Emotional Resilience Blog from The Fear Course

The latest research, realisations and thinking in the world of emotional resilience, anxiety and fear reduction from around the world.

What Causes Social Anxiety? New Research

What Causes Social Anxiety? New Research

Social anxiety is one of the most frequent and debilitating anxieties around. The effects range from mild discomfort in social situations to full scale avoidance of and panic attacks during social events and even phobic responses such as agoraphobia. A series of research studies examining this common series of anxieties have found that people who have at some stage in their life been a victim of bullying, criticism and or rejection in any situation are significantly more likely to develop a social anxiety compared to the rest of the population.
Indeed the definition of a social anxiety centres around the fear of scrutiny or negative evaluation/judgement by others. This usually results in people having the feeling that they are not good enough for other people, and/or the assumption that others will automatically reject them and includes often intense feelings of insecurity in a wide range of situations.

It is estimated that about 1 in 5 or 20% of the population suffer from some form of social anxiety. This can be a severely debilitating and distressing disorder for the sufferer which can have massive negative effects on the quality of life of the sufferer and as a result I pay particular attention to research in this area. A student at University of British Columbia in Vancouver, Klint Fung has just gained his Masters this month with an interesting series of experiments which helps us to understand a bit more about social anxiety.

What Fung did was get a group of 88 people and initially test them for their level of social anxiety. He then subjected them to an experimental social event where they would be either rejected (rarely interacted with) or included (frequently positively interacted with) in the activity of the event. All the participants were then invited to a second social event.
The research found that rejection or inclusion from just one event had a significant effect on the anxiety the individuals felt towards and during the second event. Importantly it was discovered that virtually all of the anxiety experienced stemmed from the hurt feelings induced during the first event.

It would appear and is backed up by other research that how hurt we feel following an incident can then predict how sensitive we are likely to be to the possibility of future exclusion especially when this is interpreted as rejection by the individual.

What this and other pieces of research shows is that treatment which helps to reduce sensitivity to exclusion and helps the individual to regulate their own emotions (prevent the hurt feelings) is likely to be most effective. Certainly from my experience the development of emotion regulation techniques coupled with cognitive reappraisal (both strategies I teach) have a significant impact on social anxiety disorders.
Indeed one client I finished with this week went from agoraphobic (unable to leave the house due to social anxiety) to returning to work in 16 days.

On Wednesday 3rd September I will be running a live online seminar about 'How We Catch Fear and Anxiety'. Click here for more details.

Free Live Seminar - How we catch Fear and anxiety - September 3rd

References
Fung, K. (2014) How does rejection induce social anxiety? A test of hurt feelings as a mechanism. University of British Columbia - Masters Thesis August 2014.

Levinson, C. A., Langer, J. K., & Rodebaugh, T. L. (2013). Reactivity to exclusion prospectively predicts social anxiety symptoms in young adults. Behavior Therapy, 44(3), 470-478.

Lissek, S., Levenson, J., Biggs, A. L., Johnson, L. L., Ameli, R., Pine, D. S., & Grillon, C. (2008). Elevated fear conditioning to socially relevant unconditioned stimuli in social anxiety disorder. The American Journal of Psychiatry, 165(1), 124-132.

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How To Forgive And Let Go

How To Forgive And Let Go

I have heard over the years lots of people say how important forgiveness is and I never ever really understood what they meant. I didn't know how to do it and I certainly had no appreciation of what it was. In fact forgiveness became a word I would end up squinting at sideways, with suspicion.

"Forgiveness became a word I would end up squinting at sideways, with suspicion"

I have heard religious people talk at length about forgiveness and therapists (yes I've had a few) talk about forgiving myself to the extent that it had become a sort of non-word for me. I kept hearing the word but no-one told me how to do it.

It was only in the last few years that I think I have started to understand what it is and how to do it.

Most of us carry around hurts and anger about things other people have done or said and embarrassment, shame or even horror at things we ourselves have done or said.

It wasn't until I realised that at any particular time, everyone is doing the best that they can, with the thoughts, emotions and beliefs that they have - at that moment. At any moment in time they make the decisions they make believing them to be the best response right then. Even if the outcome has dire consequences.

I was a police officer for 18 years and over that time met many many criminals and people who had done terrible things including murder. When I look back on the long line of people I dealt with, every single one of them (even the odd socio and psychopath) were doing what they believed was a reasonable response given the way they saw, felt and believed the world to be at that moment.

When I think back to the hurts I have carried, inflicted by loved ones and others and perpetrated myself...

When I think back to the hurts I have carried, inflicted by loved ones and others and perpetrated myself, they were each and every one, responses to how they (and I) saw the situation at that moment. They (and I) were doing the best they could in that moment with everything they felt, understood and believed.

Now that's not to say they (and I) couldn't do better. It is only after the fact that we may (or may not) reflect on what happened and hopefully learn.

This realisation has helped me to 'forgive', let go of things and find peace.

This understanding is also the basis of another thing I never understood. Be gentle with/on yourself. For me, now being gentle requires forgiveness which in turn requires understanding the nature of the way we often decide to do and say things.

"The weak can never forgive. Forgiveness is the attribute of the strong." ~Mahatma Gandhi

The problem is if we don't forgive and let go, we become prisoners, locked in the cells of our own making - with only our hurt, anger or shame as cell mates.

 

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Why the Fear of the Fear is More Damaging than the Original Fear

Why the Fear of the Fear is More Damaging than the Original Fear

When someone gets anxious or has a fear the feelings, thoughts, memories, physical sensations and other internal experiences the the fear or anxiety bring about are frequently so unpleasant that the individual will do just about anything to avoid them. This fear of the fear, or more correctly the fear of the effects of the fear is so distressing for many people that even talking about the issue is a problem. The distress is often heightened when there is no apparent direct cause or fear as occurs with GAD or General Anxiety Disorder or SAD Social Anxiety Disorder. There is a fear that these feelings could strike at any time.

It is not surprising then that people with fear and anxiety often end up not just avoiding the object of the anxiety, if there is one, but also of the resultant feelings, thoughts, memories, physical sensations and other internal experiences. This second type of avoidance is known as Experiential Avoidance.

Recent research has shown that how one reacts to the emotions and feelings that result from the anxiety makes a huge difference as to whether the individual is likely to get worse or not.

A swath of research is showing that people who are unwilling to experience the feelings, thoughts, memories, physical sensations and other internal experiences associated with the anxiety are much more likely to find the symptoms escalating and deeper problems arising.

Part of the problem is avoidance can only ever be a temporary relief and will never 'fix or solve' the problem. It merely side-steps the issue, which means that it is left still to face later. This is one reason why people who engage in avoidance as an emotion regulation strategy keep having the same and often escalating problem.

Another issue is that avoidance of anything psychologically reinforces the idea that the thing, in this case the feelings and thoughts, being avoided are bad or even dangerous in some way.

In order to avoid something requires that you end up focussing on and in many cases often obsessing about the very thing you are trying to avoid. This then means that the individual is focussing and obsessing about a negative. This takes time and effort and in effect crowds out all the other experiences of being a human, many of which are positive and joyful. As the individual focusses more and more on avoiding the horrible feelings and experiences, less and less concentration is placed on the positive things in life. In effect it becomes a negative vortex, dragging the individual down, often resulting eventually in depression, OCD, resorting to drugs and alcohol, self-harming, restricting food intake and even suicide.
We are finding that all of these problems frequently stem from Experiential Avoidance.

This is one of the reasons I deal with the avoidance as a matter of importance whilst treating the presenting anxiety and help the individual develop better and more effective emotion regulation strategies.

 

 

 

References

Chawla, Neharika; Ostafin, Brian (2007). "Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review". Journal of Clinical Psychology 63 (9): 871–90. doi:10.1002/jclp.20400.PMID 17674402.

Gámez, Wakiza; et al (2011). "Development of a measure of experiential avoidance: The Multidimensional Experiential Avoidance Questionnaire". Psychological Assessment23 (3): 692–713. doi:10.1037/a0023242. PMID 21534697.

Hayes, Steven C.et al (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: Guilford Press. ISBN 1-57230-481-2.

Hayes, Steven C. Et Al (1996). "Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment". Journal of Consulting and Clinical Psychology 64 (6): 1152–68. doi:10.1037/0022-006X.64.6.1152. PMID 8991302.

Losada, A. etal (2014) Development and validation of the experiential avoidance in caregiving questionnaire (EACQ). Aging & Mental Health. Volume 18, Issue 7, 2014

 

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Problems caused by anxiety during pregnancy

Problems caused by anxiety during pregnancy

Around 3-17% of pregnant women suffer from some form of antenatal depression during pregnancy and up to 40% suffer from heightened anxiety.

A rash of studies have shown that this can have a number of negative effects not just on the mother to be but also on her social, personal and marital relationships as well as later mother and infant interactions and of course the infant. Now there is a growing body of evidence to show that anxiety also increases the fear of the birth which results in increases in elective caesarian section and also predicts a range of obstetric problems and also pre and post natal depression.

A study just published today, looked at the prevalence of increased anxiety during the first trimester (gestation weeks 8-12) and the problems associated with anxiety during this period.

The researchers found that 15.6% of women reported significantly increased levels of anxiety during the first trimester. Additionally they found that women under the age of 25 are at an increased risk of contracting problematic anxiety. Further they discovered that additional risk factors include being pregnant in a country where the the mothers native language isn't primarily spoken, lower levels of educational attainment, unemployment, smoking (obviously) and previous bouts of depression or anxiety. Not only that, women who have these risk factors are more likely to develop either or both pre and post natal depression unless the anxiety is successfully treated.

The researchers conclude that all women in the risk category groups and any pregnant women who develops anxiety should obtain treatment for the anxiety (i.e. learning emotion regulation techniques) as a matter of course.

References

Conde A, Figueiredo B, Tendais I, Teixeira C, Costa R, Pacheco A, Ceu Rodrigues M, Nogueira R (2010) Mother's anxiety and depression and associated risk factors during early pregnancy: effects on fetal growth and activity at 20–22 weeks of gestation. J Psychosom Obstet Gynecol 31(2):70–82

Heron J, O'connor GT, Evens J, Golding J, Glover V (2004) The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord 80:65–73

Rubertsson, C et al. (2014) Anxiety in early pregnancy: prevalence and contributing factors. Archives of Women's Mental Health June 2014, Volume 17, Issue 3, pp 221-228

van Bussel CHJ, Spiz B, Demyttenaere K (2009) Anxiety in pregnant and postpartum women. An exploratory study of the role of maternal orientations. J Affect Disord 11:232–242 CrossRef

van den Bergh BRH, Marcoen A (2004) High antenatal maternal anxiety is related to ADHD symptoms, externalizing problems, and anxiety in 8 and 9 year olds. Child Dev 75:1085–1097

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People with anxiety are more likely to develop depression

People with anxiety are more likely to develop depression

A central question that has been argued over for years in the anxiety - depression field is, are anxiety and depression linked and importantly does can anxiety lead to depression?

A study published in the journal Psychological Medicine recently helps to answer this issue. The research by scientists at the Departments of Psychiatry and Preventive Medicine, Rush University Medical Center, Chicago conducted a long term (12 years) analysis of the metal health of 425 women (278 Caucasian and 147 African American) women in america. The women were measured annually for symptoms of anxiety and depression to see if where any depression manifested itself, anxiety tended to be a precursor to the depression.

Firstly they found that women with anxiety were more likely to suffer from a major depressive disorder than those who did not suffer from anxiety in the first place. In fact they discovered that if you suffer from anxiety for a year you are almost 50% more likely to suffer from depression than people without anxiety. If you have already suffered from a bout of depression you are even more likely to suffer a recurring episode of depression.

The researchers recommend people with anxiety are closely monitored for signs of the onset of depression during the year. Obviously it would be better to treat the anxiety and reduce the chance of depression significantly.

 

Reference

Kravitz HM, Schott LL, Joffe H, Cyranowski JM, Bromberger JT (2014) Do anxiety symptoms predict major depressive disorder in midlife women? The Study of Women's Health Across the Nation (SWAN) Mental Health Study (MHS). Psychological Medicine [2014:1-10] DOI: 10.1017/S0033291714000075

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A link found between anxiety and cancer - Research just published

A link found between anxiety and cancer - Research just published

Currently an area of great interest and focus in the medical research and in particular the cancer research world, are a set of types of cell known as regulatory T cells or Treg cells. Treg cells are part of our immune system and in effect, they suppress or stop the immune responses of other cells. Basically what Treg cells do is turn off an immune response once it has done its work of eliminating any invading 'bugs'. This is a vital function, otherwise our predatory immune system cells would stay on the rampage even after the threat had passed.

As you may know, the problem with cancers is that the cells in the body 'forget' to turn off and keep multiplying. These cancerous or non turning off cells then often keep growing out of control, eventually killing the individual concerned. So Treg cells essentially turn off the immune system response to prevent this happening.

It is already known that the immune system of mice and other animals tends to reduce in effectiveness when the animal is subject to chronic stress and anxiety, and in particular Treg cells become less effective and efficient at doing their job.

A study published this week in The Journal of Immunology has made a potential link between anxiety and cancer.

In this study nine patents were measured for their level of anxiety and the number and effectiveness of the Treg cells in their blood, both before and after an anxiety reduction programme. All of the patents were suffering from GAD or general anxiety disorder.
It was found that the patents had much lower levels of Treg cells in their blood, and those Treg cells that did exist were less efficient in the GAD patients.

These patients were then put on an eight week anxiety treatment programme and then tested again.

After the anxiety reduction programme it was found that the Treg cells had returned to normal levels and functioning. In effect the patents immune system had been returned to normal and was therefore allowing their systems to suppress and turn off immune responses as they were designed to do. The researchers state that this should reduce the risk of cancer in these individuals.

Now whilst it is early days yet with this research, and the numbers in this study were small, it is a strong indication about one possible mechanism of the proliferation of cancer.

As a result of this study the researchers from the University of Pennsylvania School of Medicine in Philadelphia and the Department of Pathology and Laboratory Medicine at the Children's Hospital of Philadelphia recommend that anxiety is treated as a matter course wherever it is found to reduce the potential risk of cancer.

This just highlights the importance of learning and developing genuine emotion regulation strategies and anxiety reduction techniques.

Reference

Akimova, T. et al (2014) Amelioration in generalized anxiety disorder is associated with decreased Treg number and function
The Journal of Immunology May 1, 2014 vol. 192 no. 1 Supplement 52.27

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How to deal with bad memories

How to deal with bad memories

What happens when you find yourself thinking about a bad memory? It could be a sad memory of the death of someone close or something embarrassing like making a fool of yourself in front of other people for example. How do you end up feeling?

Quite often these types of bad memories can just arrive out of the blue and the frequently show up when we are feeling down or anxious.

A team of researchers at the Beckman Institute at the University of Illinois have been researching a series of strategies for dealing with such bad memories. The findings of the study, published yesterday in a journal paper reveal a strategy that makes a significant difference to the emotional effect of such memories, and can really reduce the negative emotion associated with such memories.

These memories, known as episodic memories are common and everyone has them. An episodic memory is a memory trace which is laid down in the brain which includes the associated feelings present at that time. So when we come back to the memory we also tend to get the feeling present at the time the incident was occurring. The interesting thing about episodic memories is that a lot of other information also gets encoded, especially during significant emotional events like a funeral or a wedding for example. Information like the weather, what people were saying, who was there etc.

Police use this effect in a process called cognitive interviewing, to get more detailed pictures of what happened during high emotion events like accidents, robberies and the like. As these memories are strung together using an emotional thread, it is possible to use the emotion and the cognitive linking to get the detail back out from such an incident.

In the study, participants were asked to share their most emotional negative and positive memories, such as the birth of a child, winning an award, or failing an exam, for example. A number of weeks later the subjects were given cues that would trigger those memories whilst they were in an MRI scanner, to see what was happening in their brains as they recalled the memories and put a series of strategies into effect to reduce the negative impact of this memories.

Before each memory cue, the participants were asked to remember each event by focusing on either the emotion surrounding the event or the context. For example, if the cue triggered a memory of a close friend's funeral, thinking about the emotional context could consist of remembering your grief during the event. If you were asked to remember contextual elements, you might instead remember what outfit you wore or what you ate that day.

What the researchers found was that focussing on the context of the memories, rather than the emotional element had a significant effect to both reduce the impact of bad memories but also improve and enhance positive memories.

"One thing we found is that when participants were focused on the context of the event, brain regions involved in basic emotion processing were working together with emotion control regions in order to, in the end, reduce the emotional impact of these memories." explained Ekaterina Denkova the lead author of the paper.

So if you find yourself, like many of us do, stuck in a bad memory, focus on the context, what were people wearing, what was the weather like, or the decor of the room, the temperature etc.

And if you have treasured memories doing the same will give you greater pleasure.

I have an Exam Nerves Class running here in Oxford on the 10th May 2014. There are a few seats left. Click herehttp://www.fearcourse.com/Exams.html

Reference

Denkova, E., Dolcos, S. & Dolcos, F. (2014) Neural Correlates of 'Distracting' from Emotion during Autobiographical Recollection. Journal of Social, Cognitive and Affective Neuroscience. 9 (4) doi:10.1093/scan/nsu039

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