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May 4

5 Missed Signs of Child Anxiety

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By Natasha Daniels

Not all signs of anxiety are obvious. Here are 5 missed signs of child anxiety.
Anxiety in children is obvious, right? Kids would tell you their fears. They would be scared all the time. They might cling to you in new situations.

You would know if your child is anxious – wouldn’t you?

Unfortunately, anxiety isn’t always that obvious. Some children don’t vocalize their worries. They don’t show their fears. And anxiety isn’t on their parents’ radar.

In my child therapy practice parents often bring their children in for other reasons, only to discover that the problem is actually anxiety.

Here are five missed signs of child anxiety:

PHYSICAL SYMPTOMS:

Anxiety isn’t just in our minds, it is in our body as well. Here are just a few examples-

Your child won’t poop. They have been constipated for weeks. You’ve been to the doctor and there is no medical origin.

Your child’s stomach hurts. They feel like throwing up. They are having gastrointestinal problems. You brought them to the pediatrician. You went to the gastrointestinal specialist. Your child has been poked, prodded and maybe even scoped. No medical origin has been found.

Anxiety isn’t just in the mind, it can be felt in the body as well.

SCHOOL REFUSAL:

Your child used to love school. They’ve always had friends and they have always gotten good grades. Now it is a battle just to get them in the car. They tell you they don’t feel well. Their stomach hurts. They say they are going to throw up. You keep them home – only to feel bamboozled because they seem fine shortly thereafter.

You talk to the teacher and the counselor. Everyone swears up and down that your child has friends. That they are not being bullied. That they enjoy school.

Weekends are pain-free. Your child seems completely healthy – and then Sunday rolls around. The cycle begins again.

ANGER:

Anger can be tricky. Kids can be angry for so many reasons. They might have difficulty self-regulating. They might have a mood issue. They might have a hard time accepting no. But along with the usual contenders, anxiety can be the underlining cause of anger too.

If your child stuffs their worries way down deep – the only thing to bubble to the surface might be their anger.

They come home from school ready to explode. Bedtime brings with it rage and resistance. New situations cause unusual hostility and defiance.

Pay attention to when and why your child gets angry – as it could be the key to unearthing the true cause.

AVOIDANCE OF ACTIVITIES:

Your child used to love soccer practice and now they are refusing to go. Your child said they wanted to take swim lessons, but after the first lesson you can’t get them back to class. Your child always wants to stay home and refuses to go to restaurants and stores with you.

When a child starts avoiding situations they used to enjoy – it is time to take a second look at why. It might be that they simply no longer like soccer or swim class – but it might be something more significant.

The #1 unhealthiest, go-to coping mechanism for anxiety is AVOIDANCE. Avoid at all costs.

If I don’t go to soccer, then I won’t have to worry about the ball hitting my face.

If I say I don’t want to go to swim, then I won’t have to worry about sinking to the bottom of the pool.

If I put up a big fight – then I won’t have to go to the restaurant and worry about throwing up in public.

ROUTINES VERSUS RITUALS:

Your child has to line up all their stuffed animals in a perfect row before they go to bed. You have to say “I love you” in a certain way – for a certain number of times – before your child will go to bed.

Parents often mistake ritualistic behavior for routines. Routines are comforting and predicable. Rituals are rigid and need to be redone if not done “correctly.” Routines are a healthy part of childhood – rituals are an indication of anxiety.

Anxiety is a very treatable condition. The earlier children get help – the better the prognosis in the long run. If you feel like your child is having some signs of anxiety, seek out the advice of a mental health professional. It can never hurt to get some professional input and guidance.

May 3

By Natasha Daniels

You can’t parent an anxious kid the way you would your other kids. Here are the top 9 things to NOT do when parenting an anxious child. That is of course unless you like meltdowns!
Anxious kids are a different breed. If you parent one – you know what I am talking about. Perhaps this realization dawned on you when you watched your friends interact with their children. What seemed to work for them – completely backfired for you.

In my child therapy practice I will often hear things such as, “I don’t get it. Everything that worked with our other kids won’t work with our anxious kid.”

You can throw your regular parenting book out the window – you need a completely different playbook for an anxious child.

Let’s countdown the 9 most ineffective parenting approaches for anxious kids

Each child is unique – even anxious kids. Some of these might actually work with your anxious kiddos – but in general these approaches are much less likely to work on an anxious mind.

RUSHING YOUR CHILD

You want to see anxious children have a complete meltdown – tell them to hurry up. Most anxious kids completely implode when we tell them to speed up. I can bark at two of my kids to hurry up and they’ll get moving. If I did that to my third child – we’d have to tack on 30 more minutes to allow for the meltdown that will ensue.

SINK OR SWIM

Many parents feel they just need to throw their kids into a feared situation and the kids will do fine. The sink or swim approach. Anxious kids will sink. They will plummet to the deepest darkest depths and will not come up for air.

SET A TIMER

A great parenting approach for time management might include a timer. Such as, “when the timer goes off it is time for you to stop playing your video game.” A timer is a ticking time bomb for anxious children. Instead of speeding them up – they will ruminate over the clock and will probably explode into tears or screams long before the buzzer sounds.

MAKE A RACE OF IT

Similar to the timer – any type of time-limiting approach is most likely not going to work. Anxious kids get overwhelmed with time limits. Timed tests. Timed activities. None go down well. Trying to make things fun with comments such as, “who can get there first?” can turn an anxious child into a puddle of a tears.

TELL THEM ABOUT THE FUN THEY’LL MISS

Your anxious child doesn’t want to go to a party. They don’t like crowds or new social situations. You tell them they are going to miss out on all the fun.

Telling your anxious child what fun they’ll miss if they don’t go won’t work. They know they are missing the fun. It upsets them more than maybe you know. Reminding them of what they’ll miss out on will just increase their anxiety. Instead, address the fear that is driving the behavior. Talk about how they can handle the new social situation and give them tools to get through it.

FOOD BATTLES

You want to see an anxious child throw up? Have a food battle with him or her. Drawing a line in the sand will result in a loss for both of you. You’ll be frustrated and your children will never again touch whatever food you are trying to metaphorically (hopefully) shove down their throat.

My twelve year old still won’t touch broccoli due to a food battle when she was three. The tongue never forgets!

Anxious kids can be picky eaters due to oral sensitivities and the fear of new foods. Encourage your children to eat new things. Place new foods on their plate. But, don’t make mealtime a battle zone.

PUNISHING YOUR CHILD FOR TOILETING ISSUES

Some anxious kids are slow to potty train. Older kids might fear pooping (yes, that is a thing) and may avoid pooping at all costs. This can cause constipation and conversely accidents. I know this can be a gross and frustrating parenting issue. But shaming, blaming or punishing this behavior will not fix it. Address the fear – not the behavior.

SCARE THEM INTO BEHAVING

Parents will use facts to help their children do things they would otherwise not do. Brush your teeth or they’ll fall out! Hold my hand or you’ll get hit by a car! Put a helmet on or you’ll crack your head open. I know these things have flown out of my mouth at times. I also know that sometimes I say the wrong scary thing and I have to do damage control for weeks afterwards.

Try to focus on more positive statements. Brush your teeth and make them sparkly clean. Hold my hand so I can make sure to keep you safe.

ALL OR NOTHING RESPONSES

Anxious behavior can sometimes be mislabeled as oppositional. Anxious kids might completely freak out when told no. This can be misconstrued as spoiled and entitled behavior – but in reality anxious kids can’t handle the concept of no. They can’t handle the finality of no.

Speaking in absolute terms typically doesn’t go down well with anxious kids. When possible, focus on when they can do it or when they can have it – even if it is far away. Tell them things such as, “You can have that for your birthday” or “you can have that after dinner.” You can even motivate them with comments like, “You can save up your money and get it.”

Now having said that – sometimes “no” will just be “no.” Just like other kids, anxious kids need to learn how to handle not always getting what they want. In reality, sometimes there is no future “yes” to their answer.

Parenting any child can be a struggle. Parenting an anxious child can make your head swirl.
Now that you know what doesn’t work, click here to read about what does work!

Mar 6

Why Some People Have Increased Risk for Anxiety

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By Rick Nauert PhD

New research suggests people suffering from anxiety perceive the world in a fundamentally different way than others. Investigators believe this finding may help to explain why certain people are more prone to anxiety.

The new study, published in the journal Current Biology, shows that people diagnosed with anxiety are less able to distinguish between a neutral, “safe” stimulus.

Researchers tested their hypothesis using the sound of a tone — a stimuli that had earlier been associated with gaining or losing money.

Investigators found that when some people have emotionally-charged experiences, they show a behavioral phenomenon known as “over-generalization.”

“We show that in patients with anxiety, emotional experience induces plasticity in brain circuits that lasts after the experience is over,” says Prof. Rony Paz of the Weizmann Institute of Science in Israel.

“Such plastic changes occur in primary circuits, and these later mediate the response to new stimuli. The result is an inability to discriminate between the experience of the original stimulus and that of a new, similar stimulus.

Therefore anxiety patients respond emotionally to the new stimuli as well and exhibit anxiety symptoms even in apparently irrelevant situations. They cannot control this response: it is a perceptual inability to discriminate.”

The study was a collaboration between psychiatrist Dr. David Israeli and Paz, and it was led by Dr. Offir Laufer, then a Ph.D. student in Paz’s group.

Paz and his colleagues recruited anxiety patients to participate in the study. They trained the patients to associate three distinct tones with one of three outcomes: money loss, money gain, or no consequence.

In the next phase, the participants were presented with one of several new tones and were asked whether the tone was one they had heard before while in training. If they were right, they were rewarded with money.

The best strategy would be to take care not to mistake (or over-generalize) a new tone for one they had heard in the training phase. But people with anxiety were more likely than healthy controls to think that a new tone was one they had heard earlier.

That is, they were more likely to mistakenly associate a new tone with the earlier experience of money loss or gain. Those differences were not explained by differences in participants’ hearing or learning abilities.

Investigators explain that the participants simply perceived sounds that were earlier linked to an emotional experience differently.

Functional magnetic resonance images (fMRIs) of the brains of people with anxiety and those of healthy controls revealed differences in the activity of several brain regions. These differences were mainly found in the amygdala, a region related to fear and anxiety, as well as in the primary sensory regions of the brain.

Researchers believe these results strengthen the idea that emotional experiences induce long-term changes in sensory representations in anxiety patients’ brains.

The findings might help explain why some people are more prone to anxiety than others.

The underlying brain plasticity that leads to anxiety isn’t in itself bad, Paz says.

“Anxiety traits can be completely normal; there is evidence that they benefitted us in our evolutionary past. Yet an emotional event, sometimes even a minor one, can induce brain changes that can potentially lead to full-blown anxiety,” he says.

Therefore, understanding how the process of perception operates in anxiety patients may help lead to better treatments for the disorder.

Source: Weizmann Institute of Science

Nov 23

Behavioral Treatment for Kids With Anxiety

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Jerry Bubrick, PhD
Senior Director, Anxiety & Mood Disorders Center; Director, Intensive Pediatric Obsessive-Compulsive Spectrum Disorders Program
CHILD MIND INSTITUTE
When a child shows signs of anxiety, we tend to think it will go away—she’s just nervous or shy, and she’ll grow out of it. But when the anxiety becomes so intense that it’s seriously interfering with a child’s life, and the life of her family, it’s important to get help.
Serious untreated anxiety tends to get worse over time, not better, because the child learns that avoidance works in reducing the anxiety, at least in the short run. But as the child—and, indeed, the whole family—work to avoid triggering those fears, they only grow more powerful.
Medication is often prescribed for children with anxiety, as it is for adults. And medication—antidepressants are usually our first choice—often helps reduce anxiety. But what many people don’t know is that cognitive behavioral therapy (CBT) can be very effective for kids who are anxious. In fact, research over more than 20 years has shown that CBT is the most effective treatment for reducing symptoms of severe anxiety. And unlike taking medication, the therapy gives children the tools to manage the anxiety themselves, now and in the future.
What is cognitive behavioral therapy?
Cognitive behavioral therapy is based on the idea that how we think and act both affect how we feel. By changing thinking that is distorted, and behavior that is dysfunctional, we can change our emotions. With younger children, focusing first on the behavioral part of CBT can be most effective. The goal is, essentially, to unlearn avoidant behavior.
One of the most important techniques in CBT for children with anxiety is called exposure and response prevention. The basic idea is that kids are exposed to the things that trigger their anxiety in structured, incremental steps, and in a safe setting. As they become accustomed to each of the triggers in turn, the anxiety fades, and they are ready to take on increasingly powerful ones.
What to Do (and Not Do) When Children Are Anxious
It’s tempting to protect kids from things that make them anxious, but learning to tolerate anxiety is how we overcome fears.
Exposure therapy is very different from traditional talk therapy, in which the patient and a therapist might explore the roots of the anxiety, in hopes of changing her behavior. In exposure therapy we try to change the behavior to get rid of the fear.
Exposure therapy is effective on many different kinds of anxiety, including separation anxiety, phobias, obsessive-compulsive disorder (OCD), and social anxiety.
The Bully in the Brain
For children with anxiety disorders, the process begins by helping them, and their parents, get some distance from the anxiety and start thinking of it as a thing that is separate from who they are. One way I do this is by having them conceptualize it as a “bully in the brain,” and I encourage kids to give the bully a name and talk back to him. Kids I’ve worked with have called him the Witch, Mr. Bossy, Chucky, the Joker, and, in the case of some teenagers, names I cannot repeat here.
We explain that we are going to teach skills to handle the bully, giving children the idea that they can control their anxiety rather than it controlling them.
It’s also important to help kids really understand how their anxiety is affecting their lives. I may actually map out things a child can’t do because of his fears—like sleeping in his own bed, or going to a friend’s house, or sharing meals with his own family—and how that makes him feel. Getting kids to understand how their anxiety works and gaining their trust is important because the next step—facing down their fears—depends on them trusting me.
Adopting Robert Frost’s observation that “the only way around is through,” exposure therapy slowly and systematically helps a child face his fears, so he can learn to tolerate his anxiety until it subsides rather than reacting by seeking reassurance, escaping, avoidance or engaging in ritualistic behaviors such as hand washing.
How does exposure therapy work?
The first step is identifying triggers. We design a “hierarchy of fears”—a series of incremental challenges, each of which is tolerable, and which together build to significant progress. Instead of thinking in black and white terms—I can’t touch a dog or I can’t cross a bridge—kids are asked to consider degrees of difficulty. We might ask a child with contamination fears, for example, “On a scale of 1 to 10, how difficult would it be to touch the door handle with one finger? To touch and open the door?”
For a child with a fear of vomiting, we might ask: “How difficult would it be to write the word vomit?” If that is a 3, saying “I will vomit today” might be a 5. To see a cartoon of someone vomiting might rate a 7. To watch a real video of someone vomiting might be a 9. At the top of the hierarchy would likely be eating something the child thinks will make him vomit. By rating these different fears, kids come to see that some are less extreme, and more manageable, than they had thought.
Next, we expose the child to the trigger in its mildest possible form, and support him until the anxiety subsides. Fear, like any sensation, diminishes over time, and children gain a sense of mastery as they feel the anxiety wane.
Best Medications for Kids With Anxiety
For treating anxiety, antidepressants are the evidence-based choice. READ MORE
Intensive treatment
With a child who is severely anxious—who can, for instance, barely leave his room for fear that his parents will die, or must wash his hands dozens of times a day to avoid contamination—I may work with him several times a week, for several hours at a time. We do exposures in the office and then, when a child is comfortable enough, do them outside.
For someone with social anxiety, for instance, we might go out wearing silly hats, or walk a banana on a leash. For someone afraid of contamination, we might ride the bus together, or shake hands with strangers, then eat chips without washing.
Once we have worked through some exposures and he is feeling more confident, I assign homework to practice what we did in the sessions. We want kids to really master their exposures before moving up the ladder. And parents are taught to help kids progress by encouraging them to tolerate anxious feelings, rather than jumping in to protect them from their anxiety.
Treatment for mild to moderate levels of severity usually takes eight to 12 sessions, and some kids make more progress if they are also taking medication to reduce their anxiety, which can make them more able to engage in therapy.
It’s important to understand that exposure therapy is hard work, both for kids and their parents. But as fear diminishes, kids get back to doing things they like to do, and the family gets back a child they feared they had lost—and that’s a great reward.

Oct 27

By Rick Nauert PhD

New research suggests the practice of using benzodiazepines to treat psychiatric conditions should be abandoned as evidence suggests the drugs heighten the risk for dementia and death.

Benzodiazepines include branded prescription drugs like Valium, Ativan, Klonopin, and Xanax. This class of drug received FDA approval in the 1960s and was believed to be a safer alternative to barbiturates.

Despite new psychiatric protocols, some physicians continue to prescribe benzodiazepines as a primary treatment for insomnia, anxiety, post-traumatic stress disorder, obsessive compulsive disorder, and other ailments.

“Current research is extremely clear and physicians need to partner with their patients to move them into therapies, like antidepressants, that are proven to be safer and more effective,” said Helene Alphonso, DO, a board-certified psychiatrist and Director of Osteopathic Medical Education at North Texas University Health Science Center.

“Due to a shortage of mental health professionals in rural and underserved areas, we see primary care physicians using this class of drugs to give relief to their patients with psychiatric symptoms. While compassionate, it’s important to understand that a better long-term strategy is needed.”

Alphonso will review current treatment protocols, outpatient benzodiazepine detox strategies, and alternative anxiety treatments at OMED 15, to be held October 17-21 in Orlando. OMED is the annual medical education conference of the American Osteopathic Association.

A Canadian review of 9,000 patients found those who had taken a benzodiazepine for three months or less had about the same dementia risk as those who had never taken one. Taking the drug for three to six months raised the risk of developing Alzheimer’s disease by 32 percent, and taking it for more than six months boosted the risk by 84 percent. Similar results were found by French researchers studying more than 1,000 elderly patients.

Experts say the case for limiting the use of benzodiazepines is particularly compelling for patients 65 and older, who are more susceptible to falls, injuries, accidental overdose, and death when taking the drugs. The American Geriatric Society in 2012 labeled the drugs “inappropriate” for treating insomnia, agitation, or delirium because of those risks.

“It’s imperative to transition older patients because we’re seeing a very strong correlation between use of benzodiazepines and development of Alzheimer’s disease and other dementias. While correlation certainly isn’t causation, there’s ample reason to avoid this class of drugs as a first-line therapy,” Alphonso said.

Source: American Osteopathic Association/EurekAlert

Sep 16

An Overthinker’s Nightmare

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By Sharon Martin

A few years ago I remodeled my kitchen. Having to make that many decisions is an overthinker’s nightmare. If you’ve ever remodeled, you know that it’s one decision after another — fixtures, appliances, countertops, paint. Do you even know how many models of faucets are made?

People who overthink feel like their brains won’t turn off. They are constantly questioning, second-guessing, and evaluating to the extent that they create analysis paralysis, or the inability to make decisions.

Overthinking is common among anxious perfectionists. It is obsessive thinking or ruminating. Sometimes you can’t even decide something simple like what you want for dinner. Instead you say “I don’t know” or “I don’t care” and inevitably annoy your partner or friends because you never seem to have an opinion.

It’s easier for overthinkers to let someone else decide. For example, I tend to order the same thing repeatedly when I go out to eat. It’s just easier than choosing something unknown.

Even after agonizing over choices, overthinkers tend to regret their decisions and second-guess themselves.
Overthinkers tend to:

analyze things to death
second-guess everything
catastrophize or expect the worst
have insomnia
hate making decisions
prefer someone else to decide for them
regret often
struggle with letting things go
take things personally
be perfectionists
criticize themselves a lot
never feel 100 percent certain
feel anxious
feel like they can’t turn their brains off
Overthinkers easily get caught up in the “what-ifs.” What if I make the wrong choice? What if I wear the wrong thing? What if my boss hates my idea? What if my boyfriend disagrees?

Below are some ways to get out of an overthinking rut:

Plan a time to think about it.
For example, you can schedule yourself worry time from 8:00 – 8:15. Whenever you notice you are worrying or overthinking, redirect and remind yourself that you can think about this issue at 8:00, but until then you are focusing on other things. This way you aren’t thinking about it all day and letting it interfere with your productivity.
Put a time limit on it.
Similar to above, don’t allow yourself endless time to decide or worry. Allow a reasonable amount of time and when it’s over, you can no longer think about it. It’s done.
Limit your choices.
I didn’t have to look at all 12,000 refrigerator models. And you don’t have to read the review of every single parenting book on Amazon before making a choice. Fewer choices make deciding easier.
Distract yourself.
Distraction is a very practical strategy that we all use. Sometimes you need to find something else to do or think about to divert your attention. Talking to a friend, watching a funny video, reading, or music can do the trick.
Firmly tell yourself to stop thinking about it.
Snapping a rubber band against your wrist serves the same purpose. It’s almost a wake-up call to startle yourself into thinking and acting differently.
Write it down.
Simply writing the worry or dilemma down can help clear your mind and clarify your options and priorities.
Let go of perfection.
Life isn’t perfect. Just focus on making a “good enough” decision. Most decisions are not life-altering. I knew that if I hated Serene Grey on my kitchen walls, I could repaint it.
Embrace mistakes.
Taking action and making decision means that sometimes they will be wrong or people may disagree. The alternative is never trying anything, never stating an opinion, never getting what you really want. That’s no way to live.
Stay in the present.
When your mind is wandering into “what-if land,” practice some mindful meditation or grounding to bring your focus back to the present.
Don’t let yourself get stuck in indecision. Life is too short. When you’re trying to change, practice is always key.

By Janice Wood

The pressure to be constantly available and respond 24/7 on social media can cause depression, anxiety, and reduce sleep quality for teenagers, according to a new study.

For the study, presented at a British Psychological Society conference, researchers Dr. Heather Cleland Woods and Holly Scott of the University of Glasgow provided questionnaires to 467 teenagers regarding their social media use overall, as well as at night time.

A further set of tests measured sleep quality, self-esteem, anxiety, and depression.

The researchers also measured the teens’ emotional investment in social media, which relates to the pressure felt to be available 24/7 and the anxiety around, for example, not responding immediately to texts or posts, they explained.

“Adolescence can be a period of increased vulnerability for the onset of depression and anxiety, and poor sleep quality may contribute to this,” Cleland Woods said. “It is important that we understand how social media use relates to these. Evidence is increasingly supporting a link between social media use and wellbeing, particularly during adolescence, but the causes of this are unclear.”

An analysis of the collected data showed that overall and night-time specific social media use, along with emotional investment, were related to poorer sleep quality and lower self-esteem, coupled with higher anxiety and depression levels.

“While overall social media use impacts on sleep quality, those who log on at night appear to be particularly affected,” Cleland Woods said.

“This may be mostly true of individuals who are highly emotionally invested. This means we have to think about how our kids use social media, in relation to time for switching off.”

Source: The British Psychological Society

Jul 13

The Narcissistic Cycle of Abuse

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By Christine Hammond, MS, LMHC
The cycle of abuse Lenore Walker (1979) coined of tension building, acting-out, reconciliation/honeymoon, and calm is useful in most abusive relationships. However, when a narcissist is the abuser, the cycle looks different.

Narcissism changes the back end of the cycle because the narcissist is constantly self-centered and unwilling to admit fault. Their need to be superior, right, or in charge limits the possibility of any real reconciliation. Instead, it is frequently the abused who desperately tries for appeasement while the narcissist plays the victim. This switchback tactic emboldens the narcissist behavior even more, further convincing them of their faultlessness. Any threat to their authority repeats the cycle again.

Here are the four narcissistic cycles of abuse:

Feels Threatened. An upsetting event occurs and the narcissist feels threatened. It could be rejection of sex, disapproval at work, embarrassment in a social setting, jealousy of other’s success, or feelings of abandonment, neglect, or disrespect. The abused, aware of the potential threat, becomes nervous. They know something is about to happen and begin to walk on eggshells around the narcissist. Most narcissists repeatedly get upset over the same underlying issues whether the issue is real or imagined. They also have a tendency to obsess over the threat over and over.
Abuses Others. The narcissist engages in some sort of abusive behavior. The abuse can be physical, mental, verbal, sexual, financial, spiritual or emotional. The abuse is customized to intimidate the abused in an area of weakness especially if that area is one of strength for the narcissist. The abuse can last for a few short minutes or as long as several hours. Sometimes a combination of two types of abuse is used. For instance, a narcissist may begin with verbal belittling to wear out the abused. Followed by projection of their lying about an event onto the abused. Finally tired of the assault, the abused defensively fights back.
Becomes the Victim. This is when the switchback occurs. The narcissist uses the abused behavior as further evidence that they are the ones being abused. The narcissist believes their own twisted victimization by bringing up past defensive behaviors that the abused has done as if the abused initiated the abuse. Because the abused has feelings of remorse and guilt, they accept this warped perception and try to rescue the narcissist. This might include giving into what the narcissist wants, accepting unnecessary responsibility, placating the narcissist to keep the peace, and agreeing to the narcissistic lies.
Feels Empowered. Once the abused have given in or up, the narcissist feels empowered. This is all the justification the narcissist needs to demonstrate their rightness or superiority. The abused has unknowingly fed the narcissistic ego and only to make it stronger and bolder than before. But every narcissist has an Achilles heel and the power they feel now will only last till the next threat to their ego appears.
Once the narcissistic cycle of abuse is understood, the abused can escape the cycle at any point. Begin by coming up with strategies for future confrontations, know the limitations of the abused, and have an escape plan in place. This cycle does not need to continue forward.

Jul 12

How Fear Fuels Obsession

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By Christine Hammond, MS, LMHC

Do you have clients caught in a repetitive trap resulting in feelings of helplessness, frustration and discouragement? Is their careful and cautious behavior perceived by others as obsessive? Does it repel others instead of drawing them closer? Certain emotions such as fear can add fuel to an obsessive cycle causing an out of control feeling.

It begins with a painful event: abuse by a relative, abandonment by a friend or rejection from a job. Each of these events can spark fear directed inward or at another person. The feeling of dread is so uncomfortable, that a person overcompensates with a desire to over control. Sample obsessions include: cleaning, checking, washing, excessive order, repeating the same conversation, repetitive thoughts, hoarding, perfectionism, reassurance seeking, rituals or counting. Other people don’t like the preoccupation so they in turn withdraw. This leaves feelings of confusion. After all, the reason for the obsession was to avoid the fearful or anxious feelings. The result is another painful event such as a fight, more distance in relationships or further loss.

Acknowledge. The first step to stopping the crazy cycle is acknowledging the repetitive behavior. The crazy cycle is continuing. This is not the time to blame others for it; this is the time to accept responsibility. Everyone is responsible for their own behavior. This maybe a new concept as our culture is quick to blame others, parents, churches, organizations, companies, governments, and even nations for bad behavior. But this is not constructive thinking, it is destructive thinking.

Stop at Fear. There is nothing wrong with feeling fearful. But the response to fear doesn’t have to be obsession. It is OK to be fearful when hurt or when others hurts. Just don’t take it to the next step and become controlling. Rather deal with the fear by confronting feelings and taking responsibility for the actions that follow. Just saying the words, “I am fearful or anxious but I’m going to act responsibly” can restore that out of control feeling to restraint.

Know Obsessions. What is the obsession of choice? More than likely there is moe than one. Not all of the obsessive behaviors are listed above so taking an inventory is extremely helpful. Many times, a person goes directly from the painful event to the obsession and skips right past the fearful emotion. This is a conditioned response similar to Pavlov’s dogs. In Pavlov’s experiment, he trained dogs to salivate at the ringing of a bell by first giving food along with ringing the bell. Before long, he only needed to ring the bell for the dogs to salivate. The same thing is done with the obsession. Trace backwards from the fixation to the dread anytime the desire arises.

It is possible to take responsibility and stop the crazy cycle from destructive behavior. However, when a mistake is made and things slip backwards, it is never too late to turn around. Who a person is, is NOT defined by their mistakes. Rather, it is defined by the character developed along the way.

Jul 11

John Cordray Apr 28, 2015

It happened so suddenly and out of the blue. Racing thoughts filled my mind, my chest felt tight, and my heart was pounding so fast; I just knew I was having a heart attack.

Speeding to the emergency room, and finally getting the attention of a doctor, I was told I didn’t have a heart attack – I had a panic attack.

This was the story that a client of mine recounted to me as he described his latest panic attack. Panic attacks are real, scary, and are often confused with heart attacks.

Panic disorder affects about 1 out of every 75 people according to the American Psychological Association. That’s a lot of people who suffer from an invisible hell.

Panic disorder affects about 1 out of every 75 people according to the APA.
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Panic attacks can lead to other anxiety disorders, relationship problems, depression, and can dramatically alter one’s lifestyle.

Imagine feeling that your worse fear is coming true, and you can’t do anything about it. Would you freak out? I think so. But for so many people who experience panic attacks it’s more than just “freaking out” – the fear is intense and magnified tenfold.

I always remind my anxious clients to remember two things about panic attacks:

1. There’s always a beginning and an end. I refer to this as the panic window. Panic attacks start slow (most of the time), then it peaks (high point), then it comes back down. The majority of panic attacks last for about 10-15 minutes.

2. Panic attacks won’t kill you. It may feel like your dying in the midst of a panic attack, but it won’t kill you.

Feeling out of control is a hallmark of a panic attack, so learning to take back control is the key to stopping it. As a therapist, I teach my clients 5 steps that will stop panic attacks in their tracks.

Try these 5 steps the next time you experience a panic attack.

Step #1: Go to a Quiet Place

Remove yourself from loud environments. Loud sounds and active movements in the room can heighten the panic.

Step #2: Take Slow, Deep Breath’s

I often call this “Smell the flowers, blow out the candles” to help people remember to close their mouth’s, inhale through their nose, hold their breath for 3 seconds, then exhale through their mouth’s as if blowing out candles. Do this slowly for 8 times.

Step #3: Practice Active Observation

During a panic attack people are not thinking clearly, they’re experiencing distorted thinking. Active observation forces you to stay in the moment by observing everything in the room using all of your senses. What do you see? What do you hear? What do you physically feel? What do you smell? Be as specific as you can with what you observe.

Step #4: Splash Cold Water on Your Face

Cold water will send active signals to your brain that will jolt you into reality. When you put cold water, ice or frozen gel packs on your face or neck your brain kicks in logical thinking automatically.

Step #5: Talk to Yourself – Refocus

After you’re able to gain more control, refocus by telling yourself the truth. Talk to yourself about what happened during the day, remind yourself of your blessings, focus on the positives in your life. Tell yourself to calm your heart and mind down. Tell yourself – I got this.

Repeat the steps above as needed.

It’s always difficult for people who suffer from panic attacks to describe how they feel to other’s who never had one. It’s very important for those who experience panic attacks to have people believe that they’re actually experiencing an attack on their emotions.

People who are having a panic attack can’t simply get over it. Panic attacks are not something you can just switch off. So, if you have never experienced a panic attack, please believe the person who has. They’re not making it up or trying to get attention. What people suffering from panic disorder need the most (besides a cure) is someone who will believe and support them through the attack. Panic sufferers need someone to remain rational and objective when they’re not.

***

If you suffer from a panic disorder please seek help from a trained professional to help you gain a sense of control. Don’t suffer alone, let someone help you through your invisible hell. You no longer have to feel helpless to fight your panic attacks.

You can do it. You got this.

Jul 5

Panic Disorder Linked to Physical Illnesses

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By Rick Nauert PhD

While it is well known that mental health is linked to physical heath, physicians often disregard a person’s complaints of physical symptoms when a mental illness is present.

New research hopes to end this practice as investigators discover a cadre of physical disorders appear to occur in combination with particular mental conditions.

Jeremy D. Coplan, M.D., professor of psychiatry at SUNY Downstate Medical Center, and colleagues has documented a high rate of association between panic disorder and four domains of physical illness.

The findings may change how physicians and psychiatrists view the boundaries within and between psychiatric and medical disorders.

“Patients who appear to have certain somatic disorders — illnesses for which there is no detectable medical cause and which physicians may consider to be imagined by the patient — may instead have a genetic propensity to develop a series of real, related illnesses,” says Dr. Coplan, an expert in neuropsychopharmacology.

The researchers found a high association between panic disorder, bipolar disorder, and physical illness. Saliently, they discoverer a significantly higher prevalence of certain physical illnesses among patients with panic disorder when compared to the general population.

“Panic disorder itself may be a predictor for a number of physical conditions previously considered unrelated to mental conditions, and for which there may be no or few biological markers,” explains Dr. Coplan.

As reported in the Journal of Neuropsychiatry and Clinical Neurosciences, the researchers proposed the existence of a spectrum syndrome comprising a core anxiety disorder and four related domains, for which they have coined the term ALPIM:

A = Anxiety disorder (mostly panic disorder);
L = Ligamentous laxity (joint hypermobility syndrome, scoliosis, double-jointedness, mitral valve prolapse, easy bruising);
P = Pain (fibromyalgia, migraine and chronic daily headache, irritable bowel syndrome, prostatitis/cystitis);
I = Immune disorders (hypothyroidism, asthma, nasal allergies, chronic fatigue syndrome); and
M = Mood disorders (major depression, Bipolar II and Bipolar III disorder, tachyphylaxis. Two thirds of patients in the study with mood disorder had diagnosable bipolar disorder and most of those patients had lost response to antidepressants).

Dr. Coplan notes that the proposal of ALPIM as a syndrome is not entirely new, in that it contains significant elements of previously described spectrum disorders. ALPIM’s primary contribution is to add novel elements and groupings, and to shed light on how these groupings overlap.

The study documented high prevalence of physical disorders among patients with panic disorder compared to the general population.

For example, joint laxity was observed in 59.3 percent of patients in the study compared with a prevalence of approximately 10 percent to 15 percent in the general population; fibromyalgia was observed in 80.3 percent of the subjects compared with approximately 2.1 percent to 5.7 percent in the general population; and allergic rhinitis was observed in 71.1 percent of subjects, whereas its prevalence is approximately 20 percent in the general population.

“Our argument is that delineations in medicine can be arbitrary and that some disorders that are viewed as multiple disparate and independent conditions may best be viewed as a single spectrum disorder with a common genetic etiology,” says Dr. Coplan.

“Patients deserve a more informed scientific understanding of spectrum disorders. The disorders that are part of the ALPIM syndrome may be better understood if viewed as a common entity.”

Source: SUNY Downstate Medical Center/EurekAlert

Jul 3

5 Things Never to Say to an Anxious Child

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By Renee Jain, MAPP
I wanted to sleep with a bat under my pillow. It was plastic; nonetheless, it was a weapon. I was five years old, and I firmly believed that each night when I went to sleep, a robber would break into the house. I needed something to defend myself (and maybe my family), and my brother’s yellow Wiffle ball bat seemed ideal. Unfortunately, my parents never complied with my request.

They didn’t understand why I was so worried. After all, there was no logical evidence to support my anxiety: our neighborhood was safe, we had never experienced a break-in, and we had a security alarm to alert us of any danger. But who said anxiety was logical? It’s generally not. Actually, let’s back up. Who said what I was experiencing was “anxiety”?

Anxiety is a word that I use now, based on personal and professional hindsight. Back then, as far as my parents and I were concerned, I was simply prone to a bit of extra worry. None of us understood that my fearful thoughts were actually provoking a real nervous system response.

So how did my loving parents deal with my countless “what if” questions? “What if we get robbed?” “What if we forget to turn the alarm on?” “What if we leave the door unlocked?” “What if the robber finds my room?” How did they handle it when I knocked on their door at two o’clock in the morning, asking to go downstairs to check the lock once more for good measure?

My parents’ first line of defense was always reassurance. The next strategy involved invoking my logic. When all else failed, which it often did, they (understandably) became frustrated and sometimes expressed it.

Please know that my parents are amazing. They always supported me, but they didn’t really understand what I was going through at the time. It took me a couple of decades to figure it out and to find ways to help alleviate my worries.

To help other families going through something similar, I want to point out five phrases that were said to me out of great love yet never helped when I was in the throes of anxiety. Knowing what I know now, I’ll also tell you what I wish I could’ve expressed to my parents. Finally, I’ll present some alternative ways to help a child experiencing anxiety. Here’s that list:

1. Mommy said, “It’s going to be OK. Trust me.”

I wish I could have said, “Mommy, I know you’re trying to make me feel better, but my mind is telling me the opposite: ‘It’s NOT going to be OK.’ And my body seems to be responding to my mind. My heart is racing, my palms are sweating, and my tummy feels funny. It’s hard for your loving words to overpower what’s happening inside of me.”

Here’s what we know: The stress response is hardwired into our nervous system as a protective mechanism devised to enact the fight-or-flight reaction to threats. Anxiety mimics this response. As such, when your child is knee-deep in anxiety, a rapid stream of chemicals is dumped into the body for survival. This makes it difficult to think clearly and, subsequently, for words of reassurance to sink in.

Try this: Respond to your child’s nervous system first. Help them calm down with deep breathing. This can take the mind and body from fight-or-flight to rest-and-digest mode.

2. Daddy said, “There’s nothing to be scared of.”

I wish I could have said, “Daddy, remember the first time you asked Mommy out on a date? Remember your first day at a new job? Or remember the time when you got in that bike accident? Maybe your parents knew everything was going to be OK, too, but you didn’t know that. You experienced real fear. My fear is real, too.”

Here’s what we know: Anxiety initiates a fear alarm inside your child’s mind and body. It’s a false alarm, but nevertheless, it feels very real. That alarm is for protection; your child feels “stress” or “fear” in order to survive. To make sure one is really paying attention, the mind might even exaggerate the object of the worry (e.g., mistaking a stick for a snake).

Try this: Validate your child’s emotions. You can say, “I see that you’re scared. I’ve been scared before, too, and I know what that feels like.”

3. Mommy said, “Let me tell you all the reasons you don’t have to worry.”

I wish I could have said, “Mommy, I know that what you’re saying makes sense. It’s just that it’s hard to think clearly and logically in this moment. I have a lot of feelings right now and I’m just focusing on those. It’s just really hard to think clearly.”

Here’s what we know: One by-product of the anxiety response is that the prefrontal cortex—the more logical part of the brain—gets put on hold while the more automated emotional brain takes over. After all, cave people didn’t have a lot of time to use logic when it came to running away or fighting a predator.

Try this: Soothe the nervous system with a visualization exercise. Ask your child to envision a still, quiet place. Ask them to breathe in and out in a way that’s comfortable and to describe this place to you. Once your child is calm, discuss with the idea that feelings are not necessarily facts. Feelings can be challenged by saying, “Hey, I don’t think you’re really true!” Self-disputation is a great way to quell worry.

4. Daddy shouted, “STOP BEING SUCH A WORRIER!”

I wish I could have said, “Daddy, I know that you’re frustrated and even angry. This makes me feel so bad because I want to stop being a worrier; I really do. I want it to stop, but I just don’t know how. I wish I knew how.”

Here’s what we know: Kids who worry know that they worry more than others because they are labeled as “worriers” from a young age. They also compare themselves to others who have less anxious reactions to the same fears. In fact, many kids develop anxiety about having anxiety. Add on a dose of guilt from parents, and kids can feel completely miserable. Remember, kids often feel as helpless as adults do when it comes to chronic worry.

Try this: To the best of your ability, do not label your child. Instead, when they’re in a relaxed state, explain the evolutionary basis of worry. Seriously? Yes! Kids love to know that worry has a purpose and that everyone worries to some extent. You can use this infographic to guide your explanation.

5. Mommy and Daddy said, “We don’t understand why you’re so worried.”

I wish I could have said, “I know you don’t understand, but I need you to try. I need you to try to understand what I’m going through. Put your hand on my racing heart, listen to my shallow breath, look at me… this is real. I want you to understand. I need you to understand. Please tell me you get it. Please.”

Here’s what we know: When a child is anxious, they feel scared and helpless. If you also feel helpless as a parent, empathy can help guide your actions. By stepping into your child’s shoes and understanding their feelings and perspectives, your reaction to their needs will be more authentic and in line with their needs.

Try this: When your child feels anxious, try to recall a time when you felt true fear. Then connect with your child using these three words: “I get it.” Let your child know that you see that they are going through something challenging. Let your child know that you really see them.

On a final note, I wanted to say something to my parents and to all parents on behalf of anxious children: “We, too, get it. We understand what you sacrifice for us. We know that our pain and struggle become your own. We know that even on the days you feel completely helpless, you still try to support us—and you do. By never losing faith and never giving up, you are our models of grit and perseverance. Thank you.”

Jun 22

What is Commitment Phobia & Relationship Anxiety?

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By John M. Grohol, Psy.D.
For most people, relationships are fairly easy things. They come as naturally to life as breathing or making a meal.

For some, however, relationships are not so easy. In fact, they present such a challenge to the individual, that a person can be said to have relationship anxiety, a fear of relationships, or suffer from “commitment phobia.”

Commitment issues in relationships are nothing new. But our understanding of how the fear of commitment for some people can be paralyzing has increased. And while you won’t find “commitment phobia” in any diagnostic manual, it is a very real experience of anxiety and fear.

Here’s the lowdown on commitment phobia and relationship anxiety.

People who have commitment issues, commitment phobia or relationship anxiety (I’ll use these terms interchangeably) generally have a serious problem in staying in a relationship for the long-term. While they still experience love like anyone else, the feelings can be more intense and scary than they are for most people. These feelings drive increased anxiety, which builds upon itself and snowballs as the relationship progresses — and the expectation of a commitment looms larger.

People with a commitment phobia long and want a long-term connection with another person, but their overwhelming anxiety prevents them from staying in any relationship for too long. If pressed for a commitment, they are far more likely to leave the relationship than to make the commitment. Or they may initially agree to the commitment, then back down days or weeks later, because of their overwhelming anxiety and fears.

Some people with relationship anxiety may confuse positive feelings of excitement for another person and the potential of a relationship with the feelings of anxiety. For instance, normal feelings of anticipation or may be misconstrued by the person as a panic reaction, or general negative anxiousness. Some may also just have a difficult time resolving the inherent conflict of romantic relationships — the craving of intimacy while wanting to retain their own individuality and freedom.

People with commitment issues come in all shapes and sizes, and their exact dating and relationship behaviors can vary. Some refuse to have any serious or long-term relationships longer than a week or a month, because of their fears. Others may be able to be involved with one person for a few months, but as the relationship becomes more serious and deeper, their old fears again come to the forefront, driving the person away.

Both men and women can suffer from relationship anxiety and commitment phobia, although traditionally it was thought primarily to be a male problem.

The Causes of Commitment Phobia

The causes of commitment phobia are as varied as the people who suffer from it. Typically, however, many people with commitment issues have complained of having experienced poor romantic relationships, either first-hand or through observation of others (such as their parents’ acrimonious relationship or divorce while growing up). Other common causes of commitment phobia may include:

Fear of, or having had, the relationship end without notice or signs
Fear of not being in the “right” relationship
Fear of, or having been in, an unhealthy relationship (characterized by abandonment, infidelity, abuse, etc.)
Trust issues because of past hurts by those close to the person
Childhood trauma or abuse
Unmet childhood needs or attachment issues
Complicated family dynamics while growing up
How to Help One’s Fear of Relationships

No matter what the specific cause of commitment phobia, it can be helped. A person who suffers from relationship anxiety doesn’t have to suffer from it their entire lives. There is help, but a person needs to want to change and find a way to overcome their relationship anxiety. It cannot be done by others.

There are many strategies to help someone with commitment phobia, depending on the severity of the anxiety. If it’s so severe it’s preventing one from even considering dating, much less finding the person of their dreams, then it may be time to seek out psychotherapy. A trained therapist who’s experienced in working with people with commitment issues can help a person understand the cognitive distortions they’re telling themselves, and how to turn them around.

Counseling may also be appropriate for anyone who’s gone through a round of serious relationships, only to have them end when the person couldn’t take the relationship to the next step. A therapist will help a person understand there is no “perfect” relationship, and that all relationships need nurturing, care and constant attention. A person will also learn in therapy that open communication with their partner will reduce the likelihood of there being any future surprises or trust issues.

Some people with milder commitment issues may benefit from getting support for their concerns through an online support group for relationship issues. And while self-help books vary in their usefulness and practice advice, these may of particular consideration to check out:

He’s Scared, She’s Scared: Understanding the Hidden Fears That Sabotage Your Relationships
Men Who Can’t Love: How to Recognize a Commitmentphobic Man Before He Breaks Your Heart/
Getting to Commitment: Overcoming the 8 Greatest Obstacles to Lasting Connection (And Finding the Courage to Love)
The fear of commitment can be overcome. The first step is being open to change, and wanting to make the changes in your life and your thinking that can help you be less anxious in future relationships.

Jun 21

Sitting Linked to Increased Anxiety

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By Janice Wood

A new study has found that low-energy activities that involve sitting are associated with an increased risk of anxiety.

“Anecdotally we are seeing an increase in anxiety symptoms in our modern society, which seems to parallel the increase in sedentary behavior,” said Megan Teychenne, lead researcher and lecturer at Deakin University’s Centre for Physical Activity and Nutrition Research (C-PAN) in Australia.

“Thus, we were interested to see whether these two factors were, in fact, linked. Also, since research has shown positive associations between sedentary behavior and depressive symptoms, this was another foundation for further investigating the link between sedentary behavior and anxiety symptoms.”

For their study, C-PAN researchers analyzed the results of nine studies that examined the association between sedentary behavior and anxiety.

The studies varied in what they classified as sedentary behavior from television viewing and computer use to total sitting time, which included sitting while watching television, sitting while on transport, and work-related sitting. Two of the studies included children and adolescents, while the remaining seven included adults.

It was found in five of the nine studies that an increase in sedentary behavior was associated with an increased risk of anxiety, the researchers reported.

In four of the studies it was found that total sitting time was associated with increased risk of anxiety.

The evidence about screen time — TV and computer use — was less strong, but one study did find that 36 percent of high school students who had more than two hours of screen time were more likely to experience anxiety compared to those who had less than two hours, according to the researchers.

The C-PAN researchers suggest the link between sedentary behavior and anxiety could be due to disturbances in sleep patterns, social withdrawal theory, and poor metabolic health.

Social withdrawal theory proposes that prolonged sedentary behavior, such as television viewing, can lead to withdrawal from social relationships, which has been linked to increased anxiety.

The researchers note that more follow-up studies are required to confirm whether anxiety is caused by sedentary behavior.

“It is important that we understand the behavioral factors that may be linked to anxiety in order to be able to develop evidence-based strategies in preventing (and) managing this illness,” Teychenne said.

“Our research showed that evidence is available to suggest a positive association between sitting time and anxiety symptoms, however, the direction of this relationship still needs to be determined through longitudinal and interventional studies.”

The study was published in the open-access journal BMC Public Health.

Source: Biomed Central

By John M. Grohol, Psy.D.

According to the Center for Collegiate Mental Health 2014 annual report, anxiety is the number one concern of college students’ mental health needs today, with depression placing second. As college counseling centers continue to deal with ever-expanding workloads and needs of the college students they serve, it’s concerning that so many students are facing serious mental illness, such as anxiety and depression.

University counseling centers were originally setup to help students primarily with academic and relationship concerns, as well as just the issues that arise from living on your own for the first time in your life. But in the past two decades, these centers — whose services are usually provided at little or no cost to students, covered by their student fees — have begun serving more and more students with serious mental illness.

The most recent data comes from a survey that was conducted in 2013-2014 and included over 101,000 college students seeking services from 2,900 clinicians providing services at 140 college and university counseling centers.

In the survey, clinicians identified that for clients who sought out counseling services, anxiety was the top-most concern of nearly 20 percent of all college clients. Nearly 16 percent of students complained of depression, while another 9 percent came to the counseling center for a relationship issue.

http://g4.psychcentral.com/blog/wp-content/uploads/2015/06/graph-image-college-students.jpg

Stress was the top issue for nearly 6 percent of college students, while nearly 5 percent of students complained that their academic performance was their main issue. Family, interpersonal functioning, grief/loss and mood instability rounded out concerns expressed by more than 3 percent of college students seeking services.

The New York Times also covered the story, noting the rise of anxiety concerns among students:

Anxiety has become emblematic of the current generation of college students, said Dan Jones, the director of counseling and psychological services at Appalachian State University in Boone, N.C.

Because of escalating pressures during high school, he and other experts say, students arrive at college preloaded with stress. Accustomed to extreme parental oversight, many seem unable to steer themselves. And with parents so accessible, students have had less incentive to develop life skills.

“A lot are coming to school who don’t have the resilience of previous generations,” Dr. Jones said. “They can’t tolerate discomfort or having to struggle. A primary symptom is worrying, and they don’t have the ability to soothe themselves.”

The good news is that due to mental illness stigma becoming more and more of a non-issue amongst younger generations, more young people have no problem seeking out services for these concerns. The bad news is that we live in a society where providing coordinated and integrated care for mental illness remains firmly stuck in the past.

College counseling centers are usually not well-integrated within their local community of care. And students often are reluctant to seek care away from their university, since such care might only be affordable by using insurance — usually, their parents. Despite the reduction in stigma and uptick in those seeking care, there still are limits on what a person might want to share with their parents, including their mental health battles.

Counseling centers are equipped (and funded) only to offer fairly short-term treatments. Yet more and more students are turning to these under-funded centers for their care, resulting in long wait lists, or less-than-ideal short-term care.

In an effort to cater to the rise in the number of students seeking services, more colleges are offering workshops (for psychoeducation) and groups to help treat these rising numbers. It’s no wonder — the students coming to them are more informed and better-educated about mental health treatments than at any previous time in history. As the Times article notes, “Half of clients at mental health centers in their most recent report had already had some form of counseling before college. One-third have taken psychiatric medication.”

We hope universities continue to expand their services and get creative in better serving their young adult students. After all, these are some of the most important, formative years for the students.

Jun 2

By Annabella Hagen, LCSW, RPT-S

If you suffer from obsessive-compulsive disorder, you likely feel exhausted every day. The anxiety and tormenting thoughts may lead you to internal and external rituals. These compulsions provide relief — at least temporarily. You probably wish there was a magic pill or treatment that could take the suffering away permanently.

If you were told that the answer to a better life is found at the top of a high mountain, would you be willing to climb it? You would be warned, “It will be a stormy and an arduous ascent, but once you get to the top, you’ll find what you are looking for!” Would you take the chance and do what it takes to get there? It could be the hardest thing you’ve done in your life. Would you still consider it?

You might hesitate to sign up for such a challenge. You may hope that “things will get better.” After all, your compulsions grant you the relief you need daily. You may experience “good days,” and decide that climbing this mountain may not really be for you. It is human nature not to want to do hard things. If there are easier ways to obtain what we need, we usually opt for that. Why not?

Some OCD sufferers may choose to continue doing their compulsions. They may believe they are unable to do difficult things. Others may continue to endure in silence and may be unaware that there are answers to their misery. There are some who begin the climb and realize they aren’t ready to do it. However, if you are in search of an answer to your OCD challenges, consider these six things. They will enhance your chances to successfully find what you need.

Know that OCD is a physiological illness just like other illnesses. It’s not your fault that you have OCD. OCD may target what you care about the most, and your obsessions may be related to or triggered by an event in your life. However, OCD has nothing to do with your character and your worth. It has to do with a neurological dysfunction in some of the structures and chemicals in your brain. Research also shows that OCD is most likely a genetic predisposition. You may have a close or distant relative with OCD or related disorders. Know that medication is relevant in treating obsessive-compulsive disorder.
Understand that behavioral, cognitive, and environmental factors are also involved in OCD. Medication often is not enough. There might be some individuals who are fortunate to find relief from most of their symptoms once they start medication. However, this doesn’t happen often. You need to understand that medication doesn’t take care of the mental and behavioral rituals. A combination of medication and psychotherapy will provide best results.
Your compulsions heighten OCD symptoms. You need a treatment that will help you understand how to decrease and eventually eliminate those compulsions. You’ll also need to be aware of your thinking errors and learn how to address them. Studies provide evidence that cognitive-behavioral therapy (CBT) that includes exposure and response prevention (ERP) is the psychotherapy of choice for OCD. CBT that includes ERP will provide the best opportunity to change your brain pathways. Not all CBT skills that are adequate for treating depression, anxiety and other disorders are effective in treating OCD. OCD is a complicated illness and your provider needs to understand what elements of CBT are useful for treating OCD. Research is also showing that implementation of mindfulness skills will enhance the opportunity for success. The IOCD Foundation website is a great resource to keep you informed regarding evidence-based treatments for OCD.
“Doing” is the key to success. OCD sufferers often ask how they can make sure to remember what’s being taught. The answer is usually, “your OCD mind will ‘get it’ when you practice the skills.” This response may be difficult for some people who aren’t used to practicing the skills they are taught. Getting into new routines can be difficult and uncomfortable. This might be one of the more grueling segments of treatment.The effectiveness of CBT, ERP, and mindfulness skills are tested as individuals climb to the top of the mountain — one step at a time. When individuals “graduate’ from treatment, they are asked, “What made the difference in your progress? What helped you the most?” They usually answer, “It was the exposures. When I was proactive in doing exposures, my OCD mind finally got it!”
Trust the process. The research is there. If your treatment provider knows how to treat OCD, you will see the results. Put forth your best effort and you’ll have a meaningful and rich life despite OCD. It takes courage to climb up a mountain that you’ve never climbed before. But as you think of your life and where OCD has taken you or is taking you, it may be worth your effort. The climb may be arduous, but you and your loved ones will appreciate the results.
Take advantage of the relentlessness you have inherited from OCD. OCD is a stubborn illness and most likely you have a stubborn streak within you. Turn it into strength. Become determined to climb the mountain. Endure it the best you can as you learn new skills for life.
As much as you may wish for a magic pill and a treatment that won’t take much effort, OCD will continue to play a huge part in your life. The answer to your pain is out there, but you’ve got to work for it. The satisfaction you’ll find as you reach the summit will be priceless. You will find that the “magic” is in doing and becoming proactive in your treatment. Remember that many individuals have done it, and so can you.

May 25

Overanalyzing? Here is why.

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By Diana C. Pitaru, M.S., L.P.C.

Defense Mechanism: Overthinking/overanalyzing

One of the most employed tools in dealing with fear and anxiety is overanalyzing or overthinking.

Typically when we try to make our mind about something or make a decision that has the potential to impact us negatively we panic (afraid of the consequences), become more controlling about the problem at stake, and eventually attempt to fend off danger by intensely focusing our attention on the occurring possibilities (also known as overthinking or overanalyzing). And yes, we drive ourselves mad in the process and the miracle solution never seems to come along.

While overthinking is a very common strategy (lots and lots of people employ it) it is also a very unhelpful tool and a defense system meant to give us the illusion of control while wreaking havoc in the background.

When we overanalyze or overthink things all we do is focus on the mind while ignoring our emotions and the body. We become removed and disconnected from ourselves, trapped in a self-induced hypnotic like state. The longer we stay in, the harder it feels to get back to that state of internal balance which instinctively we try to achieve. It is this state that leads to disconnecting from ourselves, our intuition and creativity.

Sometimes we act as if being in touch with our emotions is a sign of weakness and live our lives with the belief (delusion) that we can control our own emotions as well as others’. We ask ourselves for perfection and hope/ believe that somehow, we’re above the rest. In trying to prove ourselves different though, we exchange our humanity for a false sense of super power and close ourselves to the flawed beauty inside and out, to the inspiration that surrounds us, the dreams and creativity we all are capable of, and to the emotions (not only the ones we like) that makes us who we are.

It takes an iron like willingness and a desire to truly understand yourself to be able to pull yourself out of the trance and achieve balance, and it is doable.

As with working through any defense systems, when dealing with overthinking you must first become self-aware. Not that you go about living in the world completely unaware because up to a certain extent we all maintain a certain level of self-awareness. Draw from your child-like curiosity (that insatiable curiosity that knows no boundaries) and use it to fully understand where you are, how stuck you are and finally make a conscious decision to break through the prison you’ve created for yourself while knowing what the consequences are for both sticking with overthinking or moving away from it. Can you think of the benefits and risks of either choice?

If you’ve been using the tool of overanalyzing for most of your life, the idea of putting an end to it might be both desirable as well as frightening. On one hand you may be thinking that it would be nice not to have to split hairs over everything while, on the other hand overthinking seems to give you a sense of control; plus, it’s “the devil you know”.

So what lies outside of the familiar and beyond the walls of this defense mechanism?

The Unknown

It is the willingness to take the leap into the unknown that will make a difference for the better.

The unknown is a repository holding your discarded emotions, the repressed and suppressed ones, the things you keep to yourself, your secrets and your shame.

The idea of taking a leap into everything that you want to forget is fear inducing; after all, you’ve worked hard to put things (emotions) behind you, to not have to deal with them anymore. Why would you consciously go there? Because the emotions that make up the unknown are not behind you or outside of you. We carry them with us and at the same time we choose to not look, understand, and ultimately accept this big part of ourselves.

The leap into the unknown is what ultimately will bring clarity, resolve, and self-acceptance (and with it a deep understanding of your core self and your own flawed and beautiful humanity).

Apr 26

Why Anxious Minds Can’t Think Right

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By Traci Pedersen
Scientists have long wondered why people with anxiety often seem paralyzed when it comes to decision-making. A new study reveals that people with anxiety have decreased neural inhibition in their brain, a process in which one nerve cell suppresses activity in another.

For the study, researchers wanted to test the theory that neural inhibition in the brain plays a big role in decision-making. So they developed a computer model of the brain called a “neural network simulation.”

“We found that if we increased the amount of inhibition in this simulated brain, our system got much better at making hard choices,” said Hannah Snyder, a psychology graduate student who worked with the researchers on the study.

“If we decreased inhibition in the brain, then the simulation had much more trouble making choices.”

Using the model, the team analyzed the brain mechanisms involved when we choose words. They then tested the model’s predictions on humans by asking them to think of the first verb that comes to mind when they are given a noun.

“We know that making decisions, in this case choosing our words, taps into this left-front region of the brain, called the left ventrolateral prefrontal cortex,” University of Colorado at Boulder psychology Professor Yuko Munakata, lead author of the study, said.

“We wanted to figure out what is happening in that part of the brain that lets us make these choices. Our idea here, which we have shown through the word-choosing model, is that there’s a fight between neurons in this area of the brain that lets us choose our words,” said Munakata.

They also tested the model’s predictions by observing the effects of increased and decreased inhibition in people’s brains.

Researchers increased inhibition with a drug called midazolam and found that people got much better at making hard decisions. It didn’t influence other aspects of their thinking, but only the area of making choices.

“We found that the worse their anxiety was, the worse they were at making decisions, and the activity in their left ventrolateral prefrontal cortex was less typical,” Munakata said.

The results of the study shed light on the brain mechanisms associated with making decisions and could be helpful in improving treatments for the millions of people who suffer from anxiety.

According to Snyder, there are drugs that already increase neural inhibition and these medications are currently being used to treat the emotional symptoms in anxiety disorders; however, the findings show that these drugs might also lessen the difficulty many sufferers of anxiety have in selecting one option when there are too many choices.

“[A] more precise understanding of what aspects of cognition patients are struggling with could be extremely valuable in designing effective approaches to therapy for each patient,” she said.

“For example, if someone with an anxiety disorder has difficulty selecting among multiple options, he or she might benefit from learning how to structure their environment to avoid choice overload.”

Said Munakata, “A lot of the pieces have been there. What’s new in this work is bringing all of this together to say here’s how we can fit all of these pieces of information together in a coherent framework explaining why it’s especially hard for people with anxiety to make decisions and why it links to neural inhibitors.”

A paper on the findings titled “Neural inhibition enables selection during language processing” was published in the Aug. 30 Proceedings of the National Academy of Sciences. CU-Boulder professors Tim Curran, Marie Banich and Randall O’Reilly, and graduate students Hannah Snyder and Erika Nyhus and undergraduate honors thesis student Natalie Hutchison co-authored the paper.

Source: University of Colorado at Boulder

By Brigit Katz
On a recent afternoon, JD Bailey was trying to get her two young daughters to their dance class. A work assignment delayed her attempts to leave the house, and when Bailey was finally ready to go, she realized that her girls still didn’t have their dance clothes on. She began to feel overwhelmed and frustrated, and in the car ride on the way to the class, she shouted at her daughters for not being ready on time. “Suddenly I was like, ‘What am I doing?'” she recalls. “‘This isn’t their fault. This is me.’ ”
Bailey has dealt with anxiety for as long as she can remember, but it has become more acute since the birth of her second daughter, when she began to experience postpartum depression. She knows that her anxiety occasionally causes her to lash out at her daughters when she doesn’t really mean to, and she can see that it affects them. “You see it in your kids’ face,” Bailey says. “Not that they’re scared, but just the negativity: ‘Oh my God, my mommy’s upset.’ You’re their rock. They don’t want to see you upset.”
Taking cues from you
Witnessing a parent in a state of anxiety can be more than just momentarily unsettling for children. Kids look to their parents for information about how to interpret ambiguous situations; if a parent seems consistently anxious and fearful, the child will determine that a variety of scenarios are unsafe. And there is evidence that children of anxious parents are more likely to exhibit anxiety themselves, a probable combination of genetic risk factors and learned behaviors.
It can be painful to think that, despite your best intentions, you may find yourself transmitting your own stress to your child. But if you are dealing with anxiety and start to notice your child exhibiting anxious behaviors, the first important thing is not to get bogged down by guilt. “There’s no need to punish yourself,” says Dr. Jamie Howard, director of the Stress and Resilience Program at the Child Mind Institute. “It feels really bad to have anxiety, and it’s not easy to turn off.”
But the transmission of anxiety from parent to child is not inevitable. The second important thing to do is implement strategies to help ensure that you do not pass your anxiety on to your kids. That means managing your own stress as effectively as possible, and helping your kids manage theirs. “If a child is prone to anxiety,” Dr. Howard adds, “it’s helpful to know it sooner and to learn the strategies to manage sooner.”
What to Do (and Not Do) When Children Are Anxious
It’s tempting to protect kids from things that make them anxious, but learning to tolerate anxiety is how we overcome fears. READ MORE
Learn stress management techniques
It can be very difficult to communicate a sense of calm to your child when you are struggling to cope with your own anxiety. A mental health professional can help you work through methods of stress management that will suit your specific needs. As you learn to tolerate stress, you will in turn be teaching your child—who takes cues from your behavior—how to cope with situations of uncertainty or doubt.
“A big part of treatment for children with anxiety,” explains Laura Kirmayer, an associate psychologist at the Child Mind Institute, “is actually teaching parents stress tolerance, It’s a simultaneous process—it’s both directing the parent’s anxiety, and then how they also support and scaffold the child’s development of stress tolerance.”
Model stress tolerance
You might find yourself learning strategies in therapy that you can then impart to your child when she is feeling anxious. If, for example, you are working on thinking rationally during times of stress, you can practice those same skills with your child. Say to her: “I understand that you are scared, but what are the chances something scary is actually going to happen?”
Try to maintain a calm, neutral demeanour in front of your child, even as you are working on managing your anxiety. Dr. Howard says, “Be aware of your facial expressions, the words you choose, and the intensity of the emotion you express, because kids are reading you. They’re little sponges and they pick up on everything.”
The Secret to Calm Parenting
Helping kids relax, focus and shed anxiety by quieting their bodies to quiet their minds. READ MORE
Explain your anxiety
While you don’t want your child to witness every anxious moment you experience, you do not have to constantly suppress your emotions. It’s okay—and even healthy—for children to see their parents cope with stress every now and then, but you want to explain why you reacted in the way that you did.
Let’s say, for example, you lost your temper because you were worried about getting your child to school on time. Later, when things are calm, say to her: “Do you remember when I got really frustrated in the morning? I was feeling anxious because you were late for school, and the way I managed my anxiety was by yelling. But there are other ways you can manage it too. Maybe we can come up with a better way of leaving the house each morning.”
Talking about anxiety in this way gives children permission to feel stress, explains Kirmayer, and sends the message that stress is manageable. “If we feel like we have to constantly protect our children from seeing us sad, or angry, or anxious, we’re subtly giving our children the message that they don’t have permission to feel those feelings, or express them, or manage them,” she adds. “Then we’re also, in a way, giving them an indication that there isn’t a way to manage them when they happen.”
After JD Bailey lost her temper at her daughters on their way to dance class, she made sure to explain her reaction, and then focused on moving forward. “I said, ‘I’m sorry. Mom is a little stressed out because I have a lot of work going on. Let’s listen to some music,’ ” Bailey recalls. “We cranked up the music in the car, and it changed our mood.”
Make a plan
Come up with strategies in advance for managing specific situations that trigger your stress. You may even involve your child in the plan. If, for example, you find yourself feeling anxious about getting your son ready for bed by a reasonable hour, talk to him about how you can work together to better handle this stressful transition in the future. Maybe you can come up with a plan wherein he earns points toward a privilege whenever he goes through his evening routine without protesting his bedtime.
These strategies should be used sparingly: You don’t want to put the responsibility on your child to manage your anxiety if it permeates many aspects of your life. But seeing you implement a plan to curb specific anxious moments lets him know that stress can be tolerated and managed.
The Power of Mindfulness
The meditation practice that helps kids become less anxious, more focused, and more in charge of their own behavior. READ MORE
Know when to disengage
If you know that a situation causes you undue stress, you might want to plan ahead to absent yourself from that situation so your children will not interpret it as unsafe. Let’s say, for example, that school drop-offs fill you with separation anxiety. Eventually you want to be able to take your child to school, but if you are still in treatment, you can ask a co-parent or co-adult to handle the drop off. “You don’t want to model this very worried, concerned expression upon separating from your children,” says Dr. Howard. “You don’t want them to think that there’s anything dangerous about dropping them off at school.”
In general, if you feel yourself becoming overwhelmed with anxiety in the presence of your child, try to take a break. Danielle Veith, a stay-at-home mom who blogs about her struggles with anxiety, will take some time to herself and engage in stress-relieving activities when she starts to feel acutely anxious. “I have a list of to-do-right-this-second tips for dealing with a panic, which I carry with me: take a walk, drink tea, take a bath, or just get out the door into the air,” she says. “For me, it’s about trusting in the fact that the anxiety will pass and just getting through until it passes.”
Find a support system
Trying to parent while struggling with your own mental health can be a challenge, but you don’t have to do it alone. Rely on the people in your life who will step in when you feel overwhelmed, or even just offer words of support. Those people can be therapists, co-parents, or friends. “I am a part of an actual support group, but I also have a network of friends,” says Veith. “I am open with friends about who I am, because I need to be able to call on them and ask for help. ”
You can also look for support on blogs, online forums, and social media. JD Bailey runs a site called Honest Mom, where mothers can post essays about mental health and parenting. “I write about mental health to connect with other moms and help them not feel so alone,” Bailey explains. “I get email and Facebook messages from readers, and the most common comment is, ‘I felt so alone until I found your site.’ And yes, writing about depression and anxiety helps me, too!”

Rachel Ehmke
Senior Writer
CHILD MIND INSTITUTE
When you’re a teen you start being more aware of what other people think. There seems to be a “right” thing to wear, or say, or do. There also seem to be things that you shouldn’t do—things that could be embarrassing, or lose you points with friends.
The idea that people might be paying particular attention to what you do makes a lot of kids anxious—some are so anxious that they have something called social anxiety disorder. It’s when you worry so much about how you appear to others that you stop doing things you need to (and want to) do for fear of embarrassing yourself.
Most people with the disorder start noticing this anxiety when they’re between the ages of 8 and 15. For a while, kids are usually able to hide it. Their parents and teachers may not notice that anything is wrong, especially since kids are often ashamed to admit how anxious they are about things that other people don’t seem to get upset about.
At the Child Mind Institute we’ve heard from a lot of young people who are wondering if they might have social anxiety disorder, and how to tell their parents about it. This is an explanation of what it looks like, and what to do if you think you (or your child) might have it.
Not just being shy
Kids with social anxiety disorder aren’t just nervous when they’re at parties or giving a speech in class. “It’s not a phobia of being in social situations, it’s being terrified of how people are going to perceive you,” explains Dr. Jerry Bubrick, a clinical psychologist and the head of the Anxiety and Mood Disorders center at the Child Mind Institute.
Even small interactions, like answering a question in class or eating with friends in the cafeteria, can feel extremely scary to kids with social anxiety disorder. That’s because they fear they might accidentally do something embarrassing or offensive, and it will make others judge or even reject them.
Tips for Managing Social Anxiety
If worrying about embarrassing yourself is getting in your way, some strategies for beating the fear. READ MORE
And while kids who are just shy will gradually warm up to new people and situations over time, kids with social anxiety don’t. Rachel Busman, PsyD, another psychologist at the Child Mind Institute who specializes in anxiety, explains: “Shyness might hold you back to some extent from doing things, but it won’t significantly impact your ability to do your job as a teenager, which is to function in school, function in your family, and to have friends and be a part of your peer-related community.” But social anxiety will.
Examples
The kinds of situations that are anxiety provoking can vary a lot depending on the person. Some kids with social anxiety mostly just fear performing in front of people, while others are anxious in many situations—talking to a sales clerk, asking for help, eating or drinking in front of others. Here are some examples of what social anxiety might look like:
You walk into the cafeteria and see your friends whispering and laughing. You’re afraid they’re laughing at you—and even when they promise they weren’t, you keep worrying.
You love soccer and you want to try out for the team, but you don’t because you’re worried about people looking at you.
You want to ask the teacher a question, but you can’t because you’re afraid you’ll sound stupid.
You agonize over taking a position in a paper you’re writing because you think it might be the “wrong” one.
You dread reading out loud because you might pronounce something wrong or skip a word.
What you feel—and what others see
If you have social anxiety disorder, you probably think your anxiety is obvious for all to see—in fact looking anxious is another thing kids with social anxiety are afraid of. But other people might not recognize it. That’s because a lot of the symptoms of anxiety are happening under the surface. You might be having panicked thoughts and feeling some of the physical symptoms of anxiety—like a racing heart or an upset stomach—but other people probably aren’t going to pick up on that. More visible signs like blushing can be a clue, but even blushing tends to be something people pay more attention to when it is happening to themselves.
Because kids with social anxiety disorder are afraid of doing anything that is embarrassing, Dr. Busman adds, they can be experts at hiding how they really feel. “One of the girls I’ve worked with had panic attacks and was very highly anxious. Because I know her pretty well, I’d know that if she looked at the floor and was quiet that meant she was feeling anxious. But other people don’t notice that, and can only assume by what they see.”
How to Talk Your Parents About Getting Help
Asking for help can be tough, but it is important to do. Here are some tips to make talking about it a little easier. READ MORE
For other kids, their anxiety can make them seem angry or aggressive, like one boy Dr. Bubrick worked with. “Someone came up to him randomly and said, ‘I hear you want to see a picture of Sarah in a bikini.'” The boy was mortified and “went ballistic,” says Dr. Bubrick. “He was throwing papers, he kicked the principal. The school thought he was being oppositional, but underneath it all was this horrendous fear of being embarrassed.”
Why avoiding anxiety doesn’t work
One of the things that kids learn to do when they are anxious is to avoid the things that worry them—making excuses to stay home from school or skip parties or other social events. While this might work to calm your anxiety in the short term, experts warn that hiding from your anxiety really only makes it get worse. Besides, you’ll still need to learn how to do those things that at some point, and practicing them helps.
Another dangerous thing about avoiding fears is that it can become a habit, so you might find yourself withdrawing more and more. This will make your anxiety worse, and other people won’t understand why you are withdrawing. This can make you feel even more alone.
Examples
You’re so worried about giving a presentation in school that you decide to cut class, because you’d rather take a lower grade than give your speech. Doing this makes the teacher think you don’t care about grades and are just doing the bare minimum to get by, when in fact you care a lot about school but are paralyzed at the idea of getting in front of the class.
You are becoming friends with your new lab partner and he keeps inviting you to play video games with him after school. You would like to go, but you’re afraid you’ll do something weird, so you keep coming up with excuses. Eventually he will start seeking you out less and less and assume you don’t want to be friends after all.
Why it’s important to ask for help
Having social anxiety can stop you from doing the things you want to do, and close you off from people you’d like to be friends with. It can also make you more likely to get depressed. Asking for help can be hard, but it really is important.
Dr. Busman says she wants kids to know they’re not alone. “Many teens experience anxiety disorders. Being brave and telling someone how you feel might seem scary, but if you can get over that hurdle, someone will want to listen.”

Jan 3

Focused Ultrasound May Ease OCD Symptoms

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By TRACI PEDERSEN Associate News Editor

High-intensity focused ultrasound may help relieve symptoms of obsessive-compulsive disorder (OCD) in hard-to-treat patients, according to preliminary findings of new research.

The procedure applies high-intensity focused ultrasound energy to heat and destroy diseased or damaged tissue through ablation (the removal of tissue).

The study is being conducted with 12 patients by Jin Woo Chang, M.D., Ph.D., at the Yonsei University Medical Center in Seoul, Korea. The results of the first four patients with six months follow-up were published in the Journal of Molecular Psychiatry.

Although many OCD patients improve with medication, some patients have debilitating symptoms that are resistant to treatment. For these patients, psychosurgery can be performed to destroy (ablate) a targeted region of the brain (anterior internal capsule) associated with the disorder.

The four patients, who suffered from disabling OCD that was unresponsive to medication, were treated with a focused ultrasound system called InSightec ExAblate Neuro. The treatment targeted the part of the brain called the anterior internal capsule.

All four patients had the targeted areas of the brain successfully ablated with no complications or side effects. They experienced gradual improvements in their obsessive-compulsive thoughts and behaviors and showed nearly immediate and sustained improvement in depression and anxiety which lasted over six months.

“There is a need for non-invasive treatment options for patients with OCD that cannot be managed through medication,” said Chang.

“Using focused ultrasound, we were able to reduce the symptoms for these patients and help them get some of their life back without the risks or complications of the more invasive surgical approaches that are currently available.”

“If these initial results are confirmed in the remaining eight patients in this study as well as in a larger pivotal trial of safety and efficacy, focused ultrasound could emerge as an alternative to surgery for improving quality of life in a cost-effective manner for patients with OCD,” said Neal F. Kassell, M.D., chairman of the Focused Ultrasound Foundation.

“This could also serve as the predicate for non-invasive therapy for other psychiatric disorders.”

The currently available ablative approaches are invasive or involve radiation, such as radiofrequency ablation, stereotactic radiosurgery, and deep brain stimulation.

Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by recurring anxiety-provoking thoughts (obsessions) that are alleviated only by ritualistic actions (compulsions). Severe cases can lead to overwhelming impairment and dysfunction.

OCD patients also have a high risk for depression, with two-thirds of OCD patients developing major depression. Chang plans to begin a study using focused ultrasound to treat depression in 2015.

Source: Focused Ultrasound Foundation

By RENEE JAIN, MAPP

Anxiety What If Questions

“What if I don’t get asked to the dance?”

“What if you run out of gas and can’t pick me up from school?”

“What if we get robbed?”

“What if… [insert your child’s anxious thought here]?”

If your child’s anxious, it’s likely they do something I like to call what-iffing. This is the tendency to ponder possible future scenarios and then worry about them excessively in the form of ‘what if’ questions. As a parent, you also worry excessively… about your child’s worrying. You want to ease their pain. You may try to reassure them with words, comfort them with hugs, or even yell at them in frustration. If your child is not assuaged by any of these methods, please know you are not alone. Please also know there are approaches that can help.

Here’s the thing: Humans are natural-born time travelers. We travel to the past and future on a regular basis using just our minds. In fact, research shows that 47 percent of the time, we’re actually thinking about something other than what we’re doing. I’m sure you’ve been driving somewhere and have ended up at your destination without knowing exactly how you reached there. You see, we all have an uncanny ability to wander off with our minds, but ruminating on things that have yet to happen can be troubling as studies show that we tend to overestimate the uncertainty of the future.

Don’t get me wrong; thinking about the future has value. It helps us plan and set goals. It unleashes our creativity and imagination. The flipside is that our ability to visualize the future can be so realistic that if we’re worried about something, it can activate our nervous system. So, while we are the only species on Earth thinking critically about the future, we are also the only ones who can throw ourselves into a full nervous system response from a simple thought.

In other words, what-iffing about the future can be perceived by your child as some

Nov 17

By RENEE JAIN, MAPP

As all the kids line up to go to school, your son, Timmy, turns to you and says, “I don’t want to take the bus. My stomach hurts. Please don’t make me go.” You cringe and think, Here we go again. What should be a simple morning routine explodes into a daunting challenge.

You look at Timmy and see genuine terror. You want to comfort him. You want to ease the excessive worry that’s become part and parcel of his everyday life. First, you try logic. “Timmy, we walk an extra four blocks to catch this bus because this driver has an accident-free driving record!” He doesn’t budge.

You provide reassurance. “I promise you’ll be OK. Timmy, look at me… you trust me, right?” Timmy nods. A few seconds later he whispers, “Please don’t make me go.”

You resort to anger: “Timothy Christopher, you will get on this bus RIGHT NOW, or there will be serious consequences. No iPad for one week!” He looks at you as if you’re making him walk the plank. He climbs onto the bus, defeated. You feel terrible.

If any of this sounds familiar, know you are not alone. Most parents would move mountains to ease their child’s pain. Parents of kids with anxiety would move planets and stars as well. It hurts to watch your child worry over situations that, frankly, don’t seem that scary. Here’s the thing: To your child’s mind, these situations are genuinely threatening. And even perceived threats can create a real nervous system response. We call this response anxiety and I know it well.

I’d spent the better part of my childhood covering up a persistent, overwhelming feeling of worry until, finally, in my early twenties, I decided to seek out a solution. What I’ve learned over the last two decades is that many people suffer from debilitating worry. In fact, 40 million American adults, as well as 1 in 8 children, suffer from anxiety. Many kids miss school, social activities and a good night’s rest just from the worried thoughts in their head. Many parents suffer from frustration and a feeling of helplessness when they witness their child in this state day in, day out.

What I also learned is that while there is no one-size-fits-all solution for anxiety, there are a plethora of great research-based techniques that can help manage it — many of which are simple to learn. WAIT! Why didn’t my parents know about this? Why didn’t I know about it? Why don’t they teach these skills in school?

I wish I could go back in time and teach the younger version of myself how to cope, but of course, that’s not possible. What is possible is to try to reach as many kids and parents as possible with these coping skills. What is possible is to teach kids how to go beyond just surviving to really finding meaning, purpose and happiness in their lives. To this end, I created an anxiety relief program for kids called GoZen. Here are 9 ideas straight from GoZen that parents of anxious children can try right away:

1. Stop Reassuring Your Child
Your child worries. You know there is nothing to worry about, so you say, “Trust me. There’s nothing to worry about.” Done and done, right? We all wish it were that simple. Why does your reassurance fall on deaf ears? It’s actually not the ears causing the issue. Your anxious child desperately wants to listen to you, but the brain won’t let it happen. During periods of anxiety, there is a rapid dump of chemicals and mental transitions executed in your body for survival. One by-product is that the prefrontal cortex — or more logical part of the brain — gets put on hold while the more automated emotional brain takes over. In other words, it is really hard for your child to think clearly, use logic or even remember how to complete basic tasks. What should you do instead of trying to rationalize the worry away? Try something I call the FEEL method:

• Freeze — pause and take some deep breaths with your child. Deep breathing can help reverse the nervous system response.
• Empathize — anxiety is scary. Your child wants to know that you get it.
• Evaluate — once your child is calm, it’s time to figure out possible solutions.
• Let Go – Let go of your guilt; you are an amazing parent giving your child the tools to manage their worry.

2. Highlight Why Worrying is Good
Remember, anxiety is tough enough without a child believing that Something is wrong with me. Many kids even develop anxiety about having anxiety. Teach your kids that worrying does, in fact, have a purpose.

When our ancestors were hunting and gathering food there was danger in the environment, and being worried helped them avoid attacks from the saber-toothed cat lurking in the bush. In modern times, we don’t have a need to run from predators, but we are left with an evolutionary imprint that protects us: worry.

Worry is a protection mechanism. Worry rings an alarm in our system and helps us survive danger. Teach your kids that worry is perfectly normal, it can help protect us, and everyone experiences it from time to time. Sometimes our system sets off false alarms, but this type of worry (anxiety) can be put in check with some simple techniques.

3. Bring Your Child’s Worry to Life
As you probably know, ignoring anxiety doesn’t help. But bringing worry to life and talking about it like a real person can. Create a worry character for your child. In GoZen we created Widdle the Worrier. Widdle personifies anxiety. Widdle lives in the old brain that is responsible for protecting us when we’re in danger. Of course, sometimes Widdle gets a little out of control and when that happens, we have to talk some sense into Widdle. You can use this same idea with a stuffed animal or even role-playing at home.

Personifying worry or creating a character has multiple benefits. It can help demystify this scary physical response children experience when they worry. It can reactivate the logical brain, and it’s a tool your children can use on their own at any time.

4. Teach Your Child to Be a Thought Detective
Remember, worry is the brain’s way of protecting us from danger. To make sure we’re really paying attention, the mind often exaggerates the object of the worry (e.g., mistaking a stick for a snake). You may have heard that teaching your children to think more positively could calm their worries. But the best remedy for distorted thinking is not positive thinking; it’s accurate thinking. Try a method we call the 3Cs:

• Catch your thoughts: Imagine every thought you have floats above your head in a bubble (like what you see in comic strips). Now, catch one of the worried thoughts like “No one at school likes me.”

• Collect evidence: Next, collect evidence to support or negate this thought. Teach your child not to make judgments about what to worry about based only on feelings. Feelings are not facts. (Supporting evidence: “I had a hard time finding someone to sit with at lunch yesterday.” Negating evidence: “Sherry and I do homework together–she’s a friend of mine.”)

• Challenge your thoughts: The best (and most entertaining) way to do this is to teach your children to have a debate within themselves.

5. Allow Them to Worry
As you know, telling your children not to worry won’t prevent them from doing so. If your children could simply shove their feelings away, they would. But allowing your children to worry openly, in limited doses, can be helpful. Create a daily ritual called “Worry Time” that lasts 10 to 15 minutes. During this ritual encourage your children to release all their worries in writing. You can make the activity fun by decorating a worry box. During worry time there are no rules on what constitutes a valid worry — anything goes. When the time is up, close the box and say good-bye to the worries for the day.

6. Help Them Go from What If to What Is
You may not know this, but humans are capable of time travel. In fact, mentally we spend a lot of time in the future. For someone experiencing anxiety, this type of mental time travel can exacerbate the worry. A typical time traveler asks what-if questions: “What if I can’t open my locker and I miss class?” “What if Suzy doesn’t talk to me today?”

Research shows that coming back to the present can help alleviate this tendency. One effective method of doing this is to practice mindfulness exercises. Mindfulness brings a child from what if to what is. To do this, help your child simply focus on their breath for a few minutes.

7. Avoid Avoiding Everything that Causes Anxiety
Do your children want to avoid social events, dogs, school, planes or basically any situation that causes anxiety? As a parent, do you help them do so? Of course! This is natural. The flight part of the flight-fight-freeze response urges your children to escape the threatening situation. Unfortunately, in the long run, avoidance makes anxiety worse.

So what’s the alternative? Try a method we call laddering. Kids who are able to manage their worry break it down into manageable chunks. Laddering uses this chunking concept and gradual exposure to reach a goal.

Let’s say your child is afraid of sitting on the swings in the park. Instead of avoiding this activity, create mini-goals to get closer to the bigger goal (e.g., go to the edge of the park, then walk into the park, go to the swings, and, finally, get on a swing). You can use each step until the exposure becomes too easy; that’s when you know it’s time to move to the next rung on the ladder.

8. Help Them Work Through a Checklist
What do trained pilots do when they face an emergency? They don’t wing it (no pun intended!); they refer to their emergency checklists. Even with years of training, every pilot works through a checklist because, when in danger, sometimes it’s hard to think clearly.

When kids face anxiety they feel the same way. Why not create a checklist so they have a step-by-step method to calm down? What do you want them to do when they first feel anxiety coming on? If breathing helps them, then the first step is to pause and breathe. Next, they can evaluate the situation. In the end, you can create a hard copy checklist for your child to refer to when they feel anxious.

9. Practice Self-Compassion
Watching your child suffer from anxiety can be painful, frustrating, and confusing. There is not one parent that hasn’t wondered at one time or another if they are the cause of their child’s anxiety. Here’s the thing, research shows that anxiety is often the result of multiple factors (i.e., genes, brain physiology, temperament, environmental factors, past traumatic events, etc.). Please keep in mind, you did not cause your child’s anxiety, but you can help them overcome it.

Toward the goal of a healthier life for the whole family, practice self-compassion. Remember, you’re not alone, and you’re not to blame. It’s time to let go of debilitating self-criticism and forgive yourself. Love yourself. You are your child’s champion.

Simple tools can help alleviate your child’s anxiety. Start teaching your child coping skills with two animated lessons from www.gozen.com

Nov 13

By RENEE JAIN, MAPP

“I didn’t get invited to Julie’s party… I’m such a loser.”

“I missed the bus… nothing ever goes my way.”

“My science teacher wants to see me… I must be in trouble.”

Distort Reality GoZen Anxiety Relief

These are the thoughts of a high school student named James. You wouldn’t know it from his thoughts, but James is actually pretty popular and gets decent grades. Unfortunately, in the face of adversity, James makes a common error; he falls into what I like to call “thought holes.” Thought holes, or cognitive distortions, are skewed perceptions of reality. They are negative interpretations of a situation based on poor assumptions. For James, thought holes cause intense emotional distress.

Here’s the thing, all kids blow things out of proportion or jump to conclusions at times, but consistently distorting reality is not innocuous. Studies show self-defeating thoughts (i.e., “I’m a loser”) can trigger self-defeating emotions (i.e., pain, anxiety, malaise) that, in turn, cause self-defeating actions (i.e., acting out, skipping school). Left unchecked, this tendency can also lead to more severe conditions, such as depression and anxiety.

Fortunately, in a few steps, we can teach teens how to fill in their thought holes. It’s time to ditch the idea of positive thinking and introduce the tool of accurate thinking. The lesson begins with an understanding of what causes inaccurate thinking in the first place.

We Create Our Own (Often Distorted) Reality

One person walks down a busy street and notices graffiti on the wall, dirt on the pavement and a couple fighting. Another person walks down the same street and notices a refreshing breeze, an ice cream cart and a smile from a stranger. We each absorb select scenes in our environment through which we interpret a situation. In essence, we create our own reality by that to which we give attention.

Cognitive Distortions GoZen.com Anxiety Relief for Kids

Why don’t we just interpret situations based on all of the information? It’s not possible; there are simply too many stimuli to process. In fact, the subconscious mind can absorb 12 million bits of information through the five senses in a mere second. By intelligent design, data is filtered down so that the conscious mind focuses on only 7 to 40 bits. This is a mental shortcut.

Shortcuts keep us sane by preventing sensory overload. Shortcuts help us judge situations quickly. Shortcuts also, however, leave us vulnerable to errors in perception. Because we perceive reality based on a tiny sliver of information, if that information is unbalanced (e.g., ignores the positive and focuses on the negative), we are left with a skewed perception of reality, or a thought hole.

Eight Common Thought Holes

Not only are we susceptible to errors in thinking, but we also tend to make the same errors over and over again. Seminal work by psychologist Aaron Beck, often referred to as the father of cognitive therapy, and his former student, David Burns, uncovered several common thought holes as seen below.

Jumping to conclusions: judging a situation based on assumptions as opposed to definitive facts
Mental filtering: paying attention to the negative details in a situation while ignoring the positive
Magnifying: magnifying negative aspects in a situation
Minimizing: minimizing positive aspects in a situation
Personalizing: assuming the blame for problems even when you are not primarily responsible
Externalizing: pushing the blame for problems onto others even when you are primarily responsible
Overgeneralizing: concluding that one bad incident will lead to a repeated pattern of defeat
Emotional reasoning: assuming your negative emotions translate into reality, or confusing feelings with facts
Going from Distorted Thinking to Accurate Thinking

Once teens understand why they fall into thought holes and that several common ones exist, they are ready to start filling them in by trying a method we developed in the GoZen! anxiety relief program called the 3Cs:

Check for common thought holes
Collect evidence to paint an accurate picture
Challenge the original thoughts
Self-disputation – GoZen.com Anxiety Relief Kids

Let’s run through the 3Cs using James as an example. James was recently asked by his science teacher to chat after class. He immediately thought, “I must be in trouble,” and began to feel distressed. Using the 3Cs, James should first check to see if he had fallen into one of the common thought holes. Based on the list above, it seems he jumped to a conclusion.

James’s next step is to collect as much data or evidence as possible to create a more accurate picture of the situation. His evidence may look something like the following statements:

“I usually get good grades in science class.”

“Teachers sometimes ask you to chat after class when something is wrong.”

“I’ve never been in trouble before.”

“The science teacher didn’t seem upset when he asked me to chat.”

With all the evidence at hand, James can now challenge his original thought. The best (and most entertaining) way to do this is for James to have a debate with himself. On one side is the James who believes he is in big trouble with his science teacher; on the other side is the James who believes that nothing is really wrong. James could use the evidence he collected to duke it out with himself! In the end, this type of self-disputation increases accurate thinking and improves emotional well-being.

Let’s teach our teens that thoughts, even distorted ones, affect their emotional well-being. Let’s teach them to forget positive thinking and try accurate thinking instead. Above all, let’s teach our teens that they have the power to choose their thoughts.

As the pioneering psychologist and philosopher, William James, once said, “The greatest weapon against stress is our ability to choose one thought over another.”

For more unique anxiety relief techniques for tweens and teens, visit www.gozen.com

Nov 10

Overcoming Fear With Oxytocin

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By JANICE WOOD Associate News Editor

Researchers at the University of Bonn Hospital have demonstrated that the bonding hormone oxytocin inhibits the fear center in the brain, allowing fear to subside more easily.

The study, which appears in the journal Biological Psychiatry, could usher in a new era in the treatment of anxiety disorders, according to the researchers.

The researchers note that significant fear becomes deeply entrenched in memory. For example, following a car accident, a person might become conditioned to feel quite anxious just hearing tires screeching.

Gradually, that person learns that not every screeching tire means danger. This active overwriting of the memory is known as “extinction.”.

“In this process, however, the original contents of the memory are not erased, but instead merely overlaid with positive experiences,” said psychiatrist René Hurlemann, M.D., from the Department of Psychiatry and Psychotherapy of the University of Bonn Hospital.

“If there are dangerous situations once again, the fear, which was believed to have been already overcome, frequently flares up once more.”

Extinction is often used in therapy for anxiety disorders. For example, part of the treatment for a person suffering from a spider phobia is to have them gradually and increasingly come face to face with spiders.

First the patient views photos of spiders and then looks at living examples until finally he holds a tarantula in his hand. This helps the patient realize they do not need to fear the trigger — or the spider, researchers explained.

“However, this can take a very long time, because this confrontation with the fearful situation frequently has to be experienced. In addition, there may be relapses because the original trace of fear is still anchored in the memory,” Hurlemann said.

This is one reason researchers began looking for a way to overwrite fearful memories in a faster and longer-lasting way.

That brought them to oxytocin.

It has been known for a long time that the hormone oxytocin does not just have a bonding effect in the mother-child relationship and in the case of sex partners, but that it is also considered to be anxiolytic, meaning it reduces anxiety.

“Oxytocin actually reinforces extinction: Under its influence, the expectation of recurrent fear subsequently abates to a greater extent than without this messenger,” reported Hurlemann.

For the study, the research team induced fear conditioning in 62 healthy male subjects. In a brain scanner, using video glasses, the men viewed photos. For 70 percent of the images, they received a very brief, unpleasant electrical shock to the hand via electrodes.

“In this way, certain images were associated with an experience of anxiety in the test subjects’ memory,” Hurlemann said.

The scientists used two methods to prove that the pairing of a particular photo and pain was actually anchored in the mens’ brains. The expectation of an electrical shock was demonstrated by increased cold sweat, which was measured via skin conductivity, while the brain scans proved that the fear regions in the brain were particularly active.

Half of the test subjects then received oxytocin via a nasal spray. The rest received a placebo.

Then the extinction phase began. The men were shown the same pictures, but they no longer received electrical shocks.

In the men under the influence of oxytocin, the amygdala, as the fear center in the brain, was overall far less active than in the control group, whereas fear-inhibiting regions were more stimulated, the researchers reported.

Over time, the messenger caused the fear to initially be somewhat greater but then it abated to a far greater extent than without oxytocin.

“Oxytocin initially reinforces the test subjects’ conscious impressions and thus the reaction to the electrical shock, yet after a few minutes, the anxiolytic effect prevails,” explained Hurlemann.

The scientists said they hope that patients with anxiety can be helped more quickly with the aid of oxytocin and that a relapse can be better prevented.

“In addition,” they said, “the hormone likely facilitates bonding between the therapist and the patient, leading to more successful treatment.”

“However, this must first be demonstrated by clinical studies,” he concluded.

Source: University of Bonn

Sep 28

5 Mindful Treatments for Rumination

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By LAURA C. MEYER

Rumination is a mental habit which leads to fixation on flaws and problems, thus extending a negative mood.

With continued attention to our problems, we become obsessed with our pain and can retreat from life. We stop eating (or eating more), sex drive disappears, sleep is disrupted, we are tired all the time, life is dull, and we do less and less.

Rumination starts off as a dim light that we stop putting energy into, allowing it to get darker and darker until we can’t see anymore.

It begins with a stressor — let’s say a divorce, a spouse cheating, or even being single for longer than one would like.

Regret shows up with “You should have been a better spouse”; “You should have taken better care of yourself”; “You are doing everything wrong.” You start believing Regret, and start ruminating, making it personal with, “I should have, and there is something wrong with me.” Then Anxiety arrives with Worry, and Fear adding, “How am I going to make it on my own? How will it affect the kids?”

With all this mental madness, we stop “plugging in” to the light sources we need to stay alive. The mental madness dominates our attention, and we can’t focus on anything else. We are physically drained by the internal warring, and the war keeps us up all night.

Rumination is winning and has depressed any positive aspect of our life. Hopelessness is here. We can’t see anymore. It’s too dark. We are depressed.

Here are 5 mindful ways to combat rumination.

Acceptance. What if you didn’t look at the stressor as a napalm bomb, but as an unexpected curveball? — “where did that come from?” instead of, “I’m going to die!” What if you came to accept that life isn’t always predictable? And what if life was actually doing you a favor? Disruption and destruction also come with possibility.
Truth. How would your life change if you stopped blaming others and paused to consider it might be true? What if you could have been a better spouse? What if you could have taken better care of yourself? And what if you are doing things that aren’t serving your best interest?
Curiosity. What if you decided to get curious about the disruption? What if you learned from your mistakes, or learned something new? What if you started putting energy into new things like learning to be a loving spouse for your next relationship? What if you started exercising and started feeling confident? What if you got over your fears and started dating?
Gratitude. What if you took the attention away from the discomfort of the change, and gave some attention to what was good and positive in your life? As Jon Kabat-Zinn says in the Stress Reduction Program, “If you are breathing, there is more right with you than there is wrong.”
Inner discipline. What if in one year, you look back and realize that curveball was a gift? What if the pain and destruction drew you to be the person you’ve always wanted to be? What if you had more inner discipline to cultivate acceptance, truth, curiosity, and gratitude, and you are now handling life’s curveballs with a little more grace?

Sep 22

By JANICE WOOD Associate News Editor

While antidepressants are the most commonly used treatment for social anxiety disorder, cognitive behavioral therapy (CBT) is more effective and — unlike medication — can have lasting effects long after treatment has stopped, according to a new study. CBT is one of the most common forms of talk therapy or psychotherapy.

According to researchers at John Hopkins University, social anxiety disorder, which is characterized by intense fear and avoidance of social situations, affects up to 13 percent of Americans and Europeans.

Most people never receive treatment. For those who do, medication is the more accessible treatment because there is a shortage of trained psychotherapists, according to the researchers.

“Social anxiety is more than just shyness,” said study leader Evan Mayo-Wilson, D.Phil., a research scientist in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health.

“People with this disorder can experience severe impairment, from shunning friendships to turning down promotions at work that would require increased social interaction.

“The good news from our study is that social anxiety is treatable. Now that we know what works best, we need to improve access to psychotherapy for those who are suffering.”

The study, a network meta-analysis that collected and analyzed data from 101 clinical trials comparing multiple types of medication and talk therapy, was a collaboration between the Johns Hopkins Bloomberg School of Public Health, Oxford University and University College in London, where Mayo-Wilson formerly worked.

For the new study, the researchers analyzed data from 13,164 participants in 101 clinical trials. All had severe and longstanding social anxiety. Approximately 9,000 received medication or a placebo, while more than 4,000 received a psychological intervention.

Few of the trials looked at combining medication with talk therapy, and there was no evidence that combined therapy was better than talk therapy alone, the researchers noted.

After comparing several different types of talk therapy, the researchers found that individual CBT was the most effective. CBT, which focuses on relationships between thoughts, feelings and behaviors, helps people challenge irrational fears and overcome their avoidance of social situations, according to Mayo-Wilson.

For people who don’t want talk therapy, or who lack access to CBT, the most commonly used antidepressants — selective serotonin reuptake inhibitors (SSRIs) — are effective, the researchers found. But they caution that medication can be associated with serious adverse events, that it doesn’t work at all for some people, and that improvements in symptoms do not last after patients stop taking the pills.

The researchers acknowledge that medication is important, but say it should be used as a second-line therapy for people who do not respond to or do not want psychological therapy.

According to Mayo-Wilson, the analysis has already led to new treatment guidelines in the U.K. and it could have a “significant impact on policymaking and the organization of care in the U.S.”

“Greater investment in psychological therapies would improve quality of life, increase workplace productivity, and reduce health care costs,” Mayo-Wilson said.

“The health care system does not treat mental health equitably, but meeting demand isn’t simply a matter of getting insurers to pay for psychological services. We need to improve infrastructure to treat mental health problems as the evidence shows they should be treated. We need more programs to train clinicians, more experienced supervisors who can work with new practitioners, more offices, and more support staff,” he said.

The study was published in The Lancet Psychiatry.

Source: Johns Hopkins University

Aug 16

When ADHD and Anxiety Occur Together

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By MARGARITA TARTAKOVSKY, M.S.

When ADHD and Anxiety Occur TogetherIt’s not uncommon for individuals with attention deficit hyperactivity disorder (ADHD) to struggle with anxiety, whether it’s several symptoms or a full-blown disorder.

In fact, about 30 to 40 percent of people with ADHD have an anxiety disorder, which includes “obsessive-compulsive disorder, generalized anxiety disorder, phobias, social anxiety and panic disorder,” according to Roberto Olivardia, Ph.D, a clinical psychologist and clinical instructor at Harvard Medical School. The Anxiety Disorders Association of America even estimates the figure to be almost 50 percent.

Here’s why ADHD and anxiety co-occur (occur together), how this affects treatment and several strategies for coping with anxiety.

Why ADHD & Anxiety Co-occur
ADHD symptoms can be very intrusive and make life a lot more stressful. For instance, you might miss a critical deadline at work and get fired, forget about your math final and fail the exam or act impulsively and put yourself in danger. Even the fear that you might forget something can keep people continuously worried and anxious.

In other words, “People with ADHD, especially when untreated, are more likely to feel overwhelmed and to have more things fall through the cracks which evokes more frequent negative situations—others are angry with them, they feel disappointed in themselves,” said Ari Tuckman, PsyD, a clinical psychologist and author of More Attention, Less Deficit: Successful Strategies for Adults with ADHD.

People with ADHD tend to be sensitive, which can leave them especially “vulnerable to feeling things more deeply and being more affected by situations and emotions,” Olivardia said.

Genetics also may explain why ADHD and anxiety co-occur. According to Olivardia, there’s good evidence to show that ADHD and OCD have genetic underpinnings. (Here’s one study.) Studies from Massachusetts General Hospital suggest that 30 percent of people with OCD have ADHD.

How Anxiety Affects Treatment
“Anxiety adds another element to ADHD treatment, because you are both developing strategies for the ADHD symptoms and working with the resulting anxiety simultaneously,” Olivardia said.

It also potentially complicates treatment because anxiety can paralyze and leave people stuck in their old ways. As Tuckman said, “People who are anxious are less likely to try new things for fear of them not working out—this includes new strategies to help them get on top of their ADHD.”

Anxiety has another side effect. “We don’t think as clearly when we feel anxious or preoccupied which can add to the ADHD-based distractibility and forgetfulness,” Tuckman said. This can happen particularly with more complex problems, he added.

Anxiety & Stimulants
Stimulant medications are highly effective in treating ADHD. But stimulants “can sometimes exacerbate anxiety symptoms,” Olivardia said. Still, symptoms should subside after several days or weeks, Tuckman said.

Also, these symptoms actually might be responses to the medication. According to Tuckman, “the physical sensations of faster heartbeat, dry mouth, etc. are just normal reactions to the medication, just as we would expect that our heart rate would increase after running up a flight of stairs.”

If people can’t tolerate stimulants, psychiatrists may prescribe a non-stimulant along with a selective serotonin reuptake inhibitor (SSRI), which has anxiety-reducing effects. (Tuckman noted that non-stimulants may be less effective than stimulants.)

However, if a person doesn’t want to take several medications, they might decide to medicate one of the disorders and cope with the other behaviorally, Olivardia said.

Also, therapy is very effective for anxiety, said Tuckman, who typically “prefer[s] to address the ADHD first and then see how much of the anxiety shakes out on its own…”

Anxiety-Alleviating Strategies
Understand how your anxiety and ADHD work. Determining how your anxiety functions will help to “inform your treatment,” Olivardia said. “For example, if you found that most of your anxiety was coming from consequences of your ADHD, then the focus of treatment should be the ADHD. If you find they are independent of each other, although are affecting each other, then you want to make sure you are adequately giving each the clinical attention it deserves,” he said.
Minimize worry. Anxious people worry excessively, and these negative thoughts can run your life if you let them. Instead, “Try to come up with alternate explanations or predictions,” Tuckman said. Let’s say your boss was short with you. Instead of thinking that you did something wrong, consider that she’s stressed because of personal reasons, he said. Unless you have a specific reason or actual proof, worrying is needless (and only makes things worse).
Don’t believe everything you think. Again, worry thoughts energize anxiety. But you don’t have to listen to them. “Notice your anxious thoughts without believing everything your imagination comes up with nor feeling compelled to act on it,” Tuckman said.
He explained that anxiety acts as an alarm that “warns us of danger.” For some people, this alarm is super sensitive. He compared it to a “fire alarm that goes off every time someone burns the toast. It’s bothersome to listen to that alarm go off, but we don’t go running from the building. We check out the situation, see there is nothing to worry about, then go about our business.”

Engage in healthy habits and good self-care. Poor nutrition, lack of sleep and little exercise also fuel anxiety, and ensure you have a shorter fuse when it comes to stress. It’s tremendously helpful to eat nutritious foods, participate in enjoyable physical activities and get enough sleep.
Minimize stress. Olivardia suggested that readers “lower [the] stress in their lives and introduc[e] activities that they enjoy and feel soothed by.”
Surround yourself with supportive people. Negative people only add to your stress. Instead, fill your life with “positive, affirming people,” Olivardia said.
Practice relaxation techniques. “Engaging in relaxation training and deep breathing can help [alleviate anxiety],” according to Olivardia. Learn more about relaxation and meditation methods and deep breathing.
Both anxiety and ADHD are very treatable with medication and psychotherapy, and there are many effective strategies to manage symptoms and lead a more enjoyable life.

Apr 16

Is It Anxiety or Stress?

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By MICHELE L. BRENNAN, PSY.D.

StressChronic anxiety and chronic stress often share a lot in common. They have similar emotional symptoms, they result in similar physiological reactions, and can easily be confused with the other. In a fast paced world, experiencing stress and anxiety is common and frequently people experience them simultaneously; however, it is important to understand the etiology of the symptoms and luckily there are differences which can help tell them apart.

Chronic anxiety sufferers who have experienced therapy are often aware of their triggers, they can identify when they are ruminating about something and implement techniques such as thought stopping to help control worrying, and with practice they can learn to let go of irrelevant things to focus on the important ones. They have learned to prioritize and with time lead a medication free life. However, things are not always this black and white.

Let’s look at Anna as an example. Anna became overwhelmed with family changes, added responsibilities, demands at work, and demands of life. She was adjusting to new additions to her home, suddenly responsible to care for a family while trying to manage increasing work demands. Social engagements were pressing in, adding time constraints to her already busy schedule. Although she was fully aware of their importance, maintaining relationships and self care became challenging because she was already overwhelmed.

Anna recognized her these symptoms, and quickly implemented the coping strategies that she has previously mastered. She started by focusing in on her worrying, she tackled these by prioritizing her responsibilities and making a To Do: list which freed up her mind from worry. She did relaxation breathing to calm panic and worry, and tried to reduce her feelings of being overwhelmed by delegating tasks, and systematically working to reduce her worry.

After a few weeks of this, things were getting worse. Anna could not understand why she was continuing to feel overwhelmed. In the past all these coping strategies had worked wonders for her, but now they didn’t seem to help. She didn’t have the worried thoughts in her head, she didn’t spend time ruminating about her problems, and yet she was experiencing an increasing amount of emotional and physical symptoms. She couldn’t sleep, she was emotionally fragile, easily pushed over the edge to tears and could be overwhelmed with the smallest problem, she was more irritable, and withdrawn.

After some exploration further, Anna realized that she was managing her anxiety but she had been overcome by the emotional symptoms of chronic stress. Emotional symptoms of chronic stress in women often include depressed mood, mood swings, and irritability. Behavioral symptoms of chronic stress include an increase in addictive behaviors such as nicotine, alcohol, and drug usage. They also include changes in sleep patterns, eating habits, poor concentration, increased forgetfulness and indecision when they are stressed. These symptoms of stress are comparable to symptoms of stress found in men.

With anxiety and stress being so similar in presentation and symptoms it can be hard to really understand how they differ. The difference between the two becomes very important when receiving treatment or when trying to manage symptoms. For example, an effective way to treat anxiety is to focus on calming the mind, through meditation, mindfulness or thought stopping techniques. Stress can be managed differently by focusing on giving the body a rest. A simple approach to managing stress is taking time to drink peppermint tea, schedule down time regularly, and always remember the soothing elements of a hot bath/shower. These changes are often very good at managing stress levels but will not address the cognitive aspects of anxiety.

Understanding the etiology of symptoms will ultimately help you understand the best way to conquer your own symptoms. Having knowledge as to whether you are experiencing either or both will affect the approach to treatment that you decide to take. If you are unsure about your symptoms or they are persistent, you should contact a mental health professional to help accurately diagnosis your symptoms.

Mar 29

How to Handle Panic Attacks

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It may seem hard to get a grip on anxiety during a panic attack, but learning the right techniques can help you get your anxiety back under control.

By Diana Rodriguez
Medically reviewed by Niya Jones, MD, MPH

Panic attacks can be terrifying. These attacks stem from profound anxiety that can make your heart pound and your knees go weak. Panic attacks can make it difficult to catch your breath and can also cause chest pain and dizziness — you may even think you’re having a heart attack. A panic attack may only last a few minutes, but it can leave you feeling frightened and uneasy.

Understanding Panic Attacks

A panic attack and its symptoms of tremendous anxiety can strike suddenly, out of the blue. While a panic attack itself may be brief, it can lead to a lasting fear of having another episode. When panic attacks and the fear of having attacks occur repeatedly, people are said to have a panic disorder, a type of anxiety disorder.

“People have these panic attacks under various circumstances,” explains Martin N. Seif, PhD, a clinical psychologist in New York City and Greenwich, Conn. They constantly worry about having an attack and may avoid certain situations as a result. Eventually, people with panic disorder may realize that they aren’t actually afraid of the situation they’re avoiding, but rather of experiencing additional panic attacks, notes Seif.

Fortunately, you don’t have to live in fear of panic attacks. There are specific strategies you can use to help manage your anxiety and control your physical symptoms as well.

Panic Attacks: How to Take Control

The best way to stave off future panic attacks is by learning how to control your anxiety so that if you do start to notice symptoms of a panic attack, you can calm your mind and body until the symptoms fade.

“People who experience panic attacks have to learn how to cope with their feelings of panic,” says Seif. While medication can be effective, cognitive-behavioral therapy is one of the best techniques for managing panic and anxiety. “It involves recognizing that the panic-producing process is fueled by future-oriented, catastrophic thinking,” explains Seif. People with panic disorder have to become aware that their thoughts trigger a physical reaction, which results in a panic attack.

To gain control over panic disorder, it’s important to learn and practice anxiety management techniques, says Seif. Strategies that you can use to help you curb a panic attack include:

Breathing slowly and deeply. Anxiety can cause you to breathe very quickly, which makes both the mental and physical symptoms of a panic attack even worse. When you start to feel panicky, be sure to take slow, deep breaths to soothe your mind and body.
Stop and think. When your thoughts start spinning out of control, simply tell yourself to stop. Organize your thoughts and decide what you need to do to get yourself calm again.
Think positively. Push negative thoughts out of your mind, and remind yourself that you are in control. Think about times when you’ve been able to manage situations successfully and reduce anxiety.
Stand up for yourself. If you need to leave a situation, do so or tell someone you need to leave. Don’t be afraid to ask for help. Allowing yourself to become more upset will not help if what you really need is to take a walk and blow off some steam.
Relax your muscles. Anxiety causes your entire body to tense up, so make a conscious effort to relax each muscle from your toes all the way up to your neck and face.
Don’t wait for a panic attack to begin to try these techniques. Seif notes that it’s important to use these strategies regularly and learn to manage your anxiety in gradual stages. As you become more confident that you can rein in a panic attack, you can walk out the door each day breathing easier.

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