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.

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.


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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Can losing weight reduce anxiety?

Can losing weight reduce anxiety?

I have written a number of times about the effect of diet on anxiety levels (here) for example. However if you are overweight will reducing weight also reduce anxiety levels?

A study just published this week looked at this very question.

It has been found that patients with metabolic syndrome, which is combination of diabetes, high blood pressure and obesity, (and these conditions often go together), also often report higher levels of anxiety as well. The question is are the increased levels of anxiety linked to the metabolic syndrome or in particular, obesity?

There are a set of neurotransmitters or chemicals in the brain, called monoamines which it is believed are connected to anxiety levels. We think monoamines are vital components of our emotional and thinking systems. It has been found that problems with the effectiveness of monoamines in the brain occur in issues like depression and anxiety. Some drugs used to treat these problems increase the effectiveness of the monoamines.

This study examined the levels of anxiety, weight and monoamines levels in a group of patents aged between 40 and 60 who had been diagnosed with metabolic syndrome.

They were tested for weight, anxiety levels and monoamine levels before and after being placed on a 6 month weight reduction diet.

The results were marked to say the least. They found that of the patents placed on the diet and who lost weight, increased their levels of monoamines, and decreased their anxiety levels by almost a third over the same time. In fact the study found that the level of weight loss for these patents paralleled the decrease in anxiety levels suffered by the individuals in the study. So the answer appears to be that weight and anxiety are linked, at least with people suffering from metabolic syndrome.


Perez-Cornago, A. et al (2014) Effect of dietary restriction on peripheral monoamines and anxiety symptoms in obese subjects with metabolic syndrome. Psychoneuroendocrinology May 2014.http://dx.doi.org/10.1016/j.psyneuen.2014.05.003

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This weeks Emotional Resilience Podcast

This weeks Emotional Resilience Podcast

Download this episode (right click and save)

Connect with iTunes - click here

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Do controlling parents have any effect on their children's development?

Do controlling parents have any effect on their children's development?

Most parents try to provide a guiding hand as their children grow up with a mixture of control, support and encouragement. But as there isn't exactly a manual or formula for parenting it's often hard for parents to know what the best course of action is at times. As a father of five (4 girls and a boy) I often wondered whether we were being too hard, too soft,etc. However recent research is showing some interesting and more importantly useful ways forward.

One consistent question what is the ideal amount of control parents should exert over their children as they grow?

Now obviously that is going to depend on a lot of different things or variables. Things like how old the child is, how responsible the child is, what the situation or context is, what the attitude the parent has to the situation and their child for example.

An interesting study published this year in the Journal Parenting: Science and Practice looked at the effects of different levels of parental control on adolescents and in particular how parental control effects how well adjusted the adolescent is and how parental control might effect the childs' ability to regulate or control their own emotions.

The researchers, from five universities across the US and Canada* looked at the responses and outcomes of 206 adolescents (10 - 18 years old) and their parents in terms of reported levels of parental control (from both the adolescents and the parents), the levels of adolescent anger regulation, depression and aggressiveness.

The researchers found that the higher the level of parental control the lower the level of adjustment and flexibility the child was able to maintain. This was even more pronounced with adolescents who had emotion regulation problems to start with, which may be connected to the level of psychological control the parents exerted before the age of 10.

In effect the greater the level of psychological control parents exert on their children the less well adjusted they become. This is not however an argument for no control or laissez faire parenting. This also causes adjustment and emotion regulation problems.



Barber, B. K. (1996). Parental psychological control: Revisiting a neglected construct.
Child Development, 67, 3296–3319. doi:10.2307/ 1131780

Barber, B. K., & Harmon, E. L. (2002). Violating the self: Parental psychological control of children and adoles-
cents. In B. K. Barber (Ed.), Intrusive parenting: How psychological control affects children and adolescents (pp.15–52). Washington, DC: American Psychological Association. doi:10.1037/10422-002

Buckner, J. C., Mezzacappa, E., & Beardslee, W. R. (2003). Characteristics of resilient youths living in poverty: The role of self-regulatory processes.
Development and Psychopathology,15, 139–162. doi:10.1017/ S0954579403000087

Cui, L. teal (2014) Parental Psychological Control and Adolescent Adjustment: The Role of Adolescent Emotion Regulation. Parenting: Science and Practice. 14:1, 47-67, DOI:10.1080/15295192.2014.880018

Han, Z. R., & Shaffer, A. (2013). The relation of parental emotion dysregulation to children's psychopathology
symptoms: The moderating role of child emotion dysregulation. Child Psychiatry & Human Development, 44, 591–601. doi:10.1007/ s10578-012-0353-7

Kunz, J. H., & Grych, J. H. (2013). Parental psychological control and autonomy granting: Distinctions
and associations with child and family functioning. Parenting: Science and Practice, 13, 77–94. doi:10.1080/ 15295192.2012.709147

Pettit, G. S., & Laird, R. D. (2002). Psychological control and monitoring in early adolescent: The role of
parental involvement and earlier child adjustment. In B. K. Barber (Ed.), Intrusive parenting: How psychological control affects children and adolescents
(pp. 97–123). Washington, DC: American Psychological Association. doi:10.1037/10422-004



* Oklahoma State University, The University of Toronto, Oklahoma State University, Indiana University-Purdue University and The University of Pittsburgh

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This week's Emotional Resilience Podcast Episode 6

This week's Emotional Resilience Podcast Episode 6


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The effects of pre-operation anxiety on the recovery of heart surgery patients

The effects of pre-operation anxiety on the recovery of heart surgery patients

A study just released in the Journal of the American College of Cardiology looked at the connection between pre-operation anxiety levels in patients and how well those patients improved during the first year after the surgery.

The study by a group of cardiologists looked at the anxiety levels of patients just before they were to undergo heart surgery. They then tracked those patients for the first year of their recovery after the surgery to see if there was any impact of the anxiety levels on their quality of life during recovery. The study followed 720 patients who were operated on and measured their levels of anxiety just before the operation. They found that almost half (347 or 48%) of the patients had what could be described as high levels of anxiety just before the operation.

The researchers found that both the high and low anxiety groups had similar operation success rates, however the recovery of the high anxiety group was much slower and their quality of life had significantly poorer improvement outcomes.

This level of evidence should be a call to health providers and patients to ensure the patients are equipped to lower their levels of anxiety before surgery. occurs.


Mohanty, S. et al (2014) Baseline anxiety impacts improvement in quality of life in atrial fibrillation undergoing catheter albtion. J Am Coll Cardiol. 2014;63(12_S):. doi:10.1016/S0735-1097(14)60395-8

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How exercising an avatar can reduce anxiety and improve self-body image

How exercising an avatar can reduce anxiety and improve self-body image

Exergaming or video fitness games that require bodily movement of the player to play, and usually drive the movements of an avatar may have more going for them than might at first appear. The Wii Fit and Kinetic are two examples of these types of exergaming. A number of research studies have found that exergames with activities such as dancing, kickboxing and aerobics for example can have a number of beneficial health effects. However a series of previous studies have also found that people who exercise with other people tend to report more positive wellbeing and less anxiety as opposed to those who exercise on their own.

There is a group of people for whom group exercise is not an appealing thought. People with poor self-image perception or put another way, high levels of body image dissatisfaction, tend to find group or social exercise both demotivating and anxiety increasing, for obvious reasons. This especially occurs in situation where the majority other members of a workout group appear to be fitter or look better and in environments which have large mirrors.

So is it really better to exercise with others or on your own?

There is a syndrome known as social physique anxiety, where people have the feeling that their bodily looks are being negatively evaluated by others and as a result they suffer from embarrassment in many social settings. This is actually a subset of social anxiety. As one can imagine in such situations the motivation to exercise in front of others is quite low. In fact in some situations the anxiety can be so pronounced that a complete aversion to exercise can develop with the obvious health consequences.

A study to be published in July looks at the effects of solitary exergaming using avatars in situations where social physique anxiety and high levels of body image dissatisfaction occur.

You can probably see where this research is going, however there is an interesting twist in this study and it's called the Proteus Effect.

The Proteus Effect refers to a phenomenon noticed years ago in the online gaming world. It was found that people often tend to take on the attributes of the digital persona or avatar or character they are operating with. Studies have found for example, that people who use tall lean avatars in games tend to close the physical space between themselves and other people's avatars more than if they are using short fat avatars. Other studies have shown shifts in a range of persona attributes including general attitude, confidence, aggression levels, empathy, communication style, problem solving style etc. Researchers have been finding that it's not just online behaviour that can change as a result of the Proteus Effect. There have been a number of successful therapeutic interventions using avatars in areas such as weight loss, addiction, aggression / anger and confidence problems using avatars as role models.

The term Proteus Effect comes from the Greek sea god Proteus who is mentioned in Homers 'Odyssey'. Proteus, who lived in the sea, knows everything, everything that has happened, everything that is happening and everything that will happen and consequently was much valued. The only problem was that Proteus was somewhat of an elusive god and didn't like to give up his secrets. If approached Proteus would hide by transforming himself into other sea creatures so you couldn't work out who he was and get hold of this powerful knowledge.

The proteus effect refers then to the taking on of the attributes and persona of the avatar by the game player.

Not only can the shape, attractiveness and general attributes of an avatar change our online behaviour, but it also affects how we feel about the game or activity, other people and ourselves. Game designers have known for some time that people with more attractive and successful hero type avatars tend to build deeper affiliations with the game and other players and consequently tend to stay with the game longer. Avatar based games such as the ever popular Warcraft and online environments such as Second Life measure player engagement in terms of years as a direct result of this effect.

The thing to note here are these are emotional reactions. Emotions such as enjoyment, attachment, confidence and even grief are experienced whilst operating through an avatar. Not only are these emotions real for the participant but they are being altered as a direct result of the percieved personality of the avatar. In effect we tend to take on the personality projected by the character we are in effect role playing.

This study (remember that?) looked at three research questions:

1. How do body image dissatisfaction and exercise context affect individuals' (a) enjoyment, (b) mood, and (c) perceived exercise accomplishment during exergame play?
2. In the group context, will social physique anxiety be reduced during exergame play?
3. What is a role of self-presence in predicting perceived exercise accomplishment?

They had 732 people attend both group exercise classes and do solitary exergaming. Half of the population reported suffering from some form of body image anxiety.

  • The researchers found that all the participants significantly improved their enjoyment of solitary exercise using an avatar over doing the exercise in a live group situation. People with high levels of body image dissatisfaction had even greater levels of enjoyment than those with less of an issue about their body image.
  • When it came to an increase in positive mood, people with high body image dissatisfaction reported a significantly elevated effect on their mood as well whilst using an exergaming programme.
  • Again when it came to the perception of having accomplished something, everyone reported a significant increase whilst engaging in solitary exergaming over group exercise. This effect I assume is quite likely to be down to the progress bars and the like such games produce.
  • The big win from the research was that everyone saw a significant decrease in body image anxiety during exergaming when compared to social exercise and the effect was significantly more pronounced for those with higher levels of body image dissatisfaction than those with lower levels of body image anxiety.
  • Finally for the last question the researchers found that the role of the avatar was significant in these results. Basically what happens is that people identify emotionally and physically with their avatar and begin to experience the world through the percieved avatars personality, what scientists call self-presence. In other words, when playing such games we tend to experience the game as the avatar might rather than from our own perspective. The Proteus Effect in action.

So you can get into or more into exercise, reduce body image anxiety and feel better about the whole exercise thing by exercising an avatar!


Ball, K., Crawford, D., & Owen, N. (2008). Obesity as a barrier to physical activity.
Australian and New Zealand Journal of Public Health, 24, 331–333. http://

Belling, L. R. (1992). The relationship between social physique anxiety and physical
activity. Unpublished master's thesis, University of North Carolina, Chapel Hill.

Ersner-Hershfield, H., Bailenson, J. N., & Carstensen, L.L. (2008). Feeling more
connected to your future self: Using immersive virtual reality to increase retirement
saving. Paper presented at the Association for Psychological Science Annual
Convention, Chicago, IL.

Fox, J., & Bailenson, J. N. (2009). Virtual self-modeling: The effect of vicarious
reinforcement and identification on exercise behaviors. Media Psychology, 12,
1–25. http://dx.doi.org/10.1080/15213260802669474.

Song, H et al (2014) Virtual vs. real body in exergames: Reducing social physique anxiety
in exercise experiences. The journal of Computers in Human Behaviour. July 2014. http://dx.doi.org/10.1016/j.chb.2014.03.059

Yee, N., & Bailenson, J. (2007). The proteus effect: The effect of transformed self-
representation on behavior. Human Communication Research, 33, 271–290.

Yee, N., Bailenson, J. N., & Ducheneaut, N. (2009). The proteus effect: Implications of
transformed digital self-representation on online and offline behavior.
Communication Research, 36, 285–312. http://dx.doi.org/10.1177/0093650

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