Reflections From A Chair

If the economy isn’t enough to give you agita (see my earlier post), then all the press about swine flu might do the trick.

Let’s recall the basics of anxiety: something bad, we’re not sure just what but it’s bad, may happen in the future and there’s nothing we can do about it. I discussed this in the third post in this series, last October. More formally stated, Wikipedia has it that “Anxiety is a generalized mood state that occurs without an identifiable triggering stimulus. As such, it is distinguished from fear, which occurs in the presence of an external threat.”

If you’ve been following along, those two sentences give a key to one of the ways to deal with anxiety. That is, turn anxiety into fear. We should get as specific as we can about the nature of the threat and then do what we can to prepare for it. After that, get on with your daily life, stop ruminating about the potential threat, enjoy the Spring.

In that vein, here are links to the most recent and reliable information I could find about swine flu.

• Centers For Disease Control and Prevention

By the way, doesn’t the very name of that agency help your anxiety? The name promises control and ways to prevent disease.

• United States National Library of Medicine
• Medline Plus

In addition to the tips on what to do in those articles, here are some recommendations for general emergency preparedness.

• Ready America

Now, turn off the TV and do a bit of light exercise. Then make plans to go out and have some fun. And remember to get seven to eight hours of sleep per night and eat a sensible diet. Avoid caffeine, nicotine, alcohol and other drugs.

Long term stress suppresses the immune system. So by following these steps, you can reduce your stress levels and maintain a healthy immune system just in case you need it later.

Just a short post today.

It’s very annoying when my dogs relieve themselves when they are alone in the house. They’ll even do it just after being outside for an extended time and then are left alone in the house.

It’s not something they do if anybody is home with them.

Till today, I never thought of it as a possible symptom of separation anxiety. Who knew?

Here’s an informative and helpful article in The Post and Courier.

And as the author points out, “adding another pet to the household generally will not work.” At least it didn’t in my case. I’m going to try out the other suggestions.

Meanwhile, I’m working on two other posts. One about national healthcare and the other about a recent study on comorbid anxiety disorders.

Three new pieces of research on the interconnection of stress and the body.

The first comes to us from Journal of the American College of Cardiology. As reported by CNN, there may be “a link between mental stress and sudden cardiac arrest, which causes more than 400,000 deaths every year.” The study’s author, Dr. Rachel Lampert, suggests that “Perhaps if we treat them with something like stress management or anger management, we may decrease the likelihood of arrhythmias,” she said.

The New York Times reported on a study by McGill University. The study found that “people who were abused or neglected as children showed genetic alterations that likely made them more biologically sensitive to stress.” There is still much follow-up research needed. But this study partly explains how childhood stress and abuse can create lasting problems for the abused.

The NIMH also has new research on chronic stress and its long-term effects. “repeated exposure to stress may be related to many physical and mental illnesses.” “However, chronic stress may lead to chronically elevated levels of glucocorticoids, which in turn may reduce cell functioning, via the interaction between GR/Bcl-2 and mitochondria. The decrease in proper cell function may be at the root of certain physical and mental illnesses”

A recent study, Beyond extinction: erasing human fear responses and preventing the return of fear, is making a lot of headlines.

I will go through the study in a moment. But first I want to make an observation from my clinical experience.

A number of persons that I treated for anxiety disorders were on propanolol. Some used it for cardiac health, some took it to help with their anxiety problems. Their anxiety disorders ranged from uncomplicated phobias to severe, chronic PTSD stemming from service in the Viet Nam war.

For better or worse, I cannot confirm the results claimed in the new study. I did not, then or in retrospect now, find that the exposure trials or treatment in general went any smoother or quicker for the persons on propanolol. Nor did I find that the medication extinquished the fear associated with memories of the war.

Admittedly, my sample size is not as statistically significant as the one in the study. My treatment approach did not incorporate the fact, one way or another, that the patient was on propanolol. In fact, for all intents and purposes, I ignored whether or not they were on that medication.

But I think I would have noticed something if propanolol had such beneficial effects. At least I would recall those patients as being easy cases. In fact, two of them are among the most memorable for the tenacity and duration of their symptoms.

With that caveat, let me summarize the recent research.

When we bring a memory to consciousness, there is the potential to change parts of that memory and the emotions assoicated with it. This, itself, is not a new concept. It goes back to at least Freud. The process of recalling and changing aspects of a memory is termed "reconsolidation" in this and other studies.

The authors "repeatedly showed healthy volunteers pictures of spiders, one image of which was followed by an electrical shock." (Aren’t you glad you did not volunteer for that study?)

The volunteers learned to associate the image of the spider with fear. The degree of fear was measured by the "startle response" exhibited by the subjects.

Afterwards, some of the volunteers received propanolol and others got a placebo. They were then tested for how much of a startle response was elicited by the the image of the spider.

The authors found that for persons given the propanolol "the conditioned fear response was not only reduced but even eliminated…"

In contrast, those who got the placebo, their "startle response remained significant."

Simply put, after receiving propanolol, “The people did not forget seeing the photograph of the spider,” Kindt says. ”But the fear associated with the image was erased."

How does that work in the brain? The authors suggest that "(i)t may be hypothesized that beta-adrenergic blockade during reconsolidation may selectively disrupt the protein synthesis of the amygdalar fear memory, resulting in deconsolidation of the fear memory trace while leaving the declarative memory in the hippocampus untouched."

Furthermore, “Beta-blockers wouldn’t stop reconsolidation of only frightening memories, the researchers say. ‘It’s likely that any emotional memory, happy or sad, recalled after taking the drug would be dulled,’ Kindt speculates.”

On the clinical side, these findings would suggest using propanolol in conjunction with procedures like Breur’s abreaction, Freud’s cathartic method, some Gestalt therapy procedures, NLP’s dissociating and reframing, venting, exposure and other methods.

The question remains about how to square this study’s findings with my clinical experience. Here are a few guesses. It may be that there was something peculiar to the patients I treated that made them resistant to the benefits of propanolol. That, I suppose, is possible but I do not think it is likely. Alternatively, it may be that propanolol is useful in treating newly acquired fears or phobias. Or it may have a prophylactic benefit for people soon to be exposed to a trauma (think of a firefighter going to his/her first apartment building fire, a sniper fresh from boot camp about to be deployed to an Afghan hilltop).

In the end, I agree with the Guardian’s conclusion: "we don’t know whether the results would apply outside of this artificial situation. We need to see good-quality studies among people who have suffered a genuinely painful or upsetting event, to see whether this type of treatment can help them in a meaningful way."

And then there are some ethics questions to be addressed.

Kerri Smith hints at this by recalling the movie “Eternal Sunshine of the Spotless Mind.” Do we use drugs to extinguish affective memories of unhappy relationships?

If propanolol is effective in negating or dulling the emotional aspect of an event, what impact would that have on the decision-making of, say, a sniper determining whether or not to take a shot if the pathway to the target was through the body of a civilian? Would it embolden persons considering a heroic act? What would it do for persons about to commit a violent crime?

This study, for me, raises as many questions as it answers.

NPR had a nice piece on the emotional impact of the economic recession. From resilience to panic to suicide attempts, NPR covers it all.

You can read it here: Economic Crisis, Unemployment Take Emotional Toll.

Or you can listen to it here.

• Washington University’s newspaper reports on a study of social phobia among college students. One of its findings is that unstructured discussion of past upsetting events raises the distress level for some people. On the other hand, when the interview was structured, the “subjects’ moods did not worsen.”
• The NIH is promoting meditation, yoga, tai chi and Pilates as means to improving physical and mental health. There is also discussion of the interconnection between physical and mental well-being. You can read the Washington Post’s article here.
• Empowerher.com reports on a study of the long-term relationship between childhood separation anxiety disorder and adult panic disorder. “Genetic determinants appear to be the major, underlying cause…” However, “childhood parental loss is a truly environmental risk factor uninfluenced by genetic factors, it can further affect susceptibility to panic disorder and perhaps alter an individual’s respiratory physiology for a long time.” Read more about this interesting article here.
• “The Capital Times” writes about the effect of the current economy on persons’ mental health. Some of the conclusions are “As people lose jobs or watch their retirement savings dry up, some local psychiatrists say they are seeing an increasing number of new patients with depression or anxiety, and that the symptoms of some current patients have worsened.Beyond that, these doctors say, many who need treatment aren’t receiving it because they cannot pay, having lost their jobs or their insurance.”
• A study on “unexplained chest pain” finds that there are “several common factors among those affected, including stress at work, anxiety, depression and a sedentary lifestyle.”
  Which reinforces the benefits of stress reduction and an active lifestyle, as mentioned above in the reference to the NIH’s recent efforts.