Posts Tagged ‘anxiety’

Mind and Medicine

March 19, 2018

The title of this post is identical to the title of the title of a chapter in Daniel Goleman’s book “Emotional Intelligence.” There are two extreme views regarding the mind and medicine. One view, and it is unfortunate that there are physicians who hold this view, is that there is no relationship between the mind and medicine. The other extreme is that the mind controls all and medicine is unnecessary. Actually, this extreme view is the view adopted by some religions such as Christian Scientists, that prayer and meditation, not the mind, provides the basis for treating all illnesses. As the reader will see, the truth lies somewhere in between.

The truth is that there are links between the immune system and the central nervous system, and the field that studies this, psychoneuroimmunology (PNI) is a leading-edge medical science. It’s name acknowledges the links: psycho, or mind; neuro, for the neuroendocrine system (which subsumes the nervous system and hormone systems); and immunology, for the immune system.

Some surgeons will cancel scheduled surgeries for people who are panicked by the prospect of surgery. Every surgeon knows that people who are extremely scared do terribly in surgery. They bleed too much, they have more infections and complications, and they have a harder time recovering. Patients do much better if they are calm.

A study of anger in heart patients was done at Stanford University Medical School. All the patients in the study had suffered a first heart attack, and the question was whether anger might have a significant impact of some kind on their heart function. While the patients recounted incidents that made them mad, the pumping efficiency of their hearts dropped by 5 percentage points. Some patients showed a drop in pumping efficiency of 7% or greater. This is a range that cardiologists regard as a sign of myocardial ischemia, a dangerous drop in blood to the heart itself.

Another study by Dr. Redford Williams of Duke University found that those physicians who had had the highest scores on a test of hostility while still in medical school were seven times as likely to have died by the age of fifty as were those with low hostility scores. This is a stronger predictor of dying your than were other risk factors such as smoking, high blood pressure, and high cholesterol.

Anxiety, the distress evoked by life’s pressures, is perhaps the emotion with the greatest weight of scientific evidence connecting it to the onset of sickness and course of recovery. Yale psychologist Bruce McEwen noted a broad spectrum of effects: compromising immune functions to the point that it can speed the metastasis of cancer; increasing vulnerability to viral infections; exacerbating plaque formation leading to atherosclerosis and blood clotting leading to myocardial infarction; accelerating the onset of Type 1 diabetes and the course of Type II diabetes; and worsening or triggering an asthma attack. Stress can also lead to ulceration of the gastrointestinal tract, triggering symptoms in ulcerative colitis and in inflammatory bowel disease. The brain itself is susceptible to the long-term effects of sustained stress, including damage to the hippocampus, and so to memory.

There are also medical costs of depression. In patients with chronic kidney failures who were receiving dialysis, those who were diagnosed with major depression were most likely to die within the following two years; depression was a stronger predictor of death than any medical sign.

Heart disease is also exacerbated by depression. A study of 2832 middle-aged men and women tracked for twelve years, those who felt a sense of nagging despair and hopelessness had a heightened rate of death from heart disease. For the 3% who were most severely depressed, the death rate from heart disease compared to those with no feelings of depression was four times greater.

As there are medical costs to pessimism, there are medical advantages to optimism. For example, 122 men who had their first heart attack were evaluated on their degree of optimism or pessimism. Eight years later, of the 25 most pessimistic men, 21 had died; of the 25 most optimistic, just 6 had died.

There is medical value from relationships. Two decades of research involving more than 37,000 people show that social isolation, the sense that you have nobody with whom you can share your private feelings or have close contact—doubles the chance of sickness or death. A 1987 report in “Science” concluded that isolation is as significant to mortality rates as smoking, high blood pressure, high cholesterol, obesity, and and lack of physical exercise. Goleman takes care to note that solitude is not the same as isolation; many people who live on their own or see few friends are content and healthy. Rather, it is the subjective sense of being cut of from people and having no one to turn to that is a medical risk.

Goleman argues that for medicine to enlarge its vision to embrace the impact of emotions, two large implications of the scientific findings must be taken to heart:

HELPING PEOPLE BETTER MANAGE THEIR UPSETTING FEELINGS—ANGER, ANXIETY, DEPRESSION, PESSIMISM, AND LONELINESS IS A FORM OF DISEASE PREVENTION. The data show that the toxicity of these emotions, when chronic, is on a par with smoking cigarettes, helping people handle them better could potentially have a medical payoff as great as getting heavy smokers to quit. One way to do this that could have broad public-health effects would be to impart most basic emotional intelligence skills to children, so that they become lifelong habits. Another high-payoff preventive strategy would be to teach emotion management to people reaching retirement age, since emotional well-being is one factor that determines whether an older person declines rapidly or thrives. A third target group might be so-called at-risk populations—the very poor, single working mothers, residents of high-crime neighborhoods, and the like—who live under extraordinary pressure day in and day out, and so might do better medically with help in handing the emotional toll of these stresses.
MANY PATIENTS CAN BENEFIT MEASURABLY WHEN THEIR PSYCHOLOGICAL NEEDS ARE ATTENDED TO ALONG WITH THEIR PURELY MEDICAL ONES. While it is a step toward more humane care when a physician or nurse offers a distressed patient comfort and consolation, more can be done. But emotional care is an opportunity too often out of the way medicine is practiced today; it is a blind spot for medicine. Despite mounting data on the medical usefulness of attending to emotional needs, as well as supporting evidence for connecting between the brain’s emotional center and the immune system, many physicians remain skeptical that their patients’ emotions matter clinically, dismissing the evidence of this as trivial and anecdotal, as “fringe, or worse as the exaggerations of a self-promoting few.


Passion’s Slaves

March 13, 2018

Passion’s Slaves is the title of a chapter in Daniel Goleman’s book “Emotional Intelligence.” Since the time of Plato a sense of self-mastery, of being able to withstand the emotional storms that the buffeting of Fortune brings rather than being “passion’s slave,” has been praised as a virtue. The ancient Greek word for it was “sophrosyne.” Page DuBois, a Greek scholar translates it as “care and intelligence in conducting one’s life; a tempered balance and wisdom.” The Romans and the early Christian church called it “temperantia”, temperance, the restraining of emotional excess. The goal is balance, not emotional suppression. Aristotle observed, what is wanted is appropriate emotion, feeling proportionate to circumstance. The passions discussed in this post are anger and rage, worry and anxiety, and depression and melancholy.

Anger and Rage

The design of the brain means that we very often have little or no control over when we are swept by emotion, nor over what emotion it will be. However, we can have some say on how long an emotion will last. Consider the anatomy of rage. Say you are cut off in traffic by a driver. You think, “He could have hit me! That bastard—I can’t let him get away with that!” Your knuckles whiten as you tighten your hold on the steering wheel, which you regard as a surrogate for strangling his throat. You body mobilizes to fight not run—leaving you trembling, beads of sweat on your forehead, your heart pounding, the muscles in your face locked in a scowl.”

Compare that sequence of building rage with a more charitable line of thought toward the driver who cut you off. “Maybe he didn’t see me, or maybe he had some good reason for driving so carelessly, such as a medical emergency.” Such thoughts tempers anger with mercy or at least an open mind, short-circuiting the buildup of rage. Aristotle’s challenge is to have only appropriate anger reminds us, is that more often than not, our anger surges out of control. Benjamin Franklin put it well: “Anger is never without a reason, but seldom a good one.” There are different kinds of anger. The amygdala is a main source of the sudden spark of rage we feel at the driver whose carelessness endangers us. On the other end of emotional circuitry, the neocortex, most likely foments more calculated angers, such as cool-headed revenge or outrange at unfairness or injustice.

Rage seems to be the most intransigent of al the moods. Researcher Diana Tice found that anger is the mood people are worst at controlling. Anger is the most seductive of the negative emotions; the self-righteous inner monologue that propels it along fills the mind with the most convincing arguments for venting range. Unlike sadness, anger is energizing, even exhilarating. Anger’s persuasive power might explain why some views about it are so common: that anger is uncontrollable, or that it should not be controlled, and venting anger in “catharsis” is to the good. A contrasting view holds that anger can be prevented entirely. However, a careful reading of research findings suggests that all these common attitudes toward anger are misguided if not outright myths.

The train of angry thoughts that stokes anger is also potentially the key to one of the most powerful ways to defuse anger: undermining the convictions that are fueling the anger in the first case. The longer we ruminate about what has made us angry, the more “good reasons” and self-justification for being angry we can event. Brooding just fuels anger’s flames. Seeing things differently douses those flames. Tice found that reframing a situation more positively was one of the most potent ways to put anger to rest. Timing matters. The earlier in the anger cycle, the more effective. Anger can be completely short-circuited if the mitigating information comes before the anger is acted on.

The second way of de-escalating anger is cooling off physiologically by waiting out the adrenal surge in a setting where there are not likely to be further triggers for rage. This is a common way of dealing with anger according to Tice’s research. One such fairly effective strategy is going off to be alone while cooling down. People go for a drive or a walk. Of these two, the second is preferable. Exercise also works. Relaxation methods such as deep breathing and muscle relaxation, perhaps because they change the body’s physiology from the high arousal of anger to a low-arousal state, and perhaps too because they distract from whatever triggered the anger. [enter “Relaxation Response” into the search block of the healthy memory blog to find relevant posts].

However, a cooling-down period will not work if that time is used to pursue the train of anger-inducing thought, since each such though will trigger more cascades of anger.

Distractions like TV, movies, reading and the like work, but not shopping or eating.

Ventilation does not work. In fact there is a ventilation fallacy. Ventilation may feel satisfying, but it is counterproductive. Tice found that ventilating anger is one of the worst ways to cool down: outbursts of rage typically pump up the emotional brain’s arousal, leaving people feeling more angry not less.

Worry and Anxiety

Worrying is at the heart of all anxiety. The reaction that underlies worry is the vigilance for potential for potential danger that has, no doubt been essential for survival over the course of evolution. When fear triggers the emotional brain, part of the resulting anxiety fixates attention on the threat at hand, thus forcing the mind to obsess about how to handle it and ignore anything else. Worry is a rehearsal of what might go wrong and how to deal with it. The purpose of worrying is to come up with positive solutions for life’s perils by anticipating dangers before they arise.

Worrying becomes a problem with chronic repetitive worries that go on and on never getting nearer to a positive solution. Goleman writes that a “close analysis of chronic worry suggests that it has all the attributes of a low-grade emotional hijacking. Worries that seem to come from nowhere and are uncontrollable generate a study hum of anxiety, are impervious to reason and lock the worrier into a single, inflexible view of the topic of worry. When this cycle of worry intensifies and persists, it crosses over the line into a full-blown neural hijacking, the anxiety disorders: phobias, obsessions and compulsions, panic attacks.

For each disorder worry fixates in a distinct fashion: phobic anxieties rivet on the feared situation; obsessive disorders fixate on preventing some feared calamity; panic attacks can focus on fear of dying or on the prospect of having the anxiety attack itself.

Researchers have observed that anxiety comes in two forms: cognitive, or worrisome thoughts, and somatic, the physiological symptoms of anxiety, like sweating, a racing heart, or muscle tension. Insomniacs are suffering from anxiety attacks. Their main problem preventing them from sleeping were intrusive thoughts. No matter how sleepy they were, they could not stop worrying. The one technique that worked in helping them get to sleep was getting their minds off their worries, focusing instead on the sensations produced by a relaxation method. In summary, the worries could be stopped by shifting attention away.

Unfortunately, most worriers seem unable to do this. These worriers get a partial payoff from worrying that reinforces the habit. It seems that there is something positive in worries: worries are ways to deal with potential threats. When the work of worrying succeeds, it is to rehearse what those dangers are, and to reflect on ways to deal with them. But Goleman writes that worry doesn’t work that well. “New solutions and fresh ways of seeing a problem do not typically come from worrying, especially chronic worry. Instead of coming up with solutions to these potential problems, worriers typically simply ruminate on the danger itself, immersing themselves in a low-key way in the dread associated with it while staying in the same run of thought. Chronic worriers worry about a wide range of things, most of which have almost no chance of happening; they read dangers into life’s journey that others never notice.”

Still chronic worriers report that worrying helps them, and that their worries are self-perpetuating. So why should worry become what seems to amount to a mental addiction? Borkovec notes that the worry habit is reinforcing in the same sense that superstitions are. Since people worry about many things that have a very low probability of actually occurring, to the primitive limbic brain there appears to be something magical about it. “Like an amulet that wards off some anticipated evil, the worry psychologically gets the credit for preventing the danger it obsesses about.”

Borkovic discovered simple steps the can help even the most chronic worrier control the habit.

The first step is self-awareness, catching the worrisome episodes as near their beginning as possible. Borkovec trains people in this approach by first teaching them to monitor cues for anxiety, especially learning to identify situations that trigger worry, or the fleeting thoughts and images that initiate the worry, as well as the accompanying sensation of anxiety in the body. With practice people can identify the worries at an earlier and earlier point in the anxiety spiral. People also learn relaxation methods that they can apply at the moment they recognize the worry beginning, and practice the relaxation method daily so they will be able to use it on the spot. [Much has been written about relaxation in the healthy memory blog. Enter ‘relaxation’ into search block of the healthy memory blog.]

Goleman offers the following precaution: “for people with worries so severe they have flowered into phobia, obsessive-compulsive disorder, or paid disorder, it may be prudent—indeed a sign of self-awareness—to turn to medication to interrupt the cycle A retraining of the emotional circuitry through therapy is still called for, however, in order to lessen the likelihood that anxiety disorders will recur when medication is stopped.

Melancholy and Depression

The single mood people put most effort into shaking is sadness: Tice found that people are most inventive when it comes to trying to escape the blues. Melancholy like every other mood has its benefits. The sadness that a loss brings has certain effects: it closes down our interest in divisions and pleasures, focuses attention on what’s been lost, and saps our energy for starting new endeavors, hopefully for the time being. It causes a reflective retreat from life’s pursuits, and leaves us in a state to mourn the loss, mull over its meaning, and make the psychological adjustments and new plans to continue with out lives.

Although bereavement is useful, a full-blown depression is not. In a major depression, love is paralyzed: no new beginnings emerge. The very symptoms of severe depression place a life on hold. For most people psychotherapy can help as can medication.

The far more common sadness that at its upper limits becomes a “subclinical depression” is sometimes referred to as melancholy. This is a range of despondency that people can handle on their own, if they have the internal resources. Unfortunately, some of the strategies most often resorted to can backfire, leaving people feeling worse than before. One such strategy is staying alone. However, more often than not this only adds a sense of loneliness and isolation to the sadness.

Tice found the most popular tactic for battling depression is socializing. Going out to eat, to a ball game or movie. Doing something with friends or family. This works well if the effect is to get the person’s mind off his sadness.

One of the main determinants of whether a depressed mood will persist or lift is the degree to which people ruminate. Worrying about what’s depressing us seems to make the depression all the more intense and prolonged. In depression, worry takes several forms, all focusing on some aspect of the depression itself, such as how tired we feel, how little energy or motivation we have, or how little work we’re getting done. Typically this reflection is not accompanied by any concrete course of action that might alleviate the problem.

Cognitive therapy aimed at changing these thought patterns has been found in some studies to be on a pair with medication for treating mild clinical depression, and superior to medication in preventing the return of mild depression. Two strategies are particularly effective. One is to learn to challenge the thoughts at the center of rumination. The other is to purposely schedule pleasant, distracting events.

Tice found that aerobic exercise is one of the more effective tactics for lifting mild depression, as well as other bad moods. A caveat here is that the mood-lifting benefits of exercise work best for the lazy, those who don’t work out very much. For those with a daily exercise routine there is a reverse effect on mood: they start to feel bad on those days when they skip their workout. Exercise seems to work well because it changes the physiological state the mood evolves: depression is a low-arousal state, and aerobics pitches the body into high arousal. Relaxation techniques, which put the body into a low-arousal state work for anxiety, a high-arousal state, but not so well for depression.

Tice reports that a more constructive approach to mood-lifting is engineering a small triumph or easy success: tackling some long-delayed chore around the house of getting to some other duty they’ve been wanting to clear up. Lifts to self-image were also cheering, even if only in the form of getting dressed up or putting makeup.

One of the most potent antidotes is cognitive reframing. For example, stepping back and thinking about the ways a relationship wasn’t so great, and ways you and your partner were mismatched, seeing the loss in a more positive light is an antidote to sadness.

This post offers some tips for dealing with emotional problems. Should problems persist and become chronic, please see professional help. Should you ever fear that you are a danger to yourself or others, SEEK PROFESSIONAL HELP IMMEDIATELY. If necessary, go to an emergency room.

Meditation as Psychotherapy

December 5, 2017

The title of this post is identical to the title of Chapter 10 of a book by Daniel Goleman and Richard J. Davidson. The subtitle is “Science Reveals How Meditation Changes Your Mind, Brain, and Body. Meditation was not originally intended to treat psychological problems. However, in modern times it has shown promise in the treatment of some disorders, particularly depression and anxiety disorders. A meta-analysis of forty-seven studies on the application of meditation methods to treat patients with mental health problems found that meditation can lead to decreases in depression (especially severe depression), anxiety, and pain. They were about as effective as medications, but had no side effects. To a lesser degree, meditation can reduce the toll of psychological stress. Loving-kindness meditation may be especially beneficial to patients suffering from trauma, especially those with Post Traumatic Stress Disorder (PTSD).

Mindfulness as been melded with cognitive therapy to produce Mindfulness Based Cognitive Therapy (MBCT). MBCT has become the most empirically well-validated psychological treatment with a meditation basis. This integration is having a wide impact in the clinical world. Empirical tests of applications to an ever larger range of psychological disorders are underway. Although there have been occasional reports of the negative effects of meditation, the findings to date point to the potential promise of meditation-based strategies. The enormous increase in scientific research in these areas makes for an optimistic future.

Some Common Ideas Debunked

August 28, 2017

This post is based on the groundbreaking book by Seth Stephens-Davidowitz “Everybody Lies: Big Data, New Data, and What the Internet Reveals About Who we Really Are.”

A common notion is that a major case of racism is economic insecurity and vulnerability. So it is reasonable to expect that when people lose their jobs, racism increases. But neither racist searches nor membership in Stormfront rises when unemployment does.

It is reasonable to think that anxiety is highest in overeducated big cities. A famous stereotype is the urban neurotic. However, Google searches reflecting anxiety—such as “anxiety symptoms” or “anxiety help” tend to be higher in places with lower levels of education, lower median incomes, and where a larger portion of the population lives in rural areas. There are higher search rates for anxiety in rural upstate New York than in New York City.

It is reasonable to think that a terrorist attack that kills dozens or hundreds of people would automatically be followed by massive, widespread anxiety. After all, terrorism, by definition, is supposed to instill a sense of terror. Seth looked for Google searches reflecting anxiety. He tested how much these searches rose in a country in the days, weeks, and months following every major European or American terrorist attack since 2004. So, on average, how much did anxiety-related searches rise? They didn’t. At all.

Humor as long been thought of as a way to cope with frustrations, the pain, the inevitable disappointments of life. Charlie Chaplin said, “laughter is the tonic, the relief, the surcease from pain.” Yet, searches for jokes are lowest on Mondays, they day when people report they are most unhappy. They are lowest on cloudy and rainy days. And they plummet after a major tragedy, such as when two bombs killed three and injured hundreds during the 2013 Boston Marathon. Actually people are more likely to look for jokes when things are going well in life than when they aren’t.

Seth argues that the bigness part of big data is overrated. He writes that the smartest Big Data companies are often cutting down their data. Major decisions at Google are based on only a tiny sampling of all their data. Seth continues, “You don’t always need a ton of data to find important insights. You need the right data. A major reason that Google searches are so valuable is not that there are so many of them; it is that people are so honest in them.

Conclusions for Suggestible You

March 29, 2017

There have been a dozen posts on Erik Vance’s “Suggestible You:  The Curious Science of your Brain’s Ability to Deceive, Transform, and Heal” because there is so much interesting material that is relevant to a healthy memory.  Nevertheless, these posts just scratch the surface.  Readers are encouraged to read the original book.

The power of our minds is enormous.  Our brains are an extremely valuable gift.  We need to use them to best advantage and to help them grow.  It is hoped that these dozen or so “Suggestible You” posts have accomplished  that.

Not much has been written about meditation, not because meditation was not covered in the book.  It was covered, but HM thought that the importance of meditation had been covered fairly well in other healthy memory blog posts.  And there will be many more posts on mindfulness and meditation in the future.

Suggestibility can have an enormous effect on many medical conditions, but not all of them.  Although Parkinson’s responds well to placebos, Alzheimer’s does not.  This makes sense, because suggestibility  involves the brain and Alzheimer’s destroys the brain.  The healthy memory blog has many posts on how to build a cognitive reserve.  There are many people who died with the defining amyloid plaques and neurofibrillary tangles of Alzheimer’s, have never shown any of the cognitive or behavioral symptoms.  It is said that a cognitive reserve precluded the cognitive and behavioral symptoms.

Anxiety responds to placebos, as does depression.  The pharmaceutical companies are spending a fortune trying to beat placebo effects.   But obsessive-compulsive disorders traditionally do not respond well to placebos.  Although the pain and nausea of cancer can be eased with placebos, tumors cannot.  Vance writes that the spontaneous regression—the sudden retreat of a tumor for no obvious reason is more common than you might think, but is not a product of suggestion (at least not that we know of).

And don’t forget to be suggestible to yourself.  When sad, remember that you can cheer yourself up, and that it is your mind and the chemicals in your body that affect your mood.  And you do have an ability to control your emotions due to your own suggestibility.  Meditation and mindfulness can also help here.

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