Saturday, June 26, 2010

Genetic Tests for Antidepressants & Epigenetics in Psychopharmacology

Newsweek has an article on the recent breakthroughs in identifying genetic elements in antidepressant prescribing - seems they can now tell who metabolizes the drugs quickly and may need different dosages or time-release formulas, and those who do not.

This is probably only the first step - soon we will be able to identify which drug works better for a given individual. See below for more on using epigenetics in psychopharmacology.

Doctors, Depression, and DNA

Can a genetic test help patients get on the right antidepressant?

Joe Raedle / Getty Images

Click to view a gallery of drugs that changed lives for better or worse.

Psychiatrists call it the “trial and error factor”: when they set out to prescribe an antidepressant, they have no clinically proven way of knowing which one to choose. Any given antidepressant tends to help only about a third of patients; the other two-thirds end up doing the prescription shuffle, trying one drug, then another, then a third or fourth in hopes of finally hitting on a treatment that works.

In theory, pharmacogenetics—the subfield of personalized medicine that focuses on how people with different DNA variants respond to drugs—is supposed to solve this problem. The idea is to allow doctors to tailor their prescribing to their patients’ genes. But so far, despite all the research that has been done in the decade since the first draft of the Human Genome Project was released, the genetics of mental illness are still a maddeningly complex mystery.

What, then, to make of GeneSightRx, a new test that identifies variants in five genes and tells doctors which antidepressant to pick based on its results?

The test’s biggest advocate—Jim Burns, president and CEO of AssureRx, which makes it—says it is “ready for prime-time clinical use,” part of a “first wave” of long-awaited pharmacogenetic progress. The test has recently become standard of care or similar at the Mayo Clinic and Cincinnati Children’s Hospital Medical Center, the two institutions where it was developed, and it’s starting to garner enthusiasm in the press. But given how little is known about psychiatric genetics, how much trust can doctors and patients put in it? Phrased another way: if you’re planning to take an antidepressant, should you have this test first?

The scientific thinking behind GeneSightRx is actually pretty solid. Pharmacogenetics may be new to medical clinics, but it’s a mainstay of labs. At the Mayo, doctors have been laying the basic-research groundwork for how it could be used in both adults and children for three decades. Although they know fairly little about the genetics of mental illness, they know much more about genes that influence the way the body processes drugs. They’ve developed a particular expertise around a group of enzymes referred to as the “cytochrome P450 superfamily,” or CYP450 for short, which is involved in how the liver metabolizes many chemicals. If you have certain variants in the genes that make proteins in the CYP450 group, you may metabolize a drug more quickly (causing it to zoom through your system, with its effects soon wearing off) or slowly (causing it to hang around in your bloodstream, remaining effective for longer) than other people.

GeneSightRx reaps the benefits of that knowledge. Three of its five genes code for proteins involved in the CYP450 pathway. (The other two code for variants in the brain’s serotonin receptors and transporters, respectively.) “These genes are well described,” says Burns. He’s not kidding: you can read far more than you’re likely to need to know about them here, in a textbook by David Mrazek, a leader in psychiatric pharmacogenomics who—not coincidentally—is based at Mayo and was instrumental in developing GeneSightRx. Two other Mayo researchers recently published an extensive article explaining how CYP450 genotyping could be helpful in choosing antidepressants for children.

The value of GeneSightRx, however, isn’t really in the fact that it identifies CYP450 variants. In theory, your family doctor or psychiatrist could do that without GeneSightRx, by employing a firm that does “à la carte” genetic testing. The problem is that your doctor would then have to comb through the scientific literature looking for references to how your particular variants affect the metabolism of different drugs, then evaluate several antidepressants (by searching the literature some more) and choose one for you accordingly.

Few family doctors have the time to do that, if they even know it’s an option. What GeneSightRx essentially does is take all that work out, running the genetic analysis and then sorting medications into color-coded categories based on the results: green for drugs that will be safe for a patient who metabolizes them in a particular manner, yellow for those that need to be used “with caution,” and red for those to avoid.

So far, 12,000 patients at Mayo and Cincinnati Children’s have been assessed with GeneSightRx and had their meds tailored to their metabolic tendencies. “At Children’s, almost every child that comes in there [with a psychiatric diagnosis] will get a pharmacogenetic profile,” says Burns.

One of those 12,000 patients, who asked to remain anonymous, says he took the test six months ago, and it allowed him to drastically cut the dose of antidepressant he was taking—without any side effects or diminishment in its benefits. He had tried Prozac and Zoloft in the past, but those hadn’t worked. So he had switched to Effexor, which “was working fairly well,” he says. “That having been said, I thought it would not hurt to take the test, just to see the results.” The test showed the patient was metabolizing drugs slowly—meaning that a lower dose would probably be OK, because his body wasn’t burning through the drug as fast as other people’s would. The doctor cut his dose from 300mg per day to 150, and “the new dose works just fine,” he says.

Patients like him are the first targets for GeneSightRx, people who “have definitive diagnoses and have gone through multiple drug trials,” says Burns. “They’re on their third, fourth, sometimes fifth trial, or they’ve experienced adverse drug reactions and have become noncompliant. That’s who we’re targeting in the beginning.” That rationale seems to fly with insurance companies, some of which are already reimbursing for the test.

Before GeneSightRx can be expanded to all patients who might find antidepressants useful, though, there will need to be more research on its effectiveness. Specifically what’s needed is a large, well-controlled clinical trial. “With these sorts of things, the question is, what’s the state of the evidence?” says Bruce Cohen, a leading psychiatrist at Harvard-affiliated McLean Hospital who also has a Ph.D. in molecular pharmacology. “No one’s ever proven that any of these [serotinergic antidepressant] drugs are more effective than any of the others, so that’s a cautionary point right there. And no one has published and had it replicated that any set of genetic tests can be used to determine who should go on what medication. If they have gotten very strong results from 12,000 people, that needs to be published in the peer-reviewed literature and replicated before you really want to trust it.” Cohen adds that there’s a simpler way to get at whether a patient is a fast or slow metabolizer: “Ask about side effects and measure the level of drug they have in their blood.”

Still, he says, the rationale for GeneSightRx “makes some sense. Would I run off and get the test? Not on the basis of anything I know, but I’d be willing to look at their data. And there’s very low risk in doing what they’re doing. Since [choosing an antidepressant] is based on trial and error at the moment, it’s hard to imagine that adding this test could make things worse.”

The Mayo and Cincinnati doctors may soon have a response to some of Cohen’s concerns. They are running a clinical trial at three different sites in the Midwest that will ultimately involve about 500 patients. They have also begun to publish thoughtful, peer-reviewed papers considering the challenges of bringing genotyping into psychiatric clinics.

The test, too, is changing with the times. Next week, says Burns, the company hopes to add a sixth gene to the profile it can provide, and it is “on schedule to have gene 7, 8, 9, and 10 before the end of the year.” As more well-characterized genes are added to the test, it will become a more reliable guide for picking medications. For psychiatric pharmacogenetics, then, it’s still early days—but exciting ones.

A related story from psychiatry weekly looks briefly at the use of epigenetics in psychopharmacology.

Trends in Psychopharmacology

Epigenetics As a Therapeutic Target for Psychiatric Illnesses

June 21, 2010

Stephen M. Stahl, MD, Phd

Adjunct Professor of Psychiatry, University of California, San Diego

First published in Psychiatry Weekly, Volume 5, Issue 15, on June 21, 2010

The strategy of targeting epigenetic mechanisms as a route to new therapeutics in psychiatry may be more feasible than modifying human genes, a complex, ethically troublesome, and potentially dangerous undertaking. That is, good or bad, the sequence of your genes is faithful throughout your lifetime. However, the developmentally programmed silencing and activation of some of your genes may be open to change if enticed by seductive epigenetic molecular mechanisms. This approach is based upon the idea that if mental illnesses are caused by the expression of risk genes that make altered proteins, or by the expression of normal genes that turn them into risk genes by making normal proteins but at the wrong time, then maybe silencing risk genes or activating compensatory genes would treat or even prevent mental illnesses.1-3

Click to enlarge

tableIn order to turn your genes on or off, epigenetic mechanisms must be employed. Epigenetic molecular switches turn genes on and off by modifying the structure of chromatin in the cell nucleus.1-4 Chromatin is an octet of proteins called histones, around which your DNA is wrapped (Figure).1-4 DNA contains genes and also promoters that tell genes when to make RNA, which can then go on to make proteins. To silence genes, histones can be methylated or gene promoter DNA sequences can be methylated. Methylation is often followed by another chemical process called de-acetylation, which occurs at histones, and which also inactivates nearby genes. To activate genes, the reverse is done: histones and genes are demethylated and histones are acetylated. All of these processes are regulated by numerous enzymes, and methylation is regulated by the availability of methyl donors, as well.1-4

Therapeutic epigenetics seeks to silence undesirable genes without silencing desirable genes, and to activate desirable genes without activating undesirable ones. This is a complex process, because there are over 20,000 genes and it is not yet proven which genes conspire to cause which mental disorders, let alone how to target the right genes selectively without also going off target and silencing or activating the wrong genes, as well. Furthermore, psychiatric illnesses are likely to be caused by a conspiracy of many genes and many epigenetic mechanisms that act simultaneously, so therapeutics may ultimately require multiple simultaneous genes to be silenced while others are activated.4 This can appear to be a formidable task, but some progress is already being made in epigenetic therapeutics in psychiatry by taking three main approaches to this: silencing genes by promoting methylation, activating genes by blocking de-acetylation, and stopping genes from being translated into proteins by interfering with their RNA.

Click here to view the unabridged version of Dr. Stahl's article at CNS Spectrums.


1. Nestler EJ. Epigenetic mechanisms in psychiatry. Biol Psychiatry. 2009;65:189-90.

2. Stahl SM. Epigenetics and methylomics in psychiatry. J Clin Psychiatry. 2009;70:1204-1205.

3. Sweatt JD. Experience-dependent epigenetic modifications in the central nervous system. Biol Psychiatry. 2009;65:191-197.

4. Stahl SM. Methylated Spirits: Epigenetic Hypotheses of Psychiatric Disorders. CNS Spectr. 2010;15:220-230.

Science Saturday: Authenticity, Delusion, and Pleasure (Robert Wright and Paul Bloom)

A discussion of Paul Bloom's new book, How Pleasure Works: The New Science of Why We Like What We Like.

Play entire diavlog
Recorded: June 25 Posted: June 26

Philip Zimbardo: The Secret Powers of Time (Animated)

In this RSA Animate, Professor Philip Zimbardo conveys how our individual perspectives of time affect our work, health and well-being. Time influences who we are as a person, how we view relationships and how we act in the world.

Based on Philip Zimbardo's recent book, The Time Paradox: The New Psychology of Time That Will Change Your Life.

The Dalai Lama - The Function of Consciousness

by the Dalai Lama, root text by Kamalashila,
translated by Geshe Lobsang Jordhen,
Losang Choephel Ganchenpa,
and Jeremy Russell


Dalai Lama Quote of the Week

Knowing or understanding is the function of consciousness.... That which possesses the function of knowing is consciousness.

Consciousnesses vary in the scope of their knowledge and in their intensity or sharpness. An obvious example is the consciousness of a human being, compared to an animal's consciousness. The human being's perception is much broader and it understands a much greater variety of objects. The consciousnesses of human beings vary with education and experience--the more educated you are and the more experience you have, the broader your consciousness.

Knowledge and understanding develop on the basis of a consciousness that has the ability to perceive its objects. When the necessary conditions are met, the mind's ability to perceive increases, the scope of its objects of knowledge expands, and understanding deepens. In this way the mind can develop its full potential. Omniscience is the full consummation, or perfection, of the mind's ability to perceive objects.

--from Stages of Meditation by the Dalai Lama, root text by Kamalashila, translated by Geshe Lobsang Jordhen, Losang Choephel Ganchenpa, and Jeremy Russell, published by Snow Lion Publications

Stages of Meditation • 5O% off • for this week only
(Good through July 2nd).

Friday, June 25, 2010

Steve Bradt - How Touch Can Influence Judgments (Harvard Gazette)


A cool article from the Harvard Gazette - researchers suggest that "interpersonal interactions can be shaped, profoundly yet unconsciously, by the physical attributes of incidental objects: Resumes reviewed on a heavy clipboard are judged to be more substantive, while a negotiator seated in a soft chair is less likely to drive a hard bargain."

How touch can influence judgments

Researchers say that how objects feel can influence the ways in which people proceed to interpret them

By Steve Bradt, Harvard Staff Writer

Thursday, June 24, 2010

Psychologists report in the journal Science that interpersonal interactions can be shaped, profoundly yet unconsciously, by the physical attributes of incidental objects: Resumes reviewed on a heavy clipboard are judged to be more substantive, while a negotiator seated in a soft chair is less likely to drive a hard bargain.

The research was conducted by psychologists at Harvard University, the Massachusetts Institute of Technology, and Yale University. The authors say the work suggests that physical touch — the first of our senses to develop — may continue to operate throughout life like a scaffold upon which people build their social judgments and decisions.

“Touch remains perhaps the most under-appreciated sense in behavioral research,” said co-author Christopher C. Nocera, a graduate student in Harvard’s Department of Psychology. “Our work suggests that greetings involving touch, such as handshakes and cheek kisses, may in fact have critical influences on our social interactions, in an unconscious fashion.”

Nocera conducted the research with Joshua M. Ackerman, assistant professor of marketing at MIT’s Sloan School of Management, and John A. Bargh, professor of psychology at Yale.

“First impressions are liable to be influenced by the tactile environment, and control over this environment may be especially important for negotiators, pollsters, job seekers, and others interested in interpersonal communication,” the authors wrote in the latest issue of Science. “The use of ‘tactile tactics’ may represent a new frontier in social influence and communication.”

The researchers conducted a series of experiments probing how objects’ weight, texture, and hardness can unconsciously influence judgments about unrelated events and situations:

  • To test the effects of weight, metaphorically associated with seriousness and importance, subjects used either light or heavy clipboards while evaluating resumes. They judged candidates whose resumes were seen on a heavy clipboard as better qualified and more serious about the position, and rated their own accuracy at the task as more important.
  • An experiment testing texture’s effects had participants arrange rough or smooth puzzle pieces before hearing a story about a social interaction. Those who worked with the rough puzzle were likelier to describe the interaction in the story as uncoordinated and harsh.
  • In a test of hardness, subjects handled either a soft blanket or a hard wooden block before being told an ambiguous story about a workplace interaction between a supervisor and an employee. Those who touched the block judged the employee as more rigid and strict.
  • A second hardness experiment showed that even passive touch can shape interactions. Subjects seated in hard or soft chairs engaged in mock haggling over the price of a new car. Subjects in hard chairs were less flexible, showing less movement between successive offers. They also judged their adversaries in the negotiations as more stable and less emotional.

Nocera and his colleagues say these experiments suggest that information acquired through touch exerts broad, if generally imperceptible, influence over cognition. They propose that encounters with objects can elicit a “haptic mindset,” triggering application of associated concepts even to unrelated people and situations.

“People often assume that exploration of new things occurs primarily through the eyes,” Nocera said. “While the informative power of vision is irrefutable, this is not the whole story. For example, the typical reaction to an unknown object is usually as follows: With an outstretched arm and an open hand, we ask, ‘Can I see that?’ This response suggests the investigation is not limited to vision, but rather the integrative sum of seeing, feeling, touching, and manipulating the unfamiliar object.”

Nocera said that because touch appears to be the first sense that people use to experience the world -- for example, by equating the warm and gentle touch of a mother with comfort and safety -- it may provide part of the basis by which metaphorical abstraction allows for the development of a more complex understanding of comfort and safety. This physical-to-mental abstraction is reflected in metaphors and shared linguistic descriptors, such as the multiple meanings of words like “hard,” “rough,” and “heavy.”

Nocera, Ackerman, and Bargh’s work was supported by the Sloan School of Management at MIT and by the National Institute of Mental Health.

Gianluca Castelnuovo - Empirically Supported Treatments in Psychotherapy

With managed care only providing between 12-20 counseling sessions for most clients, the therapeutic push in the last 20 years has been toward empirically supported treatments - an evidence-based psychology in clinical settings.

One of the most stringent models is the PESI model: Principles of Empirically Supported Interventions (Wampold et al, 2020). The American Psychological Association (APA) also has their own strict standards:
With respect to evaluating research on specific interventions, current APA policy identifies two widely accepted dimensions. As stated in the Criteria for Evaluating Treatment Guidelines (American Psychological Association, 2002),
The first dimension is treatment efficacy, the systematic and scientific evaluation of whether a treatment works. The second dimension is clinical utility, the applicability, feasibility, and usefulness of the intervention in the local or specific setting where it is to be offered. This dimension also includes determination of the generalizability of an intervention whose efficacy has been established. (p. 1053)
Types of research evidence with regard to intervention research in ascending order as to their contribution to conclusions about efficacy include “clinical opinion, observation, and consensus among recognized experts representing the range of use in the field” (Criterion 2.1); “systematized clinical observation” (Criterion 2.2); and “sophisticated empirical methodologies, including quasi experiments and randomized controlled experiments or their logical equivalents” (Criterion 2.3; American Psychological Association, 2002, p. 1054). Among sophisticated empirical methodologies, “randomized controlled experiments represent a more stringent way to evaluate treatment efficacy because they are the most effective way to rule out threats to internal validity in a single experiment” (American Psychological Association, 2002, p. 1054).

Evidence on clinical utility is also crucial. Per established APA policy (American Psychological Association, 2002), at a minimum this includes attention to generality of effects across varying and diverse patients, therapists, settings, and the interaction of these factors; the robustness of treatments across various modes of delivery; the feasibility with which treatments can be delivered to patients in real-world settings; and the costs associated with treatments.

Evidence-based practice requires that psychologists recognize the strengths and limitations of evidence obtained from different types of research. Research has shown that the treatment method (Nathan & Gorman, 2002), the individual psychologist (Wampold, 2001), the treatment relationship (Norcross, 2002), and the patient (Bohart & Tallman, 1999) are all vital contributors to the success of psychological practice. Comprehensive evidence-based practice will consider all of these determinants and their optimal combinations. (APA, 2006)

With that background, a new article in (Frontiers in Psychology for Clinical SettingsCastelnuovo, 2010) questions the validity of these requirements. Part of the problem, however, is that only short-term models are now being tested for efficacy (as a result of the limited # of sessions) and only manualized treatments are being tested because the results have to be replicable for any therapist using the treatment.

The result is that long-term models, more client-based models, and more intuitive (in the moment) approaches are not only failing to be tested, but also being rejected in the evidence-based models.

However, a lot of therapists acknowledge the empirically supported treatments, but use whatever they have found to work, no matter if it has been validated or not.

The field of research and practice in psychotherapy has been deeply influenced by two different approaches: the empirically supported treatments (ESTs) movement, linked with the evidence-based medicine (EBM) perspective and the “Common Factors” approach, typically connected with the “Dodo Bird Verdict”. About the first perspective, since 1998 a list of ESTs has been established in mental health field. Criterions for “well-established” and “probably efficacious” treatments have arisen. The development of these kinds of paradigms was motivated by the emergence of a “managerial” approach and related systems for remuneration also for mental health providers and for insurance companies. In this article ESTs will be presented underlining also some possible criticisms. Finally complementary approaches, that could add different evidence in the psychotherapy research in comparison with traditional EBM approach, are presented.

Keywords: evidence based medicine, empirically supported treatments, psychotherapy research, common factors, efficacy, evidence based in clinical psychology, EBM, EST

Citation: Castelnuovo G (2010) Empirically supported treatments in psychotherapy: towards an evidence-based or evidence-biased psychology in clinical settings?. Front. Psychology 1:27. doi:10.3389/fpsyg.2010.00027

Copyright: © 2010 Castelnuovo. This is an open-access article subject to an exclusive license agreement between the authors and the Frontiers Research Foundation, which permits unrestricted use, distribution, and reproduction in any medium, provided the original authors and source are credited.
If you want to read the whole article, here is the Provisional PDF.

APA. (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271-285. doi:10.1037/0003-066X.61.4.271

Castelnuovo G (2010) Empirically supported treatments in psychotherapy: towards an evidence-based or evidence-biased psychology in clinical settings?. Front. Psychology 1:27. doi:10.3389/fpsyg.2010.00027

Wampold BE, Lichtenberg JW, Waehler CA. Principles of empirically supported interventions in counseling psychology. Counseling Psychologist. 2002;30:197-217.

What's Up with Ken Wilber?

Over at Headthegong, Bob posted an interesting observation on a recent blog post from Ken Wilber (or at least attributed to him on his blog). Wilber posted A Narrative on Guruji, a rather rambling, and disturbing endorsement of another guru, in this case a man who claims to be able to alter the molecular structure of matter.

Here is a brief piece of Wilber's post:
What I am claiming—and supporting—is that Guruji's capacity to conduct and transmit universal spiritual energy (or "shakti") is utterly remarkable, as proven by scientific experiments themselves. It is these direct, specific, scientific experiments and their results that I am reporting, and on which I am basing my endorsement. This is a scientific conclusion, not a spiritual one (although, of course, you are free to make those as well—but I am reporting the direct science, which is indeed astonishing).

To put it briefly, Mr. Trivedi has an empirically demonstrated capacity to alter the atomic and molecular structure of phenomena simply through his conscious intentionality. The number of experiments done on this capacity (known in Sanskrit as shaktipat) that have been done in coordination with Mr. Trivedi is quite extraordinary—so far, over 5,000 empirical studies by universities and scientific research organizations all over the world (including the world renowned materials scientist Dr. Rustum Roy at the University of Pennsylvania).
So I took the bait and did some deep searching of the internets to find these studies. But I couldn't find any of the 5,000 scientific studies - aside from Trivedi's own site, there is almost nothing on the web (nothing from a known, peer-reviewed journal), and Dr. Rustum Roy is not exactly a reliable source - he is a very vocal proponent of homeopathy.

So what's up with all of this?

Bob posted an interesting take on Wilber's history of wanting to identify and attach himself to individuals who appear to support his "integral" model of spiritual development.

Has Ken Wilber jumped the shark?

want to make clear right from the start that Ken Wilber has authored several of my all-time favorite nonfiction books. I dig a lot of his work and use his “four quadrants” to frame my own understanding of Integral Health. I remember reading Wilber’s Sex, Ecology, Spirituality and thinking to myself, “This guy is the shit!” Yesterday, however, after reading Wilber’s latest blog post (A Narrative on Guruji), I couldn’t help but think, “This guy has lost his shit!”

The first thing that struck me as odd about Wilber’s post was the style of presentation, which was riddled with rambling redundancies, poor reasoning, and flat-out bad writing. This from a man capable of exquisitely lucid prose. Now, maybe he meant it as an off-the-cuff type of thing and I’m being a bit unfair, but this is a guy who rarely posts on his own blog, so I was surprised he’d go on record with this scattered post. Then there’s the content of the post, which is a strong public endorsement of a spiritual teacher named Mahendra Kumar Trivedi.
And this:
Wilber seems to have a lot of confidence in the conclusions of one researcher in particular, the “world renowned” Dr. Rustum Roy. It should be noted, however, that Roy, like his associate Deepak Chopra, is not exactly lauded by mainstream scientists, as I’ve seen his name (perhaps unfairly) paired with words like “woo” and “pseudoscience” on more than one occasion (for instance here and here). Of course, there are plenty of science-based crusaders out there who would tear me apart, along with many of my intellectual heroes, so that kind of criticism in-and-of-itself doesn’t put Wilber’s endorsement on shaky ground. Rather, it’s Wilber’s credulity and weak justifications that have me scratching my head, and even cringing in embarrassment at times.
Check out the whole post - and be sure to check out the comments section where Julian Walker makes some very clear and compelling points.

It's sad to see this pattern repeating itself with Wilber (think Adi Da, Andrew Cohen, Marc Gafni, and so on).

Ervin Lazslo - 10 Questions to Test Your Consciousness

Ervin Laszlo is a systems philosopher, integral theorist, and a concert pianist. He is the author of The Akashic Experience: Science and the Cosmic Memory Field, Quantum Shift in the Global Brain: How the New Scientific Reality Can Change Us and Our World, and The Chaos Point: The World at the Crossroads among other books.

This is less a post on consciousness than it is about how we want to contribute to the world we live in - who and what do we want to support with our energy, with our money, with our attention?

This comes from Huffington Post.
10 Questions to Test Your Consciousness
By Ervin Laszlo

Einstein said that we can't solve a problem with the same kind of thinking that gave rise to the problem. His insight applies also to the domain of consciousness: we can't solve the problems of our time with the same kind of consciousness that created them. We live in global times, yet most of us have a tribal kind of consciousness -- it's me or you, my group or yours, and whoever isn't with us is against us. The continuation of tribal consciousness is nothing less than a recipe for disaster in a world of nuclear weapons, environmental devastation, increasing population and dwindling resources.

There can be no doubt: if we're going to live sustainably and in peace with each other, we must all shift from a tribal to a planetary consciousness.

But just what is planetary consciousness? Here is how we defined it in the Manifesto on Planetary Consciousness that I drafted with the Dalai Lama and other luminaries of the Club of Budapest in 1996: "Planetary consciousness is knowing as well as feeling the vital interdependence and essential oneness of humankind, and the conscious adoption of the ethic and the ethos that this entails."

It was our conclusion at that time that the evolution of planetary consciousness was the foundational imperative for the survival of the human species. I remain more convinced than ever that this is the case.

But what do you think? Assuming you agree that we must evolve beyond tribalism if we are to survive, would you consider yourself to have planetary consciousness? Here are 10 questions that I believe, if answered honestly, will tell you whether you do.

Do you:

  1. Satisfy your basic needs without diminishing other people's chances of satisfying theirs?
  2. Pursue your own happiness with due regard for the similar pursuit of others?
  3. Respect the right to economic development for all people, wherever they live and whatever their ethnic origin or belief system?
  4. Live in a way that respects the integrity of nature around you?
  5. Work with like-minded people to safeguard and restore your local environment?
  6. Require your government to relate to other nations peacefully and in a spirit of cooperation, recognizing the legitimate aspirations of all the members of the international community?
  7. Buy from companies that accept responsibility for stakeholders at all levels of the supply chain?
  8. Consume media that provides unbiased information relevant to you and your community?
  9. Do something to help at least one other person escape the hopeless struggles and abject humiliations of extreme poverty?
  10. Believe all young people are entitled to the education they need to be productive members of their community?

Answering these ten questions with an honest yes doesn't call for money or power. It calls for dedication and solidarity, for the spirit that creates true community, both locally and globally.

The evolution of planetary consciousness is without question an imperative for human survival on our planet. In its absence it's difficult to see how all seven billion of us will be able to live in peace -- or even just survive. To paraphrase Gandhi, "Live consciously, so that all of us may live."

Khenchen Thrangu Rinpoche - Nondual, Nonconceptual Awareness


by Khenchen Thrangu Rinpoche
edited, introduced and annotated
by Lama Tashi Namgyal


Dharma Quote of the Week

If we can attain nondual, nonconceptual awareness in meditation, we are engaged in profound political activity, even though we may lose this awareness during the times we are not formally meditating (the buddha's awareness in post-meditation is the same as during meditation). Meditating in nondual, nonconceptual awareness, which is meditating on the dharmadhatu, immediately begins systematically to destroy in ourselves the structure of dualistic consciousness with all its attendant cognitive obscurations and emotional affiictions. From the standpoint of duality, since this dualistic consciousness also involves other sentient beings as the other pole of our duality, our activity in dissolving this consciousness has a profound impact on them as well.

While our nondualistic, nonconceptual meditation is purifying our own obscurations and afflictions and thereby transforming our personal experience of others, it is also becoming a spark of buddha activity in those others. As our meditation becomes effective, the attitude of others towards us begins to change, and they themselves begin to turn inward and to search with greater conscientiousness through the stuff of their own minds and lives for spiritual solutions to their own problems. And as the power of our meditation increases, this effect reaches ever-widening concentric circles of sentient beings with whom we have karmic interdependence, which in this day and age includes not only our immediate family and friends, working associates, and local communities, but also everyone with whom we are connected through all the media of our lives.

--from The Ninth Karmapa's Ocean of Definitive Meaning by Khenchen Thrangu Rinpoche, edited, introduced and annotated by Lama Tashi Namgyal, published by Snow Lion Publications

Ocean of Definitive Meaning • Now at 5O% off
(Good until July 2nd).

His  Holiness the 17th Karmapa

On June 26th His Holiness the Karmapa celebrates his 25th birthday. Please join us in wishing him long life and the fulfillment of his aspirations!
Read more about the Karmapa's life in Music in the Sky.

Thursday, June 24, 2010

Sounds True - Andrew Harvey: Evolutionary Mysticism

Nice podcast from Sounds True - Tami Simon interviews Andrew Harvey.
Andrew Harvey: Evolutionary Mysticism
Tuesday, June 22, 2010

Andrew_HarveyTami Simon speaks with Andrew Harvey a poet, teacher, writer, mystic, and sacred activist. His work is deeply involved with the transformative nature of the spiritual path and the call in our time for mystics to become what Andrew calls, sacred activists—sacred activists in a world that needs us. He has created several powerful audio programs with Sounds True including Radiant Heart, Song of the Sun, and The Direct Path. Andrew discusses the birth of universal mysticism, the dark night of the soul, and the transfiguration of the body that occurs as we progress on the spiritual path.
(59 minutes)

Read the transcript

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Humor - The Traffic Stop

Jami sent this to me, from our friend Pat - funny little story (though I'm sure it's made up). And yes, it plays on stereotypes - but there is more than a little truth in the stereotype, or it would not be funny.

The light turned yellow, just in front of him. He did the right thing, stopping at the crosswalk, even though he could have beaten the red light by accelerating through the intersection.

The tailgating woman was furious and honked her horn, screaming in frustration, as she missed her chance to get through the intersection, dropping her cell phone and makeup.

As she was still in mid-rant, she heard a tap on her window and looked up into the face of a very serious police officer. The officer ordered her to exit her car with her hands up.

He took her to the police station where she was searched, fingerprinted, photographed, and placed in a holding cell.

After a couple of hours, a policeman approached the cell and opened the door. She was escorted back to the booking desk where the arresting officer was waiting with her personal effects.

He said, ''I'm very sorry for this mistake. You see, I pulled up behind your car while you were blowing your horn, flipping off the guy in front of you and cussing a blue streak at him.

I noticed the 'What Would Jesus Do' bumper sticker, the 'Choose Life' license plate holder, the 'Follow Me to Sunday-School' bumper sticker, and the chrome-plated Christian fish emblem on the trunk, so naturally. . . . I assumed you had stolen the car.''
This is why I have no Buddhist bumper stickers on my car - all my good intentions and work on compassion disappear when I get behind the wheel. Strangely, it ONLY happens when I drive.

Joachim I. Krueger, Ph.D. - Reason and emotion: A note on Plato, Darwin, and Damasio

Many of us like to think that we use reason and facts to make decisions, but more and more research suggests that we make decisions with our emotions first, often before we are consciously aware of them, then use reason to justify and explain the decisions we have already made.

In his One Among Many blog at Psychology Today, Dr. Joachim Krueger looks at some of the research on decision-making, and the question of which is more important in the process, reason or emotions.

Reason and emotion: A note on Plato, Darwin, and Damasio

If reason and emotion affect decision-making, which matters more?
reason and emotion

I wrote this essay with Anthony Evans and Gideon Goldin

It is common to think that emotions interfere with rational thinking. Plato described emotion and reason as two horses pulling us in opposite directions. Modern dual-systems models of judgment and decision-making are Platonic in the sense that they endorse the antagonism between reason and emotion. The activities of one system are automatic and often emotional, whereas the activities of the other are controlled and never emotional. The automatic system gets things done quickly, but it is prone to error. The controlled system's mission is to keep a watchful eye and to make corrections when necessary. Like a watchful parent, this system reins in our impulses and overrides our snap judgments.

Emotions can be powerful experiences, but they usually do not last long. They sometimes make us do things we later regret. Today, we are angry at a colleague and want to yell at her. Tomorrow, we wish we had acted more rationally, no matter how compelling our desire was at the time. By transforming goals and desires in the heat of the moment, emotions can lead us to make choices that hurt our long-term interests. Doing something that you do not want to do is one of the hallmarks of irrationality - hence, emotions make us irrational.

The struggle of reason against emotion is an appealing image. But do emotions always lead us astray? Clearly, one of their functions is to guide us towards pleasure and away from pain. To succeed in gaining what is good and avoiding what is bad is difficult in an uncertain environment. We often make decisions that resemble gambles. When we invest in a company, buy a new house, or get married, there is a chance that things won't work out as hoped. It's critical that we're able to judge what risks are worth taking - and emotions can help us make those judgments.

A few years ago, neurologist Antonio Damasio and his colleagues showed how negative emotions can improve decisions involving risk. They devised a gambling task, in which players repeatedly selected cards from four decks. With each draw, they either gained or lost money. Two of the decks were safe and advantageous; choosing them consistently would gradually accrue money over the course of the task. The other two decks were riskier. Although the winning cards were worth more than the winning cards from the safe decks, the losing cards were so damaging that, if chosen repeatedly, the risky decks would eventually bankrupt the player. The best strategy was to consistently choose from the safe decks.

Damasio and colleagues found that participants were initially attracted to the risky decks because of their large positive payoffs. However, players soon retreated to the safer decks where they fared better in the long run. How did they figure out that playing it safe was better? The answer came from a group of neurological patients with damage to a brain region associated with emotional sensitivity to reward and punishment (i.e, the orbitofrontal cortex). Though these patients' cognitive reasoning was unimpaired, they could not experience the negative emotions that normally accompany large losses. Like the unimpaired participants, these patients were initially attracted to the riskier decks, but because they failed to respond emotionally to large losses, they never learned to avoid the risky gambles.

So, if fear of loss can protect us from courting disaster, can we conclude that negative emotions always play an adaptive role in decision-making? The answer is no, and to show why, Shiv, Damasio, and others followed up the original gambling study with an interesting variation. In their experiment, participants repeatedly chose between keeping and investing $1. If they invested $1, they had a 50% chance of winning $2.50 and a 50% chance of losing the invested dollar. In this game, it is best to always choose the risky option. Individuals who fail to invest, out of fear, suffer financially. As in the first experiment, players were initially attracted to betting on risky gains, but as before, they became more conservative after experiencing loss. In contrast, orbitofrontal patients (who have trouble experiencing negative emotions) continued to invest regardless of losses. In this task, the patients who were not encumbered by emotion outperformed individuals experiencing the fear of loss.

The lesson from these studies is that the experience of negative emotions can help and hurt decision-making; it all depends on the context. Considered in isolation, emotions are rather arational (neither rational nor irrational). It seems then that we are right back to the Platonic dualism of reason and emotion. If we can't trust that emotions will always steer us in the right direction, there is no way around a dispassionate calculation of potential gains and losses. This controlled, quantitative approach is most useful for decisions with clear, measurable outcomes. With economic choices, it's possible to estimate the probabilities of different consequences and to quantify how good or bad those outcomes are. For example, in the games of roulette and blackjack, we can mathematically ascertain that the best strategy is to never play. Similarly, we can come up with mathematical criteria to judge where we should invest our money.

Things get a bit murky, though, when we try to apply calculated reasoning to social decision-making. Many social situations involve costs and benefits that are difficult to assess and compare. Consider the gambit of asking an attractive stranger out on a date. Being rejected is a type of loss (just as being accepted is a type of gain), but assigning numerical values to such outcomes may seem contrived or arbitrary. Likewise, we can assume that there is some probability of rejection, but how to come up with a specific value is not obvious. Understanding human choices in their natural context is harder than understanding the rules of a laboratory game. What's more, the way people respond to social situations is somewhat subjective and variable. The anxious and avoidant might respond to rejection more strongly than the emotionally secure. In a world where something that is rational for one person may be irrational (or even unfathomable) for another, prescribing a rational or adaptive response is difficult.

So Plato's rationalism may not win the day either. Darwin would argue that the influence of emotions on decision-making has survived the rigors of natural selection. In review, we see three reasons why this may be so. One reason, as noted in the preceding paragraph, is that emotions give useful guidance whenever the environment fails to provide all the information needed for thoughtful analysis. The other reason is an asymmetry that might be lurking behind the two Damasio studies. When looking at the two gambling studies, it is tempting to discard emotions from the process of decision-making. If they help in one context and hurt in another the net outcome seems to be a zero effect. It may be the case, however, the type of context in which emotions help is more common in our world than the type of context in which they hurt. The final reason not to discard emotions remains the fact that they make us act quickly and decisively.

Bechara, A., Damásio, A. R., Damasio, H., & Anderson, S. W. (1994). Insensitivity to future consequences following damage to human prefrontal cortex, Cognition, 50, 7-15.

Shiv, B., Loewenstein, G., Bechara, A., Damásio, H., & Damasio, A. R. (2005). Investment behavior and the negative side of emotion. Psychological Science, 16, 435-439.

Dr. Joshua M. Simmons - We Don’t Have Complexes; They Have Us

A good old-fashioned Jungian article showed up at Good Therapy the other day, and since I tend to think of complexes as a kind of subpersonality, I found it useful - although none of the information is new to readers of Jung's book.

We Don’t Have Complexes; They Have Us

June 18th, 2010

By Dr. Joshua M. Simmons, Psy.D., Jungian Psychotherapy Topic Expert Contributor

Jungian psychology has had a significant impact on the way that people think about themselves and others. Whether it is Jung’s classification of extroverts and introverts or his study of the collective unconscious, core elements of his thinking have found their way into the popular culture. Of Jung’s vast body of work, his use of the word “complex” is best known by the general public. After all, many people at one time or another have spoken about or heard of someone refer to an “inferiority complex” or an “authority complex.” Others may have a vague idea that there are certain subjects which, when confronted with, drive them into a frenzied state. As Jung notes, in actuality, we don’t have complexes; they have us.

A complex is a powerful unconscious emotional preoccupation. It is a painful subject area in the psyche which, when activated, acts autonomously, arbitrarily, and usually, contrary to the wishes of our conscious selves. When a complex erupts, the unity of consciousness is disrupted. That is, we are often surprised at who we become and what we do when we are in the midst of a complex. It is like being possessed by an alien form. In extreme cases, reality is distorted, bodies exhibit signs of stress and agitation, and it is difficult or impossible to achieve our goals in the moment. In less severe cases, we casually misspeak and disclose inappropriate thoughts, lose our physical coordination, or forget basic pieces of information about ourselves and others. As Jung notes, the complex pierces through one’s persona and lodges itself into the dark layer of the unconscious. It is like a split off personality that emerges rather suddenly from the depths and acts as “an animated foreign body.”

The term “complex” was actually first coined by German psychiatrist Theodor Ziehen in 1898. Jung expanded the idea of complexes (or what he originally referred to as “feeling toned complex of ideas”) in the early 20th century while working at the Burgholzli mental hospital in Zurich, Switzerland. In his attempt to understand mental associations, he utilized word-association tests in which individuals were given a word and then asked to respond as quickly as possible with the first idea that came into their mind. Individuals who participated in the experiment were timed and Jung discovered that certain words produced longer reaction times than others. In other cases, individuals laughed, coughed, or fidgeted in response to the stimulus word. Some could not even respond at all or remember their previously given answers.

Jung postulated that interference in responding was beyond the control of the will. It was, in fact, an unconscious emotional experience erupting, usually the result of trauma and/or emotional shock. As Jolan Jacobi notes, complexes do not necessarily imply inferiority of the individual who has them; they merely indicate that “something ununited, unassimilable, conflicting exists…a hindrance…to fresh successes.”

Complexes are essentially unfinished business; business that can be worked through thoughtfully or acted out in the world. But how? As with any part of the psyche which is unknown, we must begin to develop a relationship to it. This entails becoming increasingly mindful of situations and subjects which cause us to emotionally unravel and lose our conscious minds. During these moments, we must carefully examine our thoughts and feelings and investigate the origins of them. We must also explore the conscious and unconscious ways in which we continue to perpetrate our complexes against ourselves. It is not uncommon for individuals to repeatedly end up in relationships and situations which resemble their early traumas and subsequently, elicit their complexes. Take note of who you choose to associate with and the situations which often cause you pain and regret.

If you feel stuck, look to your dreams. Complexes usually appear quite vividly in dreams. Examine the characteristics of the figures who appear and the specific relational dynamics between them. You will likely notice a pattern.

Jung once likened complexes to psychic hobgoblins that delighted in crashing through houses in the darkest hours of the night. Indeed, complexes can be monstrous and when one surfaces, our reality can be turned on its head. In the end, taming these impish parts of ourselves requires significant training and is only possible when we become increasingly mindful of the present and curious about our past.

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Melancholic versus non-melancholic depression: A longitudinal study protocol

BMC Psychiatry published an interesting article on the difference between melancholic and non-melancholic depression in terms of cognitive function, and the authors have offered a research design and protocol to test their hypothesis.

It's an open source publication, so the PDF is free to read.

Melancholic versus non-melancholic depression: differences on cognitive function. A longitudinal study protocol

Saray Monzon email, Margalida Gili email, Margalida Vives email, Maria JESUS Serrano email, Natalia Bauza email, Rosa Molina email, Mauro Garcia-Toro email, Joan Salva email, Joan Llobera email and Miquel Roca email

BMC Psychiatry 2010, 10:48doi:10.1186/1471-244X-10-48

Published: 17 June 2010

Abstract (provisional)


Cognitive dysfunction is common among depressed patients. However, the pattern and magnitude of impairment during episodes of major depressive disorder (MDD) through to clinical remission remains unclear. Heterogeneity of depressive patients and the lack of longitudinal studies may account for contradictory results in previous research.


This longitudinal study will analyze cognitive differences between CORE-defined melancholic depressed patients (n=60) and non-melancholic depressed patients (n=60). A comprehensive clinical and cognitive assessment will be performed at admission and after 6 months. Cognitive dysfunction in both groups will be longitudinally compared, and the persistence of cognitive impairment after clinical remission will be determined.


The study of neuropsychological dysfunction and the cognitive changes through the different phases of depression arise a wide variety of difficulties. Several confounding variables must be controlled to determine if the presence of depression could be considered the only factor accounting for group differences.

Here is the beginning of the article, offering some definitions and background for the study. Essentially, the authors are proposing that studies on major depression have been flawed in terms of defining subjects. They propose using melancholia ("a disorder with definable clinical signs") which describes a depression in physical symptoms are predominant. This is contrasted by a "reactive or non-melancholic form of depression" which we might generally define as situational or as sadness ("the presence of low mood and tearfulness is frequent and biological markers are not predominant").
Over the last years cognitive dysfunction has increasingly been recognized as a core feature of major depressive disorder (MDD). Clinical studies have focused on the pattern and magnitude of impairment during and between episodes of MDD as well as the neuropsychological domains affected and the origin of these abnormalities [1]. However, results from neuropsychological and neuroimaging studies are still controversial. These contradictory results could be explained mainly by two methodological factors. The first factor is the absence of homogeneity in clinical samples. The heterogeneity of patients evaluated in clinical studies may derive from the different criteria (DSM, ICD) currently used to diagnose MDD and its subtypes. Some authors have pointed out that these criteria poorly identify samples for clinical and outcome studies [2,3]. The second factor explaining controversial results is related to the lack of longitudinal studies that focus on the changes on cognitive function produced through the clinical course of depression. Whether cognitive impairment manifested during periods of depression is long lasting or improves after remission and recovery remains a central issue of study [4]. The cognitive domains affected have neither been clearly identified [5].

To overcome the limitation derived from the first methodological factor, a more accurate selection of depressed patients is required. A pattern of cognitive dysfunction may be more evident in a form of depression characterized by biological markers than in more heterogeneous depressed samples. Melancholia is a disorder with definable clinical signs that identifies more specific populations than the DSM-IV [3]. It describes episodes in which physical symptoms are predominant and is opposed to a reactive or non-melancholic form of depression in which the presence of low mood and tearfulness is frequent and biological markers are not predominant [6].

Overcoming the limitation derived from the lack of longitudinal data imply the development of cohort studies. Longitudinal assessment of cognitive functions seems to be a potentially powerful method of identifying and distinguishing state-related from trait-related cognitive deficits [4]. Previous studies report residual neuropsychological deficits in melancholic patients despite improvement in their depressive symptomatology [7]. Particularly, persisting executive functions and memory disturbances have been observed. This would indicate that some cognitive dysfunction may not be simply secondary to mood disturbances in depression but may represent trait vulnerability markers for MDD. Deficits in other domains of cognitive performance appear to be more state-dependent [8]. The high risk of relapse in depression makes it important to analyze the existence of persisting cognitive impairments during remission, recovery and the euthymic phase of depression. A better understanding of these issues is crucial as it has been suggested that cognitive impairment worsens for every episode of depression and that the observed cognitive impairment in a nonsymptomatic phase of depression may be related to the number of previous episodes [9].

The course of cognitive changes through to clinical improvement in samples of depressed participants with and without melancholia has scarcely been longitudinally studied [6]. The present study aims to analyze longitudinally the cognitive performance of a homogeneous sample of depressed patients. Results of this study can have relevant implications for treatment and neuropsychological rehabilitation.
Read the whole paper.