Cover Story

Facing up to Facebook

Jeffrey E. Barnett will outline the promises — and perils — of psychotherapy in the Internet age.

The world’s gone online, and that’s changing the way people communicate, interact and relate to others, says Loyola University Maryland psychology professor Jeffrey E. Barnett, PsyD. It’s especially true for the increasing number of “digital natives,” people who grew up with Twitter, Facebook, e-mail and text messaging and who expect to connect with psychotherapists through these technologies, Barnett says.

Psychologists are rightly cautious when faced with new communication technology — you wouldn’t want clients texting you at all hours, expecting an immediate response, he notes. But psychotherapists should begin to define how, when and whether mobile and online communication can be therapeutic, Barnett says.

“Clinically and ethically, psychologists need to be cognizant of the issues they will increasingly be facing,” he says. “We need to get out ahead of this and think about what’s next.”

In his talk, Barnett will discuss promising new interventions that harness the Internet to help people with panic disorder, gambling problems and diabetes. He’ll also outline the ethical, legal and logistical concerns new technologies raise. For example, how can you be sure the person texting you is, in fact, your client? What should you do when a client sends you an online “friend” request? How will licensure laws handle it when therapists regularly provide treatment across state, or even national, borders?

It’s an exciting moment for psychology, one that’s ripe with possibility as well as peril, Barnett says.

“Imagine doing a virtual psychotherapy session with someone who is homebound because of disability, a lack of transportation or mental health problems,” he says. “These media can bring psychology to people who never before had access to care.”

The love code

Sue Carter and Stephen Porges will discuss how ancient molecules and neural systems allow us to survive and reproduce in an uncertain world.

Picture a mother holding her newborn infant. The mother calmly and contentedly rocks her baby, not clutching for fear of dropping the infant. At the heart of this moment is the uniquely mammalian hormone oxytocin, says Sue Carter, PhD, a neuroscientist in the Brain Body Center at the University of Illinois at Chicago who will co-present with Stephen Porges, PhD, also of the University of Illinois at Chicago. Oxytocin acts on autonomic systems, such as the brain stem, and allows us to manage the challenge of meeting a new partner, falling in love and caring for our offspring.

“Love — acting in part through oxytocin — helps us heal body, brain and behavior,” Carter says.

Animal studies have shown that oxytocin can facilitate maternal behavior and social bonding. It also can reverse the effects of isolation and reduce symptoms of depression and anxiety. There’s also increasing evidence that when oxytocin is administered through the nose, it can quiet arousal and allow people to perceive others in a more positive light. Much less is known about the actions of oxytocin produced within the body. But in a study published online in February’s Psychoneuroendocrinology, Carter, working with researchers from Ohio State University, including Jean-Phillipe Gouin, PhD, and Janice Kiecolt-Glaser, PhD, found that people with very high levels of oxytocin showed faster wound healing and more positive interactions with their partners.

“At first, these effects seemed like magic,” says Carter. “We now know that oxytocin is a central piece of a neuroendocrine system necessary for mental and physical health.”

Creating a better world through psychotherapy

Clinical pioneer Steven C. Hayes wants psychologists to ‘scale up’ their practices to help society, not just individuals.

Relentless exposure to horror in the media — and personal traumas of their own — causes many people to try to avoid thinking about or feeling pain, says Steven C. Hayes, PhD.

In response, he wants psychotherapists to think about how their skills can help people develop psychological flexibility by learning how to acknowledge, confront and work through painful experiences, thoughts and emotions and to express compassion for others and themselves.

“We’ve gotten our culture organized in such a way that it’s very judgmental, avoidant and oriented toward feeling good now, even though that might mean not feeling good later,” says Hayes, a psychology professor at the University of Nevada. “I think psychotherapists know that’s not wise, and we have to figure out a way to put some of that wisdom into the culture.”

Hayes pioneered Acceptance and Commitment Therapy (ACT), which seeks to help people become more accepting of their feelings and more mindful of their thoughts, allowing them to live lives that are based on what they value most, not social pressure. Research shows that ACT helps clinicians help clients with a variety of problems. A study in the Journal of Consulting and Clinical Psychology (Vol. 75, No. 2) found that Type-II diabetes patients who applied acceptance and mindfulness skills to diabetes-related thoughts and feelings reported better diabetes self-care.

ACT has also been found to help address such social problems as racism and job burnout. It’s also helped people with addiction by helping them confront self-stigma and shame and achieve better treatment outcomes, Hayes says.

Psychologists can bring psychotherapy’s insights to everyone, everywhere, he says.

“It’s going to help humanize the world if we do it right,” Hayes says.

How stress affects health

Janice Kiecolt-Glaser will discuss the many ways that chronic stress harms the body.

Over the last three decades, Janice Kiecolt-Glaser, PhD, and her research team at the Ohio State University Medical Center, have shown that chronic stress wreaks havoc on the body — leading to cardiovascular disease, cancer, stroke, osteoporosis, diabetes and frailty.

“It’s just a laundry list of everything you don’t want to hear,” she says.

At this year’s convention, Kiecolt-Glaser will share her findings on how feelings of being overwhelmed have such far-reaching, physical effects. The culprit, she says, is stress-induced chronic inflammation, resulting from an immune system in a constant state of high alert. This wears you down and, paradoxically, makes your body less able to fight disease, heal wounds and develop antibodies after a vaccination.

Kiecolt-Glaser’s new research takes that finding a step further, showing that people who had difficult childhoods are especially susceptible to the physical effects of chronic stress. Abused children’s immune systems may learn to mount hyperactive responses to psychological stress, and that early programming seems to kick in when they are faced with stress as adults, she says.

However, the news isn’t all bad: Yoga devotees respond less to stress at a physiological level than yoga novices, according to as-yet-unpublished research by Kiecolt-Glaser and her colleagues. In the study, yoga novices’ blood had 41 percent more interleukin-6 — a marker for inflammation — than yoga experts following a stressful experience.

“The theory with yoga is it’s supposed to help you deal with your daily life in a different way,” she says. “It’s supposed to help you reset your stress response and so, metaphorically, if you have someone come up behind you and yell ‘Boo!’ you don’t jump as high.”

How a distressing childhood hurts your health

Karen Matthews will explain the psychological links between childhood experiences and adult chronic disease.

By looking at your child’s social and emotional well-being now, Karen Matthews, PhD, can determine what may influence his or her risk for developing cardiovascular disease later in life. That link is the focus of Matthews’s plenary presentation, which will explain how our early experiences — such as stress or our parents’ socioeconomic status — affect the likelihood we’ll develop chronic diseases as adults, regardless of well-known risk factors including poor diet, lack of exercise and smoking.

Matthews, who directs the Pittsburgh Mind-Body Center at the University of Pittsburgh, says her research has uncovered an important lesson for those who study adult chronic disease: Shift your attention to early development.

“It’s not that what happens in your 40s, 50s and 60s isn’t important,” she says. “It’s just that the roots are more important.”

In her presentation, Matthews will use cardiovascular disease as an example, summarizing the key psychological factors that link adverse childhood environments to elevated cardiovascular risk in adulthood. For example, she says, if parents rent instead of own a home, did not go to college and have less “prestigious” jobs, their children’s cardiovascular health is more likely to be compromised in adulthood — independent of the financial success the children may attain on their own. The risk associated with these circumstances emerges in adolescence.

Matthews’s research has important implications for preventing disease. “The earlier you can identify your risk for disease, the sooner you can do something about it,” she says.

Surfing the crave wave

G. Alan Marlatt will describe a new approach to preventing addictions relapse.

When a smoker who’s trying to quit gets a cigarette craving or an alcoholic gets the urge to drink, he or she can avoid relapse with a mindfulness-based technique called “urge surfing,” suggests research by G. Alan Marlatt, PhD. Instead of ignoring or suppressing the urge for a cigarette or beer, people can imagine the craving as a building wave, and their breath as a surfboard, riding the urge until it rolls by.

That’s just one technique Marlatt, a pioneer in relapse prevention and addiction treatment and director of the University of Washington’s Addictive Behaviors Research Center, will describe during his talk at this year’s convention.

The approach is part of Mindfulness-Based Relapse Prevention, which Marlatt developed with fellow researchers. The intervention is a combination of meditative practices and cognitive behavioral therapy techniques, including techniques adapted from Buddhist meditation, such as breath control for relieving stress, anger and depression. Participants also use role-playing exercises to learn skills for navigating social situations that trigger drinking, smoking or other substance use.

The approach reduces post-treatment alcohol and drug use in people with severe substance abuse problems compared with a standard treatment approach, according to a study in Substance Abuse (Vol. 30, No. 4).

About 85 percent of people being treated for addictions relapse, Marlatt says. “Some who have a lapse get back on track, but a large number of people, once they’ve had a lapse, that just keeps them in relapse,” he says.

Remembrance of things future

Daniel L. Schacter will share research on how memories and predictions link up.

Best known for his groundbreaking work on amnesia, memory distortion and forgetfulness, Harvard psychologist Daniel L. Schacter, PhD, has turned his attention to how we imagine the future. Joining an emerging area of research on the relationship of past and future thinking, Schacter and his team have found that many of the same brain regions activate when people recall the past and consider the future.

While researchers have long tried to understand how memory works, there’s been little emphasis on why we use it, he says.

“Maybe one reason memory is subject to distortion is because we need to use it in a flexible way to think about what might happen, to recombine past events and think about different scenarios,” he says.

In his plenary talk, Schacter will share his neuroimaging data and other new research and discuss how this line of research might offer new insights into memory loss and everyday memory mistakes.

The power of a mother’s love

Stephen Suomi will share new research on the value of good early-life mothering.

Take a rhesus monkey with a genetic disposition toward anxiety, raise it with a caring, attentive mother, and odds are you’ll end up with an adult monkey that never fully develops anxiety, says Stephen Suomi, PhD, a developmental psychologist and chief scientist at the National Institute of Child Health and Human Development’s comparative ethology lab.

At this year’s convention, Suomi will discuss his findings on how mothering and other environmental factors during development contribute to individual differences in humans’ and monkeys’ temperaments. It’s good to know the similarities between them, Suomi says, because many “risk alleles” — clusters of genes known to affect the chances of developing anxiety, depression, enhanced aggression and other at-risk characteristics — are shared by the two species.

What’s more, scientists think that up to a fifth of rhesus monkeys’ genes are affected by early experiences, and humans have many of those same genes, Suomi says.

“We know that there are behavioral characteristics that are heritable, but they are also greatly affected by the environment,” he says.

Suomi’s research builds on earlier and ongoing work in epigenetics — environmental factors that influence gene expression — exploring the effects of mothering on rats by one of last year’s plenary speakers, Michael Meaney, PhD. Meaney and Suomi, friends and colleagues, are finding that what’s true for rats is true for monkeys is true for people: “Good parenting is exceedingly important,” Suomi says.