All My Life’s a Circle

Hey, semi-loyal readers. It’s been awhile.

I’ve been spending time being sarcastic and funny on my other site for several months, but I’ve returned to KnowFear for a simple reason.

I’m back in therapy – this time with a psychiatrist instead of a psychologist – hoping to make it up another level on the terrace of healing. Nothing like having lofty goals, right?

All of which reminds me of the lyrics to an old Harry Chapin song, suitable since Harry won’t be having any new songs:

All my life’s a circle;
Sunrise and sundown;
Moon rolls thru the nighttime;
Till the daybreak comes around.

All my life’s a circle;
But I can’t tell you why;
Season’s spinning round again;
The years keep rollin’ by.

It seems like I’ve been here before;
I can’t remember when;
But I have this funny feeling;
That we’ll all be together again.
No straight lines make up my life;
And all my roads have bends;
There’s no clear-cut beginnings;
And so far no dead-ends.

I’d been doing pretty well for a bit. Highly functional, I believe is the term, the moniker both descriptive and low-balling at the same time. But I’d developed some hitches in my giddy-up and thought it was time for someone who knew what they were doing to take a peek under the hood before I use too much torque and snap off a bolt.

The issues? Falling out of regular practice with my tools, because I get lazy when things go well for a bit until I’m reminded that the Soapbox Derby car only has momentum until it reaches the bottom of the hill. Then what?

Home issues have presented themselves as we attempt to balance a super-smart nine year old son with moderate-to-severe ADHD with a father dealing with anxiety problems and a mom with her own ADHD-driven challenges. There are just times when we’re all takers at the same time, when normally there’s a good balance within the triangle. What the heck is one supposed to do about that?

The good news is that spring has sprung. The trees (mostly) have buds sprouting, and we’ll be greening up nicely in the next couple of weeks. Spring is usually my mental rebirth after months of cold and gray, a period I long ago christened The Dark Ages. Seasonal Affective Disorder? Please.

I’m not sure how often I’ll write, or what topics will rise to the top of the pile. I’m leery of becoming a lamenter, worried that anything I might bring to the party might be either over-done or trite. But I’ll let the comments be my guide. I do read them all, you know.

The Anxiety Lamp is lit. Smoke ’em if you’ve got ’em.

Image via Wikimedia Commons

Evolution and Depression

Scientific American takes a look at depression from a different perspective in asking if perhaps it’s the result of an evolutionary process that’s more helpful than harmful.

The authors posit that our brains play an important role in survival and reproduction, and therefore they should be resistant to high rates of malfunction. Most mental illness is rare, except for depression. Why is that?

One possible answer is that depression isn’t a disorder at all, but rather an adaptation that brings both costs and benefits.

Here’s an example:

So what could be so useful about depression? Depressed people often think intensely about their problems. These thoughts are called ruminations; they are persistent and depressed people have difficulty thinking about anything else. Numerous studies have also shown that this thinking style is often highly analytical. They dwell on a complex problem, breaking it down into smaller components, which are considered one at a time.

Without completing restating the entire article here, the main point being articulated is that depression is nature’s way of letting you know that you have some complex social problems to solve, and that your brain is actively engaged in seeking those solutions. And rather than attempting to stop depressive ruminations, therapists would be wise to encourage them in an attempt to find the answers to the problems causing the bouts of depression in the first place.

If you’ve suffered from depressive episodes, I’d like your thoughts on this concept. Does this ring true for you?

Link , via Scientific American

Welcoming and Releasing Emotions

Urban Monk has a powerful piece on the practice of dealing with our emotions rather than living a life of avoidance. As noted in the article, we tend to avoid people and situations that cause us pain and discomfort, because why put yourself in those situations if you don’t have to?

In our internal world, however, that does us more harm than good. It isn’t until we’re willing to face our pain and troubling thoughts that we begin to understand them and work through them to obtain a measure of peace.

The three steps outlined in the posting – awareness, relax into the raw emotion, and bypassing the mind, are pretty familiar to anyone who has ever experienced exposure therapy or engaged in any sort of meditation. From my perspective, it can be boiled down into one word – feel.

When we choose to feel, rather than think, rationalize, intellectualize – insert your favorite -ize here – we’re getting down to our raw base. Some people call it inviting the emotion in, and they facilitate it by naming what they are feeling out loud.

Pain, come in and walk around – I won’t push you away or hide from you. I’ll let myself be awash in you. All creatures feel pain. It’s okay.

Sadness, my old friend, good to see you again. Come sit with me and get soggy from my tears as I allow myself to acknowledge your presence and understand that it’s normal to feel you. You don’t last forever.

Fear, you’re intruding into my life, as you often do, so rather than wrestling with you, fighting and grappling in an intellectual cage match, I’m going to let you swirl around a bit, knowing that you have no stamina, and that you will soon pass and allow me to focus on more meaningful things.

It can be difficult to embrace and understand your emotions if you’ve been avoiding them for a time. In addition to how you react in your brain, what physical symptoms do various emotions cause?

Muscle tension is a good one for fear or panic, along with rapid pulse, increased rate of breathing, perhaps some dizziness or disorientation. Recognizing them, calling them out, is a good way to label them for what they are – physical manifestations of emotional reaction, temporary in nature, and not indicative of anything else. No pending heart attack or stroke, just your body physically reacting to emotions that you haven’t spent much time with lately.

My experience has been that once I welcomed these emotions, embraced them, named them, understood them, and let them flow through me, two distinct patterns emerged. First, the racing mind and physical symptoms tended to be less severe and the amount of time they lasted became less and less. Secondly, I found myself  with less apprehension about them when there was a possibility that they would occur. Since I knew what they are, what they did, and that I was able to acknowledge and embrace them, they lost all mystery and negative connotation. In the words of our friends from The Sopranos, it is what it is.

So I encourage you to stop avoiding your emotional side and send it an invitation to sit down for a chat. Buy it a cup of coffee or an herbal tea. Know that viewing your emotions as a necessary part of yourself that’s needed to make you a whole being should make it easier to make friends with your emotions, and learn to benefit from the lessons they hold.

We don’t always need to think and analyze and dissect. Sometimes, it’s best to just sit back and feel.

Core Practice: Welcoming and Releasing Emotions, via Urban Monk

Paxil Might Handicap Your Little Sperms

Great – as if taking an SSRI didn’t come with enough side-effects (erectile dysfunction, problems with ejaculation, your girlfriend no longer calling you Zeus), now comes word that up to half of men taking the compound paroxetine may suffer from increased DNA fragmentation, a predictor of compromised fertility.

First, let’s look at the bright side – since you’re medicated, you probably won’t be as anxious about this as you might have been, so that’s a plus.

From the study:

Lead author Dr Cigdem (Cori) Tanrikut explains that while the exact mechanism isn’t understood, the evidence points to the drug slowing sperm as it travels through the male reproductive tract from the testis to the ejaculatory ducts. Sperm gets “hung up,” she says, allowing it to get old and its DNA damaged.

Ack! My boys hit roadblocks and get punished on the way to the dance, so when they arrive, they’ve already got rumpled suits and tousled hair! They’ll never make it with the cute cheerleader now!

Since about half of all reproductive troubles are on the male side, this will be of particular interest to men who are looking to start (or increase) a family at the same time they are taking certain SSRI meds. Since the half-life of SSRIs isn’t very long, the study was able to show that guys returned to normal within a month of ceasing the medication.

It’s good information to have if you happen to be in that category of male patients being treated with SSRIs who are also trying to make a baby – certainly something to discuss with your doctor.

Paroxetine (Paxil®) may affect sperm quality , via Anxiety Insights

Internet Psychotherapy Proving Effective

You know, there might just be one good thing that comes out of Internet webcams after all!

Anxiety Insights links to an Australian study that demonstrates online therapy can be just as effective as face-to-face sessions. What’s interesting is that patients only required an average of 111 minutes of clinician contact over an eight-week period, which is far less than most patients spend in office therapy sessions over the same timeframe.

The online program centers around treatment for depression, and 34% of patients felt they were no longer depressed after the two-month program, while 82% reported being either very or mostly satisfied with the treatment regimen at completion.

This bodes well for those who avoid seeking treatment due to social stigma, transportation, and provider availability issues, and since most of the program involves email contact and homework lessons, high-speed Internet connectivity isn’t a requirement – sorry to disappoint you webcam fiends.

Technology is opening new treatment vectors all the time, and the online experience can help with one of the sticky aspects of conditions like depression, which is the tendency to withdraw and avoid contact. Online therapy is a good middle step between no treatment and office visits.

On-line psychotherapy as effective as face-to-face therapy, via Anxiety Insights

Treating the Children of Anxious Parents

Researchers at the Johns Hopkins Children’s Center have found that when one or both parents has an anxiety disorder, therapy involving a family-based program was effecting in reducing anxiety symptoms among the kids and subsequently the risk of these children developing their own anxiety issues later in life.

Newswise has the details of the study, which although small in sample size (40 kids between the ages of 7-12), seems promising. From the study:

Within a year, 30 percent of the children in the no-intervention group had developed an anxiety disorder, compared to none of the children who participated in the family-based therapy. Parents along with researchers who evaluated the children and their parents independently reported a 40-percent drop in anxiety symptoms in the year following the prevention program. There was no reduction of anxiety symptoms among children on the waiting list.

That seems like a statistically significant percentage to me. Not just the children benefit from the therapy, either. Parents were able to develop coping mechanisms and modify their behaviors in several areas, such as “overprotection, excessive criticism and excessive expression of fear and anxiety in front of the children.”

Hopkins is now hoping to expand the study to 100 families. For more information, email CAPS@jhmi.edu .

When Adult Patients Have Anxiety Disorder, Their Children Need Help Too , via Newswise

Does Serotonin Help Moods?

In the treatment of depression, SSRIs (selective serotonin reuptake inhibitors) or SNRIs (selective norepinephine reuptake inhibitors) have become mainstrays in pharmaceutical treatment for many patients. Scientists are now asking two questions – do they work, and do they work the way everyone assumes they work?

Anxiety Insights has an interesting look at some research being performed at universities in Oxford and Belfast that questions the common belief that low serotonin levels are behind depression, and instead posit that serotonin therapies affect emotional processing.

In a recent randomized double-blind study, 42 healthy men and women who did not is have depression were given antidepressants (SSRIs or SNRIs), or a placebo for seven days. After a few days of treatment with SSRIs, they became more positive in their emotional outlook based on performance on tasks of emotional processing. These positive biases in emotional processing were independent of their reported mood.

“The drugs work quickly to change how people experience the world emotionally. We believe this is due to the effect of the drugs on emotional processing, rather than directly altering mood. Remembering and experiencing events in a more positive light helps to lift a person out of their depression,” he said. This mechanism of the action of antidepressants is compatible with cognitive behavior therapy suggesting that this dual approach will be helpful for people with depression.

Add to this research into genetic indicators that may shed some light into which patients might benefit from treatment and which might be prone to certain side effects, like weight gain, and it’s clear that while much is known about serotonin, there are many mysteries yet to be solved.

Rethinking Serotonin , via Anxiety Insights

10 Ways to Beat the Blues

BBC News Magazine has posted an article on some recommendations from mental health professionals on steps we can take to get the funk out, as it were.

Here’s the abbreviated list:

1. Lightboxes
2. Going out in the garden
3. Get yourself out of breath
4. Cook a meal from scratch
5. Stroke a cat
6. Pat yourself on the back
7. Take up a lifetime hobby
8. Do something for someone else – for free
9. Seek intimacy
10. Good things take time

The common theme coming out of this list is to slow down, stay engaged, and get connected to those around you. If that doesn’t work, perhaps a little John Lee Hooker or Robert Johnson is in order.

10 ways to beat the blues?

What would the child you were say to the adult you are?

My husband will often call me over as he’s writing, to show me some fantastical something he’s found as he’s read what you all are writing on the web. More often than not, it’s something akin to the Mc Gang Bang (a McChicken sandwich inside a double cheeseburger) from thisiswhyyourefat.com, but today it was site where Chino Otsuka creates double-portraits, pictures of herself today, overlaid with photos of herself as a child (via Andrew Sullivan’s Blog).

Some time back, when I started the work to live with my eating disorder, a therapist took the group I was part of through a visualization exercise. Being cocky, cynical, and 26, I rolled my eyes before I closed them, but decided to play along. After some breathing exercises she began: “Imagine”, she said, “you are walking down a small pathway. You pass lovely trees and somewhere in the background you hear water trickling over rocks. You have nothing pressing to do; it’s the kind of day that makes your chattering mind stop pestering you, the kind of day that you find yourself fully present.”

“You come around a small bend in the pathway, and see ahead of you a wooden bench, and on that bench, a small child with their back towards you.  The child turns to look at you over their shoulder, and you realize that this child is you, at 5 years old. The child says to you:…” – and she paused. “What,” she asked, “does that child say?”

It was the first time, in months of therapy, that I cried. Out loud. In the dark, my eyes closed, surrounded by women who had been raped, been beaten, been neglected, all with lives any typical person would have said had been far worse than the 26 year old me had lived.

Because the five year old who was me had turned to me  smiling. “What?”, she said, kicking her legs in her yellow dress with pink butterflies made for me with love by my Papa’s girlfriend Pam, “What’s happened to you?”.  She feels so bad that I have chosen this suffering.

Today I’m sitting in my lovely house, with my lovely trees, and in the background instead of the sound of water flowing over rocks I hear the sound of the young business man who does our lawn aerating our backyard. And the five year old girl that no longer sits on some bench in some visualization, but instead in my head, fully there most every day, says to me as my husband shows me Chino Otsuka’s photos, “What’s happened to you?”.

And I laughed when I told this story to my husband, before I cried as I wrote this, because today I’m smiling back at me.

“..everything unendurable was in the head, was the head not Abiding in the Present but hopping the wall and doing a recon and then returning with unendurable news.” – David Foster Wallace, Infinite Jest

The Line Between Stress and Anxiety

Molly Belmont writes in the Albany Times Union about the blurred line between stress and anxiety.

The article posits that a clear delineation between the two is easily derived. Stress is based on actual events and eventually dissipates, where anxiety is a more pervasive worry aligned with various aspects of ones life.

John Forsyth, an associate professor of psychology at the State University of New York at Albany has written a book, The Mindfulness and Acceptance Workbook for Anxiety, and he’s a proponent of a new therapy technique called Acceptance and Commitment Therapy, or ACT.

According the Forsyth, the key of ACT is to get patients to separate their disorder from how they feel about themselves. That sounds a little like the concept of self-compassion that I wrote about in my posting Compassion for Self Healing .

Psychologist Terry Mooney provides some common examples to point out the differences Mooney sees between stress and anxiety:

Most people wake up in the middle of the night once in a while. People with an anxiety disorder wake up several times a week, and can’t fall back asleep for 15 minutes or more. Sometimes, they wake up flailing, or suffer from nocturnal panic attacks, Mooney said.

Most people feel nervous in social situations. People with an anxiety disorder wouldn’t go into social situations. They would avoid them, or they would drink or use substances to numb themselves, Mooney said. High co-morbidity exists between alcoholism/substance abuse and anxiety disorders.

Most people worry about family and loved ones. People with an anxiety disorder worry mostly about themselves, Mooney said. Without assistance, their health, their job, their ritualized behavior can become all-consuming, leaving little room for the other people or activities in their lives that they enjoy.

The blurred line between stress and anxiety