# Changing your thoughts in IBS



## eric (Jul 8, 1999)

I know there is often talk on this discussion forum, on all the possible causes of IBS and little attension is payed to the suffering and emotional states of people with IBS and the fears and worries of what could it be and many other issues and how that really effects our symptoms.But it would be good to think of another aspect of IBS which is very important, while they find the cause/causes for IBS and the suffering that people have now.Changing your thoughts in IBS-------------------------------------------------------------------------------- FYIIt is well known in IBS stress and anxiety can play a major role in triggering symptoms and contribute to making pain worse and effecting the colon. I would like this thread to be about such issues and psycophysiolgoical workings of the brain gut axis and psycophysiological arousal and distress, anxiety, antisipatory anxiety, and negative reaction to symptoms, and how calming the Mind and body often makes a significant difference in symptoms. I know for myself and many others, that the symptoms themselves are enough to contribute to negative thought processes and more anxiety and worry and anger and a whole array of negative thought processes. The longer a person has IBS, the deeper these thought processes can become imbedded in our thinking and in our mental states and the more a person suffers from the vicous cycle of IBS.This is not to say IBS "is all in the head" it is not, it is a very real physical problem and that is well known by most nowadays hopefully.First and this is bascially a form of CBT, this is on going to the dentist, but lets apply it to IBS and we can use our imagniantions and subsitute IBS for going to the dentist and how these negative thought processes effect the gut and gut function, which is also very well known now.SOThe key to being relatively calm in the dentistï¿½s chair begins wellbefore the actual visit. I say relatively calm because if youï¿½resuffering from dental phobia and have been for a while, itï¿½s unlikelythat you will feel "perfectly" comfortable your first or second visit.Each of us must take an active part in overcoming our fears. Peopledonï¿½t get over their fear of heights for instance, in an flash. It takespractice - practice changing your thoughts. Long before thedreaded event you must take charge of your thinking. If youconsciously make an effort at being more calm, you will be morecalm. Letï¿½s create a mental picture. Youï¿½re sitting at your desk and glanceat the calendar. You notice your dental appointment is only twoweeks from today. Immediately your mind kicks into overdrive. "Iknow itï¿½s going to be terrible. What if I get nauseous while Iï¿½m in thechair? What if the anesthetic doesnï¿½t take hold quickly enough? Iknow itï¿½s going to hurt. Iï¿½m grateful I found a new dentist whoadvertises gentle procedures, but can I trust him to be gentle withmy mouth? Oh I remember that awful antiseptic stench from when Iwas a youngster. I wonder if theyï¿½ve found anyway to correct that?"As you think about the upcoming visit, your body begins respondingto your fear thoughts. Physical sensations can range from mild tosevere depending on how vivid a scene youï¿½ve painted in your mind,and how long you engage in the working up process. Yourshoulders and neck may feel tense. Your jaw may start to hurtbecause youï¿½ve got it got your teeth clamped together so tightly.You may find yourself short of breath or a headache may belooming on the horizon. Your stomach may be churning and yourinsides trembling.Actually these body signals can be viewed as good instead of bad.They are a sure sign that you are thinking fear and a signal for youto take action. You see the body doesnï¿½t know the differencebetween an imagined experience and a real one. How can that beyou say! If you doubt my words, think about a frightful dream youexperienced, one where someone or something was chasing you.You awaken from the dream feeling as though your heart ispounding out of your chest, perhaps even perspiring. Your bodywas reacting to an imagined fear, thoughts you were having in adream state. The character in your dream was not reality, yet yourbody responded as if he were genuine.Each and every time you catch yourself anxious about yourupcoming appointment, stop and W.A.I.T. Stop and ask yourself:What Am I Thinking? Rather than letting your thoughts control you,take the time to control your thoughts. Consciously toss out theunhealthy fear thoughts and replace them with healthy secure andrealistic thoughts. Using the picture we created earlier, here are a few ways toreprogram whatï¿½s going on in your mind. The original thoughts are initalic, followed by the replacement thought(s).Your dental appointment is only two weeks from today You can view that fact insecurely, the appointment is onlytwo weeks away, or securely - the appointment is still twoweeks away. I know itï¿½s going to be terrible You really donï¿½t know how uncomfortable itï¿½s going to be.The anticipation is always worse than the actual event. What if I get nauseous while Iï¿½m in the chair? Feeling nauseous is uncomfortable, but doesnï¿½t necessarilymean that anything worse is going to happen. Feelingnauseous is distressing, but it is not dangerous. Feelingsand sensations will rise, fall and run their course if wedonï¿½t attach danger to them. Take away the fear (danger)and your stomach will quiet down on itï¿½s own accord. What if the anesthetic doesnï¿½t take hold quickly enough? If you feel the first poke of a dental instrument, speak up.Tell the doctor it hurts. If you begin to feel pain while thedrillingï¿½s going on, hold up your hand as a signal to thedoc. You may not be able to speak clearly with theposition youï¿½re mouth is in, but you can make some kind ofsound, Grunt if you need to.- but do show some sign thatyouï¿½re feeling pain. Remember your pain receptors are inyour body. Even though the dentists fingers are in yourmouth, he has no clue of what youï¿½re feeling unless you lethim know. Do not suffer in silence. And if youï¿½re concernedabout sounding a bit odd, donï¿½t. Dentists, assistants andhygienists are used to hearing us "talk with our mouths full."I know itï¿½s going to hurt The replacement thought here is simply: I donï¿½t know if itï¿½sgoing to hurt - because you really donï¿½t know! None of uscan predict the future. Iï¿½m grateful I found a new dentist who advertises gentleprocedures, but can I trust him to be gentle with my mouth? Realistically there is no guarantee. But in all probability theman or woman is more compassionate and caring than thedentists of long ago. Oh I remember that awful antiseptic stench from when I was ayoungster. I wonder if theyï¿½ve found anyway to correct that? Most probably they have. New technology dentistry nowincludes pleasant flavors for the things they place in ourmouths. If the flavors have improved, so have the scents.Everything on the patient end of dentistry Is moreuser-friendly these days. And all those physical sensations you experience two weeks beforeyour appointment are the direct result of your fear thoughts - theytoo are distressing, but they are not dangerous.Practice in reprogramming thoughts has two beneficial effects. Itcalms down the anticipatory fear you have before your visit, andmakes it easier to calm yourself down at the office. Itï¿½s much easierto recall secure and realistic thoughts if youï¿½ve taken the time to usethem before. You can have them at your fingertips or the tip of yourtongue, ready to use while youï¿½re in the chair.Another excellent method for stopping racing thoughts is objectivity- the process of thinking of something measurable and verifiable.This is a great technique to use, when youï¿½re stuck "in the chair."Think about your automobile and picture every detail - interior andexterior colors, number of doors, the shape of the door handles, allthe indicators on the dashboard, the type of fabric on the seats.The list is endless. If you donï¿½t own an automobile, think of aspecific room in your home. Think about the size of the room -length, width, height of the ceiling, how the furniture is placed, thecolors, lamps and all other accessories. Itï¿½s a fact that we can onlyhave a single thought in a single instant. Describing in your mind(thinking about) an object or objects that are familiar to you doesnï¿½tgive the mind a chance to harbor racing, upsetting thoughts. Fearthoughts are persistent and they will try to sneak back in. Whenthey do, simply bring your attention (your thoughts) back todescribing your chosen object or place.When you have a fear of dentists you really have the choice of twodiscomforts -the actual discomfort you may feel during theappointment (notice I said "may" have), or you have the discomfortof not going and having the needed work done and beating yourselfup for giving into your fear. The dialogue goes like this: Iï¿½m such acoward. But I canï¿½t help it. Iï¿½m scared. But I canï¿½t admit it toanyone.Every act of self-control produces a sense of self-respect. Alongwith the relief you feel for having the dental procedure behind youinstead of staring you in the face, I guarantee you that when youface your fear you will gain a realistic sense of self-pride. This nextstep is important whether you do it immediately after you leave theoffice or later on in the day - take time to give yourself a mental paton the back. You deserve it! No one else needs to be aware of it. Itwas your effort that got you through. Itï¿½s your victory and you canbe proud of it.Whether your fear is dentists or tax audits, driving or diving, theabove tactics will work at reducing anxiety. If your anxiety hasgrown into a full blown phobia, itï¿½s merely going to take more ofyour effort. The key as with any life skill is do put to use whatyouï¿½ve learned. Changing thoughts is the first step in taking backcontrol of your life.Print this article and carry it with you for easy reference. Memorizeand use the phrase "distressing but not dangerous." Do whatever ittakes to help you be an active participant in reprogramming yourmind.Itï¿½s true - Change your thoughts and change your life.1998 Rose VanSickleAuthor - Peace of Body, Peace of MindDoes the above ring true for anyone, in going on long car rides for example or "where is the bathroom for example, or even anger in consitpation that you can't go or anxiety that you can go, which can contirbute to not going, or anxiety with d, which can contribute to d. ect. Or worry and anxiety the doctors have missed something which is causing your IBS Ect..


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## NancyCat (Jul 16, 1999)

This is exactly what I have been looking for. I know that anxiety (anticipatory and learned over many years)is a major factor in my IBS. Sometimes at least for me its almost like it's becomes a vicious circle. Much of it has been learned over time, its not often even apparent but I've printed the article which I think at least for me will be very helpful in attempting to reprogram how I "think" about my IBS.Thanks for posting this Eric. Return e-mail is in the works for you


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## eric (Jul 8, 1999)

No problem Nancy, I can only but try to help explain some of the gut brain intereactions that are known to trigger symptoms. This is a very important part of IBS and IBS research and things they already know and understand about the disorder. I will keep posting more on it here, in the hopes it will help some understand the physical systems that the digestive system is connected too.This is the actual the stress system and how it works and on a side not it is connected to fighting pathogens and threats to the digestive system.Stress System Malfunction Could Lead to Serious, Life Threatening DiseaseNOTE: IBS is not a serious life threatening disease that is just the name of the article with the information in it."The Stress CircuitThe HPA axis is a feedback loop by which signals from the brain trigger the release of hormones needed to respond to stress. Because of its function, the HPA axis is also sometimes called the "stress circuit." Briefly, in response to a stress, the brain region known as the hypothalamus releases corticotropin-releasing hormone (CRH). In turn, CRH acts on the pituitary gland, just beneath the brain, triggering the release of another hormone, adrenocorticotropin (ACTH) into the bloodstream. Next, ACTH signals the adrenal glands, which sit atop the kidneys, to release a number of hormonal compounds. These compounds include epinephrine (formerly known as adrenaline), Norepinephrine (formerly known as noradrenaline) and cortisol. All three hormones enable the body to respond to a threat. Epinephrine increases blood pressure and heart rate, diverts blood to the muscles, and speeds reaction time. Cortisol, also known as glucocorticoid, releases sugar (in the form of glucose) from the body reserves so that this essential fuel can be used to power the muscles and the brain.Normally, cortisol also exerts a feedback effect to shut down the stress response after the threat has passed, acting upon the hypothalamus and causing it to stop producing CRH.This stress circuit affects systems throughout the body. The hormones of the HPA axis exert their effect on the autonomic nervous system, which controls such vital functions as heart rate, blood pressure, and digestion.The HPA axis also communicates with several regions of the brain, including the limbic system, which controls motivation and mood, with the amygdala, which generates fear in response to danger, and with the hippocampus, which plays an important part in memory formation as well as in mood and motivation. In addition, the HPA axis is also connected with brain regions that control body temperature, suppress appetite, and control pain. Similarly, the HPA axis also interacts with various other glandular systems, among them those producing reproductive hormones, growth hormones, and thyroid hormones. Once activated, the stress response switches off the hormonal systems regulating growth, reproduction, metabolism, and immunity. Short term, the response is helpful, allowing us to divert biochemical resources to dealing with the threat." http://www.nichd.nih.gov/new/releases/stress.cfm The stress sytem is also part of all humans fight or flight system. "What is the "fight or flight response?"This fundamental physiologic response forms the foundation of modern day stress medicine. The "fight or flight response" is our body's primitive, automatic, inborn response that prepares the body to "fight" or "flee" from perceived attack, harm or threat to our survival.What happens to us when we are under excessive stress?When we experience excessive stressï¿½whether from internal worry or external circumstanceï¿½a bodily reaction is triggered, called the "fight or flight" response. Originally discovered by the great Harvard physiologist Walter Cannon, this response is hard-wired into our brains and represents a genetic wisdom designed to protect us from bodily harm. This response actually corresponds to an area of our brain called the hypothalamus, whichï¿½when stimulatedï¿½initiates a sequence of nerve cell firing and chemical release that prepares our body for running or fighting.What are the signs that our fight or flight response has been stimulated (activated)?When our fight or flight response is activated, sequences of nerve cell firing occur and chemicals like adrenaline, noradrenaline and cortisol are released into our bloodstream. These patterns of nerve cell firing and chemical release cause our body to undergo a series of very dramatic changes. Our respiratory rate increases. Blood is shunted away from our digestive tract and directed into our muscles and limbs, which require extra energy and fuel for running and fighting. Our pupils dilate. Our awareness intensifies. Our sight sharpens. Our impulses quicken. Our perception of pain diminishes. Our immune system mobilizes with increased activation. We become preparedï¿½physically and psychologicallyï¿½for fight or flight. We scan and search our environment, "looking for the enemy."When our fight or flight system is activated, we tend to perceive everything in our environment as a possible threat to our survival. By its very nature, the fight or flight system bypasses our rational mindï¿½where our more well thought out beliefs existï¿½and moves us into "attack" mode. This state of alert causes us to perceive almost everything in our world as a possible threat to our survival. As such, we tend to see everyone and everything as a possible enemy. Like airport security during a terrorist threat, we are on the look out for every possible danger. We may overreact to the slightest comment. Our fear is exaggerated. Our thinking is distorted. We see everything through the filter of possible danger. We narrow our focus to those things that can harm us. Fear becomes the lens through which we see the world.We can begin to see how it is almost impossible to cultivate positive attitudes and beliefs when we are stuck in survival mode. Our heart is not open. Our rational mind is disengaged. Our consciousness is focused on fear, not love. Making clear choices and recognizing the consequences of those choices is unfeasible. We are focused on short-term survival, not the long-term consequences of our beliefs and choices. When we are overwhelmed with excessive stress, our life becomes a series of short-term emergencies. We lose the ability to relax and enjoy the moment. We live from crisis to crisis, with no relief in sight. Burnout is inevitable. This burnout is what usually provides the motivation to change our lives for the better. We are propelled to step back and look at the big picture of our livesï¿½forcing us to examine our beliefs, our values and our goals.What is our fight or flight system designed to protect us from?Our fight or flight response is designed to protect us from the proverbial saber tooth tigers that once lurked in the woods and fields around us, threatening our physical survival. At times when our actual physical survival is threatened, there is no greater response to have on our side. When activated, the fight or flight response causes a surge of adrenaline and other stress hormones to pump through our body. This surge is the force responsible for mothers lifting cars off their trapped children and for firemen heroically running into blazing houses to save endangered victims. The surge of adrenaline imbues us with heroism and courage at times when we are called upon to protect and defend the lives and values we cherish.What are the saber tooth tigers of today and why are they so dangerous?When we face very real dangers to our physical survival, the fight or flight response is invaluable. Today, however, most of the saber tooth tigers we encounter are not a threat to our physical survival. Todayï¿½s saber tooth tigers consist of rush hour traffic, missing a deadline, bouncing a check or having an argument with our boss or spouse. Nonetheless, these modern day, saber tooth tigers trigger the activation of our fight or flight system as if our physical survival was threatened. On a daily basis, toxic stress hormones flow into our bodies for events that pose no real threat to our physical survival.Once it has been triggered, what is the natural conclusion of our fight or flight response?By its very design, the fight or flight response leads us to fight or to fleeï¿½both creating immense amounts of muscle movement and physical exertion. This physical activity effectively metabolizes the stress hormones released as a result of the activation of our fight or flight response. Once the fighting is over, and the threatï¿½which triggered the responseï¿½has been eliminated, our body and mind return to a state of calm. Has the fight or flight response become counterproductive?In most cases today, once our fight or flight response is activated, we cannot flee. We cannot fight. We cannot physically run from our perceived threats. When we are faced with modern day, saber tooth tigers, we have to sit in our office and "control ourselves." We have to sit in traffic and "deal with it." We have to wait until the bank opens to "handle" the bounced check. In short, many of the major stresses today trigger the full activation of our fight or flight response, causing us to become aggressive, hypervigilant and over-reactive. This aggressiveness, over-reactivity and hypervigilance cause us to act or respond in ways that are actually counter-productive to our survival. Consider road rage in Los Angeles and other major cities.It is counterproductive to punch out the boss (the fight response) when s/he activates our fight or flight response. (Even though it might bring temporary relief to our tension!) It is counterproductive to run away from the boss (the flight response) when s/he activates our fight or flight response. This all leads to a difficult situation in which our automatic, predictable and unconscious fight or flight response causes behavior that can actually be self-defeating and work against our emotional, psychological and spiritual survival.Is there a cumulative danger from over-activation of our fight or flight response?Yes. The evidence is overwhelming that there is a cumulative buildup of stress hormones. If not properly metabolized over time, excessive stress can lead to disorders of our autonomic nervous system (causing headache, irritable bowel syndrome, high blood pressure and the like) and disorders of our hormonal and immune systems (creating susceptibility to infection, chronic fatigue, depression, and autoimmune diseases like rheumatoid arthritis, lupus, and allergies.)To protect ourselves today, we must consciously pay attention to the signals of fight or flightTo protect ourselves in a world of psychologicalï¿½rather than physicalï¿½danger, we must consciously pay attention to unique signals telling us whether we are actually in fight or flight. Some of us may experience these signals as physical symptoms like tension in our muscles, headache, upset stomach, racing heartbeat, deep sighing or shallow breathing. Others may experience them as emotional or psychological symptoms such as anxiety, poor concentration, depression, hopelessness, frustration, anger, sadness or fear. Excess stress does not always show up as the "feeling" of being stressed. Many stresses go directly into our physical body and may only be recognized by the physical symptoms we manifest. Two excellent examples of stress induced conditions are "eye twitching" and "teeth-grinding." Conversely, we may "feel" lots of emotional stress in our emotional body and have very few physical symptoms or signs in our body. By recognizing the symptoms and signs of being in fight or flight, we can begin to take steps to handle the stress overload. There are benefits to being in fight or flightï¿½even when the threat is only psychological rather than physical. For example, in times of emotional jeopardy, the fight or flight response can sharpen our mental acuity, thereby helping us deal decisively with issues, moving us to action. But it can also make us hypervigilant and over-reactive during times when a state of calm awareness is more productive. By learning to recognize the signals of fight or flight activation, we can avoid reacting excessively to events and fears that are not life threatening. In so doing, we can play "emotional judo" with our fight or flight response, "using" its energy to help us rather than harm us. We can borrow the beneficial effects (heightened awareness, mental acuity and the ability to tolerate excess pain) in order to change our emotional environment and deal productively with our fears, thoughts and potential dangers. " http://www.mindbodymed.com/EducationCenter/fight.html and when we talk about this keep this definition in mind. and also this article. But also keep in mind IBS is a physical problem, this is not "IBS is all in the head or psycobabble, but how all humans systems operate and the effects, as either a contributer to getting IBS in PI IBS studies or as a major trigger to IBSers, down to emotions, anxiety stress, worry, fear, pain, and the above mentioned feelings. But also later in ways work on these very real coordinated biological, behavioral, and psychological responses. "The Neurobiology of Stress and EmotionsBy: Emeran A. Mayer, M.D., UCLA Mind Body Collaborative Research Center, UCLA School of Medicine, California "We often hear the term "stress" associated with functional gastrointestinal (GI) disorders, such as irritable bowel syndrome (IBS). Many patients experience a worsening of symptoms during times of severely stressful life events. But what is stress? How often does it occur? How does our body respond to stress? This article explores the mechanisms that link stress and emotions to responses that have evolved to ensure survival and that, in the modern world, affect healthï¿½including gastrointestinal function. ""Introduction Stress is an adaptive response that is not unusual or unique to only certain individuals. In humans and animals, internal mechanisms have developed throughout evolution, which allow the individual to maximize their chances of survival when confronted with a stressor. A stressor in this context is any situation that represents an actual or perceived threat to the balance (homeostasis) of the organism. In a wide variety of real, life threatening situations -- such as an actual physical assault or a natural disaster -- stress induces a coordinated biological, behavioral, and psychological response. " http://www.aboutibs.org/Publications/stress.html


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## eric (Jul 8, 1999)

This has to do with fear, the fight or flight and emotions and the brain. First is looking at these things like anxiety (mind chatter) and Fear (of symptoms say or getting in a car or where is the bathroom or when will the next pain attack start etc. )understanding them, then its how they apply to IBS and how to help change how we react.ButPart 1DISCOVER Vol. 24 No. 3 (March 2003)Table of ContentsLearning Series: The Brain and Emotions - part 1FearRecent research shows that when something bad happens to you, part of your brain begins thinking independently, storing its own memories so it can save you next time. That worked fine a million years agoBy Steven JohnsonPhotograph by Elinor CarucciGraphics by Don FoleyYou are driving at night down a quiet suburban street, listening to Van Morrison's ''Brown Eyed Girl'' on the stereo. As you cross an intersection, your peripheral vision picks up the flash of headlights descending on the right side of the car. In the split second before you hear the sound of metal grinding into metal, your body tenses, blood flows to your extremities, adrenaline surges, and time slows down. At impact you find yourself noticing surreal detailsï¿½the bright orange jacket of a startled pedestrian, the low-hung branches of a dogwood tree at the side of the road. After a split second that seems like 10 minutes, your car lurches to a halt against the curb.The physical event of one car colliding with another has run its course, but its emotional impact continues. The adrenaline and other stress hormones released in your body have brought you to a state of almost superhuman alertness; you feel more awake than you've felt in your entire life. You can review the details of the crash as though you were replaying a DVD of the event, all the details immaculately preserved. For weeks, as memory fades, details continue to haunt you. Driving through an intersection causes you to flinch, anticipating another crash; the flash of headlights makes your gut tighten. For months, driving at night seems far more dangerous than driving during the day. Even a year later, the sight of drooping dogwood flowers triggers a sense of dread. Hearing ''Brown Eyed Girl'' brings the whole sequence back to consciousness with astonishing clarity.Anyone who has been through a traumatic event will recognize this scenario immediatelyï¿½ the sudden physical response of fear and its often debilitating persistence in memory. The feeling of fear, like all emotions, is something that happens to the body and the mind. Few memories are as easily triggered and as hard to shake as those in which we are confronted with an immediate threat. For people who have undergone serious trauma, including war veterans and rape survivors, memories of fear can sometimes play a dominant role in shaping personality, a condition we now call post-traumatic stress disorder.Unraveling the mystery of how the mind experiences fearï¿½ perhaps the most primal and enduring of all the emotionsï¿½ turns out to be one of the most interesting and instructive quests in the annals of recent neuroscience. We have learned that fear plays tricks with our memory and our perception of reality; we have also learned that the fear systems in the brain have their own perceptual channels and their own dedicated circuitry for storing traumatic memories. As scientists have mapped the path of fear through the brain, they have begun to explore ways to lessen its hold on the psyche, to prevent that car accident from keeping us off the road months later.It seems intuitive to us that we would remember vividly the details of a frightening event like a car accident. But here is a question with a surprising answer: Would we remember our fear if we had no long-term memory?An experiment performed nearly 100 years ago by Swiss psychologist ï¿½douard Claparï¿½de provides a clue: Claparï¿½de was treating a woman suffering from a debilitating form of amnesia that left her incapable of forming new memories. She had suffered localized brain damage that preserved her basic mechanical and reasoning skills, along with most of her older memories. But beyond the duration of a few minutes, the recent past was lost to herï¿½ a condition brilliantly captured in the movie Memento, in which a man suffering similar memory loss solves a mystery by furiously scrawling new information on the backs of Polaroids before his memories fade to black.Claparï¿½de's patient would have seemed straight out of a slapstick farce had her condition not been so tragic. Each day the doctor would greet her and run through a series of introductions. If he then left for 15 minutes, she would forget who he was. They'd do the introductions all over again. One day, Claparï¿½de decided to vary the routine. He introduced himself to the woman as usual, but when he reached to shake her hand for the first time, he concealed a pin in his palm.It wasn't friendly, but Claparï¿½de was onto something. When he arrived the next day, his patient greeted him with the usual blank welcomeï¿½ no memory of yesterday's pinprick, no memory of yesterday at allï¿½ until Claparï¿½de extended his hand. Without being able to explain why, the woman refused to shake. She was incapable of forming new memories, yet she had nevertheless remembered somethingï¿½ a subconscious sense of danger, a remembrance of past trauma. She failed utterly to recognize the face and the voice she'd encountered every day for months. But somehow, buried in her mind, she remembered a threat.Click on the image to enlarge. (23k)The amygdala, which directs signal traffic in the brain when danger lurks, receives quick and dirty information directly from the thalamus in a route that neuroscientist Joseph LeDoux dubs the low road. This shortcut allows the brain to start responding to a threat within a few thousandths of a second. The amygdala also receives information via a high road from the visual cortex. Although the high road encodes much more detailed and specific information, the extra step takes at least twice as longï¿½ and could mean the difference between life and death. LeDoux says the disconnection between the two routes may underlie some disorders: "While in terms of survival it may be better to mistake a stick for a snake, people who have pathological fears may be treating sticks as snakes much of the time."ï¿½ Jocelyn SelimAbout 25 years ago, a young postdoctoral student at weill Medical College of Cornell University in Manhattan named Joseph LeDoux was casting about for a research focus. Cognitive science, with an emphasis on computer modeling, was the hot new field. But LeDoux was interested in emotions, and "there wasn't a lot going on there,'' he remembers, sitting in his office at New York University, where he is a professor of neural science. ''So I read around and came across studies on fear conditioning." Claparï¿½de's pin turns out to be a somewhat diabolical twist on the classic behaviorist experiment of fear conditioning: Put a rat in a cage, play a tone, and simultaneously deliver a shock to the animal. After a few rounds of tone and shock, the rat starts to fear the tone even if it's not accompanied by the shock. The fear reactionï¿½ noticeable because the rat freezes in placeï¿½ has been observed in species as diverse as pigeons, rabbits, baboons, and humans. It is called a conditioned response. The rat has an unconditioned innate fear of shocks, but it can be conditioned to be afraid of tones if the two are associated with each other. In Claparï¿½de's version of the experiment, the pin was the shock. His outstretched hand was the tone. After only one exposure to the shock and the tone, the amnesiac patient acquired a conditioned fear response to shaking hands with her doctor.Conditioned fear is easy: Fruit flies, marine snails, even lizards can be trained to display defensive behavior in response to threatening stimuli, along the lines of the tone and shock experiments. Conditioned fear turns out to be one of the most essential techniques that natural selection stumbled across to increase the survival odds of organisms in an unpredictable environment. But until a few decades ago, we had almost no idea how that learning actually took place. The ubiquity of conditioned fear in the animal kingdom, combined with the amnesiac's ability to remember potential threats, made it clear that learning to be afraid involved different mechanisms than, say, learning how to ride a bicycle or memorizing the capitals of all 50 states. But what was the mechanism? That's what LeDoux set out to determine. There had been almost no research into how the fear response actually came into being. ''In fact,'' LeDoux says with a smile, ''my first grant on this topic in the early 1980s was turned down," because scientists reviewing his application believed it was impossible to scientifically study emotions.LeDoux forged ahead anyway. ''I started from the outside,'' he says. ''I had the sound that produced the fear response. I wanted to know: How does that sound go through the brain and create the response?'' Like most brain researchers in the age before advanced imaging technology, LeDoux's approach was surgical subtraction. Take a healthy rat and begin extracting specific parts of his brain. If you remove a region and the rat can still learn to associate the tone with the shock, then the region you've removed isn't relevant to fear conditioning. But if the rat stops learning, you know you've got something relevant.Click on the image to enlarge. (85k)ANATOMY OF FEARWithin seconds of perceiving a threat, the primitive amygdala sounds a general alarm. The adrenal system promptly floods the body with adrenaline and stress hormones. Nonessential physiological processes switch off. Digestion stops, skin chills, and blood is diverted into muscles in preparation for a burst of emergency action. Breathing quickens, the heart races, and blood pressure skyrockets, infusing the body with oxygen while the liver releases glucose for quick fuel. The entire body is suddenly in a state of high alert, ready for fight or flight.ï¿½ J. S.''Because the auditory pathways are fairly well worked out in mammals, I could use that as a starting point. I started with the top of the auditory pathway, which is the auditory cortex. I took that out, and the animals learned fine. Then I went down one station to the auditory thalamus, took that out, and they couldn't learn at all. So that meant that the sound had to go through the system to the level of the thalamus but didn't go through the cortex. So where was it going?'' The question was puzzling because the traditional understanding of the brain's activity emphasized the role of the cortex over most other regions. The cortex was where the sensory informationï¿½ in this case, the sound of the toneï¿½ was integrated into conscious awareness, alongside other sensory data transmitted from other parts of the brain. The auditory thalamus was supposed to be just a relay station from the ear to the primary destination, the auditory cortex. So there was something strangely inverted about LeDoux's result. You could eliminate the primary destination altogether without affecting the learning, but if you took out the relay station, the learning stopped.LeDoux's assumption was that the auditory thalamus harbored a link to another part of the brain, in addition to its link to the cortex. Using a tracer dye to follow pathways out from the auditory thalamus, LeDoux discovered a connection to the amygdala, an almond-shaped region in the forebrain long associated with emotional states. When he removed the amygdala, the rats failed to learn. Perusing the literature, he found earlier experiments that demonstrated a crucial part of the amygdala known as the central nucleus contained links to the key brain stem areas that control the autonomic functions involved in the fear response, like acceleration of breathing and heart rate. ''I didn't start out looking for the amygdala,'' LeDoux says. ''The research led me to it.''The key insight that emerged is that the experience of danger follows two pathways in the brain: one conscious and rational, the other unconscious and innate. These were quickly dubbed the high road and the low road. Say you're walking though a forest, and out of the corner of your eye you detect a slithering shape to your left, accompanied by a rattling sound. Before you even have time to formulate the word snake, your body has frozen in its tracks; your heart rate has accelerated; the sweat glands on your palms have dilated. In your brain, the information flow looks something like this: Your eyes and ears transmit basic sensory information to the auditory and visual thalamus, where the information is then transmitted along two paths. One stream of data heads towards the cortex, where it will be integrated with other real-time sensory data, along with more elaborate associations like the word rattlesnake, or your childhood memories of a pet python, or the snake scene from Raiders of the Lost Ark. At the same time, the slithering is also transmittedï¿½ in less rich detailï¿½ to the amygdala itself, which blasts out an alarm to the brain stem, alerting the body that a potential threat is nearby. The key difference between the two paths is data transmission time. It might take a few seconds to establish the presence of the snake and formulate a response via the high road, but the low road kicks the body into a freezing response within a fraction of a second. And you don't have to learn the elaborate bodily choreography involved, the way you might learn a complicated yoga position. Your body knows how to execute the freezing response without any training at all. In fact, it knows the response so well that it is nearly impossible to keep it from happening.As a survival mechanism, LeDoux's low road made perfect sense. But other questions remained: How did the amygdala know to be afraid of a snake in the first place? How could Claparï¿½de's patient learn to be afraid if she lacked memory?We're accustomed to describing someone as having a good or a bad memory, as though memory were a single attribute that covers the entire range of storing and recalling information. We now know that the brain's memory systems are far more diverse than this. There are systems devoted to explicit or declarative memories, like your childhood recollection of that pet python, and systems devoted to procedural memories that usually involve physical movement, like learning how to ride a bicycle. And then there are emotional memories. If you watch the activity in someone's brain using a modern fMRI scanner, you see a different profile depending on which kind of memory the subject is conjuring up.In ordinary cases of fear conditioningï¿½ encountering that snake in the grassï¿½ a declarative memory will occur more or less simultaneously with an emotional memory. You'll feel the freezing response kick in, and moments later you'll remember seeing that scene from Raiders of the Lost Ark. The latter feels like our traditional idea of memory; there's a mental picture from the past experience that comes into consciousness, as though you were sifting through pages of a photo album. The transition to a freezing response doesn't feel like a memory in that conventional sense of the term, but for all intents and purposes it is one. It is recalled information from past experience that alters your state of mind. The transition to a freezing response happens too fast for it to be a conscious, deliberate memory, but it's a form of memory nonetheless.In brain anatomy terms, the declarative memory of Indiana Jones in the snake pit is laid down by the hippocampus, a long, curved ridge located next to the amygdala. The emotional memory of a threat, on the other hand, is mediated by the amygdala itself. This explains the mystery of the remembered pinprick: Claparï¿½de's patient lacked the ability to form declarative memories, but she had a functioning amygdala that kept the memory alive, albeit unconsciously. If you had a past encounter with a snake and you felt actively threatened, a trace of that memory would have been stored by the amygdala as well as by the hippocampus. Some brain scientists believe that our fear systems are prepared to learn about threatsï¿½ snakes, spiders, or heightsï¿½ that have been major obstacles to survival over the millions of years it has taken the modern brain to evolve, which explains why it is easier to develop phobias about snakes than about threats that are statistically much more likely to kill you, such as electricity.Some scientists believe the amygdala doesn't have its own discrete storage system for emotionally charged memories but rather marks memories created by other brain systems as being somehow emotionally significant. In 2001 James McGaugh of the University of California at Irvine conducted a telling variation on the classic fear-conditioning experiment. He took a rat and subjected it to the traditional foot shock if the animal took a step. After administering the shock, McGaugh injected cyclic AMPï¿½ a cellular messenger that strengthens neuronal synapses, leading to stronger memoryï¿½ into the animal's cortex. Two days later, the rats were tested to see how well they were conditioned; those that received the injections turned out to have enhanced memories of the shock. ''So we know the cortex is involved in the memory that's based on fear in that situation,'' McGaugh says. ''Now, if we make a lesion of the amygdala, the stimulation of the cortex doesn't do anything. In other words, you have to have a working amygdala for the cortex to do its job.''McGaugh concludes, ''That experiment tells me that fear is not learned in the amygdala. Amygdala projections are coming up to brain regions where information is being stored, and they're saying: 'You know this memory you're storing? Well, it turns out to be a very important one, so make it a little stronger, please.' It provides selectivity in our lives. You don't need to know where you parked the car three weeks ago, unless it was broken into that day.'' You can think of it as the brain's way of underlining.Neuroscientists have determined that the memory of a fear stimulus triggers dramatic changes in the vital signs of rats. In a series of conditioned-response experiments, rats are first exposed to a painful shock accompanied by a tone. Whenever the tone is repeated, the rats immediately stop dead in their tracks. Blood pressure shoots up within three seconds, and heart rate peaks within five seconds. After 20 seconds, increased levels of stress hormones like corticosterone flood the body, and highly oxygenated and fuel-charged blood is pumped into the muscles to prime them for action.The trouble with emotional memories is that they can be fiendishly difficult to eradicate. The brain seems to be wired to prevent the deliberate overriding of fear responses. Although there are extensive neural pathways from the amygdala to the neocortex, the paths running the reverse direction are sparse. Our brains seem to have been designed to allow the fear system to take control in threatening situations and prevent our conscious awareness from reigning.This may have been an optimal design for predator-rich environments in which survival was a minute-by-minute question, but it is not a good adaptation for modern environments in which the stressors can be job performance reviews. The amygdala may be looking out for your best interests by preserving a memory of that nighttime car accident, but if the result is an inability to drive after dark, the fear circuitry has gone too far. Because the low-road memories are so tenacious, one question neuroscience is now wrestling with is how to subdue the amygdala when those memories hurt the organism.As a New Yorker who works in downtown Manhattan, LeDoux has been thinking a lot about these issues since September 11, 2001. Many local residents experienced a conditioned fear response that day, making it hard for them to work in tall buildings or visit the downtown area. LeDoux suspects those traumatic memories will persist in the brains of New Yorkers. The treatment possibilities are not about eliminating the memories so much as retraining the amygdala to respond differently when those memories are triggered.''The contrast,'' LeDoux says, sitting in his university office above Washington Square Park, with Ground Zero lurking not far to the south, ''is between taking action and being stuck, frozen in fear, headed toward despondency, unable to control your life. There's an interesting experiment along these lines: You have a rat that goes into a chamber. A tone goes off, and he gets a shock, and he freezes with the fear response. The next day he goes into chamber B, the tone goes off, and he freezes. But if he takes a step, the tone stops. Eventually he learns that he has to crawl across the chamber to eliminate the tone completely. So by taking that action, he's able to prevent fear from existing in his life.''In order for the rat to do this,'' LeDoux continues, standing up to sketch out his ideas on a cluttered white board, ''he's got to throw a switch in the amygdala. Normally, the fear response goes from the lateral nucleus to the central nucleus and then out of the amygdala. In order for the rat to take a step, the stimulus has to go not to the central nucleus but to the basal nucleus, and then out to the parts of the brain that are involved in active behavior.'' In other words, the amygdala wants to associate the memory with the freezing response, but it can be trained to associate it with something less debilitating. When you hear an airplane rumbling overhead, you can freeze, or you can take a step. And with every step you reroute the path of fear through the amygdala.Our new understanding of fear has also led to cunning pharmacological treatments for post-traumatic stress disorder. McGaugh talks about two recent studies that involved giving beta-blockers to people who had recently suffered a traumatic event, studies that built on McGaugh's own research: ''Say you have a traumatic experience. The memory of that experience will pop into your brain the next day, whether you want it to or not. And when that memory pops into your brain, you're going to have that whole autonomic response that you had originally. It's going to come back again. So it's not only that you remember that you were mugged, but you also get very emotionally excited about it when the memory happens.'' That emotional excitement triggers the memory-enhancing cycle all over again, making the traumatic memory even stronger, like a spinning tire deepening the muck hole it's stuck in with each jab on the accelerator. By preventing the autonomic reaction, beta-blockers keep the memory from forming deeper grooves in the brain, making post-traumatic stress symptoms less severe, ''which I think is a really interesting development,'' McGaugh says with a hearty laugh. ''Forty-five years of my life I've spent studying rats and out pops something useful!"Because the fear response can play a direct role in life-and-death struggles, it's not surprising to find that the brain contains elaborate machinery dedicated to its routines. The fact that the amygdala's basic architecture reappears in so many species is testimony to its evolutionary importance: Natural selection generally doesn't tinker with components that have proved essential to basic survival. Of course, the persistence of the low road in a world where predators are largely nonexistent may no longer be adaptive, but that's the trade-off of human culture. Evolution made our brains so smart that we ended up building environments that made some of our mental resources obsolete. No matter how calculating and erudite the neocortex becomes, it can't simply switch off the amygdala. In that sense, you can see the battles between these different regions as a re-enactment of Freud's clash between man's civilized superego and his primal id.There is great elegance in the way this system has evolved, with its complex mix of instinct and learning. Like all emotions, the fear circuitry steers the organism toward desirable statesï¿½ away from predators or other threatsï¿½ without knowing that much in advance about the world that the organism will actually inhabit. We are not slaves to our emotions, but they are hardly at our beck and call either. They propel us in directions that our rational minds don't always understandï¿½ fear most of all. The amygdala, like the heart in Pascal's famous phrase, has reasons of which reason knows nothing. www.discover.com/search/index.html


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## eric (Jul 8, 1999)

And because its part two of the series and everyone likes to Laugh, I hope and because its good to keep a sense of humor. And it can also help.And interesting to note also that Laughter starts out as a fight or flight responce. Discover Magazine -------------------------------------------------------------------------------- Part 2DISCOVER Vol. 24 No. 4 (April 2003)Table of ContentsLearning Series: The Brain and Emotions - part 2LaughterIf evolution comes down to survival of the fittest, then why do we joke around so much? New brain research suggests that the urge to laugh is the lubricant that makes humans higher social beingsBy Steven JohnsonGraphics by Don FoleyPhotograph by Elinor CarucciRobert Provine wants me to see his Tickle Me Elmo doll. Wants me to hold it, as a matter of fact. It's not an unusual request for Provine. A professor of psychology and neuroscience at the University of Maryland, he has been engaged for a decade in a wide-ranging intellectual pursuit that has taken him from the panting play of young chimpanzees to the history of American sitcomsï¿½ all in search of a scientific understanding of that most unscientific of human customs: laughter.The Elmo doll happens to incorporate two of his primary obsessions: tickling and contagious laughter. "You ever fiddled with one of these?" Provine says, as he pulls the doll out of a small canvas tote bag. He holds it up, and after a second or two, the doll begins to shriek with laughter. There's something undeniably comic in the scene: a burly, bearded man in his mid-fifties cradling a red Muppet. Provine hands Elmo to me to demonstrate the doll's vibration effect. "It brings up two interesting things," he explains, as I hold Elmo in my arms. "You have a best-selling toy that's a glorified laugh box. And when it shakes, you're getting feedback as if you're tickling."Provine's relationship to laughter reminds me of the dramatic technique that Bertolt Brecht called the distanciation effect. Radical theater, in Brecht's vision, was supposed to distance us from our too-familiar social structures, make us see those structures with fresh eyes. In his study of laughter, Provine has been up to something comparably enlightening, helping us to recognize the strangeness of one of our most familiar emotional states. Think about that Tickle Me Elmo doll: We take it for granted that tickling causes laughter and that one person's laughter will easily "infect" other people within earshot. Even a child knows these things. (Tickling and contagious laughter are two of the distinguishing characteristics of childhood.) But when you think about them from a distance, they are strange conventions. We can understand readily enough why natural selection would have implanted the fight-or-flight response in us or endowed us with sex drives. But the tendency to laugh when others laugh in our presence or to laugh when someone strokes our belly with a featherï¿½what's the evolutionary advantage of that? And yet a quick glance at the Nielsen ratings or the personal ads will tell you that laughter is one of the most satisfying and sought-after states available to us.Funnily enough, the closer Provine got to understanding why we laugh, the farther he got from humor. To appreciate the roots of laughter, you have to stop thinking about jokes.Anatomy of a Belly LaughLaughter may feel good, but physiologically it starts out as a body stressor that closely mimics a fear-induced fight-or-flight response. When higher regions of the brain detect a tickle sensation or get a joke, the brain stem and limbic system coordinate a sudden surge in adrenaline and other stress hormones, driving up heart rate, blood pressure, and metabolism while initiating a respiratory response close to hyperventilation. The benefits come afterward. Some studies suggest that laughter aftershocks boost immune activity, but the supporting data are sparse. The real reward, says neuroembryologist Robert Provine, may have more to do with the social bonds that laughter helps strengthen: "We know that social support plays a role in everything from healthy aging to cardiovascular disease. So at least in that regard, good humor equals good health."ï¿½ Jocelyn SelimThere is a long, semi-illustrious history of scholarly investigation into the nature of humor, from Freud's Jokes and Their Relation to the Unconscious, which may well be the least funny book about humor ever written, to a British research group that announced last year that they had determined the World's Funniest Joke. Despite the fact that the researchers said they had sampled a massive international audience in making this discovery, the winning joke revolved around New Jersey residents:A couple of New Jersey hunters are out in the woods when one of them falls to the ground. He doesn't seem to be breathing; his eyes are rolled back in his head. The other guy whips out his cell phone and calls the emergency services. He gasps to the operator: "My friend is dead! What can I do?"The operator says: "Take it easy. I can help. First, let's make sure he's dead." There is silence, then a shot is heard. The guy's voice comes back on the line. He says, "OK, now what?"This joke illustrates that most assessments of humor's underlying structure gravitate to the notion of controlled incongruity: You're expecting x, and you get y. For the joke to work, it has to be readable on both levels. In the hunting joke there are two plausible ways to interpret the 911 operator's instructionsï¿½either the hunter checks his friend's pulse or he shoots him. The context sets you up to expect that he'll check his friend's pulse, so theï¿½admittedly darkï¿½humor arrives when he takes the more unlikely path. That incongruity has limits, of course: If the hunter chooses to do something utterly nonsensicalï¿½untie his shoelaces or climb a treeï¿½the joke wouldn't be funny.A number of studies in recent years have looked at brain activity while subjects were chuckling over a good jokeï¿½an attempt to locate a neurological funny bone. There is evidence that the frontal lobes are implicated in "getting" the joke while the brain regions associated with motor control execute the physical response of laughter. One 1999 study analyzed patients with damage to the right frontal lobes, an integrative region of the brain where emotional, logical, and perceptual data converge. The brain-damaged patients had far more difficulty than control subjects in choosing the proper punch line to a series of jokes, usually opting for absurdist, slapstick-style endings rather than traditional ones. Humor can often come in coarse, lowest-common-denominator packages, but actually getting the joke draws upon our higher brain functions.When Provine set out to study laughter, he imagined that he would approach the problem along the lines of these humor studies: Investigating laughter meant having people listen to jokes and other witticisms and watching what happened. He began by simply observing casual conversations, counting the number of times that people laughed while listening to someone speaking. But very quickly he realized that there was a fundamental flaw in his assumptions about how laughter worked. "I started recording all these conversations," Provine says, "and the numbers I was gettingï¿½I didn't believe them when I saw them. The speakers were laughing more than the listeners. Every time that would happen, I would think, 'OK, I have to go back and start over again because that can't be right.'"Speakers, it turned out, were 46 percent more likely to laugh than listenersï¿½and what they were laughing at, more often than not, wasn't remotely funny. Provine and his team of undergrad students recorded the ostensible "punch lines" that triggered laughter in ordinary conversation. They found that only around 15 percent of the sentences that triggered laughter were traditionally humorous. In his book, Laughter: A Scientific Investigation, Provine lists some of the laugh-producing quotes:I'll see you guys later./Put those cigarettes away./I hope we all do well./It was nice meeting you too./We can handle this./I see your point./I should do that, but I'm too lazy./I try to lead a normal life./I think I'm done./I told you so!The few studies of laughter to date had assumed that laughing and humor were inextricably linked, but Provine's early research suggested that the connection was only an occasional one. "There's a dark side to laughter that we are too quick to overlook," he says. "The kids at Columbine were laughing as they walked through the school shooting their peers."As his research progressed, Provine began to suspect that laughter was in fact about something elseï¿½not humor or gags or incongruity but our social interactions. He found support for this assumption in a study that had already been conducted, analyzing people's laughing patterns in social and solitary contexts. "You're 30 times more likely to laugh when you're with other people than you are when you're aloneï¿½if you don't count simulated social environments like laugh tracks on television," Provine says. "In fact, when you're alone, you're more likely to talk out loud to yourself than you are to laugh out loud. Much more." Think how rarely you'll laugh out loud at a funny passage in a book but how quick you'll be to make a friendly laugh when greeting an old acquaintance. Laughing is not an instinctive physical response to humor, the way a flinch responds to pain or a shiver to cold. It's a form of instinctive social bonding that humor is crafted to exploit.At the Baltimore campus of the University of Maryland, laughter expert Robert Provine (left) studies how David Spadacino and Julie White react to a Tickle Me Elmo doll. "There is a lot of science in Elmo," Provine says.Photograph by Greg MillerProvine's lab at the Baltimore County campus of the University of Maryland looks like the back room at a stereo repair storeï¿½long tables cluttered with old equipment, tubes and wires everywhere. The walls are decorated with brightly colored pictures of tangled neurons, most of which were painted by Provine. (Add some Day-Glo typography and they might pass for signs promoting a Dead show at the Fillmore.) Provine's old mentor, the neuroembryologist Viktor Hamburger, glowers down from a picture hung above a battered Silicon Graphics workstation. His expression suggests a sense of concerned bafflement: "I trained you as a scientist, and here you are playing with dolls!"The more technical parts of Provine's workï¿½exploring the neuromuscular control of laughter and its relationship to the human and chimp respiratory systemsï¿½draw on his training at Washington University in St. Louis under Hamburger and Nobel laureate Rita Levi-Montalcini. But the most immediate way to grasp his insights into the evolution of laughter is to watch video footage of his informal fieldwork, which consists of Provine and a cameraman prowling Baltimore's inner harbor, asking people to laugh for the camera. The overall effect is like a color story for the local news, but as Provine and I watch the tapes together in his lab, I find myself looking at the laughers with fresh eyes. Again and again, a pattern repeats on the screen. Provine asks someone to laugh, and they demur, look puzzled for a second, and say something like, "I can't just laugh." Then they turn to their friends or family, and the laughter rolls out of them as though it were as natural as breathing. The pattern stays the same even as the subjects change: a group of high school students on a field trip, a married couple, a pair of college freshmen.At one point Provineï¿½dressed in a plaid shirt and khakis, looking something like the comedian Robert Kleinï¿½stops two waste-disposal workers driving a golf cart loaded up with trash bags. When they fail to guffaw on cue, Provine asks them why they can't muster one up. "Because you're not funny," one of them says. They turn to each other and share a hearty laugh."See, you two just made each other laugh," Provine says."Yeah, well, we're coworkers," one of them replies.The insistent focus on laughter patterns has a strange effect on me as Provine runs through the footage. By the time we get to the cluster of high school kids, I've stopped hearing their spoken words at all, just the rhythmic peals of laughter breaking out every 10 seconds or so. Sonically, the laughter dominates the speech; you can barely hear the dialogue underneath the hysterics. If you were an alien encountering humans for the first time, you'd have to assume that the laughing served as the primary communication method, with the spoken words interspersed as afterthoughts. After one particularly loud outbreak, Provine turns to me and says, "Now, do you think they're all individually making a conscious decision to laugh?" He shakes his head dismissively. "Of course not. In fact, we're often not aware that we're even laughing in the first place. We've vastly overrated our conscious control of laughter."The limits of our voluntary control of laughter are most clearly exposed in studies of stroke victims who suffer from a disturbing condition known as central facial paralysis, which prevents them from voluntarily moving either the left side or the right side of their faces, depending on the location of the neurological damage. When these individuals are asked to smile or laugh on command, they produce lopsided grins: One side of the mouth curls up, the other remains frozen. But when they're told a joke or they're tickled, traditional smiles and laughs animate their entire faces. There is evidence that the physical mechanism of laughter itself is generated in the brain stem, the most ancient region of the nervous system, which is also responsible for fundamental functions like breathing. Sufferers of amyotrophic lateral sclerosisï¿½Lou Gehrig's diseaseï¿½which targets the brain stem, often experience spontaneous bursts of uncontrollable laughter, without feeling mirth. (They often undergo a comparable experience with crying as well.) Sometimes called the reptilian brain because its basic structure dates back to our reptile ancestors, the brain stem is largely devoted to our most primal instincts, far removed from our complex, higher-brain skills in understanding humor. And yet somehow, in this primitive region of the brain, we find the urge to laugh.We're accustomed to thinking of common-but-unconscious instincts as being essential adaptations, like the startle reflex or the suckling of newborns. Why would we have an unconscious propensity for something as frivolous as laughter? As I watch them on the screen, Provine's teenagers remind me of an old Carl Sagan riff, which begins with his describing "a species of primate" that likes to gather in packs of 50 or 60 individuals, cram together in a darkened cave, and hyperventilate in unison, to the point of almost passing out. The behavior is described in such a way as to make it sound exotic and somewhat foolish, like salmon swimming furiously upstream to their deaths or butterflies traveling thousands of miles to rendezvous once a year. The joke, of course, is that the primate is **** sapiens, and the group hyperventilation is our fondness for laughing together at comedy clubs or theaters, or with the virtual crowds of television laugh tracks.I'm thinking about the Sagan quote when another burst of laughter arrives through the TV speakers, and without realizing what I'm doing, I find myself laughing along with the kids on the screen. I can't help itï¿½their laughter is contagious.In his lab, Provine turns away from the dour visage of his mentor Viktor Hamburger as he records his own laughter. He uses an acoustic analyzer to isolate patterns that make up both common and "forbidden" laugh variants.Photograph by Greg MillerWe may be the only species on the planet that laughs together in such large groups, but we are not alone in our appetite for laughter. Not surprisingly, our near relatives, the chimpanzees, are also avid laughers, although differences in their vocal apparatus cause the laughter to sound somewhat more like panting. "The chimpanzee's laughter is rapid and breathy, whereas ours is punctuated with glottal stops," says legendary chimp researcher Roger Fouts. "Also, the chimpanzee laughter occurs on the inhale and exhale, while ours is primarily done on our exhales. But other than these small differences, chimpanzee laughter seems to me to be just like ours in most respects."Chimps don't do stand-up routines, of course, but they do share a laugh-related obsession with humans, one that Provine believes is central to the roots of laughter itself: Chimps love tickling. Back in his lab, Provine shows me video footage of a pair of young chimps named Josh and Lizzie playing with a human caretaker. It's a full-on ticklefest, with the chimps panting away hysterically when their bellies are scratched. "That's chimpanzee laughter you're hearing," Provine says. It's close enough to human laughter that I find myself chuckling along.Parents will testify that ticklefests are often the first elaborate play routine they engage in with their children and one of the most reliable laugh inducers. According to Fouts, who helped teach sign language to Washoe, perhaps the world's most famous chimpanzee, the practice is just as common, and perhaps more long lived, among the chimps. "Tickling . . . seems to be very important to chimpanzees because it continues throughout their lives," he says. "Even Washoe at the age of 37 still enjoys tickling and being tickled by her adult family members." Among young chimpanzees that have been taught sign language, tickling is a frequent topic of conversation.Like laughter, tickling is almost by definition a social activity. Like the incongruity theory of humor, tickling relies on a certain element of surprise, which is why it's impossible to tickle yourself. Predictable touch doesn't elicit the laughter and squirming of ticklingï¿½it's unpredictable touch that does the trick. A number of tickle-related studies have convincingly shown that tickling exploits the sensorimotor system's awareness of the difference between self and other: If the system orders your hand to move toward your belly, it doesn't register surprise when the nerve endings on your belly report being stroked. But if the touch is being generated by another sensorimotor system, the belly stroking will come as a surprise. The pleasant laughter of tickle is the way the brain responds to that touch. In both human and chimpanzee societies, that touch usually first appears in parent-child interactions and has an essential role in creating those initial bonds. "The reason [tickling and laughter] are so important," Roger Fouts says, "is because they play a role in maintaining the affinitive bonds of friendship within the family and community."A few years ago, Jared Diamond wrote a short book with the provocative title Why Is Sex Fun? These recent studies suggest an evolutionary answer to the question of why tickling is fun: It encourages us to play well with others. Young children are so receptive to the rough-and-tumble play of tickle that even pretend tickling will often send them into peals of laughter. (Fouts reports that the threat of tickle has a similar effect on his chimps.) In his book, Provine suggests that "feigned tickle" can be thought of as the Original Joke, the first deliberate behavior designed to exploit the tickling-laughter circuit. Our comedy clubs and our sitcoms are culturally enhanced versions of those original playful childhood exchanges. Along with the suckling and smiling instincts, the laughter of tickle evolved as a way of cementing the bond between parents and children, laying the foundation for a behavior that then carried over into the social lives of adults. While we once laughed at the surprise touch of a parent or sibling, we now laugh at the surprise twist of a punch line.Bowling Green State University professor Jaak Panksepp suggests that there is a dedicated "play" circuitry in the brain, equivalent to the more extensively studied fear and love circuits. Panksepp has studied the role of rough-and-tumble play in cementing social connections between juvenile rats. The play instinct is not easily suppressed. Rats that have been denied the opportunity to engage in this kind of playï¿½which has a distinct choreography, as well as a chirping vocalization that may be the rat equivalent of laughterï¿½will nonetheless immediately engage in play behavior given the chance. Panksepp compares it to a bird's instinct for flying. "Probably the most powerful positive emotion of allï¿½once your tummy is full and you don't have bodily needsï¿½is vigorous social engagement among the young," Panksepp says. "The largest amount of human laughter seems to occur in the midst of early childhoodï¿½rough-and-tumble play, chasing, all the stuff they love."Playing is what young mammals do, and in humans and chimpanzees, laughter is the way the brain expresses the pleasure of that play. "Since laughter seems to be ritualized panting, basically what you do in laughing is replicate the sound of rough-and-tumble play," Provine says. "And you know, that's where I think it came from. Tickle is an important part of our primate heritage. Touching and being touched is an important part of what it means to be a mammal."There is much that we don't know yet about the neurological underpinnings of laughter. We do not yet know precisely why laughing feels so good; one recent study detected evidence that stimulating the nucleus accumbens, one of the brain's pleasure centers, triggered laughter. Panksepp has performed studies that indicate opiate antagonists significantly reduce the urge to play in rats, which implies that the brain's endorphin system may be involved in the pleasure of laughter. Some anecdotal and clinical evidence suggest that laughing makes you healthier by suppressing stress hormones and elevating immune system antibodies. If you think of laughter as a form of behavior that is basically synonymous with the detection of humor, the laughing-makes-you-healthier premise seems bizarre. Why would natural selection make our immune system respond to jokes? Provine's approach helps solve the mystery. Our bodies aren't responding to wisecracks and punch lines; they're responding to social connection.In this respect, laughter reminds us that our emotional lives are as much outward bound as they are inner directed. We tend to think of emotions as private affairs, feelings that wash over our subjective worlds. But emotions are also social acts, laughter perhaps most of all. It's no accident that we have so many delicately choreographed gestures and facial expressionsï¿½many of which appear to be innate to our speciesï¿½to convey our emotions. Our emotional systems are designed to share our feelings and not just represent them internallyï¿½an insight that Darwin first grasped more than a century ago in his book The Expression of the Emotions in Man and Animals. "The movements of expression in the face and body, whatever their origin may have been, are in themselves of much importance for our welfare. They serve as the first means of communication between mother and infant; she smiles approval, and thus encourages her child on the right path. . . . The free expression by outward signs of an emotion intensifies it."And even if we don't yet understand the neurological basis of the pleasure that laughing brings us, it makes sense that we should seek out the connectedness of infectious laughter. We are social animals, after all. And if that laughter often involves some pretty childish behavior, so be it. "I mean, this is why we're not like lizards," Provine says, holding the Tickle Me Elmo doll on his lap. "Lizards don't play, and they're not social the way we are. When you start to see play, you're starting to see mammals. So when we get together and have a good time and laugh, we're going back to our roots. It's ironic in a way: Some of the things that give us the most pleasure in life are really the most ancient."www.discover.com/search/index.html


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## california123 (Jun 8, 2003)

I sincerely applaud all Eric's posting and hope they help many to overcome their atress/anxiety. For me, I could not stay calm enough to do anything with my anxiety-induced D...certainly couldn't think of concrete ways to reduce my stress from other sources. Once I got on anti-anxiety medication--Xanax--the D stopped within a day and I was able to calm down. Lots of work with my psyciatrist on stress issues after that--along with anti-depressants for sadness of Alzheimer parents--and now I have been D free for 1 1/2 years, except for a few really bad days surrounding my mother's dying. I'm now off the anti-depressant and take only .25 of Xanax each morning. I will be tapering off of that too once I finish a cross country driving trip in a few weeks--I figure that is the last place I want to get D. Take care all.


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## eric (Jul 8, 1999)

Thansk Cal, glad your doing better and happier.







and as a side not to what he said about not staying calm.Relaxation Resistance http://www.ec-online.net/Knowledge/Article...tionresist.html


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## eric (Jul 8, 1999)

and new in regards to what this is all about."Are doctors focusing on fixing the wrong thing when a patient shows signs of having irritable bowel syndrome? http://www.thewgalchannel.com/health/3739601/detail.html although this is short and could have gone more indepth.


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## NancyCat (Jul 16, 1999)

Eric this info is great. I am running out of ink printing it all. Thanks


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## california123 (Jun 8, 2003)

As I have said time and again, I think anyone suffering from chronic D, whether it has been "diagnosed" as IBS or not, should try a true anti-anxiety med, like Xanax, for at least a few days. So much D is anxiety caused that should be one of the first treatments tried, not one of the last. Take care all.


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## knothappy (Jul 31, 1999)

Sorry ,I am not a big fan of all this cognitive stuff. I went to a psycologist thinking this might work.. no way. Maybe some people just cannot think" I will not not have IBS today , all will be well" and have it come true.Replacing bad thoughts with good thoughts just does not stop the gurgling cramping and violent urge to go to the bathroom when I am out somewhere. If I stood there thinking.." I do not have to go right now, this can wait"... I would be standing in a puddle of poop!!!What we do need is med. miracle , a pill that works for IBS like the pills that work for sugar diabetes and all the other diseases. Lotronex is a joke, it worked the first time and now I think they changed it and it does not work as before. Besides no doctor wants to go through all the mumbo jumbo paper work to get it, so they just say they donot prescribe it.We need answers, but all we get is band aid cures,something is gravely wrong with our insides not to be working like a normal person, why can't anyone find out what is wrong with us. To find the cure , you have to find the cause first!!


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## NancyCat (Jul 16, 1999)

knothappy-I agree that you can't think yourself out of IBS but I believe that these therapies help along with medication which is needed specifically for all symptoms of IBS. The medical community is working on the cause but its slow going which can be depressing and frustrating.


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## Kathleen M. (Nov 16, 1999)

Having done CBT for IBS the thought replacement you are discussing was NOT in anyway part of my treatment. It that is all they offered you, the person treating was NOT TRAINED to treat IBS with CBT, IMO.How you respond to the symptoms can help to ramp them up or help to ramp them down, but it usually isn't some sort of magical "I'm not pooping now" sort of thought replacement.And example for me.If when the symptoms occur I go into the "How can I possibly live the rest of my life in this much pain I will never be able to do anything ever again..." That pattern of thought..that keeps the symptoms going, much longer than they would probably go on by themselves.If I focus on "this too shall pass" the length of the attack is less.Over time the time between attacks increased as well.They are doing a lot to find out what is wrong. FWIW CBT, HT, Lotronex, Zelnrom, etc. all work on the basic understanding of what is wrong with us.Now if you can come up with a way to find and replace specific nerves within the Enteric Nervous System....Until then (you will know we are close when they can repair spinal cords so people aren't paralyzed anymore







) treatments AIMED at getting the nerves to behave better is where we need to focus.But what we have now as treatments is BASED on what we know is the underlying problem in IBS. They aren't IGNORING the causes, it is just what causes it is difficult to treat effectively in poeple as a whole. Some treatments work very well for some individuals.Hopefully you will find something that works for you soon.K.


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## eric (Jul 8, 1999)

An impoartant part of the above information is in every human there is the fight or flight responce and the relaxation responce. Some people have a very hard time with the relaxation responce and are more anxiety prone and in fight or flight more then others.But these are basic physiological responces to stressors in all humans, they just effect the problem of IBS more and the neurotransmitters and hormaones and peptides, that are part of having IBS and the brain gut communication that every human has, but is dysregulating in IBS.Not all of this is changing your thoughts, I just have not gotten to other parts of this yet either, some of this is meditation, progressive muscle relaxation, CBT and HT and other methods that illict the relaxation responce as opposed to the fight or flight responce which triggers the stress responce.Knothappy, I to went to a psycologist, she was not helpful either, because she was just into talk therapy, did not understand IBS, although she suffered from migraines herself and told me to go back to the gi doc after moonths f seeing her, but with all doctors, there are different kinds and different specaities, she was the wrong one, that is what happened to you above, they did not teach you how to really truely relax along with working on changing your thoughts, its a combination of things, that specialist in IBS use and there is also some doctors who "getit" and some that don't, so like other doctors, you have to find the right one, a. for you and B. that "gets it" to help with IBS.


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## eric (Jul 8, 1999)

These things can also be done with medications, its not an exclusive one or the other, some people might even need meds at first, to help get more relaxed.In IBS it is the combination of things that have also been shown to help, treating the gut and the brain.The above is also not becusae IBS is "all in the head" it is not, it is a very real physical problem.


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## eric (Jul 8, 1999)

Part of all this is crawling before learning how to walk and learning how to walk before learning how to jump.This is not an overnight process, it takes time and patients and learning and very very importantly an active participation. And perhaps some trial an error to a certain degree.


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## eric (Jul 8, 1999)

There are also some people whos minds are pretty calm, but the body is stressed, or whose minds are stressed and the body is calmer, or those whos mind and bodies are stressed. And on an everyday basis, a person can go back and forth from any of the above.


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## eric (Jul 8, 1999)

WEB MDOn pain, but tied to what I am posting here and to ibs.Mind-Body-Pain Connection: How Does It Work?By Michael Henry JosephWebMD Live Events Transcript Archive Reviewed By Event Date: 05/11/2000.Moderator: Welcome to WebMD Live's World Watch and Health News Auditorium. Today we are discussing "The Mind-Body-Pain Connection: How Does It Work?" with Brenda Bursch, Ph.D., Michael Joseph, M.D., and Lonnie Zeltzer, M.D.Brenda Bursch, Ph.D., is the Associate Director of the Pediatric Pain Program, Co-Director of Pediatric Chronic Pain Clinical Service and Assistant Clinical Professor of Psychiatry & Biobehavioral Sciences at UCLA Department of Pediatrics in the School of Medicine. She has written about asthma, developmental & behavioral pediatrics, emergency medicine, AIDS education and prevention, chronic digestive diseases and pediatric bowel disorders. She has membership in the American Pain Society, American Psychological Association, Munchausen Syndrome by Proxy Network, and the UCLA Center for the Study of Organizational and Group Dynamics. Michael Henry Joseph, MD, is an assistant professor of pediatrics and co-director of Chronic Pain Services at the University of California at Los Angeles Children's Hospital. He is a recipient of the Golden Apple Award for Excellence in Teaching. Lonnie Zeltzer, M.D., is an expert in the field of pediatric pain. She is a former president of the Society for Adolescent Medicine and member of the National Institute of Health?s Human Development Study Section. She is currently a Professor of Pediatrics and Anesthesiology at the UCLA School of Medicine. She is Director of the UCLA Pediatric Pain Program and Associate Director of the Patients & Survivors Section, Cancer Prevention and Control Research Branch of the UCLA Jonsson Comprehensive Cancer Center. She has well over one hundred scientific publications, reviews and chapters in medical journals, and has lectured internationally. http://my.webmd.com/content/article/1/1700...C-9531713CA348}


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## eric (Jul 8, 1999)

Digestion works through the autonomic nervous system, you don't have to conciously think about digesting you food.The autonomic nervous system is divided into three partsThe ANS is divided into three parts:The sympathetic nervous system The parasympathetic nervous system The enteric nervous system.The last being the "gut brain"When your in fight or flight mode, digestion is slowed down and the sympathetic nervous system takes over.When your relaxed the parasympathetic nervous system takes over, "rest and digest"One reason why stress may effect someone after the fact. Although parasymapthetic is better long term.This will help explain it. http://faculty.washington.edu/chudler/auto.html A persons thoughts and emotions and anxiety and stress, all effect these systems greatly in all humans, but very importantly in IBS. Even positive stress like excitement.


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## eric (Jul 8, 1999)

Brain Function And Physiology"Limbic System (controls mood and attitude) Functions sets the emotional tone of the mind filters external events through internal states (emotional coloring) tags events as internally important stores highly charged emotional memories modulates motivation controls appetite and sleep cycles promotes bonding directly processes the sense of smell modulates libido Problems moodiness, irritability, clinical depression increased negative thinking perceive events in a negative way decreased motivation flood of negative emotions appetite and sleep problems decreased or increased sexual responsiveness social isolation http://www.brainplace.com/bp/brainsystem/limbic.asp You might see a lot of similarities to complaints from IBS patients and the functioning of the limbic systemFoundation for Digestive Health and Nutrition (FDHN) to educate healthcare professionals about the epidemiology, pathophysiology, diagnosis and treatment of irritable bowel syndrome (IBS).Irritable Bowel Syndrome at a Glance - Nosology, Epidemiology, and Pathophysiology (Monograph I)Brain Physiology"The limbic system is involved in emotion, mood, and visceral autonomic control. Limbic abnormalities are seen in depression and IBS. Thus, this system is a possible site of convergence where emotional disturbance provokes intestinal dysfunction. " http://www.fdhn.org/html/education/gi/ibs_nosology.htm


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## eric (Jul 8, 1999)

One reason also why smells may trigger attacks."directly processes the sense of smell"or a loss of "libido"or "appetite and sleep problems "for examples.


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## eric (Jul 8, 1999)

I will also come back to issues very important and physical problems in the gut of IBSers and these back and forth communications, between the gut brain and the Brain.


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## eric (Jul 8, 1999)

This is also just fyi, harvard health newletters you can get.The Sensitive Gut Take a trip through your digestive tract and find out what can go wrong and why. Our doctors describe how to help prevent and treat common and not-so-common digestive problems from heartburn to irritable bowel syndrome.Prepared by the editors of the Harvard Health Letter in consultation with Lawrence S. Friedman, M.D., Associate Physician at Massachusetts General Hospital's Gastrointestinal Unit and Associate Professor of Medicine at Harvard Medical School. 40 pages.Here's an Excerpt from this Digestive Health Special Health Report Stomach cramps, a gnawing pain in the abdomen, embarrassing gas, diarrhea, constipation ï¿½ a rebelling digestive tract has affected everyone from prince to peasant at one time or another. It is the price we pay for our romance with food and the occasional stress induced by family reunions, big decisions at work, deadlines ï¿½ even doctorsï¿½ appointments.For most of us, stomach upsets are sporadic and fairly tolerable, the consequence of an intestinal bug, foreign travel, or an indulgent holiday meal. But one in four people has frequent gastrointestinal (GI) problems that can cause discomfort and disrupt life. Sufferers often undergo uncomfortable and unnecessary tests, spend a fortune on supposed remedies, and miss untold days from work. Though the misery they inflict is real, these problems are considered functional gastrointestinal disorders ï¿½ and unlike ulcers or stomach cancer they cannot be attributed to an infection or structural abnormality. More than 20% of people who consult a gastroenterologist about such problems do not receive a medical explanation for their complaints.Nevertheless, people plagued by GI distress can benefit from a better understanding of their symptoms. This report focuses on five disorders considered functional: gastroesophageal reflux disease, nonulcer dyspepsia, irritable bowel syndrome, constipation, and excessive gas. Although they sound different, sometimes the problems they cause are similar and the symptoms overlap. Despite their severe names, these maladies usually do not imply serious illness. Unfortunately, there is no tried-and-true cure for a sensitive gut. Yet, with proper knowledge and the support of a thoughtful, caring doctor, people can worry less and focus on dietary and lifestyle changes that can reduce symptoms ï¿½ or at least make coping with them easier. http://www.health.harvard.edu/hhp/publicat...view.do?name=SG Stress Control: Techniques for Preventing and Easing Stress Stress has been linked to heart disease and stroke, and it may also influence cancer and chronic respiratory diseases. It has implications for many other ailments, as well. Depression and anxiety, which afflict millions of Americans, can be caused or exacerbated by stress. It also triggers flare-ups of asthma, rheumatoid arthritis, and gastrointestinal problems, such as irritable bowel syndrome. And illness is just the tip of the iceberg. Stress affects you emotionally, as well, marring the joy you gain from life and loved ones.While no one can completely avoid stressful situations, itï¿½s possible to influence how these situations affect you. This special report can help you identify triggers for stress in your own life and understand the obvious and hidden ways in which stress affects your body. Applying the practical techniques in these pages ï¿½ such as meditation, progressive muscle relaxation, yoga and tai chi, cognitive restructuring, and breath focus ï¿½ can help you neutralize its damaging effects. The report also includes tools to help you get started, including a checklist of the warning signs of stress, a portable guide to stress relief, a meditation wallet card, and a stress-relief planning chart.Prepared by the editors of the Harvard Health Letter in consultation Herbert Benson, M.D., Mind/Body Medical Institute Associate Professor of Medicine, Harvard Medical School; Alice D. Domar, Ph.D., Director of the Mind/Body Center for Womenï¿½s Health at Boston IVF; and Ichiro Kawachi, Ph.D., Associate Professor of Medicine at Harvard Medical School. 40 pages.Here's an Excerpt from this Stress Management Special Health Report Stress and its toll on your bodyIntuitively, the stress response makes sense. It allows us to rise to occasions and events that reward heightened awareness and abilities. You see a bus rushing toward you and the surge of adrenaline helps you sprint out of its path far faster than you normally move. The stress hormones that spilled into your bloodstream at the sight of the bus found the perfect physical outlet.But experience tells us obvious dangers are not the only scenarios that elicit that response. Any situation you perceive as threatening may do the same. Thatï¿½s where the trouble starts. Your body does a poor job of distinguishing between life-threatening events and day-to-day stressful situations. Anger or anxiety triggered by less momentous sources of stress, such as financial fears or traffic jams, doesnï¿½t find a quick physical release and tends to build up as the day rolls on. Anticipation of potential problems, which might include anxiety brought on by government warnings of terrorist activity or more personal worry stemming from awaiting medical results, adds to the turmoil.When your body repeatedly launches the stress response or when a heightened state of arousal following a terrible trauma is never fully switched off, worrisome health problems can occur. A prime example of this is consistently high blood pressure, which plays a major role in heart disease. Another is suppression of the immune system, which increases susceptibility to common illnesses like colds.Itï¿½s impossible to sidestep all sources of stress, nor would you want to. Our lives are full of physical and psychological challenges, which add zest to life and sometimes deliver satisfying rewards. But while you canï¿½t easily erase certain sources of stress, you can learn to perceive and respond to them differently. The section entitled ï¿½ How to prevent and manage stressï¿½ on page 11 describes many tools to help you accomplish this. http://www.health.harvard.edu/hhp/publicat...view.do?name=SC


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## eric (Jul 8, 1999)

"Images Show a Snub Really is Like Kick in the GutThu October 09, 2003 01:58 PM ET By Maggie Fox, Health and Science Correspondent WASHINGTON (Reuters) - The feeling is familiar to anyone who has been passed over in picking teams or snubbed at a party -- a sickening, almost painful feeling in the stomach. Well, it turns out that "kicked in the gut" feeling is real, U.S. scientists said on Thursday. Brain imaging studies show that a social snub affects the brain precisely the way visceral pain does. " http://www.scn.ucla.edu/labnewsdw/reuters_dw.html This article is really worth reading also.""Stress: It's Worse Than You ThinkProvided by Psychology Today Psychological stress doesn't just put your head in a vise. New studies document exactly how it tears away at every body system--including your brain. But get this: The experience of stress in the past magnifies your reactivity to stress in the future. So take a nice deep breath and find a stress-stopping routine this instant. " http://health.yahoo.com/health/centers/stress/1205.html and further on stress and the immune system.and how stress can have a delayed reaction. http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=1;t=039331 an why a person with an enteric infection, who is stressed at the time of infection, contributes to PI IBS, after resolution of the intial infection, because stress and the immune system are intricately connected.and next the role of serotonin and it being majorally impicated in IBS and the brain gut axis communications between the enteric nervous system and the brain.Serotonin: a neurotransmitter.The functions of serotonin are numerous and appear to involve control of appetite, sleep, memory and learning, temperature regulation, mood, behavior (including sexual and hallucinogenic behavior), cardiovascular function, muscle contraction, endocrine regulation, and depression. Peripherally, serotonin appears to play a major role in platelet homeostasis, motility of the GI tract"First its a very important role in gut function, which I will get to next, but it also has a very important role in anxiety, depression and also relaxation.But its role in gut motility is next, along with brain gut axis communications. It is also involved in pain transmission from the gut to the brain.


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## eric (Jul 8, 1999)

Some detailed information on IBS and serotonin."IBS: Improving Diagnosis, Serotonin Signaling, and Implications for Treatment"CMEAuthors: Lucinda Harris, MD; Lin Chang, MD http://www.medscape.com/viewprogram/2750_pnt


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## kel1059 (Feb 28, 2003)

knothappy wrote:


> quote: Sorry ,I am not a big fan of all this cognitive stuff. I went to a psycologist thinking this might work.. no way. Maybe some people just cannot think" I will not not have IBS today , all will be well" and have it come true.Replacing bad thoughts with good thoughts just does not stop the gurgling cramping and violent urge to go to the bathroom when I am out somewhere. If I stood there thinking.." I do not have to go right now, this can wait"... I would be standing in a puddle of poop!!!


I did the same thing. i went for 7 years of CBT and it did nothing for my IBS. however, that is not to say it can't help someone else.i also tried HT and that failed miserably also. --but HT does seem to really help some of the highly anxious diarrhea types. it also may help some people with the pain.these treatments should be explored and if they help that is good.================================================just want to say that my enteric nerves were not replaced, nor were they fixed with some drug. they are working great as they are.all i can do is sit back and shake my head with a feeling of helplessness here. --but at the same time feel so incredibly thankful that i listened to my MD when he told me to see the homeopath (he hired the homeopath/acupuncturist as part of his practice).at the same time i am incredibly frustrated with it because if you read Garywest's posts you will see that it took him a VEEEERY long time to achieve his remission. it took close to 10 months before he was feeling substantially better. it took me 4 1/2 agonizing months to achieve my cure.all i know is that i finally understand what those 100,000 European MDs understand. there is something out there but it will frustrate you to no end if you decide to go after it. that is one of the reasons why it is far from being fully accepted.=======================================eric, good post.


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## eric (Jul 8, 1999)

95 percent of the serotonin in the body is stored in the gut. The majority of that serotonin is stored in enteroendocrine (or enterochromaffin) cells that line the gut wall. These cells are pressure sensitive to either chemical or mechanical stimulation of the gut mucosa. Once the cells are activated they release serotonin which in turn initiates peristalsis. (gut contractions)(as a side note these cells have been seen increased in Post infectious IBSers.)It also signals from the gut to the brain up nerve fibers, the serotonin does not actually go from the gut to the brain, but signals up the nerve fibers to communicate with the brain in a bidirectional communication.But at the moment this is at the gut level.Harvard Health"The Trusted Source..Harold J. DeMonaco, M.S.Harold J. DeMonaco, M.S., is senior analyst, Innovative Diagnostics and Therapeutics, and the chair of the Human Research Committee at the Massachusetts General Hospital. He is author of over 20 publications in the pharmacy and medical literature and routinely reviews manuscript submissions for eight medical journals...June 19, 2001.A:Irritable bowel syndrome is now recognized as a disorder of serotonin activity. Serotonin is a neurotransmitter in the brain that regulates sleep, mood (depression, anxiety), aggression, appetite, temperature, sexual behavior and pain sensation. Serotonin also acts as a neurotransmitter in the gastrointestinal tract.Excessive serotonin activity in the gastrointestinal system (enteric nervous system) is thought to cause the diarrhea of irritable-bowel syndrome. The enteric nervous system detects bowel distension (expansion) on the basis of pressure-sensitive cells in the bowel lumen (opening). Once activated, these pressure-sensitive cells promote the release of serotonin, which in turn promotes both secretory function and peristaltic function (the contractions of the intestines that force the contents outward). At least four serotonergic receptors have been identified to be participants in the secretory and peristaltic response.Patients with diarrhea-predominant IBS may have higher levels of serotonin after eating than do people without the disorder. This recognition led to the development of the first drug used specifically to treat diarrheal symptoms of IBS, alosetron (also known as Lotronex). Alosetron blocked the specific serotonin receptors responsible for recognizing bowel distention. In doing so, it blocked the effects of serotonin and reduced both bowel secretions and peristalsis. Constipation was the most common side effect seen. (Note: Alosetron was removed from the market by the manufacturer after repeated reports of a dangerous condition known as ischemic colitis became known.) Tegaserod (Zelmac) is another drug under development and under review by the U.S. Food and Drug Administration for approval. Tegaserod is indicated for the treatment of constipation-predominant IBS and works to increase enteric nervous system serotonin activity.So, increasing serotonin activity in the enteric nervous system produces increased bowel secretions and peristalsis (and potentially diarrhea), whereas depressing serotonin activity produces reduced secretions and reduce peristalsis (and potentially constipation). Increasing serotonin activity in the brain would increase awareness and, in higher doses, produce anxiety, insomnia and restlessness"They are also working to see if these receptors are malfunctioning and a lot of work has gone into it, from around the world.However, also to note is that the majority of IBSers presenting to gastroenterologists, have demonstrated effective serotonin dysregulation.Also to note is an increase in serotonin after eating in d predominate IBS."Levels of 5-Hydroxytryptamine Increase After Meals in Women With Irritable Bowel SyndromeNEW YORK Reuters Health May 05 - Platelet-depleted plasma 5-hydroxytryptamine 5-HT levels increase after meals in women with diarrhea-predominant irritable bowel syndrome d-IBS whose symptoms increase following food ingestion, according to a report in the May issue of Gut.In small studies, 5-HT concentrations in platelet-poor plasma appear higher in women with d-IBS than in healthy women, the authors explain, suggesting a possible link between 5-HT and postprandial symptom exacerbations or IBS itself.Dr. L. A. Houghton from University Hospital of South Manchester, UK and colleagues assessed 5-HT and 5-HIAA its metabolite concentrations, 5-HT turnover, and platelet 5-HT stores in 39 women with d-IBS and 20 healthy female volunteers before and after a standard carbohydrate meal.Although there was no difference in the ratio of postprandial to fasting 5-HT levels between d-IBS patients and healthy controls, the authors report, d-IBS subjects did have higher postprandial concentrations of 5-HT with earlier peak 5-HT levels than did healthy women.Women with d-IBS who reported symptoms following the meal also tended to have higher 5-HT concentrations and higher peak concentrations than did other women, the report indicates, though there was no difference in the time to peak levels compared with asymptomatic women with d-IBS.""Our results have shown for the first time that symptom exacerbation following meal ingestion in female subjects with d-IBS is associated with increased levels of plasma 5-HT, together with a reduction in 5-HT turnover," the authors conclude. "In addition, baseline platelet stores of 5-HT are elevated in female subjects with d-IBS compared with healthy subjects, supporting increased exposure of platelets to 5-HT in the systemic circulation.""Postprandial plasma 5-hydroxytryptamine in diarrhoea predominant irritable bowel syndrome: a pilot study http://gut.bmjjournals.com/cgi/content/full/42/1/42 There is way more research on serotonin and IBS and its implications however and although majorally implicated the jury is not out yet on all the specifics and IBS, other then they know it is implicated, there are still very important avenues of research still needed to be done. IBS is a very complex condition to research.


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## eric (Jul 8, 1999)

This is very complex infromation, but worth familarizing yourself with and there are some important graps to review on this page.Irritable Bowel Syndrome (IBS): Examining New Findings and TreatmentsAuthors: Marvin M. Schuster, MD; Michael D. Crowell, PhD; Nicholas J. Talley, MD, PhD"The Role of Serotonin in the Pathophysiology of IBSThe Brain-Gut InteractionThe enteric nervous system (ENS) functions semi-autonomously.[3] It acts directly upon effector systems such as smooth muscles, endocrine cells and blood vessels, facilitating serotonin (5-HT) -mediated secretion and motility. However, the parasympathetic and sympathetic nervous systems have a pivotal role in GI function through autonomic integrative processes that facilitate the brain-gut interaction. Neuronal interactions that involve numerous neurotransmitters (eg, 5-HT, norepinephrine [NE], dopamine [DA], acetylcholine [ACh], glutamate), neuropeptides (eg, substance P, vasointestinal peptide, calcitonin gene-related peptide [CGRP]), and other neuromodulators (eg, neurotrophic factors) occur in both the brain and the gut. Whereas short reflex pathways include a circuit of local and spinal cord neurons, long reflexes involve vagal and spinal pathways. Visceral pain information, for instance, traverses A-delta and C fibers and synapse in the dorsal horn of the spinal cord (specifically laminae I and II). The neural signal ascends through the contralateral spinothalamic tract to the brain where pain is perceived. The processing of pain information within the CNS varies between normal individuals and those with IBS. The CNS-processed information is sent to the effector through descending pathways traversing brainstem nuclei (eg, periaqueductal gray, raphï¿½ nucleus, and locus coeruleus) -- pathways that use 5-HT and NE.""Serotonin influences motility, visceral perception, and secretion in the gut. The pervasive role of 5-HT in normal and pathological GI conditions is apparent in its pattern of distribution -- 95% of 5-HT in the body is in the GI tract and approximately 5% is localized in the brain.[3] Serotonin is released primarily by enterochromaffin cells, but also by neuronal and mast cells." http://www.medscape.com/viewprogram/725_pnt Mentioned above are mast cells which are also connected to the HPA axis and immune system.I will come back to that however.


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## eric (Jul 8, 1999)

New news on serotonin which may at a later date have possible ramifications for IBS."UI sheds new light on behavior-affecting chemical By GREG KLINEï¿½ 2004 THE NEWS-GAZETTEPublished Online October 4, 2004 Serotonin plays a powerful role in the function of the brain and elsewhere in the body. When it's working properly, it makes us content or happy, scientists believe, while a glitch in the amount or processing of the chemical can stimulate depression, anxiety or aggressive behavior, even when they're unwarranted. "It's one of the central organizing factors in behavior," University of Illinois Professor Rhanor Gillette said recently. The illegal drug Ecstasy releases massive amounts of serotonin, making the user feel great, at the eventual cost of what amounts to overloading and burning out the cells in the area of the brain affected. Problems with serotonin also may contribute to sudden infant death syndrome, attention deficit hyperactivity disorder and irritable bowel syndrome, among other things." http://www.news-gazette.com/story.cfm?Number=16857


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## AlphaMale (Jan 21, 2004)

Eric I am little confused about serotonin blockers drugs like prozack and cipram(prozac does not have any effect on me while cipram does)Are such drugs recomended for IBS C, D or both?Thanks


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## Kathleen M. (Nov 16, 1999)

Antidepressants main target is not the two serotonin receptors that Lotronex and Zelnorm effect. (5-HT3 and 5-HT4...which speed up and slow down the gut specifically).The side effect profile for most of the antidepressants can cause diarrhea in some people and constipation in others. So most can be used for either one and it is hard to guess which one will effct any give person without a test run. Some seem more likely to go one way or the other, but there is individual variation even with those. Most of them will help regulate the pain issues that you find with any stool issue.K.


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## tmar89 (Apr 11, 2004)

I just spend an hour on this thread. Thanks for all the information, Eric. I've been going to CBT for over a month now and have tried Mike's HT CDs. I am also on Effexor. Hopefully this starts to help soon. I haven't noticed any difference yet with anything.


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## eric (Jul 8, 1999)

AlphaMale , Like K, said different drugs effect people differently, but some are more known to cause certain side effects perhaps.Also, like K said they can help block pain transmission, because serotonin is also used as a singaling transmitter for pain.There are also newer drugs being tested on some of these issues, that target stress hormones and a different approach. Although this study was preliminary, its results were promicing. There are others as well.Tmar, keep at it and its good your trying the CBT. IBS is still a physical problem and there can be issues that account for people taking longer for the HT or CBT to take effect. If you start getting more rleaxed as you go, try the tapes again at a later date, also.But importantly trying to learn this information and its effect on the gut, for normals even, but very importantly for IBS will help in a variety of ways, some of which I will keep posting about.However, these things do take time and a lot of persistence, dedication and focus on the IBSers part to keep at it and learn about it all. The it will start to help and a person will start feeling and seeing the connections. Part of this involveds moods states and the distress the condition causes in and of it self.CRH Antagonist Reduces IBS Responses to StressJune 30, 2004 ï¿½ Peripheral administration of the nonselective corticotropin-releasing hormone (CRH) antagonist α-helical CRH9-41 (αhCRH) improves gastrointestinal motility, visceral perception, and negative mood in response to gut stimulation without affecting the hypothalamo-pituitary-adrenal axis in patients with irritable bowel syndrome (IBS), according to the results of a preliminary study published in the July issue of Gut. ï¿½IBS is presumed to be a disorder of the brain-gut link associated with an exaggerated response to stress,ï¿½ write Y. Sagami, MD, and colleagues of the Department of Psychosomatic Medicine at the Tohoku University School of Medicine in Sendai, Japan. ï¿½CRH is considered to be a major mediator of stress responses in the brain-gut axis.ï¿½ The investigators enrolled 10 healthy subjects and 10 subjects diagnosed with diarrhea-predominant IBS according to the Rome II criteria. IBS medication was discontinued one week prior to the study. A barostat bag and three transducers were inserted into the proximal portion of the descending colon of each subject and connected to an analog-digital converter and a visceral stimulator. An electrode catheter was set in the rectum for electrical stimulation of the mucosa.The study was conducted in two segments, one using a 20-mL saline bolus followed by continuous infusion, and the other using a 2 ï¿½g/kg αhCRH bolus followed by 8 ï¿½g/kg continuous infusion. Both segments included baseline, rectal electrical stimulation, recovery, and tracking phases. Colonic tone was evaluated by noting the lowest volume in the barostat bag at which the subject felt pressure. Subjective symptoms were self-assessed by subjects on an ordinate scale.Basal bag volume tended to be lower in IBS subjects than controls, indicating higher colonic tone. Administration of αhCRH resulted in significantly increased baseline barostat bag volume in control subjects (from a mean standard error of the mean (SEM) of 105.8 30.5 mL to 148.3 37.4; P = .004) but not IBS subjects. IBS subjects responded to electrical stimulation with significantly decreased bag volume both in the first segment (P = .01) and after the αhCRH infusion (P = .004). Electrical stimulation did not reduce bag volume in the control subjects.ï¿½Colonic tone in IBS patients increased throughout our experiment and was even exaggerated by electrical stimulation of the rectum,ï¿½ the authors note. ï¿½The increased sensitivity of the gut to CRH in IBS patients may account for this phenomenon.ï¿½Motility indices of the colon induced by electrical stimulation were significantly higher in IBS patients compared with control subjects (mean SEM, 421.5 171.6 vs. 124.5 46.5; P = .04). This exaggerated motility response in IBS subjects was significantly attenuated by αhCRH (P .05).In IBS subjects, αhCRH significantly decreased evaluations of abdominal pain (P = .02) and anxiety (P< .0001) resulting from electrical stimulation.Administration of αhCRH had no inhibitory effects on the hypothalamo-pituitary-adrenal axis; levels of plasma adrenocorticotropic hormone and serum cortisol were not reduced. ï¿½Because of the small number of subjects included in the study, this initial clinical investigation warrants replication in a larger group of IBS patients and further assessment using a placebo control group,ï¿½ comments Y. Tachï¿½, MD, from the Digestive Diseases Research Center in Los Angeles, California, in an accompanying editorial, adding that the findings also support the testing of more potent CRH antagonists. The authors report no pertinent financial disclosures.Gut. 2004;53:919-921, 958-964


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## eric (Jul 8, 1999)

AlphaMale , Like K said different drugs effect people differently, but some are more known to cause certain side effects perhaps.Also, like K said they can help block pain transmission, because serotonin is also used as a singaling transmitter for pain.There are also newer drugs being tested on some of these issues, that target stress hormones and a different approach. Although this study was preliminary, its results were promicing. There are others as well.Tmar, keep at it and its good your trying the CBT. IBS is still a physical problem and there can be issues that account for people taking longer for the HT or CBT to take effect. If you start getting more rleaxed as you go, try the tapes again at a later date, also.But importantly trying to learn this information and its effect on the gut, for normals even, but very importantly for IBS will help in a variety of ways, some of which I will keep posting about.However, these things do take time and a lot of persistence, dedication and focus on the IBSers part to keep at it and learn about it all. The it will start to help and a person will start feeling and seeing the connections. Part of this involveds moods states and the distress the condition causes in and of it self.CRH Antagonist Reduces IBS Responses to StressJune 30, 2004 ï¿½ Peripheral administration of the nonselective corticotropin-releasing hormone (CRH) antagonist α-helical CRH9-41 (αhCRH) improves gastrointestinal motility, visceral perception, and negative mood in response to gut stimulation without affecting the hypothalamo-pituitary-adrenal axis in patients with irritable bowel syndrome (IBS), according to the results of a preliminary study published in the July issue of Gut. ï¿½IBS is presumed to be a disorder of the brain-gut link associated with an exaggerated response to stress,ï¿½ write Y. Sagami, MD, and colleagues of the Department of Psychosomatic Medicine at the Tohoku University School of Medicine in Sendai, Japan. ï¿½CRH is considered to be a major mediator of stress responses in the brain-gut axis.ï¿½ The investigators enrolled 10 healthy subjects and 10 subjects diagnosed with diarrhea-predominant IBS according to the Rome II criteria. IBS medication was discontinued one week prior to the study. A barostat bag and three transducers were inserted into the proximal portion of the descending colon of each subject and connected to an analog-digital converter and a visceral stimulator. An electrode catheter was set in the rectum for electrical stimulation of the mucosa.The study was conducted in two segments, one using a 20-mL saline bolus followed by continuous infusion, and the other using a 2 ï¿½g/kg αhCRH bolus followed by 8 ï¿½g/kg continuous infusion. Both segments included baseline, rectal electrical stimulation, recovery, and tracking phases. Colonic tone was evaluated by noting the lowest volume in the barostat bag at which the subject felt pressure. Subjective symptoms were self-assessed by subjects on an ordinate scale.Basal bag volume tended to be lower in IBS subjects than controls, indicating higher colonic tone. Administration of αhCRH resulted in significantly increased baseline barostat bag volume in control subjects (from a mean standard error of the mean (SEM) of 105.8 30.5 mL to 148.3 37.4; P = .004) but not IBS subjects. IBS subjects responded to electrical stimulation with significantly decreased bag volume both in the first segment (P = .01) and after the αhCRH infusion (P = .004). Electrical stimulation did not reduce bag volume in the control subjects.ï¿½Colonic tone in IBS patients increased throughout our experiment and was even exaggerated by electrical stimulation of the rectum,ï¿½ the authors note. ï¿½The increased sensitivity of the gut to CRH in IBS patients may account for this phenomenon.ï¿½Motility indices of the colon induced by electrical stimulation were significantly higher in IBS patients compared with control subjects (mean SEM, 421.5 171.6 vs. 124.5 46.5; P = .04). This exaggerated motility response in IBS subjects was significantly attenuated by αhCRH (P .05).In IBS subjects, αhCRH significantly decreased evaluations of abdominal pain (P = .02) and anxiety (P< .0001) resulting from electrical stimulation.Administration of αhCRH had no inhibitory effects on the hypothalamo-pituitary-adrenal axis; levels of plasma adrenocorticotropic hormone and serum cortisol were not reduced. ï¿½Because of the small number of subjects included in the study, this initial clinical investigation warrants replication in a larger group of IBS patients and further assessment using a placebo control group,ï¿½ comments Y. Tachï¿½, MD, from the Digestive Diseases Research Center in Los Angeles, California, in an accompanying editorial, adding that the findings also support the testing of more potent CRH antagonists. The authors report no pertinent financial disclosures.Gut. 2004;53:919-921, 958-964


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## eric (Jul 8, 1999)

sorry about the double post.


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## eric (Jul 8, 1999)

It should be noted, that regardless of how complex all this is, some basic approaches really make a huge difference in IBS symptoms for the vast majority of IBSers.Its not needed to understand this all in serious depth, although that helps too, but to just learn the basics.This is on the bigger picture of IBS and IBS research in general, it is quite in depth. And actually save me some time.







Irritable Bowel Syndrome: Taking Concepts Into Clinical Practice Chairperson: Michael D. Gershon, MD; Faculty: Kevin W. Olden, MD; Walter L. Peterson, MD; Nicholas J. Talley, MD, PhD; Gervais Tougas, MD, CM, FRCPCCopyright ï¿½ 2002 CME Consultants, Inc.This CME activity is based on transcripts and slides of presentations as delivered by the faculty at the "Irritable Bowel Syndrome: Taking Concepts Into Clinical Practice" symposium held at the Palace Hotel in San Francisco, California on May 20, 2002. http://www.medscape.com/viewprogram/1985_pnt


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## eric (Jul 8, 1999)

bump


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## eric (Jul 8, 1999)

You often see cortisol or ACTH or Histimine and other stress hormones in IBS research and IBS education. This helps even more to explain what I have been talking about on this thread and how very important it is in IBS and psycophysiological brain gut intereactions.MayoStress: Why you have it and how it hurts your health"Often referred to as the "fight-or-flight" reaction, the stress response occurs automatically when you feel threatened. Your pituitary gland, located at the base of your brain, responds to a perceived threat by stepping up its release of adrenocorticotropic hormone (ACTH), which signals other glands to produce additional hormones. When the pituitary sends out a burst of ACTH, it's like an alarm system going off deep in your brain. This alarm tells your adrenal glands, situated atop your kidneys, to release a flood of stress hormones into your bloodstream. These hormones ï¿½ including cortisol and adrenaline ï¿½ focus your concentration, speed your reaction time, and increase your strength and agility. How stress affects your body After you've fought, fled or otherwise escaped your stressful situation, the levels of cortisol and adrenaline in your bloodstream decline. As a result, your heart rate and blood pressure return to normal and your digestion and metabolism resume a regular pace. But if stressful situations pile up one after another, your body has no chance to recover. This long-term activation of the stress-response system can disrupt almost all your body's processes, increasing your risk of obesity, insomnia, digestive complaints, heart disease and depression.Digestive system. It's common to have a stomachache or diarrhea when you're stressed. This happens because stress hormones slow the release of stomach acid and the emptying of the stomach. The same hormones also stimulate the colon, which speeds the passage of its contents. Chronic stress can also lead to continuously high levels of cortisol. This hormone can increase appetite and cause weight gain. Immune system. Chronic stress tends to dampen your immune system, making you more susceptible to colds and other infections. Typically, your immune system responds to infection by releasing several substances that cause inflammation. In response, the adrenal glands produce cortisol, which switches off the immune and inflammatory responses once the infection is cleared. However, prolonged stress keeps your cortisol levels continuously elevated, so your immune system remains suppressed. In some cases, stress can have the opposite effect, making your immune system overactive. The result is an increased risk of autoimmune diseases, in which your immune system attacks your body's own cells. Stress can also worsen the symptoms of autoimmune diseases. For example, stress is one of the triggers for the sporadic flare-ups of symptoms in lupus.Nervous system. If your fight-or-flight response never shuts off, stress hormones produce persistent feelings of anxiety, helplessness and impending doom. Oversensitivity to stress has been linked with severe depression, possibly because depressed people have a harder time adapting to the negative effects of cortisol. The byproducts of cortisol act as sedatives, which contribute to the overall feeling of depression. Excessive amounts of cortisol can cause sleep disturbances, loss of sex drive and loss of appetite. Cardiovascular system. High levels of cortisol can also raise your heart rate and increase your blood pressure and blood lipid (cholesterol and triglyceride) levels. These are risk factors for both heart attacks and strokes. Cortisol levels also appear to play a role in the accumulation of abdominal fat, which gives some people an "apple" shape. People with apple body shapes have a higher risk of heart disease and diabetes than do people with "pear" body shapes, where weight is more concentrated in the hips. Other systems. Stress worsens many skin conditions ï¿½ such as psoriasis, eczema, hives and acne ï¿½ and can be a trigger for asthma attacks." http://www.mayoclinic.com/invoke.cfm?objec...C10563A6FFB68E8


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## eric (Jul 8, 1999)

IBS ï¿½ Beyond the Bowel:The Meaning of Co-existing Medical ProblemsOlafur S. Palsson, Psy.D. and William E. Whitehead, Ph.D.UNC Center for Functional GI & Motility DisordersSYMPTOMS ALL OVER THE BODY IN IBSSeveral research reports have established that IBS patients report non-bowel symptomsmore frequently than other GI patients and general medical patients. For example, fourstudies that have asked IBS patients about a wide variety of body symptoms(1-4) all foundheadaches (reported by 23-45% of IBS patients), back pain (28-81%), and frequenturination (20-56%) to be unusually common in individuals with IBS compared to otherpeople. Fatigue (36-63%) and bad breath or unpleasant taste in the mouth (16-63%) werefound in three of these four studies to be more common among IBS patients, as well.Furthermore, a large number of other symptoms have been reported to occur withunusually high frequency in single studies. In our recent systematic review of the medicalliterature(5), we found a total 26 different symptoms, listed in Table 1, that are reported tobe more common in IBS patients than comparison groups in at least one study.Table 1. Non-gastrointestinal symptoms more common in irritable bowel syndromepatients than in comparison groups(5).1. Headache2. Dizziness3. Heart palpitations or racing heart4. Back pain5. Shortness of breath6. Muscle ache7. Frequent urinating8. Difficulty urinating9. Sensitivity to heat or cold10. Constant tiredness11. Pain during intercourse (sex)12. Trembling hands13. Sleeping difficulties14. Bad breath/unpleasant taste inmouth15. Grinding your teeth16. Jaw pain17. Flushing of your face and neck18. Dry mouth19. Weak or wobbly legs20. Scratchy throat21. Tightness or pressure in chest22. Low sex drive23. Poor appetite24. Eye pain25. Stiff muscles26. Eye twitching http://www.med.unc.edu/medicine/fgidc/beyond_the_bowel.htm See any similarities?


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## eric (Jul 8, 1999)

The nervous system as a whole is divided into two parts.The Central Nervous System and the Peripheral Nervous System.The central nervous system is the brain and the spinal cord.The Peripheral Nervous system.The peripheral nervous system is divided into two major parts: the somatic nervous system and the autonomic nervous system.1. Somatic Nervous SystemThe somatic nervous system consists of peripheral nerve fibers that send sensory information to the central nervous system AND motor nerve fibers that project to skeletal muscle.2. Autonomic Nervous SystemThe autonomic nervous system is divided into three parts: the sympathetic nervous system, the parasympathetic nervous system and the enteric nervous system. The autonomic nervous system controls smooth muscle of the viscera (internal organs) and glands. Okay so the "brain in the gut" is called the enteric nervous system. This system runs autonomically under the control of the autonomic nervous system. You don't have to conciously think about digesting your food, its done autonomically, like breathing and heart rate, etc., because these systems are under control of the autonomic nervous system.I will come back to this a little more later, because there are important implications here and IBS.But"The enteric nervous system detects bowel distension (expansion) on the basis of pressure-sensitive cells in the bowel lumen (opening). Once activated, these pressure-sensitive cells promote the release of serotonin, which in turn promotes both secretory function and peristaltic function (the contractions of the intestines that force the contents outward). At least four serotonergic receptors have been identified to be participants in the secretory and peristaltic response."So when the bowel is distended, it releases serotonin to start contractions. However, it is also major in sending information about sensations in the gut to the brain.


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## eric (Jul 8, 1999)

Stomach Noises."Sarah, a 21 year old student, who was diagnosed with IBS, tell the story of her struggle with the condition. The wrong lesson I taught myself in the lecture room It was almost 11 o'clock on a Monday morning of March 1994. I was on my way to a Research Methods lecture, totally unaware that my first encounter with IBS lay shortly ahead.Probably the only clue was this odd feeling in my stomach; it was this hollow kind of nausea & a really strange, uncomfortable sensation that I had never experienced before. It made me feel uneasy. Thinking that it would pass, I decided that I would go ahead and sit through the lecture. But within a few minutes, I was left wishing I had never entered the room.Shortly after the lecture began, my stomach started making strange, loud noises. Wind was pioneering up and down my stomach like a rollercoaster, but far more critically for me, people could actually hear it doing so. Somebody sniggered behind me. And from that moment on, all I registered was humiliation. I felt trapped, out of control and totally isolated. With each noise that my stomach made, I became more and more terrified. Eventually, when I felt I could cope no longer, I left the lecture room." http://www.surgerydoor.co.uk/livingwith/de...l2=Case%20Study


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## eric (Jul 8, 1999)

Has not been much responce to this thread, but am going to keep the information flowing on all this, because its all part of IBS.The autonomic nervous system."To summarize:Thoughts and even subtle emotions influence the activity and balance of the autonomic nervous system (ANS).The ANS interacts with our digestive, cardiovascular,immune and hormonal systems and is therefore ideally suited to translate mind states into organ functions/dysfunctions Negative reactions create disorder and imbalance in the ANS. Positive feelings such as appreciation and a state of relaxation create increased order and balance in the ANS, resulting in increased hormonal and immune system balance and more efficient brain function. It has been shown in a number of studies that during mental or emotional stress and physical stress, there is an increase in sympathetic activity and a decrease in parasympathetic activity. This results in increased strain on the heart as well as on the immune and hormonal systems. Increased sympathetic activity is associated with a lower ventricular fibrillation threshold and an increased risk of fibrillation, in contrast to increased parasympathetic activity, which protects the heart." http://www.cns.med.ucla.edu/Articles/Patie...icleSm02ANS.htm


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## eric (Jul 8, 1999)

"How does stress affect gastrointestinal problems?A person with a gastrointestinal disease or disorder is vulnerable to the effects of anxiety specifically in the area of their existing illness. Stress may also increase the experience of pain, aggravate the disease process, and interfere with healing. *We should note that research has not shown emotional stress to cause structural problems in the gastrointestinal system, however, one study has found changes to the bowel mucosal lining in people who had experienced many stressful events during the preceding year.* While stress does not causes gastrointestinal problems, it can make existing conditions worse.As mentioned, our bodies respond to sudden crisis situations by going into the fight-or-flight state - sometimes called a red alert state - in which we are ready to take action to deal with a potential threat. Physical changes of this response also include a shift of blood flow away from the digestive system in addition to the increased muscle tension and immune system suppression. It is these changes that are significant to people with gastrointestinal conditions.An individual who is not able to handle difficult situations effectively may perpetually remain in the red alert state. The body is being maintained in an over-activated condition, thus disrupting the body's normal operation, including that of the digestive system. " http://www.badgut.com/index.php?contentFil...ss%20Management This study was very important and more studies have been done since then. It is one of the inlfammatory cells seen in IBS that can contribute to pain and is connected to irritable bladder and food sensitivies and histimine as well as why some people develop IBS after an enteric infection, from a bacteria, parasite and now maybe possible a virual infection in the gut.


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## eric (Jul 8, 1999)

and why I am in part posting this thread and how strongly I believe the importance of it all is in brain gut axis dysregulations.FYIDiagnosis, Pathophysiology, and Treatment of Irritable Bowel Syndrome "Pathophysiology of IBSThe pathophysiology of IBS is a work in progress. Roughly 200 years after its initial description by the English physician William Powell, our understanding of what causes IBS symptoms remains incompletely understood. For most of the second half of the 20th century, tremendous attention was paid to the concept of altered gut motility as a cause of IBS symptoms.20 However, several difficulties are apparent in this approach. First, although altered motility of the colon and small bowel can be demonstrated in patients with IBS, there is a very poor correlation between IBS symptomatology and the presence of alterations in gastrointestinal motility. 21 Likewise, drugs that alter gastrointestinal motility alone, such as antispasmodic22,23 and prokinetic drugs like metoclopramide and cisapride,24,25 have not been shown to be of any significant benefit in relieving IBS symptoms. The third dilemma facing investigators in this area is that no pathognomonic pattern of gut dysmotility can be identified specifically with IBS, as opposed to other functional or organic disorders of the gut.20 Altered motility, as occurs in IBS, is currently seen as one of many epiphenomena associated with the disorder, as opposed to being a cause of the disorder itself. In the early 1980s, it was discovered that upon balloon distention in the rectum, individuals suffering from IBS were more sensitive to distention than were individuals who did not suffer from IBS.26 This means that IBS patients feel discomfort at lower levels of balloon inflation in the rectum and lower bowel than do normal controls. This finding has been replicated in numerous studies, and the concept of "visceral" hypersensitivity has been established.27 A second level of investigation in this area is the fascinating finding that individuals with IBS not only have a unique local response (in the rectum) to visceral stimulation, but they also tend to process signals in the brain differently from non-IBS controls. Mertz and others[27] have shown that IBS patients have differential responses in the anterior cingulate cortex and other areas of the brain when stimulated with rectal or sigmoid colon distention, compared with controls. These findings have been replicated by other investigators.28 These data certainly suggest the possibility of a "brain-gut axis" where peripheral symptoms are processed in the end organ (ie, the colon), and then neural signals are carried via visceral afferents to the spinal cord, and then to the brain, where they are subject to additional processing. 29 It is this brain-gut axis that has received considerable attention recently in IBS research. The findings of enhanced visceral sensitivity in the colon and rectum, as well as altered processing of signals in the brain, have provided new insight. Regarding the pathophysiology of IBS, the altered processing of neural sensation in IBS patients logically raises the question as to which neurotransmitters play a role in this abnormal signal transmission." http://www.cfids-cab.org/cfs-inform/Ibs/ibs.medscape03.htm


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## eric (Jul 8, 1999)

Still to make this clear as a bell, IBS is not caused by stress or anxiety or depression. It can however contribute and recent research has shown ways in can and does matter in IBS, in pain and in symptoms and even in physiological changes in the gut.However."although this is on depression, there are very clear known connections on anxiety, stress, depression and pain and also bowel symptoms.Not ony that but a major implicator player in IBS is serotonin, again which the majority of is stored in the gut.The Pain-Depression Conundrum: Bridging the Body and Mind "IntroductionPain and depression seem to go hand in hand. What person with intractable pain would not, understandably, be depressed? Yet the relationship of these conditions is complex and unpredictable. Indeed, people in pain are not invariably depressed, although approximately one third of patients with pain do experience comorbid depression. By contrast, three fourths of those with depression will present with physical symptoms, including pain. Certainly, individuals with pain-related disorders are at risk for depression.1-6 In fact, some research suggests that pain can be the best indicator of depression, especially among the elderly.7 A number of studies also suggest that depression can augment the impairment associated with pain. In a 24-month study of 228 elderly patients with depression or pain living in retirement communities,8 Mossey and colleagues9 evaluated the severity of depression and pain and their impact on functional activity. Initially, almost 50% of the patients who did not suffer depression reported limitations associated with their pain. Over the course of 2 years, however, people who began experiencing depressive symptoms also began reporting more impairment associated with the pain. In addition, high levels of depression were consistently associated with high levels of pain-associated impairment, and in the presence of pain, even low levels of depression were associated with increased healthcare utilization.10The relationship between pain and depression clearly is complex and still emerging. *Recent research shows that serotonin and norepinephrine may modulate pain as well as mood. * Understanding the shared pathophysiology of these phenomena will help clinicians to manage both conditions and ultimately help their patients to achieve remission. This Clinical Update will detail the epidemiologic, neurobiologic, and pharmacologic correlates of pain and depression. "Pain and Depression in Primary CarePainful or uncomfortable physical symptoms are among the most common reasons individuals seek medical care. In a recent study, 107 HMO participants were asked to record all symptoms they experienced during a given 3-week period.11 The results revealed that each person experienced at least 1 symptom, including backache, headache, or stomach pain, every 3-4 days. Yet patients reported less than 6% of these problems to a physician.When and why, then, do people bring their aches and pains to the doctor? Evidence suggests that people seek out medical care when symptoms become worrisome, interfere with their daily lives, or are disabling. In addition, studies show that when depression, anxiety, panic, or other psychiatric conditions are present, symptoms are more likely to reach this threshold.12-17 In fact, persons who seek healthcare for fatigue, migraine headaches, and gastrointestinal complaints experience more stressful life events, more distress, and are more likely to have an anxiety or depressive disorder than are those who do not seek care.18,19 Several studies of irritable bowel syndrome (IBS) poignantly demonstrate the role of psychiatric disorders in healthcare-seeking behavior for corporeal aches and pains. Drossman and colleagues14-16 studied 72 patients with IBS who sought medical care, 82 persons with IBS who had not sought medical care, and 84 healthy subjects. They found that patients with IBS who seek care and those with IBS who do not seek care experience the same symptoms. However, IBS patients who seek help from a physician are significantly more likely to have psychiatric disorders, abnormal personality patterns, and more life stress. In fact, evidence suggests that half of all high medical care users are psychologically distressed. What specific psychiatric disorders are most common among this group? According to a study by Katon and colleagues,12 40% have depressive disorders, 22% have generalized anxiety disorder, 20% have somatization disorders, 12% have panic disorder, and 5% are alcohol abusers.Statistics on the relationship between specific common physical symptoms and psychiatric disorders in primary care patients illustrate the pervasiveness of this comorbidity. Kroenke and colleagues17 found that the presence of any physical symptom increased the likelihood of a diagnosis of a mood or anxiety disorder by as much as 3-fold. Furthermore, 34% of patients with joint or limb pain, 38% of patients with back pain, 40% of patients with headache, 46% of patients with chest pain, and 43% of patients with abdominal pain also had a mood disorder. While psychological problems may be prevalent among high healthcare users, what specific symptoms prompt most patients to seek out medical care? Physical symptoms account for half of all primary care physician visits.20 And while physical symptoms restrict the activities of Americans an average of 9.7 days annually, most of these physical manifestations are never explained by a disease or injury (Figures 1, 2). " http://www.medscape.com/viewarticle/441743_2


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## eric (Jul 8, 1999)

serotonin and foods. http://www.ibsgroup.org/cgi-local/ubbcgi/u...1039;p=0&r=actu


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## veggiemuffin (Nov 24, 2004)

I've felt that is my problem for a long time. My problem started about 10 years ago when I had a stressful job and I'd always have to stop on the way to work to go to the bathroom. It wasn't easy to get off the highway and I'd often be late to work as a result, making me even more anxious. I also learned to carry extra underwear with me in case I had an accident when I couldn't make it to the restroom. My problem is only in the morning. I guess I should try to have only 2nd shift jobs. Now I usually work from home so don't have a problem but I will be having to drive to work in February and I'm feeling nervous about it. It will be a 1 hour drive on the highway and I'm already thinking where the restrooms are. I'll have to leave extra early, of course.Is there any solution for this - short of wearing a diaper, I mean?


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## veggiemuffin (Nov 24, 2004)

I also forgot to mention in my previous post that I have come up with a way to help myself during long drives in the morning. I do a kind of meditation. I slowly breathe in and out while counting my breaths up to ten. Then I start over. It relaxes me and keeps the nervous thoughts away and I can often make it to work without any stops if I do it well. It's hard to keep other thoughts away (just like in meditation) but just go back to counting. It does help me.


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## tmar89 (Apr 11, 2004)

I reread this post from time to time and I was happy to see it bumped again. This is by far one of the most valuable posts here if you consider your IBS related to your mind and anxiety like I do. Thanks, eric!


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## eric (Jul 8, 1999)

Your welcome Tamar, keep reading.







This doesn't come easy, it takes a while to learn these things for sure, but well worth it. Also the more you read it the more it starts making sense and the easier it all is to read.Welcome veggiemuffin You might want to read this thread. http://www.ibsgroup.org/ubb/ultimatebb.php...c;f=11;t=000017


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## eric (Jul 8, 1999)

Not sure if I put this here yet really.IBS ï¿½ Beyond the Bowel:The Meaning of Co-existing Medical Problems http://www.ibsgroup.org/ubb/ultimatebb.php...c;f=10;t=001032


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## mxwe (Apr 7, 2002)

Veggiemuffun,The best advice I ever saw on driving and IBS is to buy a custom van with a bathroom in it. This is extreme, but there has been a many of tome I wished I had one.


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## nnaiden (Nov 19, 2004)

What a wealth of information! Thank you!I am a psychologist, and can speak to that a little. When you go to a psychologist all they can do is help you learn what you may do to heal yourself - sessions with a psych only go as far as the individual takes it. And that said not all psych's are equal by any means. Some are gifted, extraordinary people who push clients to get better and challenge you - they also use all the therapies around from REMD to biofeedback referrals to mediation practice. Meditation is not head stuff in the old sense of the phrase. Head stuff IS body stuff. With enough meditation you effect something known as 'the relaxation response' which can affect your whole body positively, not to mention your life. Yoga can do the same thing when you practice regularly. This is quite different from the response people get from excercise, but every bit as remarkable.Medicine can only take us so far, even with a serotonin related problem in gut neurons there is much you can do to mediate your own biochemistry. But it takes daily practice, a strong will to get better, and a willingness to confront yourself on your own beliefs and practices. Not for everyone. But for those who want to take the time it can sure help! Thanks


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## eric (Jul 8, 1999)

Hope welcome and glad to have you posting. You talked about medittation. Have you ever seen this?"The Dalai Lama came over here from Tibet to be Pet scan on meditation and the brain."In a rare convergence of spirituality and science, the Dalai Lama and a handful of Western neuroscientists met this week at the university to discuss ways in which they can collaborate to conduct research on meditation.""The scientists sought the Dalai Lama's ideas on studying meditation, the central practice of Buddhism for 2,500 years."Our scientific lives have been deeply affected by these interactions with His Holiness," says Richard Davidson, director of the Keck Laboratory for Functional Brain Imaging and Behavior and UW professor of psychology. "This dialog has motivated us to vigorously pursue research on contemplative practice because we believe it can be beneficial. We hope eventually to take techniques involved in various kinds of meditation out of their Buddhist context and apply them to secular training that may improve mental and physical health."Buddhism essentially has the same goal, the Dalai Lama says."All human beings have an innate desire to overcome suffering, to find happiness. Training the mind to think differently, through meditation, is one important way to avoid suffering and be happy," he says.""The Dalai Lama says he has shunned the warnings of others who fear that science is the killer of religion. Going his own way, as the Buddha advised, His Holiness says he sees many benefits in science."I have great respect for science, " he says. "But scientists, on their own, cannot prove nirvana. Science shows us that there are practices that can make a difference between a happy life and a miserable life. A real understanding of the true nature of the mind can only be gained through meditation."" http://www.news.wisc.edu/story.php?get=6205 Listening to the Dalai Lama and other monks, it seemed clear that the single superpower idea is deeply rooted in individual psychology. Buddhist psychology sees each of us as susceptible to a number of mental afflictions including, among other things, excessive will to control, expressed as "grasping." We lust for power. We want to make ourselves feel safe by exerting control over the world. The problem is that our desire for power often leaves us more powerless, because in grasping we tend to interfer with natural processes of individual and community growth and development.Western psychology is far behind the Buddhists, in my view. Yet there were some interesting research findings discussed at the conference. My favorite psychologist was Richard Davidson from the University of Wisconsin. Working with senior monks, he finds their minds function very differently from those of non-meditators. For example he has used PET scans and MRIs to demonstrate that in experienced meditators the brain areas associated with joy and pleasure are dramatically more active than in non-meditators. He is also carrying out studies that show that short periods of non-religious mediation carried out by beginners over a few months have significantly positive effects on both brain and immune system function. http://blogs.law.harvard.edu/jim/discuss/m...$246?mode=topic Also many of us have used clinical gut directed hypnotherapy. You might be nterested in that, its a very specific gut focused HT for IBS.Hypnotherapy for Functional Gastrointestinal Disorders By: Peter J. Whorwell, M.D., University Hospital of South Manchester, England http://www.aboutibs.org/Publications/hypnosis.html Hypnosis Treatment of Irritable Bowel Syndrome By: Olafur S. Palsson, Psy.D., Research Associate, Department of Medicine, University of North Carolina at Chapel Hill http://www.aboutibs.org/Publications/HypnosisPalsson.html http://www.ibshypnosis.com/index.html


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## eric (Jul 8, 1999)

FYI""Every time you are tempted to react in the same old ways, ask if you want to be a prisoner of the past or a pioneer of the future. The past is closed and limited; the future is open and free."Deepak Chopra


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## eric (Jul 8, 1999)

"Your Digestive System and How It WorksFrom NIH Publication No. 04-2681, May 2004 " http://www.iffgd.org/Publications/DigestiveSystem.html The Psychosocial Adjustment to Illness in Irritable Bowel Syndrome http://www.giresearch.org/Dumitrascu.html Stigma and Personal Health Challenges: A Commitment to ChangeBy: Nancy J. Norton, President and Founder, IFFGD, Milwaukee, WI "Based on the text of a presentation given by Ms. Norton at an international meeting sponsored by The Simon Foundation, entitled "Stigma in Healthcare" held in Chicago, IL on June 26-27, 2003.I have been asked to discuss the topic of stigma and personal health challenges. I would like to frame my presentation as more of a case study around the stigma associated with bowel disorders - in particular irritable bowel syndrome (IBS) and incontinence - and how to move towards change. The following quote from a book by Michael Gershon, M.D. regarding "the call to stool" is quite revealing about our society when it comes to continence. http://www.aboutibs.org/Publications/Stigma.html


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## SpAsMaN* (May 11, 2002)

AGAIN and wow!""Every time you are tempted to react in the same old ways, ask if you want to be a prisoner of the past or a pioneer of the future. The past is closed and limited; the future is open and free."So well said!


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## eric (Jul 8, 1999)

Gastroenterology. 2004 Dec;127(6):1695-703. Related Articles, Links Effect of acute physical and psychological stress on gut autonomic innervation in irritable bowel syndrome.Murray CD, Flynn J, Ratcliffe L, Jacyna MR, Kamm MA, Emmanuel AV.St. Mark's Hospital, Harrow, Middlesex HA1 3UJ, England.BACKGROUND & AIMS: Stress is an important causative factor in irritable bowel syndrome (IBS). It remains unknown whether stress-related changes in gut function are mediated by altered autonomic efferent gut-specific innervation. We studied the effect of acute physical and psychological stress on autonomic innervation and visceral sensitivity in healthy volunteers and patients with IBS. METHODS: Twenty-four patients (20 women) with constipation-predominant IBS and 12 healthy volunteers (8 women) underwent either physical (cold water hand immersion) or psychological (dichotomous listening) stress on separate occasions. Assessments included stress perception (visual analogue scale), gut-specific autonomic innervation (rectal mucosal blood flow [RMBF] by laser Doppler flowmetry), and viscerosomatic sensitivity (anal and rectal electrosensitivity). RESULTS: Patients with IBS had a heightened baseline perception of stress (P .01). RMBF decreased during physical stress (29.6% +/- 2.8% and 28.7% +/- 3.9%) and psychological stress (24.4% +/- 2.1% and 23.5% +/- 4.3%) in patients with IBS and controls, respectively (mean +/- SEM). During physical stress, rectal perception (23.2% +/- 6% vs .6% +/- 3% [IBS vs control group, P .05]) and rectal pain thresholds (27.0% +/- 4% vs 1.3% +/- 5%, P < .001) decreased in patients with IBS only. Psychological stress reduced thresholds for rectal perception (19.4% +/- 6% vs 8% +/- 6%, P .01) and rectal pain (28.4% +/- 4% vs 3.4% +/- 3.8%, P .001) in patients with IBS only. Acute stress elevated anal perception thresholds in patients with IBS but not controls (physical stress: 14.7% +/- 14% vs -9.3% +/- 11%, P .05; psychological stress: 24.7% +/- 9% vs 11% +/- 11%, P .05). CONCLUSIONS: Acute stress alters gut-specific efferent autonomic innervation in both controls and patients with IBS, although normalization is delayed in IBS. By contrast, only patients with IBS show heightened visceral sensation, suggesting involvement of a different regulatory mechanism, either central or peripheral.PMID: 15578507


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## marta (Jul 14, 2001)

Hi, I'm always very concerned about passing wind inadvertitely and smelling. Recently I have asked friends and family if I smell. Everybody sayd I don't. Somebody has also suggested for me to see a psychiatrist because I hear "smell" or "disgusting" in the street or at work. The psychiatrist thinks I suffer from hallucinations and is trying to convince me that I don't smell. I belive that most of what he is saying about me is correct and I have no doubts that after suffuring from IBS for such a long time my brain is so conditioned that I missinterpret thinks. I also believe that my friends are telling me the true but I still have some doubts. I am confused.


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## eric (Jul 8, 1999)

What is the psychiatrist working with you on?Did you go to them specifically for IBS?Does he/she use any forms of CBT?Barbara Bradley Bolen, Ph.D.bbolen###optonline.netSeptember 5, 2002COGNITIVE BEHAVIORAL THERAPY FOR IRRITABLE BOWEL SYNDROMEThere is an old saying that if you give a child a fish, you feed that child for a day, but if you teach a child to fish, they are fed for a lifetime. In accordance with this old proverb, Cognitive behavioral therapy (CBT) is a form of psychotherapy that strives to actively teach people skills and strategies that they can use to help themselves feel better. A considerable amount of research indicates that CBT is effective in helping to reduce the symptoms of Irritable Bowel Syndrome.Many people wonder how psychotherapy can help IBS if IBS is a physical disorder. One of the major triggers that can set off or exacerbate IBS is stress. In addition, IBS is a very stressful disorder to live with. CBT provides an individual with tools for combating stress, reducing the anxiety response and thus calming the GI system.The cognitive therapy part of CBT helps individuals to identify, challenge and replace unhealthy thought patterns. When we are thinking clearly, we are able to deal with the world in a calm, rational manner. However, our thinking often gets distorted, due to our personalities, our past history, our emotional state or lack of information. When thinking gets distorted it can lead to excessive emotional reactions. For an individual with IBS, these thought distortions may lead to an anxiety response that can trigger symptoms. For example, if a person with IBS thinks ï¿½My stomach is rumbling. Uh, oh! I know I am going to be sick. What is I canï¿½t make it to the bathroom? This is terrible!ï¿½, that person is going to experience anxiety and perhaps set off the very symptoms they are afraid of. If instead, the person thinks, ï¿½Just because my stomach is making some noise does not necessarily mean I am going to have symptoms. I will just focus on what I am doing and see what happensï¿½, that person will remain calm and be less likely to stimulate their digestive system.The behavioral aspect of CBT involves skill training. Relaxation techniques, including deep breathing skills and progressive muscle relaxation, help the individual to reduce the physiological symptoms of anxiety. An anxiety reaction can be likened to a home security alarm. Relaxation techniques send the message to the body that there is no emergency and that the alarm can be shut off. CBT for IBS may also include skill training in assertion and anger management, as research has shown that IBS patients often have difficulty in these areas.IBS can wreak havoc on a personï¿½s quality of life. CBT helps IBS sufferers to regain a sense of control over their life. With the skills gained in CBT, one no longer needs to be a passive victim of this disruptive disorder, but can now actively use strategies which are effective in reducing the frequency, intensity and duration of IBS symptoms. Barbara Bradley Bolen, Ph.D.bbolen###optonline.netAuthor of:Breaking the Bonds of Irritable Bowel SyndromeNew Harbinger Publications (2000)


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## eric (Jul 8, 1999)

Mayo Clinic in RochesterFriday, December 10, 2004Gastrointestinal Disorders Are Associated Significantly With Sleepless NightsIrritable bowel syndrome, frequent indigestion common in people with insomnia ROCHESTER, Minn. -- Mayo Clinic researchers report in the current issue of Mayo Clinic Proceedings an association between gastrointestinal disorders and sleep disturbances. The association is important because these problems cause significant health issues including greater need for general medical and mental health treatment. Itï¿½s estimated that nearly one-half of American adults experience one or more symptoms that indicate sleep disturbances or insomnia, at least a few nights a week. The authors of the study note that this is the first population-based study, to their knowledge, that assesses the association between sleep disturbances and irritable bowel syndrome, frequent indigestion and frequent heartburn. In the past, studies have reviewed patients, not the general population. Assessing the general population helps physicians better understand an overall cause-and-effect relationship between the various problems. The researchers looked at the responses to a detailed questionnaire (previously tested and found to be reliable) from 2,269 people. After they adjusted their findings for age, sex and other factors, they determined that irritable bowel syndrome was significantly more common in people with sleep disturbances than those without sleep disturbances. Itï¿½s uncertain whether GI disturbances and sleep disturbances cause one another or they are caused by another underlying problem. ï¿½We think the findings will generate further research to understand the interactions between emotional or psychological distress and sleep disturbances and GI disturbances,ï¿½ says Santhi Swaroop Vege, M.D., a Mayo Clinic physician and lead author of the study. The National Sleep Foundation has defined insomnia as any of the following: difficulty falling asleep, waking a lot during the night, waking too early with inability to get back to sleep or waking up feeling tired. Using this broad definition, the 2003 Sleep in America poll, which included 1,506 adults ages 55 to 84 from various parts of the United States, found a prevalence of insomnia in 48 percent. Researchers who co-authored this report are: G. Richard Locke III, M.D., Amy Weaver, Sara Farmer, L. Joseph Melton III, M.D., and Nicholas Talley, M.D., Ph.D. A peer-review journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by the Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 75 years and has a circulation of 130,000 nationally and internationally. Copies of the articles are available on-line at www.mayo.edu/proceedings. http://www.mayoclinic.org/news2004-rst/2538.html


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## marta (Jul 14, 2001)

Thanks EricI hear voices. People in the street and at work say that I smell. My friends and family say that I don't. The psychiatrist thinks that I suffer from hallucinations. My explanation for the smell is that I pass wind without noticing. Other people on this BB are in the same situation(see the pain/wind forum). Also in their case family and friends assure them they don't smell. I'm worried about my mental health and I'm confused. I'm seeing the psychiatrist because some of my friends has told me that I immagine things and I am scared. Marta


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## eric (Jul 8, 1999)

bump


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## eric (Jul 8, 1999)

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## eric (Jul 8, 1999)

""During stress, trauma or 'fight or flight' reactions, the barrier between the lumen, the interior of the gut where food is digested, and the rest of the bowel could be broken, and bad stuff could get across," Dr. Wood said. "So the big brain calls in more immune surveillance at the gut wall by activating mast cells." These mast cells release histamines and other inflammatory agents, mobilizing the enteric nervous system to expel the perceived intruders, and causing diarrhea. "


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## eric (Jul 8, 1999)

bump for Cat


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## 17176 (Mar 31, 2005)

I sympathise with you marta, i myself have been upset at things i see and hear, mental health is no laughing matter, although some peeps see me as a freak i honestly dont give a damn..My shrink said i was suffering from post traumatic stress, i feel this year i have came on leaps and bounds, although i still get "dark" days, but without my councellor id be a lot worse, maybe even dead.. stay strong, i know its hard, but my outlook is " dont let the b******* grind you down.. take care...








ps: i take venlafaxine and amatrip to help with my mental health probs and i really do believe they have helped me...


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## eric (Jul 8, 1999)

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## eric (Jul 8, 1999)

Stress can wreak gastrointestinal havochttp://www.sanluisobispo.com/mld/dfw/news/...dfw_news_to_use


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## eric (Jul 8, 1999)

NewsweekUsing the Mind to Heal the Bodyhttp://msnbc.msn.com/id/6037690/site/newsweek/


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## eric (Jul 8, 1999)

FYIStudy Points to a Solution for Dread: Distraction http://www.nytimes.com/2006/05/05/health/05dread.htmlThe Other Brain Also Deals With Many Woeshttp://ibsgroup.org/eve/forums/a/tpc/f/71210261/m/369100861vidoesexcellentIntegrated Approach to Irritable Bowel Syndromehttp://www.ja-online.com/dukeibs/#Cool graphicsExploring Serotonin in the GI Tract (2001) Videohttp://www.archive.org/details/Explorin2001intestinal serotonin signalling in irritable bowel syndrome.http://ibsgroup.org/eve/forums/a/tpc/f/71210261/m/880106032


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## eric (Jul 8, 1999)

FYIUS NEWS and World Report"Clinical Trial News: Treating IBS by changing your thinkingBy Sarah BaldaufPosted 9/6/06Related LinksMore from Best Health Consider a possible mind-body connection: Might an overactive brain be irritating your bowel? Researchers at the University of California-Los Angeles are now conducting a clinical trial aimed at figuring out whether changing certain cognitive processes might alleviate the symptoms of irritable bowel syndrome. The condition, characterized by abdominal pain, diarrhea, and constipation, is the most common diagnosis gastroenterologists make. Yet little is known about its pathology. One theory is that the brain and central nervous system start to overrespond to normal gastrointestinal sensations, says psychologist and principal investigator Bruce Naliboff.Volunteers join one of three intervention groups. Those in the first group are taught progressive muscle relaxation techniques to reduce tension, since stress can trigger or exacerbate symptoms. The second group focuses on identifying situations and thought processes that aggravate their symptoms. The reasoning: They can learn not to react overly anxiously to events in their lives--or "catastrophize"--and thus manage their symptoms, says Michael Frese, psychologist and trial manager. The third group is given educational materials on the physiology of IBS to find out if an understanding of the science might result in better control of symptoms. Volunteers in all three groups receive 10 weekly sessions with a psychologist and a follow-up meeting after six months.Using brain imaging and other techniques on willing participants, the researchers also are investigating how strong the feedback system between the GI tract and the brain actually is. The research, sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases, is expected to continue recruiting subjects through the winter of 2007. Further details can be found at clinicaltrials.gov.http://www.usnews.com/usnews/health/articl.../6healthweb.htm


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## Twocups424 (Mar 26, 2002)

Boy I wish I could afford a shrink. I say that very respectfully. WHO COULDN'T BENNIFIT FROM SOMEONE ACTUALLY LISTENING TO YOU FOR AWHILE. I bet half my symptoms might go away if I felt I had someone who really heard me and gave half a s--t.


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## 22943 (Aug 27, 2005)

Well see what happens once I'm done with my intensive therapy program that I'm in right now. Right now, I don't see any difference in my IBS at all. I've been in the program for 4 weeks and have one more to go. No change in my pain. The naturopath added magnesium to my sleep routine and while I am a bit more relaxed, it hasn't changed any of my symptoms either and in fact has changed me over to the "D" side of things.


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## eric (Jul 8, 1999)

honugirl AKA Accident Girl What kind of therapy are you doing?Does it use say progressive muscle relaxation or CBT and working on thought processes?I am not sure naturopaths have the kind of training for this kind of therapy perhaps.By the way magnesium can contribute to the D.Things like meditation, CBT, HT, progressive muscle relaxations and deep relaxation techniques, that calm the mind body and nervous systems.This is new also since I in part started the thread with the HPA axis, which is the bodies stress system.Gastroenterology. 2006 Feb;130(2):304-11. Links Comment on: Gastroenterology. 2006 Feb;130(2):596-600. Hypothalamic-pituitary-gut axis dysregulation in irritable bowel syndrome: plasma cytokines as a potential biomarker?Dinan TG, Quigley EM, Ahmed SM, Scully P, O'Brien S, O'Mahony L, O'Mahony S, Shanahan F, Keeling PW. Alimentary Pharmabiotic Centre, University College Cork, Ireland. t.dinan###ucc.ieBACKGROUND & AIMS: Irritable bowel syndrome (IBS) is a functional disorder with an etiology that has been linked to both psychological stress and infection. The primary aim of this study was to examine the hypothalamic-pituitary-adrenal axis in patients with IBS and to relate such response to plasma cytokine profiles. METHODS: A total of 151 subjects, 76 patients and 75 controls, were recruited. The patients with IBS were diagnosed according to Rome II criteria. Forty-nine patients and 48 matched controls had cytokine levels measured, and a subset of 21 patients and 21 controls also underwent a corticotropin-releasing hormone (CRH) stimulation test with plasma levels of adrenocorticotropic hormone (ACTH) and cortisol measured. The remaining 27 patients and 27 controls underwent a dexamethasone (1 mg) challenge. RESULTS: Cortisol and the proinflammatory cytokines interleukin (IL)-6 (together with its soluble receptor) and IL-8 were elevated in all IBS subgroups (diarrhea predominant, constipated, and alternators), although the elevation was most marked in the constipated subgroup. There was no alteration in the anti-inflammatory cytokine IL-10. Following CRH infusion, an exaggerated release of both ACTH and cortisol was observed in patients with IBS. There was a significant correlation between the ACTH response (deltaACTH) and the IL-6 levels. A similar relationship existed between the deltaACTH/deltacortisol ratio and the IL-6 levels. Dexamethasone suppression of cortisol was similar in patients and controls. CONCLUSIONS: IBS is characterized by an overactivation of the hypothalamic-pituitary-adrenal axis and a proinflammatory cytokine increase.PMID: 16472586


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## eric (Jul 8, 1999)

Twocups, its a common complaint that some doctors are not spending enough time with their patients and working things out.A good doctor patient relationship can be extremely benefical if you find a good doctor.Even with mental health professionals they have to know and have studied IBS to be particularly helpful. Acombination of a good doctor who really understands and a good mental health professional who teaches relaxation and works with thought processes can be very helpful.


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## eric (Jul 8, 1999)

Therapy, Hypnosis for Irritable Bowel?Cognitive Behavioral Therapy, Hypnosis May Help Patients With Irritable Bowel Syndrome (IBS)"No 'Head Shrinking'"While we have a psychological treatment, our treatment is not shrinking heads," Lackner says."Our treatment is teaching patients to manage their illness. This is what is done with cardiac rehabilitation. This is done with diabetesdiabetes management, arthritisarthritis management. We need to use that same approach for IBS." The therapy covered information on IBS, muscle relaxation training, developing a flexible set of problem-solving skills for IBS, and curbing worry about IBS. For instance, Lackner says someone with IBS going on a date might worry that their date will think they're "weird" if they have to go to the bathroom during the date."We encourage them to say [to themselves], 'Listen, I don't really know what's going to happen four hours down the road. I can only deal with the evidence, the information I have available to me and I'll deal with that when it comes up."The bottom line: "Our goal is to try to teach them to control that worried thinking in a way that reduces their symptoms," says Lackner. He and his colleagues developed the at-home workbook used in the study."


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## eric (Jul 8, 1999)

bump


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## eric (Jul 8, 1999)

More on all thishttp://ibsgroup.org/groupee/forums?a=tpc&s...00972#134100972


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## eric (Jul 8, 1999)

bump


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