What Causes Anxiety Attacks?

Those who deal with anxiety attacks often worry about getting another one at the wrong time or place and this can severely limit their ability to have a normal life. There are several commonly-thought reasons why

 anxiety attacks happen. One is the "fight or flight" response that all humans have in-grained into their psyche. Basically, when a perceived threat exists, the brain sends off huge levels of chemicals called endorphins which cause all the muscles, voluntary and involuntary, to react. The brain and body goes on "high alert" while the muscles decide to start moving out of there quickly. While this was probably the reason why so many of our ancestors survived and we are here today, it's not always the best way for modern humans to react to their world. Panic attacks occur when the brain starts producing too many of these endorphins when there is no threat and the body and mind goes into a state of panic- for no good reason.

Another reason why panic attacks occur can be hereditary. Yes, that's right... if your parents or grandparents were "nervous" people, then there's a good chance that you also suffer from continual symptoms of anxiety following by panic attacks. Thinking back, you may remember someone in your family who got overly nervous about things and didn't set a very good example of how to cope. You yourself now may have a hard time coping with little stresses in life. There's no real explanation for this, it's just the way studies have shown it to be.

A third reason why anxiety attacks occur can be dietary. If someone lacks the proper nutrients or vitamins for proper brain function, they can be prone to anxiety attacks. Some vitamins like calcium, vitamin A and

 magnesium have been shown to lessen the experience of effects of anxiety and consequently attacks. Likewise, diet and lifestyle can include anxiety producing chemicals like caffeine, nicotine or sugar. Reducing or eliminating these from your diet can produce a positive effect on your anxiety levels. You can always substitute these chemicals with natural herbal products like green tea, for example to take the edge off your cravings.

Lastly, anxiety attacks can be psychological in that they may be occurring as a result of a traumatic incident such as a car accident, warfare, or physical or mental crisis. This is called post-traumatic stress disorder (PTSD) and someone who is going through this may often experience anxiety attacks as one of the major symptoms. It's important to get proper psychological help if this is the reason for the anxiety attacks. One can also take advantage of natural products such as lavender oil or chamomile tea to cope with the feelings and calm the nerves. Counseling combined with use of these natural products will often lessen the bouts of anxiety and create a feeling of peace.

There is hope for those who suffer with anxiety attacks in the form of many traditional and natural treatments that can help you with the symptoms that come before, during and after an attack. If you are struggling with anxiety attacks, be sure to seek the help that's right for you and find the support you need in friends and family. Soon you will be on your way to feeling better and experiencing less episodes of anxiety so that you may return to a normal way of life.

Depressed men struggle more with functioning than depressed women

A new wide-ranging study by the University of Otago, Wellington has shown that men with common mental disorders, such as depression or anxiety, are more likely than women with those disorders to have difficulties with social and role functioning. This is despite the common perception that women often have more problems with mental health and subsequent disabilities.
The study by Dr Kate Scott and Associate Professor Sunny Collings has recently been published in the international Journal of Affective Disorders and breaks new ground in research in this area. It counters smaller and less robust studies which have suggested that women with depression have more disabilities than men.
“Our research confirms that women are more likely than men to experience mood and anxiety disorders, but what is new is our finding that among men and women with those disorders, it is actually men who experience greater difficulties in role, social and cognitive functioning,” says Dr Scott.
“This runs counter to most prior findings and needs to be noted by clinicians and policymakers.”
She says a key result shows that men with a current mood disorder are ten times more likely to report role disability than men without a mood disorder, while women with a mood disorder are four times more likely to have role disability than women without a mood disorder. A similar pattern is seen with social and cognitive functioning, and with anxiety disorders.
“What’s happening here is that both men and women who suffer from depression or anxiety have problems functioning in their day-to-day roles, in social situations and with communicating, but men have more difficulty in these areas than women”.
The study, funded by the Health Research Council, is based on data from Te Rau Hinengaro: The New Zealand Mental Health Survey (2003/2004). 7435 people 16 years and over were interviewed using a standard diagnostic assessment of mental disorders; health-related disabilities were measured by the WHO Disability Assessment Schedule.
However Dr Scott says the study does not point to exact reasons for the gender differences, and these differences did not happen with substance use disorders.
“One explanation for the difference may be that women are more willing to seek treatment than men. They also have greater intimate and emotional ties to family or friends, which may help offset the impact that depression and anxiety have on social functioning.”
Dr Scott says as most males are seen as the primary ‘breadwinner’ one might think that this is the reason for a higher rate of role disability. However, she found that among men and women who work, men still have greater problems in role function if they are experiencing depression or anxiety. In fact the gender difference is even greater for this group she says.
One of the key clinical implications of this study for GPs and other health professionals is that better assessment of a male patient’s mental health may be achieved by questioning role and social functioning, rather than focusing on depression and anxiety symptoms.
Dr Scott also says that because men go to the doctor less frequently than women, more attention needs to be paid to raising the profile of common mental disorders and disabilities in the workplace, especially those that employ large numbers of males.
“The evidence from this study is that a more systematic and assertive focus on men in this area is overdue for humanitarian, social and economic reasons,” she says.

NIHSeniorHealth.gov offers info on anxiety disorders in older adults

Anxiety caused by stressful events like moving or losing a job is a normal part of life. Anxiety disorders, on the other hand, are characterized by persistent, excessive and disabling fear and worry and get progressively worse if left untreated. It is estimated that anxiety disorders affect between 3 and 14 percent of older adults in a given year. To provide an older audience with additional information, NIHSeniorHealth, the health and wellness website for older adults from the National Institutes of Health (NIH), has added a topic about anxiety disorders at their website.
Visitors to the website can learn about the risk factors, symptoms and treatments for generalized anxiety disorder, social phobia, panic disorder, post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD) and specific phobias such as fear of flying or fear of public speaking. Anxiety disorders can severely affect a person’s life, and they are often overlooked in older adults.
"Conditions that commonly occur with age, such as depression, heart disease and diabetes, may have symptoms that mimic or mask anxiety symptoms, making diagnosis in older adults difficult," says Thomas R. Insel, M.D., director of the National Institute of Mental Health (NIMH), which developed the anxiety disorders topic for NIHSeniorHealth. "Often, these health conditions will need to be addressed before a person will respond to treatment for an anxiety disorder."
It can sometimes be difficult to distinguish between common anxiety caused by adapting to difficult life changes — such as fear of falling after a hip replacement—and an actual anxiety disorder. The new topic on NIHSeniorHealth is a good way for older adults to learn more about the way these disorders can affect them.
Information about anxiety disorders is the latest addition to the roster of health topics offered on NIHSeniorHealth. A joint effort of the National Institute on Aging (NIA) and the National Library of Medicine (NLM), the website features research-based, easily accessible information on a range of health issues of interest to older people. To improve access for older adults, NIHSeniorHealth includes short, easy-to-read segments of information in a number of formats, including various large-print type sizes, open-captioned videos and an audio version.
Current NIHSeniorHealth topics include ways to exercise properly; safe use of medicines; and management of diseases such as stroke, diabetes, osteoporosis and Alzheimer’s disease. Future topics will focus on hip replacement, long-term care and non-medical drug use.
The NLM is the world's largest library of the health sciences and collects, organizes and makes available biomedical science information to scientists, health professionals and the public.
The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure.
The NIA leads the federal government effort conducting and supporing research on aging and the health and well-being of older people. The Institute's broad scientific program seeks to understand the nature of aging and to extend the healthy, active years of life.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases.
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The Role of Choice in Treatments for Anxiety

Research shows that offering depression sufferers choices in their approach to treatment allows them to take ownership over their treatment and leads to greater success.  Now anxiety specialists have sought to determine whether a similar method might help people with anxiety, as well. Indeed, a recent study showed that patients with anxiety experience greater improvement in symptoms when they have a choice between cognitive behavior therapy, medication, or both, along with computer-assisted treatment support.
According to the National Institute for Mental Health, approximately 26% of Americans who are 18 and older have an anxiety disorder. Now, a new approach to treatment named Coordinated Anxiety Learning and Management (CALM), has been found to be effective for patients with the four most common anxiety disorders, which are:

• Panic disorder
• Generalized anxiety disorder
• Social anxiety disorder
• Post traumatic stress disorder (PTSD)

According to researchers, when patients are given a choice of their preferred treatment, the effectiveness of care is enhanced. This more flexible approach also works better to improve health-related quality of life.
Researchers conducted a randomized trial of CALM therapy in 17 primary care clinics in four U.S. cities to compare it to the usual care. Over 1,000 patients, between 18 and 75 years old, with anxiety disorders participated, receiving treatment for 3 to 12 months. Follow up occurred at 6, 12, and 18 months after the trial began, with anxiety symptoms measured via survey results.
At every follow up period, anxiety symptoms were significantly reduced for patients in the CALM group. This result was true for patients both with and without accompanying depression. Additionally, because the study made a point to include an ethnically diverse group of subjects of varied socioeconomic backgrounds, it indicates that CALM treatment could be appropriate for a wide range of patients, health professionals, and clinical settings.
Conquering anxiety doesn’t happen overnight, but it is possible to free yourself from its grip. Choosing care that suits your wants and needs may help you to regain a sense of control over your anxiety. Numerous treatments exist that could put you on the path to better emotional health, so take advantages of the choices presented to you by taking ownership of your treatment.

Management of dental phobia

Surveys report that 13 percent to 24 percent of people are afraid of going to the dentist.
In most cases, dental anxiety is unpleasant but doesn’t interfere with health. People whose dental fear is severe, however, may so dread the thought of going to the dentist that they cancel appointments, delay seeking care, and sometimes wind up needing more invasive and painful procedures as a result — thereby meeting some of the criteria for specific phobia described in the “Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition (DSM-IV)”.
In the DSM-IV, dental phobia is considered a type of specific phobia (the blood-injection-injury type). A large Dutch study using DSM-IV criteria to assess the prevalence of 11 specific phobias found that dental phobia was the most common (followed by phobias of heights and spiders). While it may be possible to avoid heights and spiders, dental problems such as toothaches or broken teeth necessitate a visit to the dentist.
Similar to findings about prevalence in other types of anxiety disorders, women are more likely than men to report experiencing dental fear and phobia. About half of adults who suffer from dental phobia can trace their fears back to unpleasant childhood experiences — memories that may be triggered at the sight of a dentist’s chair, the sound of a dental drill, or the smell of antiseptic chemicals.
Although medications such as diazepam (Valium) and lorazepam (Ativan) may help reduce anxiety, they’re best used in conjunction with various cognitive, educational and behavioral strategies — especially those that help patients gain a sense of control in a situation where they may feel helpless. The following techniques are easy to learn, get better with practice, and can be combined during a dental visit:
• Breathing techniques. Physical tension and emotional stress can increase the subjective experience of pain. People who are anxious tend to hold their breath or breathe rapidly. This sort of breathing pattern only heightens anxiety and muscle tension.
Deep breathing can counter physical and mental tension. One simple method to foster deep breathing is to breathe in slowly and count to five before exhaling to another count of five. Another technique is to place one hand beneath the belly button and breathe so that the abdomen rises and falls with each breath.
• Muscle relaxation. Progressive muscle relaxation (tensing and then releasing one group of muscles at a time in order to promote whole-body relaxation) can help to slow heart rate and promote calmness. Just a few minutes of progressive muscle relaxation, focused on two or three major muscle groups, may help during an appointment.
• Desensitization. This approach combines deep breathing and relaxation with gradual exposure (either through audiotapes, videotapes or the patient’s own imagination) to the cue that most triggers dental phobia. A patient afraid of needles, for example, may look at pictures of a dentist’s needle in a safe environment, such as at home or in a therapist’s office, while practicing relaxation and breathing techniques. The goal is to help the patient learn to relax while confronting a trigger of dental fear.
• Distraction. Putting the mind’s focus elsewhere is another way to diminish the anxiety and pain of dental visits. The more complicated the task meant to distract, the better (listening to soothing music may not be enough). Children who are anxious may be distracted with stories or riddles.
Adults can try counting (such as tiles on the ceiling, or slats on a window blind) as a way of turning attention away from the procedure itself. Another technique is to have the patient try to raise both legs at once whenever anxiety starts increasing, to provide a physical distraction.
• Hypnosis. Hypnosis involves a state of deep relaxation attained through a combination of deep breathing, muscle relaxation and attention modification. People who can’t tolerate anesthesia and those who are afraid of needles may want to try hypnosis. It may be difficult to find a dentist trained in this technique, however.
Because children tend to have more vivid imaginations than adults and are more open to suggestion, hypnosis may be a particularly good technique for pediatric patients. Some patients may also be able to hypnotize themselves by combining relaxation techniques with positive imagery or focus words.
• Combined approach. Many patients with dental phobia may need a backup strategy in case the first one is not sufficient. The best relief may come from combining approaches and finding a dentist who is willing to incorporate them into the visit

Tricyclic antidepressants can be harmful to heart

Research that followed nearly 15,000 people in Scotland has shown that a class of older generation anti-depressant is linked to an increased risk of cardiovascular disease (CVD). The study showed that tricyclic anti-depressants were associated with a 35% increased risk of CVD, but that there was no increased risk with the newer anti-depressants such as the selective serotonin reuptake inhibitors (SSRIs).

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The study is published online December 1 in the European Heart Journal and was led by researchers from University College London (UCL).
The prospective study, which followed 14,784 men and women without a known history of CVD, is the first to look at the risks associated with the use of anti-depressants in a large, representative sample of the general population. Until now, there have been uncertain and conflicting findings from earlier studies that have looked at the link between anti-depressant use and the risk of CVD.
Dr Mark Hamer, Senior Research Fellow in the Department of Epidemiology and Public Health at UCL (London, UK), said: "Our study is the first to contain a representative sample of the whole community, including elderly and unemployed participants, men and women, etc. Therefore, our results can be generalised better to the wider community. The majority of previous work in this area has focused on clinical cardiac patients, so studies in healthy participants are very important. Given that anti-depressants, such as SSRIs, are now prescribed not only for depression, but for a wide range of conditions such as back pain, headache, anxiety and sleeping problems, the risks associated with anti-depressants have increasing relevance to the general population."
Dr Hamer and his colleagues used data from the Scottish Health Survey, which collects information from the general population every three to five years. They combined data from separate surveys in 1995, 1998 and 2003 in adults aged over 35 and linked them with records on hospital admissions and deaths, with follow-up until 2007. Anyone with a history of clinically confirmed CVD was excluded.
During the surveys, interviewers visited eligible households and asked participants a range of questions on demographics and lifestyle, such as smoking, alcohol intake and physical activity, and measured their height and weight. They assessed psychological distress using a questionnaire (the General Health Questionnaire) that enquires about symptoms of anxiety and depression in the last four weeks. In a separate visit, nurses collected information on medical history, including psychiatric hospital admissions, and medication, and took blood pressure readings.
During an average of eight years follow-up there were 1,434 events related to CVD, of which 26.2% were fatal. Of the study participants, 2.2%, 2% and 0.7% reported taking tricyclic anti-depressants, SSRIs or other antidepressants respectively. After adjusting for various confounding factors, including indicators of mental illness, the researchers found there was a 35% increased risk of CVD associated with tricyclic anti-depressants. The use of SSRIs was not associated with any increased risk of CVD, nor did the researchers find any significant associations between anti-depressant use and deaths from any cause.
Dr Hamer said: "Our findings suggest that there is an association between the use of tricyclic anti-depressants and an increased risk of CVD that is not explained by existing mental illness. This suggests that there may be some characteristic of tricyclics that is raising the risk. Tricyclics are known to have a number of side effects; they are linked to increased blood pressure, weight gain and diabetes and these are all risk factors for CVD."
He continued: "It is important that patients who are already taking anti-depressants should not cease taking their medication suddenly, but should consult their GPs [primary care physicians] if they are worried. There are two important points to be made. First, tricyclics are the older generation of anti-depressant medicines and we found no excess risk with the newer drugs (SSRIs). Secondly, people taking the anti-depressants are also more likely to smoke, be overweight, and do little or no physical activity -- by giving up smoking, losing weight, and becoming more active a person can reduce their risk of CVD by two to three-fold, which largely out-weighs the risks of taking the medications in the first place. In addition, physical exercise and weight loss can improve symptoms of depression and anxiety.
"Our findings suggest that clinicians should be cautious about prescribing anti-depressants and should also consider lifestyle advice, such as smoking cessation, exercise and sensible alcohol intake."
Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Cyber therapy in counseling

His talk was going just fine until some members of the audience became noticeably restless. A ripple of impatience passed through the several dozen seated listeners, and a few seemed suddenly annoyed; then two men started to talk to each other, ignoring him altogether.

''When I saw that, I slowed down and then stopped what I was saying," said the speaker, a 47-year-old public servant named Gary, who last year took part in an unusual study of social anxiety treatment at the University of Quebec.

The anxiety rose in his throat -- What if I'm not making sense? What if I'm asked questions I can't answer? -- but subsided as his therapist, observing in the background, reminded him that the audience's reaction might have nothing to do with him. And if a question stumped him, he could just say so: No one knows everything.

He relaxed and finished the talk, and the audience seemed to settle down. Then he removed a headset that had helped create an illusion that the audience was actually there, not just figures on a screen. "I just think it's a fantastic idea to be able to experience situations where you know that the worst cannot happen," he said. "You know that it's controlled and gradual and yet feels somehow real."

For more than a decade, a handful of therapists have been using virtual environments to help people to work through phobias, like a fear of heights or of public spaces. But now advances in artificial intelligence and computer modeling are allowing them to take on a wider array of complex social challenges and to gain insight into how people are affected by interactions with virtual humans -- or by inhabiting avatars of themselves.

Researchers are populating digital worlds with autonomous, virtual humans that can evoke the same tensions as in real-life encounters. People with social anxiety are struck dumb when asked questions by a virtual stranger. Heavy drinkers feel strong urges to order something from a virtual bartender, while gamblers are drawn to sit down and join a group playing on virtual slot machines. And therapists can advise patients at the very moment those sensations are felt.
In a series of experiments, researchers have shown that people internalize these virtual experiences and their responses to them -- with effects that carry over into real life.


The emerging field, called cybertherapy, now has annual conferences and a growing international following of therapists, researchers and others interested in improving behavior through the use of simulations. The Canadian military has invested heavily in virtual-reality research; so has the U.S. Army, which has been spending about $4 million annually on programs with computer-generated agents, for training officers and treating post-traumatic stress reactions.

The trend has already generated a few critics, who see a possible downside along with benefits.

''Even if this approach works, there will be side effects that we can't anticipate," said Jaron Lanier, a computer scientist and author of "You Are Not a Gadget: A Manifesto" (Knopf, 2010). "And in some scenarios I would worry about defining humans down: defining what's normal based on what we can model in virtual environments."

But most researchers say that virtual therapy is, and will remain, no more than a therapist's tool, to be used only when it appears effective. "There's a real and understandable distrust of technology as a shortcut for good clinical skills," said Albert Rizzo, a psychologist at the University of Southern California, "but I think, deep down, most therapists will want any tool that can help them do their work, and they'll be open to using virtual approaches."

VIRTUAL HUMANS, REAL THERAPY

''My abilities are somewhat limited," says a female voice. "For example, I can speak and listen to what you say, but I can't do any physical activity."

In an office at the Institute for Creative Technologies at the University of Southern California, a virtual woman named Angelina is addressing a college student from a computer screen.

Angelina looks to be about 30 or so, a pretty, athletic figure with an open, intelligent face framed by short black hair. Her eyes and expression, guided by video cameras and microphones, stay in sync with the student's, as an empathetic therapist's would. "What are some of the things you hate about yourself?" asks the voice.

The student stalls for a moment. "Well," she says, in a video of the exchange, "I don't like that I can be really quiet in social situations. Sometimes people take that as me being rude, but it's just me being quiet."

Angelina nods sympathetically and then asks another question, about what the student fears most.

Interacting with a virtual human programmed to be socially sensitive in this way is oddly liberating. The figures are clearly not human; some are balky with language, others mute. Many have a 2-D graphic-arts quality.

But the faces are mobile, blinking, alive, the body language and gestures seemingly natural; in some cases, the voice recognition and choice of replies are good enough to conduct a stiff but convincing conversation. The result is a living presence that is responsive but not judgmental.

In a recent study using this virtual confidant, researchers at USC have found that Angelina elicits from people the crucial first element in any therapy: self-disclosure. People with social anxiety confessed more of their personal flaws, fears and fantasies to virtual figures than to live therapists conducting video interviews, the study found.

The researchers are incorporating the techniques learned from Angelina into a virtual agent being developed for the Army, called SimCoach. Guided by language-recognition software, SimCoach -- there are several versions, male and female, young and older, white and black -- appears on a computer screen and can conduct a rudimentary interview, gently probing for possible mental troubles.

Using SimCoach on a laptop, veterans and family members would anonymously ask about difficulties they're having, whether due to post-traumatic stress or other strains of service.

"It does not give a diagnosis," said Jonathan Gratch, a co-author of the Angelina study with Sin-Hwa Kang, also of USC. "But the idea is that the SimCoach would ask people if they would like to see a therapist; and if so, could then guide them to someone in their area, depending on what it has learned."

Once people are in treatment, therapists can use virtual technology to simulate threatening situations -- and guide patients through them, gradually and incrementally, calibrating the intensity of the experience.

In person-to-person sessions to address anxieties or phobias, for instance, therapists may have patients do this in their imaginations. Revisit a dreaded experience -- say, a rooftop party, for a person afraid of heights -- while defusing the physical reactions to the memory in the office. Out in the world, patients then practice the same techniques, gradually increasing their exposure, beginning with modest heights, for instance, and working up.

Using virtual environments, therapists can run this entire drill in their offices. At the Virtual Reality Medical Center in San Diego, psychologists have treated hundreds of patients using gradual virtual exposure, for post-traumatic stress and agoraphobia, among other anxieties. At USC, Rizzo has designed a program specifically for veterans of the Iraq war.

In one scenario, wearing a headset, the patient is in a virtual Humvee, motoring along a desert road toward a small Iraqi village. To the right is a passenger, another soldier; behind and above rides a gunner; in front is another Humvee. As the motorcade approaches the village, engines rumbling, there is a flurry of gunfire, and more. A roadside bomb goes off, bullets pierce the window -- your fellow soldier on the right is wounded badly, now dying -- all of it under control of the therapist.

''We can control the intensity of the experience, and then work on the patient's response," Rizzo said.

When it works, the therapy breaks the association between reminders of an upsetting experience and the racing heart, the flushing, the panic that the person has been struggling with.

Adding autonomous virtual humans to the landscape allows therapists to begin addressing some of the most complex problems of them all -- social ones. In one continuing study at the University of California, Davis, for instance, researchers are trying to improve high-functioning autistic children's ability to think and talk about themselves while paying attention to multiple peers.

The hope is similar for people with social anxiety: that practice interacting with a virtual boss, suspicious strangers or virtual partygoers who are staring as one enters the room will also lead to increased comfort, with the help of a therapist. "The figures themselves don't even have to be especially realistic to evoke reactions," said a psychologist, Stephane Bouchard, who directs the cybertherapy program at the University of Quebec in Ottawa. "People with social anxiety, for example, will feel they are being judged by virtual humans who are simply watching them."

In the pilot study that included Gary, the University of Quebec researchers tracked two groups of patients: one that received an hour of talk therapy once a week for 14 weeks and another that got talk therapy with a virtual component, practicing virtual interactions. Both groups showed improvement, faring much better than a comparison group put on a waiting list, preliminary results suggest. But those who got virtual therapy achieved the same gains without having to practice interactions in the real world, deliberately putting themselves in embarrassing situations or dreaded encounters. The researchers are now working to identify which people benefit most, and whether combining virtual and real-world experiences accelerates recovery.

MY AVATAR, MYSELF

The face in the mirror does not look familiar; it has a generic, computer-generated look. Yet it does appear to be staring out from a mirror. Lift a hand and up goes its hand. Nod, wave, smile, and it does the same, simultaneously. Now, look down at your own body: And there, through the virtual reality headset, are a torso, legs, clothes identical to those in the mirror.

In a matter of minutes, people placed in front of this virtual mirror identify strongly with their "body" and psychologically inhabit it, researchers at Stanford University have found. And by subtly altering elements of that embodied figure, the scientists have established a principle that is fundamental to therapy -- that an experience in a virtual world can alter behavior in the real one.

''The remarkable thing is how little a virtual human has to do to produce fairly large effects on behavior," said Jeremy Bailenson, director of the Virtual Human Interaction Lab at Stanford and the author, with James Blascovich, of the coming book "Infinite Reality" (HarperCollins 2011).

In one recent experiment, Bailenson and Nick Yee, now at the Palo Alto Research Center, had 50 college students enter a virtual environment and acquire a virtual body, an avatar. Each student then participated in a negotiation game with a member of the experimental team, who was introduced as another student.

But all the avatars were not created equal. Some were 4 inches taller than their human counterparts, and others were 4 inches shorter. The participants didn't notice this alteration, but those made taller negotiated in the virtual game much more aggressively than those made shorter. A later study led by Yee found that this effect carried over into face-to-face negotiations after the virtual headsets were removed.

The researchers have demonstrated a similar effect in the case of attractiveness. In another experiment, they created generic avatars for some participants that were about 25 percent "more attractive" than average, based on features that the group had rated as attractive. Compared with study participants whose avatars were made 25 percent "less attractive," the virtual beauties were more socially confident, standing closer in virtual conversation, revealing more about themselves -- an effect that also seeped into social interactions after the headsets came off.

Again, no one noticed the manipulation; its effects were entirely subconscious.

The authors argue that the participants, in effect, psychologically internalized their virtual experience. "What we learn in one body is shared with other bodies we inhabit, whether virtual or physical," they concluded.

It seems people will psychologically inhabit almostany virtual body if the cues are strong. In recent research a team led by Mel Slater, a computer scientist at the University of Barcelona, induced what it calls body-transfer illusion -- showing that men will mentally take on the body of a woman, for instance, if that's the body it appears they're walking around in virtually. The experience is especially powerful, Slater said, when the men feel a touch (on a shoulder, in a recent study) at the same time the avatar is touched.

''You can see the possibilities already," said Slater. "For example, you can put someone with a racial bias in the body of a person of another race."

These kinds of findings have inspired a variety of simple experiments. Dropping a young man or woman into the virtual body of an elderly person does in fact increase sympathy for the other's perspective, research suggests.

''This is to me the most exciting thing about using virtual environments for behavior change," Bailenson said. "It's not only that you can create these versions of reality; it's that you can cross boundaries -- that you can take risks, break things, do things you could not or would not do in real life."

MINI-ME IN ACTION

In the virtual studio at the University of Quebec, patients wearing a headset can have a short conversation with a diminutive, attentive virtual therapist. Except for slight stature, it is a ringer for Bouchard: the same open face, the same smile, the same pelt of dark hair around a bald pate.

''Mini-Me, we call it," Bouchard said.

The hologramlike figure seems at first to be minding its own business, looking around, biding time. Then it approaches slowly, introduces itself and kindly asks a question, like some digital-age Socrates: "What is the best experience you've ever had?"

For now, Mini-Me cannot do much more than cock its head at the answer and nod, before programmers begin to guide the conversation; the scientists are adding more language-recognition software, to extend interactions. Yet Mini-Me offers a glimpse of where virtual humans are headed: three-dimensional forms that can be designed to resemble people in the real world.

''You could scan in a picture of your mother or your boss or someone else significant and, with some voice recording samples, use a system that would automatically and quickly recreate a virtual facsimile of that person," said Rizzo of USC, where programmers have set up an Old West bar scene, complete with a life-size, autonomous virtual bartender, a waitress and a bad guy. "Then, perhaps, we'd be able to stage interactions that might closely resemble those in a patient's life to help work through challenging issues."

Anyone could rehearse the dance of social interaction, tripping without consequence, until the steps feel just about right.

''The great thing about it," said Gary, the civil servant, referring to his own virtual therapy, "is that you can do anything you want and just see what happens. You get to practice."

Canadian researchers find link between anxiety and depression brain

Sorry, I couldn't read the fromt this page.
View the original article here

The use of benzodiazepines, say MPs

The safety of tranquillizing drugs prescribed to millions of people over the past 50 years must be urgently investigated, MPs and peers will demand this week.

A group of cross-party parliamentarians want publicly funded health bodies to be forced to carry out research into the dangers of benzodiazepines which they say have destroyed the lives of hundreds of thousands of people.

Their demand comes as the Medicines and Health care products Regulatory Agency (MHRA), the drug safety watchdog, admitted issuing 26 new licenses for a powerful tranquillizer, Lorazepam, despite the fact it no longer holds any safety information about the drug.

Lorazepam, manufactured under the name Ativan by John Wyeth since 1972, is 10 times stronger than Valium, the most common tranquillizer drug, and many patients find it extremely hard to withdraw from it.

The MHRA has issued generic licenses for the manufacture and distribution of the drug under a European directive which allows it to "bridge back" to the safety dossier and clinical trial evidence provided by the original manufacturers in their original license application. John Wyeth voluntarily canceled its license for "commercial reasons" in 2008.

However, it has now admitted that it "no longer holds" the safety information because, after 15 years, "files are destroyed unless there is a legal, regulatory or business need to keep them, or they are considered to be of lasting historic interest". No one knows when or who reviewed the safety information last.

GPs issued more than 20 million prescriptions for benzodiazepines and similar Z-drugs – a group of nonbenzodiazepine drugs with effects similar to benzodiazepines – last year, including nearly one million prescriptions for Lorazepam. Around 1.5 million people are addicted to these drugs in the UK after being prescribed them for stress, anxiety, insomnia and muscle spasms.

MPs from across the country are fighting to secure help for many of these long-term users who cannot stop and display symptoms consistent with brain damage, sometimes years after they have stopped taking the drugs. Currently, the only NHS-funded withdrawal clinic is in Oldham.

Jim Dobbin, chair of the All-Party Parliamentary Group for Involuntary Tranquillizer Addiction, last night said the MHRA's policy of destroying drug safety information was "absolutely frightening" and "irresponsible". He promised to raise the issue with the Health minister Anne Milton on Wednesday. The regulator has issued 5,200 product licenses for 400 different drugs under the same EU directive since 2003.

Last month, The Independent on Sunday revealed that the government-funded Medical Research Council was warned nearly 30 years ago that benzodiazepines could cause brain damage in some people, similar to the effects of long-term alcohol abuse. Jim Dobbin wrote to Sir John Savill, the MRC chairman, more than a month ago asking him to explain why no further research has been carried out. He is still waiting for answers.

Meanwhile, lawyers are now examining those secret documents in order to determine what legal action could be taken against the MRC, which spent £704m of public money on research in 2008/09.

Mr Dobbin said: "The Government needs to get every one of these organizations into the same room so that they can stop blaming each other, stop passing the buck, and start listening to the victims. The cost to the individual and their families is huge; the cost to the taxpayer is horrendous. We want the Government to order a proper review into these drugs."

The Department of Health is currently conducting a review, but its narrow scope and delays have attracted widespread criticism from campaigners, victims, MPs and the Lords. Mr Dobbin is to meet with the Department of Work and Pensions Secretary, Iain Duncan Smith, in order to discuss the financial benefits of investing in support for addicts since so many are unable to function, never mind work.

Eric Ollerenshaw, Tory MP for Lancaster and Fleetwood since May, has asked a series of questions in Parliament about the safety of benzo diazepines after meeting a long-term addict, now a constituent, during his election campaign.

Mr Ollerenshaw, a former teacher, last night said: "I came into this completely objectively, but the more I have delved into it, the odder the situation appears. I know all drugs have side-effects, but these are ruining people's lives. There needs to be much more cross-checking and analysis between the public health organizations, who I had assumed would already be sitting around the same table to make sure drugs were safe. In my naivety, I thought the priority would be people's health. But if the priority is, in fact, a fear of litigation, then we have come to a pretty pass."

The role of the selection in the treatment of anxiety

Research shows that offering depression sufferers choices in their approach to treatment allows them to take ownership over their treatment and leads to greater success.  Now anxiety specialists have sought to determine whether a similar method might help people with anxiety, as well. Indeed, a recent study showed that patients with anxiety experience greater improvement in symptoms when they have a choice between cognitive behavior therapy, medication, or both, along with computer-assisted treatment support.
According to the National Institute for Mental Health, approximately 26% of Americans who are 18 and older have an anxiety disorder. Now, a new approach to treatment named Coordinated Anxiety Learning and Management (CALM), has been found to be effective for patients with the four most common anxiety disorders, which are:

• Panic disorder
• Generalized anxiety disorder
• Social anxiety disorder
• Posttraumatic stress disorder (PTSD)

According to researchers, when patients are given a choice of their preferred treatment, the effectiveness of care is enhanced. This more flexible approach also works better to improve health-related quality of life.
Researchers conducted a randomized trial of CALM therapy in 17 primary care clinics in four U.S. cities to compare it to the usual care. Over 1,000 patients, between 18 and 75 years old, with anxiety disorders participated, receiving treatment for 3 to 12 months. Follow up occurred at 6, 12, and 18 months after the trial began, with anxiety symptoms measured via survey results.
At every follow up period, anxiety symptoms were significantly reduced for patients in the CALM group. This result was true for patients both with and without accompanying depression. Additionally, because the study made a point to include an ethnically diverse group of subjects of varied socioeconomic backgrounds, it indicates that CALM treatment could be appropriate for a wide range of patients, health professionals, and clinical settings.
Conquering anxiety doesn’t happen overnight, but it is possible to free yourself from its grip. Choosing care that suits your wants and needs may help you to regain a sense of control over your anxiety. Numerous treatments exist that could put you on the path to better emotional health, so take advantages of the choices presented to you by taking ownership of your treatment.

A new version of old drugs could help treat autism

One night in 2006, Kathy Roberts rushed her autistic daughter, Jenny, to the hospital. Nothing had been able to stop the young woman, then in her mid-20s, from vomiting. Jenny had recently suffered several major seizures and her entire gastrointestinal system was going haywire.


To try to calm Jenny's GI tract, doctors at Massachusetts General Hospital prescribed baclofen, an antispasmodic drug that is also being studied as a potential treatment for alcoholism and other addictions. The drug relieved Jenny's vomiting, but it did something else too — a completely unexpected and welcome side effect.

"Within 24 hours, I saw a change," says Roberts. "Right away, I saw that it was globally calming. I've always described a state that she would get into where it seemed like she wasn't comfortable in her own skin, and was trying to crawl out. I saw that calmed down."
Roberts, founder of the Giant Step school for children with autism in Southport, Conn., called Mark Bear, professor of neuroscience at MIT and advisory board member of Giant Step. In 2005, Bear had co-founded a drug company called Seaside Therapeutics to develop treatments for autism and other developmental disorders. Roberts told Bear about baclofen's effect on her daughter, and a new line of research was born.

In September, Seaside announced positive results from a phase II clinical trial of STX209, an experimental drug that is chemically related to baclofen. In the trial, which was not blinded or placebo controlled, STX209 led to a reduction in agitation and related emotional outbursts in autistic people. Such behavior is common in people with autism — often, a result of anxiety caused by extreme sensory oversensitivity or frustration over being unable to communicate their needs. To cope, autistic people often develop behavioral mechanisms, include tantrums, social withdrawal or repetitive behaviors like rocking or hand flapping.
STX209, while not a cure, appeared to ease anxiety. "We're seeing reductions in a lot of types of outbursts and irritable behavior, along with increased communication and social behavior," says Dr. Randall Carpenter, co-founder, president and CEO of Seaside.

Carpenter says his team has conducted two clinical studies of STX209. One trial included 32 people with autism spectrum disorders. The other involved 63 people with Fragile X syndrome, a family of inherited developmental disorders linked with autism that are caused by changes in a single gene, the FMR1 gene. Fragile X is the most common known single-gene cause of autism, associated with 2% to 6% of all autism cases. About 25% of people with Fragile X have full-blown autism, but "pretty much 100% are on the spectrum," according to Carpenter.

"A common characteristic in Fragile X is that people would like to be social, but [their condition] makes them very anxious," Carpenter says. Children with the disorder often shy away from new people — or approach them and then withdraw into repetitive motions.
But when these children take STX209, Carpenter says, "What we end up seeing is that they are more sociable. They communicate more, they make friends, they interact more and are less withdrawn."

What Is Baclofen — and STX209?
Like many drugs, baclofen contains two types of its main molecule, which are mirror images of each other. Often, one is an active ingredient, while the other is not. STX209, also known as arbaclofen, contains only the "right-handed" molecule of baclofen, the drug's active component.

According to Carpenter, STX209 is about 10 times more potent than baclofen. In mice with a genetic mutation similar to the one that produces Fragile X in humans, Seaside's research found that the baclofen's left-handed molecule did not have the same effect as STX209 and, in fact, actually increased anxiety-related behavior.
Baclofen itself is a very old drug. It has been used since the 1920s as a treatment for muscle spasticity in conditions like cerebral palsy. Because of the way it affects a neurotransmitter called GABA, it has also been studied in animals since the 1980s as a potential treatment for addiction.  Recently, it got a boost from a French doctor who himself suffers from alcoholism, who published a book on his recovery via baclofen called The End of My Addiction in 2009.

Increasing GABA action calms the brain: drugs like Valium (benzodiazepines) and alcohol increase the neurotransmitter's activity. But unlike these drugs, which can produce an addictive high, baclofen eases anxiety without the euphoria. For all the time its been on the market, it has never become a drug of abuse. (Baclofen can cause withdrawal symptoms, however, if stopped abruptly.)
And interestingly, treating anxiety could be one key to treating addiction. Alcoholics and addicts often describe themselves without their drug of choice as being "not being comfortable in my own skin"— exactly the expression Roberts used to describe her daughter's state of discomfort before taking baclofen.

Anectodally, baclofen has shown notable success at keeping alcoholics from drinking. But while some clinical trials have found positive results for addiction ranging from nicotine to cocaine, some found no effect. The most recent study, a double-blind placebo-controlled trial involving 80 alcoholics, saw neither a reduction in heavy drinking nor an increase in abstinence. However, that study used a 30-mg dose of baclofen, much lower than the 80-mg dose typically used by individuals and physicians who have reported success with the drug.
"Our research didn't find a separation of baclofen from placebo on drinking outcomes," says James Garbutt, a psychiatry professor at the University of North Carolina-Chapel Hill and author of the study, which was published in Alcoholism: Clinical and Experimental Research in November. "But it did reduce anxiety. We're actually interested in trying to do another trial with a higher dose."
Garbutt adds, "I really don't know a lot about autism but there does seem to be an anti-anxiety effect of baclofen...[and] if the fear circuitry is thought to be involved in autism, potentially, it could be of value."

What GABA and Fear Have to Do with Autism
Animal models of autism and Fragile X suggest that part of the problem in these disorders is overactivity in a brain region called the amygdala, which is associated with fear and anxiety, and is normally calmed by GABA. Another problem may be a general reduction in activity in the whole brain's inhibitory circuitry, which relies on GABA as its main neurotransmitter.
A study published in the Journal of Neuroscience in July found that mice missing the same gene that fails in Fragile X not only had fewer inhibitory brain connections in general, but also had reductions in GABA availability in a key part of the amygdala. In these mice, a drug that increased GABA action (via a different route than that used by STX209) reduced the over activity in the amygdala that resulted from the GABA deficit.
In another animal model of autism which found amygdala effects, researchers exposed pregnant rats to a drug called valproic acid (VPA). One in 10 human babies whose mothers have taken valproic acid during pregnancy develop autism. Rat pups born to exposed mothers were found to have increased activity in the amygdala and a resulting intensification of fear, compared with rats with mothers that didn't get the drug. VPA rats were quicker than unexposed rats to learn to fear a situation; they were also more likely to generalize that fear to other similar experiences, and slower to learn when the scary situation was rendered safe.  They also showed other, autistic-like behavior
.
Kamila Markram, director of the Autism Project at the Brain Mind Institute of the École Polytechnique Fédérale de Lausanne in Switzerland, has studied the VPA rat. She also has a stepson with an autistic condition. "We tried quite a lot of medications and therapies, from sports to different diets and all kinds of things," she says. "We did see that reducing anxiety in him was one of things that worked." Markram has not tried baclofen or STX209 for her stepson, but calls the idea of developing such a drug for autism "absolutely interesting."
What Is the Future of STX209?
Carpenter hopes to complete clinical trials of STX209 for autism and Fragile X in 2011. He says that the soonest a drug could possibly hit the market, if all goes well, would be 2013. Meanwhile, some parents are already using baclofen to treat autistic children "off label," a legal practice since the drug is approved for other uses.
Carpenter says that participants in both of Seaside's STX209 trials were offered the option to switch to baclofen once the trial was complete, if they thought their children had been helped. "After about eight or 10 people tried it, the parents and clinicians were up in arms because they didn't think [baclofen] was working as well as what they'd seen in trial," he says. "The FDA allowed us to continue [treating people with STX209] under its provisions for compassionate use. Some are coming up on a year now and they continue to see improvement and stay on. Very few have dropped out."
Whether the drug will prove safe and effective in the long term, of course, is yet to be seen. But with no drugs approved for Fragile X and only two to treat autism — both aimed at relieving symptoms rather than treating the underlying problem — the development of STX209 will undoubtedly be closely watched, both by parents and the pharmaceutical industry.

Change the trajectory of anxiety in children at risk youth [articles]

Objective: Increasing evidence for the importance of several risk factors for anxiety disorders is beginning to point to the possibility of prevention. Early interventions targeting known risk for anxiety have rarely been evaluated. The authors evaluated the medium-term (3-year) effects of a parent-focused intervention for anxiety in inhibited preschool-age children.


Method: The study was a randomized controlled trial of a brief intervention program provided to parents compared with a monitoring-only condition. Participants were 146 inhibited preschool-age children and their parents; data from two or more assessment points were available at 3 years for 121 children. Study inclusion was based on parent-reported screening plus laboratory-observed inhibition. The six-session group-based intervention included parenting skills, cognitive restructuring, and in vivo exposure. The main outcome measures were number and severity of anxiety disorders, anxiety symptoms, and extent of inhibition.


Results: Children whose parents received the intervention showed lower frequency and severity of in anxiety disorders and lower levels of anxiety symptoms accordg to maternal, paternal, and child report. Levels of inhibition did not differ significantly based on either parent report or laboratory observation.


Conclusions: This brief, inexpensive intervention shows promise in potentially altering the trajectory of anxiety and related disorders in young inhibited children.

Toll pills deadly mounting

Deaths from prescription drugs continue to rise in Southwest Florida and across the state, causing far more fatalities than traditional street drugs in the first half of 2010, according to a new state report.

HIGH STAKES:

Painkillers and anxiety medications far
outstrip street drugs

The statistics show how bad the prescription drug epidemic has become in Florida, with the painkiller oxycodone and the anxiety-reducer Xanax responsible for the vast majority of drug-related deaths in Southwest Florida, according to the report. In many instances, the deaths were caused by a mix of drugs, often prescription drugs and alcohol.

"I think it's a matter that the supply of these drugs just keeps increasing," said Russell Vega, the medical examiner for Sarasota, Manatee and DeSoto counties. "We haven't been able to curb the demand. It's just a recipe for all kinds of problems, including deaths."

Oxycodone, when combined with acetaminophen, is popularly known as Percocet. It is also available in many other forms.

Deaths from illicit drugs such as heroin and cocaine continue to fall statewide. Heroin deaths decreased by more than 40 percent from the last six months of 2009.

The Florida Department of Law Enforcement report examined data on several drugs, including alcohol; benzodiazepines, like Valium and Xanax, which reduce anxiety; and opioids like codeine and methadone.

When alcohol was excluded, prescription drugs accounted for 81 percent of drugs found in the bodies of the deceased in lethal and non-lethal levels, according to the statewide data.

In all, 72 percent of oxycodone deaths were ruled accidental. With Xanax, 69 percent of deaths were accidental.

Statewide, 4,150 people who died were found with drugs in their bodies. In more than 1,250 of those cases, prescription drugs were the cause of death.

Vega noted that law enforcement faces unique challenges in curbing prescription drug abuse.

"You can't just arrest the doctors," he said. "You would be doing a disservice to the patients that really need them."

In the area that includes Sarasota, Manatee and DeSoto counties, oxycodone was responsible for 60 deaths in the first half of the year, the report said. In an area that includes Charlotte and Lee counties, oxycodone was responsible for 17 deaths.

Statewide, oxycodone deaths jumped 25 percent over the same time period last year. But the number grew at a faster pace in the area that includes Sarasota, Manatee and DeSoto counties -- in the first six months of last year it caused 38 deaths versus 60 deaths for the first six months of this year.

In the benzodiazepine category, Xanax was responsible for 55 deaths in the Sarasota region and Valium was responsible for 23 deaths in the time period tracked.

Cocaine was listed at the cause of 33 deaths locally, and 603 statewide. Heroin was the cause of only one death in Sarasota, Manatee and DeSoto counties and none in Charlotte or Lee counties.

Anxiety in Northville program

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Physical signs of anxiety attack

Anxiety is a feeling of fear, apprehension and discomfort over a situation. This is actually a good and healthy feeling since the body is able to recognize something that it needs to address. This “flight or fight” response enables the body to get that much needed boost of energy to react to the specific situation. In this case, anxiety is helpful. However, if it gets intense, recurring and exaggerated, it may already be considered as an anxiety attack.
The exact cause of an anxiety attack is not fully understood, but research suggests that genetics, life experiences and brain chemistry contribute to the onset of the attack. What is known is that during the attack, a person shows signs and changes in the body.
The immediate sign of anxiety attack is increased heartbeat or palpitation. This is the most distressing among anxiety symptoms. But this is generally a good thing since the heart works harder to pump more blood to your body, especially to your legs and your arms, enabling you to have a surge of energy to respond quicker than normal to any emergency. The chest feels tight as if it refuses to expand to accommodate air the body needs. Sometimes, the feeling is like someone is pushing a pillow into your face.
The additional oxygen requirement of the body must be compensated by breathing. Thus, during an anxiety attack, you breathe faster. As your arms and legs receive more oxygen and energy, your muscles tend to get tensed, which is important when abrupt movement is needed.
As your arms and legs receive more supply of oxygen through the blood, other parts of the body receive less than normal supply of oxygen (the stomach and the brain can survive with less oxygen during emergency situations). In other words, the oxygen that is supposed to go to the stomach is redirected to the arms and legs. This explains why a person who is undergoing an anxiety attack experiences churning feeling in the stomach. Because the brain receives less amount of oxygen for a short period of time, the person experiences light-headedness and dizziness. (Take note, however, that the reduced supply of oxygen in the brain is just enough to produce these symptoms and doesn’t cause any permanent brain damage.)
Because your heart pumps more blood to your muscles, your body temperature increases. So to keep a relatively normal temperature, you begin to sweat.

Aside from these signs, you can also experience weakness or fatigue, tingling sensation, and dry mouth. Also, side-effects of these signs may include diarrhea and constant urination.
These body responses are automatic. Meaning, there is no “switch” to turn it on. Thus, there is also no way you can turn it off by simply thinking that you should not feel any of these symptoms. What you should do, especially if the attack is chronic, recurring and it already affects your life, is to seek medical help. This way, your doctor will be able to identify and rule out any other possible causes of these signs which are unrelated to anxiety.
Allow your doctor to conduct a physical exam. He may prescribe you a drug or may refer you to a psychologist or a therapist. Following your doctor is important so do not ignore any advice and believe that you are totally okay.

Blog de Carlat, NY Times: difficult to Tough cover story

Let’s face it, primary care doctors don’t know much about treating psychiatric disorders. If they were lucky, they had one, brief clinical rotation through psychiatry during medical school, and even if they did, they didn’t learn much, and they’ve long since forgotten it. Yet with the acute shortage of psychiatrists in this country, primary care doctors are treating many, many cases of depression, anxiety, and other serious psychiatric ailments. So where do they turn for help? Among other sources, to reference books written by the pros–working psychiatrists.
The chairman of the psychiatry department at Emory University would seem like a reliable source. Especially if he were a widely recognized researcher who had been honored with a long string of research grants.
Two fascinating stories in the past week suggest he isn’t a reliable source. The man’s name is Charles B. Nemeroff (above), a name that will be familiar to anyone who follows psychiatry news. The New York Times has a rich archive of stories on Nemeroff. In September, 2003, Gardner Harris reported that Nemeroff had published an article praising three products to which he had financial ties–and that he did not disclose those ties. Nemeroff said “he would have disclosed his financial interests had the journal asked him to.” Don’t ask, don’t tell.
In October, 2008, Harris reported that Nemeroff had “earned more than $2.8 million in consulting arrangements with drug makers between 2000 and 2007, failed to report at least $1.2 million of this income to his university, and violated U.S. research rules.” The paper described him as “one of the nation’s most influential psychiatrists.”
This week, Duff Wilson of the Times reports that Nemeroff–who moved to the University of Miami in 2009–and a colleague (Alan Schatzberg, former chairman of psychiatry at Stanford) wrote a book of the kind I mentioned above–a psychiatry text teaching primary care doctors how to treat mental illness. The book, published in 1999, was paid for by an “unrestricted education grant” from what was then called SmithKline Beecham, now part of GlaxoSmithKline.
So: Is this Glaxo propoganda, or an unbiased expert guide?
From Wilson’s story:

The grant paid for a writing company to develop the outline and text for the two named authors, the documents show, and then the writing company said it planned to show three drafts directly to the pharmaceutical company for comments and “sign-off” and page proofs for “final approval.”

The Times reprints the letter with the evidence. Nice touch. The authors told the Times that SmithKline “had no sign-off in content.” The letter says it did. Oh, and one last thing: The book was published by The American Psychiatric Association! The chief executive of its publishing arm said he “found no evidence of influence by the writing company or GlaxoSmithKline.” He also said he had been unaware of the letter.
The Times deserves praised for following the Nemeroff story closely. But what the Times did not do was to search the contents of the book to see whether it did, in fact, favor GlaxoSmithKline products. That would seem to complete the case against Nemeroff and Schatzberg.
That’s not something Wilson could have done. His recourse would be to persuade an independent psychiatrist to review it and comment on that point, and he did not do that.
And thus we come to the second praiseworthy story this week. Dr. Daniel Carlat, a practicing psychiatrist in Newburyport, Mass., and a crusader against conflicts of interest in medicine, took that job on himself. And he reports his conclusions on his Carlat Psychiatry Blog, in a post entitled, “Nemeroff and Schatzberg’s “Textbook” Pushed Paxil.” (Paxil is made by GlaxoSmithKline.)
Carlat isn’t shy:

So I finally got the book, ripped open the manila envelope from an Amazon reseller, and found out exactly what a $120,000 “unrestricted educational grant” will buy: an advertisement for Paxil. Not obvious, not blatant. But artfully crafted, subtle, smooth—more in the style of Nemeroff than Schatzberg…the final result is such a finely crafted piece of promotion that any reputable “author” should be embarrassed and ashamed.

I’ll leave it to you to follow the link and read Carlat’s detailed analysis of the book, but here’s the punch line: “…an analysis of the book’s content shows that it was crafted to encourage primary care doctors to prescribe Paxil preferentially over its competitors, such as Zoloft.”
That’s a nice payoff for a measly $120,000 educational grant. For all we know, that book could have sparked millions of dollars in sales or Paxil, or tens or hundreds of millions. Nemeroff and Schatzberg should have held out for more.
This is a tough story, with important legal ramifications–and dangers for those who write about it. Wilson and the other Times writers have the paper to back them up in any lawsuit. Carlat has only his own resources, whatever they might be.
Both the Times and Carlat deserve our praise, and our thanks for bringing honor to our craft.

Yoga and Anxiety.

If, like me, you don't know your mountain pose from your fish posture, then it's clear that yoga has passed you by. However, if you'd like to improve your mood and lessen your anxiety naturally, yoga may be just the thing for you.

One thing I do know a little about is gamma-aminobutyric acid (GABA) and this is the key to what we might call the yoga effect. Yoga is said to increase levels of GABA, so to understand its significance it helps to know a thing or two about GABA.

GABA is a naturally occurring substance found in the brain. It is a neurotransmitter that has a specific role in the anxiety response. The main action of GABA is one of inhibiting nerve cells from firing. Low levels of GABA means high levels of activity between nerve cells, all of which results in the fight-or-flight response associated with stress. Put another way, low levels of GABA leads to high levels of fear.

The effect of benzodiazepine drugs such as Diazepam (Valium) is to enhance the action of GABA, which in turn reduces levels of anxiety. Similarly, alcohol is known to enhance the action of GABA within the hypothalamus and sympathetic nervous system. The problem with alcohol is that it also has the effect of reducing natural production of GABA and this can easily lead to dependence on alcohol in order for the person to maintain their desired emotional state. Although stopping the intake alcohol may be uncomfortable to begin with, the good news is that natural levels of GABA are eventually re-established.

And so to yoga. Researchers at the Boston University School of Medicine (BUSM) have been reporting interesting findings with yoga for some time. In 2007, they published findings in the Journal of Alternative and Complementary Medicine, suggesting that depression and anxiety could be relieved through the practice of yoga. The group compared levels of GABA in volunteers prior to and after one hour of yoga and compared the results with another group of volunteers who sat and read for the same amount of time. A 27 percent increase in GABA was observed in volunteers who undertook yoga.

More recently, the researchers compared yoga with walking and other forms of exercise. Once again they found that yoga had a greater positive effect. The conclusion is that yoga postures seem to stimulate specific areas of the brain associated with GABA production. Quite how the mechanism works and how sustainable the effects are have yet to be fathomed. Still, as an alternative or possibly even a supplement to drugs, it clearly appears to have merit for further investigation. Meanwhile, there's nothing stopping any of us getting involved in this natural and useful form of exercise and relaxation.

What causes anxiety attacks?

Those who deal with anxiety attacks often worry about getting another one at the wrong time or place and this can severely limit their ability to have a normal life. There are several commonly-thought reasons why

 anxiety attacks happen. One is the "fight or flight" response that all humans have in-grained into their psyche. Basically, when a perceived threat exists, the brain sends off huge levels of chemicals called endorphins which cause all the muscles, voluntary and involuntary, to react. The brain and body goes on "high alert" while the muscles decide to start moving out of there quickly. While this was probably the reason why so many of our ancestors survived and we are here today, it's not always the best way for modern humans to react to their world. Panic attacks occur when the brain starts producing too many of these endorphins when there is no threat and the body and mind goes into a state of panic- for no good reason.

Another reason why panic attacks occur can be hereditary. Yes, that's right... if your parents or grandparents were "nervous" people, then there's a good chance that you also suffer from continual symptoms of anxiety following by panic attacks. Thinking back, you may remember someone in your family who got overly nervous about things and didn't set a very good example of how to cope. You yourself now may have a hard time coping with little stressors in life. There's no real explanation for this, it's just the way studies have shown it to be.

A third reason why anxiety attacks occur can be dietary. If someone lacks the proper nutrients or vitamins for proper brain function, they can be prone to anxiety attacks. Some vitamins like calcium, vitamin A and

 magnesium have been shown to lessen the experience of effects of anxiety and consequently attacks. Likewise, diet and lifestyle can include anxiety producing chemicals like caffeine, nicotine or sugar. Reducing or eliminating these from your diet can produce a positive effect on your anxiety levels. You can always substitute these chemicals with natural herbal products like green tea, for example to take the edge off your cravings.

Lastly, anxiety attacks can be psychological in that they may be occurring as a result of a traumatic incident such as a car accident, warfare, or physical or mental crisis. This is called post-traumatic stress disorder (PTSD) and someone who is going through this may often experience anxiety attacks as one of the major symptoms. It's important to get proper psychological help if this is the reason for the anxiety attacks. One can also take advantage of natural products such as lavender oil or chamomile tea to cope with the feelings and calm the nerves. Counseling combined with use of these natural products will often lessen the bouts of anxiety and create a feeling of peace.

There is hope for those who suffer with anxiety attacks in the form of many traditional and natural treatments that can help you with the symptoms that come before, during and after an attack. If you are struggling with anxiety attacks, be sure to seek the help that's right for you and find the support you need in friends and family. Soon you will be on your way to feeling better and experiencing less episodes of anxiety so that you may return to a normal way of life.

Behavioural activation, mood and inhibition in early-onset bipolar disorder symptoms.

Hypomania/mania and depression are hypothesized to correspond to high and low expressions of behavioral activation system (BAS) activity, respectively, in bipolar individuals. In contrast, behavioral inhibition system (BIS) activity is hypothesized to regulate anxiety. The aim of the present study was to examine whether self-reported levels of BAS functioning in bipolar adolescents corresponded with levels of concurrent manic and depressive symptomatology. The secondary aim was to investigate whether self-reported BIS levels were associated with self-reported anxiety symptoms.

METHODS: Twenty-five adolescents diagnosed with bipolar I, II or not otherwise specified were recruited from a treatment-development study. Adolescents were interviewed using the Depression and Mania Rating Scales of the Kiddie Schedule for Affective Disorders and Schizophrenia and given the Self-Report for Childhood Anxiety Related Disorders. Next, they completed the Behavioral Inhibition/Activation Scales.

RESULTS: Contrary to hypotheses, adolescents with higher BAS levels exhibited less severe concurrent mania symptoms. Furthermore, levels of BAS sensitivity were not associated with concurrent levels of depression. As predicted, BIS scores correlated positively with self-reported anxiety scores. Adolescents reporting higher levels of the motor activity symptoms of mania also reported higher levels of anxiety symptoms.

LIMITATIONS: The conclusions are based upon cross-sectional analyses in a small sample.

CONCLUSIONS: In bipolar adolescents, mania and depression appear to be independent of self-reported behavioral activation levels. However, mood symptoms in adolescent patients are closely tied to components of anxiety, which may lead to diminished approach behaviors.

5 self-defeating methods of adaptation for sufferers of anxiety disorders

Anxiety disorders are very serious and can affect a person’s life negatively in many aspects. The symptoms of anxiety disorders are powerful and sufferers will try many different things to get relief from these symptoms, often not being aware that their coping methods may do more harm than good. These are the top 5 of self-defeating coping methods of people with anxiety disorders:
5. Withdrawal from family and friends
Some sufferers of anxiety disorders are ashamed of their fears and they will try to hide their problem from family and friends. Withdrawing from others out of shame or fear of being criticized or stigmatized may help keeping the disorder hidden, but it also causes loneliness and depression. A good social support network helps a lot when trying to address and conquer fears.
4. Setting unreasonable goals
When deciding to face one’s fears, people often think the best approach is to throw themselves into the feared situation and that the simple fact that they “survived” will make them overcome their anxiety. Unfortunately, this is very unlikely to work. Even though exposure helps reduce anxiety, it should be approached slowly and reasonably. Having unrealistic expectations of oneself leads to defeat, which leads to frustration and depression and can actually also worsen the anxiety.
3. Creating safety behaviors
Safety behaviors can range from always having another person with one when having to go to a feared place or always carrying medicine in case of a panic attack, to creating rituals that seemingly stop bad things from happening. While safety behaviors may give anxiety sufferers some relief, they also make them dependent on a person or object and can hinder them from normal functioning when that person or object isn’t around.
2. Avoidance
Often people with anxiety disorders try to ease their anxiety by simply not exposing themselves to the feared object or situation. Even though it may help control their anxiety, this kind of behavior can lead to extreme restrictions in somebody’s professional, family or social life.
1.Self-medication
Many anxiety sufferers resort to alcohol or drugs when having to deal with stressful situations that could trigger their anxiety. Because this sort of self-medication doesn’t treat the cause of the anxiety but only eases the symptoms temporarily, this is especially dangerous because it can lead to addiction, trouble with the law, and can have serious health risks.
The best way to deal with and overcome anxiety disorders is to talk to a mental health specialist that can help find healthy ways to ease the symptoms of anxiety and come up with a specialized plan that treats the cause of the anxiety rather than just the symptoms. Various forms of cognitive-behavioral therapy have been proven to be very successful in the treatment of anxiety disorders and often, medication is not even necessary.

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