ANXIETY IN NANOSECONDS, WHAT CAN YOU DO?

Over the past several months I have helped a number of people who have had traumatic experiences that keep bothering them even after they are no longer exposed to the traumatic situation[s].  They report becoming very anxious very rapidly when anything reminds them of the traumatic events.  They often have develped a number of good coping skills but they are always having to use them after the anxiety has been triggered.  In trying to understand this, I recalled reading a study that found that the amygdala can respond in nanoseconds when our brains feel that something overwelming may occur.  In other words, the brain continually scans our environment and our reactions looking for potential danger.  If we have been trauatized in the past, our brains will frequently see the possibility of danger and will trigger the amygdala very rapidly.  A nanosecond is one millionth of a second!

I have found that treating the anxiety after it has been triggered can reduce the intensity of the anxiety but not lower the frequency of it.   The problem with treating the anxiety before it occurs is that the medication to reduce the anxiety needs to be present all the time and be well tolerated in between times when there is not anxiety symptoms but also be able to contain the anxiety so the amygdala is not triggered.  I have had success with low doses of atypical antipsychotic medications with monitoring for metabolic side-effects.  I do not know yet how long these medications will need to be taken.

AFTER BEING BULLIED, IT STILL HURTS TEN YEARS LATER

The most recent AACAP News summarized an article by Copeland, etal., in JAMA Psychiatry 20:1-8 that looked at children and adolescents who were bullied or the bullies 10 years later.  This was a follow-up from the Great Smoky Mountain Epidemiological study that was done in wesern North Carolina.  They found that both those who were bullied and those who did the bullying continued to suffer.  Those who had been bullied were still at high risk for several anxiety disorders and depression.  In addition, suicidal impulses were very increased in males who had been bullied and agoraphobia was very increased in females who had been bullied.  For those who had done the bullying, the only increased risk for any psychiatric disorder was for antisocial personality disorder.  

It is important to also mention that the increased risk for psychiatric disorders was related to the bullying and not to genetic or other environmental factors.  This points out the serious consequences of being bullied and also the consequences for the bullies as well.  It is possible that the continuing suffering is related to the development of Post Traumatic Stress Disorders [PTSD] and ongoing symptoms related to the PTSD.  The PTSD is treatable and yet must be recognized as PTSD to help the treatment to be successful. I have treated a number of children and adolescents in the hospital who developed suicidal behavior related to their being bullied.  

I hope that increasing awareness of the severe consequences of bullying will help efforts to stop bullying and treat it as a serious problem that often leads to longterm suffering.  We have zero tolerance for threats of violence in our school systems.  Maybe it is time to have zero tolerance for bullying as well. 

METTA...LOVING KINDNESS?!

In an earlier blog I mentioned research by Ms. Fredrickson and her colleagues at the University of North Carolina at Chapel Hill that involved one group receiving training in metta meditation while a control group did not.  The metta meditation really seemed to help that group feel better and be more positively connected to others.  This type of meditation has also been used to successfully treat people with Borderline Personality Disorder, a disorder that is difficult to treat based in part on the negative and unstable relationships these people tend to have.  

So, what is this metta?  Metta is described as an attitude that recognizes and respects all sentient beings [all living things capable of having feelings] and wishes them well.  It requires that we recognize that all sentient beings are united in their desire to find fulfillment and escape suffering.  This then allows us to feel friendly, compassionate and even loving to others.   

The practice of developing metta involves first cultivating this attitude and experience of life towards ourselves.  Then toward family members and good friends.  Next toward neutral people and then toward difficult [hard to like] people.  The final practice involves feeling this loving kindness toward people who do very bad things.  It seems that when we withhold our kindness towards anyone, it becomes a weight or burden for us to carry.  I may have mentioned the following story in another blog.  However, since it concerns carrying things I will repeat it.  Two monks were walking down a muddy dirt road and saw a very nicely dressed woman standing  on the side of the road.  She would get her dress muddy if she had to cross the road  One of the monks went over and carried her to the other side.  Five hours later, the other monk asked why he did that.  The monk who carried her stated that he had carried her for 30 seconds while the other monk had carried her for 5 hours.

Here's wishing all of us the joys of letting go of our burdens that keep us from experiencing metta.

CONNECTED TO EVERYWHERE BUT NOT TO EACH OTHER?

Much has been written about the wonders of being connected through the internet to the world and the potential problems of changing how we connect to each other.  My daughter forwarded an article from the NY Times by Barbara Fredrickson about this topic.  Ms. Fredrickson is a professor of psychology at the University of North Carolina at Chapel Hill and she was writing about research that she and her colleagues have completed that is published in a recent issue of "Psychological Science."  They measured the capacity for people to have warm interpersonal connections in daily life by having half of the participants chosen at random participated in a six week workshop on a very old mind-training practice called Metta that is translated as "loving kindness." that teaches developing warmth and tenderness towards oneself and others.  The participants who were exposed to the loving kindness workshop, were more positive and socially connected and also had improved "vagal tone."  

Vagal tone is the connection between your brain and your heart and other organs.  The higher the vagal tone, the better your brain is regulating your internal organs and immune system.  Also, Fredrickson referenced Stephen Porges, a behavioral neuroscientist, who has shown that vagal tone is important to facial expressivity and the abiity to tune into the frequency of the human voice.  Thus, it would seem that a higher vagal tone could improve one's capacity to connect to others, form friendships and be empathic.

So, it might be better to put down the i phone and say hello to someone.

NEGATIVE IMPACT OF ADD/ADHD IN ADULTS

Jason Fletcher from the Yale School of Public Health published a study showing some of the economic impact of childhood ADD/ADHD on the adult labor market.  Using data from the National Longitudinal Study of Adolescent Health, Dr. Fletcher shows that employment is reduced by 10-14%, earnings are reduced by one third and the need for public assistance is increased by 15% for adults who were diagnosed with ADD/ADHD as children.  There was also an indication that the earilier the diagnosis the greater the impact. Dr. Fletcher believes that treatment of ADD/ADHD can lesson the impact on employment and other negative effects of childhood ADD/ADHD.

Related to the question if treatment of ADD/ADHD will reduce negative outcomes as adults, Lichensteinet al., in the November 22, 2012 issue of the New England Journal of Medicine published findings indicating that treatment of ADD/ADHD can lower the rates of criminal behavior.  These findings held up looking at the pooled data and if looked at on an individual basis.  The authors believe that this shows that treatment of ADD/ADHD lowers the risk of criminal behavior and likely lowers the risk of other negative outcomes from untreated ADD/ADHD such as the employment rate as discussed above.

An epidemiologic study of ADD/ADHD by Costello and Angold out of Duke University and published in the Archives of General Psychiatry in 1996, using children from western North Carolina, showed that ADD/ADHD was underdiagnosed and undertreated.  This would seem to underscore the importance of identifying children who have ADD/ADHD and providing effective treatment in order to prevent negative outcomes as adults, including lower employment and criminal behavior.