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No antibiotics worked, so this woman turned to a natural enemy of bacteria to save her husband’s life | CNN

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CNN
—

In February 2016, infectious disease epidemiologist Steffanie Strathdee was holding her dying husband’s hand, watching him lose an exhausting fight against a deadly superbug infection.

After months of ups and downs, doctors had just told her that her husband, Tom Patterson, was too racked with bacteria to live.

“I told him, ‘Honey, we’re running out of time. I need to know if you want to live. I don’t even know if you can hear me, but if you can hear me and you want to live, please squeeze my hand.’

“All of a sudden, he squeezed really hard. And I thought, ‘Oh, great!’ And then I’m thinking, ‘Oh, crap! What am I going to do?’”

What she accomplished next could easily be called miraculous. First, Strathdee found an obscure treatment that offered a glimmer of hope — fighting superbugs with phages, viruses created by nature to eat bacteria.

Then she convinced phage scientists around the country to hunt and peck through molecular haystacks of sewage, bogs, ponds, the bilge of boats and other prime breeding grounds for bacteria and their viral opponents. The impossible goal: quickly find the few, exquisitely unique phages capable of fighting a specific strain of antibiotic-resistant bacteria literally eating her husband alive.

Next, the US Food and Drug Administration had to greenlight this unproven cocktail of hope, and scientists had to purify the mixture so that it wouldn’t be deadly.

Yet just three weeks later, Strathdee watched doctors intravenously inject the mixture into her husband’s body — and save his life.

Their story is one of unrelenting perseverance and unbelievable good fortune. It’s a glowing tribute to the immense kindness of strangers. And it’s a story that just might save countless lives from the growing threat of antibiotic-resistant superbugs — maybe even your own.

“It’s estimated that by 2050, 10 million people per year — that’s one person every three seconds — is going to be dying from a superbug infection,” Strathdee told an audience at Life Itself, a 2022 health and wellness event presented in partnership with CNN.

“I’m here to tell you that the enemy of my enemy can be my friend. Viruses can be medicine.”

How this ‘perfect predator’ saved his life after nine months in the hospital

During a Thanksgiving cruise on the Nile in 2015, Patterson was suddenly felled by severe stomach cramps. When a clinic in Egypt failed to help his worsening symptoms, Patterson was flown to Germany, where doctors discovered a grapefruit-size abdominal abscess filled with Acinetobacter baumannii, a virulent bacterium resistant to nearly all antibiotics.

Found in the sands of the Middle East, the bacteria were blown into the wounds of American troops hit by roadside bombs during the Iraq War, earning the pathogen the nickname “Iraqibacter.”

“Veterans would get shrapnel in their legs and bodies from IED explosions and were medevaced home to convalesce,” Strathdee told CNN, referring to improvised explosive devices. “Unfortunately, they brought their superbug with them. Sadly, many of them survived the bomb blasts but died from this deadly bacterium.”

Today, Acinetobacter baumannii tops the World Health Organization’s list of dangerous pathogens for which new antibiotics are critically needed.

“It’s something of a bacterial kleptomaniac. It’s really good at stealing antimicrobial resistance genes from other bacteria,” Strathdee said. “I started to realize that my husband was a lot sicker than I thought and that modern medicine had run out of antibiotics to treat him.”

With the bacteria growing unchecked inside him, Patterson was soon medevaced to the couple’s hometown of San Diego, where he was a professor of psychiatry and Strathdee was the associate dean of global health sciences at the University of California, San Diego.

“Tom was on a roller coaster — he’d get better for a few days, and then there would be a deterioration, and he would be very ill,” said Dr. Robert “Chip” Schooley, a leading infectious disease specialist at UC San Diego who was a longtime friend and colleague. As weeks turned into months, “Tom began developing multi-organ failure. He was sick enough that we could lose him any day.”

Patterson's body was systemically infected with a virulent drug-resistant bacteria that also infected troops in the Iraq War, earning the pathogen the nickname

After that reassuring hand squeeze from her husband, Strathdee sprang into action. Scouring the internet, she had already stumbled across a study by a Tbilisi, Georgia, researcher on the use of phages for treatment of drug-resistant bacteria.

A phone call later, Strathdee discovered phage treatment was well established in former Soviet bloc countries but had been discounted long ago as “fringe science” in the West.

“Phages are everywhere. There’s 10 million trillion trillion — that’s 10 to the power of 31 — phages that are thought to be on the planet,” Strathdee said. “They’re in soil, they’re in water, in our oceans and in our bodies, where they are the gatekeepers that keep our bacterial numbers in check. But you have to find the right phage to kill the bacterium that is causing the trouble.”

Buoyed by her newfound knowledge, Strathdee began reaching out to scientists who worked with phages: “I wrote cold emails to total strangers, begging them for help,” she said at Life Itself.

One stranger who quickly answered was Texas A&M University biochemist Ryland Young. He’d been working with phages for over 45 years.

“You know the word persuasive? There’s nobody as persuasive as Steffanie,” said Young, a professor of biochemistry and biophysics who runs the lab at the university’s Center for Phage Technology. “We just dropped everything. No exaggeration, people were literally working 24/7, screening 100 different environmental samples to find just a couple of new phages.”

While the Texas lab burned the midnight oil, Schooley tried to obtain FDA approval for the injection of the phage cocktail into Patterson. Because phage therapy has not undergone clinical trials in the United States, each case of “compassionate use” required a good deal of documentation. It’s a process that can consume precious time.

But the woman who answered the phone at the FDA said, “‘No problem. This is what you need, and we can arrange that,’” Schooley recalled. “And then she tells me she has friends in the Navy that might be able to find some phages for us as well.”

In fact, the US Naval Medical Research Center had banks of phages gathered from seaports around the world. Scientists there began to hunt for a match, “and it wasn’t long before they found a few phages that appeared to be active against the bacterium,” Strathdee said.

Back in Texas, Young and his team had also gotten lucky. They found four promising phages that ravaged Patterson’s antibiotic-resistant bacteria in a test tube. Now the hard part began — figuring out how to separate the victorious phages from the soup of bacterial toxins left behind.

“You put one virus particle into a culture, you go home for lunch, and if you’re lucky, you come back to a big shaking, liquid mess of dead bacteria parts among billions and billions of the virus,” Young said. “You want to inject those virus particles into the human bloodstream, but you’re starting with bacterial goo that’s just horrible. You would not want that injected into your body.”

Purifying phage to be given intravenously was a process that no one had yet perfected in the US, Schooley said, “but both the Navy and Texas A&M got busy, and using different approaches figured out how to clean the phages to the point they could be given safely.”

More hurdles: Legal staff at Texas A&M expressed concern about future lawsuits. “I remember the lawyer saying to me, ‘Let me see if I get this straight. You want to send unapproved viruses from this lab to be injected into a person who will probably die.’ And I said, “Yeah, that’s about it,’” Young said.

“But Stephanie literally had speed dial numbers for the chancellor and all the people involved in human experimentation at UC San Diego. After she calls them, they basically called their counterparts at A&M, and suddenly they all began to work together,” Young added.

“It was like the parting of the Red Sea — all the paperwork and hesitation disappeared.”

The purified cocktail from Young’s lab was the first to arrive in San Diego. Strathdee watched as doctors injected the Texas phages into the pus-filled abscesses in Patterson’s abdomen before settling down for the agonizing wait.

“We started with the abscesses because we didn’t know what would happen, and we didn’t want to kill him,” Schooley said. “We didn’t see any negative side effects; in fact, Tom seemed to be stabilizing a bit, so we continued the therapy every two hours.”

Two days later, the Navy cocktail arrived. Those phages were injected into Patterson’s bloodstream to tackle the bacteria that had spread to the rest of his body.

“We believe Tom was the first person to receive intravenous phage therapy to treat a systemic superbug infection in the US,” Strathdee told CNN.

“And three days later, Tom lifted his head off the pillow out of a deep coma and kissed his daughter’s hand. It was just miraculous.”

Patterson awoke from a coma after receiving an intravenous dose of phages tailored to his bacteria.

Today, nearly eight years later, Patterson is happily retired, walking 3 miles a day and gardening. But the long illness took its toll: He was diagnosed with diabetes and is now insulin dependent, with mild heart damage and gastrointestinal issues that affect his diet.

“He isn’t back surfing again, because he can’t feel the bottoms of his feet, and he did get Covid-19 in April that landed him in the hospital because the bottoms of his lungs are essentially dead,” Strathdee said.

“As soon as the infection hit his lungs he couldn’t breathe and I had to rush him to the hospital, so that was scary,” she said. “He remains high risk for Covid but we’re not letting that hold us hostage at home. He says, ‘I want to go back to having as normal life as fast as possible.’”

To prove it, the couple are again traveling the world — they recently returned from a 12-day trip to Argentina.

“We traveled with a friend who is an infectious disease doctor, which gave me peace of mind to know that if anything went sideways, we’d have an expert at hand,” Strathdee said.

“I guess I’m a bit of a helicopter wife in that sense. Still, we’ve traveled to Costa Rica a couple of times, we’ve been to Africa, and we’re planning to go to Chile in January.”

Patterson’s case was published in the journal Antimicrobial Agents and Chemotherapy in 2017, jump-starting new scientific interest in phage therapy.

“There’s been an explosion of clinical trials that are going on now in phage (science) around the world and there’s phage programs in Canada, the UK, Australia, Belgium, Sweden, Switzerland, India and China has a new one, so it’s really catching on,” Strathdee told CNN.

Some of the work is focused on the interplay between phages and antibiotics — as bacteria battle phages they often shed their outer shell to keep the enemy from docking and gaining access for the kill. When that happens, the bacteria may be suddenly vulnerable to antibiotics again.

“We don’t think phages are ever going to entirely replace antibiotics, but they will be a good adjunct to antibiotics. And in fact, they can even make antibiotics work better,” Strathdee said.

In San Diego, Strathdee and Schooley opened the Center for Innovative Phage Applications and Therapeutics, or IPATH, in 2018, where they treat or counsel patients suffering from multidrug-resistant infections. The center’s success rate is high, with 82% of patients undergoing phage therapy experiencing a clinically successful outcome, according to its website.

Schooley is running a clinical trial using phages to treat patients with cystic fibrosis who constantly battle Pseudomonas aeruginosa, a drug-resistant bacteria that was also responsible for the recent illness and deaths connected to contaminated eye drops manufactured in India.

And a memoir the couple published in 2019 — “The Perfect Predator: A Scientist’s Race to Save Her Husband From a Deadly Superbug” — is also spreading the word about these “perfect predators” to what may soon be the next generation of phage hunters.

How naturally occurring viruses could help treat superbug infections

“I am getting increasingly contacted by students, some as young as 12,” Strathdee said. “There’s a girl in San Francisco who begged her mother to read this book and now she’s doing a science project on phage-antibiotic synergy, and she’s in eighth grade. That thrills me.”

Strathdee is quick to acknowledge the many people who helped save her husband’s life. But those who were along for the ride told CNN that she and Patterson made the difference.

“I think it was a historical accident that could have only happened to Steffanie and Tom,” Young said. “They were at UC San Diego, which is one of the premier universities in the country. They worked with a brilliant infectious disease doctor who said, ‘Yes,’ to phage therapy when most physicians would’ve said, ‘Hell, no, I won’t do that.’

“And then there is Steffanie’s passion and energy — it’s hard to explain until she’s focused it on you. It was like a spiderweb; she was in the middle and pulled on strings,” Young added. “It was just meant to be because of her, I think.”

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Laziness isn’t why you procrastinate. This is | CNN

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CNN
—

If you’re stuck in what seems like an endless cycle of procrastination, guilt and chaos, you might be wondering, “Why am I so lazy?” or “Why can’t I just get myself together?”

Despite that common perception, laziness usually isn’t the reason behind procrastination, said Jenny Yip, a clinical psychologist and executive director of the Los Angeles-based Little Thinkers Center, which helps children with academic challenges.

“Laziness is like, ‘I have absolutely no desire to even think about this.’ Procrastination is, ‘It troubles me to think about this. And therefore, it’s hard for me to get the job done.’ That’s a big difference.”

Knowing why you procrastinate and learning how to combat it are the only ways to change your behavior, according to experts. Psychologist Linda Sapadin sought to help this self-improvement effort with her book “How to Beat Procrastination in the Digital Age.”

You could be the perfectionist, the dreamer, the worrier or the defier — these are all procrastination styles that Sapadin lists in her book.

These procrastination types aren’t specific diagnoses and aren’t backed by research, but “they are psychological types or reasons why someone might procrastinate,” said Yip, who is also a clinical assistant professor of psychiatry at the University of Southern California’s Keck School of Medicine.

Procrastination can have practical consequences, such as falling behind at work or failing to achieve personal goals or to cross off errands from a to-do list. But there are also emotional or mental impacts. It has been associated with depression, anxiety and stress, poor sleep, inadequate physical activity, loneliness and economic difficulties, according to a January study of more than 3,500 college students.

“Particularly in America, where so much of our worth is tied up into what we do, how we work, what we produce — it can feel very shameful if you can’t do that,” said Vara Saripalli, a Chicago-based clinical psychologist. “It can leave people feeling very defeated and feeling like there’s no point in trying.”

Knowing why you procrastinate can make you self-aware, but you still need strategies to break the habit. “Otherwise, we’ll just keep repeating things,” Saripalli said. “The strategy you’re going to employ to beat procrastination is going to change based on the purpose procrastination is serving for you.”

Here’s how to explore which type of procrastinator you might be — though remember, you could embody the traits of more than just one type.

A procrastinator is usually a perfectionist, Yip said.

“Because the perfectionist needs things done perfectly — all Ts crossed and Is dotted — it takes an insurmountable amount of effort. And if (they) don’t have a plan of how to get this task completed, then the perfectionist will get lost.”

Worriers tend to be indecisive and dependent on others for advice or reassurance before taking initiative on their own. They also have a high resistance to change, preferring the safety of the known.

Both perfectionists and worriers might put off starting tasks due to a fear of failure or criticism, said Itamar Shatz, a researcher at the University of Cambridge in the United Kingdom and creator of the website Solving Procrastination.

Challenge those beliefs and your behavior by recognizing that perfectionistic standards are unrealistic, Shatz said. “Replace them with standards that are good enough instead while giving yourself permission to make some mistakes,” he added.

Avoid all-or-nothing thinking and give yourself a time limit for completing a task. (And then stick to that time limit — don’t just give up if you don’t meet it.)

A “dreamer” procrastinator doesn’t like the nitty-gritty logistical details often needed to get projects done, Saripalli said. “They like to have ideas,” she added. “That stuff is fun. It’s kind of difficult or boring to then execute these visions.”

Dreamers might also think of themselves as people for whom fate will intervene, making proactive hard work and efficiency appear unnecessary.

And like a perfectionist, a dreamer might always want something better, Yip said. Train yourself to differentiate between dreams and goals, and approach goals with six questions: what, when, where, who, why and how. Change “soon” or “one day” to specific times. Write your plans into a timeline, specifying each step.

People with defiant procrastination tend to view life in terms of what others expect or require them to do, not what they want. This pessimism diminishes their motivation to complete tasks.

If you have this mindset, find positive ways to feel in control, Shatz said. Strive to act rather than react and try to work with a team or supervisor, not against them.

“If something doesn’t sit well with you, rather than being passive-aggressive about it, acknowledge what is or isn’t working and then have a conversation with whoever is giving you this assignment,” Yip said. “Defiers usually don’t feel equipped to have these conversations with who they see as authority figures, or they don’t believe that having the conversations would give them any benefit or positive outcome. … That’s not necessarily true.”

Just like working on anxiety or other mental health issues, addressing procrastination can be hard, especially if it comes from deep-rooted issues, Shatz said.

For some people who procrastinate, “their sense of self is so fragile that the idea of doing something and failing would just tip them over into complete worthlessness,” said Sean Grover, a New York City-based psychotherapist specializing in group therapy.

In such cases, “consider contacting a professional, like a psychologist, who might be able to help you,” Shatz added.

“Visualization works,” Yip said. “If you can visualize yourself completing (a task), then it becomes more achievable simply because you have an idea that it can be done.”

At the end of the day, how you approach life is “all about your belief system,” Yip said. “If you believe you can, you can. If you believe you cannot, you can’t. So whatever you believe, you’re right.”

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We all need ‘Sushi Tuesdays’: Lessons in understanding and finding a way forward after suicide | CNN

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Editor’s Note: If you or someone you know is struggling with mental health, help is available. Dial or text 988 or visit 988lifeline.org for free and confidential support.

CNN
—

When Sam Maya, a beloved husband, father, friend, stockbroker and coach, died by suicide 16 years ago, he left a note. He apologized to his wife, Charlotte, for being a burden and telling her and their two sons, then 6 and 8, that he loved them.

In her recent heartbreaking memoir, “Sushi Tuesdays: A Memoir of Love, Loss and Family Resilience,” Charlotte Maya bears witness to Sam’s life, death and the aftermath with a singular purpose: to humanize the face of suicide and help readers develop a fluency in discussing mental health.

She spent nearly a decade writing “Sushi Tuesdays,” beginning with a blog by the same name, an homage to the weekly ritual she created after her husband’s death.

Every Tuesday while her kids were at school, Maya set aside her overwhelming to-do list as a lawyer and widowed single parent. Tuesdays began with a yoga class, then therapy, followed by whatever she needed most: perhaps going back to bed, going on a hike or heading to a solo sushi lunch.

I met Maya in a memoir workshop last year. I have a family history of mental illness and suicide, so I connected with her work and motivation for sharing her story.

In 2021, suicide was the second leading cause of death for Americans ages 10 to 34, the fifth for ages 35 to 54, and the 11th leading cause of death nationwide, claiming the lives of more than 48,000 people, according to the US Centers for Disease Control and Prevention.

The suicide rate among men in 2021 was nearly four times higher than the rate of women, according to the CDC. Research supports the assumption that men typically choose more effective and lethal means, such as firearms, to complete suicide, according to Dr. Ashwini Nadkarni, a psychiatrist and researcher at Brigham and Women’s Hospital in Boston.

Additionally, men are less likely to seek treatment for depression due to gendered expectations that equate masculinity with emotional stoicism, Nadkarni said.

Suicide is a national health crisis, Maya told me, but when we hear of such a loss, we often attribute each death to the unique problem the deceased faced, such as financial or legal troubles.

These stressors don’t explain suicide, she said. “Lots of people lose money, and they don’t take their own lives. They figure things out.”

When her husband died, Maya knew he had back pain and was stressed about work and money, but she didn’t think these things added up to being suicidal. In retrospect, she can now spot clues, such as his review of his will shortly before he died.

“I wanted to turn back the clock after Sam died,” she said. “I felt so strongly that if I could get back to that morning, I could have changed everything. It’s hard to reckon with what cannot be undone, to face straight into what I did or didn’t do, where I failed, where Sam failed.”

“Whenever I say that Sam made a mistake, the mistake I mean is that he didn’t ask for help,” Maya said. “It’s hard to say you’re suffering when you’re suffering, so let your loved ones know you are available to help.”

Asking people directly about suicidal thoughts may reduce, rather than increase, suicidal ideation, according to a 2014 review of scholarly literature in the journal Psychological Medicine.

That does require that people look for and notice signs that others may be struggling, such as changes in mood, behavior, appetite or sleep habits or that they are giving away cherished possessions.

The writer has since remarried. The combined family includes Gregory Stratz (from left), Tim Stratz, Jason Maya, Parker (the dog), Charlotte Maya, Danny Maya and Daniel Stratz, here in 2011.

Speaking directly about mental health became a trademark of Maya’s single parenting. She aimed for her boys “to live full and fruitful lives, not defined by their father’s suicide, not limited by their father’s suicide, but also not ignoring their father’s suicide.”

Her sons grieved their dad in their own ways, including denial (one pretended his father was on an extended business trip) and rageful episodes that ended with destroyed Lego sets and tears. Maya mourned with them about the “daddy-shaped space in their hearts” but promised that someday they’d be able to say, “I survived my father’s suicide, and I can do anything.”

“It can be awkward to say yes when people ask to help,” Maya said. “Because I was so shocked and overwhelmed, I just said yes. I recommend that course of action to people. Let people show up and help you.”

The support from Maya’s village was so vast that she wrestled with which of her friends would be fully fledged characters in “Sushi Tuesdays” and which would have cameo appearances.

She dealt with this challenge — and the confusion caused by many friends with names starting with the letter J — by cleverly referring to her friends, collectively, as “The Janes.” Given her background as a lawyer, she thought of them as Jane Doe No. 1, Jane Doe No. 2 and so on.

In the book, readers meet District Attorney Jane who helped with the coroner’s office, Engineer Jane who gets the boys to school each day on time and Prayer Warrior Jane who prays for Maya while she’s “not exactly on speaking terms with God.”

One friend, identified not as a “Jane” but as “Bess” in the narrative, is Katherine Tasheff, a college friend from Rice University. When Sam Maya died, Tasheff was a single mother living on a budget in Brooklyn and couldn’t travel to California to visit. So, she did what she could: She wrote her friend an email. And then another. And another. Morning and night for 365 days following Sam’s death.

The emails were always heartfelt and genuine but often mixed with dark humor. In one, Tasheff wrote, “We did an informal poll on whose husband was most likely to take his own life, and I want you to know that Sam came in last place.”

Almost immediately, Charlotte Maya replied, “Dead last?”

This kind of banter fueled Maya, who told her therapist to “call 911” if she ever lost her sense of humor. Finding moments of levity, she said, helped her hold onto her humanity. “Humor doesn’t cancel out what is devastating,” Maya told me. “Just like gratitude cannot cancel out what is horrifying. What’s important is having the capacity to hold both of those things.”

After her husband's death, Charlotte Maya says moments of levity helped her hold on to her humanity.

Seven years after her husband died, in 2014, Maya felt ready to write about surviving his suicide. Tasheff acted with her signature hadn’t-been-asked swiftness, setting up a blog site for sushituesdays.com within an hour.

By then, Maya had met and married the most eligible widower in her town, now nicknamed Mr. Page 179 because that’s where he shows up in the book. They each brought two sons to the marriage. (Coincidentally, each has a child named Daniel, so they now have two Daniels.)

Maya continues to honor her Tuesdays with therapy and yoga, a hike with a friend, and sometimes a sushi lunch.

She urges everyone — especially single parents and anyone managing anxiety or depression — to carve out a similar weekly ritual, even if it’s just an hour to “treat yourself with the same compassion as you treat your dearest friends.”

The coping mechanisms that Maya relied on in her grief may further explain the gender disparity in suicide rates, according to psychologist Lauren Kerwin.

Men may be less likely to have strong support networks or to engage with them when in stress or emotional pain and may be more likely to use maladaptive coping strategies, such as substance abuse or isolation, Kerwin said.

Seeking social connection and professional help is critical to preventing suicide.

“Now, more than ever, we have a better understanding of the neuroinflammatory basis for depression — the medical framework gives us a model in which to consider depression as a medical condition and one which can be treated,” said Nadkarni, the Boston psychiatrist.

If you see warning signs or are worried about someone who may be struggling, the American Foundation for Suicide Prevention recommends you assume you are the only one who will reach out. Find a time to speak privately and listen. Let people know their life matters to you and ask directly if they are thinking about suicide. Then encourage them to use the national suicide hotline by calling or texting the 988 Suicide & Crisis Lifeline, contact their doctor or therapist or seek treatment.

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What is autism? An expert explains | CNN

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CNN
—

Some individuals with autism have challenges processing senses. Others struggle to communicate. Still others might have a tough time socializing, thinking, physically moving or just going about daily living.

People with autism have their own ways of interacting with the world, because autism is a developmental disability that affects everyone who has it a little differently, according to Dr. Daniel Geschwind, the Gordon and Virginia Macdonald distinguished professor of human genetics, neurology and psychiatry at UCLA.

Geschwind has spent 25 years studying autism and what causes it. To mark Autism Awareness Month, CNN talked with him about what autism is and what causes it.

This conversation has been lightly edited and condensed for clarity.

CNN: What is autism?

Dr. Daniel Geschwind: Autism refers to a broad range of conditions characterized by challenges with social skills and social and communication and repetitive behaviors, resistance to changes in routine, or restricted interests. I prefer to call it “the Autisms,” because it’s not one thing, and no two autistic children or adults are exactly alike even though they may share basic features. People with autism may also have some sensory-motor integration issues, especially sensory hypersensitivity.

CNN: How prevalent is autism today?

Geschwind: It isn’t rare. The most recent statistics (from the US Centers for Disease Control and Prevention) came out in March, pulled data from 11 sites (in the United States) and reported 1 out of every 36 kids is autistic. The study before that estimated around 1 in 40. About 10 years ago, the autism rate was 1 in 100, or even lower.

It would be easy to look at this trend and say autism is increasing, but that’s not really what is happening. The most recent data reflects that our ability to recognize autism and diagnose it early has improved dramatically. We’re now able to diagnose people with autism who might have (previously) fallen through the cracks.

Everybody is neurodivergent to some extent. For example, if you look at a simple IQ test, a substantial portion of people will perform really badly on one specific item. That doesn’t mean they have problems — it’s just that it means we all have strengths and weaknesses.

If I were being tested on artistic ability, for example, or engineering ability, I would be far below what’s called typical. I think we have to accept that intelligence is not just one thing, that cognition isn’t one thing, that there’s not just one way to behave.

CNN: What does it mean when people describe some as being “on the spectrum”?

Geschwind: About a decade ago, the term “autism spectrum disorder” was adopted to encompass everything that we called autism into one rubric. The intent was simply to describe the variability in how people with autism act and behave biomedically. There are some autistic individuals who just need accommodations and don’t need treatment. There are other autistic individuals who need a lot of treatment. The spectrum was intended to include them all.

Over time, non-autistic people began referring to the spectrum in a linear fashion: high to low. That means some autistic individuals were categorized as “high-functioning,” while others were categorized as “low-functioning.” For many, the notion of a spectrum is now a loaded term. Many believe that instead of talking about autism in a linear fashion, we should talk about it as a wheel or pie, where each slice represents a different trait and every individual has different strengths and weaknesses.

CNN: Is there a cure for autism?

Geschwind: There is no cure. At the same time, we’ve come very far in understanding what autism is, and we’re making progress on how to treat it. When I started researching autism 25 years ago, the autism rate was 1 in 1,000 or 1 in 2,000. To put it in deeper historical perspective, I think at that time there was only about $10 million a year or less in autism research being done that was funded (by the National Institutes of Health). And so, there was a huge disconnect between the research dollars, public awareness and the real needs of patients and families.

The notion of the term “curing” autism can be controversial. From my perspective, our true goal is to establish a kind of personalized medicine, or precision health in autism and other neuropsychiatric disorders, so that each autistic person is seen as the individual they are. We envision a world where individuals who are severely impacted by autism have the opportunity to get therapy and drugs that can help them — and those for whom a therapy is not warranted or who don’t want it will have opportunities to live life the way they want to as well. Patient autonomy and societal accommodation are important aspects when considering these issues.

CNN: What causes autism?

Geschwind: Almost every medical condition has both genetic and environmental components. In autism, it seems that heritability is very high. The most recent large study suggested that heritable genetic factors — the things that you get from your parents that your parents have in their DNA — are probably somewhere around 80% or slightly higher.

That leaves 20% that’s nonheritable, and of that we know that at least 10% of autism is caused by rare mutations that are not inherited. And that sounds like a paradox, but it’s not. If you think about Down syndrome, that’s a genetic mutation that the parents don’t have in their DNA. That’s called a new, or de novo, mutation.

You can calculate a risk score for having autism based on genetics, (but) right now, the risk score for autism is not that predictive because we haven’t done enough research. For other conditions like cardiovascular or certain cancers, risk scores are very predictive because very large numbers of people have been studied.

Even so, this autism risk score is strongly correlated with high educational attainment, or a high IQ, which again speaks to the strengths associated with being autistic and highlights that we need to be more aware of the strengths that autistic individuals may have as well to optimize their opportunities to achieve their goals or contribute to society.

There also are several environmental factors that have been shown to increase the risk of autism. One of them is maternal exposure to valproate, which is an anti-epilepsy medication. There are several maternal viral infections that have been associated with autism. And two other things: the interbirth interval — how quickly after one birth a mother has another — and the age of the father. The thought on the last point is that as a man ages, their DNA repair mechanisms are maybe less active, and there are more frequent mutations in sperm.

A key point is that all these known environmental factors act prenatally, so in most cases the tendency towards being on the spectrum is something that individuals are born with.

CNN: To what extent has research debunked the controversial notion that vaccines can cause autism?

Geschwind: The notion that vaccines cause autism has been entirely (disproved). There have been dozens of studies, using very different methodologies. There is absolutely no evidence that vaccines cause autism, and there’s been much more harm than good done by purveyors of that fiction.

CNN: How do you treat autism?

Geschwind: It is imperative to have an early diagnosis, because we know that early identification and early intervention with behavioral therapies can be effective in up to 50% of kids. Some kids will respond so well that it’s very hard to make a diagnosis of autism when they’re 9 years old if the therapy is started early enough.

The problem is that for many autistic individuals, current therapies are not that effective. There’s a lot of work being done developing more effective cognitive behavioral therapies, figuring out which therapy is the best for which child. There’s also work being done to develop medications that can be helpful to treat certain symptoms such as injurious behavior, repetitive behavior or difficulty with changes in routines.

My colleagues and I want to use treatment to augment and improve people’s symptoms, not change who they are fundamentally. We believe strongly in every individual’s autonomy. We also believe in personalized medicine so that it’s not one-size-fits-all. There will be some patients in whom we’re trying to correct a severe genetic mutation that has profound consequences, and there’ll be others that need only a handful of accommodations, just like we provide for folks who need wheelchairs.

CNN: What will your research focus on next?

Geschwind: There are two basic frontiers in my research. One recognizes that most of the work in neuropsychiatric disorders and autism has been done in primarily White European populations and focuses on a pressing need to be studying diverse populations. About seven or eight years ago, I started working with African American communities because certain aspects of genetics are population-specific, and we as researchers really need to understand that.

The frontier that is crosscutting across all of this is we need to be able to move from genetics in a population to genetics in an individual, so that by looking at somebody’s genetic makeup, we can understand the mechanism of their autism. This is precision medicine.

My work is trying to understand how specific genetic variants, how specific mutations, impact brain development to eventually lead to the symptoms of autism. If my colleagues and I can understand that mechanism, just like we can understand the genetic mechanism in cancer, we can find a drug to target that and improve those symptoms over time.

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Why we have nightmares and how to stop them | CNN

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—

We leave behind our fears of monsters under the bed as we say goodbye to our childhoods, but one can follow us into adulthood and loom over our heads.

Nightmares are more common in childhood, but anywhere from 50% to 85% of adults report having occasional nightmares.

Almost everyone can experience nightmares.

“Dreams do usually incorporate things that happened during the day, leading some researchers to hypothesize that dreams and rapid eye movement sleep is essential for memory consolidation and cognitive rejuvenation,” said Joshua Tal, a sleep and health psychologist based in Manhattan.

“Nightmares are the mind’s attempts at making sense of these events, by replaying them in images during sleep.”

Nightmares are what the American Academy of Sleep Medicine call “vivid, realistic and disturbing dreams typically involving threats to survival or security, which often evoke emotions of anxiety, fear or terror.”

If someone has frequent nightmares — more than once or twice weekly — that cause distress or impairment at work or among people, he or she might have nightmare disorder. Treatments include medications and behavioral therapies.

Addressing frequent nightmares is important since they have also been linked to insomnia, depression and suicidal behavior. Since nightmares can also cause sleep deprivation, they are linked to heart disease and obesity as well.

Trying out these 10 steps could help you ease your nightmares and improve your sleep and quality of life.

Nightmares occur during rapid eye movement sleep, the phase during which our muscles relax and we dream. Waking up during REM sleep enables recollection of the dream and resulting distress, said Jennifer Martin, a professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles, and member of the American Academy of Sleep Medicine’s board of directors.

“One of the most effective ways to treat nightmare problems in adults is actually to get them sleeping more soundly (so) they wake up less often,” Martin said.

A healthy sleep routine begets sound sleep. Develop one by exercising, setting regular sleep and waking times, ensuring your room is dark and cool, avoiding stimulating beverages after midafternoon and engaging in relaxing activities.

Alcoholic beverages can induce restlessness and awakenings throughout the night — potentially helping you remember nightmares, Martin said.

“A lot of people use alcohol as a way to wind down and feel sleepy at the end of the day, but it’s really not the right solution,” she added. Instead, try herbal teas and other beverages conducive to sleep. If drinking was the only part of your relaxation routine, chat with your partner or read instead.

One drink more than three hours before bedtime is OK, Martin said. Just pay attention to whether it causes a post-dinner nap and alertness at bedtime, and eliminate that drink if it does.

Avoid snacking before bed to prevent spiking your metabolism and activating your brain.

Snacking can boost metabolism, which causes your brain to be more active and could lead to nightmares, according to the National Sleep Foundation.

While some people sleep better after eating a light snack, you should stop eating two to three hours before bedtime. If you notice that you have nightmares afterward, try avoiding nighttime snacking or heavier meals before bed.

Some medications can prompt nightmares by interrupting REM sleep.

“If people can identify that their nightmares either started or increased when they had a change in their medication, that’s definitely a reason to talk to their doctor” about their medication schedule or alternatives, Martin said.

Melatonin, while a popular sleep aid, influences our circadian rhythm that regulates REM sleep, and can lead to more or fewer nightmares. If you want to take melatonin for better sleep, work with a sleep specialist to ensure you’re taking it at the right time and not compounding the problem, Martin said.

Calming activities can deactivate your fight-or-flight response and trigger your relaxation system.

Progressive muscle relaxation — tensing muscle groups as you inhale and relaxing them as you exhale — has been effective for reducing nightmares.

“Nightmares activate the sympathetic nervous system, the ‘fight or flight system,’ the body’s natural response to imminent danger,” said Tal via email.

“The body also has an innate relaxation system: the parasympathetic nervous system, aka the ‘rest and digest’ system.” Progressive muscle relaxation and other relaxation activities can help activate that system.

Journaling can help you release your anxieties.

Write down your worries to get them all out ahead of time, lest they rear their disquieting heads at night. Journaling can be helpful for alleviating nightmares and stress in general, Tal said.

Images from any exciting or disturbing content you watched before bed can appear in your dreams.

Since our nighttime observations can appear during sleep, “spend some energy engaging with things that are more emotionally neutral or even positive” before bedtime, Martin suggested.

During the pandemic, our everyday lives are looking pretty scary, too. “Reading the news media and then hopping into bed is more likely to trigger disturbing and upsetting dreams than looking through pictures from your last vacation with your family,” she added.

Imagery rehearsal therapy is effective “when the chronic nightmares are showing similar themes and patterns,” Tal said.

Since nightmares can be learned behavior for the brain, this practice involves writing down in detail the narrative elements of the dream. Then rewrite the dream so that it ends positively. Just before falling asleep, set the intention to re-dream by saying aloud, “If or when I have the beginnings of the same bad dream, I will be able to instead have this much better dream with a positive outcome.”

“By practicing a rewrite during the daytime, you increase your chances of having them at night while you’re sleeping instead of your nightmare,” Tal said.

Silence is key in a sleep routine, but “for people who either don’t like it to be completely quiet or who are awakened by noises they can’t control during the night,” background noise “is a good strategy,” Martin said.

Try a fan or a white noise machine or app for several consecutive nights to help your brain adapt, she added.

If nothing works and you’re still having nightmares, talk with a therapist or sleep specialist.

“Nightmares might be a sign of a larger issue, such as PTSD or a mood disorder,” Tal said. “It is possible to treat the nightmares without treating the underlying disorder, but it may also be helpful to treat both the symptom and the disorder.

“There has been great progress on psychological treatments for nightmares, insomnia, anxiety and mood disorders,” Tal added. “Do not be afraid to ask for help; psychotherapy works and it is often short term and accessible.”

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Working in neuroscience taught me that music is key to our well-being

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For many of us, the understanding that music can calm our nerves, improve our mood, and make us feel connected to one another, is largely intuitive.

Parents sing to their babies to facilitate sleep, modulate mood, and scaffold communication. Likewise, adults turn to uplifting music for energy and motivation and soothing music for relaxation and calm.

While such effects can feel mysterious, the truth is that they arise mechanistically from the interaction between musical tones and rhythms with our brains.

Although I had been a musician since I was a child, and had studied the biological foundations of music for more than a decade, the relevance of music’s effects on the brain for mental health was not initially obvious to me.

Intellectually, I understood that music is an important part of human nature, with deep roots in the biology of social communication, which goes a long way towards explaining its emotional power.

Practically, I knew that I looked to music every day as a source of joy, motivation, and connection.

But, perhaps like many basic scientists, I was naïve about how closely such effects align with critical dimensions of mental health (like mood, anxiety, focus, and sociality).

I didn’t understand how overlap in underlying neurophysiology could provide a scientific basis for music as therapy.

Leaving my comfort zone helped me as a scientist

This began to change when, after nearly 10 years abroad completing my studies, I returned to the US for a job in the Department of Psychiatry and Behavioral Sciences at Stanford School of Medicine.

There, I quickly learned about the magnitude of our society’s growing problems with mental health (especially for young people) and the tremendous need for better services.

I also felt the collective frustration with our current best practices (i.e., our best behavioural and pharmacological therapies), which unfortunately have so little to offer so many in need, and which often carry significant burdens through side effects.

In what felt like a cliché at the time, I was also contacted by a start-up, Spiritune, about consulting work within several weeks of my arrival in Silicon Valley.

Despite my initial scepticism, I’ve learned some important things that have changed how I think about the value of music.

In taking a closer look at musical applications in health, I’ve come face-to-face with the mountain of evidence showing that music-based therapies and interventions are broadly effective, e.g., at reducing core symptoms and/or quality of life across many of our most common ailments, including disorders of anxiety, mood, social function, psychosis, and dementia.

Together, these and other insights have made me wonder how much more music could do for us.

What if we stopped thinking about music primarily as a source of entertainment and profit and more as an essential form of social communication with real neurobiological benefits?

This is how we came up with a lulaby for Syrian children

One of the more satisfying applications of my research so far has been in working with Spiritune on the Frequencies of Peace campaign, which seeks to bring a bit of peace to Syrian children in a world plagued by war and natural disasters.

As part of a larger effort to supply toys, blankets, and other sleep aids to these kids, Babyshop, a Middle-Eastern retailer of products for children, came up with the goal of composing a special Arabic lullaby to be played over the radio at bedtime in homes, camps, orphanages, and hospitals all over the region.

The small editorial role played by us in this process was in iterating back and forth with a local composer to help ensure that the final lullaby was acoustically aligned with parameters that communicate peace and calm and that is suitable for use in a context of helping children for whom unpredictability has engendered a fundamental state of hyper-vigilance and anxiety.

While the magnitude of the problems faced by these children, now and in the future, far outweighs what we can hope to have achieved with a single lullaby, the effort remains important in a number of ways.

Can a song really help?

First and foremost, we hope that it will provide some immediate comfort and predictability in the lives of these children while also serving as a window into the tenderness and kindness that exists in the world.

Second, we hope that it will draw attention to the emotional plight of these children and stimulate other local and international partnerships aimed at helping them.

And third, we want this campaign to highlight the tangible value of music for mental health, not only for the most vulnerable but for us all.

The capacity of music to soothe, lull, and generally calm our nerves applies broadly, as does its capacity to stimulate positive emotions, motivate and reward, and bring people together.

These effects have a biological reality that we are increasingly coming to understand, and the effects are just as real as those of other interventions that have become staples of modern mental health care.

Music does more for our mental health than you think

As problems with mental health continue to rise and the world faces new challenges, music will continue to help people, as it always has.

If we continue to overlook this reality, we will miss an important opportunity in a time of need. We need to double down on understanding music’s effects on the brain, promote them, and perhaps most importantly, teach our children how to leverage them.

The onus is thus on scientists, clinicians, educators, musicians, public funders, and private companies to push forward with work that advances the integration of music into our healthcare systems and wellness practices.

This project will not be without its challenges, but the collective knowledge of musicians, music therapists, and biological music researchers can already provide considerable insight into the way forward.

We are also starting to learn how to target musical treatments to individuals with greater precision, which, combined with new technologies, will allow us to develop better ways of getting the right music to the right people at the right time.

All of this is to say that a world in which music does more for our mental health is eminently achievable, and I would encourage anyone who has ever felt moved by music to take it seriously and actively seek out ways in which music can improve their condition.

Daniel Bowling, PhD, is a neuroscientist working at Stanford School of Medicine’s Parker Lab, focusing on auditory-vocal function in human social communication.

At Euronews, we believe all views matter. Contact us at [email protected] to send pitches or submissions and be part of the conversation.

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Whether you’re a ‘shark,’ ‘teddy bear’ or ‘fox,’ here’s how to ease conflict with family and friends | CNN

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Editor’s Note: The views expressed in this commentary are solely those of the writers. CNN is showcasing the work of The Conversation, a collaboration between journalists and academics to provide news analysis and commentary. The content is produced solely by The Conversation.

The Conversation
—

For all the joy they bring, families and close friendships often involve conflict, betrayal, regret and resentment. Prince Harry’s recent memoir, “Spare,” is a reminder of the fact that the people closest to us often have the greatest power to hurt us. He describes power struggles, conflict, challenging family dynamics and decades of guilt, jealousy and resentment.

This sort of conflict can feel impossible to resolve. It’s not easy to move past, and sometimes it simply isn’t going to happen — at least in the short term. But psychology has helped us understand more about the breakdown of close relationships and what factors make resolution more likely.

In the course of a lifetime, it is difficult to avoid hurting, upsetting or being in conflict with people we love. It is an inevitable part of most lives, and learning how to negotiate it is a more useful and realistic goal than avoiding it. The first step is understanding what makes relationship conflict so difficult and the different approaches people have to it.

Canadian psychologists Judy Makinen and Susan Johnson have used the term attachment injuries to describe the sorts of wounds inflicted when we perceive that we have been abandoned, betrayed or mistreated by those closest to us.

These wounds sting so sharply because they lead us to question the safety, dependability or allegiance of these people. They trigger a myriad of emotional and behavioral responses, including aggression, resentment, fear, avoidance and reluctance to forgive. These responses have evolved as self-protection and are rooted to our personal histories and personality.

But the pain can linger indefinitely, continuing to influence us from the shadows. So what have psychologists learned about how people heal, move through the hurt and even learn and grow from it?

Much research has been carried out studying conflict resolution. Social psychologist David W. Johnson studied conflict management “styles” in humans and modeled the typical ways we respond to conflict.

He argued that our responses and strategies in conflict resolution tend to involve an attempt to balance our own concerns (our goals) with the concerns of the other people involved (their goals and preservation of the relationship).

Johnson outlined five main styles or approaches to this balancing act.

“Turtles” withdraw, abandoning both their own goals and the relationship. The result tends to be frozen, unresolved conflict.

“Sharks” have an aggressive, forceful take and protect their own goals at all costs. They tend to attack, intimidate and overwhelm during conflict.

“Teddy bears” seek to keep the peace and smooth things over. They drop their own goals completely. They sacrifice for the sake of the relationship.

“Foxes” adopt a compromising style. They are concerned with sacrifices being made on both sides and see concession as the solution, even when it results in less-than-ideal outcomes for both sides.

“Owls” adopt a style that views conflict as a problem to be resolved. They are open to solving it through whichever solutions offer both parties a pathway to achieve their goals and maintain the relationship. This can involve considerable time and effort. But owls are willing to endure the struggle.

Research has suggested that our conflict resolution styles are related to our personalities and attachment histories. For example, people whose early attachment experiences taught them that their feelings are unimportant or invisible may be more likely to develop conflict management styles that instinctively minimize their needs (for example, the teddy bear).

Some psychologists have also suggested that our conflict management styles can be modified in long-term relationships but do not tend to change dramatically. In other words, while a teddy bear may have the potential to develop conflict management characteristics that reflect other styles, they are highly unlikely to turn into a shark.

Psychologists Richard Mackey, Matthew Diemer and Bernard O’Brien argued conflict is inevitable in all relationships. Their research found the duration of a relationship heavily depends upon how conflict is dealt with, and the longest-lasting, most fulfilling relationships are those in which conflict is accepted and constructively approached by both parties.

So, while a relationship between two sharks might be enduring, the likelihood that it will be harmonious is significantly less compared with a relationship between two owls.

Forgiveness is often hailed as the ultimate goal in relationship conflict. Jungian analysts Lisa Marchiano, Joseph Lee and Deborah Stewart describe forgiveness as reaching a place where we are able to “hold in our hearts at the same time, the magnitude of the injury that has been done to us and the humanity of the injurer.” That’s not an easy place to reach because it can feel as though we are minimizing our suffering by forgiving someone.

Psychologists Masi Noor and Marina Cantacuzino founded the Forgiveness Project, which provides resources to help people overcome unresolved grievances. They include a set of essential skills or tools that they argue can help us reach forgiveness.

These include understanding that all humans are fallible (including ourselves), giving up competing over who has suffered more, finding empathy for how others see the world and acknowledging that other perspectives exist, and accepting responsibility for how we might have contributed to our own suffering, even if it’s a bitter pill to swallow.

As Mark Twain put it: “Forgiveness is the fragrance that the violet sheds on the heel that has crushed it.”

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Why you keep having the same dream | CNN

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For years, dreams of my teeth cracking, loosening or falling out plagued my sleep. Loved ones of mine have repeatedly dreamed of flying, rolling away in a self-operating car, or running late for school or work. These aren’t typical nightmares, which usually happen once. They’re some of the most common recurring dreams, which tend to lean negative and can take some work to overcome.

“Recurring dreams are likelier to be about very profound life experiences or just very character logic issues that are kind of guaranteed to recur in waking life because they’re part of you rather than a one-time event,” said dream researcher Deirdre Barrett, a lecturer of psychology in the department of psychiatry at Harvard Medical School.

Since our dreams typically don’t repeat themselves, all it takes is dreaming the same dream twice or more for it to be considered recurring, Barrett said. They’re more common in childhood, Barrett said, but can last into adulthood. And recurring dreams don’t always happen in close proximity to each other — they can pop up multiple times per month or years apart, Barrett said.

Recurring dreams might be the same every time, or they might just recycle the same types of scenarios or worries, experts said.

“It is difficult to assess the prevalence of recurrent dreams because it is not something that happens on a regular basis for most people,” said clinical psychologist Dr. Nirit Soffer-Dudek, a senior lecturer in the department of psychology at Ben-Gurion University of the Negev in Israel, via email. “And when people are asked about past dreams in their life, they may be influenced by memory distortions, interest in dreams (or lack thereof), or other factors.”

Regardless, anything that comes up repeatedly is worth investigating, said sleep medicine specialist Dr. Alex Dimitriu, founder of Silicon Psych, a psychiatry and sleep medicine practice in Menlo Park, California.

“People have this kind of touch-and-go approach with things that are uncomfortable or fear-inducing, and I think dreams are, in some way, the same way,” Dimitriu said. “As a psychiatrist, I’m inclined to say that there is some message that might be trying to be conveyed to you. And the answer, then, might be to figure out what that is. And I think when you do, you might be able to put the thing to rest.”

Here’s how to figure out what’s triggering your recurring dreams.

For some recurring dreams, the message is straightforward — if you repeatedly dream about running late for school or work, you’re probably just often nervous about being unprepared for those things. But others, despite their commonness, might not have a universal meaning, requiring you do some soul-searching to learn more.

“In interpretation, we really don’t believe there are universal symbols, but that (it’s) what an individual’s own sort of personal symbol system is and their associations to something are,” Barrett said.

In addition to unpreparedness, other common themes of recurring dreams include social embarrassment, feeling inadequate compared with others, and danger in the form of car crashes or natural disasters, Barrett and Dimitriu said.

Some people have dreams revolving around test anxiety even if they haven’t been in school in years, Barrett said. This can reflect a general fear of failure or a sense of being judged by authority figures. Dreams of tooth loss or damage might have to do with loss of something else in your life, feelings of hopelessness or defenselessness, or health concerns.

When faced with a recurring dream, ask yourself what the message could be, Dimitriu said. What is your relationship to the things or people in the dream? What are your fears and belief systems about those things? What are the top five things in your life that might be triggering it or related to it? What are you really worried about?

“I definitely think it’s fine to do informal dream interpretation, either on your own or with a close, trusted person who may just sort of see things to question in it that you don’t,” Barrett said.

People with post-traumatic stress disorder or anxiety are more likely to have recurring dreams, especially ones with anxious natures, Dimitriu said. A PTSD dream stems from a trauma so severe it keeps returning as a nightmare.

“The brain is trying to resolve something and lay it to rest,” he added. But “in people with PTSD, their dreams are so vivid that they wake them up from sleep. And that becomes the problem because the dream never gets processed. … And that’s why it recurs — it’s unfinished work.”

Sometimes recurring dreams can point to biological sources, too. “People with sleep apnea will report dreams of, like, drowning, suffocating, giant waves, gasping for air, being underwater or being choked,” Dimitriu said, when they’re actually experiencing breathing interruptions because of their condition.

There can be environmental triggers as well, such as a car alarm down the street or a dripping faucet, he added, which can set off dreams with imagery of those things.

Once you have a better sense of what your worries are, writing about them before bed can be helpful for alleviating negative recurring dreams and stress in general.

“For my patients and myself, journaling is such a powerful tool,” Dimitriu said. Meditating could also help.

When you know what fear is behind your dream, Dimitriu recommended processing it via a three-column method used in cognitive behavioral therapy: What is your automatic thought? What’s your automatic feeling? Lastly, what’s the more reality-based alternative thought?

Dream rehearsal therapy, also known as imagery rehearsal therapy, can be effective for both recurring dreams and nightmares. This approach involves writing down in detail the narrative elements of the dream, then rewriting it so it ends positively. Right before falling asleep, you’d set the intention to re-dream by saying aloud, “If or when I have the beginnings of the same bad dream, I will be able to instead have this much better dream with a positive outcome.”

If your recurring dreams are making you stressed or unhappy, causing other symptoms, or starting to impair your ability to function on a regular basis, it’s time to seek professional help, experts said.

Recurring dreams could also stem from poor sleep hygiene, Soffer-Dudek said.

“A lot of awkward things happen in the night when people are sleep deprived, drink caffeine too late, drink alcohol too late, worked too late or slept four hours last night because they stayed up too late,” he said. “The fundamental core and foundation of healthy dream life starts with healthy sleep.”

Dimitriu also recommended limiting distractions that interfere with your time to reflect and process, such as spending unnecessary time on your phone or always filling the silence.

When your mind is always occupied, “what happens is all that processing has to happen somewhere,” he said. “So now there’s more pressure for that to happen in your dream life.”

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Men with advanced prostate cancer going without life-prolonging medication amid shortage | CNN

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CNN
—

Doctors across the United States who treat people with advanced prostate cancer can’t find supplies of a medicine that may help them live longer.

Pluvicto, a drug to treat metastatic castration-resistant prostate cancer, also known as mCRPC, is in such short supply that its maker, Novartis, said it cannot allow further supply to new patients until it can produce more of the drug. The company said it is working to produce enough doses to treat existing patients.

“We recognize that this situation is distressing for patients whether they are currently in the treatment process and being rescheduled, or waiting for their first dose of Pluvicto,” Novartis said in a statement to CNN. “Any interruption in the process, from unplanned manufacturing events to doses not arriving in time, may result in patient doses being rescheduled and can have a cascading effect on patients scheduled for future treatment.”

The Swiss company said it has been in touch with treatment centers and providers in the US and is “actively engaging with them to manage rescheduling of patient doses.”

The problem is that Novartis’ manufacturing facility in Ivrea, Italy, can’t keep up with demand for the drug. In May, it had to suspend production at the facility due to what it said was “an abundance of caution” related to potential quality issues. It also paused production at a New Jersey plant that makes the drug for the Canadian market.

Novartis resumed production at both plants in June.

The company hopes to get the New Jersey plant authorized to produce the drug for the US market, but it’s not clear when that might happen. Novartis said in early March that it had completed its filing for approval from the US Food and Drug Administration.

Someone who has a late-stage cancer that has spread to other parts of the body doesn’t have a lot of time to wait for the company to make more, doctors say, nor do they have many other treatment options. So even if Novartis got approval for the New Jersey plant quickly, the help will come too late for many people, according to Dr. Daniel Spratt, chair of the Department of Radiation Oncology at University Hospitals Seidman Cancer Center in Cleveland.

Novartis said it is prioritizing people who are currently being treated with Pluvicto, which is given in six cycles. But Spratt said the supply has recently been too low even for some of these patients.

“Many patients are missing months of therapy,” he said. “The real tragedy is the patients partially under treatment who have had great responses and we can’t get them the rest of their therapy in a timely fashion.”

Next to skin cancer, prostate cancer is the most common cancer in American men, according to the American Cancer Society. Most men do not die from prostate cancer, but about 34,700 people are expected to die from it this year. It’s the second leading cause of cancer death for American men, behind only lung cancer.

Pluvicto is a targeted radioligand therapy, meaning it uses radioactive atoms to deliver radiation to targeted cells, fighting cancer while limiting damage to the surrounding tissues.

There is no cure for this advanced stage of cancer, but Pluvicto can help people live longer. When the drug got FDA approval in March 2022, Spratt said, there was a lot of excitement about its potential. His patients who had heard about the trials have been asking about it for years.

One study from Novartis’ trials found that people who got the drug lived a median of about 15 months after diagnosis, four months longer than the median for people who didn’t get the treatment. For a handful of people, the recovery is even more dramatic.

“There are some patients that really do have those sort of miraculous responses, so it does occasionally give us one of those ‘wow’ moments,” said Dr. William Dahut, chief scientific officer at the American Cancer Society.

Dahut said doctors also like Pluvicto because, compared with other cancer treatments, it’s easy to administer and has relatively few side effects, other than dry mouth.

Another side effect of the shortage is that it’s slowing the progression of research. There is some indication that the drug could help people before their cancer reaches such a late stage.

“We’re anxious to have greater supply to study it in broader populations,” Dahut said.

Spratt said he is working closely with the medical oncologists in his health care system to try to find alternative treatment options, and he’s been looking to get people into clinical trials so they can get access to the therapy.

“But there’s really very few options available,” he said.

Novartis said that if the FDA approves its plant in Milburn, New Jersey, it could supply more Pluvicto as early as this summer.

The agency told CNN that it “is not able to discuss details regarding any possible communications or actions with companies due to commercial confidential information.”

“To be clear, FDA does not manufacture, produce, bottle, or ship drugs and cannot force companies to do so or make more of a drug. However, in general, the FDA works with firms making drugs in shortage to help them ramp up production if they are willing to do so. Often, they need new production lines approved or need new raw material sources approved to help increase supplies. FDA can and does expedite review of these to help resolve shortages of medically necessary drugs.”

Novartis is also building a plant in Indianapolis where the drug will be produced, but that won’t be up and running until the end of the year, the company said.

In the meantime, doctors will often have to tell their patients that they probably won’t be able to help get them this life-extending drug for some time.

“Some men and their physicians will feel that some hope was taken from them,” Spratt siad. “Cancer is the enemy here, not the company, but it’s unfortunate to have that excitement that your physician will be able to prescribe it to you and just not be able to give it to them.”

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Older people with anxiety frequently don’t get help. Here’s why | CNN

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CNN
—

Anxiety is the most common psychological disorder affecting adults in the United States. In older people, it’s associated with considerable distress as well as ill health, diminished quality of life and elevated rates of disability.

Yet when the US Preventive Services Task Force, an independent, influential panel of experts, suggested last year that adults be screened for anxiety, it left out one group — people 65 and older.

The major reason the task force cited in draft recommendations issued in September: “(T)he current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety” in all older adults. (Final recommendations are expected later this year.)

The task force noted that questionnaires used to screen for anxiety may be unreliable for older adults. Screening entails evaluating people who don’t have obvious symptoms of worrisome medical or psychological conditions.

“We recognize that many older adults experience mental health conditions like anxiety,” and “we are calling urgently for more research,” said Lori Pbert, associate chief of the preventive and behavioral medicine division at the University of Massachusetts Chan Medical School and a former task force member who worked on the anxiety recommendations.

This “we don’t know enough yet” stance doesn’t sit well with some experts who study and treat older people with anxiety. Dr. Carmen Andreescu, an associate professor of psychiatry at the University of Pittsburgh, called the task force’s position baffling because “it’s well-established that anxiety isn’t uncommon in older adults and effective treatments exist.”

“I cannot think of any danger in identifying anxiety in older adults, especially because doing so has no harm and we can do things to reduce it,” said Dr. Helen Lavretsky, a psychology professor at UCLA.

In a recent editorial in JAMA Psychiatry, Andreescu and Lavretsky noted that only about one-third of seniors with generalized anxiety disorder — intense, persistent worry about everyday matters — receive treatment. That’s concerning, they said, considering evidence of links between anxiety and stroke, heart failure, coronary artery disease, autoimmune illness and neurodegenerative disorders such as dementia.

Other forms of anxiety commonly undetected and untreated in older adults include phobias (such as a fear of dogs), obsessive-compulsive disorder, panic disorder, social anxiety disorder (a fear of being assessed and judged by others) and post-traumatic stress disorder.

The smoldering disagreement over screening calls attention to the significance of anxiety in later life — a concern heightened during the Covid-19 pandemic, which magnified stress and worry among older people. Here’s what you should know.

According to a book chapter published in 2020, authored by Andreescu and a colleague, up to 15% of people 65 and older who live outside nursing homes or other facilities have a diagnosable anxiety condition.

As many as half have symptoms of anxiety — irritability, worry, restlessness, decreased concentration, sleep changes, fatigue, avoidant behaviors — that can be distressing but don’t justify a diagnosis, the study noted.

Most senior citizens with anxiety have struggled with this condition since earlier in life, but the way it manifests may change over time. Specifically, older adults tend to be more anxious about issues such as illness, the loss of family and friends, retirement and cognitive declines, experts said. Only a fraction develop anxiety after turning 65.

Older adults often minimize symptoms of anxiety, thinking “this is what getting older is like” rather than “this is a problem that I should do something about,” Andreescu said.

Also, they are more likely than younger adults to report “somatic” complaints — physical symptoms such as dizziness, fatigue, headaches, chest pain, shortness of breath and gastrointestinal problems — that can be difficult to distinguish from underlying medical conditions, according to Gretchen Brenes, a professor of gerontology and geriatric medicine at Wake Forest University School of Medicine.

Some types of anxiety or anxious behaviors — notably, hoarding and fear of falling — are much more common in older adults, but questionnaires meant to identify anxiety don’t typically ask about those issues, said Dr. Jordan Karp, chair of psychiatry at the University of Arizona College of Medicine in Tucson.

When older adults voice concerns, medical providers too often dismiss them as normal, given the challenges of aging, said Dr. Eric Lenze, head of psychiatry at Washington University School of Medicine in St. Louis and the third author of the recent JAMA Psychiatry editorial.

Simple questions can help identify whether an older adult needs to be evaluated for anxiety, he and other experts suggested: Do you have recurrent worries that are hard to control? Are you having trouble sleeping? Have you been feeling more irritable, stressed or nervous? Are you having trouble with concentration or thinking? Are you avoiding things you normally like to do because you’re wrapped up in your worries?

Stephen Snyder, 67, who lives in Zelienople, Pennsylvania, and was diagnosed with generalized anxiety disorder in March 2019, would answer “yes” to many of these queries. “I’m a Type A personality and I worry a lot about a lot of things — my family, my finances, the future,” he told me. “Also, I’ve tended to dwell on things that happened in the past and get all worked up.”

Psychotherapy — particularly cognitive behavioral therapy, which helps people address persistent negative thoughts — is generally considered the first line of anxiety treatment in older adults. In an evidence review for the task force, researchers noted that this type of therapy helps reduce anxiety in older people seen in primary care settings.

Also recommended, Lenze noted, is relaxation therapy, which can involve deep breathing exercises, massage or music therapy, yoga and progressive muscle relaxation.

Because mental health practitioners, especially those who specialize in geriatric mental health, are extremely difficult to find, primary care physicians often recommend medications to ease anxiety.

Two categories of drugs — antidepressants known as SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) — are typically prescribed, and both appear to help to older adults, experts said.

Frequently prescribed to older adults, but to be avoided by them, are benzodiazepines, a class of sedating medications such as Valium, Ativan, Xanax, and Klonopin. The American Geriatrics Society has warned medical providers not to use these in older adults, except when other therapies have failed, because they are addictive and significantly increase the risk of hip fractures, falls and other accidents, and short-term cognitive impairments.

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