The benzodiazepines are a class of drugs typically prescribed for the treatment of anxiety or chronic seizure. They work by slowing the electrical activity in the brain, resulting in a sedative effect. Doctors may prescribe these drugs for brief or prolonged periods, or simply as needed—such as in the event of a panic attack. The potential adverse effects of benzodiazepines are fairly well understood by the medical community. People may experience drowsiness, headache, dizziness, and an unsteady feeling. High doses have an intoxicating effect similar to alcohol consumption.

However, the effect of chronic low doses of medications like Xanax (alprazolam) and Klonopin (clonazepam) on human tissue and organs is still to be determined. Previous studies have suggested that long-term administration of benzodiazepines may weaken the immune system, although no conclusive evidence of such a link exists.

A clinical experiment with rats tested the effects of Klonopin and Xanax on stressed and nonstressed male rats. The stress procedure involved confining the rats to a small mesh cage for 2.5 hours each morning. Some rats received Klonopin, some Xanax, and others only a control solution of distilled water. The study continued for four weeks, after which the rats were euthanized and the clinicians carefully examined them. The research team was most interested in the health of the immune system, and they primarily investigated lymph glands and blood cell counts. The findings have implications for the treatment of anxiety in humans.

Both stressed and nonstressed rats showed immune system deficits after treatment with either Klonopin or Xanax. Rats treated with Xanax demonstrated the most serious deficits, possibly because of the medication’s unique chemical structure. Because of the experimental design, researchers were able to distinguish between immune deficiencies caused by stress alone and those caused by medication. Nonstressed, medicated rats showed less decline than their stressed counterparts, but the decline was still clinically meaningful. It’s worth noting also that these rats received relatively low doses of medication. Continued administration beyond four weeks might reveal even more profound immune system effects.

These results argue for more caution when prescribing anti-anxiety medications. Both Xanax and Klonopin appear to degrade the immune system in distinct ways. Overall, Klonopin’s effects were less severe than those of Xanax, but were still worrisome. Patients with already compromised immune systems may want to avoid this class of medications if possible. Otherwise, Klonopin may be the safest choice. In addition, short-term use of the drug is definitely preferable to a long-term prescription.

References:

1. Elmesallamy, G. E., Abass, M. A., Refat, N., and Atta, A. H. (2011). Differential effects of alprazolam and clonazepam on the immune system and blood vessels of non-stressed and stressed adult male albino rats. Interdisciplinary Toxicology, 4(3), 132-143.
2. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Alprazolam. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000807/

Sports generally are viewed as harmless pursuits, a source of social interaction and bonding, exercise, and stress relief. But in recent years, highly publicized incidents of fan violence have raised concerns about the culture surrounding sports. The vicious 2011 beating attack on Bryan Stow at Dodger Stadium in Los Angeles is just one such example. Alcohol-fueled fights and skirmishes are increasingly common at all levels of competition, from playgrounds to professional leagues. Most people who have attended a sporting event have witnessed at least one example of an out-of-control fan.

What’s behind this surge in violence? The problem may not be the nature of sports themselves, but rather the way society treats sports in conjunction with personal factors. A closer look at some factors that may contribute to fan violence:

Overidentification

For many sports fans, their teams of choice become a proxy for their own identities. Overidentifying personally with a favorite team may be a contributing factor to sports violence. A person who watches a favorite team lose, or witnesses an unfavorable referee call, may behave as if he or she has personally suffered. The advent of Facebook and other social media, as well as message boards and other gathering places for fans, may make it difficult to disengage from favorite teams or let go of bad memories. These platforms also provide more access to inflammatory views from rival teams’ fans, fueling deep feelings of loyalty, protectiveness, and anger that boil to the surface amid the emotional current of a live game.

Alcohol

Alcohol plays a significant role in many fan altercations. At National Football League games in 2011, more than 7,000 fans were ejected for inappropriate or violent behavior. Some fans spend all morning and afternoon tailgating and drinking with friends before watching the event and then celebrating—or grieving—afterward. People often are intoxicated before even entering a venue. The feelings of deep loyalty and anger that many fans feel can be exacerbated by alcohol consumption.

Hypermasculine Culture

Despite years of progress toward gender equality, many men feel pressured to meet expectations of traditionally masculine behavior. Sports can be a significant platform for masculine identity, and people who identify with hypermasculine culture may be more likely to attend sports events. Combined with adrenaline, overidentification, and ready access to fans with opposing allegiances, some men may be inclined to be violent when exposed to triggers. Likewise, women in hypermasculine environments that promote disrespectful or violent behavior may also be more inclined to engage in it.

Sociological Factors

Certain people are at a greater risk of engaging in violent behavior. People who have experienced a recent stress such as job loss, the death of a loved one, or a perceived humiliation are already on edge and more likely to react emotionally. Many people attend sporting events to alleviate stress. However, when a favored team loses, a person is heckled, or a person loses a significant bet associated with a game’s outcome, stress may explode into rage.

Group Dynamics

Millions of people attend sporting events every year, and the vast majority never commit a violent act. When 100,000 people pack a stadium, though, the odds are high that a number of them are under the influence of alcohol. Combine this with an emotional, hypermasculine environment and exposure to opposing sentiment, and you’ve created a recipe for fan violence. Proactive measures such as reporting inappropriate behavior immediately, limiting alcohol intake, and actively encouraging sportsmanship among peer groups, can help address an increasingly challenging threat to our enjoyment of sporting events.

References:

1. Aguirre, B. E. (2008). Sports fan violence in North America. Contemporary Sociology: A Journal of Reviews, 37(2), 157-158. doi: 10.1177/009430610803700235
2. Associated Press. (2012, May 31). Witnesses describe violent scene. ESPN. Retrieved from http://espn.go.com/los-angeles/mlb/story/_/id/7991565/witnesses-depict-violent-scene-bryan-stow-beating
3. Handwerk, B. (n.d.). Sports riots: The psychology of fan mayhem. National Geographic. Retrieved from http://news.nationalgeographic.com/news/2005/06/0620_050620_sportsriots.html

Cyber bullying has become more common with advances in technology. Messages can be posted on social networking websites, and pictures can be downloaded, altered, and made available to the world in seconds. Although there has been abundant research into the consequences of cyber bullying and traditional bullying, little has been done to determine which type may cause more psychological damage. It is well established that bullying itself—the act of terrorizing, intimidating, and ridiculing another through verbal or physical acts—can have numerous deleterious effects.

Those who endure bullying are at increased risk for internalizing problems such as anxiety, depression, and suicide ideation. Understanding how each type of bullying impacts young people is of critical importance in order to target those most vulnerable and help them deal with the ramifications. To get a better idea of the effects of cyber bullying in comparison to traditional bullying, Sheri Bauman of the University of Arizona’s College of Education recently conducted a study asking college students to rate their levels of distress based on hypothetical cyber and traditional bullying scenarios. The scenarios were similar in nature and differed only in delivery.

Bauman discovered that three main bullying themes emerged, including generalized bullying, name calling, and sexual victimization through explicit sexual images. Although the female participants reported higher levels of distress for all three types of bullying, the method of delivery did not impact emotional response. Specifically, although their responses varied by bullying scenario, all participants reported similar distress levels whether the bullying event was traditional in nature or cyber bullying.

However, Bauman found that one type of bullying was the most distressing. “We … found that bullying with sexual material, whether conventionally or by technological methods, is the most upsetting kind of incident to targets,” she said. This was especially true for female participants. Those with a history of victimization had higher distress than those without. In sum, Bauman believes that these findings demonstrate that it may not be the delivery method of bullying behavior that is most detrimental to young people, but rather the content of the message conveyed.

Reference:
Bauman, S., Newman, M. L. (2012). Testing assumptions about cyber bullying: Perceived distress associated with acts of conventional and cyber bullying. Psychology of Violence. Advance online publication. doi: 10.1037/a0029867

Generalized anxiety (GAD) is the most commonly diagnosed form of anxiety among adults. Symptoms of GAD include excessive worry or fear that interferes with daily life. For younger adults, a wealth of data exists showing the effectiveness and safety of Lexapro (escitalopram) in treating GAD. However, far less information exists regarding treatment outcomes for older adults.

Surveys indicate that at least 7% of adults in residential living centers undergo treatment for GAD. Those living on their own may experience GAD at an even greater rate. The elderly population as a whole experiences mood problems at a disproportionately higher rate. In addition, the elderly often have comorbid conditions such as dementia or major depression. For these reasons and others, elderly individuals with GAD often respond poorly to treatment. A study published in the Journal of the American Medical Association shed light on the question of whether Lexapro is a good choice for older adults, but still there are more questions than answers.

Study authors recruited 177 subjects aged 60 years or older with confirmed diagnoses of GAD. Approximately half of the participants received a 12-week treatment with Lexapro, while the remainder received placebo. A variety of psychological tests were administered to gauge response to the treatment. Self-reporting also weighed heavily in the final results.

Because adverse effects represent a potentially more serious concern among older adults, vital signs were taken at regular intervals. At the end of the 12-week study, the Lexapro group showed significant improvement in GAD symptoms. Side effects were mostly minor and included fatigue and sleep disturbances. Regular checks of vital signs confirmed that Lexapro caused no cardiac anomalies for any of the participants.

Among the interesting findings from this study is the observation that Lexapro only separated itself from placebo at week 4. This finding highlights the fact that adherence to a treatment regimen is an essential, but sometimes neglected, component of generating benefits for the individual. Geriatric individuals are in fact more likely to miss doses or stop taking medication entirely, especially if 2 or 3 weeks pass with no changes to their anxiety. Add to this circumstance the fact that elderly people often have additional diagnoses and decreased cognitive functioning, and this population becomes far more at risk.. Primary care physicians must be sure to emphasize the slow-acting nature of Lexapro as they screen the elderly for anxiety problems.

Reference:

1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Escitalopram. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000214/
2. Jenze, E. J., Rollman, B. L., Shear, M. K., Dew, M. A., Pollock, B. G., Ciliberti, C., Constantino, M. (2009). Escitalopram for older adults with generalized anxiety disorder: a randomized controlled trial. Journal of the American Medical Association, 301(3), 295-303.

This is the second in a series of articles designed to explore some of the issues and concerns that arise around what is currently called Asperger’s syndrome, which will soon be incorporated into the broader spectrum of autism disorder when the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is published in 2013.

Emotional intelligence (EI) is generally understood to be a person’s ability to identify and assess his or her emotional state, as well as the emotional state of others. It is not related to the kind of intellectual capability or intelligence typically assessed by IQ tests. Rather, it corresponds to a person’s ability to relate to others, work in groups, read between the lines in conversation, and interpret behaviors and moods displayed by others. It also relates to an individual’s understanding and regulation of those qualities within. High emotional intelligence provides a sort of shorthand for smooth interpersonal relations and communication.

Emotional intelligence is related to theory of mind. (See my previous blog, titled Asperger’s Syndrome: Theory of Mind.) The better able you are to imagine the world from another person’s point of view, the more likely you are to score high on a measurement of emotional intelligence. Persons with high EI are able to anticipate what someone might do in reaction to certain circumstances or statements. They are able to empathize with unspoken sadness because they are able to interpret an event in ways another person is likely to interpret it, given what they know about that person. They are able to avoid certain topics of conversation because they can predict which subjects might be problematic for another person. They understand the concept of conversational finesse. High EI is at the very heart of diplomacy.

A person with Asperger’s syndrome experiences the world in a very different way. With a tendency to take conversations and events literally, the emotional subtext often is unseen. This can lead to behavior that appears inappropriate at best, heartless or cruel at worst.

Imagine, for example, not being able to understand why the death of a beloved pet is still a sensitive issue for your friend even several years after the pet has passed away. Imagine saying something such as, “But that cat has been dead for two years!” And then imagine the reaction of your friend, who in that moment is feeling sad about the loss, feeling it as strongly as if he or she had lost the pet yesterday. Your friend is not likely to react well. Your words might sound intentionally cold, uncaring, and thoughtless. But when your friend does not respond favorably, you are confused. What do you do now? You made a simple statement of fact, and now your friend is upset with you.

This is the experience of challenged emotional intelligence. This is commonly the experience of a person with Asperger’s. Anxiety soars as the person wonders what he or she did wrong, what he or she failed to understand, or what was missed.

With therapy, a person with Asperger’s can learn to decode some of what seems mysterious in the realm of emotional intelligence. It is possible to discern intellectually what may not come naturally emotionally. For example, to use the above scenario as a basis of conversation in a therapy session might help a person with Asperger’s see that there are different ways of responding to the death of a pet, and that the person’s own, seemingly logical way may not be the way others respond to something as essentially emotional as the loss of a pet.

Learning that there is such variability helps a person with Asperger’s navigate the complex emotional undertones of daily life. It also helps relieve the free-floating anxiety that can accompany conversations and events, both familiar and unfamiliar, because it broadens the range of expectations and softens the likelihood of inadvertent blunders.

Emotional intelligence is a challenge for individuals with Asperger’s, but it is also a fruitful topic for exploration in therapy because it is so central to most interactions with others, both in social and in intimate contexts.

One of the most common methods for assessing the behavioral and emotional state of a child is a parental report. This type of evaluation usually comprises a parent’s observation and evaluation of the child’s feelings, mood states, and behaviors over a period of time. But just how accurately do parents gauge the emotional temperature of their children? That was the question at the center of a recent study conducted by C. Emily Durbin of the Department of Psychology at Michigan State University. Because parental reports can vary quite dramatically from reports obtained by other observers, such as teachers, counselors, and classmates, Durbin wanted to determine what factors, if any, skewed parents’ perceptions.

Durbin chose to focus on the effects of maternal depression on parental reports. She based her decision on the fact that other conditions, such as alcoholism, parental anxiety, and family distress, have been shown to influence maternal reports. Durbin extended the existing research and compared mothers’ reports with those of unbiased observers on a sample of 190 children ranging from 3 to 6 years old. Participants were instructed to rate levels of sadness, fear, happiness, surprise, and anger in the children after they completed 10 emotion-inducing tasks. Durbin found that the mothers with a history of depression or anxiety tended to rate their children as less happy than mothers with no such history. Additionally, these same mothers viewed their children as overly fearful, and rated girls as sadder than boys. This could be a result of maternal sensitivity to emotions such as fear and sadness. However, the outcome showed a significant disparity between observers’ ratings and those of the mothers with a psychological history. “These mothers may have greater difficulty setting aside their perceptions of the child’s typical emotional adjustment to focus solely on rating the behavior the child is currently exhibiting,” Durbin said. Although the sample size was limited to young children and did not contain a large number of mothers currently exhibiting depressive symptoms, the results warrant further investigation. Durbin believes it is essential to expand this research to include older children, comparison to other assessment tools, and evaluation of other aspects of childhood development.

Reference:
Durbin, C. Emily, and Sylvia Wilson. Convergent validity of and bias in maternal reports of child emotion. Psychological Assessment 24.3 (2012): 647-60. Print.

Dialectical behavior therapy (DBT) is a comprehensive, evidence-based treatment approach used to treat individuals with a wide variety of issues, including relationship conflict, anxiety, depression, bipolar, self-injury, eating issues, and substance abuse. Developed in the 1980s by psychologist Marsha M. Linehan for the treatment of borderline personality disorder and chronic suicidality, this method has since been adapted and utilized to help clients with much less severe issues. The therapy can help clients who exhibit extreme emotional reactions, helping them develop self-acceptance while also learning coping skills to better regulate their emotions and handle distress. DBT uses both individual therapy sessions and group skills training, as well as telephone coaching between sessions.

The DBT model combines a behavioral therapy approach with eastern mindfulness practices. In one sense, the term dialectical refers to the goal of synthesizing the extreme opposites inherent in the rigid “black and white” thinking of many clients who have trouble regulating their emotions. “Dialectical” also applies to the core DBT principle of practicing acceptance strategies while implementing change strategies, in the process of reducing and modifying self-destructive behaviors.

This type of therapy is very support-oriented; it helps clients identify their strengths, build new skills, and increase their self-esteem. DBT focuses on cognitive issues by indentifying destructive thought patterns and replacing them with more neutral and accepting internal dialogues. It is designed to be a nonjudgmental collaboration, with the therapist and client working together to increase emotional awareness and understanding, minimize negative thought patterns and behaviors, and develop new coping and problem-solving skills.

The four modules of dialectical behavior therapy:

• Core mindfulness: The first of the four primary modules of DBT, this concept involves learning to observe one’s emotions, describe those emotions, and fully participate in present experiences. This skill forms the foundation for the other three modules, and is derived largely from eastern practices of living in the moment.
• Interpersonal effectiveness: The second core component of DBT teaches clients assertiveness skills and strategies to ask for what they need, set boundaries and say no when appropriate, and deal more effectively with interpersonal conflict.
• Distress tolerance: The third module entails clients developing nonjudgmental acceptance of themselves as well as their current situation. The focus is on learning to accept the present reality and to tolerate crises, and making use of strategies such as distraction, self-soothing, and improving the moment. Practicing these skills will increase the client’s ability to tolerate challenging events and environments.
• Emotion regulation: The final module of DBT consists of three main goals: to understand one’s emotions, reduce emotional vulnerability, and decrease emotional suffering. With this in mind, some of the specific skills taught in DBT include identifying and labeling emotions as well as evaluating: events that prompt the emotion, interpretations that trigger the emotion, how the emotion is experienced, how the emotion is expressed behaviorally, and the aftereffects of the emotion.

In the case of adolescent treatment, Dr. Alec Miller has adapted Dr. Linehan’s model to incorporate parents attending skills training groups with their teens. There is an additional module, “walking the middle path,” which focuses on helping parents and their children understand each other’s viewpoints and reduce conflict and invalidation.

The five functions:

Dialectical behavioral therapy was designed to fulfill five primary functions:

• Enhance behavioral capabilities: DBT helps clients develop important life skills that help them regulate emotions, experience the present moment, improve interpersonal interactions, and better tolerate distressing situations.
• Improve motivation to changes: DBT supports clients’ motivation to change by tracking and reducing detrimental behaviors, thereby increasing quality of life.
• Generalize capabilities to other environments: In order for the client to make progress, the skills learned in therapy must transfer to a wide variety of situations. This is accomplished through homework assignments and practicing skills. Telephone consultations also can be valuable in helping clients utilize these skills in their daily lives.
• Support client and therapist capabilities: DBT aims to maintain and build the capabilities of therapists through continued training and consultation-team meetings.
• Enhance therapist motivation: The DBT model encourages the use of support, validation, feedback, and encouragement between therapists to avoid burnout and improve their effectiveness.

Stages of treatment:

The course of DBT generally flows through three stages:

• Stage 1: This stage is primarily focused on eliminating or reducing serious behaviors, including self-injury, suicidal thinking, and aggression. Behaviors that interfere with therapy also are addressed, such as missing appointments and not returning phone calls.
• Stage 2: The client strives to increase quality of life and experience emotions in a less intense manner. The client continues to eliminate or decrease destructive behaviors, and address other issues or situations that are interfering with daily life, such as past trauma.
• Stage 3: The client is experiencing increased feelings of completeness, self-respect, and love.

Who can benefit:

Though DBT originally was developed to treat more severe issues, such as borderline personality disorder, suicidal behaviors, and self-harm, the treatment has become a widely respected method for treating clients who exhibit the following, much milder traits and issues:

• Difficulty with emotional regulation
• A high level of reactivity, with a slow return to baseline
• Impulsiveness with a tendency toward self-destructive behaviors
• An inclination toward extreme thinking, unable to perceive a middle ground
• A lack of sense of self, tending to feel incomplete or empty
• A history of instability in relationships, and difficulty with interpersonal interactions
• Extreme sensitivity, accompanied by rapid mood swings, anxiety, and depression
• Fears of abandonment and trouble with intimate relationships

Dialectical behavior therapy has proven to be a very effective tool to help people manage intense emotions, change negative thought patterns, and decrease self-destructive behaviors. Individual therapy sessions focus on current detrimental behaviors in the client’s life, while group sessions involve learning skills from the four modules: mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation.

Fear can be a strong motivator. People who are afraid of living in poverty may be motivated to pursue any career option in order to avoid financial destitution. In a similar way, individuals who are afraid that they may develop specific health-related problems may work tirelessly to maintain optimal physical condition. Fear often has been linked to motivation, both positively and negatively. Until recently, however, few studies examined how fear of failure affects activity-related performance.

Jocelyn J. Bélanger of the University of Maryland sought to determine how negative feedback on specific tasks affected motivation in individuals fearful of failure (obsessive) and those who were passionate about their activity but less worried about setbacks (harmonious). In a series of experiments, Bélanger found that individuals who are passionate about achieving their goal perform differently based on their style of commitment. In particular, those with obsessive passion responded with positive motivation to negative/failure cues while those with harmonious passion saw no change in performance. In fact, the harmonious passion participants maintained the same level of performance throughout the experiments, regardless of whether they received success or failure feedback.

“Obsessive passion, associated with defensiveness, predicts performance aimed at avoiding failure, whereas harmonious passion, associated with a secure self-concept, predicts stable performance,” Bélanger said. These findings suggest that fear works as a motivator for individuals with obsessive passion. Bélanger believes that people who feel their sense of self is threatened by failure of goal attainment may unconsciously respond to that threat by increasing their performance. However, those who have harmonious passion traits are less threatened and view the feedback, positive or negative, merely as information needed to continue the process of attaining their goals. The results of this study offer valuable information that could be used for the development of goal-attainment strategies in the professional, academic, and sports arenas, and could help clinicians better understand an individual’s reaction to goal-achievement outcomes.

Reference:
Bélanger, J. J., Lafrenière, M.-A. K., Vallerand, R. J., Kruglanski, A. W. (2012). Driven by fear: The effect of success and failure information on passionate individuals’ performance. Journal of Personality and Social Psychology. Advance online publication. doi: 10.1037/a0029585

I almost always suggest to clients that they learn focused abdominal breathing and practice a minimum of 5 minutes every day; for the best results, I recommend they practice 20 or more minutes per day. Sometimes they look at me funny and ask “You mean all I have to do is just breathe and everything will be better?” I tell them that no, everything is not going to magically change to exactly what you want in life, but learning and practicing focused abdominal breathing every day WILL do this for you:

1) Special breathing techniques can help reduce physical pain. Often when people are in pain, they breathe in a very shallow, disordered pattern. They also may frequently hold their breath without even realizing it. These are mostly unconscious protective reactions to pain, but they can actually increase the level of pain. Several recent scientific studies have shown that breathing at a slower rate from the diaphragm can significantly reduce sensations of pain.

2) Breathing helps to properly balance oxygen and carbon dioxide levels in the body.  Breathing properly from the diaphragm will:
•    Fuel energy production
•    Improve focus and concentration
•    Increase relaxation and calmness
•    Reduce tension and anxiety
•    Eliminate toxins
•    Strengthen the immune system
•    Improve bowel function
•    Lower blood pressure
•    Increase metabolism, aiding in digestion and weight loss

On the other hand, not breathing correctly can cause problems for a number of systems in the body, including the immune, circulatory, endocrine, and nervous systems. Improper breathing can produce various symptoms including:
•    Difficulty focusing attention
•    Dizziness
•    Numbness
•    Anxiety
•    Chest pain
•    Digestive problems
•    Irritable bowel
•    Neck and shoulder pain

3) Breathing releases emotional energy that is trapped in the body. People with anxiety and/or depression are almost always (and I mean 99.9% of the time) either breathing very shallowly or frequently holding their breath. Holding the breath is one of the most common ways that people stop emotions from coming up (think about the last time you tried not to cry, feel afraid, or get angry). Once you hold in an emotion it stays trapped in your body, until you release it. Breathing allows stifled, buried emotions to finally start to surface and be released.

4) Breathing keeps you in the present moment, instead of the past or the future. People with depression are often stuck in thoughts about the past, and people with anxiety are stuck in thoughts about the future. When you’re concentrating on your breathing, you are paying attention to your body sensations, the sound of your breath, and the process of breathing, all of which are happening RIGHT NOW. When you’re paying full attention to RIGHT NOW, you take AWAY energy and attention from the thoughts about the past or future. When you bring your attention to NOW, you automatically feel calmer.

Using the breath is a way to learn how the body and mind are connected. This is why I teach proper breathing to clients. Thoughts are directly related to feelings in the body and likewise, body sensations give rise to thought patterns in the mind. Mind and body are in a constant dance of influence, and it is important for people to learn that they have more choice and control in the matter than they thought.

Basic Instructions for Focused Abdominal Breathing
More than likely, if you are experiencing depression, anxiety, or pain, you are breathing shallowly from your upper chest. You want to train yourself to breath from your diaphragm/abdomen. Although it’s most effective to have someone teach you the process in person, here are the basic steps:

1) Sit in a comfortable upright position with your back against your chair and your feet on the ground. Keep your back straight, but let your shoulders and the rest or your body be very relaxed.

2) Place your left hand on your abdomen. Imagine that the entire area from your lower abdomen up to your chest is one large, rectangular balloon. Now, start by exhaling as completely as possible. Empty out as much air as possible. Your left hand will move inwards as the “balloon” area deflates. Now, slowly and gently, inhale, imagining that you are filling the balloon starting from the bottom, all the way up to the top. When you are breathing correctly from your abdomen, your lower abdomen will inflate, followed by your chest expanding, and your left hand will be pushed outward. Your shoulders will not go up, they will stay in place. When you inhaled did your hand move? Or did your shoulders go up instead? If your shoulders rise up when you inhale, you are breathing from your upper chest. Exhale and try again. This type of breathing may take a little practice to get the flow going. Work on this step until you can fill and empty the “balloon” completely. Then add the next steps.

3) Now that you are breathing abdominally, relax into a natural breathing rate. Your body will take over the breathing and settle into its own rate and depth. Your job is to just observe your breathing. Focus your attention on the tip of your nose and intently notice the pressure, temperature, and sensations of the air passing in and out of your nose. If it helps you to focus, you may also silently say “breathing in” on your inhalation and “breathing out” on your exhalation. Do this focusing for 5 minutes a day to start with, and work up to 20 minutes or more per day.

4) During your focused breathing session, especially when you first start practicing, you will more than likely notice that you are thinking about something else other than breathing. Thoughts have intruded into your mind and distracted your attention. When this happens, try not to react with any emotion (such as frustration). Just gently and silently allow the thoughts to drift upwards far away in to the sky like a soap bubble and then turn your attention back to your breath. At first you will find yourself re-directing your attention many, many times each session. Over time you’ll be able to maintain focus on your breathing for longer and longer periods of time and it will get easier to let go of intruding thoughts. It will even become easier to let go of unhelpful thoughts you have during the rest of the day (such as disturbing thoughts of the past or worrisome thoughts of the future). The most important thing is to keep doing the focused breathing every day, no matter what.

Open, full, unrestricted, unobstructed breathing is very important for your physical, mental and emotional health. It is something simple that can make a very big difference in your life. There are many things in life that we have no control of, so doesn’t it make sense to do the things we can have some control over? You can actively affect your own physiology and mental/emotional state just by mastering the art of breathing, focusing, and being present.

Related articles:
Deep Breathing and Guided Imagery
Alcohol and Anxiety: Not As Helpful As You Think
Managing Your Moods Through Mindfulness

Adolescent girls are among the most vulnerable for issues that relate to body image. They are assaulted with unrealistic images and unachievable ideals from virtually every media outlet. Teen girls struggle to find their identity at a time when appearance often determines their social circle and affects their self-esteem. In fact, research shows that teen girls worry more about their bodies than they do about academics, family life, or any other stressors. Young women who develop unhealthy eating behaviors can find themselves in a lifelong battle of physical and mental distress. Eating and food issues can lead to other negative psychological problems such as depression, anxiety, or even suicidal ideation.

Kathryn E. Rayner of the Centre for Emotional Health of the Department of Psychology at Macquarie University in Australia recently led a study to explore how peer relationships affect eating and body image issues in young women. Social acceptance is critical to teens, so Rayner theorized that perhaps young women select their friends based on eating and body image similarities, or perhaps they shape their own perceptions and behaviors based on the friends in their social circle. Rayner examined selection versus socialization in a sample of 1,197 teen girls from nine separate high schools in Australia. The adolescents were assessed for bulimic and dieting patterns, body satisfaction, and peer relations over a period of three years.

The results of the study revealed some interesting trends. First, the participants tended to choose friends with similar body satisfaction/dissatisfaction levels and bulimic behaviors. However, they did not choose girls with similar dieting and eating patterns. The girls also chose to engage in friendships that were bidirectional and avoided one-sided friendships. Rayner discovered that the girls who dieted the least had more people who wanted to befriend them, while those with more depressed mood and overt dieting behaviors had fewer peers soliciting their friendship. Additionally, the girls in the study, although they selected girls with dissimilar behaviors from their own, did not change their own actions to model those of their friends. Rayner believes the results of her study shed new light on some of the factors that influence eating, dieting, and body image in girls at risk. She added, “These findings represent important building blocks in facilitating the formation of more effective prevention and intervention strategies.”

Reference:
Rayner, K. E., Schniering, C. A., Rapee, R. M., Taylor, A., Hutchinson, D. M. (2012). Adolescent girls’ friendship networks, body dissatisfaction, and disordered eating: Examining selection and socialization processes. Journal of Abnormal Psychology. Advance online publication. doi: 10.1037/a0029304

A client that drops out of therapy is one who does not complete the recommended course of treatment. Many therapeutic approaches, such as cognitive behavioral therapy, do not have a specific treatment deadline, and clients are considered dropouts when they have voluntarily stopped therapy prior to resolving the issues and symptoms that brought them there to begin with. Dropout is a serious concern for the medical community and the general population. Individuals who drop out of therapy are more likely to have future psychological complications and seek services multiple times, which places an economic burden on society. Because they do not learn adaptive coping strategies and fail to address the issues that plague them most seriously, they are likely to be less than productive in their careers, families, and communities. Additionally, therapists who experience client dropout may begin to question their ability to help clients and their own adequacy.

Understanding the factors that contribute to dropout can provide clinicians with the information they need to address the problem. Joshua K. Swift of the Department of Psychology at the University of Alaska in Anchorage wanted to explore this problem further and made it the focus of his most recent study. Swift analyzed over 650 studies that included more than 83,000 clients and looked at factors such as client age, therapy setting, therapist experience, type of therapy, issues addressed in therapy, and clinician definition of dropout.

Swift found that nearly 20% of all the clients in the studies ended their treatment early. He found that some variables, such as therapy setting, influenced the rates of dropout. He also discovered that rates of dropout were highest among the youngest participants and those seeking treatment for personality or eating problems. Swift believes that more work is needed to determine specific nuances that effect retention. He hopes efforts will be aimed at isolating psychological issues, such as anxiety or depression, and approaches, such as psychodynamic or behavioral therapy, in order to get a clearer idea of the different dimensions affecting treatment completion. Swift said, “By paying attention to these variables and making adaptations where needed, clinicians may be able to reduce rates of premature discontinuation in their work with clients.”

Reference:
Swift, J. K., Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology80.4: 547-559.

Binaural beat technology (BBT) was discovered in the early 1800s and first described in the popular literature in the early 1970s. In the last four decades, binaural beat audio programs have been touted as tools for reducing stress, improving sleep, enhancing concentration, and even fostering altered states of consciousness. In the ‘70s and ‘80s, BBT audiotapes were primarily found in more esoteric venues, such as New Age bookstores, health food emporia, and retreat centers dedicated to consciousness exploration. One such center, the Monroe Institute in Virginia, is well known for their use of Hemi-Sync recordings, which feature BBT.

Today, BBT has become more commonplace, as one can download MP3s and smartphone applications in a matter of moments. Although the prevalence and popularity of such products has waxed and waned, several studies examining the potential usefulness off BBT have been conducted with a variety of populations.

What is BBT?
The term “binaural beat” refers to the brain’s tendency to hear the difference between two similar tones that are played in opposite ears as one new tone.  Our ears hear tones in terms of hertz (Hz), or cycles (the number of times a wave repeats itself) per second. Beats played at frequencies that are characteristic of brain wave frequencies are both audible and thought to facilitate alterations in our predominant brain-wave state.

Types of Brain Waves and Their Associated States
At any given time, our predominant brain wave may be in the frequency associated with deep sleep or deep trance (delta; 1-4 Hz), meditation (theta; 4-8 Hz), relaxed awareness or daydreaming, (alpha; 8-12 Hz), a state of relaxed focus (low-beta, or sensorimotor rhythm [SMR]; 12-15 Hz), alert mental activity/concentration (mid-beta; ~15-18 Hz), anxiety (high-beta; >18 Hz), or high-level information processing (gamma; >30 Hz). Gamma brain-wave states appear to be the least well researched. There is no “best” state to be in; however, at different times we will understandably want to be able to shift into one that is appropriate to the task at hand, whether sleeping, working on a project, or relaxing.

What Type of BBT for Which Conditions?
It has been hypothesized that a number of conditions, including chronic stress, chronic and postoperative pain, migraines and other headaches, problems with attention/concentration or learning, and insomnia, to name a few, reflect an imbalance or irregularity in brain-wave states. The deliberate use of BBT to change the predominant brain-wave state is referred to as brain-wave entrainment (BWE). BWE is not limited to BBT, but discussion of other methods is outside the scope of this article. However, a 2008 review of the BWE literature found that delta stimulation was associated with improvement in migraines and other headaches and reduction in short-term stress. A single session of alpha stimulation was associated with stress reduction in some settings, but not for those undergoing root canal. Alpha stimulation was also linked to pain relief. Beta improved attention, reduced short-term stress, alleviated headaches, reduced behavioral problems, and improved performance on measures of overall intelligence. An alpha-beta protocol improved verbal skills performance and attention, and a beta-gamma protocol showed improved arithmetic skills in children who had learning disabilities or attention-deficit hyperactivity. Most of these studies examined photic stimulation (presented via flashing lights) or combined photic and BBT entrainment rather than BBT alone. Thus, it is difficult to draw a definitive conclusion about the specific utility of BBT from this review.

BBT as a Potential Tool for Reducing Anxiety and Pain
The results of a small pilot study published in 2007 found that listening to an hour-long program emphasizing delta BBT for 60 days was associated with a decrease in self-reported trait anxiety and an increase in quality of life among eight healthy adults. The level of dopamine (an excitatory neurotransmitter) was also decreased significantly and may be related to the decrease in trait anxiety scores. Interestingly, the team assessed changes in the level of growth hormone because the BBT’s producer claimed that listening would increase these levels. Growth hormone decreases with age, and thus, an increase would be considered a potentially beneficial outcome; yet, listening to this BBT program was associated with a significant decrease in growth hormone. Both the reasons for this result and it’s implications are unclear.

Perhaps two of the more intriguing studies about BBT were the following trials with patients undergoing surgery. The first is a 2005 double-blind, randomized controlled trial in which 108 patients undergoing general anesthesia for elective surgeries received either a BBT plus music audio, the same music without BBT, or no intervention other than standard care for a 30-minute period prior to their operations. The BBT audio featured a progressively slowing beat that ended with 10 minutes of delta. No adverse events were noted, and although initial state anxiety scores were higher in the BBT group (prior to the intervention), the most significant decrease in anxiety was also in the BBT group—even after adjusting for the fact that participants in this group on average had higher initial anxiety. Listening to music alone was also associated with a significant decrease in anxiety, but this decrease was of a lesser magnitude than that of the BBT group. This study showed that an inexpensive, one-time intervention of short duration was beneficial despite the stress characteristic of undergoing surgery.

The other study was a randomized controlled trial of 60 patients about to have surgery with general anesthesia. Twenty patients were assigned to each of three conditions: a Hemi-Sync BBT program, listening to the music of their choosing, or listening to a blank audiocassette for 30 minutes prior to surgery. None of the participants was offered any sedative premedication. Stereo headsets from all groups of participants were removed before the patients entered the operating room but were replaced and the respective audio programs restarted after the induction of anesthesia. Headsets were discontinued at the conclusion of surgery. The researchers found that using the Hemi-Sync programs resulted in significantly less intraoperative use of fentanyl (a very potent, synthetic opiate pain medication), lower self-reported pain scores several hours after the surgery, and being discharged from the hospital sooner. Unfortunately, the specific frequency of BBT was not described in this article.

Anecdotally, several months ago I went for my first-ever root canal and noticed considerable anxiety at the thought of having a very sensitive tooth drilled (even with anesthetic). On the way to the endodontist’s office, I listened to both a guided imagery program designed specifically for medical procedures in which one must remain awake (available via HealthJourneys.com) and also to a free delta BBT program (Napuru) I’d downloaded for my iPhone. The delta tones were played against a backdrop of ocean waves. My subjective experience was that the BBT and imagery, combined with mindfulness practice before and during the root canal, reduced my anxiety significantly and enabled me to get through what seemed like an eternity of loud drilling. I cannot say what the most “active” ingredient in this integrative approach was; however, the point is that this nondrug, inexpensive, easy-to-use adjunct was effective for me.

BBT has been around for decades and is now readily and inexpensively available. There are some data to suggest that it may be helpful for relieving anxiety in general and in the context of a stressful event. There is also some evidence that BBT or other methods of brainwave entrainment may help with pain, concentration, headaches, and other issues, and serious risks or side effects have not been reported. The current research does not definitively answer the question of whether there would be a dose-response effect or a benefit from listening to BBT more regularly versus listening once; however, this seems plausible. More research needs to be done to better elucidate whether BBT could be used as an independent therapeutic tool, however. Additionally, assuming BBT is effective, one should not drive or perform tasks requiring sharp focus when listening to delta, theta, or alpha tones, as these may induce a very relaxed state.

For More Information:

1. Dabu-Bondoc, S., Vadivelu, N., Benson, J., Perret, D.,  Kain, Z. N.  (2010). Hemispheric Synchronized sounds and perioperative analgesic requirements. Anethesia & Analgesia, 110(1), 208-210.
2. Huang, T. L., Charyton, C. (2008). A comprehensive review of the psychological effects of brainwave entrainment. Alternative Therapies in Health and Medicine, 14(5), 38-50.
3. Padmanabhan, R., Hildreth, A. J., Laws, D. (2005). A prospective, randomised, controlled study examining binaural beat audio and pre-operative anxiety in patients undergoing general anesthesia for day case surgery. Anesthesia, 60, 874-877.
4. Wahbeh, H., Calabrese, C., Zwickey, H. (2007). Binaural beat technology in humans: A pilot study to assess psychologic and physiologic effects. The Journal of Alternative and Complementary Medicine, 13(1), 25-32.

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