January 29th, 2009

Reality came crashing down around me this morning as I watched him walk out the door with his coat, luggage, and my heart. I have never felt pain like this and could not have imagined the physical ache that would accompany his leaving. I knew it was going to happen but a part of me didn’t want to believe it and another part hoped he would take me with him. I have never stopped loving him, no matter what I have tried to say, and don’t think I ever will.

D you are my heart, my soul, my universe. I will love you till the day I die. Every day I will live with the pain of knowing that you are gone forever. When you hugged and kissed me goodbye, I wished something in you would wake up and you would feel the same as I do. That you would know that we shouldn’t be apart. But you didn’t and now you’re gone forever and I will never be the same.

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January 26th, 2009

Today is a bad day. And it is only the first of what will be one of the hardest weeks of my life. I just found out that D is leaving on Thursday to move back to Romania. I knew this was coming but I think on some level I had convinced myself it wouldn’t happen. I know I have written about how angry I get at him and how over it all I am but clearly I am not. I burst into tears every time I think about him leaving. Friday when I wake up it will be the first day of a life without him and that is a life I don’t want. As angry as he makes me I would rather fight with him than laugh with anyone else. He is my sun, moon, and stars; my whole universe. Even when we are yelling at each other he is at least there. Now I have to face the reality that he never will be again. We can’t even maintain a friendship because he will be on another continent. My already broken heart is shattering into even smaller pieces.

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January 25th, 2009

I have posted a few articles on tips for controlling stress lately and I hope they have been helpful. I wanted to post something about what I do to help with my stress levels. I have found a few things that seem to be working very well for me.

Meditation

I find that attempting to meditate to handle stress can be frustrating to me because I can’t always focus, so this only really works if I can incorporate it into a scheduled time every day. I focus on positive thoughts for about 15 minutes in the morning and the evening in an effort to train myself to think this way and while it makes a difference in my overall mood, it doesn’t seem to help when things happen unexpectedly.

Exercise

I unfortunately do not enjoy working out so I do little things to get myself moving. I have found that if I take my dogs for a long walk instead of a quick one I feel better. I’m not a morning person so this generally happens in the evening but it helps me unwind and go to sleep. The only downfall is that my Jack Russell, Athos, comes home wound up and ready to play. He seems to react to the walk as a sort of activity appetizer. Haha. Also things like turning on the radio and dancing around while I clean make a difference. I might look like an idiot but at least I am doing something to make the chores I hate more fun and it really motivtes me to actually get moving instead of lying around getting more depressed.

Gardening

My biggest stress relievers have come from a couple very unexpected places. I received a Chia Terra Cotta Gourmet Herb Gardenfor Christmas and it has been the best thing for my stress, so much so that I bought another one and an AeroGarden Garden Kitwith flowers. There is something very calming and fulfilling about seeing these plants thriving due to my constant attention. I water, feed, trim, and monitor them religiously and it feels like my stress levels shrink every time they grow a little. I am thinking about getting some houseplants and possibly even a bonsai tree since this seems to be very therapeutic for me. I understand now why so many people garden. I have a tiny backyard that is mostly concreted and have 5 dogs so a big vegetable garden isn’t very practical but if you have the space I would recommend giving it a try. If not, try one of these inside gardens; you might be shocked at the sense of accomplishment you will have and the effect that will have on your depression and anxiety.

Animals

Another thing I take great joy in is my pets. As I said I have five dogs; Kenya (Black Lab), Merlin (Tibetan Lhasa Apso), Athos (Jack Russell/Maltese Mix), Hope (Maltese), and Zoe (Chihuahua). Last night D bought me a baby Angora Teddy Bear Hamster and I think her name is going to be Dulce Valentin (this translates to Sweet Valentine). Animals are a great stress releiver. There is nothing better than a dog that loves you unconditionally running up to you, tail wagging, just thrilled to see you after a bad day; or a good one for that matter. They have a sense of when you are sick or upset and their entire purpose in life is to make you happy. I can be so stressed I am in tears and when one of my pups crawls into my lap and cuddles up to me I instantly feel my heart lift a little. There are days that the only thing that can make me smile is watching them run and play.

Writing

This is a good outlet for anyone. Write it down, get it out of your head, and come back later and read it. I have always written. To me seeing things in black and white puts them in a completely different perspective. The good doesn’t feel real and the bad seems so much worse until I pour it all out on paper and read it. For me there is just something about the flow of words on a page, as opposed to the swirling chaos in my head, that makes me feel connected to the experiences I am writing about.

What I am trying to say is that we all react to different things in life. The articles I post are suggestions, mostly to show that there are things you can do to take control of your life. Not everything will work for everybody. Try different things and find what will work for you. It’s all about finding the joy in your life and using that to combat the negative feelings before you become overwhelmed by them. It’s your life and you can take control.

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January 20th, 2009

“Foolproof Ways to Battle Anxiety

Tuning out your worries and improving your state of mind is easier than it sounds.

Rebecca Ruiz- Forbes
1.20.09

If the Dow just closed after a dismal day of trading and a tightening sensation is beginning to spread through your chest, stop and try this exercise:

Instead of focusing on the money you’ve already lost or obsessing over future losses, try zeroing in on the present moment. Let go of distractions like a looming bill or the record unemployment rate and concentrate on your breath. Take in all the air you can, pause and then release.

“It’s actually totally boring concentrating on your breath,” says Dr. Michael J. Baime, director of the Penn Program for Stress Management at the University of Pennsylvania Health System. “Lifting a barbell is totally boring too, but it’s exercising a muscle.” After 10 repetitions, he says, you should start to feel some degree of calm.

Though anxiety is the body’s natural response to a threat, that alarm system sometimes sounds unnecessarily, cluttering the mind with the chatter of negative thinking. The breathing exercise helps divert the mind’s attention elsewhere.

Controlled breathing isn’t the only strategy for anxiety relief, either. Others include engaging the brain and body, cognitive and behavioral adjustments and meditative techniques.

The Origins of Anxiety
If it’s difficult to understand why you are plagued by certain anxious thoughts, don’t take it personally–it’s a phenomenon that still eludes scientists. What is known, says Dr. Sonia Bishop, an assistant professor of psychology at the University of California, Berkeley, is that anxiety involves responses in two parts of the brain: the amygdala and the pre-frontal cortex.

The amygdala is responsible for the fight-or-flight response, while the pre-frontal cortex controls executive functions like decision-making and planning. A human foraging for berries, for example, would use the pre-frontal cortex to decide which berries to collect. If a predator suddenly jumped from the bushes, the amygdala would sound the alarm.

Scientists don’t fully understand why certain individuals are more prone to anxiety, but some theories suggest varying levels of neurotransmitters–the chemicals that relay signals between neurons and cells and affect how well the amygdala and pre-frontal cortex function–may play an important role.

What interests Bishop, however, is how the anxiety-ridden can reverse course regardless of pre-disposition. That’s why she recently conducted a brain-imaging study with 17 participants, some of whom had “high trait anxiety,” which was determined using a standardized measurement.

While being monitored by an MRI that tracks changes in brain activity, each participant had to engage the pre-frontal cortex by identifying certain letters and ignoring others. When the task increased in difficulty, both groups did well on recruiting that region of the brain. But when the task was easy, those with trait anxiety did a poor job. This was particularly telling, says Bishop, because the participants were not exposed to any anxiety-triggering threats.

The results have led her to believe that the anxiety-prone may have difficulty preventing the mind from lingering on distractions when performing easy, day-to-day tasks.

Though not yet tested by other scientists, Bishop’s conclusion seems to reflect what works well in other successful techniques for battling anxiety: meaningful distraction.

Overcoming Anxiety
You could try informally testing Bishop’s theory by doing a crossword puzzle instead of watching TV. More commonly accepted remedies for curbing anxiety include socializing and exercise, the latter of which can increase levels of dopamine, the body’s naturally occurring, mood-boosting chemical. Such distractions are most effective, though, when paired with a real effort to switch your focus.

In the simplest terms, that’s what Dr. Israel Liberzon,a professor of psychology and psychiatry at the University of Michigan, tries to teach his patients. Using cognitive and behavioral techniques, Liberzon shows patients–many of whom suffer from anxiety disorders–how to change the way they deal with their worries.

Often he advocates for reconsidering what you associate with anxiety, trying to judge perceived threats using a more rational scale or creating an emotional distance from certain fears. In other words, putting things in perspective.

But since that reaction is hardly intuitive, Liberzon recommends seeking out professional help. In addition to the Anxiety Disorders Association of America, a nonprofit organization that provides information on anxiety treatments, Liberzon says support groups and local universities with anxiety and stress research centers can serve as useful resources.

Like Dr. Bishop, Liberzon also recommends mindfulness meditation, a well-regarded technique that has been shown as effective in clinical settings. Mindfulness meditation emphasizes focusing on the present moment instead of dwelling on regrets or worries.

Dr. Baime, of the Penn Program for Stress Management, teaches dozens of these meditation techniques and says they can be learned by reading literature on the subject. He recommends Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness by pioneer of mindfulness meditation Dr. Jon Kabat-Zinn, which Baime uses as a textbook in his classes.

Another alternative is to find local practitioners. While there is no certification process required to teach these methods, Baime says consumers can weed out potential snake-oil salesmen by asking to speak to previous students and inquiring about where the instructor learned the methods and how many students he or she has taught.

With the right tools, says Baime, mindfulness meditation can help the anxious reclaim their lives.

“When you learn to bring your attention into the present moment in a balanced way,” he says, “you learn to undo those negative predictions for the future.”"

9 Foolproof Ways To Deal With Anxiety (originally posted in Forbes)

“Try a Breathing Exercise

Instead of focusing on a looming bill or the record unemployment rate, take a moment to concentrate on your breath. Take in all the air you can, pause and then release. After 10 repetitions, you should start to feel some degree of calm, says Dr. Michael J. Baime, director of the Penn Program for Stress Management at the University of Pennsylvania Health System.

Mindfulness Meditation

Mindfulness meditation emphasizes focusing on the present moment instead of dwelling on regrets or worries. To learn more about it, try reading Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness by Dr. Jon Kabat-Zinn, the pioneer of the subject. You can also find a local practitioner in your community, but be sure to speak to previous students and inquire about where the instructor learned the methods and how many students he or she has taught.

Engage Your Brain

The brain processes anxiety in two separate regions. The amygdala emits a fight-or-flight response while the pre-frontal cortex handles executive tasks like decision-making. A recent brain-imaging study showed that those prone to anxiety may have difficulty mediating their worries if not engaged in a task that requires diverting attention from the amygdala to the pre-frontal cortex. Though not yet replicated by other scientists, the findings reflect what works well in other successful techniques: high-quality distraction.

Socializing

Spending time with friends and family is not only a diversion from obsessing over the unknown, it can also improve your mood by forcing you to laugh or gain perspective on your fears and worries. During these rough times, socializing can also mean commiserating with your peers. But instead of collectively dwelling on the negative, try discussing positive developments.

Physical Activity

Exercise is another great diversion tactic. At a vigorous-enough pace, exercise can help produce increased amounts of the body’s naturally occurring, mood-boosting chemical dopamine. Getting active also gives people a sense of control and accomplishment, which can eclipse feelings of doubt and anxiety. There is one thing to remember, though: Be sure to focus on the task at hand instead of letting the mind wander.

Preventive Care

Anxiety is a powerful emotion that can overwhelm those who experience it. But instead of turning to alcohol, fatty food or television, try following the basic rules of good health and preventive care: stay physically active, eat well and get plenty of rest. Also avoid chemical substances like caffeine and nicotine, which can worsen anxiety, according to the Mayo Clinic.

Cognitive and Behavioral Techniques

Dr. Israel Iberzon,a professor of psychology and psychiatry at the University of Michigan, uses cognitive and behavioral techniques to help his patients overcome anxiety. These include “changing the narrative” associated with the anxiety, creating emotional distance and assessing the threat with a new perspective. Since these reactions are hardly intuitive, Iberzon recommends seeking out professional help to better understand them.

Psychotherapy

Therapy can be an effective tool for those who want to learn more about cognitive and behavioral coping techniques, but it may also be necessary for those who have a clinical disorder. Anxiety disorders, according to the nonprofit organization Anxiety Disorders Association of America, are the most common illnesses in the U.S. A psychotherapist can make an official diagnosis and provide support and treatment.

Anti-anxiety and Anti-depressant Medications

Prescription medicine can alleviate symptoms of a clinical anxiety disorder. For short-term relief, patients can take benzodiazepines, which work as sedatives. Anti-depressants like duloxetine (Cymbalta) and fluoxetine (Prozac) have also been used to treat anxiety disorders, according to the Mayo Clinic. A new study in the Journal of the American Medical Association found that the anti-depressant Lexapro was very effective in treating adults with Generalized Anxiety Disorder over the age of 60.”

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January 4th, 2009

Expectant Brains Help Predict Anxiety Treatment Success
A network of emotion-regulating brain regions implicated in the pathological worry that can grip patients with anxiety disorders may also be useful for predicting the benefits of treatment.
ScienceDaily - Jan. 4, 2009

A new study appearing online Jan. 2 reports that high levels of brain activity in an emotional center called the amygdala reflect patients’ hypersensitivity to anticipation of adverse events. At the same time, high activity in a regulatory region known as the anterior cingulate cortex is associated with a positive clinical response to a common antidepressant medication.

The study will appear in an upcoming issue of the American Journal of Psychiatry.

For individuals with anxiety disorders, the anticipation of a bad outcome can be worse than the outcome itself, says Jack Nitschke, assistant professor and clinical psychologist at the University of Wisconsin-Madison School of Medicine and Public Health and lead author of the new study. Some individuals spend so much time worrying about getting into a negative situation or having a panic attack, he says, that the condition becomes debilitating. “In an extreme situation, they might not even leave their home,” he says.

To study how the brain responds to anticipation, researchers at the UW-Madison Waisman Laboratory for Brain Imaging and Behavior used functional magnetic resonance imaging (fMRI) to examine patients with generalized anxiety disorder (GAD) as they viewed a set of negative and neutral images. Patients were shown pre-image cues several seconds before each picture so they would know what to expect: a circle before a neutral image and a minus sign before an aversive image.

While GAD patients showed no difference compared to healthy subjects in brain activation in response to the aversive or neutral pictures themselves, they displayed unusually high levels of amygdala activity in response to both anticipatory cues. According to Nitschke, the response suggests that the patients are hypersensitive to the anticipation of any stimuli, even those they are told will not be negative.

“In response to both of those anticipatory signals, the GAD subjects — the anxious folks — are showing huge amounts of amygdala activation that is much more than what healthy control subjects showed,” he says.

The researchers believe the high levels of amygdala activity seen in GAD patients reflects an indiscriminate and disproportionately large response to the idea that something negative might happen in the future, even in a lab setting where they know nothing bad will actually occur, he says.

“It suggests that there are differences in anticipatory brain processing in these individuals,” he says, adding that the result has important implications for other related disorders as well. “That’s the crux of what’s debilitating in people with anxiety disorders, whether it’s panic disorder, obsessive compulsive disorder or post-traumatic stress disorder.”

The patterns of brain activity also appear to hold predictive power for how patients will respond to treatment for their anxiety. After their brain scans, the GAD patients in the study received an eight-week course of treatment with venlafaxine (Effexor), a common antidepressant. Clinical improvement on the medication was associated with higher levels of pre-treatment brain activity in the anterior cingulate cortex (ACC) in anticipation of both aversive and neutral stimuli.

The ACC is a regulatory brain region important for modulating emotional responses. Activity in the same area has been shown to predict clinical outcome in patients with depression.

“When you look within the GAD patient population, that area is what predicts whether they respond to this treatment,” says Nitschke. “What it suggests is that people who still have some residual functioning of that area are the people who are more likely to get better” with this drug.

Choosing the most appropriate treatment approach for an individual patient is an important and difficult issue, he says, because anxiety disorders encompass a range of conditions with diverse symptoms and causes. Anxiety disorders are also frequently associated with depression, and Nitschke and his collaborators next plan to examine GAD patients with and without major depressive disorder.

“This is a critical new direction that the field is already moving in — using fMRI to predict treatment response,” he says. “Hopefully we’ll be able to use that eventually to determine what kind of treatment to provide to people.”"

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