anxiety

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Don’t Worry, Be Rational: Why Extreme Fear Of Ebola Is Bad For Your Health

A licensed clinician participates in a CDC training course in Alabama earlier this month for treating Ebola patients. (Brynn Anderson/AP)

A licensed clinician participates in a CDC training course in Alabama earlier this month for treating Ebola patients. (Brynn Anderson/AP)

Let’s face it, Ebola is scary. My kids are scared. The moms at school are talking about giving their children extra multi-vitamins to boost their immune systems in a desperate attempt to do something, anything, to protect their families. But we live in Boston and there are no cases here — yet. Still, that “yet” can make us crazy.

So, in a crisis, who do you call for comfort? The level-headed risk perception consultant: David Ropeik, who spoke with me briefly today about why such intense, prolonged worry and anxiety can backfire, make your body weaker and perhaps even damage your health:

Here, edited, is our short interview:

RZ: So, why is being scared of Ebola bad for your health?

DR: The health ramifications of this are profound. When we worry, that, biologically, is stress — that’s a mini fight-or-flight response going on in the body. When stress persists for more than several days (short-term stress is not the problems), it becomes damaging to our health. Chronic stress raises our blood pressure and increases the risk of cardiovascular problems; it suppresses our immune system and makes us more likely to catch infectious diseases or get sicker from them if we do. It interferes with neurotransmitters associated with mood, and it is strongly associated with clinical depression. Chronic stress interferes with digestion and memory and depresses fertility and bone growth (slows it down).

[The negative effects of chronic stress are widely reported, but Ropeik cites the book "Why Zebras Don't Get Ulcers," by the biologist Robert Sapolsky, as a key source here.]

So you think people are overreacting and we’re moving into some kind of widespread nation-wide chronic stress phenomenon here?

We’re on the cusp. It’s like what the fear of SARS did to people in Canada — it freaked [them] out for weeks: “Here it comes again,” is what they’re saying.

How do you see all this evolving?

In the last day and a half the criticism of how health officials have handled things and the mistakes they made in Dallas, real as those mistakes are, have become a focus, and it’s now starting to undermine trust in our health care system.

In a crisis, trust is the pivotal factor for how worried people are. Continue reading

Enterovirus D68: Good News, Bad News, What To Do

(CDC)

(CDC)

Pick your viral anxiety: Do you want to focus your media-fueled jitters on Ebola or on enterovirus D68?

Personally, even with today’s news of the first U.S. death from Ebola, I pick the enterovirus every time. For one thing, it’s actually around; it’s not a single case in Texas. But I’d prefer no anxiety at all, and the best antidote tends to be knowledge. So here are some data points:

The Massachusetts Department of Public Health fact sheet on enterovirus D68 is here and the CDC’s here. At a news conference last week, Dr. Alfred DeMaria, the department’s medical director for the Bureau of Infectious Disease, told reporters that enterovirus D68 had probably been “the predominant cause of respiratory illness over the last four weeks.”

Mostly, that meant colds, he said, and he thinks he even had the bug himself. But reports of lung ailments have “decreased significantly over the past couple of weeks,” he said, so “enterovirus 68 seems to be going away.”

Let’s hope. But what the heck? Here & Now reports that the enterovirus has been connected to five deaths nationwide, most recently of a 4-year-old in New Jersey. Of course, we know that viruses can sometimes lead to deaths by unleashing bacterial infections; flu has been known to kill dozens of American children in a bad year. But still, what to make of all the coverage of this unfamiliar virus?

I asked Dr. Ben Kruskal, chief of infectious diseases at Harvard Vanguard Medical Associates. My takeaway: Yes, this is quite a bit like flu, only it’s drawing attention because it’s a virus that’s acting atypically, surprisingly. Our conversation, edited:

There are so many viruses around; why are we even hearing about this one and what should we make of the coverage?

We’re hearing about it because it is not just a strain of a virus we don’t see very often but because it’s causing unusual manifestations, and manifestations that have enough impact for us to pay attention to. It’s actually in 30 or 40 states now, and we don’t really know how widespread it is because it’s clinically not terribly distinctive. It’s a respiratory virus that looks like a lot of other respiratory viruses, including the flu and the cold viruses and a whole bunch of others. And the reason we’re paying attention is not just the fact that it’s an unusual strain — then it would be a sort of laboratory curiosity — but because it’s actually on a more severe end of the spectrum for some people.

So it’s been confirmed that it’s here in Massachusetts, and it sounds like we have had more kids being hospitalized for respiratory trouble than usual in recent weeks, right? For example, Tufts Medical Center tells us that they’ve had 54 hospital admissions of kids with repiratory problems this year, compared to 27 admissions by this date last year, and they’re tending to stay in longer and need more treatment.

I understand from Dan Slater, who’s the director of pediatrics here at Harvard Vanguard, that we went months without having to admit any kids with asthma to the hospital, and in the last few weeks we’ve had quite a few admissions.

So what’s your public health message then at this point? What do you say to parents?

It’s reasonable to think of this outbreak in most respects as being like a sort of a nastier flu season. The timing is different from the flu season but in terms of how it manifests itself, it’s pretty similar to a severe flu. Remember that the flu and this virus — like any infectious agent — have a spectrum of severity. So even though this one is on average more severe, there are still lots of people who will get just a regular old cold. And there are some people who will get kind of a nasty cold. And there are some people who will get more severe things, including asthma-like illness in people who don’t have pre-existing asthma or an exacerbation of underlying asthma in people who do.

So are there telltale symptoms to watch for? Continue reading

School Lockdown Calculus: The Line Between Preparedness And Trauma

(Cory Doctorow/flickr)

(Cory Doctorow/flickr)

By Dr. Steven Schlozman
Guest Contributor

“If there’s a lockdown and they tell me to go under the table, and there’s a window open next to my desk, I’m going out that window. There’s no way I’m sticking around.”

That’s what a 14-year-old boy recently told me after he was reminded again that with the start of the school year comes as well the now increasingly familiar “lockdown” drill protocols.

Not very long ago, you’d probably have to ask kids what “lockdown drill” meant. Now, however, most kids recognize the term as routine. There’s recess, lunch-time, fire drills and lockdowns. Since the beginning of this school year alone, there have been more than 10 actual school lockdowns across our nation. One, as recently as this week, in New York. Importantly, none of these incidents featured the horrible images that come to mind when we picture nightmares like Sandy Hook or Columbine. A child might think she’s seen a gun in the school, or neighbors nearby might brandish shotguns in the midst of suburban altercations.

In all cases, schools aren’t taking any chances. The lockdown is quickly enacted and, school officials are quick to note, no one gets hurt.

But at what cost? Is there a psychological risk to what has now become routine practice? It’s time that we examine the lockdown and all its potential repercussions.

As a child psychiatrist, I worry a lot about these drills. Schools regularly ask for advice from mental health professionals on these matters, and parents often reach out and ask, understandably, what we ought to do in the setting of the still enormously rare and, at the same time, increasing and enormously traumatic spate of school shootings. The implementation of the mandatory lock down drill at our nation’s schools represents an awful lot of energy and resources and a potentially significant threat to the psychological well-being of our students in preparation for something that still thankfully hardly every happens.

Here are the facts:

•School shootings are horrific.

•School shootings are extremely rare.

•School shootings are increasing (at least according to this FBI analysis).

•Given how rare these events are, one can accurately say that school shootings are in fact increasing at a steady clip.

In other words, if we go hypothetically from one event to four events per year, that’s a fourfold increase even though the overall number of schools without incidents still massively dwarfs the schools that have had to endure a shooter.

•Every parent and every teacher worries about these events.

•Kids, it turns out, seems to worry less about these shootings than do adults.

•Some kids, however, are significantly frightened by these drills. Continue reading

Meditation ‘Overrated’? Not So Fast.

(RelaxingMusic/Flickr via Compfight)

(RelaxingMusic/Flickr via Compfight)

My doctor recently suggested I stop multi-tasking. Focus on one thing at a time, she said: our brains aren’t wired to take on the kind of intense juggling — from chauffeuring to food prep, extracurricular logistics, work strategies, worry over aging parents, anxiety about climate change — that many of us attempt (with varying degrees of success) every day.

For me, meditation and yoga offer a lifeline: a quiet sanctuary where focusing on one thing is the only thing required.

So I was slightly annoyed by the headline of a recent Scientific American story: “Is Meditation Overrated?”

The premise of the piece is this: Many people report that meditation improves their mood and relieves various symptoms of chronic stress and other health problems, BUT the data on this isn’t terribly robust. So, the story continues, “Johns Hopkins University researchers carefully reviewed published clinical trials and found that although meditation seems to provide modest relief for anxiety, depression and pain, more high-quality work is needed before the effect of meditation on other ailments can be judged.”

So shouldn’t the headline be: “Meditation Relieves Some Modern Woes; More Research Needed To Conclusively Prove Further Benefits?”

Or, my own personal headline: “Meditation Helps Me Scream At My Kids Less And Not Attack My Husband When There’s Yet Another Wet Towel On The Bed.” (See also, a new study, entitled: “I Am A Nice Person When I Do Yoga!!!)Continue reading

Understanding Aster: How Singing And Dancing Help Heal A Child’s Trauma

For the past four years, I’ve been involved with a local nonprofit, the North Cambridge Family Opera, which stages original productions featuring cast members age 7 to grandma, and with a range of abilities. In 2011, I wrote about how performing in the group’s opera helped children with autism. This year, I was struck by the story of how music helps heal the past trauma of one young cast member, 8-year-old Aster, adopted from Ethiopia after her birth parents died. I asked Aster’s mother to write a bit about their experience. Here’s her post:

By Marina Vyrros
Guest contributor

In the mid 1990s, I worked as a refugee aide in the Guatemalan rainforest.

Many people in that community — having fled horrific atrocities, like their villages being razed or worse — were suffering from post-traumatic stress.

Atrocities notwithstanding, a contingent of ranchero musicians somehow managed to lug homemade, oversized guitars to the camps and play music each night, often in the 100-degree heat.

While the NGO’s provided a valuable service — helping the people rebuild their external structures — the service that the ranchers provided, though perhaps less tangible, was invaluable. Their nightly gatherings, singing songs about their plight, helped the community to rebuild and heal internally.

Four years ago, when I adopted an almost 4-year old child from Ethiopia (who continues to recover from the trauma of having lost both birth parents during her formative, early childhood years) the lesson of the power of music was not lost on me.

Claudia M. Gold, a pediatrician, blogger and author of “Keeping Your Child in Mind: Overcoming Defiance, Tantrums, and Other Everyday Behavior Problems by Seeing the World Through Your Child’s Eyes,” explains what may be going on in my daughter’s brain:

“Severe meltdowns are common in children who have experienced early trauma, at the time when the higher cortical centers of the brain were not yet fully developed. Stress of a seemingly minor nature can lead the rational brain to in a sense go ‘off-line.’ The child will have access only to the lower brain centers that function more instinctively.”

Especially during her first few years in Cambridge, Aster’s meltdowns were epic, but music and dance have consistently provided the most important vehicle to help her regulate her emotions.

Before, she might bang on the walls, now, to relieve her frustration, she pounds on a djembe, an African drum, in an afterschool program; instead of crying over seemingly inconsequential things, now, to release her emotions she invents and belts out Whitney Houston-y type songs, tears streaming down her face. To release her energy — which is abundant — she dances around. Everywhere. It all helps.

Recently, over the past five months, Aster’s been singing, dancing and even acting with the North Cambridge Family Opera based in Cambridge. In this year’s production, “Rain Dance,” she and the other animals living on the South African savannah elect a Machiavellian lion in a desperate attempt to end the local drought. Trouble ensues.

All kinds of research suggests that music can minimize the symptoms of post traumatic stress and other types of trauma. A 2011 study found that guitar-playing can help veterans with PTSD drown out the traumatic memories of bombs blasting; and in 2008 researchers found some reduction of post-traumatic stress symptoms following drumming, in particular “an increased sense of openness, togetherness, belonging, sharing, closeness, connectedness and intimacy, as well as achieving a non-intimidating access to traumatic memories, facilitating an outlet for rage and regaining a sense of self-control.”

Dr. Ross Greene, author of “The Explosive Child” writes that “children with behavioral issues don’t lack the will, they lack the skills.” Continue reading

Study: Meditation Relieves Some Anxiety, Depression Beyond Placebo

papermoons/flickr

papermoons/flickr

We’ve all been there: feeling low, overwhelmed, anxious, or just majorly bummed out about the freezing cold, the dead-end job, the noncompliant spouse, whatever, and we dream of a pill — a quick fix — to put an end to all that negative muck.

Of course, pills have side effects, and don’t always work. But it turns out there’s something that may be more effective with no downside, though it takes a bit of effort: meditation for about 30 minutes a day.

A new analysis by researchers at Johns Hopkins find that just a half-hour of “mindfulness meditation” may improve some of these garden variety, not yet full-blown, symptoms of anxiety and depression. The findings, published online in JAMA Internal Medicine, also found that some pain symptoms can also be relieved through a consistent meditation practice.

This should not come as breaking news. Many studies over many years link meditation to all kinds of health improvements. But I think it’s worth restating, since meditation is still viewed as a crunchy, ineffective practice by so many — including those in the medical mainstream.

Here’s lead study author Dr. Madhav Goyal, assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine, quoted in the news release:

“A lot of people use meditation, but it’s not a practice considered part of mainstream medical therapy for anything,” says Goyal, M.D. M.P.H. “But in our study, meditation appeared to provide as much relief from some anxiety and depression symptoms as what other studies have found from antidepressants.” Continue reading

High Anxiety: How I (Sort Of) Overcame My Fear Of Flying

Screen shot 2013-08-01 at 9.39.48 AM

Imagine this tense scene at Logan International Airport’s Terminal E earlier this summer:

A woman with two young children rummages through her medication bag while awaiting an overnight flight to Europe. She pulls out a bottle of pills, then grabs her phone to text her therapist:

Woman: How early can I take half a Xanax? Flight at 8:20. Getting shaky.

Therapist’s response: You can take it now. You can do this!!!!

The scene, sadly, is all too real; that frantic woman is me.

I hate flying. Just writing the word ‘flying’ gives me a pang of dread, twinges of imminent diarrhea and the feeling that I might choke on my own fear.

I’m like Woody Allen on the plane in “To Rome With Love,” a death-grip on Judy Davis’ arm when turbulence hits. “I can’t unclench when there’s turbulence,” he says. “I don’t like this, the plane is bumpy, it’s bumpy… I don’t like when the plane does that… I get a bad feeling.”

In my case, to avoid this excruciating feeling, I have cancelled family trips at the last minute, pretended to be ill, and dragged my children on a 30-hour train ride from Boston to Orlando.

This summer, I’d finally had enough of my fear and its invasive grip on my life. But could I overcome it? I honestly wasn’t sure.

(Before I go on, let me say clearly that mine is definitely a “first-world problem.” There’s no poverty, abuse or major life-threatening illness going on here — just a “problem bred of privilege,” as one friend put it. Still, it’s fairly widespread, and worse since 9/11. Though precise prevalence numbers don’t exist, a 2008 study published in the Journal of Anxiety Disorders says fear of flying is “estimated to affect 25 million adults in the United States and nearly 10–40% of the adults in industrialized countries.” Similarly, a 2007 New York Times report quotes an NIH estimate that about 6.5 percent of Americans fear flying so intensely that it qualifies as a phobia or anxiety disorder.)

woowoowoo/flickr

woowoowoo/flickr

Russian Planes With Duct Tape

It wasn’t always this way for me. As a single, childless reporter, I flew all over: to Africa and Vietnam, to Cuba on a Russian-made plane lined with duct tape and in China on a domestic flight on which the pilot told everyone to move to the left side of the plane for “balance.” I flew in tiny, private planes across Washington state in bad weather, and to Provincetown on a little 9-seater.

Then, while walking to work across the Brooklyn Bridge on September 11, 2001, I saw the second plane hit the World Trade Center.  A year later, when I was pregnant with my first child, my flying anxiety suddenly took hold.  When the baby was six months old, I rescheduled a family trip abroad to avoid heavy rain. After that, for the next 10 years, I never took a flight more than three hours long.

I said “no” to weddings, work trips and excursions with my husband to romantic locales. I always had a good excuse not to travel, but in reality, avoiding these trips was all about my fear.

Flying Coffins And Familial Anxiety

There are likely genetics at play here: anxiety is a family trait, and several of us have suffered with flying fears. Years ago, a close relative freaked out on a flight from D.C. to San Francisco and, after a scheduled layover in the midwest, refused to get back on the plane. Instead, he took a train home. For a while, my father called planes “flying coffins,” and took a heavy dose of Klonapin, usually prescribed for seizures and panic attacks, before flights. Continue reading

Data-Driven Parenting To The Max: Spreadsheets For Each Poop

Has data-driven parenting run amok? Are spreadsheets to measure every poop output and breast-milk intake necessary? Do we need a time stamp for each “ga” “mmm” and “da-da”? Or is this just, frankly, insane? A way to try to ease the sometimes overwhelming anxiety of parenting with cold, emotion-free numbers?

Tampa Band Photos/flickr

(Tampa Band Photos/Flickr)

For writer Amy Webb, a so-called “digital strategy expert,” measuring everything her child does makes loads of sense. In her controversial and truly mind-blowing piece on Slate last week, Webb revealed the process by which she documents every minuscule element of data on the kid’s existence.

One sample:

During the first feeding at home, I put my laptop on the nightstand beside my bed and filled out the chart as I tried to burp my daughter:

Time: 11:15 a.m.
Breast Milk: 75 milliliters
Formula Supplement: none
Wet Diaper: 1
Yellow Scale (1 = clear, 10 = call the hospital): 3
Dirty Diaper: 1
Poop Scale (1 = Dijon mustard, 5 = pâté, 10 = tar): 5
Dessert: 0
At 2 a.m. the next morning, I attempted the same routine. Laptop on left nightstand, baby attached to right boob.

But it doesn’t stop there: “At 15 months, we knew the 37 complete words she’d mastered and the 11 miscellaneous vowel sounds that meant real-world objects… By her 18-month pediatrician visit, she could point to her throat, ankle, eyebrow, teeth, shin, knee, and belly button when prompted, and we’d tracked it all in our series of spreadsheets, which we’d prepared for our appointment.”

Webb claims all this poop-measuring and morsel-tracking is state-of-the-art parenting, with myriad benefits for the child.  In this approach, nothing is left unrecorded: “When she was 6 months old, we added a tab to the spreadsheet for new foods. Rice cereal, 2 teaspoons, on Oct. 3. Steamed, mashed carrots, 1 ounce, on Oct. 30; didn’t like at all. Steamed, mashed sweet potato, 1 ounce, on Nov. 10; liked even less. Steamed, mashed peas, 2 ounces, on Nov. 18; wanted more.” Continue reading

What ‘Bad Dogs’ Can Teach Humans About Compulsive Behavior

Casey was diagnosed with canine compulsive disorder. He’s now on Prozac. (Courtesy)

Casey was diagnosed with canine compulsive disorder. He’s now on Prozac. (Courtesy)

When Casey, a 6-year-old German Shepherd, gets anxious, she chases her tail.

But it’s not the kind of endearing, once-around-and-it’s-done kind of tail-chasing we’ve all seen. Left unchecked, Casey circles around and around, pursuing her tail until she can bite it. Then, even when the blood starts flowing, the dog is driven to continue the chase.

“It’s upsetting,” says Paula Bagge, a Hopkinton, Mass. business owner who has been living with Casey since puppyhood. “And it’s damaging. She hurls herself around the house, and it’s like a big bloody paintbrush spraying the walls.” Once, Bagge tied the dog’s leash to a coffee table in an attempt to control the chasing. But Casey, who weighs about 85 pounds, just started dragging the coffee table around with her. Now, she’s on Prozac.

Dogs, it turns out, can have obsessive-compulsive disorder, just like people. And in a new study, Dr. Nicholas Dodman, a professor of clinical sciences at the Cummings School of Veterinary Medicine at Tufts University, found that structural brain abnormalities in dogs, in this case Doberman pinschers, with canine compulsive disorder (CCD) are similar to those of humans with OCD.

In an earlier study, Dodman, a leading researcher on repetitive behavior in animals, found a specific gene associated with canine OCD.

Studying anxiety disorders in dogs, Dodman says, may ultimately help scientists come up with better therapies and medications to treat OCD and related conditions in people. Current drugs for OCD, such as SSRI’s (or for dogs, a beef-flavored form of Prozac) are notoriously ineffective for many sufferers. Indeed, Dodman says, only around 43 to 60 percent of people suffering from OCD show a postive response from an SSRI; the average reduction of symptoms in people taking these drugs is only about 23 to 43 percent. “Certainly not a panacea,” he says.

So, to further this research, Dodman spends time thinking about bears who pace obsessively, for instance, or parrots unable to stop preening and picking their feathers and beagles who overeat to the point of exploding,

Dodman calls the latest dog-brain imaging study, conducted in collaboration with researchers at McLean Hospital, in Belmont, Mass., “another piece of the puzzle, another brick in the wall.”

He says while more research must be done, it’s becoming increasingly evident that dogs with OCD are a great model for exploring human psychopathology: they show similar behaviors, respond to drugs in comparable ways and now, at least in this small study, seem to have the same brain abnormalities as people with the condition. “When you know what your dealing with it’s much easier to create targeted approaches,” to treatment, Dodman says. “If you don’t know what you’re dealing with it’s just kind of like going with your sense of smell.”

OCD afflicts about 2 percent of the population and often goes untreated or undiagnosed. People suffering from the disorder, marked by intrusive thoughts and repetitive behaviors such as hand washing, locking and unlocking doors, counting, or repeating the same steps, feel these impulses as uncontrollable. And the compulsive rituals, often triggered by stress or trauma, can be incredibly time-consuming, interfering with daily life.

Famously, Lena Dunham, the star and creator of the HBO series “Girls” came out with her own OCD on air, with repetitive tics, obsessive counting and painfully compulsive use of Q-tips. Continue reading

Growing Up Brave: Expert Advice On Kids’ Anxiety, From Separation To Monsters

Donna Pincus

Donna Pincus (courtesy of BU, Photo by Crystal Conte for Portrait Simple)

I am not an anxious person — I was born with an even keel — but I am one hell of an anxious mother. Everyone knows that mothers tend to worry, but still, I’ve found it shocking how intense, and how nearly unbearable, concern for a child can be, even when the cause clearly doesn’t merit the distress.

So when I saw the BU Today headline “When the world is scarier than it should be” this morning, of course I immediately clicked. And now I have a new book on my wish list: “Growing Up Brave: Expert Strategies for Helping Your Child Overcome Fear, Stress, and Anxiety,” by Donna Pincus. BU Today writes:

Pincus, director of research for the Child and Adolescent Fear and Anxiety Treatment Program at BU’s Center for Anxiety and Related Disorders, walks readers through techniques to reduce or eliminate childhood anxiety.
The book, which weaves science and anecdotes into an enlightening guide for parents, teachers, and health care workers, offers a readable counterpoint to the many less informed prescriptions kicking around on the internet.

And, it must be noted, less-informed parenting strategies that arise from our well-meaning instincts — whether we’re being over-protective, or pooh-pooh-ing children’s fears, or over-sharing our own fears.

BU Today: Will most parents who read this book recognize themselves in it?
Pincus: Parents will likely relate to the many difficult situations we are all regularly faced with—for example, knowing when to follow our so-called instincts to protect and when to take a step back and allow a child room to navigate certain challenges on his or her own. Most parents have faced this challenge of knowing how to strike the best balance. Numerous parents have related that they recognized themselves in the chapter on parent-child interaction styles that affect anxiety—and that their awareness of these parenting styles was the first step in modifying the ways they interact with their children.

The interview, by Susan Seligson, is worth a full read. I found particularly interesting this hint of the sorts of techniques that are being developed to help with childhood anxiety: Continue reading