Monday, December 24, 2012

Reducing Anger

Have you ever felt a flame of anger igniting when you were provoked—and wished you could keep your cool instead?  New research has a trick that can help do just that.

The trick is to pretend that you have stepped back and are seeing the situation from a distance, as though you are an observer instead of a participant.  From this more distant spot you can look at your feelings.

“Self-distancing” is the term researchers at Ohio State University and the University of Michigan gave to the technique.  The findings of two related experiments were published online in the Journal of Experimental Social Psychology.

“The secret is to not get immersed in your own anger and, instead, have a more detached view,” says Dominik Mischkowski, an Ohio State graduate student and lead author of the research.  “You have to see yourself in this stressful situation as a fly on the wall would see it.”  Mischkowski says the self-distancing approach helped people regulate their angry feelings and also reduced their aggressive thoughts.

Other studies have shown that self-distancing can minimize how angry and aggressive people feel when aggravated, but this research shows that the technique can be learned quickly and can work in the heat of the moment, when people are most likely to act aggressively.

Student participants were provoked to anger in a series of situations, then were assigned to a control group, to visualize the situation again, or to imagine the scene from a distance.  Their levels of aggression were then measured when given the opportunity to retaliate to those who provoked them.

“If you focus too much on how you’re feeling, it usually backfires.  It keeps the aggressive thoughts and feelings active in your mind, which makes it more likely that you’ll act aggressively,” says Brad J. Bushman, a professor of communication and psychology at Ohio State and one of the study’s co-authors.

Another technique sometimes suggested is to use distraction when angered.  Mischkowski says that although this may work in the moment, the anger will return when the person is no longer distracted.  “But self-distancing really works, even right after a provocation.  It is a powerful intervention tool that anyone can use when they’re angry.”  

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 25.  To download this issue in PDF format, or past issues, visit our newsletter archives online at

Monday, December 17, 2012

Predicting Heart Failure Death in the ER

Ten pieces of information often gathered in the ER may be able to predict the risk of death for people with heart failure within seven days of presentation.

The new tool is called the Emergency Heart Failure Mortality Risk Grade (EHMRG).  To develop the tool lead researcher Douglas Lee, MD, PhD, of the Institute for Clinical Evaluative Sciences in Toronto, and colleagues examined three years’ worth of data from 12,591 heart failure patients in 86 hospitals in Ontario, Canada, from 2004 to 2007.

Within seven days of presentation 2% of the patients had died.  Researchers looked for common links—everything from medications, to lab values and transportation.  After adjustments were made, the 10 factors significantly associated with a greater risk of death in the first week were:

  • Older age
  • Transportation by emergency medical services
  • Lower triage systolic blood pressure
  • Higher triage heart rate
  • Reduced oxygen saturation
  • Higher creatinine
  • Potassium level of 4.6 mmol/L or higher
  • Elevated serum troponin
  • Active cancer
  • Use of metolazone at home
The researchers noted limitations of the study, especially the lack of information about left ventricular ejection fractions and brain natriuretic peptide.  The authors also noted that, “Symptomatic improvement, ability of the patient to seek follow-up care, and social circumstances should also be considered, along with quantification of acute prognosis.”  They indicated that the tool is not for use in patients who have chronic, symptomatically stable heart failure.

Lee is applying for a U.S. patent.

For more details or to read the entire study see the June 5 issue of the Annals of Internal Medicine, Prediction of Heart Failure Mortality in Emergent Care

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 25.  To download this issue in PDF format, or past issues, visit our newsletter archives online at

Monday, December 10, 2012

Distractions Cut Pain

It is established that distracting mental activities can minimize perception of pain, but how this happens has not been well understood.  A study published in Current Biology online has found that it is related to a spinal process involving opioid neurotransmission.

A study of 20 men with an average age of 27 found that distraction not only takes the focus away from the pain, but can dampen the body’s initial physiological response to pain through endogenous opioids.
Painful levels of heat were administered to the subject while undergoing functional MRIs.  Those doing complex memory tasks were pre-occupied to the extent that they experienced 19% less pain than those doing simpler mental tasks.

“This phenomenon is not just a psychological phenomenon, but an active neuronal mechanism reducing the amount of pain signals ascending from the spinal cord to higher-order brain regions,” said lead author Christian Sprenger, of the University Medical Center Hamburg-Eppendorf in Hamburg, Germany.

Sprenger and his colleagues repeated the experiment with another group of 15 men, average age 25.  This time they administered naloxone to block opioid effect or saline solution.  Perception of pain was 40.5% greater for those with the difficult cognitive task when given the opioid antagonist naloxone. This provided the evidence that endogenous opioids play a role in the distraction phenomenon.

“Our findings strengthen the role of cognitive-behavioral therapeutic approaches in the treatment of pain diseases, as it could be extrapolated that these approaches might also have the potential to alter the underlying neurobiological mechanisms as early as in the spinal cord,” Sprenger and colleagues concluded.  

For more information see the May 17, 2012 online issue of Current Biology.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 25.  To download this issue in PDF format, or past issues, visit our newsletter archives online at

Monday, December 3, 2012

Therapy by Telephone

Can therapy for depression work when done by telephone?  The short answer is yes.  This type of therapy may be slightly less effective than face-to-face meetings, but patients are less likely to drop out of phone therapy. 

These were the findings of David Mohr and colleagues at the Northwestern University Feinberg School of Medicine published in the Journal of the American Medical Association in June of this year.  Mohr said, “One of the things we’ve found over the years is that it’s very difficult for people with depression to access psychotherapy.”  The authors speculated that reducing time commitments, transportation problems and cost may play a role in the lower drop-out rate for phone therapy.

Around 25% of all primary care visits are with patients who have clinically significant depression, according to the authors.  Cognitive behavioral therapy is an effective treatment for depression, but the drop-out rate is high.

Researchers in the randomized study had 325 people diagnosed with depression undergo 18 weeks of therapy, half by phone and half in person.  The quality of the telephone therapy was calculated to be equivalent to in-person treatment. By the end of the period 53 participants had dropped out of face-to-face therapy compared with 34 in the phone therapy group.

Patients in both groups felt decreased levels of their depression, however six months later patients who met with their therapists in person tended to feel less depressed than those who had phone sessions, but the difference was very small.

“At this point these findings do suggest that psychotherapy for depression can be administered both safely and effectively over the phone. Providers can be comfortable doing that and insurers and payers should feel comfortable” reimbursing for it, Mohr said.  Cognitive behavioral therapy by phone, “can overcome barriers to adhering to face-to-face treatment.” 

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 25.  To download this issue in PDF format, or past issues, visit our newsletter archives online at