Saturday, February 9, 2013

Coping with Stress in High-Pressure Situations

Some people thrive under pressure; others buckle. What accounts for the difference? In this week’s New York Times Magazine, Po Bronson and Ashley Merryman write about differences in the ways that kids cope with stress, but the research has something for adults too.

They describe research that identifies variants of a gene known as COMT that distinguishes between “warriors,” who cope well with stress and “worriers,” who don’t. Kids with the “worrier” version of the gene do better with cognitive tasks under low pressure, but in high pressure situations, they don’t do as well. In contrast, kids with the “warrior” version do not perform as well on workaday tasks, but then will rally when the pressure is on.


One way of thinking about these results is to understand that the children are interpreting a particular situation as either a threat or a challenge.  “Worriers” are more likely to interpret the physical symptoms that they feel in a high-stakes situation  to mean that they are in a threatening situation, and that response ends up being detrimental to their performance. A “warrior,” on the other hand, might experience the same symptoms and view the experience as a challenge that he or she can rise to.


All is not lost for the worrier, though. Practice and experience can erase the difference. In a study with Air Force pilots, inexperienced warriors performed better than inexperienced worriers. But among more experienced pilots, the worriers outperformed the warriors. Acclimating to stressful situations through practice, in other words,  can help with performance. This repetition appears to help worriers relabel the scary situation into a challenging one.


Most people who have taken the SAT or a similar standardized test will have an idea of whether they fall on the warrior or worrier end of the spectrum. If you’re a warrior, lucky you. If you’re a worrier, don’t avoid stress; instead, try to experience it in manageable doses. Try to learn ways of reframing anxious situations and reminding yourself that the anxiety you feel may help you be more focused and alert and better able to meet a challenge.


Monday, November 19, 2012

Overcoming Anxiety


What makes a panic attack so scary? Well, first there comes the sudden onset of  debilitating symptoms--racing heartbeat, tightness in the chest, nausea, among others--that can be mistaken for a heart attack. Then, once you realize that you’re not dying comes the fear that this sudden anxiety will strike again.

This makes a recent New York Times article about professional golfer Charlie Beljan all the more remarkable. He had a panic attack (although he didn’t identify it as such while he was experiencing it)  before a practice round for a PGA tournament. He managed to play through his anxiety and complete the round. For some, the initial panic attack can lead to avoidance of similar situations (for example, avoiding driving after having a panic attack while driving). In this case, Beljan returned to the tournament the next day, after spending the night in the hospital getting a medical workup.And despite the residual effects of the previous day’s experience, he won the tournament.

It’s hard to imagine experiencing such anxiety and then performing so well under pressure. Golf has a well-deserved reputation as a nerve-wracking sport--one in which a player’s greatest enemy is the psychological turmoil inside. The history of professional golf is filled with episodes in which a golfer nears the end of a tournament leading by a wide margin, only to buckle under the pressure, start playing badly and lose the top spot. In this case, he attributed the anxiety not to the pressure from the tournament, but recent changes and stressors in his personal life, such as having a new baby. After the tournament, the article notes, he contacted a psychologist for treatment.

Beljan’s story shows how disruptive and frightening anxiety can be, but also shows that it is possible to overcome it. His story is truly impressive and inspirational.


Sunday, September 23, 2012

Male Anorexia

“20% of Anorexics are Men” is the to-the-point title of an article in the September issue of GQ, which profiles male anorexics and highlights some of their difficulties. Some takeaways:
  • The number of male anorexics is rising quickly. One contribution may be the increased focus on hard-to-attain physical attributes like the six-pack
  • Risk factors include being overweight as a youth and getting teased for it; a family history of eating disorders or obesity; being gay; and having participated in a sport that emphasizes speed or weight control (distance running, wrestling, etc.).
  • Anorexia has the highest mortality rate of any mental illness--between 5 and 10 percent--a result of both suicide and health complications. It lasts longer in men (8 years) than women, in part because men are likely to wait longer to get treated.
  • Even with recovery, there are likely to be health complications which can affect life expectancy. The prolonged deprivation can weaken the heart muscles, the bones, and cause cognitive damage which may lead to medical issues long after treatment is completed.
The photos that accompany the article are arresting and disturbing, as are the sad stories of the suffering men profiled. Included are one man on the verge of death, so emaciated that the fat from the pads on his ear that seal his Eustachian tube is gone, leading him to hear a constant rushing of air; and a subclinical anorexic, whose weight is low but not dangerously so, but who tightly controls his exercise and food intake so as to maintain it. What is striking in all of these stories is the amount of focus and energy on food and exercise, and the isolation that accompanies it. Either because of the time and energy devoted to losing or maintaining weight or the need to hide the extent of restriction from others, the men profiled appear lonely, virtually friendless and withdrawn from others. It is truly a sad and moving article.

Wednesday, August 1, 2012

Why a little self-deception is good

How important is it to see yourself clearly, to be able to assess your strengths and weaknesses accurately? Maybe not as important as you might think, some researchers say.

In the July 30 Wall Street Journal, Sue Shellenbarger reports on research that looks at ways people deceive themselves to in order to feel better about themselves. Studies show, for example, that people tend to think that they are smarter, better looking, and easier to get along with than they really are.

The research brings to mind earlier studies of “depressive realism” -- the concept that depressed people are more accurate in assessing some situations, while non-depressed people displayed more “positive illusions.” We all use psychological defenses to avoid facing up to unpleasant things, and perhaps when we’re depressed, those defenses are less sturdy.

People who have studied self-deception say that a little bit of it can be good for you. Overestimating your strengths and downplaying your weaknesses may spur you to take on new challenges. In contrast, ruthlessly assessing your deficits and minimizing your strengths may hold you back.

Too much self-deception, though, can be harmful. Politicians are a good illustration of this. If you run for office, you have to be a little self-deceiving. You have to believe that you are the person most qualified person to solve the problems of thousands or millions of people. You have to shake off a lot of criticism and harsh attacks -- even if it’s all true. Yet history has proven over and over again that politicians’ self-deception can border on delusional -- most colorfully when they commit ethical misdeeds believing they have no risk of being caught. Self-deception, like most other character traits, exists on a continuum. Some is good, but too much can be destructive.

Sunday, July 22, 2012

Body Image and Sororities

It was somewhat disturbing to read in the Sunday New York Times about a new kind of service business: sorority coaches. These are women who get paid to help girls at college to pledge sororities. As part of their work, the coaches advise these young women on how to dress, shape their resume, and present themselves in order to maximize their chances of being asked to join a sorority.

As an adult long past this stage of life, I feel sympathy for young women who have to, or feel they have to, put so much effort into packaging themselves in a particular way to find a circle of friends at school. But what I found most disappointing in the article was its offhand discussion about weight and the necessity of losing weight before sorority rush. The author writes, “Many aspiring sisters spend their summer working out and dieting,” and cites a study that among girls in a normal weight range, the thinner ones are more likely to end up in a sorority. “It’s just you are being judged on how you look,” says one college student quoted in the story.

That the author and the participating girls just accept this without question or comment strikes me as sad. It also shows how ingrained in our culture it is that girls should strive to attain the a thin ideal. Given the pressure for conformity in sororities that this article describes (in many areas, not just weight), it is not at all surprising how prevalent body image concerns are among college women.

Sunday, June 3, 2012

College Students and Prozac

What does it mean that there has been an explosion in the number of college students taking psychiatric medication? Does it mean that more students with mental illness are attending college? That people are more willing than in the past to seek treatment for anxiety and depression? That mental illness has been redefined? Or is it something else?

Katherine Sharpe -- a writer who discloses that she took antidepressants while attending college in the late 1990s -- makes a thoughtful attempt to answer these questions in the latest issue of the Chronicle of Higher Education. Facing increased stress, competition and pressure on campus, students feel the need to present themselves to others as being without flaws or weaknesses, writes Sharpe. Citing the research of Joseph Davis, a sociology professor at the University of Virginia, Sharpe says that students use medication to protect themselves from experiencing the emotions that they deem unacceptable -- emotions such as “discouragement and loneliness, nervousness and insecurity, jealousy and emotional vulnerability, shame and humiliation, shame and self-blame.” The desire to avoid such emotions diminishes, for these students, the appeal of traditional therapy, any form of which will require some exploration of the unpleasantness they feel. Medication, by contrast, can seem quicker and less painful.

What is going on, Sharpe writes, is a kind of “medicalization” of negative emotions -- a perception that if you experience these emotions, they must be connected to some kind of disorder. What can be lost is the opportunity to explore and reflect on normal negative emotions that may in fact have some significance and meaning. Overall, the emergence of effective psychiatric medications has enabled many students and non-students to thrive and few would argue with that. However, it is unfortunate if these medications also contribute to college students’ sense that they must achieve emotional perfection, and their mistaken belief that those around them have already achieved it. Much research shows that medication and psychotherapy can be more effective when used in tandem than either approach is when used by itself; it would be a shame if college students were to lose the added benefit of therapy because they want to avoid feelings of vulnerability.


Friday, March 16, 2012

Technology and Eating Disorders

Technology has changed our lives in ways that we don’t often think about. Remember when the only way to look something up was in a book? Or the only way to access the Internet was on a desktop computer? Now we have uninterrupted access to information that’s always easy to seek out -- even when it may not be good for us.

Information access, for example, is not always such a good thing when it comes to eating disorders. In a recent article at Thefix.com, a website covering addiction and recovery, a colleague, Diana Freed, discusses how technology can be detrimental to people with eating disorders. She describes working with a 24 year-old woman who constantly checks her iPhone -- a phone loaded with apps that count calories, record her weight, and track her body mass index and body fat. Though the patient severely restricts her own food intake, she has also downloaded onto her iPhone recipe apps that she can look at and think about. In other words, at the same time she is seeking treatment to help her alter her preoccupation with weight and food, technology makes it easier for her to constantly retrieve images and information fueling the very impulses she is seeking to change.

Freed’s article raises an array of technology-related issues that I need to consider in my work. It’s important to know how much time a patient is spending on the Internet or engaging in social media, and what he or she believes to be getting from those experiences. Does using a certain app make you feel worse about yourself? Or are there apps you can use in the service of recovery? These are just two of the questions about technology that I and other psychologists must now explore.