Worried to Death

5 More Steps to Cope with Irritability

info — Sun, 24 Oct 2010 14:42:51 +0000

This is a cross posting from my brain fitness blog. As it turns out, worry is probably bad for your brain fitness, so coping with worry not only can improve your mood but may also help improve your thinking and memory. Here the post:

Irritability means letting small things that happen to all of us everyday set off a train of upsetting thoughts. Last week I posted about the negative effect of obsessions and ruminations on brain fitness – some researchers now call them unconstructive repetitive thoughts, or URT (for that post, click here). I wrote about the process of thinking about things that cause negative emotions.

It’s likely that this kind of thinking is associated with increases in cortisol and immune system markers associated with inflammation. The whole “chemical soup” is neurotoxic. The same chemicals are associated with mental and physical decline in older persons. Younger persons aren’t off the hook, though, because research increasingly shows that cognitive decline starts in early life. As several researchers remarked at the Cognitive Aging Summit two weeks ago, “Aging begins at birth.”

One of the things that sets off URT for many people is a random or casual event or thought. Someone cuts you off on the freeway, or you get stuck in the wrong line at the grocery store, or a co-worker makes a comment that upsets you. It’s at that point that the URT gets going, and it’s at that point that you can do something to stop it.

From the point of view of cognitive therapy, the actual event isn’t so important. It’s the fact that it sets off. or activates, a underlying pattern of thought that some people call a schema.You have a choice: (1) go with the URT, and feel upset, and activate a set of chemical processes that are bad for your brain, or (2) stop by the process and move on (in your mind, or in your life) to something else.

In my previous post, I laid out a three-step plan for dealing with URT. Those steps emphasized being aware of the thoughts, deciding whether thinking about the upsetting event was going to resolve anything, and then making a commitment to dealing with the thoughts.

Here are 5 more steps to deal with irritability and improve your brain fitness:

Assign yourself homework: Commit to noticing when you engage in URT at least once a day for a week.
Pay attention to the event that set you off.
Decide what the event means to you. Did the comment from a coworker set off worries about how good you are at your job? Did the person on the freeway make you feel as though everyone was down on you? Did the line at the grocery make you feel panicky about getting everything you had to do done?
Come up with a more reasonable response to what you’re thinking. Maybe say something like, “That person probably didn’t mean to upset me,” or “Even if he or she did that to make me feel bad, I get to choose how I react.”
Repeat each step at least once a day. The way you think is a habit, and the only way to change a habit is to practice doing something different.

Three Ways to Deal with Unconstructive Repetitive Thoughts

info — Fri, 15 Oct 2010 03:07:11 +0000

Several researchers have shown that negative mood, anxiety, and distress can be associated with cognitive decline. Wilson and his colleague Patricia Boyle (both at Rush in Chicago) have shown with data from the Religious Orders Study that persons who are chronically distressed have a greater chance of cognitive decline.

At the Cognitive Aging Summit (sponsored by the National Institute on Aging and featuring NIA-supported research), Martin Sliwinski reported data that show that the specific aspect of emotional distress that may be linked to problems in thinking and memory is something called unconstructive repetitive thought (URT).

Although the term reeks of jargon, it is helpful because it helps us understand the difference between various types of worry, ruminating, or obsessing. URT means that someone thinks a lot about something that is upsetting, but it doesn’t go anywhere.

It’s a little like pushing at a sore tooth in your mouth – you know that you shouldn’t, and that if you don’t leave it alone, you may make it worse. But still, it’s hard to stop.

It’s easy to guess that repeatedly thinking about upsetting things (your boss or spouse yelling at you, an especially bad ride home on the freeway that involved someone cutting in front of you) might cause repeated releases of stress-related neurohormones and immune factors.

Since we know that many of these substances have the capacity to be neurotoxic, it’s a simple (though unproven) link from URT to cognitive impairment.

How do you deal with URT?

First, pay attention to thoughts that bother you and are upsetting. You may be engaging in URT without realizing it. Ask yourself, Is thinking about this making my heart race or making me feel jumpy and angry? Notice what you’re thinking about.
Second, decide whether thinking is going to resolve anything. Sometimes, thinking about something over and over can help you figure out a solution to a problem. But worrying over and over about something in the past or future that you can’t control just makes you miserable. No matter how much you think about something, you can’t change the past or control the future.
Third, make a commitment to deal with thoughts if you can’t deal with the problem. If you’re want to spend time going over something in your mind over and over, schedule a time (maybe 15 minutes) and do so. Don’t do the thinking any other time. Usually, people who learn to relax through meditation or breathing can learn to stop their URT. Regular mediation practice can also help you stop.

Brain Fitness and The Mind of a Monk

info — Tue, 12 Jan 2010 03:20:20 +0000

I saw an interesting blog post several days ago on the site of the Huffington Post about the potential benefits of meditation – or at least about what one woman thinks might be the benefits.

Priscilla Warner writes about the contrast between Tibetan monks’ apparent calm, evident even on brain scans, and her own anxiety disorder.

Ms. Warner says that she suffers from panic disorder, a severe form of anxiety in which a person can have multiple anxiety attacks every day, even in the middle of the night. Her post is titled “I Want the Brain of a Monk” Although most people don’t suffer from anxiety this severe, many people have symptoms of anxiety. And research has consistently shown that higher levels of anxiety are related to more memory problems.

What’s the relation to brain fitness? In my brain fitness class, I often mention the usefulness of meditation in helping reduce stress and anxiety, both of which have negative effects on memory. You don’t have to go to Tibet to get the benefits of meditation. If you simply take 10 minutes several times a day to break in to the ongoing rush of getting things done, you’ve made a start. Use those 10 minutes to sit quietly, relax your muscles, and breathe deeply.

If you do that every day for two weeks, I think you’ll notice that you feel calmer and better able to focus. And if you’re better able to focus, you will be better able to pay attention and remember things.

Do GAD and Depression Overlap?

info — Tue, 12 Jan 2010 03:07:33 +0000

An article in this month’s Archives of General Psychiatry presents a study that looks at the relation of depression to generalized anxiety disorder (GAD).

The relation of anxiety to depression is complex at least in part because of the way the two conditions overlap. Most people with depression have at least some symptoms of anxiety, and many people with anxiety have significant symptoms of depression.

The study reported in the Archives shows that patterns of GAD over time are similar to those of other anxiety disorders, such as social phobia and panic disorder. At the same time, the course of depression was different from the anxiety disorders.

This study shows again that in spite of similarities, GAD and other anxiety disorders are in many ways distinct from mood disorders. In spite of the overlap in symptoms (and often, treatments), GAD may be separate from depression.

Reference:

Beesdo K, et al. (2010). Incidence and risk patterns of anxiety and depressive disorders and categorization of generalized anxiety disorder. Archives of General Psychiatry, 67, 47-57.

Simple Ways to Cope with Anxiety without Medications

admin — Mon, 02 Mar 2009 14:10:06 +0000

With all the uncertainty in the economy, more and more people are asking about how to manage anxiety. Although several types of medications can be helpful in coping with anxiety, some of them (drugs in the group of benzodiazepines, such as Valium, Xanax, and Ativan) can actually have a negative impact on your memory. Other patients whom I see simply don’t want to take medicines for their anxiety. Since anxiety and stress can make your memory worse, managing your anxiety should be near the top of your brain fitness list.

Top ways to manage anxiety without medications:

Find out what you’re anxious about, and do something about it. Many patients have vague anxiety and aren’t quite sure what it’s about. See if you can figure it out. Talk to a friend about how you feel. Sometimes just talking about a problem can help make it clear. Another person’s viewpoint may help you to see a problem in another light.

Exercise. Both aerobic (walking, running, bicycling, swimming) and nonaerobic (weight training) can help you manage anxiety. People usually feel less anxious after exercising. If you aren’t exercising now, check with your doctor to make sure it’s OK to start. Even 10-15 minutes a day of walking can make a difference.

Relax and breathe. Researchers long ago noticed that it’s almost impossible to breathe deeply and feel anxious at the same time. Take 10 minutes twice a day to sit quietly, relax the muscles in your neck and back, and breathe fully. If you do this for a week you’ll feel better.

Meditate. Researchers have shown that almost any kind of meditation improves anxiety. I believe that meditation that helps you develop attentional focus will not only relieve stress and anxiety but also improve your memory. Mindfulness meditation is one form of meditation that is very helpful.

Distract yourself. Sometimes you can’t solve a problem but just have to live with it. Even after you exercise and meditate, you may still have to confront a problem over which you have little control. Try to find things that you enjoy doing that can help give you a break from feelilng anxious. Hobbies can often help people distract themselves. Doing something that is intellectually challenging is also good for your brain health.

Cognitive Therapy and Post Partum Depression

info — Fri, 02 Jan 2009 13:10:50 +0000

A reader recently reported that she is suffering from post partum depression and asked whether cognitive therapy might help her. She wondered whether cognitive therapy might help her get off her current medications.
It’s not possible for us to comment on any specific case in this blog, because it’s beyond the scope of the blog to provide treatment. At least one study has shown that cognitive therapy is helpful in post partum depression (Misri S, Reebye P, Corral M, Milis L. The use of paroxetine and cognitive-behavioral therapy in postpartum depression and anxiety: a randomized controlled trial. J Clin Psychiatry. 2004 Sep;65(9):1236-41), so it may be worth considering this treatment option.
What’s most important is that anyone with post partum depression get treatment! I would suggest that anyone interested in this issue first consult with the person who is prescribing the medication for depression. Don’t stop the medication without the advice of the clinician who is prescribing the medication!
If your clinician doesn’t know any competent cognitive therapists, you can contact the Academy of Cognitive Therapy for a possible referral (Academy of Cognitive Therapy website).

Behavioral Sleep Medicine

info — Mon, 05 May 2008 13:09:38 +0000

In my last post back a few months ago, I promised I’d talk more about cognitive and behavioral treatments for insomnia. Although many people with insomnia view sleep medication as the single best answer to their sleep problem, a lot of folks would rather find ways to help their insomnia without taking medications. Why?

Medications help you sleep quickly, and for a lot people that’s a very high priority. But some people have side effects from sleep medications, including memory problems and drowsiness the next day. Many commonly-used medications for sleep can cause dependence on them. And unless you have pretty good insurance, many of the newer medications (the one’s you see advertised on TV) are pretty expensive. So medications are usually helpful in getting people to sleep and keeping them asleep, but may cause other problems.

What are alternatives? An increasing number of behavioral health specialists are interested in using cognitive-behavioral techniques to treat insomnia. You might think that insomnia is just a medical problem. The truth is that a lot of medical problems are associated with people’s behaviors. An example is diabetes. It’s a disorder of how the body uses sugar. That’s physical. But diabetes is affected by things like diet, exercise, and depression. Behavioral factors can affect diabetes.

Insomnia is also influenced by behavior. Things like having a regular bed time, not drinking coffee before bed time, and having a cool and quiet bedroom are important. Many people with insomnia have a number of habits that interfere with getting a good night’s sleep. Working with a qualified behavioral health specialist may help with your insomnia without medications.

A good article on cognitive-behavioral treatment of insomnia is available on the Mayo Clinic website, here.

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Insomnia

info — Sat, 17 Feb 2007 01:12:57 +0000

After 50, a lot of us don’t sleep as well as we used to. In my work with people over 50, sleeping difficulties are one of the most common complaints I hear. As people get older, sleep changes (it’s not just your imagination). To understand this, you have to know a little bit about what happens when you go to sleep.

Sleeping is an active process. It isn’t that your brain just shuts down and then restarts itself in the morning. When you go to sleep, your brain activity changes. Sleep doctors talk about sleep stages. Stages are defined by what’s going on in your brain at any given moment, usually based on looking at brain waves recorded from the skin on your head. As your sleep changes, the brain waves change. You go through several sleep stages in cycles during the night, from a shallow kind of sleep to a much deeper kind of sleep.

As you get older, the light sleep stage gets even lighter. You may wake up more easily, and may have more trouble going back to sleep. You may not feel as well rested when you wake up, too.

Doctors talk about different types of insomnia. Initial insomnia is when you have trouble getting to sleep in the first place. People with initial insomnia may lay in bed worrying about things that happened during the day. Middle insomnia occurs when you get to sleep OK, but then wake up during the night. Final insomnia happens when you wake up early in the morning and can’t get back to sleep. There are a number of causes for any of these insomnias, but anxiety and depression are common causes of insomnia. There are a number of physical causes, too, so anyone with insomnia needs to have a regular check up.

Although most people think about using some kind of sleeping pill for insomnia, there are some major drawbacks to taking sleep medication. Some people may have daytime sleepiness, memory loss, and problems with balance. Having said that, there’s no doubt that medications can be really helpful.

Another treatment option is cognitive behavioral treatment for sleep problems. The core idea here is to use psychological techniques to treat the insomnia. Research studies have shown that this approach to treating insomnia works, and people may avoid some of the problems that come along with using medications for insomnia.

More next time about cognitive behavioral treatments for insomnia.

Generalized Anxiety Disorder

info — Sat, 03 Feb 2007 14:26:27 +0000

What is Generalized Anxiety Disorder, or “GAD?” Is it the same thing as worrying a lot?

If you worry a lot, other things may happen. You may be tense and you may not sleep too well. You may not be able to concentrate very well, and even may think that you have memory problems. You may have muscle tension and you may feel restless and be “jumpy.”

How does a doctor diagnose GAD? He or she would ask you about these symptoms. Many doctors use a list of symptoms from the DSM, or Diagnostic and Statistical Manual, of the American Psychiatric Association. (Click here if you’re interested in reading more about the DSM on Wikipedia.) If you have the right symptoms, and don’t have other reasons for having them (for example, an illness with your thyroid gland), then you may have GAD.

Do you want to take a short screening test about GAD? You can find one on the website of the Anxiety Disorders Association of America, ADAA. Click here to go to their GAD test.

Treatments for GAD include psychotherapy, medication, and lifestyle changes. More in our next post.

Worry

info — Thu, 25 Jan 2007 13:40:24 +0000

Worrying about what’s going on in your life? Do these thoughts keep you tossing and turning at night rather than letting you get to sleep. Are your friends or family noting that you seem ready to bite someone’s head off for no apparent reason? Is it hard for you to stay focused?

If this sounds like you, perhaps you are a worrier. That said, everyone worries. However, for someone who is a worrier, this behavior is very typical rather than in response to a particular event. For example, are you worried about your job? If you recently were informed that your company is downsizing, you may be rightly concerned that you could lose your job. On the other hand, if the organization you work for has had a banner year and you had a glowing performance review complete with a raise and a bonus, your concern is far more likely to be ill founded.

When worry is purposeful, it motivates you to consider the alternatives that are available and to develop a plan of action. In this case, a reasonable amount of stress works to your advantage. However, when your concerns are more in the realm of “What if’s…” then you may be spinning your wheels. Not surprisingly, worriers fall into this latter group.

We all know people who worry. These are people who always seem like there is a part of their body that is in constant motion. They cannot sit still! They always seem to be on the brink of some catastrophe — except when you think about their situation, it does not seem anywhere nearly as awful as they suggest, especially since they do not look for solutions — they just keep worrying. Other worriers have a myriad of physical complaints that are related to stress — they have headaches, backaches, are restless, complain of feeling jittery or on edge, have problems with their sleep, or are tired all the time. Some worriers are irritable or seem forgetful because they have trouble keeping themselves focused on the task at hand.

So what do worriers worry about? Simply put, everything! Their worries may involve ordinary, day-to-day tasks or chores or concerns about getting to places on time or just getting things done. They may be focused on work or school, about family life, finances, or relationships. Your own health or the health of the people that you care about may be a source of worry. Some people even spend an undue amount of time worrying about community or world affairs.

If everyone worries, why is this a problem? For some people, their worry spins out of control. Worriers can spend hours each day wrapped up in concerns over situations that are so far off in the future that it is unclear whether the feared catastrophic outcomes will ever occur. These worries also interfere with their ability to enjoy life. Instead of enjoying that their glass is almost full, worriers are miserable over the idea that there is some possiblity that there will be nothing available to refill their glass again.