Emotional Resilience Blog from The Fear Course

The latest research, realisations and thinking in the world of emotional resilience, anxiety and fear reduction from around the world.

Dealing with anxiety - important new research

Dealing with anxiety - important new research

It has been known for a long time that people suffering from anxiety process information differently compared to people who don't have anxiety. People who suffer from anxiety are much more likely to appraise a situation, even a neutral situation as a threat than people without an anxiety disorder. In effect people with anxiety disorders are invariably hyper-sensitive to situations, and are frequently searching for threat or something to worry about compared to those who don't suffer from anxiety.

This hyper sensitivity is associated with significantly increased activity in a couple of areas of the brain, particularly the older limbic parts in the centre of the brain and the prefrontal cortex, just behind our forehead. Additionally anxiety sufferers display higher and different heart rate functioning when they perceive a threat.

This new study by colleagues at my own university, the University of Oxford, and the University of Bristol, University College London (UCL) and Universitaire Vaudois in  Switzerland carried out a ground breaking series of experiments looking at the responses of a group of anxiety sufferers compared to an equal umber of non-sufferers.

What they did was present everyone (both anxiety and non-anxiety sufferer) with a set of images whilst they were in an fMRI scanner and whilst they were also monitoring their heart response.

They got the subjects to do two tasks whilst their brain activity and heart responses were being monitored and they were being presented with the images.

The first task was to do nothing but watch the images. A number of the images were considered to be threat images. In this condition they found what they expected. The anxiety sufferers responded with anxiety to each of the threat images faster and with a greater response than the non anxiety sufferers. The anxiety sufferers also frequently reacted to the non-threat images. No surprise there.

They then taught all of the people in the experiment an emotion regulation technique based on a couple of techniques we use on the Fear Breakthrough Course. These techniques, known as reappraisal techniques basically get people to see things differently.

This time, when anxiety sufferers used the emotion regulation techniques they saw the effect immediately both in the brain and with their heart responses. Not only did the techniques reduce the hyper-activity within the brain, it also had an immediate effect of reducing the heart response to the threat. What surprised the researchers was that in many cases the techniques actually reversed the effects of the anxiety induced hyper-activity.

In effect what this means is that the techniques we use not only reduce the level of anxiety at the time but have the power to reverse the effects of the anxiety and stop it happening altogether.

Reference

A Reinecke et al (2015) Effective emotion regulation strategies improve fMRI and ECG markers of psychopathology in panic disorder: implications for psychological treatment action. Translational Psychiatry (2015) 5, e673; doi:10.1038/tp.2015.160

 

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Suffer from anxiety? Your reaction times could have predicted it...

Suffer from anxiety? Your reaction times could have predicted it...

A number of research studies over the years have shown that people suffering from anxiety and depression tend to take longer to react to situations, particularly new and unusual situations. This effect is made worse when there is a potential for loss or any form of perceived risk in the new situation or circumstances or the individual is under stress.

A new study from a team of researchers from University of Edinburgh, University of Southampton, University College London, Sackler Institute of Psychobiological Research, University of Glasgow, and The Rockefeller University, New York City has shed some important new light on this phenomenon.

The researchers followed a group of 705 people from their 16th birthday until they were 36 years old and measured, among other things, their anxiety levels and reaction times.

They found that not only do people with anxiety and depression tend to react slower to situations and make slower decisions but that people who have slower reaction times as adolescents tend to be at significantly more risk of developing anxiety and depression later in life. This direction of effect was not expected. There appears to be some mechanism that increases an individuals susceptibility to anxiety and depression that is connected to how fast they react and make decisions at an earlier age.

Clearly some anxieties are created from increased levels of analysis (worry about possible outcomes etc.), and also that an individuals ability to process information is connected to the level of stress they are under (known as allostatic load). However it would appear that reaction and decision making time can be a predictor of anxiety and depression.

Reference

Gale, C. R., Batty, G. D., Cooper, S. A., Deary, I. J., Der, G., McEwen, B. S., & Cavanagh, J. (2015). Reaction Time in Adolescence, Cumulative Allostatic Load, and Symptoms of Anxiety and Depression in Adulthood: The West of Scotland Twenty-07 Study. Psychosomatic medicine.

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The 1 Thing That Predicts If You Will Get General Anxiety Disorder (GAD)

The 1 Thing That Predicts If You Will Get General Anxiety Disorder (GAD)

It is now generally accepted by professionals that people who suffer from GAD (General Anxiety Disorder or Generalized Anxiety Disorder) tend to get into such a situation because they have been unwittingly engaging in what are termed 'maladaptive coping strategies'.

In other words people with GAD tend to have been using coping techniques to life in general and anxiety in particular, which actually end up making their situation worse. I have reported in previous blogs for example the role avoidance has in strengthening anxiety. It has been found for example that distraction and avoidance techniques used by some therapists can at first mask and then later exacerbate GAD.

A study just published by colleagues at the Department of Psychology, Ryerson University, in Canada has added considerably to our understanding of GAD and what contributes to the onset or creation of this disorder.

The researchers looked at the extent to which 217 people were able to tolerate distress, particularly distress emanating from what are considered to be the 6 prime trigger experiences for distress in humans:

  1. Uncertainty
  2. Negative emotions
  3. Ambiguity
  4. Frustration
  5. Physical discomfort, and
  6. The perceived consequences of anxiety

They then measured the subjects for symptoms of GAD and found that GAD sufferers were significantly less likely to be able to tolerate distress from each of the six prime trigger experiences than other people, including people with depression. In effect what they found was that a lack of tolerance for distress is a prime indicator for the development of GAD. This is not the case for depression.

Further they discovered that the level of tolerance an individual has for physical discomfort can be used as a sole predictor for whether or not an individual is likely to end up with GAD.

Whilst the study in itself is interesting, it does provide further insight into therapeutic interventions which can most effectively help GAD sufferers. Building emotional resilience is a key part of the process of recovery from GAD.

 

 

Reference

MacDonald, E.M. etal (2014) An Examination of Distress Intolerance in Undergraduate Students High in Symptoms of Generalized Anxiety Disorder. Journal of Cognitive Behaviour Therapy. Oct 2014 DOI: 10.1080/16506073.2014.964303

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What Causes Social Anxiety? New Research

What Causes Social Anxiety? New Research

Social anxiety is one of the most frequent and debilitating anxieties around. The effects range from mild discomfort in social situations to full scale avoidance of and panic attacks during social events and even phobic responses such as agoraphobia. A series of research studies examining this common series of anxieties have found that people who have at some stage in their life been a victim of bullying, criticism and or rejection in any situation are significantly more likely to develop a social anxiety compared to the rest of the population.
Indeed the definition of a social anxiety centres around the fear of scrutiny or negative evaluation/judgement by others. This usually results in people having the feeling that they are not good enough for other people, and/or the assumption that others will automatically reject them and includes often intense feelings of insecurity in a wide range of situations.

It is estimated that about 1 in 5 or 20% of the population suffer from some form of social anxiety. This can be a severely debilitating and distressing disorder for the sufferer which can have massive negative effects on the quality of life of the sufferer and as a result I pay particular attention to research in this area. A student at University of British Columbia in Vancouver, Klint Fung has just gained his Masters this month with an interesting series of experiments which helps us to understand a bit more about social anxiety.

What Fung did was get a group of 88 people and initially test them for their level of social anxiety. He then subjected them to an experimental social event where they would be either rejected (rarely interacted with) or included (frequently positively interacted with) in the activity of the event. All the participants were then invited to a second social event.
The research found that rejection or inclusion from just one event had a significant effect on the anxiety the individuals felt towards and during the second event. Importantly it was discovered that virtually all of the anxiety experienced stemmed from the hurt feelings induced during the first event.

It would appear and is backed up by other research that how hurt we feel following an incident can then predict how sensitive we are likely to be to the possibility of future exclusion especially when this is interpreted as rejection by the individual.

What this and other pieces of research shows is that treatment which helps to reduce sensitivity to exclusion and helps the individual to regulate their own emotions (prevent the hurt feelings) is likely to be most effective. Certainly from my experience the development of emotion regulation techniques coupled with cognitive reappraisal (both strategies I teach) have a significant impact on social anxiety disorders.
Indeed one client I finished with this week went from agoraphobic (unable to leave the house due to social anxiety) to returning to work in 16 days.

On Wednesday 3rd September I will be running a live online seminar about 'How We Catch Fear and Anxiety'. Click here for more details.

Free Live Seminar - How we catch Fear and anxiety - September 3rd

References
Fung, K. (2014) How does rejection induce social anxiety? A test of hurt feelings as a mechanism. University of British Columbia - Masters Thesis August 2014.

Levinson, C. A., Langer, J. K., & Rodebaugh, T. L. (2013). Reactivity to exclusion prospectively predicts social anxiety symptoms in young adults. Behavior Therapy, 44(3), 470-478.

Lissek, S., Levenson, J., Biggs, A. L., Johnson, L. L., Ameli, R., Pine, D. S., & Grillon, C. (2008). Elevated fear conditioning to socially relevant unconditioned stimuli in social anxiety disorder. The American Journal of Psychiatry, 165(1), 124-132.

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A simple way to help with exam nerves - new research

A simple way to help with exam nerves - new research

Researchers from Universities in the Netherlands and Australia have just published an interesting paper reporting on a series of experiments they conducted on school children taking exams.

One of the big problems that anxiety causes during exams is that it degrades performance significantly. In particular it it uses up valuable processing power in the brain, particularly in the areas used for working memory, which is a vital component especially during tests. We use the working memory to store short term information whilst we are working things out during an exam.

The researchers tested the hypothesis that if the students simply read through all of the questions before starting to answer anything, this would in effect reduce some of the anticipatory anxiety and as a consequence lower the loading on the working memory. The result of this should be more 'space' for problem solving and therefore better results.

The researchers showed the method of reading through all of the questions before putting pen to paper to 50% of a group of 117 students, chosen at random before a real exam. Those students that did read through the exam paper first performed significantly better than those that didn't. Additionally the students who carried out the tactic reported lower levels of anxiety during the exam compared to those that didn't.
Interestingly this tactic worked regardless of the level of anxiety the student was experiencing before the exam.

I have a free live webinar you can join next Wednesday all about the latest research on How We Catch Fear and Anxiety. Click here to find out more and book a free place.

 

Free Online Seminar - How We Catch Fear And Anxiety

 

Reference

Mavilidi, M., & Hoogerheide, V (2014) A Quick and Easy Strategy to Reduce Test Anxiety and Enhance Test Performance. Applied Cognitive Psychology. 1099-0720 August 2014 DOI: 10.1002/acp.3058

 

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The Top 10 Fears / Anxieties And How Long It Takes To Treat Them

The Top 10 Fears / Anxieties And How Long It Takes To Treat Them

Every year I do an audit of the anxieties and fears we treat and how long it took to treat them. There are five numbers to look at.

  1. Frequency - the number of people presenting with a particular fear or anxiety.
  2. Control average - The average time (in days) it took to get the fear or anxiety to level 3 (0 = no feelings of anxiety or fear. 10 = Maximum anxiety and fear feelings). Level 3 is a definition of the disorder being under control by the individual. Most people present to us at levels 8-10.
  3. Control range - How long in days (quickest to longest) it took to get the disorder to get to level 3 (see notes above).
  4. Discharge average - the average time (in days) it took individuals to feel they had the fear or anxiety under control enough to discharge themselves from the programme. Usually at level 0.
  5. Discharge range - How long in days (quickest to longest) it took to get the disorder under complete control (to get to level 0 or 1) and to discharge themselves or leave the programme having been successfully treated.
Anxiety / Fear   Frequency 

 Control Av 

 Control Rng   Discharge Av   Discharge Rng 
1. General Anxiety Disorder 403 12 4 - 21 16 11 - 33
2. Social Anxiety Disorders * 368 9 3 - 16 16 13 - 21
3. Fear of Rejection 360 10 7 - 14 16 12 - 22
4. Fear of Failure 337 11 7 - 20 17 14 - 31
5. Fear of Meetings 324 9 5 - 17 15 7 - 20
6. Panic or Anxiety Attacks 211 7 2 - 9 10 6 - 19
7. Public Speaking Anxieties 209 8 5 - 16 15 7 - 19
8. Agoraphobia 194 7 3 - 22 19 8 - 34
9. Sexual Performance Anxieties  162 14 7 - 30 23 11 - 38
10. Fear of Flying 131 9 7 - 18 16 12 - 19

 

*Social anxiety disorders (SAD) include fears and anxieties around being in social situations, meeting people, dating, having to talk to people unexpectedly, going to gatherings etc.

Notes:

  1. The top three fears and anxieties tend (but not always) to be versions of a fear of rejection.
  2. When I started conducting therapeutic interventions the presence I was surprised about the predominance of a fear of meetings. At first I assumed a fear of meetings was a subset of public speaking anxieties, however over the years I have come to recognise both the prevalence of this disorder and its grounding in a fear of rejection, social anxieties and public speaking issues.
  3. The treatment times are only for the period until the disorder is brought down to levels 0 (no anxiety) or 1 (aware of a minor heightened sense of arousal) this does not include the confidence and assertiveness phases of the programme. I firmly believe that to just treat an anxiety or fear is not enough as it leaves the client susceptible to forming similar fears and anxieties at a later date. To prevent this I usually include a confidence and assertiveness skills course to prevent this occurring.

 

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The Cost of Anxiety

The Cost of Anxiety

It is widely known in the medical research community that anxiety disorders are the most common disorders there is, bar none. Not only are anxiety disorders the most frequently suffered disorder there is, a research paper published in journal Neuropsychopharmacology worked out that in the US alone in 2002 anxiety cost about 100 Billion dollars or £58,326,044,000 per year, which is the last reliable estimate of the general cost of anxiety. Given that this was firstly back in 2002 and secondly just in the US, which only accounts for about 4,44% of the worlds population you can start to get some idea of the size of the problem.

The cost obviously goes way beyond the financial burden, in terms of the incalculable effects it has on people's lives on a daily basis. Especially when you take into account the reduction in opportunities anxiety causes. Right now as I write this I have personal clients who:

  • couldn't go out,
  • wouldn't fly,
  • found it hard to speak at meetings,
  • got flustered and avoided social events, meetings, dating and a whole host of other social situations,
  • couldn't go shopping,
  • wouldn't drive,
  • wouldn't be a passenger in a car being driven by someone else,
  • couldn't go for job interviews,
  • wouldn't take a promotion,
  • avoided public places,
  • avoided intimate relationships,
  • were putting off an operation,

and that is just the start. The cost to these people in terms of the reduced opportunities and social functioning cannot be put into monetary terms. Not only that the emotional cost is almost impossible to articulate. Until you have had a panic or anxiety attack, or found yourself avoiding things or had depression, it is very difficult to understand what this does inside to a person.

The cost does not end there. There is now a growing body of evidence about the direct and indirect health costs of anxiety disorders. For example people with an anxiety disorder are 3 to 4 times more likely to develop cardiovascular disease, and twice as likely to die from some form of heart problem or a heart attack as the people without anxiety. Additionally as I reported in 'People with anxiety are more likely to develop depression' people with anxiety are 50-70% more likely to develop depression than the general population. Further there are a whole host of other health problems associated with anxiety which greatly effect the quality of life like cancer and cost the individual in mental and emotional ways beyond just financial costs.

And yet if you go to the doctors with any anxiety disorder the frequent response is to be put on a waiting list for online CBT or anti-depressants. Whilst I understand the primacy physical illnesses like coronary and cancer ( See 'Links between anxiety and cancer' ) care has, it is about time anxiety disorders also got the attention and priority other illnesses have form the medical professions. Anxiety which often either underlies, predicts or complicates the physical illness or as reported here '(The effects of pre-operation anxiety on the recovery of heart surgery patients') actually exacerbates or worsens the prognosis of the patient.

Anxiety treatment and prevention needs to become a priority for all of the health services. It's not like there is a lack of evidence.

 

 

References

Bardeen, J.R. etal (2014) Exploring the relationship between positive and negative emotional avoidance and anxiety symptom severity: The moderating role of attentional control. Journal of Behavior Therapy and Experimental Psychiatry. Volume 45, Issue 3, September 2014, Pages 415–420

Chalmers J, Quintana DS, Abbott MJ and Kemp AH (2014). Anxiety disorders are associated with reduced heart rate variability: A meta-analysis. Front. Psychiatry 5:80. doi: 10.3389/fpsyt.2014.00080

Fagundes, C.P. etal (2014) Attachment Anxiety is Related to Epstein-Barr Virus Latency. Brain, Behavior, and Immunity (2014), doi: http:// dx.doi.org/10.1016/j.bbi.2014.04.002

Jacobson N.C. & Newman, M.G. (2014) Avoidance mediates the relationship between anxiety and depression over a decade later. Journal of Anxiety Disorders. 28 (2014) 437-445.

Kessler, R. C., & Greenberg, P. E. (2002). The economic burden of anxiety and stress disorders. Neuropsychopharmacology: The fifth generation of progress, 67, 982-992.

Kravitz HM, Schott LL, Joffe H, Cyranowski JM, Bromberger JT (2014) Do anxiety symptoms predict major depressive disorder in midlife women? The Study of Women's Health Across the Nation (SWAN) Mental Health Study (MHS). Psychological Medicine [2014:1-10] DOI: 10.1017/S0033291714000075

Mohanty, S. et al (2014) Baseline anxiety impacts improvement in quality of life in atrial fibrillation undergoing catheter albtion. J Am Coll Cardiol. 2014;63(12_S):. doi:10.1016/S0735-1097(14)60395-8

Rubertsson, C et al. (2014) Anxiety in early pregnancy: prevalence and contributing factors. Archives of Women's Mental Health June 2014, Volume 17, Issue 3, pp 221-228

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