Part II (see previous blog entry for Part I of this interview, conducted by David DiSalvo)

Tell us what “anxiety” really is in a clinical sense, and how it’s different than “a case of nerves” that everyone occasionally feels.

You’re correct that everyone feels stress and gets a case of nerves from time to time. You couldn’t live a meaningful life without them. Normal anxiety occurs when you’re faced with real challenges and hassles. Normal anxiety can even prepare you to deal with such challenges more effectively. Some experts call this type of anxiety facilitative anxiety. Normal anxiety dissipates when the problem is solved or diminishes.

Think of preparing for an examination. If you have no anxiety or worry at all, you’re likely to feel little motivation to prepare. If you’re moderately anxious, you’ll spend a lot more time studying. If your anxiety goes over the top, you may study a lot, but be unable to concentrate or you may deal with the anxiety by procrastination or avoidance of the task. In other words, complete absence of anxiety isn’t always such a good thing, moderate amounts can help and excessive anxiety interferes with performance.

Clinical anxiety debilitates rather than facilitates. By definition, most anxiety disorders persist for months. They involve reactions that exceed the objective nature of whatever seems to trigger them and in some cases; no trigger is even easily identifiable. Clinical anxiety comes with strong physical symptoms such as fatigue, restlessness, interrupted sleep, poor concentration, muscle tension, and irritability. Clinical anxiety reduces quality of life.

When it comes to prescribing meds for anxiety, the voices of dissent are many. Tell us something about the controversy surrounding benzodiazepines and other anxiety meds.

Evidence suggests that many anxiety disorders are treated especially effectively with certain psychotherapies most of which are based on cognitive behavior therapy. Thus, we would rarely suggest medications as the first line strategy. Benzodiazepines, although frequently prescribed for anxiety by general practitioners, are especially problematic for a variety of reasons including:

• Benzodiazepines have a significant addictive potential which may be heightened among those with anxiety disorders.
• Some data suggests that these drugs may actually increase …
  Continue reading… »

We thought you might find a recent interview conducted by David DiSalvo of interest. We have broken it into two parts for easy reading. We’ll publish Part II next week. Also, sorry we haven’t blogged in a while; we were busy traveling in the Mediterranean.

Part I

Depression For Dummies, Overcoming Anxiety For Dummies, Obsessive-Compulsive Disorder For Dummies, Borderline Personality Disorder For Dummies–these are just a few of the titles penned by Dr. Laura Smith and Dr. Charles Elliott, a writing duo with a library of psychology and self-help books between them. Tackling challenging topics with an accessible style is their specialty, and has allowed many readers gain a better understanding of anxiety, depression, OCD, and borderline personality disorder, among other topics. They recently spent some time discussing the For Dummies series and a variety of psychology issues and questions with www.Neuronarrative.com

You’ve written several books on depression, anxiety, OCD and related topics, including some of the wildly popular For Dummies books. What led you to the Dummies format to address these topics?

Yes we have; in fact, we’ve just finished our sixth book in the series. As clinical psychologists, we’ve read dozens of self-help books. Most of them focus on how to deal with some specific mental disorder such as depression, obsessive compulsive disorder, or generalized anxiety disorder. Some of these books ignore empirical findings and present an interesting, but highly idiosyncratic and non-data based set of recommendations. Many of the better books in this genre are written by highly renowned researchers and do a great job of presenting the findings from a specific researcher’s approach to the disorder. However, in the past couple of decades, the mental health field has managed to develop a number of empirically based treatment strategies for most emotional disorders. We believe people can profit from knowing about a range of strategies so long as they rest on a research base.

In the For Dummies series, we saw an opportunity to provide consumers with an unusually comprehensive approach to each topic covered. Thus, in all of our books we discuss a variety of …

Today we spent the afternoon in Split, Croatia. Our moods were positive and we enjoyed lunch at a quaint local restaurant. The last few days presented a much greater challenge to our moods. In a series of weather related incidents from fog in Denver, storms in Philadelphia, and overworked airline agents unable to keep track of our luggage, we left for Venice dubious as to whether we would ever meet up with our baggage again.

Luckily we had listened to our savvy travel agent at Diane.Presnar@AmericasVacationCenter.com and had packed at least a few essentials and a change of clothes in our carryon bags. But the hours of planning just the right clothes, items, and essentials for a long anticipated vacation seemed hopelessly wasted.Dismal thoughts that our vacation would be ruined creeped into our minds. Thousands of dollars spent on what would become a miserable 15 days in the Mediterranean. And indeed, we remained bagless the first two days in Venice. However, within hours of arriving in Venice, it occurred to us that we needed to do some cognitive therapy on ourselves. We stepped back and asked ourselves:

• How much will not having just the “right” clothes affect our good time?
• Can we use this story as a blog? (Seriously, we asked ourselves this question and guess what?)
• Will people really think we’re inappropriate if we wear informal clothes on “formal” night? And if they do, will it really matter in the long run?
• Can we not replace enough items to get by in various shops in Italy, Greece, Croatia, and Turkey?
• Do we ever think anything about how other people dress when we go on vacation?
• Can we not have a great time anyway?
• Will the friends who came with us really care?
• Could this incident generate some great, funny stories?
• Can we use this “tragedy” to keep ourselves focused on what’s really important?

On the third day, fifteen minutes before we left the port in Venice, our bags arrived at our cabin. We were very glad, but we were even more appreciative that we had figured out that what had seemed so distressing for a little while actually was not. People, places, and experiences …

A good work of fiction captures your attention and takes you into a different world. The plots and details of science fiction, mysteries, or horror can, in the light of day, seem totally illogical and implausible. However, a good author can make the unlikely seem possible and the irrational rational. The reader turns off the part of the brain that focuses on what is real versus what is not.

The thoughts and beliefs of the OCD mind can be much like the writings of a good author. But in this case, the mind’s writings focus on themes of horror. Most obsessions and compulsions don’t hold up to logical scrutiny, but like well written horror stories, there are many parts of the plots and details that can easily be believed. And those with OCD buy into the plot much like a movie audience does.

For example, people with “hit and run” OCD worry about hurting someone while driving a car. They may interpret bumps in the road as evidence that they have run over someone. People with this disorder frequently return to the scenes of their accidents, look for damage to their cars, read obituaries in the newspaper, or call hospital emergency rooms to check on accident victims. These worries are excessive, cause intense distress, take enormous amounts of time, and interfere with productive functioning.

Another good example can be found by looking at superstitious OCD. People with this type of OCD obsess over the idea that certain objects, colors, numbers, thoughts, or actions may end up causing harm to people they care deeply about. And when that harm occurs they imagine that they will be to blame for not having successfully avoided the various superstitions that they have.

Thus, if you have OCD, we recommend that you start having a conversation with the fiction horror writer that dwells in your mind. When you start to obsess over causing harm to others, encountering germs and other contaminants, or other types of catastrophes, tell that horror writer in your mind something like, “Well, much as I appreciate your creativity, I am going to walk out on this movie or stop reading …

If you’re a human being and live on this planet, you probably can come up with something that you don’t especially like about your body. Perhaps you feel you have a few extra pounds, think your nose is too large, or feel that you’re not as tall as you’d like to be. These are pretty normal concerns that most people have from time to time. In fact, if you saw your body as absolutely gorgeous, stunning, and perfect, people would probably think you’re rather narcissistic.

Something called Body Dysmorphic Disorder (BDD) takes normal, minor dissatisfactions to an entirely different level. People with BDD have painful distortions in the images they have of their bodies. They literally obsess about one or more perceived bodily flaws and see these imperfections as grotesque. Some typical concerns of those with BDD include worries about having:

• Hair that’s too thick or too thin
• A slightly crooked nose
• A chin that’s too large or too small
• A forehead that’s too large
• A trivial scar
• Lips that are too thin
• Slight discolorations of the skin
• Ears that don’t look quite right
• Crows’ feet

Other people with BDD worry about the size of their genitals or their musculature. Their worries may shift from one imagined defect to another over time. And these worries are far from trivial. Those with BDD commonly imagine that their bodies are seriously deformed, blemished, or disfigured. Yet other people rarely see them that way; in fact, other people often do not even perceive anything as especially wrong with the actual appearance of those with BDD.

Yet when people with BDD worry about these issues, they sometimes engage in a host of rituals or compulsive behaviors in order to feel better. Unfortunately, they feel better only for a brief time. Some of these compulsions include:

• Seeking plastic surgery (often many times)
• Asking others for reassurance about their appearance
• Checking their “defects” in the mirror over and over again
• Seeing dermatologists excessively and requesting numerous procedures
• Wearing gobs of makeup to hide their presumed defects
• Picking at imagined skin imperfections, thus causing irritations and scars
• Wearing clothing designed to hide their presumed deformity
• Extensive body building
• Steroid injections, supplements, and hormones to build body mass

If you think that BDD sounds a …