Support For Victorians With Anxiety

The Andrews Labor Government is ensuring Victorians struggling with anxiety and distress get the support they need.

Anxiety Recovery Centre Victoria will receive an extra $200,000 to provide surge capacity for their specialist OCD and anxiety helpline, which has experienced a 232 percent rise in demand this year.

This comes following a $250,000 investment to ARCVic earlier this year, to improve access to support and ongoing care for people with obsessive compulsive disorder (OCD) and other anxiety conditions.

Since the start of the pandemic, the service has recruited 70 more volunteers and extended its operating hours, so more Victorians can access the support they need, when they need it. This funding will deliver the new CARES 4ME program to be run by ARCVic, that caters to those who require ongoing support.

CARES 4ME program matches clients to trained volunteers with lived experience of anxiety. Volunteers provide emotional support and practical guidance to help people work through their individual needs and to develop anxiety management strategies.

This initiative continues to fill the gaps in the system during the pandemic and ensuring Victorians get the specialised support they need, by providing regular check-ins.

The Victorian Budget 2020/21 is investing $868.6 million in the recent budget, to ensure Victorians get the mental health support they need when they need it. This investment will fund the rollout of the interim recommendations from the Royal Commission into Mental Health.

Since the start of the pandemic, the Labor Government has invested more than $220 million into mental health services, to help Victorians reaching out for help with stress, isolation and uncertainty during and after the coronavirus pandemic.

For OCD and anxiety support call ARCVic on 1300 269 438. Other mental health resources and support service are available at https://www.dhhs.vic.gov.au/mental-health-resources-coronavirus-covid-19.

As stated by Acting Minister for Mental Health Martin Foley

“Victorians experiencing anxiety will get the mental health supports that address their specific needs.”

“This vital funding will ensure that we meet the demand of Victorians reaching out for help with OCD and other anxiety conditions, during and after the pandemic.”

As stated by ARCVic CEO, Michelle Graeber

“ARCVic is here to let you know you don’t need to be alone. We are only a phone call away; we understand anxiety and can provide people with the strategies and knowledge that will help them on the journey to recovery.”

“We are all dealing with unprecedented uncertainty and major changes to the way we live our lives as a result of the coronavirus pandemic. Having to adapt in ways that are completely new and with mounting uncertainty can bring unwanted anxiety, stress and worry.”

Hoarding: Definition, Symptoms, Causes, Treatment

Hoarding, also known as hoarding disorder and compulsive hoarding, is a serious psychological disorder where people accumulate a large number of belongings. People who hoard are called hoarders. Even when these objects have little to no value or are considered garbage by others, hoarders struggle to get rid of them.

man looking at house mess

PhotoAlto/Frederic Cirou / Getty Images

Definition of Hoarding

People with hoarding disorder excessively save items that others may view as worthless. As a result, items are cluttered inside a home until rooms and furniture can no longer be used as intended. This can lead to unsafe and unsanitary conditions, including fire hazards and tripping hazards, for the hoarder, who is unable to acknowledge and address their problem.

Hoarding may also lead to family strain and conflicts, isolation and loneliness, unwillingness to have anyone else enter the home, and an inability to perform daily tasks, such as cooking and bathing in the home.

Hoarding disorder occurs in about 2-6% of the population, and often leads to substantial distress and problems with daily functioning. Some research has shown that hoarding disorder is more common in men and older adults. There are three times as many adults 55 to 94 years old who are affected by hoarding disorder compared with people who are 34 to 44 years old.

Hoarding vs. Collecting

Hoarding is not the same as collecting. Collectors look for specific items, such as model cars or stamps, and may organize or display them. People with hoarding disorder often save random items and store them haphazardly. In most cases, they save items that they feel they may need in the future, are valuable, or have sentimental value. Some may also feel safer surrounded by the things they save.

Symptoms

The urge to collect and keep a large quantity of objects often occurs alongside other mental health conditions, such as obsessive-compulsive disorder (OCD) and depression. While hoarding disorder exists within the spectrum of OCDs, it is considered independent from other mental disorders. Research shows that just 18% of people clinically diagnosed with hoarding disorder have additional OCD symptoms present.

Hoarders have addictive traits when it comes to objects. This means they have a strong desire to acquire items, and keeping them fulfills an emotional need that makes discarding the item highly upsetting. 

The symptoms of hoarding disorder include:

  • Lasting problems with throwing out or giving away possessions, regardless of their actual value
  • The problems are due to a perceived need to save the items and to distress linked to parting with them
  • Items fill, block and clutter active living spaces so they cannot be used, or use is hampered by the large amount of items

How to Seek Help

If you suspect that you or a loved one are struggling with hoarding, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

Diagnosis

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), a person must meet several characteristics to be clinically diagnosed with hoarding disorder. This diagnosis is typically made by a psychologist or psychiatrist.

These criteria include:

  • Persistent difficulty parting with items despite actual value of the items
  • This difficulty is due to a perceived need to save the items and to the distress associated with discarding them
  • The difficulty discarding possessions results in the accumulation of possessions that clutter active living areas and substantially compromises their intended use. If living areas are uncluttered, it is only because of the interventions of family members, cleaners, or the authorities
  • The hoarding causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, including maintaining a safe environment safe for oneself or others
  • The hoarding is not attributable to another medical condition like brain injury or cerebrovascular disease
  • The hoarding isn’t better explained by symptoms of another mental health disorder, such as psychotic disorders, depression, or obsessive compulsive disorder

Mental health professionals may also ask permission to speak with friends and family to help make a diagnosis or use questionnaires (rating scales) to help assess level of functioning.

In addition to the core features of difficulty with getting rid of possessions, excessive saving, and clutter, many people with hoarding disorder also have associated problems like indecisiveness, perfectionism, procrastination, disorganization, and distractibility. These associated features can contribute greatly to their problems functioning and overall severity.

Causes

Hoarding can happen for a variety of reasons. However, research shows that most people who hoard have experienced a traumatic life event (TLE). That refers to any incident that caused physical, emotional, or psychological harm, including childhood neglect, physical assault, loss of a loved one, serious injury, or a natural disaster.

Research demonstrates that 51% of people diagnosed as hoarders also have major depressive disorder. The same study showed that 24% of hoarders have social phobia and 24% experience generalized anxiety.

These disorders can occur as a result of hoarding since the poor state of one’s health, home, and hygiene can contribute to feelings of sadness, low self-worth, and inability to engage with others. Hoarding can also be a direct result of these disorders.

Researchers have also found that hoarding can be genetic, though the results are varied and more research is needed to determine whether this trait is inherited at a biological or behavioral level.

Types of Hoarding

How hoarding interferes with one’s safety and hygiene depends on what they hoard. The main types of hoarding include:

  • Object hoarding: This is the most common type of hoarding. It includes the hoarding of items that are no longer useful, including empty containers, garbage, old or expired food, and unwearable clothing
  • Animal hoarding: This type of hoarding is characterized by the collection of pets. People who hoard pets have difficulty maintaining the health of their animals and cannot clean up after them properly. It’s common for animal hoarders to keep dead animals in the home 
  • Compulsive shopping: This is also a type of hoarding where someone is focused on acquiring more items, no matter how many things they already have. People who shop compulsively continuously buy things they don’t need and struggle to get rid of things they already bought

Treatment

Scientists continue to study the best treatments for hoarding disorder. More randomized controlled trials are needed to determine the best approach. However, there has been some demonstrated success with the following treatments for hoarding disorder:

  • Group therapy: Highly structured in-person support groups can give people the community and motivation they need to recognize and change their hoarding habits
  • Cognitive behavioral therapy (CBT): This therapy involves identifying and changing one’s negative thought patterns and behaviors. It could help with hoarding by improving the underlying conditions that contribute to obsessive collecting, like anxiety and depression
  • Cognitive enhancers: This type of medication could improve memory, attention, and brain functioning, which may make it easier for a person to succeed at CBT and maintain a more cleanly and uncluttered lifestyle
  • Stimulants: This type of medication could improve attention, alertness, and information-processing speed, which could help them better incorporate skills learned in CBT or other forms of talk therapy

Coping

Someone who hoards might not think they need help. If you suspect someone you know has hoarding disorder, reassure them that nobody is going to go into their home and throw everything out. You’re just going to have a chat with their doctor about their hoarding to see what can be done and what support is available to empower them to begin the process of decluttering.

If you think you have hoarding disorder, talk to your primary care provider about your problem and they may be able to refer you to a mental health professional who can help with diagnosis and treatment.

It’s generally not a good idea to get extra storage space or call in the council or environmental health to clear the rubbish away. This won’t solve the problem and the clutter often quickly builds up again.

A Word From Verywell

Hoarding is a great disruption to a person’s quality of life. It may also interfere with their safety and health, as well as the well-being of their family members outside the household. The most important thing to remember about hoarding is that it’s likely caused by a traumatic event or another mental disorder, such as anxiety. Maintaining compassion when helping someone with hoarding disorder can ensure their dignity while improving the potential of positive treatment outcome.

Does Anxiety Ever Go Away?

Anxiety is treated by psychologists, psychiatrists, and other mental health professionals.

Anxiety disorders sometimes coexist with other conditions, such as depression or substance use disorder. It’s important that other mental health conditions are also addressed.

Treatment options for anxiety include:

Behavioral therapy

Research shows that cognitive behavioral therapy (CBT) is very effective in treating anxiety disorders and is associated with improved quality of life.

CBT is based on the idea that thoughts, feelings, and behaviors are related. Changing the way you think changes the way you feel and, in turn, changes your behavior.

Similarly, changing your behavior can also change the way you think and feel.

In CBT, you start out with a set number of sessions, typically 20 or fewer. Sessions focus on specific problems and changing the way you deal with them. You practice with your therapist and on your own in between sessions.

One common method of treating anxiety disorders is a type of CBT called exposure therapy. This involves identifying the things that cause anxiety and then, in a safe setting, systematically exposing yourself to them, virtually or in real life.

This method may also involve learning relaxation techniques, a form of exposure therapy called systematic desensitization that incorporates relaxation techniques as well.

As you’re exposed to a stressful or feared situation or thing in a safe setting, you begin to feel less anxious about it.

Exposure therapy is a short-term treatment, usually 10 sessions or fewer.

Talk therapy

Psychotherapy, or talk therapy, involves one-on-one sessions with a therapist.

During therapy, you can speak openly about your anxieties and other concerns. Your therapist can help you identify problems and work on strategies to overcome them.

Medicines

When anxiety is unmanageable with therapy alone, your doctor may prescribe anti-anxiety medications such as:

  • benzodiazepines
  • buspirone
  • serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • selective serotonin reuptake inhibitors (SSRIs)
  • tricyclic antidepressants

When prescribed for anxiety, these medications are typically combined with therapy.

The Persian COVID stress scales (Persian-CSS) and COVID-19-related stress reactions in patients with obsessive-compulsive and anxiety disorders

This article was originally published here

J Obsessive Compuls Relat Disord. 2020 Dec 17:100615. doi: 10.1016/j.jocrd.2020.100615. Online ahead of print.

ABSTRACT

The COVID Stress Scales (CSS) were designed to assess stress related to the COVID-19 pandemic. Emerging evidence indicates that people with anxiety disorders (ADs) and obsessive-compulsive disorder (OCD) may be more negatively impacted by COVID-19 than those with mood disorders or healthy individuals. Accordingly, this study sought to validate the Persian CSS (Persian-CSS) and to compare COVID-19-related stress reactions among patients with specific ADs and OCD. Patients with OCD (n = 300) and ADs (n = 310) completed the Persian-CSS and other scales developed to assess anxiety-related traits and COVID-19-related distress. The Persian-CSS replicated a five-factor structure similar to the original CSS in OCD and ADs. The total CSS and its scales had good reliability and validity. Patients with generalized anxiety disorder, panic disorder, and OCD had higher COVID-19 stress reactions than patients with social anxiety disorder and specific phobia. Patients with panic disorder had higher danger and contamination fears and xenophobia than patients with OCD. The study suggests that the Persian-CSS is a valid scale to be used in patients with OCD and ADs, each of whom differs in their specific patterns of COVID-19-related stress reactions.

PMID:33354499 | PMC:PMC7746142 | DOI:10.1016/j.jocrd.2020.100615

Generalized Anxiety Disorder (GAD): Symptoms, Causes, and Treatment

Worrying is a part of life. It’s natural to worry about the stressful things in our lives. But what happens when that worry becomes invasive and persistent? For people with generalized anxiety disorder (GAD), worrying can take over their lives, becoming excessive and exaggerated.

A person with GAD doesn’t simply have rational worries based on actual risk—they worry regardless of outside stressors, exaggerate the perceived level of risk, and cannot rationalize away the worry.

Portrait of young woman with anxiety

recep-bg/Getty Images


What Is Generalized Anxiety Disorder?

Affecting about 6.8 million adults—or 3.1% of the U.S. population—in any given year, GAD is a common mental illness that is characterized by an excessive, chronic worry that interferes with a person’s ability to function normally.

People with GAD do not have a focused fear of a specific nature, such as found with a phobia, but rather their anxiety is spread out or changes from one thing to another repeatedly.

For example, someone without GAD may notice that a friend has not answered their text and make a mental note to follow up with them. Someone with GAD may see this unanswered text and picture their friend hurt or even dead from an accident. They may wonder if their friend is angry with them, or does not want to continue their friendship. They are likely to check and recheck their phone constantly until that friend answers the text.

Often times, a person with GAD is aware that their fear is irrational or disproportionate to the situation, but cannot turn off the worry. Because the anxiety is not based in reality, confronting it with logic or reassurance is not enough to quell it.

Is My Worrying Normal?

A person with GAD may be worried about the same things as a person without GAD, but they take that worry to the extreme.

Paradoxically, for many people with GAD, worrying feels productive. Though they usually recognize it as magical thinking, people with GAD can feel like worrying wards off bad things from happening, and that if they stop worrying about it, their fears will come true.

GAD is exhausting mentally and physically. It impacts nearly every aspect of a person’s life, and can be very overwhelming.

Symptoms

To meet the DSM-5’s criteria for GAD, the following must be met:

  • Excessive anxiety and worry about a number of activities or events, occurring more days than not for at least 6 months
  • Difficulty controlling your worry
  • Three (or more) of the following six symptoms (one or more for children), with at least some symptoms having been present for more days than not for the past 6 months:
  1. Restlessness, feeling keyed up or on edge
  2. Being easily fatigued
  3. Difficulty concentrating or mind going blank
  4. Irritability
  5. Muscle tension
  6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)
  • Significant distress or impairment in social, occupational, or other important areas of functioning, caused by worry or anxiety
  • Symptoms are not caused by a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism)
  • Symptoms are not better explained by another mental illness or disorder

Some other symptoms of GAD include:

  • Nervousness or irritability
  • Feeling a sense of impending danger, panic, or doom
  • Increased heart rate
  • Hyperventilation (rapid breathing)
  • Sweating
  • Trembling
  • Feeling weak or tired
  • Difficulty concentrating
  • Gastrointestinal (GI) problems
  • Muscle tension, headaches, and other unexplained pains

It’s important to note the differences between typical worrying with the disordered worrying that comes with GAD.

Anxiety Triggers Are Not Universal

Both children and adults can experience excessive worry about any area, activity, or concept—or they may experience feelings of anxiety not attached to anything specific. These triggers also do not have to be logical or make sense to other people.

People with GAD may engage in behaviors to try to control their excessive worrying, such as:

  • Avoiding news on TV, online, or in newspapers
  • Limiting or skipping out on participation in activities that cause them worry
  • Seeking excessive reassurance or approval (particularly in children).
  • Over-planning or preparing
  • “Rehearsing” or replaying scenarios in their mind

Diagnosis

GAD is more often diagnosed and treated by family physicians and primary care providers than by psychiatrists.

To determine a diagnosis of GAD, your health care provider may:

Is It GAD, Or Something Else?

Generalized anxiety disorder can mimic other psychiatric disorders and vice versa. As well, GAD often occurs at the same time as other psychiatric disorders (this is called comorbidity). It’s important to get a comprehensive diagnosis in order to make a treatment plan that addresses your unique needs.

Causes

Scientists are not yet sure of the specific causes of GAD, but they believe it arises from a combination of biological and environmental factors. These might include:

  • Differences in brain chemistry and function
  • Genetics
  • Differences in the way threats are perceived
  • Development and personality

Risk Factors

  • Gender: Women are diagnosed with GAD more often than men.
  • Age: GAD can develop at any time, but the risk is highest between childhood and middle age.
  • Personality: Those who are timid or have a negative temperament, or those who are very cautious/danger averse may be more prone to generalized anxiety disorder.
  • Genetics: GAD appears to run in families.
  • Experiences: A history of significant life changes, traumatic or negative experiences during childhood, or a recent traumatic or negative event may increase the risk of developing GAD. Chronic medical illnesses or other mental health disorders may also increase risk.

Treatment

As with any psychiatric disorder, finding a successful treatment for GAD can take some trial and error. What works for one person with GAD may not work as well as another treatment for someone else with GAD. If the first treatment you try is not successful or has side effects you can’t tolerate, don’t assume your GAD is untreatable—go back to your health care provider with your concerns and work together to try a new plan.

GAD is primarily treated with either therapy, medication, or a combination of both.

Therapy

The most common form of therapy used to treat generalized anxiety disorder is cognitive-behavioral therapy (CBT). CBT helps analyze the way we think in order to recognize and correct distortions. Using CBT, people with GAD can change their automatic thinking processes that lead to anxiety and replace them with healthier ways of thinking.

The five components of CBT for anxiety are:

  • Education: Before re-training your thinking processes, it’s important to learn both how anxiety works and how the process of CBT works. In this stage, you will focus on gaining an understanding of GAD and how it affects your thinking and your behavior. You will also learn what to expect from CBT treatment.
  • Monitoring: You will be taught ways to monitor your anxiety. What triggers it? What specific things do you worry about? How intense are your episodes and for how long do they last? Monitoring your anxiety gives you an overall view of what GAD looks like for you. Being aware of how your anxiety manifests and what triggers it will help you implement ways to change it. It may help to keep a diary for this part of therapy.
  • Physical control strategies: Anxiety elicits a “fight or flight” response. In this stage of CBT, you will learn techniques to combat this physical over-arousal.
  • Cognitive control strategies: This is where the “thinking about thinking” comes in. These strategies help you to realistically examine and evaluate the thinking patterns that contribute to GAD, and alter them to be more productive. Challenging these negative thoughts helps to lower your anxiety.
  • Behavioral strategies: Avoidance is a common reaction to anxiety, but not usually a productive one. This stage focuses on learning to tackle your anxiety and face your fears head-on instead of avoiding the things that make you anxious.

Medication

The medications prescribed for generalized anxiety disorder are often the same ones prescribed for other mental illnesses or medical conditions.

Be Careful of Interactions

Medications used to treat anxiety can have negative effects when taken with some other medications. This includes some herbal and “natural” treatments. Always tell your health care provider and your pharmacist what other medications—prescription or not—you are taking.

These medications can also interact with alcohol. Check with your health care provider or pharmacist about whether or not it is safe to drink alcohol while taking your medication.

Antidepressant drugs

These drugs act on neurotransmitters involved in many regions of the brain that affect anxiety, mood, and arousal.

Selective serotonin reuptake inhibitors (SSRIs) prescribed for anxiety include:

  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Citalopram (Celexa)

Serotonin-norepinephrine reuptake Inhibitors (SNRIs) may also be prescribed. They include:

  • Venlafaxine (Effexor)
  • Duloxetine (Cymbalta)

Sometimes an antidepressant works well for GAD symptoms but has side effects. Common side effects of antidepressants might include, but are not limited to:

  • Sexual problems
  • Weight gain
  • Insomnia

Buspirone

Buspirone (BuSpar) is an anti-anxiety medication that works using a different mechanism than SSRIs and SNRIs.

Buspirone may not be effective at a low dose. Higher (therapeutic) doses may be more effective, but can also cause more side effects.

Some common side effects of buspirone include:

  • Nausea
  • Headache
  • Changes in dreams
  • Feeling dizzy
  • Drowsiness
  • Lightheadedness

Tricyclic antidepressants

Some people with GAD find tricyclic antidepressants work better for them than other medications.

These medications may be prescribed:

  • Imipramine (Tofranil)
  • Nortriptyline (Pamelor)
  • Desipramine (Norpramin)
  • Clomipramine (Anafranil)

For some people, tricyclic antidepressants have unpleasant side effects like:

  • Dizziness
  • Constipation
  • Blurred vision
  • Trouble urinating

Others find they tolerate the side effects of tricyclic antidepressants better than other types of medication.

Never Stop Treatment “Cold Turkey”

Many medications used to treat mental illness, including ones for GAD, can have side effects when stopped abruptly. Some of these side effects can be serious. Always consult your health care provider before stopping your medication. Your provider can help you make a plan to taper off.

Over time, generalized anxiety is associated with an increased risk of developing or worsening:

  • Digestive or bowel problems, such as irritable bowel syndrome or ulcers
  • Headaches and migraines
  • Chronic pain and illness
  • Sleep problems and insomnia
  • Heart-health issues

GAD often occurs alongside other mental illnesses, including:

These coexisting conditions can make treatment more difficult, but not impossible.

Help Is Available

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor.

If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Treatment success varies by person and both therapy and medication can take a while to become effective. If you don’t notice an improvement right away, give it a little bit. Your health care provider can give you an idea of how long to wait before trying something else. Your provider is likely to want you to come in for regular follow-ups when you begin a new medication until you reach a type and dose that works well for you.

If at any time you feel your treatments are no longer as effective, talk to your health care provider to see if adjustments can be made.

Coping

While treatment such as therapy and/or medication is often needed to manage GAD, there are lifestyle changes you can make to help ease some of your anxiety and support your treatment plan.

  • Make connections with others: Reach out to friends or join a support group. Having the company and support of others can ease anxiety.
  • Learn how to self-soothe: When you are in a moment of high anxiety, engaging your senses can help ground you. These senses include look, listen, smell, taste, tough, and move.
  • Relaxation techniques: Practicing things like deep breathing, progressive muscle relaxation, and meditation. helps to fight the physical responses your body has to anxiety.
  • Health body habits: Eat healthy foods, get enough sleep, and avoid or limit substances that may aggravate your anxiety.
  • Get organized: Seek help early, keep a journal or diary, and prioritize your needs.

A Word From Verywell

GAD can be difficult and frightening to live with. If you are feeling the effects of GAD, see your health care provider right away. While finding the right treatment might take a bit of work and experimentation with the help of your health care provider, GAD can be managed, and living a life free of excessive and intrusive anxiety is possible.

  1. Anxiety and Depression Association of America. Generalized anxiety disorder (GAD).

  2. HelpGuide. Generalized anxiety disorder: GAD. Updated September 2020.

  3. American Psychiatric Association. DSM-5 criteria for diagnosing generalized anxiety disorder. Updated 2013.

  4. Center For Addiction and Mental Health. Generalized anxiety disorder.

  5. Gliatto MF. Generalized anxiety disorder. AFP. 2000;62(7):1591-1600. Updated December 15, 2020.

  6. Harvard Health. Generalized anxiety disorder. Updated May 2019.

  7. National Alliance on Mental Illness. Buspirone (BuSpar). Updated January 2019.

Related Articles

Can’t Clear Your Mind? Study Finds 3 Ways to Help Get Rid of Nagging Thoughts

Humans have been trying to ‘let it go’ long before Queen Elsa began singing in her icy isolation. Now that many in the world are facing their longer quarantines, it’s become much harder to stop ruminating on all our fresh concerns.

A new psychology study has come at just the right time. Brain imaging and behavioural research has now revealed the three best ways to rid a thought from your mind.

When people focus on ‘replacing’ a notion with another, or ‘clearing’ their minds through meditation, researchers found brain signatures of the thought faded faster, leaving only a remnant shadow in the background.

When people focus on ‘suppressing’ a new thought, however, its signature takes longer to disappear, although when it finally does, its departure is more complete.

“We were thrilled,” says professor of psychology Marie Banich from the University of Colorado, Boulder, about the results.

“This is the first study to move beyond just asking someone, ‘Did you stop thinking about that?’ Rather, you can actually look at a person’s brain activity, see the pattern of the thought and then watch it fade as they remove it.”

Rumination, or overthinking, is a symptom of several psychiatric disorders, including depression, anxiety, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder, and it’s thought to arise from some sort of deficit in a person’s working memory

Working memory is the part of our brains concerned with the at-hand, and it can only hold so much information, usually about three or four concepts at a time. Getting rid of irrelevant thoughts on the regular and storing relevant ones for the future is therefore essential.

Unfortunately, negative thoughts are harder to banish, but when we consciously put our minds to it, we do have some control over how the information is processed in our brains. Some mental training has been shown to clear the mind faster, others slower, and there are techniques that do not work at all.

Still, many of these results are simply based on self-reports or indirect behavioural tests. Brain imaging gives us a more objective measurement.

Previous imaging research from 2015 showed that changing the contents of your working memory activates the parietal region of the brain, where we receive and process sensory information. Clearing the contents of your working memory, however, activates the prefrontal cortex, which is involved in complex cognitive processes like decision making.

Interestingly, volunteers in this study who had more trouble controlling their inner thoughts showed greater activity in the prefrontal cortex and Broca’s area, which is associated with inner speech. 

The 2015 research was conducted by several of the same authors involved in this new study and focuses on three distinct strategies for removing thoughts from your mind.

Lying down inside a functional magnetic resonance imaging (fMRI) machine, 50 participants were randomly shown pictures of famous faces, fruits, and recognisable scenes, which they actively thought about for four seconds apiece.

Creating ‘brain signatures’ for each one of these objects, participants were then told to either clear the thought with meditation, suppress the thought by focusing on it and then actively forgetting it, or replace the thought with another object seen in the study.

Analysing the resulting data with machine learning, researchers discovered a hierarchy of brain regions involved to varying degrees in controlling our thoughts, including the parietal and frontopolar regions, as well as the dorsolateral prefrontal, which is linked to attention and working memory.

What areas were involved in each situation and to what extent depended on the mental approach used by participants, ultimately resulting in different outcomes.

By looking at the brain’s activity patterns, the team was able to show when a thought was actually removed from a person’s working memory – a first for the field. 

It’s still not clear exactly what is happening to all this information in the brain, but it does suggest a thought can be rapidly and temporarily removed from our working memory with the right focus of attention. It can also be more permanently removed, making room for new thoughts, through proactive mental ‘interference’.

“We found that if you really want a new idea to come into your mind, you need to deliberately force yourself to stop thinking about the old one,” says Banich. 

“The bottom line is: If you want to get something out of your mind quickly use ‘clear’ or ‘replace’. But if you want to get something out of your mind so you can put in new information, ‘suppress’ works best.” 

If you’re studying one subject, for instance, and you need to dive into another, you might want to try suppressing your working memory first.

When it comes to mental health, suppressing long-term memories is often considered a bad thing. In cases of PTSD, as the researchers point out, it can allow trauma to simmer under the surface, thereby increasing its impact. As a result of this thinking, exposure therapy is often used to actively address and restructure certain traumatic memories, so they bear less emotional and mental weight in the long run.

These new findings, however, suggest working memory may also be targeted for therapy, although this time through suppression.

Further research needs to explore how brain signatures and cognitive operations are impaired or disrupted in those with depression, anxiety, or PTSD. But once a memory has reached consciousness and entered a person’s working memory, the authors think suppression might actually be a valuable initial tool for some, “as this process allows for the complete removal of the information from mind.”

In comparison, replacing or clearing a thought from working memory only takes that item out of our conscious attention. While this deactivates the item’s neural signature, it still leaves the information intact.

“It may be that training an individual to shift their attention by redirecting (i.e., replacing) thought or through mindfulness techniques (i.e., clearing thoughts) could be a fruitful first step followed by training to exert cognitive control to suppress the thought, and thereby reduce its potency,” the authors conclude.

“Further work will need to explore these ideas, but our results, nonetheless, point the way to potentially fruitful translation to clinical practice.”

The study was published in Nature Communication.

CBD for OCD: Research, Benefits, Dosage, Recommended Products

Currently, CBD’s ability to ease symptoms of OCD is largely theoretical and anecdotal. That’s because there’s a very limited amount of research examining the effectiveness of CBD for people with OCD.

A handful of case reports describe people with OCD who experienced improved symptoms after being treated with CBD or other cannabinoids. But more large-scale clinical trials are needed to assess CBD’s effectiveness and safety.

In a 2020 study, researchers examined the effects of medical cannabis on a group of 87 people with OCD. The researchers found that patients reported a:

  • 60 percent reduction in compulsions
  • 49 percent reduction in intrusive thoughts
  • 52 percent reduction in anxiety

Cannabis with higher doses of CBD led to a larger reduction in compulsive behavior.

However, in another small 2020 study with only 14 participants, researchers compared the effects of cannabis containing varying concentrations of tetrahydrocannabinol (THC) and CBD to a placebo. They found that smoking cannabis containing primarily CBD or primarily THC had little acute impact on OCD symptoms.

How is CBD thought to help with OCD symptoms?

CBD is one of the more than 80 biologically active compounds found in the cannabis plant. THC is the primary psychoactive compound that makes you “high.” CBD is non-psychoactive but has a number of effects on the body including relieving pain and potentially reducing anxiety and depression.

The cause of OCD is thought to be multifactorial, but there’s a growing amount of evidence that the body’s endocannabinoid system plays a role in regulating anxiety, fear, and repetitive behaviors.

Your endocannabinoid system is a pathway of receptors in your body that play a role in regulating sleep, mood, appetite, and other processes. When CBD interacts with your endocannabinoid system, it can cause changes to these processes. However, researchers are still not sure exactly how CBD interacts with this system.

Best form of CBD for OCD

CBD comes in many forms including oils, tinctures, patches, and gummies. There’s no evidence that any form is more effective than the others. It’s likely that the amount of CBD per serving is more important than the form.

Even though CBD may be beneficial alone, some research suggests that taking CBD along with THC and other chemicals found in cannabis called terpenes may enhance its benefits. This phenomenon is often referred to as “the entourage effect.”

How a teenager who is a perfectionist may be dealing with crippling anxiety

Published Tuesday, Dec. 15, 2020, 9:51 am

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Most teenagers are always juggling between the demands of academics, friendships, sports, social media and many other activities. A teen who is a perfectionist may therefore tend to be on a mission to try and show total perfection in everything that they do in all these spheres of life. They, for this reason, may set standards that are often so high, and which may only be met with very great difficulty. The result therefore is that such teens will always have constant fear of making even the smallest of mistakes, since they fear that that could show that they are worthless and failures. This, with time, may lead to high levels of anxiety.

Relationship between perfectionism and anxiety

Most teenagers who suffer from being perfectionists may experience various forms of distress, especially through being overly anxious. This is so because perfectionism is more about trying very much to push yourself to achieve a goal. In actual sense, this is often a mirage of the inner self, masked in deep anxiety.

The kind of anxiety that these teenagers may experience can come in the form of a number of disorders. The latter includes General Anxiety Disorder, Obsessive Compulsive Disorder, Panic Disorder and many other related triggers surrounding anxiety.

Perfectionism by itself therefore tends to further propel anxiety by creating very high standards that the state of anxiousness in itself hinders these teens from achieving. For this reason, many teenagers who are perfectionists end up having a very hard time in deciphering tasks that are done to their satisfaction.

What the feeling of desperately wanting to be perfect, leads to eventually is exhaustion, great frustration, procrastination, risk-aversion and lack of the much-needed focus that will ultimately interfere with the ability to complete tasks. For such teens, even in the event that a task is successfully completed, the anxiety will not really get quenched, since they will immediately get a new target and hence the cycle begins again.

Common signs of perfectionism in teenagers

There are quite a number of things that you can look out for, that can help tell whether or not your teenager is a perfectionist. Listed below are some of the most common signs:

  • Mostly avoids raising their hands in class to answer questions, for fear of being wrong.
  • Gets overly stressed and upset when they attain grades that are below what they had anticipated.
  • Keep procrastinating doing assignments until they are 100% sure that they have all that it takes in terms of what to do, or how to earn a very high grade on the assignment.
  • Gets easily dissatisfied and unappreciative with standard work, which is perceived by others to be just fine and acceptable.
  • May avoid starting a task for fear that they might end up not doing it well and right.
  • Have real struggle with coping with mistakes, and at the same time, may seem to take very personally, any form of criticism.
  • Have a high fixation on neatness and general appearance of any work they are tasked with, and may often start over several times, just to get it right.

Factors that may contribute to perfectionism in teenagers

There are very many factors that may result in perfectionism in teenagers. Discussed below are some of these factors:

Biological factors

Research has shown that perfectionism may be related very closely to certain mental illnesses.

These illnesses include disorders such as obsessive-compulsive disorder (OCD), as well as eating disorders. Some research scientists therefore do strongly believe that perfectionism may have a biological component linked to it.

Academic pressures

Most teenagers are often under the impression that you have to get stellar performance academically in order to get anywhere in life. Some of them also get this kind of pressure as a way of wanting to please their parents. They may even fear that test scores that are less than perfect may thwart their chances of receiving scholarships at school. The result of this therefore is often the pressure to be perfect in everything they do academically, which often really makes them feel so anxious all the time.

Being raised by parents who are perfectionists

When you as a parent tends to be a perfectionist whatever you do, then there will be very high likelihood in your children imitating that; with the thought that it is the norm. The child will hence have learned behavior from the quest for perfection, being shown by the parent. This may then lead to genetic disposition, since these children will also grow up and pass it to their own kids.

Trauma

Traumatic experiences of the children as they are growing up; may in a very big way affect them when they are teenagers. This is mostly because they will then grow feeling unloved and have a falsified feeling that they will not be loved or accepted by the society, unless they are super perfect.

Influence from parents

There are times when too much praise and accolades from parents may lead to the teenagers believing that making mistakes is a bad thing. The result is that the teenagers will somewhat do whatever it takes to ensure that they live up to their parent’s expectations all the time. This will also push them towards believing that they have to succeed at all times no matter what. This is how anxiety will then get the room to check in.

Sensationalism of failure and success

The media always has a way of portraying most celebrities to be very perfect. These could range from athletes, musicians among other celebrities. The same media will try and portray how one single mistake led to a celebrity’s fall from glory. The impact of teenagers will then be the illusion that you have to be very perfect in everything that you do.

How to help your teenager deal with perfectionism

Perfectionism is very dangerous since it can easily lead to great anxiety and even depression in extreme cases. However, this can be avoided. As a parent, you can help your teenager overcome perfectionism through the following ways:

Help your teenager develop healthy self-esteem

You can help them with this by engaging them in activities that will make them feel good about what they have been able to achieve, and who they are in general.  You can also do this by encouraging them to learn new stuff and also volunteer in different projects.

Regulate your expectations on your teenager

You must ensure that you are not putting much pressure on your child to live up to very impossible expectations that you have set up for them, especially academically. Create very reasonable expectations for them, and even in the event that they don’t meet them, you still need to encourage them that it is well; and that there is always a next time.

Help them identify control issues

Help your teenager to clearly understand that there are some things that she can have control over, but there are others that she is not able to control. For instance, you need to help them learn and understand that they may not be able to control the circumstances that may influence their success academically. However, you can encourage them that they can control their effort towards striving for success.

Teach them healthy skills

You need to teach your child how to use and exercise personal compassion, as opposed to personal criticism all the time. Teach them to learn to have conversations with themselves from time to time in a bid to self-assure themselves that they can still do better tomorrow; irrespective of not being able to achieve what they had anticipated today. You also need to teach them how best to cope with failures. They need to know that failing is also part of life, in a quest to become better. This way, they will learn not to beat themselves up too much whenever they encounter failures. Such skills are often mostly taught and offered at places like the Child Anxiety Center in Cincinnati.

Conclusion

Perfectionism in teenagers is something that is very commonplace. It often results in great levels of anxiety that inhibits normalcy in them. In most cases, it often gets to affect their academic performance. There are quite a number of signs that you can look out for, as a parent in your child, that will show that they are struggling with this problem. However, there are also some ways in which you can help your teenage child overcome perfectionism, to live a normal and comfortable life.

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D-cycloserine for Anxiety Disorders: What Psychiatrists Need to Know

Before the exposures, the therapist helps patients identify situations they avoid as well as subtle behaviors (ie, safety behaviors) in which they engage to ease their distress. It is generally believed that individuals develop specific fears due to conditioning that occurs in a particular context; in turn, these generalize to other contexts. The individual tends to avoid the feared situation due to the false belief that situation is dangerous or unmanageable. Avoidance is assumed to maintain the fear as well as this false belief. During exposure therapy, patients systematically enter anxiety-provoking situations until there is a significant reduction in the anxiety response due to extinction learning.4 In addition, exposures serve as behavioral experiments aimed at testing the validity of maladaptive cognitions and feared outcomes. By modifying these maladaptive cognitions, emotional distress and engagement in maladaptive behaviors will decrease, and the individual can learn a new safe memory associated with the previously feared stimulus or context.

Despite the superior efficacy of CBT, there is still considerable room for improvement.5 Researchers have supplemented CBT with anxiety-reducing pharmacotherapies, as some individuals do not improve—or improve sufficiently—with exposure alone. However, augmenting exposure with anxiolytic drugs has resulted in minor success. Furthermore, these augmentation strategies may result in less successful treatment outcomes, as individuals may attribute treatment gains to medication rather than to their own effort, thereby undermining self-efficacy. More recent approaches have focused on strengthening CBT education, utilizing pharmacotherapy that affects the neurobiology implicated in the fear extinction processes.6 This approach aims at enhancing the memory processes underlying extinction. 

D-Cycloserine as Treatment Adjunct

Fear extinction is a prime area of research in the anxiety literature, as researchers continue to investigate novel and effective ways to reduce the salience of distressing memories and replace these with more neutral memories. One such pathway, the N-methyl-D-aspartate (NMDA) receptor in the basolateral amygdala, is known to play an important role in controlling neural plasticity and memory. Recent research suggests that NMDA activity mediates fear extinction.7 As such, a compound known as d-cycloserine (DCS) has been demonstrated to augment extinction learning by serving as a partial NMDA agonist.8

Because DCS has long been used as an antibiotic medication for treating tuberculosis at high dosing for an extended period of time, it can be safely administered as a cognitive enhancer in exposure therapies for anxiety disorders at much lower dosing for a much shorter period of time. Accordingly, a vast body of research focuses on translating preclinical basic neuroscience findings about DCS into clinical trials with humans diagnosed with a large range of anxiety disorders.3

Efficacy of DCS

The first human trial of DCS as an augmentation strategy for exposure in patients with anxiety yielded promising results.9 The effects of a single dose of DCS taken prior to exposure sessions by patients with acrophobia were examined. Results revealed that DCS significantly enhanced extinction learning after the 2 sessions of acute treatment and at 3 months follow-up. Patients randomly assigned to the DCS condition subsequently reported less avoidance of heights in their daily activities after study completion. Therefore, DCS appeared to enhance the memory of successful exposure experiences and influence subsequent willingness to confront fearful situations. This promising study led to a further line of research that aimed to elucidate the possible enhancing effects of DCS on various anxiety disorders.

Subsequent studies from our group on social anxiety disorder and panic disorder found similarly successful results for DCS as an augmentation strategy.10 Other studies, however, presented null effects.11 Of particular interest and concern was 1 trial with posttraumatic stress disorder (PTSD). It found that patients who received DCS reported more symptoms at posttreatment than those who received placebo.12 As will be discussed further in this article, this study suggests that DCS might also augment fear memory reconsolidation and, therefore, might produce counter-therapeutic effects under certain circumstances.

These studies revealed the complex therapeutic and counter-therapeutic effects of DCS. The 3 main literature findings should be carefully considered when using DCS in exposure therapy: (1) Effect of dose and timing of administration; (2) DCS as an accelerator of early treatment response; (3) Specific conditions in which DCS can lead to fear reconsolidation and worsen symptoms.

Effect of Dose and Timing of Administration

DCS Dosing and dose timing could explain the inconsistent findings from previous studies. The results from several animal and human studies suggest that DCS only shows the extinction augmentation effect when administered in low (eg, 50 mg) and isolated (ie, acute) dosing, but not when administered chronically (ie, repeatedly over an extended period of time).7

Timing is another important issue. Peak blood levels of DCS typically are evident 4 to 6 hours after ingestion. Extinction learning processes usually happen at the end of an exposure session. Therefore, DCS is likely to be most effective when administered within 1 to 2 hours before an exposure session. Indeed, studies demonstrated that DCS administration 1 to 2 hours before exposure achieved greater effects than studies DCS administration multiple hours before exposure.13 These results hint at a rather narrow therapeutic window of DCS, as it appears DCS needs to be administered acutely and in small doses approximately 1 to 2 hours before exposures.

DCS as an Accelerator of Early Treatment Respons

Rather than directly targeting anxiolysis, DCS is used to enhance consolidation of the therapeutic learning offered by CBT. As DCS is a cognitive enhancer, it was reasonable to expect that DCS would strengthen the benefits of CBT through faster learning. Studies that examined the application of DCS for obsessive-compulsive disorder (OCD) revealed that DCS had an effect that attenuated with subsequent administrations.14 These results provided the first hints that DCS primarily acts by accelerating treatment response in the early part of therapy.

Furthermore, with repeated exposure sessions, studies have revealed that exposure alone can eventually show similar effects to the initial DCS augmentation effects. This apparent catch-up effect has also been shown in animal models and human trials for social anxiety disorder, agoraphobia, and panic disorder.15 Although these studies did not show an advantage at the end of treatment in terms of response or remission rates for DCS, faster treatment response can have far-reaching effects. For example, a rapid reduction in distress and disability is linked with a lower dropout rate, as treatment gains are realized more quickly.11,14

Possible Fear Reconsolidation

The mixed results of the efficacy of DCS may be partially explained by the fact that DCS might not only augment fear extinction learning, but also fear memory reconsolidation, or the stabilization of a fear-related memory after initial fear acquisition.16,17 For example, we found in one study that DCS can actually worsen symptoms by enhancing reconsolidation of fear memory when treatment ends with the individual in a high state of fear.6 Since DCS has the capacity to consolidate both extinction and reconsolidation processes, it may be vital to ensure that extinction learning is the predominant process occurring during DCS-augmented sessions.

Post-session DCS administration augmented exposure sessions only when exposure sessions were deemed successful and ended with low levels of fear.18 Accordingly, administering DCS post-extinction learning and judiciously (only after sessions wherein extinction learning is evident) may prevent potentially deleterious effects of DCS. Furthermore, posttreatment fear (rather than a change in fear) should be used as an index for predicting DCS augmentation effects.

Concluding thoughts

Evidence for DCS as an augmentation strategy for CBT for anxiety disorders has been promising, thanks to small placebo-controlled trials across the anxiety disorders. Yet, as research on DCS augmentation has progressed to more diverse protocols and large multicenter trials, the effect size for its benefit has started to falter.6 Subsequent studies and closer examination of the existing data shed light on the mechanism of DCS as a cognitive enhancer in exposure therapy. These studies have revealed important moderators for the use of DCS and guidance for accurate and effective use. There is ongoing research to determine if DCS can be applied to CBT that does not rely solely on exposure interventions. These types of treatments include cue exposure for substance use disorders,19 exposure to feared foods and weight restoration in eating disorders, cognitive restructuring for depression, and imaginary re-scripting therapy for PTSD. Future studies are needed to confirm augmentation effects and to explore whether, like the application of DCS to anxiety disorders, judicious use of DCS is warranted.

A recent individual participant level meta-analysis shed additional light on the use of DCS for exposure-based cognitive behavior therapy.8 Mataix-Cols et al meta-analysis revealed that DCS had a small but significant augmentation effect at posttreatment, with mixed support for the maintenance of its effects at follow up. Importantly, results revealed significant decrease in the augmentation effect of DCS across the time frame covered by the meta-analysis (21 studies published across a 14-year period). In a reanalysis of this meta-analysis, Rosenfield et al.20 examined potential explanations of the apparent declining effect and provided important concrete suggestions for dosing and dose timing.20 Data indicated that participants might benefit most from about 9 doses of DCS, and from administering the doses more than 60 minutes prior to exposure. Additionally, the recommended dose is 50 mg, as the data did not support improved effectivity for greater than 50 mg dosage. Optimizing DCS administration might achieve substantial improved treatment outcomes.

Beyond the important clinical implications of DCS literature, it is an excellent example of translational research from neuroscience to clinical science that directly translates findings from animal studies to clinical trials in humans. We hope that rather than simply combining treatment strategies, which aim for a cumulative effect, future research will continue to focus on elucidating the specific circumstances in which clinical applications (novel and traditional) may (or may not) be successful. This might allow clinicians to tailor treatments accurately to achieve the best possible results for their patients. 

Ms Moskow is a clinical extern at McLean Hospital/Harvard Medical School Psychology and a third-year doctoral student at Boston University. Dr Snir is a clinical psychologist and postdoctoral research fellow at Boston University. Dr Hofmann is a professor of psychology at the Department of Psychology at Boston University, where he directs the Psychotherapy and Emotion Research Laboratory. Dr Hofmann receives financial support from the Alexander von Humboldt Foundation (as part of the Humboldt Prize), NIH/NCCIH (R01AT007257), NIH/NIMH (R01MH099021, U01MH108168), and the James S. McDonnell Foundation 21st Century Science Initiative in Understanding Human Cognition – Special Initiative. He receives compensation for his work as editor from SpringerNature and the Association for Psychological Science, and as an advisor from the Palo Alto Health Sciences Otsuka Pharmaceuticals, and for his work as a Subject Matter Expert from John Wiley Sons, Inc. and SilverCloud Health, Inc. He also receives royalties and payments for his editorial work from various publishers. 

References

1. Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU. Twelve month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2012;21:169–74.

2. Hofmann SG, Asnaani A, Vonk JJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research. 2012;36:427-440.

3. Hofmann SG, Carpenter JK, Otto MW, et al. Dose timing of D-cycloserine to augment cognitive behavioral therapy for social anxiety: study design and rationale. Contemp Clin Trials. 2015;43:223-230.

4. Bouton ME, Westbrook RF, Corcoran KA, Maren S. Contextual and temporal modulation of extinction: behavioral and biological mechanisms. Biol Psychiatry. 2006;60(4):352-360.

5. Carpenter JK, Andrews LA, Witcraft SM, et al. Cognitive behavioral therapy for anxiety and related disorders: A meta‐analysis of randomized placebo‐controlled trials. Depression and Anxiety. 2018;35(6):502–514.

6. Otto MW, Kredlow MA, Smits J, et al. Enhancement of psychosocial treatment with D-Cycloserine: models, moderators, and future directions. Biological Psychiatry. 2016;80(4):274–283.

7. Davis M. Role of NMDA receptors and MAP kinase in the amygdala in extinction of fear: clinical implications for exposure therapy. European Journal of Neuroscience. 2002;16(3):395-398.‏

8. Mataix-Cols D, Fernández de la Cruz L, Monzani B, et al. D-cycloserine augmentation of exposure-based cognitive-behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders: Systematic review and meta-analysis of individual participant data. JAMA Psychiatry. 2017;74(5):501-510.

9. Ressler KJ, Rothbaum BO, Tannenbaum L, et al. Cognitive enhancers as adjuncts to psychotherapy: use of d-cycloserine in phobic individuals to facilitate extinction of fear. Arch Gen Psychiatry. 2004;61:1136-44.

10. Hofmann SG, Meuret AE, Smits JAJ, et al. Augmentation of exposure therapy for social anxiety disorder with d-cycloserine. Arch Gen Psychiatry. 2006;63:298-304.

11. Siegmund A, Golfels F, Finck C, et al. D-cycloserine does not improve but might slightly speed up the outcome of in-vivo exposure therapy in patients with severe agoraphobia and panic disorder in a randomized double blind clinical trial. J Psychiatr Res. 2011;45:1042-7.

12. Litz BT, Salters-Pedneault K, Steenkamp M, Et al. A randomized placebo-controlled trial of d-cycloserine and exposure therapy for post-traumatic stress disorder. J Psychiatr Res. 2012;46:1184-1190.

13. Hofmann SG, Otto MW, Pollack MH, Smits JA. D-cycloserine augmentation of cognitive behavioral therapy for anxiety disorders: an update. Current psychiatry reports. 2015;17(1):532.‏

14. Kushner MG, Kim SW, Donahue C, et al. D-cycloserine augmented exposure therapy for obsessive-compulsive disorder. Biol Psychiatry. 2007;62:835–838.

15. Ren J, Li X, Zhang X, et al. The effects of intrahippocampal microinfusion of D-cycloserine on fear extinction, and the expression of NMDA receptor subunit NR2B and neurogenesis in the hippocampus in rats. Prog Neuropsychopharmacol Biol Psychiatry. 2014;44:257–264.

16. Hofmann SG. D-cycloserine for treating anxiety disorders: Making good exposures better and bad exposures worse. Depression and Anxiety. 2014;31:175-177.

17. Hofmann SG. Schrödinger’s cat and d-cycloserine to augment exposure therapy – both are dead and alive. JAMA Psychiatry. 2016;73(8):771-772.

18. Smits JAJ, Hofmann SG, Rosenfield D, et al. D-cycloserine augmentation of cognitive behavioral group therapy of social anxiety disorder: prognostic and prescriptive variables. J Consult Clin Psychology. 2013;81(6):1100-1112.

19. MacKillop J, Few LR, Stojek MK, et al. D-cycloserine to enhance extinction of cue-elicited craving for alcohol: A translational approach. Translational Psychiatry. 2015;5:e544.

20. Rosenfield D, Smits JAJ, Hofmann SG, et al. Changes in dosing and dose timing of d-cycloserine explain its apparent declining efficacy for augmenting exposure therapy for anxiety-related disorder: an individual participant-data meta-analysis. J Anxiety Disord. 2019;68:102149.

Mindfulness May Be a Mediator of Anxiety When Responding to an Uncertain Threat

The relationship between mindfulness and anxiety may involve reactions to uncertainty. These findings were published in the Journal of Anxiety Disorders.

Students (N=55) at the University of Groningen in the Netherlands were recruited to participate in this study. The participants were assessed for panic, social anxiety, worry, obsessive compulsive symptoms, mindfulness, and uncertainty by a questionnaire and tested by the threat-of-shock task (NPU-threat test).

During the NPU-threat test, prompts on a computer screen indicated that no shock, predictable shocks, or unpredictable shocks would be administered through electrodes attached to the left hand. Reactions to the shocks were assessed by 2 questions following the prompts and by electrodes for facial electromyography.

Participants were mostly women (n=32) who were aged mean 23.25 (standard deviation [SD], 3.87) years. Participants received financial compensation (n=48) or they participated to fulfill a program requirement (n=7).


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During the NPU-threat test, condition (F[294], 105.43; P .001; hp2, .692), cue (F[147], 80.256; P .001; hp2, .631), and the interaction between the 2 (F[1.589,74.691], 50.091; P .001; hp2, .516) were significant for startle magnitude and subjective anxiety.

Compared with the no shock condition, both predictable (P =.001) and unpredictable (P .001) shock conditions elicited a greater startle magnitude.

Anxiety differed significantly during condition (F[1.666,78.287], 94.152; P .001; hp2, .667) in which anxiety was greater during predictable (P .001) and unpredictable (P .001) shock conditions compared with the no shock treatment. Anxiety was highest during the unpredictable shock condition (P .001).

Five Facet Mindfulness Questionnaire (FFMQ) scores were inversely related with all measures of anxiety (range, -.27 to -.67; all P .05) and intolerance and uncertainty (range, -0.53 to -0.61; all P .05). Measures of intolerance and uncertainty were positively associated with all anxiety measures (range, .29-.66; all P .05) except for interoceptive fear (range, .01-.14; P =.30).

FFMQ scores were not associated with response to uncertainty (r, -.176; P =.232) or startle (r, .073; P =.622).

Mindfulness mediation was observed to have a significant direct effect on social anxiety (-.592; SD, .121; P .01), agoraphobia (-.256; SD, .094; P .01), and worry (-.434; SD, .120; P .01) but not on obsessive compulsive symptoms (.066; SD, .103).

These results may have been biased by the small sample size, especially because the investigators reported a high amount of response variability of the psychophysiological measures.

This study was the first to find a relationship of uncertainty with mindfulness and anxiety, indicating mindfulness may be an important therapeutic tool across multiple psychological disorders. Future studies are needed to confirm this relationship between mindfulness and anxiety.

Reference

Papenfuss I, Lommen MJJ, Grillon C, Balderston NL, Ostafin BD. Responding to uncertain threat: A potential mediator for the effect of mindfulness on anxiety. J Anxiety Disord. 2020;77:102332. doi:10.1016/j.janxdis.2020.102332

Pandemic-related selective increase in obsessive-compulsive symptoms in UK study – News

COVID-19 has now been around for almost a year and has caused enormous stress among the developed nations of the Western world. A devastating new study shows how a large-scale wave of increased obsessive-compulsive (OC) symptoms affected public behavior, such as seeking information about the pandemic and following government guidelines. This could predict long-term sustained disruptions of mental health as an unexpected sequel to the pandemic.

This study was published in the pre-print server medRxiv*.

Study Results

Study Results. Image Credit: https://www.medrxiv.org/content/10.1101/2020.12.08.20245803v1.full.pdf

Stress and Psychiatric Symptoms

All life events associated with significant stress cause an upsurge of ill mental health. The COVID-19 pandemic was no exception. It ushered in an era of disrupted finances, social interactions, and health. Predictably, all psychiatric symptoms increased over the first wave of the pandemic. This includes symptoms in already diagnosed patients with anxiety, depression, bipolar disease, schizophrenia, and obsessive-compulsive disorders (OCD).

Members of the general public also showed a significant increase in symptoms of anxiety and depression. However, in typical situations, once the individual adapts to the situation, such symptoms return to the baseline. This is mediated by the re-appraisal of the situation and the evolution of coping strategies.

OCD is a mental condition that is selectively cultivated by pandemic conditions because the campaign to contain severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread pivots around the need to prevent and remove contamination by cleaning. This pervasive fear of an invisible foe which spreads by contamination and is combated by cleaning and other non-pharmaceutical interventions (NPIs), including face mask use and social distancing, caters to OCD behavior.

“These news coverages and governmental guidelines may thus give validity to OCD-symptomatic behavior, potentially intensifying or triggering them.”

This may lead to a wave of OC symptoms in the general public as well, as more attention is paid to the area of contamination and cleaning.

Study Details

To assess this risk, the researchers carried out a longitudinal study on the impact of COVID-19 on OC, anxiety, and depression. They followed psychiatric scores in these three areas for several months from May to August 2020. They also observed any correlations between OC symptoms, information-seeking about COVID-19, and the following government guidelines.

The first data collection was from April 24, 2020, to May 7, 2020, the peak of the first wave. Here, standardized questionnaires were used to record the three types of symptoms among 416 participants, and information-seeking behavior, along with their use of news and social media. They also had a mental ability test.

This assessment was repeated at the second time point, between July 15 and August 15, 2020, with an additional assessment of how well they followed COVID-19 guidelines. At this time, the largest relaxation of pandemic restrictions had just occurred, and thus the effects of a significant change in the environment could also be measured. At this point, there were 304 participants.

The researchers used self-administered questionnaires to measure OC (Padua Inventory-Washington State University Revision (PI-WSUR)), with anxiety and depression (Hospital Anxiety and Depression Scale (HADS)). They also asked about the average use of news and social media pre-pandemic. At the second assessment, they asked also how far the respondents observed pandemic-related recommendations by the authorities.

Initial Rise in Psychiatric Scores

The investigators found that all psychiatric scores were initially elevated, some components of the PI-WSUR being scored at OCD level. With the HADS, too, about half and 40%, respectively, met the cut-off for anxiety and depression, respectively.

The corresponding population-level rates for the latter conditions before the pandemic, in one of the largest studies, was around 20% for both, showing high symptoms scores during the first wave of COVID-19.

Selective Increase in OC Symptoms in Later Phase

Over time, however, only the OC symptoms showed a further rise, even when items related to contamination and cleaning were excluded from the analysis. Thus, normal adaptation did not occur concerning OC symptoms during the lockdown, but instead, they continued to rise. Curiously, anxiety, and depression showed the expected drop, due to adaptation.

Increased Adherence to Guidelines

The third area of investigation was the role of these symptoms in causing pandemic-related behavior, especially since people with high OC symptoms were seen to be engaged in increased information-seeking behavior. They found that most of such behavior in respondents occurred at the beginning of the lockdown, and was due to the lack of knowledge about the pandemic.

The researchers also looked at the link between information seeking and psychiatric symptoms. They found that OC symptoms were related to a higher expression of this behavior at both early and late time points. The same was also true of anxiety scores but to a smaller extent. This was true even after adjusting for age, gender, and social media use unrelated to the pandemic.

What are the Implications?

When analyzed using all the psychiatric symptoms as potential predictors for information-seeking behavior, the only consistent association was found to be with OC symptoms. The association with anxiety disappeared in this analysis. Thus, although information-seeking decreased over time, the reverse was observed in connection with OC symptoms. This favors the role of OC symptoms as the main reason for pandemic-related information seeking.

Again, the increase in information seeking related to OC symptoms was found to result in the increased tendency to adhere to government COVID-19 guidelines even after the relaxation of restrictions. Both these behaviors were independently predictive of the tendency to follow these guidelines.

The benefit to society from such OC symptoms is obvious, with respect to viral containment, though they do impose a burden of care on the individual. On the other hand, the rise and prolonged duration of such symptoms suggest the need to put policies in place to follow up on individuals with a high risk of developing OCD. Interventions are necessary to prevent and treat the condition before long-term mental ill-health sets in.

Our findings highlight that OC symptoms are disproportionally affected by the pandemic by documenting their selective increase throughout the pandemic for the first time, which may result in serious adverse long-term consequences.”

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.