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Thinking of Choices Can Improve Patience

Anxiety - Wed, 06/07/2017 - 11:30

Many worry that today’s fast-paced world rewards or at least encourages instant gratification. To that end, a new study may provide some reassurance that individuals can learn to exercise patience by framing potential choices as a sequence of events.

Investigators explain that when faced with a tempting choice, it can be hard to stop and think through the potential consequences.

“People often have difficulty forgoing immediate temptations, like hitting the snooze button on the alarm, for the sake of later benefits. One possible reason is that people tend to consider the immediate consequences of a particular action, like getting a few more minutes of sleep, more than the later ones, like not having time for breakfast,” said Dr. Adrianna Jenkins at the University of California, Berkeley.

“Past work has shown that a subtle change in how choices are framed can increase people’s patience. We found evidence that this change affects patience by increasing imagination and its role in decision-making,” she adds.

A considerable amount of research has shown that people who are able to forego immediate temptations in lieu of future rewards experience all sorts of benefits later on, including greater physical, psychological, and financial well-being.

But the typical explanation for this ability — using willpower to tamp down our immediate desires — does not always seem to underlie increases in patience.

For example, research on framing effects indicates that people’s ability to exercise patience can differ based on small differences on how current and future choices are presented, even without changes in willpower.

In this light, Jenkins and UC Berkeley colleague Ming Hsu wondered whether reframing decisions might increase people’s reliance on a second possible route to patience: imagination. In one experiment, Jenkins and Hsu presented 122 participants with a series of binary choices and the participants had to choose which option they preferred.

In some cases, the options were framed as independent — for example, they could choose between receiving $15 tomorrow or $20 in 30 days. In other cases, however, the options were framed as sequential — that is, receive $15 tomorrow and $0 in 30 days versus receive $0 tomorrow and $20 in 30 days.

Replicating past research, people were more likely to exercise patience when the options were framed as a sequence relative to when they were framed as independent. Importantly, the options were financially equivalent regardless of how they were framed.

In a second online experiment, 203 participants were randomly assigned to receive either an independently framed choice or a sequentially framed choice with higher stakes: $100 tomorrow or $120 in 30 days. This time, Jenkins and Hsu also measured participants’ imagination.

In the second experiment, people were more likely to imagine the potential outcomes of the options when choices were framed as sequences. This increased reliance on imagination was apparent in both participants’ self-reports and also in the notes they took about what they were thinking while making their decision.

In a third experiment, the researchers looked at brain imaging data from another group of participants making the same kinds of decisions. They found that when options were framed as a sequence, choosing the patient option was linked to activity in brain regions associated with imagination.

When the options were framed as independent, choosing the patient option was more strongly linked with activity in brain areas associated with willpower.

These findings, the researchers say, provide evidence that reframing options as a sequence influenced the route by which participants exercised patience.

“Our findings suggest that imagination and willpower represent dissociable routes to patience,” said Jenkins. “Willpower might enable people to override impatient impulses after they’re formed, whereas imagining future consequences might affect the formation of the impulses themselves.”

Imagining future consequences may be a particularly useful strategy, the researchers note, when circumstances are less than ideal — say, when you’re multitasking, distracted, stressed, or just tired — since is it possible for willpower to be compromised in these situations.

So when your alarm clock rings tomorrow and you don’t feel like getting out of bed, try reframing your options.

Instead of choosing between “get out of bed now” and “sleep 20 more minutes,” try thinking of your options more in terms of “get out of bed now and have time for breakfast” or “sleep 20 more minutes and have no time for breakfast.”

It may just help you throw off the covers and get ahead on your day.

Source: Association for Psychological Science

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Postpartum depression guide for women and men

Depression - Tue, 06/06/2017 - 16:54
An increase of new mothers have been opening up about their battle with postpartum depression. Virginia blogger Jamie Fuller, describes the signs of the condition.
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Conquering the Fear of Cancer Recurrence

Anxiety - Tue, 06/06/2017 - 12:15

Among cancer survivors, the fear of disease recurrence can be so distressing that it significantly affects medical follow-up behavior, mood, relationships, work, goal setting and quality of life.

In fact, about half of all cancer survivors and 70 percent of young breast cancer survivors report moderate to high fear of recurrence. Still, there are very few interventions designed to tackle this important issue.

In a new study, a psychological intervention called Conquer Fear was shown to substantially reduce fear of recurrence immediately after the therapy as well as three and six months later. General anxiety, cancer-specific distress, and quality of life were better in the psychological intervention group immediately after the intervention.

The study is being presented at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting.

“The reduction in fear of recurrence in the psychological intervention group was large enough to improve survivors’ psychological and emotional wellbeing,” said lead study author Jane Beith, M.D., Ph.D., a medical oncologist at the University of Sydney in Australia, who developed the Conquer Fear intervention with colleagues, including psycho-oncologist Dr. Phyllis Butow, M.P.H., Ph.D.

“The majority of participants were young women with breast cancer, but we expect the intervention may be appropriate for other patients who have moderate to high fear of recurrence.”

The Conquer Fear psychology intervention is based on a novel theoretical framework developed by the authors (the intervention was developed for research and is not yet used in clinical practice). Trained study therapists delivered the intervention in five 60- to 90-minute individual, face-to-face sessions over 10 weeks.

Conquer Fear focuses on the following aspects:

  • accepting the inherent uncertainty of whether the cancer would come back;
  • teaching strategies to control worry;
  • giving survivors more control over where they place their attention;
  • helping them focus on what they want to get out of life;
  • choosing a sensible level of cancer screening and sticking to it.

Researchers randomly assigned 222 survivors of stage I-III breast cancer, colorectal cancer, or melanoma who reported high fear of recurrence to either the Conquer Fear intervention or relaxation training (control group). All participants had finished cancer treatment two months to five years before enrolling in this study and were cancer free at the time.

The control group received five 60-minute, individual, face-to-face relaxation sessions. The sessions were delivered over 10 weeks by trained study therapists and incorporated muscle relaxation, meditative relaxation, and visualization and quick relaxation techniques. Both groups received instructions for home-based practice.

To measure any changes in fear of cancer recurrence, researchers used total scores (0 to 168) from a validated 42-item questionnaire called Fear of Cancer Recurrence Inventory or FCRI. Higher scores indicated a worse fear of recurrence. Survivors completed the questionnaire at enrollment, immediately after the intervention, and three and six months later.

At the beginning of the study, the average FCRI score was 82.7 in the intervention group and 85.7 in the control group. The findings show that the total fear-of-cancer-recurrence score was reduced significantly more in the intervention group (by 18.1 points on average) than in the control group (by 7.6 points on average), immediately after the intervention. This represents a standardized effect size of 0.44, within the range considered clinically important.

FCRI scores continued to decrease over time, with significant difference between groups at 6 months, decreasing by 27.2 points on average in the intervention group and 17.8 points on average in the control group.

The researchers also explored other patient outcomes, including cancer-specific distress (how much someone is plagued with thoughts about cancer), general distress (anxiety, depression, and stress), and quality of life (covers independent living, physical pain, mental health, happiness, coping, relationships, and self-worth). The psychological intervention had a greater positive effect on these outcomes than relaxation training.

The authors note that while Conquer Fear is effective in a face-to-face format, it is a time- and resource-intensive intervention. Other formats, such as delivery via internet, in a group, or by phone, may be possible. A stepped care approach could also be considered, with only those with severe fear of recurrence receiving face-to-face intervention.

“In this study, the interventions were delivered by experienced psycho-oncologists. It is possible that community psychologists or other professionals who have basic training in cognitive therapy could deliver the interventions, given appropriate training and supervision,” said Beith.

Source: American Society of Clinical Oncology

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Sleep Duration May Impact Success of CBT

Anxiety - Tue, 06/06/2017 - 11:30

A new study discovers sleeping for seven hours or more a night influences the success of cognitive behavioral therapy for insomnia (CBTI) and depression.

Researchers discovered that when insomnia and depression co-occur, longer pre-treatment objective sleep duration is predictive of remission of both disorders when patients are given a combination of CBTI for insomnia and antidepressant medication for depression.

“A seven-hour, objective sleep duration of patients prior to entering treatment increased their chances of achieving both depression and insomnia remission by their treatment endpoints,” said lead author Jack D. Edinger, Ph.D., professor in the Section of Sleep Medicine at National Jewish Health in Denver, Colorado.

Researchers evaluated 104 adults, including 75 women, who enrolled in the Treatment of Insomnia and Depression Study and completed one baseline night of polysomnography.

Participants received 16 weeks of anti-depressant medication and were randomly assigned either to CBTI or sham insomnia therapy. The Hamilton Rating Scale for Depression (HAMD-17) and Insomnia Severity Index were administered at baseline and then bi-weekly during treatment to determine depression and insomnia remission.

The study was part of a larger research project involving investigators from the University of Pittsburgh, Duke University, University of California, San Francisco; and Stanford University. Rachel Manber, Ph.D., professor of psychiatry and behavioral sciences at the Stanford University Medical Center is the lead principal investigator.

“Our findings highlight the importance of adequate objective sleep in the recovery from depression and insomnia,” said Manber.

“The data suggest that short sleep duration may be a risk for refractory depression.”

The research abstract was published recently in an online supplement of the journal Sleep and will be presented at SLEEP 2017, the 31st Annual Meeting of the Associated Professional Sleep Societies LLC (APSS).

Source: American Academy of Sleep Medicine/EurekAlert

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Some THC Relieves Stress, But Higher Dose May Up Anxiety

Anxiety - Mon, 06/05/2017 - 13:45

Many marijuana smokers say they use the drug to relax or relieve stress. A new study supports this rationale — but only when very low doses are used.

Researchers at the University of Illinois at Chicago and the University of Chicago discovered the effects from levels tetrahydrocannabinol, or THC, the main psychoactive compound in marijuana, are very dose-dependent.

Very low levels of THC can reduce stress while slightly higher doses, enough to produce a mild “high,” actually increase anxiety.

Study findings appear in the journal Drug and Alcohol Dependence.

Despite recent decriminalization in some states, cannabis remains a highly regulated category 1 substance, and researchers point out that permits to study the drug are difficult to obtain.

While it is common knowledge that many people use cannabis for its stress-relieving effects, “very few published studies have looked into the effects of THC on stress, or at the effects of different levels of THC on stress,” said Dr. Emma Childs, associate professor of psychiatry and corresponding author on the study.

“We found that THC at low doses reduced stress, while higher doses had the opposite effect, underscoring the importance of dose when it comes to THC and its effects.”

Childs and her colleagues recruited 42 healthy volunteers 18 to 40 years old who had some experience with cannabis use but who were not daily users.

Participants were randomly divided into three groups: The low-dose group received a capsule containing 7.5 milligrams of THC; the moderate-dose group received a capsule containing 12.5 milligrams of THC; and a placebo group received a capsule containing none. Neither the participants nor the researchers knew who was in each group.

“The doses used in the study produce effects that are equivalent to only a few puffs of a cannabis cigarette,” said Childs, noting that it is difficult to compare doses of smoked cannabis to doses of ingested THC.

“We didn’t want to include a much larger dose, because we wanted to avoid potential adverse effects or cardiovascular effects that can result from higher doses of THC.”

Participants attended two four-hour sessions at the University of Chicago, five days apart. At each session, they took their capsule and then relaxed for two hours to allow the THC to be absorbed into the bloodstream.

During one session, participants were asked to spend 10 minutes preparing for a mock job interview. They were then subjected to a five-minute interview with lab assistants who did not offer any feedback, verbally or through body language, although video display was visible to the participant, showing their performance.

Participants were then instructed to count backwards from a five-digit number by subtracting 13, for five minutes; a task that is “very reliably stress-inducing,” Childs said.

In their second visit, participants were asked to talk to lab assistants about a favorite book or movie for five minutes and then play solitaire for another five minutes.Before, during and after each of the two activities, participants rated their stress levels and feelings about the tasks. Blood pressure, heart rate, and cortisol, a key stress hormone, were measured at intervals.

The participants who received 7.5 milligrams of THC reported less stress after the psychosocial test than those given a placebo, and their stress levels dissipated faster after the test.

Participants who received 12.5 milligrams of THC before the two tasks reported greater negative mood before and throughout the task, and were more likely to rate the psychosocial task as “challenging” and “threatening” beforehand.

Participants who received this dose also had more pauses during the mock interview compared to those in the placebo group.

There were no significant differences in participants’ blood pressure, heart rate or cortisol levels before, during or after the doses or the tasks.

“Our findings provide some support for the common claim that cannabis is used to reduce stress and relieve tension and anxiety,” Childs said.

“At the same time, our finding that participants in the higher THC group reported small but significant increases in anxiety and negative mood throughout the test supports the idea that THC can also produce the opposite effect.”

“Studies like these — examining the effects of cannabis and its pharmacological constituents under controlled conditions — are extremely important, considering the widespread use of cannabis for both medical and non-medical purposes,” she said.

“Unfortunately, significant regulatory obstacles make it extremely difficult to conduct this type of research — with the result that cannabis is now widely available for medical purposes with minimal scientific foundation.”

Source: University of Illinois – Chicago

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Sleeping Partner May Unintentionally Contribute to Insomnia

Anxiety - Mon, 06/05/2017 - 13:00

New research suggests that partners of people who have insomnia may engage in behaviors that inadvertently conflict with treatment recommendations.

Investigators discovered that 74 percent of partners encouraged an early bedtime or late wake time, which is in direct conflict with the principles of cognitive behavioral therapy for insomnia (CBTI).

Forty-two percent also encouraged doing other things in bed, such as reading or watching TV, and 35 percent encouraged naps, caffeine or reduced daytime activities.

“It is possible that partners are unwittingly perpetuating insomnia symptoms in the patient with insomnia,” said lead author Alix Mellor, PhD, coordinator of the Researching Effective Sleep Treatments (REST) project in the School of Psychological Sciences at Monash University in Victoria, Australia.

“It is therefore important for more data to be collected to determine whether insomnia treatments may better benefit patients and their partners by proactively assessing and addressing bed partner behaviors in treatment programs.”

The research team was led by Mellor and chief investigator Sean P. A. Drummond, PhD, professor of clinical neuroscience at the Monash Institute of Cognitive and Clinical Neurosciences.

They studied 31 partners, including 14 women, of individuals seeking treatment for insomnia as part of a randomized, controlled trial investigating partner-assisted interventions for insomnia.

Partners completed several questionnaires at baseline: the Family Accommodation Scale, Beck Anxiety Inventory, and Dyadic Adjustment Scale. The insomnia patients also completed baseline questionnaires, including the Insomnia Severity Index, and kept a sleep diary for one week prior to starting treatment.

Results also show that bed partners made accommodations that affected their own functioning, including their sleep and life outside of work.

Researchers believe this behavior may explain why partners who attempted to be helpful experienced more anxiety, even though the insomnia patients perceived the relationship to be more satisfying.

“Our preliminary results suggest that while some of these behaviors make the patient feel supported, their partner may be experiencing more anxiety,” said Mellor.

The research abstract was published recently in an online supplement of the journal Sleep and will be presented at SLEEP 2017, the 31st Annual Meeting of the Associated Professional Sleep Societies LLC (APSS).

Source: American Academy of Sleep Medicine/EurekAlert

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Mental Health Peer Navigators Can Help Others in Need

Anxiety - Mon, 06/05/2017 - 12:15

Investigators at the University of Southern California (USC) believe a new care model can enhance the physical health and extend the lives of people with mental illness, who typically die 25 years earlier than the general population.

In a study published in Schizophrenia Research, investigators suggest the magic bullet may involve peer navigators. These trained role models use their life experience with recovery from mental illness, such as schizophrenia, bipolar disorder or depression, to help motivate others who could self-manage their own health needs.

“Peer navigators have proven effective at building a strong connection with clients, and this empowerment has resulted in patients having more outpatient visits with doctors, less preference for emergency room visits, more confidence in self-managing their own health care and better detection of diseases,” said principal investigator Dr. John Brekke, Professor of Social Work at the USC Suzanne Dworak-Peck School of Social Work.

Investigators explain that people who want to do this work generally have been through a life-changing medical event themselves or with a loved one. They have learned the hard way how difficult it is to navigate and manage a complicated diagnosis, treatment or chronic condition.

They experienced the confusion, lack of coordination, dangers and inefficiencies in the U.S. health care system, and now they want to share both what they have learned and how to avoid missteps along the way. In many cases, these are laypeople with no prior medical experience or training.

As federal, state and local programs work to leverage the promise of the Affordable Care Act (or its replacement under the Trump administration) for better health outcomes, new approaches are necessary.
Use of peer navigators can facilitate greater access to quality care and treatment — for the afflicted, it’s a matter of life and death.

“These individuals have often times given up — they can’t help themselves — and they aren’t getting standard primary health care,” Brekke said.

“What’s disturbing is that they are dying from preventable medical conditions.

“Just to bring this home, I often tell audiences that if I had been diagnosed with a serious mental illness, the aggregate data suggest that I would have died over a decade ago,” he added.

The causes — high blood pressure, heart disease, diabetes, obesity and asthma — are treatable. The problem is that people with serious mental illness tend to be socioeconomically disadvantaged and often don’t get the best available health care.

Frequently, their own mental health providers pay too little regard to their physical health.

Brekke blames a fragmented health care system — one that segregates the services for physical health and mental health — for the health disparities in these individuals that often lead to uncoordinated, inferior care and increased health care costs.

“These departments are not integrated and they never have been. Providers in one field are not trained in the other, and they don’t want to deal with the issues that don’t directly involve them,” he said.

“We need a health care system that is prepared to deal with persons who have a serious mental illness. They require a different kind of approach.”

Brekke and his team developed and tested a behavioral model of health-service use focused on educating patients with serious mental illness about self-care.

The new model gives people with mental illness the tools to manage their own care and ultimately helps them find the confidence to navigate a complicated health care system — with peer navigators as coaches.

“Many of our clients are insured, but do not know how to access and use medical care. Many did not learn as young adults how to take care of their health,” said Laura Pancake, vice president of wellness, recovery, integrated care and training at Pacific Clinics.

“In many cases, families did not prioritize health, often turning to the emergency room as their primary health care provider.”

Peer navigators use motivational strategies, modeling, role-playing and coaching to help clients achieve certain behavioral goals.

They assist clients in making medical appointments, finding transportation, communicating with providers, following through with lab tests and filling prescriptions, and adhering to a doctor’s care plan.

“Peer navigators serve a critical role in coordinating care among mental health care providers, primary care providers, substance abuse providers and specialty care,” Pancake said.

Feedback indicates interactions with peer navigators improves the health care experience and gives consumers better access to services.

“Physicians like it because it helps them develop relationships with their patients and facilitates communication and understanding,” she said.

Brekke acknowledged a secondary outcome of his research has been the positive effect on the peer navigators themselves.

“It improved aspects of their self-esteem, their confidence and job satisfaction. It actually made them much more aware of their own health care needs,” he said.

Source: USC

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Deployment Stress May Impact Male, Female Veterans Differently

Anxiety - Mon, 06/05/2017 - 11:30

A new study of veterans reveals how gender may influence the link between military exposure and post-deployment well-being. The findings suggest that men and women may experience and react differently to deployment stress.

While previous research has shown an association between the development of mental health issues, particularly PTSD, and decreased functioning and satisfaction with family and work for veterans, most studies have not considered gender as a variable nor the role of particular deployment stressors.

“Our study illustrates the complex interplay between specific military exposures, mental health, and subsequent post deployment well-being between the genders,” said lead author Brian Smith, Ph.D., assistant professor of psychiatry at Boston University School of Medicine and research psychologist in the Women’s Health Sciences Division, National Center for PTSD at VA Boston Healthcare System.

For the study, published in the journal Clinical Psychological Science, 522 Iraq and Afghanistan War veterans (male and female) completed two surveys. The first survey was completed within two years of separation from military service, and included questions about veterans’ military experiences as well as their current mental health.

The second survey was completed approximately three and a half years later and included questions about functioning and satisfaction in regards to work, romantic relationships and parenting.

The researchers concluded that each of the deployment stressors examined — warfare exposure, military sexual harassment and family stressors — had implications for veterans’ subsequent functioning and satisfaction in the areas of work and family. Furthermore, these exposures were often indirectly linked to functioning and satisfaction via mental health.

Interestingly, the links differed between men and women. The findings show that PTSD symptoms played an important role for both genders, but depression played a particularly strong role in female veterans. For example, while PTSD linked all three deployment exposures and subsequent functioning and satisfaction in romantic relationships for men, both PTSD and depression played significant roles for women.

Some gender differences were also found regarding the direct effects of military exposures on work and family quality of life. For example, family stressors during deployment were directly associated with increased risk for parental impairment for female veterans, whereas for men the effect was only indirect through PTSD.

The study found some gender similarities as well. In the context of parenting, PTSD linked deployment exposures with reduced functioning for male and female veterans alike, and depression was the most important link in predicting lower satisfaction.

These findings support the position that men and women may experience different military exposures and react in different ways.

“This understanding of risk for reduced well-being, including the role of gender differences, may provide further important insight as to how to best cater post-military services to veterans’ unique needs following military service,” added Smith.

“From a clinical perspective, these findings suggest that services aimed at addressing returning veterans’ reintegration into work and family life might pay particular attention to male and female veterans’ experiences while deployed, as well as their current mental health.”

Source: Boston University Medical Center


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Kids more likely to suffer depression from toxic parents

Depression - Sat, 06/03/2017 - 13:33
Melissa Bright, a psychology research scientist at the University of Florida, is exploring how stressful experiences during childhood relates to a child's health.
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Dying May Not Be That Bad After All

Anxiety - Sat, 06/03/2017 - 12:00

While most of us fear dying, a new study suggests that the actual emotional experiences of the dying are more positive than people expect.

“When we imagine our emotions as we approach death, we think mostly of sadness and terror,” said psychological scientist Dr. Kurt Gray of the University of North Carolina at Chapel Hill. “But it turns out, dying is less sad and terrifying — and happier — than you think.”

The study, which examined the writings of terminally ill patients and inmates on death row, suggests that we focus disproportionately on the negative emotions caused by dying, without considering the broader context of everyday life.

“Humans are incredibly adaptive — both physically and emotionally — and we go about our daily lives whether we’re dying or not,” Gray said. “In our imagination, dying is lonely and meaningless, but the final blog posts of terminally ill patients and the last words of death row inmates are filled with love, social connection and meaning.”

Gray, his graduate student Amelia Goranson, and their co-authors Ryan Ritter, Adam Waytz, and Michael Norton started thinking about the emotional experience of dying when they came across the last words of death-row inmates in Texas, collected by the state’s Department of Justice.

The researchers said they were surprised by how upbeat the statements were, and wondered whether our feelings about death and dying might be clouded by our tendency to zero in on negative experiences.

In their first study, the researchers analyzed the emotional content of blog posts from terminally ill patients who were dying of cancer or amyotrophic lateral sclerosis (ALS). To be included in the study, the blogs had to have at least 10 posts over at least three months and the author had to have died in the course of writing the blog.

For comparison, the researchers asked a group of online participants to imagine that they had been diagnosed with terminal cancer and to write a blog post, keeping in mind that they had only a few months to live.

Using a computer-based algorithm, trained research assistant coders, and online participant coders, the researchers analyzed the actual and imagined blog posts for words that described negative and positive emotions, such as “fear,” “terror,” “anxiety,” “happiness,” and “love.”

The results revealed that blog posts from individuals who were terminally ill included considerably more positive emotion words and fewer negative emotion words than those written by participants who simply imagined they were dying.

Looking at the patients’ blog posts over time, the researchers also found that their use of positive emotion words actually increased as they neared death, while their use of negative emotion words did not.

These patterns held even after the researchers took the overall word count and number of blog posts into account, suggesting that the increase in positive emotion words was not simply due to the effects of writing over time.

In a second study, the researchers conducted similar analyses comparing the last words of inmates on death row with the poetry of death-row inmates and the imagined last words of another group of online participants.

Again, they found that the words of those who were actually close to death were less negative and more positive in emotional tone than the words of those who were not close to death.

Both the terminally ill patients and the inmates facing execution seemed to focus on things that help us make meaning of life, including religion and family, suggesting that such things may help quell anxiety about death as it approaches.

The researchers acknowledge that the findings may not apply to all people who are approaching death. They noted that it is unclear whether individuals facing a great deal of uncertainty or those who die of old age express similarly positive emotions near the end of life.

Ultimately, the study’s findings suggest that our expectations may not match the reality of dying, which has important implications for how we treat people who are dying, the researchers said.

“Currently, the medical system is geared toward avoiding death, an avoidance that is often motivated by views of death as terrible and tragic,” the researchers wrote in the study, which was published in Psychological Science, a journal of the Association for Psychological Science.

“This focus is understandable given cultural narratives of death’s negativity, but our results suggest that death is more positive than people expect: Meeting the grim reaper may not be as grim as it seems.”

Source: Association for Psychological Science

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Anxiety, Depression Frequently Linked with Chronic Pain

Anxiety - Fri, 06/02/2017 - 13:00

A new survey discovers that many adults with anxiety or a mood disorder also report experiencing chronic pain.

Researchers from Columbia University’s Mailman School of Public Health discovered nearly half of the people surveyed with a mood disorder — including included depression or bipolar disorder — report chronic pain.

The findings, which show the link between mental health and physical symptoms are published online in the Journal of Affective Disorders.

“The dual burden of chronic physical conditions and mood and anxiety disorders is a significant and growing problem,” said Silvia Martins, M.D., Ph.D., associate professor of Epidemiology at the Mailman School of Public Health, and senior author.

The research examined survey data to analyze associations between DSM-IV-diagnosed mood and anxiety disorders and self-reported chronic physical conditions among 5,037 adults in São Paulo, Brazil. Participants were also interviewed in person.

Among individuals with a mood disorder, chronic pain was the most common, reported by 50 percent, followed by respiratory diseases at 33 percent, cardiovascular disease at 10 percent, arthritis reported by nine percent, and diabetes by seven percent.

Anxiety disorders were also common for those with chronic pain disorder at 45 percent, and respiratory at 30 percent, as well as arthritis and cardiovascular disease, each 11 percent.

Individuals with two or more chronic diseases had increased odds of a mood or anxiety disorder. Hypertension was associated with both disorders at 23 percent.

“These results shed new light on the public health impact of the dual burden of physical and mental illness,” said Dr. Martins.

“Chronic disease coupled with a psychiatric disorder is a pressing issue that health providers should consider when designing preventive interventions and treatment services — especially the heavy mental health burden experienced by those with two or more chronic diseases.”

Source: Columbia University/EurekAlert

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Study Shows Physical Proof of Internet Addiction

Anxiety - Fri, 06/02/2017 - 11:30

European researchers have discovered that among some people, high use of the internet is associated with elevated heart rate and increased blood pressure.

In the study, scientists and clinicians from Swansea and Milan Universities followed 144 participants, aged 18 to 33 years, monitoring heart rate and blood pressure levels before and after a brief internet session. Additionally, participant’s anxiety and self-reported internet-addiction were assessed.

Investigators discovered increases in physiological arousal on terminating the internet session for those who self-reported internet-addiction (problematically-high internet usage). These increases in heart rate and blood pressure were mirrored by increased feelings of anxiety. However, there were no such changes for participants who reported no internet-usage problems.

The study, which researchers say is the first controlled-experimental demonstration of physiological changes as a result of internet exposure, appears in the international peer-reviewed journal, PLOS ONE.

The study lead, Professor Phil Reed, of Swansea University, said, “We have known for some time that people who are over-dependent on digital devices report feelings of anxiety when they are stopped from using them, but now we can see that these psychological effects are accompanied by actual physiological changes.”

Investigators found an average three to four percent increase in heart rate and blood pressure, and in some cases double that figure, immediately on termination of internet use for those with digital-behavior problems.

Although this increase is not enough to be life-threatening, such changes can be associated with feelings of anxiety, and with alterations to the hormonal system that can reduce immune responses.

The study also suggested that these physiological changes and accompanying increases in anxiety indicate a state like withdrawal seen for many “sedative” drugs, such as alcohol, cannabis, and heroin.

Moreover, this state may be responsible for some people’s need to re-engage with their digital devices to reduce these unpleasant feelings.

Dr. Lisa Osborne, a clinical researcher and co-author of the study, said, “A problem with experiencing physiological changes like increased heart rate is that they can be misinterpreted as something more physically threatening, especially by those with high levels of anxiety, which can lead to more anxiety, and more need to reduce it.”

The authors go on to speculate that internet use is driven by more than just the short-term excitement or joy of the technology, but that over-use can produce negative physiological and psychological changes that may drive people back onto the internet, even when they do not want to engage.

Professor Reed said, “The individuals in our study used the internet in a fairly typical way, so we are confident that many people who over-use the internet could be affected in the same way.

However, there are groups who use the internet in other ways, like gamers, perhaps to generate arousal, and the effects of stopping use on their physiology could be different — this is yet to be established”.

Professor Roberto Truzoli of Milan University, a co-author of the study, added, “Whether problematic internet use turns out to be an addiction — involving physiological and psychological withdrawal effects — or whether compulsions are involved that do not necessitate such withdrawal effects — is yet to be seen, but these results seem to show that, for some people, it is likely to be an addiction.”

The study also found that the participants spent an average of five hours a day on the internet, with 20 percent spending over six hours a day using the internet.

Additionally, over 40 percent of the sample reported some level of internet-related problem — acknowledging that they spend too much time online.

There was no difference between men and women in the tendency to show internet addiction. By far the most common reasons for engaging with digital devices were digital communication media (‘social media’) and shopping.

Previous studies by this group, and many others, have shown short-term increases in self-reported anxiety when digitally-dependent people have their digital devices removed, and longer-term increases in their depression and loneliness, as well as changes to actual brain structures and capability to fight infections in some.

Professor Phil Reed said, “The growth of digital communication media is fueling the rise of ‘internet’ use, especially for women. There is now a large amount of evidence documenting the negative effects of overuse on people’s psychology, neurology, and now, in this study, on their physiology.

Given this, we have to see a more responsible attitude to the marketing of these products by firms — like we have seen for alcohol and gambling.”

Source: Swansea University

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Damage to tiny blood vessels causes depression

Depression - Fri, 06/02/2017 - 11:15
Damage to the microvascular system, made up of capillaries, is often caused by poor diets leading to high blood pressure or diabetes, and is worsened by smoking, Dutch scientists say.
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Family Support Reduces College Students’ Loneliness, Risk of Suicide

Anxiety - Thu, 06/01/2017 - 13:30

New research finds that family support matters, even for college kids. University of Michigan investigators discovered that when college students feel isolated and disconnected, support from family members can keep them from harming themselves during difficult times,

“Parents can serve as a first-line of defense in efforts to prevent or reduce the risk of suicide in students,” said Dr. Edward Chang, the study’s lead author and a professor of psychology and social work.

The study, found in the Family Journal, consisted of 456 Hungarian college students whose ages ranged from 18 to 35. Among its co-authors was Dr. Tamás Martos, senior research fellow at the University of Szeged in Hungary.

Respondents rated the frequency of feeling isolated and the extent of family support. To assess for suicide risk, respondents indicated if they felt depressed or had suicidal thoughts during the past 12 months.

Investigators discovered that when lonely students had high family support, they had fewer depressive symptoms compared to those with lower family support, the study found.

The same results were found for those who thought about suicide–that family support provided a small but significant improvement from following through on self-harm.

According to the researchers, the findings suggest new strategies to reduce heightened suicide risk in college students.

For instance, parents might be trained to look for and identify early signs of risks, such as social isolation. Families must also get counselors involved to create more positive environments for students that may be at risk for suicide.

Chang said the key is that as children grow up and out of the house, it’s important for parents to remain invested in the health of their child.

“Going away to college does not mean that young emerging adults have sufficiently established a strong social support network or cultivated the sort of coping strategies to deal with their new roles as college students,” he said.

“Parents represent a child’s foundation for support and growth.”

And since parents and college students often are out of daily physical interactions, both parties would likely benefit from routinely letting each other know that they remain on their minds, he said.

Source: University of Michigan/EurekAlert

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Prolonged Maternal Stress Can Affect Baby Via Amniotic Fluid

Anxiety - Wed, 05/31/2017 - 14:15

Children whose mothers experienced prolonged periods of stress during pregnancy are at greater risk of developing a mental or physical illness later in life, such as attention-deficit hyperactivity disorder (ADHD) or cardiovascular disease.

Now a new study by researchers at the University of Zurich in Switzerland helps uncover the mechanisms behind this risk. Their findings show that long-term physical stress to the mother can change the metabolism in the placenta and influence the growth of the unborn child. Short-term stress, however, does not seem to have a negative effect on the development of the fetus.

During difficult situations, the human body releases hormones to handle the greater stress. This includes the corticotropin-releasing hormone (CRH), which leads to an increase in the stress hormone cortisol — a mechanism which also persists during pregnancy. Furthermore, the placenta, which supplies the fetus with nutrients, can also emit stress hormone CRH.

As a result, a small amount of this hormone enters the amniotic fluid and fetal metabolism. Previous studies on animals have shown that this hormone can boost the development of the unborn baby. Unfavorable conditions in the mother’s environment, for example, can lead to an increased release of the hormone, thereby improving the chances of survival in case of a premature birth.

Under prolonged circumstances, however, this increase can also have negative consequences. “An excessive acceleration of growth may occur at the expense of the proper maturation of the organs,” said Dr.Ulrike Ehlert, psychologist and program coordinator.

To test whether short-term stress affects the fetus, the researchers evaluated 34 healthy pregnant women, who were getting an amniocentesis within the scope of prenatal diagnostics. This procedure is comparable to a short-term stressful situation as the expectant mother’s body briefly secretes cortisol during the test.

To determine whether the placenta also releases stress hormones, the researchers compared the cortisol level in the mother’s saliva with the CRH level in the amniotic fluid and determined that there was no connection. “The baby obviously remains protected against negative effects in case of acute, short-term stress to the mother,” Ehlert said.

The situation regarding prolonged stress is completely different, as was determined using questionnaires for diagnosing chronic social overload.

“If the mother is stressed for a longer period of time, the CRH level in the amniotic fluid increases,” said Dr. Pearl La Marca-Ghaemmaghami, psychologist and program researcher.

This higher concentration of stress hormone in turn accelerates fetal growth. This has been observed in animals such as tadpoles. If their pond is on the verge of drying out, for example, CRH is released in tadpoles, thereby driving their metamorphosis.

“The corticotropin-releasing hormone CRH obviously plays a complex and dynamic role in the development of the human fetus, which needs to be better understood,” said La Marca-Ghaemmaghami.

In conclusion, the researchers suggested that pregnant women exposed to longer-term stressful situations may want to seek support in order to help reduce stress levels. Stress during pregnancy cannot always be avoided, however.

But, said La Marca-Ghaemmaghami, “A secure bond between the mother and child after the birth can neutralize negative effects of stress during pregnancy.”

Source: University of Zurich

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Rock climbing significantly reduces depression

Depression - Tue, 05/30/2017 - 16:58
Researchers from the University of Arizona believe a combination of the sport's physicality, alongside its social aspect and required concentration eases symptoms.
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When Meditation Leads to Distress, Not Serenity

Anxiety - Tue, 05/30/2017 - 12:45

As the ancient practice of meditation gains popularity in Western cultures as a intervention with medical and psychological benefit, a new study finds that meditation can produce a much wider variety of outcomes, not all of them calm and relaxing.

Researchers from Brown University said that while meditation often helps many people achieve therapeutic goals, others encounter a much broader range of experiences — sometimes distressing and even impairing — along the way.

That’s according to a new study in PLOS ONE, in which Dr. Willoughby Britton, assistant professor in the Department of Psychiatry and Human Behavior, and her co-authors chronicled and categorized such experiences as well as the factors that influence them.

“Many effects of meditation are well known, like increased awareness of thoughts and emotions, or improved calm and well-being,” said study lead author Dr. Jared Lindahl, visiting assistant professor in Brown’s Cogut Center for the Humanities.

“But there is a much broader range of possible experiences. Exactly what those experiences are, how they affect individuals and which ones show up as difficult is going to be based on a range of personal, interpersonal and contextual factors.”

The study purposely sought out “challenging” experiences because they are underrepresented in the scientific literature, the authors said.

With that goal, the study therefore was not designed to estimate how common those experiences are among all meditators. Instead the purpose of the Varieties of Contemplative Experience study was to provide detailed descriptions of experiences and to start to understand the multiple ways they are interpreted, why they might happen and what meditators and teachers do to deal with them.

Though rare in the scientific literature, the broader range of effects including meditation-related difficulties have been documented in Buddhist traditions, the researchers wrote.

For example, Tibetans refer to a wide range of experiences — some blissful but some painful or disturbing — as “nyams.” Zen Buddhists use the term “makyō” to refer to certain perceptual disturbances.

“While the positive effects have made the transition from Buddhist texts and traditions to contemporary clinical applications, the use of meditation for health and well-being has obscured the wider range of experiences and purposes traditionally associated with Buddhist meditation,” Lindahl said.

To understand the range of experiences encountered among Western Buddhists practicing meditation, Britton, Lindahl and their co-authors interviewed nearly 100 meditators and meditation teachers from each of three main traditions: Theravāda, Zen and Tibetan. Each interview told a story, which the researchers meticulously coded and analyzed using qualitative research methodology.

The researchers also employed standardized causality assessment methods that are used by agencies like the U.S. Food and Drug Administration to ensure that meditation likely played a causal role in the experiences they documented.

Based upon their interviews, the researchers developed a taxonomy of 59 experiences organized into seven types, or “domains.“ The areas included cognitive, perceptual, affective (i.e. emotions and moods), somatic (relating to the body), conative (i.e. motivation or will), sense of self and social.

They also identified another 26 categories of “influencing factors” or conditions that may impact the intensity, duration or associated distress or impairment.

All meditators reported multiple unexpected experiences from across the seven domains of experience.

For example, a commonly reported challenging experience in the perceptual domain was hypersensitivity to light or sound, while somatic changes such as insomnia or involuntary body movements were also reported. Challenging emotional experiences could include fear, anxiety, panic or a loss of emotions altogether.

Britton noted that the duration of the effects people described in their interviews also varied widely, ranging from a few days to months to more than a decade.

Sometimes experiences were ostensibly desirable, such as feelings of unity or oneness with others, but some meditators reported them going too far, lasting too long or feeling violated, exposed or disoriented.

Others who had meditation experiences that felt positive during retreats reported that the persistence of these experiences interfered with their ability to function or work when they left the retreat and returned to normal life.

“This is a good example of how a contextual factor can affect associated distress and functioning,” Lindahl said.

“An experience that is positive and desirable in one situation may become a burden in another.”

Moreover, in some cases, an experience that some meditators reported as challenging, others reported as positive.

To understand why this was the case, the researchers also aimed to determine the “influencing factors” that affect the desirability, intensity, duration and impact of a given experience.

The researchers documented four main domains of influencing factors: practitioner-related (i.e. the meditator’s personal attributes), practice-related (such as how they meditated), relationships (interpersonal factors) and health behaviors (such as diet, sleep or exercise).

For example, a meditator’s relationship with the instructor was for some people a source of support and for others a source of distress.

While many teachers cited the meditator’s practice intensity, psychiatric history or trauma history, and quality of supervision as important, these factors appeared to play a role only for some meditators.

The researchers wrote in PLOS ONE that in many cases, challenging experiences could not be attributed to just those factors:

“The results also challenge other common causal attributions, such as the assumption that meditation-related difficulties only happen to individuals with a pre-existing condition (psychiatric or trauma history), who are on long or intensive retreats, who are poorly supervised, who are practicing incorrectly, or who have inadequate preparation.”

Britton says the finding do not reflect conclusive causes. Rather, the influencing factors identified should be viewed as “testable hypotheses” of what might impact a meditator’s outcome.

For example, future research could investigate whether certain types of practice are associated with different kinds of challenging experiences, or whether the degree of perceived social support influences the duration of distress and impairment.

“It is likely that an interaction of multiple factors is at play,” Lindahl said. “Each meditator had their own unique story.”

It’s important to acknowledge that this study represents an initial step in a much longer discussion and investigation, Britton said. “The take-home message is that meditation-related challenges are a topic worthy of further investigation, but there is still a lot more to understand.”


Source: Brown University

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Rock Climbing Can Be Useful Add-On to Treat Depression

Anxiety - Sun, 05/28/2017 - 14:15

A new study shows that bouldering, a form of rock climbing, can be an effective adjunct to depression treatment.

University of Arizona researcher Eva-Maria Stelzer and Dr. Katharina Luttenberger of the University of Erlangen-Nuremberg led a team that involved more than 100 individuals in a bouldering intervention in Germany, where some hospitals have begun to use climbing as a therapeutic treatment.

The participants were randomly split into two groups. One immediately began the intervention, while the other group had to wait to start bouldering, which involves climbing rocks or walls to a moderate height without ropes or a harness.

Each participant bouldered for three hours a week over the course of eight weeks.

The research team measured the depression of group members at different points in the study using the Beck’s Depression Inventory and the depression subscale of the Symptom Check List Revised, known as SCL-90-R.

The researchers found that the immediate intervention group’s Beck’s Depression scores improved by 6.27 points. During the same time period, the group that was initially wait-listed improved by only 1.4 points.

The difference in score reflects an improvement of one severity grade from moderate to mild depression levels, the researchers explained.

Also during the study, both groups were taught about how to cultivate positive social interactions and about meditation and mindfulness throughout the study. All told, the study intervention and follow-up lasted 24 weeks.

“Bouldering, in many ways, is a positive physical activity,” said Stelzer, who began researching the benefits of bouldering while completing her master’s in psychology at the University of Erlangen-Nuremberg in Germany and is now completing her doctorate at the UA.

“There are different routes for your physical activity level, and there’s a social aspect, along with the feeling of an immediate accomplishment when bouldering.”

The researchers have expanded the study to compare the bouldering intervention with cognitive behavior therapy involving individuals in Erlangen, Munich and Berlin.

The researchers drew on their own experiences as avid rock climbers and boulderers to investigate the benefits the sport could provide to those dealing with anxiety, depression, social isolation, and self-esteem issues.

“Patients enjoyed the bouldering sessions and told us that they benefited greatly,” said Luttenberger, a psychometrics expert at the University of Erlangen, located just north of Nuremberg in Germany. “Since rumination is one of the biggest problems for depressed individuals, we had the idea that bouldering could be a good intervention for that.”

Most of the patients involved in the study were new to bouldering.

Stelzer added that bouldering has a number of other important characteristics that make it especially beneficial for the treatment of depression; namely that it helps boost self-efficacy and social interactions, both of which hold innate benefits for dealing with depression.

“You have to be mindful and focused on the moment,” she said. “It does not leave much room to let your mind wonder on things that may be going on in your life — you have to focus on not falling.”

“Bouldering not only has strong mental components, but it is accessible at different levels so that people of all levels of physical health are able to participate,” she continued.

She added that because many people who are depressed deal with isolation, bouldering as a treatment could bolster physical activity and be used as a social tool allowing people to interact with one another.

Given the positive results, the researchers believe that bouldering may be used to complement traditional care for clinical depression. They are now working to develop a manual that could be adopted for an eight-week program integrating bouldering and psychotherapeutic interventions for groups.

“I’d always encourage patients to do the sport they like, be it climbing or something else, as sport is a wonderful possibility to prevent all possible sorts of illnesses, mental and physical,” Luttenberger said.

Source: University of Arizona

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High-Level Changes at Work Can Stress Workers

Anxiety - Sun, 05/28/2017 - 13:00

Half of American workers report being affected by upper management organizational changes within the past year or say they expect to be soon, according to the 2017 Work and Well-Being Survey released by the American Psychological Association (APA).

The survey findings show that employees affected by these work-related changes are more likely to report chronic work stress, experience physical health symptoms at work, and say they plan to quit within the next year. They are also less likely to trust their employer compared with those who haven’t been affected by organizational change.

“Change is inevitable in organizations, and when it happens, leadership often underestimates the impact those changes have on employees,” said David W. Ballard, Psy.D., M.B.A., head of APA’s Center for Organizational Excellence.

“If they damage their relationship with employees, ratchet up stress levels, and create a climate of negativity and cynicism in the process, managers can wind up undermining the very change efforts they’re trying to promote.”

The survey involved more than 1,500 U.S. adults who were employed full time, part time, or self-employed.

Underlying employee reactions to organizational change may be their perceptions of the motivation behind those changes and the likelihood of success, according to the survey.

For example, nearly a third of workers said they were cynical when it comes to changes, reporting that they believed management had a hidden agenda (29 percent), that their motives and intentions were different from what they said (31 percent), and that they tried to cover up the real reasons for the changes (28 percent).

Surveyed employees also appear skeptical regarding the outcomes of organizational changes. Only four in 10 employees (43 percent) had confidence that changes would have the desired effects and almost three in 10 doubted that changes would work as intended and achieve their goals (28 percent each).

In addition, employees who had experienced recent or current changes were more likely to report work-life conflict (39 percent vs. 12 percent for job interfering with non-work responsibilities and 32 percent vs. seven percent for home and family responsibilities interfering with work).

They were also more likely to feel cynical and negative toward others during the workday (35 percent vs. 11 percent) and to eat or smoke more during the workday than outside of work (29 percent vs. eight percent).

Working Americans who reported recent or current change were almost three times more likely to say they don’t trust their employer (34 percent vs. 12 percent) and more than three times as likely to say they intend to seek employment outside the organization within the next year (46 percent vs. 15 percent) compared with those with no recent, current, or anticipated change.

“For organizations to successfully navigate turbulent times, they need resilient employees who can adapt to change,” Ballard said.

“Disillusioned workers who are frustrated with change efforts, however, may begin to question leaders’ motives and resist further changes. To build trust and engagement, employers need to focus on building a psychologically healthy workplace where employees are actively involved in shaping the future and confident in their ability to succeed.”

Source: American Psychological Association

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Body’s Opioid System Implicated in Trauma Sensivitity

Anxiety - Sat, 05/27/2017 - 15:00

What happens in the brain when we see other people experiencing a trauma or being subjected to pain?

According to a new study, the same regions that are involved when we feel pain are also activated when we observe other people who appear to be going through some painful experience.

But we are sensitive to different degrees to learning fear from other people, according to researchers at the Karolinska Institutet in Sweden. They say one explanation for that may be found in the endogenous opioid system.

Seeing others express pain or anxiety can give us important information about things around us that are dangerous and should be avoided, the researchers noted.

Sometimes, however, we can develop fear of situations that, rationally speaking, are not dangerous.

While the opioid system is supposed to alleviate pain and fear, it does not work as effectively in all of us. This might be one of the reasons some people develop anxiety syndrome merely by seeing others experience a trauma, the researchers said.

“Some people are over-sensitive to this form of social learning,” said main author Dr. Jan Haaker, associated researcher at Karolinska Institutet’s Department of Clinical Neuroscience.

“Our study shows that the endogenous opioid system affects how sensitive we are and may explain why some people develop post-traumatic stress disorder (PTSD) merely by observing others who are experiencing traumatic events. After terror attacks, sensitive people might be afraid even if they themselves were not present.”

In a double-blind study, the researchers altered the brain’s internal chemistry in 22 healthy subjects by using a pharmaceutical substance to block the opioid system. Another 21 subjects were given an inactive placebo. The subjects then watched a video where other people were subjected to electric shocks.

The brain normally updates its knowledge of danger based on whether we are surprised, but when the opioid system was blocked, the people continued to react as if they were surprised even though they knew the electric shock would come, the researchers discovered.

The response was amplified even when they continued to watch other people being subjected to shocks.

The response increased in regions of the brain such as the amygdala, the periaqueductal gray and the thalamus, which seems to indicate that the same functions as in self-perceived pain were involved, the researchers said.

Communication also increased between these and other regions of the brain that are linked to the ability to understand other individuals’ experiences and thoughts.

“When the people participating in the experiment were themselves subjected to threatening stimuli that they had previously associated with other people’s pain, they perspired more and displayed more fear than those who had been given a placebo,” said research team leader Dr. Andreas Olsson, senior lecturer at the institutet’s Department of Clinical Neuroscience.

“This enhanced learning was even visible three days after the social learning episode.”

The researchers said they hope the new findings will eventually mean that people with anxiety conditions will be able to be given better, more individual-adapted clinical help.

The study was published in Nature Communications.

Source: Karolinska Institutet

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