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.

Why some babies cry a lot and how it causes later problems

Why some babies cry a lot and how it causes later problems

Anyone who has had a baby that cried excessively can probably attest to the stress and anxiety this can cause.

Obviously people's tolerance for crying babies differs, however excessively crying has been defined as crying for more than 3 hours a day on at least 3 days a week over a period of 3 weeks or more, when that crying is not associated with hunger or physical pain.

A study just published this week by researchers at the Institute of Clinical Psychology and Psychotherapy, at the Technical University of Dresden, Germany looked at 306 expectant mothers and followed them from just after they became aware they were pregnant until 16 weeks after the birth of their child. Two of the factors they measured was the mothers level of anxiety and depression both before and after the birth of the baby. Firstly they found that just over 10% of the mothers reported excessive crying in their infants according to the definition above.

What they discovered was that there was a significant link between the level of anxiety the mother experienced before the birth and the chance of the baby engaging in excessive crying in the 16 weeks after birth. Additionally there was no link with depression and excessive crying.

Another study published in the Journal 'Pediatrics' on the 6th of January this year, by a team of scientists from Finland showed that excessive crying in babies has significant links to later behavioural problems for the child and also (not surprisingly) increased stress for both the mother and father as the child grows.

Mothers who suffer from any form of anxiety during pregnancy are 3-7 times more likely to have a baby that cries excessively than the rest of the population of mothers to be. The researchers recommend early identification, monitoring and treatment of anxiety in all mothers to be.



Korja, P., etal (2014) Preterm Infant's Early Crying Associated With Child's Behavioral Problems and Parents' Stress. Pediatrics 2014; 133:2 e339-e345; published ahead of print January 6, 2014, doi:10.1542/peds.2013-1204

Petzoldt, J., etal (2014) Maternal anxiety disorders predict excessive infant crying: a prospective longitudinal study. Archives of Disease in Childhood. June 2014 doi:10.1136/archdischild-2013-305562

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The Perfect Catch 22: Anxiety

The Perfect Catch 22: Anxiety

In Joseph Hellers famous book 'Catch 22', the servicemen found themselves in a perfect double bind. In order to escape conscription you had to prove you were mad. The problem was that if you tried to get discharged by showing you are mad the authorities assumed you are sane as you wanted to be discharged. As only mad people would want to fight, they wouldn't want to be discharged and therefore wouldn't try to show they were mad. Therefore the only people trying to get discharged due to madness must be sane and as a result weren't eligible to be discharged and as the mad people wanted to fight and not apply for discharge the military couldn't discharge them either as they weren't trying to prove they were mad!

In many ways anxiety is the perfect double bind or catch 22.

One of the defining symptoms of anxiety is avoidance. People with anxiety tend to have a heightened threat assessment which means they tend to perceive things as being a risk that other people might not. For example, talking at a meeting, going on a date or to a party for example. Many people don't have an emotional problem with these activities. They just do them and reap the benefits. However a person with an anxiety about talking at meetings for example will focus on the risk of embarrassment, saying the wrong thing, being seen to be stupid, or just the fear of general rejection.

This then results in flight or avoidance behaviour.

The issue of avoidance now becomes a three tiered problem. Firstly the individual is likely to go to increasing lengths to not go to meeting where they might have to talk. The effect of this is that firstly, the individual will never realise any of the benefits of talking at meetings such as increased self-worth, confidence, greater credibility, closer social relationships etc. Secondly, once the individual starts to engage in flight behaviour as a coping strategy, the avoidance tends to become the first strategy to use for any difficult emotion. This then very quickly becomes a habit or habituated response, making it much more likely to be the response in future experiences which give rise to anxiety, thus accelerating other anxieties.

The third level of problem avoidance brings about, is that not only will the individual avoid the problematic experience, dating, parties, flying etc. but in many cases they are also likely to avoid any contact with anything associated with the anxiety. This includes facing up to the emotions and dealing with them.

People with anxiety are much less likely to get the anxiety treated than people with other conditions. Herein lies the perfect double bind. Anxiety leads to avoidance. Avoidance makes the anxiety worse. Heightened levels of anxiety leads to greater levels of avoidance, to the exert that the individual won't seek treatment as they don't want to approach the anxiety. This avoidance then leads to even greater levels of avoidance.

Avoidance is a coping strategy, not a treatment.




Bardeen, J.R. etal (2014) Exploring the relationship between positive and negative emotional avoidance and anxiety symptom severity: The moderating role of attentional control. Journal of Behavior Therapy and Experimental Psychiatry. Volume 45, Issue 3, September 2014, Pages 415–420

Hayes et al., (1996) Experiential avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64 (1996), pp. 1152–1168

N. Eisenberg, R.A. Fabes, I.K. Guthrie, M. Reiser (2000) Dispositional emotionality and regulation: their role in predicting quality of social functioning Journal of Personality and Social Psychology, 78 (2000), pp. 136–157

Maner, J.K. & Schmidt, N.B. (2006) The Role of Risk Avoidance in Anxiety. Behavior Therapy. Volume 37, Issue 2, June 2006, Pages 181–189

Maner. J.K. et al (2007) Dispositional anxiety and risk-avoidant decision-making. Personality and Individual Differences 42 (2007) 665–675

Salters-Pedneault et al., (2004) The role of avoidance of emotional material in the anxiety disorders. Applied and Preventive Psychology, 11 (2004), pp. 95–114

Williams et al., (1997) Are emotions frightening? an extension of the fear of fear concept. Behaviour Research and Therapy, 35 (1997), pp. 239–248

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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.


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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Who do you trust and why - the answer may surprise you

Who do you trust and why - the answer may surprise you

As a human, trust is vital to us for a secure and flourishing life. It is what underpins our relationships and the closer and more intimate those relationships become the greater the level of trust employed in them. But who do we decide to trust or not trust when we first meet people. Who is it that passes the first few trust tests so that we often go on to form deeper relationships with?
Trust is an emotion. It is an emotional response to the apparent congruence between our perception of someone and our interpretation of their actions. In other words we tend to trust people if what they say and what they do are similar and their actions are not harmful in anyway towards us.
The psychologist Erik Erikson has the formation of trust as the very first stage of psychological development of a child and that all human attachment and safety stems from the first bonds of trust they develop. Erikson firmly understood that the formation of trust with the child's caregiver is the most important stage of human development and will, in effect, lay down the blueprint for forming secure, trusting and intimate relationships for the rest of that individual's life.
The effect of trust being broken will depend on the level of relationship you have with the other individual. When a trust is broken in an intimate relationship, the results can be devastating.

So who do we trust and why? A series of recent studies sheds some interesting light on what happens. One would think that trust is earned. However it would appear to be the opposite for most people. We tend to trust first and then remove the level of trust if it is shown to have been incorrect. The obvious exception to this is where we have recently had a previous significant negative experience, however studies have shown that for most people this doesn't usually last too long.

A number of studies found that we tend to trust strangers far more than there is evidence to do so. Indeed in laboratory simulations, it has been found that people tend to trust people they don't know even where the risk, if the trust were betrayed, would lead to significant loss or even injury. A study published last month showed that what the researchers termed 'excessive trust' in strangers, in most cases stems from an emotional sense that they are fulfilling a 'social duty' or 'responsibility'. In other words it is perceived to be socially unacceptable to show distrust without evidence, especially in the case of strangers. In the case of strangers there is some evidence that anxiety about being judged as mean or not a nice person fuels this excessive trust.

In another study, published this week, it was shown that we tend to be more likely to trust strangers who smile and not trust people who look angry. Children in the age range of 6-12 are particularly susceptible to this effect and children with ASD or Autism Spectrum Disorder show an even more marked trust response to individuals who smile. As a parent I find this particularly disturbing.

However it is not just children. Adults are also more likely to trust a stranger who smiles over one with a neutral or angry face.

Numerous studies show that people of all ages tend to make a decision whether to trust someone or not purely based on the look of a stranger's face. What is more there is a cognitive bias called the bias blind spot. We all tend to believe that we are less biased than others and that our beliefs are more likely to be accurate even in the face of evidence to show that we are no more correct than random chance.

The main thing to take from this is that we tend to overly believe our estimations of trustworthiness based on facial 'look' and that for most people social anxiety about being perceived as mean or 'not nice' pushes into what we believe is socially acceptable niceness of trusting first and the belief that we should always show respect for the other person's character, even if there is a lot at risk.




Adolphs R, Tranel D, Damasio AR (1998) The human amygdala in social judgment. Nature: 470–473.

Caulfield F, Ewing L, Burton N, Avard E, Rhodes G (2014) Facial Trustworthiness Judgments in Children with ASD Are Modulated by Happy and Angry Emotional Cues. PLoS ONE 9(5): e97644. doi:10.1371/journal.pone.0097644

Chang LJ, Doll BB, van't Wout M, Frank MJ, Sanfey AG (2010) Seeing is believing: Trustworthiness as a dynamic belief. Cognitive Psychology 61: 87–105.

Dunning, D. etal (2014) Trust at zero acquaintance: More a matter of respect than expectation of reward. Journal of Personality and Social Psychology, May 12 , 2014 doi: 10.1037/a0036673

Gao X, Maurer D (2010) A happy story: Developmental changes in children's sensitivity to facial expressions of varying intensities. Journal of Experimental Child Psychology 107: 67–86.

Gao X, Maurer D (2009) Influence of intensity on children's sensitivity to happy, sad, and fearful facial expressions. Journal of Experimental Child Psychology 102: 503–521.

Hassin R, Trope Y (2000) Facing faces: Studies on the cognitive aspects of physiognomy. Journal of Personality and Social Psychology 78: 837–852.

Haynes S (2011) Judgments of trustworthiness from faces: Do children and adults judge alike?: The University of Western Australia.

Rotenberg KJ, Fox C, Green S, Ruderman L, Slater K, et al. (2005) Construction and validation of a children's interpersonal trust belief scale. British Journal of Developmental Psychology 23: 271–293.

Rotenberg KJ (1994) Loneliness and interpersonal trust. Journal of Social and Clinical Psychology 13: 152–173.

Rule NO, Krendl AC, Ivcevic Z, Ambady N (2013) Accuracy and consensus in judgments of trustworthiness from faces: Behavioral and neural correlates. Journal of Personality and Social Psychology 104: 409–426.

Rule NO, Ambady N (2008) The face of success. Psychological Science 19: 109–111.

Todorov A, Pakrashi M, Oosterhof NN (2009) Evaluating faces on trustworthiness after minimal time exposure. Social Cognition 27: 813–833.

Willis J, Todorov A (2006) First impressions: Making up your mind after 100 ms exposure to a face. Psychological Science 17: 592–598.

Zebrowitz LA, Montepare JM (2008) Social psychological face perception: Why appearance matters. Social and Personality Psychology Compass 2: 1497–1517.

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Can Acupuncture help with anxiety?

Can Acupuncture help with anxiety?

A typical symptom of the transition into menopause (known as Climacteric syndrome) for women in the age range of 35 and 65 is anxiety. A number of studies have found that menopausal symptoms such as irritability, excessive emotional reactions and excessive mood swings (known as emotional lability), persistent worrying and negative rumination are often symptoms of heightened anxiety brought about by Climacteric syndrome.

Previous studies about the usefulness of acupuncture with anxiety have been mixed. About a third of previous studies have found acupuncture can help with anxiety, with the rest finding that acupuncture has no effect on anxiety and depression.

A study has just been published in the Journal of Nursing by researchers and practitioners from the Federal University of Ceará in Brazil has shown some very promising results for women suffering from these Climacteric symptoms.

The study looked at 30 women between the ages of 41 and 65 with Climacteric based anxiety and emotional lability symptoms. Half of the sample were treated with acupuncture and half (15) were given a placebo acupuncture treatment, where the women thought they were receiving acupuncture, but actually were being punctured 1.2 cm away from the the internationally recognised acupunture points. The results were then compared to the recovery rates from over 320 women who did not undergo any treatment. 75% of the women in the treatment groups had histories of previous emotional problems like anxiety. They also looked at other factors which may be exacerbating anxiety levels in the women, which I will cover below.

The researchers found that acupuncture, both genuine and placebo, was clinically effective for the treatment of the women's anxiety. 93.3% of the women who had the genuine acupuncture and 86.6% of the women who had the placebo effect had a marked improvement in anxiety levels over 10 sessions.

They also found that two particular factors had a significant negative impact, promoting greater levels of anxiety and emotional lability, on women with Climacteric syndrome. These are poor marital/partner relationships and stressful professional lives.

Other studies have shown that anxiety and sleep disruption problems during menopause increases the risk of depression by 4 to 5 times.



Girão ÁC, Alves MDS, Alves e Souza ÂM et al. (2014) Acupuncture in the treatment of anxiety in climacteric: additional therapy in mental health promotion. J Nurs UFPE on line., Recife, 8(6):1538-44, June., 2014

Luca AC de, Fonseca AM da, Lopes CM, Bagnolli VR, Soares JM, Baracat EC. (2011) Acupuncture-ameliorated menopausal symptons: single-blind, placebo-controlled, randomized trial. Climateric [Internet]. 2011 Feb [cited 2013 Jan 12];14(1):140-5

Polisseni AF, Polisseni F, Fernandes LM, Moraes MA, Guerra MO. (2009) Depressão em mulheres climatéricas. HU ver [Internet]. 2009 July/Sept [cited 2012 Dec 15] ; 35(3): 183-9.

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One of the reasons anxiety turns into depression - new study

One of the reasons anxiety turns into depression - new study

As reported in Thursdays blog, more and more evidence is being found that long term untreated anxiety is likely to turn into depression. The study quoted on thursday found that this was likely to happen to about 50% of the population of anxiety sufferers. Another study also published recently suggests that untreated long term anxiety is likely to turn into depression in up to 77% of cases.
It has also been found that those that develop depression following long term anxiety, tend to get more severe forms of depression compared to those who develop depression without first suffering bouts of anxiety.

These are sobering findings and really highlight the importance of dealing with anxiety in its early forms and of learning the tools and techniques of proper emotion regulation.

However a question arises as to what is causing the anxiety to turn into depression. Surprisingly only three studies have looked look at the potential causes of this phenomenon. The first research study from 1999 looked at whether specific negative life events or reassurance seeking behaviours could be what transforms anxiety into depression, however the researchers could not find the expected connections. The second study from 2009 looked at the hypothesis that a lack of problem solving skills or individuals with anxiety who perceive that they have little or no control over the things that happen to and around them might cause, in part at least, the anxiety to turn to depression. Like the 1999 study, this study was unable to find such a causal effect.

However a study published a few weeks ago does finally shed light on this transformation. The study by researchers at The Pennsylvania State University in the United States used a large scale sample between 1994 and 2008 in four waves of observation with between 6504 and 4834 people to try to find what might be one of the causes for depression with people suffering from anxiety.

A prominent feature of anxiety is avoidance or flight. If an individual is anxious about something, say meetings, or public speaking or flying for example, they will tend to avoid engaging in that activity as a method trying to regulate the anxiety. As members of the free course will know this is one of three primary responses to what is known as the 'fear of the fear' phenomenon.

The researchers tested the hypothesis that avoiding the anxiety inducing subject, e.g. flying, public speaking etc. was a factor in the onset of depression. If this hypothesis were to prove to be correct one would expect that the greater the level of avoidance the greater the chance the individual has of becoming depressed. Indeed this is exactly what the researchers found.
The more someone avoids the anxiety promoting stimulus the greater their chances of becoming depressed.

There is now a hunt ongoing to find why this might be the case.


N.C. Jacobson & M.G. Newman (2014) Avoidance mediates the relationship between anxiety and depression over a decade later. Journal of Anxiety Disorders. 28 (2014) 437-445.

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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.



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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