On rumination depression and anxiety

Most of those with panic, anxiety, or depression know exactly what obsessive thinking is like. "Something's wrong with my heart. My heart's not beating right. It's skipping beats. Didn't that basketball player collapse on the court and die because his heart was skipping beats? What if I get to the supermarket, and collapse right their in the frozen foods aisle? I'll be so far from home! And what if nobody helps me? I know that's not really going to happen. But my heart's skipping beats -- what if it does? What if I have a heart attack, and collapse, and die?"

That kind of thing.

This blog post, which discusses the correlation between depression and obsessive thinking (a correlation that is, of course, just as strong between obsessive thinking and panic and anxiety), opens with a wonderful description by Sylvia Plath of depressive rumination: "I am terrified by this dark thing/That sleeps in me; All day I feel its soft, feathery turnings, its malignity." It goes on to say:

One theory is that ruminators have a particular cognitive style, a neuronal inflexibility that distorts the normal executive functioning of the brain. Two psychologists at the University of Colorado, Boulder, decided to explore this idea in the laboratory, to see if they could identify the specific deficit underlying such perseveration. Anson Whitmer and Marie Banich gave several hundred young adults a widely used test to measure their ruminative tendencies. The ones who scored high were not clinically depressed, but they did display this signature cognitive style.

Then the psychologists gave both the ruminators and those who scored very low on this trait a complicated mental test in which they were required to pay attention to certain stimuli, switch their attention elsewhere, suppress thoughts and replace them with new ones, and so forth. The idea was to sort out two ways that normal attention can malfunction. Sometimes we simply can’t shake an unwanted thought, hard as we try. At other times we cannot switch from one way of thinking to a newer, fresher way. These sound similar, but to the brain’s executive neurons they are distinct. The subjects were required to respond as rapidly as they could, in order to tap into these fundamental, unconscious processes.

The results, as reported in the June issue of Psychological Science, were plain. The ruminators, when compared to normal thinkers, had much more difficulty suppressing unwanted thoughts. Imagine trying as hard as you can not to think of the death of a loved one or a failed relationship--or trying to expel the embodiment of your melancholy--and failing; that’s the clinical equivalent of these lab results.

But Whitmer and Banich went one step further. They studied the same two cognitive processes in two other kinds of rumination, namely angry rumination and intellectual reflection. Angry rumination is, well, think of the rude guy who just cut you off in traffic—and the visceral feelings you still have, hours later. Reflection, as the word conveys, is good rumination; it’s peaceful and creative focus on an idea.

It turns out that, as different as they are emotionally, angry rumination and intellectual reflection are cognitively similar—and cognitively distinct from the distorted thinking of depression. Both involve difficulty switching to a new topic, rather than difficulty inhibiting a negative thought. In a sense, depressive rumination is an avoidance problem, while angry rumination and reflection are characterized by uncommon persistence in a way of thinking.

Fascinating stuff. Many thanks to the We're Only Human blog.

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Blue light cure for anxiety

From an April 2011 release from the National Institute of Mental Health:

Scientists, for the first time, have switched anxiety on-and-off in active animals by shining light at a brain pathway. Instinctively reclusive mice suddenly began exploring normally forbidding open spaces when a blue laser activated the pathway – and retreated into a protected area when it dimmed. By contrast, anxiety-like behaviors increased when an amber laser inhibited the same pathway.

Researchers, supported in part by NIMH, used a virus, genetic engineering and fiber-optics to control the pathway in the brain's fear center with millisecond precision.

"Our findings reveal how balanced antagonistic brain pathways are continuously regulating anxiety," explained Karl Deisseroth, M.D., Ph.D., of Stanford University, a practicing psychiatrist as well as a neuroscientist. "We have pinpointed an anxiety-quelling pathway and demonstrated a way to control it that may hold promise for new types of anti-anxiety treatments."

The hope is that ultimately scientists will be able to develop a treatment to "quell anxiety instantly without producing unwanted side effects, such as drowsiness, often experienced with current anti-anxiety medications." In other words, "a treatment something like deep brain stimulation for depression."

Photo credit.

A brief history of anxiety

One of the books on my reading list is A Brief History of Anxiety, by Patricia Pearson, reviewed here. In it, the author explores her own history with anxiety:

Ms. Pearson married and had children. She has a successful writing career. But the woman she describes can barely hold her life together. One night she dreams that she is lying on a cushioned bench admiring the Grand Canyon. Suddenly she realizes that the bench is attached at one end to a cliff face but is otherwise suspended in midair.

“If I moved even an inch in any direction, I would fall for miles,” she writes. “The choking panic that I felt was extraordinary. I felt a perfect — a Platonic — sense of terror.”

That, in a nutshell, is her situation, one that she addresses through therapy, pull-up-your-socks willpower and a blend of religion and the insights of writers like the cultural geographer Yi-Fu Tuan.

In addition, Pearson uses the book to explore the broader cultural history of anxiety:

Her subject is elusive. Unnamed until Freud coined the term “anxiety neurosis,” the uninvited stranger lurks at the margins of history. When King David, in the Bible, says that “fearfulness and trembling are come upon me,” is he suffering an anxiety attack? Ms. Pearson cites an 18th-century English treatise blaming city living for “a class and set of distempers, with atrocious and frightful symptoms, scarce known to our Ancestors,” that is, “nervous disorders” afflicting a third of the population. Could this be it?

Everywhere and nowhere, anxiety, Ms. Pearson writes, is “unbearably vivid yet insanely abstract.” In many cases it is the fear of fear itself, a free-floating, nebulous entity that, like a mutant virus, feeds on any available host. Reason is powerless against it. Ms. Pearson argues, in fact, that rationalism, intended to banish superstition and fear, has instead removed one of the most effective weapons against anxiety, namely religious faith and ritual.

Even worse, the worship of reason and science, by encouraging the notion that human beings can control their environment, has created a terrible fault line in the modern psyche, although not all societies suffer equally. Mexicans have lots to worry about but don’t. The World Mental Health Survey, conducted in 2002, found that only 6.6 percent of Mexicans had ever experienced a major episode of anxiety or depression. Meanwhile, to their north, 28.8 percent of the American population has been afflicted with anxiety, the highest level in the world. Mexicans who move to the United States adapt, becoming more anxious.

I'd never heard anything like the bit about anxiety rates in Americans, Mexicans, and Mexican-Americans. I'm skeptical; I wonder how much of the result is due to cultural difference. I.e. Are Mexicans culturally less likely than Americans and Mexican-Americans to admit to mental health problems? But the idea that American culture skews towards "the worship of reason and science", and that anxiety rates are higher than they might be otherwise as a result, is an interesting one. In any case, this sounds like a book that's both intelligent and entertaining; I'm looking forward to reading it.

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Different kinds of anxiety

According to this summary of a recent University of Illinois study of brain activity, there are two distinct varieties of anxiety: "anxious apprehension (verbal rumination, worry) and anxious arousal (intense fear, panic, or both)." In brief, those exhibiting anxious apprehension (which maps to a diagnosis of Generalized Anxiety Disorder) show increased activity in the left brain, while those exhibiting anxious arousal (which maps more to panic disorder) show increased activity in the right brain. From the article:

The researchers used functional Magnetic Resonance Imaging (fMRI) to map the brain areas with heightened neural activity during a variety of psychological probes.

As the researchers had predicted, the anxious apprehension group exhibited enhanced left-brain activity and the anxious arousal group had heightened activity in the right brain. The anxious apprehension group showed increased activity in a region of the left inferior frontal lobe that is associated with speech production. The anxious arousal group had more activity in a region of the right-hemisphere inferior temporal lobe that is believed to be involved in tracking and responding to information signaling danger.

Other studies using electroencephalographic (EEG) methods had found that patients diagnosed with generalized anxiety disorder and obsessive-compulsive disorder had heightened activity in the left brain, whereas patients with panic disorder, panic symptoms or those subjected to high stress situations exhibited enhanced activity in the right hemisphere.

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