Author: Nikita Kohli

I come from a family of doctors. Growing up surrounded by doctors, of all the things I heard at the dinner table the one thing that repeatedly peaked my interest was mental health. This encouraged me to shadow a psychiatrist and observe patients with schizophrenia, depression, anxiety, bi-polar disorder, autism and attention-deficit/hyperactivity disorder. As a health science major, I want to work towards removing the stigma and misconceptions associated with mental illnesses, thus preventing people with mental illnesses to feel alienated from society. I still remember when the psychiatrist taught me to say “people with schizophrenia” rather than “schizophrenic people”.

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Anxiety and Anxiety Disorders

Cutting-Edge Therapies for Selective Mutism

In the tenth episode of the sixth season of critically acclaimed legal-drama TV show called ‘Drop Dead Diva’, Kim Kaswell, one of the head lawyers, takes up a case regarding a ventriloquist who is accused of wrongly utilizing the Americans with Disability Act to gain a seat for his puppet in an airplane. When Kaswell goes to prison to bail him out, she finds him without his puppet. The ventriloquist is unable to speak properly, he stammers and struggles to communicate effectively. Without his constant companion, his puppet, he struggles to perform an activity he does for a living.

Ventriloquism is defined as the “production of the voice in such a way that the sound seems to come from a source other than the vocal organs of the speaker”; in this manner, an individual may express their ideas or feelings through a fictional character, commonly puppets.

The ventriloquist suffers from selective mutism, an anxiety disorder defined by the American Psychiatric Association as “consistent failure to speak in certain social situations where there is a natural expectation of speaking” due to anxious thoughts. With the help of his puppet, the character is able to overcome his anxiety of speaking and effectively connects with his audience. Today, many such projective techniques are employed to treat selective mutism. Masks may also have a similar remedy for those seeking treatment for selective mutism.

In addition, drama therapy defined as “the intentional use of drama and/or theater processes to achieve therapeutic goals,” utilizes a unique form of therapy for selective mutism.  A case study done involving Gladys, a 5-year-old girl diagnosed with selective mutism, found that drama therapy, when offered “ in the context of play, with play as the primary reinforcer” brought out speech within a tense period of time (Oon, 2010). This improvement allowed her to join dramatic play and speak spontaneously. This case study observed the effects of the main elements of drama therapy: the playspace, role-playing, and dramatic projection. Gladys’s self-esteem and sense of spontaneity increased. Subsequently, these two qualities helped her generalize her speech to new settings on her own. Gladys’s newly harnessed spontaneity further helped her become more sociable and comfortable. This study advances the possibility of integrating a behavioral skill with drama therapy for therapeutic benefits of a child with an anxiety-related condition like selective mutism.

Such novel approaches to selective mutism have been successful in remodeling the social worlds of individuals without the sober tone that therapy can sometimes entail. Unaccompanied by an emphasis on their anxiety disorder, children and adolescents may benefit from unconventional therapies that focus on developing the individual rather than the illness.

References:

Drop Dead Diva RECAP 6/1/14: Season 6 Episode 10 “No Return”. (n.d.). Celebrity Dirty Laundry. Retrieved December 01, 2017, from https://www.celebdirtylaundry.com/2014/drop-dead-diva-recap-6114-season-6-episode-10-no-return/

What is Drama Therapy? (n.d.). North American Drama Therapy Association. Retrieved December 01, 2017, from http://www.nadta.org/what-is-drama-therapy.html

Sound Advice – Selective Mutism Foundation. (n.d.). Selective Mutism Foundation. Retrieved December 01, 2017, from https://www.selectivemutismfoundation.org/info-on-selective-mutism/sound-advice

Playing with Gladys: A case study integrating drama therapy with behavioural interventions for the treatment of selective mutism. (n.d.). Sage Journals. Retrieved December 01, 2017, from http://journals.sagepub.com/doi/abs/10.1177/1359104509352892

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Anxiety and Anxiety Disorders

When Your Furballs Get Too SAD

Big brown eyes with russet tear stains leading to their warm and moist snout, violently sniffing you every time you enter your home. Staring at you with complete adoration, but a hint of suspicion and accusation, almost saying: “Is that another dog I smell on you? How dare you? ” And yet there is love and wild excitement to see you – a love so pure that your heart never becomes immune to it. How often do we look to our canine friends for support?

For centuries humans have found a friend, and a reason to smile, in dogs. Today, for those who do not have dogs, sensational “puppy videos” are created and uploaded on social media and these provide relaxation to some. Their innocence, playfulness, and unconditional love are key for many individuals to deal with their anxiety disorders. These furballs distract them from their over-worked minds and soothe their nerves. However, what happens when these tail-waggers have an anxiety disorder? Dogs may stop eating or act in an unruly manner if their owner’s absence makes them nervous. Language has been a communicative barrier. We do not know what they are feeling; a wag of a tail, a lick, a bark, can all be interpreted differently by us humans. How can we tell if a dog’s anxiety is a persistent issue that may need treatment?

Twenty percent of the nation’s 80 million dogs have separation anxiety disorder or SAD, according to Dr. Nick Dodman of Tufts University’s Cummings School of Veterinary Medicine, and around 29 to 50 percent of senior dogs are affected (Borreli 2014). Dr. Dodman explains that dogs usually develop this disorder at a young age, and older dogs may develop an anxiety disorder as a response to their dependency on their owners when they are ill. They are not only loyal to their owners, but also very emotionally attached. Therefore, they may get anxious when separated from their owner. While we may not be able to understand dogs as clearly as another human who is able to communicate their anxiety to us verbally, there are defining symptoms in their behavior that can be observed if they suffer from separation anxiety, just like there would be in a human’s behavior. “Signs of separation anxiety are caused by a dog’s need to reduce tension or stress and only occur in the owner’s absence,” describes Dodman. “The most common complaints by pet parents is that their dogs are disruptive or destructive when left alone. They might urinate or defecate; bark and howl; or chew on objects, door frames or window sills,” he pointed out.  

Dianne Larson of California described her experience with her young black Labrador, Ruby, when her 14-year old son, Tanner, goes to school: “School started two weeks ago and Ruby still searches for Tanner when he’s gone. She stays in his room. If his door is closed, she will whine to get in. If she isn’t in Tanner’s room, she’s at the front window watching for him” (Borreli 2014). Experts say that dogs who suffer from this anxiety disorder may whimper frequently and refuse to eat when their owners absent. Dr. Dodman further explained, “There will be an exuberant greeting when you do come home, one that can last several minutes and be completely crazy, then the dog will run to the food bowl.”

There are several activities that pet-owners can engage their dogs in themselves to alleviate their anxiety. Some recommendations by Dr. Dodman are: walking your dog before you leave the house, leaving home with puzzles and toys for your dog to play with and keeping departures and arrivals “low-key.” If the severity of your dog’s anxiety persists, Dr. Stephanie Borns-Weil of Cummings School of Veterinary Medicine at Tufts University recommends a formalized independence training that aims to stop reinforcement of attention-seeking behavior, ensure the dog has plenty of mental and physical exercise because a “tired dog is a happier, more relaxed dog,” and several other techniques.

Dogs provide comfort and joy to countless individuals. The least we can do for them is to interpret their behavior correctly and identify their stress. We mustn’t take their unconditional love for granted and ensure their optimum mental health.

References:

Borreli, L. (2014, August 29). Puppy Love: Dogs Suffer Back-To-School Blues With Separation Anxiety From Kids, But Can It Be Treated? Medical Daily. Retrieved November 16, 2017, from http://www.medicaldaily.com/puppy-love-dogs-suffer-back-school-blues-separation-anxiety-kids-can-it-be-treated-300532

“I’ll Be Right Home”. (2017, June 30). Tufts University. Retrieved November 16, 2017, from http://news.vet.tufts.edu/2014/07/ill-be-right-home/

Categories
Anxiety and Anxiety Disorders

Foreseeing the Unforeseen: Anxiety and Romance

You were not expecting this. Your life has come to a standstill. Other people dismiss it as “teenage drama” and expect you to get over it. It’s frivolous and temporary, they think. It’s a transient phase in every teenagers’ life. Is that why you underestimate and dismiss your own feelings? You shove them away somewhere deep inside, plaster a smile on your face and hold your shoulders high, ready to face the world, as if it doesn’t affect you at all. But because of the termination of a romantic relationship in your life panic, fear and anxiety have set in. You’re not the same person anymore, but nobody can see it. The damage is not physical– there are no fractures or bruises, it is intangible.

Romantic relationships during adolescence are not uncommon. Dr. Wyndol Furman, an editor of the book ‘The Development of Romantic Relationships in Adolescence’ described adolescence as, ”a roiling emotional caldron whose major fuel — more than parents, peers or school and almost as much as those things combined”– is romance (Gallagher Nov 2001). While romantic relationships can provide companionship and joy, the termination of such a relationship, whether expected or unexpected, can cause emotional tribulations in the lives of the affected. Feelings of sadness and depression may be expected to occur in such a scenario, but feelings of panic or anxiety, especially when a person has never experienced it before, can be surprising and scary (Robboy).

An example of an who individual who expressed their surprise to the anxiety they experienced after their breakup on a relationship-anxiety forum, gives us insight into what it could feel like: “I also think I’ve been experiencing mini-anxiety attacks but I don’t really know. The only other time I’ve had an anxiety/panic attack was during a rough patch in my life. I don’t know how to control this especially since I’m a student who is fairly busy all day long” (upsided0wnn, 2017). Their words delineate confusion and doubt regarding the reality of her anxiety. Adolescents may experience this confusion because they are not informed about the symptoms and prevalence of different forms of anxiety disorders. Another crucial factor that may cause this confusion could be the assumption that symptoms are normal and what is expected after ending a romantic relationship. They may feel that being sad after a breakup is typical, but since anxiety after a breakup is less heard of or anticipated, they could be hindered from recognizing it.

Perhaps recognizing the cause of anxiety after a breakup could facilitate adolescents to anticipate it, and thus seek help or treatment. Sadness post-breakup can sometimes be an awaited emotion, and root cause of sadness may not impossible to decipher either. However, since the cause of anxiety may not be that easy to pinpoint, it could overwhelm them. Caroline Robboy, founder and executive director of a counseling organization in Philadelphia called Center for Growth Inc, explained why anxiety might be experienced after a breakup. She explained that since the discontinuation of a significant relationship engenders a major transition in a person’s life, they are bound to move into at least “some degree of unknown territory.” She further elaborated that anxiety is an “extremely normal feeling to have when facing the unknown.” This unknown territory could be in the form of not being able to rely on their partner for “social engagement, financial support or even life advice”, which was previously a major constant in our lives (Robboy). When such familiar feelings and habits are abruptly taken away from us, anxiety could set in.  

Adolescents may be in vulnerable phases– they are fascinated with experimenting and romance. Some fall in love with the idea of love and want to be swept away in a whirlwind of movie-like romance, while some fall prey to popular culture that focuses on just having a good time. Either way, mental health should always be given importance. It is easy, especially at this age, for emotions to feel blurry and overwhelming, but being aware of mental health issues that might arise in certain situations could help get intervention and prevention at early stages.

References:

Anxiety after a breakup • r/Anxiety. (n.d.). Retrieved October 24, 2017, from https://www.reddit.com/r/Anxiety/comments/5fecoi/anxiety_after_a_breakup/

End of Relationship Anxiety. (n.d.). Retrieved October 24, 2017, from http://www.therapyinphiladelphia.com/tips/end-of-relationship-anxiety

Gallagher, W. (2001, November 12). Young Love: The Good, the Bad and the Educational. Retrieved October 24, 2017, from http://www.nytimes.com/2001/11/13/health/young-love-the-good-the-bad-and-the-educational.html

Categories
Anxiety and Anxiety Disorders

Taking off the Invisibility Cloak

“We human beings are social beings. We come into the world as the result of others’ actions. We survive here in dependence on others. Whether we like it or not, there is hardly a moment of our lives when we do not benefit from others’ activities. For this reason, it is hardly surprising that most of our happiness arises in the context of our relationships with others.”

Dalai Lama XIV summed up the essential nature of social interactions with this statement. He believes that humans need each other to progress and develop in life, and without co-dependence, it is difficult to further oneself in life. Stronger together, he urged. College is a time where people invest in the future they’ve always dreamed of, it can be a demanding and trying period in a student’s life. The support of fellow students and professors can be key to success, and reaching out for help may make messy situations drastically easier. However, if students are being hindered by anxiety about social interactions, college can become more difficult.

Social anxiety is defined by the DSM-V as the “fear or anxiety about social situations in which the individual is exposed to possible scrutiny by others.” For example, social situations involving a conversation with someone, or meeting an unfamiliar person, or being observed (for example while eating or drinking), and/or performing in front of others, can almost always produce anxiety in people who suffer from social anxiety (DSM-V).  The prevalence of social anxiety on college campuses has increased tremendously, however, have the resources to accommodate this disorder grown parallel (Weaver 2012)? How can a person with social anxiety navigate the plethora of social situations a student can be exposed to, such as: on-campus employment,  group projects, class presentations, attending professor office hours or even writing emails, during their time at college?

An individual’s living condition can either provide stability or break the peace of mind of that individual. For people with social anxiety, a place where they are comfortable is a place where they can escape to after a long day of socializing. This location is crucial for their health. A thread on a website called ‘Social Anxiety Support’ discusses people’s experiences of living in a college dorm could be like. A user called CaptainRoommate said, “I’m sure everyone in my hall thought I was a complete jerk because I didn’t talk to them. Some of the more outgoing people made an effort but I was dismissive. They left me alone most of the time, and the last three years I lived in an apartment.” Another user called Dead Leaves states, “ I lived with three roommates my freshman year of college. I tend to be a pretty open guy, so details about my social anxiety and depression were known to them after a few months. I began to withdraw when I started to worry I was boring them.” These stories share a common theme: avoidance from the fear that they were being negatively evaluated. Negative evaluation is the hallmark of social anxiety– the fear of being rejected, humiliated or even offensive can lead people to withdraw from their social situations (DSM-V). In a post in the HuffPost, Jessica G. gave insight into what goes on inside the head of someone suffering from social anxiety: “I actually find myself talking a lot when I am with my friends… in my mind I’m telling myself, be quiet, you’re talking too much, no one cares, everyone is judging you.”

While the residential setup of college campuses can be distressing for people who suffer from social anxiety, achieving the academic expectations in a social environment can also be extremely challenging. ‘Social Anxiety Support’ discusses a user named SArainadash’s academic struggle: “I get tense when a class is about to start. I’m too anxious to eat in the dining halls. I haven’t made a single friend. I looked through every of my college classes’ syllabus, there is just no way I can cope with all those presentations, interviews, speeches, etc. My biggest nightmare right now is not being able to drop out… I know it sounds crazy but I just can’t do these things without shaking in embarrassment. I do not want to attend college until my social anxiety subsides.” A user named ‘gthopia94’ responded to him saying, “I barely made it through 2 months of college a couple of years ago. Don’t even know why I even bothered in the first place.” The narration of such incidents brings to light that surely, dropping out cannot be the only solution for people who suffer from social anxiety in college. Between facing extreme discomfort and dropping out there must be a middle ground, an area of compromise where they can receive accommodations for their comfortability.  A 10-year summary report done by the Center for Collegiate Mental Health in 2015 showed that the overall growth in enrollment at universities was responsible for an increased usage of psychological counseling services, and the rise in demand for such services outpace that of enrollment growth by five times as much, thus making them available to fewer people (Kwai 2016).

While more effort to increase psychological counseling facilities on college campuses is imperative, perhaps an action for bigger change is also appropriate and necessary for all people who have to silently struggle with social anxiety. In 2015, the Equal Employment Opportunities Commission defined the “ability to interact with others” as a major life activity, bringing social anxiety disorder under the protection afforded by the Americans with Disabilities Act (ADA) (Cubbage 2015). While the world is growing and developing exponentially, and all of us are running our rat races, it is important to look back and ensure that we’re providing support and equal opportunities to everyone. Social anxiety affects 7 to 13 percent of the population on the western hemisphere, depending on the diagnostic threshold (Furmark, 2002). Having the ability to access resources provided by the Americans with Disabilities Act (ADA) is one step towards making college a less stressful experience, but we can surely do more to accommodate the needs of those with social anxiety.

References:

Anxiety Disorders. (n.d.). Retrieved October 06, 2017, from http://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm05

Contributed by EmpowHER writer Rheyanne Weaver. (2013, November 16). Social Anxiety Can Be a Hidden Problem in College. Retrieved October 06, 2017, from https://www.goodtherapy.org/blog/social-anxiety-college-students-0717126

College Kids: How’d You Survive Dorm Life?? (1969, December 31). Retrieved October 06, 2017, from http://www.socialanxietysupport.com/forum/f26/college-kids-how-d-you-survive-dorm-life-139302/

Mighty, T. (2017, September 19). 24 Things People Don’t Realize You’re Doing Because Of Your Social Anxiety. Retrieved October 06, 2017, from http://www.huffingtonpost.com/entry/24-things-people-dont-realize-youre-doing-because_us_59b2cfdde4b0c50640cd66e0

College big problem. (2017, March 10). Retrieved October 06, 2017, from http://www.socialanxietysupport.com/forum/f289/college-big-problem-2067425/

Anxiety over Reasonable Accommodation under the ADA for Social Anxiety Disorder. (n.d.). Retrieved October 06, 2017, from https://www.natlawreview.com/article/anxiety-over-reasonable-accommodation-under-ada-social-anxiety-disorder

Furmark, T. (2002, April 04). Social phobia: overview of community surveys. Retrieved October 06, 2017, from http://onlinelibrary.wiley.com/doi/10.1034/j.1600-0447.2002.1r103.x/full

Categories
Anxiety and Anxiety Disorders

Ensuring the Best for Your Baby by Putting Yourself First

The nine months of pregnancy are romanticized as the happiest and most blissful period in a woman’s life. It marks the birth of another soul and the transformation of a woman into a mother: where she learns to put her baby before herself, always. These nine months are spent planning every detail of the baby. Knowing that as a parent, you have the power to create and shape another human can be scary and beautiful in equal parts.

Due to the high stakes involved in this nine-month period, pre-existing anxiety disorders are prone to exacerbation (Rubinchik, 2005). There are psychological and physiological changes happening in the mother-to-be’s life such as increased heart rate, increased blood flow and increased activity in the kidneys may be some (Brown). According to DSM-V, anxiety is defined as the “anticipation of future threat” or “cautious or avoidant behaviors to avoid future danger” During a stressful period such as pregnancy, new mothers can develop protective instincts and worry about providing for their child, thus stress and caution running high. In addition, there are 100 to 1000-fold hormonal variations occurring, which may also exacerbate such emotional difficulties (Rubinchik, 2005). This brings us to a pertinent question: How do mothers deal with anxiety disorders during pregnancy, which is supposedly the epitome of womanhood?

Everything the mother experiences, within herself and her surroundings, affects the fetus (Murphy, 2011) . Hence parents-to-be tend to be extremely careful of what they are exposed to, particularly medication. Everything the mother consumes is absorbed into her blood, and that blood goes into the fetus (Children’s Hospital of Philadelphia). Thus many clinicians admit that they prefer not to prescribe pregnant women medications during these prime nine months. Although there’s no definite information about the effect of anti-anxiety drugs on a fetus, women affected with anxiety do not have access to medication. There are very few studies on expecting women (What to Expect, 2015); Dr. Stephanie Ho, a reproductive psychiatrist, states that FDA’s warning on the SSRI paroxetine (Paxil) risk of increasing cardiovascular defects in a fetus was based on three unpublished studies. This insufficient amount of researched data has caused most women to discontinue their medication for the safety of their child, thus disrupting the blissful period that they are supposed to have during her pregnancy.

On ‘BabyCenter Community’ many women discuss whether taking anxiety medication would be safe for their babies. A user said: “When I was pregnant my doctor stopped my medication and I relapsed. My panic attacks, that had once been under control, were now worse than ever. I developed a new fear of leaving my house and began to feel like a prisoner in my own home. I couldn’t drive either. What bothered me the most though is that there were meds to treat this but my obstetrician thought it was best for me to stay away from them.” Another user said, “I started having panic attacks when I was 11 years old. I am 24 years old now and 19 weeks pregnant. I started suffering from panic attacks again probably after the first trimester. I have one almost every time I leave my house. I talked to my care provider about this and she suggested I stay at home and limit what I do. She said, “I know that doesn’t sound fun, but if it can keep you off meds then do it.” However, she did mention that she would prescribe me meds if my panic attacks did not get any better. I want to be able to do normal things without freaking out so I know I need to get on something. I went so many years without a panic attack and now that I’m pregnant it’s triggering them again. Good luck to you all! I wouldn’t wish panic attacks on anyone.”

Discontinuing medication or not having resources available during a pregnancy can be extremely emotionally taxing for the mother and those around her. Most of the mothers on this “Baby Center Community”  wish that they could continue taking their medication: pregnancy without panic attacks can be exhausting in itself. Constraints like not being able to step out of your house along with additional mental difficulties may leave the mother with unpleasant memories, and perhaps even less willing to bear another child. A mother’s physical health has always been given utmost importance during her pregnancy, such as yoga and nutrition. Adequate research has been done about the physical needs of mothers and the baby’s, however, not enough research has been done regarding medications that are safe to use while pregnant.

On 13 September 2017, Dr. Yonkers at Yale University released the results of a study about the true implications of benzodiazepines and serotonin reuptake inhibitors, which are common medications for Generalized Anxiety Disorder and panic disorder, on pregnant women and their babies. The study recruited women at 137 obstetric practices in Connecticut and Massachusetts before 17 weeks of pregnancy, reassessed them at 28 (±4) weeks of pregnancy, and at 8 (±4) weeks postpartum. The diagnoses of anxiety disorders were determined by the World Mental Health Composite International Diagnostic Interview and other information such as treatment with medications, substance use, previous adverse birth outcomes, and demographic factors were also assessed (Yonkers, 2017).

Dr. Yonkers’ study concluded that with maternal benzodiazepine treatment, 61 out of 1000 newborn babies required ventilatory support and the duration of gestation was shortened by only 3.6 days. On the other hand, mothers who used serotonin reuptake inhibitor to treat their anxiety disorder, gestation was shortened by 1.8 days and 152 of 1000 additional newborns required minor respiratory interventions. What this means is that although there was an increase in some adverse effects, the rates were very modest. It is up to the parents and doctors to decide if continuation of these medications is the best option for the pregnancy, but this study opened an avenue for pregnant women by empowering them with the knowledge of consequences and allowing them to make a more informed rather than cautionary decision.

Every expecting parent’s primary concern is to give their child the very best. To do so, it is vital for them to ensure their own well-being, both mental and physical. Based on Dr. Yonkers’ study, expecting females who struggle with anxiety disorders can consider staying on or starting anxiety medication such as serotonin reuptake inhibitor and benzodiazepines, after consulting their physician, because if they are mentally healthy and eased, their baby gets a healthier mother. Hence, mothers: by putting yourself first you’re actually putting your babies first.

References:

Mom Answers. (2010, February 06). Retrieved September 20, 2017, from https://www.babycenter.com/400_can-pregnancy-bring-on-anxiety-attacks-is-it-safe-to-take-an_2460541_633.bc

Paul, A. M. (n.d.). What we learn before we’re born. Retrieved September 24, 2017, from https://www.ted.com/talks/annie_murphy_paul_what_we_learn_before_we_re_born

Philadelphia, T. C. (2014, August 23). Blood Circulation in the Fetus and Newborn. Retrieved September 24, 2017, from http://www.chop.edu/conditions-diseases/blood-circulation-fetus-and-newborn

Physical Changes During Pregnancy – Women’s Health Issues. (n.d.). Retrieved September 24, 2017, from http://www.merckmanuals.com/home/women-s-health-issues/normal-pregnancy/physical-changes-during-pregnancy

Rubinchik, S. M., Kablinger, A. S., & Gardner, J. S. (2005). Medications for Panic Disorder and Generalized Anxiety Disorder During Pregnancy. Primary Care Companion to The Journal of Clinical Psychiatry, 7(3), 100–105.

(2015, May 28). Anxiety During Pregnancy: What’s Normal and What’s Not? Retrieved September 20, 2017, from https://www.whattoexpect.com/pregnancy/anxiety/

Yonkers, K. A., Gilstad-Hayden, K., Forray, A., & Lipkind, H. S. (2017). Association of Panic Disorder, Generalized Anxiety Disorder, and Benzodiazepine Treatment During Pregnancy With Risk of Adverse Birth Outcomes. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.2733

Categories
Anxiety and Anxiety Disorders

Take A Breath

One of the 10 most influential therapists of the past quarter-century, John Gottman, states, “Empathy and understanding must precede advice.” Oftentimes, when people share their dilemmas, we try to give them quick-fixes and solutions when instead they are searching for compassion and empathy; we present them with solutions thinking we are helping them, when we may be giving them incorrect information. What seems like conventional wisdom could be scientifically incorrect, even when given with the best intentions. People look for understanding and caring, as Gottman suggests.

A generally underrated condition, ‘panic attack’ is a term that is thrown around loosely to describe a feeling of panic and distress a person experiences when something happens unexpectedly. We frequently hear people say, ‘If I forget to take my homework to class tomorrow I’ll have a panic attack,’ or, ‘If my favorite T-shirt shrinks I’ll have a panic attack.’ While these situations may be extremely distressing for some of us or even cause panic attacks, it eludes the true meaning of what a real panic attack may feel like.

Undervaluing panic attacks might prevent us from empathizing with people who actually suffer from them. A panic attack, as described by DSM-V, is an “abrupt surge of intense fear or intense discomfort,” accompanied by at least 4 of a given list of physical symptoms of which include accelerated heart rate, sweating, trembling, and sensations of shortness of breath. The Huffington Post attempted to bring to light some corporal aspects of panic attacks through descriptions of its  Facebook and Twitter communities:

“I can’t stand up, I can’t speak. All I feel is an intense amount of pain all over, like something is just squeezing me into this little ball. If it is really bad I can’t breathe, I start to hyperventilate and I throw up.”

“It feels like my throat is being choked. My arms start tingling because I’m breathing shallowly and not getting enough oxygen, which of course panics me more.”

When these panic attacks become recurrent and unexpected, a person may be suffering from a panic disorder.

People with panic disorders are usually tormented by the fear of these attacks repeating, which may wreck their peace of mind and inhibit them from certain activities (Mayo Clinic). Chores they take for granted may be interrupted by panic attacks, impeding their desire and capacity to carry them out. Sarah, a mother of three, described how panic disorder distressed and altered her life: “One day I was standing in a queue at the bank with a friend and suddenly everything went hazy. I can remember my friend shaking me and asking if I was okay. I felt like something was really wrong, I just needed to get home. My friend was crying with fear. That was my biggest mistake, as the only place I felt safe than was home and it became my prison for 5 years. I was forced by my family to seek medical help and my [general practitioner] made me feel I was overreacting. Asking for help every time I needed shopping was degrading. The worst day of my life came when my daughter fell and broke her wrist and she was terrified and crying and I had to watch her being taken to hospital by someone else as the panic had too big [a] hold on me.”

Panic attacks may affect people mentally, physically, or emotionally. Understanding, love, and care can make them feel like they have space to heal and someone to heal for. Sarah’s personal experience coincides with this:

“There is also nothing like the feeling of watching friends and family go on holiday and knowing I couldn’t take my children anywhere. My eldest son couldn’t bare to see me suffering and moved out at 16 to live with his girlfriend, but my other two children never once asked anything of me. We spent many hours having great times at home, playing games and watching movies. They were the reason I was determined to recover.”

It may not always be obvious when someone is experiencing a panic attack, but if they do share with you, you may be inclined to assist them in some way. It is crucial that legitimate guidance be given. About 6 million people suffer from panic disorder in America (ADAA), the majority of whom experience hyperventilation during their attacks. According to Mark Tyrrell, a therapist trainer for 15 years, 60% of panic attacks are accompanied by hyperventilation. Literally translating to ‘over-breathing’, they could be a cause or an effect of panic attacks. When it occurs, the person enduring it may feel like they are short of breath because there isn’t enough oxygen in the body. However, the contrary is true– hyperventilation is a symptom of too much oxygen in the body (Tyrell).

Panicking people are often told to “calm down” and “take deep breaths,” but for someone hyperventilating during a panic attack deep breathing is a bad idea. Symptoms like dizziness and numbness occur, making the person feel like they’re suffocating; thus “taking deep breathes” would further exacerbate the problem by increasing the oxygen in the body (Meuret). A new form of therapy called capnometry-assisted respiratory training (CART) therapy teaches patients to take shallow breaths and has been found efficient in assuaging panic symptoms. Thus, the fitting action in such a situation would be to take quick, shallow breaths to balance the carbon dioxide and oxygen contents in the body.

Panic disorder can be overwhelming and debilitating for the person who suffers from it. While adopting new breathing techniques and finding the right therapy style is essential, those with panic disorders need tenderness and support of family and friends in order to heal.

References:

Holmes, L. (2014, October 21). This Is What A Panic Attack Physically Feels Like. Retrieved April 30, 2017, from http://www.huffingtonpost.com/2014/10/21/panic-attack-feeling_n_5977998.html

Chapter 16. Panic Disorder. (n.d.). Retrieved April 30, 2017, from http://psychiatryonline.org/doi/full/10.1176/appi.books.9781585625048.gg16

Pappas, S. (2010, December 26). To Stave Off Panic, Don’t Take a Deep Breath. Retrieved April 30, 2017, from http://www.livescience.com/9204-stave-panic-deep-breath.html

Part 4: Panic attack symptoms – Hyperventilation (over-breathing). (n.d.). Retrieved April 30, 2017, from http://www.panic-attacks.co.uk/course/4-panic-attack-symptoms-hyperventilation-over-breathing/

Panic attacks and panic disorder. (2015, May 19). Retrieved April 30, 2017, from http://www.mayoclinic.org/diseases-conditions/panic-attacks/basics/definition/con-20020825

Sarah’s Anxiety Story. (2014, October 01). Retrieved April 30, 2017, from https://www.nopanic.org.uk/sarahs-anxiety-story/

Facts & Statistics. (n.d.). Retrieved April 30, 2017, from https://www.adaa.org/about-adaa/press-room/facts-statistics

Categories
Anxiety and Anxiety Disorders

#MightyAndMedicated: Utilizing Our Options

Isaac Asimov accurately summarized the plight of society when he stated, “The saddest aspect of life right now is that science gathers knowledge faster than society gathers wisdom.”

Science and technology have made the world a relatively easy place for us to live in; advancements in the field of medicine have enabled us to decode symptoms and ameliorate our ailments. Cancer can be treated, holes in the heart can be closed without surgery, smallpox has been eradicated, and vaccines can facilitate prevention of diseases. The world of science, as stated by Isaac Asimov, has made tremendous progress for the betterment of humans lives. However, why do we hesitate to utilize these developments to maintain our mental health? Or to alleviate our anxiety?

Understanding anxiety and the changes it can cause in our bodies may contribute to our decisions on how to curtail it. Mia Lundin, a nurse practitioner and an international leader in her field, explained that anxiety could be an outcome of deteriorations or deficiencies in the body. Chronic stress, which causes depletion of stress hormones in the adrenal glands, could be one. When the adrenal glands become fatigued, stress hormones become imbalanced, resulting in possible anxiety or panic attacks. On the other hand, higher or lower levels of important neurotransmitters in the brain such as dopamine and GABA, respectively, could also lead to anxiety disorders (Lundin). Recognizing that science can offer us answers that may otherwise seem inexplicable may help us be more willing to accept support.

The ideology that science adds a valuable choice to the process of healing ourselves is not shared by everybody. Recently, a Twitter account called ‘Team Not Ashamed’ started a movement called ‘#imnotashamed’ advocating that people should regulate the biochemicals in their brains naturally by living a healthy life and that drugs make people “artificially happy.” This evoked a strong reaction in Nicole Campbell, who has been struggling with generalized anxiety for 10 years. She wrote an article addressing the team titled: ‘To the Person Who Called Me a ‘Drug User’ for Taking Anti-Anxiety Medication.’ She explained that the hearsay surrounding anxiety medication about the negative impact of its side-effects could leave people who wish to try it feeling skeptical: “I understand the negative place you’re coming from. When I was first diagnosed and treated, it was a guessing game. I tried medication after medication. Moved from one therapist to another. Had to deal with my diagnosis changing faster than I changed my gym clothes. Many of the medications prescribed weren’t right for me. Some aggravated my migraines, made me a zombie and some just didn’t work at all. But I was no longer suffering as much as I had been.”

Paxil and Zoloft, two of the more popular anti-anxiety medications, improve moods (Folk and Folk, 2015). They may have side-effects such as insomnia or sleepiness, sexual dysfunction, and/or weight gain. However, despite the symptoms, they are considered an effective treatment for anxiety disorders. Another class of common drugs include Xanax and Valium which reduce the physical symptoms of anxiety. Increased doses may be required to achieve the same effect over time (ADAA), but they are considered efficient in easing muscles tension caused by anxiety.

In October 2015, Erin Jones posted a photograph of herself holding her prescriptions on Facebook to mark her return to her treatment. She said, “I have tried living this life without prescription help. It seems to have me on top of the world one minute and rocking in the corner the next. There is no consistency. I’m done with that. Anxiety and antidepressant medication to the rescue.” This inspired many others to share their stories of anxiety medication using the hashtag ‘#MedicatedAndMighty’. It also encouraged people who had been silent and afraid of psychiatric medications to reach out. Amelia Bienstock tweeted about her experience, “Became depressed a year ago. Cried every day until August. Wish I’d gone on meds sooner. That was terrifying for me to post but if it helps anyone it was worth it. #MedicatedAndMighty #EndtheStigma”

Jones was thanked by people all over the world for opening up a conversation about mental health and medication. In an interview following this incident, she said, “It’s as if all these people were just waiting for someone to say, ‘It’s okay to take care of yourself.’”

It is this barrier that we must overcome. Most prescribed medicines have side-effects (Conger). Things that help us usually come with a price tag or a set of consequences. Anxiety medications do too. It can be difficult to find the right medication, just like it can be hard to find the right therapist. Once found, further hassles can crop up. But the knowledge that something can help may make the path ahead look a little brighter–anxiety medications can be that ray of hope for some people. Reducing symptoms that cause extreme distress to a person could open up new avenues for them, and possibly metamorphose their perspectives.

References:

Lundin, M. (n.d.). Anxiety: What is it? What causes it? How Can You Feel Better? – Mia Lundin. Retrieved April 14, 2017, from https://mialundin.com/anxiety-what-is-it-what-causes-it-how-can-you-feel-better/

Ending the Stigma of Psychiatric Medication. (2016, August 26). Retrieved April 14, 2017, from https://www.bridgestorecovery.com/blog/medicatedandmighty-ending-the-stigma-of-psychiatric-medication/

Folk, J. (n.d.). Anxiety Disorder General Statistics. Retrieved April 14, 2017, from http://www.anxietycentre.com/anxiety-statistics-information.shtml

Campbell, N., & Schuster, S. (n.d.). To the Person Who Called Me a ‘Drug User’ for Taking Anti-Anxiety Medication. Retrieved April 14, 2017, from https://themighty.com/2016/02/to-the-person-who-called-me-a-drug-user-for-taking-anti-anxiety-medicati0n/

Medication. (n.d.). Retrieved April 14, 2017, from https://www.adaa.org/finding-help/treatment/medication

Conger, K. (1970, March 14). Scientists discover multitude of drug side effects, interactions using new computer algorithm. Retrieved April 14, 2017, from https://med.stanford.edu/news/all-news/2012/03/scientists-discover-multitude-of-drug-side-effects-interactions-using-new-computer-algorithm.html

Categories
Anxiety and Anxiety Disorders

Planting a Seed of Doubt in Anxious Minds

“I never shared my anxiety with any of my friends, not even the closest ones. This was mostly because it was so exhausting trying to explain something so inexplicable to those who I knew would not be able to understand.”

Solome Tibebu, founder of a mental health help site for youth, Anxiety In Teens, explained her troubles with anxiety disorder in a November 2012 TEDxTC talk. She stated she felt misunderstood because the few times that she did try to reveal her anxiety to her friends, it turned into a group discussion about their panic attacks of the week. One reason for the supposed panic attacks was when one of her friend’s ice-cream scoop fell onto the sidewalk. Due to the misconstrued ideas about what a panic attack was, Solome felt like her friends couldn’t comprehend the magnitude of her anxiety.

Anxiety disorders, as described by DSM-V, “include disorders that share features of excessive fear, anxiety and related behavioral disturbances.” The difference between the fear or distress that most people experience and anxiety disorders is that while the former is caused by “real or perceived imminent threats,” the latter is usually a result of  “anticipation or overestimation of a future threat.”

A similar incident to Salome’s happened in my life a few months before I had been formally diagnosed with generalized anxiety disorder. I told a friend about my persistent anxious thoughts and received the reply of,  “We all get anxious. School is hard. You’re normal.”

Solome Tibebu’s situation is not uncommon–anxiety disorders are often underestimated and considered an exaggeration of commonplace anxiety. A study conducted by the Australian National University on perceived stigmas revealed that 56% of people felt that most people do not consider anxiety disorders real medical illnesses. Moreover, 52.7%  of people felt that most people think an anxiety disorder is a sign of personal weakness and 55.3% believed that most people think that people with an anxiety disorder could “snap out of it” if they wanted to.

This unawareness about the difference between anxiety disorders and regular anxiety could leave people with anxiety feeling misunderstood and disconnected from the world. “I was completely alone in my thoughts,” Solome Tibebu said, expressing that neither her dad, nor her friends could gauge the nature of her feelings. Trivialization rarely eludes anxiety disorders. However, internalizations of such erroneous underestimations can lead to self-stigma in people who have anxiety disorders. Self-stigma is defined as the “incorporation of others’ prejudices and stereotypes into beliefs about oneself” (Lucksted and Drapalski).

In November 2016, Ashley J. shared her story of self-stigma with the Humanology Project. “At seven years of age I had my first anxiety attack and that’s when I started to wonder if I was a broken, sick child. The emergency room doctor told my parents I was a hypochondriac and to this day his words still haunt my mind. This made me discredit my emotions and anxiety attacks for years. Growing up was perhaps one of the hardest hurdles I had to face: questioning myself, hating myself, and being so angry that I was not normal.”

The negative consequences of self-stigma are more prevalent in people who have anxiety disorders, according to a study conducted by Activitas Nervosa Superior Rediviva, an international peer-reviewed journal. People with anxiety disorders often have a lower self-esteem and a more sensitive temperament; thus when they hear misguided theories discrediting their disorder, they may internalize them more easily than others–just like Ashley did. Feelings of shame and anger may follow, leading to a delay in treatment and chronification of the disorder (Ociskova, Prasko and Sedlackova).

From personal experience backed by scientific research, I would like to encourage the people who have anxiety disorders to try to disengage with these stigmas of them. What you feel and experience every day is your reality, other’s may not be aware of it. Just because your feelings don’t align with another persons’, or are more intense, doesn’t imply that they’re not real. On the other hand, while your emotions and experiences may not be nonpareil, they are nothing to be ashamed of. The certainty you have about the existence of your emotions should be not be affected by seemingly ignorant opinions other people have of them.

References:

Ociskova, Marie, Jan Prasko, and Zuzana Sedlackova. “Stigma And Self-Stigma In Patients With Anxiety Disorders”. Activitas Nervosa Superior Rediviva. N.p., 2013. Web. 2 Apr. 2017.

(2012, November 30). Retrieved March 30, 2017, from https://www.youtube.com/watch?v=8PcdRyB8YJY

Director, C. (2016, September 21). Generalised Anxiety Stigma Scale (GASS). Retrieved March 30, 2017, from http://cmhr.anu.edu.au/mental-health-measures/generalised-anxiety-stigma-scale-gass#field-cmhr-scale-resource-tab-0

Lucksted, A., & Drapalski, A. L. (2015). Self-Stigma Regarding Mental Illness: Definition, Impact, and Relationship to Societal Stigma. Retrieved March 28, 2017, from https://www.apa.org/pubs/journals/features/prj-prj0000152.pdf

Ashley J. (n.d.). Retrieved March 30, 2017, from http://www.humanologyproject.org/stories//ashley-j

Categories
Anxiety and Anxiety Disorders

Interview: Raising the Rainbow Flag

This is an interview with a student who recently discovered a new part of herself– her homosexuality. This article explores her struggle with anxiety through her and one of her friends. She would like to remain anonymous, thus she will be referred to as Eva and her friend as Lindsey in this article.

The Humanology Project: When did you first meet Eva?

Lindsey: Eva was my first friend at college. We met on our college’s housing portal and awkwardly agreed to share a room together. For a while, we were each other’s only friends – we got our meals together, did our laundry together. As we got comfortable with each other I found that behind her shy persona was an outgoing, selfless girl that had struggled with her sexuality and anxiety for a while. She concealed her troubles and pain with levity, hiding them so well that if I hadn’t known her personally, I might’ve dismissed it as a self-reflexive sense of humor.

THP: Eva, what would you describe as your biggest struggle?

Eva: I always knew that I had anxiety; it took me longer to come to terms with my sexuality. At first I came out as bisexual, but then I met the kind of guy I’d always wanted and it still didn’t seem right. The situation was baffling for me because although I thought I had found the perfect label for myself, I now had to deal with the of challenge of accepting myself all over again. I think I found it (only a little) easier to accept myself as bisexual because in my head, perhaps, bisexuality was a compromise between society’s norm of heterosexuality and my own true desires. Embracing myself as homosexual meant that I was “atypical” in the eyes of the society that I had grown up in.

My anxiety heightened during this phase, I cried myself to sleep a lot and felt like I was “abnormal.” Anxious thoughts, such as negative reactions I could get from people about my sexuality, manifested into self-hate. When I was sixteen years, I used to stare at myself in the mirror and try to convince myself that I’m not a lesbian because I had dated boys.

Certain events from my past contributed to anxious thoughts about my homosexuality. Girls in my high school would insult other girls by calling them lesbians. The derogatory use of this term perhaps delayed me in labelling myself as one, and created challenges in loving myself as one. When I got into my first homosexual relationship and told my friends that I lost my virginity to a girl, one of them retaliated by saying, “You can’t lose your virginity to a girl.” However, virginity is something you define for yourself. This comment, unexpectedly, infuriated me instead of increasing my anxiety. It made me want to defend and accept myself more.

THP: Is there anything that has helped you calm your anxiety?

Eva: I started seeing a therapist for my anxiety a few months ago, but we mainly discussed regular stressful college affairs and basic coping skills. I’m now seeing a different therapist, who seems to be a better fit. Perhaps we as humans are scared of dealing with some of our more severe emotions, so we deal with what’s easier first, warming up to our real battles later when we find the courage to.

Television has also helped me tremendously. Seeing queerness normalized on a national television network, where I knew a lot of other people were also watching it and recognizing it as normal, gave me the sense of belonging I needed. TV series like Carmilla and Grey’s Anatomy have gay protagonists or bisexual characters that have generated huge fan bases and gay communities. These are diverse and positive safe spaces where I feel like I’m a part of something, and that comforts me. These groups have played a role in accepting myself and contributed to building a healthy self-love.

THP: How has this friendship impacted you?

Lindsey:  Eva is the first person I think of when something troubles me. She always knows what to say to alleviate my perturbation. Because of her experiences, perhaps Eva can decipher the complexities of other people’s emotions and perceive their insecurities. She emanates compassion and empathy and I can express my apprehensions to her openly, without the fear of being judged. She is truly an incredible roommate and best friend. 

I’ve never had a friend who has experienced such inner conflict, or even a friend who was gay. It has given me more insight into issues that I didn’t know existed. Watching someone close to me struggle has made me wonder how many others must struggle with their sexuality and anxiety, among other things.

THP: What kind of stigma do lesbians face?

Eva: A common stigma that lesbians face is that when we come out, some of our female friends may assume that we’re attracted to them and feel threatened. This is misguided. On the other hand, men may say things like, “You haven’t been with me, I’ll make you straight.” Some men may even find lesbian women sexually appealing and thus, accept them more easily than they would accept gay men. These comments depict the ignorance of many people in our society. People also often assume that lesbiansim is a choice, that women “chose” to be lesbian because a man broke their heart or didn’t treat them well. Lesbianism is not a choice. This comment, just like all the others, is unschooled and presumptuous. It reflects the beliefs some people possess about the invalidity of homosexuality.

THP: Do you think coming out has made Eva stronger? If you could give everyone a message what would it be?

Lindsey: Eva was my first gay friend and that gave me a new perspective about things in general. Coming out has been the first step in improving her state of mind; without acknowledging the thing that causes you such strife and internal conflict, you cannot make progress. Her coming out was an intense time for her because she had to say it to two of the most important people in the world to her–her parents. It is essential to accept yourself, but sometimes people forget how important it is for those who you care about to accept you. It took a lot of courage for her to say it.

Most people have to deal with anxiety, it’s something that happens under stressful situations. However, it must be difficult to feel it so intensely and frequently. Some people don’t take much notice to it, they think ‘everyone has anxiety.’ There is a difference between what people who don’t have anxiety feel and those who do. The severity of it can be very impactful.  

I’ve always been very accepting of the LGBTQ* community–you are who you are and that’s that – it doesn’t change the fact that you are a human being with your rights to be who you are. Since I’m so open I believe that everyone must be as nonchalant about it as I am. Why would anyone be anything less than accepting? But I’m not gay and I forget there are people who are nasty and close-minded and uneducated, who can’t accept that. Living with the fear that someone wants you dead for your sexuality must be unbearable. I think that people should respect the struggle and the fight that these people go through daily for self acceptance–the acceptance of others–the fight for every right that they deserve, and the fight for decency and freedom to be who they are with no questions asked.

Eva: “The anxiety mainly develops from having to come out to people. The reason is because even if you know they will be perfectly fine with who you are and accept you 100%, your anxiety comes up with every negative possibility in your head and those negative thoughts kind of manifest.”

“Earlier, when I would come out to people I would get shaky and stutter and wouldn’t really say the words. I’ve finally been able to use the word “gay” rather than, “Oh I like girls too/and boys.” Meeting various kinds of people from the LGBTQ* community who have accepted themselves makes me believe that there’s hope for me too.”

This interview has been edited.

Categories
Anxiety and Anxiety Disorders

“Mother,Which Flavor of Ice Cream Should I Pick?”

Imagine an eight-year-old child stressing about choosing the flavor of their ice-cream as much as they would about a test at school. They stand next to a white ice-cream truck with a descriptive and colorful menu hanging on it. Chocolate chip, vanilla, strawberry, butter pecan, cookies and cream, cookie dough, raspberry ripple – the choices are overwhelming. This may be reality for a child with generalized anxiety disorder (GAD).

GAD is one of the most common disorders seen in medical settings, affecting 3% of US children and 10.8% of US adolescents (Roche, 2015). According to the Children’s National Health System, GAD occurring between the ages six and eighteen may have symptoms such as fretting about situations or decisions before, during, and after they happen, social acceptance, and school. Many adults assume this kind of worrying is normal and even a part of growing up, thus ignoring the symptoms as they appear and maintain; however, when these symptoms continue for 6 months or more, it is considered a disorder.

On an episode of her CTV News show, Bell Canada addressed GAD in children. She hosted Libby Norris, a mother whose young son has GAD, and Dr. Sandra Mendlowitz, a psychologist in the child and youth outpatient mental health program at Toronto Sick Kids Hospital. Norris recalled her struggle as a mother commenting on the inadequacy of support systems at school for her son. The stigma surrounding mental illnesses made it harder to cope. Her son’s school suggested that his lack of concentration indicated ADHD; however, after a series of tests following a grand mal seizure, he was diagnosed with GAD. Concerning this common issue, Dr. Sandra Mendlowitz said, “Diagnosis can also be tricky as children suffering from the disorder may also have trouble concentrating, which may cause confusion with other mental health issues.” There is a lack of awareness about this disorder occurring in young children.

It is important for parents to pay attention to their child’s feelings and not disregard their seemingly errant thoughts or behaviors as typical or unimportant. A child’s mental health is as important as his physical health and thus it is important to be aware that GAD can occur in people of all ages, even young children.  

References:

How parents can cope with generalized anxiety disorder. (n.d.). Retrieved February 12, 2017, from http://www.ctvnews.ca/health/how-parents-can-cope-with-generalized-anxiety-disorder-1.3255084

Generalized Anxiety Disorder (GAD). (n.d.). Retrieved February 12, 2017, from https://www.adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad

Generalized Anxiety Disorder – Children’s National Health System. (n.d.). Retrieved February 12, 2017, from https://childrensnational.org/choose-childrens/conditions-and-treatments/mental-health-behavioral-disorders/generalized-anxiety-disorder

(2016, February 10). Generalized Anxiety Disorder Statistics. Retrieved February 12, 2017, from http://mental-health-matters.com/generalized-anxiety-disorder-statistics/

Home. (n.d.). Retrieved February 12, 2017, from http://www.worrywisekids.org/