Saturday, June 10, 2017

Critical thinking can be taught

May 23, 2017
Norwegian Institute of Public Health
10-12-years-olds can be taught how to think critically at school, even with few teachers and limited resources. Parents can also be taught to assess claims about health effects.

10-12-years-olds can be taught how to think critically at school, even with few teachers and limited resources. Parents can also be taught to assess claims about health effects.
These findings come from two research articles published in The Lancet.
In a randomised trial of 120 schools and over 10,000 children in Uganda, researchers evaluated the effects of a programme aimed to teach 10-12-year-old pupils how to critically assess health effect claims. In a parallel study, the effect of a podcast intended to teach over 500 parents was also evaluated.
Educational programme gave significant results
This study was the first of its kind to evaluate whether teaching primary school pupils how to critically assess health claims had any effect.
"The educational programme led to nearly 50 per cent more children passing a test where they were asked to assess treatment claims. This is a significant effect. We did not register any negative consequences of the programme but the time spent (13 hours over a 3 month period) was necessarily at the expense of other school activities," explains Atle Fretheim, head of the Centre for Informed Health Choices at the Norwegian Institute of Public Health.
Podcast for parents
This was also the first attempt to evaluate how podcasts can help adults who are not healthcare personnel to critically assess health claims.
"Among those who listened to the podcast, 34 per cent more people passed the test that measured their ability to critically assess health claims. This group was compared with those who were asked to listen to a series of public health information announcements about similar topics," continues Fretheim.
May stop the spread of "fake news" and alternative facts
"In a time of rapidly spreading fake news, it is more important than ever that people are able to distinguish the truth from "alternative facts." In addition, we need to be able to assess what is a sensible interpretation of facts, particularly when facts are used to argue for or against implementing measures. This applies to claims about what causes better or worse health, says Fretheim.
"Based on this and the results of our research, this type of education programme should be considered in other countries, including Norway," he adds.
It is uncertain how applicable the results are to other countries but the programme was pilot tested at a school in Norway. The school chose to continue using the programme after the testing ended.
In poorer countries it is paramount that decisions and measures are knowledge-based, so that valuable resources are not wasted on ineffective measures, or even those with a negative effect.
"Even though Norway has more resources than Uganda, resources are also wasted here. Studies have shown that children and adults in Norway struggle to assess health claims," ​​concludes Fretheim.
The studies were funded by the Research Council of Norway's GLOBVAC-programme.

Friday, June 9, 2017

Marlboro students get head start on 'adulting'

MARLBORO — Third graders Kristen Tsim and Daniel Martinez took cookie cutters and pressed them down on slices of cinnamon raisin bread.
A few seats away, students mixed a bowl of blueberries and yogurt, scooping them into plastic cups.
"It's like we're real chefs," Martinez said.  "We're making food like in a restaurant."
The Robertsville Elementary School bistro is open for business with dozens of students from grades 3 to 5 at the helm. Once a month, they cook snacks or small meals for their peers. Speech therapist Annemarie Hanley, who coordinates the program, says it helps students learn how to apply basic math in a real-life setting and build on intrapersonal communication.
The program also helps students find healthier snack options and learn how to cook — skills that some people two or three times their age say they wish they had learned as children, according to one national survey.
In other words, they're "adulting."
Adulting is known as living independently and taking on everyday responsibilities — as adults typically do — such as having a job, taking clothes to the dry cleaner or cooking, as defined by the Merriam-Webster dictionary online.

These are all life skills that the kids should learn at a young age, that way ... they know the value of money, they know how to budget, especially if they want to have food for seven days," said Annmarie Milano, whose 9-year-old son Nick is in the bistro program. "I'm very big on bringing all these skills back into the schools."
Many young adults wish those basic skills were taught in high school or college, according to a Bank of America/USA Today poll. Most respondents said they wished they had learned more financial topics, with only 41 percent of college attendees surveyed saying higher education taught them sound financial habits and 31 percent saying their high education provided that training. Twelve percent of respondents also said they wished they had learned more about cooking.
There is now an Adulting School in Maine. It offers training on cooking, budgeting and folding fitted bedsheets — as well as similar seminars across the country.

Amy Nardella says her 11-year-old son Dominick Nardella, who has a learning disability, has learned to cook more and started to come out of his shell, which she attributes in part to the bistro program.
"It has reading skills. It has math skills. It gives them kitchen safety," Nardella said. "It's very well-rounded, and it gives them a sense of community."

Thursday, June 8, 2017

Novel DNRI Agent Improves ADHD Symptoms in Study

Wednesday, June 7, 2017

9 Ways to Test and Improve Your Emotional Control

Emotion regulation can be yours with this new, research-based approach.

Posted Apr 11, 2017

Every time you “lose it,” whether by becoming overwhelmed by angerlaughter, or anxiety, your happiness and your relationships stand to suffer. It’s okay for toddlers to become instantly enraged when a sibling takes a toy away from them, or for teenagers to get a case of the giggles at a friend's faux pas. As adults, we’re expected to hold our emotions in check, or at least cover them up, so they don’t make us look foolish, immature, or unreliable.
A considerable amount of research on emotion regulation attempts to identify the factors that determine who is able to do so and who is not, but much of it is based on the rather untrustworthy use of self-report instruments. As we know, people are unable to determine their strengths and weaknesses when no one is there to verify their responses. It's also not clear from a questionnaire whether people are all that good at doing what they say they can. A new interview-based measure of emotion regulation addresses the limitations of self-report and also provides practical ways to apply this important concept to your own life.
Based on the premise that individuals' self-reports aren't the best way to test their emotion regulation, Auburn University’s Daniel Lee and colleagues (2017) developed an alternate approach, which they call the "Semi-Structured Emotion Regulation Interview" (SERI). Intended for use by clinicians, the SERI contains a set of questions for which respondents provide their own ratings about themselves. The advantage of this interview-based approach is that people aren't always able to label their own emotions accurately, They also may not experience each of the emotions covered in an all-purpose questionnaire. For example, if they’ve not felt extreme anger recently, then it wouldn't be appropriate to have questions that focus on anger control. If anxiety is their target emotion, the interviewer can switch instead to this area of questioning. A questionnaire would not have this flexibility. Additionally, the semi-structured nature of the interview measure means that reasonably standard questions are asked of different people, an important criterion for a psychologically useful measure. Interviewers are trained to employ follow-up questions that use approximately the same wording for each individual, rather than just playing it by ear.
For the SERI, then, once participants identify the target emotion, the interviewer proceeds to ask them about these 9 possible emotional-regulation strategies. See which ones you tend to use:
  1. Social support seeking: Turning to others for reassurance and ideas.
  2. Self-medication: Using substances or alcohol to assuage one’s emotions.
  3. Deliberate self-harm: Inducing harm onto oneself.
  4. Acceptance: Taking a situation in stride.
  5. Positive reappraisal: Looking at the bright side of a troubling situation.
  6. Expressive suppression: Trying to contain one’s emotions.
  7. Rumination: Going over and over in one’s mind the situation that provoked the emotion.
  8. Behavioral avoidance: Staying away from the emotion-laden situation.
  9. Cognitive avoidance: Staying away from thoughts about the emotion-laden situation.
     For each strategy regarding one of your target emotions, indicate whether you've used it while experiencing the emotion, how often, and whether the strategy seemed to work for that situation. 
A key feature of interest in these emotion-regulation strategies is whether they actually work. By definition, some strategies are less effective than others at reducing the emotion you’re trying to control. Rumination will only make anger, sadness, and anxiety increase. Self-medication and self-harm are clearly damaging to the your mental and physical well-being. Avoidance isn’t very effective when there’s a problem you need to deal with, rather than shove under the surface.
No emotion-regulation strategy is very effective, by definition, if it doesn’t reduce the strength of the emotion you’re experiencing and help you feel better. But despite the inherent disadvantages to some of these strategies, the individuals in the Lee et al. study reported using them anyhow. In part, this might be because people don't realize that the strategies themselves are problematic (such as self-medication), or they just aren't able to identify or practice more effective approaches. People responding to these questions may not have anyone they can share their problems with, or may not know how to engage in the process of reappraisal. It may seem easier just to avoid things — either behaviorally or cognitively — than to confront a potentially anxiety or anger-provoking situation.
The Auburn University-led team made several interesting observations in testing the ability of the SERI to correspond to other previously-established measures of emotion control. One was that respondents weren’t always able to recognize when they actually had experienced a negative emotion. After indicating that they probably were using one of the avoidance strategies at the beginning of the interview, as the examiner continued to query, these individuals gained some insight into their own emotional experiences. Second, respondents weren’t always able to distinguish among related emotion-regulation strategies, requiring that the interviewers provide greater elaboration.
Because it provides a more “nuanced” assessment of emotion regulation than self-reporting, the authors maintain that the SERI is a better way to get at the strategies people actually use when they try to deal with painful emotions than the standard self-report. This suggests that when we read studies based on self-report, we take them with a fairly large grain of salt. Being able to acknowledge your emotions and then detect the way you handle them is a big step toward regulating them. If you know enough to answer a self-report scale, then you probably have enough insight to go about managing the way you handle these painful feelings.
To sum up, the Lee et al. study suggests that you can benefit from taking stock for yourself of which of the 9 strategies you use for your problematic emotions. The rule of thumb in the coping literature is that there’s no one “best” way to cope with stress. However, when it comes to emotion regulation, your strategy needs to work by at least allowing you to get your emotions under control. 
Your emotional fulfillment depends on the positive generally outweighing the negative in the grand scheme of your daily life. Finding the strategies that work for you from those listed in the SERI can help you move toward that more positive and fulfilling route of self-expression.

Tuesday, June 6, 2017

How to Stand up to the People Who Step All Over You

How to Stand up to the People Who Step All Over You
New research shows what to do when others take advantage of you.

The norms of ordinary social convention include the expectation that adults respect each other’s rights to make their own decisions and maintain their individuality, even in close relationships. The closer the relationship, the more fluid are the lines that separate us from each other. However, most people still prefer that their intimate partners allow them to retain at least some privacy. In professional or collegial relationships, the lines we maintain around ourselves are far less permeable. The term boundary is used in psychology to refer to such a line, and it implies that there needs to be some type of fence, however fluid, that protects our identity and autonomy. When someone steps on, or over, you, it’s a sign that the individual has decided your boundaries aren’t worth respecting. This behavior could involve handing you a task that isn’t part of your job description, prying into your personal affairs, or telling you something that is better left unsaid.
According to University of Connecticut’s Anne Dailey (2017), “We say that people have good boundaries when they are able to restrain their impulses, to limit desire, to hold back, to tolerate frustration” (p. 13). We object when those with poor boundaries invade our space. Women may complain about male privilege, for example, when the men in their lives presume that they have the right to ask women about personal matters, a presumption they would never make with men. The behavior of disrespecting boundaries can reflect a power differential (men feeling they have the “right” to intrude on women’s lives), but it can also reflect an individual’s failing to learn about boundaries from parentswho themselves were intrusive and controlling.
The “bright lines” of boundaries “separate lawful from unlawful, consensual from coerced, free from exploited, ownership from trespass, fantasy from reality.” From this perspective, boundaries are everywhere in human relationships. Some boundaries are wide “grey areas,” “but the notion of a boundary always entails this idea of separation” (p. 14).
In psychoanalytic treatment, which is the focus of Dailey’s work, it's sometimes the case that therapists feel sexually drawn to their clients. Clearly, if they acted on this attraction, it would constitute unacceptable professional behavior. The therapist needs to “keep her hands off the patient” and sublimate, or refocus, those feelings onto the work itself. Used in this manner, the therapist’s attraction toward the client can help provide important clues about that individual’s inner life. Further, the feelings the therapist has toward the client may be similar to those that know the client outside the context of treatment. By understanding those feelings, the therapist gains insight into the client's most important relationships.
In everyday life, people experience such unwanted and unacceptable desires all the time. Work-related talk among colleagues suddenly results in “enflaming wishes for more” (p. 16). If they are to maintain the boundaries of their relationship, coworkers need to use a similar process of sublimation to turn passion toward each other into passion toward achieving successful work outcomes. There is a certain sadness to this: “the loss of spontaneity and desire unmediated by words” (p. 17). However, we have to give up those “lived intensity” moments for protection against violating or being violated.
In situations when you feel these urges, Dailey’s work suggests that you don’t try to shove them out of your consciousness, but instead use them to help gain insight into your relationship with that other person. It’s possible that you’re responding to cues from that other person, and this is why you feel so attracted. The notion of “countertransference” that forms the core of Dailey’s argument is that the feelings you experience toward others are in part a reflection of how they feel toward you. Sublimation means that you don’t act on those feelings, so that nothing changes in the outward nature of your relationship.
Let’s flip the situation around toward you being the unwanted recipient of someone else’s boundary violations. It’s all very well and good to analyze why this is happening and to use the experience to promote self-understanding, but it’s still unpleasant to be placed in this position. Perhaps you’re meeting a potential romantic partner for the first time and so you are just in testing mode with respect to this person. Early in the conversation, though, you find yourself being asked to answer some pretty intrusive questions: “What led to your divorce?” “Why didn’t you finish college?” “How much do you earn?” These seem inappropriate given the stage of your relationship, causing you to squirm or dodge the questions. It’s possible that the other person just feels very comfortable around you and thinks it’s okay to take the conversation in this direction, but you would still prefer not to.
Consider another example that more directly indicates boundary crossing in the form of taking advantage of you: Let’s say you’ve been invited to a reception honoring a colleague you know somewhat well, but the relationship is entirely work-based. A ceremony is about to begin in which the honoree will need to have his hands free. Seeing you enter the room, he shoves a plate of food and a wine glass into your hands, expecting you to hold it for the duration of the event. Does it seem to you that your colleague has mistaken you for a table? Was the act done with the air of someone used to having people wait on him hand and foot? This is hardly a violation of the sort encountered by people who are victims of real boundary crossing, but it feels insulting nevertheless.
When people with poor boundaries act in this way, you’re placed in the impossible situation of not wanting to seem rude, but also not wanting to be seen as a piece of furniture. Dailey’s work would suggest that you confront the feelings of insecurity that such acts trigger within you. Why should you feel it’s necessary to comply with inappropriate requests? Additionally, and perhaps more importantly, you can also use these situations to gain insight into what’s going on with others that led them to violate your autonomy and needs.  
Being able to identify the unwanted crossing of boundaries that occurs when people invade yours is the first step toward asserting your rights to self-control, privacy, and individuality. It’s this recognition that will allow you to take that next step of acting on those rights. Boundaries are part of all of our relationships, and maintaining yours will help boost your own feelings of personal fulfillment.

Monday, June 5, 2017

Students have trouble judging the credibility of information online, researchers find

Education scholars say youth are duped by sponsored content and don't always recognize political bias of social messages.
Stanford University
November 23, 2016 

When it comes to evaluating information that flows across social channels or pops up in a Google search, young and otherwise digital-savvy students can easily be duped, finds a new report from researchers at Stanford Graduate School of Education.

The report, released this week by the Stanford History Education Group (SHEG), shows a dismaying inability by students to reason about information they see on the Internet, the authors said. Students, for example, had a hard time distinguishing advertisements from news articles or identifying where information came from.
"Many people assume that because young people are fluent in social media they are equally perceptive about what they find there," said Professor Sam Wineburg, the lead author of the report and founder of SHEG. "Our work shows the opposite to be true."
The researchers began their work in January 2015, well before the most recent debates over fake news and its influence on the presidential election.
The scholars tackled the question of "civic online reasoning" because there were few ways to assess how students evaluate online information and to identify approaches to teach the skills necessary to distinguish credible sources from unreliable ones.
The authors worry that democracy is threatened by the ease at which disinformation about civic issues is allowed to spread and flourish.

"Many of the materials on web credibility were state-of-the-art in 1999. So much has changed but many schools are stuck in the past," said Joel Breakstone, the director of SHEG, which has designed social studies curriculum that teaches students how to evaluate primary sources. That curriculum has been downloaded 3.5 million times, and is used by several school districts.

The new report covered news literacy, as well as students' ability to judge Facebook and Twitter feeds, comments left in readers' forums on news sites, blog posts, photographs and other digital messages that shape public opinion.
The assessments reflected key understandings the students should possess such as being able to find out who wrote a story and whether that source is credible. The authors drew on the expertise of teachers, university researchers, librarians and news experts to come up with 15 age-appropriate tests -- five each for middle school, high school and college levels.
"In every case and at every level, we were taken aback by students' lack of preparation," the authors wrote.
In middle school they tested basic skills, such as the trustworthiness of different tweets or articles.
One assessment required middle schoolers to explain why they might not trust an article on financial planning that was written by a bank executive and sponsored by a bank. The researchers found that many students did not cite authorship or article sponsorship as key reasons for not believing the article.
Another assessment had middle school students look at the homepage of Slate. They were asked to identify certain bits of content as either news stories or advertisements. The students were able to identify a traditional ad -- one with a coupon code -- from a news story pretty easily. But of the 203 students surveyed, more than 80 percent believed a native ad, identified with the words "sponsored content," was a real news story.

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Sunday, June 4, 2017

Five Ways to Fit in With Just About Any Crowd

Gain acceptance with almost anyone by following these 5 tips.

Posted Apr 25, 2017

Being able to stand out from the crowd is, in many cases, important to your success in relationships. Individuality is a quality to strive for when you want to gain recognition for your unique personal attributes. There are other times, though, when being able to fit into the crowd becomes more beneficial in helping you achieve your goals. Perhaps you’ve been invited by a friend to a family gathering and, as the one new person, don’t want to draw attention to yourself. In a work setting, being considered a team player means that you stick within a set of established boundaries. Socially, going along with the crowd can also help when you’re getting other people to like you. New research on conformity provides guidance on how to blend in when that is your goal.
Social norms are those expectations we hold about how to behave as the occupant of a particular role, group, or society in general. You follow those norms, often without giving the matter much thought, whenever you act in a way consistent with whatever feature is most relevant at the time. You may be a mother at home but a coworker in the office, and it would be unusual for you to adhere to the maternal role at the office or the colleague role at home. In social norms defined by one of your intrinsic features, such as your gender, age, or ethnicity, you have fewer degrees of freedom for straying from that set of expectations. Roles that you occupy by virtue of your inherent qualities or your social position provide narrower norms than roles or positions that are more fluid. You may be the outsider at a family gathering of your friend, but you become the insider at your own family’s social function. It will be much easier to express your individuality when everyone knows you than if you’re not sure of how that individuality will come across.
In norms that are more programmed into your inherent qualities, fitting in might require that you ascribe to the established set of expectations that others in your society hold toward people who have those qualities. Older people are expected to “act their age,” and men and women are expected (especially in certain societies) to behave in stereotypically masculine or feminine ways. When they don’t, they may suffer negative consequences, but they may suffer similarly aversive consequences when they do.
In a large-scale meta-analysis of 78 samples involving 19,453 individuals (the majority of whom were male), Indiana University Bloomington’s Y. Joel Wong and colleagues (2017) examined the mental health outcomes of conformity to the stereotypical masculine norms of self-reliance, power over women, and playboy. Conformity to all three of these components of the masculine role was reliably related to poor mental health outcomes. Men who conformed to these three aspects of the masculine role were also less likely to seek psychological help when distressed. However, conformity to other aspects of the masculine role was not associated with poorer mental health or an unwillingness to get help. Making work a priority and being willing to take risks had no negative associations with mental health. In fact, being willing to take risks was related to better mental health.

Thus, you may not always want to conform to your group’s norms. In fact, the Wong et al. study showed that adherence to stereotypical masculine norms was more strongly related to mental health among non-college than college samples. It’s quite likely that peer pressure to be masculine had more of a negative impact on the mental health of men situated in an environment that is less friendly toward men who don’t adhere to stereotypically masculine norms.
As the Wong et al. team note, it’s “well-established in the theoretical and empirical literature” that adhering to the norms of the group may be beneficial to an individual’s mental health (p. 88). The beneficial turns to harmful when those norms become too constraining, as shown in the study of masculinity. Social norms are there to help guide us, but when they cut you off from your own set of values and ideas, they can have the opposite effects.
Until you know whether a group or culture’s norms will fit your sense of identity, taking the more conservative route of fitting in seems to be the safer path to follow. These 5 tips will help lead you to that path:

1. Most importantly, decide if you want to fit in. The Indiana University study showed that having to fit into a crowd that doesn’t match your values or personality can sap your mental health. If you’re constantly having to adjust your identity to the group’s, you may want to find a different group.
2. Choose clothes according to the situation. If you’re going to a funeral, you probably wouldn’t want to be the only one wearing white. Similarly, if invited to a social gathering where you’re not sure what to wear, you may want to ask someone you know before you get your outfit together. That proverbial “I didn’t get the blue memo” suggests that we do pay attention to the color worn by the other people around us. If you didn’t get that "memo," you may feel unusually awkward, because you feel that you don’t look quite right. Your colors don’t have to match everyone’s, but the general level of formality should.
3. Tune in to the nonverbal cues of the people around you. If everyone else is serious, you don’t want to be the only one laughing or even smiling. At a serious event, you need to maintain your composure, but if you do so at a jolly one, you’ll be seen as unfriendly. It’s especially important to read these cues when you don’t know the people in the group very well, but it’s usually wise to err on the side of being a bit more restrained than everyone else.
4. Respect the norms of the group. If you’re the newest person to join a well-established group, you may not realize just how people in this group normally interact. Let’s say you’re the newest employee, and you come from a company where people stopped and chatted at each other’s desks, even if there was a lot of work to do. At your new company, this behavior may be frowned upon, so before you become known as someone to steer clear of, see whether your new company follows these same norms.
5. Keep the focus of attention on others, not you. You’ll be most likely to be appreciated by others when it seems that you’re genuinely interested in them. It may not come naturally to you, but try to maintain a low profile until you feel more sure of yourself.
We can all gain fulfillment by meeting new people and exposing ourselves to new situations. The study by Wong and colleagues showed the dangers of sacrificing your values to those of the people around you when you honestly don’t adhere to them. Sticking around in the group long enough to see whether this is one you want to join requires that they let you into their world. After that, it’s up to you.

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Friday, June 2, 2017

Bright Light Therapy for Nonseasonal Depression: An Emerging Intervention

Bright light therapy (BLT), also called phototherapy, is “an accepted modality for treatment of major depressive disorder with a seasonal pattern, commonly referred to as seasonal affective disorder (SAD).”1 It has also been shown to be effective in nonseasonal depression, both as monotherapy and as augmentation of pharmacotherapies.2 However, despite its relatively low-risk profile, phototherapy is an underused modality in the treatment of nonseasonal depressive disorders.3
“Although BLT is a well-established treatment for SAD, it has not been as widely accepted in nonseasonal depression,” observed Thomas M. Penders, MD, clinical associate professor, department of psychiatry and behavioral medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina. 
There are several reasons for this, Dr Penders told Psychiatry Advisor. “It is difficult to conduct a placebo-controlled study, since participants obviously know whether they are or are not receiving light therapy, so some of the research has been criticized.”
Another reason is that, unlike most pharmacotherapies, BLT is not being actively promoted to clinicians, he added.
Cost is an additional reason for the underuse of BLT, according to a study in 197 psychiatrists who responded to an email survey regarding their use of BLT in clinical practice.3 Lack of insurance coverage for light-delivery devices was identified as the most formidable barrier.
A Substantial Research Base
Dr Penders, who was the lead investigator on a systematic review and meta-analysis of BLT,explained that he and his colleagues treated patients with nonseasonal depression with BLT in the morning and found it to be helpful. “Although we did not turn this into a formal study, we did go back and look at the literature to see what studies had already been done.”
His team found “a fair amount of evidence to show that BLT in the morning had a beneficial effect on depression,” he said. Their published review in particular was “targeted to see whether people treated in the usual way — with drugs or therapy — could have enhanced treatment outcomes by adding light therapy.”1
For inclusion in the review, a study had to compare antidepressant pharmacotherapy combined with BLT (≥5000 lux for ≥30 minutes) to antidepressant pharmacotherapy without BLT for the treatment of nonseasonal depression. Trials of both unipolar major depressive disorder (MDD) and bipolar depression were included in the analysis.
Ten studies involving 458 patients met these criteria. The addition of BLT was found to be superior to antidepressant pharmacotherapy alone in alleviating symptoms of depression, with an effect size “similar to that of other accepted augmentation strategies (roughly 0.5).”1
The researchers concluded that BLT “is effective and can add to the armamentarium of interventions available to patients with refractory depressive disorders.”1
A study comparing BLT, fluoxetine monotherapy, and combination therapy in patients with nonseasonal MDD found BLT to be efficacious and well-tolerated in the treatment of adults with MDD, although the combination therapy had the “most consistent effects.”4 And a trial comparing venlafaxine monotherapy with the combination of venlafaxine and BLT found that the combination “induced significantly stronger and more rapid beneficial effects."5
BLT has been investigated and found effective in alleviating depressive symptoms in patients with a variety of illnesses, including cystic fibrosis,6 childhood and adolescent depression, antepartum depression, eating disorders,7 postoperative delirium,8 and Parkinson disease.8
Mechanism of Action
Almost all of the physiological functions of the body, including the sleep-wake cycle, follow specific rhythmic changes throughout the day and are driven by the “master clock” — ie, the suprachiasmatic nucleus (SCN).10 The SCN, which is located within the anterior hypothalamus, maintains the circadian cycle.10 Circadian rhythms are typically driven by endogenous self-sustaining processes that rely upon “circadian time cues” (zeitgebers) to “remain appropriately oriented to the individual's environment and desired routine.”11
Melatonin (N-acetyl-5-methoxytryptamine) is a “central hormone of internal clock circuitries, that is secreted primarily by the pineal gland in a specific circadian pattern, in accordance with the light-dark cycle (high at night, low during the day) and the seasonal cycle (longer peak in winter, shorter peak in summer).”10 Melatonin is synthesized from its precursor, serotonin. It “functions as a biochemical marker transducing photoperiodic information and signaling seasonal variations of the light-dark cycle to all cells.”10
Melanopsin-containing retinal cells perceive and transduce the light-dark cycle. Melanopsin is primarily responsible for resetting the timing of the SCN, suppressing pineal melatonin secretion and improving alertness.10 The effect of BLT appears to be mediated through the eyes; extraocular administration has failed to show any significant antidepressant qualities.10
Melatonin can be a “state marker” as well as a “trait marker” of mood disorders.12 Measurement of melatonin, either in saliva or plasma, has shown significant alterations in melatonin secretion in acute phases of MDD. Both the levels and the timing of melatonin secretion are altered in bipolar disorder and SAD.12
“People fall into 3 groups in terms of their chronobiology,” Dr Penders explained. “'Early birds' go to sleep early and wake up early. ‘Night owls' go to sleep late at night and wake up late in the morning. There is a large group in the middle that does not fall into either of those categories.”
Individuals with depressive disorders are more likely to be “night owls” and are particularly vulnerable to chronobiological disturbances. “Measuring the time of melatonin onset provides a specific marker for a person's chronobiology,” Dr Penders commented.
BLT suppresses melatonin production.12 “It moves melatonin onset time forward” so that 'night owls' begin to go to sleep earlier,” Dr Penders said.
Practical recommendations for the administration of BLT can be found in the table below.
Safety Considerations and Potential Adverse Effects
“BLT is safe and although there can be side effects, they are rare,” Dr Penders observed. “The risk-reward ratio is good.”
Adverse effects can include headache, eyestrain, nausea and agitation; these tend to remit spontaneously or after dose reduction.10 Patients with bipolar disorder may switch to hypomania during therapy, and suicidality may sporadically occur early in the course of treatment. BLT can also cause menstrual irregularities.10  
Since retinal degeneration can occur in patients with a family or personal history of retinal damage, patients should consult an ophthalmologist before initiating treatment, Dr Penders advised.  In addition, patients should not stare directly at the light. “Ambient light is sufficient.”
Results of the survey of psychiatrists showed limitations in practitioner knowledge of BLT.3Respondents also indicated that there was an absence of BLT in treatment algorithms for depressive disorders. The study investigators stated that these are the “two leading modifiable factors to encourage broader implementation” of BLT.2