Monday, October 29, 2007

Major Stress in America: Studies Examine the Effects

Many people see stress as a natural part of life. However, extreme levels of it can prove to be quite dangerous. According to a survey recently released by the American Psychological Association (APA), one-third of Americans are living with extreme stress. The report published by the APA explains how the survey explored various issues, such as appropriate and excessive levels; circumstances, situations and life events that cause stress; activities, resources and behaviors people use to deal with it; and the personal costs of stress. This ongoing concern with stress and its physical symptoms has led many researchers to examine how mechanisms in the brain control the ability to adapt to it. It is important that researchers continue to study the effects of stress in order to develop new ways to promote resilience to psychological stress. This will prove beneficial to individuals whose stress contributes to the development of other mental disorders, such as anxiety and depression.

The APA report states that stress is taking its toll on people, contributing to health problems, poor relationships and lost productivity at work. The survey reports that half of Americans claim that they are more stressed than they were five years ago. In an APA press release, Russ Newman, APA executive director for professional practice, had this to say: “We know that stress is a fact of life and some stress can have a positive impact, however, the high stress levels that many Americans report experiencing can have long-term health consequences, ranging from fatigue to obesity and heart disease.” Even though 28% of Americans claimed to be managing their stress extremely well by engaging in activities such as exercising, praying, and listening to music, an even higher percentage reported experiencing the physical symptoms of stress (see image to the right). Surveys such as the one conducted by the APA are important in exploring what causes individuals the most stress. This survey found that the majority of American’s stress arose from work (74%) and money (73%). By knowing what aspects of life cause the most stress, specific programs can be designed to reduce stress in those target areas.

This great concern with the effects of stress has served to inspire many researchers to explore stress' underlying properties. For example, in a new study published online by Cell found that there is a distinct mechanism in the brains of mice that cause them to be resistant to stress. During stressful situations, vulnerable mice had excessive rates of impulse-firing by cells that make the chemical messenger dopamine in the brain. Adaptive mice on the other hand, maintained normal rates of firing due to a boost in activity of channels that allow the mineral potassium to flow into cells. The vulnerable mice were also found to have more activity of a protein called BDNF; resistant mice did not have this increase in BDNF. One of the authors of the study, Eric J. Nestler (pictured to the left, in the center with the other authors of the study) notes, “The fact that we could increase these animals’ ability to adapt to stress by blocking BDNF and its signals means that it may be possible to develop compounds that improve resilience.” He goes on to say that this is a great opportunity to explore potential ways of increasing stress-resistance in people faced with situations that might otherwise result in other disorders, such as post-traumatic stress disorder.

Continuing research on stress is essential in developing new and effective methods of regulating stress. One study that came out in the October issue of General Psychiatry, examined how behavioral intervention helps boost the stress regulating hormone, cortisol, in children who were at high-risk for developing antisocial behavior. The behavioral intervention proved to be successful in teaching these high-risk children the appropriate social skills needed to adapt to stressful situations. Interventions such as this one are important because they lessen the stress people would otherwise be left to face. Another study even examined the way video games can be a success in combating the stress by training people to change their perceptions of social threats and boost their self-confidence.

Collectively, all these studies done on stress work to explain how the dynamic interaction between the environment and the brain determine how one adapts to stress in life. More research will eventually lead to new medicine and treatments that will promote resilience to psychological stress. As new methods for controlling stress surface, they will undoubtedly help individuals deal with the pressures they face in life, from the post-traumatic stress of war to the stress induced by paying mortgage bills.

Sunday, October 21, 2007

Labeling Human Traits: Is it Shyness or Social Anxiety Disorder?

In honor of World Mental Health Day, which took place on October 10th, I would like to address issues that have been stirring the mental health community for some time now. Rick Nauert, Senior News Editor for the Psych Central website recently wrote an article looking at how a book, titled Shyness: How Normal Behavior Became a Sickness, challenges the method by which human behaviors are classified as psychiatric disorders. In his book, the author, Christopher Lane, a Northwestern University professor, brings attention to how labeling human traits as disorders leaves the doors wide open for the pharmaceutical industry to intervene and prescribe medication to fix the presumed biological imbalances. Lane argues that recent changes made to the Diagnostic and Statistical Manual of Mental Disorders (DSM) have set the diagnostic bar too low and more people may be diagnosed as having social anxiety disorder when in fact they may just be suffering from normal shyness. Issues such as these definitely need to be taken into consideration during the upcoming revisions to the DSM, because further ambiguity in diagnostic criteria will surely lead to high rates of over-diagnosis and harmful treatments. By examining the treatment for social anxiety disorder, for example, we can see how medications may not always be an effective approach to treating the disorder.

With more and more shy people being diagnosed with social anxiety disorder it would seem apparent that the DSM-IV is in need of revisions. In a New York Times article, “Shy on Drugs”, Lane reveals that, troublingly, in the fundamental handbook of psychiatry “the diagnostic criteria for shyness are far from clear.” Since the team of people who will oversee the development of the newest edition of the DSM, version V, scheduled to be published in 2012, has already been announced, it will be up to these professionals to make sure that diagnostic criteria are made clearer when it comes to disorders like social anxiety. In regards to the new edition of the DSM, Lane states that “this time they should make sure to carefully distinguish normal—even healthy—shyness from social anxiety disorder.” By making the language in the next DSM more direct and precise, mental health care providers might avoid misdiagnosing patients as having a serious disorder when the individual is only exhibiting typical personality traits.

It is also important to note that the drug industry has taken advantage of these high recurring disorders. The makers of Paxil, for example, came out in the late 1990s saying that it could treat social anxiety as well. Let us keep in mind that this drug was originally used to treat depression. Lane stresses the fact that “after being prescribed Paxil or Zoloft for their shyness and public-speaking anxiety, a disturbingly large number of children, studies found, began to contemplate suicide and to suffer a host of other chronic side effects.” In October 2004, the Food and Drug Administration placed a black box warning on all antidepressant medications. Dr. Lester M. Crawford, Acting FDA Commissioner, said that these actions “represent the FDA’s conclusions about the increased risk of suicidal thoughts and the necessary actions for physicians prescribing these antidepressant drugs and for the children and adolescents taking them.” The prescription of these dangerous drugs is undoubtedly unacceptable, especially if they are being used to treat symptoms that do not actually constitute a real disorder.

The fact that a more than 1.4 billion antidepressant prescriptions are being issued to children per year goes to show that too many in the United States are now opting for what seem to be quick fixes and not considering alternative treatments. Mental health care providers should discourage the use of medications when it comes to treating conditions such as social anxiety disorder because studies have shown that there are other available options. For instance, one study published in the Journal of Child Psychology and Psychiatry examined the efficacy of a school-based, cognitive-behavioral intervention on adolescents with social anxiety disorder. The study found that emphasizing exposure and rehearsal of social skills during the intervention was highly efficacious. It also proved that effective interventions can be transported to nonclinical settings like schools. Non-medication treatments such as this one are a safer option, especially for those individuals whose diagnosis may be on the borderline of normal shyness and social anxiety disorder.

According to the Social Phobia/Social Anxiety Association approximately 7% of the population suffers from social anxiety disorder. Therefore, it is important that the above mentioned and unclear diagnostic criteria issues be resolved soon because many people may be suffering more from a misdiagnosis than from an actual disorder. This issue of diagnostic uncertainty does not only pertain to social anxiety but to other disorders as well. I believe that the release of the new DSM will help ease the number of black box warning prescriptions being issued because it will make diagnostic criteria more precise. But as the mental health community awaits the release it is important that we keep other forms of treatments in mind.

Monday, October 8, 2007

Technological Treatments: Can Computer Programs Cure Phobias?

In a world connected by technology it is no surprise that people suffering from phobias are now turning to computers to cure them of their fears. MSNBC recently published an article explaining that in Britain, general practitioners are issuing passwords allowing their patients to access computer programs that mimic sessions with psychiatric counselors. The computerized cognitive behavior therapy program mainly works to teach patients new ways to think or react in order to alter their fearful behavior and emotions. Many believe that these programs are a great innovation because patients in Britain often struggle to get appointments with their therapists. Although it sounds like this new technology is capable of helping many, it may not be suited for everyone and could possibly fall short in providing adequate treatment to all patients.

The computer therapy does offer many advantages to patients suffering from phobias. In one of the programs called FearFighter, patients are taught to recognize the signs that trigger their panic attacks in order to prevent future attacks and they are also taught how to deal with their fears. People living with phobias are not the only ones encouraged to use FearFighter. Individuals with obsessive compulsive disorder, post traumatic stress disorder, depression and sleep disorder are all urged to use the program as well. Another clinically proven computer program, Beating the Blues, is also being recommended to combat anxiety and depression.

Both the National Institute for Health and Clinical Excellence (NICE) and the Department of Health in the United Kingdom have previously published reviews that offer guidance to using computerized cognitive behavior therapy programs. These reviews proved that the computerized programs were not recommended to treat such a wide range of disorders. For example, when it came to obsessive compulsive disorder, NICE was unable to recommend any computerized program for treatment. When it came to depression, Beating the Blues was only recommended for mild and moderate depression, and not severe depression. Therefore, not everyone will be able to benefit from these computerized programs. Furthermore, recommending a computerized cognitive behavior therapy program to a depressed patient may not be so beneficial because they may actually need to be prescribed medication and only a certified practitioner can do that. Depressed patients may in fact benefit more from interacting with a therapist than from interacting with a computer screen because an interpersonal relationship is formed. The therapists can also be more beneficial in letting their patient know that social support is seen to be essential in dealing with emotional pain.

By relying solely on the computerized CBT, patients suffering from phobias may also be missing out on other successful treatments that occur specifically in therapists’ offices, such as systematic desensitization and exposure therapy. In systematic desensitization the patient is taught various relaxation skills and together with the therapist they develop a hierarchy of anxiety-provoking situations. Someone who is afraid of spiders, for example, might start off by looking at a picture of a spider (see image above) and they then go on to apply these relaxation techniques to this fear inducing situation. However, these are techniques that work better if conducted with the supervision of a therapist. In exposure therapy, the therapist helps the patient overcome their phobia by exposing them to the stimuli that actually frightens them. Sometimes exposure therapy might involve reliving a traumatic event in a controlled, therapeutic environment. Exposure therapy has helped many trauma victims overcome PTSD and this just goes to show how interaction with therapists may prove to be better than interactions with computers.

Computerized CBT programs undeniably work well to help individuals deal with their phobias and depression. In Britain, a few thousand people are estimated to have already been treated with the programs. However, CBT should not in any way be used to replace real therapy conducted with a therapist because patients may miss out on other valuable components of therapy.

Monday, October 1, 2007

The Gap of Happiness: Exploring Whether Men are Happier than Women

Abraham Lincoln once said, “Most folks are about as happy as they make up their minds to be.” Helen Keller believed “happiness is not attained through self-gratification but through fidelity to a worthy purpose.” And according to George Burns “happiness is having a large, loving, caring, close-knit family in another city.” These are just a few examples of the many ways in which individuals have come to define the concept of happiness. If, however, people view happiness in distinct ways, how can researchers come to accurately measure it? The New York Times recently published an interesting article that examines studies conducted on gender and happiness levels. The article, written by David Leonhardt, looks at two unpublished studies that have concluded that men are slightly happier than women. The first study, by Betsy Stevenson and Justin Wolfers, proposes that the decrease in women’s happiness may be due to life improvements they have acquired since the 1970s. Noted in the second study, by Alan Krueger, is the gradual downward trend in the proportion of time men spend on unpleasant activities. Although the findings of these two new studies could help us to better understand the subjective well-being of individuals, the concept of happiness will continue being a stochastic phenomenon, one incapable of being accurately and consistently measured over time.

To begin with, it seems that both studies did an excellent job exploring possible cultural reasons as to why women may at times be less happy than men. One study emphasized the fact that women have obtained access to many more opportunities that were not available to them before, while the other examines the activities that men might find pleasant to partake in but women fail to enjoy. These are important factors to examine because happiness does change from situation to situation. Nevertheless, how one feels at the moment and how one feels on average over time may primarily be a matter of chance and not a matter of statistical significance. This is in fact what one study from the University of Minnesota concluded back in 1996. Therefore, it can be argued that more men may have reported feeling happier than women by chance. John M. Grohol, CEO and publisher of Psych Central, was able to do his own analysis on the raw data from the Stevenson and Wolfer study and asserted that women are becoming more “pretty happy” and less “very happy.” He also found that the “not happy” category remained unchanged (see image to right). In his blog, Grohol assures readers that he is not sure he would read that much into the data, certainly not as much as the authors did.

If we were to look at the findings of these studies from the Biopsychosocial Model perspective, we would note that change in individual’s happiness may be caused by many factors. This model works to explain human behavior by taking into consideration biological, cognitive-affective, social interpersonal, social institutional and cultural factors. Thus, simply stating that because women have faced more life improvements they are less happy is not sufficient evidence. Culture alone has a strong impact on our happiness. Jeremy Dean, a freelance writer and creator of PsyBlog, considers the power of culture and argues that the New York Times article “is not only claiming to describe a happiness gap between the sexes, it is also creating it.” Mental health issues related to women such as depression, postpartum depression and eating disorders may also be at fault for lower levels of happiness.

Finally, the assertion made by the Stevenson and Wolfer study declaring that the decreased happiness in women is ubiquitous across the old and young, employed and unemployed, married and divorced, seems to be a jump to conclusions. This would undoubtedly challenge the studies that have come out in previous years stating that recently divorced women feel liberated and happier. And although the study claims to be ubiquitous, it also states that the phenomenon does not occur across racial groups. For example, African American women have become happier just as much as African American men have. The study also points out that women’s subjective well-being “may be driven simply by a change in how [they] answer the question, i.e. a measurement, rather, than a hedonic trend.” These speculations, therefore, do not support the claim that women are in fact less happy than men.

Ubiquitous or not, happiness continues to be a complicated state of being to measure. Many factors influence it and the way happiness is experienced varies from individual to individual. Although studies such as the one conducted by Krueger or Stevenson and Wolfer provide some insight as to how gender differences in society explain happiness levels, their findings fail to provide external validity. Typically at the end of psychology articles, the authors of the study present ideas for possible future research that may offer more validity to their claims. In this case, however, given the complexity of the measuring happiness between genders I believe that further research might not contribute much to what is already known.
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