Research: Depressed adolescents at risk for developing anxiety

anxiety

Research: Depressed adolescents at risk for developing anxiety

Stock photo of pensive teenSome adolescents who suffer with symptoms of depression also may be at risk for developing anxiety, according to a new study of children’s mental health.

The study found that among youth who have symptoms of depression, the risk is most severe for those who have one or more of three risk factors, said SMU psychologist Chrystyna Kouros, who led the study.

Specifically, those who are most vulnerable are those who have a pessimistic outlook toward events and circumstances in their lives; those who have mothers with a history of an anxiety disorder; or those who report that the quality of their family relationships is poor, Kouros said.

A depressed adolescent with any one of those circumstances is more at risk for developing anxiety, the researchers found. The findings suggest that mental health professionals could target adolescents with those risk factors. Early intervention might prevent anxiety from developing, Kouros said.

“Depression or anxiety can be debilitating in itself,” said Kouros, an assistant professor of psychology in SMU’s Dedman College of Humanities and Sciences. “Combined, however, they are an even bigger threat to a child’s well-being. That’s particularly the case during adolescence, when pre-teens and teens are concerned about fitting in with their peers. Anxiety can manifest as social phobia, in which kids are afraid to interact with friends and teachers, or in school refusal, in which children try to avoid going to school.”

The findings are reported in Development and Psychopathology. The study, “Dynamic temporal relations between anxious and depressive symptoms across adolescence,” appears on the journal’s web site.

Kouros co-authored the research with psychiatrist Susanna Quasem and psychologist Judy Garber, both of Vanderbilt University. Data for the study were collected by Garber, a Vanderbilt professor of psychology and human development.

The finding was based on data from 240 children from metropolitan public schools and their mothers, all of whom were assessed annually for six years. The children were followed during the important developmental period from sixth grade through 12th grade. The study was evenly divided between boys and girls.

Consistent with previous research, the authors found also that “symptoms of anxiety were a robust predictor of subsequent elevations in depressive symptoms over time in adolescents.” That link has been known for some time, Kouros said, and the current study confirmed it.

Less well understood by researchers, however, has been the link between depressive symptoms developing further into elevated anxiety, she said.

“The current study showed that depressive symptoms were followed by elevations in anxious symptoms for a subset of youth who had mothers with a history of anxiety, reported low family relationship quality, or had a more negative attributional style,” the authors reported.

Written by Margaret Allen

> Read more at the SMU Research blog

September 5, 2013|For the Record, Research|

Research Spotlight: Reduced anxiety may be a breath away

A new treatment program teaches people who suffer from panic disorder how to reduce the terrorizing symptoms by normalizing their breathing.

The method has proved better than traditional cognitive therapy at reducing both symptoms of panic and hyperventilation, according to a new study.

The biological-behavioral treatment program is called Capnometry-Assisted Respiratory Training, or CART, said SMU assistant professor of psychology and panic disorder expert Alicia Meuret.

CART helps patients learn to breathe in such a way as to reverse hyperventilation, a highly uncomfortable state where the blood stream operates with abnormally low levels of carbon dioxide, said Meuret, one of the researchers conducting the study. Hyperventilation results from excessively deep or rapid breathing and is common in patients with panic disorders.

“We found that with CART it’s the therapeutic change in carbon dioxide that changes the panic symptoms – and not vice versa,” Meuret said.

During the treatment, patients undergo simple breathing exercises twice a day. A portable capnometer device supplies feedback during the exercises on a patient’s CO2 levels. The goal of these exercises is to reduce chronic and acute hyperventilation and associated physical symptoms. This is achieved by breathing slower but most importantly more shallowly. Contrary to lay belief, taking deep breaths actually worsens hyperventilation and symptoms.

“Most panic-disorder patients report they are terrified of physical symptoms such as shortness of breath or dizziness,” Meuret said. “In our study, cognitive therapy didn’t change respiratory physiology, but CART did effectively reduce hyperventilation. CART was proved an effective and powerful treatment that reduces the panic by means of normalizing respiratory physiology.”

The findings, “Respiratory and cognitive mediators of treatment change in panic disorder: Evidence for intervention specificity,” appeared in the Journal of Consulting and Clinical Psychology. Meuret, who developed CART, is co-director of the the Stress, Anxiety and Chronic Disease Research Program in the Department of Psychology of SMU’s Dedman College. The Beth & Russell Siegelman Foundation funded the research.

The study pitted CART against a conventional cognitive therapy treatment, or CT. Traditional CT teaches patients techniques aimed at helping them change and reverse catastrophic thoughts in order to reduce fear and panic.

In the CART-CT study, 41 patients were assigned to complete either a CART or CT treatment program for panic disorder and agoraphobia, a fear of being trapped with no means of escape or help.

Both treatment programs were equally effective in reducing symptoms, said Meuret. But CART was the only treatment to physiologically alter panic symptoms by actively reversing hyperventilation in the patients. Cognitive therapy didn’t change the respiratory physiology, said Meuret.

he researchers plan to branch out with their studies on CART by taking the program into the community, particularly to ethnic minorities. They believe CART is a more universally understood treatment due to its physical exercises – as opposed to cognitive therapy’s more intellectual methods – and therefore more accessible to a broader range of people with varying levels of education and different cultural backgrounds. Ongoing studies will test the efficacy of CART in patients with asthma and fear of blood.

Co-authors of the study at SMU were David Rosenfield, associate professor of psychology, and psychology graduate students Anke Seidel and Lavanya Bhaskara. Stefan G. Hofmann, psychology professor at Boston University, was also an author on the paper.

Written by Austin Reed

> Read more from the SMU Research blog
> Watch a video demonstration of CART techniques through the SMU YouTube channel video

January 26, 2011|Research|

Research Spotlight: Exercise is the Rx for depression, anxiety

Exercies%20for%20anxiety%2C%20swimmer%2C%20150.jpgExercise is a magic drug for many people with depression and anxiety disorders, according to researchers who analyzed numerous studies, and it should be more widely prescribed by mental health care providers.

“Exercise has been shown to have tremendous benefits for mental health,” says Jasper Smits, director of SMU’s Anxiety Research and Treatment Program. “The more therapists who are trained in exercise therapy, the better off patients will be.”

The traditional treatments of cognitive behavioral therapy and pharmacotherapy don’t reach everyone who needs them, says Smits, an associate professor of psychology.

“Exercise can fill the gap for people who can’t receive traditional therapies because of cost or lack of access, or who don’t want to because of the perceived social stigma associated with these treatments,” he says. “Exercise also can supplement traditional treatments, helping patients become more focused and engaged.”

Exercise%20for%20anxiety%2C%20weights%2C%20400.jpgSmits and Michael Otto, psychology professor at Boston University, presented their findings to researchers and mental health care providers March 6 at the Anxiety Disorder Association of America’s annual conference in Baltimore.

Their workshop was based on their therapist guide “Exercise for Mood and Anxiety Disorders,” with accompanying patient workbook (Oxford University Press, September 2009).

The guide draws on dozens of population-based studies, clinical studies and meta-analytic reviews that demonstrate the efficacy of exercise programs, including the authors’ meta-analysis of exercise interventions for mental health and study on reducing anxiety sensitivity with exercise.

“Individuals who exercise report fewer symptoms of anxiety and depression, and lower levels of stress and anger,” Smits says. “Exercise appears to affect, like an antidepressant, particular neurotransmitter systems in the brain, and it helps patients with depression re-establish positive behaviors. For patients with anxiety disorders, exercise reduces their fears of fear and related bodily sensations such as a racing heart and rapid breathing.”

After patients have passed a health assessment, Smits says, they should work up to the public health dose, which is 150 minutes a week of moderate-intensity activity or 75 minutes a week of vigorous-intensity activity.

At a time when 40 percent of Americans are sedentary, he says, mental health care providers can serve as their patients’ exercise guides and motivators.

“Rather than emphasize the long-term health benefits of an exercise program – which can be difficult to sustain – we urge providers to focus with their patients on the immediate benefits,” he says. “After just 25 minutes, your mood improves, you are less stressed, you have more energy – and you’ll be motivated to exercise again tomorrow. A bad mood is no longer a barrier to exercise; it is the very reason to exercise.”

Smits says health care providers who prescribe exercise also must give their patients the tools they need to succeed, such as the daily schedules, problem-solving strategies and goal-setting featured in his guide for therapists.

“Therapists can help their patients take specific, achievable steps,” he says. “This isn’t about working out five times a week for the next year. It’s about exercising for 20 or 30 minutes and feeling better today.”

Written by Sarah Hanan

> Read more at the SMU Research blog

April 7, 2010|Research|

Research Spotlight: Breathe right for asthma relief

SMU's Alicia Meuret with an asthma study participantAs the health care reform debate turns to cutting costs and improving treatment outcomes, two SMU professors are expanding a study that shows promise for reducing both the expense and suffering associated with chronic asthma.

Thomas Ritz and Alicia Meuret, both of SMU’s Psychology Department, have developed a four-week program to teach asthmatics how to better control their condition by changing the way they breathe.

With the help of a four-year, $1.4 million grant from the National Institutes of Health, they plan to engage 120 Dallas County patients in four weeks of breathing training by the study’s projected end in July 2012. Their co-investigators include David Rosenfield, also of SMU’s Psychology Department, and Mark Millard, M.D., of Baylor University Medical Center.

More than 22 million Americans suffer from asthma at an estimated annual economic cost of more than $19 billion, according to the American Lung Association. The number of cases doubled between 1980 and 1995, prompting the U.S. Department of Health and Human Services to classify the disease as an epidemic in 2000.

During an attack, sufferers tend to hyperventilate, breathing fast and deep against constricted airways to fight an overwhelming feeling of oxygen deprivation.

Unfortunately, this makes the problem worse by lowering the body’s carbon dioxide levels, which restricts blood flow to the brain and can further irritate already hypersensitive bro nchial passages.

Patients who “overbreathe” on a sustained basis risk chronic CO2 deficiencies that make them even more vulnerable to future attacks. Rescue medications that relieve asthma symptoms do nothing to correct breathing difficulties associated with hyperventilation.

As part of SMU’s Stress, Anxiety and Chronic Disease Research Program, Ritz and Meuret use their biofeedback-based Capnometry-Assisted Respiratory Training (CART) to teach asthma patients to normalize and reverse chronic overbreathing. A hand-held device called a capnometer measures the amount of CO2 exhaled. Using this device, patients learn how to breathe more slowly, shallowly and regularly.

CART techniques could have a positive impact on quality of asthma treatment even as they reduce the need for acute care, Ritz says.

“The research shows that this kind of respiratory therapy can limit both the severity and frequency of asthma attacks,” he says. “That means fewer doctor visits and less frequent use of rescue medications, with the associated savings of both time and money.”

And for those who count any year without a trip to the emergency room as a year with a good treatment outcome, that means a higher quality of life, says Meuret, who lives with asthma herself.

“The training gives patients new ways to deal with acute symptoms, and that helps them to feel more in control,” she says.

Read more at the SMU Research blog

Above, SMU Professor Alicia Meuret (at right in photo) uses biofeedback data to demonstrate the relationship between oxygen and carbon dioxide levels in hyperventilation.

September 22, 2009|Research|
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