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.

Different types of control predicts depression

Different types of control predicts depression

Following on from the research articles reported in last week's blogs (here and here) about the links between anxiety and depression and the finding that people who avoid the object that is causing their anxiety are much more likely to have their anxiety turn to depression if the anxiety continues for some time, a third article just published sheds more light on the situation..

Largely there are three types of control that people use to cope with negative emotions: primary, secondary and disengagement control.
Primary control coping is based on changing and influencing our environment in order to cope. Choosing which friends to go out with based on who makes us feel good, problem solving to deal with the situation and engaging in emotion regulation techniques.
Secondary control is coping by adjusting ourselves to the environment, for example accepting the situation.
The third form of coping people engage in is to disengage completely or avoid the object or situation that is causing the negative emotion.

A study just published in Anxiety, Stress & Coping looked at the coping mechanisms of people who had previously been depressed and compared them with the coping mechanisms of people who have never been depressed
They found that people who had never had depression and who tend to use fewer primary coping skills in preference for avoidance coping strategies are significantly more likely to develop depression.
People, whether they had previously had depression or not, who develop secondary coping strategies, accepting the situation and their emotions (which is different to resignation), tend to see a decrease in their depressive symptoms.
They also discovered that people with greater levels of mental flexibility also tended to suffer from less depressive symptoms and recover more quickly from depression than people with less cognitive flexibility.

The researchers recommend that people at risk of depression should either be helped to develop emotion regulation strategies (primary control coping) or acceptance strategies (secondary control coping). Obviously learning both would be better, significantly reducing the risk of depression regardless of whether you have had it or not before.

 

Reference

Morris, M.C. et al (2014) Executive function moderates the relation between coping and depressive symptoms. Anxiety, Stress & Coping: An International Journal. 2014 June DOI: 10.1080/10615806.2014.925545

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This weeks Emotional Resilience Podcast. Episode No. 9

This weeks Emotional Resilience Podcast. Episode No. 9

 

Download this episode (right click and save)

Download it from itunes

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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.

Reference

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.

 

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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How we inadvertently teach children to become emotional eaters

How we inadvertently teach children to become emotional eaters

A number of research studies have estimated that about 1 in 3 mothers of young children suffer from stress, anxiety and/or depression particularly during the first few years of motherhood. The question is does this have any effect on the children and if so what?

A series of studies have shown that that there is a connection between the stress, depression and anxiety levels of the mother and later life depression, stress and anxiety in the child. Other connections have been found with how well the children grow to learn how to regulate their own emotions. For example the greater the level of maternal stress, anxiety and depression during the first two to four years, the greater the chance the child will also have problems with regulating their own emotions as they grow up.

A new study about to be published next month in the academic journal Appetite, an international research journal specialising in the social science, psychology and neuroscience of food consumption, looked at the effects of the mother's level of anxiety, depression and stress on:

  1. The mother's level of emotional eating, and
  2. Whether the mother feeds the child in order to regulate the child's emotions.

The definition of emotional eating is eating for any reason other than just hunger.

There are broadly three feeding practices that parents tend to engage in with their children:

  1. Nutritive feeding, which is giving the child food only when the child is hungry
  2. Instrumental feeding, which is feeding a child as a reward, for example sweets for being good or doing something, and
  3. Emotional feeding, which is when the parent feeds the child to pacify it when it is upset. An example of this would be when a child has hurt itself or has had a toy taken by another sibling and gets given chocolate to help calm it down as a kind of 'there there". Pleasure or feel good feeding, "I got you this because you like it" is also emotional feeding.

The study, conducted by scientists and practitioners at six universities and hospitals in the US, France and Australia, looked at the levels of stress, anxiety and depression in 3 mothers of children between one and a half and two and a half years old (the average age of the mothers in the study was 35), and examined the links with any emotional eating behaviours of the mothers, child- feeding practices, and lastly the child's own emotional eating habits.

This is important because other studies have found strong links between the use of consuming food to regulate emotions and both childhood and later life obesity, with all the health risks that entails. Additionally last week I reported on a study which found a link between being overweight and the level of anxiety a person experiences, and how losing weight can reduce anxiety levels as well as having a range of other health benefits.

The mothers were observed for whether or not they were using food as any kind of reward (called instrumental feeding) or when the child started to display unwanted emotions or behaviours (emotional feeding).

The first links the researchers found was that, as the mothers' anxiety, stress and/or depression increased so did their own emotional eating. They found exactly the same pattern with the children. As their anxiety or stress increased so did the level of emotional eating.

The question is how did the children learn to engage in emotional eating?

The researchers were able to separate out the factors and found a sequence of events that lead to the child self-medicating emotional issues with food.

They discovered that as the mothers' anxiety, stress and/or depression increased so did their tendency to engage in both instrumental and emotional eating themselves and as a consequence of this they then started engaging in non-nutritive feeding practices with their children.

In other words, when the mothers experienced stress, anxiety or depression, they tended to first engage in emotional eating themselves and then transfer this to their feeding behaviour towards the children. So it is much more likely that a mother would feed a child when she is feeling down or anxious rather than waiting until the child is hungry itself and as a result, the child then learns to use food as an emotion regulation strategy, rather than only eating when hungry.

As stated before, emotional eating tends to result in obesity which in turn increases a loss of self-worth and an increase in anxiety, which then leads to more emotional eating and so on.

Learning better and more healthy emotion regulation strategies than emotional eating is therefore essential to breaking this habit and the spiral that ensues.

 

Click here to learn how to regulate your emotions without engaging in emotional eating

 

Reference
Rachel F. Rodgers, Susan J. Paxton, Siân A. McLean, Karen J. Campbell, Eleanor H. Wertheim, Helen Skouteris, Kay Gibbons, Maternal Negative Affect is Associated with Emotional Feeding Practices and Emotional Eating in Young Children, Appetite (2014), http://dx.doi.org/doi:10.1016/j.appet.2014.05.022.

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This weeks Emotional Resilience Podcast

This weeks Emotional Resilience Podcast

Download this episode (right click and save)

Itunes podcast link https://itunes.apple.com/gb/podcast/calm-composed-confident/id847626776

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The emotional impact of internet addiction on our children

The emotional impact of internet addiction on our children

The internet is an amazing resource and social connector and a recent study found that about 90% of school children with internet access use it to get educational information for school work, as well as other activities such as playing games and social interaction for example. Like most things in life, used responsibly the internet is a fantastic resource and can be a lot of fun.

However there have been a rash of recent studies showing that the prevalence of internet addiction, the feeling one needs to go online as a first recourse and as a preference to engaging with other real life activities, especially among children, is growing. The estimations of the growth of internet addiction in academic research studies range from 1.4% up to 17.9% of the adolescent population or 11 - 15 year olds in both western and eastern cultures. With newly published studies coming in at the higher end of this range, this means that somewhere approaching 1 in 6 of our 11-15 year old children may well be addicted to the internet. Given the study I reported on last week, this is likely to get worse as todays internet toddlers grow into adolescents.

Like every addiction, internet addiction carries a cost and a study to be published next month in the journal Comprehensive Psychiatry highlights some of that cost.

The study looked at 2293 11-14 year olds and assessed them for levels of depression, hostility, social anxiety whilst also monitoring their online habits. The researchers then measured the children a year later to see if there were any links. Now a number of studies have already linked internet addiction with depression, particularly in young adults, 16 - 21 year olds.

The interesting thing about this study is the inclusion of social anxiety. There have been a number of studies already which show that people tend to feel less social anxiety whilst online compared to face-to-face interaction. There is strong speculation in the academic world that this effect maybe driving some peoples addiction to the internet as a proxy for live 'in person' social engagement.

Additionally two studies have found that people with depression also have lower levels of anxiety and hostility when socialising online. This sounds like the internet is a good thing for these people, right?

A famous study in 2011 found that chronic online gamers suffered from greater levels of depression, social anxiety, social phobia (complete aversion to face-to-face contact), and aggression / hostility than individuals who either didn't partake of such games or were just light users. The effects of this aren't just mental. Studies have found that people with higher levels of internet derived aggression and hostility also have higher levels of cardiovascular issues as well as other circulatory problems.

Anyway, this study, led by Dr. Ju-Yu Yen an academic, medical doctor and psychiatrist, found that the longer an individual is addicted, particularly in the adolescent years, the slower the recovery, when treatment or an intervention occurs. Basically the sooner internet addiction is found and dealt with the better the outcome and the faster the symptoms of depression, anxiety and hostility / aggression will reduce.

A number of interventions have been tested where internet addicted people with high levels of depression, anxiety and aggression / hostility have their online addiction treated with positive results. The aggression / hostility tends to reduce the fastest after the individuals are no longer using the internet in such heavy doses, with depression levels also dropping as face to face socialisation increases. Anxiety tends to be the last issue to reduce following such an intervention.

I am currently writing a book titled "ADJUSTED: What the research says about how to bring up emotionally well adjusted, resilient and competent children". If you would like to get your hands on an advanced copy just click here.

 

References

Chih-Hung Ko, et al, (2014) The exacerbation of depression, hostility, and social anxiety in the course of internet addiction among adolescents: a prospective study. Com- prehensive Psychiatry (2014), doi: 10.1016/j.comppsych.2014.05.003

Other papers

Calles JL Jr. (2007) Depression in children and adolescents. Prim Care 2007;34:243-58.

Constantine MG. (2006) Perceived family conflict, parental attachment, and depression in African American female adolescents. Cultur Divers Ethnic Minor Psychol 2006;12:697-709.

Crutzen R, et al (2011) Strategies to facilitate exposure to internet-delivered health behavior change interventions aimed at adolescents or young adults: a systematic review. Health Educ Behav 2011;38:49-62.

Ferguson CJ, & Kilburn J. (2009) The public health risks of media violence: a meta-analytic review. J Pediatr 2009;154:759-63.

Gentile DA et al. (2011) Pathological video game use among youths: a two-year longitudinal study. Pediatrics 2011;127:e319-29.

Greydanus DE, & Greydanus MM. (2012) Internet use, misuse, and addiction in adolescents: current issues and challenges. Int J Adolesc Med Health 2012;24:283-89.

Ha JH, et al (2007) Depression and Internet addiction in adolescents. Psychopathology 2007;40:424-30.
Kitamura T, & Fujihara S. (2003) Understanding personality traits from early life experiences. Psychiatry Clin Neurosci 2003;57:323-31.

Ko CH, et al (2007) Factors predictive for incidence and remission of internet addiction in young adolescents: a prospective study. Cyberpsychol Behav 2007;10:545-51.

Ko CH, et al (2009) The associations between aggressive behaviors and internet addiction and online activities in adolescents. J Adolesc Health 2009;44:598-605.

Ko et al (2009) Predictive values of psychiatric symptoms for internet addiction in adolescents: a 2-year prospective study. Arch Pediatr Adolesc Med 2009;163:937-43.

Lam LT & Peng ZW. (2010) Effect of pathological use of the internet on adolescent mental health: a prospective study. Arch Pediatr Adolesc Med 2010;164:901-6.

Mythily S, Qiu S, & Winslow M. (2008) Prevalence and correlates of excessive internet use among youth in Singapore. Ann Acad Med Singapore 2008;37:9-14.

Norris ML. (2007) Adolescents and the internet. Paediatr Child Health 2007;12:211-16.

Park S, et al (2013) The association between problematic internet use and depression, suicidal ideation and bipolar disorder symptoms in Korean adolescents. Aust N Z J Psychiatry 2013;47:153-9.

Prinstein MJ, et al (2005) Adolescent girls' interpersonal vulnerability to depressive symptoms: a longitudinal examination of reassurance-seeking and peer relationships. J Abnorm Psychol 2005;114:676-88.

Siomos KE, et al (2008) Internet addiction among Greek adolescent students. Cyberpsychol Behav 2008;11:653-7.

Yen JY, et al (2007). The comorbid psychiatric symptoms of Internet addiction: attention deficit and hyperactivity disorder (ADHD), depression, social phobia, and hostility. J Adolesc Health 2007;41:93-6.

Yen JY, et al (2012) Social anxiety in online and real-life interaction and their associated factors. Cyberpsychol Behav Soc Netw 2012;15:7-12.

Yen JY, et al (2011) Hostility in the real world and online: the effect of internet addiction, depression, and online activity. Cyberpsychol Behav Soc Netw 2011;14:649-55.

Young KS. (1998) Internet addiction: The emergence of a new clinical disorder. Cyberpsychol Behav 1998;1:237-44.

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