Men Drink, Women Ruminate Leading to Anxiety and Depression When Stressed

Women and men tend to have different types of stress-related psychological disorders. Women have greater rates of depression and some types of anxiety disorders than men, while men have greater rates of alcohol-use disorders than women. A new study of emotional and alcohol-craving responses to stress has found that when men become upset, they are more likely than women to want alcohol.

"We know that women and men respond to stress differently," said Tara M. Chaplin, associate research scientist at Yale University School of Medicine and first author of the study. "For example, following a stressful experience, women are more likely than men to say that they feel sad or anxious, which may lead to risk for depression and anxiety disorders. Some studies have found that men are more likely to drink alcohol following stress than women. If this becomes a pattern, it could lead to alcohol-use disorders."

As part of a larger study, the researchers exposed 54 healthy adult social drinkers (27 women, 27 men) to three types of imagery scripts - stressful, alcohol-related, and neutral/relaxing - in separate sessions, on separate days and in random order. Chaplin and her colleagues then assessed participants' subjective emotions, behavioral/bodily responses, cardiovascular arousal as indicated by heart rate and blood pressure, and self-reported alcohol craving.

"After listening to the stressful story, women reported more sadness and anxiety than men," said Chaplin, "as well as greater behavioral arousal. But, for the men ... emotional arousal was linked to increases in alcohol craving. In other words, when men are upset, they are more likely to want alcohol."

These findings - in addition to the fact that the men drank more than the women on average - meant that the men had more experience with alcohol, perhaps leading them to turn to alcohol as a way of coping with distress, added Chaplin. "Men's tendency to crave alcohol when upset may be a learned behavior or may be related to known gender differences in reward pathways in the brain," she said. "And this tendency may contribute to risk for alcohol-use disorders."
There is a greater societal acceptance of "emotionality," particularly sadness and anxiety, in women than in men, noted Chaplin.

"Women are more likely than men to focus on negative emotional aspects of stressful circumstances, for example, they tend to 'ruminate' or think over and over again about their negative emotional state," she said. "Men, in contrast, are more likely to distract themselves from negative emotions, to try not to think about these emotions. Our finding that men had greater blood pressure response to stress, but did not report greater sadness and anxiety, may reflect that they are more likely to try to distract themselves from their physiological arousal, possibly through the use of alcohol."

Chaplin TM, Hong K, Bergquist K, Sinha R. Gender Differences in Response to Emotional Stress: An Assessment Across Subjective, Behavioral, and Physiological Domains and Relations to Alcohol Craving. Alcohol Clin Exp Res. 2008;doi: 10.1111/j.1530-0277.2008.00679.x [Abstract]

Research on Effectiveness of Psychotherapies for Children

The National Instititute of Mental Health has completed en evaluation of research and the effectiveness for mental disorders for children. Please see NIMH site and below..

Reviews of the current research on psychosocial and behavioral therapies, or psychotherapies, for children and adolescents found a number of "well established" and "probably efficacious" treatments for many mental disorders. For example, six were "probably efficacious" for anxiety disorders, and two were "well established" for attention deficit hyperactivity disorder (ADHD), according to scientists funded by NIMH and the National Institute on Drug Abuse, divisions of the National Institutes of Health.

The results were published in a special issue of the Journal of Clinical Child and Adolescent Psychology, and cover the current state of research psychotherapies for children and adolescents with mental disorders. NIMH grantees Wendy Silverman, Ph.D., of Florida International University, Miami, and Stephen Hinshaw, Ph.D., of the University of California, Berkeley, served as guest editors. This special issue provides a 10-year update on the original special issue on psychosocial treatments, published in 1998."

Even for the most effective interventions, there is substantial individual variability in treatment response," said Benedetto Vitiello, chief of NIMH's Child and Adolescent Treatment and Preventive Intervention Research Branch. "Further research is needed to understand the factors accounting for treatment effects and to identify predictors of response, in order to eventually arrive at more targeted and specific intervention strategies."

Overall, the 10 articles in the special issue reveal considerable advances over the past decade in the quality and quantity of research on psychosocial treatments for children with mental disorders.

Among notable findings:A review of 32 studies by Silverman and her colleagues concluded that six therapies for anxiety disorders have substantial research support and met the criteria for "probably efficacious" and may be helpful for treating children and adolescents with anxiety disorders. These treatments are:
Individual cognitive behavioral therapy.
Group cognitive behavioral therapy (GCBT).
GCBT with parents.GCBT for social phobia.

Social effectiveness training for children with social phobia.Few large-scale trials on anxiety disorders have compared specific psychosocial therapies with credible control conditions. As a result, to date, no specific psychotherapies met the most stringent criteria for "well-established treatments" used for this article. However, the second-highest ranking of "probably efficacious" denotes considerable research evidence supporting a treatment's usefulness, so mental health care providers can be confident in using the therapies listed, Silverman says.

A review of 46 studies by William Pelham, Jr., Ph.D., and Gregory Fabiano, Ph.D., both of the State University of New York at Buffalo, found that two psychosocial treatments are "well-established" for treating ADHD in children and adolescents:

Behavioral parent training.
Behavioral classroom management.

The authors also found a third type of well-established behavioral intervention called the Summer Treatment Program (STP), which focuses on peer relationships and is often given in recreational, summer camp-like settings. Children in STP typically receive more hours of treatment in a week compared to other weekly forms of psychotherapy, but STP is more expensive, and harder to provide in the community, and harder to find than behavioral parent training and behavioral classroom management.

In addition to anxiety and ADHD, the special issue also evaluates evidence-based psychosocial treatments for autism, eating disorders, depression, obsessive-compulsive disorder, exposure to traumatic events, disruptive behavior, and substance abuse. In addition, one of the articles focused on psychotherapies and treatment approaches specific to different ethnic and cultural backgrounds.

Mental disorders are generally treated with psychotherapy, medications, or a combination of the two. As scientists find out more about how mental disorders affect the brain and behavior, they also better understand what makes a treatment work for certain disorders or certain people. This can sometimes lead to new medications or therapies, or new uses for existing treatments. However, such treatments may not be proven by research (evidence-based).

The special issue helps address knowledge gaps by reporting on the current state of evidence-based psychosocial treatments in children and adolescents. For each article, scientists provided a review of the research literature in their field of expertise. The articles also:Identify the most effective psychosocial treatments, using and building on guidelines developed in 1995 by the American Psychological Association Task Force on Promotion and Dissemination of Psychological Procedures.

Discuss factors that may affect a child's response to treatment.Suggest directions for future research.Each article also discusses practice recommendations based on available research for doctors and other mental health care providers. However, these recommendations are intended more as a guide to current treatments and are not a requirement or prescription for best care."

We can only hope that the current generation of child and adolescent psychosocial treatment researchers will heed the call expressed in these articles for even more sophisticated, more rigorous, and more statistically powerful studies," said Drs. Silverman and Hinshaw.

Reference
Silverman WK, Hinshaw SP. The Second Special Issue on Evidence-Based Psychosocial Treatments for Children and Adolescents: A Ten-Year Update. J Clin Child Adolesc Psychol. 2008 Jan-Mar;37(1)

Our Deepest Fear.......MLK Day!

Our deepest fear is not that we are inadequate.
Our deepest fear is that we are powerful beyond measure.
We ask ourselves, Who am I to be brilliant, gorgeous, talented, fabulous?
Actually, who are you not to be?
We were born to make manifest the glory of God that is within us.
And as we let our own light shine, we unconsciously give other people permission to do the same.

-Martin Luther King, Jr.

Teen Brain Still Maturing

Provided by: Associated Press
Written by: Malcolm Ritter, THE ASSOCIATED PRESS Dec. 2, 2007
NEW YORK - The teenage brain, Laurence Steinberg says, is like a car with a good accelerator but a weak brake. With powerful impulses under poor control, the likely result is a crash.

And, perhaps, a crime.

Steinberg, a Temple University psychology professor, helped draft an American Psychological Association brief for a 2005 case in which the U.S. Supreme Court outlawed the death penalty for crimes committed before age 18.

That ruling relies on the most recent research on the adolescent brain, which indicates the juvenile brain is still maturing in the teen years and reasoning and judgment are developing well into the early to mid 20s. It is often cited as state legislators consider scaling back punitive juvenile justice laws passed during the 1990s.

"As any parent knows," wrote Justice Anthony Kennedy for the 5-4 majority, youths are more likely to show "a lack of maturity and an underdeveloped sense of responsibility" than adults. "These qualities often result in impetuous and ill-considered actions and decisions."

He also noted that "juveniles are more vulnerable or susceptible to negative influences and outside pressures, including peer pressure," causing them to have less control over their environment.

Some child advocates have pointed to the Supreme Court decision and the research as evidence that teens - even those accused of serious crimes - should not be regarded in the same way as adults in the criminal justice system.

Dr. David Fassler, a psychiatry professor at the University of Vermont College of Medicine who has testified before legislative committees on brain development, says the research doesn't absolve teens but offers some explanation for their behavior.

"It doesn't mean adolescents can't make a rational decision or appreciate the difference between right and wrong," he said. "It does mean, particularly when confronted with stressful or emotional decisions, they are more likely to act impulsively, on instinct, without fully understanding or analyzing the consequences of their actions."

Experts say that even at ages 16 and 17, when compared to adults, juveniles on average are more:
-impulsive.
-aggressive.
-emotionally volatile.
-likely to take risks.
-reactive to stress.
-vulnerable to peer pressure.
-prone to focus on and overestimate short-term payoffs and underplay longer-term consequences of what they do.
-likely to overlook alternative courses of action.

Violence toward others also tends to peak in adolescent years, says psychiatrist Dr. Peter Ash of Emory University. It's mostly likely to start around age 16, and people who haven't committed a violent crime by age 19 only rarely start doing it later, he said.

The good news here, he said, is that a violent adolescent doesn't necessarily become a violent adult. Some two-thirds to three-quarters of violent youth grow out of it, he said. "They get more self-controlled."

Some of the changes found in behavioral studies are paralleled by changes in the brain itself as youths become adults.

In fact, in just the past few years, Steinberg said, brain scans have given biological backing to commonsense notions about teen behavior, like their impulsiveness and vulnerability to peer pressure.

It's one thing to say teens don't control their impulses as well as adults, but another to show that they can't, he said. As for peer pressure, the new brain research "gives credence to the idea that this isn't a choice that kids are making to give in to their friends, that biologically, they're more vulnerable to that," he said.

Consider the lobes at the front of the brain. The nerve circuitry here ties together inputs from other parts of the brain, said Dr. Jay Giedd of the National Institute of Mental Health.

This circuitry weighs how much priority to give incoming messages like "Do this now" versus "Wait! What about the consequences?" In short, the frontal lobes are key for making good decisions and controlling impulses.

Brain scans show that the frontal lobes don't mature until age 25, and their connections to other parts of the brain continue to improve to at least that age, Giedd said.

The inexplicable behavior and poor judgments teens are known for almost always happen when teens are feeling high emotion or intense peer pressure, conditions that overwhelm the still-maturing circuitry in the front part of brain, Giedd said.