How self-compassionate are you?

If you're like me, probably not very. To learn whether that's indeed true, take this self-compassion test. (Note: A low score is bad thing, not a good thing. Not like golf.)

A tsunami of new hikikomori: another "lost generation" in Japan?

According to one recent article, "Given that the earthquake and its aftermath will likely bring pre-existing cases of hikikomori to clinical attention for the first time, and cause brand new cases as well, Japan will face an unprecedented need for psychiatric services, far more than would be expected in similar crises in other countries."

And what's a hikikomori? A 2006 NPR piece describes them as "mostly young men who lock themselves away in their bedrooms, fearful of society's expectations."

Sounds like a different flavor of agoraphobia.

Image source.

In defense of therapy.

A couple of weeks ago, I posted about an Economist article looking at the supposed promise of a new psychological therapy called cognitive-bias modification (CBM); that article implied that the short-term, therapist-free nature of CBM made it preferable to more traditional kinds of therapy.

I wonder what Jonah Lehrer thinks of CBM. Back in December, in a post to his Wired blog entitled In Defense of Therapy, he wrote:

When anti-depressants work, they are little blue miracles. But they often don’t work, at least not at rates higher significantly higher than placebo. (Plus, they often have unpleasant side-effects, which leads more than half of patients to stop taking the drugs shortly after the worst symptoms disappear. And then they relapse, which helps explain why patients treated with SSRI’s have relapse rates above 75 percent.) And that’s why I’m troubled by the drop in talk therapy, as most studies demonstrate that the most effective treatment for depression is pharmaceuticals coupled with a good therapist....

What we often forget is that therapy alters the chemical brain, just like a pill. It’s easy to dismiss words as airy nothings and talk therapy as mere talk. Sitting on a couch can seem like such an antiquated form of treatment. But the right kind of talk can fix our broken mind, helping us escape from the recursive loop of stress and negative emotion that’s making us depressed. Changing our thoughts is never easy and, in severe cases, might seem virtually impossible. We live busy lives and therapy requires hours of work and constant practice; our cortex can be so damn stubborn. But the data is clear: If we are seeking a long-lasting cure for depression, then it’s typically our most effective treatment.

How to avoid having panic attacks on the subway.

This is one dude's funny, self-deprecating look at his experiences with panic attacks on New York subway trains. The first one went like this:

out of nowhere, i started feeling really intense feelings that i couldn’t control, like more and more and more nervous and scared and i wanted to get off the subway so much but i couldn’t obviously because it was moving. then my legs started shaking and i was sweating and i could only see straight in front of me it felt like the universe was collapsing in my mind, and i was hyperventilating and i slid my headphones down to my neck and gently touched the arm of this middle-aged woman next to me who was also holding onto the pole. it felt like i couldn’t control my thoughts and they were spiraling towards a point where my mind would snap and/or i would actually die

so the woman whose arm i touched took one of her ipod earbuds out and suspiciously said “is everything okay?” like i think she thought i was like trying to get money from her or gonna bomb the train or something because i was nervous and sweaty and i look a little middle-eastern, and my hand was trembling, and i said to her “i don’t know what’s happening to me, i’m really sorry, i’m terrified, i don’t know why, can you talk to me please? just for like thirty seconds?”

But the panic attacks apparently didn't end there, and over time, to combat panic, the writer came up with the five techniques for managing his anxiety on the subway. (Actually, there are eight, but who's counting?) For instance, technique number one:

wear a bunch of rubber bands around your wrist and then when you start feeling terrified, pull them as far from your wrist as possible and then release them so they snap back against your wrist and it stings. this is a cheap solution that will distract you from the terror, but you will also confirm peoples’ suspicions that you have a mental illness

And technique number three-point-five:

try to envision where you are, but above ground, when you’re on the subway. like if you are on the C line for example, between Spring Street and Canal Street, think about that car wash on 6th Avenue that charges different prices for a carwash depending on the time of day, then think about that restaurant Lupe’s, then think about the Soho Grand hotel, then you’re at Canal! then do that all the way home. you will find that you know the city better than you thought you did

Clever stuff. Worth a read, for sure.
Also worth a read, or so I hoped when I wrote it five years ago: an account of my first subway panic attack.

Anxiety is caused by chinks in the brain's circuits.

As I've discussed previously on PANIC!, two separate areas of the brain are central to whether potentially fearsome external stimuli -- a loud, sudden sound, for instance, like the shriek of an automobile's tires on pavement, or a scary-looking person, like, say, Carrot Top -- result in in an experience of fear escalating to the level of panic. These are the amygdala, the brain's fear center, which performs a quick-and-dirty assessment of the fearsomeness of everything our sense organs experience, and the prefrontal cortex, which performs a slower, more careful assessment of our experience of the world. In general, if the amygdala sees potential danger in what you're experiencing, you feel the beginnings of fear. If the prefrontal cortex then concludes that there is no actual danger in what you're experiencing, it issues a kind of "stand down" order overriding the amygdala's assessment, and your fear dissipates. Unless you have panic disorder, of course, in which case it's probable that your prefrontal cortex is unable to issue the stand-down order forcefully enough to switch off your fear.

A recent study has shed new light on how these two parts of the brain work vis-a-vis fear:

Why do some people fret over the most trivial matters while others remain calm in the face of calamity? Researchers at the University of California, Berkeley, have identified two different chinks in our brain circuitry that explain why some of us are more prone to anxiety....

In the brain imaging study, researchers from UC Berkeley and Cambridge University discovered two distinct neural pathways that play a role in whether we develop and overcome fears. The first involves an overactive amygdala, which is home to the brain’s primal fight-or-flight reflex and plays a role in developing specific phobias.  

The second involves activity in the ventral prefrontal cortex, a neural region that helps us to overcome our fears and worries. Some participants were able to mobilize their ventral prefrontal cortex to reduce their fear responses even while negative events were still occurring, the study found.

“This finding is important because it suggests some people may be able to use this ventral frontal part of the brain to regulate their fear responses – even in situations where stressful or dangerous events are ongoing,” said UC Berkeley psychologist Sonia Bishop, lead author of the paper.

Still more support for cognitive-behavioral therapy (CBT) and meditation in managing panic...

Therapist-free therapy? A look at cognitive-bias modification (CBM).

A recent article in the Economist discusses cognitive-bias modification (CBM), a new psychological treatment that promises to help people resolve their mental strife without having to meet with a therapist; it "appears to be effective after only a few 15-minute sessions, and involves neither drugs nor the discussion of feelings ... All it requires is sitting in front of a computer and using a program that subtly alters harmful thought patterns." Here's how it's supposed to work:

CBM is based on the idea that many psychological problems are caused by automatic, unconscious biases in thinking. People suffering from anxiety, for instance, may have what is known as an attentional bias towards threats: they are drawn irresistibly to things they perceive to be dangerous. Similar biases may affect memory and the interpretation of events. For example, if an acquaintance walks past without saying hello, it might mean either that he has ignored you or that he has not seen you. The anxious, according to the theory behind CBM, have a bias towards assuming the former and reacting accordingly.  

The goal of CBM is to alter such biases, and doing so has proved surprisingly easy. A common way of debiasing attention is to show someone two words or pictures—one neutral and the other threatening—on a computer screen. In the case of social anxiety these might be a neutral face and a disgusted face. Presented with this choice, an anxious person instinctively focuses on the disgusted visage. The program, however, prods him to complete tasks involving the neutral picture, such as identifying letters that appear in its place on the screen. Repeating the procedure around a thousand times, over a total of two hours, changes the user’s tendency to focus on the anxious face. That change is then carried into the wider world. 

Emily Holmes of Oxford University, who studies the use of CBM for depression, describes the process as like administering a cognitive vaccine. When challenged by reality in the form of, say, the unobservant friend, the recipient of the vaccine finds he is inoculated against inappropriate anxiety.

I'm all for faster, more effective treatments for psychological distress. If CBM truly turns out to be effective -- and there's research supporting the idea that it will, at least for certain conditions -- it'll be a boon for lots of people looking for relief from psychological pain. But I can't help being a bit suspicious, here. This seems to me to be a kind of CBT-lite -- effective at helping people resolve pain so they can continue to function in the world, but of little use in helping them achieve the kind of self-understanding that allows them to see how they're evolving psychologically, or to process new psychological challenges as they do. In other words, it seems more like a band-aid -- valuable for stanching the bleeding, but not offering much in the way of an understanding of how and why we get cut in the first place.

And then, this is the Economist, home to endless praise for corporations that manage to increase shareholder value via enhanced efficiencies (read: layoffs, outsourcing -- stuff that may make investors see dollar signs, but too often results in real pain for people with grocery bills and mortgage payments). It's no surprise that this publication would similarly laud efforts to "downsize" therapy, much less that it would take a dismissive attitude towards efforts at self-understanding. (The article's final sentence: "...CBM does look extremely promising, if only because it offers a way out for those whose answer to the question, 'Do you want to talk about it?' is a resounding 'No.'") 

My take: Maybe CBM will be a useful tool. But will it replace the hard work required to achieve self-understanding? I doubt it.