Children Of Combat-Deployed Parents Show Increased Worries, Even After Parent Returns

There should be an image here!The current conflicts in Iraq and Afghanistan have resulted in extended and repeated combat-related deployments of U.S. military service members. While much has been reported about the problems, both physical and psychological, many bring back with them, new research out of UCLA shows that the family back home can have issues as well.

The suddenly single parents left at home and their children must quickly adjust to altered family roles and the stress of having a loved one in a distant and dangerous land, in addition to dealing with potential psychological or physical health problems the active-duty parent may have upon their return.

Reporting in the April edition of the Journal of the American Academy of Child and Adolescent Psychiatry, UCLA assistant professor of psychiatry Dr. Patricia Lester and her colleagues found that it is the number and length of repeated deployments that cause higher levels of anxiety in children and that this anxiety persists even after the deployed parent returns home.

Second, they found that the level of anxiety children experience can be predicted by the amount of psychological distress shown by both the active-duty parent and the at-home parent.

Lester and her colleagues studied 171 families in which either the mother or father was on active duty, currently deployed or recently returned from serving in Iraq or Afghanistan. Of the sample, the active-duty parent had, on average, been deployed more than twice and had been away from home for 16 months.

The researchers found that approximately one-third of the children in these families had increased symptoms of anxiety. Strikingly, the anxiety remained even after the deployed parent returned home.

“It’s known that, in general, a child’s level of distress is linked to parental distress,” Lester said. “Here, we found that approximately one-third of the at-home parents and almost 40 percent of the recently returned deployed parents showed elevations in anxiety and depression.

“We also found that the at-home parent showed higher levels of anxiety when their spouse was deployed. But the two key markers for anxiety in the child were the distress levels of both parents and the number of months a parent had been deployed during the child’s lifetime.”

Interestingly, the study suggests that school-aged boys and girls behave differently during and after a parent’s deployment. Girls showed an increase in acting out and disruptive behavior when the parent was deployed, while boys appeared to have more difficulties after the deployed parent returned.

“For the boys, this may be related to reduced autonomy and increased structure in the family life upon the return of the deployed parent,” Lester said.

Notably, the children also showed indices of resilience, and their experiences of other types of emotional and behavioral problems were comparable to what is seen normally within any general community of kids.

Lester noted that the military demographic in the U.S. has changed in the past several decades to include a much larger proportion of service members with families. She said planning is needed for extended military operations to take into account the impact on family members.

“These findings suggest that there is a cumulative wear and tear upon the military family from multiple deployments during wartime,” she said.

Lester and her colleagues have developed a program to help such military families. Called FOCUS (Families OverComing Under Stress), the program provides both parents and children customized training that addresses the impact of wartime deployment on families and helps them learn very specific communication and problem-solving skills to address these challenges.

Mark Wheeler @ University of California — Los Angeles

[Photo above by The U.S. Army / CC BY-ND 2.0]

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SLU Doctor Warns Against St. John's Wort For Anxiety

There should be an image here!In a broad-based review of studies focused on drugs that treat anxiety, a Saint Louis University doctor found no evidence supporting the use of so-called “natural” treatments in combating the effects of anxiety.

St. John’s wort, kava extract and valerian, herbal remedies touted on the Internet, have not been proven to be effective in treating anxiety wrote Kimberly Zoberi, M.D., associate professor of family and community medicine at Saint Louis University School of Medicine. Additionally, she raised concerns about the safety of valerian, particularly lacking any long-term studies of the herb.

“Patients should be extremely cautious about garnering medical advice from the Internet,” says Zoberi. “There is no evidence that those medications are effective. If a patient wishes to avoid drug therapy, her doctor can suggest alternatives such as cognitive behavioral therapy.”

In addition to the findings regarding “natural” treatments, Zoberi compared the differing prescription drug regimens available on the market for patients suffering from anxiety. According to Zoberi, most physicians recommend selective serotonin reuptake inhibitors (SSRIs) as a first-line treatment because they were safe, effective and less expensive. However, some patients suffer sexual or gastrointestinal side effects.

Zoberi found that medications from the anticonvulsant class of drugs are among the quickest and most effective ways to provide relief to patients in distress without the side effects of other first-line treatments. The downside is that these prescriptions are fairly expensive compared to other treatments.

Ultimately, Zoberi strongly recommends consulting with a health care professional before beginning any drug regimen for anxiety.

Nancy Solomon @ Saint Louis University

[Photo above by Mike Chaput-Branson / CC BY-ND 2.0]

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Mental Health Providers Should Prescribe Exercise More Often For Depression, Anxiety

There should be an image here!Exercise is a magic drug for many people with depression and anxiety disorders, and it should be more widely prescribed by mental health care providers, according to researchers who analyzed the results of numerous published studies.

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

Smits and Michael Otto, psychology professor at Boston University, based their finding on an analysis of dozens of population-based studies, clinical studies and meta-analytic reviews related to exercise and mental health, including the authors’ meta-analysis of exercise interventions for mental health and studies on reducing anxiety sensitivity with exercise. The researchers’ review demonstrated the efficacy of exercise programs in reducing depression and anxiety.

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.”

The researchers presented their findings March 6 in Baltimore at the annual conference of the Anxiety Disorder Association of America. Their workshop was based on their therapist guide “Exercise for Mood and Anxiety Disorders,” with accompanying patient workbook (Oxford University Press, September 2009).

“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.”

Kim Cobb @ Southern Methodist University

[Photo above by My Yoga Online / CC BY-ND 2.0]

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Acupuncture Calms Highly Anxious Dental Patients

There should be an image here!Acupuncture can calm highly anxious dental patients and ensure that they can be given the treatment they need, suggests a small study published in Acupuncture in Medicine.

A visit to the dentist provokes extreme fear and anxiety in an estimated one in 20 people, and can put them off going altogether, a condition termed odontophobia. And up to a third of patients report moderate anxiety at the prospect of dental treatment, studies show.

The authors base their findings on 16 women and four men from eight dental practice lists.

Each of the patients was moderately or extremely anxious about going to the dentist for treatment, as assessed by a validated questionnaire — the Back Anxiety Inventory (BAI).

All were in their 40s and had been trying to deal with this problem for between two and 30 years.

The BAI score was assessed before and after five minutes of acupuncture treatment, targeting two specific acupuncture points (GV20 and EX6) on the top of the head.

The acupuncture was carried out by the dentists themselves, all of whom are members of the British Dental Acupuncture Society.

The average BAI score of 26.5 fell to 11.5, and all 20 patients were able to undergo their planned treatment, whereas before this had only been possible in six — and then only partially and after a great deal of effort on the part of both dentist and patient.

The authors point out that several attempts have been made to conquer this type of anxiety, including sedatives, relaxation techniques, behavioural therapies, biofeedback and hypnosis. The research indicates that these do help, but they are time consuming and require considerable levels of psychotherapeutic skills, if applied properly, say the authors.

They caution that further larger studies are needed to confirm the value of acupuncture in these sorts of cases, but suggest that acupuncture “may offer a simple and inexpensive method of treatment.”

Emma Dickinson @ British Medical Journal

[Photo above by Deborah Leigh / CC BY-ND 2.0]

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Regular Exercise Reduces Patient Anxiety By 20 Percent

There should be an image here!The anxiety that often accompanies a chronic illness can chip away at quality of life and make patients less likely to follow their treatment plan. But regular exercise can significantly reduce symptoms of anxiety, a new University of Georgia study shows.

In a study appearing in the Archives of Internal Medicine, researchers analyzed the results of 40 randomized clinical trials involving nearly 3,000 patients with a variety of medical conditions. They found that, on average, patients who exercised regularly reported a 20 percent reduction in anxiety symptoms compared to those who did not exercise.

“Our findings add to the growing body of evidence that physical activities such as walking or weight lifting may turn out to be the best medicine that physicians can prescribe to help their patients feel less anxious,” said lead author Matthew Herring, a doctoral student in the department of kinesiology, part of the UGA College of Education.

Herring pointed out that while the role of exercise in alleviating symptoms of depression has been well studied, the impact of regular exercise on anxiety symptoms has received less attention. The number of people living with chronic medical conditions is likely to increase as the population ages, he added, underscoring the need for a low-cost, effective treatment.

The researchers limited their analysis to randomized controlled trials, which are the gold standard of clinical research, to ensure that only the highest quality data were used. The patients in the studies suffered from a variety of conditions, including heart disease, multiple sclerosis, cancer and chronic pain from arthritis. In 90 percent of the studies examined, the patients randomly assigned to exercise had fewer anxiety symptoms, such as feelings of worry, apprehension and nervousness, than the control group.

“We found that exercise seems to work with just about everybody under most situations,” said study co-author Pat O’Connor, professor and co-director of the UGA Exercise Psychology Laboratory. “Exercise even helps people who are not very anxious to begin with become more calm.”

Exercise sessions greater than 30 minutes were better at reducing anxiety than sessions of less than 30 minutes, the researchers found. But surprisingly, programs with a duration of between three and twelve weeks appear to be more effective at reducing anxiety than those lasting more than 12 weeks. The researchers noted that study participants were less likely to stick with the longer exercise programs, which suggests that better participation rates result in greater reductions in anxiety.

“Because not all study participants completed every exercise session, the effect of exercise on anxiety reported in our study may be underestimated,” said study co-author Rod Dishman, also a professor of kinesiology. “Regardless, our work supports the use of exercise to treat a variety of physical and mental health conditions, with less risk of adverse events than medication.”

Wendy Jones @ University of Georgia

[Photo above by Lady Jove / CC BY-ND 2.0]

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