plate, Review After 6 Months: Is It Worth It?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Is it push-button exercise, or an expensive fad, or something else entirely? Robin, from “The Science of Self-Care”, has insights:

    Science & Experience

    According to the science (studies cited in the video and linked-to in the video description, underneath it on YouTube), vibration therapy does have some clear benefits, namely:

    • Bone health (helps with bone density, particularly beneficial for postmenopausal women)
    • Muscle recovery (reduces lactate levels, aiding faster recovery)
    • Joint health (reduces pain and improves function in osteoarthritis patients)
    • Muscle stimulation (helps older adults maintain muscle mass)
    • Cognitive function (due to increased blood flow to the brain)

    And from her personal experience, the benefits included:

    • Improved recovery after exercise, reducing muscle soreness and stiffness
    • Reduced back pain and improved posture (not surprising, given the need for stabilizing muscles when using one of these)
    • Better circulation and (likely resulting from same) skin clarity

    She did not, however, notice:

    • Any reduction in cellulite
    • Any change in body composition (fat loss or muscle gain)

    For a deeper look into these things and more, plus a demonstration of how the machine actually operates, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    Take care!

    Don’t Forget…

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  • Never Too Late To Start Over: Finding Purpose At Any Age

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Dana Findwell’s late 50s were not an easy time, but upon now hitting 60 (this week, at time of writing), she’s enthusiastically throwing herself into the things that bring her purpose, and so can you.

    Start where you are

    Findwell was already no stranger to starting again, having been married and divorced twice, and having moved frequently, requiring constant “life resets”.

    Nevertheless, she always had her work to fall back on; she was a graphic designer and art director for 30 years… Until burnout struck.

    And when burnout struck, so did COVID, resulting in the loss of her job. Her job wasn’t the only thing she lost though, as her mother died around the same time. All in all, it was a lot, and not the fun kind of “a lot”.

    Struggling to find a new career direction, she ended up starting a small business for herself, so that she could direct the pace; pressing forwards as and when she had the energy. This became her new “ikigai“, the main thing that brings a sense of purpose to her life, but getting one part of her life back into order brought her attention to the rest; she realized she’d neglected her health, so she joined a gym. And a weightlifting class. And a hip-hop class. And she took up the practice of Japanese drumming (for the unfamiliar, this can be a rather athletic ability; it’s not a matter of sitting at a drum kit).

    And now? Her future is still not clear, but that’s ok, because she’s making it as she goes, and she’s doing it her way, trusting in her ability to handle what may come up, and doing the things now that future-her will be glad of having done (e.g. laying the groundwork of both financial security and good health).

    Change can sometimes be triggered by adverse circumstances, but there’s always the opportunity to find something better. For more on all of this, enjoy:

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    Want to learn more?

    You might also like to read:

    Our Resources About Ikigai

    Take care!

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  • Hearing voices is common and can be distressing. Virtual reality might help us meet and ‘treat’ them

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Have you ever heard something that others cannot – such as your name being called? Hearing voices or other noises that aren’t there is very common. About 10% of people report experiencing auditory hallucinations at some point in their life.

    The experience of hearing voices can be very different from person to person, and can change over time. They might be the voice of someone familiar or unknown. There might be many voices, or just one or two. They can be loud or quiet like a whisper.

    For some people these experiences are positive. They might represent a spiritual or supernatural experience they welcome or a comforting presence. But for others these experiences are distressing. Voices can be intrusive, negative, critical or threatening. Difficult voices can make a person feel worried, frightened, embarrassed or frustrated. They can also make it hard to concentrate, be around other people and get in the way of day-to-day activities.

    Although not everyone who hears voices has a mental health problem, these experiences are much more common in people who do. They have been considered a hallmark symptom of schizophrenia, which affects about 24 million people worldwide.

    However, such experiences are also common in other mental health problems, particularly in mood- and trauma-related disorders (such as bipolar disorder or depression and post-traumatic stress disorder) where as many as half of people may experience them.

    Rawpixel/Shutterstock

    Why do people hear voices?

    It is unclear exactly why people hear voices but exposure to prolonged stress, trauma or depression can increase the chances.

    Some research suggests people who hear voices might have brains that are “wired” differently, particularly between the hearing and speaking parts of the brain. This may mean parts of our inner speech can be experienced as external voices. So, having the thought “you are useless” when something goes wrong might be experienced as an external person speaking the words.

    Other research suggests it may relate to how our brains use past experiences as a template to make sense of and make predictions about the world. Sometimes those templates can be so strong they lead to errors in how we experience what is going on around us, including hearing things our brain is “expecting” rather than what is really happening.

    What is clear is that when people tell us they are hearing voices, they really are! Their brain perceives voice experiences as if someone were talking in the room. We could think of this “mistake” as working a bit like being susceptible to common optical tricks or visual illusions.

    man's head with image of brain scan superimposed
    There may be differences in the brains of people who hear voices. Triff/Shutterstock

    Coping with hearing voices

    When hearing voices is getting in the way of life, treatment guidelines recommend the use of medications. But roughly a third of people will experience ongoing distress. As such, treatment guidelines also recommend the use of psychological therapies such as cognitive behavioural therapy.

    The next generation of psychological therapies are beginning to use digital technologies and virtual reality offers a promising new medium.

    Avatar therapy allows a person to create a virtual representation of the voice or voices, which looks and sounds like what they are experiencing. This can help people regain power in the “relationship” as they interact with the voice character, supported by a therapist.

    Jason’s experience

    Aged 53, Jason (not his real name) had struggled with persistent voices since his early 20s. Antipsychotic medication had helped him to some extent over the years, but he was still living with distressing voices. Jason tried out avatar therapy as part of a research trial.

    He was initially unable to stand up to the voices, but he slowly gained confidence and tested out different ways of responding to the avatar and voices with his therapist’s support.

    Jason became more able to set boundaries, such as not listening to them for periods throughout the day. He also felt more able to challenge what they said and make his own choices.

    Over a couple of months, Jason started to experience some breaks from the voices each day and his relationship with them started to change. They were no longer like bullies, but more like critical friends pointing out things he could consider or be aware of.

    A digital image of a man's face with settings to right to shape voice characteristics
    A screenshot from HekaVR, the software used in the Australian AMETHYST trial. HekaVR, CC BY-ND

    Gaining recognition

    Following promising results overseas and its recommendation by the United Kingdom’s National Institute for Health and Care Excellence, our team has begun adapting the therapy for an Australian context.

    We are trialling delivering avatar therapy from our specialist voices clinic via telehealth. We are also testing whether avatar therapy is more effective than the current standard therapy for hearing voices, based on cognitive behavioural therapy.

    As only a minority of people with psychosis receive specialist psychological therapy for hearing voices, we hope our trial will support scaling up these new treatments to be available more routinely across the country.

    We would like to acknowledge the advice and input of Dr Nadine Keen (consultant clinical psychologist at South London and Maudsley NHS Foundation Trust, UK) on this article.

    Leila Jameel, Trial Co-ordinator and Research Therapist, Swinburne University of Technology; Imogen Bell, Senior Research Fellow and Psychologist, The University of Melbourne; Neil Thomas, Professor of Clinical Psychology, Swinburne University of Technology, and Rachel Brand, Senior Lecturer in Clinical Psychology, University of the Sunshine Coast

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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