Tag Archives: anxiety

Hippocrates on Social Anxiety Disorder

Hippocrates of Kos (c. 460 BCE – c. 370 BCE)

Hippocrates of Kos (c. 460 BCE – c. 370 BCE)

I’m catching on that many Anxiety Disorder NOS diagnoses may be Social Phobia. To quote the Father of Medicine:

“(this man) … through bashfulness, suspicion, and timorousness, will not be seen abroad; loves darkness as life and cannot endure the light or to sit in lightsome places; his hat still in his eyes, he will neither see, nor be seen by his good will. He dare not come in company for fear he should be misused, disgraced, overshoot himself in gesture or speeches, or be sick; he thinks every man observes him.”

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Bad for your heart, bad for your mood

It’s a therapist’s job to help people find their own answers. When it comes to healthy living,  we spend a lot of time telling them what they should do. By the time you’ve explained how one’s mood and stress level benefit from exercise, regular hours, spiritual practice and skipping drugs and alcohol,  your index finger can be exhausted from the waggling.

Luscious, hot, salty yummy-nummies, just dripping with despair

This paradox will only grow worse, with the University of Montreal Hospital Research Center’s new study on diet and mice’s behavior.  Stephanie Fulton, Ph.D and her team found that after twelve weeks of high-fat, high sugar meals, their subjects froze under stress. They were less likely to explore new environments, and more likely to scurry for safety. Compared to a control group of mice fed the pelletized equivalent of grilled quinoa and kale, they gave up faster in tests of  ‘behavioral despair’.  In short,  they looked anxious and depressed.

Behavior can have lots of explanations, of course. It’s  been assumed that anxiety and unhealthy eating correlate, because we seek solace in ‘comfort food’ when we feel stressed.  Sadly, Fulton’s study suggests the reverse. Brain scans indicated the mice on high-fat diets had elevated levels of corticosterone, a hormone conclusively linked to anxiety and CREB, a molecule implicated in the fear response. Saturated fat appears to be the enemy here – the mice who were fed “good fats” like olive oil didn’t show as much anxiety.

Dopamine depletion in T-minus 100… 99… 98…

In interviews, Fulton theorized there’s also a neurological link between scrumptiously unhealthy food and depression. She surmises  that because high-fat, high-sugar eats are so ineffably delicious, they trigger releases of dopamine. That’s a neurotransmitter associated with pleasure, particularly with reward-driven learning. Life being unfair, the rush of dopamine leads to a corresponding crash, which causes symptoms of depression. Over time, per Fulton, this can reshape the brain’s reward circuits. Instead of easing life’s suffering, steady consumption of greasy, sugary treats may create an addictive pattern of short-term highs and long-term gloom.

… told you so.

David C.W. Lau MD PhD, editor of Canadian Journal of Diabetes emphasized this study only shows association, not causation.  The researchers freely admit it is hard to square their findings with other studies where mice on similar diets became more docile. Given that, two points come to mind:

1. The clash between offering health advice and helping people find their own answers? It’s an irony, but not a conflict. We’d be remiss if we didn’t tell people there are quick steps to improve one’s mood. “You have worse problems than lack of exercise,” I’ll say. “But exercise would help.”

2. Occasional indulgences are not a high-sugar, high-fat diet. Vegetarians’ organic, easy-going good humor is enviable, but not every client will be pried away wholly from sugar and fats. Good food is one of life’s great pleasures, and life has to be worth living. As  clients often ponder when they’re offered MAOIs: if you give up chocolate, cheese and wine entirely in trade for an effective antidepressant, has your life actually improved?

Citation: Diet-induced obesity promotes depressive-like behaviour that is associated with neural adaptations in brain reward circuitry. Sharma S, Fulton S. Int J Obes (Lond). 2012 Apr 17. doi: 10.1038/ijo.2012.48. PMID: 22508336 [PubMed – as supplied by publisher]

@ 2012 Jonathan Miller All Rights Reserved

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Filed under anxiety, depression

What (exactly) is Anxiety?

If you were to see this, technically, you would feel anxiety.

There’s a terrific post here from Joseph LeDoux, professor of neural science and psychology at New York University, that defines anxiety, from the amygdala on up. LeDoux specifies anxiety as a flavor of fear. When you expect that you might face a threat, you feel anxiety. When you actually face that threat, you feel  fear.

The explanation is more necessary than it might seem. Twice in recent months, I’ve had male clients stare blank-faced and ask, “What exactly is anxiety?”  The first time, I had to stammer out an explanation of apprehension, physiological arousal and the fight-or-flight reaction, while hiding my surprise that  someone would need to ask. The second time, examples worked well: “Anxiety is what you feel when you walk in a room and everyone goes quiet.” “Anxiety is what you feel when the police car behind starts its’ siren.” For this client, “Anxiety is what you feel when your girlfriend says, ‘We need to talk’,” made the concept crystal-clear.

If you were to see this, technically, you would feel fear.

These conversations made me wonder why the question isn’t more common, and why only men have asked. In session, guys often seem more comfortable talking about ‘edginess’ or ‘agitation’ than with the A-word.  LeDoux’s explanation of anxiety hints at one possible reason why:

“… human anxiety is greatly amplified by our ability to imagine the future, and our place in it, even a future that is physically impossible.  With imagination we can ruminate over that yet to be experienced, possibly impossible scenario. We use this creative capacity to great advantage when we envision how to make our lives better, but we can just as easily put it to work in less productive ways — worrying excessively about the outcome of things.”

For some men, especially those with long memories of junior high school,  the best definition  might be, “Anxiety is what you feel when you think your buddies can see you’re nervous.”

 

@ 2012 Jonathan Miller All Rights Reserved

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Why mindfulness works – The behavioral view

Photo @2005-2011 Juanita de Paola - http://www.juanita.it/

Experts have known since 500 BCE that mindfulness practice can lead to greater feelings of equanimity and contentment.  Mindfulness- based therapies have been part of western psychology at least since 1979, when Jon Kabat-Zinn opened the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. Unlike many other “eastern” treatments, empirical studies have accumulated to support claims of effectiveness against depression[i] and anxiety disorders such as generalized anxiety disorder[ii], obsessive-compulsive disorder[iii], and even irritable bowel syndrome[iv].

What has been less well understood is how it works. Michael Treanor, of the University of Massachusetts published a meta-analysis[v] this February that suggests exposure is key. Since Joseph Wolpe’s time (and before), we’ve known if you expose yourself long enough to something that causes anxiety, your amygdala and sympathetic nervous system will (eventually) realize it’s not so dangerous. The difficulty has always been how to stay with the phobic object when every part of you wants to run. Treanor’s meta-analysis finds empirical support for the idea that mindfulness works as a conditioned inhibitor – meaning, in this case, it eases the urge to flee.

Treanor’s findings were anticipated in a 2005 article[vi] by Shapiro, Carlson et al. They defined mindfulness as choosing to focus one’s attention on the present moment, with an open, accepting attitude, and the intention of calming, exploring, or regulating oneself.  Marsha Linehan made it part of Dialectical Behavioral Therapy because it helped her chronically suicidal clients stay present with their emotions long enough to recognize and tolerate them.  For those overwhelmed by dysphoria, mindfulness can be like the difference between watching a football game from the 50-yard line, and being  tackled and trampled by players on the field.

Exposure, naturally, is the key intervention in Edna Foa’s prolonged exposure therapy, which is the U.S. military’s treatment of choice for Post-Traumatic Stress Disorder. This article tells how Sgt. Richard Low, a veteran of 280 combat missions in Iraq, recovered from PTSD symptoms with help from Sudarshan Kriya yoga:

When he came back from the service, he didn’t think his experience affected him in any major way. He had nightmares, and he startled easily, but he chalked that up to just something veterans live with.

Then he enrolled in a study he initially wrote off as “just some hippie thing,” where he learned about yoga breathing and meditation. A year later, Low, 30, sums up his experience with two words: “It works.”

Heads-up to tough guys of the world: Mindfulness is not just a hippie thing. It’s also a Shaolin Monk thing.

 

@ 2011 Jonathan Miller All Rights Reserved


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Filed under mindfulness, Post-Traumatic Stress Disorder