The Virtual News, Volume 2(3)
Current Events at VRMC
VRMC is participating in a Centers for Disease Control (CDC) funded study to train high school students using VR driving simulators. The CDC has recognized that teenage driving accidents are a public health concern and remain the #1 cause of death among those under 18. The study will track driving behavior for two years following completion of training to determine if VR lowers accident rates, DUIs, and traffic-related fatalities.
The Interactive Media Institute, VRMC’s affiliated 501c3 non-profit, has received funding from both the European Union and the National Institutes of Health, National Institute for Drug Abuse for the CyberTherapy 2003 Conference to be held in January 2003. The conference will focus on interactive technologies in the behavioral, social, and neurosciences. Simulations, virtual reality, videoconferencing, Internet, and personal robotics are now being used by professionals in mental health, assistive technologies, and rehabilitation. The IMI plans to offer other conferences during the year, and is interested in receiving additional funding.
We would like to extend our sincere thanks to Lawrence Nelson, a former patient at the San Diego clinic, who is shown in the photograph at the right. Larry has composed a “Survival Checklist” for those patients visiting VRMC and who are beginning the condensed treatment exposure protocol. The Survival Checklist will be featured on the VRMC website, www.vrphobia.com soon and will be available to help others interested in this treatment.
As part of our mission to continue public education, VRMC was featured on Animal Planet this August. The story featured a demonstration of a patient successfully completing treatment for fear of spiders.
The Santa Monica clinic continues to expand, and we will be offering additional treatment modalities next month including treatment for driving difficulties. We are in current negotiations to open our 3rd clinic, in the San Francisco area, later this year.
Anxiety Disorders Throughout The Lifetime
Anxiety is a natural emotion experienced by human beings that is necessary to our survival. A normal anxious response alerts the body to danger, causing one to avoid harm. However, people who suffer from anxiety disorders may feel excessively frightened, distressed and panicked during everyday tasks and situations. These feelings can begin to interfere with relationships, careers and overall satisfaction with life.
Anxiety disorders affect approximately 10% of individuals, making them the most common mental illness. The good news is that they are among the most successfully treated of mental disorders. It is believed that gender, temperament, and family history are all factors that influence the likelihood of developing an anxiety disorder. Females have a higher rate of diagnosis, as do those with a family member who suffers from an anxiety disorder. Some feel that temperament and personality make one susceptible. Currently, the majority of scientists believe that all of these aspects in combination must be considered.
Research on anxiety disorders and treatment has typically been performed on young to middle-aged adults. These are the easiest subjects to include in clinical trials, as they are able to give their own consent, unlike children, and lack the physical ailments and limitations of older patients. However, it is becoming increasingly difficult to ignore the prevalence of anxiety disorders found in children and the elderly. This issue of the newsletter is dedicated to providing information on anxiety disorders in both those early in life, and those in their golden years.
With Wisdom Comes…Anxiety?
While it was previously thought that the incidence of anxiety disorders declined with age, it has recently been found that anxiety and aging are not correlated. Anxiety is as prevalent in the older population as in the young; however the manifestations of these disorders are different.
Risk FactorsThe elderly may become vulnerable to anxiety disorders due to stresses unique to their age group. The aging process can bring chronic physical problems, loss of autonomy, and significant emotional pain that inflicts great tension. This added strain can easily lead to anxiety and fear for one’s well being.
As in the general population, being a woman and having less formal education leads to a higher risk for anxiety disorders. In addition, depression often accompanies these disorders. Research has shown that nearly half of all who suffer from depression meet the criteria for anxiety, and ¼ of those diagnosed with anxiety disorders also experience depression. Some hypothesize that many older adults dealing with an anxiety disorder have a history of the disorder that remained undiagnosed in earlier years.
Spotting a Possible ProblemAnxiety disorders tend to present differently in the elderly than in the general population. They are more likely to complain about physical symptoms than psychological problems. This can make distinguishing a medical condition from an anxiety disorder more complicated. Those with Alzheimer’s or adult-onset dementia may provide a further obstacle in the way of accurately diagnosing anxiety disorders. In fact, much of the agitation that was previously considered part of Alzheimer’s may in reality be a sign of an anxiety disorder. It is important that any older patient with symptoms of depression or medically unexplained physical symptoms be evaluated for an anxiety disorder. Diagnosis should not rely solely on what patients say, but also on how they behave.
Treatment OptionsIt is suggested that older individuals suffering from the symptoms of an anxiety disorder begin treatment with their primary care physician who they may already have an established relationship with, and then seek his/her advice on a possible mental health referral. Treatment may involve a combination of Cognitive Behavioral Therapy (CBT) and medication. CBT can include relaxation, replacing anxiety-producing thoughts and exposure therapy (possibly in Virtual Reality). In the elderly, it has been found that anti-depressants may be more effective than anti-anxiety medications because they are less likely to cause over-sedation and physical dependence. The specific combination recommended for treatment depends on discussion between the patient, their family, and their physician.
It is estimated that 5-20% of all children have been diagnosed with an anxiety disorder, indicating that like the adult population, it is the most common mental illness. The anxiety suffered can involve a fear of separation, natural disaster, being judged in social situations, or many other things. Studies have suggested that teens with anxiety disorders are at risk for developing major depression or substance abuse, while anxiety disorders in children can lead to reduced school attendance, low self-esteem, deficient social skills, and adjustment difficulty.
The Most Common Anxiety Disorders in YouthThere are four Anxiety Disorders that are most common in children. The first is Separation Anxiety Disorder (SAD), which includes an extreme fear of being away from home or from their primary caretakers. Approximately 4% of children have SAD. A second Anxiety Disorder is Social Phobia (SOC). Often described as “painfully shy” a child with SOC has a nagging fear of being negatively judged by others. A common disorder in both adults and children is Generalized Anxiety Disorder (GAD), which involves excessive uncontrollable worry even when there is no realistic cause. Physiological symptoms to look for include, disturbance of sleep pattern, difficulty concentrating, muscle aches or tension and irritability. Panic Disorder with or without Agoraphobia (PD) can be diagnosed through its classic panic attack symptoms such as shortness of breath and terror in certain situations. All of these Anxiety Disorders have a high incidence of co-morbidity with other disorders. It is known that up to ¾ of children with an anxiety disorder also suffer from another anxiety disorder or depression.
When to be ConcernedIt is important to observe the child’s behavior closely. While normal anxiety only occurs a small proportion of the time, symptoms of an anxiety disorder may be present for the majority of every day. These symptoms interfere with the child’s daily activities and productivity. Notice if the child complains about these symptoms and if they are causing the child distress. In addition, young people who have an anxiety disorder may try to control situations that make them anxious or may avoid them altogether.
TreatmentsTreatments for children are similar to those for adults. Cognitive Behavioral Therapy (CBT) has a long-lasting effect that helps prevent relapse. It can take several months to take effect, and should involve the family members of the sufferer. CBT is often used in combination with medication in order to produce a more rapid effect. The effects of medication alone however, cease as soon as the patient stops treatment.
How Parents Can HelpIf a parent feels something is wrong with their child, it is important to push to get help. Often, a general physician may not be the best person to treat an anxiety disorder. Make sure you go into the doctor with a record of your child’s behavior. If necessary, ask for a referral to a mental health professional.
There are many things one can do to help a child cope with an anxiety disorder as they undergo treatment. Let them know that you are open to hearing about their feelings and fears. Be honest about reality, but help them put uncomfortable situations in perspective. Never make fun or scold a child for their symptoms. Help bolster their self-esteem by reminding them of something brave they have done in the past. Most importantly, be sure the child feels supported from all directions, at home and at school.
One Size Does Not Fit All
A recent study published in Science this July discussed the relation of anxiety to DNA. In the study, scientists placed volunteers inside an MRI machine while showing them faces of frightened or angry people on VR goggles. During a brain scan, it was noted that these images increased the activity in the subjects’ amygdalas, the almond-shaped area in the brain that controls emotion. A certain gene that varies among the individuals produces a protein that limits stimulation of the nervous system. Those who had the “long” version of this cell had much less activity in the amygdalas than their counterparts with the “short” version, and therefore remained calmer. Thus a possible correlation can be drawn between this gene and anxiety.
Though this study is significant in the area of anxiety’s relationship to DNA, researchers caution that these findings are not conclusive. Scientists stress that a combination of factors disposes one to anxiety. Whatever possible causes for anxiety disorders can be hypothesized, this study will certainly not be the last that focuses on DNA’s connection to anxiety and other mental disorders.
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Dr. Brenda K. Wiederhold, Ph.D., MBA, BCIA Dr. Mark D. Wiederhold, M.D., Ph.D., FACP Ruth Kogen Executive Director Medical Director Research Editor
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