USING SSRI FOR THE TREATMENT OF ANXIETY

USING SSRI FOR THE TREATMENT OF ANXIETY

SSRI or TCA: Which antidepressant is best suited to treat anxiety?

When it comes to understanding anxiety, the role of serotonin is quite complex. Studies have shown that anxiety is caused by low levels of serotonin in the brain. To be precise, due to low levels of serotonin, the brain develops a condition called hyperfrontality. This state occurs when there is increased flow of cerebral blood fluid in the prefrontal cortex region of the brain. This condition causes generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder. To be more specific, the frontal lobe is involved in generalized anxiety disorder and the locus coeruleus is involved in causing the panic disorder. On the contrary, when serotonin levels are high, it causes hypofrontality because of which the person becomes completely detached and that is considered to be very dangerous.

Although depression and anxiety are comorbid, they don’t necessarily occur together in all cases. If you compare both the disorders, the symptoms appear to overlap. However, the main feature that distinguishes the two is the fact that in depression, the patient loses all hope, whereas, in anxiety, the person is excessively concerned about the future.

There are three main reasons for depression: Low production of serotonin, the inability of serotonin to reach the receptor sites, and shortage of tryptophan. Tryptophan is significant as serotonin is basically made out of it. Hence, it is established that the deficiency in serotonin is the main reason why depression is caused. However, a change in the amount of serotonin in the brain isn’t the only cause for anxiety.

Antidepressants are most commonly prescribed to patients of depression and anxiety. Selective Serotonin Reuptake Inhibitors (SSRI) are antidepressants that are utilized for the treatment of anxiety in cases where the effect of Tricyclic Antidepressants (TCA) is the same. SSRI is responsible for the absorption of serotonin in the brain. The reason why SSRI are considered to be more effective is that they are “selective” and do not interfere with other neurotransmitters of the brain. Furthermore, they ease up the transmission of brain cells which results in the stability of moods. In addition to this, SSRI are considerably safer and more tolerant.

Marshmallow Study – The Game Of Temptation

Marshmallow Study – The Game Of Temptation

The rules are simple.
You can eat one marshmallow now. But if you wait, you can have two later.
That’s not all though. You are left alone in the room with that one tasty marshmallow. For 15 minutes. And you’re just a 4 year old. Can things get any worse for your 4-year-old self? I guess not.
When Dr Walter Mischel was cooking this experiment in his mind, he thought he was just studying “self-control” in pre-school children. The results did their best in clearing his assumptions though. What if that one marshmallow could shine a light over your 4-year child’s future? That’s right. This Marshmallow Study exceeded all expectations and explained how your child’s personality can pretty much explain his future. Let’s see this experiment in detail before we hold the discussion on the results.

THE EXPERIMENT
In the early 1960s, Mischel first administered this experiment on a group of preschoolers at Stanford University’s Bing Nursery School. These children were brought to a room, free of any distractions, but with a table and chair, and of course a bowl full of Marshmallows. He then told the children that they can eat one marshmallow whenever they want but if they wait for him to return, they can have two.
According to Mischel, he just wanted to see the children in an inner conflict. 15 minutes might not be too much for an adult with a marshmallow but for a 4-year-old, they seemed like an eternity. It was instant marshmallow gratification versus delayed marshmallow reward (Chuck Hadad, C.). Without this crucial conflict, there was no self-control.
Mischel was watching this experiment from behind the doors with his three young daughters and a lot of his colleagues while witnessing dramatic changes occurring within these children. That was the moment when he realized that there was something more going on than just a simple self-control ability check. During the study, Mischel noticed that the children who succeeded in waiting for two marshmallows thought of creative ways to distract themselves from the marshmallows, apparently which was the only distraction in the room for them. They tried covering their eyes, pushing the bowl away from them, turning around from the bowl, looking everywhere but the bowl, singing little songs, playing with their hairs, etc. Little did Mischel know that these different strategies children showed to delay gratification had a profound effect on them for decades. But since Mischel had already discovered that something unusual is occurring, he took one step further, or shall we say several steps further, and followed the lives of these children for 50 years. The results did not disappoint him or anybody else. And now we shall move towards the results.

RESULT
Shall we say that the results were so much more unexpected than Dr Mischel’s expectations that he ended up writing up a book about them “The Marshmallow Test: Mastering Self-Control”? He found that about one-third of the preschoolers failed to resist the temptation and ate the marshmallow. The second third of preschoolers were able to wait a bit but not the whole 15 minutes. Therefore, they did not get the second marshmallow. The last group of preschoolers were not only able to wait 15 minutes, in some cases, they even waited for as much as 20 minutes. They received the second marshmallow.
40 years after the Marshmallow Study, B.J. Casey, PhD, of Weil Cornell Medical College, along with Mischel, Yuichi Shoda, PhD, of the University of Washington, and other colleagues tried to find those 4-year-olds who Mischel experimented on (Casey et al., 2001). They found 59 subjects who were now in their 40s. The researchers did another of their tests on these 40+-year-olds to see if their willpower has decreased, increased or remained the same over the course of their lives. And they found out that their willpower and a lot of other positive factors have increased over these years (Casey et al., 2001).
In his book, Mischel explained that the children who were able to delay gratification, later in their lives, have higher SAT scores (an important college entrance examination in the United States of America), have lower Body Mass Index, low rates of addiction, and a lower rate of divorce (Mischel, 2015). These children were already programmed to defeat the stress to achieve their goals. This explained their successful lifestyles in those 50 years.
So is it safe to conclude that the children who ate that one marshmallow (or the whole bowl of marshmallows in some extraordinary cases) as soon as examiner left are doomed forever? Not necessarily. Mischel believes that self-control skills are teachable at any age. They just have to teach their minds to control their emotional need for something it’s trying to avoid. The techniques used by two marshmallow children can easily be taught by parents at home (Mischel, Shoda and Rodriguez, 1989).. As for adults, they can teach themselves self-control by aversive techniques. Something that is very appealing to you can be turned into something that’s not even worth looking twice.
We can achieve more in the long run if we control ourselves, discipline ourselves and resist instant gratification (Casey et al., 2001). If a smoker resists the temptation of another cigarette, he can enjoy a healthy set of lungs and even healthier lifestyle. If a shopaholic keeps a hold on his wallet and credit card, he can probably enjoy a comfortable time after retirement. If a student just holds on and watch the recent episode of his favourite television series after the test, he can enjoy a good grade and ultimately, a good job. This connection between willpower, self-control and instant gratification is not new. It can easily be traced back to the story of Adam and Eve when they tasted the apple from the forbidden tree and lost the luxury of paradise. So I guess we have not learned our lesson yet, right?
After these set of results, Dr Walter Mischel proposed a system, which he named “Hot and Cool” to shine the light on why willpower succeeds or fails. Our cool system is based on our feelings, actions, sensations, and goals. It’s basically a thinking system. More like our Superego. It reminds us why we shouldn’t eat that marshmallow. On the other hand, our hot system is based on our instincts. It’s impulsive. It’s like the Id part of our ego. It just needs to pop that mouth-watering marshmallow in our mouth without thinking about the consequences. It’s like comparing the limbic system vs. pre-frontal cortex!
APPLICATIONS OF MARSHMALLOW STUDY
Have you ever made New Year Resolutions? Or even seen other people making them? Like this year I’ll work harder, practice more, pay more attention in class, finish every assignment on time, achieve the ideal weight, write that novel, spend less money, decrease my time on social media, help my parents, read more books, keep my house cleaner, make my family proud of me, stop wasting time, etc. How many times have you seen yourself or others succeeding these resolutions? Not that many times, right? Or maybe not at all. And that’s just because we fall for that one marshmallow.
So how do we learn and use self-control? Maybe before answering this question, we should know that this can be done. It’s all scientifically tested and proven. Hence before going forward, you got to believe that it can be done. Doubting just won’t help in this case specifically. As for how can it be done, there are many different ways given by all sorts of psychologists. However, first, we are going to discuss the ones given by our Dr Walter Mischel, the person who introduced the Marshmallow Test to us. Among many of the techniques mentioned in his book, we will take two of them to be discussed here.

1. Makeup “If . . . Then” Rules:

The main cause of our falling knees first in front of instant gratification is because our minds have been trained to respond in a way it is used to. Habits are not that easy to break (Mischel, Shoda and Rodriguez, 1989). If we see a delicious thing in front of us, we eat it. We don’t wait 15 minutes to get another. When we have been playing games every single day, we don’t know how not to play games that one day before the exam. When we are used to delaying everything and do them last minute every single time, we don’t just start doing them as soon as we get them just because we made a “resolution”. That’s not how habits are broken. That’s why we have to start making our very own “If . . . then” rules. If I want another marshmallow, I should not look at this one. If I want good scores in my exam then when I go home, then I shall study and not touch my x-box that day. Of course, saying or thinking this won’t work like magic. Nothing works like magic but magic. So we have to practice. It takes about at least 30 days to form a habit. Give yourself 30 days. And then after that, it will become your automatic response.

2. Cool The Now, Heat The Later

As previously discussed, this is somewhat another version of aversive technique adults can use to increase self-control. That’s what you should do: Every time you want to play video games or watch another episode of your favourite drama, vividly imagine your report grade with a big fat F on it and the disappointed faces of your parents. By bringing your future forward, or as we said it in the title “Heating up our later”, we can control ourselves in front of our emotional needs.

3. Make habits To Break Habits

According to Dr Elliot Berkman, Director, Social and Affective Neuroscience Laboratory, Department of Psychology, University of Oregan, it is not that easy to break a habit (Mischel, Shoda and Rodriguez, 1989). Or to form a habit. What’s relatively easy is to replace a habit. If you want to break the habit of using cigarettes, start using chewing gum instead. Simply quitting takes much more effort, will power and time than replacing it with another habit. Give it a try yourself.

Dr Walter Mischel’s study brought a lot of new findings to us. And it’s still showing us more the more we research on it. However, we still need to know as to why some people more sensitive to emotional triggers and temptations and some are not. We still have a lot of ground to cover.

 

References

Casey, B., Somerville, L., Gotlib, I., Ayduk, O., Franklin, N., Askren, M., Jonides, J., Berman, M., Wilson, N., Teslovich, T., Glover, G., Zayas, V., Mischel, W. and Shoda, Y. (2001). Behavioural and neural correlates of delay of gratification 40 years later. Proceedings of the National Academy of Sciences, 108(36), pp.14998-15003.

Chuck Hadad, C. (2018). What ‘marshmallow test’ can teach you about your kids – CNN. Retrieved 2 November 2018, from https://edition.cnn.com/2014/12/22/us/marshmallow-test/index.html

How Long Does It Take to Break a Habit? Science Will Tell You. (2018). Lifehack. Retrieved 3 November 2018, from https://www.lifehack.org/667495/how-long-does-it-take-to-break-a-habit

Metcalfe, J. and Mischel, W. (1999). A hot/cool-system analysis of delay of gratification: Dynamics of willpower. Psychological Review, 106(1), pp.3-19. Mischel, W., et al (1989). Delay of gratification in children. Science, 244(4907), 933-938.

Mischel W., Ayduk, O. (2004). Willpower in a cognitive-affective processing system. The dynamics of delay of gratification. In R. F. Baumeister & K.D. Vohs (Eds.), Handbook of Self-Regulation Research, Theory, And Applications. New York, NY. Guildford Press

Mischel, W. (2015). The Marshmallow Test: Mastering Self-Control. 1st ed. New York: Back Bay Books.

You Can Prevent Major Depression through Web-based Counselling Services: Latest Research

You Can Prevent Major Depression through Web-based Counselling Services: Latest Research

A doctoral researcher of Psychology, Claudia Buntrock, at Leuphana University in Lueneburg, Germany found in her examination the effectiveness of online psychotherapy or Web-based Counselling Services in treating depressive episodes.

The analyst considered both male and female participants who were suffering from depressive symptomatology. They were provided with online treatment by a web-based mentor. Another category of participants was just given access to self-help manuals and guidelines about how to deal with depression. The second group of participants had no access to an online mentor. All of the participants who were part of this experiment were interviewed after one year. Interesting findings were obtained through the research. The group of individuals having no access to online counselling showed a significant increase in depressive symptomatology despite having access to written material on self-improvement while those receiving online help were less likely to develop depressive episode. This experiment has opened new boulevards for internet-based treatment services.

The creator of this study has recommended that an online self-help program is only effective when guided by an online counsellor. This kind of treatment not only helps to deal with depression effectively but also prevents the onset of the depressive episode.

The implications of findings suggested that individuals who simply encounter even minor depressive manifestations, for example, low mood, lack of interest in activities, fatigue, appetite disturbance, lethargy, absence of hope, absence of enthusiasm, self-blaming, suicidal ideation and so forth can approach an online specialist and therefore keep an outbreak of depressive episode.

Hence, it is an alarming sign for the individuals who are at the edge of mental illness while here is uplifting news for the individuals who have lost any trust in online treatment. You can now certainly profit from online psychological services to turn away your depressive manifestations. The sooner you look for online help, the better results you will get.

Written By:
Mehwish Mursaleen,
Senior Psychologist/ Online Psychotherapist/ Chief Editor
Consult-A-Psychologist

Treatment Approaches Aimed At Healing Psychological Problems

Treatment Approaches Aimed At Healing Psychological Problems

The term “psychological problem” is defined as any kind of mental state in which a person feels distressed or disturbed. The psychosocial functioning of the person gets affected such as academics and job performance is not up to the mark, the friendships, social contacts, and family relationships become troublesome and person’s daily life is messed up. This upsetting condition last for longer durations let’s say more than a week or a month. There are different kinds of psychological problems for example depressive state is associated with mood, anxiety relates with worries, adjustment issues are related with long-lasting stress and psychotic disorders are a kind of perceptual disturbance in which person has extrasensory experiences e.g. hearing unusual voices or seeing weird things which others can’t experience.

A variety of psychological treatments is now available for the management of psychological disorders. Behavioural therapy, psychodynamic approach, client-centered treatment, and cognitive behavioural therapy are some of the treatment options one can avail from a psychologist. Among this variety of treatments, cognitive behavioural therapy is proved to be the best treatment for most of the psychological disorders.

Recent researches by clinical psychologists suggest the effectiveness of cognitive behaviour therapy in the long run. Cognitive behavioural treatment in some cases is supposed to be more effective than pharmacological treatments. For example, a study conducted by clinical psychologist Mehwish Mursaleen along with Dr Uzma Ali associate professor at Institute of Clinical Psychology, University of Karachi shows the effectiveness of cognitive behavioural treatment for quick recovery of Panic Disorder with Agoraphobia. They had a client with severe symptoms of anxiety and panic. The client was unable to move out of home due to the fear of sudden anxiety attacks. Her life was limited to the bedroom and she even feared to drive or travel a car. She had not travelled through a plane for a long time. The client had three to five panic attacks per day. She had constant nausea and anxiety. With increasing severity of the panic disorder, she also developed symptoms of depression. All these symptoms started after an event of an emergency situation raised during her travelling through an aeroplane. She also had one of her uncles died of heart attack during plane travel. Before the development of psychological problems, she had a very social and active life but after such incidents, she had confined herself inside her room and she couldn’t run her home due to which all of her family life was disturbed.

She had all her medical test reports showing normal results while she was suspecting to have any heart disease. As recommended by medical professionals, she approached to a psychological clinic where psychologists treated her with cognitive behavioural therapy. She was provided with therapeutic interventions including cognitive restructuring in which thought processes were altered to create healthy thoughts/beliefs. De-catastrophizing continuum offered normal perceptions regarding travelling, minor bodily symptoms, and her ability to control the symptoms. Systematic desensitization was useful in regulating her anxiety through graded exposure, imagination, and relaxation.

With the completion of treatment within four months, she became perfectly all right and started managing her daily tasks effectively. She had two to three plane travels from Pakistan to abroad and within Pakistan without any single moment of anxiety. She was even able to handle her life situations in a more efficient manner than it was prior to the development of her anxiety symptoms.

With this case study, the researchers showed the effectiveness of CBT in a clinical setting. There are many other instances of treating mental disorders with the help of cognitive behavioural techniques. Psychological management is becoming first-line treatment nowadays, whether it is a hospital, rehabilitation, private clinic or community setting. Therefore, our mental health professionals are acclaimed to include psychological strategies and be committed providing the best services to our people.

Training The Brain

Training The Brain

Latest Research Regarding the Use of “Ignoring Strategies”

Up till now psychologists focused more on the emotional domain of person’s disturbed state and changing those disturbing factors to adopt new healthy ways. This is true for the cognitive behavioural approaches to psychotherapy which is a widely used approach in mental health treatments.

New research conducted by Doctor Noga Cohen showed intriguing findings. She conducted a study on a group of German participants in order to find out the effect of ignoring irrelevant information on the brain areas which deal with emotions. The researcher engaged participants in two kinds of tasks. One which involved emotional kind of activity in which they had to ignore negatively charged emotional pictures. Other task involved simply notifying the pointing of an arrow to either left or right side while ignoring its direction to any side. The participants were trained in this activity and while performing the tasks both groups of participants were tested through fMRI showing activity in different areas of the brain. The researcher found that participants who were trained in ignoring emotional stimuli exhibited less activity in their amygdala which is responsible for producing negative emotions like depression, anxiety and anger etc. compared to the other group which was trained in ignoring simple things like direction of the arrow. Moreover, the intense training group showed more activity in brain connections to frontal cortex which is responsible for effective handling of emotions.

This study showed that if we train our patients suffering from a psychiatric illness about how they can ignore irrelevant emotional situations, they can better manage their psychological problems. This study has developed new ways for cognitive behavior therapists who can modify new strategies to treat their patients.

Source:

PsychologyMatters.Asia

Is Yawning Contagious?

Is Yawning Contagious?

Revealing the Logic of Our Brain behind Irrational Yawning Behavior
You must have experienced or listened by someone that yawning is contagious. You might be exposed to various comments regarding this phenomenon. You might have observed that if someone else is yawning you also tend to yawn. Is the sound of a yawn contagious? Have you ever experienced anyone watching a video or picture of a yawning person tend to yawn instantly? If someone yawns while observing others yawn must be sleepy? Is he getting bored? Because we are social beings so is the yawning transferred socially? These and many other questions regarding the phenomenon of yawn were existing in everyone’s mind. Do you know this debate is now under research and scientific observation? Yes! this is true. Just like everyone, this topic developed curiosity in scientists who observed this phenomenon under scientifically controlled settings.

One of the research conducted during 2013 by researchers in Switzerland who studied this matter. In Zurich University, they gathered 11 volunteers and showed them 3 different kinds of videos i.e. one containing laughing incidents, another containing neutral situations, and a video of yawning person. While the participants were watching videos, their fMRI was recorded. It was found that more than half of the participants who watched other persons yawning in the video were more likely to yawn as they watched the video. The brain area called inferior frontal gyrus was highlighted while they yawned. Whereas, those who were watching videos of laughing or neutral acts showed no activity in this area of the brain. This interesting study revealed brain area to be responsible for making a mirror image in brain cells (through mirror neurons) which tend to be imitated by the person (i.e. the person yawns in response to a yawn).
You can test this with a simple experiment. Visualize an image of a person yawning. Just maintain your focus on the image. Observe what happens. You will be surprised even while reading this article unconsciously some people tend to yawn. You may also tend to yawn unintentionally while visualizing, hearing, or reading about yawn.

There is more to study about the yawning phenomenon. Animal studies have been conducted to gain more insights about the facets of yawning. An article published in Frontiers of Neurology and Neuroscience revealed more aspects of contagious yawning with respect to social, evolutionary and neuroscience links of human behaviors. In an Italian Zoo, neuroscientists observed twenty-one baboons with respect to behaviors such as yawning, sleeping, nurturing, priming, and walking. They found that not merely observing other baboons led them to yawn, but their yawning behavior was more related to the time they spend in nurturing and grooming of each other. Thus, it is more about the connection, affection, and closeness in the relationship which determines their contagious yawning behavior.

The interesting findings regarding the phenomenon of contagious yawning are opening doors for many other facts. If the mirror neurons play a role in contagious yawning and this behavior is further related to social familiarity and the degree of closeness among creatures, there might be indications that mirror neurons can also show links with imitation or understanding of other person’s experiences. Empathy is the state where a person can put himself in the other’s shoes. Can there be a link between mirror neurons and the development of empathy? We await further discoveries to unleash the topic.

Written By:

Dr. Mehwish Mursaleen

Ph.D. Clinical Psychology

Source: Psychology Today

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