Brain immune cells may protect against OCD, anxiety

Over the last decade, scientists have been discovering that microglia, a type of immune cell that resides in the brain, do more than respond to illness and infection.

New research suggests a novel treatment for OCD and anxiety.

Now, new research in mice has linked the dysfunction of microglia of a particular genetic lineage to anxiety and obsessive-compulsive disorder (OCD).

The recent Cell Reports study also shows that female sex hormones can worsen the anxiety symptoms that arise when this subset of microglia do not function correctly.

The discovery sheds light on the brain biology of anxiety and conditions that relate to it, such as OCD, whose root causes have remained unclear.

“More women than men experience debilitating anxiety at some point in their lives,” says lead study author Dimitri Traenkner, Ph.D., a research assistant professor in biological sciences at the University of Utah in Salt Lake City.

“In this study,” Traenkner adds, “[we] were able to link anxiety to a dysfunction in a type of microglia and to female sex hormones.”

Microglia have many functions

Since their discovery in the 1920s, scientists have come to appreciate the important roles that microglia play in the brain following injury, infection, and illness.

They have shown that these innate immune cells play a part in conditions ranging from Alzheimer’s disease and multiple sclerosis to brain cancer.

More recently, however, a wealth of research has revealed that microglia have a large repertoire of functions.

Studies have shown, for instance, that microglia contribute to many aspects of brain development, including the generation of the myelin sheath that protects nerve fibers and the stimulation and pruning of connections between brain cells.

In addition, scientists are starting to appreciate that the influence of microglia extends into behavior.

‘At least two different lineages’

In their study paper, Traenkner and colleagues cite studies that have suggested that under conditions of prolonged stress, abnormal microglia activity may cause depression or anxiety.

They also explain that not all microglia are the same. For example, in their own research, they “recently demonstrated that there are at least two different lineages of microglia” and that it is possible to program them to do different things.

In that earlier work, the team identified a specific subset of microglia whose precursors express the protein Hoxb8 during embryonic development.

Hoxb8 is a transcription factor, which is a protein that can alter cell behavior by switching genes on and off.

It appears that about one-third of all microglia in the adult mouse brain descend from Hoxb8 precursors.

Other researchers have also shown that mice that have no Hoxb8 tend to overgroom, a behavior similar to the human disorder trichotillomania, a type of OCD that causes individuals to pull out their hair. However, they did not establish which cells are involved.

Hoxb8-lineage microglia

What Traenkner and colleagues did in the new study was to identify the cells responsible for this behavior as microglia that have descended from precursors with a Hoxb8 lineage.

Their experiments showed that inactivating Hoxb8-lineage microglia in mice caused overgrooming and that active Hoxb8-lineage microglia can stop the compulsive behavior.

“Researchers have long suspected,” notes Traenkner, “that microglia have a role in anxiety and neuropsychological disorders in humans because this cell type can release substances that may harm neurons.”

So, the fact that microglia can protect against anxiety surprised them, he adds.

In their experiments, the researchers also saw how female sex hormones can worsen the OCD and anxiety that arises from dysfunctional Hoxb8-lineage microglia. The symptoms were consistently more severe in the female mice than in the male mice.

In addition, female mice displayed anxiety that was not present in the males. The team saw evidence of this in a new test that they developed and validated, in which the animals’ pupils dilated markedly under stress conditions.

To confirm that female sex hormones were driving the symptoms of OCD and anxiety, the researchers varied the animals’ levels of two female sex hormones: estrogen and progesterone.

When the team manipulated these hormone levels in the female mice to resemble those typically present in males, the OCD and anxiety symptoms in the female mice were like those of males.

Conversely, when the hormones in males were at the levels typically present in females, the OCD and anxiety symptoms in the male mice were like those of females.

New direction for drug research

Traenkner suggests that these findings make a strong case for the existence of a mechanism that links biological sex and genetic family history in the risk of developing anxiety-related disorders.

The team does not claim to have found a cure for anxiety but suggests that the findings point to a new direction in which to look for new drugs to treat the condition.

Nearly one-third of adults in the United States will experience an anxiety disorder at some point in their lives, according to estimates from the National Institute of Mental Health, which is one of the National Institutes of Health (NIH).

The symptoms of anxiety can be so severe that they disrupt people’s relationships and their ability to work, study, and carry out their daily activities.

[This study] opens up a new avenue for thinking about anxiety. Since we have this model, we have a way to test new drugs to help these mice, and hopefully, at some point, this will help people.”

Dimitri Traenkner, Ph.D.

Obsessive-Compulsive Disorder and Secrecy

A critically important clinical feature of obsessive-compulsive disorder (OCD) is the pervasive secrecy of patients suffering from the condition. OCD involves recurrent, disturbing thoughts and recurrent and excessive behaviors, including rituals and constant checking. Secrecy about OCD symptoms has been responsible for a long-standing, marked underestimation of the true incidence of the illness. Although clinical recognition has increased, patients’ secrecy, shame and denial continue to have an impact on assessment, treatment, and the validity of research results.

More than with many other psychiatric disorders, OCD patients do not spontaneously or voluntarily report their symptoms to health providers or even intimate family members. OCD patients fear that revealing their symptoms will lead to severe censure and disapproval because the symptoms are often ego-dystonic and seemingly antisocial or bizarre in nature: repetitive obscene or blasphemous phrases, for example, or thoughts of attacking children or loved ones or removing one’s clothes in public. Also, there is reason to believe that secrecy has its own function in both the formation and perpetuation of OCD symptoms, which serve to protect against painful anxiety.

The feelings of shame and desire for secrecy strongly influence patients’ open acknowledgment of the senselessness of symptoms. OCD patients are characteristically highly concerned with approval from other people, and their acknowledgment or denial of symptom senselessness is often determined by assumptions about the expectations of interviewers, raters or administrators of self-report measures, rather than provisions of truthful accounts. There is very likely somewhat more acknowledgment of senselessness in those indulging in checking or else cleanliness behaviors, the latter being more congruent with the values of middle-class culture and therefore more individually and socially acceptable.

Attempts at diagnostic measurement, including studies of accompanying personality disorder symptoms, have been extensively confounded by the problem of shame and secrecy. These studies have shown markedly variable results. Such wide variation in itself suggests unreliability of diagnostic instruments, but less shameful-feeling obsessive-compulsive personality disorder (OCPD) patients are also secretive about reporting certain behaviors and characteristics—in this case, irrational control, hoarding, rigidity, miserliness, and meticulous perfectionism.

Sensitive extended clinical evaluations, because of trust and familiarity developed, reveal a full range of OCD patterns. Patients will readily supply answers when asked simple questions in an unthreatening manner. The questions must rely on voluntary report and in each case, the patient should be asked to evaluate the excessiveness and inappropriateness of behaviors stipulated.

How much is “excessive”? It is up to the trained clinician together with the patient to determine the answer. This orientation is also necessary for ongoing treatment and the following of specific features of the illness. In order to determine whether the patient engages in excessive checking behavior, information is gathered about job histories, including whether one repeats tasks. If so, how often?

At home, how many times is the lock on the door tested when the patient goes out, how often are the stove burners checked, how long does it take to dress in the morning? In order to assess cleanliness, the patient is asked about patterns of housekeeping, showering and handwashing. Are particular places avoided because of possible contamination or dirt? For symmetry and order, questions are directed toward preferred placement of objects in the home, pictures on the wall, and preferences about physical work environments.

For assessment of obsessional thinking, information is effectively evoked by identifying everyday difficulties in living and performing. Commonly reported problems in sleeping are followed by questions about the possibility of bothersome or repetitive thoughts that keep the patient awake. Similarly, if a patient reports distractions and inability to concentrate at work or at school, questions are asked about mental preoccupations.

Obsessive-compulsive disorder has long been hidden and difficult for both sufferers and therapists. Currently, various treatments are available with varying degrees of promise. A number of SSRI medications have shown beneficial effects, including clomipramine, fluoxetine, paroxetine, sertraline, and fluvoxamine—and psychotherapy is an absolute must.

A specialized brain cell could be a root cause of OCD and anxiety, especially in women

Anxiety disorders affect more than 40 million adults in the United States, making them the most common mental illness in the country.

Women, in particular, are at greater risk for anxiety and associated conditions such as Obsessive Compulsive Disorder.

The underlying causes of these disorders are still not very well understood, but new research suggests a specific type of brain cell may be responsible for certain behaviors common, Medical Xpress reported.

Scientists from the University of Utah have identified a potentially linked type of cell that plays a critical role during development in the womb. Lower levels of this cell type may play a role in the eventual onset of anxiety disorders.

The researchers looked specifically at a subset of microglia, a cell that helps wire together brain structures and neural circuitry. This subset, called Hoxb8-lineage microglia, accounts for about 30% of all microglia in the brain.

In a series of tests on mice, it was found that those who had Hoxb8-lineage microglia disabled showed excessive grooming behavior. The authors noted the similarity to trichotillomania, a condition that causes people to compulsively pull out their hair.

The findings were not only more noticeable in female mice, but ebbed and flowed when scientists adjusted the female sex hormones in both the female and male mice.

Curiously, the results of the study were not necessarily what the research team expected.

“Researchers have long suspected that microglia have a role in anxiety and neuropsychological disorders in humans because this cell type can release substances that may harm neurons,” lead author Dimitri Traenkner said. “So, we were surprised to find that microglia actually protect from anxiety, they don’t cause it.”

The study published in Cell Reports may form the basis of a new approach to developing drugs for those with anxiety disorders.

If You’re An Obsessive Compulsive Thinker, You May Notice These Thought Patterns

Have you ever felt painfully stuck on a thought loop in your head? While it’s common to go through periods where you think about a particular issue, scenario, thing, or person a whole lot — there is a difference between fixating on something and having obsessive compulsive thinking that truly intrudes on your life and peace of mind. If the latter sounds familiar, know that you aren’t alone, and there are both ways to tell if OCD is an issue for you, and the things you can do to cope with the symptoms.

As Tamar Chansky, Ph.D., founder of the Children’s and Adult Center for OCD and Anxiety and author of Freeing Your Child From Obsessive Compulsive Disorder, tells Bustle, OCD is a disorder where you have intrusive thoughts that are “unwanted, time-consuming, and can cause distress.”

“In other words they barge into your thinking when you don’t want them to,” Chansky says. “It’s different from being upset about something about your life and you feel stuck in a loop thinking about it.”

That is unpleasant too, Chansky says, but with OCD, often the content is not really relevant to your life. It may feel strange. You might be thinking about harm, contamination, being a bad person, or the evenness of items around you.

“The other part of OCD is that people do ‘compulsions’ or rituals to neutralize a thought,” Chansky says. “OCD makes an obstacle course for its sufferers, making them feel like they need to repeat, redo and rethink things that are not needing to be on their worry list at all,” Chansky says.

OCD can cause extreme stress and mental discomfort on the day to day. Shutterstock

“The core issue in OCD is unwillingness to accept certain kinds of uncertainty,” counselor Stephanie Woodrow, LCPC, NCC, who was recently named an emerging leader by the Anxiety and Depression Association of America, tells Bustle.

Obsessions are recurrent, persistent, unwanted, and intrusive thoughts or images that are disturbing and cause marked anxiety or distress, Woodrow says. The compulsions or rituals that accompany them for people with OCD are mental behaviors aimed at reducing distress, anxiety, disgust, or a “just not right” feeling.

“Research shows that everyone has unwanted, intrusive thoughts and images,” Woodrow says. “The difference between someone who develops OCD and someone who can dismiss them is the ability to not give those thoughts and images importance or value.”

Some of the common OCD themes include things like contamination with germs or bodily fluids, perfectionism, unwanted sexual thoughts, fear of illness, or superstition. And some of the common compulsions or rituals are things like checking and reviewing, seeking reassurance or confessing, thinking a safe thought, or ordering and arranging things, among many others.

Woodrow says that while research suggests a person must have a biological vulnerability in order to develop OCD, at this point researches don’t know what causes the “OCD gene” to kick in. But she does reiterate that “people do not cause their OCD, and neither does parenting.”

Woodrow says that options for treatment are extensive — they can include medications, outpatient, inpatient, or partial hospitalization therapy programs, mindfulness practice, and a variety of therapeutic modalities like Cognitive Behavioral Therapy (CBT).

Elise Hall, LCSW a clinical social worker with a private practice specializing in the treatment of OCD and anxiety disorders tells Bustle that “the gold standard” for OCD treatment is Exposure Response Prevention, wherein a trained therapist guides you through different exposure tasks to help your brain and central nervous system learn that the feared outcomes of the obsessive thoughts are unlikely and/or tolerable.

Chansky says too that professional help is definitely the way to go when you suffer from OCD. But on the day to day, a first step is to relabel the thought you are having as not being about you, and not being your fault.

“It’s a brain hiccup that is said in words, but still as meaningless as a hiccup,” Chansky says. “You need to train yourself to ‘under-react’ to the frightening thoughts because they only carry the weight you give them, they have no authority in your life unless you give them that attention.”

Of course, that doesn’t mean that recognizing that the thoughts are obsessive will make them disappear. It can be a long process, Chansky says. But one of the treatments for OCD is to essentially start skipping or “breaking the rules” of what your OCD brain is telling you what to do.

“Over time, as you stop tapping, touching, redoing, washing etc., via neuroplasticity, your brain re-learns that those warnings are unnecessary and starts filtering them out,” Chansky says. “Don’t avoid the OCD situations — face them, and change the rules gradually shaping your actions to how you would want to respond if you didn’t have OCD.”

Chansky says that if you’re even struggling with non-OCD thoughts getting stuck on a loop, it’s good to use neuroplasticity there too.

“Rather than jumping into worry mode whenever a thought comes in your mind, compartmentalize, create structure, and worry on a schedule rather than having those thoughts interfere in your work day,” Chansky says. “If you can’t kick the worry habit entirely, set a time for worrying 5 minutes where you name your fears and then fact check them.”

We have to shift out of worry mode intentionally to see that it is not useful to us, Chansky says.

If you’re concerned that OCD might be an issue for you, reach out for professional help. It is a treatable disorder — and you can find relief.

Experts:

Tamar Chansky, Ph.D., founder of the Children’s and Adult Center for OCD and Anxiety and author of Freeing Your Child From Obsessive Compulsive Disorder.

Stephanie Woodrow, LCPC, NCC, recently named an emerging leader by the Anxiety and Depression Association of America, tells Bustle.

Elise Hall, LCSW a clinical social worker with a private practice specializing in the treatment of OCD and anxiety disorders.

Studies sourced:

Hezel, D. M., Simpson, H. B. (2019, January). Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343408/.

Five signs you may be living with anxiety

When checks revealed no physical health problems, Robert’s GP determined the symptoms as panic attacks, a common sign of an anxiety disorder.

Says Dr Blashki: “Anxiety, and in particular panic attacks, usually involve significant physical symptoms such as a racing heart, breathlessness, dizziness, a choking feeling, a churning stomach, chest pains.”

He adds: “The symptoms can come on quite suddenly and can escalate within minutes. Not surprisingly, someone experiencing a panic attack is often worried they’re going to pass out, embarrass themselves, or even die — so it can be quite a terrifying experience.”

Worry that’s out of proportion

When worry becomes your constant companion, you could be experiencing an anxiety condition.

Unrelenting worry with no single focus and a tendency to escalate into catastrophic thoughts is a red flag, says Dr Blashki.

“People who are experiencing social anxiety get very caught up worrying about what other people think of them and imagine that others are observing and criticising them,” he says.

“People with Generalised Anxiety Disorder are very prone to catastrophic thinking and imagining the worst possible outcome of any situation.”

He adds: “The psychological approach called cognitive behavioural therapy targets negative thinking and helps people to put these thoughts into perspective.”

Obsessive thinking

Anxiety conditions can provoke persistent, distressing thoughts that can make you feel stuck in a loop.

Natasha*, 35, had started lying awake nightly, ruminating over perceived slights at work. She’d fixate on answered emails or texts. Had she caused offence? Was her job in danger?

Her obsessive brooding, disrupting her sleep and mood, turned out to be a key symptom of an undiagnosed anxiety condition.

Obsessive thinking can also indicate a specific type of anxiety condition: Obsessive Compulsive Disorder (OCD).

Says Dr Blashki: “The central feature of OCD is recurring intrusive thoughts that can lead to significant disability and lost quality of life.

“Common themes for obsessions include cleanliness, safety and checking, counting or hoarding and sometimes sexual or religious/moral issues.”

He adds: “OCD usually manifests in the need to repeat activities like checking or hand washing, to obtain a sense of relief.”

Avoidance

Lisa* froze outside her office one day. “I just couldn’t move my feet forward,” she says. “I turned around, went home, and called in sick.”

After increased absences from work, Lisa sought help. With a diagnosis from her GP, she was able to manage her anxiety condition.

“Avoidance and withdrawal from anxiety-provoking situations is very common,” says Dr Blashki, “and unfortunately when anxiety is not addressed, the situations in which a person feels safe tend to become increasingly restricted.”

He adds: “People sometimes develop a secondary condition we call agoraphobia, where they avoid any place where they might feel trapped, embarrassed or helpless.”

Unwanted flashbacks

Post-traumatic stress disorder (PTSD) is an anxiety condition that can occur after someone experiences a traumatic event, such as war, an accident, assault or natural disaster.

“Often the person experiences upsetting memories, flashbacks or dreams,” says Dr Blashki. “Or they

might find they get very distressed when something reminds them of the event.”

“People with PTSD might find themselves always on guard and vigilant, easily startled and easily irritated. Some also find that they feel emotionally detached and disconnected,” he adds.

If you think you or someone you know is experiencing symptoms of anxiety, reach out to Beyond Blue for support. Visit https://www.beyondblue.org.au/ to learn more.

*Real names weren’t used for anonymity

Common Misconceptions About OCD and Its Symptoms

Common symptoms of OCD include (but are not limited to) anxiety, intrusive thoughts, or images that may be violent or disturbing and don’t go away quickly, excessive reassurance-seeking, avoidance, a fear of losing control, and a need for things to feel “just right.”

Are there different types of the disorder?

OCD is a wily disorder that can take on many different forms or subtypes. Sometimes people will suffer from multiple subtypes of the disorder throughout their lives. Different types include contamination, harm OCD, pure O, scrupulosity or religious OCD, relationship OCD, and postpartum OCD.

Contamination is one of the most common types of OCD. People with OCD who fixate on contamination are likely to wash their hands or shower far more than is necessary to maintain health and hygiene and will avoid coming into contact with certain things that they fear may be contaminated. Contamination is the sort of OCD that is usually depicted in pop culture, which Syzmanski says sometimes leads people to think that compulsions like washing and cleaning are the only symptoms of OCD.

Then there’s harm OCD. “I see a lot of harm OCD,” Maxwell says, which consists of fears that the person will cause harm to others or themselves, or that serious harm will be inflicted on them by others, and so they try to be hypervigilant of their thoughts, words, and behavior in order to prevent doing damage. Maxwell adds that in her work with children who have OCD, it’s common for them to have a fear of being kidnapped, and the accompanying compulsive behaviors are elaborate bedtime rituals in which the child will repeatedly check door locks, windows, alarm systems, and seek reassurance from their parents that they will be okay.

Some OCD patients don’t suffer from compulsive behaviors at all. In cases where someone has pure O — meaning pure obsessions — they will experience disturbing, obsessive thoughts and images, but do not carry out rituals in order to quell their fears.

How long does it take to get diagnosed?

For a variety of reasons, it can often take a really long time for people with OCD to get a proper diagnosis. According to a 2015 article published in the journal American Family Physician, it typically takes 11 years between the onset of OCD symptoms and receiving treatment.

According to Syzmanski, one of the main reasons why it can take such a long time to get a proper diagnosis is due to the fact that people with OCD are often ashamed of their thoughts and behaviors. “Because people [with OCD] recognize, for the most part, that what they’re feeling and their behavior is out of the norm and they don’t want to be doing it, they get ashamed and tend to hide and isolate.” People with harm OCD in particular may be convinced that they have committed or are capable of committing serious offenses against others, and will feel tremendous guilt and shame over things they’ve never done or been accused of. If the person isn’t opening up about their symptoms, it can be a lot harder for anyone, even a professional, to notice that they have the disorder.

It’s also the case that even in the medical community, there are a lot of misunderstandings about OCD. Szymanski says that half of the cases of this particular disorder are misdiagnosed by medical professionals.

How is OCD caused?

As is true with many different mental illnesses, researchers have not found a definitive cause, but BeyondOCD.org notes that there is a neurobiological basis for OCD. That is, the brains of people with OCD work differently than the brains of people without it. Further, research shows that it may be caused by a combination of neurobiological, genetic, environmental, and cognitive and behavioral factors. A quarter of people with OCD also have an immediate family member with OCD.

Hope is a key factor in recovering from anxiety disorders: Hope increases in therapy

The concept of hope has long stirred opinion. In the sixteenth century, Martin Luther celebrated its power, claiming “Everything that is done in this world is done by hope.” Two centuries later, Benjamin Franklin warned that “He that lives upon hope will die fasting.” Into the conversation, Gallagher reports that psychotherapy can result in clear increases in hope and that changes in hope are associated with changes in anxiety symptoms.

More than pure philosophy, Gallagher has empirical evidence. His study examined the role of hope in predicting recovery in a clinical trial of 223 adults in cognitive behavior therapy (CBT) for one of four common anxiety disorders: social anxiety disorder, panic disorder, generalized anxiety disorder and obsessive-compulsive disorder.

“In reviewing recovery during CBT among the diverse clinical presentations, hope was a common element and a strong predictor of recovery,” said Gallagher who reports that moderate-to-large increases in hope and changes in hope were consistent across the five separate CBT treatment protocols.

In terms of psychotherapy, hope represents the capacity of patients to identify strategies or pathways to achieve goals and the motivation to effectively pursue those pathways. Significantly, the results of this study indicate that hope gradually increases during the course of CBT, and increases in hope were greater for those in active treatment than for those in the waitlist comparison. The magnitude of these changes in hope were consistent across different CBT protocols and across the four anxiety disorders examined, which underscores the broad relevance of instilling hope as an important factor in promoting recovery during psychotherapy.

“Our results can lead to a better understanding of how people are recovering and it’s something therapists can monitor. If a therapist is working with a client who isn’t making progress, or is stuck in some way, hope might be an important mechanism to guide the patient forward toward recovery,” said Gallagher.

Hope is closely related to other positive psychology constructs, such as self-efficacy and optimism, that have also been shown to have clear relevance to promoting resilience to and recovery from emotional disorders, said Gallagher.

Gallagher is the first author of the paper. The research is part of a larger project examining the efficacy of CBT for anxiety disorders led by David H. Barlow, founder and director emeritus of the Boston University Center for Anxiety and Related Disorders.

Hope is a key factor in recovering from anxiety disorders

IMAGE: University of Houston associate professor of clinical psychology, Matthew Gallagher reports in Behavior Therapy that hope is a trait that predicts resilience and recovery from anxiety disorders.
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Credit: University of Houston

University of Houston associate professor of clinical psychology, Matthew Gallagher, has added his voice to a debate that spans the ages — the importance of hope. Gallagher reports in Behavior Therapy that hope is a trait that predicts resilience and recovery from anxiety disorders.

The concept of hope has long stirred opinion. In the sixteenth century, Martin Luther celebrated its power, claiming “Everything that is done in this world is done by hope.” Two centuries later, Benjamin Franklin warned that “He that lives upon hope will die fasting.” Into the conversation, Gallagher reports that psychotherapy can result in clear increases in hope and that changes in hope are associated with changes in anxiety symptoms.

More than pure philosophy, Gallagher has empirical evidence. His study examined the role of hope in predicting recovery in a clinical trial of 223 adults in cognitive behavior therapy (CBT) for one of four common anxiety disorders: social anxiety disorder, panic disorder, generalized anxiety disorder and obsessive-compulsive disorder.

“In reviewing recovery during CBT among the diverse clinical presentations, hope was a common element and a strong predictor of recovery,” said Gallagher who reports that moderate-to-large increases in hope and changes in hope were consistent across the five separate CBT treatment protocols.

In terms of psychotherapy, hope represents the capacity of patients to identify strategies or pathways to achieve goals and the motivation to effectively pursue those pathways. Significantly, the results of this study indicate that hope gradually increases during the course of CBT, and increases in hope were greater for those in active treatment than for those in the waitlist comparison. The magnitude of these changes in hope were consistent across different CBT protocols and across the four anxiety disorders examined, which underscores the broad relevance of instilling hope as an important factor in promoting recovery during psychotherapy.

“Our results can lead to a better understanding of how people are recovering and it’s something therapists can monitor. If a therapist is working with a client who isn’t making progress, or is stuck in some way, hope might be an important mechanism to guide the patient forward toward recovery,” said Gallagher.

Hope is closely related to other positive psychology constructs, such as self-efficacy and optimism, that have also been shown to have clear relevance to promoting resilience to and recovery from emotional disorders, said Gallagher.

Gallagher is the first author of the paper. The research is part of a larger project examining the efficacy of CBT for anxiety disorders led by David H. Barlow, founder and director emeritus of the Boston University Center for Anxiety and Related Disorders.

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Lessening anxiety: A key to unlocking greater health

LEFT unchecked, anxiety can spiral into an uncontrollable monster.

The disorder presents symptoms that may range from heart palpitations and difficulty breathing, to a sudden breakout in perspiration, feelings of dread, and mental confusion.

While anxiety describes a feeling of nervousness or worry, when those feelings persist even in the absence of the thing causing the anxiety, then anxiety may lead to a disorder.

Dr Julian Walters, a leading adult and child psychiatrist at the Fairview Medical Centre in Montego Bay, St James, reports that approximately 40 per cent of Jamaican children struggle with depression and anxiety, triggered by abuse. It is not difficult to see these young ones maturing into adults, carrying with them a bigger baggage as they deal with another round of anxiety challenges.

The figures are spiking on the world scene, because according to the US National Institute of Mental Health (NIMH), “anxiety disorders affect about 40 million American adults age 18 years and older…in a given year”.

When one member suffers an anxiety disorder, the entire family is affected. Due to leading research in the field, NIMH affirms that “effective therapies for anxiety disorders are available, and research is uncovering new treatments that can help most people with anxiety disorders lead productive, fulfilling lives”.

One should get a proper diagnosis in order to access correct treatment and advice, since, at the end of the day, lesser anxiety unleashes the potential to greater health.

Could one of the following anxiety disorders affect you?

Understanding anxiety disorders is vital, especially when the people involved are immediate family members or close friends. How much do you know? Consider five types of such disorders, and what some have done to cope.

Panic disorders

Not only do anxiety attacks cripple, but in-between the attacks, there is the constant dread that an attack is going to happen again.

True, sufferers tend to avoid places where the attack was triggered, even becoming so restricted they remain housebound with many times a fear to confront the place triggering the anxiety, unless accompanied by a trusted family member or friend.

Some sufferers explain that merely being alone can trigger an attack, and have attested to the fact that a close family member or friend does provide security — even helping them to face the situation or the place causing the anxiety.

Obsessive-compulsive disorder (OCD)

Individuals obsessed with germs or dirt could become victims to a compulsion to wash their hands on a repeated basis.

One OCD sufferer describes his mind as being in a state of constant turmoil, rehashing past mistakes, dissecting them, reanalysing them, and looking at them from every possible angle imaginable. He constantly wants to confess past mistakes to others, and as such, mentions that he is in constant need of reassurance.

Medication has also been of help in controlling his obsession.

Post-traumatic stress disorders (PTSD)

In recent times, this term has come to capture a host of psychological symptoms people suffer after an event of extreme traumatic proportions, usually occasioning physical harm or such, like threat. PTSD sufferers tend to be easily frightened, become irritable, numb emotionally, lack interest in the things they once considered enjoyable, even having trouble expressing or feeling affection for others with whom they were once close.

Not to be overlooked is the violence or aggression some develop, often tending to avoid situations that bring to mind the original traumatic incident. Many sufferers have benefited from cognitive behavioural therapy (CBT), which focuses on changing the thought patterns and processes responsible for disturbing the mind.

Just talking about the trauma or verbalising where your fears come from with a therapist may provide relief. For anxiety on the whole, never underestimate the power of breathing and relaxing techniques, while endeavouring to get proper rest and moderate exercise.

You may just be surprised, too, how powerful regularly drinking water is for general well-being.

Social phobia or social anxiety disorder

This term describes the feelings of those who undergo overwhelming anxiety, coupled with being overly self-conscious in day-to-day social situations. Some sufferers mention a strong and persistent fear that others looking on are doing so with watching and judging eyes.

The thought of attending an event may occasion great worry, days or weeks leading up to the event. The severity of social phobia disorder or social anxiety disorder is such that it may interfere with work, school or normal day-to-day activities — easily causing them to strain relationships with friends.

CBT has proven an effective treatment, and some doctors recommend antidepressants. Bear in mind though, that your body may take some time to respond to such medication, and since there may be side effects, it may take a little time to find the medication that gives the right fit for your body.

Generalised anxiety disorder

Those who suffer with this disorder tend to be on the lookout for disasters, even when there is no need to, and express an over preoccupation with health issues, money, family problems, or difficulties at work.

It takes something as simple as the thought of getting through the day to produce anxiety. Worries tend to be exaggerated even, as mentioned, with little or nothing to provoke them. Psychotherapy and talk therapy have yielded good results as worry-managing techniques, again with a balance of medication.

While following up with medical treatment is advised after the diagnosis, do not underestimate how critical it is to get family and friends on board whose understanding touch may enhanced coping skills. A listening ear may make a world of a difference and, for sure, kind words and a gentle, understanding tone show deep care while averting hurtful insinuations.

Since anxiety attacks from the level of the mind, it is of utmost importance to constantly train the mind, or have it trained with positive thoughts, while endeavouring to come to terms with or purging oneself of negativity.

Even if you do not suffer from severe anxiety disorder, do remember that it is your responsibility to try to keep your anxiety levels in check since, if left unmonitored, it can escalate into a disorder. And, having a working knowledge of anxiety and its disorders is crucial in case we or a family member fall victim.

Remember, even if we do not suffer with such disorders and a family member does, that in itself may be a source of increased anxiety for us if we do not endeavour to help the person access the needed assistance.

Many have suffered from different levels of anxiety, yet are determined to live and are living healthy, normal lives. So can you!

 

Warrick Lattibeaudiere (PhD), a minister of religion for the past 22 years, lectures full-time in the School of Humanities and Social Sciences at the University of Technology, Jamaica.

Lots of Americans have a fear of flying. There are ways to overcome the anxiety disorder.

Tami Augen Rhodes needed to fly to Washington. An invitation to a black-tie event at the Supreme Court was an opportunity the 49-year-old lawyer in Tampa did not want to miss. But Rhodes had not flown since she was 35, when an escalating dislike of flying grew into a firm phobia.

Desperate to get to Washington without resorting to a long train ride, Rhodes called into a weekly group-telephone chat run by Tom Bunn, a former Air Force and commercial airline pilot and licensed clinical social worker who runs a program for fearful fliers.

Bunn asked her what she was afraid of.

“I started crying,” Rhodes recalled. She told the group what worried her. “I am afraid of dying.”

Fear of flying, or aviophobia, is an anxiety disorder. About 40 percent of the general population reports some fear of flying, and 2.5 percent have what is classified as a clinical phobia, one in which a person avoids flying or does so with significant distress.

As with other situational phobias, the fear is disproportionate to the danger posed. Commercial air travel in the United States is extremely safe. A person who took a 500-mile flight every day for a year would have a fatality risk of 1 in 85,000, according to an analysis by Ian Savage, associate chair of the Economics Department at Northwestern University. In contrast, highway travel accounts for 94.4 percent of national transportation fatalities.


Tom Bunn is a former Air Force and commercial airline pilot and licensed clinical social worker who runs a program for fearful fliers. (Elisa Narsu)

But for many, statistics are not enough to quell phobias.

The Anxiety and Depression Association of America suggests eight steps to help identify triggers and defuse them. Martin Seif, a clinical psychologist who wrote the steps, identifies the variety of conditions that may comprise the phobia — panic disorder, social anxiety disorder, obsessive compulsive disorder and panic disorder, among them.

For some, breathing exercises, anti-anxiety medication and cognitive behavioral therapy work. But the strategies do not work for everyone.

Bunn has worked with fearful fliers since 1980 after becoming curious about the psychological and physical components that produced anxiety and panic in situations that he as a pilot knew to be safe. He developed a set of mental exercises for fearful fliers. One, called the “strengthening exercise,” links specific phases of air travel with a joyful personal memory, a visualization technique meant to trigger a sense of calm.

Rhodes had two months to prepare. She delved deeply into written exercises, videos, phone sessions. The day of her flight, she felt anxiety. But she was organized, equipped with magazines, memorized mental exercises and had an understanding of the expected noises and sensations of flight.

It worked.

“The panic never came,” she said, describing her flight. Since then, she has flown several more times, including a trip to Seattle to surprise her best friend.

Fear of flying, according to one overview, is far less studied than other conditions that can be detrimental to relationships and careers such as social anxiety, obsessive compulsive and post-traumatic stress disorders. Little is known about what keeps people afraid even after exposure to successful flights. And there are few experts in the field who are trained as both pilots and clinical social workers.

Stacey Chance, a pilot who flew with American Airlines for 30 years, runs a free online Fear of Flying Help Course, a one-hour overview of each aspect of flight. He includes video clips from therapists and pilots and printable checklists for managing anxiety. He was surprised to learn that many passengers fear they will “lose control and open a door in flight,” a scenario he said is impossible.

The door is pressurized.

Tonya McDaniel, a licensed clinical social worker at the Center for Growth in Philadelphia, uses a virtual-reality program designed for psychologists: While patients navigate stages of air travel with an avatar — from packing, boarding, takeoff and even weather — McDaniel monitors their heart rates and self-assessed level of distress, measured as SUDS (subjective units of distress scale.)

The goal of the exposure therapy is to recalibrate a person’s response, eventually teaching the body that the experiences are “not dangerous and this is okay,” she said.

After patients complete the sessions, McDaniel encourages them to keep practicing, even if it is simply going to the airport to watch planes.

“Phobias breed on avoidance,” she said.

Untreated, the phobia takes a toll. Rhodes did not go to her grandmother’s funeral or her best friend’s wedding.

Bunn trained as a fighter pilot, a vocation he chose because growing up in a small town in North Carolina after World War II, “the ones who got all the attention were ex-pilots,” he said. He finished top of his class in flight school and got assigned to the F-100 Super Sabre, a supersonic fighter.

While based in Germany in the early 1960s, sitting around on “nuclear alert,” he delved into books on psychology, an interest spurred by his mother’s mental illness. Later, as a commercial pilot for Pan Am, he helped a fellow pilot with a graduation class for fearful fliers run by the airline.

“People were sitting on the plane doing breathing exercises, doing exactly what we told them, and they still had panic,” he said. It was awful to be so helpless, he thought.

By 1982, Bunn started his own course, and eventually earned a master’s degree in social work at Fordham University. He did shifts at a Veterans Affairs hospital, and in 1996 retired from flying to work full time as a licensed clinical social worker in Bridgeport, Conn.

His program for fearful fliers, SOAR, continued to grow until it became his sole focus. Clients, me among them, call him “Captain Tom.”

He found that home study helped.

“[People] were in control,” he said. “They didn’t have to show up in an airport and fly in two days,” Bunn said.

Lisa Hauptner, a former client, quit her job in the corporate world to help run the business. Her own fear began as many do, with work-related stress and a sense of impending change.

“There are usually stressors, good or bad, happening at the time,” Hauptner said. “The average age of onset is 27. Think about what’s going on when you are 27 years old. You may be getting married, or may be moving, or may be engaged or having a child.”

Cognitive behavioral therapy, often used to treat anxiety and panic with measurable results, was helping people on the ground, they found, but left them vulnerable to feelings of panic in flight. Once panic starts, “cognitive ability is fried,” Bunn said. Stress hormones and a fight or flight response take over.

Bunn said that people can “retune” their ability to calm themselves before panic escalates, relying on unconscious or procedural memory, the kind used to ride a bike. He offers exercises that are simple, but require practice, conditioning the body to respond to triggers (turbulence, for example) with less alarm.

He was influenced by the work of Stephen Porges, Distinguished University Scientist at Indiana University and Professor of Psychiatry at the University of North Carolina University, whose Polyvagal theory examines how our nervous system detects and responds to threat.

Porges described Bunn’s exercises as using “visualization to help people deal with fear of flying, or deal with anxiety.” The images send the body cues that it is safe and not in a state of defense.

At age 83, Bunn is busy. He responds to 30 to 40 emails a day from anxious fliers and conducts up to eight private phone sessions. His weekly email goes to more than 17,000 subscribers. Last April, he released a book, “Panic Free: The 10-Day Program to End Panic, Anxiety, and Claustrophobia,” which uses the system developed for fearful fliers. Since the Boeing 737 Max crashes, activity has increased, he said.

Not everyone responds to his system. Hauptner, who is also a mental health counselor, said fliers who are in the middle of another big event, such as a divorce or quitting smoking, may not respond. “Or, they want perfection, and there is no perfection,” she said.

No one strategy may work for everyone. Porges said some people find breathing exercises, a common coping strategy for panic, effective if done with a slow exhale.

Joe Spatola sought help shortly after he got engaged, setting his sights on a honeymoon in Italy.

Spatola said Bunn helped him break down his feelings, recognize his heartbeat and employ a technique for calming himself that transfers anxiety to a cartoon character.

“I use Popeye,” he said. His biggest annoyance with turbulence now is not being able to get up to use the lavatory.

I found “Captain Tom” on the Internet 18 years ago, back when his program arrived in the mail on audiocassettes. My fear of flying hit at age 26 when I started a new job at CBS News — the age and phase of young adulthood when it typically manifests. I listened to the tapes. I read the typed material. I flew to my destination and worked on an assistant producing assignment.

On the return trip, I was delayed, first in Tallahassee and then in Atlanta because of mechanical problems. As the night wore on, my confidence waned, and I did not want to board the plane. I decided to try the phone session that came with my course.

Bunn picked up right away. His voice reflected his North Carolina upbringing and a calm demeanor, my idealized version of a pilot and therapist rolled into one. I flew home to New York and arrived late that evening, Sept. 10, 2001.

There was no good place to be the following day, tragedy hit families across the country and stranded travelers for days. My own anxieties shifted and grew, and it would take another concerted effort years later to work on flying again.

But I always look back on that night and the indecision I had waiting alone in the Atlanta airport. And I thank Captain Tom for picking up the phone.

Investigators Suggest Better Predictors to Diagnosis Mental Illness

Claire Gillan, PhD

Claire Gillan, PhD

In a new study, investigators suggest a need for more individualized approaches to defining mental illnesses because of substantial overlap across different disorders.

A team of investigators, led by Claire M. Gillan, PhD, School of Psychology, Trinity College Institute of Neuroscience and Global Brain Health Institute, recently completed a 285-patient cross-sectional study in the US for individuals diagnosed with obsessive-compulsive disorder (OCD) and/or generalized anxiety disorder (GAD).

The investigators found self-reported compulsivity was more strongly linked with goal-directed deficits than a diagnosis of OCD compared with GAD.

The results could have implications for research assessing the association between brain mechanisms and clinical manifestations, as well as for understanding the structure of mental illness.

The aim of the study was to identify if deficits in goal-directed planning better identified by self-reported compulsivity or a diagnosis of obsessive-compulsive disorder. Each patient completed a telephone-based diagnostic interview by a trained rater, internet-based cognitive testing, and self-reported clinical assessments between 2015-2017.

The investigators collected follow-up data as well to test for replicability.

Performance was measured on a test of goal-directed planning and cognitive flexibility using the Wisconsin Card Sorting Test (WCST), as well as a test for abstract reasoning.

Clinical variables included a DSM-5 diagnosis of OCD and GAD, as well as 3 psychiatric symptom dimensions—general distress, compulsivity, and obsessionality—derived from a factor analysis.

Overall, deficits in goal-directed planning in OCD was strongly tied with a compulsivity dimension than with a OCD diagnosis.

The mean age of the 285 patients was 32, with a range of 18-77 years old. The patient population included 219 females, 111 individuals with OCD, 82 patients with GAD, and 92 patients with both disorders.

“A diagnosis of OCD was not associated with goal-directed performance compared with GAD at baseline (P = .18),” the authors wrote. “In contrast, a compulsivity dimension was negatively associated with goal-directed performance (P = .003).”

This pattern was also found with abstract reasoning tasks as well as WCST.

“The compulsivity dimension was associated with abstract reasoning (P  .001) and several indicators of WCST performance (P  .001), whereas OCD diagnosis was not (abstract reasoning: P = .56; categories completed: P = .38),” the authors wrote.

However, other symptom dimensions related to OCD, obsessionality, and general distress had no reliable association with goal-directed performance, WCST, or abstract reasoning.

Obsessionality also had a positive association with requiring more trials to reach the first category on the WCST at baseline (P = .04), while general distress was linked to impaired goal-directed performance at baseline (P = .01).

Despite this, neither survived correction for multiple comparisons or was replicated at follow-up testing.
 
In the past, dimensional definitions of transdiagnostic mental health problems has been recommended as an alternative to a categorical diagnosis. Using this technique allows clinicians to capture heterogeneity within diagnostic categories and similarity across them to bridge more naturally psychological and neural substrates.

“This study suggests that transdiagnostic compulsivity symptoms may have greater biological validity than a diagnosis of obsessive-compulsive disorder,” the authors wrote.

There are fundamental issues with using popular international categories for neurobiological research such as the DSM-5 and International Classification of Mental and Behavioural Disorders, 10th Revision.

While diagnostic groups are highly heterogeneous, patients often have the same diagnosis with vastly different symptom profiles.

Individuals without a psychiatric diagnosis usually differ from patients with a diagnosis in several ways beyond the diagnosis under investigation, including anxiety, depression, physical illness, and early-life adversity.

As a result, potential biomarkers, intermediate phenotypes, and etiologic substrates often can only show a modest association with a categorical clinical phenotype, but is unlikely to be specific to that phenotype.

The study, “Comparison of the Association Between Goal-Directed Planning and Self-reported Compulsivity vs Obsessive-Compulsive Disorder Diagnosis,” was published online in JAMA Psychiatry.

Anxiety disorders top mental health issues in UAE

One of the triggers for suicides in society is unattended or poorly managed anxiety and depression. Speaking at a two-day suicide prevention workshop at the Zayed University Dubai, Dr Justine Thomas, professor of psychology at the university, said, “Globally, 300 million people suffer from depression. Depression varies in severity, but at the sharp end, it can lead to suicide. Around 800,000 people die due to suicide each year, the second leading cause of death among those between the ages of 15 and 29.”