Peter H Brown Clinical Psychologist

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All By Myself…The Tyranny of The Loneliness Epidemic

Credit Dr Ronald Pies, M.D. via psychcentral.com

The recent controversy over the still-developing DSM-5 — that compendium of mental disorders the media love to call, inappropriately, “The Bible of Psychiatry” –has gotten me thinking about loneliness. Now, thankfully, nobody has seriously proposed including loneliness in the DSM-5. Indeed, loneliness is usually thought of as simply an unpleasant part of life — one of the “slings and arrows” that pierce almost all of us from time to time. Loneliness, in some ways, remains enmeshed in a web of literary and cultural clichés, born of such works as Nathaniel West’s darkly comic novel, Miss Lonelyhearts, and the Beatles’ whimsical anthem, “Sgt. Pepper’s Lonely Hearts Club Band.”

But loneliness turns out to be a serious matter. And as psychiatry debates the diagnostic minutiae of DSM-5, all of us may need to remind ourselves that millions in this country struggle against the downward tug of loneliness. Yet even among health care professionals, few seem aware that loneliness is closely linked with numerous emotional and physical ills, particular among the elderly and infirm.

It’s easy to assume that loneliness is simply a matter of mind and mood. Yet recent evidence suggests that loneliness may injure the body in surprising ways. Researchers at the University of Pittsburgh School of Medicine studied the risk of coronary heart disease over a 19-year period, in a community sample of men and women. The study found that among women, high degrees of loneliness were associated with increased risk of heart disease, even after controlling for age, race, marital status, depression and several other confounding variables. (In an email message to me, the lead author, Dr. Rebecca C. Thurston, PhD, speculated that the male subjects might have been more reluctant to acknowledge their feelings of loneliness).

Similarly, Dr. Dara Sorkin and her colleagues at the University of California, Irvine, found that for every increase in the level of loneliness in a sample of 180 older adults, there was a threefold increase in the odds of having heart disease. Conversely, among individuals who felt they had companionship or social support, the likelihood of having heart disease decreased.

The young, of course, are far from immune to loneliness. Researchers at Aarhus University in Denmark studied loneliness in a population of adolescent boys with autism spectrum disorders (an area of great controversy in the proposed DSM-5 criteria). More than a fifth of the sample described themselves as “often or always” feeling lonely—a finding that seems to run counter to the notion that those with autism are emotionally disconnected from other people. Furthermore, the study found that the more social support these boys received, the lower their degree of loneliness. We have no cure for autism in adolescents–but the remedy for loneliness in these kids may be as close as the nearest friend.

And lest there be any doubt that loneliness has far ranging effects on the health of the body, consider the intriguing findings from Dr. S.W. Cole and colleagues, at the UCLA School of Medicine. These researchers looked at levels of gene activity in the white blood cells of individuals with either high or low levels of loneliness. Subjects with high levels of subjective social isolation—basically, loneliness — showed evidence of an over-active inflammatory response. These same lonely subjects showed reduced activity in genes that normally suppress inflammation. Such gene effects could explain reports of higher rates of inflammatory disease in those experiencing loneliness.

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Could inflammatory changes, in turn, explain the correlation between loneliness and heart disease? Inflammation is known to play an important role in coronary artery disease. But loneliness by itself may be just one domino in the chain of causation. According to Dr. Heather S. Lett and colleagues at Duke University Medical Center, the perception of poor social support — in effect, loneliness — is a risk factor for development, or worsening, of clinical depression. Depression may in turn bring about inflammatory changes in the heart that lead to frank heart disease. This complicated pathway is still speculative, but plausible.

Loneliness, of course, is not synonymous with “being alone.” Many individuals who live alone do not feel “lonely.” Indeed, some seem to revel in their aloneness. Perhaps this is what theologian Paul Tillich had in mind when he observed that language “… has created the word “loneliness” to express the pain of being alone. And it has created the word “solitude” to express the glory of being alone.” Conversely, some people feel “alone” or disconnected from others, even when surrounded with people.

Let’s admit that not everybody is capable of experiencing the “glory of being alone” or of transforming loneliness into “solitude.” So what can a socially-isolated person do to avoid loneliness and its associated health problems? Joining a local support group can help decrease isolation; allow friendships to form; and give the lonely person an opportunity both to receive and to provide help. This reciprocity can bolster the lonely person’s ego and improve overall well-being. Support groups geared to particular medical conditions can also help reduce disease-related complications. Although there are always risks in going “on line” to find support, Daily Strength appears to be a legitimate and helpful website for locating support groups of all types, including those for loneliness. Psych Central also provides opportunities to exchange ideas and “connect” with many individuals who feel isolated or alone. For those who feel lonely even in the midst of friends, individual psychotherapy may be helpful, since this paradoxical feeling often stems from a fear of “getting close” to others.

No, loneliness is not a disease or disorder. It certainly shouldn’t appear in the DSM-5 — but it should be on our minds, as a serious public health problem. Fortunately, the “treatment” may be as simple as reaching out to another human being, with compassion and understanding.

Ronald Pies MD is a psychiatrist affiliated with Tufts University School of Medicine and SUNY Upstate Medical University. He is also Editor-in-Chief of Psychiatric Times and author of Everything Has Two Handles: The Stoic’s Guide to the Art of Living. . Disclosure information for Dr. Pies may be found at www.psychiatrictimes.com

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April 29, 2010 Posted by | Age & Ageing, anxiety, Aspergers Syndrome, Books, brain, depression, diagnosis, Health Psychology, Identity, mood, Pain, self harm, stress | , , , , , , , , , , , , , , , , , | 1 Comment

“I Saw It Happen”: Children Who Witness Bullying Can Be Traumatized Too

Students who witness bullying of their peers may suffer more psychologically than the victim or the bullies.

Read The Original Research Paper (PDF)

2002 students ages 12 to 16 were surveyed at public schools in England. The survey asked them whether they’d committed, witnessed, or been the victim of several types of bullying behavior (e.g., kicking, name-calling, threatening, etc.) and whether they had experienced psychological stress symptoms such as anxiety, depression, or hostility.

Why bystanders suffer more than victims of bullying

As reported in the article, previous research shows that children who witness bullying feel guilty, presumably for not doing anything to help the victim.

In addition, they may have felt more stressed by vacillating between doing what they thought they should do (i.e., help the victim) on the one hand, and being afraid of being victimized themselves, on the other.  Being in this type of “approach/avoidance” conflict has been shown in numerous studies to create high levels of stress.

The combination of guilt and fear among witnesses that they will experience the same thing may be another reason why they are more affected by bullying than the actual victims.

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Uncertainty, especially combined with feelings of fear or guilt, contributes to stress. Stress leads to depression, anxiety, and other mental disorders.

Sitting down and discussing feelings of fear and guilt with your child may help to minimize the destructive force and ultimate impact of those emotions on mental health.  Practical “survival” tips about how to avoid, distract, or other means of handling bullies would help, too, giving kids options if they are cornered by or are a witness to bullies in action.
Read The Original Research Paper (PDF)

Source: Psychological Association (2009, December 15). Witnesses to bullying may face more mental health risks than bullies and victims. ScienceDaily.
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April 22, 2010 Posted by | Adolescence, Books, Bullying, Child Behavior, Parenting, Resilience | , , , , , , , , , , , | 8 Comments

Anxiety & Depression: Self-Help Internet Interventions Work!

A little while ago I posted a list of free interactive self-help web sites, all research based, which have been shown to effective in the treatment of anxiety & depression. A recent study adds to the body of evidence which supports web based intervention as a viable treatment option or adjunct.

Cognitive behaviour therapy (CBT) via the internet is just as effective in treating panic disorder (recurring panic attacks) as traditional group-based CBT. It is also efficacious in the treatment of mild and moderate depression. This according to a new doctoral thesis soon to be presented at Karolinska Institutet.

Read the original research thesis here (PDF)

“Internet-based CBT is also more cost-effective than group therapy,” says Jan Bergström, psychologist and doctoral student at the Center for Psychiatry Research. “The results therefore support the introduction of Internet treatment into regular psychiatry, which is also what the National Board of Health and Welfare recommends in its new guidelines for the treatment of depression and anxiety.”

It is estimated that depression affects some 15 per cent and panic disorder 4 per cent of all people during their lifetime. Depression can include a number of symptoms, such as low mood, lack of joy, guilt, lethargy, concentration difficulties, insomnia and a low zest for life. Panic disorder involves debilitating panic attacks that deter a person from entering places or situations previously associated with panic. Common symptoms include palpitations, shaking, nausea and a sense that something dangerous is about to happen (e.g. a heart attack or that one is going mad).

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It is known from previous studies that CBT is an effective treatment for both panic disorder and depression. However, there is a lack of psychologists and psychotherapists that use CBT methods, and access to them varies greatly in Sweden as well as in many other countries. Internet-based CBT has therefore been developed, in which the patient undergoes an Internet-based self-help programme and has contact with a therapist by email.

The present doctoral thesis includes a randomised clinical trial of 104 patients with panic disorder and compares the effectiveness of Internet-based CBT and group CBT within a regular healthcare service. The study shows that both treatments worked very well and that there was no significant difference between them, either immediately after treatment or at a six-month follow-up. Analyses of the results for the treatment of depression show that Internet-based CBT is most effective if it is administered as early as possible. Patients with a higher severity of depression and/or a history of more frequent depressive episodes benefited less well from the Internet treatment.

Jan Bergström works as a clinical psychologist at the Anxiety Disorders Unit of the Psychiatry Northwest division of the Stockholm County Council. This research was also financed by the Stockholm County Council.

“Thanks to our research, Internet treatment is now implemented within regular healthcare in Stockholm, at the unit Internetpsykiatri.se of Psychiatry Southwest, which probably makes the Stockholm County Council the first in the world to offer such treatment in its regular psychiatric services,” says Jan Bergström.

Read the original research thesis here (PDF)

Credit: Adapted from materials provided by Karolinska Institutet.

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April 18, 2010 Posted by | anxiety, Books, Cognitive Behavior Therapy, depression, diagnosis, Education, Internet, research, stress, Technology, therapy | , , , , , , , , , , , , , , , , , , , | 10 Comments

Bipolar Mood Disorder: How Long Does An Episode Last?

Credit:John M Grohol PsyD PsychCentral
Bipolar disorder is characterized by a cycling from depression to mania, and back again over time (hence the reason it used to be called manic depression, because it includes both mania and depression). One of the commonly asked questions […] is, “How long does a typical bipolar episode last?”

The answer has traditionally been, “Well, it varies considerably from person to person. Some may have rapid cycling bipolar disorder where that person can cycle back and forth between depression and mania in the course of a day or multiple times a week. Others may be stuck in one mood or the other for weeks or months at a time.”

New research (Solomon et al., 2010) published in The Archives of General Psychiatry sheds a little more empirical light onto this question.

In a study of 219 patients with bipolar I disorder (the more serious kind of bipolar disorder), researchers asked patients to fill out an evaluation every 6 months for five years. The evaluation survey asked a number of questions to determine the length, type and severity of the person’s mood episodes.

They discovered that for patients with Bipolar I disorder, the median duration for any type of mood episode — either mania or depression — was 13 weeks.

They also found that “more than 75% of the subjects recovered from their mood episodes within 1 year of onset. The probability of recovery was significantly less for an episode with severe onset” and for those who had a greater number of years spent ill with a mood episode.

The researchers also discovered that manic episodes or mild depressive episodes were easier to recover from than severe depressive episodes for people with Bipolar I disorder in this study. They also found that those who have a cycling episode — switching from depression to mania or vice-a-versa without an intervening period of recovery — fared worse.

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So there you have it. The average length of time someone with Bipolar I disorder spends either depressed or manic is about 13 weeks. Of course, as always, your mileage may vary and individual differences will mean that very few people will actually have this exact average. But it’s a good, rough yardstick in which to measure your own mood episode lengths.

Reference:

Solomon, DA, Andrew C. Leon; William H. Coryell; Jean Endicott; Chunshan Li; Jess G. Fiedorowicz; Lara Boyken; Martin B. Keller. (2010). Arch Gen Psychiatry — Abstract: Longitudinal Course of Bipolar I Disorder: Duration of Mood Episodes. Arch Gen Psychiatry, 67, 339-347.

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April 15, 2010 Posted by | depression, diagnosis, Education, mood, research | , , , , , , , , | 5 Comments

A Change by Itself is NOT as Good as a Proper Holiday: Don’t Just Sit There…Go Somewhere!

Just having a break from work is not enough suggests new research, it is activities in the open air which have the strongest restorative effects on our mental states.

Everyone gets down sometimes – it’s only natural. It would be more unusual never to be depressed. The idea that depression is an on-off condition with a purely chemical foundation is a myth no psychologist would endorse. The causes of depression can be many and widespread. But one cause many of us have to cope with is work.

One of the main weapons against stress building up from work is going on vacation. Holidays are a firmly established way of allowing the mind and body to recuperate. In  research, however, published in the Journal of Environmental Psychology, Hartig, Catalano and Ong (2007) find that all holidays are not created equal.

Getting out in the openfield

The lead author of this paper, Terry Hartig, lives and works in Sweden, a country well known for its long, dark winters. As such, the Swedes know the importance of getting out in the sunshine, when it finally arrives. There is even a law requiring employers to provide four consecutive weeks of holiday in the summer. And it’s actually this law that is crucial to Hartig et al’s findings.

Hartig and colleagues suggest that being stuck indoors on vacation can limit mental recuperation. On the other hand, when able to roam outdoors, we can exert ourselves at a favourite sport or simply linger in the park. Psychologically, beautiful scenery can distract us from our troubles, help us forget our normal stressful environments and reconnect us to nature.

This is a nice theory that is intuitively attractive and plausible. The problem is how to test it scientifically.

Anti-depressant prescriptions and the weather

Hartig et al. decided to use the number of SSRI anti-depressants prescribed between 1991 and 1998 as a proxy for the general level of depression in the population of Sweden. They then looked for correlations between the weather and the amount of anti-depressants prescribed, which they duly found.

Wait, though, there’s a problem with this. Perhaps people are simply happier when the weather is warmer? It would then follow there would be an association between anti-depressant prescriptions and temperature.

Hartig et al. anticipated this problem. They remove the variation in anti-depressant prescriptions associated with the general change in monthly mean temperature from the equation. Then they get a really interesting finding. Now there’s only a correlation between temperature and anti-depressant medications in one month: July. There’s no similar effect even for the adjacent months of June or August.

How can that be explained? Why would the relationship only occur in July?

Why July is unusual

Here is the authors’ reasoning. In Sweden people take most of their holiday in July at the centre of the period stipulated by law (from 1 June to 31 August). A survey found it is over 90%. This means that during July they have the highest likelihood of being free to enjoy outdoor pursuits. On average, the rest of the year they will be working, so even if the weather is unseasonably warm in May, for example, they won’t be able to take advantage of it.

The reasoning goes, then, that if the weather is bad in July people are stuck indoors. This means they are unable to fully recuperate mentally before returning to work. Alternately, if the weather is good in July people are, on average, mentally rested and have less need for medication.

Remember that this explanation relies on averaging out many people’s behaviour across nine years. Obviously not everyone requires anti-depressants to get through a spell of bad weather. Similarly some people require them whatever the weather. But think about it in terms of the people who are slipping across the boundary of requiring/asking for medication. Then the authors’ explanation makes sense.

Happiness is…

I know this study falls into the category of telling us something we already know. But it does so in rather an ingenious way that takes advantage of Swedish vacation patterns. Also, we can’t be reminded often enough that we should take every opportunity to get out in the open air.

Truly, happiness is looking out across fresh fields, gazing at a distant tree, feeling the sun on your back and the wind brushing your skin.

Sourced from Psyblog.com

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August 25, 2009 Posted by | depression, Exercise, Health Psychology, Resilience, stress | , , , , , , , , , , , | 4 Comments