On avatars and anxiety

I've long been fascinated with the idea of using computers to deliver treatments. I've always been described as a gearhound and if you were to see my office, you'd understand why. While it may seem counter-intuitive that a psychologist would like to see computers doing more of my job, I think actual people will continue to have a place in treatment.

The New York Times reports on using computers to aid in anxiety treatment:

The anxiety rose in his throat — What if I’m not making sense? What if I’m asked questions I can’t answer? — but subsided as his therapist, observing in the background, reminded him that the audience’s reaction might have nothing to do with him. And if a question stumped him, he could just say so: no one knows everything.

There's something unique about anxiety disorders when they are found in isolation, as they are in studies such as these. Specifically, the typical response and thought patterns found are visceral and fairly predictable. These thoughts tend to be less rational and thought-out than our more mature thoughts might be, making them relatively¹ easy to refute. Similarly, the typical physiological response is pretty clear to the person suffering the anxiety, again making it an easier target to address, perhaps using mindfulness techniques to enhance your interoceptive awareness.

That said, there are a number of situations in which computer-aided psychotherapy for anxiety might not be effective. Even in the above linked article, there was a psychologist coach present for the role-playing event. The bottom-line is that we are still many years away from being able to get away from actual trained clinicians for the treatment of many of our mental disorders. And don't you think it'll still nice to be able to talk to a real person from time to time, anyway?

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1. I don't think that they are easy by any real stretch of the imagination. As far as psychotherapy goes, though, restructuring the cognitive distortions associated with a non-comorbid anxiety disorder is relatively easy. ↩

It's not just for kids, anymore.

Psychologists have long known that one's age isn't a protective factor against eating disorders, but conventional wisdom, and perhaps treatment and research, have biased us against considering how an eating disorder affects middle-aged women. The NY Times reports:

‘At a certain point,’ she said, ‘you cross that line and you can’t help what you are doing, and the eating disorder owns you. I lost my bearings on reality and maturity.’

While this is an older article, it's worth keeping in mind when thinking about how mental health needs to be monitored across the lifespan.

Prevention tips: exercise during leisure time

The BBC reports:

People who were not active in their leisure time were almost twice as likely to have symptoms of depression compared to the most active individuals, the study found.

This finding is hardly surprising, but the researchers point out two particular tidbits that may be new:

1. Exercise during leisure time is the important part, not just physical activity in general.
2. The intensity of the exercise appears to be unrelated to its protective effects.

That means it's time to get up and get moving, even if it's just a little while for a little bit.

Depression in pre-schoolers

It is probably really easy to scoff at the notion of depression in pre-schoolers and write off irritability (which can be a manifestation of sadness) as kids being difficult, but there is a qualitative difference between being crabby or sad and clinically depressed. The NY Times writes:

parents tend to feel responsible. Children of depressed parents are two to three times as likely to have major depression. Maternal depression in particular has been shown to have serious effects on development.

Keep in mind that these are just probabilities and stats and don't mean that every child of a depressed parent will be depressed. The Times continues:

But it’s easy to overstate the role of maternal depression. “Most kids of depressed parents don’t get depressed,” says Arnold Sameroff, a developmental psychologist at University of Michigan’s Center for Human Growth and Development, who has studied children of parents with mental problems.

The bottom line with this issue is that you need to trust your parental intuition. If you suspect your child isn't just being a 3 year-old, ask a professional.

PSA for Paxil CR users

The New York Times reports:

Some of the antidepressant Paxil CR produced at the plant was ineffective because a layer of active ingredient split from a layer of a barrier chemical during manufacturing, the government said, and some lots contained only the barrier chemical.

This is obviously quite concerning for some of the readers of this site. The good news is that the drugs were all manufactured between 5 and 9 years ago, so you probably don't have any more of it. Please read the press release for more information.

Forbes.com: The Forgotten Patients

Forbes magazine has a lengthy article on suicidality and its treatment. The magazine reports:

Wixom spent the next year in group and individual sessions learning practical skills to manage her emotions so that they didn't spiral out of control. They included distress tolerance techniques like plunging her head into ice water, devising ways to distract herself when bad thoughts arose and learning not to leap to the conclusion that one bad day implies a life of misery. She has not been hospitalized since. "DBT is the best thing in the world. It changed my life," says Wixom, who got married halfway through therapy and is raising two daughters, ages 10 months and 2 years.

The article discusses the difficulty in finding support for the treatment of suicidality but does highlight the importance of not ignoring the issue. Related to the purpose of our practice, however, is the prominence of DBT in the treatment of chronic suicidality. There is help, you just have to know where to find it.

A Curveball’s Curve? It’s All in Your Head

Wired says:

A curveball is a unique pitch, in that the ball exhibits two distinct types of motions. The ball approaches batters, dancing across their field of view — from peripheral to center (or vice versa) — all the while rapidly spinning on its own axis.

Baseball is a game of inches, but it doesn't even take that much to fool us. The brain is so fascinating.

Pros and cons of medications

As always when taking medications, even ones that don't seem like they might affect brain functioning, it's important to pay attention to potential side effects. Statins are medications like Crestor and Lipitor the help control cholesterol levels. These medications can affect myelin sheaths that help our brains conduct electrical signals, resulting in potential impact on learning and memory. Scientific American weighs in:

Two small trials published in 2000 and 2004 by Matthew Muldoon, a clinical pharmacologist at the University of Pittsburgh, seem to suggest a link between statins and cognitive problems. The first, which enrolled 209 high-cholesterol subjects, reported that participants taking placebo pills improved more on repeated tests of attention and reaction time taken over the course of six months—presumably getting better because of practice, as people typically do. Subjects who were on statins, however, did not show the normal improvement...

That said, it's important to recognize the typical nature of research:

But other studies have found no significant link between statins and memory problems. Larry Sparks, director of the Laboratory for Neurodegenerative Research at the Sun Health Research Institute in Sun City, Ariz., goes so far as to say that “you’ve got a better chance of buying a winning lottery ticket, walking outside and getting hit by lightning and dying” than you do of suffering a cognitive side effect from statins.

Just remember to pay attention to what's happening with you and if you notice a change in your cognitive functioning, bring it up. Better to be aware than to ignore something so simple yet important. This also reinforces the notion that there are pros and cons to taking medications and in some instances it may be better to control your cholesterol behaviorally rather than medically.

TED talks: Music is medicine

The TED series of lectures and conferences is fascinating. There are some really interesting presentations covering all sorts of topics and subject materials, presented by some very talented people. All the talks I’ve seen have been thought provoking and just visually appealing. 

Reflections on addiction

I found this article written about video games and addiction to be quite fascinating. From a therapeutic perspective, I’m not sure there’s much to be gained, but from a purely “understanding the disorder” perspective, I found it to be insightful.

Many children who want to believe their tastes are adult will bravely try coffee, find it to be undeniably awful, but recognise something that could one day, conceivably, be enjoyed. Once our tastes as adults are fully developed, it is easy to forget the effort that went into them. Adult taste can be demanding work – so hard, in fact, that some of us, when we become adults, selectively take up a few childish things, as though in defeated acknowledgment that adult taste, with its many bewilderments, is frequently more trouble than it is worth.

Many parents, I’m sure, wonder about whether playing video games can make kids violent or glorify deviant behavior. This is such a tough question to answer and I don’t believe that there’s any real consensus on the subject. I’ve been gathering a number of articles recently written on both sides of the argument and I hope to writing a more lengthy piece later about it. For now, I think, as with all good parenting, you’ve got to be involved in what your kids are playing. End of story.