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Mental Health News

Following are the latest news and information resources for the various mental health topics that we cover. We hope you will find the news educational and the links in the resources section useful in helping you to get even more in-depth data.

Internet-Based Cognitive Behavior Therapy For Adolescents With Anxiety Disorders

Anxiety in adolescents

Prior to adulthood the prevalence of anxiety disorders is high (Rapee et al., 2009) at approximately 5 to 19% in the general population, making anxiety disorders one of the most common psychiatric disorders of children and adolescents (James et al., 2013).

Point prevalence estimates of anxiety disorders suggest a prevalence of 2.5–5% (Rapee et al., 2009). Anxiety that occurs during childhood has a moderate to high impact on functioning and could lead to severe disability that, if left untreated, continues into early adulthood (Rapee et al., 2009).

Social anxiety disorders, for example, become more prevalent after the adolescent has entered puberty but anxiety disorders with onset in childhood continue to persist during adolescence and early adulthood (James et al., 2013).

This is the first study of adolescents suffering from anxiety disorder in Sweden to receive individually tailored internet-based treatment within a child and adolescent psychiatric clinic. The primary aim of this effectiveness study was to examine the effects of tailored internet-based cognitive behaviour therapy for adolescents.

11 adolescents, aged 15-19 years, were allocated to treatment after assessment. Screening consisted of online questionnaires followed by a diagnostic face-to-face interview at the clinic. Treatment consisted of individually prescribed cognitive behaviour therapy (CBT) text modules adapted for the age group. Therapist guidance was via an online platform along with telephone support and face-to-face sessions if needed.

Statistically significant improvements were found on all dependent measures immediately following treatment for the 8 adolescents who completed treatment. The within-group effect size on the Beck Anxiety Inventory, the primary outcome measure, was d = 2.51 at post-treatment and 80 percent (4/5) adolescents no longer met DSM-IV criteria for their primary anxiety disorder as measured by the Anxiety Disorders Interview Schedule for DSM- IV: Child and Parent Versions.

Based on the results from this pilot study the tentative conclusion might be that tailored internet delivered CBT could be useful for adolescents with anxiety disorders along with standard treatment delivered in child and adolescent psychiatric clinics.

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How Magnets “Reset” Depressed Brains

Magnetic pulses from a device applied to the head appear to "reset" the brains of depressed patients, according to a new study from the United Kingdom. The circuitry in a part of the right prefrontal cortex is known to be too active in depressed patients, causing excessive rumination and self absorption and impaired attention. When the TMS was applied to healthy subjects in this study, the activity in that region slowed.

"We found that one session of TMS modifies the connectivity of large-scale brain networks, particularly the right anterior insula, which is a key area in depression," lead scientist Sarina Iwabuchi, told the European College of Neuropsychology at a conference in Amsterdam this week.

This was the first time an MRI was used to guide the TMS impulses and, at the same, time measure subtle changes in brain circuit activity. In addition, the researchers used magnetic resonance spectroscopy to analyze subjects' brain chemistry.

"We also found that TMS alters concentrations of neurotransmitters. Iwabuchi said, "which are considered important for the development of depression," and which are the targets of most current antidepressant medications.

Transcranial Magnetic Stimulation is the use of an electromagnetic coil to deliver small, powerful bursts of energy to targeted areas known to be involved in mood regulation. It is a painless, non-invasive treatment than involves no drugs, no IVs, or any other kind of sedation, and whose chief possible side effect is a headache. (The Food and Drug Administration approved limited use of TMS in 2008 for the treatment of depression.)

The importance of a new tool to treat depression, say experts, cannot be understated. It's been more than 30 years since a truly new medication has come on the market and for those with intractable depression, TMS could be a much-needed alternative. Previously, when multiple courses of drugs have not helped, electroconvulsive therapy was often a patient's only option. Formerly known as shock treatment, ECT has been around for decades, requires anesthesia, and the electricity delivered to the brain is much more direct and much less targeted than with TMS. Scientists also have little understanding about why electroconvulsive therapy works, when it does. Its side effects, including memory loss, can also be significant.

"These findings are an exciting step in understanding how targeting the brain activity with magnetic stimulation may exert beneficial effects in the treatment of depression," said Prof. Catherine Harmer on behalf of the European College of Neuropsychology. "TMS techniques are still evolving . . . This kind of experimental medicine study is therefore essential for the improved personalization and treatment of depression in the future."

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Study: Depression And Serotonin Levels

Depression and anxiety disorders are the most common psychiatric disorders. Over the last few years, molecular brain imaging using Positron Emission Tomography (PET) has helped us to identify important mechanisms involved in the development and treatment of these disorders, particularly those associated with the serotonin neurotransmitter system. The drugs that are used for these conditions (SSRIs) were developed 30 years ago. To celebrate this anniversary, a team from MedUni Vienna, led by Siegfried Kasper, Director of the University Department of Psychiatry and Psychotherapy, has summarized the latest status of global research in this field in the leading journal, The Lancet Psychiatry.

"People laughed at us when we started treating depression with SSRIs (selective serotonin reuptake inhibitors) 30 years ago," explains Siegfried Kasper, who is also one of the pioneers of this method of treatment. "Today it is State of the Art and we are able to quantify disturbances in serotonin signal transmission in the brain as the cause of depression and anxiety disorders." 80% of those suffering from depression are treated with SSRIs – the success rate is around 70%. Kasper: "Their quality of life is enhanced and there is a significant and lasting improvement in their motivation and mood."

Quantifiable mechanisms

Using Positron Emission Tomography (PET) from nuclear medicine, it is possible to quantify receptors, transporters and enzymes, in order to diagnose neurochemical differences in brain disorders but also to make a detailed analysis of the effects a drug has on the brain.

For example, it was also shown that the level of serotonin transporter (SERT) is greatly reduced in certain parts of the brain in patients with depression. At the same time, PET showed that SSRIs are a very effective pharmacological first-line therapy that brings about specific changes in the activity of the serotonin system. The serotonin transporter (SERT) is a cell membrane protein that facilitates return of the neurotransmitter serotonin (commonly known as the "happy hormone") into the cell. The activity of the serotonin transporter influences neural networks in the brain that are changed in depression. The serotonin transporter therefore also serves as a point of attack for the main antidepressants, such as SSRIs.

The current study is the result of a collaboration with the Neurobiology Research Unit of Copenhagen University Hospital. Rupert Lanzenberger's research group at the University Department of Psychiatry and Psychotherapy, under the direction of Siegfried Kasper, is one of the leading international research teams in the field of PET brain imaging in psychiatric disorders. The underlying mechanisms for this were investigated in Vienna, in collaboration with the University Department of Radiology and Nuclear Medicine.

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Intelligence, Creativity And Bipolar Disorder May Share Underlying Genetics

Serious mood disorders such as bipolar may be the price humans have had to pay for our intelligence and creativity.

That’s according to new research which links high childhood IQ to an increased risk of experiencing manic bipolar traits in later life.

Researchers examined data from a large birth cohort to identify the IQ of 1,881 individuals at age eight. These same individuals were then assessed for manic traits at the age of 22 or 23.

The statements they provided were part of a checklist widely used to diagnose bipolar disorder. Each person was given a score out of 100 related to how many manic traits they had previously experienced.

Individuals who scored in the top 10% of manic features had a childhood IQ almost 10 points higher than those who scored in the lowest 10%. This correlation appeared strongest for those with high verbal IQ.

“Our study offers a possible explanation for how bipolar disorder may have been selected through generations,” said Daniel Smith of the University of Glasgow , who led the study.

“There is something about the genetics underlying the disorder that are advantageous. One possibility is that serious disorders of mood - such as bipolar disorder - are the price that human beings have had to pay for more adaptive traits such as intelligence, creativity and verbal proficiency.”

Smith emphasizes that as things stand, having a high IQ is only an advantage: “A high IQ is not a clear-cut risk factor for bipolar, but perhaps the genes that confer intelligence can get expressed as illness in the context of other risk factors, such as exposure to maternal influenza in the womb or childhood sexual abuse.”

The results are consistent with previous research that suggests individuals with an increased genetic propensity to bipolar disorder were more likely to show a range of creative abilities, especially in areas where verbal proficiency may prove advantageous, such as in literature or leadership roles.

Bipolar disorder is thought to affect one in 100 people in the UK and is characterised by periods of depression followed by episodes of mania, during which people can feel extraordinarily happy, ambitious and creative. It can also include periods of psychosis.

Smith hopes the results, which were published today in the British Journal of Psychiatry, will help improve approaches for the earlier detection of the disorder. “I suspect there are things that can be done early on to help someone at high risk of bipolar, such as making certain lifestyle changes, protecting sleep patterns, avoiding certain stresses. The sooner we can intervene in bipolar the better the outcome,” he said.

Suzanne Hudson, chief executive of Bipolar UK, said “Given the rise in requests for support from parents and families of children to Bipolar UK, research that helps identify young people more at risk of developing bipolar disorder is vitally important.”

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Epigenetics Research Suggests Anxiety May Have Genetic Markers

"Is everything OK?"

When my children ring me, this is how I answer the phone. There is none of the playfulness I overhear when other women speak to their adult children. It's the same when they travel. I worry, endlessly watching for dots on messages. If the phone rings, I imagine the worst.

For years, when talking to friends who'd been Australians for generations, I'd explain this away as being a "born worrier". I'd just laugh it off – and restrain myself from dashing over to save their children from the risks of the trampoline.

The truth was a little more complex. I may not have been a born worrier – but by the time I was old enough to recognise my place in my family, I had the idea that life was filled with terror, with unpredictability. That in all circumstances, one must be always on the lookout for possible attacks.

My parents survived the Holocaust. My aunt survived a death camp. My father survived a labour camp, my mother ran from country to country and eventually met my father in a refugee camp in Austria. Most of the rest of their families died in concentration camps, certainly that was the fate of all my grandparents.

How your parents behave towards you when they have survived that adolescence, such a young adulthood, is irrevocably shaped by those circumstances. The effects of being a Holocaust survivor include survival guilt, but there is so much more than that. A wide variety of researchers have documented the many and varied psychiatric symptoms of those who lived, and their children. My parents were so anxious every time I left the house – and god forbid, I should ever go to a sleepover at the home of someone who wasn't Jewish. I let my kids go to sleepovers but slept with the phone right next to my bed, the ring tone up loud.

New research from Rachel Yehuda, a professor of psychiatry in the Icahn School of Medicine at Mount Sinai Hospital in the United States, has been hailed as proof that psychological burdens of parents might affect their children not only as part of their upbringing, but that a form of molecular imprint might also be transferred. The main finding in her paper is that in her study of Holocaust survivors and their offspring, there are distinct chemical tags on a gene involved in stress responses. That research is called epigenetics – it's not the study of the genes themselves or the code in them, but of chemical "bookmarks" attached to them.

Many people have responded to these findings by saying the end is nigh, that the epigenetic changes in their children’s could only have been caused by the parents' exposure to the Holocaust. That we can never escape trauma.

But, although both generations differed in the epigenetic marks of the gene compared to control subjects, the change in the parents is the dead set opposite of what is seen in the children. Besides, as Yehuda herself says, the researchers can only show correlation; whether the epigenetic changes actually contribute to differences in psychological make-up of individuals remains to be proven. The study was set up to compare demographically similar groups so that only the Holocaust experience differed between affected families and controls. There are of course many possible variables.

"The message is not that we are damaged forever as a result of things that we experienced," she says. "It could be that the offspring change is the reaction to the parental biology ... the last thing you should say is that we are stuck, what we have is a way of adapting to our environment."

Is the study proof of anything except finding a higher density of a chemical tag among the parental group and then a lower density of this tag in the same genetic region among the offspring group?

Not exactly, which Yehuda is quick to make clear.

Thomas Preiss​, a professor of genome science at the Australian National University familiar with the molecular basis of epigenetics, explains that the Yehuda study investigated a small number of subjects and that even with those chemical changes, the epigenetic changes, you can't generalize to an entire population.

"It's a disposition that will be apparent in large numbers; but on any individual? You can't say there has to be any effect," he says. "The effect is much more subtle ...  the social component of a situation like that is likely to be very strong.

"Even on the side of the perpetrators these things have a strong and lasting impact, a psychological effect which may take time over generations to work through.  Epigenetics won't be the complete explanation."       

And Marnie Blewitt, a laboratory head in the division of molecular medicine at the Walter and Eliza Hall Institute of Medical Research in Melbourne, says that any definitive research in this area needs to be more statistically powered. Many more subjects. Much more data. She is also very wary of any interpretation which encourages the ordinary reader to imagine that their destiny is predetermined.

"What can't be ruled out is that the group was genetically different in the first place," she says.

The conversations with Blewitt, Preiss and Yehuda cheer me up. Perhaps I won't pass my intensity on to my children. Maybe the scientists don't understand how much that worries people like me.

Finally, I talk to Anna Rosner Blay​, whose 1998 book Sister Sister explained to me why I felt the way I did. She says friends have been sending her the reports of the Yehuda research; and that it would not surprise her to know that there was some genetic impact.

"We pick up a lot from our parents, that predisposition to be a worrier," she says.

And when she tells me how she feels, day to day, I recognize this feeling as if it is my own.

"I don't know if the glass is half-full or half-empty but it is too close to the edge of the table."

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Depression Induced Hypersomnia

The majority of patients with depression have problems with sleep, usually insomnia. But about 10 to 12 percent have the opposite problem.

In this edition of Vital Signs, Dr. Madhukar Trivedi, Director of UT Southwestern’s Center for Depression Research and Clinical Care, and chief of the Mood Disorders Division of Psychiatry at UT Southwestern, talks about hypersomnia and how aerobic exercise may alleviate the problem.

What is hypersomnia: “Hypersomnia is when people sleep too much. When they wake up, even though they’ve slept ten, 12 hours, they don’t feel rested. During the daytime, they also get sleepy or have small naps, and therefore hypersomnia lasts all 24 hours. It does seem it’s disrupting the circadian rhythm all of us have. Secondly, that may be associated with different kinds of hormones and proteins in the brain that may be responsible for this.”

Hypersomnia’s link to major depressive disorder: “That’s the primary symptom. People who have hypersomnia also eat a lot, or at least snack a lot, much more weight gain as opposed to people with insomnia, and more fatigue and a different subtype of depression.”

Why aerobic exercise may alleviate hypersomnia: “There’s very good pre-clinical, or animal, data showing that if exercise leads to neurogenesis – that is, brain cells actually regenerate – and there are also reductions in stress hormone and inflammation, in a related publication from this very study we find that those patients who have more inflammation do better with exercise. And if you compare that with other studies, SSRI’s like Prozac, etc, they actually do less for people who have inflammation. So it’s almost like exercise is an anti-inflammatory treatment.

“So what we found is that people who have this higher inflammation, they are really not responding to regular antidepressants. When you give them exercise as a treatment, either on a treadmill or on a bike with moderate intensity, this inflammation goes down and that is how their sleep improves.

“Before they were put into the study, they had tried an SSRI. The SSRI had not worked, and they still had significant depressive symptoms. When we put them through the exercise regimen for 12 weeks with this intensity of exercise, the effect of exercise of their depression is very similar to the effect you see with an SSRI.”

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FBI Agent Recommends 3-Step Exercise To Beat Anxiety

In my experience, the problem with feeling stressed during an important presentation is twofold.

One, I'm typically dealing with some combination of sweaty palms, shaky legs, and violent heart palpitations. And two, I'm trying to conceal all that from my audience, feigning the calmness of a Zen Buddhist monk.

In other words, I've got anxiety about the presentation and then meta-anxiety about masking my feelings.

Faced with this perennial dilemma, and figuring I wasn't the only one, I called up Joe Navarro, a former FBI agent and the author of "What Every BODY is Saying."

I wanted Navarro to tell me how to manage the impression you make on other people when you're nervous. How do you control those behaviors that are dead giveaways of how anxious you are?

His answer: don't.

"The first thing I tell people is, if you're nervous, there's a good reason for it," he says. Maybe you're meeting people for the first time or going on a job interview, or giving that dreaded presentation.

"Go ahead and front that, don't try to conceal it."

Navarro says acknowledging that you're nervous — and being okay with that — can actually help alleviate some of your anxiety.

"Stress is a natural event, and you can drive yourself crazy trying to control it, when sometimes it's just easier to admit, 'I'm nervous, and I should let others know about it.'"

Navarro's philosophy on anxiety and conquering it boils down to a three-step strategy:

1. Declare to yourself that you're anxious.

2. Declare to your audience that you're anxious.

3. Adapt your nervous behaviors.

The first step is perhaps the hardest. Research suggests that, in stressful situations, people's general impulse is to try to calm down. Admitting that you're anxious means making yourself somewhat vulnerable and allowing yourself to feel, instead of trying to suppress, those emotions as usual.

The irony is that your audience may be more understanding of your anxiety than you are. Step two involves telling your listeners that you're nervous — a simple statement like, "Boy, it's tough talking to a big group" should suffice.

Novarro predicts that your audience will smile in response because not only do they want you to succeed, but they also likely understand exactly what it's like to have your nerves get the better of you. That reaction will help you relax.

The third step allows you to tweak your nervous tics — without eliminating them entirely — so that you don't look quite so frazzled.

For example, if you know that you tend to wring your hands or twirl your hair when you're under stress, try slowing down the behaviors. If you bite your lip, practice doing it more gently. You'll still get the soothing effect of engaging in these repetitive actions, but it won't be so noticeable to your audience.

You can also redirect the behaviors to a less visible part of your body. Instead of continually touching your face, you can tap your leg under the table where no one can see it.

Yet while there are plenty of strategies for making yourself look more composed, Navarro says the bottom line is that you should expect to feel anxious once in a while.

"We mustn't assume that life is supposed to be without any kind of stress."

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Symptoms Of England’s Most Common Mental Health Problem: Anxiety

Anxiety is one of the most common mental health problems in the UK.

Roughly one in four people in the UK will experience a mental health problem each year, according to the Mental Health Foundation.

It's also estimated that one in six experience a neurotic disorder such as anxiety or depression.

Talking about the symptoms of anxiety disorders - specifically generalized anxiety disorder (GAD) - psychologist Douglas Mennin reveals that these disorders can affect different people in different ways and on varying scales.

But, he says, "they all provoke extreme fear or worry that interferes with daily life".

Symptoms of anxiety:

  • Chronic or unsubstantiated worry.
  • Repeated, random panic attacks or persistent worry and anticipation of another panic attack.
  • Irrational fear or avoidance of an object, place or situation that poses little or no threat or danger.
  • Performing uncontrollable, repetitive acts such as washing your hands or checking things over and over.
  • Ongoing and recurring nightmares, flashbacks and emotional numbing relating to an emotional event in your life.

Mennin adds that symptoms of anxiety may pass quickly, and in other people they may last for a long time.

Generalized anxiety disorder (GAD)

According to NHS Choices, GAD is a long-term condition that causes you to feel anxious about a wide range of situations and issues, rather than one specific event.

It is estimated to affect about one in every 25 people in the UK.

"People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed," reads the site.

"It can cause both psychological (mental) and physical symptoms. These vary from person to person, but can include feeling restless or worried and having trouble concentrating or sleeping."

Mennin also states that women are twice as likely to be affected as men.

"People with this disorder experience constant worry, it disrupts social activities and interferes with work, school or family," he says.

"They might also experience physical symptoms such as muscle tension and fatigue, restlessness and irritability, or gastro and intestinal discomfort of some kind."

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More Supporting Evidence For New Depression Treatment

Local scientists say they've discovered a way to potentially develop fast new treatments for depression. The University of Auckland says Dr Suresh Muthukumaraswamy has developed research into the action of ketamine on the brain. The university said the research sheds light on neural pathways that will help scientists develop fast-acting medications for treating depression.

Dr Muthukumaraswamy's research focused on brain imaging and using the latest technology in brain imaging to understand and treat brain disorders.

The technique used in the research was magnetoencephalography (MEG), measuring the brain's magnetic fields in combination with the latest in computational models.

"Our interest is in the mechanism of action that ketamine uses to be active in the human brain," Dr Muthukumaraswamy said. "That will give us a target for other compounds."

He said ketamine, developed in the 1960s, was off-patent now and primarily used as an anaesthetic and sometimes for chronic pain.

Only low doses of ketamine were needed, compared to anaesthetics, to create those anti-depressant effects, the University of Auckland said,

"We know that ketamine is active in the frontoparietal circuit of the brain and disconnects these two parts," he said.

"In depression those two parts of the brain work overtime in an over-connected way. It may be that ketamine works as an antidepressant by disconnecting those two parts of the brain and stopping that over-connectivity."

He said ketamine, unlike other anti-depressants, was very fast-acting. Yet other clinical trials found the ketamine-induced anti-depression effect only lasted a week or so.

"It's important as a mechanism to identify potential biomarkers of antidepressant activity in human patients, but for other reasons, we cannot use it for treatment."

Dr Muthukumaraswamy said ketamine was not licenced for depression because it was still very experimental in that role.

"Ketamine's anti-depressant properties were discovered relatively recently and did well in clinical trials. Unfortunately, ketamine is also a drug of abuse, as it's mildly hallucinogenic and it is unclear if it could be used in routine clinical practice," he said.

The research team investigated what effect ketamine was having on the brain to work so quickly. Further work is needed to explore this mechanism, he says.

The data was collected by colleagues while Dr Muthukumaraswamy was based at the University of Cardiff. Those colleagues tested the ketamine in healthy volunteers to see what parts of the brain it affects.

The findings were published today in the Journal of Neuroscience. Dr Muthukumaraswamy is a Rutherford Fellow and a senior research fellow in the university's schools of Pharmacy and Psychology at the University of Auckland. He's also a member of the University's Centre for Brain Research.

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Too Much Anxiety Can Stifle Personal Growth

Even with the gentle August sunsets we have been having and the soft feeling of summer passing by, there are people suffering from significant stress.

In fact, speaking with some college-aged individuals, there is already a growing trepidation or anxiety developing about their imminent return to school. This matches research that shows that a significant number of adults experience Sunday anxiety as a result of worrying about going back to work the next morning.  The anxiety is prevalent enough to actually impair or rob them of enjoyment of their day off.

In another real-life example, a man named Bill wanted more than anything to give the toast at his friend's wedding this summer. He mulled it over for days, thinking about what he would say and imagining how others might respond to him. Sometimes he felt like he was ready to say "yes" to his friend and commit to making the toast, but other times he felt like he just couldn't bear the thought of making a mistake and having people think poorly of him.

In the end, Bill told his friend that he could not make the toast and to ask someone else. Bill felt relief from his avoidance, but he also felt a deep despair and disappointment that he had once again allowed anxiety to prevent him from doing something he wanted to do. Bill is not alone, as anxiety is the most prevalent mental health problem in our country.

Many people don't realize that despite all of the problems it causes, what many of us consider as "anxiety" is a natural emotion that can serve a useful purpose when it occurs at the right time and in the right proportion. Anxiety, in small to moderate amounts, is simply a signal that can alert someone to the need to be more vigilant.

Studies of performance show that, without any anxiety, people may feel flat and listless and not perform their best. At the same time, too much anxiety can create havoc and destroy a person's ability to think clearly or succeed at their task. In other words, both too little arousal and too much anxiety can be self-defeating and interfere with life.

Optimal performance is related to just enough heightened arousal to be on one's toes without tripping over them.

Many people suffer from anxiety disorders and feel that high amounts of anxiety rule their life and effect almost everything they do. The natural reaction for many anxiety sufferers is to avoid situations that may involve this unpleasant feeling. This leads to lost opportunities, missed experiences and eventually living in a very small and constricted "safe" world.

Unfortunately, most anxiety sufferers do so in silence and do not share their fears with others, partly for fear of being ostracized or being told to "just get over it," which leads them into even further isolation and even despair.

Anxiety can be a devastating emotion for those who experience it too often and too intensely. Because anxiety is a "warning" system, it involves and effects almost every major system of the body. When the mid-brain perceives threat, no matter how abstract or trivial it may actually be, the body's "alarm" goes off and signals the central nervous system, the endocrine system, the digestive system, the circulatory system and the muscular-skeletal system to be on alert.

Under pressure, the body dumps adrenaline and cortical steroids into the bloodstream and the heart beats faster, blood pressure rises, blood vessels constrict, muscles tense and become engorged with blood (for running or fighting) and digestions slows or even stops.

These rapid changes in the physiology of the body are accompanied by emotional perceptions as well.

In more extreme anxiety, there is a pervasive sense of foreboding or even doom that creates a feeling of loss of control and fear. For others, there is a sense of challenge, vigilance or even threat that may be ill defined and ambiguous, but is there nonetheless.

Many anxious people will report that they are not sure what they are worried about, but that they just feel worried. That is much like having your home security system alarm going off, but not knowing what triggered it. That can be very frustrating and eventually exhausting.

These feelings can lead to avoidance of potential anxiety-provoking situations in an attempt to side-step the issue. People who get into this pattern often use a series of maneuvers including passive and dependent behaviors like oversleeping, cancelling at the last minute, using drugs or alcohol, or being sick as efforts to avoid their discomfort.

This can create occupational and relationship problems, which feed back into and worsen the core anxiety creating a vicious circle that keeps building in intensity.

The key to handling anxiety — regardless of its specific manifestation, which is different for each person — is to re-frame or view anxiety as a signal, rather than as a problem in itself. Once the origin and purpose of anxiety is understood, it can be seen as a maladaptive communication or "false alarm" that the brain is generating in a well-intentioned effort to protect the individual.

This understanding facilitates the person choosing not to "listen to" or act on the signal because it does not contain any meaningful information and to make an effort to manage or turn the false alarm off.

This also means empowering the individual to face the false alarm rather than succumb to it and to make every effort to do what they wanted to do regardless of that feeling. By facing anxiety and engaging in what is feared, the brain's feedback loop will incorporate and accommodate the new learning and eventually turn the alarm off, at least for that activity.

If Bill wanted to deliver the toast at the wedding and understood what he was facing, he would write the speech he wanted to give, practice it in front of the mirror, give it in front of his closest family and friends (or join Toastmasters group and do the same thing) before eventually actually delivering it at the wedding.

Over time, even his anxious brain would calm down and understand that he is safe and there is no threat to worry about.

Understandably, this is not always easy to do as the discomfort of anxiety can be quite disconcerting. Think of the last time you heard an alarm go off and what your reaction to it was, and imagine that happening inside your body.

Counseling and therapy for anxiety can be very effective in helping people understand and face their discomfort in order to transform it back into a motivational signal rather than a hindrance. Good therapists teach anxiety sufferers about anxiety and also practice tools for managing it effectively in order to face it head on. Tools like deep breathing, positive self-talk, use of imagery, self-cuing and even hypnosis can all help anxiety sufferers overcome their discomfort and engage fully in living again.

So if you are like Bill in avoiding meaningful life activities, or like many other Americans dreading upcoming challenges and feeling chronically anxious, consider making the decision to get help and reclaiming control over your life. You will be glad that you did!

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Did You Know?

More than one in four American adults has a diagnosable mental-health disorder, and one in 17 has a serious disorder such as schizophrenia or bipolar disorder


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