“Why are you out of bed?”
“I’m scared.”
“What are you afraid of?”
“There’s a monster under my bed!”
“There are no monsters. Go back to bed.”
“Nooooooo, I’m scared.”
Sound familiar? Almost every parent has done this. Holding a little hand, down on your hands and knees with a flashlight to prove there is nothing under the bed—unless you count the stray sock, a missing toy, and a few dust bunnies.

Your little one thinks you are a superhero. You faced the monster and saved the day, or in this case, the night. With imagination tamed, feeling safe and secure, your child falls asleep.

Imagination is an amazing thing. Children hone it to a fine art. With a towel on their shoulders and a leap from the couch, they fly!! They feed you imaginary sandwiches and wipe imaginary crumbs from your chin. They introduce you to friends only they can see. They scare themselves at bedtime. Years pass, towels are used for bathing, imaginary sandwiches and friends are forgotten. Monsters no longer hide under the bed. Reality replaces imagination.

Or does it? Many adults continue to exercise their imagination. They don’t have towels on their shoulders or imaginary friends, but they do believe in monsters created entirely with their imagination. Your child, no longer afraid of monsters, is a teenager now. You worry she doesn’t take school seriously, or her current boyfriend is a bad influence, or her college fund isn’t going to be enough. Get the picture?

Adults may not imagine monsters under the bed, but they do imagine a multitude of scenarios that would scare Freddy Krueger, and it’s socially acceptable. A vivid imagination is never questioned if the name is changed from imagination to worry. It is commonly accepted that everyone worries; it’s part of being a responsible adult. How else can you be prepared when the unthinkable happens? If you have played out the worst-case scenarios in your mind, you are ready to deal with them.

Worry is as useful for you as monsters under the bed were for your child. You make things up in your head, believe them, and scare yourself. Who will take you by the hand, shine the flashlight on your imaginary fears, and make them disappear?

Worry is using your thinking to predict the future or to continue to relive the past. Predictions rarely come true, and if they do, worry did not change the outcome. It only made you miserable before the outcome happened. How much have you changed the past by worrying about it? Unless you conquered time travel, it doesn’t work. The past is past. It doesn’t change and it doesn’t cause you pain unless you bring it into your present by thinking about it. So the monsters (worries) of the future and the past are simply you using your imagination to scare yourself. Seems a bit silly, doesn’t it?

Worry (scaring yourself with your imagination) raises your level of tension and lowers your mood. From that low state of mind you expect to find solutions to your problems. It won’t happen. High tension and low mood doesn’t make for good problem solving—ever. Recognizing that you are scaring yourself helps the worries go away. You shine the flashlight on your fears and recognize they are imaginary. From a calmer state of mind, you deal with problems as they occur rather than in the future or the past.

Related articles:
Don’t Worry – Be Happy!
Self-Soothe in Your Own Compassionate Hammock
Mindfulness Practice: Learning to Live in the Moment

The world of psychiatry is full of unusual phobias. There’s symmetrophobia, the fear of symmetry, xerophobia, the fear of dryness, and ideophobia, the fear of ideas. But these phobias are exceedingly rare, and in the psychiatric interest on strange phobias, more mundane—and more dangerous—phobias are easily forgotten. Needle phobia is one such fear. There is significant evidence that fear of needles sparks physical changes in the body that can result in cardiac episodes and other health problems when a patient is exposed to needles. But needles are a part of life and are often necessary for medical treatment. Needle phobia, then, can cause a person to avoid life-saving care and, if a needle is forced upon a phobic patient, the results could be disastrous.

Needle Phobia and Cardiac Episodes
Most people dislike needles, but a true needle phobia feels overwhelming and uncontrollable to patients. People who have needle phobia may experience an extremely elevated heart rate and blood pressure immediately before a needle puncture. When the puncture occurs, the heart rate may drop precipitously. This exposes them to significant danger of heart arrhythmias and other cardiac episodes. Dr. James Hamilton, a pioneer in the treatment and study of needle phobia, reports that at least 23 deaths have been caused by a needle puncture that led to a cardiac episode.

Medical Issues
Doctors, nurses, and other people tasked with administering vaccinations and drawing blood are not typically properly educated about needle phobia. They’re accustomed to patients who dislike needles and may reassure them with promises that the puncture won’t hurt or will only take a minute. But with a true needle phobic, these reassurances don’t work. The person isn’t afraid of pain or injury: he or she is afraid of the needle itself. This poses serious obstacles to medical treatment. As many as 10% of people have some degree of needle phobia, and a significant portion of these individuals report that they would rather die than receive a needle puncture. These people tend to avoid medical care because of their fear, allowing their illnesses much more time to worsen than illnesses of nonphobic people.

Causes
Although traumatic experiences with needles such as painful blood draws or blood transfusions can cause needle phobia, people can’t typically trace the origin of the phobia. Needle phobia seems to run in families, but this does not mean the fear is genetic. Children may learn it from watching their parents show fear of needles. Restraining children during vaccinations and blood draws is strongly correlated with the later development of needle phobia. Consequently, parents should strive to ensure that their children’s early experiences with needles are positive and that children are not restrained unless the needle puncture is needed immediately to save the child’s life.

Treatment
Some people have good luck with hypnotherapy, but the most common treatment for needle phobia is counterconditioning. This process can take several years because the mere sight of a needle is sufficient to send many patients into a full-blown panic attack. Treatment providers typically start by asking the person to envision a needle, progress to showing the person a needle, and ultimately move toward getting the person to accept a needle puncture. For people who require needles for medical treatment, it may be necessary to administer general anesthesia to prevent life-threatening reactions. In less severe cases, anti-anxiety medications can lessen the symptoms of needle phobia.

Sources:

1. Hamilton, J. G. (n.d.). Needle phobia: A neglected diagnosis. Needle Phobia. Retrieved from http://needlephobia.info/pages/Hamilton-Needlephobia.pdf.
2. Emanuelson, J. (n.d.). The Needle Phobia Page – fear of needles and needle procedures. The Needle Phobia Page – Fear of Needles and Needle Procedures. Retrieved from http://www.needlephobia.com/
3. The phobia list. (n.d.). The Phobia List. Retrieved from http://phobialist.com/

Related articles:
The Other Side of Normal: An Interview With Jordan Smoller
Three Steps for Dealing with Panic Attacks
Breathing Lessons

I first met Albert Ellis, the founder of Rational Emotive Behavior Therapy (REBT), about 35 years ago. Soon after I became an Associate Fellow and a Supervisor with the Albert Ellis Institute in New York City, and was a died-in-the-wool devotee for decades.

Al was open to all of us adding or subtracting a variety of techniques, whether meditation, homeopathy, yoga philosophy, or anything else, as he had already incorporated disparate ideas from areas as diverse as Buddhism and behaviorism. He wanted each therapist to put his or her own stamp on their ways of working, although I believe he assumed we would all keep the REBT skeleton beneath whatever robes we draped it in.

Rigid, dogmatic thinking was not the coin of his realm. In fact, he loved to engage in lively discussions of all therapeutic techniques and was happy to incorporate anything he believed would help shift a client to becoming more unconditionally self-accepting.

Of course, like any parent, he was proud and delighted when his baby, REBT (the precursor of cognitive behavioral therapy [CBT]), would be “proven” to be effective in alleviating depression, anxiety, anger issues, or anything else, as it was with 40-plus years’ worth of studies.

This plethora of evidence-based practice studies that have lauded the effects of REBT and CBT is what led to the Swedish government’s decision to invest heavily in training clinicians to provide CBT to people with depression and anxiety and spend no money on training or treatment in other modalities. Naturally, the Swedish government was a bit shocked when a recent study showed that training therapists in and treating clients with CBT had little or no effect.

In response to these findings, Scott D. Miller, Ph.D. wrote: “The widespread adoption of the method has had no effect whatsoever on the outcome of people disabled by depression and anxiety.  Moreover, a significant number of people who were not disabled at the time they were treated with CBT became disabled.”

Apparently, this has not deterred the American Psychological Association from resurrecting its plan to draft and promulgate a series of guidelines pushing specific treatments for different mental health issues.

Dr. Miller and his colleagues at the International Center for Clinical Excellence have analyzed many studies showing little difference between treatment approaches in terms of outcome. They argue that all approaches work almost as well, and efforts to target specific treatments for each psychiatric diagnosis are not an effective use of time and money.

Dr. Miller recently talked about what works in behavioral health and recommended shifting the focus to designing client-tailored services rather than spending so much energy on examining specific treatment models and techniques. Meanwhile, Sweden has decided to end the exclusive use of CBT for the treatment of anxiety and depression, realizing that people need to have therapy choices.

As a holistic psychotherapist for almost 40 years, I think it is obvious when treatment is working: people self-report feeling better. They engage in life more fully, sleep better, take better care of themselves, and have more satisfying relationships and more meaningful life experiences.

As much as it can be wonderfully useful to study psychological modalities, theories, and philosophies, at the end of the day it all boils down to whether the person has been helped or not. Using evidence-based practice studies as a Procrustean bed will only cause pain and prolong suffering, just as the original one tried to stretch or shrink people to fit its specifications.

Source:
Miller, S. D. (May 13, 2012). Revolution in Swedish mental health practice: The cognitive behavioral therapy monopoly gives way. Retrieved from http://www.scottdmiller.com/?q=node%2F160&goback=%2Egde_53475_member_125725759

Related articles:
What is CBT?
Deep Breathing and Guided Imagery
When Someone Really Listens, We Heal

Adults who have survived childhood abuse are more likely to experience mental health problems than those who were not abused during their youth. Depression, anxiety, panic, posttraumatic stress, eating and food issues, and substance abuse are just some of the psychological conditions that these survivors face. Another consequence of childhood abuse is diminished physical health. Research has shown that negative psychological well-being decreases physical health and can lead to serious health problems, including hypertension and heart disease. But few studies have examined how specific types of childhood abuse affect physical health directly.

To address this gap in research, Cathy Spatz Widom, Ph.D., of the Psychology Department at John Jay College at the City University of New York recently conducted a study that sought to determine the link between three individual types of abuse and later physical health problems. Widom analyzed data from adults who had been abused prior to their 12th birthday. The average age of the participants was 41. Each participant underwent a complete physical examination and blood test in adulthood. Based on documented reports of the abuse, Widom compared how sexual abuse, neglect/maltreatment, and physical abuse in childhood affected the participants’ health in adulthood.

She found that the adults who had experienced neglect and maltreatment had poorer oral and visual health as well as impaired airflow and increased risk for diabetes. The adult survivors of sexual abuse were more likely than the other participants to develop oral health issues and hepatitis C. They also had higher rates of HIV and malnutrition. Those who had survived physical abuse were also at increased risk for malnutrition and diabetes. Although some of these conditions could be attributed to maladaptive coping techniques, such as smoking, drug or alcohol use, and poor nutrition, the findings clearly show that adults who have survived childhood abuse are still at increased risk for significant physical health problems. Widom believes that these findings have strong clinical implications. She said, “Understanding the mechanisms that place abused and neglected children at higher risk for these adult physical health outcomes will help focus these efforts.”

Reference:
Widom, C. S., Czaja, S. J., Bentley, T., Johnson, M. S. (2012). A prospective investigation of physical health outcomes in abused and neglected children: New findings from a 30-year follow-up. American Journal of Public Health, 102.6, 1135-1144.

I am frequently asked what the best complementary or alternative therapies for kids are. This is a broad and potentially complex question, with appropriate courses of treatment depending on both on the child’s struggles and the balance of safety and efficacy of the therapy being considered. Eventually, many parents eventually find a complementary or alternative medicine (CAM) therapy that feels right for their child.

The most recent data from the National Center for Complementary and Alternative Medicine (NCCAM) found that 12% of the 9,000 children surveyed in 2007 had used some form of CAM during the previous year. CAM use typically ranges from providing remedies in lieu of medical treatments—such as using a homeopathic flu remedy instead of a prescription—to using CAM in conjunction with conventional remedies. The latter can be as simple as giving a child a zinc lozenge or tea with honey in addition to the antibiotics a doctor prescribes when a child has a sore throat or throat infection. Another example is when a child has been diagnosed with attention deficit hyperactivity disorder (ADHD), and his or her parents employ dietary changes even if the child is also receiving medication or psychotherapy. CAM therapies are often used to help children manage symptoms of chronic pain conditions or notable anxiety, ideally in combination with psychotherapy (and appropriate medical care, if this is indicated).

Remembering Developmental Differences

A point NCCAM emphasizes is that children are not merely smaller versions of adults. Similarly, more studies have been conducted regarding the effects of many CAM therapies on adults, although there is a growing body of research on CAM with children. Thus, what may be considered an appropriate CAM therapy or dose of therapy for an adult is not necessarily what we can recommend for a child.

That being said, there are a number of treatments that are considered generally safe for children, particularly when provided or informed by appropriately trained professionals. My favorites are listed here. I chose to emphasize non-oral intake therapies, although at times these may also be appropriate.

1. Guided imagery or self-hypnosis can be helpful for managing mood symptoms, pain and itching, sleep difficulties, and nausea.
2. Mindfulness or other types of meditation can aid in improving mood, pain, itching, sleep, nausea, and concentration.
3. Aromatherapy can help reduce anxiety and enhance feelings of calm, especially when paired with other therapies, including cognitive behavioral therapy, meditation, imagery/hypnosis, or massage.
4. Movement therapies, such as yoga, dance therapy, or tai chi can increase a child’s feelings of mastery, discharge excess physical tension, provide focus, and improve mood.
5. Massage  decreases muscle tension or soreness and increases relaxation.
6. Energy therapies, such as Reiki or therapeutic touch, may help increase calmness and decrease stress. These may also help with some physical discomforts.
7. Art therapy can help children cope with change, shed light on emotions and concerns that they may have trouble verbalizing, and reinforce healing images created during guided imagery and hypnosis.
8. Homeopathy is gently calming and is reported to help with fears, anxiety, and tantrums. There is less data on this therapy, but it is generally considered to be safe.
9. Diluted ginger tea can help with upset stomach/nausea.
10. Dietary changes, which may include eliminating processed foods, caffeine, or sugar and emphasizing whole grains, fruits, vegetables, legumes, and healthy sources of protein, are health-supportive overall, and some parents report improved mood, sleep, and concentration when processed foods are limited or eliminated.

One common theme that runs through most of the therapies listed above is that they help children to feel calmer. Some of the approaches provide children with tools to help them directly impact how they feel via what they do (movement therapies, imagery/hypnosis, meditation, art), which enhances children’s feelings of mastery and control. All of these approaches require at least initial participation and monitoring from parents—a key ingredient in helping children to feel safe, loved, and supported.

As always, it is essential to keep healthcare providers in the loop when using CAM therapies with children, particularly with those who have a medical or psychological illness.

Modeling Emotional Intelligence

Finally, if I were to add a number 11 to the list, it would be to emphasize that children pick up on and are undoubtedly affected by their parents’ moods. It is essential for parents dealing with anxiety, depression, or other psychological challenges to obtain appropriate treatment. Doing so helps parents feel better, enhances their ability to cope with the many demands of parenting, and teaches children about the value of self-care. Furthermore, emotionally healthy parents tend to parent more effectively, which also reduces children’s feelings of anxiety and depression.

Resources:

• National Center for Complementary and Alternative Medicine: CAM Use and Children
• Columbia University’s Integrative Therapies Program for Children with Cancer: A leading program that emphasizes both research and clinical practice. Their website contains a wealth of information about a variety of therapies, as well as helpful links.
• This article details an integrative (CAM) treatment of pediatric pain and itch (pruritus) with a seven year-old girl:
  • Stein, T. R., Sonty, N., and Saroyan, J. M. (2012). “Scratching” beneath the surface: An integrative psychosocial approach to pediatric pruritus and pain. Child Clinical Psychology and Psychiatry, 17(1), 33-47.

Children with social, emotional, and behavioral difficulties (SEBD) often exhibit speech, language, and communication needs (SLCN) as well. Clinicians and educators who work with these children have the challenge of identifying which type of treatments will best serve the needs of these special children. SEBD has been shown to be linked to communication deficits, but this relationship has not been fully explored. Gender, social conditions, intelligence, and relationship styles are factors that contribute to both SLCN and SEBD. Most children with these problems are not identified until they enter school, making the correlation between them more convoluted. For instance, executive function deficits may not be discovered until children enter school and exhibit symptoms of attention deficit hyperactivity disorder (ADHD). Other children may live with negative psychological and physical conditions such as abuse or neglect that can cause the children to stifle their communication, resulting in communication problems later on.

The most common type of treatment for SEBD is cognitive behavioral therapy (CBT). In a recent analysis of existing research, James Law of the Institute of Health and Society at Newcastle University in the UK looked to see whether CBT was ever combined with communication therapy for children. He also studied the research on CBT outcomes in children with Asperger’s, autism, and anxiety to determine whether the therapy had any positive impact on communication skills. For his research, Law examined 19 separate studies that included data from 148 children with SEBD and SLCN.

Although Law did not isolate one particular CBT approach that would be most beneficial for these children, he did discover that variation in communication enhancement techniques had a positive impact. Specifically, more formal techniques appeared to help the children with autism spectrum issues the most, and naturalistic and educational approaches were identified as effective methods for children with mild communication and behavior problems. In conclusion, Law added, “The potential overlap between SLCN and SEBD needs to be widely recognized by practitioners, and the implications for practice of this overlap explored more fully.”

Reference:
Law, J., Plunkett, C. C., Stringer, H. (2012). Communication interventions and their impact on behaviour in the young child: A systematic review. Child Language Teaching and Therapy, 28.1, 7-23.

Several research studies have investigated the possibility that the antidepressant medication Luvox (fluvoxamine) could be an effective therapy for alcoholism. Most of the studies involved rats, but researchers consider the results applicable to humans as well. Despite the enormous public health burden of alcoholism, treatments for the disease are still well behind the curve. The rate of successful remission and abstinence is low, regardless of treatment plan. Comorbid disorders such as severe depression or anxiety further complicate matters and increase the likelihood of eventual relapse. Adequate treatment usually requires a combination of approaches—cognitive therapy for treatment of mood disorders, pharmaceuticals for managing alcohol withdrawal and cravings, and ongoing counseling to reduce the chances of a return to drinking.

A study with lab rats revealed that Luvox potentially reduces the response to food, or alcohol, or both, depending upon the experimental conditions. The goal of the study was to determine if Luvox might reduce the craving for alcohol, but the results were not conclusive in that regard. Significant changes in stimulus response were recorded even at very low doses of the medication. When food and alcohol were presented together, rats treated with Luvox responded less to food but maintained the same consumption of alcohol. However, presenting one stimulus and then another in sequence had differential effects. Responses to the second stimulus, regardless of whether it was food or alcohol, were decreased in the presence of Luvox. The temptation has always been to link all reward-seeking behaviors into a single category. Studies like the above, however, demonstrate that food-seeking and drug- or alcohol-seeking are biologically distinct events. The intricate and complex workings of such behaviors are still largely mysterious.

Due to uncertainties in its effectiveness for the purpose, Luvox is unlikely to play a role in the reduction of alcohol cravings. The rat studies returned mixed or confusing results, and no human trials have demonstrated a predictable, reliable mechanism of action. At this time,  there  isn’t enough evidence to conclude that the medication can successfully manage alcohol cravings. However, Luvox is effective in treating the depression and anxiety that accompany the recovery process after alcoholism. As a safe and effective mood stabilizer, Luvox reduces the chances of relapse. When Luvox is combined with cognitive therapy, a person recovering from alcohol addiction has a high likelihood of achieving a healthy outcome.

References

1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Fluvoxamine. Retrieved April 4, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000955/
2. Ginsburg, B. C., Lamb, R. J. (2006). Fluvoxamine effects on concurrent ethanol- and food-maintained behaviors. Experimental and Clinical Psychopharmacology, 14(4), 483-492.

Cognitive fusion is a process that involves attaching a thought to an experience. Cognitive fusion is beneficial in many ways. Through the process of cognitive fusion, people can become interested in story lines in movies and books because they attach their emotions to the events. Hobbies that elicit positive feelings can be enhanced as a result of cognitive fusion as well. Even feelings of love can be influenced by cognitive fusion. But this process can also impair behavior in individuals with certain psychological issues. People who struggle with anxiety and depression experience negative thoughts that can prevent them from taking positive actions. For instance, when someone with depression focuses on feelings of worthlessness because they have been unable to overcome their depression, they may continue to avoid seeking help because of the perceived outcome. Individuals who suffer with anxiety also find themselves trapped by cognitive fusion when for instance, they believe they will panic if they are exposed to stressful situations, and therefore avoid all situations that could induce stress, even if they are necessary for recovery.

Understanding how cognitive fusion affects mental health is a relatively new area of research. Acceptance and commitment therapy (ACT) is a mindfulness-based therapeutic approach that teaches clients how to accept negative feelings independently of perceived outcome. Therefore, ACT and other mindfulness techniques aim to teach cognitive de-fusion. Because there is little evidence exploring this, Kristen N. Herzberg of the Department of Psychology at the University at Albany of the State University of New York, recently conducted a study that employed a new tool to measure the effectiveness of ACT on cognitive fusion.

Herzberg and her colleagues developed the Believability of Anxious Feelings and Thoughts Questionnaire (BAFT) and administered it to over 900 individuals, half of whom struggle with extreme anxiety, undergoing 12 weeks of internet ACT treatment. She found that BAFT was quite accurate at identifying levels of cognitive fusion. Specifically, the BAFT was able to measure anxiety sensitivity, avoidance, and cognitive de-fusion in the participants. The results also showed that the anxious participants saw significant reductions in avoidant behaviors after completing the cognitive fusion–targeted ACT program. Herzberg added, “Taken together, these findings suggest the BAFT to be a reliable, valid, and useful measure of cognitive fusion.”

Reference:
Herzberg, K. N., Sheppard, S. C., Forsyth, J. P., Credé, M., Earleywine, M., Eifert, G. H. (2012). The Believability of Anxious Feelings and Thoughts Questionnaire (BAFT): A psychometric evaluation of cognitive fusion in a nonclinical and highly anxious community sample. Psychological Assessment. Advance online publication. doi: 10.1037/a0027782

Women have been stereotypically defined as being more emotional than men. In popular culture, women are depicted as being more emotionally volatile, often erupting into fits of sadness, anger, despair or jealousy much more frequently than their male counterparts. But is this portrayal scientifically accurate? Research has shown that there are differences in how men and women emotionally respond to situations. However, little research has addressed the core self-conscious emotions (SCE) of men and women and how they differ. Nicole M. Else-Quest of the Department of Psychology at the University of Maryland in Baltimore sought to debunk the myth that women have less emotional regulation than men. She recently conducted a study that compared male and female levels of embarrassment, shame, guilt, and pride in data gathered from over 300 studies.

[fat_widget_right]

Existing research has shown that women and men differ in their risks for some mental health issues such as depression, food and eating issues, anxiety, and self-worth. How men and women experience SCEs has a direct influence on their likelihood of developing these and other psychological problems. Else-Quest analyzed over 200,000 self-reports and found that for the most part, women and men had similar levels of SCEs. The results revealed slightly higher levels of guilt and shame in the women, but minimal differences in pride and embarrassment. Else-Quest also looked at age as a factor because men and women tend to exhibit the first signs of depression, anxiety, and low self-esteem at different ages. She found that although there were relatively few differences in SCEs in early childhood, women reported higher levels of SCEs, primarily shame and guilt, during adolescence.

Overall, Else-Quest discovered that women experienced the highest levels of guilt and shame when they were asked about sex, food and eating, body image, or the environment. Although the rates of SCEs in these areas were only slightly higher for women than men, these results support existing research regarding women’s emotional perceptions about sex, body image, and eating problems. Else-Quest concluded by saying that even though women had minimally elevated levels of guilt and shame, the men and women reported levels of pride and embarrassment that were virtually identical. She added, “These findings contribute to the literature demonstrating that blanket stereotypes about women’s greater emotionality are inaccurate.”

Reference:
Else-Quest, N. M., Higgins, A., Allison, C., Morton, L. C. (2012). Gender differences in self-conscious emotional experience: A meta-analysis. Psychological Bulletin. Advance online publication. doi: 10.1037/a0027930

Cognitive behavioral therapy (CBT) is a widely used approach to treat symptoms of general anxiety disorder (GAD). The goal of CBT is to help an individual be more tolerant of their worrying behaviors, thus decreasing the negative psychological and physical symptoms of GAD. Applied relaxation (AR) is an alternative approach that is used for various mental health problems, including GAD. It focuses on the somatic symptoms of tension and physical discomfort associated with anxiety, with the goal of reducing worry. Both CBT and AR have been shown to be effective at diminishing the symptoms of GAD in individuals who struggle with emotional and somatic symptoms. However, few studies have compared the dynamics that cause the symptom reduction in each of these treatment approaches.

Eleanor Donegan of the Department of Psychology at Concordia University in Montreal sought to identify the mechanisms by which AR and CBT worked and also to determine if one was more effective than the other at maintaining long-term symptom reduction. For her study, Donegan evaluated 57 individuals who underwent either AR or CBT over a period of 12 weeks. She found that for both groups, the amount of time they spent worrying each day decreased from approximately 36% of the time to 20%. Additionally, both AR and CBT reduced the amount of daily anxiety by nearly 50%.

Donegan noted that even though the participants were much less anxious as a result of their treatment, they still had significantly higher levels of worry and anxiety than non–clinically anxious individuals. When Donegan looked at how the effects were achieved, she found similarities and differences. Specifically, even though both AR and CBT decreased somatic anxiety, the effect on worry was more significant in the individuals who underwent CBT. However, Donegan believes that both of these techniques could be useful to address GAD. She added, “Change in worry occurs in part because of change in somatic anxiety, and vice versa, in both CBT and AR.”

Reference:
Donegan, E., Dugas, M. J. (2012). Generalized anxiety disorder: A comparison of symptom change in adults receiving cognitive-behavioral therapy or applied relaxation. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0028132

Racism and prejudice are issues that are at the forefront of social concern today. Ethnic differences are causing riots, uprisings, and loss of life in nations throughout the world, including our own. Classic conditioning is a theory that suggests that individuals learn racism and prejudice through exposure to events by either experiencing them personally or observing them. Once a perspective is formed, it can be reinforced through continual verbal, visual, or actual cues. For instance, a person who has a fearful encounter with someone from another race may later see others exhibit fear, thus reinforcing their opinion and prejudice of that race. Likewise, this effect can be reversed if this same person goes on to experience positive situations with people of the other race. Either way, discrimination and prejudice are learned at a very young age and unless it is reversed, can lead to significant stress and anxiety. People who are discriminated against based on their religion, race, or sexual preference often face obstacles in many areas of their lives. Finding a career, a job, or school can be a challenging experience for people who are faced with prejudice and discrimination.

To identify how different ethnic groups learn racism and how it is perceived across different races, David Rollock, Associate Professor of the Department of Psychological Sciences at Purdue University, recently conducted a study involving participants who were African American, White, Asian, and Hispanic. The 282 participants ranged in age from 17 to 61 years old and responded to a questionnaire that asked them about their experiences with prejudice. They were instructed to report their emotional responses to various interracial encounters, positive and negative.

Rollock discovered that the White participants had the strongest negative emotions as a result of bad interracial experiences, while other races experienced lower levels of negativity. The findings also showed that Whites reported fear as the most common response to negative interracial experiences, regardless of whether they were verbal, observed, or physically experienced. Whites and African Americans had similar levels of anxiety, but these levels were much lower than levels found in the Asian and Hispanic participants.

Although all the participants exhibited anger as a result of interracial experiences, it was minimal. Rollock also found that some of the participants had positive interracial experiences that decreased their prejudice, but the effect was minimal. Rollock added, “Interestingly, people from different ethnic and sex groups did not appear to ‘learn’ their adverse race-elicited emotions in different ways, suggesting that strategies that build or reduce adverse race-elicited emotion for members of one group should be similarly effective with other groups.” This finding could help clinicians who are dealing with victims and perpetrators of racial intolerance. By understanding that the mechanism that leads to prejudice and racism is similar across all races, mental health professionals should be able to help most people overcome these obstacles, regardless of their ethnicity.

Reference:
Conger, A. J., Dygdon, J. A., Rollock, D. (2012). Conditioned emotional responses in racial prejudice. Ethnic & Racial Studies 35.2, 298-319.

Making a diagnosis of generalized anxiety is sometime a tricky proposition. Anxiety has many manifestations as well as many underlying causes. Anxiety may be chronic and always at the edge of a person’s consciousness or the condition may flare up in acute episodes called panic attacks. Appropriate treatment is essential and typically involves a mix of cognitive-behavioral therapy, pharmaceuticals, and careful follow-up by the treating physician. Xanax (alprazolam) is currently one of the preferred medications for dealing with many anxiety-related psychological illnesses. Anxiety should not be ignored, as the effects of nervous tension and fear include a decrease in quality of life, along with possible secondary effects such as high blood pressure.

Researchers in the Netherlands recently tested a model for understanding the nature of anxiety in humans. At the same time, the experiment highlighted the effectiveness of certain medications at reducing some aspects of anxiety. Specifically, these researchers used the startling effects of white noise and electric shocks to induce surprise or fear in the subjects. In addition to Xanax, subjects were given Lyrica (pregabalin), diphenhydramine (a common sedative ingredient in over-the-counter cold remedies), or placebo. Individual anxiety levels were measured through subjective reporting and a number of objective tests, including eye movements, pupil dilation, and skin conductance. The design of the experiment included random shocks and noises, both with and without prior warning.

As expected, shocking events preceded by a warning produced less anxiety than those that came by surprise. Both Xanax and diphenhydramine reduced overall levels of anxiety but for very different reasons. Whereas Xanax works by altering certain neurotransmitter levels, diphenhydramine has a more general, systemic effect. Surprisingly, subjects given Lyrica showed very little modulation of their anxiety levels. Researchers surmised that because Lyrica takes longer (up to 6 hours) to reach peak effectiveness, the experiment wasn’t capturing an accurate picture of events.

This experiment confirmed that Xanax is effective at reducing one manifestation of anxiety: the so-called “fear-potentiated startle response.” However, the results were less informative about anxiety in general than the researchers had hoped. The sample size was too small to uncover any new revelations about the nature of human anxiety. Ideally, research will one day make the work of quickly and accurately diagnosing anxiety disorders much easier and more straightforward.

References
Baas, J., Mol, N., Kenemans, J. L., Prinssen, E. P., Niklson, I., Xia-Chen, C., et al. (2009). Validating a human model for anxiety using startle potentiated by cue and context: the effects of alprazolam, pregabalin and diphenhydramine. Psychopharmacology, 205, 73-84.