Category: Anxiety

 In a look at how major stressors during childhood can change a person's biological risk for psychiatric disorders, researchers at Butler Hospital have discovered a genetic alteration at the root of the association. The research, published online in PLoS ONE on January 25, 2012, suggests that childhood adversity may lead to epigenetic changes in the human glucocorticoid receptor gene, an important regulator of the biological stress response that may increase risk for psychiatric disorders.

The association between childhood adversity, including parental loss and childhood maltreatment, and risk for psychiatric disorders such as depression and anxiety has been established in multiple studies. However, researchers have yet to define how and why this association exists in humans. "We need to understand the biology of this effect in order to develop better treatment and prevention programs," said Audrey Tyrka, MD, PhD, director of the Laboratory for Clinical and Translational Neuroscience at Butler Hospital and associate professor of Psychiatry and Human Behavior at Brown University. "Our research group turned to the field of epigenetics to determine how environmental conditions in childhood can influence the biological stress response."

Epigenetics is the study of changes to the genome that do not alter the DNA sequence, but influence whether genes will be expressed, or "turned on," versus whether they will be silenced. Knowing that the connection between childhood maltreatment and psychiatric disorders has been linked to the hormone system that coordinates biological stress responses, the researchers sought to identify the root cause at a genetic level.

The glucocorticoid receptor is an important regulator of the stress response, and methylation is a particularly stable type of epigenetic modification. "We knew that epigenetic changes to this gene could be affected by childhood parenting experiences because previous animal research showed that rodents with low levels of maternal care had increased methylation of this gene, and consequently, as adults these animals had greater stress sensitivity and fear in stressful situations," said Tyrka.

The researchers looked at 99 healthy adults, some of whom had a history of parental loss or childhood maltreatment. DNA was extracted from each of the participants using a blood sample, then analyzed to identify epigenetic changes to the glucocorticoid receptor. The researchers then performed a standardized hormone provocation test to measure the stress hormone, cortisol.

The researchers found that adults with a history of childhood adversity — maltreatment or parental loss — had increased methylation of the glucocorticoid receptor (GR) gene, which is thought to change the way this gene is expressed on a long-term basis. They also found that greater methylation was linked to blunted cortisol responses to the hormone provocation test. "Our results suggest that exposure to stressful experiences during childhood may actually alter the programming of an individual's genome. This concept may have broad public health implications, as it could be a mechanism for the association of childhood trauma with poor health outcomes, including psychiatric disorders as well as medical conditions such as cardiovascular disease," said Tyrka.

In early studies of animals, researchers have identified drugs that can reverse methylation effects. "More research is needed to better understand the epigenetic mechanism behind this association," said Tyrka, noting a larger scale study currently underway at Butler and a study of this association in children. "This line of research may allow us to better understand who is most at risk and why, and may allow for the development of treatments that could reverse epigenetic effects of childhood adversity."

Increasing the involvement of workers through job design does affect employees' satisfaction and in turn organizational performance. But increasing the involvement of employees in the wider organization and encouraging them to be more proactive and flexible may reduce satisfaction and increase anxiety, even though it may increase organizational performance.

Managers encouraging employees to be more proactive and flexible do make gains in performance and productivity. But this is at the expense of employee job satisfaction, according to the latest research in the journal Human Relations. Increased expectations from their employers may lead employees to perceive a less secure and more demanding work environment.

Researchers led by Stephen Wood, from the University of Leicester, set out to test a widely held assumption — that direct employee involvement methods can lead to high levels of worker job satisfaction, which in turn lead to a better performing organization. Armed with data from the UK's Workplace Employment Relations Survey 2004 survey, the researchers used statistical methods to look at in the effects of two distinct management models: enriched job design and high involvement management (HIM).

Statistical analysis of data from 14,127 employees and 1,177 workplaces shows that HIM is directly and positively related to labour productivity, financial performance, and quality, but not to absenteeism. The researchers also found a direct relationship between HIM and job satisfaction and anxiety — but surprisingly, it was a negative: HIM may be a source of dissatisfaction with the job and of anxiety. In fact, the negative effect of HIM on job satisfaction depresses its overall positive effects on organizational performance.

The enriched job design approach to management also had a positive relationship with labour productivity, financial performance and quality but this was positively related to job satisfaction, though not workplace anxiety. Moreover, the job satisfaction explains how the enriched job design affects performance.

The enriched job design approach offers employees discretion, variety and high levels of responsibility; while the HIM model encourages wider organizational involvement such as team working, idea-capturing schemes or functional flexibility (the ability to take on aspects of others' roles). Enriched job design concentrates on the employee's core job, while HIM is about organizational involvement, which entails workers participating in decision-making beyond the narrow confines of the job.

HIM originated in the 1990s, and a lot of research has followed on how this approach improves performance. However, to date most of this research has focused on the outcomes for organizations, with little attention to the effect on employees' satisfaction and well-being.

According to the authors, HIM entails a qualitative change in demands, not a simple quantitative change in effort levels. It may be that management's approach toward encouraging employees to be proactive and flexible creates anxieties and dissatisfaction. Increased expectations associated with involvement may actually make employees more stressed. In enriched job design, individuals have greater responsibility and autonomy, possibly offering more choices and pleasurable experiences that contrast with feelings evoked by a pressured environment.

"Treating enriched job design and HIM as discrete has certainly been vindicated by our findings, as has taking a multi-dimensional approach to well-being," Wood says. "The study offers further grounds for encouraging policy makers and managers to put job quality high on their agendas."

Workplace data were collected by face-to-face interview with a manager in each workplace, and through a survey of employees.

The more afraid a person is of a spider, the bigger that individual perceives the spider to be, new research suggests.

In the context of a fear of spiders, this warped perception doesn't necessarily interfere with daily living. But for individuals who are afraid of needles, for example, the conviction that needles are larger than they really are could lead people who fear injections to avoid getting the health care they need.

A better understanding of how a phobia affects the perception of feared objects can help clinicians design more effective treatments for people who seek to overcome their fears, according to the researchers.

In this study, participants who feared spiders were asked to undergo five encounters with live spiders — tarantulas, in fact — and then provide size estimates of the spiders after those encounters ended. The more afraid the participants said they were of the spiders, the larger they estimated the spiders had been.

"If one is afraid of spiders, and by virtue of being afraid of spiders one tends to perceive spiders as bigger than they really are, that may feed the fear, foster that fear, and make it difficult to overcome," said Michael Vasey, professor of psychology at Ohio State University and lead author of the study.

"When it comes to phobias, it's all about avoidance as a primary means of keeping oneself safe. As long as you avoid, you can't discover that you're wrong. And you're stuck. So to the extent that perceiving spiders as bigger than they really are fosters fear and avoidance, it then potentially is part of this cycle that feeds the phobia that leads to its persistence.

"We're trying to understand why phobias persist so we can better target treatments to change those reasons they persist."

The study is published in a recent issue of the Journal of Anxiety Disorders.

The researchers recruited 57 people who self-identified as having a spider phobia. Each participant then interacted at specific time points over a period of eight weeks with five different varieties of tarantulas varying in size from about 1 to 6 inches long.

The spiders were contained in an uncovered glass tank. Participants began their encounters 12 feet from the tank and were asked to approach the spider. Once they were standing next to the tank, they were asked to guide the spider around the tank by touching it with an 8-inch probe, and later with a shorter probe.

Throughout these encounters, researchers asked participants to report how afraid they were feeling on a scale of 0-100 according to an index of subjective units of distress. After the encounters, participants completed additional self-report measures of their specific fear of spiders, any panic symptoms they experienced during the encounters with the spiders, and thoughts about fear reduction and future spider encounters.

Finally, the research participants estimated the size of the spiders — while no longer being able to see them — by drawing a single line on an index card indicating the length of the spider from the tips of its front legs to the tips of its back legs.

An analysis of the results showed that higher average peak ratings of distress during the spider encounters were associated with estimates that the spiders were larger than they really were. Similar positive associations were seen between over-estimates of spider size and participants' higher average peak levels of anxiety, higher average numbers of panic symptoms and overall spider fear. These findings have been supported in later studies with broader samples of people with varying levels of fear of spiders.

"It would appear from that result that fear is driving or altering the perception of the feared object, in this case a spider," said Vasey, also the director of research for the psychology department's Anxiety and Stress Disorders Clinic. "We already knew fear and anxiety alter thoughts about the feared thing. For example, the feared outcome is interpreted as being more likely than it really is. But this study shows that even perception is altered by fear. In this case, the feared spider is seen as being bigger. And that may serve as a maintaining factor for the fear."

The approach tasks with the spiders are a classic example of exposure therapy, a common treatment for people with phobias. Though this therapy is known to be effective, scientists still do not fully understand why it works. And for some, the effects don't last — but it is difficult to predict who will have a relapse of fear, Vasey said.

He and colleagues are studying these biased perceptions as well as attitudes with hopes that the new knowledge will enhance treatment for people with various phobias. The work suggests that fear not only alters one's perception of the feared thing, but also can influence a person's automatic attitude toward an object. Those who have developed an automatic negative attitude toward a feared object might have a harder time overcoming their fear.

Though individuals with arachnophobia are unlikely to seek treatment, the use of spiders in this research was a convenient way to study the complex effects of fear on visual perception and how those effects might cause fear to persist, Vasey noted.

"Ultimately, we are interested in identifying predictors of relapse so we can better measure when a person is done with treatment," he said.

This work is supported by the National Institute of Mental Health.

Co-authors include Michael Vilensky, Jacqueline Heath, Casaundra Harbaugh, Adam Buffington and Vasey's principal collaborator, Russell Fazio, all of Ohio State's Department of Psychology.

Shyness may be the result of deficits in two areas of the brain, new research from Vanderbilt University finds. Extremely shy or inhibited individuals are typically slow to acclimate to new people.

The study, recently published in the journal Social Cognitive and Affective Neuroscience, found that individuals who identified themselves as inhibited may experience habituation failure — or the inability to adapt to new stimuli — in the amygdala and the hippocampus regions of the brain.

The researchers used functional magnetic resonance imaging (fMRI) to examine adults with either an inhibited or uninhibited temperament. Study participants were shown pictures of unfamiliar faces multiple times.

Individuals with an uninhibited temperament demonstrated habituation in both the amygdala and hippocampus. Their brain response increased when the faces were new but declined as they became familiar.

In contrast, individuals with an inhibited temperament failed to habituate across repeated presentations of faces, meaning familiar faces triggered the same brain response as the unfamiliar.

"This failure to habituate provides a novel neural mechanism for understanding the shy and cautious behavior that is characteristic of inhibited individuals," said Jennifer Urbano Blackford, Ph.D., assistant professor of Psychiatry and Psychology and lead author of the study.

"Individuals who familiarize more slowly may find encounters with new people overwhelming and thus avoid new social experiences, whereas those who adjust more quickly may be more likely to seek novel social experiences."

Blackford and colleagues think that this failure to habituate may be a key cause of social anxiety disorder, the persistent, chronic fear of a specific social situation. Social anxiety disorder is the second most common anxiety disorder and affects approximately one in 10 adults in the United States.

She is continuing her research by studying inhibited children to see if this brain deficit is present early in development.

Blackford conducted this research with Amil Allen, fourth-year Vanderbilt University School of Medicine student; Ronald Cowan, M.D., Ph.D., associate professor of Psychiatry; and Suzanne Avery, third-year Neuroscience doctoral student.

Anxious people have long been classified as "hypersensitive" — they're thought to be more fearful and feel threatened more easily than their counterparts. But new research from Tel Aviv University shows that the anxious may not be hypersensitive at all — in fact, they may not be sensitive enough.

As part of a study on how the brain processes fear in anxious and non-anxious individuals, Tahl Frenkel, a Ph.D. candidate in TAU's School of Psychological Sciences and the Adler Center for Research in Child Developmental and Psychopathology, working with her supervisor Prof. Yair Bar-Haim, measured brain activity as study participants were shown images designed to induce fear and anxiety. Using an EEG to measure electrical activity caused by the neuronal activity that represents deep processing of these stimuli, the researchers discovered that the anxious group was actually less stimulated by the images than the non-anxious group.

The results of the study were recently published in Biological Psychology.

Measuring fear in the subconscious

Surprisingly, anxious study participants weren't shown to be as physiologically sensitive to subtle changes in their environment as less fearful individuals, Frenkel explains. She theorizes that anxious people could have a deficit in their threat evaluation capabilities — necessary for effective decision-making and fear regulation — leading to an under-reaction to subtle threatening stimuli. Non-anxious individuals seem to have a subconscious "early warning system," allowing them to prepare for evolving threats. Essentially, anxious people are "surprised" by fearful stimuli that non-anxious individuals have already subconsciously noticed, analyzed, and evaluated.

To get a more accurate picture of both behavioral and neural reactions to fear-inducing stimuli, the researchers drew participants from a group of 240 undergraduate students at the university. Using the Speilberger's State-Trait Anxiety Inventory trait scale, they identified the 10 percent "most anxious" individuals and 10 percent "least anxious" individuals to participate in the final study.

In the first part of their study, the researchers measured behavioral responses to fear-inducing stimuli. A set of pictures, featuring a person looking progressively more fearful on a scale of 1-100, was shown to the participants. When shown the sequence of pictures, anxious people were quicker to respond to the fear in the subject's face. They identified a face as being "fearful" at a rating of only 32, while non-anxious people did not describe the same face as fearful until it reached a rating of 39.

But the EEG data tells a different story, Frenkel says. The researchers also measured the participants' brain waves by EEG while they were being shown the photographs and discovered that non-anxious individuals completed an in-depth processing of fear-inducing stimuli that informed their behavioral response, whereas anxious individuals did not.

Compensating for an "insensitive" brain

When confronted with a potential threat, Frenkel concluded, non-anxious people unconsciously notice subtle changes in the environment before they consciously recognize the threat. Lacking such preparation, anxious individuals often react more strongly, as the threat takes them more "by surprise."

"The EEG results tell us that what looks like hypersensitivity on a behavioral level is in fact the anxious person's attempt to compensate for a deficit in the sensitivity of their perception," she explains.

Journal Reference:

1. Tahl I. Frenkel, Yair Bar-Haim. Neural activation during the processing of ambiguous fearful facial expressions: An ERP study in anxious and nonanxious individuals. Biological Psychology, 2011; 88 (2-3): 188 DOI: 10.1016/j.biopsycho.2011.08.001

Children who suffer from persistent or recurring chronic pain may miss school, withdraw from social activities, and are at risk of developing internalizing symptoms such as anxiety, in response to their pain. In the first comprehensive review of chronic pain in children and adolescents in 20 years, a group of researchers found that more children now are suffering from chronic pain and that girls suffer more frequently from chronic pain than boys.

"We found that persistent and recurrent chronic pain is overwhelmingly prevalent in children and adolescents, with girls generally experiencing more pain than boys and prevalence rates increasing with age," said lead investigator Sara King, PhD, currently Assistant Professor, Mount Saint Vincent University, Halifax, Nova Scotia. "Findings such as these argue that researchers and clinicians should be aware of the problem and the long-term consequences of chronic pain in children."

Researchers from Dalhousie University and the IWK Health Centre, Halifax, systematically examined epidemiological studies of pain to evaluate progress made since the first comprehensive review of pain in children and adolescents, published by Goodman and McGrath in PAIN^®in 1991. Additionally, they identified a set of criteria to assess the quality of the studies included in the review. They looked at 32 studies and categorized them according to the type of pain investigated: headache, abdominal pain, back pain, musculoskeletal pain, combined pain, and general pain.

Their findings indicate that most types of pain are more prevalent in girls than in boys, but the factors that influence this gender difference are not entirely clear. Pain prevalence rates tend to increase with age. Psychosocial variables impacting pain prevalence included anxiety, depression, low self-esteem, and low socioeconomic status. Headache was found to be the most common studied pain type in youth, with an estimated prevalence rate of 23%. Other types of pain, ie, abdominal pain, back pain, musculoskeletal pain, and pain combinations, were less frequently studied than headache, and prevalence rates were variable because of differences in reporting. However, the overall results indicated that these pain types are highly prevalent in children and adolescents, with median prevalence rates ranging from 11% to 38%. "These rates are of great concern, but what is even more concerning is that research suggests that the prevalence rates of childhood pain have increased over the last several decades," stated Dr. King.

Researchers also found that many studies did not meet quality criteria and there was great variability in prevalence rates across studies due to time periods over which pain was reported. The authors suggest that future epidemiological studies in this area are in need of better operational definitions of pain and better measures of pain intensity, frequency, and duration. Such quality criteria across studies would allow for direct comparison.

The review identified several demographic and psychosocial factors associated with high prevalence rates of specific pain types. "By shifting focus to factors associated with chronic and recurrent pain, it may be possible to identify the most salient risk factors, leading to early and intensive interventions for the most at-risk groups," concluded Dr. King.

Journal Reference:

1. Sara King, Christine T. Chambers, Anna Huguet, Rebecca C. MacNevin, Patrick J. McGrath, Louise Parker, Amanda J. MacDonald. The epidemiology of chronic pain in children and adolescents revisited: A systematic review. PAIN, 2011; 152 (12): 2729 DOI: 10.1016/j.pain.2011.07.016

Depression may have more far-reaching consequences than previously believed. Recent data suggests that individuals who suffer from a mood disorder could be twice as likely to have a heart attack compared to individuals who are not depressed.

This process has been poorly understood — until now. A new study led by Concordia University has found that depressed individuals have a slower recovery time after exercise compared to those who are non-depressed.

These findings suggest that a dysfunctional biological stress system is at play among depressed individuals. Published in the journal Psychophysiology, the research warns of the importance of testing for cardiovascular disease among people suffering from major depression.

"There have been two competing theories as to why depression is linked to cardiovascular disease," says first author Jennifer Gordon, who is a PhD candidate at McGill University. "Depressed people may have poorer health behaviors, which may in turn lead to heart problems. The other possibility is physiological: a problem with the stress system known as the fight or flight response. Our study was the first to examine the role of a dysfunctional fight or flight response in depression in a large population."

Heart rate recovery is a powerful diagnostic tool

A total of 886 participants, who were on average 60 years old, took part in the study conducted by Concordia in association with the Montreal Heart Institute, McGill University, the Hôpital Sacré-Coeur de Montréal, the Université du Québec à Montréal and the University of Calgary.

Approximately 5 per cent of participants were diagnosed with a major depressive disorder. All individuals were asked to undergo a stress test after which their heart rate and blood pressure were recorded. Recovery heart rates and blood pressure levels were compared between depressed and non-depressed individuals.

"We found that it took longer for the heart rate of depressed individuals to return to normal," says senior author, Simon Bacon, a professor in the Concordia University Department of Exercise Science and a researcher at the Montreal Heart Institute. "Heart rate recovery from exercise is one way to measure the fight or flight stress response. The delayed ability to establish a normal heart rate in the depressed individuals indicates a dysfunctional stress response. We believe that this dysfunction, can contribute to their increased risk for heart disease."

"The take-home message of this study is that health care professionals should not only address the mental disorder, but also the potential for heart disease in patients who are suffering from major depression," adds Bacon. "Both of these health issues should be treated to minimize risk of severe consequences."

Journal Reference:

1. Jennifer L. Gordon, Blaine Ditto, Kim L. Lavoie, Roxanne Pelletier, Tavis S. Campbell, André Arsenault, Simon L. Bacon. The effect of major depression on postexercise cardiovascular recovery. Psychophysiology, 2011; 48 (11): 1605 DOI: 10.1111/j.1469-8986.2011.01232.x