In our last blog we discussed the use of Ecstasy in treating people with anxiety. Other researchers have investigated the role of oxytocin, a hormone that the body produces during orgasm in men and women as well as during childbirth and breastfeeding. Interestingly, Ecstasy increases oxytocin.

So, what does this have to do with anxiety? Researchers at the University of Zurich have found that people with social phobia who were given small amounts of oxytocin in a nasal spray minutes before participating in cognitive behavioral therapy, became more confident in social situations and seemed more open to engaging in their therapy.

It’s also interesting that oxytocin levels have been found to be lower in people with autism spectrum disorders. People with autism often have difficulty relating socially. And some limited research has found that giving oxytocin to a sample of adults with autism improved their performance on a task that required identifying emotional content.

Oxytocin has been found to increase people’s ability to trust others in some studies. In other research, it has increased people’s ability to understand the emotions of others. If you think of people with social anxiety, they tend to be excessively shy and worry about how other people are judging them. Most of the time, their worries are unfounded. So, improving the ability to accurately read feelings and be able to trust others would logically decrease social anxiety.

By the way, in general, we’re not wild about most medication approaches for anxiety. Some are addictive and others not especially effective. And it’s way too early to endorse either MDMA or oxytocin as anti-anxiety strategies. However, the possibility is intriguing, especially because their use in most cases would likely be limited to serving as an adjunct to exposure therapy sessions.

On the other hand, some medications may actually decrease the effectiveness of exposure therapies. For example, Michael Otto at the Massachusetts General Hospital has found that benzodiazepines (such as valium and xanax) actually interfere with exposure.

Our last blog discussed impulse control disorders such as Tricotillomania and Kleptomania. We wrote a bit about how they can be compared and contrasted to compulsive disorders such as OCD. Both impulsions and compulsions can be considered urges to carry out some action either physical, like washing hands, pulling hair, or mental like counting, chanting, or yelling.

People with other mental disorders also have problems with impulsivity. For example, many people diagnosed with Attention Deficit Hyperactivity Disorder have this trouble. They tend to speak without thinking, interrupt others, or have difficulty waiting their turns. Impulsivity is a characteristic of Bipolar Disorders, as well as Borderline Personality Disorder and Antisocial Personality Disorder. People with substance abuse problems, kids with fetal alcohol syndrome, and those who suffer some types of brain damage also act impulsively.

Most of us think about impulsivity as acting (or speaking) without thinking. We all do that from time to time. But impulsivity appears to have four separate components and people with impulsivity don’t always have all four of these issues. The following examples will illustrate each type of impulsive factor:

1. Aaron likes to take risks. He enjoys rock climbing, hang gliding, and tends to drive too fast. He craves excitement and sometimes takes excessive risks. Aaron’s impulsivity is called sensation seeking.

2. Beth has dropped in and out of college. She gets excited about a career or area of study then finds herself losing interest. At home, she has difficulty finishing books, tasks; she lacks discipline and flits from one thing to another. Her impulsivity is called lack of perseverance.

3. Cathy is very bright and energetic. She has big ideas but rarely gets them off the ground. She has huge credit card debts, can’t seem to give up smoking, and fails to plan for the future. Her type of impulsivity involves lack of planning.

4. David’s relationships are constantly conflicted. He becomes excessively enthusiastic, and then quickly gets bored. He can’t seem to handle stress very well. His reactions are instantaneous and often rash. His type of impulsivity involves acting without thinking.

So, you can think about impulsivity as …

Losing a job, worrying about holding on to a job, or fearing ever being able to find a job-these concerns are greater than ever in this economy. Lots of baby boomers look at dwindling retirement accounts and worry about how they will have enough to live on. Young people struggle to find their first jobs and layoffs affect almost every extended family. The shrinking economy has lots of people stressed out. Stress and OCD don’t mix very well. We know that obsessions and compulsions become more frequent and increase in severity when people with OCD experience stress and worry.

Furthermore, even if you have never had OCD, it’s possible for symptoms to appear when you’re tense and worried. Obsessions and compulsions can be ways of the brain to handle extreme fears or stress. For example:

Jan, a single mother, was laid off from work 6 months ago. She collected unemployment and cut expenses to the bone. For the first time she found herself shopping in resale shops when her kids outgrew their shoes. The family ate lots of rice and beans. She always kept a clean house, but lately Jan has been having worries about keeping her kids safe from germs. She spends her days cleaning and re-cleaning the house. She tells the kids that they can’t afford to get sick because her health insurance was cancelled. She starts to make them take showers when they come home from school and put their school clothes in the washing machine so that she can decontaminate them. Her oldest daughter, frightened by her mother’s strange behavior, phones her grandmother. “Grandma,” she whispers into the phone, “something’s wrong with mommy.”

Bill, a 67 year old retired autoworker understandably worries about the future of his health care benefits, pension, and retirement savings. These realistic concerns send him to his computer to check the daily news, stock market conditions, and the balances of his portfolio. The checking, rather than helping ease his tension, only increases his anxiety. He finds himself spending more time at the computer and less time with friends and family. Spending all day at the computer …

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 …
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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 …

I read a well written, moving article in the Sunday NYT magazine section about a woman with severe, unremitting depression. Although the ending offered a small bit of hope, the piece induced in me the feeling that depression has a life of its own, and that those of us who try to help people with depression are mostly powerless bystanders. Daphne Merkin, the author writes, “What’s more, after a lifetime of talk therapy and medication that never seemed to do more than patch over the holes in my self, I wasn’t sure that I still believed in the concept of professional intervention.”

At first, I thought that writing about that piece could be dangerous, that anything I wrote would be construed as me not understanding the depth and darkness of real depression. But then, I thought that stance would be cowardly and fighting depression takes courage. So here goes.

I find myself wondering why people who live in New York City (and write about depression) seem to have such poetic yet intractable depressions. Okay, some of my favorite people live in or come from NYC; but really, sometimes it seems to me that those that venture west appear more able to plod through life than those remaining in the dark canyons and gray skies of NYC.

On a more serious level, I also wonder why so many people persist in getting therapy that does not seem to be working. If you are in therapy for a “lifetime” and are not getting better, ask for a referral! Do so again if the new therapy doesn’t seem to be doing you any good after a few months. There are literally thousands of practitioners, especially in New York that offer empirically validated treatments for depression such as cognitive behavioral therapy. And finally, if you are getting medications that are not helping you, talk to, and yes, complain to your doctor (but please don’t abruptly discontinue without talking to your doctor).

I write this because I have studied many hundreds of research articles that show people who receive cognitive behavioral therapy for depression, whether mild or severe, can and usually do recover. Other …

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 …