For the first time, email has been used to screen college students for clinical depression at 4 major US universities, as a feasible and inexpensive way to detect the disorder. The findings were presented at the American Psychiatric Association 2010 Annual Meeting in New Orleans. Undergraduate and graduate students at 4 colleges were invited through email to complete a depression screening survey. Students who agreed to participate were linked to an online questionnaire to answer demographic and treatment history questions and asked to complete the Patient Health Questionnaire 9 (PHQ-9). A total of 631 students consented to take the survey. About one quarter of the students were identified as having clinical symptoms of depression. Of these, almost 13% reported having suicidal symptoms.
I am sure there is a reason why things keep going the wrong way. Once my grandmother told me that I looked like someone who would never be happy. I still remember her saying that, her tone of voice was so… matter of fact. All I have to do to believe her is to look at my relationships: it’s like looking at a trailer park after a tornado. (…) Oh my so-called career… let’s not even go there. (…) I had so many dreams when I was a kid. Where have they gone? I can’t even dream anymore. Heck, I can’t even sleep. (…) And my health! Every bone in my body screams bloody murder… I panic just thinking about going somewhere. (…) Why can’t I just be happy?
These statements (taken from a variety of similar cases) are representative of the way of thinking that is characteristic of individuals suffering from a stress disorder. They are so categorical–and, in the patient’s view, so logical–that anything anyone could say or do would appear to be just another futile attempt at fixing the irretrievably broken. The gloom can be so palpable and real that it falls over the therapy room like a cloak.
The apparent logic of these statements requires the experienced therapist to apply a judicious dosage of empathy and attunement while gently challenging their validity, in order to establish a positive therapeutic relationship.
Unfortunately, this type of personal narrative is not uncommon. In fact, most individuals who come in for help on issues of depression, anxiety, and stress disorders have a similar presentation. In some cases, the symptoms are focused on a specific stressor, but in many cases
Dr. Daniel Pine, a psychiatrist, directs the research program on mood and anxiety disorders of children and adolescents at the National Institute of Mental Health in Bethesda, MD
Q. What is the difference between an anxiety disorder and anxiety that is an appropriate response to an uncomfortable or threatening situation?
A. The easiest way to differentiate between these two responses is to talk about the concept of impairment. The idea behind impairment is that the person’s anxiety interferes with his or her ability to do something. The feelings of anxiousness prevent that person from doing something that other people in the same situation could do, leading to avoidance. In other words, the anxiety prevents the individuals from going places or doing things that they would like to do.
For example, everybody has some degree of anxiety in social situations. But we think of it as a disorder when the anxiety is so extreme that the person would refuse to do presentations at work or would refuse to go to parties or would not talk in public places where one is obligated to talk — for example, ordering a meal in a restaurant or requesting a book from a librarian. This is the easiest way to distinguish between normal and abnormal anxiety.
The number of suicides reported by the Army has risen to the highest level since record-keeping began three decades ago. Last year, there were 192 among active-duty soldiers and soldiers on inactive reserve status, twice as many as in 2003, when the war began. (Five more suspected suicides are still being investigated.) This year’s figure is likely to be even higher: from January to mid-July, 129 suicides were confirmed or suspected, more than the number of American soldiers who died in combat during the same period. The New York Times
What Is PTSD?
Posttraumatic stress disorder (PTSD) can occur after the trauma of experiencing or witnessing threatened or actual death or serious injury, or other serious threat to the physical integrity of self or others, such as assault. This type of trauma is usually accompanied by intense fear, helplessness, or horror at the time of the event. Symptoms of reliving the trauma and avoiding any reminder of it often create significant distress and negatively affect the individual’s interpersonal and occupational functioning. In the acute phase, PTSD symptoms can last up to three months after the event. When the symptoms persist longer, PTSD is said to be chronic. Often, symptoms do not begin immediately and they can be delayed for six months or more after the event. When inadequately treated, PTSD can have fatal consequences such as homicide and suicide.
Who Is Affected?
It is estimated[i] that 50%–90% of all people are exposed to at least one serious traumatic event during their lifetimes. However, only about 6%-8% develop PTSD and a third of those suffer a severe form of the condition.
What Are the Causes?
The mechanism by which some individuals are vulnerable to PTSD and not others has been variously hypothesized. The most prominent theories are:
- The biological model
Information about external stimuli and their assessment is processed by the amygdala. Traumatic stressors produce an emotional reaction of fight, flight or freeze and significant increases in stress hormones. The hippocampus and medial prefrontal cortex mediate the final response of the individual in trying to cope with the traumatic event. This theory suggests that posttraumatic stress disorder occurs when there is a failure to regulate the activity of the amygdala, which results in hyper-reactivity to threat (what is often referred to as the amygdala hijack).
- The early childhood experiences model
Most researchers have found that childhood trauma, chronic adversity, and family stressors increase the risk for PTSD in adulthood.
- The traumatic memory model
A theory that has gained prominence in recent years, it distinguishes between memories that are easily recalled and are associated with emotions related to the trauma and repressed memories that cannot be deliberately accessed and are associated with typical PTSD symptoms such as nightmares and flashbacks.
How Is It Treated?
Most treatments for PTSD consist of techniques that expose the individuals to imagined re-experiencing of the trauma under safe therapeutic conditions, an approach that dates back to the treatment of World War II veterans. This type of treatment includes extensive emotional processing and narrative reconstruction of traumatic events in psychotherapy session, and may also include daily home review of audiotaped sessions.
Other efficacious treatments are cognitive behavioral psychotherapy and eye movement desensitization and reprocessing (EMDR). These treatments also induce patients to consciously review (and thus reprocess) painful details of their traumatic experience in a therapeutically safe environment.
PTSD and Childhood Attachment
A recent study[ii] by Columbia and Cornell researchers suggests that childhood attachment problems may play a crucial role in the development of adult PTSD and that exposure treatment may not be the sole important treatment mechanism.
According to attachment theory, secure and insecure childhood attachment to the primary caregiver (most often the mother) has important consequences for adult functioning and psychopathology. The theory, developed by British psychologist, psychiatrist and psychoanalyst John Bolwby, suggested that the innate human drive to form attachments that elicit protective, caretaking behaviors from adults is a crucial aspect of healthy infant development. When the caregivers are available and responsive, the infant develops a secure attachment “base” that facilitates the child’s exploration of the world and relationships. When the caregivers are absent or uncaring, an insecure attachment style results, with consequences for adult self-esteem, perceived safety and interpersonal functioning.
Too much anxiety forces impulsive action. When the choice between fight or flight is invariably fight, personal power and sheer determination can make things happen. Hastily taking charge of the situation however can also be a sign of anxiety brought on by low self esteem, insecurity and fear of failure. Emotional decision making prompted by anxiety, anger, or fear often has the result of producing change but also fostering unpredictability and chaos.
Too much anxiety often sabotages a person’s achievements. There is no balance in the approach to problem-solving and either too much energy is devoted to the task, or inadequate resources are mustered. The drive toward success generates a pathological focus that can quickly lead to exhaustion. In some cases, the organism simply shuts down, in other cases it is maintained in operation through artificial means such as drugs or alcohol.
Too little anxiety creates an avoidance of challenges and a drive toward comfort. Often these individuals are quite comfortable in true and tried approaches to problem-solving and are loath to try anything new. In many cases, a short and quick fix is applied to challenges, without much thought or conviction. Far from being healthy, too little anxiety lowers an individual’s guard against potential threats, physical or psychological, by instilling a false sense of security and of foolish invulnerability.
Just enough anxiety and we feel the right level of motivation toward change, while not losing sight of the need for adequate preparation, adequate rest, and balance. We accept the incontrovertible fact that too much or too little of anything, including anxiety, can impede learning, stunt growth, endanger health. Striving for success is important, as are solving problems and facing challenges as they arise. The right dose of anxiety (the good stress that mobilizes our resources) is just what it takes to not only meet these demands, but to thrive.
Copenhagen – Researchers assessed the effect of psychological stress on total and cause-specific mortality among men and women. Danish participants in the Copenhagen City Heart Study were asked two questions on stress intensity and frequency in 1981 and were followed in a nationwide for twenty-three years. The results show that men with high stress had higher mortality. This finding was most pronounced for deaths due to respiratory diseases, accidents, and suicide. High stress was related to a significantly higher risk of heart disease mortality for younger men. In general, the effects of stress were most pronounced among younger and healthier men. No associations were found between stress and mortality among women.
American Journal of Epidemiology. 2008;168(5):481-491.
The now irreversible and accelerating developments in communication technology (multiple e-mail addresses available from any platform, high-speed anywhere Internet access, smart mobile phones, tablets, e-readers, and what not) have enabled greater flexibility and mobility (e.g., teleworking, telecommuting) but they also have removed traditional boundaries between different roles in life (work, family, leisure). Thanks to these ubiquitous and always-on hardware devices and the software tools they provide, there often is no solution of continuity between work and non-work states, between being somewhere dedicated to work activities and being somewhere else, where relationships or relaxation are possible.
In addition, short-term employment, work on time-limited projects, and working two or even three part-time jobs simultaneously are becoming increasingly more common. These trends may indeed be producing beneficial effects in terms of greater task variety and flexibility, but also an increased risk of stress due to work overload, disruption of natural circadian patterns, role conflicts, and lack of time for relationships, for rest and energy replenishment through sleep or relaxation activities.
The individual executive, rather than the company, is now tasked with setting appropriate boundaries between work and other roles in life. This is a particularly challenging task for the executive who may be classified as exhibiting Type A behavior. What is type A behavior and why is it becoming increasingly problematic?
Good stress motivates and mobilizes to action. Bad stress, of the pathological kind, ambushes and attacks with vicious relentlessness. Its favorite areas of attack are self-esteem, self-assessment and analytical abilities as they relate to past experiences, present situations, and expected outcomes. When stress strikes, the past can become a repository of bad precedents, the present a bleak landscape of dangers, and the future a (seemingly) real possibility of annihilation. Sounds exaggerated? Yes, when stress is at manageable levels. However, in the presence of a real or perceived grave stressor, one’s abilities to cope with or respond to the challenging situation can become severely impaired, leading to three possible outcomes: flight or running away from the stressor, fight or direct confrontation, or the glacial paralysis of freeze.
Can we prepare for a stressor of significance, e.g. a major financial loss, with any degree of success? If so, what needs to happen before the stressor occurs? What mental/physical preparation can one make?
Animals, and particularly rodents that are routinely used in observations and experiments, tell us a lot of what we know about our own psychology. Rodents? How can a mouse or a rat know the first thing about what motivates and directs human reactions and behaviors? As a matter of fact, no rodent has yet provided any evidence of self-awareness or consciousness of the elevated kind, the sense of self that we attribute to ourselves and that is often used to explain why we do the things we do. And that is the very reason why rodents make such reliable exemplars of human psychology.