Living with an Anxiety Disorder By Margarita Tartakovsky, M.S.

Learning that you have an anxiety disorder may bring relief (finally having a name for your struggles), more questions (why me?) and more worry (not knowing what to do next). The good news is that anxiety disorders are among the most treatable.

According to Peter J. Norton, Ph.D, Director of the Anxiety Disorder Clinic at the University of Houston and co-author of The Anti-Anxiety Workbook, anxiety disorders have success rates that make other researchers jealous. The key is to get the right treatment and stick with it.

Here’s a look at what effective treatment entails, including the ins and outs of psychotherapy and medication, plus tips for finding a qualified therapist, managing panic attacks and more.

Common Misconceptions

1. Anxiety disorders aren’t that serious. This myth persists because “anxiety is a universal and normative emotion,” said Risa Weisberg, Ph.D, Assistant Professor (research) and Co-Director of the Brown University Program for Anxiety Research at Alpert Medical School. However, anxiety “can be a hugely distressing and impairing symptom.”
2. “I can overcome this on my own.” In her research on anxiety disorders in primary care, Weisberg found that nearly half of primary care patients with anxiety disorders weren’t taking medication or attending therapy. When asked about their reasons for not engaging in treatment, one of the most common answers was that they didn’t believe in receiving these treatments for emotional problems. Anxiety disorders have a chronic course and “the bottom line is that good treatments exist, so there is no reason to suffer on your own,” Weisberg said.
3. Anxiety disorders are a character defect. “Anxiety has a genetic and neurological basis,” said Tom Corboy, MFT, Director of the OCD Center of Los Angeles.
4. “I need medication in order to improve.” Though medication can be effective in treating anxiety disorders, “research suggests that in many cases, cognitive-behavioral therapy (CBT) is better or just as good as CBT plus medication,” said Jon Abramowitz, Ph.D, Associate Professor at the University of North Carolina at Chapel Hill and Director of the UNC Anxiety and Stress Disorders Clinic. CBT teaches patients the skills for lasting benefits.

Disclosing Your Diagnosis

You may be unsure about sharing your diagnosis with others. Corboy suggested discussing your anxiety with individuals you trust, who have your best interests in mind. If you’re considering telling a significant other, wait “until that person has earned your trust,” he said.

Treatment

A great deal of research over the past 10 to 15 years has shown that CBT is the most effective treatment for most anxiety disorders, Corboy said, making it the first line of treatment. Research also has shown that selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants and benzodiazepines are effective in treating anxiety.

Doctors usually prescribe SSRIs and SNRIs first because they’re effective, can treat depression — which often co-occurs — and tend to be better tolerated. According to the scientific literature, there’s a higher rate of relapse with medication, Norton said. The key is to supplement medication with CBT, said Peter Roy-Byrne, M.D., Professor and Chief of Psychiatry at the University of Washington at Harborview Medical Center. In fact, medication is sometimes used to facilitate psychotherapy.

Psychotherapy

The first step in CBT is to understand your anxiety, Abramowitz said. You and the therapist will work together to gain insight into how your thoughts and behaviors fuel your anxiety. “People with anxiety tend to jump to conclusions and overestimate,” he said. Behavior such as regularly rehearsing what you’re about to say actually feeds your anxiety, nourishing the belief that you can’t think on your feet and you’re a poor public speaker.

Cognitive restructuring helps patients identify their thoughts and expectations and modify problematic patterns, Abramowitz said. He pointed out that cognitive restructuring “is not the power of positive thinking; it’s the power of logical thinking.”

In exposure therapy, another CBT technique, therapists help patients face their fears in various contexts in a systematic and safe way. Together, you and your therapist create a hierarchy, listing the least anxiety-provoking situation to the greatest, and work your way up, confronting each situation.

Most CBT programs consist of 8 to 15 weekly sessions, Norton said. When individuals start to experience gains varies. At his clinic, Norton typically sees patients improve the most from the 5th to 7th session of their 12-week program. However, there’s no universal standard for staying in therapy. Weisberg recommended that patients continue with CBT until they fully understand and have mastered the above skills to manage their anxiety.

Preventing and Overcoming a Lapse

It’s not uncommon to experience a resurgence of symptoms—a lapse—after treatment, especially during stressful times, Abramowitz said. “We want people to recognize that this is entirely normal.” CBT helps clients recognize signs of an impending episode so that they can take action to prevent it, Norton said. Usually, this involves creating a plan with a series of signs — like not leaving the house for two days — and actionable steps — like reviewing your anxiety workbook or calling your old therapist.

“This helps prevent a lapse from turning into a relapse,” Norton said. Whereas a lapse is a hiccup — like having a double cheeseburger when trying to eat healthy — a full relapse involves reverting to old patterns, where anxiety and avoidance dominate your life, he said. If you do experience a relapse, you may need several booster sessions.

So the work doesn’t just stop at the end of therapy. Norton likened this to reaching a healthy weight: You don’t stop exercising and eating well after getting to your goal weight. Norton helps his patients develop long-term plans for managing and challenging their anxiety. For a socially anxious person, part of the plan may include signing up for Toastmasters, an organization that helps members develop their public speaking and leadership skills in a nonthreatening environment.

Common Challenges in Psychotherapy

• Lack of time and energy. Weisberg’s research found that a large proportion of patients believed that they were too busy for psychotherapy. Corboy sees many successful clients who work 60 to 70 hours a week while raising families. Yet, others might have so much on their plate — barely making ends meet, no babysitter — that they can’t attend therapy in the first place. Norton usually refers these patients to a psychiatrist for pharmacological treatment and asks them to stay in touch as things ease up. For patients who have milder symptoms, Norton recommends purchasing a self-help anxiety workbook—preferably one grounded in CBT—and creating their own hierarchy. Some workbooks still rely heavily on relaxation techniques, which are a good way to reduce anxiety in the moment but not long-term, Norton said.
• Active participation. In the beginning, patients may not be used to actively learning and practicing new skills. CBT requires a strong commitment and lots of work outside of therapy, Abramowitz said.
• Tackling anxiety head-on. To effectively treat anxiety, you have to be willing to confront your fears, so you may feel worse before you feel better. This means challenging anxiety “on a regular basis, between sessions,” Corboy said. The one hour in therapy pales in comparison to the other 167 hours in a week.

  If you’re having an especially difficult time applying the skills you learn in therapy, discuss it with your therapist. It might be that the exposure task is too frightening at this time, and your therapist may need to adapt it. Also, “it may be empowering to realize that avoidance is actually a choice,” Weisberg said. “Although no one chooses to have an anxiety disorder, they do choose to avoid certain things.” Weisberg works with patients to help them decide if they’d rather experience anxiety for several weeks during exposure therapy or live without ever doing a particular task. Facing your fears in the present leads to a calmer future, Abramowitz said.

Finding a Therapist

Because CBT is the gold standard for treating anxiety disorders, it’s important to find a therapist who’s well-trained in the technique and has extensive experience working with patients with anxiety disorders. Here are several suggestions for finding a qualified therapist:

• Visit the therapist finders at the Association for Behavioral and Cognitive Therapy for CBT-trained therapists and the Anxiety Disorders Association of America. Therapists listed on ADAA don’t necessarily specialize in CBT. Also, check whether your local university offers special services, which tend to be inexpensive treatments that use cutting-edge techniques, Norton said.
• Familiarize yourself with CBT. Dr. Roy-Byrne suggested reading a CBT patient manual from the series Treatments that Work. This will give you a good idea about what to expect from treatment and the kinds of questions to ask therapists.
• When speaking with a therapist on the phone, ask how he or she will treat your anxiety disorder, Abramowitz said. Does it line up with what you’ve read? He suggested also asking: How many patients with anxiety disorders have you worked with? What kind of training have you had in treating anxiety disorders and CBT? Attending several workshops isn’t enough. “You don’t learn CBT in a day; it takes years,” Abramowitz said.

Medication

The type of anxiety disorder, its severity, the presence of co-occurring disorders and level of distress typically will guide the medication you’re prescribed, the starting dose and the length of treatment. For someone with panic disorder, physicians usually prescribe a low dose of a SSRI — lower than that for depression or social anxiety disorder — because these patients are particularly sensitive to the effects of medication, said Michael R. Liebowitz, M.D., Professor of Clinical Psychiatry at Columbia University and Managing Director of The Medical Research Network.

In principle, patients take medication for about a year, but in practice, this can be longer, Dr. Roy-Byrne said. If someone is experiencing stress and still has some co-occurring anxiety, phobic or depressive symptoms, it’s very likely he or she will relapse after stopping medication, he said. Some anxiety disorders, such as obsessive-compulsive disorder (OCD), generally take longer to treat, Dr. Liebowitz said.

For more information on medication, see here. If you can’t afford medication, consider participating in clinical trials. In Dr. Liebowitz’s studies, participants receive six months of free treatment after completing the clinical trials.

Concerns about Medication

Concerns about side effects and withdrawal are common. Patients often worry that taking medication is somehow artificial, and some turn to herbal supplements and drugs like marijuana, Dr. Liebowitz said. The truth is exactly opposite: Medication serves as a correction. It doesn’t introduce new chemicals into the brain, but instead alters the level of certain neurotransmitters, Dr. Liebowitz said.

SSRIs, the first line of treatment, can cause insomnia, sexual dysfunction and weight gain. If a medication is helpful, the prescribing physician can help you work around these side effects. One way is to adjust the time you take the medication: If you’re experiencing insomnia, you may take medication during the day or at night if you’re drowsy, Dr. Liebowitz said. If weight gain is an issue, you may need to watch your calories and exercise regularly.

“Because medication causes neurochemical changes in the brain, you may experience some withdrawal symptoms after discontinuing use, as the brain re-adjusts itself to the lack of medication,” Dr. Roy-Byrne said. This is true of all medication, he said, not just that for psychiatric disorders.

Abruptly discontinuing medication can have fairly potent effects, even with SSRIs, according to Dr. Liebowitz. Slowly tapering off the dose under a physician’s guidance reduces these problems.

Dr. Liebowitz recalled helping a patient taper off 40 mg of Paxil. The patient gradually went from 40 mg to 10 mg without trouble; however, going from 10 to 0 caused the patient dizziness and discomfort. After informing Dr. Liebowitz, he and the patient agreed to adjust the dose to 10 mg every second day for several weeks. Communicating with your doctor about your progress and any problems is vital to your treatment.

In addition to tapering off the medication, your physician may prescribe another medication to ease discontinuation syndrome. For patients taking Paxil, Dr. Roy-Byrne adds Prozac. They stop taking Paxil but continue taking Prozac for about six weeks before quickly tapering off this over a few days. (Prozac has a very short half-life, or the time it takes for a drug to lose half its activity in the bloodstream, thus making it ideal in such situations.) Using this technique can eliminate withdrawal symptoms, Dr. Roy-Byrne said.

And it may not be withdrawal after all. Patients can mistake the original anxiety for withdrawal symptoms. “If you stop an anxiety drug, the anxiety may come back, and with the passage of time, it could be worse than before,” Dr. Roy-Byrne said.

Tips for Taking Medication

1. Before. Weisberg has seen many patients accept a prescription without asking many questions or without knowing what symptoms or disorder the medication is supposed to be treating. Remember that you and your prescribing physician are a “health care team,” she said. Before taking medication, Dr. Roy-Byrne and Dr. Liebowitz suggested asking the following:
   • What is my diagnosis?
   • What are my treatment options, including medication and psychotherapy?
   • How will I know if this medication is working?
   • What are the side effects, and what do I do if I experience them?
   • When will the medication start to work?
   • How long will I have to take it?
   • If I take it for X amount of time, what’s the likelihood of reducing symptoms?
   • What are the dose requirements?
   • Will you be monitoring me throughout the course of this medication?
   • When will you talk to me next?
2. During. Dr. Roy-Byrne has patients keep track of symptoms and side effects using a rating scale. Recording your reactions to medication lets you and your doctor know if you’re getting better, whether your health problem is anxiety or high blood pressure. “I want to know if you’re 20, 40, 60 percent better, so I can know what to do next,” Dr. Roy-Byrne said. He also has his patients monitor their symptoms before they start medication, so they don’t attribute natural changes in their anxiety to the medication. “This is consistent with ‘measurement-based care,’ which is becoming the state-of-the-art approach to monitoring treatments and their outcomes,” he said.
3. Other tips. Avoid skipping your medication and make sure you don’t run out, Dr. Liebowitz said. If you go away for the weekend and leave your pills at home, call your physician for an emergency prescription. For additional advice, see here.

Managing Panic Attacks

Patients can suffer panic attacks with any anxiety disorder. Corboy suggested four steps in managing them:

1. Accept the anxiety. Individuals with an anxiety disorder become exceedingly sensitive to anxiety. “At the first hint of anxiety, they often become terrified that a panic attack is imminent,” Corboy said. Accepting that anxiety exists doesn’t mean liking it or resigning yourself to being anxious forever; “it just means accepting reality as it is.”
2. Challenge distorted thoughts. People often interpret a panic attack as a significant threat, but it’s important to realize that “nothing catastrophic is going to occur as a result of being anxious or even panicking.”
3. Breathe. Instead of hyperventilating, which energizes anxiety, “make a point of consciously breathing.”
4. Resist the urge to flee. Running away from anxiety only reinforces the idea that you’re unable to handle it and that escaping the situation is your best solution. Instead, a long-term solution is to “learn that we can tolerate the discomfort, that it won’t hurt us and that it will naturally dissipate over time if we sit with it.”

Pitfalls and Pointers

You may hit some snags as you work toward managing your anxiety. Here’s a list of common ones and practical solutions for them:

• Keeping symptoms to yourself. A primary care physician can’t make a proper diagnosis or treatment recommendation without having all the information.

  “If you have been feeling uncontrollably worried, anxious, fearful, have been having panic attacks, or have found that you are avoiding things that are important to you or to those around you because of fear – tell your doctor,” Weisberg said.

• Fighting anxiety as if it were your adversary. It’s important to understand that anxiety is a helpful response and a normal part of life, Abramowitz said.
• Masking it. Whether it’s alcohol, illicit drugs or benzodiazepines (such as Xanax or Ativan), these substances offer short-term relief and are akin to running away from anxiety, Abramowitz said. Because benzodiazepines quell anxiety quickly and strongly, they can increase avoidance and impair your ability to overcome anxiety-provoking situations, Dr. Roy-Byrne said.

  Instead of pursuing what maintains your anxiety — avoidance — face your fears directly with the help of a therapist.

• Giving up too quickly. Whether it’s medication or CBT, these interventions “can take a while to work,” Weisberg said. “Keep your long-term goals clearly in mind, giving each treatment enough time and effort.”
• Being too motivated. Jumping in head-first isn’t recommended either, Norton said. Instead of sprinting through treatment, give it time to sink in and strike a balance.

General Tips

• Have realistic expectations. It’s unrealistic to think that you’ll eliminate anxiety forever. Instead, realize that you’ll be able to manage symptoms and stop avoiding certain situations.
• See stress as normal. It’s normal to feel stressed. You can’t fight stress, but you can work through it, Abramowitz said.
• Adopt a balanced approach. Rather than overestimating the magnitude of a situation, “step back and look at things in a more objective light,” Abramowitz said. Instead of thinking that you’ll lose your savings in today’s shaky economy, consider that the market will return and focus on the steps you can control to manage your money.
• Adopt an anxiety-free lifestyle. In The Anti-Anxiety Workbook, Norton includes the ingredients for an anxiety-free life: adequate sleep; a balanced diet (think food pyramid, not diets that delete food groups); exercise and a solid support system, all of which are powerful in decreasing anxiety. Like a pricey car that needs high-grade gasoline to run optimally, our incredibly efficient body functions better with the right nutrients, Norton said.

  How we treat our bodies also directly affects anxiety sensations. Being out of shape can make your heart race even when you’re just walking. Caffeine and poor nutrition can amplify anxiety, producing jitteriness and trembling. Simply curtailing one’s caffeine intake can be helpful, Norton said.

  For more information on anxiety disorders, see Psych Central’s resources at http://psychcentral.com/disorders/anxiety/

Contrarian Approach for PTSD

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on June 17, 2009

A different approach to managing PTSD suggests that for some people repressing rather than exposing the traumatic memories may be better for an individual’s health.

Geisinger Health System senior investigator and U.S. Army veteran Joseph Boscarino, Ph.D., is proud of his military service, yet he doesn’t like to talk much about his combat experiences.

Before becoming a renowned researcher of psychological trauma, Dr. Boscarino served a tour of duty with an artillery unit in Vietnam from 1965-66, during which he witnessed heavy combat and its aftermath. To this day, he tries hard not to reflect on those battlefield memories.

The research by Dr. Boscarino and Tulane University investigator Charles Figley, Ph.D., shows that for some people exposed to traumatic events, repressing these memories may be less harmful in the long run.

“Going back to the days of Sigmund Freud, psychiatrists and mental health experts have suggested that repression of traumatic memories could lead to health problems,” Dr. Boscarino said. “Yet we have found little evidence that repression had an adverse health impact on combat veterans exposed to psychological trauma many years later.”

In a study that appears in the June issue of the research publication Journal of Nervous & Mental Diseases, Drs. Boscarino and Figley examined the long-term mortality rates of Vietnam veterans who were evaluated in 1985 with followup in 2000.

By studying the death certificates and records of a random sample of more than 4,000 veterans 30 years after military service, the researchers found that having PTSD along with a repressive personality trait does not necessarily lead to premature death.

The researchers say this is an important finding because exposure therapy is a prevailing practice in psychiatry, a technique that encourages patients to relive painful or traumatic events. Yet, for some patients, this therapy may inadvertently cause a resurfacing of PTSD symptoms and psychological distress, putting that patient at risk for health problems.

Previous research by Boscarino has shown that PTSD may cause premature death from heart disease, leads to elevated white blood cell counts and higher erythrocyte sedimentation rate levels (both of which indicates inflammation), and may cause other diseases such as rheumatoid arthritis.

“While the dominant therapy model for PTSD should not be abandoned at this point, emerging research suggests that it might need to be seriously re-evaluated, at least for some PTSD patients,” Dr. Boscarino said. “More research is clearly needed.”

Dr. Figley, another renowned trauma scholar who co-authored the 2007 book Combat Stress Injuries, said he was not surprised by the findings since they are consistent with a new theory of combat-related stress.

“Repression is a self-regulator and a method of memory management,” Dr. Figley said. “In other words, ‘keeping your stressful memories inside or it will kill you’ is a myth.”

Dr. Figley, who served in Vietnam as a Marine at the same time as Dr. Boscarino, believes this study is a wakeup call to all those who care about combat veterans.

“These men and women deserve our respect in recognizing that they often know better than we do in how to manage their stressful memories, in most cases,” Dr. Figley said.

Source: Geisinger Health System

Find out what your dreams mean

By TIFFANY SHARPLES Tiffany Sharples

Dreams may not be the secret window into the frustrated desires of the unconscious that Sigmund Freud first posited in 1899, but growing evidence suggests that dreams - and, more so, sleep - are powerfully connected to the processing of human emotions.

According to new research presented last week at the annual meeting of the Associated Professional Sleep Societies in Seattle, adequate sleep may underpin our ability to understand complex emotions properly in waking life. "Sleep essentially is resetting the magnetic north of your emotional compass," says Matthew Walker, director of the Sleep and Neuroimaging Lab at the University of California, Berkeley. (See the top 10 scientific discoveries of 2008.)

A recent study by Walker and his colleagues examined how rest - specifically, rapid eye movement (REM) sleep - influences our ability to read emotions in other people's faces. In the small analysis of 36 adults, volunteers were asked to interpret the facial expressions of people in photographs, following either a 60- or 90-minute nap during the day or with no nap. Participants who had reached REM sleep (when dreaming most frequently occurs) during their nap were better able to identify expressions of positive emotions like happiness in other people, compared with participants who did not achieve REM sleep or did not nap at all. Those volunteers were more sensitive to negative expressions, including anger and fear.

Past research by Walker and colleagues at Harvard Medical School, which was published in the journal Current Biology, found that in people who were sleep deprived, activity in the prefrontal lobe - a region of the brain involved in controlling emotion - was significantly diminished. He suggests that a similar response may be occurring in the nap-deprived volunteers, albeit to a lesser extent, and that it may have its roots in evolution. "If you're walking through the jungle and you're tired, it might benefit you more to be hypersensitive to negative things," he says. The idea is that with little mental energy to spare, you're emotionally more attuned to things that are likely to be the most threatening in the immediate moment. Inversely, when you're well rested, you may be more sensitive to positive emotions, which could benefit long-term survival, he suggests: "If it's getting food, if it's getting some kind of reward, finding a wife - those things are pretty good to pick up on."

Our daily existence is largely influenced by our ability "to understand our societal interactions, to understand someone else's emotional state of mind, to understand the expression on their face," says Ninad Gujar, a senior research scientist at Walker's lab and lead author of the study, which was recently submitted for publication. "These are the most fundamental processes guiding our personal and professional lives."

REM sleep appears to not only improve our ability to identify positive emotions in others; it may also round out the sharp angles of our own emotional experiences. Walker suggests that one function of REM sleep - dreaming, in particular - is to allow the brain to sift through that day's events, process any negative emotion attached to them, then strip it away from the memories. He likens the process to applying a "nocturnal soothing balm." REM sleep, he says, "tries to ameliorate the sharp emotional chips and dents that life gives you along the way." (See the top 10 medical breakthroughs of 2008.)

"It's not that you've forgotten. You haven't," he says. "It's a memory of an emotional episode, but it's no longer emotional itself."

That palliative safety-valve quality of sleep may be hampered when we fail to reach REM sleep or when REM sleep is disrupted, Walker says. "If you don't let go of the emotion, what results is a constant state of anxiety," he says.

The theory is consistent with new research conducted by Rebecca Bernert, a doctoral candidate in clinical psychology at Florida State University who specializes in the relationship between sleep and suicidal thoughts and behaviors, and who also presented her work at the sleep conference this week.

In her study of 82 men and women between the ages of 18 and 66 who were admitted into a mental-health hospital for emergency psychiatric evaluation, Bernert discovered that the presence of severe and frequent nightmares or insomnia was a strong predictor of suicidal thoughts and behaviors. More than half of the study participants had attempted suicide at least once in the past, and the 17% of the study group who had made an attempt within the previous month had dramatically higher scores in nightmare frequency and intensity than the rest. Bernert found that the relationship between nightmares or insomnia and suicide persisted, even when researchers controlled for other factors like depression.

Past studies have also established a link between chronic sleep disruption and suicide. Sleep complaints, which include nightmares, insomnia and other sleep disturbances, are listed in the current Substance Abuse and Mental Health Services Administration's inventory of suicide-prevention warning signs. Yet what distinguishes Bernert's research is that when nightmares and insomnia were evaluated separately, nightmares were independently predictive of suicidal behavior. "It may be that nightmares present a unique risk for suicidal symptoms, which may have to do with the way we process emotion within dreams," Bernert says.

If that's the case, it may help explain the recurring nightmares that characterize psychiatric conditions like posttraumatic stress disorder (PTSD), Walker says. "The brain has not stripped away the emotional rind from that experience memory," he says, so "the next night, the brain offers this up, and it fails again, and it starts to sound like a broken record ... What you hear [PTSD] patients describing is, 'I can't get over the event.' "

At the biological level, Walker explains, the "emotional rind" translates to sympathetic nervous-system activity during sleep: faster heart rate and the release of stress chemicals. Understanding why nightmares recur and how REM sleep facilitates emotional processing - or hinders it, when nightmares take place and perpetuate the physical stress symptoms - may eventually provide clues to effective treatments of painful mental disorders. Perhaps, even, by simply addressing sleeping habits, doctors could potentially interrupt the emotional cycle that can lead to suicide. "There is an opportunity for prevention," Bernert says.

The new findings highlight what researchers are increasingly recognizing as a two-way relationship between psychiatric disorders and disrupted sleep. "Modern medicine and psychiatry have consistently thought that psychological disorders seem to have co-occuring sleep problems and that it's the disorder perpetuating the sleep problems," says Walker. "Is it possible that, in fact, it's the sleep disruption contributing to the psychiatric disorder?"

Click Here To find Out What Your Dreams Mean

PTSD Can Take Years Before Surfacing

By Psych Central News Editor
Reviewed by John M. Grohol, Psy.D. on

Post-traumatic stress disorder (PTSD) doesn’t always appear immediately after a traumatic event. New research has found that it can take up to two years or longer following a traumatic event before symptoms of PTSD surface.

Researchers have long believed that signs of PTSD occur shortly after a traumatic event. Symptoms can include flashbacks, nightmares, sleeping and memory problems, and unexplained family or work difficulties.

Yet the new research by Geisinger Center for Health Research senior investigator Joseph Dr. Boscarino, Ph.D., finds that some people can experience post-traumatic stress disorder (PTSD) up to two years after the original trauma.

The findings have long-term implications for today’s returning military veterans, Dr. Boscarino said.

“More than 5 million members of the military have served in the Persian Gulf conflicts,” Dr. Boscarino said.

“This country needs to be prepared to deal with veterans who could be experiencing war-related mental health stress years after combat.”

Co-authored by Kent State University social psychologist Richard E. Adams, Ph.D., the study was based on interviews of several thousand New York City residents after the Sept. 11, 2001, terrorist attacks on the World Trade Center.

The study found that people with delayed PTSD onset were more likely to have lower self-esteem, have experienced previous negative life events and suffered past traumas.

“PTSD onset … is complex and appears to be related to exposure, individual predispositions, and external factors not directly related to the original traumatic event,” the authors wrote.

The research also found that 4 percent of those surveyed had delayed onset of PTSD and that women were more likely to experience PTSD than men. A diagnosis of depression before the event was also found to be a significant risk factor for a later PTSD diagnosis.

The study appears in the electronic edition of the research journal Social Psychiatry & Psychiatric Epidemiology.

Source: Geisinger Health System

Free Yourself From Trauma, Phobias & Anxiety

"How to Free Yourself from Trauma, Phobias And Anxiety in 7 Days or Less!" is a uniquely effective audio self-help program comprised of over 180 minutes of powerful, emotionally healing content. The techniques we teach in this program go far beyond what is typically offered in conventional psychotherapeutic treatment for most single-stimulus phobias and the classic symptoms of post-traumatic stress (PTSD).

Traditional therapeutic interaction is generally of a talk-based, discussion-oriented nature. That is to say, through discussion of past and present life circumstances, feelings and reactions to those events, it is anticipated that the client will eventually develop a certain amount of insight into the nature and cause of their symptoms. The hope and expectation is that such insight will somehow be curative, and that the client's symptoms will now spontaneously abate.

The challenge with conventional therapy, however — particularly when it come to the kinds of highly subconsciously driven problems so common to anxiety disorders — is that insight, understanding and awareness are rarely sufficient to effect lasting change. This is because all learning, all behavior and all permanent and (seemingly effortless) change occurs — when it does occur — at the subconscious level, not the conscious level. This is why individuals with chronic, debilitating forms of anxiety often remain in therapy for years, often moving from one mental health professional to the next, often changing from one medication to the next as well in the process.

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Relax...

Image by HaPe_Gera via Flickr

Your Recommended Daily Allowance for Relaxation

Stress is the curse of living in modern times. Everyone suffers from stress. And the stress we suffer takes a heavy toll on our bodies, emotions and minds.

Feeling stressed out, worn out by fatigue or just simply having a miserable day, the best thing to do is relax.

Watching television may be a form of relaxation for some, but is not a recommended method by experts. When we watch TV we are bombarded with commercials, ads, sounds and images. So how do we achieve relaxation? If there are thousands of ways we can get stressed, one of them is not meeting deadlines, there are also many ways we can relax.

In recent studies, experts have determined that heart disease is linked to anger and irritability is linked to mental stress. Too much stress brings about ischemia that can lead to or cause a heart attack. Relaxation takes on added importance in light of this matter. Managing your anger and attitude is significant to heart health, and relaxation can help you manage stress.

One way of relaxation is transcendental meditation. Recent studies have also shown that this method might reduce artery blockage, which is a major cause for heart attack and stroke. People practice transcendental meditation by repeating uttering soothing sounds while meditating, this is to achieve total relaxation. The researchers found that practitioners of transcendental meditation significantly reduced the thickness of their arterial wall compared with those who didn't practice transcendental meditation.

Another study on another method of relaxation, acupuncture, seems to reduce high blood pressure by initiating several body functions for the brain to release chemical compounds known as endorphins. Endorphin helps to relax muscles, ease panic, decrease pain, and reduce anxiety.

Yoga is also another method for relaxation and may also have similar effects like acupuncture. In another study, participants were subjected to several minutes of mental stress. Then they were subjected to various relaxation techniques, such as listening to nature sounds or classical music. Only those who did Yoga significantly reduced the time it took for their blood pressures to go back to normal. Yoga is a form of progressive relaxation.

Breathing is one of the easiest methods to relax. Breathing influences alamost all aspects of us, it affects our mind, our moods and our body. Simply focus on your breathing, after some time you can feel its effects right away.

There are several breathing techniques that can help you reduce stress.

Another easy way to achieve relaxation is exercise. If you feel irritated a simple half-hour of exercise will often settle things down. Although exercise is a great way to lose weight, it does not show you how to manage stress appropriately. Exercise should also be used in conjunction with other exercise method.

One great way of relaxation is getting a massage. To gain full relaxation, you need to totally surrender to the handling and touch of a professional therapist.

There are several types of massages that also give different levels of relaxation.

Another method of relaxation is Biofeedback. The usual biofeedback-training program includes a 10-hour sessions that is often spaced one week apart.

Hypnosis is one controversial relaxation technique. It is a good alternative for people who think that they have no idea what it feels like to be relaxed. It is also a good alternative for people with stress related health problems.

Drugs are extreme alternatives to relaxation. They are sometimes not safe and are not effective like the other relaxation methods. This method is only used by trained medical professionals on their patients.

These relaxation techniques are just some of the ways you can achieve relaxation. Another reason why we need to relax, aside from lowering blood pressure in people and decreasing the chances of a stroke or a heart attack, is because stress produces hormones that suppress the immune system, relaxation gives the immune system time to recover and in doing so function more efficiently.

Relaxation lowers the activities within the brains' limbic system; this is the emotional center of our brain.

Furthermore, the brain has a periodic need for a more pronounced activity on the right-hemisphere. Relaxation is one way of achieving this.

Relaxation can really be of good use once a relaxation technique is regularly built into your lifestyle. Choose a technique that you believe you can do regularly.


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