Archive for March, 2009

When the brain sounds a false alarm

Monday, March 30th, 2009

Anxiety disorders, like most mental disorders, involve multiple causes including genetic, biological, social, and learning. And successful treatments sometimes target psychological or biological systems. Nevertheless, it is useful to consider that for most people with an anxiety disorder, there are false alarms sounding in the brain that set off a spiral of effects on the body that can lead to significant health concerns.

Let’s start at the beginning. Most people are frightened or startled by:

  • loud noises
  • sudden unexpected movements
  • dark unfamiliar places
  • large animals growling
  • suddenly appearing snakes
  • precarious heights

When scary things happen, the brain sends signals to the rest of our body to get ready to run like hell or take a stand and fight. Two areas in the brain appear to be the most crucial to fear responses: the hippocampus, which helps store verbal memories, especially those with emotional tones and the amygdala, which seems to govern and interpret fear. This circuit sends messages to the multiple brain systems that activate various stress hormones that in turn make the heart beat faster, increase blood pressure, and boost muscle power. This response evolved to keep us safe and works well when dangers are encountered.

The problem in anxiety disorders is that this system in the brain is turned on when there are no slimy snakes, roaring elephants, or dark and scary places. The fears and worries that people with anxiety have often involve anticipatory worries-or “what if?”

Being in this constant state of false alarm (imagine a fire signal blaring continuously in your brain) increases anxiety and can also damage your body. People with chronic Post Traumatic Stress Disorder have been found to have decreased volume in certain areas of the hippocampus (an area that is associated with memory). Physical costs of anxiety are far reaching, but surprisingly, so are the financial costs. One study in the Netherlands reported in the Journal of Abnormal Child Psychology found that anxious children cost society 21 times more than those children not judged anxious. Adults with anxiety disorders are more likely to have high blood pressures, diabetes, thyroid disease, gastrointestinal disorders, and cardiac disorders.

With all of the costs, including emotional, financial, and physical, treatment is …

The ABC's of OCD Treatment for Kids

Saturday, March 28th, 2009

Parents of children with OCD or symptoms of OCD want to help their kids get the best and most effective treatments. There are many options with many different names. For example in the treatment of OCD, we hear about CBT, BT, EXRP, ERP, E & RP. Professionals love initials! So how does a parent without a doctorate degree in psychology make an informed decision about what treatment to seek?

There is a large body of scientific literature that discusses evidence based psychotherapies for children. Despite the various names, settings, and formats, treatments that work often have common theoretical bases. In other words, whether the treatment is called CBT (cognitive behavioral therapy), BT (behavioral therapy), or one of the many initial permutations of Exposure and Response Prevention (EXRP, ERP, or E & RP), all of these treatments use elements of learning theory as a core foundation. The most widely studied and frequently used technique for treating OCD is exposure and response prevention.

Helping a child with OCD usually includes educating the parent about the disorder. Seeing a child once a week for therapy is seldom sufficient for eradicating OCD. That’s why parents will benefit from learning about how their own behaviors can influence their child’s symptoms. If your child is receiving therapy, the therapist is likely to show you exactly how these principles may be used to understand and help your specific child. Here are a few points based on learning theory the therapist may discuss depending upon an analysis of your child’s OCD:

  • Positive reinforcement: When a child behaves and the parents give positive reinforcement the behavior will increase. For example, although most parents generally wouldn’t do this, if a child with OCD washes her hands for long periods of time and her parent tells her what a good job she is doing, this behavior is likely to increase. That’s because for most children, praise is a positive reinforcement. Other positive reinforcements can include hugs, treats, or special time together.
  • Negative reinforcement: Negative reinforcement occurs whenever an action results in the cessation of an unpleasant, aversive event (stimulus). So when a child throws a temper tantrum (an unpleasant event) and …

OCD Sprouts Early

Tuesday, March 24th, 2009

Lots of young children have OCD like symptoms that never develop into the disorder. For example, we have two grand-babies under the age of two. One of our granddaughters, Alaina, comes over to our house and gets the same book out of the same bookcase and pulls one of us over to read her that book about 10 times. Throughout the day, whenever she is tired or stressed, she finds the book and finds an adult and the book is read another few times. This simple pattern provides her with comfort and a sense of security in her world.

Our grandson, Carter, has a different pattern. He usually goes to two kitchen drawers (that we have especially designed for him). In one drawer, he takes out the measuring cups, several large stirring spoons, and what ever else we have put in the drawer. Then he moves to the next drawer where he has completely unraveled some aluminum foil (we’ve since moved the roll to a higher drawer). After getting “his” utensils on the floor, he is ready to begin exploring. During this time, he seriously walks around the house opening and closing all of the doors. With his work done, he can go off to play.

These rituals are perfectly normal. However, if they continue to occur when the kids are 6 or 7, we might begin to be concerned. That’s because OCD, even more so than depression or anxiety, usually starts to make its appearance during childhood.

We know that OCD is caused by a mixture of nature and nurture. But what can parents do to make sure that they don’t increase the odds of having a child with OCD?

Giving too much information to young children. The world is a scary place. But your 2 or 3 year old should not be exposed to news stories about violence, kidnapping, or terror. It is the parents’ responsibility to keep a young child safe.

Be careful about what you say. Kids tend to believe what their parents say. Here are a few examples: Johnny age 5 kicks his 4 year old sister for taking her toy. It’s perfectly okay …

Hoarding OCD

Friday, March 20th, 2009

Many people have trouble throwing things away. Actually, to a degree that’s me! But, most of us aren’t considered true hoarders. Hoarders are people who collect huge (and I mean huge) quantities of useless junk and refuse to part with it even when it gets in the way of living in the home. Hoarders often have stacks of stuff on appliances and stairways and desks and floors. It gets so bad that their homes turn into fire hazards, become infested with insects, and pose increased risk of falls. In fact, the appliances in the homes of most hoarders no longer function properly because calling a repair person could result in the hoarder being turned into the Public Health Department.

Hoarding currently is considered a type of OCD, but experts debate whether Hoarding quite fits under the OCD umbrella. So, you just might see Hoarding recategorized in the next version of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM). Some of the reasons that Hoarding OCD may not be true OCD include:

  • Unlike most people with OCD, the majority of hoarders do not want help. This fact also happens to make them much more difficult to treat.
  • Medication doesn’t work with Hoarding OCD nearly as well as it does for other types of OCD.
  • People with Hoarding OCD seem to have certain cognitive deficits (like the ability to categorize and make decisions) that are not shared by people with other types of OCD.
  • Hoarding OCD treatment typically takes much longer than other types of OCD treatment.
  • Hoarding OCD is more prone to relapse than other types of OCD.

Click through on the video screen below to see a good example of what Hoarding OCD can look like. If you watch this video, you can also see why many hoarders never marry. Those that do often end up divorced because of the effects hoarding has on marriages. If you know someone who is a hoarder and actually wants to change, there’s a great book on OCD hoarding written by Gail Steketee, Ph.D. and Randy Frost, Ph.D. We highly recommend it. This book can also be used in conjunction with treatment that’s ordered by the courts (all too often what happens for hoarders).

The Common Cold of Anxiety

Wednesday, March 18th, 2009

Generalized Anxiety Disorder (GAD) is the most common form of anxiety affecting more people around the world than any other type of anxiety. People with GAD report a mix of symptoms–physical sensations, emotions, and thoughts.

  • Physical feelings of restlessness
  • Feeling jumpy and keyed up
  • Tense muscles in the back, neck, or shoulders
  • Trembling
  • Shortness of breath
  • Difficulty swallowing
  • Irritability
  • Fatigue
  • Trouble concentrating
  • Problems going to sleep and waking up
  • Feelings of dread or impending doom
  • Worries about performance
  • Thoughts about being humiliated
  • Worries about being rejected
  • Thoughts about safety

In order to be diagnosed with GAD these symptoms must persist on most days for at least 6 months. People with GAD worry about their jobs, their kids, safety, and school. These worries are not just everyday concerns–but a mountain of worries over molehill problems. GAD interferes with life. People with GAD often avoid doing things that can bring on symtoms which leads to greatly restricted activites. They may pass up on opportunities, isolate themselves, and procrastinate due to fear of failure.

GAD does not seem to be directly caused by one significant stressor such as a traffic accident, terrorist attack, or other trauma. However it does get worse under stress. Like most mental disorders,interactions of genetics, learning, and biology lead to GAD.

GAD can be difficult to diagnosis because of the variety of symptoms. In addition, some of these symptoms can be a result of medications or physical illness. However, there are great treatments available for anxiety. Cognitive Behavioral Therapy (CBT) helps you look at how your thinking may be related to your feelings. You learn to look at evidence and find any disortions in the way you interpret events. A variety of medications have also been found to help people with GAD. Sometimes a combination of medication and psychotherapy is called for, but that’s not always necessary.

Getting help for GAD is crucial. Chronic anxiety increases your chances of having headaches, chronic pain, stomach upset, high blood pressure, and even suppressed immune systems. If you have symptoms like those described above, please check with your primary care doctor to rule out physical causes and then discuss treatment options.

When Your Ear Has Worms

Sunday, March 15th, 2009

WARNING: Seriously, if you truly get bothered by songs that run through your head over and over again, you probably don’t want to read the rest of this blog.

“It’s a small world after all, it’s a small world after all…”  Can you hear the melody in your head? You get in one of those boats at Disney Land and the song plays over and over and over again. Now do you hear it? Okay, if you don’t have access to small children, then maybe you can’t remember the melody. Let’s try some others.

Have you been to a wedding in the last 30 years? At the reception the band leader or DJ makes a few remarks encouraging everyone to get up and dance, then the music comes on and everyone starts swinging and contorting their bodies to: “Y.M.C.A. It’s fun to go to the Y.M.C.A….” or how about “Macarena.” Advertizers work hard to deliver short melodies that stick in your head. “I love my baby back, baby back . . . ”

Scientists like to label everything. Those melodies that get stuck in your head are called earworms. Gross–imagine a slimy worm slithering around your brain singing “Y.M.C.A.” while you’re trying to concentrate on something else. Why do we bring this up? Earworms are quite a bit like obsessional thoughts. Like obsessions, the melodies tend to pop into your mind unannounced, take your attention, are not especially desired and sometimes even a little distressing. Like those with obsessive thoughts, people with earworms try unsuccessfully to supress them. But, the more you try to get rid of unwanted tunes or an obsessive thoughts, the louder they get and the more often they come back. And earworms, like obsessive thoughts crop up more often when people are worried. Earworms, like obsessive thoughts, fade the more you can accept that they will be there at times and refuse to give them a whole lot of meaning.

So,are there earworm exterminators? Nope. Once you have an earworm it tends to stick around for awhile. Some people try to find another melody to play in their head. Others attempt to give their earworms …

Anxious About the Economy?

Friday, March 13th, 2009

Reuters recently reported on a survey of over 1,000 adults who are currently employed. About one in five of them reported that the economy has impacted their mental health negatively. And a third or more said that their stress levels on the job have increased. It’s not difficult to understand why people are worried and distressed. Reasons include:

  • No one can deny that the economy is bad and that the outlook is uncertain.
  • Few people can say that their jobs are 100% secure.
  • Most folks would struggle to make it if they lost their jobs and couldn’t find another one quickly.
  • Most people at least know one or more people who have lost their jobs or are in great jeopardy of losing their jobs.

The article cited a recommendation by one author who suggested that workers adopt a mantra, to wit: “Everybody else is losing their job, but I’m not the one. That’s for somebody else. I’m not going to be that one.” Good advice?

We don’t think so. Following that suggestion would merely encourage denial that could easily be ripped apart by a dose of reality. Dr. Smith and I both suggest the value of cognitive therapy (and its cousin behavior therapy) for treatng problems with anxiety and stress. A very common misconception about cognitive therapy is that the approach tries to get you to see the rosey side of any situation. In actuality, we and most advocates of cognitive approaches do not recommend simplistic denials or rationalizations of real life issues. And the economy is a realistic concern.

But we aren’t suggesting panic either. The problem comes about when you find yourself worrying constantly while carrying around a pervasive sense of doom and dread. That style of thinking doesn’t solve anything. Try setting aside a specified period of time each day, perhaps twenty minutes or so for engaging in “productive” problem solving. Brain storm all of your options in case you lose your job. Consider alternative things you might be able to do and/or what sources of help or support you might have. Once your problem solving time is up though, try to put the worries off until the next scheduled session. If you …

More dirt about germs

Wednesday, March 11th, 2009

Yesterday, Chuck wrote about germs and resistance. Since contamination OCD is the most common subtype, here’s a great study that adds a little more to his thoughts about germs.

Scientists at the Columbia University in New York City wanted to know if antibacterial cleaning supplies actually decreased the number of infectious diseases among the people who use them. Well, everyone wants free stuff so they cleverly designed an experiment that involved giving away household cleaning supplies, hand-washing products, and laundry detergent. People in the study knew that they were getting either supplies with or without antibacterial properties. But, they didn’t know which ones they had. All of the brand and ingredient labels were removed.  

In research, this design methodology is referred to as a double blind, placebo controlled procedure. Double blind means that both the recepients of a treatment and the people providing the treatment are unaware of whether the intervention (e.g. medication, therapy, or cleaning supplies) is a placebo or a real treatment. In this case, the intervention consisted of the antibacterial properties of the cleaning supplies.

The persistent researchers from Columbia University kept track for a whole year while 1,178 people in Manhattan enjoyed using their free cleaning products. They documented the numbers of colds, runny noses, fever, sore throats, vomiting, diarrhea, boils, and conjunctivitis  among all of the participants. They found no differences in the rate of infectious diseases among those who used the antibacterial products and those who used the regular soaps.

So, save your money and buy green. Don’t worry too much about killing every germ. In fact, if you kill too many, scientists speculate that you may inadvertently foster the development of new resistant strains of bacteria. So, once again, try to relax and breathe.

We also realize that if you have OCD, our advice is easier to give than to follow. We plan to provide you with additional ideas about tackling OCD related issues in blogs to come. And if you have a serious case of OCD, you should seek the assistance of a mental health professional with specific expertise in the treatment of OCD.

Germs: Resistance is Futile

Monday, March 9th, 2009

The following is based in part on an excerpt from our book Obsessive Compulsive Disorder For Dummies. We’ve added a little discussion as well. It illustrates that OCD and so-called “normal” can be a fine line to draw at times.

Like most “mental disorders” OCD appears to represent a normal process that spins out of control. Perhaps making matters worse, the media seizes upon reports from researchers about hidden sources of germs, viruses, and bacteria. When they report on this concern, those with OCD worry all the more and people without OCD start wondering if they should be more worried.

For example, many people with OCD vacuum for hours hoping to eliminate dust and dirt in their homes. Research conducted by Dr. Charles Gerba at the University of Arizona recently found that household vacuum cleaners not only scatter germs throughout the house, but also provide a safe haven for accumulating bacteria. Furthermore, vacuum brushes harbor fecal material, mold, and even E. coli.

What to do about this situation? One allegedly serious recommendation has been to spray antibacterial disinfectant on vacuum brushes after every use. Who has time for that? Another solution that’s been recommended in the media is to buy a new type of vacuum that ostensibly kills bacteria and germs through the use of an ultraviolet, germicidal light.

Other researchers have found bacteria and fecal matter in all sorts of places–in ice machines at restaurants, on restaurant menus, escalator handrails, and hotel room pillows and bedding. Therefore, would it not seem logical to suggest not using ice machines, not allowing a menu to touch your plates, washing your hands after selecting your food from the infected menu, not holding on to escalator handrails, and bringing your own clean bedding to your hotel room?

Admittedly, when we read such articles, we too start to feel a little squeamish. We’ve been in a few seedy hotel rooms and touched a few sticky menus. Where should you draw the line?

The problem with these studies and recommendations is that no one has proved that any of these sources cause significant amounts of illness or disease. Though reasonable precautions are always a good …

Sometimes a Snake is Just a Snake

Friday, March 6th, 2009

Do you think that you have an anxiety disorder or OCD? We don’t recommend self diagnosis. If you think you have a problem, then please talk to your health care provider.

Nevertheless, we think it’s a good idea to think about your feelings. Because the way you feel and think and behave are all related. Anxiety itself is perfectly normal. It helps alert you to danger and protect you when something bad happens. Unfortunately, it can also cause physical illness, turn into depression, and keep you from doing what needs to be done. Does anxiety interfere with your life in a meaningful way?

  • Are you missing work or school
  • Staying at home too much
  • Have you been neglecting school assignments, work projects, or household tasks
  • Isolating yourself from friends and family
  • Are you spending time checking for safety
  • Worrying about getting contaminated
  • Constantly worried that something bad is about to happen
  • Having unexplained physical symptoms

If any of these issues are affecting you, you might want to check with your health provider. What these questions are getting at is the concept of clinical significance. What we try to determine is if the symptoms of anxiety are interfering with everyday health, happiness, and life.

Here’s an example. We live in a rural area of New Mexico. Wildlife is abundant in the beautiful mesas and mountains of our state. Almost every day we see quails, road runners, and coyotes. They tend to stay away from us as we walk our dogs. Not very often on our walks, we see a snake. When we do, we notice that our hearts beat a bit faster and we feel pretty anxious. We’re not fond of snakes. As a matter of fact, rattle snakes scare us. But, most days when we’re home, we walk the dogs.

So in terms of considering the possibility of an anxiety “disorder” our snake anxiety does not keep us from leaving home. We don’t go to extreme measures to avoid snakes, and we actually live in an area that we’re likely to keep on seeing an occasional snake. Now, …

Anxiety & OCD Exposed

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Laura L. Smith, Ph.D. and Charles H. Elliott, Ph.D. are authors of many books, including Overcoming Anxiety for Dummies and Child Psychology & Development for Dummies.

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