探花直播 of Cambridge - Baland Jalal

Meditation-relaxation therapy may offer escape from the terror of sleep paralysis

cjb250 — Wed, 12 Aug 2020 04:00:25 +0000

Sleep paralysis is a state involving paralysis of the skeletal muscles that occurs at the onset of sleep or just before waking. While temporarily immobilised, the individual is acutely aware of their surroundings. People who experience the phenomenon often report being terrorised by dangerous bedroom intruders, often reaching for supernatural explanations such as ghosts, demons and even alien abduction. Unsurprisingly, it can be a terrifying experience.

As many as one in five people experiences sleep paralysis, which may be triggered by sleep deprivation, and is more frequent in psychiatric conditions like post-traumatic stress disorder. It is also common in narcolepsy, a sleep disorder involving excessive daytime sleepiness and sudden loss of muscle control.

Despite the condition being known about for some time, to date there are no empirically-based treatments or published clinical trials for the condition.

Today, in the journal Frontiers in Neurology, a team of researchers report a pilot study of meditation-relaxation therapy involving 10 patients with narcolepsy, all of whom experience sleep paralysis.

探花直播therapy was originally developed by Dr Baland Jalal from the Department of Psychiatry, 探花直播 of Cambridge. 探花直播current study was led by Dr Jalal and conducted in collaboration with Dr Giuseppe Plazzi鈥檚 group at the Department of Biomedical and Neuromotor Sciences, 探花直播 of Bologna/IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy.

探花直播therapy teaches patients to follow four steps during an episode:

Reappraisal of the meaning of the attack 鈥� reminding themselves that the experience is common, benign, and temporary, and that the hallucinations are a typical by-product of dreaming
Psychological and emotional distancing 鈥� reminding themselves that there is no reason to be afraid or worried and that fear and worry will only make the episode worse
Inward focused-attention meditation - focusing their attention inward on an emotionally-involving, positive object (such as a memory of a loved one or event, a hymn/prayer, God)
Muscle relaxation 鈥� relaxing their muscles, avoiding controlling their breathing and under no circumstances attempting to move

Participants were instructed to keep a daily journal for four weeks to assess sleep paralysis occurrence, duration and emotions. Overall, among the 10 patients, two-thirds of cases (66%) reported hallucinations, often upon awakening from sleep (51%), and less frequently upon falling asleep (14%) as rated during the first four weeks.

After the four weeks, six participants completed mood/anxiety questionnaires and were taught the therapy techniques and instructed to rehearse these during ordinary wakefulness, twice a week for 15 min. 探花直播treatment lasted eight weeks.

In the first four weeks of the study, participants in the meditation-relaxation group experienced sleep paralysis on average 14 times over 11 days. 探花直播reported disturbance caused by their sleep paralysis hallucinations was 7.3 (rated on a ten-point scale with higher scores indicating greater severity).

In the final month of the therapy, the number of days with sleep paralysis fell to 5.5 (down 50%) and the total number of episodes fell to 6.5 (down 54%). There was also a notable tendency towards reductions in the disturbance caused by hallucinations with ratings dropping from 7.3 to 4.8.

A control group of four participants followed the same procedure, except participants engaged in deep breathing instead of the therapy 鈥� taking slow deep breaths, while repeatedly counting from one to ten.

In the control group, the number of days with sleep paralysis (4.3 per month at the start) was unchanged, as well as their total number of episodes (4.5 per month initially). 探花直播disturbance caused by hallucinations was likewise unchanged (rated 4 during the first four weeks).

鈥淎lthough our study only involved a small number of patients, we can be cautiously optimistic of its success,鈥� said Dr Jalal. 鈥淢editation-relaxation therapy led to a dramatic fall in the number of times patients experienced sleep paralysis, and when they did, they tended to find the notoriously terrorising hallucinations less disturbing. Experiencing less of something as disturbing as sleep paralysis is a step in the right direction.鈥�

If the researchers are able to replicate their findings in a larger number of people 鈥� including those from the general population, not affected by narcolepsy 鈥� then this could offer a relatively simple treatment that could be delivered online or via a smartphone to help patients cope with the condition.

鈥淚 know first-hand how terrifying sleep paralysis can be, having experienced it many times myself,鈥� said Dr Jalal. 鈥淏ut for some people, the fear that it can instil in them can be extremely unpleasant, and going to bed, which should be a relaxing experience, can become fraught with terror. This is what motivated me to devise this intervention.鈥�

Reference
Jalal, B et al. Meditation-Relaxation (MR Therapy) for Sleep Paralysis: 聽A Pilot Study in Patients with Narcolepsy. Frontiers in Neurology; 12 Aug 2020; DOI: 10.3389/fneur.2020.00922

Sleep paralysis 鈥� a condition thought to explain a number of mysterious experiences including alleged cases of alien abduction and demonic night-time visits 鈥� could be treated using a technique of meditation-relaxation, suggests a pilot study published today.

I know first-hand how terrifying sleep paralysis can be, having experienced it many times myself. But for some people, the fear that it can instil in them can be extremely unpleasant, and going to bed, which should be a relaxing experience, can become fraught with terror

Baland Jalal

Wikipedia

探花直播Nightmare by Henry Fuseli, 1781

探花直播text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright 漏探花直播 of Cambridge and licensors/contributors as identified.聽 All rights reserved. We make our image and video content available in a number of ways 鈥� as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

Yes

Licence type:

Public Domain

Contaminating a fake rubber hand could help people overcome OCD, study suggests

cjb250 — Thu, 09 Jan 2020 08:48:07 +0000

Obsessive compulsive disorder (OCD) affects as many as one in 50 people worldwide. One of the most common types of the condition, affecting almost a half of OCD patients, is characterised by severe contamination fears 鈥� even from touching something as commonplace as a door knob 鈥� leading to excessive washing behaviour. 探花直播condition can have a serious impact on people鈥檚 lives, their mental health, their relationships and their ability to hold down jobs.

OCD is treated using a combination of medication such as Prozac and a form of cognitive behavioural therapy (鈥榯alking therapy鈥�) termed 鈥榚xposure and response prevention鈥�. This exposure therapy often involves instructing OCD patients to touch contaminated surfaces, such as a toilet, but to refrain from then washing their hands; however, this experience can be so stressful that many patients cannot take part.

鈥淥CD can be an extremely debilitating condition for many people, but the treatments are not always straightforward,鈥� explained Baland Jalal, a neuroscientist based in the Department of Psychiatry at the 探花直播 of Cambridge. 鈥淚n fact, exposure therapy can be very stressful and so is not always effective or even feasible for many patients.鈥�

To overcome this challenge, a team of researchers from the UK and USA tested whether, rather than asking patients to contaminate their own hands, it might be possible to help them overcome their fears by contaminating a fake hand instead 鈥� a procedure they call 鈥榤ultisensory stimulation therapy鈥�.

探花直播technique builds on a famous trick known as the 鈥榬ubber hand illusion鈥�. In this illusion, an individual places both hands in front of them on a table, either side of a partition such that they cannot see their right hand. Instead, to the left of the partition they see a fake right hand. 探花直播illusionist 鈥� in this case, the experimenter 鈥� strokes both the fake hand and hidden right hand using a paintbrush. After several minutes of stroking the individual often reports 鈥榝eeling鈥� touch arising from the fake hand as though it was their own.

In the majority of cases, the rubber hand illusion only works if both hands are stroked in synchrony; if they are stroked asynchronously, the illusion is diminished or disappears entirely. However, in a number of psychiatric conditions such as schizophrenia and body dysmorphic disorder, the illusion appears to work in both cases, suggesting that the body image held in the minds of these patients is more malleable than in healthy individuals.

In a previous study, carried out by Jalal and neuroscientist VS Ramachandran using healthy volunteers, once the illusion had begun to work, the researchers contaminated the dummy hand with fake faeces. 探花直播participants reported disgust sensations as if it were their own hand that had been contaminated.

In a new study published today in Frontiers in Human Neuroscience, Jalal and Ramachandran teamed up with researchers at Harvard 探花直播鈥� Richard J McNally, Director of Clinical Training in Department Psychology and Jason A Elias and Sriramya Potluri in the Department Psychiatry.

探花直播team recruited 29 OCD patients from the McLean Hospital Obsessive Compulsive Disorder Institute, an intensive residential treatment programme affiliated with Harvard Medical School. Sixteen of these patients had their hidden and dummy hands stroked at the same time, while the remaining 13 patients (the control group) had their hands stroked out of synch.

After 5 minutes of stroking, the participant was asked to rate how much the rubber hand felt like their own. 探花直播experimenter then used a tissue to smear the fake faeces on the rubber hand while simultaneously dabbing a damp paper towel on the participant鈥檚 real right hand (to create the sensation of having the contaminant smeared on their real hand). 探花直播participant was then asked to rate their disgust, anxiety and handwashing urge levels, and the experimenter rated the participant鈥檚 facial expression of disgust.

探花直播researchers found that patients in both the experimental and control groups felt an equally strong rubber hand illusion. In other words, even when their real and fake hands were being stroked asynchronously, they had still begun to sense the fake hand as their own. Unsurprisingly, therefore, patients in both groups initially reported similar levels of contamination.

探花直播experimenter then removed the clean paper towel and the tissue that had been used to contaminate the rubber hand, leaving fake faeces on the rubber hand. 探花直播experimenter continued to stroke the rubber hand and the participant鈥檚 real hand for an additional 5 minutes, after which the participant again provided contamination ratings and the experimenter rated their facial expression.

Now, the patients in the experimental condition were more disgusted: 65% of participants in the experimental condition had a disgust facial expression compared to 35% in the control. This supports previous studies that show that the rubber hand illusion becomes stronger the longer the hand is stroked.

Next, the experimenter stopped the stroking and placed the fake faeces on the patient鈥檚 real, right hand and asked the participant once again to provide contamination ratings. Now the differences were much more pronounced in the experimental condition. While those in the control group had average disgust, anxiety and washing urge levels at nearly 7, the experimental group had levels of nearly 9 鈥� that is, an overall 23% difference in contamination ratings.

鈥淥ver time, stroking the real and fake hands in synchrony appears to create a stronger and stronger and stronger illusion to the extent that it eventually felt very much like their own hand,鈥� said Jalal. 鈥淭his meant that after ten minutes, the reaction to contamination was more extreme. Although this was the point our experiment ended, research has shown that continued exposure leads to a decline in contamination feelings 鈥� which is the basis of traditional exposure therapy.鈥�

Jalal says it can be safely assumed that the fake hand contamination procedure would lead to similar fall in levels of disgust and contamination ratings, possibly after 30 minutes.

Jalal says the rubber hand illusion may offer a way of treating OCD patients without the high stress levels that exposure therapy can cause. 鈥淚f you can provide an indirect treatment that is reasonably realistic, where you contaminate a rubber hand instead of a real hand, this might provide a bridge that will allow more people to tolerate exposure therapy or even to replace exposure therapy altogether.鈥�

Jalal has previously worked on other indirect treatments for treating patients with OCD, including a smartphone app. He says that unlike other indirect treatments, this new approach creates a compelling illusion that a part of the patient鈥檚 body is being exposed to contamination and so could be even more immersive. It also has additional benefits: 鈥淲hereas traditional exposure therapy can be stressful, the rubber hand illusion often makes people laugh at first, helping put them at ease. It is also straightforward and cheap compared to virtual reality, and so can easily reach patients in distress no matter where they are, such as poorly resourced and emergency settings.鈥�

Jalal says the next step is to do randomised clinical trials and compare this technique to existing treatments. Ramachandran agrees, adding: 鈥淭hese results are compelling but not conclusive. We need larger samples and to iron out some methodological wrinkles.鈥�

Other applications of multisensory stimulation therapy might include therapy for people afraid of needles. Exposure therapy would mean repeated needle injections into a real arm and could result in punctured veins. Using a fake hand could provide a clever and convenient alternative.

Reference
鈥淔ake it till You Make it鈥�! Contaminating Rubber Hands (鈥淢ultisensory Stimulation Therapy鈥�) to Treat Obsessive-Compulsive Disorder. Frontiers in Neuroscience; 9 Jan 2020; DOI: 10.3389/fnhum.2019.00414

探花直播famous, but bizarre, 鈥榬ubber hand illusion鈥� could help people who suffer from obsessive compulsive disorder overcome their condition without the often unbearable stress of exposure therapy, suggests new research.

Whereas traditional exposure therapy can be stressful, the rubber hand illusion often makes people laugh at first, helping put them at ease

Baland Jalal

Divya Kumar

Rubber hand illusion

Yes

Brain training app helps reduce OCD symptoms, study finds

cjb250 — Tue, 23 Oct 2018 09:00:00 +0000

In a study published in the journal Scientific Reports, Baland Jalal and Professor Barbara Sahakian from the Department of Psychiatry, show how just one week of training can lead to significant improvements.聽

One of the most common types of OCD, affecting up to 46% of OCD patients, is characterised by severe contamination fears and excessive washing behaviour. Excessive washing can be harmful as sometimes OCD patients use spirits, surface cleansers or even bleach to clean their hands. 探花直播behaviours can have a serious impact on people鈥檚 lives, their mental health, their relationships and their ability to hold down jobs.

This repetitive and compulsive behaviour is also associated with 鈥榗ognitive rigidity鈥� 鈥� in other words, an inability to adapt to new situations or new rules. Breaking out of compulsive habits, such as handwashing, requires cognitive flexibility so that the OCD patient can switch to new activities instead.

OCD is treated using a combination of medication such as Prozac and a form of cognitive behavioural therapy (鈥榯alking therapy鈥�) termed 鈥榚xposure and response prevention鈥�. This latter therapy often involves instructing OCD patients to touch contaminated surfaces, such as a toilet, but to refrain from then washing their hands.

These treatments are not particularly effective, however 鈥� as many as 40% of patients fail to show a good response to either treatment. This may be in part because often people with OCD have suffered for years prior to receiving a diagnosis and treatment. Another difficulty is that patients may fail to attend exposure and response prevention therapy as they find it too stressful to undertake.

For these reasons, Cambridge researchers developed a new treatment to help people with contamination fears and excessive washing. 探花直播intervention, which can be delivered through a smartphone app, involves patients watching videos of themselves washing their hands or touching fake contaminated surfaces.

Ninety-three healthy people who had indicated strong contamination fears as measured by high scores on the 鈥楶adua Inventory Contamination Fear Subscale鈥� participated in the study. 探花直播researchers used healthy volunteers rather than OCD patients in their study to ensure that the intervention did not potentially worsen symptoms.

探花直播participants were divided into three groups: the first group watched videos on their smartphones of themselves washing their hands; the second group watched similar videos but of themselves touching fake contaminated surfaces; and the third, control group watched themselves making neutral hand movements on their smartphones.

After only one week of viewing their brief 30 second videos four times a day, participants from both of the first two groups 鈥� that is, those who had watched the hand washing video and those with the exposure and response prevention video 鈥� improved in terms of reductions in OCD symptoms and showed greater cognitive flexibility compared with the neutral control group. On average, participants in the first two groups saw their Yale-Brown Obsessive Compulsive Scale (YBOCS) scores improve by around 21%. YBOCS scores are the most widely used clinical assessments for assessing the severity of OCD.

Importantly, completion rates for the study were excellent 鈥� all participants completed the one-week intervention, with participants viewing their video an average (mean) of 25 out of 28 times.

Mr Jalal said: 鈥淧articipants told us that the smartphone washing app allowed them to easily engage in their daily activities. For example, one participant said 鈥榠f I am commuting on the bus and touch something contaminated and can鈥檛 wash my hands for the next two hours, the app would be a sufficient substitute鈥�.鈥�

Professor Sahakian said: 鈥淭his technology will allow people to gain help at any time within the environment where they live or work, rather than having to wait for appointments. 探花直播use of smartphone videos allows the treatment to be personalised to the individual.

鈥淭hese results while very exciting and encouraging, require further research, examining the use of these smartphone interventions in people with a diagnosis of OCD.鈥澛犅犅犅�

探花直播smartphone app is not currently available for public use. Further research is required before the researchers can show conclusively that it is effective at helping patients with OCD.

探花直播research was funded by the Wellcome聽Trust, NIHR Cambridge Biomedical Research Centre, the Medical Research Council and the Wallitt Foundation.

Reference
Baland Jalal, Annette Bruhl, Claire O鈥機allaghan, Thomas Piercy, Rudolf N. Cardinal, Vilayanur S. Ramachandran and Barbara J. Sahakian. Novel smartphone interventions improve cognitive flexibility and obsessive-compulsive disorder symptoms in individuals with contamination fears. Scientific Reports; 23 Oct 2018;聽DOI: 10.1038/s41598-018-33142-2

A 鈥榖rain training鈥� app developed at the 探花直播 of Cambridge could help people who suffer from obsessive compulsive disorder (OCD) manage their symptoms, which may typically include excessive handwashing and contamination fears.

This technology will allow people to gain help at any time within the environment where they live or work, rather than having to wait for appointments

Barbara Sahakian

Thomas Piercy

Images from app

Researcher profile: Baland Jalal

鈥淐ambridge is the perfect place for the 鈥榠dealistic scholar鈥� 鈥� those who believe they can re-write the science textbooks. 探花直播culture鈥攍ike no other鈥攅mbraces novel ideas, even if outlandish and far-fetched on the surface,鈥� says聽Baland聽Jalal, a neuroscientist at the聽Behavioural聽and Clinical Neuroscience Institute and PhD candidate at Trinity College.

鈥淚t is no coincidence that the foremost scientists in history have stepped foot here, including my scientific hero Newton. One cannot help but feel inspired, as if part of a lineage of greatness鈥斺€榮tanding on the shoulder of giants鈥�.鈥�

Jalal聽considers himself fortunate to have been able to stand on the shoulders of proverbial giants throughout his research career. He received his initial training at the 探花直播 of California in the laboratory of legendary neuroscientist VS聽Ramachandran.

鈥淐alifornia was an enchanting experience. Rama and I would often go for long strolls on San Diego鈥檚 beaches where he would tell mesmerizing stories about the good-old-days when he was a Cambridge student and how he later invented his famous 鈥榤irror box鈥� for phantom limb pain. He was like a second father 鈥� a mentor who instilled in me a genuine love of science.鈥澛�

Jalal聽now works with husband-and-wife team Professors Barbara聽Sahakian聽and Trevor Robbins, who he describes as embodying 鈥渢he 鈥楥ambridge spirit鈥� of innovation鈥�. His work is ultimately about developed new psychiatric treatments. 鈥淭his often involves taking an unorthodox and somewhat radical approach鈥攖hinking 鈥榦utside the box鈥� so to speak,鈥� he says. Ideas include the above treatment for OCD and a second treatment based on the 鈥榬ubber hand illusion鈥�, making a fake hand feel like it is your own.

His other area of interest is in sleep paralysis鈥攂eing paralyzed from head to toe while seeing ghosts and space aliens when waking up from sleep. He has studied this peculiar phenomenon around the world and recently invented a novel meditation-relaxation therapy for this condition, called MR Therapy.

鈥淚 hope my research will lead to new therapies that can help people in distress around the world - especially folks in low-income countries who don鈥檛 have adequate access to health care. 探花直播feeling I have when someone tells me that my work has helped alleviate their anguish is 鈥� simply 鈥� indescribable.鈥�

Yes

Licence type:

Attribution