Few Effective Treatments

Photo by Emiliano Vittoriosi

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No single treatment stands out as especially effective for borderline personality disorder, a mental illness that can involve self-harm and suicide attempts, according to two new reviews of recent studies.

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BPD does appear to respond more strongly to certain kinds of psychological “talk” therapies, British researchers found. However, the psychological treatments that showed the most promise were relatively new and supported by “too few data for confidence,” the authors write.

Because both are complex, intensive therapies that require long-term staff training, “we believe that such treatments will only be available to a select few patients,” said co-author Mark Fenton.

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The team, led by Conor Duggan of the University of Nottingham and Clive Adams of the University of Leeds, conducted separate reviews on psychological and drug therapies for BPD.

The reviews appear in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

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The team analyzed findings from seven studies on structured talking therapies, comprising 262 adult outpatients with either a formal diagnosis of BPD or at least three criteria for the illness.

People undergoing a treatment called dialectical behavior therapy appeared to have fewer suicide attempts or thoughts of suicide at six months compared to those in usual care. Introduced in 1991, the treatment involves individual psychotherapy sessions, telephone coaching, lengthy group therapy sessions and cognitive modification.

Treating patients in a day hospital unit geared to psychoanalytic treatment also seemed to “decrease admission and use of prescribed medication and increase social improvement and social adjustment,” the reviewers found.

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Although both treatments are “difficult to apply to everyday care,” the researchers say that results so far suggest that “the problems of people with borderline personality disorder may be amenable to treatment.”

BPD is characterized by “an internal sense of emptiness and an inability to regulate emotion, going from high to low levels of emotion very quickly,” according to Scott Haltzman, M.D, a professor at Brown University. “These people tend to respond to the world with swings from rage to glee.”

Two percent of the general population and 20 percent of psychiatric inpatients have borderline personality disorder. Borderline patients are overwhelmingly female (75 percent).

“This group of people is often a challenge to health service providers,” said Fenton, who is also editor of the U.K.-based “Database of Uncertainties About the Effects of Treatments. He said that people with BPD have difficulty engaging in relationships, including relationships with therapists.

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Unlike some other psychiatric conditions, there is no widely accepted drug regimen for borderline personality disorder.

“If offered medication, people with BPD should know that this is not based on good evidence,” the reviewers concluded.

The second review pooled results from ten small, short-term randomized studies on drug therapies for BPD. These studies involved 554 patients, both inpatients and outpatients

Studies of the various drugs used “show that antidepressants offered the best chance of improvement, but even here, results were not robust,” according to Fenton. “For ratings of anger, fluoxetine (Prozac) may offer some improvement over placebo,” the researchers say.

Although the antipsychotic drug haloperidol showed some improvement in symptoms of hostility, “the numbers are so small it is likely to be a false positive,” said Fenton. The reviewers do not recommend the use of antipsychotic drugs for borderline personality disorder outside of clinical trials.

Although the drug data were not encouraging, “that does not mean (medication) may not do considerable good, and there is no indication of significant harm,” the reviewers wrote. “People with BPD or their carers are in a position to lobby for and facilitate good research in this area.”

Binks CA et al. Psychological therapies for people with borderline personality disorder, The Cochrane Database of Systematic Reviews 2006, Issue 1.

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Binks CA, et al. Pharmacological interventions for people with borderline personality disorder. The Cochrane Database of Systematic Reviews 2006, Issue 1.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

INTERVIEWS Contact Mark Fenton at 0044 (0)1865 517622 or at mfenton@cochrane-sz.org

No Empathy!

Research Links Borderline Personality Traits with Lowered Empathy

Photo by Abigail Keenan

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Those with borderline personality disorder, or BPD, a mental illness marked by unstable moods, often experience trouble maintaining interpersonal relationships. New research from the University of Georgia indicates that this may have to do with lowered brain activity in regions important for empathy in individuals with borderline personality traits.

The findings were recently published in the journal Personality Disorders: Theory, Research and Treatment.

“Our results showed that people with BPD traits had reduced activity in brain regions that support empathy,” said the study’s lead author Brian Haas, an assistant professor in the Franklin College of Arts and Sciences psychology department. “This reduced activation may suggest that people with more BPD traits have a more difficult time understanding and/or predicting how others feel, at least compared to individuals with fewer BPD traits.”

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Credit: University of Georgia
Brian Haas is an assistant professor in the University of Georgia’s psychology department.

For the study, Haas recruited over 80 participants and asked them to take a questionnaire, called the Five Factor Borderline Inventory, to determine the degree to which they had various traits associated with borderline personality disorder. The researchers then used functional magnetic resonance imaging to measure brain activity in each of the participants. During the fMRI, participants were asked to do an empathetic processing task, which tapped into their ability to think about the emotional states of other people, while the fMRI measured their simultaneous brain activity.

In the empathetic processing task, participants would match the emotion of faces to a situation’s context. As a control, Haas and study co-author Joshua Miller also included shapes, like squares and circles, that participants would have to match from emotion of the faces to the situation.

“We found that for those with more BPD traits, these empathetic processes aren’t as easily activated,” said Miller, a psychology professor and director of the Clinical Training Program.

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Haas chose to look at those who scored high on the Five Factor Borderline Inventory, instead of simply working with those previously diagnosed with the disorder. By using the inventory, Haas was able to obtain a more comprehensive understanding of the relationship between empathic processing, BPD traits and high levels of neuroticism and openness, as well as lower levels of agreeableness and conscientiousness.

“Oftentimes, borderline personality disorder is considered a binary phenomenon. Either you have it or you don’t,” said Haas, who runs the Gene-Brain-Social Behavioral Lab. “But for our study, we conceptualized and measured it in a more continuous way such that individuals can vary along a continuum of no traits to very many BPD traits.”

Haas found a link between those with high borderline personality traits and a decreased use of neural activity in two parts of the brain: the temporoparietal junction and the superior temporal sulcus, two brain regions implicated to be critically important during empathic processing.

The research provides new insight into individuals susceptible to experiencing the disorder and how they process emotions.

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“Borderline personality disorder is considered one of the most severe and troubling personality disorders,” Miller said. “BPD can make it difficult to have successful friendships and romantic relationships. These findings could help explain why that is.”

In the future, Haas would like to study BPD traits in a more naturalistic setting.

“In this study, we looked at participants who had a relatively high amount of BPD traits. I think it’d be great to study this situation in a real life scenario, such as having people with BPD traits read the emotional states of their partners,” he said.

An abstract of the study, “Borderline Personality Traits and Brain Activity During Emotional Perspective Taking,” is available at http://www.ncbi.nlm.nih.gov/pubmed/26168407.

Borderline Personality Disorder—as Scientific Understanding Increases, Improved Clinical Management Needed

Even as researchers gain new insights into the neurobiology of borderline personality disorder (BPD), there’s a pressing need to improve diagnosis and management of this devastating psychiatric condition.

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The special issue comprises seven papers, contributed by experts in the field, providing an integrated overview of research and clinical management of BPD. “We hope these articles will help clinicians understand their BPD patients, encourage more optimism about their treatability, and help set a stage from which the next generation of mental health professionals will be more willing to address the clinical and public health challenges they present,” according to a guest editorial by Drs. Lois Choi-Kain and John Gunderson of the Adult Borderline Center and Training Institute at McLean Hospital, Belmont, Mass.

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Borderline Personality Disorder—Research Advances, Emerging Clinical ApproachesAlthough the diagnostic criteria for BPD are well-accepted, it continues to be a misunderstood and sometimes neglected condition; many psychiatrists actively avoid making the diagnosis. Borderline personality disorder accounts for nearly 20 percent of psychiatric hospitalizations and outpatient clinic admissions, but only three percent of the research budget of the National Institute of Mental Health. (The NIMH provides information about BPD online at www.nimh.nih.gov/health/topics/borderline-personality-disorder)

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The Guest Editors hope their special issue will contribute to overcoming the disparity between BPD’s public health importance and the attention received by psychiatry. Highlights include:• A research update on the neurobiology of BPD. Evidence suggests that chronic stress exposure may lead to changes in brain metabolism and structure, thus affecting the processing and integration of emotion and thought. This line of research might inform new approaches managing BPD—possibly including early intervention to curb the neurobiological responses to chronic stress.• The urgent need for earlier intervention. A review highlights the risk factors, precursors, and early symptoms of BPD and mood disorders in adolescence and young adulthood. While the diagnosis of BPD may be difficult to make during this critical period, evaluation and services are urgently needed.• The emergence of evidence-based approaches for BPD. While these approaches have raised hopes for providing better patient outcomes, they require a high degree of specialization and treatment resources. A stepped-care approach to treatment is proposed, using generalist approaches to milder and initial cases of BPD symptoms, progressing to more intensive, specialized care based on clinical needs.• The critical issue of BPD in the psychiatric emergency department. This is a common and challenging situation in which care may be inconsistent or even harmful. A clinical vignette provides mental health professionals with knowledge and insights they can use as part of a “caring, informed, and practical” approach to helping BPD patients in crisis.

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The special issue also addresses the critical issue of resident training—preparing the next generation of mental health professionals to integrate research evidence into more effective management for patients and families affected by BPD. Drs. Choi-Kain and Gunderson add, “For clinicians, educators, and researchers, we hope this issue clarifies an emerging basis for earlier intervention, generalist approaches to care for the widest population, and a more organized approach to allocating care for individuals with BPD.”

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About the Harvard Review of PsychiatryThe Harvard Review of Psychiatry is the authoritative source for scholarly reviews and perspectives on a diverse range of important topics in psychiatry. Founded by the Harvard Medical School Department of Psychiatry, the journal is peer-reviewed and not industry sponsored. It is the property of Harvard University and is affiliated with all of the Departments of Psychiatry at the Harvard teaching hospitals. Articles encompass all major issues in contemporary psychiatry, including (but not limited to) neuroscience, psychopharmacology, psychotherapy, history of psychiatry, and ethics.

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About Wolters KluwerWolters Kluwer is a global leader in professional information services. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk, compliance and healthcare rely on Wolters Kluwer’s market leading information-enabled tools and software solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever more dynamic world.

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Wolters Kluwer reported 2015 annual revenues of €4.2 billion. The group serves customers in over 180 countries, and employs over 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. Wolters Kluwer shares are listed on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY). Wolters Kluwer Health is a leading global provider of information and point of care solutions for the healthcare industry. For more information about our products and organization, visit www.wolterskluwer.com, follow @WKHealth or @Wolters_Kluwer on Twitter, like us on Facebook, follow us on LinkedIn, or follow WoltersKluwerComms on YouTube.

Letter to my best friend

I am so proud of you

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By Giusi Nigro

I know you since you were a child, I saw you getting bigger and I noticed the sadness in your look, the tearing eyes of who remembers things you would want to forget. They pulled your hair and they forced, you to do something that you, incredulous, struggled to understand, in that dark corner, where traces of blood, cleared by the rain, are no longer there even if you still see them and that rip you inside when you re-think about the scene.

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During the night, you do not dream anymore to be grabbed with force and troughed on the ground, and being dominated by two monsters, you dream now to be strong and combatant: one night you shoot, armed with shot gun, the following night you cut them with a kitchen knife and yet you stab or you tie them with a rope. During the night, in your loneliness, you are strong, not impotent like that evening, you announce victory, then you wake up in tears and the reality vehemently slams just in front of you impudently. Another shower delete, like to wash from your body that smell, those dirty hands which infiltrate between the underwear, and you leave the water running on the stolen innocence.  

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Many years of “why me?”, and why you? You will never find an answer, you will never understand, there is no why, it was your turn, everything just to dominate, like the savage instinct of somebody without breaks in front of the weak, like the temporary victory which gives you the title of a champion for a moment, like the forever losers which try to get even and act in group to recharge, to feel better, those sick in their head collecting trophies, fake trophies, imaginary, earned only due to the physics’ strength against a fragile person, and weaker. You were not the target but your skirt. The suffered humiliation, and the silence, have been like a boulder for you, carrying it on your shoulders for many years. The judgement of people who did not know.

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Those severe accusations which yet resound: “she was easy!” told by who was not there but wanted to believe to the story of the trophy. The popular judgement of the small town there to protect the predators and strike the victim. You were young and innocent, afraid, defenseless, you could not know you were going to regret the silence, that if you had a guide, you could have sent them to prison. You believed the treats: “if you speak, you are dead! “and you were dead anyway.   Living without existing, feeling invisible and less than nothing, believing to be wrong, abandoning yourself to cheap thoughts, cowardly take the blame: “I deserve it, I trusted the wrong people”, I do not deserve anything good, I choose always the wrong because I am wrong, refusing the good things. No, you are not wrong, you needed that therapist to make you understand. You or somebody else did not make difference to them.

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Do not be ashamed, do not let them win, they have to be ashamed of their committed crime, those fouls ex-cons. You did not report them, not to be an accomplice, but for fear, for irresponsibility, because nobody teaches to a young girl in her early teens how to deal with these cases. We are thought to be ashamed, to the mocking of the truth, in a small town where it is possible to perpetrate violence and they all will be from the side of the strong, even if the strong is not in the right side.   You cannot erase the past, I know it, and it will be your burden forever, but you can make this weight you carry around, as a good luck holder. Look at your inner side, you are not like them, you are a lot of more, you are sensitive, deep, and you are what they would like to be, you know how to dance, to dance under the rain, to look at the stars and shine with them, you know how to look at the horizon and create more joint lines, you can inspire. Look at them and ask yourself: “What are they good at? Who do they hang with?”.

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You are the living success that you can heal from the pain. Look at your eyes now, shining, look at them inside, they are the reflection of a balance you asked from so long, they scream loud that the past is behind and need to move forward, they sum the price you paid, overpaid, but paid off. Now it is your turn to live, do it, do not hesitate, stand up to change everything you do not like it, stay far from pointless people, laugh! Remember when you were laughing to void to cry? My dear friend, it will not be the same anymore, I see the light in your eyes, the strength of a healed after a terminal disease, the grit of a fighter winning against a bear. Their witch laugh which still echoed in your ears, is now your smile of happiness, calm, quiet, understanding that the torment is not a drug to be addicted of, but it is a victory against the pain, it is strength, it is putting the soul. The rest do not matter. He who laughs last laughs best!  

Your friend,

Giusi Nigro

Why We Make (and Break) New Year’s Resolutions?

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By Dr. Charles Herrick, Chair of Psychiatry, Nuvance Health

Summary:

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  • Research shows that as many as 50 percent of adults in the United States make New Year’s resolutions, but fewer than 10 percent keep them for more than a few months.
  • Giving up on New Year’s resolutions is often related to three issues: difficulty breaking old habits, focusing on specific outcomes, and problems with purpose.
  • You can increase your chances of achieving your New Year’s resolutions by setting realistic and achievable process goals that will help you form new habits, as well as following other steps for success.
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Do you feel excited about making a New Year’s resolution on January 1 each year, but find yourself losing enthusiasm as the weeks go by — only to give up entirely by late February or March? If so, you’re not alone.

Research shows that as many as 50 percent of adults in the United States make New Year’s resolutions, but fewer than 10 percent actually keep them for more than a few months. But why?

Whether your goal is to lose weight, get more exercise, quit smoking, save money, or something else entirely, the truth is that there are some common psychology-based reasons why New Year’s resolutions fall flat. But before you put your goals on the shelf until next year, here’s what you need to know about why we make and break New Year’s resolutions — as well as a tips you can use to give yourself the best chance of making your resolution stick.

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Why do people make New Year’s resolutions?

It’s human nature to set goals at the start of something new, making the start of the New Year a popular time to set new goals and expectations for the year ahead.

Why do I break my New Year’s resolutions?

There are many reasons why people may not keep New Year’s resolutions, but instances of New Year’s resolution burnout can be narrowed down to three psychology-related issues: difficulty breaking old habits, focusing on specific outcomes, and problems with purpose.

Difficulty breaking old habits

Meeting new goals usually requires creating new habits and breaking old ones — and old habits are hard to break. For example, quitting smoking will require you to eliminate smoking from your daily activities, and losing weight will require you to change your diet and exercise routine.

Our habits are ingrained and embedded in our implicit memory, which is also called our automatic memory or unconscious memory. Implicit memory uses our past experiences to help us remember things without actively thinking about them, making it easy for us to stick to similar routines and challenging for us to make changes.

Habits are also multi-faceted, meaning that many elements reinforce our habits and make them more challenging to break. For example, a smoking habit may be influenced by your lifestyle, the places you go, the people you interact with when you smoke, physical sensations associated with smoking, and other rituals. Your feelings, thoughts, and emotions related to smoking can also contribute to making the habit satisfying even before you actually smoke.

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Focusing on specific outcomes

Another reason people have trouble keeping New Year’s resolutions is that they focus on a specific outcome, such as reaching a certain body weight. Focusing on a specific outcome can be defeating if you don’t achieve your goal quickly. In most cases, it takes time to achieve a specific outcome, and many people become frustrated and eventually give up before reaching their goal.

Problems with purpose

If you’re like most people, you’re busy — and you probably don’t have a lot of time left over at the end of the day to devote to accomplishing things that aren’t interesting or important to you. If you don’t feel connected to your resolution, it isn’t meaningful to you, or you aren’t motivated to make the changes required to achieve your goals, you will be more likely to give up.

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How can I keep my New Year’s resolution?

Developing a new habit as part of your New Year’s resolution means that you will need to consciously think about the changes you need to make, at least until the new habit becomes embedded in your implicit memory. The process of developing a new habit uses a lot of declarative, or episodic, memory and working memory — and requires a lot more mental effort.

To make it easier to keep your New Year’s resolution, you need to take a multi-faceted approach. Here are a few tips that may help:

1: Find your purpose, but avoid focusing on a specific outcome 

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If you want to lose weight, for example, avoid focusing on achieving a specific weight. Instead, ask yourself why you want to lose weight and use that as the basis for your goal. Asking “why” will help you find your real purpose, which will help to improve your motivation. Setting a goal of achieving better health so you can have more energy for your hobbies, for example, takes the focus off of a specific outcome, such as getting to 150 pounds.

Also, it’s important to remember that early success will motivate you to do more, and better health and an increase in energy is an outcome you will likely be able to achieve quickly by being more active or eating a healthier diet.

By focusing on being healthier rather than achieving a specific weight, you will also be more likely to maintain your healthy habits. If you set a goal of getting to 150 pounds and achieve it, you may be more likely to eventually fall back into old habits and not sustain long-term weight loss.

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2: Break your goal into components, and set realistic and achievable process goals 

If your goal is to achieve better health, you need to figure out exactly what you need to change to make it happen. For example, you might identify two components that will help you achieve your goal: more exercise and a healthier diet.

Identifying the components is just the first step. You must also set realistic and achievable process goals for each component that make you feel excited and motivated. The more excited you are about your process goals, the more likely you will be to find the time to focus on achieving them. Some examples of process goals include:

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  • “I intend to exercise for 30 minutes, four days a week, to achieve better health.”
  • “I intend to eat three plant-based dinners each week to achieve better health.”
  • “I intend to eat one-half of my normal portion of dessert after dinner every night to achieve better health.”

These goals shouldn’t require a huge sacrifice, and they shouldn’t make you feel deprived. However, they should require some effort — you want to feel good when you achieve them, after all.

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3: Make a public commitment 

Human beings are inherently social, and we want to connect with and feel accepted by others. We also want to avoid experiencing feelings of shame and embarrassment that can sometimes be associated with letting people down.

Making a public commitment to achieving your goal can help you hold yourself accountable and ultimately follow through. Many people find that their desire to avoid letting people down — and thereby avoid feelings of shame and embarrassment — is a powerful motivator to help them deliver on their commitment.

Examples of making a public commitment include telling family or friends about your goal, signing up for a weight loss program, or joining a fitness program with a group of co-workers.

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4: Engage with likeminded people

People tend to be more successful at achieving their goals when they connect with other likeminded people. Also, we tend to model the behavior of the people we like and admire, so it’s important to surround yourself with people who reinforce habits that will help you achieve your goals.

Finding a group of likeminded people who you admire will help you stay motivated — especially during the cold, dark months of January, February, and March, when New Year’s resolutions often hit the skids. Some people may find success and accountability by being part of a larger group, while others may prefer to pair up or join a smaller group. Whatever size group you choose and whether it’s in-person or online, engaging with others will keep you connected to your goals and make you more likely to be successful.

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The bottom line: Finding your purpose, changing your focus, setting the right goals, making a public commitment, and engaging with likeminded people can help you achieve your New Year’s resolutions.

Dr. Charles Herrick is a board certified psychiatrist, and the chair of psychiatry at Nuvance Health’s Danbury Hospital and Norwalk Hospital.

New dog, old tricks?

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A new study shows that untrained stray dogs respond to gestures from people, suggesting that understanding between humans and dogs transcends training

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If you have a dog, hopefully you’re lucky enough to know that they are highly attuned to their owners and can readily understand a wide range of commands and gestures. But are these abilities innate or are they exclusively learned through training?

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To find out, a new study in Frontiers in Psychology investigated whether untrained stray dogs could understand human pointing gestures.

The study revealed that about 80% of participating dogs successfully followed pointing gestures to a specific location despite having never received prior training. The results suggest that dogs can understand complex gestures by simply watching humans and this could have implications in reducing conflict between stray dogs and humans.

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Dogs were domesticated 10,000-15,000 years ago, likely making them the oldest domesticated animals on the planet. Humans then bred dogs with the most desirable and useful traits so that they could function as companions and workers, leading to domesticated dogs that are highly receptive to human commands and gestures.

However, it was not clear whether dogs understand us through training alone, or whether this was innate. Can dogs interpret a signal, such as a gesture, without specific training, or even without having met the signaling person previously? One way to find out is to see whether untrained, stray dogs can interpret and react to human gestures.

Stray dogs are a common feature in cities around the world and particularly in many developing countries. While they may observe and occasionally interact with people, such dogs have never been trained, and are behaviorally “wild”. Conflicts between stray dogs and humans are a problem and understanding how humans shape stray dog behavior may help alleviate this.

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To investigate, Dr. Anindita Bhadra of the Indian Institute of Science Education and Research Kolkata, India, and colleagues studied stray dogs across several Indian cities. The researchers approached solitary stray dogs and placed two covered bowls on the ground near them. A researcher then pointed to one of the two bowls, either momentarily or repeatedly, and recorded whether the dog approached the indicated bowl. They also recorded the perceived emotional state of the dogs during the experiment.

Approximately half of the dogs did not approach either bowl. However, the researchers noticed that these dogs were anxious and may have had bad experiences with humans before. The dogs who approached the bowls were noted as friendlier and less anxious, and approximately 80% correctly followed the pointing signals to one of the bowls, regardless of whether the pointing was momentary or repeated. This suggests that the dogs could indeed decipher complex gestures.

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“We thought it was quite amazing that the dogs could follow a gesture as abstract as momentary pointing,” explained Bhadra. “This means that they closely observe the human, whom they are meeting for the first time, and they use their understanding of humans to make a decision. This shows their intelligence and adaptability.”

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The results suggest that dogs may have an innate ability to understand certain human gestures which transcends training. However, it should be noted that the shyer, more anxious animals tended not to participate, so future studies are needed to determine more precisely how an individual dog’s personality affects their ability to understand human cues.

Overall, dogs may be more perceptive than we realize. “We need to understand that dogs are intelligent animals that can co-exist with us,” said Bhadra “They are quite capable of understanding our body language and we need to give them their space. A little empathy and respect for another species can reduce a lot of conflict.”

It’s 2020: Time to Teach Teens ‘Safe’ Sexting

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Credit: Getty Images/Florida Atlantic University
Youth who sext open themselves up to possible significant and long-term consequences, such as humiliation, extortion, victimization, school sanction, reputational damage, and even criminal charges.

Preaching sexual abstinence to youth was popular for a number of decades, but research repeatedly found that such educational messages fell short in their intended goals. Simply telling youth not to have sex failed to delay the initiation of sex, prevent pregnancies, or stop the spread of sexually-transmitted diseases. Since the advent of photo- and video-sharing via phones, children have received similar fear-based messages to discourage sexting – the sending or receiving of sexually explicit or sexually suggestive images (photos or video) usually via mobile devices. Unfortunately, messages of sexting abstinence don’t seem to be reducing the prevalence of adolescents sharing nudes. 

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Consequently, in a new paper published in the Journal of Adolescent Health, researchers from Florida Atlantic University and the University of Wisconsin-Eau Claire, say that it is time to teach youth “safe” sexting.

“The truth is that adolescents have always experimented with their sexuality, and some are now doing so via sexting,” said Sameer Hinduja, Ph.D., co-author and a professor in the School of Criminology and Criminal Justice within FAU’s College for Design and Social Inquiry, and co-director of the Cyberbullying Research Center. “We need to move beyond abstinence-only, fear-based sexting education or, worse yet, no education at all. Instead, we should give students the knowledge they need to make informed decisions when being intimate with others, something even they acknowledge is needed.”

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Hinduja and co-author Justin Patchin, Ph.D., a professor of criminal justice at the University of Wisconsin-Eau Claire and co-director of the Cyberbullying Research Center, acknowledge that although participating in sexting is never 100 percent “safe” (just like engaging in sex), empowering youth with strategies to reduce possible resultant harm seems prudent.

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Hinduja and Patchin collected (unpublished) data in April 2019 from a national sample of nearly 5,000 youth between the ages of 12 and 17, and found that 14 percent had sent and 23 percent had received sexually explicit images. These figures represent an increase of 13 percent for sending and 22 percent for receiving from what they previously found in 2016. 

The authors do want youth to understand that those who sext open themselves up to possible significant and long-term consequences, such as humiliation, extortion, victimization, school sanction, reputational damage, and even criminal charges. But they also want youth who are going to do it anyway to exercise wisdom and discretion to prevent avoidable fallout.

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“This is not about encouraging sexting behaviors, any more than sex education is about encouraging teens to have sex,” said Hinduja. “It simply recognizes the reality that young people are sexually curious, and some will experiment with various behaviors with or without informed guidance, and sexting is no exception.”

Hinduja and Patchin provide suggested themes encapsulated in 10 specific, actionable messages that adults can share with adolescents in certain formal or informal contexts after weighing their developmental and sexual maturity.

  1. If someone sends you a sext, do not send it to — or show — anyone else. This could be considered nonconsensual sharing of pornography, and there are laws prohibiting it and which outline serious penalties (especially if the image portrays a minor).  
  2. If you send someone a sext, make sure you know and fully trust them. “Catfishing”— where someone sets up a fictitious profile or pretends to be someone else to lure you into a fraudulent romantic relationship (and, often, to send sexts) — happens more often than you think. You can, of course, never really know if they will share it with others or post it online, but do not send photos or video to people you do not know well.  
  3. Do not send images to someone who you are not certain would like to see it (make sure you receive textual consent that they are interested). Sending unsolicited explicit images to others could also lead to criminal charges.  
  4. Consider boudoir pictures. Boudoir is a genre of photography that involves suggestion rather than explicitness. Instead of nudes, send photos that strategically cover the most private of private parts. They can still be intimate and flirty but lack the obvious nudity that could get you in trouble.  
  5. Never include your face. Of course, this is so that images are not immediately identifiable as yours but also because certain social media sites have sophisticated facial recognition algorithms that automatically tag you in any pictures you would want to stay private.  
  6. Make sure the images do not include tattoos, birthmarks, scars, or other features that could connect them to you. In addition, remove all jewelry before sharing. Also, consider your surroundings. Bedroom pictures could, for example, include wall art or furniture that others recognize.  
  7. Turn your device’s location services off for all of your social media apps, make sure your photos are not automatically tagged with your location or username, and delete any meta-data digitally attached to the image.  
  8. If you are being pressured or threatened to send nude photos, collect evidence when possible. Having digital evidence (such as screenshots of text messages) of any maliciousness or threats of sextortion will help law enforcement in their investigation and prosecution (if necessary) and social media sites in their flagging and deletion of accounts.  
  9. Use apps that provide the capability for sent images to be automatically and securely deleted after a certain amount of time. You can never guarantee that a screenshot was not taken, nor that another device was not used to capture the image without you being notified, but using specialized apps can decrease the chance of distribution.  
  10. Be sure to promptly delete any explicit photos or videos from your device. This applies to images you take of yourself and images received from someone else. Having images stored on your device increases the likelihood that someone — a parent, the police, a hacker — will find them. Possessing nude images of minors may have criminal implications. In 2015, for example, a North Carolina teen was charged with possessing child pornography, although the image on his phone was of himself. 
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– FAU –

About Florida Atlantic University: Florida Atlantic University, established in 1961, officially opened its doors in 1964 as the fifth public university in Florida. Today, the University, with an annual economic impact of $6.3 billion, serves more than 30,000 undergraduate and graduate students at sites throughout its six-county service region in southeast Florida. FAU’s world-class teaching and research faculty serves students through 10 colleges: the Dorothy F. Schmidt College of Arts and Letters, the College of Business, the College for Design and Social Inquiry, the College of Education, the College of Engineering and Computer Science, the Graduate College, the Harriet L. Wilkes Honors College, the Charles E. Schmidt College of Medicine, the Christine E. Lynn College of Nursing and the Charles E. Schmidt College of Science. FAU is ranked as a High Research Activity institution by the Carnegie Foundation for the Advancement of Teaching. The University is placing special focus on the rapid development of critical areas that form the basis of its strategic plan: Healthy aging, biotech, coastal and marine issues, neuroscience, regenerative medicine, informatics, lifespan and the environment. These areas provide opportunities for faculty and students to build upon FAU’s existing strengths in research and scholarship. For more information, visit fau.edu.