Phobias & Mental Health News
Anxiety, Phobias and Kids: When to Seek Help
According to Dr. Paul Ballas, a child psychiatrist and the medical director at the Green Tree School for children with special needs in Germantown, Penn., anxiety, phobias and mood disorders are common problems for young children and adolescents.
Such anxieties often surface during the fall, when children return to school and experience changes in sleep patterns, stress levels and routines. Environmental factors such as high allergen levels have also been shown to be associated with higher rates of anxiety, Ballas said.
“This time of year is a very anxiety-producing time for many kids,” he said.
The first step in determining whether a child is suffering from a phobia or anxiety disorder is to identify whether the fear is rational. Ordinary anxiety takes place in the context of a situation, or stimulus, such as watching a scary movie or taking a test. On the other hand, phobias and anxiety disorders are characterized as fear without the stimulus, and can cause long-lasting psychological distress. Anxiety disorders often disrupt normal day-to-day function.
The main distinction between adults, adolescents and children is that adults and adolescents often recognize that the fear is irrational. An adult with a phobia of elevators may understand that riding an elevator is safe but still refuse to get on. A child with that same phobia may not understand that the fear is unreasonable or excessive and develop an excuse to not get on the elevator. Young children often confuse anxiety for physical pain and say they have a stomachache or headache to avoid situations that cause anxiety.
Ballas said that parents can help their kids through times of anxiety by first ensuring that their basic needs — adequate sleep, a healthy diet and physical activity — are met.
“You’d be amazed how much of a problem sleep deprivation is for young kids,” Ballas said. “If they get enough sleep, their anxiety might go away.”
In cases where treatment is needed to address the child’s anxiety, therapists may gradually sensitize children to the object of their fear in a controlled setting. An alternative tactic that is generally not recommended for children is known as “flooding,” which means confronting the person with the object of their fear at its worst. For example, if a child is afraid of riding the bus, he would be placed on the bus and forced to deal with it.
Cognitive behavioral therapy is a recognized short-term treatment in which a therapist identifies the cognitive distortions the child is experiencing and appeals to the child’s sense of reason as to why his fears do not make sense. This approach typically works well for children ages 5 and older, Ballas said.
Six categories of phobias common in children include:
Animal phobias: fear of insects, sharks, other animals.
Natural environment phobias: fear of storms, heights, water.
Blood, injections and injury phobias: fear of vaccinations, doctors’ offices.
Situational phobias: fear of flying, riding over bridges.
Social phobias: fear of social situations, public speaking, judgment or criticism from others.
Other phobias: any other specific phobia such as fear of choking or characters in costume.
Virtual Revulsion Therapy: Pixelated Pests Help Treat Cockroach Phobia
For people with katsaridaphobia, or the fear of cockroaches, the common pests are more than nuisances—they are the stuff of nightmares. When some phobics spot one of the skittering beasts they start sobbing uncontrollably, whereas others who have seen them in their homes seriously consider moving. Psychologists can treat such disruptive fears with exposure therapy, in which a therapist gradually presents the feared stimulus to the patient in increasingly intimate scenarios. Recently, some psychologists have successfully combined exposure therapy and virtual reality to treat fears of flying, heights and spiders, asking patients to interact with simulated environments that guarantee their safety.
Now, a team of psychologists has completed the first clinical trial testing the treatment of cockroach phobia with augmented reality—a younger cousin of virtual reality that layers digital animations over video or photos of a real-world environment. The new study, published in the September issue of Behavior Therapy, is the most recent and most significant step toward bringing augmented reality therapy out of the lab and into common clinical practice.
“I am thrilled with the research,” says Stéphane Bouchard, a psychologist at the University of Québec in Outaouais who has studied virtual reality therapy, but was not involved in the new study. “This study shows reliably the feasibility of augmented reality to treat specific phobias.”
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In the study psychologist Cristina Botella of the University of Jaume I in Spain and her colleagues treated six women diagnosed with cockroach phobia, according to criteria in the Diagnostic and Statistical Manual of Mental Disorders IV. The women wore an enclosed helmet comprising a camera and a monitor that allowed them to view their surrounding environment sprinkled with a few digital embellishments—incredibly realistic animated cockroaches, which the therapist could shrink, enlarge, multiply or vanish at will.
“With augmented reality you can modulate the exposure in ways you never could in real life,” says Soledad Quero, Botella’s colleague and a co-author of the paper. “It really shows the potential of new technologies to help people with psychological problems.”
Staring into the helmet viewer, the participants saw cockroaches scrabbling on the floor, encroaching on their personal belongings or crawling all over their fingers. The experimenters asked the phobics to keep the helmet on until their anxiety subsided by two or three subjective units of discomfort, as measured by a standard eight-point, self-reported Likert scale.
After treatment that lasted just under two hours on average all the participants demonstrated a significant reduction in their anxieties. They also reported a lessening of their condition’s severity and its ability to disrupt daily life, which the experimenters measured using similar standard scales. Most participants showed a reduction from a score of 7 or 8 to a score of 1 or 2. At a checkup 12 months later, most participants maintained these drops in angst. Directly after the therapy all the participants had been able to approach a jar containing a live cockroach, open it and place their hands inside for a few seconds. Before the procedure none could bring themselves to even touch the jar. During the checkup all but two participants successfully completed a repeat of the jar test, and three participants each killed cockroaches near their feet with a fly swatter.
“The most important finding is that the patients improve, but not only in reporting that they feel better—the changes affected what they could do in their real lives, too,” Quero says.
The trial’s small size makes it difficult to draw general conclusions about the efficacy of augmented reality therapy, but Bouchard says the results are robust enough to validate further larger studies—especially studies that specifically compare augmented reality therapy with alternative treatments, like virtual reality therapy and the most common technique, in vivo exposure, in which patients confront their fears in reality, whether it be living spiders or standing on the top floor of a skyscraper.
Successfully completed in vivo exposure therapy is usually quite effective, but nearly one quarter of patients drop out because of its intensity. In the new paper the researchers note—and Bouchard confirms—that augmented reality is not only more appealing for many patients, it should cost less than virtual reality therapy because the former involves simulating only the feared stimulus rather than an entire environment. Quero even envisions giving patients “augmented reality” homework to complete on mobile devices: Imagine, for example, using an iPhone or Droid to create the illusion of creeping cockroaches on the kitchen table.
So far, augmented reality therapy only exists in the lab, but Bouchard is encouraged by Botella’s study. “This is a pioneering application,” he says. “I can imagine we will see a diffusion of augmented reality into therapeutic settings just as we have seen with virtual reality.”
Physical illness may affect mental health
MUMBAI: As Sunday marked World Mental Health Day, doctors in the city cautioned Mumbaikars to watch out for those tell-tale signs triggered by minor illnesses. You may have wondered how a small bout of fever can cause extreme sadness, or why even the slightest noise can jar your nerves when you have a cold or a headache. Doctors have the answer-physical illness can lead to psychological problems in patients.
Doctors across specializations say that patients suffering from an illness, especially chronic, tend to develop not just minor mental problems like distress and anxiety, but also major ones like depression, phobias and even sexual dysfunction. About 14-20% of chronically ill patients have psychological problems, apart from minor distress and anxiety, say doctors.
Dr Ganesh Kumar, head of cardiology at L H Hiranandani Hospital, says that at least one in three patients is suffers from mental problems, including anxiety. “Patients suffering from a heart failure or an attack, especially younger ones, develop severe mental problems. First of all, the patients do not want to accept the fact that they are chronically ill. And when they do, they directly start fearing death,” he said. “Many young patients also start believing that having sex will stress out on their heart, which might lead to another attack. This causes sexual dysfunction and frustration in the patient as well as the spouse,” he added.
Dr Ashok Mahasur, chest physician with Hinduja Hospital, says that respiratory problems tend to make patients even more psychologically conscious. “Problems like chronic obstructive pulmonary disease, drug-resistant TB and lung fibrosis can are the ones which cause a lot of distress in the patient. As these are long-term problems, the patient’s thinking gets negative,” he said, adding that mental problems are rampant in 60-70% of patients suffering from respiratory illnesses. “Only around 20% of people-those who are not well educated or those who do not know much about the disease-have little anxiety,” Dr Mahasur added.
It is not just those suffering from cardio or respiratory problems who get worried, but also those with chronic kidney ailments. “Patients suffering from end-stage kidney disease who cannot find a donor, especially those who have to go for dialysis regularly, undergo great trauma. They cannot carry out their regular functions, feel unproductive and believe that they are a burden on the family. Most of the time, affordability of the treatment is also becomes a problem,” said Dr Bharat Shah, nephrologist, Lilavati Hospital.
Psychiatrist Dr Harish Shetty, however believes that depression in the chronically ill is generally misunderstood as anxiety. “If a person is suffering from diabetes and goes into depression, the family thinks it is because of erratic sugar levels. If symptoms of mental problems are taken care of along with the treatment for the physical illness, patients tend to recover sooner,” he said.