Perfectionism and anxiety.

"'Good enough' may be good enough for other people, but it's never good enough for me."

"When I make a mistake, I feel like a failure."

"I study hard because I'm afraid to disappoint my parents."

Do any of these lines sound like something you'd say? Then you're a perfectionist.

According to "Pitfalls of Perfectionism", from Psychology Today, perfectionists "are made and not born, commonly at an early age." Once established, perfectionism tends to get in the way of one's ability to live life to the fullest:

Perfectionism seeps into the psyche and creates a pervasive personality style. It keeps people from engaging in challenging experiences; they don't get to discover what they truly like or to create their own identities. Perfectionism reduces playfulness and the assimilation of knowledge; if you're always focused on your own performance and on defending yourself, you can't focus on learning a task. Here's the cosmic thigh-slapper: Because it lowers the ability to take risks, perfectionism reduces creativity and innovation—exactly what's not adaptive in the global marketplace.

Yet, it does more. It is a steady source of negative emotions; rather than reaching toward something positive, those in its grip are focused on the very thing they most want to avoid—negative evaluation. Perfectionism, then, is an endless report card; it keeps people completely self-absorbed, engaged in perpetual self-evaluation—reaping relentless frustration and doomed to anxiety and depression.

Perfectionism, of course, leads to heaps and loads of anxiety. Nobody's perfect, after all -- so expecting perfection is by definition a doomed enterprise. No wonder, then, that it's so prevalent among those with anxiety disorders:

Perfectionists fear that a mistake will lead others to think badly of them; the performance aspect is intrinsic to their view of themselves. They are haunted by uncertainty whenever they complete a task, which makes them reluctant to consider something finished. "People may not necessarily believe they made a mistake," explains Frost, "they're just not quite sure; they doubt the quality of their actions." Intolerance for uncertainty characterizes obsessive compulsive disorder and generalized anxiety disorder, too.

Unfortunately, according to the article, more and more Americans are growing up to be perfectionists. Why? Parents who overschedule and overmanage their kids' lives:

"I don't understand it," one bewildered student told me, speaking for the five others seated around the table during lunch at a small residential college in the Northeast. "My parents were perfectly happy to get Bs and Cs when they were in college. But they expect me to get As." The others nodded in agreement. Today's hothouse parents are not only over-involved in their children's lives, they demand perfection from them in school.

And if ever there was a blueprint for breeding psychological distress, that's it.

So lay off your kids. Let 'em know it's okay to make mistakes -- that mistakes are in fact valuable, in that they provide important lessons. I don't mean you should stop holding your kids to high standards, just that you should strive to let them know you'll love them just as much whether they succeed or fail in whatever they do. Maybe, just maybe, it'll give them the self-acceptance and flexibility of thought and behavior they need to avoid developing panic, anxiety, or OCD.

Stress rewires the brain.

I don't know about you, but I'm fascinated by the biological and psychological causes and manifestations of panic -- by looking under the hood of panic, if you will. For instance, one of the books that most helped me understand panic was The Emotional Brain by Joseph LeDoux, which wasn't a psychologist's explanation of panic disorder how to overcome it, or a memoirists depiction of the disorder, but a scientist's description of the neurology of fear. So I really enjoyed this piece from the New York Times science pages, about how difficult it is to cope with stress effectively -- because we're not wired to do so. The crux of the matter: Stress rewires the brain in such a way as to causes us to fall into behavioral and cognitive ruts -- which cause still more stress, in a feedback loop.

True for rats:

Reporting earlier this summer in the journal Science, Nuno Sousa of the Life and Health Sciences Research Institute at the University of Minho in Portugal and his colleagues described experiments in which chronically stressed rats lost their elastic rat cunning and instead fell back on familiar routines and rote responses, like compulsively pressing a bar for food pellets they had no intention of eating.

Moreover, the rats’ behavioral perturbations were reflected by a pair of complementary changes in their underlying neural circuitry. On the one hand, regions of the brain associated with executive decision-making and goal-directed behaviors had shriveled, while, conversely, brain sectors linked to habit formation had bloomed.

In other words, the rodents were now cognitively predisposed to keep doing the same things over and over, to run laps in the same dead-ended rat race rather than seek a pipeline to greener sewers. “Behaviors become habitual faster in stressed animals than in the controls, and worse, the stressed animals can’t shift back to goal-directed behaviors when that would be the better approach,” Dr. Sousa said.

And for humans:

Robert Sapolsky, a neurobiologist who studies stress at Stanford University School of Medicine, said, “This is a great model for understanding why we end up in a rut, and then dig ourselves deeper and deeper into that rut.”

The truth is, Dr. Sapolsky said, “we’re lousy at recognizing when our normal coping mechanisms aren’t working. Our response is usually to do it five times more, instead of thinking, maybe it’s time to try something new.”

Here's how it works, and why it matters:

The stress response is essential for maneuvering through a dynamic world — for dodging a predator or chasing down prey, swinging through the trees or fighting off disease — and it is itself dynamic. As we go about our days, Dr. McEwen said, the biochemical mediators of the stress response rise and fall, flutter and flare. “Cortisol and adrenaline go up and down,” he said. “Our inflammatory cytokines go up and down.”

The target organs of stress hormones likewise dance to the beat: blood pressure climbs and drops, the heart races and slows, the intestines constrict and relax. This system of so-called allostasis, of maintaining control through constant change, stands in contrast to the mechanisms of homeostasis that keep the pH level and oxygen concentration in the blood within a narrow and invariant range.

Unfortunately, the dynamism of our stress response makes it vulnerable to disruption, especially when the system is treated too roughly and not according to instructions. In most animals, a serious threat provokes a serious activation of the stimulatory, sympathetic, “fight or flight” side of the stress response. But when the danger has passed, the calming parasympathetic circuitry tamps everything back down to baseline flickering.

In humans, though, the brain can think too much, extracting phantom threats from every staff meeting or high school dance, and over time the constant hyperactivation of the stress response can unbalance the entire feedback loop. Reactions that are desirable in limited, targeted quantities become hazardous in promiscuous excess. You need a spike in blood pressure if you’re going to run, to speedily deliver oxygen to your muscles. But chronically elevated blood pressure is a source of multiple medical miseries.

You knew it already, but there's more proof for you. Stress is bad for your health -- and your happiness.

But there's hope:

...with only four weeks’ vacation in a supportive setting...the formerly stressed rats looked just like the controls, able to innovate, discriminate and lay off the bar. Atrophied synaptic connections in the decisive regions of the prefrontal cortex resprouted, while the overgrown dendritic vines of the habit-prone sensorimotor striatum retreated.

The lesson: Go on that vacation you've been putting off.

Vampire panic!

What with Twilight and True Blood and all, these days there's tons of interest in all things vampire. So this, a story about vampires in Tampa Bay, FL, ought to be of interest to PANIC! readers. From the link:

Anyone who wants to get into a Vampire Gathering needs to see the gargoyles first. They're the protectors, the first line of defense against heckling street preachers and tourists.

The women move along, but I remain, the first reporter ever allowed past the gargoyles, the first permitted to give you — my fellow "mundanes'' — a glimpse into their vampire world.

The monthly Gathering at the Castle nightclub isn't a role-playing game or a convention of Twilight fans. These people don't sleep in coffins, fear garlic or live forever.

But they do feel a need to feed on others, whether that means absorbing energy or blood. They call themselves vampires and consider their yearnings a physical affliction. They say they can't absorb energy like "mundanes," who often start every morning revved up for the day. They wake drained, needing to be charged.

Vampires have looked for other names to define themselves. They don't quibble with "parasite."

Some feed on blood volunteered by donors who allow them to cut their skin and drink.

Some feed during sex, drawing from strong energy bonds with their lovers.

And some "psychic" feed, sipping life energy from the auras of others.

Why am I linking to this story, here, on this blog? Turns out that lots of these vampires have panic disorder and depression and other mental health issues:

A survey of about 950 vampires found that 30 percent reported having been diagnosed with depression, 16 percent suffer from panic disorder, and more than 15 percent have been diagnosed as bipolar. Lest you think the research is tainted by anti-vampire bias, you should know that it was conducted by vampires — led by a fellow in Atlanta who goes by Merticus.

One psychologist's guess as to why this is true:

The idea of the vampire has helped people make sense of their world since the earliest recorded stories.

From the 16th to the 18th centuries in Eastern Europe, villagers were digging up corpses, burning them, cutting them up, putting stakes in their still hearts — all to solve what they felt was a vampire problem.

They told tales of awaking paralyzed and finding a visitor from the grave lying beside them. Modern medicine would call that "hallucinatory sleep paralysis." But back in the day, vampires provided villagers with a scapegoat for death and disease.

Today's vampire serves a different purpose, writes British psychologist Meg Barker: "The social experiences explained by real vampirism seem to be those associated with a sense of difference. Many real vampires begin their accounts by saying that they always felt 'weird' and 'different' to the people around them . . .

"Their awakening as a vampire made sense of this experience."

Whatever works, I guess. Or, as another psychologist says:

"I sometimes think a worthy definition of mental health is when people can let go of conventional life when they want to while holding on to the reins firmly enough to get back in control when they need to," says Richard Leavy, a psychology professor at Ohio Wesleyan University.

"Vampires," he said, "seem to be doing both."

TV piece about agoraphobia.

Here is a TV news story about a New Zealand woman's treatment for agoraphobia. Lighthearted but still quite informative piece to show friends and family who are struggling to understand what you're going through.

CBT vs. psychodynamic therapy.

Turns out they're equally effective, at least for General Anxiety Disorder.

On Whole Foods and health care reform.

According to insurers, panic disorder is a preexisting condition that disqualifies one for individual coverage. If you have a W-2 job when panic attacks, then you're in luck -- you have access to employer-sponsored health coverage, and can access the care you need to treat the disorder affordably. If you don't? You're shit out of luck.

Indeed, health insurance can mean the difference between overcoming panic and living a full, productive life, and dropping out of society with Boo Radley-level agoraphobia. We're a rich society; we can afford a universal public health plan. But our system denies health coverage to 45 million people; private health insurance damns increasing numbers of us to Boo Radley lives. From where I sit, that's un-American.

Which is why John Mackey ticks me off so much. CEO of Whole Foods, Mackey recently wrote a Wall Street Journal editorial claiming that basic health care is not a right -- basically, that it's more important to keep private insurers in the black than it is to provide health coverage to people who need it, whose lives would improve measurably with it. To wit, Mackey writes:

While we clearly need health-care reform, the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system.

Mackey's suggestions for private health system reform include the following, which makes it clear where his sympathies rest -- with the Haves, and to hell with the Have-Nots:

Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

In other words, if you've got a preexisting condition, you're still shit out of luck.

This is "I've got mine" libertarian bullshit, and I'm sick to death of it.

You, too? Then BOYCOTT WHOLE FOODS.

On fear of flying.

Bill McGee of USA Today recently wrote a very thorough article all about the fear of flying, from what causes it...

...the "fear" of flying may in fact be comprised of separate and distinct fears, including fear of heights, fear of loss of control, fear of losing one's balance, and fear of death itself, in addition to claustrophobia, panic disorders and social phobias. Many travelers suffer from two or more of these conditions at once, so an effective diagnosis is critical.

...to a variety of ways it can be coped with:

Some nervous fliers simply choose to medicate, though counselors say this may not always be effective. For those concerned about side effects, some travelers prefer homeopathic products, which offer a non-addictive alternative to many prescription sedatives and other medications. Homeopathic remedies for fear of flying symptoms are offered through a variety of health stores and online.

Counselors I spoke to question the effectiveness of hypnosis, but those who are receptive to such procedures may find comfort in this option. In-person visitation is the preferred method, but patients who don't have the time and/or money and/or access can purchase a variety of audio tools. Also, synchronized breathing might help some find relief and calm their nerves. Ancient exercises—such as Qi Gong—are proven stress relievers, but may not work for all nervous fliers, particularly once they're airborne. However, under certain conditions such practices could provide a low-cost and natural remedy.

One of the simplest of all solutions may prove effective for some fearful fliers: Listening to soothing music on an iPod or other electronic device can ease the stress and anxiety of flying. In addition, some recordings can be overdubbed with subliminal therapeutic advice.

Of course, psychological counseling is always an option as well.

The piece also links to fear-of-flying clinics and seminars across the country and around the world.

Fear, panic, and society, part two.

When you’re afraid, there are five basic steps to coping effectively.

First, you must identify the cause of your fear. In my case, as long as I believed that what threatened me was a heart attack or stroke, I would never identify nor begin to understand what was really causing the adrenaline to flood my system: panic.

Second, you must learn about the cause of your fear. In my case, with enough reading about panic, I finally began to believe that, despite what my body and mind were telling me during my panic attacks, I was not in mortal danger when one struck; that the places I associated with panic – the rush-hour subway, the crowded shopping mall – were not in fact dangerous; that panic is biological as well as psychological in nature, and not an indication of personal weakness or a deficient personality; and, perhaps most importantly, that millions of people experience panic – that I was not alone.

Third, you must analyze the way you process fear in your thoughts, identifying when fearful thinking is irrational and challenging that irrational thinking with logic and objective truth. Cognitive restructuring, it’s called in psychology-speak. we tend to focus on the negative, on what might go wrong; we think catastrophic thoughts, which prevent us from acknowledging that reality might not be quite so bleak as the world we’ve conjured in our head. When we listen the voice in our head that says we’re having a heart attack or a stroke, panic is terrifying. When, rather, we question that voice, offering a reality-based alternative to the story about the world it wants us to believe, panic becomes something not quite as severe – something not quite panic. “It’s not a heart attack, it’s a physiological response to adrenaline,” we tell ourselves, and panic has that much smaller a hold on us.

Fourth, you must learn to relax, to calm your body and give your mind a break from worry. Painting, reading, listening to music, hiking, working out, meditating…there’s a long list of activities people who panic can use to help keep their anxiety in check. Learning to relax and forget our fears for a while allows us to deal with those fears more realistically and effectively.

Fifth and finally, you must stop avoiding your fear, and face it head-on. You must expose yourself to the things you fear – the people, places, situations – so that you can learn that those things do not cause nearly as much existential threat as your panic has convinced you they do. After one debilitating bout of agoraphobia when I lived in Los Angeles, for instance, it was only by getting in my car and driving a bit farther from home each evening that I was able to reclaim the ability to move about that city without fear-imposed restrictions.

The weeks and months after 9/11 were a time of great fear. Unfortunately, the actions we took in response to that fear rarely mapped to these five steps; indeed, the actions we took as a result of 9/11 often ran completely counter to these proven prescriptions for dealing with fear.

Consider step one: identifying fear’s cause. The immediate cause, of course, was al Qaeda, the fundamentalist Islamic terrorist network headed by an elusive Saudi-born ideologue named Osama bin Laden, was the immediate cause of our fear. Immediately, though, we began to confuse the issue. In the weeks following 9/11, U.S. authorities rounded up some 1,200 Arab and Muslim immigrants, for the most part with no credible evidence that they were connected to al Qaeda. By 2003, we were invading Iraq – again, without credible evidence of a connection to al Qaeda.

Or step two: understanding fear’s cause. Al Qaeda has always been forthcoming with its reasons for targeting the United States; essentially, what bin Laden and his followers consider U.S. meddling in Islamic regions of the world: our covert but significant role in Afghan resistance to Soviet occupation in the 1980s, our ongoing military presence in Saudi Arabia and other Islamic countries, and our longstanding, steadfast support of Israel. But instead of explicitly acknowledging this complaint, we chose to focus on other, often completely fabricated reasons for the attacks on the World Trade Center and the Pentagon. “Islam is a violent, evil religion,” the voices of ignorance exclaimed. “They’re jealous of our freedom.”

Painting all of Islam with the “terrorist” brush is simply ignorant at best and utterly counterproductive at worst; calling their religion evil has almost certainly increased anti-American sentiment among Muslims around the world. And while we should certainly hold al Qaeda to account for its murderous acts, if we were smart – if we really wanted to lessen the threat that al Qaeda poses – we’d at least acknowledge, and consider the validity of, that organization’s political complaints.

Or step three: challenging fearful thoughts. Rather than managing our frightening but unrealistic cognitions in the wake of 9/11 by questioning their validity, our leaders went out of their way to provoke them, conjuring images of suitcase nukes and mushroom clouds rising over American cities. Everything was different, now; we had been forced into a global war on terror with no end in sight, a crusade against death-minded, heathen hordes. The threats were everywhere; no one could be trusted. Foreign-sounding strangers, people taking snapshots of government buildings – all these things justified fear, or so we were told.

Or step four: taking steps to relieve stress. We didn’t do much relaxing after 9/11. It wasn’t really possible, what with the flood of messages telling us to be afraid – very afraid. On TV, Fox News became a one-station fear machine. Each week during prime time, Jack Bauer reinforced the message that there were terrorists everywhere, that we should trust no one. At the airport, disembodied voices warned us to beware unattended baggage. I have no way of knowing whether I’m correct, but it’s my belief that a society which encourages constant vigilance and complete distrust is a society that promises to become increasingly unlivable.

And then there’s step five: avoiding avoidance. To avoid giving people, places, and situations a power over us they don’t merit in reality – to live fully in the world, going where we want to go, doing what we want to do, and in general giving ourselves the best possible shot at achieving our personal and professional aspirations – we much force ourselves to enter fearsome situations and learn to cope with the anxiety they provoke. After 9/11, though, as a society we tended more towards avoiding what we didn’t want to face. For instance, we stopped flying when (thanks to heightened security) airliners were probably the safest mode of transport available. “Just go shopping like you usually would, and everything will be okay,” our leaders told us, as though distraction and avoidance rather than honesty and engagement were the most effective ways to negotiate our way through fear.

Each step along the way, we failed to think and act in ways that are known to be effective in coping with fear. As a result, our civil liberties have been curtailed. We’ve become a nation that tortures. Our Muslim communities have been marginalized. Resentment of the U.S. is at an all-time high, and a new generation of Muslim kids has been radicalized in the Middle East and around the world. All the while, 24/7 cable newscasts and radio talk show blowhards ensure that our fear remains at fever pitch. Meanwhile, hundreds of thousands have died in an unnecessary war in Iraq – and bin Laden remains free, continuing to lead a terrorist organization that may be more powerful today than it was in 2001.

Are we better off as a result of the steps we’ve taken in response to 9/11? As the announcer used to say during Monday Night Football advertising breaks, “You make the call."

Fear, panic, and society, part one.

How world-class swimmers manage anxiety.

If you'd asked me, I'd have guessed that Olympic-level competitive swimmers are all but immune to panic. To excel to that level, after all -- to cope with the pressure of competing against the world's best -- they'd have to have the ability to rein in their anxiety. But according to a recent New York Times article, anxiety and panic are serious problems even among world-class swimmers. To wit:

Her body was quivering and she was sputtering for breath. The swimmer in obvious distress was not a toddler who took a tumble into the water; it was a future world-record holder in the warm-down pool at the 2004 Summer Games in Athens.

The teenager Katie Hoff was having a panic attack and the fully-clothed man who waded in to rescue her was not a lifeguard; it was the United States Olympic coach, Mark Schubert, who soothed her by saying the anxiety that made her palms clammy, her heart race and her mind a tangled web was a well-known opponent on the world scene.

How swimmers learn to cope:

To inoculate its team members against any strain of performance flu, United States Swimming officials periodically invite them to seminars on using visualization techniques to achieve optimal performances run by people affiliated with the Pacific Institute based in Seattle. One of their speakers last fall was Brian Goodell, a two-time Olympic gold medalist who weathered a panic attack to win the 1,500-meter freestyle at the 1976 Summer Games in Montreal.

The aim is to turn the athletes’ minds into bunkers that fortify them against self-doubts.

Man oh man, I'd love to get me one of them bunkers.