Obsessive compulsive disorder: There’s more to OCD than repetitive handwashing

Posted

June 21, 2017 11:57:29

Coloured pens lined up separately in red and blue colours.
Photo:

People with OCD tend to perform rituals in a response to their obsessions. (ABC Radio Brisbane: Jessica Hinchliffe)

While many of us have unwanted thoughts from time to time, we often can push them aside and move on.

The same cannot be said for people with OCD; for them, unwanted negative thoughts can take control of their lives.

OCD (obsessive compulsive disorder) is an anxiety disorder that affects more than 500,000 people in Australia.

Dr Emily O’Leary, director of the OCD Clinic in Brisbane, said the disorder could manifest in many different forms.

“OCD is categorised by intrusive thoughts, images and impulses that cause such anxiety that they feel like they need to do repetitive actions to make the anxiety go away,” she said.

“An example of that is a person feeling dirty or contaminated and they begin to engage in repetitive handwashing to make themselves feel better.

“I often use the contamination one as it’s what people recognise the most.”

A woman washing her hands.
Photo:

Excessive hand washing can be a symptom of OCD. (ABC Radio Brisbane: Jessica Hinchliffe)

But Dr O’Leary said that at her clinic the most common form of OCD was harming or aggressive obsessions.

“They get intrusive thoughts about bad things happening to people they love,” she told ABC Radio Brisbane’s Emma Griffiths.

“It can be life throwing bad things at them or inappropriate sexual thoughts.

“What they then do is a number of compulsive behaviours to keep them safe.”

What causes OCD?

Dr O’Leary said genetics often was a contributing factor.

“It’s a combination of factors that work together in a perfect storm to cause OCD,” she said.

“Factors such as personality, temperament, early upbringing and if it runs in the family.”

She said it was not possible to have OCD without knowing.

“There is a real difference between being quirky and obsessive and having OCD.

“People with OCD, even if they haven’t sought treatment, know it’s an issue as it interferes in their day.

“They spend vast amounts of times engaging in these rituals and it causes stress.”

Living with OCD

Dr O’Leary said there was a big gap between diagnosis and people seeking treatment, often more than 10 years.

“The main reason that they don’t seek help is that they are embarrassed and ashamed about the symptoms,” she said.

“We aim to reduce the anxiety and the OCD and form a realistic outcome through a treatment plan.

“We help people accept that the thoughts can be in their head but they don’t have to do anything with them.”

If you or someone you know are experiencing symptoms of OCD talk to your GP or contact Lifeline on 13 11 14.

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stories from Queensland

Obsessive compulsive disorder: There’s more to OCD than repetitive …

Posted

June 21, 2017 11:57:29

Coloured pens lined up separately in red and blue colours.
Photo:

People with OCD tend to perform rituals in a response to their obsessions. (ABC Radio Brisbane: Jessica Hinchliffe)

While many of us have unwanted thoughts from time to time, we often can push them aside and move on.

The same cannot be said for people with OCD; for them, unwanted negative thoughts can take control of their lives.

OCD (obsessive compulsive disorder) is an anxiety disorder that affects more than 500,000 people in Australia.

Dr Emily O’Leary, director of the OCD Clinic in Brisbane, said the disorder could manifest in many different forms.

“OCD is categorised by intrusive thoughts, images and impulses that cause such anxiety that they feel like they need to do repetitive actions to make the anxiety go away,” she said.

“An example of that is a person feeling dirty or contaminated and they begin to engage in repetitive handwashing to make themselves feel better.

“I often use the contamination one as it’s what people recognise the most.”

A woman washing her hands.
Photo:

Excessive hand washing can be a symptom of OCD. (ABC Radio Brisbane: Jessica Hinchliffe)

But Dr O’Leary said that at her clinic the most common form of OCD was harming or aggressive obsessions.

“They get intrusive thoughts about bad things happening to people they love,” she told ABC Radio Brisbane’s Emma Griffiths.

“It can be life throwing bad things at them or inappropriate sexual thoughts.

“What they then do is a number of compulsive behaviours to keep them safe.”

What causes OCD?

Dr O’Leary said genetics often was a contributing factor.

“It’s a combination of factors that work together in a perfect storm to cause OCD,” she said.

“Factors such as personality, temperament, early upbringing and if it runs in the family.”

She said it was not possible to have OCD without knowing.

“There is a real difference between being quirky and obsessive and having OCD.

“People with OCD, even if they haven’t sought treatment, know it’s an issue as it interferes in their day.

“They spend vast amounts of times engaging in these rituals and it causes stress.”

Living with OCD

Dr O’Leary said there was a big gap between diagnosis and people seeking treatment, often more than 10 years.

“The main reason that they don’t seek help is that they are embarrassed and ashamed about the symptoms,” she said.

“We aim to reduce the anxiety and the OCD and form a realistic outcome through a treatment plan.

“We help people accept that the thoughts can be in their head but they don’t have to do anything with them.”

If you or someone you know are experiencing symptoms of OCD talk to your GP or contact Lifeline on 13 11 14.

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mental-health,

health,

brisbane-4000



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stories from Queensland

A look at mold, depression, suicide

During the past 2-1/2 years of living where have and experiencing the symptoms that both my wife and I have developed, plus some information on the now deceased wife of the owner, I focused my research on the effects of mold in our personal environment and began to explore evidence-based and research backed literature for some explanation.

What I found is that neuroinflammation (chronic inflammation of the nervous system) can be caused by a variety of things including an increase in cytokines. An increase in cytokines can be triggered by mold. A very good reference book on the subject of mold is Mold Warriors by Dr. Ritchie Shoemaker. In his book, Dr. Shoemaker states that about 25% of the population is susceptible to biotoxin associated illness.

 

Recently published research on inflammation and depression from Denmark found that if you had a diagnosis of an autoimmune disease, like Hashimoto’s, rheumatoid arthritis or Sjogren’s, your risk of being diagnosed with a mood disorder like depression increased by 45 percent. If you had been hospitalized for some sort of infectious illness your risk of having mood disorders increased by 62 percent. And if you had both happen to you, you doubled the risk of being diagnosed with a mood illness. Mold has been shown to increase the likelihood of inflammation, depression and infectious illnesses.

Neurological Lyme is known to create psychiatric complications. There is good evidence that streptococcus infections not treated properly can lead to obsessive-compulsive disorder, aka PANDAS, is connected with higher rates of suicides. Some of the toxins and infections I found in my research on depression and anxiety are molds.

Inflammation of the brain, vasculitis, an inflammation of the blood vessels and microglial activation of the immune cells of the brain, can be linked to certain cytokines such as MMP9 and TGF-beta. Autoimmune disease such as Hashimoto’s can lead to an encephalopathy (a disease in which the functioning of the brain is affected by some agent or condition such as viral infection or toxins in the blood). Excitotoxicity, an increase in glutamate in the brain, and those listed above can all be triggered by mold.

One study on mold and depression was done in Europe on 6,000 adults. The researchers tested for mold by looking at the house and if they saw mold on the walls or they smelled it strongly they considered that a moldy house. There were no ERMI (environmental relative moldiness index) or other tests done.

Researchers found the level of depression in people living in visibly moldy households was about 34-40 percent higher than for residents in mold-free dwellings. It was concluded that mold increases the probability of causing the symptoms of depression.

Depression and anxiety symptoms are often treated with drugs that can cause very serious side effects, including suicide. Bipolar, aka manic depression, is a mental disorder that brings extreme high and low moods and changes in sleep, energy, thinking and behavior. People who suffer from bipolar disorder are at high risk for suicide. Information from The National Mental Health Association states that 30%-70% of suicide victims have suffered some form of depression, including bipolar disorder.

The wife of the present owner of the house we were considering in our lease/option, and who had lived in the house for years before marrying the present owner, was bipolar. She committed suicide.

R. Miller is a freelance writer and photographer who will be working with the US Forest Service teaching park visitors the basics of getting the most from their vacation photography.

Researcher investigates hallucinogen as potential OCD treatment

Rodriguez, intent on searching for better, faster treatment for her patients with OCD, took note. There was an emerging scientific theory that ketamine affects the levels of the neurotransmitter glutamate in the brain and increasing evidence that glutamate plays a role in OCD symptoms, she said. Perhaps ketamine could help regulate OCD symptoms as well as depression.

About three years after Rodriguez’s pilot study on the 24-year-old student with OCD, she and colleagues at Columbia published their results from the first clinical trial of ketamine in OCD patients. This trial randomized 15 patients with OCD to ketamine or placebo.

Once again, the effect of ketamine was immediate. Patients reported dramatic decreases in their obsessive-compulsive symptoms midway through the 40-minute infusion, according to the study. The diminished symptoms lasted throughout the following week in half of the patients. Most striking were comments by the patients quoted in the study: “I tried to have OCD thoughts, but I couldn’t,” said one. Another said, “I feel as if the weight of OCD has been lifted.” A third said, “I don’t have any intrusive thoughts. … This is amazing, unbelievable. This is right out of a movie.”

“Carolyn’s study was quite exciting,” Zarate said, adding that there were a number of similar, small but rigorous studies following his 2006 study that found fast-acting results using ketamine to treat bipolar disorder and PTSD.

“We had no reason to believe that ketamine could wipe out any symptoms of these disorders within hours or days,” he said.

Search for a safer drug

Virtually all of the antidepressants used in the past 60 years work the same way: by raising levels of serotonin or one or two other neurotransmitters. Ketamine, however, doesn’t affect serotonin levels. But exactly what it does remains unclear.

Since coming to Stanford in 2015, Rodriguez has been funded by the National Institute of Mental Health for a large clinical trial of ketamine’s effects on OCD. This five-year trial aims to follow 90 OCD patients for as long as six months after they’ve been given a dose of ketamine or an alternative drug. Rodriguez and her research team want to observe how ketamine changes participants’ brains, as well as test for side effects from use of the drug.

Ultimately, Rodriguez said, she hopes the study will lead to the discovery of other fast-acting drugs that work in the brain like ketamine but without its addictive potential.

I just don’t like the idea of people being in pain.

Recent research in the field indicates that the glutamate hypothesis that triggered her pilot study might be further refined.

“Ketamine is a complicated drug that works on many different receptor sites,” she said. “Researchers have fixated on the NMDA receptor, one of the glutamate-type receptors, but it might not be the only receptor bringing benefit.”

In May 2016, researchers from NIMH and the University of Maryland — Zarate among them — published a study conducted in mice showing that a chemical byproduct, or metabolite, created as the body breaks down ketamine might hold the secret to its rapid antidepressant actions. This metabolite, hydroxynorketamine, reversed depression-like symptoms in mice without triggering any of the anesthetic, dissociative or addictive side effects associated with ketamine, Zarate said.

“Ideally, we’d like to test hydroxynorketamine and possibly other drugs that act on glutamate pathways without ketamine-like side effects as possible alternatives to ketamine in OCD,” Rodriguez said.

Rodriguez is also interested in using ketamine as a way to kick-start a type of cognitive behavioral therapy called exposure and response prevention, an evidence-based psychological treatment designed to help patients overcome their OCD. The therapy involves teaching patients with OCD to face anxieties by refraining from ritualizing behaviors, then progressing to more challenging anxieties as they experience success.

Relaxation and other techniques also help patients begin to tolerate their anxiety — for example, postponing the compulsion to wash their hands for at least 30 minutes, then extending that time period.

“My goal isn’t to have people taking ketamine for long periods of time,” Rodriguez said. But perhaps a short-term course of ketamine could provide its own kind of exposure and response prevention by allowing patients to experience that it is possible not to be controlled by their OCD, she said.

Almost a decade after her first ketamine pilot study, Rodriguez remains inspired by the magic of seeing the 24-year-old student’s eyes light up as the drug alleviated OCD symptoms that had caused her years of daily suffering.

“After the study, I was walking her to her taxi to go home,” Rodriguez said. “The side effects of the drug had worn off; she was back to her baseline. I asked what it was like not to have OCD. She said it was the strangest feeling. She could do normal things but without the OCD symptoms. So just the fact that in a matter of hours you can disconnect from OCD makes me a believer.

“I just don’t like the idea of people being in pain,” Rodriguez said. “I want to see science translated into treatments now.”    

This Brain Nook Is Why You’re Frightened of the Future

No one really knows what tomorrow will bring. The future is full of unknowns, and while this may stress a lot of us out, it’s a tremendous source of fear for people with two specific anxiety disorders.

Unlike most anxiety disorders, people with Obsessive Compulsive Disorder (OCD) and Generalized Anxiety Disorder (GAD) are particularly susceptible to stress over not knowing what’s going to happen down the road. Among these people, a quantifiable measurement called their Intolerance of Uncertainty has been linked to enlargement of a brain region called the striatum that’s responsible for decision making and motor control. But a paper published Thursday in Emotion found this same relationship in people who don’t have anxiety disorders: The higher the Intolerance of Uncertainty, the larger the striatum.

“There weren’t that many papers that reported on the effects of brain structure or anatomy,” says Justin M. Kim, one of the scientists at Dartmouth College who ran the study. Most of what we know about how the brain relates to anxiety disorders is related to function, not the brain’s actual structure.

Kim and his team ran fMRI scans on 61 undergraduates at Dartmouth College, none of whom had any psychological disorders. The researchers weren’t deliberately targeting the striatum, choosing instead to scan the entire brain for physical differences because so little is known about how neural anatomy is linked with anxiety. All of the participants completed surveys that measured their general feelings of anxiousness — people with anxiety disorders score well above a normal range — in order to separate them from Intolerance of Uncertainty measurements, which were also collected via survey. High Intolerance of Uncertainty scores are unique to OCD and GAD.

These findings, like many of those that come out of psychological studies, were limited by the tendency to collect data from undergraduates, especially since the striatum continues developing through people’s late twenties. Kim said that he didn’t find any difference within the age range that he studied, but his window into the minds of people who were just 18 to 26 years old is too narrow to generalize and say that age doesn’t impact the newfound relationship.

“If you collect brain data from a population that’s still developing, that might affect how you interpret your findings,” says Kim.

putamen striatum fear anxiety gad ocd generalized disorder obsessive compulsive putamen striatum fear anxiety gad ocd generalized disorder obsessive compulsive
Research shows that even in people without anxiety disorders, those with a larger putamen feel more anxious about an unpredictable future.

It’s too early to draw any clinical conclusions about how these findings could predict or help treat OCD and GAD, but this study could lay the groundwork for a new branch of experimentation into how brain anatomy affects psychology. Prior to this experiment, the link between striatum volume and anxiety over the future has only been looked at in people with anxiety disorders — no one had studied the normal variation in healthy people.

Kim hopes that his experiment will lay the foundation for using physical markers to track how well treatments for OCD and GAD are working or determining whether an enlarged striatum is a risk factor for developing an anxiety disorder. “Eventually, I hope this will help with a bigger wave of studies that might aid in the diagnosis of different psychiatric disorders using the brain,” he says.

Abstract: Oversensitivity to uncertain future threat is usefully conceptualized as intolerance of uncertainty (IU). Neuroimaging studies of IU to date have largely focused on its relationship with brain function, but few studies have documented the association between IU and the quantitative properties of brain structure. Here, we examined potential gray and white-matter brain structural correlates of IU from 61 healthy participants. Voxel-based morphometric analysis highlighted a robust positive correlation between IU and striatal volume, particularly the putamen. Conversely, tract-based spatial statistical analysis showed no evidence for a relationship between IU and the structural integrity of white-matter fiber tracts. Current results converge upon findings from individuals with anxiety disorders such as obsessive– compulsive disorder (OCD) or generalized anxiety disorder (GAD), where abnormally increased IU and striatal volume are consistently reported. They also converge with neurobehavioral data implicating the putamen in predictive coding. Most notably, the relationship between IU and striatal volume is observed at a preclinical level, suggesting that the volumetric properties of the striatum reflect the processing of uncertainty per se as it relates to this dimensional personality characteristic. Such a relationship could then potentially contribute to the onset of OCD or GAD, rather than being unique to their pathophysiology.

Photos via Dartmouth College, Home Alone 1 / Hughes Entertainment

How to master your anxiety and live again

I consider myself an expert in anxiety — from professional and personal experience.

Each day in my family practice, I counsel patients suffering from the stress of personal conflicts, loss and illness.

I treat individuals suffering from generalized anxiety, phobias, panic attacks and obsessive-compulsive disorder. Some require prescription medications, but all benefit from the empowering practices of mindfulness, cognitive behavioural therapy and positive visualization.

Those who have suffered from anxiety for years find it hard to believe that they can feel any other way — that they are capable of change. Those who practise their new skills on a daily basis — as regularly as any prescription medication — through the power of neuroplasticity will transform their own minds.

Our life experiences and how we make sense of them — our personal life stories — form the foundation of our core beliefs: what we believe to be true about ourselves, others and our relationships with them.

Our core beliefs shape the running monologue of our self-talk. That self-talk at best is compassionate, kind and empowering. Too often, our self-talk is judgment of others and ourselves — makes us feel separate, different, better or worse than others —  emphasizes the negative and minimizes the positive.

And that self-talk — the content of our ruminations — takes us away from the real experience of life in the present moment, the only place we can enjoy happiness.

I grew up in the days when playgrounds were not so safe — our kids have it softer today. In Mount Pleasant’s Douglas Park, the monkey bars were made of slippery curved steel and embedded in a floor of concrete.

As a preschooler, I fell from the top of those monkey bars and knocked out my front teeth. For years, I waited for my big kid teeth to grow in. Self-conscious, I didn’t smile.

I developed social anxiety. I felt physically uneasy around anyone outside my immediate family and closest friends. My shyness held me back from speaking up in class, meeting new people, expressing myself and talking to my own cousins.

My playground fall made me uncomfortable with heights and I avoided the potential for injury in contact sports. My older brother excelled in soccer and basketball, but I chose running and swimming.

Anxiety and fear held me back from fully enjoying my life and living my potential, but in my twenties, I immersed myself in the Burnaby Public Library’s self-help books. I used the relaxation response to calm my mind and body. I learned to meditate and practised cognitive behavioural therapy to challenge my negative self-talk, and I used self-hypnosis to visualize my goals.

I overcame my unease with heights on the flying trapeze. Even after seven rib fractures (involving five ribs, two fractured in the front and the back) from one challenging trick, I was back flying after two days.

I challenged my fear of public speaking with media training, live radio and TV interviews and regular public health talks. My focus was not on myself, but on what I could share.

Though I suffered from social anxiety in medical school, I eventually felt at ease teaching medical students and physicians and leading committees and nonprofit organizations. Motivated by the needs of others and living for a purpose bigger than myself, anxiety no longer limits me. 

I know from experience that you can rewrite your life story, challenge your core beliefs, change how you think, feel and act, and expand your comfort zone.  

In my next column, we’ll explore the power of neuroplasticity and effective methods to master anxiety.

Read part one of this three part series on anxiety at vancourier.com.

Davidicus Wong is a family physician and his Healthwise columns appear regularly in this paper. For more on achieving your positive potential in health, see his website at davidicuswong.wordpress.com.

Body dysmorphic disorder visual retraining program – Medical Xpress

Body dysmorphic disorder visual retraining program
Those with BDD have difficulty recognising faces, bodies and emotions. Credit: Swinburne University of Technology

A world-first study is aiming to alleviate symptoms of those with body dysmorphic disorder (BDD) through a unique visual retraining program. BDD results in an exaggerated perception of aspects of personal appearance.

Using eye-tracking technology, the initial stage of the study tracks the eye movements of individuals with BDD, exploring how they view faces and bodies, as well as conduct visual searches.

Participants can then undertake a visual retraining program designed to align their visual patterns closer to those of average individuals.

A research group led by Swinburne’s Professor Susan Rossell has corroborated and conducted research showing that BDD is associated with anomalies in processing a range of appearance and non-appearance related stimuli.

“This includes difficulties with face and emotion recognition, object recognition and attention,” Professor Rossell says.

Some of these anomalies can be attributed to a preference for local processing, at the expense of higher-order global perception. In other words, people with BDD were seen as more likely to focus on smaller details at the expense of the overall ‘big picture’.

“Treatment for BDD typically focuses on reducing symptoms and distress, not changing visual perception.

“Our program is unique as it focuses on addressing visual aspects of the disorder.”

In a Swinburne neuroimaging study, it was also demonstrated that persons with BDD had cortical thinning (reduced brain volumes) in areas of the brain that are known to be important for visual processing.

Professor Rossell hopes that the visual retraining program will help those affected by BDD to achieve more adaptive visual processing.

Obsessing over the data

Aiming to further understand BDD, Swinburne’s research group has also been exploring the link between obsessive-compulsive disorder (OCD) and BDD.

Published in the Journal of Obsessive-Compulsive and Related Disorders, their findings reported that persons with BDD, or OCD, tend to experience similar levels of anxiety and depression, and may also exhibit similar patterns of behaviour.

“Individuals with either disorder are likely to engage in repetitive or ritualistic behaviours, for instance, involving repeated checking, but in BDD these actions tend to manifest  in areas related to one’s physical appearance, such as checking how they look in mirrors or other reflective surfaces,” Professor Rossell says.

“These activities can take up to three hours a day for those with BDD.”


Explore further:
People with anorexia and body dysmorphic disorder have similar brain anomalies

More information:
Wei Lin Toh et al. Characterisation of body dysmorphic disorder (BDD) versus obsessive-compulsive disorder (OCD): In light of current DSM-5 nosology, Journal of Obsessive-Compulsive and Related Disorders (2017). DOI: 10.1016/j.jocrd.2017.01.002

F. Beilharz et al. A systematic review of visual processing and associated treatments in body dysmorphic disorder, Acta Psychiatrica Scandinavica (2017). DOI: 10.1111/acps.12705

Sally A. Grace et al. Reduced cortical thickness in body dysmorphic disorder, Psychiatry Research: Neuroimaging (2017). DOI: 10.1016/j.pscychresns.2016.11.004

Sandy Hook shooting conspiracy theorist sentenced for threat

FORT LAUDERDALE, Fla. — A Florida woman pleaded guilty and was sent to prison Wednesday for threatening a man whose 6-year-old son was killed in the 2012 mass shooting at a Connecticut school, which she contended was a hoax.

Senior U.S. District Judge James Cohn sentenced Lucy Richards, 57, to five months in prison, followed by five months of home detention. She pleaded guilty to interstate transmission of a threat to injure in communications with Lenny Pozner, the father of Noah Pozner, who died in the Sandy Hook school shooting in Newtown, Connecticut.

Cohn called Richards’ actions toward Pozner “disturbing” and said no one should cite a conspiracy theory or belief in a hoax in the deaths of 20 children and six adults that occurred at the school.

“I’m sure he wishes this was false and he could embrace Noah, hear Noah’s heartbeat and hear Noah say ‘I love you, Dad’,” Cohn told Richards. “Your words were cruel and insensitive. This is reality and there is no fiction. There are no alternative facts.”

Investigators say Richards made four voicemail and email threats to Pozner on Jan. 10, 2016, after viewing internet sites claiming the shooting was a hoax aimed at curtailing Americans’ Second Amendment gun ownership rights. The messages said things such as “you gonna die, death is coming to you real soon” and “LOOK BEHIND YOU IT IS DEATH.”

Richards, seated in a wheelchair at the hearing, has significant mental health problems including agoraphobia – fear of leaving one’s house – obsessive compulsive disorder and anxiety disorder, court documents show. But Cohn said he did not think mental illness triggered Richards’ actions.

“You have the absolute right to think and believe as you so desire,” the judge said. “You do not have the right to transmit threats to another.”

In a statement before she was sentenced, Richards apologized and said she could not account for her actions against Pozner that day.

“I don’t know where my heart and head were that day, but they were not in the right place,” she said. “It was the worst mistake of my life and I am truly sorry.”

Others linked to the Sandy Hook massacre have reported harassment by hoax believers amid a growing trend of “fake news” stories and baseless conspiracy theories, such as the “Pizzagate” case in which a man fired an assault rifle inside a Washington, D.C., pizzeria after going there to investigate unfounded claims it harbored a child sex abuse ring.

In fact, Richards’ public defender Robert Berube said he had gotten calls from around the United States from people who think Sandy Hook was a hoax.

“There were many people who told me it never took place,” he said.

In addition to the prison time and home arrest, Richards will serve three years on probation and is barred from accessing a list of conspiracy theory websites.

She had initially been scheduled to plead guilty in March but did not show up in court, leading to her arrest April 1 and time in jail since then. Those two months already served will count toward her five-month prison sentence.

Treating anxiety disorders in children with CBT – News

insights from industryDr Lars HansenConsultant Psychiatrist and CMOHealios

An interview with Dr Lars Hansen, Consultant Psychiatrist and CMO, Healios, conducted by April Cashin-Garbutt, MA (Cantab)

What are anxiety disorders and how do they typically affect children and young people?

“Anxiety disorders” refers to a broad range of psychiatric conditions, where people are anxious. It covers things like obsessive-compulsive disorder, general anxiety disorder and phobic disorder.

Interestingly, anxiety is also a feature of severe mental illnesses such as psychosis and depression. We often forget about this. In these severe mental illnesses, anxiety can be a driving force behind the main symptoms such as low mood or, in terms of psychosis, some of the features such as hallucinations and delusions. It’s very important not to forget that.

The prevalence of anxiety disorders in children is much debated. If you look at the literature, you’ll see that different prevalences are reported. “Prevalence” simply means how many people have the condition.

Reported prevalences vary, with some people suggesting that one in three children will have an anxiety disorder at some stage during childhood, while some people say it’s closer to one in ten. I think the true number is somewhere in between those numbers.

I don’t think there’s any doubt, and the research backs this up, that anxiety disorders are on the increase in children, for a whole variety of reasons. There’s probably a lot of pressure being the first true internet generation, which makes them feel they have to perform, have to look good, have to post optimistic posts on Facebook and Instagram and all those kind of things. That’s probably pushing the numbers up.

It does differ in some ways from anxiety in adults. It’s often a hidden problem. There are a lot of children who are somehow coping by avoiding things such as school and contact with other kids.

It is very important that we pick this up as a society, because anxiety disorders can be preludes to lots of problems in later adolescence and also in adulthood; mental health disorders such as schizophrenia, depression and substance abuse and also just a lower quality of life in general. It is very important that we pick this up and provide children with evidence-based treatments for their conditions.

How many children and young people experience an anxiety disorder and why is it so important that they can access treatments?

There’s a huge gap between the need for and the provision of services for anxiety disorders in children. That’s been recognized for decades, but it’s just so difficult due to a lack of resources and qualified professionals to bridge that gap.

I think that as a society, if we don’t give this kind of preventive input early on, we will end up with not only a lot of human suffering, but also a huge cost to society and to the NHS.

I’m working part-time in the NHS and we’ve got our backs against the wall, because we’re faced with a wave of psychiatric morbidity, both in children and in adults. We do need to find some new, innovative ways of dealing with this, without diluting the quality of the input that we’re giving people.

In what ways do treatments for anxiety disorders differ between children and adults?

That is a good question because it differs in some important ways. It’s very important that, in a child, we assess what we call “therapy readiness”. We have to be developmentally sensitive. There’s a huge difference between a 7-year-old and a 17-year-old in terms of how much they can take.

Children vary greatly, even kids of the same age. We have to apply more flexibility than we do with adults. We have to build the therapeutic rapport. Of course, that’s also important for grown-ups too, but it is absolutely essential for the kids.

With children, there’s more focus on the behavioral side of things. While with grown-ups you can talk in a bit more of a sophisticated way about the cognitive or thinking problems that they have, with children, there’s a lot of focus on behavior.

We do what we call “emotional education”, where we teach kids about whether we need to respond to all of our emotions. We teach them relaxation and we also use a lot of exposure. If kids are afraid of leaving mom, for example, then, of course, sadly the treatment is that they have to leave mom for short periods of time. Then they realize “Oh, yeah, after five minutes I’m actually managing. I can do this.” Then we do it for a little longer.

That’s probably the main difference. Cognitive therapy, in itself, is based on really condensed common sense. That’s all it is. The principles are the same for grown-ups and adults; it’s more the details that are different.

We look at we call distorted thinking, e.g. ‘all or nothing thinking’ ‘personalising’ etc. We also approach behavioral analysis and look at how they could behave in a way that will be conducive for better mental health. Those are the principles, both for grown-ups and for kids, but the variation concerns the focus on behavior because that’s easier for the kids to understand, depending on their development.

Can you please describe in a little more detail what exactly Cognitive Behavioral Therapy (CBT) is?

Cognitive behavioral therapy is a talking therapy that grew out of psychoanalysis in the 1950s and ’60s. It was developed by American psychiatrists, especially, at around that time. It is a therapy that attempts to identify maladaptive thinking and maladaptive behaviors, to then see if that thinking and behavior can be reconstructed. It’s a here-and-now approach.

CBT has an enormous amounts of scientific evidence, both for treating anxiety in children and in grown-ups, and also for treating depression and psychosis. The evidence base is really very well established, unlike some other talking therapies that are also widespread, but for which the evidence base is not of the same strength.

I would like to add that there are very few side effects involved in this. Most people can immediately see the usefulness of CBT. It differs significantly from treating children with medication, in which case there are potentially devastating side effects.

What are the main challenges with CBT that Healios’ service has aimed to overcome?

We noticed early on that so many of these children are actually in need of treatment, yet they can’t access it. We’re very keen to see if we can bridge that enormous gap and hopefully deliver evidence-based treatments that can reduce the risk of mental illness later on in life.

It is treatment, but it’s also prevention. Again, there is scientific evidence to support the idea that if you treat early on, you’re less likely to have serious problems later on in life. Of course, it benefits the individual and their family, but it also benefits society.

In Healios, all our approaches are family-centric; the family is involved in the therapy. Research supports the fact that it makes the therapy more efficient because you can also address some of the dynamics going on in the family that may be toxic for the child and for the grown-ups.

Can CBT prevent onset of the other mental illnesses young people with anxiety disorders are at a greater risk of developing?

The answer to that is a resounding yes. Anxiety is very much seen as a predictor of later, life-long conditions, although it is not necessarily the case. If we can teach people some basic stuff about how to handle anxiety, how to handle rejection and how to handle a failed exam, for example, I think we can really reduce human suffering, as well as costs to society.

As I’ve mentioned 100 times already today, we’ve got the evidence, but in the traditional NHS system, we haven’t got the resources to treat our patients.

In what ways do you think CBT services for children and young people with anxiety disorders can be improved?

It can be improved by thinking out of the box. We have to do new things because we simply don’t have the finances or the resources to continue in the way that we are. We need to include the family much more in the approach.

We have been taught that we should be patient-focused. That’s of course right, but it’s too narrow. We need to include the surroundings, because often the cause of the anxiety, or at least part of the cause, is within the family dynamic and you get a unique chance to address that when you take this family-centric approach.

I also think that we need to use digital medicine to its full potential. We are very far from that stage now. We can do it a lot better and we can learn from it. Simultaneously, we need to develop more scientific evidence for these specific, new approaches.

What do you think the future holds for CBT and anxiety disorders in children?

I think it is the future. We cannot continue the way that we are doing things now,  not offering talking therapies while medicating a large number of children, because of the side effects, which can even sometimes be lethal.

I think CBT offers such a reasonable alternative. The underpinnings of CBT make straightforward common sense to most people and it is very acceptable to them. There are no side effects. People actually become wiser and better equipped to deal with life’s vicissitudes when they’ve had CBT.

What feedback have Healios received?

We’re working with this approach at a number of sites across England and the feedback is fantastic. I think one of the ways that we can judge that is by how many people actually continue the therapy. The numbers are much higher than they would be for medication and they are even higher than for face-to-face therapy. That may be because people can receive the therapy in the comfort of their own home.

Can you please explain what behavioral activation is and whether there is much evidence that it could work for children?

Behavioral activation is a sub-component of CBT. It’s a bit more sophisticated than that, but the idea is simply to make people do more things, because we know activity has a strong antidepressant effect.

We also use that in the Healios approach, along with a really innovative program where the children can contribute in a way that would be very difficult to do in simple face-to-face therapy. You can let them take over the reins. You can make them draw and you can make them line up what their interests are, for example. Behavioral activation is part of all of it.

Where can readers find more information?

You can find more information on our website, which is www.healios.org.uk

About Dr Lars Hansen

Dr Lars Hansen is a consultant psychiatrist working in Early Intervention for Psychosis in Hampshire. He is also a member of the Royal College of Psychiatrist and an Honorary Senior Lecturer.

He graduated from Copenhagen University and then went on to train as a psychiatrist in Paris and London. After his Royal College membership exams he completed a MD at Southampton University titled “The influence of CBT on suicidality in patients with schizophrenia”.

He holds a Dip in Cognitive Therapy also from Southampton University. He has published articles mainly in the areas of schizophrenia, cognitive therapy, suicidality and akathisia.

Lars has participated on programs on mental health issues on ITV, Channel Four and the BBC radio and television along with publishing a book on the mindset of the immigrant called “Destination Integration”. He has been the Chief Medical Director of Healios since 2013.

The Reality of Preschool Anxiety Disorders

Most people think that younger children can’t have anxiety. They think that because children do not have much of a life experience, what do they have to be anxious about? The truth is very different. Almost 20% of pre-schoolers (aged 3 to 4) have an anxiety condition. Anxiety can be linked with depression and problems with behavior and sleeping. Due to this, it is important to treat the condition as early as possible. A study published in the ‘Journal of Clinical Child and Adolescent Psychology’ explores diagnosis of anxiety in pre-schoolers using structured interviews. This included both the pre-schoolers and their parents. The authors, led by Lea Dougherty from University of Maryland College Park, looked at whether there was an anxiety disorder or not and then they looked at what other thinks might be linked to there being a diagnosis of anxiety.

The structured interview was designed to collect information ranging from parenting techniques to family history of mental health conditions. It was also designed to screen for anxiety disorders in this group of children. Using these data Lea and her team explored the links between certain factors and anxiety disorders in pre-schoolers. The interviews could detect the presence of any anxiety disorder, ranging from separation anxiety disorder to selective mutism which alters communication in certain social settings. The interviews could also diagnose Obsessive Compulsive Disorder (a condition where the child has intrusive thoughts, repetitive, unwanted thoughts). The interviewers also screened for Attention Deficit Hyperactivity Disorder. ADHD is made up of problems focusing and directing attention and hyperactivity. The interviews also assessed 41 events that could be traumatic for a child, including sleep related problems such as nightmares. Only the parents were interviewed using the structured schedule.

The pre-schoolers took part in a two-hour study using of various scenarios designed to detect if the child has an anxious disposition or not. The researchers prompt the child to show a range of emotion and behaviours through these scenarios. The study included leaving the participants in a room with a stranger and playing with new, exciting toys. The episodes were each recorded through a one-way mirror for later coding. Coding is the process of labelling the observations made by the researchers so that the data can be compared and analyzed.

Over 90% of the parents and preschool participants returned for another lab session. This was to assess child and parent interaction. This included six tasks ranging from book reading to block building. Over 400 mothers and 400 fathers also completed a questionnaire based on parenting style.

Lea and her colleagues interviewed 541 three to four-year-old children and their parents. From this group, 106 of them (19.6%) had an anxiety disorder. Pre-schoolers with anxiety disorders were more likely to have depression, sleep problems, behavioral issues and Oppositional Defiant Disorder. ODD is a condition which is diagnosed in children showing defiant and disobedient behavior for longer than six months. Lea and her team found that children with and without anxiety disorders were not different in terms of age, gender, ethnicity and parental marriage status. This suggests that these factors do not play a key part in whether the child will have anxiety. Children with anxiety were also more prone to sadness.

In terms of parenting, those parents who had children with an anxiety disorder were seen to be less supportive. This is compared to the parents of children with no anxiety disorder. Lea and her team also showed that the children with anxiety were more likely to have been through more stress in the previous 6 months. Of all the children who had an anxiety disorder, 32 of them had a phobia, 57 had anxiety with no specific phobia and 17 of them had both an anxiety disorder and a phobia. There were five main factors which Lea and her team thought contributed to anxiety in pre-schoolers: childhood depression, sleep problems, time spent in day care, stressful life events and behavior problems. Based on this study the way we parent our children can go a long way in protecting them from anxiety disorders. Supportive parenting can improve emotional wellbeing and help them to manage their behavior.

Children aged 3 – 4 years of age can have serious anxiety. If left untreated, some anxiety disorders can worsen. Behavioral, sleep problems and depression can also affect these young kids if anxiety is not managed. Hopefully by being aware that anxiety can seriously affect children and that is can have bad consequences we can start taking steps to prevent it.