PANIC!

Tune into PBS's "This Emotional Life."

2010-01-05T23:14:00.000-08:00

I just watched episode two of a three-part PBS series called "This Emotional Life", which explores mental health issues. I really liked it; it was intelligently written, supported its point of view using up-to-date science, and did a wonderful job of exhibiting the human costs of mental illness -- the lost relationships and the ruined careers and the ever-more entrenched self-esteem issues and so on. This particular episode was called "Facing Our Fears'; here is how it's described on the PBS website:

Our brains are designed for survival, and the negative emotions they create are vital to that mission. But those negative emotions can spiral out of control with debilitating effects. We meet a woman whose inability to control her temper is jeopardizing her relationships, a college student whose fear of flying is limiting her life and a teenager who is struggling to overcome clinical depression on the eve of attending college. We also meet veterans with post-traumatic stress disorder and follow their journeys to find effective treatment.

Across the episode, science reminds us that we are of two minds — a rational brain that’s relatively new and an emotional brain that’s older than time. Sometimes emotion overwhelms reason, sometimes reason outwits emotion, and it is the endless struggle that makes our lives so painful, so joyous and so interesting.

This is good stuff. It was difficult for me to watch at times -- the stories it told reminded me of some of my own stories, and it was a kind of prolonged exposure therapy to sit through it. But that only makes me surer this show is getting at these issues in a direct and honest manner. The website supporting the program is quite good, as well -- it's full of everything from information about stress and anxiety to videos like this one, which shows neuroscientist Robert Sapolsky discussing positive and negative stress.

Fighting phobia formation by blocking scary memories from forming?

2009-12-17T22:39:00.000-08:00

This past weekend, I came across this, an article on the Science website about NYU researchers' efforts to extinguish fearful aspects of memories during the "reconsolidation" phase of the memory-recall process. Here's how it worked:

The scientists started by creating a scary memory of a blue square. They flashed blue or yellow squares on a computer screen and gave subjects a slight shock on the wrist when only the blue square appeared. After this training session, just flashing the blue square without a shock put people on edge, which the researchers measured by recording tiny currents that pass through their skin. One day later, the scientists performed extinction training by flashing the blue square repeatedly without any shocks. To trigger reconsolidation, one-third of the subjects got a reminder--a quick flash of the blue square--10 minutes before extinction training. (Reconsolidation normally starts about 3 minutes after a memory gets recalled.) Another third received a reminder 6 hours beforehand--which meant that the extinction training began well past the time when reconsolidation ended--and the final third weren't reminded at all.

When the scientists tested the subjects' response to the blue square a day later, those who received the 10-minute reminder showed no fear, while the other two groups were still freaked out by the shape. Even 1 year later, those subjects who underwent extinction training during reconsolidation still showed no response to the blue squares, while their counterparts retained the fear memory, the scientists report online today in Nature. "Because extinction training happened during [reconsolidation], we think that ... the nature of the memory changed," Phelps says.

Imagine how helpful it would be if you could make it so that a location where you experienced a panic attack does not make you fearful or want to avoid it moving forward. Heck, my career would probably be completely different (and probably more lucrative) if I hadn't had to endure periods of being unable to commute by train or highway. The potential benefits of this research in fighting agoraphobia are exciting.

Is consumer culture making us anxious and depressed?

2009-12-16T21:29:00.001-08:00

According to one recent ABC News story, yes, it is:

Margit Burmeister, professor of psychiatry and human genetics at the University of Michigan, said it "makes very good sense with what we know of lifestyle changes in the past 50 years" that our consumer culture is affecting mental illness.

She added that "genetic vulnerability [to mental illness] is the other side of the coin that needs to be kept in mind" -- in other words, as our society piles more and more stress onto its citizens, those who are predisposed to crack under the pressure, will...

Dr. Bruce Rabin, medical director of the Health Lifestyle Program at the University of Pittsburgh Medical Center, said that beyond our society's focus on external goals, the stress level among parents in recent times has impacted the type of children we raise.

Children today "lack meaningful, healthy role models," Rabin said.

"They learn from those they love...if role models are short tempered [or] tell children to leave them alone because they are under a lot of stress...there will be an effect on the child's mental health development."

In this way, he said, children learn which aspects of life to make a priority. Relationships take a back seat, and work, success, material gains take precedence.

Lots of statistics speak to the validity of this opinion. There's no question that society is more atomized than it used to be -- that people are more geographically mobile, hold more jobs during their working years, work longer hours but are less likely to make enough money to be able afford to buy a house, and are less likely than they used to be to be part of a strong community. (See the book Bowling Alone for as many statistics along these lines as anyone will ever need.) Thanks to the growth of corporate America, there are more and more cookie-cutter office parks and shopping centers than ever, and fewer and fewer places that are culturally unique or untouched by commercialism. (Thank you, Starbucks.) Television, the internet, and the advertising and public relations industries saturate our lives with images of "the good life" while pushing on us an endless parade of products we don't really need. (Spend some time with the most recent SkyMall catalog if you don't know what I'm talking about.) A society that used to treasure privacy now produces more than a few citizens whose primary life goal is seemingly to land a spot on reality television. (E.g., the attention-whore couple who recently attended a White House function without an invitation.) It's no surprise that recent decades have brought alarming mental illness growth rates.

So what's to do? According to the article, "If increased materialism and decreased community are really to blame -- at least in part -- for this trend ... then interventions may have to be taken at the societal level."

In other words, we're screwed.

More proof that exercise lowers anxiety.

2009-12-02T14:03:00.000-08:00

According to a recent New York Times blog post, there's more and more science showing that exercise fights stress and lowers anxiety. For instance, there's a recent Princeton study showing that exercise makes rats' brains biochemically, molecularly calmer. And there's more:

In work undertaken at the University of Colorado, Boulder, for instance, scientists have examined the role of serotonin, a neurotransmitter often considered to be the “happy” brain chemical. That simplistic view of serotonin has been undermined by other researchers, and the University of Colorado work further dilutes the idea. In those experiments, rats taught to feel helpless and anxious, by being exposed to a laboratory stressor, showed increased serotonin activity in their brains. But rats that had run for several weeks before being stressed showed less serotonin activity and were less anxious and helpless despite the stress.

Other researchers have looked at how exercise alters the activity of dopamine, another neurotransmitter in the brain, while still others have concentrated on the antioxidant powers of moderate exercise. Anxiety in rodents and people has been linked with excessive oxidative stress, which can lead to cell death, including in the brain. Moderate exercise, though, appears to dampen the effects of oxidative stress. In an experiment led by researchers at the University of Houston and reported at the Society for Neuroscience meeting, rats whose oxidative-stress levels had been artificially increased with injections of certain chemicals were extremely anxious when faced with unfamiliar terrain during laboratory testing. But rats that had exercised, even if they had received the oxidizing chemical, were relatively nonchalant under stress. When placed in the unfamiliar space, they didn’t run for dark corners and hide, like the unexercised rats. They insouciantly explored.

“It looks more and more like the positive stress of exercise prepares cells and structures and pathways within the brain so that they’re more equipped to handle stress in other forms,” says Michael Hopkins, a graduate student affiliated with the Neurobiology of Learning and Memory Laboratory at Dartmouth.

Why the world looks flat and dull when you're depressed.

2009-12-02T13:22:00.000-08:00

Depression makes you see the world differently. Literally. According to a recent New Scientist article, "People with the condition find it easy to interpret large images or scenes, but struggle to 'spot the difference' in fine detail." Why is this so? "Depressed people have a shortage of a neurotransmitter called GABA; this has also been linked to a visual skill called spatial suppression, which helps us suppress details surrounding the object our eyes are focused on - enabling us to pick out a snake in fallen leaves, for instance."

The hope: that visual training may be effective in treating depression. Hey, another tool certainly can't hurt.

How to find mental health care when money is tight.

2009-11-29T17:18:00.000-08:00

This is a great New York Times article looking at how to approach mental health care when you can't even really keep up with your regular bills. The lede:

IMAGINE this situation. You fall into a deep malaise. Friends say you need help, but you don’t have insurance (or the insurance you do have has very limited mental health benefits), and you worry that extra bills will only add to your malaise. So you do nothing.

And that’s what many people do. According to a recent survey by the federal Substance Abuse and Mental Health Services Administration (Samhsa, pronounced SAM-suh) , the leading reason that people with mental health issues don’t seek treatment is cost. They fear the fees.

It doesn't have to be that way, though. You can take a variety of free and low-cost steps to improve your mental health -- making one small change in your routine per week, joining a support group, joining an online group, and so on. And if you still need help, the article suggests a number of mental health care options, from seeking out providers with sliding fee scales, school psychologists, crisis hotlines, and the likes.

Excellent New York Times article about anxiety.

2009-11-11T15:26:00.000-08:00

"Understanding the Anxious Mind" appeared in October in the NYT Magazine. It's a good read, a long, intelligent look at anxiety -- at the physiological responses related to anxiety, at neurological processes related to anxiety, but mostly at the ways nature and nurture combine to cause these disorders.

On the nature side of the equation, the article spends a lot of time looking at experiments by Harvard psychologist Jerome Kagan and others, which study temperament and its role in anxiety among adults:

Jerome Kagan’s “Aha!” moment came with Baby 19. It was 1989, and Kagan...had just begun a major longitudinal study of temperament and its effects. Temperament is a complex, multilayered thing, and for the sake of clarity, Kagan was tracking it along a single dimension: whether babies were easily upset when exposed to new things.... He suspected...that the most edgy infants were more likely to grow up to be inhibited, shy and anxious. Eager to take a peek at the early results, he grabbed the videotapes of the first babies in the study, looking for the irritable behavior he would later call high-reactive.

No high-reactors among the first 18. They gazed calmly at things that were unfamiliar. But the 19th baby was different. She was distressed by novelty — new sounds, new voices, new toys, new smells — and showed it by flailing her legs, arching her back and crying. Here was what Kagan was looking for but was not sure he would find: a baby who essentially fell apart when exposed to anything new.

Baby 19 grew up true to her temperament. This past summer, Kagan showed me a video of her from 2004, when she was 15....

On the monitor, Baby 19 is a plain-looking teenager, hiding behind her long, dark hair. The interview, the same one given to all 15-year-olds in the longitudinal study, begins with questions about school. She has very few extracurricular activities, she says in a small voice, but she does like writing and playing the violin. She fidgets almost constantly as she speaks, twirling her hair, touching her ear, jiggling her knee. “This is the overflow of her high-reactive nature,” Kagan told me, standing near the monitor so he could fast-forward to the good parts.

Here was a good part: The interviewer asks Baby 19 what she worries about.

“I don’t know,” Baby 19 says after a long pause, twirling her hair faster, touching her face, her knee. She smiles a little, shrugs. Another pause. And then the list of troubles spills out: “When I don’t quite know what to do and it’s really frustrating and I feel really uncomfortable, especially if other people around me know what they’re doing. I’m always thinking, Should I go here? Should I go there? Am I in someone’s way? ... I worry about things like getting projects done... I think, Will I get it done? How am I going to do it? ... If I’m going to be in a big crowd, it makes me nervous about what I’m going to do and say and what other people are going to do and say.” Baby 19 is wringing her hands now. “How I’m going to deal with the world when I’m grown. Or if I’m going to sort of do anything that really means anything.”

Her voice trails off. She wants to make a difference, she says, and worries about whether she will. “I can’t stop thinking about that.”

Watching this video again makes Kagan fairly vibrate with the thrill of rediscovery: here on camera is the young girl who, as an infant, first embodied for him what it meant to be wired to worry.

The article notes that while high-reactive babies are more likely to grow up to be anxious, their temperament doesn't necessarily condemn them to anxiety:

...having all the earmarks of anxiety in the brain does not always translate into a subjective experience of anxiety. “The brain state does not make it a disorder,” Kagan told me. “The brain state exists, and the statement ‘I’m anxious,’ exists, and the correlation is imperfect.” Two people can experience the same level of anxiety, he said, but one who has interesting work to distract her from the jittery feelings might do fine, while another who has just lost his job spends all day at home fretting and might be quicker to reach a point where the thrum becomes overwhelming. It’s all in the context, the interpretation, the ability to divert your attention from the knot in your gut.

Here's where nurture comes into the picture:

Attempts to see what kind of parenting works best with an anxiety-prone temperament leave almost as many questions asked as answered. Which is better for a fearful, high-strung child — a parent who coddles the child and says everything will be all right, or a parent who sets firm, strict limits and has no tolerance for skittishness? You could picture it as going either way, really. On the one hand, it might be good to shield children from the things that worry them. On the other hand, it might be better to urge them, maybe even force them, to confront the things they dread.

Scientists...have looked at this question in a systematic way, and they have come up with two somewhat different findings. Both studies involved a series of home visits and hours of videotapes of mother-baby interactions. But one study...found that what seemed to be best for high-reactive babies were mothers who set firm limits and did not rush too quickly to comfort them when they cried. And the other...found something slightly different: that the best fit for high-strung babies were sensitive mothers, who met their fearful children on their own terms and interacted with them in a way that was accepting and supportive without being intrusive. Sometimes, of course, there’s a fine line between firm and hardhearted, and a fine line between supportive and intrusive....

The best outcome, however it happens, is to rear a child who learns to wrestle his demons on his own. Some children figure out themselves what works best. “Inner struggles pulled at me for years until I was able to just let go and calm myself,” wrote one of Kagan’s high-reactive study subjects in an essay, revealing a wisdom far beyond his 13 years. “For example, when I first heard about the anthrax in Washington, I began to have an upset stomach. I realized it was simply because of my anxiety that I was feeling sick. As soon as I realized that, the stomachache went away. Because I now understand my predisposition toward anxiety, I can talk myself out of simple fears.” There are many adults, anxious or not, who can’t control their own interior monologues as well as this boy can.

For the children who need help grappling with their fears, some psychologists try to intervene early, with programs that give worried children tools for quieting the scary thoughts in their heads. Kids are often taught the same skills that anxious adults are, a variation on cognitive behavior therapy, designed to stop the endless recursive loop of rumination, replacing it with a smart, rational interior voice. In a way, it’s teaching anxious people to do what non-anxious people do naturally.

The article closes with a look at a fascinating question: Why did anxiety evolve in the first place?

In the modern world, the anxious temperament does offer certain benefits: caution, introspection, the capacity to work alone. These can be adaptive qualities. Kagan has observed that the high-reactives in his sample tend to avoid the traditional hazards of adolescence. Because they are more restrained than their wilder peers, he says, high-reactive kids are less likely to experiment with drugs, to get pregnant or to drive recklessly. They grow up to be the Felix Ungers of the world, he says, clearing a safe, neat path for the Oscar Madisons.

People with a high-reactive temperament — as long as it doesn’t show itself as a clinical disorder — are generally conscientious and almost obsessively well-prepared. Worriers are likely to be the most thorough workers and the most attentive friends. Someone who worries about being late will plan to get to places early. Someone anxious about giving a public lecture will work harder to prepare for it. Test-taking anxiety can lead to better studying; fear of traveling can lead to careful mapping of transit routes.

Kagan told me that in the 40 years he worked at Harvard, he hired at least 200 research assistants, “and I always looked for high-reactives. They’re compulsive, they don’t make errors, they’re careful when they’re coding data.” He said he would bet that when the United States sends people up in space, the steely, brave astronauts were low-reactive as infants, and the mission-control people down on the ground, doing the detail work that keeps the craft aloft, were high-reactive.

An anxious temperament might serve a more exalted function too. “Our culture has this illusion that anxiety is toxic,” Kagan said. But without inner-directed people who prefer solitude, where would we get the writers and artists and scientists and computer programmers who make society hum? Kagan likes to point out that T. S. Eliot suffered from anxiety, and that biographies indicate that he was a typical high-reactive baby. “That line ‘I will show you fear in a handful of dust’ — he couldn’t have written that without feeling the tension and dysphoria he did,” Kagan said.

Video about cognitive-behavioral therapy.

2009-11-09T12:30:00.001-08:00

Click here to view "authoritative information from the British Medical Journal on CBT, a psychotherapy used to treat depression, anxiety, panic attacks and obsessive-compulsive disorder." Bottom line, in the words of one therapist: "We take things which people are avoiding and we get people to confront them."

Zach Galifianakis to play agoraphobic.

2009-11-02T14:10:00.000-08:00

Not to turn all pop-culture fanboy, but...Zach Galifianakis is one of my favorite comedians. If you don't know him, the short bit above will give you a sense of his stage persona: absurd, askew, and very, very funny. Today's news is cool because it gives me a chance to mention him on a blog about panic and anxiety. How so? Apparently, Galifianakis going to star as an agoraphobic man in the upcoming film Town House, based on the novel by Tish Cohen.

The movie also stars Amy Adams, another great comic actor; check her out in this scene from Talladega Nights:

To top it off, Town House is being directed by John Carney, who directed Once, one of the most purely lovely films I've seen in the past decade. Here's the trailer:

I am so going to see this movie.

Stunning images of the brain.

2009-10-22T12:33:00.000-07:00

As a recent slide show makes clear, as technology and our understanding of the brain have advanced, the ways we visualize its inner working has changed:

Over the 100-year history of modern neuroscience, the way we think about the brain has evolved with the sophistication of the techniques available to study it. Improvements in microscope design and manufacture, together with the development of cell-staining techniques, afforded neuroscientists their first glimpse at the specialized cells that make up the nervous system. Microscopes with more magnifying power enabled them to probe nerve cells in greater detail, revealing distinct compartments. Newer techniques expose the connections between nerve cells, revealing the complex organization of the brain.

Anybody who's interested in the brain -- or in pretty pictures -- will enjoy these images. (The image at the top of this post, for example, is a drawing from 1899, showing "finely branched Purkinje cells, large neurons in the cerebellum that play an important role in controlling movement."

Dude, where's my anxiety?

2009-10-20T23:38:00.001-07:00

Elle magazine recently ran a piece called "Pot Stirring", by Patsy K. Eagan, about the writer's personal use of marijuana to treat her anxiety disorder:

I had a writer’s dream job, reviewing manuscripts and researching productions for a prominent Bay Area theater. But some mornings, I couldn’t step outside. I’d call in sick, often days in a row. Or if I showed up, I’d avoid contact with my boss any way I could. Eventually I had to leave that job, for reasons including my inability to concentrate. I sought out a new job and a new psychiatrist, who rediagnosed me with GAD and panic disorder and put me on Paxil. It did its job and kept me in mine, at a Berkeley bookstore, for a while.

The downside came a year later, when surges of elation or rage would seize me at work while I was doing mundane tasks, like shelving. Once, I almost threw a punch at one of the regular, but by no means normal, customers: a squat man who’d tell the female clerks not to touch the (typically women’s) magazines he was buying. After a few of these episodes, it became clear that there was no peace for me in Paxil. Calm came, I found, only from pot.

The article notes that there is no consensus as to the effectiveness of pot in treating anxiety, but points to some compellingly promising research:

Researchers are all over the map as to whether marijuana causes or reduces anxiety. One study published in a 1982 issue of Psychopharmacology found that the marijuana compound cannabidiol (CBD) muted the anxiety produced by THC—marijuana’s main psychoactive cannabinoid. In 1999, the U.S. Institute of Medicine, an outgrowth of the National Academies, which make public-policy recommendations, issued an ambiguous report stating that “the psychological effects of cannabinoids, such as anxiety reduction…can influence their potential therapeutic value,” and also that its “effects are potentially undesirable for certain patients and situations and beneficial in others.” Cannabinoids, for example, reduce nausea. But they also impair short-term memory (hence the Dude, Where’s My Car? stereotype).

Also in the past decade, scientists discovered that the brain produces its own endocannabinoid compounds, which mimic plant-made cannabinoids and transmit their chemical messages through the same neural receptors. High numbers of the receptors were also found to occur in the amygdala and the hippocampus, the parts of the brain that play the biggest role in anxiety. Also significant for anxiety sufferers, scientists concluded that endocannabinoids—and arguably cannabinoids—may serve in the forgetting of fear.

Finally, here's how the writer describes, and justifies, her use of her drug of choice:

A thimbleful is all it takes. After a day’s work, I pinch off a small amount of marijuana and put it in a steel-tooth grinder. The flowers, covered in tiny white diamonds of THC, release a piney scent when crushed. I turn on the TV, and instead of taking a glass of wine with my evening news, I take out my vaporizer and set it on the coffee table.

Outside the walls of my bungalow in Oakland, California, I can hear the rush-hour traffic, but I’ve already changed into my Big Lebowski–style robe and slippers. I tap the ground flakes into a canister that I attach to another piece, this one with a bag on the end, and set both on the vaporizer. I flip the switch, and the bag slowly inflates with plumes of white smoke. Once it’s fully clouded, I attach a mouthpiece to the canister, put this to my lips, and press. On the inhale, the cannabinoids taste like sunned grass. My prescription for anxiety disorder didn’t always begin and end with an herb. But I’ve run through enough pharmaceutical drugs to know that pot dulls my panic better than any pill.

Mindfulness vs. dysfunctional thinking.

2009-09-29T15:16:00.000-07:00

I enjoyed this article from Psychology Today, about the benefits of mindfulness meditation to cope with anxiety. In the writer's words, "One of the first prerequisites common to both cognitive therapy and mindfulness practice is learning that we do not have to believe all of our thoughts." He goes on to say:

For the past 16 years, I have also had success teaching what I call a "letting go meditation." In that meditation, students/clients can practice letting go of thoughts that were previously contributing to distress. The exercise serves several functions:

1. It demonstrates that thoughts in themselves do not cause distress or depression. It is the way in which the thoughts are dealt with that causes the distress. This technique allows people to gain this insight through their own experience.

2. One gains experience and practice in non-judgmentally noticing thoughts. One can include thoughts that have been bothersome. If someone has been getting panic attacks, typical thoughts might be "I might die," or "This is horrible," "I wish my heart would slow down." In that way he gets practice in mindfully noticing the thoughts that are a component of his problem.

3. Not only does one get practice in mindfully dealing with thoughts, as he practices the letting go exercise, the physical reaction to the thoughts can continue to decrease. In a sense, the exercise can act as desensitization to the thoughts. The thoughts that were formally very "charged," become no big deal.

He then goes on to tell the reader exactly how to go about his mindfulness practice. This stuff really works, and this article is a good intro for those who are new to it, and a good reminder for the rest of us.

Panic and shame.

2009-09-24T18:55:00.001-07:00

Shame is part of the experience for most people with panic disorder. These are people for whom being out of control is unacceptable; that they lose control regularly fills their heads with thoughts of their inadequacy. That they often stop going to the places or participating in the activities that tend to make them panic only makes the shame worse.

According to a recent study at the University of Alberta:

...people who feel debilitated by shame tend to internalize and over-personalize the situation. They also seem resigned to being unable to change their feelings or their fate....

...one of the key components to overcoming these feelings is to step back from the problem and view the picture in a different light. When sufferers can identify external factors that contributed to their actions or situation (for example, discrimination or peer pressure) and differentiate between being a bad person versus doing something bad, they can begin to break the grip of hopelessness that plagues them.

Central to breaking the shame spiral? "Only connect," as E.M. Forster wrote. Or, as the piece about the U. of Alberta puts it: "...one of the key steps to overcoming a profound sense of shame is making connections, be it with family and friends, a higher power, or humanity as a whole."

I've written about this topic before. From where I sit, the "accept yourself" step is the hardest part of cognitive-behavioral therapy.

Don't worry, be happy.

2009-09-23T20:59:00.000-07:00

I've spent a fair amount of time lately writing about ways society and we as individuals can and have failed to respond constructively to anxiety, stress, and fear. Which is why its nice to learn, in a recent USA Today article, about people who are making and researchers who are studying healthy responses to fear. For example:

* At the U. of Illinois-Urbana-Champaign, researchers are gathering evidence of the importance of "psychological wealth" in addition to financial wealth in dealing with stress successfully; as one researcher puts it, "Wealth really means having what you need, and money gives only one part of what we need."

* In South Dakota, a website designer has cultivated a positive outlook by keeping a gratitude journal -- and now has created a gratitude-journal iPhone app.

* A woman in Texas has built community by creating an online Secret Society of Happy People to help folks cope. Currently there are more than 7,000 members.

These days, of course, lots of folks are coping with what might be called recession anxiety. Less effective ways of dealing with recession anxiety include overemphasizing the value of money and underemphasizing that of positive experiences:

Psychologists also have found that being highly materialistic affects happiness, with those who are most concerned about money and possessions actually being less happy.

Keeping too close tabs on the economy, such as daily monitoring of economic indicators that have been on a roller-coaster ride since the recession began, also hinders happiness.

"We find that people whose moods are up and down a lot are less happy. People who are less reactive to every event, in general, are happier," Diener says.

But what about what money can buy? Previous research has found that using money to pay for something novel, social or experiential brings more happiness than buying things.

Some newer studies confirm these results. San Francisco State University researchers presented findings earlier this year to the Society for Personality and Social Psychology, based on what participants said about their purchases.

They said they thought eating out or buying theater tickets was money better spent than on more things, such as a new tech toy or clothing, and the experiential purchase provided greater happiness for themselves and others, regardless of the amount they paid or their income.

If you're thinking, "Huh, sounds like a good time to invest in entertainment stocks," you might be missing the point.

Illuminating depression.

2009-09-23T20:44:00.000-07:00

QUEST on KQED Public Media.

Nearly 15 million Americans suffer from depression. Learn why depression is more than just "feeling blue," the difficulties of treating it with traditional medications and how new tools and research are shedding light on brain structures that may play an integral role in treating it.

The QUEST page for this program is an excellent minisite about depression, and the way journalism should look in the digital era.

Is LSD the new Xanax?

2009-09-21T15:03:00.000-07:00

Studies have shown that psychedelic drugs may well be effective against anxiety. Unfortunately, thanks to 1960s society's fears of drug-crazed maniacs running wild in the streets, for the last generation or so, psychedelics have been strictly verboten when it comes to research into potential mental health benefits. That is, until lately. According a recent Daily Beast article, researchers are returning to psychedelics as a study subject:

The watershed moment came last September, when the FDA approved a clinical trial on the use of LSD to treat anxiety in cancer patients. According to the Multidisciplinary Association for Psychedelic Studies (or MAPS), it was the first time since the 1960s that a medical study involving LSD was permitted by the federal government. MAPS Director Rick Doblin called it “a symbol that the psychedelic renaissance is here.”

MAPS reached its fundraising goal of $225,000 in April, and will soon run its LSD trials in Switzerland, where it’s easier to legally obtain acid. The FDA’s approval is crucial, however, because it means it will accept the data that comes out of the Swiss trials. If those results prove the drug works, the agency will then run similar tests for safety and effectiveness. Doblin thinks that because of this ruling, it’s highly possible that within 10 years LSD prescriptions for treating anxiety associated with life-threatening illnesses could be available in America.

Several other clinical trials involving LSD are also under way, one of them at Harvard’s McLean Hospital. Cluster Busters, a nonprofit advocacy group co-founded by Wold, is funding research by Harvard’s Dr. John Halpern, who recently administered a modified LSD molecule to a handful of cluster patients, successfully ending most of their headache cycles for weeks or months. Halpern thinks they may have finally found the cure for an ailment that has mystified physicians for years, and hopes to run a larger clinical trial soon.

Other universities are beginning to take seriously research into LSD and other psychedelics as well. UC-Berkeley is working with the California Pacific Medical Center to understand how LSD affects the brain. And a lab at Johns Hopkins is giving subjects psilocybin mushrooms to test their “personally and spiritually meaningful experiences.”

Who knows? Maybe someday it'll be legal to trip your way to a healthier, happier you -- under a doctor's supervision, of course.

Perfectionism and anxiety.

2009-08-24T20:32:00.000-07:00

"'Good enough' may be good enough for other people, but it's never good enough for me."

"When I make a mistake, I feel like a failure."

"I study hard because I'm afraid to disappoint my parents."

Do any of these lines sound like something you'd say? Then you're probably a perfectionist.

According to "Pitfalls of Perfectionism", from Psychology Today, perfectionists "are made and not born, commonly at an early age." Once established, perfectionism tends to get in the way of one's ability to live life to the fullest:

Perfectionism seeps into the psyche and creates a pervasive personality style. It keeps people from engaging in challenging experiences; they don't get to discover what they truly like or to create their own identities. Perfectionism reduces playfulness and the assimilation of knowledge; if you're always focused on your own performance and on defending yourself, you can't focus on learning a task. Here's the cosmic thigh-slapper: Because it lowers the ability to take risks, perfectionism reduces creativity and innovation—exactly what's not adaptive in the global marketplace.

Yet, it does more. It is a steady source of negative emotions; rather than reaching toward something positive, those in its grip are focused on the very thing they most want to avoid—negative evaluation. Perfectionism, then, is an endless report card; it keeps people completely self-absorbed, engaged in perpetual self-evaluation—reaping relentless frustration and doomed to anxiety and depression.

Perfectionism, of course, leads to heaps and loads of anxiety. Nobody's perfect, after all -- so expecting perfection is by definition a doomed enterprise. No wonder, then, that it's so prevalent among those with anxiety disorders:

Perfectionists fear that a mistake will lead others to think badly of them; the performance aspect is intrinsic to their view of themselves. They are haunted by uncertainty whenever they complete a task, which makes them reluctant to consider something finished. "People may not necessarily believe they made a mistake," explains Frost, "they're just not quite sure; they doubt the quality of their actions." Intolerance for uncertainty characterizes obsessive compulsive disorder and generalized anxiety disorder, too.

Unfortunately, according to the article, more and more Americans are growing up to be perfectionists. Why? Parents who overschedule and overmanage their kids' lives:

"I don't understand it," one bewildered student told me, speaking for the five others seated around the table during lunch at a small residential college in the Northeast. "My parents were perfectly happy to get Bs and Cs when they were in college. But they expect me to get As." The others nodded in agreement. Today's hothouse parents are not only over-involved in their children's lives, they demand perfection from them in school.

And if ever there was a blueprint for breeding psychological distress, that's it.

So lay off your kids. Let 'em know it's okay to make mistakes -- that mistakes are in fact valuable, in that they provide important lessons. I don't mean you should stop holding your kids to high standards, just that you should strive to let them know you'll love them just as much whether they succeed or fail in whatever they do. Maybe, just maybe, it'll give them the self-acceptance and flexibility of thought and behavior they need to avoid developing panic, anxiety, or OCD.

Stress rewires the brain.

2009-08-18T19:15:00.000-07:00

I don't know about you, but I'm fascinated by the biological and psychological causes and manifestations of panic -- by looking under the hood of panic, if you will. For instance, one of the books that most helped me understand panic was The Emotional Brain by Joseph LeDoux, which wasn't a psychologist's explanation of panic disorder how to overcome it, or a memoirists depiction of the disorder, but a scientist's description of the neurology of fear. So I really enjoyed this piece from the New York Times science pages, about how difficult it is to cope with stress effectively -- because we're not wired to do so. The crux of the matter: Stress rewires the brain in such a way as to causes us to fall into behavioral and cognitive ruts -- which cause still more stress, in a feedback loop.

True for rats:

Reporting earlier this summer in the journal Science, Nuno Sousa of the Life and Health Sciences Research Institute at the University of Minho in Portugal and his colleagues described experiments in which chronically stressed rats lost their elastic rat cunning and instead fell back on familiar routines and rote responses, like compulsively pressing a bar for food pellets they had no intention of eating.

Moreover, the rats’ behavioral perturbations were reflected by a pair of complementary changes in their underlying neural circuitry. On the one hand, regions of the brain associated with executive decision-making and goal-directed behaviors had shriveled, while, conversely, brain sectors linked to habit formation had bloomed.

In other words, the rodents were now cognitively predisposed to keep doing the same things over and over, to run laps in the same dead-ended rat race rather than seek a pipeline to greener sewers. “Behaviors become habitual faster in stressed animals than in the controls, and worse, the stressed animals can’t shift back to goal-directed behaviors when that would be the better approach,” Dr. Sousa said.

And for humans:

Robert Sapolsky, a neurobiologist who studies stress at Stanford University School of Medicine, said, “This is a great model for understanding why we end up in a rut, and then dig ourselves deeper and deeper into that rut.”

The truth is, Dr. Sapolsky said, “we’re lousy at recognizing when our normal coping mechanisms aren’t working. Our response is usually to do it five times more, instead of thinking, maybe it’s time to try something new.”

Here's how it works, and why it matters:

The stress response is essential for maneuvering through a dynamic world — for dodging a predator or chasing down prey, swinging through the trees or fighting off disease — and it is itself dynamic. As we go about our days, Dr. McEwen said, the biochemical mediators of the stress response rise and fall, flutter and flare. “Cortisol and adrenaline go up and down,” he said. “Our inflammatory cytokines go up and down.”

The target organs of stress hormones likewise dance to the beat: blood pressure climbs and drops, the heart races and slows, the intestines constrict and relax. This system of so-called allostasis, of maintaining control through constant change, stands in contrast to the mechanisms of homeostasis that keep the pH level and oxygen concentration in the blood within a narrow and invariant range.

Unfortunately, the dynamism of our stress response makes it vulnerable to disruption, especially when the system is treated too roughly and not according to instructions. In most animals, a serious threat provokes a serious activation of the stimulatory, sympathetic, “fight or flight” side of the stress response. But when the danger has passed, the calming parasympathetic circuitry tamps everything back down to baseline flickering.

In humans, though, the brain can think too much, extracting phantom threats from every staff meeting or high school dance, and over time the constant hyperactivation of the stress response can unbalance the entire feedback loop. Reactions that are desirable in limited, targeted quantities become hazardous in promiscuous excess. You need a spike in blood pressure if you’re going to run, to speedily deliver oxygen to your muscles. But chronically elevated blood pressure is a source of multiple medical miseries.

You knew it already, but there's more proof for you. Stress is bad for your health -- and your happiness.

But there's hope:

...with only four weeks’ vacation in a supportive setting...the formerly stressed rats looked just like the controls, able to innovate, discriminate and lay off the bar. Atrophied synaptic connections in the decisive regions of the prefrontal cortex resprouted, while the overgrown dendritic vines of the habit-prone sensorimotor striatum retreated.

The lesson: Go on that vacation you've been putting off.

Vampire panic!

2009-08-17T17:23:00.000-07:00

What with Twilight and True Blood and all, these days there's tons of interest in all things vampire. So this, a story about vampires in Tampa Bay, FL, ought to be of interest to PANIC! readers. From the link:

Anyone who wants to get into a Vampire Gathering needs to see the gargoyles first. They're the protectors, the first line of defense against heckling street preachers and tourists.

The women move along, but I remain, the first reporter ever allowed past the gargoyles, the first permitted to give you — my fellow "mundanes'' — a glimpse into their vampire world.

The monthly Gathering at the Castle nightclub isn't a role-playing game or a convention of Twilight fans. These people don't sleep in coffins, fear garlic or live forever.

But they do feel a need to feed on others, whether that means absorbing energy or blood. They call themselves vampires and consider their yearnings a physical affliction. They say they can't absorb energy like "mundanes," who often start every morning revved up for the day. They wake drained, needing to be charged.

Vampires have looked for other names to define themselves. They don't quibble with "parasite."

Some feed on blood volunteered by donors who allow them to cut their skin and drink.

Some feed during sex, drawing from strong energy bonds with their lovers.

And some "psychic" feed, sipping life energy from the auras of others.

Why am I linking to this story, here, on this blog? Turns out that lots of these vampires have panic disorder and depression and other mental health issues:

A survey of about 950 vampires found that 30 percent reported having been diagnosed with depression, 16 percent suffer from panic disorder, and more than 15 percent have been diagnosed as bipolar. Lest you think the research is tainted by anti-vampire bias, you should know that it was conducted by vampires — led by a fellow in Atlanta who goes by Merticus.

One psychologist's guess as to why this is true:

The idea of the vampire has helped people make sense of their world since the earliest recorded stories.

From the 16th to the 18th centuries in Eastern Europe, villagers were digging up corpses, burning them, cutting them up, putting stakes in their still hearts — all to solve what they felt was a vampire problem.

They told tales of awaking paralyzed and finding a visitor from the grave lying beside them. Modern medicine would call that "hallucinatory sleep paralysis." But back in the day, vampires provided villagers with a scapegoat for death and disease.

Today's vampire serves a different purpose, writes British psychologist Meg Barker: "The social experiences explained by real vampirism seem to be those associated with a sense of difference. Many real vampires begin their accounts by saying that they always felt 'weird' and 'different' to the people around them . . .

"Their awakening as a vampire made sense of this experience."

Whatever works, I guess. Or, as another psychologist says:

"I sometimes think a worthy definition of mental health is when people can let go of conventional life when they want to while holding on to the reins firmly enough to get back in control when they need to," says Richard Leavy, a psychology professor at Ohio Wesleyan University.

"Vampires," he said, "seem to be doing both."

TV piece about agoraphobia.

2009-08-16T20:48:00.000-07:00

Here is a TV news story about a New Zealand woman's treatment for agoraphobia. Lighthearted but still quite informative piece to show friends and family who are struggling to understand what you're going through.

CBT vs. psychodynamic therapy.

2009-08-15T18:43:00.000-07:00

Turns out they're equally effective, at least for General Anxiety Disorder.

On Whole Foods and health care reform.

2009-08-13T23:11:00.001-07:00

According to insurers, panic disorder is a preexisting condition that disqualifies one for individual coverage. If you have a W-2 job when panic attacks, then you're in luck -- you have access to employer-sponsored health coverage, and can access the care you need to treat the disorder affordably. If you don't? You're shit out of luck.

Indeed, health insurance can mean the difference between overcoming panic and living a full, productive life, and dropping out of society with Boo Radley-level agoraphobia. We're a rich society; we can afford a universal public health plan. But our system denies health coverage to 45 million people; private health insurance damns increasing numbers of us to Boo Radley lives. From where I sit, that's un-American.

Which is why John Mackey ticks me off so much. CEO of Whole Foods, Mackey recently wrote a Wall Street Journal editorial claiming that basic health care is not a right -- basically, that it's more important to keep private insurers in the black than it is to provide health coverage to people who need it, whose lives would improve measurably with it. To wit, Mackey writes:

While we clearly need health-care reform, the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system.

Mackey's suggestions for private health system reform include the following, which makes it clear where his sympathies rest -- with the Haves, and to hell with the Have-Nots:

Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

In other words, if you've got a preexisting condition, you're still shit out of luck.

This is "I've got mine" libertarian bullshit, and I'm sick to death of it.

You, too? Then BOYCOTT WHOLE FOODS.

On fear of flying.

2009-08-11T00:16:00.000-07:00

Bill McGee of USA Today recently wrote a very thorough article all about the fear of flying, from what causes it...

...the "fear" of flying may in fact be comprised of separate and distinct fears, including fear of heights, fear of loss of control, fear of losing one's balance, and fear of death itself, in addition to claustrophobia, panic disorders and social phobias. Many travelers suffer from two or more of these conditions at once, so an effective diagnosis is critical.

...to a variety of ways it can be coped with:

Some nervous fliers simply choose to medicate, though counselors say this may not always be effective. For those concerned about side effects, some travelers prefer homeopathic products, which offer a non-addictive alternative to many prescription sedatives and other medications. Homeopathic remedies for fear of flying symptoms are offered through a variety of health stores and online.

Counselors I spoke to question the effectiveness of hypnosis, but those who are receptive to such procedures may find comfort in this option. In-person visitation is the preferred method, but patients who don't have the time and/or money and/or access can purchase a variety of audio tools. Also, synchronized breathing might help some find relief and calm their nerves. Ancient exercises—such as Qi Gong—are proven stress relievers, but may not work for all nervous fliers, particularly once they're airborne. However, under certain conditions such practices could provide a low-cost and natural remedy.

One of the simplest of all solutions may prove effective for some fearful fliers: Listening to soothing music on an iPod or other electronic device can ease the stress and anxiety of flying. In addition, some recordings can be overdubbed with subliminal therapeutic advice.

Of course, psychological counseling is always an option as well.

The piece also links to fear-of-flying clinics and seminars across the country and around the world.

Fear, panic, and society, part two.

2009-08-06T20:12:00.000-07:00

When you’re afraid, there are five basic steps to coping effectively.

First, you must identify the cause of your fear. In my case, as long as I believed that what threatened me was a heart attack or stroke, I would never identify nor begin to understand what was really causing the adrenaline to flood my system: panic.

Second, you must learn about the cause of your fear. In my case, with enough reading about panic, I finally began to believe that, despite what my body and mind were telling me during my panic attacks, I was not in mortal danger when one struck; that the places I associated with panic – the rush-hour subway, the crowded shopping mall – were not in fact dangerous; that panic is biological as well as psychological in nature, and not an indication of personal weakness or a deficient personality; and, perhaps most importantly, that millions of people experience panic – that I was not alone.

Third, you must analyze the way you process fear in your thoughts, identifying when fearful thinking is irrational and challenging that irrational thinking with logic and objective truth. Cognitive restructuring, it’s called in psychology-speak. we tend to focus on the negative, on what might go wrong; we think catastrophic thoughts, which prevent us from acknowledging that reality might not be quite so bleak as the world we’ve conjured in our head. When we listen the voice in our head that says we’re having a heart attack or a stroke, panic is terrifying. When, rather, we question that voice, offering a reality-based alternative to the story about the world it wants us to believe, panic becomes something not quite as severe – something not quite panic. “It’s not a heart attack, it’s a physiological response to adrenaline,” we tell ourselves, and panic has that much smaller a hold on us.

Fourth, you must learn to relax, to calm your body and give your mind a break from worry. Painting, reading, listening to music, hiking, working out, meditating…there’s a long list of activities people who panic can use to help keep their anxiety in check. Learning to relax and forget our fears for a while allows us to deal with those fears more realistically and effectively.

Fifth and finally, you must stop avoiding your fear, and face it head-on. You must expose yourself to the things you fear – the people, places, situations – so that you can learn that those things do not cause nearly as much existential threat as your panic has convinced you they do. After one debilitating bout of agoraphobia when I lived in Los Angeles, for instance, it was only by getting in my car and driving a bit farther from home each evening that I was able to reclaim the ability to move about that city without fear-imposed restrictions.

The weeks and months after 9/11 were a time of great fear. Unfortunately, the actions we took in response to that fear rarely mapped to these five steps; indeed, the actions we took as a result of 9/11 often ran completely counter to these proven prescriptions for dealing with fear.

Consider step one: identifying fear’s cause. The immediate cause, of course, was al Qaeda, the fundamentalist Islamic terrorist network headed by an elusive Saudi-born ideologue named Osama bin Laden, was the immediate cause of our fear. Immediately, though, we began to confuse the issue. In the weeks following 9/11, U.S. authorities rounded up some 1,200 Arab and Muslim immigrants, for the most part with no credible evidence that they were connected to al Qaeda. By 2003, we were invading Iraq – again, without credible evidence of a connection to al Qaeda.

Or step two: understanding fear’s cause. Al Qaeda has always been forthcoming with its reasons for targeting the United States; essentially, what bin Laden and his followers consider U.S. meddling in Islamic regions of the world: our covert but significant role in Afghan resistance to Soviet occupation in the 1980s, our ongoing military presence in Saudi Arabia and other Islamic countries, and our longstanding, steadfast support of Israel. But instead of explicitly acknowledging this complaint, we chose to focus on other, often completely fabricated reasons for the attacks on the World Trade Center and the Pentagon. “Islam is a violent, evil religion,” the voices of ignorance exclaimed. “They’re jealous of our freedom.”

Painting all of Islam with the “terrorist” brush is simply ignorant at best and utterly counterproductive at worst; calling their religion evil has almost certainly increased anti-American sentiment among Muslims around the world. And while we should certainly hold al Qaeda to account for its murderous acts, if we were smart – if we really wanted to lessen the threat that al Qaeda poses – we’d at least acknowledge, and consider the validity of, that organization’s political complaints.

Or step three: challenging fearful thoughts. Rather than managing our frightening but unrealistic cognitions in the wake of 9/11 by questioning their validity, our leaders went out of their way to provoke them, conjuring images of suitcase nukes and mushroom clouds rising over American cities. Everything was different, now; we had been forced into a global war on terror with no end in sight, a crusade against death-minded, heathen hordes. The threats were everywhere; no one could be trusted. Foreign-sounding strangers, people taking snapshots of government buildings – all these things justified fear, or so we were told.

Or step four: taking steps to relieve stress. We didn’t do much relaxing after 9/11. It wasn’t really possible, what with the flood of messages telling us to be afraid – very afraid. On TV, Fox News became a one-station fear machine. Each week during prime time, Jack Bauer reinforced the message that there were terrorists everywhere, that we should trust no one. At the airport, disembodied voices warned us to beware unattended baggage. I have no way of knowing whether I’m correct, but it’s my belief that a society which encourages constant vigilance and complete distrust is a society that promises to become increasingly unlivable.

And then there’s step five: avoiding avoidance. To avoid giving people, places, and situations a power over us they don’t merit in reality – to live fully in the world, going where we want to go, doing what we want to do, and in general giving ourselves the best possible shot at achieving our personal and professional aspirations – we much force ourselves to enter fearsome situations and learn to cope with the anxiety they provoke. After 9/11, though, as a society we tended more towards avoiding what we didn’t want to face. For instance, we stopped flying when (thanks to heightened security) airliners were probably the safest mode of transport available. “Just go shopping like you usually would, and everything will be okay,” our leaders told us, as though distraction and avoidance rather than honesty and engagement were the most effective ways to negotiate our way through fear.

Each step along the way, we failed to think and act in ways that are known to be effective in coping with fear. As a result, our civil liberties have been curtailed. We’ve become a nation that tortures. Our Muslim communities have been marginalized. Resentment of the U.S. is at an all-time high, and a new generation of Muslim kids has been radicalized in the Middle East and around the world. All the while, 24/7 cable newscasts and radio talk show blowhards ensure that our fear remains at fever pitch. Meanwhile, hundreds of thousands have died in an unnecessary war in Iraq – and bin Laden remains free, continuing to lead a terrorist organization that may be more powerful today than it was in 2001.

Are we better off as a result of the steps we’ve taken in response to 9/11? As the announcer used to say during Monday Night Football advertising breaks, “You make the call."

Fear, panic, and society, part one.

How world-class swimmers manage anxiety.

2009-08-06T15:25:00.001-07:00

If you'd asked me, I'd have guessed that Olympic-level competitive swimmers are all but immune to panic. To excel to that level, after all -- to cope with the pressure of competing against the world's best -- they'd have to have the ability to rein in their anxiety. But according to a recent New York Times article, anxiety and panic are serious problems even among world-class swimmers. To wit:

Her body was quivering and she was sputtering for breath. The swimmer in obvious distress was not a toddler who took a tumble into the water; it was a future world-record holder in the warm-down pool at the 2004 Summer Games in Athens.

The teenager Katie Hoff was having a panic attack and the fully-clothed man who waded in to rescue her was not a lifeguard; it was the United States Olympic coach, Mark Schubert, who soothed her by saying the anxiety that made her palms clammy, her heart race and her mind a tangled web was a well-known opponent on the world scene.

How swimmers learn to cope:

To inoculate its team members against any strain of performance flu, United States Swimming officials periodically invite them to seminars on using visualization techniques to achieve optimal performances run by people affiliated with the Pacific Institute based in Seattle. One of their speakers last fall was Brian Goodell, a two-time Olympic gold medalist who weathered a panic attack to win the 1,500-meter freestyle at the 1976 Summer Games in Montreal.

The aim is to turn the athletes’ minds into bunkers that fortify them against self-doubts.

Man oh man, I'd love to get me one of them bunkers.