The American Academy of Sleep Medicine issued the following news release:

Bright light therapy improves sleep disturbances in soldiers with combat PTSD

Study suggests that bright light therapy may be an effective treatment
for combat-related post-traumatic stress disorder

Bright light therapy has significant effects on sleep disturbances
associated with combat-related post-traumatic stress disorder, according
to a research abstract that will be presented Monday, June 7, 2010, in
San Antonio, Texas, at SLEEP 2010, the 24th annual meeting of the
Associated Professional Sleep Societies LLC.

Results indicate that bright light therapy produced a significantly
greater improvement than placebo in sleep disturbances specific to PTSD.

Bright light therapy also produced a moderate improvement in PTSD
symptoms and depression.

“Results of this ongoing study show significant effects of bright light
on disruptive nocturnal behaviors associated with combat PTSD, as well
as positive effects of bright light therapy on PTSD symptom severity,”
said study coordinator Shannon Cornelius, PhD, graduate research
assistant for Dr. Shawn D. Youngstedt in the department of exercise
science at the University of South Carolina in Columbia, S.C.

“Because bright light therapy is a relatively simple, self-administered,
inexpensive treatment with few side effects, these results are an
important step to further establish the efficacy of bright light therapy
as an alternative or adjunct treatment for combat-related PTSD.”

The study involved 16 soldiers who returned to the U.S. with combat-
related PTSD after serving in Operation Enduring Freedom or Operation
Iraqi Freedom. Following a one-week baseline, participants were
randomized to one of two four-week treatments.

Eight soldiers received 10,000 lux of bright light therapy for 30
minutes each day. The other eight participants were assigned to the
placebo group and received sham treatment with an inactivated negative
ion generator.

The Clinician-Administered PTSD Scale (CAPS-2) was completed at
baseline and immediately following completion of the study.

At weekly intervals, depression was assessed with the Beck Depression
Inventory (BDI-II), and sleep quality was assessed with the Pittsburgh
Sleep Quality Index (PSQI) with addendum for PTSD (PSQI-PTSD).

Cornelius noted that sleep disturbance is a commonly reported problem
that can play both a precipitating and perpetuating role in PTSD, making
it an important target for therapy.

“Disturbed sleep is known to interact with depression and anxiety in a
vicious cycle,” said Cornelius.

“By reducing the severity and occurrence of sleep disturbances, it may
be possible to reduce the severity of symptoms such as anxiety and
depression in combat-related PTSD.”

The American Academy of Sleep Medicine reports that 70 to 90 percent of
people with PTSD describe subjective sleep disturbance. Recurrent
nightmares of the traumatic event represent one of the most problematic
and enduring symptoms of PTSD.

These nightmares may take the form of a realistic reliving of the
traumatic event or depict only some of its elements.

Bright light therapy exposes your eyes to intense but safe amounts of
light for a specific and regular length of time.

Typically it involves exposure to up to 10,000 lux of light for
scheduled periods of 20 minutes or more using a small light box.

In a 2007 study published in the journal BMC Psychiatry, Youngstedt
reported that bright light exposure may have an anxiolytic effect.

Three hours of exposure to 3,000 lux of bright light for three
consecutive days reduced anxiety in a group of low-anxiety adults.

The new issue of *Archives of Internal Medicine* (Vol. 170, No. 4,
February 22) includes an article: “The Effect of Exercise Training on
Anxiety Symptoms Among Patients: A Systematic Review.”

The authors are Matthew P. Herring, MS, MEd, Patrick J. O’Connor, PhD, & Rodney K. Dishman, PhD.

Here’s how the article starts:

[begin excerpt]

Anxiety, an unpleasant mood characterized by thoughts of worry, is an
adaptive response to perceived threats that can develop into a
maladaptive anxiety disorder if it becomes severe and chronic.1

Anxiety symptoms and disorders are common among individuals with a
chronic illness,2-8  yet health care providers often fail to recognize
or treat anxiety and may consider it to be an unimportant response to a
chronic illness.9

Anxiety symptoms can have a negative impact on treatment outcomes in
part because anxious patients can be less likely to adhere to prescribed
medical treatments.10-11

Personal costs of anxiety among patients include reduced health-related
quality of life12 and increased disability, role impairment,13 and
health care visits.14

King’s College London issued the following news release:

Depression as deadly as smoking, but anxiety may be good for you

A study by researchers at the University of Bergen, Norway, and the
Institute of Psychiatry (IoP) at King’s College London has found that
depression is as much of a risk factor for mortality as smoking.

Utilising a unique link between a survey of over 60,000 people and a
comprehensive mortality database, the researchers found that over the
four years following the survey, the mortality risk was increased to a
similar extent in people who were depressed as in people who were smokers.


The many faces of perfectionism

The need for perfection comes in different flavors, each associated with its own set of problems, researchers say.

Monitor staff

Paul Hewitt, PhD, does not have much patience with researchers who argue that perfectionism–the need to be or appear perfect–can sometimes serve as a healthy motivation for reaching ambitious goals. “I don’t think needing to be perfect is in any way adaptive,” he says.

Hewitt should know. In more than 20 years of research, he and his colleagues–particularly psychologist Gordon Flett, PhD–have found that perfectionism correlates with depression, anxiety, eating disorders and other mental health problems. This summer, several new studies were published that help explain how perfectionism can contribute to psychopathology.

“In the literature right now–this astounds me–people have said that self-oriented perfectionism is adaptive,” says Hewitt, a practicing psychologist and professor at the University of British Columbia. “People will make that claim, and they’ll just ignore the fairly large literature that says that it’s a vulnerability factor for unipolar depression, anorexia and suicide.”

The question of adaptiveness

Since the early 1990s, Hewitt and Flett, a professor of psychology at York University in Toronto have championed the idea that perfectionism comes in different flavors, each associated with different kinds of problems. Some of those problems may be less severe than others, they argue, but no form of perfectionism is completely problem-free.

Other researchers, however, have suggested that some forms of perfectionism–particularly those that involve high personal standards–can be adaptive. World-class athletes, they argue, have extraordinarily high standards; they shouldn’t be labeled pathological just because they aim high.

That’s an oversimplification, says Hewitt, one that conflates two very different things: the desire to excel and the desire to be perfect.


Three strategies for dealing with useless worry
– a cognitive therapy approach.

Some people find the following strategies helpful for reducing pointless and upsetting worry.

1. Thought Stopping

Thought stopping is designed to be used when you find yourself worrying about the same issue again and again. It should only be used if the worry is pointless. If your worrying is actually giving you solutions to the problem, then you might want to keep doing it.  The technique takes a fair bit of practice to learn. Here’s the sequence:

a) Pick a time when you can be undisturbed at home for a couple of hours.

b) Sit down and deliberately start worrying. This may be harder than you think. You should choose an issue that bothers you but not one that will send you into deep depression or make you think about harming yourself.

c) Once you begin to feel worried do three things: stand up, clap your hands once and shout “stop!” you will feel quite silly doing this but do it anyway. You should notice that the worry stops for a bit.

d) The moment you notice yourself worrying again (probably only a few seconds later) stand, clap and shout “stop!” again. Keep repeating this. Eventually you should notice that the worry takes longer and longer to come back. At this point clap and shout without standing.   After a while stop clapping; just shout.

e) Finally stop shouting. Instead picture a large stop sign in your head and imagine yourself shouting “STOP”. Now you can have other people around again. Over the next few weeks make a point of imagining the sign and the shout whenever you catch yourself worrying about the topic. If you like you can wear a rubber band around your wrist and snap it (gently) against the skin at the same time. Then shift your mind onto some other topic. With time you can become very effective at halting periods of pointless worry.

2. Worrying Time

Worrying time is designed to help you stop worrying about problems for most of the day by saving all of your worrying for a particular time. This can be easier than stopping the worrying altogether. As well you may have to think about some of your worries in order to decide what to do about them. Here’s the strategy;

a) Pick a time during the day or week when you will sit down and think about the things that have been worrying you. You probably don’t need to do this every day but more than once a week would be a good idea. Set aside a maximum of 30 minutes when you will not be distracted.

b) Carry a pen and paper (index cards work well) with you at all times. When you catch yourself worrying, make a note of the topic. Assure yourself that you will  think about the issue but not right now. Shift your mind onto something else.

c) When it is time to worry, take out your list of topics and consider each of them in turn. With some topics you may find that you can actually come up with a solution or a decision about how to handle them. Others you may just worry about.  This strategy may sound a bit odd but it is amazingly helpful if you are disciplined about carrying it out.

3 . Worry Inflation

We frequently try to minimize our fears. Worry inflation uses the opposite approach: making the problems as big as possible. Why? Because if you exaggerate many fears they eventually become ridiculous. You find that you can’t really believe that things will get that bad, and the problem shrinks down to realistic proportions. Here’s the strategy:

a) First identify the disturbing thought you want to deal with.

b) Next decide whether inflating the worry will make it seem silly or will only make it seem worse.

c) If it looks like a good topic for worry inflation, exaggerate the disturbing thought out of all proportion. Imagine the most extreme consequences possible. For example: “If I phone my old friend she won’t remember me. She will tell the police she has had a nuisance caller. They will trace the call and arrest me. I’ll spend the rest of my life in jail”. The more extreme the worry gets; the less you may believe in it and the less that thought will be able to bother you in the future.

Randomized, Controlled Trial of the Effectiveness of Short-Term Dynamic Psychotherapy and Cognitive Therapy for Cluster C Personality Disorders

Martin Svartberg, M.D., Ph.D., Tore C. Stiles, Ph.D., and Michael H. Seltzer, Ph.D. American Journal of Psychiatry 2004; 161:810–817


Objective: This study compared the effectiveness of short-term dynamic psychotherapy and cognitive therapy for outpatients with cluster C personality disorders.

Method: Patients (N=50) who met the criteria for one or more cluster C personality disorders and not for any other personality disorders were randomly assigned to receive 40 weekly sessions of short-term dynamic psychotherapy or cognitive therapy. The most common axis I disorders in the patient group were anxiety and depression diagnoses. Therapists were experienced, full-time clinicians and were receiving manual-guided supervision. Outcome variables included symptom distress, interpersonal problems, and core personality pathology. Measures were administered repeatedly during and after treatment, and change was assessed longitudinally by means of growth modeling procedures.

Results: The overall patient group showed, on average, statistically significant improvements on all measures during treatment and also during a 2-year follow-up period. Significant changes in symptom distress after treatment were found for the group of patients who received short-term dynamic psychotherapy but not for the cognitive therapy patients. Despite these differences in intragroup changes, no statistically significant differences between the short-term dynamic psychotherapy group and cognitive therapy group were found on any measure for any time period. Two years after treatment, 54% of the short-term dynamic psychotherapy patients and 42% of the cognitive therapy patients had recovered symptomatically, whereas approximately 40% of the patients in both groups had recovered in terms of interpersonal problems and personality functioning.

Conclusions: Both short-term dynamic psychotherapy and cognitive therapy have a place in the treatment of patients with cluster C personality disorders. However, factors other than treatment modality may discriminate better between successful and poor outcomes. Such factors should be explored in future studies.

NB: Cluster C personality disorders are characterized by anxious, fearful behavior and include obsessive-compulsive, avoidant and dependent personality disorders.

And the day came

when the risk to remain tight in a bud

was more painful than the risk it took

to blossom.

Anaïs Nin

I am an old man and have known a great many troubles, but most of them never happened.  MARK TWAIN

I never think of the future. It comes soon enough. Time enough to think of the future when you haven’t any future to think of. Albert Einstein, in an interview

The future is something which everyone reaches at the rate of sixty minutes an hour, whatever he does, whoever he is. C. S. Lewis, SCREWTAPE LETTERS

To most of us the future seems unsure; but then it always has been; and we who have seen great changes must have great hopes. John Masefield, GRACE BEFORE PLOUGHING

Without measureless and perpetual uncertainty the drama of human life would be destroyed. Winston Churchill THE GATHERING STORM.

There are no hopeless situations; there are only men who have grown hopeless about them. Clair Boothe Luce EUROPE IN THE SPRING.

Hope is a risk that must be run. Georges Bernanos LAST ESSAYS.

What lies behind us and what lies before us are tiny matters, compared to what lies within us. Ralph Waldo Emerson

On facing fears of the unknown

One of the biggest things I hear from my clients and know at times from experience is that we are often anxious about the future, especially about the unknown. And yet is it’s not the unknown or the future that scares us, it’s what might happen that does. Just as it is not the dark that we are afraid of, it is the monster that might be lurking there that we fear. So identifying what it is that we area actually afraid of, looking at it, and deciding if it is worth fearing and deciding what we might need to do about it can be helpful.

There is another perspective (inspired from Bo Lozoff’s book It’s a Meaningful Life). We are built to deal with challenges. Uncertainty is simply the way it is – we are all in the dark about the future and always have been. No-one knows for sure what will happen tomorrow, never mind next year. This gives us an opportunity to see ourselves as resourceful people who are here to face the unknown, to discover the future and to deal with whatever happens at the time. Doing so can be our purpose in life – not to have guaranteed comfort or security, but instead to develop ourselves through meeting challenges. Not many people would want to say at the end of their lives “well, it was an easy life, and I never had to be strong”. There would be a sense of regret, of an opportunity lost. We are called on to be strong, to face fears and to overcome them. We are called to experience obstacles and to learn through experience how to manage. This process builds our character, determination, strength, and faith. It builds our mental and spiritual muscles.

The journey is not pre-planned and known from the start, because if it were this way, we would not have the opportunity to make choices and learn from them. There would be no growth, just the following of a pre-scripted role, repeating the lines and choices that we are handed by someone else. And this would do nothing to shape us and develop our character, skills, or wisdom.

Brian Grady, Ph.D.

12 June 2008

Reality Check

Who were you with? What were you doing? When was it? Where were you?
2. Moods
Describe each mood in 1 word. Rate how strong the mood was (1-100%)

3. Thoughts Ask yourself some or all of these questions:
For All moods: What was going through my mind just as I started to feel this way?
What images or memories do I have in this situation?
Especially for Depression: What does this say about me?
What does this mean about me? My life? My future?
Especially for Anxiety: What am I afraid might happen?
What is the worst thing that could happen if this is true?
Especially for Anger: What does this mean about how the other person feels or thinks of me?
What does this mean about the other person or people in general?
Circle the hot thought
4. Evidence that supports the hot thought.
Write factual evidence to support this:

5. Evidence that does not support the hot thought
Ask yourself questions to help you find evidence that your hot thought is not 100% true.

6. Alternative or balanced thought
a) Write an alternative or balanced thought and b) rate how believable this is for you (0-100%)

7. Re-rate your mood (0-100%)

Adapted from Greenberger & Padesky “Mind Over Mood