Rebalancing Dopamine (Without “Dopamine Fasting”)
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Rebalancing Dopamine (Without “Dopamine Fasting”)
This is Dr. Anna Lembke. She’s a professor of psychiatry at Stanford, and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic—as well as running her own clinical practice, and serving on the board of an array of state and national addiction-focused organizations.
Today we’re going to look at her work on dopamine management…
Getting off the hedonic treadmill
For any unfamiliar with the term, the “hedonic treadmill” is what happens when we seek pleasure, enjoy the pleasure, the pleasure becomes normalized, and now we need to seek a stronger pleasure to get above our new baseline.
In other words, much like running on a reciprocal treadmill that just gets faster the faster we run.
What Dr. Lembke wants us to know here: pleasure invariably leads to pain
This is not because of some sort of extrinsic moral mandate, nor even in the Buddhist sense. Rather, it is biology.
Pleasure and pain are processed by the same part of the brain, and if we up one, the other will be upped accordingly, to try to keep a balance.
Consequently, if we recklessly seek “highs”, we’re going to hit “lows” soon enough. Whether that’s by drugs, sex, or just dopaminergic habits like social media overuse.
Dr. Lembke’s own poison of choice was trashy romance novels, by the way. But she soon found she needed more, and more, and the same level wasn’t “doing it” for her anymore.
So, should we just give up our pleasures, and do a “dopamine fast”?
Not so fast!
It depends on what they are. Dopamine fasting, per se, does not work. We wrote about this previously:
Short On Dopamine? Science Has The Answer
However, when it comes to our dopaminergic habits, a short period (say, a couple of weeks) of absence of that particular thing can help us re-find our balance, and also, find insight.
Lest that latter sound wishy-washy: this is about realizing how bad an overuse of some dopaminergic activity had become, the better to appreciate it responsibly, going forwards.
So in other words, if your poison is, as in Dr. Lembke’s case, trashy romance novels, you would abstain from them for a couple of weeks, while continuing to enjoy the other pleasures in life uninterrupted.
Substances that create a dependency are a special case
There’s often a popular differentiation between physical addictions (e.g. alcohol) and behavioral addictions (e.g. video games). And that’s fair; physiologically speaking, those may both involve dopamine responses, but are otherwise quite different.
However, there are some substances that are physical addictions that do not create a physical dependence (e.g. sugar), and there are substances that create a physical dependence without being addictive (e.g. many antidepressants)
See also: Addiction and physical dependence are not the same thing
In the case of anything that has created a physical dependence, Dr. Lembke does not recommend trying to go “cold turkey” on that without medical advice and supervision.
Going on the counterattack
Remember what we said about pleasure and pain being processed in the same part of the brain, and each rising to meet the other?
While this mean that seeking pleasure will bring us pain, the inverse is also true.
Don’t worry, she’s not advising us to take up masochism (unless that’s your thing!). But there are very safe healthy ways that we can tip the scales towards pain, ultimately leading to greater happiness.
Cold showers are an example she cites as particularly meritorious.
As a quick aside, we wrote about the other health benefits of these, too:
A Cold Shower A Day Keeps The Doctor Away?
Further reading
Want to know more? You might like her book:
Dopamine Nation: Finding Balance in the Age of Indulgence
Enjoy!
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What is ‘doll therapy’ for people with dementia? And is it backed by science?
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The way people living with dementia experience the world can change as the disease progresses. Their sense of reality or place in time can become distorted, which can cause agitation and distress.
One of the best ways to support people experiencing changes in perception and behaviour is to manage their environment. This can have profound benefits including reducing the need for sedatives.
One such strategy is the use of dolls as comfort aids.
Jack Cronkhite/Shutterstock What is ‘doll therapy’?
More appropriately referred to as “child representation”, lifelike dolls (also known as empathy dolls) can provide comfort for some people with dementia.
Memories from the distant past are often more salient than more recent events in dementia. This means that past experiences of parenthood and caring for young children may feel more “real” to a person with dementia than where they are now.
Hallucinations or delusions may also occur, where a person hears a baby crying or fears they have lost their baby.
Providing a doll can be a tangible way of reducing distress without invalidating the experience of the person with dementia.
Some people believe the doll is real
A recent case involving an aged care nurse mistreating a dementia patient’s therapy doll highlights the importance of appropriate training and support for care workers in this area.
For those who do become attached to a therapeutic doll, they will treat the doll as a real baby needing care and may therefore have a profound emotional response if the doll is mishandled.
It’s important to be guided by the person with dementia and only act as if it’s a real baby if the person themselves believes that is the case.
What does the evidence say about their use?
Evidence shows the use of empathy dolls may help reduce agitation and anxiety and improve overall quality of life in people living with dementia.
Child representation therapy falls under the banner of non-pharmacological approaches to dementia care. More specifically, the attachment to the doll may act as a form of reminiscence therapy, which involves using prompts to reconnect with past experiences.
Interacting with the dolls may also act as a form of sensory stimulation, where the person with dementia may gain comfort from touching and holding the doll. Sensory stimulation may support emotional well-being and aid commnication.
However, not all people living with dementia will respond to an empathy doll.
It depends on a person’s background. Shutterstock The introduction of a therapeutic doll needs to be done in conjunction with careful observation and consideration of the person’s background.
Empathy dolls may be inappropriate or less effective for those who have not previously cared for children or who may have experienced past birth trauma or the loss of a child.
Be guided by the person with dementia and how they respond to the doll.
Are there downsides?
The approach has attracted some controversy. It has been suggested that child representation therapy “infantilises” people living with dementia and may increase negative stigma.
Further, the attachment may become so strong that the person with dementia will become upset if someone else picks the doll up. This may create some difficulties in the presence of grandchildren or when cleaning the doll.
The introduction of child representation therapy may also require additional staff training and time. Non-pharmacological interventions such as child representation, however, have been shown to be cost-effective.
Could robots be the future?
The use of more interactive empathy dolls and pet-like robots is also gaining popularity.
While robots have been shown to be feasible and acceptable in dementia care, there remains some contention about their benefits.
While some studies have shown positive outcomes, including reduced agitation, others show no improvement in cognition, behaviour or quality of life among people with dementia.
Advances in artificial intelligence are also being used to help support people living with dementia and inform the community.
Viv and Friends, for example, are AI companions who appear on a screen and can interact with the person with dementia in real time. The AI character Viv has dementia and was co-created with women living with dementia using verbatim scripts of their words, insights and experiences. While Viv can share her experience of living with dementia, she can also be programmed to talk about common interests, such as gardening.
These companions are currently being trialled in some residential aged care facilities and to help educate people on the lived experience of dementia.
How should you respond to your loved one’s empathy doll?
While child representation can be a useful adjunct in dementia care, it requires sensitivity and appropriate consideration of the person’s needs.
People living with dementia may not perceive the social world the same way as a person without dementia. But a person living with dementia is not a child and should never be treated as one.
Ensure all family, friends and care workers are informed about the attachment to the empathy doll to help avoid unintentionally causing distress from inappropriate handling of the doll.
If using an interactive doll, ensure spare batteries are on hand.
Finally, it is important to reassess the attachment over time as the person’s response to the empathy doll may change.
Nikki-Anne Wilson, Postdoctoral Research Fellow, Neuroscience Research Australia (NeuRA), UNSW Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Habits of a Happy Brain – by Dr. Loretta Graziano Breuning
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There are lots of books on “happy chemicals” and “how to retrain your brain”, so what makes this one different?
Firstly, it focuses on four “happy chemicals”, not just one:
- Serotonin
- Dopamine
- Oxytocin
- Endorphins
It also looks at the role of cortisol, and how it caps off each of those just a little bit, to keep us just a little malcontent.
Behavioral psychology tends to focus most on dopamine, while prescription pharmaceuticals for happiness (i.e., most antidepressants) tend to focus on serotonin. Here, Dr. Breuning helps us understand the complex interplay of all of the aforementioned chemicals.
She also clears up many misconceptions, since a lot of people misattribute the functions of each of these.
Common examples include “I’m doing this for the serotonin!” when the activity is dopaminergic not serotoninergic, or considering dopamine “the love molecule” when oxytocin, or even something else like phenylethylamine would be more appropriate.
The above may seem like academic quibbles and not something of practical use, but if we want to biohack our brains, we need to do better than the equivalent of a chef who doesn’t know the difference between salt and sugar.
Where things are of less practical use, she tends to skip over or at least streamline them. For example, she doesn’t really discuss the role of post-dopamine prolactin in men—but the discussion of post-happiness cortisol covers the same ground anyway, for practical purposes.
Dr. Breuning also looks at where our evolved neurochemical responses go wrong, and lays out guidelines for such challenges as overcoming addiction, or embracing delayed gratification.
Bottom line: this book is a great user-manual for the brain. If you’d like to be happier and more effective with fewer bad habits, this is the book for you.
Click here to check out Habits of a Happy Brain, and get biohacking yours!
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Better Sex Through Mindfulness – by Dr. Lori Brotto
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Female sexuality is such a taboo topic that, if one searches for (ob/gyn professor, women’s health research director, and psychologist) Dr. Brotto’s book on Google or Amazon, it suggests only “lori brotto mindfulness book”. So, for those brave enough to read a book that would have shocked Victorians, what does this one contain?
The focus is on, as the title suggests, better sex, by and for women. That said, it’s mostly because typically women are more likely to experience the problems described in the book; it’s nothing actually intrinsic to womanhood. A man with the same problems could read this book and benefit just the same.
While the book covers many possible problems between the sheets, the overarching theme is problems of the mind, such as:
- Not getting into the mood in the first place
- Losing the mood quickly and easily, such as by becoming distracted
- Difficulty achieving orgasm even when mechanically everything’s delightful
- Physical discomfort creating a barrier to enjoyment
…and yes, that last one is in part mind-stuff too! Though Dr. Brotto isn’t arguing that mindfulness is a panacea, just an incredibly useful tool. And, it’s one she not only explains very well, but also explains from the position of a wealth of scientific evidence… Enough so, that we see a one-star Amazon reviewer from Canada complained that it was too well-referenced! For us, though, it’s what we like to see.
Good science, presented clearly and usefully, giving practical tips that improve people’s lives.
Bottom line: if you’ve ever lost the mood because you got distracted into thinking about taxes or that meeting on Tuesday, this is the book for you.
Click here to check out Better Sex Through Mindfulness—you can thank us later!
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Palliative care as a true art form
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How do you ease the pain from an ailment amidst lost words? How can you serve the afflicted when lines start to blur? When the foundation of communication begins to crumble, what will be the pillar health-care professionals can lean on to support patients afflicted with dementia during their final days?
The practice of medicine is both highly analytical and evidence based in nature. However, it is considered a “practice” because at the highest level, it resembles a musician navigating an instrument. It resembles art. Between lab values, imaging techniques and treatment options, the nuances for individualized patient care so often become threatened.
Dementia, a non-malignant terminal illness, involves the progressive cognitive and social decline in those afflicted. Though there is no cure, dementia is commonly met in the setting of end-of-life care. During this final stage of life, the importance of comfort via symptomatic management and communication usually is a priority in patient care. But what about the care of a patient suffering from dementia? While communication serves as the vehicle to deliver care at a high level, medical professionals are suddenly met with a roadblock. And there … behind the pieces of shattered communication and a dampened map of ethical guidelines, health-care providers are at a standstill.
It’s 4:37 a.m. You receive a text message from the overnight nurse at a care facility regarding a current seizure. After lorazepam is ordered and administered, Mr. H, a quick-witted 76-year-old, stabilizes. Phenobarbital 15mg SC qhs was also added to prevent future similar events. You exhale a sigh of relief.
Mr. H. has been admitted to the floor 36 hours earlier after having a seizure while playing poker with colleagues. Since he became your patient, he’s shared many stories from professional and family life with you, along with as many jokes as he could fit in between. However, over the course of the next seven days, Mr. H. would develop aspiration pneumonia, progressing to ventilator dependency and, ultimately, multi-organ failure with rapid cognitive decline.
What strategies and tools would you use to maximize the well-being of your patient during his decline? How would you bridge the gap of understanding between the patient’s family and health-care team to provide the standard of care that all patients are owed?
To give Mr. H. the type of care he would have wanted, upon his hospital admission, he should have been questioned about his understanding of illness along with the goals of care of the medical team. The patient should have been informed that it is imperative to adhere to the medical regimen implemented by his team along with the risks of not doing so. In the event disease-related complications arose, advanced directives should have been documented to avoid any unnecessary measures.
It is important to note, that with each change in status of the patient’s health status, the goal of treatment must be reassessed. The patient or surrogate decision-maker’s understanding of these goals is paramount in maintaining the patient’s autonomy. It is often said that effective communication is the bedrock of a healthy relationship. This is true regardless of type of relationship.
This is why I and Megan Vierhout wrote Integrated End of Life Care in Dementia: A Comprehensive Guide, a book targeted at providing a much-needed road map to navigate the many challenges involved in end-of-life care for individuals with dementia. Ultimately, our aim is to provide a compass for both health-care professionals and the families of those affected by the progressive effects of dementia. We provide practical advice on optimizing communication with individuals with dementia while taking their cognitive limitations, preferences and needs into account.
I invite you to explore the unpredictable terrain of end-of-life care for patients with dementia. Together, we can pave a smoother, sturdier path toward the practice of medicine as a true art form.
This article is republished from healthydebate under a Creative Commons license. Read the original article.
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Health Tips for Males Too
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
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
❝Articles are very informative and helpful. Maybe it’s me but things seem to lean more toward females. That being said don’t forget us males❞
Rest assured, we could never forget you! We try to make as much as possible of our content applicable to as many as possible of our readers, but of course not everything can be relevant for everyone.
This is, presumably, in response to our recent feature on menopausal health, because previous to that, our next-most-recent main feature that centred women’s health was a month ago—that was about breast cancer, and did have a section on breast cancer in men too. You might also enjoy the book we reviewed recently about prostate health, or our regular sponsor offering testosterone therapy. Please feel free to check out our articles on saw palmetto against male pattern baldness and BPH, as well as mental health issues that disproportionally affect men.
And of course, if you have specific questions/requests about men’s health (or any other health topic) we’re only ever an email away (or use the handy feedback widget, as you did to make this request)!
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Seeds: The Good, The Bad, And The Not-Really-Seeds!
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? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
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
❝Doctors are great at saving lives like mine. I’m a two time survivor of colon cancer and have recently been diagnosed with Chron’s disease at 62. No one is the health system can or is prepared to tell me an appropriate diet to follow or what to avoid. Can you?❞
Congratulations on the survivorship!
As to Crohn’s, that’s indeed quite a pain, isn’t it? In some ways, a good diet for Crohn’s is the same as a good diet for most other people, with one major exception: fiber
…and unfortunately, that changes everything, in terms of a whole-foods majority plant-based diet.
What stays the same:
- You still ideally want to eat a lot of plants
- You definitely want to avoid meat and dairy in general
- Eating fish is still usually* fine, same with eggs
- Get plenty of water
What needs to change:
- Consider swapping grains for potatoes or pasta (at least: avoid grains)
- Peel vegetables that are peelable; discard the peel or use it to make stock
- Consider steaming fruit and veg for easier digestion
- Skip spicy foods (moderate spices, like ginger, turmeric, and black pepper, are usually fine in moderation)
Much of this latter list is opposite to the advice for people without Crohn’s Disease.
*A good practice, by the way, is to keep a food journal. There are apps that you can get for free, or you can do it the old-fashioned way on paper if prefer.
But the important part is: make a note not just of what you ate, but also of how you felt afterwards. That way, you can start to get a picture of patterns, and what’s working (or not) for you, and build up a more personalized set of guidelines than anyone else could give to you.
We hope the above pointers at least help you get going on the right foot, though!
❝Why do baked goods and deep fried foods all of a sudden become intolerable? I used to b able to ingest bakery foods and fried foods. Lately I developed an extreme allergy to Kiwi… what else should I “fear”❞
About the baked goods and the deep-fried foods, it’s hard to say without more information! It could be something in the ingredients or the method, and the intolerance could be any number of symptoms that we don’t know. Certainly, pastries and deep-fried foods are not generally substantial parts of a healthy diet, of course!
Kiwi, on the other hand, we can answer… Or rather, we can direct you to today’s “What’s happening in the health world” section below, as there is news on that front!
We turn the tables and ask you a question!
We’ll then talk about this tomorrow:
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