How were making our children more anxious and depressed

When I was a kid on Long Island, summertime would unleash a gaggle of us to roam the streets and sidewalks of our suburban neighborhood from morning 'til dark, with breaks only for lunch and dinner in the kitchens of our ranches and split levels.

Today, those same streets and sidewalks are devoid of children. Why? Here's what a recent Atlantic article says:

"Since about 1955 ... children's free play has been continually declining, at least partly because adults have exerted ever-increasing control over children's activities," says the author Peter Gray, Ph.D., Professor of Psychology (emeritus) at Boston College...

..."It is hard to find groups of children outdoors at all, and, if you do find them, they are likely to be wearing uniforms and following the directions of coaches while their parents dutifully watch and cheer."

Why has this happened? Fear: "...parents mentioned child predators, road traffic, and bullies as reasons for restricting their children's outdoor play."

Never mind that the actual threats facing our kids are likely no greater than they've ever been. If kids' lack of unstructured, self-directed play seems like a bad thing to you, you're onto something. It's the rare kid who doesn't find it stressful having a parent looking over his or her shoulder, and as we've discussed before here on PANIC!, stress is bad news. And the costs to children of not being able to explore and socialize and make mistakes and come to decisions on their own can be high, and may include an increased likelihood of anxiety and depression as they grow up:

There has been a significant increase in anxiety and depression from 1950 to present day in teens and young adults and Gray cites several studies documenting this rise. One showed that five to eight times as many children and college students reported clinically significant depression or anxiety than 50 years ago and another documented a similar trend in the fourteen- to sixteen-year-old age group between 1948 and 1989.

Suicide rates quadrupled from 1950 to 2005 for children less than fifteen years and for teens and young adults ages 15-25, they doubled.

Of course, this doesn't recognize that anxiety and depression rates depend on unknowable changes in rates of people seeking treatment for these problems and psychiatric diagnosis standards, but it seems pretty likely to me that driving our kids harder and giving them less space to find their identity and learn to manage their emotions on their own is a recipe for anxiety and depression later on.

The bottom line for parents? Try a little less structure and a little more "just be home for dinner."

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Cyberstalking and Cyberharrassment

The American Psychological Association's (APA) annual convention took place this past week in Washington DC. I didn't go but have sort of been following remotely, and one of the major topics was social media. So this week, I thought I'd post a bit about that.

I've already posted about cyberbullying, but I thought it was worth another mention. One of the speakers at APA, Dr. Elizabeth Carll, presented on electronic harrassment, and made the point that it can be more stressful, anxiety-provoking, and traumatizing than in-person bullying and harrassment.

Why? Because it's a 24-7, global kind of thing. If you get bullied in person, you can (to some extent), escape it. It's more localized. And, while terrible, once it's ended, it ends. But with cyberstalking/bullying, there are multiple ways to get to someone, and once you've posted something nasty online, because of screen-capture technology and caching and whatnot, it's there more-or-less forever, accessible by anyone in the world.

Another set of researchers gave a presentation including results from a study revealing that over a third of students report being victims of cyberbullying at least once in the past year. For just one example of how young both victims and bullies can be, check out this article about a recent case (the kids who engaged in this bullying have now received their sentences). A significant minority of cyberbullying and stalking takes place on social media sites like Facebook. There's some indication that when the bullying is anonymous, like nameless comments on message boards or blogs, it's more distressing than when you know who's giving you a hard time.

This is, of course, fodder for timely fiction, in both adult and YA--and possibly in MG. Are any of you writing about it? But also--have any of you experienced this (there's a potential resource discussed in this article)? If so, were the bullies anonymous or known? Cyberharrassment seems to be one of the risks of our hyperconnected world these days, but it certainly carries a heavy psychological price.

Because it's Monday, be sure to check out Lydia's Medical Monday post and Laura's Mental Health Monday post!

Mind the Gap!

Please do not feed sugar cubes to the rats on the subway. It causes them to smoke and play loud music.

If you step into the gap, you will be sucked quickly to Hell while the grey-faced people look on. Your tummy is unbecoming for a man your age and professional assignation.

Do not vomit hot dogs at the robotic device whilst prodding it in the duodenum with your finger in a rude and aggressive manner.

What about ponies? They do not poo in the streets!

If you do any of these bad things in this playground your head will immediately pop off like a spiked volleyball. You will also lose your feet, which are really ugly and have an oversized big toe, kind of like Uma Thurman's in Kill Bill.

Unintended Consequences of Behavior The Importance of Systems Thinking

Having been introduced to psychotherapy by psychoanalysts and, to a lesser extent, behaviorists (cognitive therapy had not yet caught on), I was very impressed when a friend of mine first introduced me to family systems theory. It taught me about the importance of feedback in interpersonal interactions. The actions of person A in a relationship do not "cause" the actions of Person B in response. Both A and B are continually affecting each other's behavior simultaneously, as each person assesses the motives and intentions of the other. A relationship evolves over the the entire time the relationship between two people exists.

People are not rats; they do not just respond to what the other persons just did, but to what they just did in relationship to everything else they have done during the history of the relationship. Additionally, we are not robotic automatons, even though most of what we do most of the time is just responding to the usual environmental cues. It is estimated by neuroscientists that about 80% of what we do during our day involves no conscious deliberation whatsoever. However, if something unexpected happens as we do that, we will then think about it.

Systems thinking is one of the main themes of Peter M. Senge's best-selling book, The Fifth Discipline, first published in 1990. The book discusses common errors business people make because of a lack of appreciation of feedback effects that take a certain amount of time before those effects become apparent. The most common examples are described using something that he calls Systems Archetypes. Understanding them is not just important in business but in all human interactions, including within family systems.

He lists ten of them. In this post, I would like to summarize just three that I think are the most relevant to the subject matter covered in this blog.

Perhaps the most famous of the archetypes is one Senge calls Shifting the Burden to the Intervener. It is the one described by the common proverb about teaching people to fish rather than giving them a fish. When a person or a group of persons is having some sort of problem that they cannot solve, they often call upon a consultant who does not tell them about general aspects of how to solve certain types of problems, but actually steps in and solves the problem. 

The next time a problem arises, the consultant is brought back to solve it. The long-term result is that the original group never learns to, or is not motivated to, solve similar problem themselves. This is the nasty side effect created by so-called helicopter parenting.

Another systems archetype is far less widely known. Senge calls it Success to the Successful. I mentioned a good example of it in my last post. It is seen in students who do poorly in school who then get diagnosed with some psychiatric disorder. 

The basic pattern is that kids in a classroom are somewhat in competition for the teacher's attention and praise. The kids who start out as attentive and well-behaved gain praise and positive attention from the teacher, while the ones who do not start out that way are seen as undeserving of praise. The teacher's negative attitude toward the latter children is observed by these students, who then start to see themselves in a negative light. 

Due to their loss of self confidence, they start to put even less effort into their schoolwork, which then feeds back into the teacher's negative view of them, which leads them to become even more discouraged, and so on. This archetype is the basis of many a case of what is commonly referred to a "self-fulfilling prophecy."

The third archetype I will mention is called Balancing Process with Delay. This occurs when a group or individual overcompensates for something in one way or another because there is a significant delay between what they have started to do and its effects. An illustrative example many of us are familiar with is a shower in which the temperature of the water responds sluggishly to changes in faucet position. 

Because the water seems to stay cold, a poor guy in the shower turns up the temperature, but nothing much seems to happen. The delay is due to the distance of the faucet from the hot water heater. So he turns it up again. If he keeps doing that, he suddenly finds himself getting burned due to a large, sudden and unexpected rise in the water temperature.

Because of delays in business, shortages of something can suddenly turn into a glut of that product, which then leads to another shortage as producers react too quickly to market conditions. In families, this may be seen in parents who had been abused as children. They try to be unlike their own parents by going to the opposite extreme and letting their child get away with murder. In response, the child starts to feel like the parent does not really care about them, because the parent seems to ignore it if they do something self-destructive like coming home intoxicated or failing in school.

When that child grows up and has a child, he or she may overcompensate back in the other direction, and become too harsh! In looking at genograms, we sometimes see entire generations going back and forth between two extremes. A generation of alcoholics begets a generation of teetotalers who beget a generation of alcoholics; a generation of workaholics begets a generation of slackers who beget a generation of workaholics, and the like.

Rave on this crazy feeling

Turns out that the party drug ecstasy (we called it X when I was a kid and it first hit college campuses, and nowadays they call it E, but technically it's known as MDMA) may have efficacy in treating post-traumatic stress disorder (PTSD) -- and by extension I'm assuming panic disorder, too.

Don't believe me? There's no reason you should. But maybe you'll believe The Economist magazine, where an article called "Agony and ecstasy" recently was published. From the article:

Dr Mithoefer’s Phase II research, which used MDMA from the only legal source—a chemist at Purdue University licensed by the DEA to distribute controlled quantities from a supply synthesised in 1985—is directly descended from the first generation of LSD psychotherapy. Subjects were given MDMA while attended by Dr Mithoefer and his wife, a psychiatric nurse. They rested on a futon, listened to music and were encouraged to revisit their trauma.

“I remember feeling incredibly safe and very motivated,” says Ms Westerfield of her first session....

The patients who received MDMA showed statistically significant improvement of their PTSD symptoms compared with those who received the same day-long therapy sessions with an inactive placebo. “All the major approaches involve revisiting the trauma in therapy”, says Dr Mithoefer, “but patients may be overwhelmed and retraumatised.” He believes the fear and defensiveness that characterise PTSD are obstacles to treatment, and that it is MDMA’s attenuation of these emotions that permits concurrent psychotherapy to be effective. He will publish the study shortly.

Sounds like MDMA may help those who panic process situations that trigger their attacks -- e.g., it might facilitate more effective cognitive-behavioral therapy (CBT) treatment. Maybe someone will do similar studies about MDMA's potential in treating panic and agoraphobia. Until then, though, rave on.

But keep it clean -- self-treatment with unprescribed medications is a risky game.

Cognitive Therapy For Writers Part II Revenge of the Smart Brain



Raaaawr! All right. So, we've established that everyone has a Sneaky Brain, the part of you that whispers all sorts of nasty things that make you feel bad.
You know, like:

• If I don't get an agent or get published, I freaking suck as a writer.
• Because that agent/editor rejected me, I am a failure.
• I got a few rejections this week/today/in the last hour, so that means no one will ever want to represent/publish me.
• I wrote one book/chapter/page/sentence, and now I can't think of what to write next. I've run out of words FOREVAH!!!!! AAAAAAH!!!!!!!

Let's pause right here and acknowledge that not everyone who writes is going to end up a published author. Not everyone who writes is even good enough to be published. Period. That's the way it is. Language is powerful, but it can be difficult to wield. The art of storytelling adds another level of difficulty. And then there's marketability ... whoa.

SO, taking into account that I, or you, might be among those who reach as far as we can but still can't close our hands around that elusive prize, how do we keep feeling OK? How do we keep our Sneaky Brains from sapping us of whatever talent and energy and creativity we have? How do we stay on track and keep writing, keep telling the stories we want to tell?

We all have Smart Brains, too. We should use them.

Don't be afraid to fight dirty.

 1. Recognize those sneaky thoughts. Listen hard, my loves. You have to HEAR and recognize what Sneaky's saying, because those thoughts can become pretty automatic over time, meaning you stop hearing them and just skip straight to the drinking-Wild-Turkey part of the equation. Don't. Listen. What do you hear?

If you hear any of the following words, perk up and slap on those boxing gloves:

ALWAYS
NEVER
SHOULD
ONLY
FOREVER

If you find yourself thinking "sure, I had some success a year/month/day/hour ago, but THAT DOESN'T COUNT ... ", do some pushups, man, because you've got some work to do.

Or if you hear "since she rejected me, that means EVERYONE will", strap on some brass knuckles. You've got a fight on your hands.

After you've recognized what the Sneaky Brain is saying ...

2. Recognize Sneaky as a bully. Sure, it's inside your brain, but that don't mean it speaks the truth, baby. When I work with kids, we "externalize the problem". Picture me (see stick figure above) talking in funny voices with puppets strapped on my 18-inch fingers.


Just like this dude.
But probably not as ripped.

 OK, don't. Instead, picture Sneaky sitting in front of you--and see what a liar it is. Those things it's whispering are a one-way ticket to depression. Despair. Giving up. What right does it have to do that to you? What right does ANYONE HAVE TO DO THAT TO YOU?!? I don't care if the bully resides between your ears. It's still a bully.






Once you recognize that:

3. Confront the bully and talk back to it. Because, seriously, logic is not its friend.

If someone's done something to upset you, like they rejected you or gave you a bit of harsh feedback, and your Sneaky Brain is saying "it's because they hate your writing and think you're a tool", use your Smart Brain to say, "Really? 'Cuz

1. they only read a tiny sample of my writing--or only a query, or
2. they had some nice things to say, too, or
3. I got a request/compliment, etc. from this same person/similarly skilled person(s) before, or
4. they probably spent a total of 60 seconds looking at it because they had 300 other queries waiting, or
5. the idea probably just didn't float their boat, but it could float other boats ...

You get the point. Use your Smart Brain to be ... smart? Use logic. Be a skeptic. If the Sneaky Brain says you're a failure because you got one rejection, I mean, WTF? Really? How many agents and editors are out there?

If it says "you should have an agent by now" or "you always mess this up" or "you will never ..." Oh, geez. What does it know? This process is frustrating enough without Sneaky going to illogical extremes. "Always"? Yeah? Use your Smart Brain to question how that could possibly be true. If you can't, that just means your Smart Brain's out of shape, NOT that Sneaky speaks the truth.

And if it whispers "the only way to be successful and happy is to get published," your Smart Brain should be screaming, "I am more than a writer. And there are many kinds of writers. And I write for many reasons. And sometimes, the end result isn't what it's about. Sometimes, it's the JOURNEY." Then, maybe toss out some obscene hand gestures for good measure. Stupid Sneaky Brain. Gut it with a spoon, my friends. That's what it deserves.

You don't have to be the only one who talks back to Sneaky. I'll bet you have friends or family or beta-readers or intriguing-strangers-you-meet-in-a-coffee-shop who can help you. Listen to their encouragement and don't discount it. But know this: no voice will ever pack a punch as powerful as your own Smart Brain.

So ... confession time. I'll be going on submission in the new year. And you know what? I'm going to be using every single one of these strategies every single day to stay calm and sane and happy. I know it won't always be easy. I know my Smart Brain won't win every round. BUT, I also know my Smart Brain is pretty damn smart. No matter what happens, I'm going to be OK. I'm going to be successful. And I'm going to define what that means for myself--I won't let anyone, including my own Sneaky Brain, define it for me.

That shapeless lump is my vanquished Sneaky Brain.

What about you? What challenge are you facing now? What's that Sneaky Brain telling you? And just how do you plan to kick its a$$??

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Dr Carolyn Kaufman Guest Blogs 21st Century Treatments for Depression

Hi everyone! On Monday I talked about how The Writer's Guide to Psychology is useful and generally fabulous. Today, the author, Dr. Carolyn Kaufman, is here to tell you about cutting edge treatments for depression.

I don't know if you folks know this, but Dr. Kaufman is an assistant professor at Columbus State Community College and also teaches classes at Otterbein College. She'll stop by later to answer any questions you have, but as a result of her teaching schedule, it will probably be in the afternoon and evening.

In addition, she's giving away one signed copy of The Writer's Guide to Psychology to one of my commenters today! I'll be announcing the winner Friday. And without further ado ...

If your character has a serious problem with depression, you probably think she has two options for treatment: psychotherapy or medications.  And you’d be right – sort of.  Those are the first two things a good therapist will try. But what happens if neither approach works?  Are there cool new 21^st-century alternatives?

You bet there are.

Now, in most cases, your character will start with psychotherapy, and in many cases, psychotherapy alone is sufficient.  Sometimes, however,  medications warrant serious consideration; here are a couple of examples of situations when your therapist will want to consider referring to a psychiatrist:

1. The client is so depressed that she’s unable to really get much out of therapy – she needs additional help.
2. The client has numerous close family members who are taking medication for the same condition – and they’re benefitting from that medication or medications.

Once in a while, however, an individual has what we call Treatment-Resistant Depression (TRD), which means that various psychotherapeutic approaches and medications have been inadequate to help the person.  Research suggests that for these people, Treatment as Usual (TAU) may only be successful in about 7% of cases.

The Old Standard

Traditionally, electroconvulsive therapy (ECT) has been used as a last-ditch effort in these situations.  The good news is that ECT is not the brutal, barbaric thing portrayed in most movies, where the wide-awake patient is strapped down and subjected to painful, terrifying shocks that cause convulsions.  Rather, the person is both asleep (thanks to a general anesthesia) and still (thanks to a muscle relaxant). Miraculously, some people feel significantly better after a single treatment, but for most people, several weeks’ worth of treatments are necessary.  After that, medications and psychotherapy are usually effective.

 The biggest downside of ECT is that it interferes with what we call the “consolidation” of memory.  In other words, over the few weeks that you’re doing ECT, you may have trouble storing information in long-term memory. That can certainly make it hard to remember your next appointment if you don’t have it written down!

Though most people say they would do ECT again if they needed it, and though it has been called “no more unpleasant” than going to the dentist (?!), some people have really bad experiences with it. For example, once in a while people who have undergone ECT say that they have problems with anterograde memory loss (which means they have trouble remembering things even after the ECT is done). Others say they have retrograde amnesia, which means they have forgotten chunks of their past.  The hard thing about these situations is that normally ECT is only done when the doctors don’t know what else to do to keep someone alive.  So which is worse – being dead, or having some memory loss?  The answer genuinely depends on the person. 

But scientists have been working on new, drug-free biological treatments for people with TRD.  Here are three.

Transcranial Magnetic Stimulation (TMS)

Transcranial Magnetic Stimulation is the least invasive of the three new treatments I want to discuss.  Unlike the other two, there is no surgery and no implantation of a device.

During TMS, the client sits in a chair that resembles a dentist’s chair (I know, what’s with the recurring dentist theme?), and an electromagnetic coil is placed near the left front of the head. The coil turns on and off rapidly, creating a magnetic field that stimulates the brain’s cells (called “neurons”) to release brain chemicals like serotonin and norepinephrine. (In people who are depressed, serotonin and norepinephrine levels are too low.)

The machine makes a very loud (and unpleasant) tap-tap-tap-tap sound as the electromagnetic coil is turned on and off, so both client and doctor wear earplugs. Many people experience prickling or discomfort of the scalp under the coil, and some experience twitching of facial muscles or headaches afterward. Research suggests, however, that about half of the people who undergo TMS experience some relief of their depression symptoms.

Vagus Nerve Stimulation (VNS)

Both Vagus Nerve Stimulation and the next treatment we talk about, Deep Brain Stimulation, involve a bigger commitment than TMS.  Both involve the surgical implantation of an expensive pacemaker-like device under the collarbone. 

With VNS, wires run from the main device up into the neck  and are wrapped around the vagus nerve, which travels up into the brain and down into the body.  Every five minutes, the VNS unit emits a mild electrical pulse.  At first, this pulse is noticeable: it feels like a very mild shock accompanied by the requisite prickle of electricity on the left side of the voice box.  Over time, however, the body adjusts and the individual is no longer aware of the pulses unless she’s paying close attention, exercising heavily, or speaking loudly (the pulse makes some people’s voices a little bit husky or hoarse). The prickling sensation goes away, and the pulse itself feels like a finger laid very lightly against the left side of the voice box.

The effects of VNS take time, and patients may take up to a year to get the full effects.  The battery in the unit is said to last up to 7 years in some patients; when it runs out, a whole new pacemaker-like device has to be implanted.

Research argues that significantly more people with TRD respond to VNS therapy than treatment as usual (ie therapy and medication alone), with about a third of patients getting significant relief and up to 80% of patients getting some relief.

Deep Brain Stimulation (DBS)

Still in the experimental stages, Deep Brain Stimulation also involves the implantation of a pacemaker-like device under the collarbone.  Rather than wrapping around the vagus nerve, however, the electrodes are placed directly into the brain.  Patients are awake when the electrode is actually inserted, and many, fascinatingly, report an immediate lifting of their depression.  Early research has shown that patients have remained in remission while the current is left on, but experience a return of symptoms when the current is switched off.

What makes DBS unique is that it may help people for whom electroconvulsive therapy has not been effective.  TMS and VNS are not usually helpful for this group.

Since DBS has not been proven in large groups of people, it has not yet been approved for depression in North America.

Particularly with the last two treatments, you may think that you wouldn’t want someone implanting anything in your body – and especially in your brain – for any reason! But for people for whom depression is an unrelenting specter, these treatments offer new hope.  Unfortunately, although both TMS and VNS  have been FDA-approved for depression in the US, insurance companies aren’t usually willing to pay for them, forcing individuals to find ways to pay for them out of pocket.

For more information on TMS:

NAMI: http://www.nami.org/Content/ContentGroups/Helpline1/Transcranial_Magnetic_Stimulation_(rTMS).htm

Neurostar (company that makes the TMS machine): http://www.neurostartms.com/Home.aspx

For more information on VNS:

VNS and Me: Wordpress Blog of someone who was implanted with the VNS device: http://vnsandme.wordpress.com/

Cyberonics (company that makes the VNS device): http://us.cyberonics.com/en/vns-therapy/

For more information on DBS:

Time Magazine article: http://www.time.com/time/magazine/article/0,9171,1214939,00.html

What do you think? Had you heard of these treatments? What questions do you have for Dr. Kaufman (they don't have to be limited to these treatments--feel free to ask general questions or anything about The Writer's Guide)? Remember--one commenter will win a signed copy of The Writer's Guide to Psychology, so ask (or just comment) away! She'll stop by after 3pm (EST) to answer!

And finally, on the Sisterhood of the Traveling Blog front, Deb Salisbury is posting today about what she does when she loses her writing mojo. Please check it out!