The stress of negative self-talk

There is a constant traveling companion who goes with us everywhere we go. Never leaves our side. Never seems to take a break. Anytime we do something, don’t do something, say something, fail to say something, our traveling companion utters a comment, blurts out a remark, passes judgment on what just happened to us. These comments are whispered directly into our brains, are not heard by anyone else, and come through sometimes subtly, sometimes very loud and clear.

To those of us who are lucky to have had a positive development of our self-esteem, this inseparable traveling companion utters encouraging, fair, balanced, and generally positive comments to our words and actions. Able to discern between a genuine mistake, a shortcoming, and a learning opportunity, our traveling companion offers helpful and positive feedback, helps us recover quickly from upsets and disappointments, and helps us deal effectively with traumatic events. Our traveling companion helps us become and remain better, happier people.

To those of us who had a difficult, traumatic childhood, or have had a series of stressful events in our adolescence or adult life, the traveling companion is a constant source of disparaging, unfair, biased, and generally negative comments about our words and actions. Unable to distinguish between our situational and systemic shortcomings, innocent mistakes, and skill deficits, our traveling companion unleashes a barrage of put-downs, decreasing our ability to face life’s challenges, forcing us to take extreme measures to shut it up (alcohol, marijuana, prescription drugs), and does nothing but add to our misery. Our traveling companion can literally undermine, sabotage and bring more ruin to our life.

Interestingly, few of us are aware that the traveling companions exists. The voice we hear in our brains becomes so familiar, so constant, so automatic, that we fail to consciously register its message, fail to really “hear it” except within our subconscious. Even when we become aware of this voice, we often accept it (or endure it) as a given, something we cannot control, something that goes with us naturally, unavoidably, and permanently.

The traveling companion I am talking about is more commonly known by the name of self-talk. Lucky are those whose self-talk is generally positive. For the rest of us, whose self-talk is generally negative, life is a struggle fought with one or both hands tied behind our backs. Stress is our constant companion. Anxiety ambushes us at every opportunity. The world becomes an inherently dangerous place, people are not to be trusted, catastrophe is just around the corner. Often, alcohol (pot or a Xanax or an oxy) helps shut down the negative self-talk, at least for a few hours. Once the effects of the chemical wear out, it’s back, often stronger and louder than before.

What can be done by those unlucky souls who are stuck with negative self-talk as a traveling companion? The three-step approach of cognitive behavioral therapy has been shown to be very effective in treating this condition and eliminating its deleterious effects. The 3-step approach requires the help of a counselor, especially when the intensity, frequency, and impact of the negative self-talk is affecting our ability to function and increasing our distress to the point of self-medication. The 3 steps are:

1. AWARENESS, which begins with the acknowledgment and acceptance of the negative self-talk existence, facilitates our ability to actually and consciously “listen” to it, and permits us to identify the times and situations when we are most likely to hear it. This is the most important step. This is not yet a fix, it is an essential identification of the problem.

2. SKILL, in developing alternative options through which to see the events and situations that are happening to us, whereby the explanation offered by our negative self-talk is only one of the possibilities, and not the only one. When our negative self-talk suggests a catastrophic outcome, we have the skill necessary to work up alternative, more positive outcomes.

2. COGNITIVE RESTRUCTURING, which leads to a transformation of the negative self-talk in either a positive self-talk or, at least, a more neutral and balanced self-talk. This last step requires time and sustained effort, to counter what is perhaps a lifetime of negative self-talk and turn it into a new, habitual, and permanent way of thinking.

Suicidal? Let’s Talk About It

Far from encouraging suicide, psychosocial talk therapy (a.k.a. individual counseling) that focuses on the suicidal thoughts can be a life saver. Findings by a recent study conducted by Johns Hopkins University researchers confirm that there is a 26% lower risk of repeated deliberate suicide attempts and death in individuals who received psychosocial therapy following a suicide attempt. This is true in spite of the well-known fact that deliberate self-harm is a strong predictor of suicide. The aim of this study was to examine whether psychosocial therapy after self-harm was linked to lower risks of repeated self-harm, suicide, and death from suicide.

The study, published in The Lancet Psychiatry, consisted of a matched cohort study of 5,678 individuals who, after deliberate self-harm, received a psychosocial therapy intervention (counseling) at suicide prevention clinics in Denmark during 1992—2010. The outcomes were compared with 17,034 people who did not receive no counseling after deliberate self-harm. The researchers sought evidence of repeated self-harm, death by suicide, and death by any cause and calculated odds ratios for 1, 5, 10, and 20 years of follow-up.

During the 20 year follow-up, 937 (16·5%) recipients of psychosocial therapy attempted suicide again, and 391 (6·9%) died, of which 93 (16%) by suicide. The psychosocial therapy intervention was linked to lower risks of self-harm (as compared to no psychosocial therapy) and death by any cause within a year. Long-term effects indicated that 145 suicide attempts and 153 deaths, including 30 deaths by suicide, were prevented by counseling.

The significance of this study, and the importance of counseling immediately following or to prevent a suicide attempt, cannot be overstated since suicide is among the top 10 cause of death in the United States. Over one million Americans try to take their lives each year, and over 40,000 succeed in their attempt. Over twenty-five percent of these suicide attempts could be prevented by timely, focused psychotherapy.  According to recent youth suicide statistics,

  • Suicide is the SECOND leading cause of death for ages 10-24. (Source: 2010 CDC WISQARS)
  • Suicide is the THIRD leading cause of death for college-age youth and ages 12-18. (Source: 2010 CDC WISQARS)
  • More teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease, COMBINED.
  • Each day in our nation there are an average of over 5,400 attempts by young people grades 7-12.
  • Four out of Five teens who attempt suicide have given clear warning signs

Among adults, the highest suicide rate is among men over 85 years old: 65 per 100,000 persons. According to the CDC, from 1999 to 2010, the age-adjusted suicide rate for adults aged 35–64 years in the United States increased significantly by 28.4%, from 13.7 per 100,000 population to 17.6 (p<0.001). The suicide rate for men aged 35–64 years increased 27.3%, from 21.5 to 27.3, and the rate for women increased 31.5%, from 6.2 to 8.1. Among men, the greatest increases were among those aged 50–54 years and 55–59 years, (49.4%, from 20.6 to 30.7, and 47.8%, from 20.3 to 30.0, respectively). Among women, suicide rates increased with age, and the largest percentage increase in suicide rate was observed among women aged 60–64 years (59.7%, from 4.4 to 7.0).

Lead researcher, Annette Erlangsen of the Department of Mental Health at Johns Hopkins, pointed out that people that have attempted suicide but failed are at an especially high risk. “We know that people who have attempted suicide are a high-risk population and that we need to help them,” she says. “However, we did not know what would be effective in terms of treatment.” Dr. Erlangsen commented on the findings. “Now we have evidence that psychosocial treatment – which provides support, not medication – is able to prevent suicide in a group at high risk of dying by suicide… Our findings provide a solid basis for recommending that this type of therapy be considered for populations at risk for suicide.”

I hate myself and it stresses me out!

Self-loveOne of the most important loves of our lives is the love of self, in the right measure, and in the proper perspective. Love of self is an important component in child development that helps produce healthy, fully functioning adults. The acquisition of a healthy love of self in the child can be disrupted or even completely blocked by a variety of factors: traumatic events; lack of love, attention and validation by primary caregivers; mental health issues such as depression, anxiety, and attention disorders. Often, children perceive a disconnect between what their mind tells them they should think of themselves and what is generally true (smart, capable, likable) and how they feel inside about themselves (not good enough or even downright unlikable). This dissonance between self-perception and reality can be quite jarring to a child or adolescent’s mind. It often leads to experimenting with artificial means of enhancing self-esteem, or of at least shutting down temporarily the negative feelings about the self: alcohol, marijuana and other “feel good” drugs.

In the right measure, love of the self is not boastful, arrogant or self-centered — this would indicate a narcissistic personality, or in extreme cases even antisocial (chiefly manifested in a near total lack of empathy towards others). In the right measure, love of the self is strong and yet balanced by an understanding and acceptance of certain shortcomings or vulnerabilities that help the individual be fully human. There is a lot of good, some bad and even some ugly in all of us: the realization of this very human mix of characteristics does not preclude love of the self, it simply makes us more emphatic, compassionate and understanding of our and other’s shortcomings.

The proper perspective on self-love comes from positive experiences, but also from the successful survival of negative experiences that occur throughout our lives. For children and adolescents, this can be hard going especially in the absence of supportive parents, mentors and positive adult role models. It is not unusual for fully grown adults to be wrestling almost daily with an incomplete or insufficient love of the self. This usually takes the form of negative self-talk, a merciless beating one’s self up for even minor mistakes, a virtual barrage of negativity toward the self that is self-produced, self-contained and, for this reason, all the more harmful and tragic. Often, one’s self image does not match that which others have of this person; friends and co-workers may think that the individual is actually pretty good or even excellent in many areas; family members may observe, to their dismay, the contradiction between what they think of their loved ones versus what they think of themselves.

What can be done, when love of the self – out of no fault of the individual – was thwarted by an unfortunate set of circumstances in childhood or adolescence? Can it be regained? The answer to this question is an unequivocal YES! Will it be easy? No, it won’t be easy. What will it require?

It will require at least these three steps:

1. Becoming aware and accepting that the problem of self-love is real, it is a problem in the individual’s life, and that it should be the target of corrective action. This is the contemplative stage of change, when the individual at least knows there is a problem, albeit not knowing what to do about it.

2. Begin noticing all the dozen, hundred and thousand ways in which the individual reinforces negative self-esteem through automatic thought processes. When making a mistake, by action or omission, what do I tell myself? What insults do I hurl at myself, in my own mind? How many times a day do I think something negative about myself? A steady diet of negative selkf-talk fed to the brain every day, over weeks and years, can do some real damage to self-esteem.

3. Begin changing the pattern of negative thoughts by switching off the automatic thinking and becoming more intentional about what we tell ourselves, replacing negative thoughts with more positive ones, at least some of the time.

This initial three-step process of change must be consolidated and maintained over time to create lasting change. Often, the old habit of self-beating comes roaring back, like some bad programming routine that runs in the background, automatically. The important thing is not to give up on the idea that change is possible, that the effort is worth doing in exchange for a happier, healthier and better-adjusted life.

Worst Stress Relievers: Pain Medication

Who is to say for sure how much pain I have right now, I had yesterday morning, or will have this afternoon?   Only I can know for sure the pain I am feeling—and I can lie, to myself and to others.  Herein lies the greatest challenge of addiction to pain medication. There is no objective measuring tool for pain. The best we can do is to ask the person to rate his or her own pain on a scale of 1 to 10, with all the accuracy that can be expected from such a subjective assessment, which isn’t very much because pain can always feel more intense than it actually is, physically or sometimes just psychologically.

The sad result of the greater availability of pain medication, its greater potency, the beneficial effects felt by the individual by taking what amounts to a legal hit of morphine is an ever increasing number of people who are dying from abusing or misusing pain medication.  Among some groups, deaths from prescription drug overdoses are more than ten times higher than they were in the late 1960s. These are the results of an age-period-cohort analysis using data from the US Vital Statistics and the US Census, available online.

In the absence of significant pain, prescription painkillers are ingested because of their very powerful relaxing effects on the central nervous system and for the sensations of well-being that characterize their action. The presence of hydrocodone, which is the equivalent of synthetic opium, in these drugs makes them highly addictive. The first signs of a painkiller overdose include loss of appetite, nausea, vomiting, stomach pain, sweating, and confusion or weakness. Later symptoms may include pain in the upper stomach, dark urine, and yellowing of the skin or the whites of the eyes. Overdose symptoms may also include extreme drowsiness, pinpoint pupils, cold and clammy skin, muscle weakness, fainting, weak pulse, slow heart rate, coma, blue lips, shallow breathing, or no breathing.

The rapid increase in mortality due to accidental poisoning that has been observed since 2000 is almost tenfold for whites and threefold for blacks over the study period. This appears to result at least in part from the coming of age of baby boomers who, as they age, are becoming addicted to prescription medications, most especially pain killers. The majority of prescription drug abuse involves painkillers, according to the Drug Enforcement Administration. In the US, Vicodin (containing acetaminophen and hydrocodone) is the most commonly abused prescription drug.

The greatest proportion of overdoses appears to occur in people in their 40s and 50s. While in 1968 about one per 100,000 white women in their early 50s died from accidental poisoning, the number has risen to 15 per 100,000 in 2007. Among black women of the same age, accidental poisoning deaths increased from about two per 100,000 to almost 17 per 100,000.

What’s the fix for this nationwide epidemic?  In the absence of an objective pain measure, it is hard to imagine how anyone can take exception to the screams of pain that can come from someone who is in the process of becoming addicted to pain medication, or already is.  Many doctors have taken the no-hassle course of prescribing, rather than questioning the veracity of the patient’s pain.  Many other medical practitioners, such as dentists and surgeons, have taken to dispensing large quantities of “samples” to patients who have had even the simplest procedure, “just in case you feel any pain.”  Of course, the patient takes the stuff, the pain (if any) goes away, and the powerful effects of the drug go to work by inducing a high that feels incredibly good. At this point, and in many sad cases, only a few short steps separate the patient from the addict.

More recently, the DEA has cracked down on pharmacies and doctors, with the intent of reducing the supply of these medications. More needs to be done to stop the flow, but also and most especially to educate the public on the potential addictive nature of these substances. They do work extremely well against pain, but at what cost?

More Stress, Skipped Lunches & Temp Jobs

In the 2011 survey, What’s Keeping HR Leaders Up at Night?, Human Resource Executive® reports that 74% of Human Resources executives say their level of job stress has increased in the past 18 months. Almost one third (32%) blame that on the difficulty they encounter in retaining key talent. “And it absolutely should keep them up at night,” says Wayne Cascio, senior editor of the Journal of World Business and a professor at The Business School at the University of Colorado in Denver. “I would be worried, too, and I’d be especially concerned about replacing high performers.”

This latest survey on the insights and perspectives of 782 senior-level HR executives at organizations nationwide finds that the top two challenges identified in last year’s survey – ensuring employees remain engaged and productive (41%), and retaining key talent as the economy recovers – also remain top of mind for this year’s respondents.

No Lunch For Most Workers

Two thirds of employees either eat lunch at their desk or take no lunch at all, according to a survey by Right Management, a division of global temporary staffing and consulting giant Manpower Inc.  One third of employees, or 34%, said they take a break for lunch, but eat it at their desks. Fifteen percent said they take a break from time to time, while another 16% said they seldom do. Only 35% said they regularly take a break for lunch.

Temporary Jobs Often the Only Game in Town

Staffing employment increased 5.4% from the first to the second quarter of this year, according to data released by the American Staffing Association (ASA). This is the sixth straight quarter of temporary and contract employment growth since the industry began its recovery from the 2007–2009 recession.

The U.S. staffing industry had a healthy second quarter as businesses continued to turn to flexible workforce solutions to meet increases in demand for their products and services—Richard Wahlquist, ASA President and CEO.

“For job seekers the news is also encouraging, as staffing and recruiting firms added more than 200,000 new jobs in the past 12 months.” U.S. staffing firms employed an average of 2.8 million temporary and contract workers from May through June — 8.6% more workers than in the second quarter of 2010.

Lower DHA Intake Linked to Higher Suicidality

ChileVolcanoEruption_EN-US1005377464Low levels of docosahexaenoic acid (DHA), the major omega-3 fatty acid concentrated in the brain, may increase suicide risk. A retrospective case-control study published in the most recent issue of the Journal of Clinical Psychiatry of 1600 United States military personnel, including 800 who had committed suicide and 800 healthy counterparts, showed that all participants had low omega-3 levels. However, the suicide risk was 62% greatest in those with the lowest levels of DHA.

Our findings add to an extensive body of research that points to a fundamental role for DHA and other omega-3 fatty acids in protecting against mental health problems and suicide risks. —  Joseph R. Hibbeln, MD, acting chief, Section on Nutritional Neurosciences at the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland

DHA is found in naturally in fish and nuts and is also available in fish oil supplements. Fish oil supplements can help lower inflammation by decreasing the synthesis of proinflammatory molecules and have been proven beneficial in treating inflammatory diseases, such as rheumatoid arthritis and Crohn’s disease. Although fish oil has been shown to be less effective in treating other stress-related illnesses such as ulcerative colitis and asthma, some patients do benefit from its intake.

The omega-3 fatty acids EPA and DHA contained in fish oil are effective in treating both cardiovascular disease and depression, often in combination with other specific medications. Higher levels of EPA and DHA are also associated with increased stress resilience.

Worst Stress Relievers: Owning Guns

SeattleSunset_EN-US1535293454Stressed by the danger of a home intrusion? We may be tempted to purchase a gun to feel safer and relieve this type of stress. The remedy, however, has its own problems. Statistics have shown consistently that guns cause more deaths to their owners and their family members than to would-be intruders. The danger for owners and their families comes from several factors: an increased risk of injury and death in domestic violence situations; a higher rate of successful suicide; an increased likelihood of accidental injury; and a rise in the rate of homicides.

In particular, the risk of successful suicide attempts is not to be underestimated: a self-inflicted gunshot is the leading cause of death among gun owners in the initial years immediately following gun purchase. In an article published by The Washington Post, the authors report that out of 395 deaths in homes where guns were present, there were 333 cases of suicide, 41 cases of domestic violence homicide, and 12 accidents. Only 9 cases were shootings of an intruder.

Guns are the most commonly used weapon in over 65% of domestic homicides. When a couple owns a gun, the risk of partner-on-partner homicide is five times as great. Three times as many women are killed in homes where a gun is present than where no such weapon was available. Children fare no better: 5,285 American children were killed by gunshots according to the 2005 data published by the Centers for Disease Control. During the same year, no child was killed in Japan, 19 were killed in the UK, 57 in Germany, 109 in France, and 153 in Canada.

It is fair to say that guns, which in theory are acquired to increase safety, vastly increase the risk of serious injury or death to their owners and their families. Outside the home, guns increase the frequency and seriousness of crime rates, as well as increase the risk of injury and death among crime perpetrators and their victims. It is also well-known that gun-related violence raises health care utilization and costs, criminal justice system expenditures, higher costs to taxpayers and for insurance premiums. No one will argue the point that gun-related violence produces a legacy of grief and hardship.

Sugary Drinks Linked to Higher Blood Pressure

aaMatisse_1948_PlumBlossomsSoft drinks, sweetened fruit juices, and sugar-loaded sports drinks raise blood pressure, according to a International Study of Macro/Micronutrients and Blood Pressure (INTERMAP). The researchers measured the consumption of sugar-sweetened drinks, sugars, and diet beverages (which contain high quantities of glucose and fructose) over the course of four days, administered two 24-hour urine collections and eight blood-pressure recordings, and asked questions about the patients’ lifestyle and medical history. Results show that there is a direct correlation between fructose and glucose intake and increases in blood pressure and that sugar-sweetened beverages are associated with a 1.1-mm-Hg increase in systolic and 0.4-mm-Hg increase in diastolic blood pressure after adjustment for weight and height.

Sugar-sweetened beverages have been linked to high blood pressure, obesity, type 2 diabetes, and heart-disease risk, and this is one more piece of evidence showing that if individuals want to drink these drinks, they should do so in moderation. Also, one of our interesting findings was that the association between sugar-sweetened beverage consumption and blood pressure was stronger in people who are consuming more sodium. We already know that salt is bad for blood pressure, but what we’re finding is that if you’re consuming more sodium, you appear to be, at least in this study, exacerbating the effects of these sugar-sweetened beverages.—Lead investigator Dr. Ian Brown (Imperial College London, UK)

Worst Stress Relievers: Prescription Drugs

SvetiJovan_EN-US1096946935More and more people in America seek relief from stressors by using artificial means, rather than developing the skills needed to cope with them naturally. Overdose mortality has now become a pressing public health problem. According to statistics released by the Centers for Disease Control, between 1999 and 2007 the rate of unintentional overdose in the United States has increased by 124%. Experts attribute this phenomenon to the exponential increase in prescription opioid overdoses. Some evidence suggests that the risk for drug-related adverse events is higher among individuals who are prescribed opioids at doses equal to 50 mg or more per day of pure morphine.

The abuse of opioid pharmaceuticals has been growing steadily for 10 years and has gotten to a point where it now overshadows all the other drug problems in the United States, certainly more so than heroin and cocaine. —Dr. John A. Renner, Associate Professor of Psychiatry at Boston School of Medicine in Massachusetts, Director of the Addiction Psychiatry Residency at the Boston VA.

According to a report by the IMS Institute for Healthcare Informatics, The Use of Medicines in the United States: Review of 2010, published April 2011, a prescription pain killer tops the list of the 10 most prescribed drugs in the U.S.  In order of number of prescriptions written in 2010, the 10 most-prescribed drugs in the U.S. are:

  1. Hydrocodone (combined with acetaminophen) — 131.2 million prescriptions
  2. Generic Zocor (simvastatin), a cholesterol-lowering statin drug — 94.1 million prescriptions. It is a known fact that an increased ability to cope with stress positively correlates with “good” cholesterol levels.
  3. Lisinopril (brand names include Prinivil and Zestril), a blood pressure drug — 87.4 million prescriptions. While there is no direct proof that stress by itself causes long-term high blood pressure, other behaviors linked to stress — e.g., overeating, drinking alcohol and poor sleeping habits — do cause high blood pressure. The short-term stress-related spikes in blood pressure caused by chronic stress may put individuals at risk of developing long-term high blood pressure.
  4. Generic Synthroid (levothyroxine sodium), synthetic thyroid hormone — 70.5 million prescriptions
  5. Generic Norvasc (amlodipine besylate), an angina/blood pressure drug — 57.2 million prescriptions
  6. Generic Prilosec (omeprazole), an antacid drug — 53.4 million prescriptions (does not include over-the-counter sales). The relationship among stress, psychological traits associated with chronic anxiety, acid reflux parameters, and perceptions of reflux symptoms has been established in numerous studies published in the last ten years.
  7. Azithromycin (brand names include Z-Pak and Zithromax), an antibiotic — 52.6 million prescriptions
  8. Amoxicillin (various brand names), an antibiotic — 52.3 million prescriptions
  9. Generic Glucophage (metformin), a diabetes drug — 48.3 million prescriptions
  10. Hydrochlorothiazide (various brand names), a water pill used to lower blood pressure — 47.8 million prescriptions.

The most prescribed drugs, however, are not the ones generating the highest income for pharmaceutical companies. According to the IMS report, Americans spent a staggering $307 billion on prescription drugs in 2010. The 10 best selling drugs are:

  1. Lipitor, a cholesterol-lowering statin drug — $7.2 billion
  2. Nexium, an antacid drug — $6.3 billion
  3. Plavix, a blood thinner — $6.1 billion
  4. Advair Diskus, an asthma inhaler — $4.7 billion. A connection between the development of infantile asthma and environmental stress, and adult stress and anxiety has been long established. That psychogenic factors can contribute to the onset and severity of asthma has been known for decades.
  5. Abilify, an antipsychotic drug — $4.6 billion. Usage of this drug developed to treat serious mental illness such as schizophrenia has grown significantly, primarily for stress and anxiety reduction, uses which the FDA has not approved.
  6. Seroquel, an antipsychotic drug — $4.4 billion. This drug, also developed to treat serious mental illness, is increasingly popular since it has been “discovered” to be an effective sleeping aid, a use which the FDA has not approved.
  7. Singulair, an oral asthma drug — $4.1 billion
  8. Crestor, a cholesterol-lowering statin drug — $3.8 billion
  9. Actos, a diabetes drug — $3.5 billion
  10. Epogen, an injectable anemia drug — $3.3 billion

It is interesting, and quite frankly worrisome, to note that so many of the drugs on the most prescribed and the best-selling lists target symptoms such as hypertension, hypercholesterolemia, gastric acidity, asthma, sleeplessness, and psychogenic pain that are directly associated with psychological disorders. These include unipolar and bipolar depression, anxiety, and primary insomnia. The inability to cope with stressors that, in our modern society, are primarily psychological in nature is paving the way for an overmedicated nation where stress signals that should mobilize individuals to take effective action are simply shut off, smothered by mass-produced chemical compounds. There are much better stress relieving approaches that do not include medication and that can enable us to face our challenges with a clearer mind, no side effects and a fatter pocketbook.

Stress of Cell Phone Use Disturbs Sleep, Mood

WestminsterAbby_EN-US1401418381Evidence of a direct link between cell phone use and mental health problems just keeps on coming. A major prospective study over a period of one year of young adults who used their cell phones frequently reveals significant disturbances to sleep patterns, increased stress symptoms, and an increased incidence of clinical depression. Researchers at the University of Gothenburg, Sweden investigated possible negative health effects of mobile phone exposure. The study, published this month in BioMed Public Health, focused on the psychosocial variables of mobile phone use and their possible effects on the mental health symptoms in a group of over 4,000 young adults.

Cell phone exposure variables in the study included the frequency of cell phone use, the demands on availability put on the individual, the perceived stressfulness of accessibility, the effects of being awakened at night by the phone, and instances of personal overuse of the cell phone. The mental health outcomes included in the study were current stress levels, symptoms of sleep disorders, and symptoms of depression. Prevalence ratios were calculated first as a baseline at the beginning of the study, and one year later. Mental health outcomes for men and women were studied separately. Any participant who reported mental health symptoms at baseline was excluded from the study.

cellphone_brainA detailed analysis of results showed a cross-sectional association between high cell phone use and elevated stress levels, increased sleep disturbances, and more frequent symptoms of depression for both men and women. High cell phone use was associated with sleep disturbances and symptoms of depression among men and symptoms of depression among women at 1-year follow-up. All exposure variables showed a correlation with mental health outcomes. In particular, cell phone overuse appeared to increase stress and sleep disturbances among women, and high accessibility appeared to produce elevated stress, sleep disturbances, and symptoms of depression among both men and women.

The researchers concluded that a high frequency of cell phone use over a period of one year is a risk factor for stress, sleep and mood disorders among young adults. The frequency of mental health symptoms was greatest among those who had perceived their near-constant accessibility via cell phones to be stressful.

A New Stressor: FOMO

Sm-bandwagonThe power of communication has been unleashed on the Internet as never before. It is now possible to know almost instantly what is happening around the world, to broadcast one’s ever-changing “status” to real or virtual friends and acquaintances, to express oneself endlessly in 160-character increments, to blog multiple times a day one’s erudite or inane musings to an audience that can number in the tens of thousands. Everyone has the power to become a “brand” and many have done so to great lengths, baring their life and its inspiring or sordid details without regard for privacy, confidentiality or simple reserve. With this phenomenon, new stressors are born, old ones are better overcome, and still others morph into more or less ominous sources of anxiety.

Take for example the ability to know, via Facebook, Twitter, Foursquare and Instagram, the whereabouts and activities of our immediate and extended social network. It is possible to know, just by virtue of swiping the screen of a smartphone, who’s out, who’s dining with whom and where, who’s at the club or the sports arena—often with photos and videos of the event as it unfolds in some sort of electronic play by play. Truly fascinating glimpses of reality in some cases, not so interesting and even banal in many others.

One of the newest stressors originated by this type of instant access is “fear of missing out,” or FOMO. It is a bizarre reversal of social anxiety, the particularly debilitating condition which causes people to reluctantly withdraw from interpersonal contact due to stress overload. In FOMO, the stress comes from the anxiety provoked in recipients of instant messages by the awareness that others are socially involved at that very minute, while they are supposedly missing out on something fun and interesting. In other words, being at home, at work, or otherwise “not there,” not doing the things others are doing and that are being portrayed in the photo or video or described in the message, is sufficient to produce anxiety, which perhaps could be referred to as non-social in nature.

texting-while-drivingFOMO is a close cognate of that other need to be connected at all times, for which there may already be an acronym of which I am not aware, yet. Being “out of touch” means not having 24×7 access to email, IM, social media—and that’s simply too horrible to contemplate. Voice calls are becoming an endangered species, as people seem to prefer, in increasingly greater numbers, to text or post. The stress of not having access, no rhyme intended, can be fiercely acute. Its excesses bear on the ridiculous, and increasingly more often, on the tragic—as in the train operator in the San Fernando Valley who wrecked his passenger train while texting to his friends. For the growing number of car accidents caused by this technological distraction there is already an acronym, TWD or texting while driving.

Worst Stress Relievers: Alcohol

aaManet_1882_BarFoliesBergeresMany people, including clinicians, researchers, and social and problem drinkers believe that drinking alcohol is somewhat effective as a temporary stress reliever. The relaxing effect of alcohol on the central nervous system, its disinhibiting and empowering effects on social impulses, and its perceived beneficial action on physical and emotional pain are often suggested as reasons why people begin and maintain their drinking, despite its abuse potential, side effects, and medium- to long-term ill effects on health. Conger (1951) proposed the Tension Reduction Hypothesis, which posits that alcohol can reduce tension and that people learn to drink alcohol to avoid or reduce unpleasant stress. Clinical observations and studies appear to support this theory.

Individual differences in the effects of alcohol on stress

Individual differences in stress-reducing effects of alcohol vary greatly. Where one individual may feel immediate relaxation from a relatively small amount of alcohol, others find that the initial effect of drinking actually increases their level of arousal. Gender, personality traits, drinking history, and a family history of alcoholism are factors that play a role in these very different responses. Individuals whose personality is characterized by sensation seeking or impulsivity traits are at increased risk for developing alcohol-related problems. Some researchers have suggested alcohol produces enhanced anxiolytic effects on these personalities, and thus increases the reinforcement value of drinking. Although no uniformity of results has been shown in these studies, they offer at least some support for this hypothesis.

From the mid-1960s through the mid-1970s, several experimental studies analyzed the effects of alcohol on stress among alcoholic participants. Although these studies were impressive for their intensive monitoring of participants over extended periods of time, the reliability of the results was limited by the small number of participants. The most reliable and valid studies confirmed an association between alcohol consumption and improved emotional states, e.g., reduction of stress levels, among these alcoholic participants.

Situational factors in stress reduction by alcohol

Situational or transient circumstances may modulate the effects of alcohol on stress. Alcohol appears to reduce stress more frequently when consumed while experiencing a pleasant, distracting activity such as a party or watching television, less so if consumed without distraction. 
There also appears to be a temporal relationship between drinking and the experience of a stressor. Alcohol consumed after a stressor has occurred, e.g., upon returning home after a stressful day, appears to be less effective in reducing stress. On the other hand, if alcohol is consumed prior to experiencing the stressor, e.g., drinking just prior to attending a party, its relaxing effects appear to be more prominent.

Cognitive stress-reducing effects of alcohol

Other hypotheses attribute the anxiety and stress-reducing effect of alcohol to its pharmacological effects on information processing. One theory views alcohol as an agent that narrows an individual’s perception of immediate stress cues and reduces cognitive abstracting capacity. This mechanism of action has the result of restricting attention to the most proximal and immediate aspects of experience. In other words, alcohol reduces the range of awareness (and thus of anxiety and worry) to such an extent that the perception of stressors is greatly reduced.

How might alcohol reduce stress?

Alcohol affects the autonomic nervous system as well as the neuroendocrine system, in particular the hypothalamic-pituitary-adrenal (HPA) pathway that is responsible for the mobilization of the organism during the stress reaction. The HPA axis is also instrumental in regulating immune protection by stimulating the production of cytokines that control inflammatory process and fight infection by pathogens.

The multifarious avenues of  communication among the neuroendocrine, immune, and nervous systems are so complex and ramified that alcohol impacts all systems, in both feed-forward and feedback directions. Alcohol is one of the few substances that readily crosses the blood-brain barrier, which permits it to have direct access to brain cells—with significant deleterious effects. Alcohol increases the resting heart rate, but it can also produce a paradoxical decrease in blood pressure in both humans and animals, much like stress, whose impact on heart rate and blood pressure is inconsistent.

The bottom line on stress reduction and alcohol

A relationship between alcohol and the physiological arousal of stress is undeniable, although the nature of this association is complex, controversial and far less than positive. The most reliable research has shown that the effects of alcohol on stress vary greatly depending on the psychophysiological characteristics of the individuals studied, their environment, the alcohol dose, the nature of the stressor, and the timing of the intake of alcohol and the stressful experience. Thus, while we can say that stress, alcohol, and alcohol addiction can form an interrelated complex, the nature of this relationship cannot be construed as ultimately beneficial. The relative ease and frequency of addiction to alcohol, the ineffectiveness of many strategies for prevention and treatment of alcohol abuse, and the variable benefits of alcohol as a relaxant pose a significant challenge to the widespread idea that alcohol may be an effective stress reliever.

Ultimate Stressors: Public Drama, Private Pain

charlie-sheenRecently televised interviews with Mr. Charlie Sheen appear to have focused attention on the symptoms and manifestations of the manic phase of bipolar disorder. A public display of inflated self-esteem or grandiosity, profuse talkativeness, increase in goal-directed activity, psychomotor agitation, and the excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish investments) are the textbook criteria for a manic episode. More privately, the individual in the grip of mania also experiences a decreased need for sleep, flight of ideas or racing thoughts, and distractibility. When this disturbance is sufficiently severe, it can cause marked or total impairment in occupational functioning, usual social activities and relationships with others and may necessitate hospitalization to prevent self-harm or harm to others. Episodes of mania, whose symptoms are the opposite of those denoting depression, are rarely seen alone. Usually, the manic state is preceded and followed by depressive periods in an alternating fashion, with each state lasting from many months to a few weeks, the latter being described as ‘‘rapid cycling.’’

This constellation of symptoms was known, until a few years ago, as manic-depressive disorder. Nowadays, it goes by the somewhat more cryptic label of bipolar disorder. The neurochemical basis of bipolar disorder is not exactly known. One of the most valid hypotheses regarding the neurochemical mechanisms of bipolar disorder is the synergy between two neurotransmitters that determine mood states, whereby a lower than normal release of norepinephrine produces a disordered mood (significantly higher or lower than the normal range), while the levels of serotonin determine the direction the symptoms will take, i.e. downward toward depression or upward toward mania.

What Bipolar Disorder Feels Like

The subjective experience of these intense mood swings ranges from abject despair and hopelessness to not entirely distressing and almost pleasurable. Depression produces a pervasive
and relentless sense of gloom, inadequacy, rumination, guilt, and worthlessness. No logic, willful effort or remembrance of wellness seems capable of dispelling these cognitive and emotional experiences, often for prolonged periods.

Mania reverses and accelerates upward from the disappearance of depression, through a state of well-being that can be considered a normal mood state. Normality soon becomes exuberance, enters into a state of unexplained euphoria, and finally culminates into a chaotic state of racing, incomprehensible, disconnected thoughts, and bizarre behaviors. Given a choice, the individuals so affected report that they much prefer the state of mania, in which they experience a release from inhibitions, a hedonistic focus, and a pursuit of pleasure and gratification that can be nearly devoid of accountability or restraint. Self-medication with alcohol and illegal drugs is often present in the manic phase, which sets up a circular relationship that exacerbates its symptoms and impedes treatment and recovery.

An individual in a state of mania can be frightening, annoying, or amusing to the casual observer. It is perhaps easy to overlook the nature of the behavior, especially when there is an assumption of intent. In most cases, however, the individual has virtually no control over thoughts, words and behaviors and little if any insight into their bizarre, provocative, and sometimes dangerous presentation. The loss of reality testing, judgment and moral restraint of bipolar disorder is sure to cause psychological pain to the people who experience it and to the people who love them. Mr. Charlie Sheen has been variously portrayed as victim and perpetrator, and variously diagnosed by experts and entertainment reporters.

Bipolar Disorder: A Brief History

The first connection between a manic state and depression as belonging to the same neurochemical disorder was established in 1686 by the French physician Theophile Bonet, who observed individuals who appeared to cycle between high and low moods, and described their presentation as ‘‘manico-melancolicus.’’ In the middle of the 19th century, two other French researchers, Falret and Baillarger, who had independently observed the same cycling of moods in their patients, arrived at the same conclusion that the symptoms must be two different presentations of the same illness. Falret described the disorder as ‘‘circular insanity’’  and hypothesized a hereditary component to the disorder. In the late 1800s to early 1900s, German psychiatrist Emil Kraepelin elaborated the description and classification for manic–depressive illness that is considered the standard presentation that we see today.

It was John F. J. Cade, a doctor in the Mental Hygiene Department of Victoria, Australia, who introduced and promoted the belief that manic–depression was a biological disorder of the brain. On the basis of his research on neurochemistry, Cade administered a lithium salt preparation to several highly agitated manic patients and observed a remarkable reduction in symptoms, with a near return to a normal mood state. Lithium is currently the standard of care for the pharmacological treatment of bipolar disorder, and still the most effective in the management of its symptoms.

Worst Stress Relievers: Pain Medication

painmeasurementscale Who is to say for sure how much pain I have right now, I had yesterday morning, or will have this afternoon?   Only I can know for sure the pain I am feeling—and I can lie, to myself and to others.  Herein lies the greatest challenge of addiction to pain medication. There is no objective measuring tool for pain. The best we can do is to ask the person to rate his or her own pain on a scale of 1 to 10, with all the accuracy that can be expected from such a subjective assessment, which isn’t very much because pain can always feel more intense than it actually is, physically or sometimes just psychologically.

The sad result of the greater availability of pain medication, its greater potency, the beneficial effects felt by the individual by taking what amounts to a legal hit of morphine is an ever increasing number of people who are dying from abusing or misusing pain medication.  Among some groups, deaths from prescription drug overdoses are more than ten times higher than they were in the late 1960s. These are the results of an age-period-cohort analysis using data from the US Vital Statistics and the US Census, available online.

In the absence of significant pain, prescription painkillers are ingested because of their very powerful relaxing effects on the central nervous system and for the sensations of well-being that characterize their action. The presence of hydrocodone, which is the equivalent of synthetic opium, in these drugs makes them highly addictive. The first signs of a painkiller overdose include loss of appetite, nausea, vomiting, stomach pain, sweating, and confusion or weakness. Later symptoms may include pain in the upper stomach, dark urine, and yellowing of the skin or the whites of the eyes. Overdose symptoms may also include extreme drowsiness, pinpoint pupils, cold and clammy skin, muscle weakness, fainting, weak pulse, slow heart rate, coma, blue lips, shallow breathing, or no breathing.

The rapid increase in mortality due to accidental poisoning that has been observed since 2000 is almost tenfold for whites and threefold for blacks over the study period. This appears to result at least in part from the coming of age of baby boomers who, as they age, are becoming addicted to prescription medications, most especially pain killers. The majority of prescription drug abuse involves painkillers, according to the Drug Enforcement Administration. In the US, Vicodin (containing acetaminophen and hydrocodone) is the most commonly abused prescription drug.

The greatest proportion of overdoses appears to occur in people in their 40s and 50s. While in 1968 about one per 100,000 white women in their early 50s died from accidental poisoning, the number has risen to 15 per 100,000 in 2007. Among black women of the same age, accidental poisoning deaths increased from about two per 100,000 to almost 17 per 100,000.

getty_rm_photo_of_woman_taking_prescription_pain_medication What’s the fix for this nationwide epidemic?  In the absence of an objective pain measure, it is hard to imagine how anyone can take exception to the screams of pain that can come from someone who is in the process of becoming addicted to pain medication, or already is.  Many doctors have taken the no-hassle course of prescribing, rather than questioning the veracity of the patient’s pain.  Many other medical practitioners, such as dentists and surgeons, have taken to dispensing large quantities of “samples” to patients who have had even the simplest procedure, “just in case you feel any pain.”  Of course, the patient takes the stuff, the pain (if any) goes away, and the powerful effects of the drug go to work by inducing a high that feels incredibly good. At this point, and in many sad cases, only a few short steps separate the patient from the addict.

More recently, the DEA has cracked down on pharmacies and doctors, with the intent of reducing the supply of these medications. More needs to be done to stop the flow, but also and most especially to educate the public on the potential addictive nature of these substances. They do work extremely well against pain, but at what cost?

Marijuana Linked to Earlier Onset of Psychosis

Manifesti_LotteriaTripoli_194_mMarijuana (cannabis), thanks to the powerful depressing action of its active ingredient tetrahydrocannabinol (THC), is one of the oldest and most widely used means of self-medication against acute and chronic stress. THC users report experiencing a pleasurable state of relaxation, with heightened sensory experiences of taste, sound and color. In addition to its psychological effects, THC produces alterations in motor behavior, perception, cognition, memory, learning, endocrine function, food intake, and regulation of body temperature. The common perception is that, of all illegal drugs, marijuana may be the safest and least addictive—despite significant evidence that it causes side effects of fatigue, paranoia, memory problems, depersonalization, mood alterations, urinary retention, constipation, decreased motor coordination, lethargy, slurred speech, and dizziness, in addition to increased tolerance and addiction.

Impaired health including lung damage, behavioral changes, and reproductive, cardiovascular and immunological effects have been associated with regular marijuana use. Regular and chronic marijuana smokers may have many of the same respiratory problems that tobacco smokers have (daily cough and phlegm, symptoms of chronic bronchitis), as the amount of tar inhaled and the level of carbon monoxide absorbed by marijuana smokers is 3 to 5 times greater than among tobacco smokers. Smoking marijuana while shooting up cocaine has the potential to cause severe increases in heart rate and blood pressure. – NHTSA Fact Sheet

New research suggests that marijuana use may play a direct causal role in the development of psychotic disorders, including schizophrenia. An extensive meta-analysis of more than 443 studies comparing the age at onset of schizophrenia in individuals who used marijuana with the age at onset of schizophrenia in non–users yielded most sobering results.

Investigators at Prince Wales Hospital and the School of Psychiatry at the University of New South Wales in Sydney, Australia, found that the mean age at illness onset was more than 2.7 years earlier for cannabis users compared with nonusers. The age of onset did not significantly differ between alcohol users and nonusers. These results were published in the February 2011 issue of the Archives of General Psychiatry.

The results support the hypothesis that cannabis use plays a causal role in the development of psychosis… (and) suggest the need for renewed warnings about the potentially harmful effects of cannabis. – Matthew Large

In presenting the findings, lead study author Matthew Large, MBBS, Department of Mental Health Services concluded that the meta-analysis provides strong evidence for a relationship between marijuana use and earlier onset of psychotic illness and of a direct causal role in the development of psychosis in some more vulnerable individuals.