The Year of Living Anxiously

by Henry Emmons, M.D.

The Anxiety Resolutions


There are sure-fire ways to make yourself anxious, if you wanted to do so. No one would do this on purpose, yet without knowing it that is exactly what many of us do every day. How do we do it? Here’s my list of some of the most common mistakes that aggravate the condition we call anxiety. But first I’d like to comment on stress.

In my opinion, stress has gotten a bad rap. Life is stressful, and always has been. Yet when we feel like ourselves, we are naturally resilient. We adapt to stresses remarkably well, often finding ourselves stronger or more skilled by having confronted life’s unavoidable challenges.

Stress alone is not the problem. Instead, we become our own enemy. The common mistakes that follow will reliably turn everyday stress into overwhelming anxiety:

1.) Keep thinking about what is wrong.
Neuroscience has confirmed what we already know: when we replay worrying thoughts again and again, we strengthen the neural pathways for those thoughts, so that they become ingrained in our mind like bad habits. It is as if we are rehearsing worry and anxiety. As with anything, we get better and better at it with practice.

2.) Keep talking about what is wrong.
Pop psychology has given us the notion that it is good to express our feelings. That can be true, but many of us take that to mean that we should “vent”. If someone is willing to listen, we often share our stories of woe. Repeated unloading keeps our anxious feelings alive and may even strengthen them.


3.) Over-stimulate yourself.
Caffeine, tobacco, loud noise, driving fast, working without breaks, skipping meals-there are so many ways to keep the body and brain on overdrive and keep the anxiety levels high.

4.) Don’t allow for time to refresh and renew.
After a stressful experience, it is normal and healthy to take time to rest and recover. That lets the body’s stress response system calm down, reset and get prepared for the next challenge. Our ancestors ran and then they rested; we stay on the treadmill. Not allowing for downtime differentiates our response to stress from every other time in human history.

5.) Stay constantly busy.
This is a variation on the last point. It is not only during the stressful times in life that we overdo. Most of us do too much every single day. You may have heard the phrase: “We are human beings, not human doings.” We are simply not designed to be on the go 24/7.

6.) Give in to your cravings.
Most of us reach reflexively, without thinking, without deciding, for something to soothe ourselves when we feel stressed or anxious. We often eat comfort food like sweets or other food laden with carbs and fats. Whatever we crave, we crave it because it makes us feel better-for much too short a time. Unfortunately, the comfort is brief and we almost always end up feeling worse in the long run.

7.) Short-change your sleep.


If there were a single sure-fire way to break a person down, it would have to be too little sleep. Lack of sleep is an accelerator toward most mental illness, and anxiety is no exception. Getting an average of 7-8 hours per night is not only helpful, it is essential.

8.) Stay sedentary.
Think about what happens in nature: the “fight or flight” reaction means that stress hormones flood the body, priming it for some kind of physical action. Sitting most of the day means the stress hormones have nothing to do but re-circulate. Moving your body helps to discharge the effects of all of those stress hormones and reset yourself back to a normal resting state.

9.) Isolate yourself.
It is a wonder that so many have become isolated and alone when we are clearly wired to connect. As the Dalai Lama has said, “We can live without religion and meditation, but we cannot survive without human affection.” Meaningful connection doesn’t solve everything, but it goes a very long way toward helping us endure the difficult side of life.

10.) Believe that you’re in it on your own.
The spiritual traditions give us a consistently reassuring message: “All will be well.” But when our brains get locked into anxious patterns, we can’t believe that. We see our small, individual selves as being solely responsible for our lives without any support. It is an illusion. If we can see through it, we can tap into a deep well of reassurance and hope.

11.) Watch the news daily.
You’ve heard that we are what we eat. We may also be what we take in through our eyes and ears. A study in Scandinavia showed that watching the evening news, filled with stories of tragedy, violence or other bad news, had a strong effect on rates of anxiety and depression. Does that mean that we should keep our head in the sand? No, but it may be wise to pay attention to what we are feeding ourselves through our minds, especially when we are going through personally hard times.

12.) Play video games.
It should come as no surprise that a game that simulates trauma and violence would put the brain into a state that is similar to the real thing. Researchers have found that common video games do just that. They may even create lasting brain changes so that things don’t go right back to normal when the game is done. The news is not all bad for video games, though. Soldiers in Iraq who played an absorbing game like Tetrus shortly after witnessing a trauma were able to protect themselves from developing post-traumatic stress symptoms.

13.) Become addicted to stress.
Some people appear to thrive on stress. They choose to remain overly committed, or constantly create high drama in their lives, and they seem to do fine. But if the stress stops, things begin to crumble. It is as if they have become addicted to stress and the high level of stress hormones that flood their body. Take the stress away, and they go into a form of withdrawal. Since no one can remain stressed forever without consequences, they should heed the warning signs and get a handle on their stress level.

We would do well to avoid what we can of the above pitfalls, but we won’t do it perfectly any more than we can keep all of our resolutions to do the right things. If we are in the game of life, stress cannot be avoided. That is all the more reason to become better at dealing with it.

Fear of Success

by Susanne Babbel, Ph.D., MFT


“Why are some people afraid to succeed but not to fail? Why are some more afraid of failure? How can one learn to embrace these two fears? What is the difference between them?”

A young Canadian woman wrote to me recently with these inquiries. I thought they were excellent questions, and decided to share my thoughts and findings here.

We are all so complex, and the way we react to situations and anticipate results is based on many physiological and psychological factors. So many, in fact, that it can be difficult to generalize why different personality types might handle success versus failure in such drastically polarized ways.

As a psychologist specializing in trauma and PTSD (Post Traumatic Stress Disorder) I’ve had firsthand experience coaching clients whose past experience feeds their current fear of success. For them, the excitement of success feels uncomfortably close to the feeling of arousal they experienced when subjected to a traumatic event or multiple events. (This feeling of arousal can be linked to sexuality, in certain cases where trauma has been experienced in that realm, but that is not always the case.) People who have experienced trauma may associate the excitement of success with the same physiological reactions as trauma. They avoid subjecting themselves to excitement-inducing circumstances, which causes them to be almost phobic about success.

There is another layer to the fear of success. Many of us have been conditioned to believe that the road to success involves risks such as “getting one’s hopes up” – which threatens to lead to disappointment. And many of us-especially if we’ve been subject to verbal abuse-have been told we were losers our whole lives, in one way or another. We have internalized that feedback and feel that we don’t deserve success. Even those of us who were not abused or otherwise traumatized often associate success with uncomfortable things such as competition and its evil twin, envy.

In order to have a healthy relationship with success (and it’s flip side, failure, or disappointment), the first step is to learn to differentiate between feelings of excitement and a “trauma reaction.”

Here is an easy exercise:

  1. Recall an event where you were successful or excited when you were younger, and notice what you are feeling and sensing in your memory. Stay with the sensation of for 5 minutes. 
  2. Recall an event where you were successful and excited recently in your life, and notice what you are feeling and sensing. Stay with this sensation of for 5 minutes.
  3. Now tap into the sensation of a memory of an overwhelming situation. I suggest not to start with a truly traumatic event, at least not without a therapist’s support. Start with something only moderately disturbing to you. 
  4. Now, go back to visualizing your success story. Do you notice a difference?

While corresponding with the young Canadian woman, I asked her to do look up bodily response to fear and excitement and let me know what she found. This is what she wrote back:

“I was looking up how the body responds to fear, and it said that when we sense fear the brain transmits signals and our nervous system kicks, in causing our breathing to quicken, our heart race to increase… we become sweaty, and we run on instinct. When we get excited or enthusiastic, doesn’t our nervous system work the same way?”

I assured her that, yes, the physical reactions to stress and to excitement are very similar. So, when we experience a traumatic event—such as a car accident or a school bullying incident—our body associates the fear we experience with the same physiological feelings we get while excited. Once we have been through enough trauma, we start to avoid those types of situations that trigger memories of fear. For this reason, trauma victims can tend to avoid excitement, and that can lead them to avoid success.

I work with trauma victims to get past their fears and associations and help them embrace and follow the path to success and healthy recovery.

Depression Thwarts Attempts to Quit Smoking

By RICK NAUERT PHD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on January 3, 2011


New research suggests diagnosed or undiagnosed depression can hinder an individual’s efforts to stop smoking.

In the study, published in the January 2011 edition of the American Journal of Preventive Medicine. scientists determined approximately 24 percent of surveyed callers to the California Smokers’ Helpline currently suffered from major depression and 17 percent of callers had mild depression.

Over half the surveyed callers, depressed or not, made at least one attempt to quit after calling the helpline.

At the two-month mark, however, the success rate of those with major depression was much lower than that of mildly depressed or non-depressed callers. Nearly one in five callers with major depression reported success, but of others, nearly one in three was able to remain smoke-free.

Most quit-lines do not assess smokers for depression, even though mild depression already is known to reduce the success of quitting. This study suggests that major depression reduces the success rate even farther.

That is important because the California quit-line receives a high number of calls from heavy smokers and smokers on Medicaid – two circumstances associated with depression. Since more than 400,000 smokers call U.S. quit-lines every year, the authors believe that up to 100,000 depressed smokers nationally are not getting the targeted treatment they need.

“Assessing for depression can predict if a smoker will quit successfully, but the assessment would be more valuable if it were linked to services,” said lead study author Kiandra Hebert, Ph.D., of the University of California at San Diego.

Hebert said an integrated health care model is a potential solution. Depressed smokers could have better quitting success if they receive services that address both issues. Quit-lines, which are extremely popular, are in a good position to offer such services to a large number of depressed smokers and to pass on the services they develop to quit-lines across the country.

Treatment programs, including quit-lines, report that a growing number of callers have other disorders, such as depression, said Wendy Bjornson, co-director of the Oregon Health & Science University Smoking Cessation Center, who was not involved in the study.

“The results of this study are important. They show the scope of the problem and point to the need for protocols that can lead to better outcomes.”

Source: Health Behavior News Service

Risk for Alcoholism Linked to Risk for Obesity

ScienceDaily


The researchers noted that the association between a family history of alcoholism and obesity risk has become more pronounced in recent years. Both men and women with such a family history were more likely to be obese in 2002 than members of that same high-risk group had been in 1992.

“In addiction research, we often look at what we call cross-heritability, which addresses the question of whether the predisposition to one condition also might contribute to other conditions,” says first author Richard A. Grucza, PhD. “For example, alcoholism and drug abuse are cross-heritable. This new study demonstrates a cross-heritability between alcoholism and obesity, but it also says — and this is very important — that some of the risks must be a function of the environment. The environment is what changed between the 1990s and the 2000s. It wasn’t people’s genes.”

Obesity in the United States has doubled in recent decades from 15 percent of the population in the late 1970s to 33 percent in 2004. Obese people — those with a body mass index (BMI) of 30 or more — have an elevated risk for high blood pressure, diabetes, heart disease, stroke and certain cancers.

Reporting in the Archives of General Psychiatry, Grucza and his team say individuals with a family history of alcoholism, particularly women, have an elevated obesity risk. In addition, that risk seems to be growing. He speculates that may result from changes in the food we eat and the availability of more foods that interact with the same brain areas as addictive drugs.

“Much of what we eat nowadays contains more calories than the food we ate in the 1970s and 1980s, but it also contains the sorts of calories — particularly a combination of sugar, salt and fat — that appeal to what are commonly called the reward centers in the brain,” says Grucza, an assistant professor of psychiatry. “Alcohol and drugs affect those same parts of the brain, and our thinking was that because the same brain structures are being stimulated, overconsumption of those foods might be greater in people with a predisposition to addiction.”

Grucza hypothesized that as Americans consumed more high-calorie, hyper-palatable foods, those with a genetic risk for addiction would face an elevated risk from because of the effects of those foods on the reward centers in the brain. His team analyzed data from two large alcoholism surveys from the last two decades.

The National Longitudinal Alcohol Epidemiologic Survey was conducted in 1991 and 1992. The National Epidemiologic Survey on Alcohol and Related Conditions was conducted in 2001 and 2002. Almost 80,000 people took part in the two surveys.

“We looked particularly at family history of alcoholism as a marker of risk,” Grucza explains. “And we found that in 2001 and 2002, women with that history were 49 percent more likely to be obese than those without a family history of alcoholism. We also noticed a relationship in men, but it was not as striking in men as in women.”

Grucza says a possible explanation for obesity in those with a family history of alcoholism is that some individuals may substitute one addiction for another. After seeing a close relative deal with alcohol problems, a person may shy away from drinking, but high-calorie, hyper-palatable foods also can stimulate the reward centers in their brains and give them effects similar to what they might experience from alcohol.

“Ironically, people with alcoholism tend not to be obese,” Grucza says. “They tend to be malnourished, or at least under-nourished because many replace their food intake with alcohol. One might think that the excess calories associated with alcohol consumption could, in theory, contribute to obesity, but that’s not what we saw in these individuals.”

Grucza says other variables, from smoking, to alcohol intake, to demographic factors like age and education levels don’t seem to explain the association between alcoholism risk and obesity.

“It really does appear to be a change in the environment,” he says. “I would speculate, although I can’t really prove this, that a change in the food environment brought this association about. There is a whole slew of literature out there suggesting these hyper-palatable foods appeal to people with addictive tendencies, and I would guess that’s what we’re seeing in our study.”

The results, he says, suggest there should be more cross-talk between alcohol and addiction researchers and those who study obesity. He says there may be some people for whom treating one of those disorders also might aid the other.

This work was supported by grants from the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse of the National Institutes of Health.

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Washington University School of Medicine.

More underage drinkers end up in ER on New Year’s

By Michelle Healy, USA TODAY


Alcohol-related New Year’s celebrations send an alarmingly high number of young people to hospital emergency rooms, says a report out today.

In 2009, 1,980 hospital emergency department visits involved underage drinking, according to the report from the federal Substance Abuse and Mental Health Services Administration (SAMHSA). That’s nearly four times the daily average number of emergency department visits for drinking-related visits by people under 21, the report says. It’s two to three times the number of visits recorded on other “party” holidays, namely Fourth of July weekend (942) and Memorial Day weekend (676)

The study looked at all alcohol-related ER visits, but it did not specify whether they involved traffic accidents, alcohol poisoning or other issues.

The huge rise of drinking-related incidents on New Year’s “should startle us. It should wake us up,” says Peter Delany, director of SAMHSA’s Center for Behavioral Health Statistics and Quality, which did the analysis.

Though any underage alcohol consumption is cause for concern, drinking can also increase the likelihood of other risky behaviors, Delany says.

The findings are in line with other research showing more alcohol-related problems over the winter holidays, SAMHSA says.

Two to three times more people die in alcohol-related vehicle crashes during that time than during comparable periods the rest of the year, the National Institute on Alcohol Abuse and Alcoholism says. And 40% of traffic fatalities during winter holidays involved an alcohol-impaired driver, compared with 28% for other dates in December.

Fueling the underage drinking problem, especially at this time of the year, is “a combination of greater access to alcohol, less parental oversight and mixed messages” about celebrating with alcohol, Delany says.

Young people are told “don’t drink, don’t do that, but in every third commercial in recent weeks, we see something linked to alcohol and drinking,” he says.

And there’s also the issue of “what kind of message parents may give,” Delany adds. “Maybe they’re drinking a lot. Kids see that it’s OK.”

What is needed is a long-term message “that underage drinking is not OK,” he says. “But adolescents don’t do well with ‘Just say no.’ We have to find ways to help young people make good decisions.”