CBT Psychotherapy Best For Anxiety Disorders

A University of Houston researcher has found that patients suffering fromanxiety disorders showed the most improvement when treated with cognitive-behavioral therapy (CBT) — in conjunction with a “transdiagnostic” approach, which allows therapists to use one kind of treatment no matter what the anxiety.

The problem up to now, according to Peter Norton, Ph.D., an associate professor in clinical psychology and director of the Anxiety Disorder Clinic at the University of Houston, has been that each anxiety disorder — such aspanic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social anxiety disorder, and phobias — has had a targeted treatment.

The transdiagnostic approach recognizes that many overlapping dimensions exist among these anxiety disorders. It suggests that thinking about anxiety disorders as a whole from a behavioral dimension and/or psychological dimension perspective may yield important insights into these disorders.

Norton, who says the specific treatments aren’t all that different from each other, has shown that a combination of CBT with the transdiagnostic approach has proven more effective than CBT combined with other types of anxiety disorder treatments, such as relaxation training.

“The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been an important breakthrough in understanding mental health, but people are dissatisfied with its fine level of differentiation,” he said. The DSM uses a categorical approach to classifying mental disorders, including anxiety concerns.

“Panic disorders are considered something different from social phobia, which is considered something different from PTSD. The hope was that by getting refined in the diagnosis we could target interventions for each of these diagnoses, but in reality that just hasn’t played out.”

Norton’s research began 10 years ago when he was a graduate student in Nebraska and found he couldn’t get enough people together on the same night to run a group session for social phobia.

“What I realized is that I could open a group to people with anxiety disorders in general and develop a treatment program regardless of the artificial distinctions between social phobia and panic disorder, or obsessive-compulsive disorder, and focus on the core underlying things that are going wrong,” said Norton.

He says cognitive-behavioral therapy, which has a specific time frame and goals, is the most effective treatment as it helps patients understand the thoughts and feelings that influence their behaviors. The twist for him was using CBT in conjunction with the transdiagnostic approach.

The patients receiving the transdiagnostic treatment showed considerable improvement, especially with treating comorbid diagnoses, a disease or condition that co-exists with a primary disease and can stand on its own as a specific disease, like depression. Anxiety disorders often occur with a secondary illness, such as depression or substance and alcohol abuse, he noted.

“What I have learned from my past research is that if you treat your principal diagnosis, such as social phobia, you are going to show improvement on some of your secondary diagnosis,” he said. “Your mood is going to get a little better, your fear of heights might dissipate. So there is some effect there, but when we approach things with a transdiagnostic approach, we see a much bigger impact on comorbid diagnoses.”

“In my research study, over two-thirds of [co-existing] diagnoses went away, versus what we typically find when I’m treating a specific diagnosis such as a panic disorder, where only about 40 percent of people will show that sort of remission in their secondary diagnosis,” he continued.

“The transdiagnostic treatment approach [appears to be] more efficient in treating the whole person rather than just treating the diagnosis… then treating the next diagnoses.”

Norton notes the larger contributions of the studies are to guide further development and interventions for how clinical psychologists, therapists and social workers treat people with anxiety disorders. The data collected will be useful for people out on the front lines to effectively treat people to reduce anxiety disorders, he said.

Source: University of Houston

Excessive Worrying May Have Co-Evolved With Intelligence

ScienceDaily (Apr. 12, 2012) — Worrying may have evolved along with intelligence as a beneficial trait, according to a recent study by scientists at SUNY Downstate Medical Center and other institutions. Jeremy Coplan, MD, professor of psychiatry at SUNY Downstate, and colleagues found that high intelligence and worry both correlate with brain activity measured by the depletion of the nutrient choline in the subcortical white matter of the brain. According to the researchers, this suggests that intelligence may have co-evolved with worry in humans.

“While excessive worry is generally seen as a negative trait and high intelligence as a positive one, worry may cause our species to avoid dangerous situations, regardless of how remote a possibility they may be,” said Dr. Coplan. “In essence, worry may make people ‘take no chances,’ and such people may have higher survival rates. Thus, like intelligence, worry may confer a benefit upon the species.”

In this study of anxiety and intelligence, patients with generalized anxiety disorder (GAD) were compared with healthy volunteers to assess the relationship among intelligence quotient (IQ), worry, and subcortical white matter metabolism of choline. In a control group of normal volunteers, high IQ was associated with a lower degree of worry, but in those diagnosed with GAD, high IQ was associated with a greater degree of worry. The correlation between IQ and worry was significant in both the GAD group and the healthy control group. However, in the former, the correlation was positive and, in the latter, the correlation was negative. Eighteen healthy volunteers (eight males and 10 females) and 26 patients with GAD (12 males and 14 females) served as subjects.

Previous studies have indicated that excessive worry tends to exist both in people with higher intelligence and lower intelligence, and less so in people of moderate intelligence. It has been hypothesized that people with lower intelligence suffer more anxiety because they achieve less success in life.

With Altered Brain Chemistry, Fear Is More Easily Overcome

ScienceDaily (June 12, 2012) — Researchers at Duke University and the National Institutes of Health have found a way to calm the fears of anxious mice with a drug that alters their brain chemistry. They’ve also found that human genetic differences related to the same brain chemistry influence how well people cope with fear and stress.

It’s an advance in understanding the brain’s fear circuitry that the research team says may hold particular promise for people at risk for anxiety disorders, including those suffering post-traumatic stress disorder (PTSD).

“What is most compelling is our ability to translate first from mice to human neurobiology and then all the way out to human behavior,” said Ahmad Hariri, a neurobiologist at the Duke Institute for Genome Sciences & Policy. “That kind of translation is going to define the future of psychiatry and neuroscience.”

The common thread in their studies is a gene encoding an enzyme called fatty acid amide hydrolase, or FAAH. The enzyme breaks down a natural endocannabinoid chemical in the brain that acts in essentially the same way that Cannabis, aka marijuana, does (hence the name endocannabinoid).

Earlier studies had suggested that blocking the FAAH enzyme could decrease fear and anxiety by increasing endocannabinoids. (That’s consistent with the decreased anxiety some experience after smoking marijuana.) In 2009, Hariri’s lab found that a common variant in the human FAAH gene leads to decreased enzyme function with affects on the brain’s circuitry for processing fear and anxiety.

In the new study, Andrew Holmes’ group at the National Institute on Alcoholism and Alcohol Abuse tested the effects of a drug that blocks FAAH activity in fear-prone mice that had also been trained to be fearful through experiences in which they were delivered foot shocks.

Tests for the ability of those mice to get over their bad experiences found that the drug allowed a faster recovery from fear thanks to higher brain endocannabinoid levels. More specifically, the researchers showed that those drug effects traced to the amygdala, a small area of the brain that serves as a critical hub for fear processing and learning.

To test for the human relevance of the findings, Hariri’s group went back to the genetic variant they had studied earlier in a group of middle-aged adults. They showed study participants a series of pictures depicting threatening faces while they monitored the activity of their amygdalas using functional magnetic resonance imaging (fMRI) scans. They then looked for how the genetic variant affected this activity.

While the activity of the amygdala in all participants decreased over repeated exposures to the pictures, people who carried the version of the FAAH gene associated with lower enzyme function and higher endocannabinoid levels showed a greater decrease in activity. Hariri says that suggests that those individuals may be better able to control and regulate their fear response.

Further confirmation came from an analysis led by Duke’s Avshalom Caspi and Terrie Moffitt of 1,000 individuals in the Dunedin Study, who have been under careful observation since their birth in the 1970s in New Zealand. Consistent with the mouse and brain imaging studies, those New Zealanders carrying the lower-expressing version of the FAAH gene were found to be more likely to keep their cool under stress.

“This study in mice reveals how a drug that boosts one of the brain’s naturally occurring endocannaboids enables fear extinction, a process that forms the basis of exposure therapy for PTSD,” Holmes said. “It also shows how human gene variation in the same chemical pathways modulates the amygdala’s processing of threats and predicts how well people cope with stress.”

Studies are now needed to further explore both the connections between FAAH variation and PTSD risk as well as the potential of FAAH inhibition as a novel therapy for fear-related disorders, the researchers say.

Treatment for Social Anxiety

By: Morty Lefkoe

If you feel emotional discomfort about social situations, interactions with others, or being evaluated or judged by others, you may have “social anxiety” — a problem shared by almost 20 millionothers in the United States.

According to Wikipedia, “The essence of social anxiety has been said to be an irrational or unreasonable expectation of negative evaluation by others.”

The American Psychiatric Association estimates that social anxiety is the number one most common anxiety disorder and is also the third most common mental disorder in the U.S.

Treatment for social anxiety

One of the most common forms of treatment consists of cognitive-behavioral therapy CBT), which attempts to help patients change their thinking process so as to eliminate the negative thoughts that cause social anxiety. When your thinking process changes, you react with less anxiety to situations.

Another approach, which I’ve successfully used with literally thousands of clients, is to help them eliminate the beliefs that cause the social anxiety. Here is a list of the beliefs that I’ve found underlie this common fear for most people.

1. “Mistakes and failure are bad.”
2. “I’m not good enough.”
3. “Change is difficult.”
4. “I’m not important.”
5. “What makes me good enough or important is having people think well of me.”
6. “Nothing I do is good enough.”
7. “I’m not capable.”
8. “I’m not competent.”
9. “I’m inadequate.”
10. “If I make a mistake or fail I’ll be rejected.”
11. “I’m a failure.”
12. “I’m stupid.”
13. “I’m not worthy.”
14. “I’ll never get what I want.”
15. “I’m powerless.”
16. “People aren’t interested in what I have to say.”
17. “What I have to say isn’t important.”
18. “It’s dangerous to have people put their attention on me (something bad will happen).”
19. “What makes me good enough or important is doing things perfectly.”

If you had these beliefs about yourself, can you see why you would have social anxiety — “an irrational or unreasonable expectation of negative evaluation by others”?

Specifically, if you had the belief, “What makes me good enough or important is having people think well of me,” is it clear that your sense of self-worth would be based on what others thought of you?

And is it real that if you believed, “It’s dangerous to have people put their attention on me (something bad will happen),” you would fear social interaction?

Conditioning also plays an important role

Although my experience with clients has led me to conclude that the primary source of social anxiety is our beliefs, I’ve discovered that conditioning also plays an important role.
The classic example of how conditioning works was an experiment a physiologist named Pavlov conducted with dogs. When presented with food, the dogs salivated. Then a bell was rung just prior to presenting the dogs with food. After numerous presentations of the food with the bell, the bell was rung and no food was delivered. The dogs salivated anyway, because they had associated the bell with the food. In other words, a neutral stimulus that normally would not produce a response does so because it gets associated with a stimulus that does produce a response. In other words, the neutral stimulus gets conditioned.

Here’s an example I use with my clients that will make the process of conditioning very clear. Imagine that I handed you an ice cream cone with one hand and made a fist with my other hand and drew it back as if to hit you. What would you probably feel? Some level of anxiety if you thought you might get hit. Now imagine that the next few times someone handed you an ice cream cone, the same thing happened and you felt anxious each time.

What do you think you would feel the next time you were handed an ice cream cone, even if there was no menacing fist? Probably anxious. And yet it’s clear that ice cream cones are not inherently scary. If this next time there was no fist, only ice cream, why would you feel anxious? Because ice cream cones got conditioned to produce fear. The ice cream cones just happened to be there every time you got scared by the fist.

The principle is that anything that occurs repeatedly (or even once if the incident is traumatic enough) at the same time that something else is causing an emotion will itself get conditioned to produce the same emotion.

There are four important conditionings involved in social anxiety.

• Conditioning: Fear associated with criticism and judgment.
• Conditioning: Fear associated with not meeting expectations.
• Conditioning: Fear associated with people putting their attention on me.
• Conditioning: Fear associated with rejection.

Can you see how being conditioned to experience fear in these four situations would lead to anxiety in social situations?

When the relevant beliefs and conditionings are eliminated, the social anxiety is also.

Source: http://www.huffingtonpost.com

Treatment for Phobias

The treatment for Social and Specific Phobias are very similar. Both disorders are treated with cognitive-behavioral therapy, but target different types of cognitive distortions. Additionally, Social Phobia frequently benefits from the addition of social skill training.

Specific Phobias

Cognitive-behavioral therapy for specific phobias is typically a straightforward and systematic approach. Behavioral exposure therapyconsists of gradual exposure to the feared object or situation either in vivo (live), in imagination, or a combination of both. Therapy participants may begin by exposure to photographs of the feared object before facing the real object or situation.

Cognitive therapy can be utilized to address cognitive distortions related to over-estimation of risk or harm associated with the feared object. For example, a person who has developed a fear of snakes may be misinformed and believe that snakes are aggressive and predatory, when in reality their tendency is to hide and avoid human contact.

Social Phobia

Social Phobia responds quite well to standard cognitive-behavioral therapy and studies demonstrate the positive effects of treatment remain after treatment ends (Taylor, 1996). There is evidence that behavioral exposure therapy alone may be as effective as a combination of cognitive and behavioral therapies. (Feske & Chamblass, 1995). Behavioral techniques for social phobia consist of exposing the therapy participant to feared interpersonal situations, such as interacting with strangers or peers, inconveniencing others, and eating in public.

Cognitive therapy frequently focuses on decreasing the excessive concern regarding the opinion of others, as well as correcting the inaccurate belief that inept, social behavior will result in becoming a social outcast. People with social anxiety also display a tendency toward excessive self-monitoring, or self-observation, when faced with anxiety-provoking, social situations.

This excessive self-focus heightens their level of distress by creating more uncomfortable physical sensations of anxiety (such as blushing); which in turn, increases the person’s worry that others will notice, and judge them in a negative way. Self-focus can also interfere with a person’s ability to fully participate in conversations, thereby strengthening their belief that they are socially incompetent.

Often, social skills training can be an important component of treatment. Social skills training is usually delivered in a group therapy format because a therapy group provides an ideal social environment in which to practice these skills. The reason social skills training is so important is because persons with Social Phobia have typically avoided social situations for much of their life.

Thus, they may lack the experience and skills needed to be effective in social situations, and often misread social cues. A high percentage of people with Social Phobia use alcohol to self-medicate before attending social events. Treatment may need to specifically address excessive alcohol use/abuse.

Source: http://www.mentalhelp.net

The Treatment of Panic Disorder

The Treatment of Anxiety Disorders

Now that we have reviewed the various theories and associated therapies that are used to treat anxiety disorders, we will turn our attention to specific anxiety disorders to describe the usual treatment approach for each disorder. However, it is important to bear in mind, that therapists tailor their treatment approach for each person.

Treatment for Panic Disorder

Panic Disorder is characterized by uncued panic attacks triggered by a false alarm. Cognitive-behavioral therapy for Panic Disorder usually begins with psychoeducation about the disorder. Psychoeducation assists therapy participants (and their family members) to better understand their disorder. This increased understanding serves an important therapeutic purpose. You may recall that two specific cognitive distortions result in an inaccurate appraisal of risk, leading to a subsequent increase in anxiety symptoms: 1) the overestimation of threat and 2) the underestimation of coping abilities.Psychoeducation enables therapy participants to make a more accurate appraisal of risk, and to improve their coping skills in the following ways:

Psychoeducation teaches therapy participants that the physical sensations of the fight-or-flight response are harmless. Therefore, persons-in-recovery learn to more accurately interpret the physical sensations they experience during a panic attack. This increased knowledge helps to reduce the anxiety resulting from an over-estimation of the risk posed by a panic attack. People with Panic Disorder are comforted to know that even though they may feel as though they are losing control, or having a heart attack, these symptoms are perfectly safe, and even adaptive in true situations of danger.

Similarly, people with Panic Disorder benefit from skills training to improve their coping skills through relaxation exercises and breath retraining. Breath retraining involves learning to consciously regulate breath during a panic attack, while relaxation training involves learning to consciously release muscle tension. The purpose of relaxation exercises and breath retraining is to “turn-off” the sympathetic nervous system, which becomes activated during fight-or-flight, and instead “turn-on” the parasympathetic nervous system. In addition, these new skills help to strengthen patients’ appraisal of their coping skills; thereby further reducing their anxiety. These skills can be taught during individual therapy sessions or in a skills-training group.

advertisement

In addition to psycho-education and skills training, cognitive therapy also helps persons-in-recovery to identify, and target, disorder-specific dysfunctional thoughts, such as the tendency to misinterpret any physical sensation as dangerous or harmful, and the tendency to believe that certain situations “cause” panic attacks (leading to avoidance of those situations). Furthermore, the relationship between underlying life stressors and the initial, uncued panic attacks may be explored. Therapy participants are encouraged to develop strategies to reduce or eliminate these stressors. 

After receiving psychoeducation, skills training, and cognitive therapy, the therapy participant is now ready to participate in the behavioral component of treatment called exposure and response prevention therapy. There are two separate components to the behavioral therapy for Panic Disorder. The first is called interoceptive cue exposure. This type of exposure is meant to desensitize the participant to their specific physical sensations of a panic attack while refraining from his/her typical avoidance or safety behaviors. For example, if a person tends to experience rapid heart rate and perspiration during an attack, the therapist would instruct this person to run up and down stairs in the heat to mimic those same uncomfortable sensations. With repeated practice, the person will no longer become anxious when experiencing these sensations.

Once the therapy participant has learned to become more relaxed in the presence of their physical sensations, the second type of exposure involves confronting the specific situations that typically precipitate their panic attacks, such as an elevator, driving over a bridge, and/or going to a crowded, public place.

Due to the process of paired association, these neutral situations have become linked to the panic attacks and now spontaneously precipitate a panic attack. Therapy participants may practice their relaxation and breath techniques during exposure to prevent a panic attack from occurring.

With practice, the fearful response becomes extinguished: i.e., the exposure to these feared situations, without a panic attack, allows the fear to fade away. In one important study, the combination of interoceptive cue exposure, along with cognitive therapy, led to 85% of the participants being panic-free (Barlow, Craske, Cerny, & Klosko, 1989).

Despite psychoeducation, skills training, and cognitive therapy, some people are unable or unwilling to tolerate exposure therapy. For these people a variety of approaches are still available. Some people with Panic Disorder may benefit from the addition of medication. In addition, the therapist may decide to take a different approach by assisting therapy participants learn to tolerate and accept their symptoms. Both Dialectical Behavior Therapy and Acceptance and Commitment Therapy are useful tools in this regard.

Source: http://www.mentalhelp.net

Treatment for Post Traumatic Stress Disorder (PTSD)

Victims of traumatic events experience numerous symptoms which can greatly interfere with their lives. Treatment must address not only the traumatic memories, but many other distressing symptoms, such as interpersonal difficulties, emotional withdrawal, anger, guilt, and depression.Support groups and treatment groups can be extremely beneficial. Prolongedexposure therapy has been found to be quite beneficial and consists of four components: 1) psychoeducation about the effect of trauma, 2) breath retraining, 3) imaginal exposure, and 4) in vivo exposure (Foa, Hembree, & Rothbaum, 2007; Foa, Rothbaum, Riggs, & Murdock, 1991).

People with PTSD are often troubled by their lack of control over their symptoms and their lives. Psychoeducation helps therapy participants (and their families INSERT LINK TO FAMILY THERAPYp59) to understand that their symptoms are a predictable and normal response to trauma. A better understanding of their disorder enables therapy participants to regain a sense of control.

Individuals with PTSD may also benefit from breath retraining, which serves to reduce the uncomfortable physical symptoms of anxiety. Breath re-training is a method of consciously regulating breath, which helps the body “turn-off” the sympathetic nervous system. Furthermore, engaging in deep breathing may facilitate falling asleep, which is a common struggle for individuals with PTSD.

Because direct exposure to the traumatic event is not possible (nor advisable!) imaginal exposure therapy is conducted to help the therapy participant confront their traumatic memories. This involves the therapist gently and systematically assisting the person to gradually recall the traumatic event in greater and more vivid detail. Imaginal exposure is most effective when the person is guided to fully engage in the memory exercises using all five senses. The goal of imaginal exposure therapy is for the therapy participant to integrate the memories of the experience, while developing the ability briefly recall the event, without experiencing panic or anxiety.

In vivo exposure (or real-life exposure), involves confronting situations that trigger the traumatic memory, such as a loud, crowded baseball game that reminds a combat soldier of battle. In addition to these therapeutic techniques, some people will benefit from the addition of medication. Treatment for PTSD can be quite challenging due to the disturbing nature of the traumatic event itself.

Acceptance and Commitment Therapy (ACT) has also become a promising treatment for PTSD. ACT is based on the principle that individuals can learn to tolerate and accept distressing thoughts and emotions, rather than attempting to change them. Therapy participants are guided to live accordingly to their values, rather than according to their symptoms. ACT is particularly useful for people who are unable or unwilling to participate in exposure therapy.

The various forms of exposure therapy are designed to promote new learning, and the extinction of fear responses associated with trauma. A very new and still quite experimental therapy for PTSD, which as of yet has no official name but which we will call Memory Reconsolidation Therapy functions by exploiting a newly discovered and game-changing insight into how learning and memory work called memory reconsolidation. Where extinction based treatments simply compete with or attempt to starve to death established fear responses, reconsolidation-based PTSD treatments, utilizing a combination of imaginal exposure and medications appear to be able to completely erase fear responses. More information on Memory Reconsolidation Therapy for PTSD can be found here.

PTSD and Borderline Personality Disorder are two disorders that frequently co-occur. Borderline Personality Disorder is a fairly severe disorder characterized by emotional dysregulation, interpersonal disharmony, impulsivity, and self-destructive behaviors. In one study, 68% of people with Borderline Personality Disorder also met the criteria for PTSD (Shea, Zlotnick, & Weisberg, 1999). In cases of co-morbid PTSD and Borderline Personality Disorder, Dialectical Behavior Therapy (DBT) is incorporated into the treatment process.

Source: http://www.mentalhelp.net

Treatment for Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder (GAD) is associated with numerous physical symptoms of stress and tension. But, since anxiety is a combination of physical sensations, behaviors, emotions, and thoughts, it is important to target each of these components. Psycho-education is used to teach therapy participants about the physical sensations of anxiety so that the participant learns how to recognize and manage those symptoms.

Progressive muscle relaxation and imagery techniques are extremely useful techniques in managing and reducing these physical sensations. Progressive muscle relaxation teaches individuals how to recognize the difference between physical tension, and relaxation. Consequently, they learn how to consciously relax their muscles. Progressive muscle relaxation consists of the therapist systematically guiding a person to tense, and then relax, multiple major-muscle groups.

Regular practice is the best way to master the technique. Therapists often provide therapy participants with a tape recording of the exercise for homework practice. Imagery techniques consist of guiding people to imagine themselves in a safe and relaxing situation, or to recall a pleasant memory, such as lying on a beach listening to the ocean. Therapy participants learn to use these techniques throughout the day to return to a state of relaxation and calm.

Cognitive therapy focuses on challenging the core belief that the world is a dangerous place and decreasing cognitive distortions such as catastrophic predictions. Furthermore, people with GAD are encouraged to test out their predictions regarding future catastrophes. Exposure and response prevention therapy can be applied during imaginal exercises. This consists of the therapist guiding the therapy participant to imagine a feared future catastrophe. Repeated exposure, via imagination, helps the therapy participant to become desensitized to worries about negative outcomes by imagining them occurring.

Source: http://www.mentalhelp.net

Normal and Abnormal Anxiety: What’s the Difference?

On the most basic level, anxiety is an emotion. Simply stated, an emotion is a subjective state of being that is often associated with changes in feelings, behaviors, thoughts, and physiology. Anxiety, like all emotional states, can be experienced in varying degrees of intensity.

For instance, we might say we are happy, but a more intense expression of this same emotion might be an experience of joy. But unlike the emotion “happiness,” which has several different words to convey these differing levels of intensity (e.g., intensity ranging from happiness to joy), anxiety is a single word that represents a broad range of emotional intensity. At the low end of the intensity range, anxiety is normal and adaptive; at the high end of the intensity range, anxiety can become pathological and maladaptive.

As we will soon see, while everyone experiences anxiety, not everyone experiences the emotion of anxiety with the same intensity, frequency, or duration as someone who has an anxiety disorder. Let’s look more closely at some of the differences between the normal emotion of anxiety, and anxiety as a disorder.

The normal emotions of anxiety and fear

Anxiety, and its close cousin fear, are both considered emotions. While there is considerable overlap between these two terms, there are some important differences. Fear is generally considered a primary emotion, while anxiety is considered a secondary emotion that represents the avoidance of fear (including the avoidance of fear-producing stimuli).

Primary emotions refer to emotions that are recognizable through facial expressions, and can easily be interpreted by an observer (e.g., happiness, anger, sadness, fear, surprise, disgust). Secondary emotions, such as anxiety, are not readily recognizable to an outside observer, and are usually considered an internal, private experience.

However, the most important distinction between fear and anxiety is that fear is the response to a danger that is currently detected in the environment, while anxiety refers to the anticipation of some potential threat that may, or may not, happen in the future.

In other words, fear is a response to an immediate danger in the present moment of time, while anxiety is associated with a threat that is anticipated in a future moment in time. Anxiety reflects the anticipation of fear and represents an adaptive attempt to prevent the fear-provoking circumstance from occurring.

In an anxious state, a person is readying themselves and preparing themselves to cope with a future problem or dilemma which they anticipate will cause some kind of harm if not prevented from occurring. In this respect, anxiety is a normal and adaptive emotion.

Emotions are simply part of the normal human experience; as such, they are neither good nor bad. It’s what occurs afterwards that determines whether we experience a particular emotion as good or bad; i.e., the changes in our feelings, behaviors, thoughts, and physiology. At this point you may be wondering, “What could possibly be good about fear and anxiety? Don’t these emotions just make people feel miserable?”

Well, the answer may come as a quite a shock, but fear and anxiety are actually very important emotions when it comes to human survival and achievement. The reason behind this statement is that anxiety and fear actually motivate us for action when faced with an immediate danger (fear), or when we anticipate a future threat to our well-being (anxiety).

For example, picture a young mother and her child are crossing the street when the mother suddenly realizes they are in the direct path of an oncoming car. Imagine what would happen is she did not feel the least bit afraid. Or, imagine a law student preparing to take his bar exam so that he can become an attorney.

What if he didn’t have any anxiety over whether he passed or failed his bar exam? Clearly without fear and anxiety to prepare their minds and bodies for automatic action, these individuals would be at risk for some very serious, negative consequences. So, while the experience of fear or anxiety may at times be an unpleasant one, we can see that without these important emotions we’d actually be far worse off.

Fear and survival: The fight-or-flight response

When people speak of fear they are often referring to the body’s physiological response to fear, known as the fight-or-flight response. More specifically, when we are in the presence of an immediate danger, our bodies will automatically begin to prepare us to either attack the threat (i.e., fight) or more often, to escape from the danger (i.e., flight), in order to ensure our survival.

For example, when we are faced with danger our hearts begin to beat very fast. The reason behind this increased heart rate is that the emotion of fear signaled our body and mind to prepare for action. The nervous system responds to the signal of danger by attempting to increase blood flow throughout the body in an effort to deliver the extra oxygen our muscles will need for energy during a fight, or an escape from danger (e.g., running really fast). This increased blood flow requires the heart work harder, and beat faster.

Similarly, because increased oxygen is beneficial when faced with danger, there is a natural tendency for people to begin breathing more rapidly and more deeply to meet the demand for extra oxygen. This extra oxygen enables the body to rise to the challenge of fight-or-flight. These physical responses are discussed in greater detail in the section, Biological Explanations of Anxiety.

Like many adaptive mechanisms, the fight-or-flight response has evolved over time to help ensure our survival. In ancient times, our ancestors came into constant contact with many types of very real dangers in their environment (lions and tigers and bears, OH MY!). Over time, with repeated exposure to these threats, our ancestors’ nervous systems began to evolve in a manner that made the fight-or-flight response automatic and immediate.

This adaptation was very beneficial because it ensured the necessary physical responses, (such as increased heart rate and respiration) would occur without wasted time (immediate) and without having to think about it (automatic). This adaptation makes sense because human beings would be at a significant disadvantage if they had to stop and rationally determine best course of action whenever they were in danger. Consider again the example of the mother and her child crossing the street when she realizes they are in the direct path of an oncoming car. Clearly she does not have time to stop and weigh out all her options.

Although in modern times we may not encounter the same sorts of danger our ancestors had to face, we nonetheless still encounter threats in our daily lives that make the fight-or-flight response useful (e.g., physical threats such as being attacked by a mugger, social threats such as being ridiculed or embarrassed, and mental threats such as “blanking-out” on a difficult exam). Unfortunately, a problem arises when the fear response is triggered when no actual threat is present in our environment, and thus serves no useful purpose. This is called a false alarm which will be discussed further, but for now it is important just to realize that without a certain amount of fear in our lives, we would actually have a much more difficult time surviving.

Source: http://www.mentalhelp.net

Understanding Anxiety

What is Anxiety?

What is anxiety? Ask anyone to define anxiety and you will quickly realize there is no shortage of examples that people can provide. However, you may be surprised to learn that although anxiety is a very common human experience, the descriptions that people provide are quite varied, and unique to each person. Anxiety is a human emotion that everyone experiences, but as we will soon see, this emotion is not experienced by everyone in the same way. The following case examples illustrate these various experiences of anxiety:

Sally is a 24-year-old sales assistant in a highly prestigious pharmaceutical firm. She constantly works under a great deal of pressure which she describes as “no big deal,” and she even believes she thrives off this stress. However, recently she has become more and more distressed over the fact that every time she walks into her local grocery store she immediately begins to sweat, her heart begins to race, and she starts to think she is “losing control.” Subsequently, she began to consider ordering her groceries on-line to specifically avoid this experience.

Bill is a 47-year-old hardware store owner. Bill is constantly “worrying” about (what seems to him) just about everything. Whether he is concerned about his business not doing well…or, what if that mole on his back is not just a beauty mark?…or, how on earth is he ever going to drive to Michigan all by himself to see his son (even with the brand new navigation system)?…Bill just cannot seem to “control” his worry.

Kim is a 36-year-old, part-time, freelance web-designer who normally would describe herself as calm and low-key; that is, as long as she does not have to go over a bridge, or travel in an airplane. For Kim, she hates places where she feels she cannot escape. She finds that she will often worry for days or even months in advance if she believes that she will have to face one of these situations. As a result, she has made a habit of avoiding these situations at all costs, or she will “barely get through them.”

Lastly, we have Pete, a 32-year-old law student who cannot quite explain why he is anxious; however, he wakes up every morning feeling a sense of “dread.” His anxiety usually lingers until about mid-day, at which point, he finally starts to get into the swing of his normal, daily routine.

So who is right? Are they all describing the same phenomenon? Well, in a nutshell, yes. The reason behind this paradox is that anxiety is best considered a complex, subjective experience; produced by multiple causes; and expressed by a diverse set of symptoms that includes physical, emotional, behavioral, and cognitive components. This is the reason that we can ask many different people about a very common experience, yet get totally different definitions of what it means to be anxious.

In addition, people differ in how often, and how intensely, they experience anxiety. For most individuals, anxiety is a normal and even adaptive occurrence, well within the bounds of normal, everyday human experience. Unfortunately for others, their anxiety may be experienced to such a heightened degree that it actually causes them significant distress. Sadly, this level of anxiety often interferes with people’s functioning in many important areas of their lives such as work, school, and relationships. When the normal human experience of anxiety reaches this level of distress, and results in impaired functioning, we begin to speak of an anxiety disorder.

Luckily, experts in the field have come a long way in understanding and treating anxiety. In the following article we will take a broad look at anxiety and the many facets that help to define it. We’ll begin with a more in-depth understanding of what anxiety is, and explain how it is actually quite beneficial in some situations. We will then go on to discuss what happens when anxiety becomes “pathological” and we will describe and explain the many different types of anxiety disorders.

Next, we present the current research findings about what experts believe are the reasons behind the development, and maintenance of anxiety disorders. Finally, we will review how this knowledge has enabled us to develop highly effective treatments for the different types of anxiety disorders. This greater understanding of anxiety, and the development of effective treatments, enables us to confidently conclude there is hope and relief for the millions of individuals whose lives are negatively impacted by anxiety.

Source:http://www.mentalhelp.net

Psychologists Develop Successful Prevention Program for Postpartum OCD

ScienceDaily (Aug. 18, 2011) — The birth of a baby can elicit many emotions, from joy and excitement to fear and uncertainty. But it can also trigger unexpected difficulties with anxiety, in particular with postpartum Obsessive Compulsive Disorder (OCD). Psychologist Kiara Timpano from the University of Miami (UM) and her collaborators developed an effective program for the prevention of postpartum obsessive compulsive symptoms.

The findings are reported online ahead of print by the Journal of Psychiatric Research.

“Postpartum depression has received much attention, but anxiety related issues, especially obsessive compulsive symptoms, can also be devastating to mothers and their families,” says Timpano, Assistant Professor in the Department of Psychology at UM College of Arts and Sciences and principal investigator of the study. “Many women experiencing these difficulties are not getting the services they need because they don’t even know that what they are experiencing has a label and can be helped.”

Most new mothers have some thoughts of concern about their babies. But according to the study, some mothers experience a more severe form of anxiety known as postpartum OCD. The condition includes intrusive thoughts about bad things happening to the baby. In order to control these unpleasant thoughts, the mothers develop rituals or other behaviors in response, like checking the baby excessively or washing a baby bottle many more times than is necessary.

“The problem with OCD is that it is like a radio that’s turned up too high,” Timpano says. “Part of our work is trying to figure out how it got turned up so high and how we can help individuals turn it back down. For example, while it’s okay to wash the baby bottle once, it is problematic if a mother ends up washing it for hours at a time.”

The new study, titled “Efficacy of a prevention program for postpartum obsessive-compulsive symptoms.” The investigation was conducted in collaboration with Jonathan S. Abramowitz, professor of psychology, and Brittain L. Mahaffey, doctoral student in psychology, both in the College of Arts and Sciences at the University of North Carolina at Chapel Hill; Norman B. Schmidt, psychology professor and director of the Anxiety and Behavioral Health Clinic, and Melissa A. Mitchell, doctoral student in psychology, both at Florida State University.

“We wanted to provide mothers with the necessary tools, which would hopefully keep them from going on to develop substantial symptoms that would interfere in their lives,” Timpano says.

To develop and test the efficacy of an intervention that would not only treat mothers once their difficulties emerged, but could also prevent symptoms from developing, the team designed a prevention program based on cognitive behavioral therapy principle — a treatment technique that has been found to be highly effective for anxiety disorders. The program was incorporated it into a traditional childbirth educational class.

Participants were a group of 71 expecting mothers at risk for developing postpartum obsessive compulsive symptoms. Half of the group was in a class that included the prevention program, the other half was in a regular childbirth education class (control group). The mothers were followed for six months after the birth of their babies. The program included information on the warning signs of anxiety and OCD, as well as specific techniques for how to deal with the symptoms.

The prevention program was successful in reducing both the incidence of obsessive compulsive symptoms and how distressing they were. Compared to the control group, the mothers in the prevention program experienced less anxiety after the babies were born and they maintained this effect for at least six months postpartum. The team also found that the intervention reduced those thinking styles that put a mom at risk to begin with.

Moving forward, the researchers would like to build on the program they created and make the treatment even more feasible and effective. “Further down the road, you can imagine some sort of scenario where mothers would get screened for postpartum anxiety, as is frequently done now for postpartum depression,” said Timpano.

Skin Condition Associated With Depression, Anxiety and Suicidal Feelings

ScienceDaily (Aug. 16, 2010) — Individuals with psoriasis appear to have an increased risk of depression, anxiety and suicidality, according to a report in the August issue of Archives of Dermatology, one of the JAMA/Archives journals.

Psoriasis affects 1 percent to 3 percent of the general population, and estimates suggest 0.4 percent to 2.3 percent of adults have the condition but have not been diagnosed. “Psoriasis has long been recognized to be associated with potentially adverse effects on mental health,” the authors write. “In the 1960s, a popular ad campaign labeled the emotional burden of this skin disease as the ‘heartbreak of psoriasis.’ However, there have been relatively few studies evaluating psychological outcomes in patients with psoriasis.”

Shanu Kohli Kurd, M.D., M.S.C.E, M.H.S., and colleagues at the University of Pennsylvania, Philadelphia, studied data from electronic medical records in the United Kingdom from 1987 to 2002. The analyses included 146,042 patients with mild psoriasis, 3,956 patients with severe psoriasis and 766,950 patients without psoriasis (five control patients for each patient with psoriasis, selected from the same practice and similar entry dates). Patients were defined as having new-onset depression, anxiety or suicidality if corresponding diagnostic codes appeared in their records after follow-up began.

Of patients with mild or severe psoriasis, 25.9 per 1,000 individuals per year were diagnosed with depression, 20.9 per 1,000 per year with anxiety and 0.9 per 1,000 per year with suicidality. The rate of these cases attributable to psoriasis was 11.8 per 1,000 individuals per year for depression, 8.1 per 1,000 per year for anxiety and 0.4 per 1,000 per year for suicidality.

“Stated another way, the excess risk attributable to psoriasis is one case of depression for every 39 patients with severe psoriasis per year (or per 87 patients in patients with mild psoriasis per year),” the authors write. “The excess risks associated with psoriasis for anxiety and suicidality correspond to one case per 123 and 2,500 patients with psoriasis per year, respectively.” Considering this data and the prevalence of psoriasis in the U.K., the authors estimate that there are more than 10,400 diagnoses of depression, 7,100 of anxiety and 350 of suicidality related to psoriasis each year.

“It is important to identify these psychiatric disorders because they represent substantial morbidity that can be improved with a variety of pharmacological and non-pharmacological approaches,” the authors conclude. “Recent data suggest that psychiatric co-morbidity may negative affect response to certain psoriasis treatments (e.g., photochemotherapy), while other studies suggest that control of psoriasis is associated with improvements in psychological symptoms. Future studies are necessary to determine the mechanisms by which psoriasis is associated with depression, anxiety and suicidality as well as approaches to prevent such adverse outcomes in patients with psoriasis.”

Yoga’s Ability to Improve Mood and Lessen Anxiety Is Linked to Increased Levels of a Critical Brain Chemical, Research Finds

ScienceDaily (Nov. 11, 2010) — Yoga has a greater positive effect on a person’s mood and anxiety level than walking and other forms of exercise, which may be due to higher levels of the brain chemical GABA according to an article in The Journal of Alternative and Complementary Medicine, a peer-reviewed journal published by Mary Ann Liebert, Inc. The article is available free online.

Yoga has been shown to increase the level of gamma-aminobutyric acid, or GABA, a chemical in the brain that helps to regulate nerve activity. GABA activity is reduced in people with mood and anxiety disorders, and drugs that increase GABA activity are commonly prescribed to improve mood and decrease anxiety.

Tying all of these observations together, the study by Chris Streeter, MD, from Boston University School of Medicine (Massachusetts) and colleagues demonstrates that increased GABA levels measured after a session of yoga postures are associated with improved mood and decreased anxiety. Their findings establish a new link between yoga, higher levels of GABA in the thalamus, and improvements in mood and anxiety based on psychological assessments. The authors suggest that the practice of yoga stimulates specific brain areas, thereby giving rise to changes in endogenous antidepressant neurotransmitters such as GABA.

“This is important work that establishes some objective bases for the effects that highly trained practitioners of yoga therapy throughout the world see on a daily basis. What is important now is that these findings are further investigated in long-term studies to establish just how sustainable such changes can be in the search for safe non-drug treatments for depression,” says Kim A. Jobst, MA, DM, MRCP, MFHom, DipAc, Editor-in-Chief of The Journal of Alternative and Complementary Medicine.

Neural Mechanisms Linked With Vulnerability to Anxiety

ScienceDaily (Feb. 9, 2011) — New research examines the anxious brain during a fear conditioning task and provides insight into why some individuals may be more or less prone to anxiety disorders. The study, published by Cell Press in the Feb. 10 issue of the journal Neuron, reveals neural mechanisms that may contribute to resilience against pathological fear and anxiety. The findings may help to direct therapeutic strategies for individuals who suffer from chronic anxiety as well as strategies that could help “at risk” individuals avoid developing anxiety disorders.

Previous studies have implicated a brain structure called the amygdala in the acquisition and expression of conditioned fear, this occurring when a stimulus (the conditioned stimulus, CS) becomes associated with an aversive object or event (the unconditioned stimulus, UCS). Another brain region, the ventromedial prefrontal cortex (vmPFC), has been shown in both animals and humans to help inhibit conditioned fear after extinction training, during which the CS is repeatedly presented without the UCS. However, it is not clear how certain personality characteristics, like a tendency or vulnerability towards anxiety, influence these mechanisms.

“We were interested in examining why it is that some of us can overcome the discrete fears and nonspecific anxiety that we experience in our lives more easily than others,” explains senior study author, Dr. Sonia J. Bishop from the University of California, Berkeley. “Or, in other words, what differences in brain function might confer increased vulnerability for chronic fear and anxiety disorders?”

Dr. Bishop and colleagues performed a neuroimaging study to examine fear conditioning in human subjects who had been classified as having varying levels of “trait anxiety,” a tendency to experience anxiety across a range of everyday situations. The researchers observed that subjects who had a high level of trait anxiety were more likely to have an enhanced amygdala response to CS fear cues and to show faster acquisition of learned “fear” of these cues. Individual differences in amygdala reactivity were independent of the second dimension of risk, this involving the vmPFC. Recruitment of this region during conditioned fear expression prior to extinction was linked with greater reduction in fear responses and was more pronounced in fear-resilient individuals.

The findings suggest that individual differences in amygdala and vmPFC function are independently associated with vulnerability to anxiety, with the amygdala potentially influencing the development of cue-specific fears (or phobias) and the vmPFC impacting the ability to downregulate both phasic fears and generalized anxiety. “An understanding of the neurocognitive mechanisms by which trait vulnerability to pathological anxiety is conferred may aid not only in explaining the variability in symptoms, but also in informing choice intervention and prediction of treatment response,” concludes Dr. Bishop.

Earlier this month, Dr. Bishop attended an awards ceremony at NIH in recognition of her receipt of one of twelve prestigious Biobehavioral Research Awards for Innovative New Scientists given to enable her further pursuit of this important line of research.

Heart Patients With Anxiety Disorder Experience More Cardiovascular Events, Deaths

ScienceDaily (July 5, 2010) — Among patients with heart disease, anxiety disorders appear to be associated with a higher risk of stroke, heart attack, heart failure and death, according to a report in the July issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

As many as 24 percent to 31 percent of patients with heart disease also have symptoms of anxiety, according to background information in the article. “Compared with the extensive literature on depression in patients with coronary heart disease, relatively few studies have examined the role of anxiety,” the authors write. “Several studies have found that anxiety symptoms are predictive of disability, increased physical symptoms and worse functional status and quality of life in patients with coronary heart disease. However, studies examining anxiety as a risk factor for future coronary heart disease have yielded conflicting results.”

Elisabeth J. Martens, Ph.D., of Tilburg University, Tilburg, the Netherlands, and colleagues assessed 1,015 outpatients with stable coronary heart disease. The baseline examination consisted of interviews, blood and urine sample testing, exercise testing and electrocardiography. The presence of generalized anxiety disorder and of depressive disorder was determined using the computerized version of the Diagnostic Interview Schedule.

After an average follow-up time of 5.6 years, a total of 371 cardiovascular events occurred. After adjusting for age, the yearly rate of cardiovascular events was 9.6 percent in the 106 participants with general anxiety disorder and 6.6 percent in the 909 participants without. After further adjustments for potentially confounding variables — including sex, co-occurring conditions, heart disease severity and medication use — generalized anxiety disorder was associated with a 74 percent increased risk of cardiovascular events.

“This leaves the question of why generalized anxiety disorder is associated with adverse outcomes in patients with coronary heart disease,” the authors write. Anxiety may be associated with surges in catecholamines, “fight or flight” hormones that may be related to heart risks, they suggest. Alternatively, patients with anxiety may be more likely to seek care when they have symptoms and therefore be more likely to receive a diagnosis of stroke or heart attack, although this would not explain the increased risk of death. It is also possible that a common underlying factor predisposes individuals to both anxiety and heart events.

“These findings have implications for clinical practice and research,” they conclude. “Generalized anxiety disorder may be considered a prognostic factor in patients with coronary heart disease and could be used in risk stratification. Evaluation and treatment of anxiety may also be considered as part of the comprehensive management of patients with coronary heart disease. Research programs designed to advance our understanding of the impact of generalized anxiety disorders on medical prognosis and biobehavioral mechanisms that link anxiety to mortality in the context of coronary heart disease are needed to develop evidence-based approaches to improving patient care.”

Common Anxiety Disorders Make It Tougher to Quit Cigarettes

ScienceDaily (Oct. 25, 2010) — Researchers may have pinpointed a reason many smokers struggle to quit. According to new research published in the journal Addiction, smokers with a history of anxiety disorders are less likely to quit smoking. The study, conducted by the University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI), offered free coaching and medications to smokers in Madison and Milwaukee.

While overall quit rates for the study were high, participants with anxiety diagnoses were much less likely to quit smoking.

Study results also showed that anxiety diagnoses were very common among participants — more than a third of them met criteria for at least one anxiety diagnosis in their lifetime. Out of all 1,504 study participants, 455 had had a panic attack in the past, 199 social anxiety disorder, and 99 generalized anxiety disorder (some reported having more than one diagnoses). Other research has shown that up to 25 percent of the more than 50 million smokers in the U.S. had at least one anxiety disorder in their lifetime. And yet, very little research has addressed smoking in this population.

Lead author Megan Piper says it surprised her that the nicotine lozenge and patch — alone or in combination — failed to help patients with an anxiety history to quit smoking. In the general population, the lozenge and patch — especially when combined — have been very effective in helping patients quit smoking. Bupropion (Zyban) alone, or in combination with the nicotine lozenge, also did not increase cessation rates among patients with a history of anxiety disorders.

“Further research is needed to identify better counseling and medication treatments to help patients with anxiety disorders to quit smoking,” Piper says.

Smokers in the study with anxiety disorders also reported higher levels of nicotine dependence and withdrawal symptoms prior to quitting. Smokers often experience craving, negative feelings and difficulty concentrating in the minutes or hours after finishing a cigarette, and those feelings can be heightened simply because the smokers know they’re about to attempt to quit. In addition, participants with a history of panic attacks or social-anxiety disorder experienced more negative feelings on their quit day than did smokers in the study without this history.

These findings suggest that clinicians should assess anxiety-disorder status when helping patients quit smoking. While anxiety medications alone haven’t boosted cessation rates, Piper is planning further research to test other quit-smoking counseling interventions and medications with patients who have had an anxiety diagnosis.

In the meantime, all smokers can call the national tobacco quit line at 1-800-QUIT-NOW for free, confidential coaching and support to quit smoking.

Blogging May Help Teens Dealing With Social Distress

ScienceDaily (Jan. 4, 2012) — Blogging may have psychological benefits for teens suffering from social anxiety, improving their self-esteem and helping them relate better to their friends, according to new research published by the American Psychological Association.

“Research has shown that writing a personal diary and other forms of expressive writing are a great way to release emotional distress and just feel better,” said the study’s lead author, Meyran Boniel-Nissim, PhD, of the University of Haifa, Israel. “Teens are online anyway, so blogging enables free expression and easy communication with others.”

Maintaining a blog had a stronger positive effect on troubled students’ well-being than merely expressing their social anxieties and concerns in a private diary, according to the article published online in the APA journal Psychological Services^®. Opening the blog up to comments from the online community intensified those effects.

“Although cyberbullying and online abuse are extensive and broad, we noted that almost all responses to our participants’ blog messages were supportive and positive in nature,” said the study’s co-author, Azy Barak, PhD. “We weren’t surprised, as we frequently see positive social expressions online in terms of generosity, support and advice.”

The researchers randomly surveyed high school students in Israel, who had agreed to fill out a questionnaire about their feelings on the quality of their social relationships. A total of 161 students — 124 girls and 37 boys, with an average age of 15 — were selected because their scores on the survey showed they all had some level of social anxiety or distress. All the teens reported difficulty making friends or relating to the friends they had. The researchers assessed the teens’ self-esteem, everyday social activities and behaviors before, immediately after and two months after the 10-week experiment.

Four groups of students were assigned to blog. Two of those groups were told to focus their posts on their social problems, with one group opening the posts to comments; the other two groups could write about whatever they wanted and, again, one group opened the blog up to comments. The number and content of comments were not evaluated for this experiment. The students could respond to comments but that was not required. Two more groups acted as controls — either writing a private diary about their social problems or doing nothing. Participants in the writing and blogging groups were told to post messages at least twice a week for 10 weeks.

Four experts, who held master’s or doctoral degrees in counseling and psychology, assessed the bloggers’ social and emotional condition via their blog posts. Students were assessed as having a poor social and emotional state if they wrote extensively about personal problems or bad relationships or showed evidence of low self-esteem, for example.

Self-esteem, social anxiety, emotional distress and the number of positive social behaviors improved significantly for the bloggers when compared to the teens who did nothing and those who wrote private diaries. Bloggers who were instructed to write specifically about their difficulties and whose blogs were open to comments improved the most. All of these results were consistent at the two month follow-up.

The authors conceded that the skewed sex ratio was a limitation to the study. However, the researchers analyzed the results separately by gender and found that boys and girls reacted similarly to the interventions and there were no major differences. However, they say future research should attempt to control for gender.

Touching Tarantulas: Overcoming Phobias With Brief Therapy

ScienceDaily (May 21, 2012) — A single brief therapy session for adults with a lifelong debilitating spider phobia resulted in lasting changes to the brain’s response to fear.

The therapy was so successful, the adults were able to touch or hold a tarantula in their bare hands six months after the treatment, reports a new Northwestern Medicine study.

This is the first study to document the immediate and long-term brain changes after treatment and to illustrate how the brain reorganizes long-term to reduce fear as a result of the therapy. The findings show the lasting effectiveness of short exposure therapy for a phobia and offer new directions for treating other phobias and anxiety disorders.

“Before treatment, some of these participants wouldn’t walk on grass for fear of spiders or would stay out of their home or dorm room for days if they thought a spider was present,” said Katherina Hauner, post-doctoral fellow in neurology at Northwestern University Feinberg School of Medicine and lead author of the paper, published in Proceedings of the National Academy of Sciences. “But after a two or three-hour treatment, they were able to walk right up and touch or hold a tarantula. And they could still touch it after six months. They were thrilled by what they accomplished.”

The study with 12 adults was conducted when Hauner was a graduate student in the lab of Susan Mineka, a professor of psychology at Northwestern.

Fear of spiders is a subtype of an anxiety disorder called specific phobia, one of the most common anxiety disorders affecting about 7 percent of the population. Common specific phobias also include fear of blood, needles, snakes, flying and enclosed spaces.

The therapy involved gradually approaching the spider. Before the session, the participants were even afraid to look at photos of spiders. When they did, the regions of the brain associated with fear response — the amygdala, insula, and cingulate cortex — lit up with activity in an fMRI scan. Next, when asked to attempt to touch a tarantula in a closed terrarium or approach it as closely as possible, they were not able to get closer than 10 feet on average.

During the therapy, participants were taught about tarantulas and learned their catastrophic thoughts about them were not true. “They thought the tarantula might be capable of jumping out of the cage and on to them,” Hauner said. “Some thought the tarantula was capable of planning something evil to purposefully hurt them. I would teach them the tarantula is fragile and more interested in trying to hide herself. ”

They gradually learned to approach the tarantula in slow steps until they were able to touch the outside of the terrarium. Then they touched the tarantula with a paintbrush, a glove and eventually pet it with their bare hands or held it.

“They would see how soft it was and that its movements were very predictable and controllable,” Hauner said. “Most tarantulas aren’t aggressive, they just have a bad reputation.”

Immediately after the therapy, an fMRI scan showed the brain regions associated with fear decreased in activity when people encountered the spider photos, a reduction that persisted six months after treatment.

When the same participants were were asked to touch the tarantula six months later, “they walked right up to it and touched it,” Hauner said. “It was amazing to see because I remembered how terrified they were initially and so much time had passed since the therapy.”

Hauner also could predict for whom the therapy would be most effective based on an individual’s brain activity immediately after the treatment. Participants with higher measurements of activity in brain regions associated with visual perception of fearful stimuli immediately after the treatment were much more likely to show the lowest fear of spiders six months later.

“This suggests that observations of brain activity immediately after therapy may be a useful future tool in predicting an individual’s long-term outcome,” Hauner said.

She also found the brain regions associated with inhibiting fear only showed changes immediately after the exposure therapy and not after six months, indicating that differing brain mechanisms may be responsible for immediate versus long-term fear reduction.

If You’re Afraid of Spiders, They Seem Bigger: Phobia’s Effect On Perception of Feared Object Allows Fear to Persist

ScienceDaily (Feb. 22, 2012) — The more afraid a person is of a spider, the bigger that individual perceives the spider to be, new research suggests.

In the context of a fear of spiders, this warped perception doesn’t necessarily interfere with daily living. But for individuals who are afraid of needles, for example, the conviction that needles are larger than they really are could lead people who fear injections to avoid getting the health care they need.

A better understanding of how a phobia affects the perception of feared objects can help clinicians design more effective treatments for people who seek to overcome their fears, according to the researchers.

In this study, participants who feared spiders were asked to undergo five encounters with live spiders — tarantulas, in fact — and then provide size estimates of the spiders after those encounters ended. The more afraid the participants said they were of the spiders, the larger they estimated the spiders had been.

“If one is afraid of spiders, and by virtue of being afraid of spiders one tends to perceive spiders as bigger than they really are, that may feed the fear, foster that fear, and make it difficult to overcome,” said Michael Vasey, professor of psychology at Ohio State University and lead author of the study.

“When it comes to phobias, it’s all about avoidance as a primary means of keeping oneself safe. As long as you avoid, you can’t discover that you’re wrong. And you’re stuck. So to the extent that perceiving spiders as bigger than they really are fosters fear and avoidance, it then potentially is part of this cycle that feeds the phobia that leads to its persistence.

“We’re trying to understand why phobias persist so we can better target treatments to change those reasons they persist.”

The study is published in a recent issue of the Journal of Anxiety Disorders.

The researchers recruited 57 people who self-identified as having a spider phobia. Each participant then interacted at specific time points over a period of eight weeks with five different varieties of tarantulas varying in size from about 1 to 6 inches long.

The spiders were contained in an uncovered glass tank. Participants began their encounters 12 feet from the tank and were asked to approach the spider. Once they were standing next to the tank, they were asked to guide the spider around the tank by touching it with an 8-inch probe, and later with a shorter probe.

Throughout these encounters, researchers asked participants to report how afraid they were feeling on a scale of 0-100 according to an index of subjective units of distress. After the encounters, participants completed additional self-report measures of their specific fear of spiders, any panic symptoms they experienced during the encounters with the spiders, and thoughts about fear reduction and future spider encounters.

Finally, the research participants estimated the size of the spiders — while no longer being able to see them — by drawing a single line on an index card indicating the length of the spider from the tips of its front legs to the tips of its back legs.

An analysis of the results showed that higher average peak ratings of distress during the spider encounters were associated with estimates that the spiders were larger than they really were. Similar positive associations were seen between over-estimates of spider size and participants’ higher average peak levels of anxiety, higher average numbers of panic symptoms and overall spider fear. These findings have been supported in later studies with broader samples of people with varying levels of fear of spiders.

“It would appear from that result that fear is driving or altering the perception of the feared object, in this case a spider,” said Vasey, also the director of research for the psychology department’s Anxiety and Stress Disorders Clinic. “We already knew fear and anxiety alter thoughts about the feared thing. For example, the feared outcome is interpreted as being more likely than it really is. But this study shows that even perception is altered by fear. In this case, the feared spider is seen as being bigger. And that may serve as a maintaining factor for the fear.”

The approach tasks with the spiders are a classic example of exposure therapy, a common treatment for people with phobias. Though this therapy is known to be effective, scientists still do not fully understand why it works. And for some, the effects don’t last — but it is difficult to predict who will have a relapse of fear, Vasey said.

He and colleagues are studying these biased perceptions as well as attitudes with hopes that the new knowledge will enhance treatment for people with various phobias. The work suggests that fear not only alters one’s perception of the feared thing, but also can influence a person’s automatic attitude toward an object. Those who have developed an automatic negative attitude toward a feared object might have a harder time overcoming their fear.

Though individuals with arachnophobia are unlikely to seek treatment, the use of spiders in this research was a convenient way to study the complex effects of fear on visual perception and how those effects might cause fear to persist, Vasey noted.

“Ultimately, we are interested in identifying predictors of relapse so we can better measure when a person is done with treatment,” he said.

This work is supported by the National Institute of Mental Health.

Co-authors include Michael Vilensky, Jacqueline Heath, Casaundra Harbaugh, Adam Buffington and Vasey’s principal collaborator, Russell Fazio, all of Ohio State’s Department of Psychology.

Mental Illness: Early-Life Depression and Anxiety Changes Structure of Developing Brain

ScienceDaily (Nov. 15, 2011) — New research identifies the brain chemicals and circuits involved in mental illnesses like schizophrenia, depression, and anxiety, giving potential new directions to their treatment. In addition, research with children shows that early-life depression and anxiety changes the structure of the developing brain.

The findings were presented at Neuroscience 2011, the Society for Neuroscience’s annual meeting and the world’s largest source of emerging news about brain science and health.

One in 17 Americans suffer from a serious mental illness, such as schizophrenia, major depression, or bipolar disorder, making it one of the leading causes of disability. Yet science is only beginning to understand the underlying physical causes of these diseases.

New findings show:

• Childhood anxiety and depression alter the way the amygdala connects to other regions of the brain. This finding may help explain how early life stress can lead to future emotional and behavioral issues (Shaozheng Qin, PhD, abstract 927.06, see attached summary).
• In animal studies, a link between two factors associated with schizophrenia, prenatal infection and impaired function of a molecule important in memory (Melissa Burt, abstract 763.11, see attached summary).
• Researchers have identified a brain chemical important to antidepressant response in mice. The findings may help in the design of therapies for major depression (Maha Elsayed, abstract 904.10, see attached summary).
• The connections between two specific areas of the brain — the prefrontal cortex and the dorsal raphe nucleus — may contribute to depression. Stimulating these circuits in rats had an antidepressant effect (Melissa Warden, PhD, abstract 306.15, see attached summary).
• An enzyme called STEP is elevated in the brains of people with schizophrenia. Mice lacking this chemical did not develop schizophrenia-like behaviors (Nikisha Carty, PhD, abstract 238.03, see attached summary).

“If we can fully understand the roots of mental illness in brain circuitry and systems, we may be able to develop better treatment targets for the millions suffering from these diseases,” said press conference moderator Carol Tamminga, MD, of the University of Texas Southwestern, who is an expert on schizophrenia.

This research was supported by national funding agencies, such as the National Institutes of Health, as well as private and philanthropic organizations.