For decades, a considerable body of research has demonstrated that a number of psychotherapies are highly effective in the treatment of depression and anxiety disorders. Cognitive behavioral treatments have received the most attention from researchers, but other treatments such as interpersonal psychotherapy have also shown significant promise. The treatment of Borderline Personality Disorder has been another matter. Marsha Linehan developed a treatment known as Dialectical Behavior Therapy (DBT) which utilizes cognitive behavioral principles in conjunction with acceptance, emotional regulation skills, and principles of validation to the treatment of Borderline Personality Disorder (DBT). Significant research supporting its efficacy did not start showing up until the 1990’s or so. And, for a while, DBT virtually stood alone as an empirically validated treatment for BPD. This treatment is fairly intensive and requires at least a full year of treatment, but a growing number of studies have supported its value.

Nonetheless, we have needed more ideas for treating BPD. Dialectical Behavior Therapy, as effective as it is, sometimes fails to improve life satisfaction and quality of life as much as one would hope. And in the past few years, new treatment ideas have begun to emerge. These include:

• Mentalization-Based Therapy (MBT)
• Transference-Focused Psychotherapy (TFP)
• Schema Therapy (ST)
• Cognitive Behavioral Therapy (CBT) tailored specifically to BPD

Research has just started to support these new approaches to BPD treatment. Schema Therapy and Mentalization-Based Therapy look especially promising, but we need more studies before anything definitive can be concluded. Interestingly, having reviewed these approaches, we have failed to discover much that seems especially incompatible among them. Therefore, we suspect that ultimately, an integrated approach to treating BPD may ultimately emerge as the best strategy. Whether or not our hunch is right, the next ten years promise to be quite exciting in the treatment of BPD.

In a future blog, we’ll discuss the role of medications in the treatment of BPD. Although most prescribers of medications recommend multiple medications for the majority of people with BPD, research has demonstrated surprisingly little value from medications for this problem. As we said, more to come…

I’t’s 4 am, I’m awake. I hope that I can go back to sleep. . . . Did I remember to get the coffee ready?  I hope the traffic won’t be so bad tomorrow night, last night it took me an hour to get home. I’ve got to decide about whether or not I’ll keep the consulting job. Geez, one of us has to write a blog tomorrow, we’ve been putting that off.  I wonder whether I can fit in the gym tonight. I have to remember to take out the trash before I leave. I have to stop thinking . . . I need sleep. Okay, I’ll try to concentrate on my breathing. Breathe in to the count of eight and then let it out slowly and then in. . . I have way too much to do tommorow….breathe in 1,2,3,3,4,5,6,7,8…….

Sound familiar? More and more people complain about poor sleep. The sale of prescriptions for sleep aids and over-the-counter solutions continue to skyrocket. One reason behind this pandemic is likely the modern lifestyle. We don’t fall into bed exhausted after spending the day doing physical labor on the farm or at the factory.

People generally need about eight hours of sleep per night. The real gauge as to whether you’re getting enough sleep is how you feel during the daytime, not the exact number of hours you get. In any case, anxiety frequently disrupts sleep, and a lack of sleep can increase your anxiety. The following list describes the most common sleep disturbances.

• Insomnia, by far the most common sleep problem, may be the result of anxiety, depression, stress, poor sleep habits, discomfort, or an inadequate sleeping environment such as living in a noisy apartment building or sleeping on a lumpy mattress. Insomniacs have difficulty falling asleep and/or staying asleep.
• Hormonal fluctuations that occur during pregnancy and menopause can cause physical discomfort and changes in bodily temperature that interrupt sleep.
• Jet lag or shift work can disrupt normal sleep patterns. People have a biological clock or rhythm that likes to stay on a regular schedule. Those who have to switch …
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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.

The anxiety disorder called Post Traumatic Stress Disorder (PTSD) can occur when a person witnesses or is involved in a traumatic experience. In most cases, the person is present at the trauma, but other times the trauma happens to someone very close. The event generally involves a serious threat of death or injury. The person feels intense horror, fear, and helplessness. Here are three examples of PTSD.Although most people don’t have all of these, symptoms of PTSD which occur after a traumatic event include:

• Intrusive and distressing images, thoughts, perceptions of the event
• Recurrent Dreams
• Flashbacks of the event
• Intense distress when reminded of the event
• Over reactive psychological symptoms
• Avoiding talking about the trauma
• Avoiding activities that bring back memories
• Attempts to repress or forget the trauma
• Less interest in life activities
• Feelings of detachment
• Belief that the future is limited
• Increased arousal
• Problems with sleep
• Angry outbursts
• Irritability
• Problems with concentration
• Hypervigilance
• Easily startled

For those with PTSD, cognitive behavioral therapy is a very good therapeutic choice. Like those with OCD, exposure to the feared event is part of the treatment. The problem in the past has been that many people with PTSD avoid getting help because of a strong desire to avoid anything that reminds them of the trauma–and exposure certainly does that.

A few recent studies have introduced a new way to perform exposure. The patient is given 3,4-methylenedioxymethamphetamine (MDMA) during the exposure. Although the studies are preliminary, it appears that MDMA may facilitate exposure.

MDMA, aka, Ecstasy, is known for its positive effects on mood and empathy. The behavioral treatments with exposure and MDMA take no longer (usually 10-12 sessions) than standard behavior therapy. The drug is given under medical supervision only during the session and is discontinued after exposure is complete. Considerably more research is required before we can wholly endorse this approach. However, we thought you might find it interesting to know what’s in the pipeline of possibilities for treating PTSD.

Finally, this should not be tried at home! Nor are we recommending MDMA for other purposes. And we recommend that you avoid Raves as well.

School is starting in many areas in the next few weeks. Most kids are excited about the beginning of school. A few kindergarten kids and sometimes even older children will exhibit symptoms of separation anxiety. The main sign of this disorder is extreme anxiety and fear when separated from a caregiver. The symptoms of this disorder vary from child to child but can include:

• getting upset while getting ready to leave for school
• worrying that something bad will happen to the caregiver
• worrying about getting lost or kidnapped when apart
• refusal to get on the bus or out of the car
• tantrums and screaming when pushed to leave
• problems with going to sleep
• nightmares
• refusing to sleep in the child’s own bed
• physical complaints when facing separation (stomach aches, headaches, even vomiting)

Separation anxiety can become a very serious problem. Concerned parents hate to see their children suffer. Parents understandably often respond to the first signs of separation anxiety with love and reassurance. When that doesn’t stop the fear, they try firmness, and sometimes nothing seems to work. Separation anxiety can appear in perfectly well adjusted children. A variety of factors likely cause it; some kids seem to be born anxious; sometimes it appears due to changes in the kid’s environment (e.g., moving, divorce, etc.); other times it just pops up seemingly out of nowhere.

My twins were sad and cried a little when I left them at home with a babysitter, but loved preschool and kindergarten. They’d pile out of the car and run full speed into school. But my younger son had separation anxiety when I dropped him off at daycare. I started each day feeling horrible-leaving him as he screamed for me. I knew that I just had to turn the corner and seconds later he’d be off playing with the other kids, but the guilt I felt was more than a little uncomfortable. By the time he was in preschool, the transition was smooth and now he travels all over the world, comfortable in almost any setting.

But not every child outgrows separation anxiety without some treatment. Usually, the school counselor or teacher …

Our contest is over. We had many correct and almost correct responses. The winners are based on number correct and speed of answering. We had some postings on the blog and others to our emails. Again, recall that there were numerous “correct” possibilities, but we used the “correct” responses that lived in our heads. Unfair? To be sure. Here are the “correct” answers:

CT Cognitive Therapy
OCD Obsessive Compulsive Disorder
ABCT Association for Behavioral and Cognitive Therapies
ERP Exposure and Response Prevention
EXP Exposure and Response Prevention
(okay, this was a tricky one and we decided in this one case to be unexpectedly “fair” and give credit for Experimental Psychology)

ACT Acceptance and Commitment Therapy
DBT Dialectical Behavior Therapy
FGU Fielding Graduate University (how did this one get in here?)
BT Behavior Therapy
IPT Interpersonal Therapy
PD Personality Disorder
PDD Pervasive Developmental Disorder
ADD Attention Deficit Disorder (if you want to follow the DSM IV, it should be ADHD)
MDD Major Depressive Disorder
BPD Borderline Personality Disorder
AN Anorexia Nervosa
PTSD Post Traumatic Stress Disorder
ASD Autism Spectrum Disorder
ODD Oppositional Defiant Disorder
APA American Psychological Disorder (oops, that should have been American Psychological “Association”)

If you are one of our winners, please email us ( anxietyocd@psychcentral.com ) with your street address and we will send you the book you asked for. Here are the winners:

1. Jessica M.
2. “croak”
3. Gwen A.
4. Kristi R.
5. Angela B.

Thanks to all who participated and especially to Bonnie for bringing us some laughs. And Laurie S., if you’d like a book, please email us with your address–we went crazy and declared a sixth winner!

This addiction causes a variety of problematic symptoms such as confusion, difficulty in communicating, laziness, and loss of memory. Very few psychologists have sought treatment for this issue and most don’t even have a desire to do so. The major psychological associations and organizations have yet to issue warnings about this problem; indeed we doubt that they ever will. AA (Alcoholics Anonymous) offers little hope for those who have this disorder and in fact, may actually contribute to the problem itself. DSM IV (the Diagnostic and Statistical Manual) used by most psychologists also adds fuel to the fire and has completely failed to consider its inclusion in the next edition. Even our esteemed colleague’s book,  Addicted? Recognizing Destructive Behaviors Before It’s Too Late (by Marilyn Freimuth, Ph.D.) failed to deal with this issue, representing the lone omission of an otherwise fine piece of work.

We ourselves have fallen prey to this pernicious issue in spite of having written six (and counting) For Dummies books. Of all people, we should have addressed this concern before now. Well, we feel strongly that it’s time to call attention to this addiction and do something about it! Unless we act, we fear that most of the general public will become so disgusted with psychologists’ behavior that they will abandon seeking their services entirely.

The problem is AA itself. No, not Alcoholics Anonymous, but Acronym Addiction (AA)! Yes my friends, AA may be the worst, un-dealt with issue psychologists face today–except that they are not facing it. In order to draw attention to this disorder, we have decided to hold a contest. Below we list 20 of our personal, favorite acronyms. This list is far from all inclusive. For the first five people who respond with the greatest number of “correct” answers, we will you send your choice of a free copy of one of our FDBs (For Dummies Books) …

Anxiety, depression, and other emotional problems are usually considered to be caused by a combination of genetic, biological, and psychological factors. However, culture may also raise the risk of certain emotional reactions. In our recent book Borderline Personality Disorder For Dummies, we discuss the emphasis on individualism, prevalent in most Western cultures as a possible contributor to a wide range of emotional and behavioral issues.

Multiple studies have looked at how increasing people’s focus on themselves causes negative feelings and lowers the ability to solve problems. In the West, people tend to celebrate the self, move from their families in order to accelerate their careers, and lavish attention on individual accomplishments. By contrast, many traditional, Eastern cultures place more emphasis on families, communities, and interdependence. Support for one another has a central place in these cultures.

Does this cultural difference matter to people’s mental health? Well, a considerable body of research supports the view that self-absorption, a tendency to focus attention on oneself, increases the chances of having the following:

• Anger
• Substance abuse
• Anxiety
• Depression
• Eating disorders
• Risky behaviors
• Self harm
• Virtually all psychopathology

People with Borderline Personality Disorder often have a number of such symptoms. We aren’t saying that people with emotional disorders are too self absorbed. Rather, we’re suggesting that any culture which overly emphasizes individualism and personal gain may be doing so at a steep emotional cost for much of its populace.

Therefore, we often recommend that clients with emotional problems find volunteer work and other activities that connect them with people. Such work often improves their adjustment. Connections and social support may have more value than merely trying to boost self esteem. Speaking of self esteem, don’t forget to check out our free gift offer celebrating the 8th anniversary of our book “Hollow Kids: Recapturing the Soul of a Generation Lost to the Self Esteem Myth.”

We are nearing the 8th anniversary of the publication of our book, Hollow Kids: Recapturing the Soul of a Generation Lost to the Self-Esteem Myth. We were especially pleased with this book. Although the book briefly received substantial attention from national media such as CNN; events around 9-11, the sale of the publisher, and other miscellaneous happenings quickly closed the door on such attention and sales. We are not bemoaning the book’s rapid demise into out of print status. But we do feel good that media such as Parent Magazine, Better Homes & Garden, the New York Post, and the Washington Times continued to write articles about it for several years after it was no longer available. And a colleague of ours recently wrote a review of the book that pleased us even more.

Even though we have a newly released book, Borderline Personality Disorder For Dummies, that we would dearly love to attract attention to, we wanted to do something special for the 8th anniversary of Hollow Kids. Does this mean we’re going to pitch an expensive copy to you? No. We feel grateful for the following we’ve had for our Anxiety and OCD Exposed blog and decided that we’d like to offer our readers a free pdf download of Hollow Kids from now until August 31st. It’s the complete book, not a condensed online version. No catch; no strings. We just want to express our gratitude for your interest and following. Of course, if you feel like checking out Borderline Personality Disorder For Dummies while you’re at it, that would be great too!

By the way, this book has been a bit controversial. We look forward to an honest, respectful debate about our ideas. Here’s the review by our colleague (presented with permission) recently published in the New Mexico Psychological Association’s newsletter. See what you think.

In our recently released book about Borderline Personality Disorder, we discuss the possible cultural conditions that nourish the beginnings of BPD. Adolescence can also be a breeding ground for increases in anxiety and depression for similar reasons. In fact, studies demonstrate that rates of anxiety and depression have been increasing at alarming rates for several decades.
Here is an excerpt from our new book: Borderline Personality Disorder For Dummies (just now available through Amazon).

Adolescence is a relatively modern concept that refers to the transition period between childhood and adulthood. Adolescence emerged as a consequence of the Industrial Revolution as a way to keep children in school and out of sweatshops–not such a bad idea. However, as it has evolved, adolescence has become a tumultuous and treacherous time for many teens. Arguably, adolescence brings with it large chunks of free time, which means numerous opportunities for teens to engage in self-destructive behaviors. Pressures mount for teens to have more, be more, and be noticed.

Adolescence is a time when psychological disorders, including signs of personality disorders such as BPD, emerge. Problems with gangs, violence, drug use, sensation seeking, eating disorders, and risky sexual behavior have burgeoned among adolescents in the past four or five decades. Of course, we’re not saying that adolescence itself causes emotional disorders; after all, many adolescents mature into adulthood with no sign of any emotional disorders. However, from a historical perspective, BPD symptoms and behaviors have only been written about in the past century or so–which coincides with the emergence of adolescence as feature of modern culture. When kids were busy milking cows and gathering crops, much less adolescent angst existed among teens. Perhaps, if we can give teens more important tasks than texting, video gaming, and hanging out at the mall, they won’t be as easily seduced by self-destructive behaviors.

What do YOU think?

We’ll discuss other possible contributors to BPD, as well as other emotional disorders, in some future blogs–obviously “adolescence” isn’t the only one! BPD has many complex interacting causes that range from genetics to early learning experiences …