Depression for Dummies, Overcoming Anxiety for Dummies, Obsessive Compulsive Disorder for Dummies– these are just a few of the titles penned by Dr. Laura Smith and Dr. Charles Elliott, a writing duo with a library of psychology and self-help books between them. Tackling challenging topics with an accessible style is their specialty, and has allowed millions of readers gain a better understanding of anxiety, depression, OCD, and borderline personality disorder, among other topics.
They recently spent some time discussing the For Dummies series and a variety of psychology issues and questions with Neuronarrative.
You’ve written several books on depression, anxiety, OCD and related topics, including some of the wildly popular For Dummies books. What led you to the Dummies format to address these topics?
Yes we have; in fact, we’ve just finished our sixth book in the series. As clinical psychologists, we’ve read dozens of self-help books. Most of them focus on how to deal with some specific mental disorder such as depression, obsessive compulsive disorder, or generalized anxiety disorder. Some of these books ignore empirical findings and present an interesting, but highly idiosyncratic and non-data based set of recommendations. Many of the better books in this genre are written by highly renowned researchers and do a great job of presenting the findings from a specific researcher’s approach to the disorder. However, in the past couple of decades, the mental health field has managed to develop a number of empirically based treatment strategies for most emotional disorders. We believe people can profit from knowing about a range of strategies so long as they rest on a research base.
In the For Dummies series, we saw an opportunity to provide consumers with an unusually comprehensive approach to each topic covered. Thus, in all of our books we discuss a variety of empirically supported treatment approaches, diagnostic issues and controversies, related disorders, etiology, prevalence, where and how to find professional help, and ideas for how friends and family can facilitate treatment. For example, in Obsessive Compulsive Disorder For Dummieswe discussed the fact that twenty years ago, the only treatments for OCD were exposure and response prevention (ERP) and medication. We were able to review not only ERP, but new mindfulness based approaches, cognitive therapy specifically tailored to OCD, medications, and Deep Brain Stimulation (a very preliminary, but possibly promising strategy).
At the same time, we appreciate the For Dummies series for its nontechnical, no nonsense approach to presenting information. We really enjoy taking complex subjects and presenting them in a way that enables intelligent consumers to understand a topic that may be new to them. Finally, we were thrilled that the editors also encourage the use of humor and a panache of irreverence. We believe that readers enjoy a touch of levity when reading about such serious subjects.
Some fear that the proliferation of medical information, particularly on the internet, is causing widespread self-diagnosis panic. What’s your take on this?
We’re firm believers in the value of information. No doubt, some people panic when they discover on the Internet that they may have a couple of symptoms of some serious disorder yet later learn that they don’t really have the actual illness or disease. But we suspect that for all those who are unnecessarily rattled by what they read, many more discover that they suffer from problems that that they were unaware of, but that can be successfully treated–and generally with greater success than they would have had by not starting treatment until their doctor discovered something at a physical exam months or years down the road.
News concerning the development of psychiatric disorders in children, such as OCD, is on the rise. In your opinion, are parents getting better at identifying symptoms in their kids? And have doctors become more willing to consider the possibility that a child needs psychiatric help?
We do believe that both parents and doctors have greater awareness about these issues than ever before. That awareness is certainly one of the reasons we see disturbing trends in the rise of various mental health issues in kids today as compared to the past. At the same time, some evidence suggests that more than increased awareness lies behind the escalating numbers we’ve seen in the past fifty years or so. Several studies have suggested that the rate of anxiety and depression in kids today greatly exceeds levels we’ve seen in the past.
We’re also concerned that there has appeared to be an over reliance on medications for dealing with these issues. Potent medications are increasingly being prescribed to kids for disorders which were once considered rare in children such as bipolar disorder. We suspect some of these diagnoses are given instead of behavioral disorder diagnoses so that these medications may be employed.
We take a more conservative approach to medications in kids because of a dearth of long term safety and efficacy studies. In fact, some studies have shown that many of these medications significantly increase risks of diabetes and sometimes set off suicidal thinking. Therefore, our usual recommendation is that treatments should first target the child’s problematic behaviors or moods as well as involve parents, the family, and the school environment. Cognitive behavioral interventions have been found to be especially effective and often obviate the need for medications. When they don’t, medications can be considered, but as judiciously as possible.
Tell us what “anxiety” really is in a clinical sense, and how it’s different than “a case of nerves” that everyone occasionally feels.
You’re correct that everyone feels stress and gets a case of nerves from time to time. You couldn’t live a meaningful life without them. Normal anxiety occurs when you’re faced with real challenges and hassles. Normal anxiety can even prepare you to deal with such challenges more effectively. Some experts call this type of anxiety facilitative anxiety. Normal anxiety dissipates when the problem is solved or diminishes.
Think of preparing for an examination. If you have no anxiety or worry at all, you’re likely to feel little motivation to prepare. If you’re moderately anxious, you’ll spend a lot more time studying. If your anxiety goes over the top, you may study a lot, but be unable to concentrate or you may deal with the anxiety by procrastination or avoidance of the task. In other words, complete absence of anxiety isn’t always such a good thing, moderate amounts can help and excessive anxiety interferes with performance.
Clinical anxiety debilitates rather than facilitates. By definition, most anxiety disorders persist for months. They involve reactions that exceed the objective nature of whatever seems to trigger them and in some cases; no trigger is even easily identifiable. Clinical anxiety comes with strong physical symptoms such as fatigue, restlessness, interrupted sleep, poor concentration, muscle tension, and irritability. Clinical anxiety reduces quality of life.
When it comes to prescribing meds for anxiety, the voices of dissent are many. Tell us something about the controversy surrounding benzodiazepines and other anxiety meds.
Evidence suggests that many anxiety disorders are treated especially effectively with certain psychotherapies most of which are based on cognitive behavior therapy. Thus, we would rarely suggest medications as the first line strategy. Benzodiazepines, although frequently prescribed for anxiety by general practitioners, are especially problematic for a variety of reasons including:
- Benzodiazepines have a significant addictive potential which may be heightened among those with anxiety disorders.
- Some data suggests that these drugs may actually increase the risk of relapse when combined with cognitive behavior therapies for anxiety.
- Benzodiazepines increase the risk of falling among the elderly and one study showed they may double the risk of automobile accidents. Of course, combined with alcohol, these risks escalate considerably.
- One study suggested that taking benzodiazepines on a prolonged basis shortly following a trauma actually increased the risk of developing Post Traumatic Stress Disorder later.
This is not to say that medications have no role to play in the amelioration of anxiety disorders. However, we generally recommend that any use of benzodiazepines be strictly limited to short-term acute stress. Other medications such as the Selective Serotonin Reuptake Inhibiters (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) sometimes appear useful as adjuncts to psychotherapy especially when appropriate therapies have failed to result in sufficient improvement.
Diagnosed cases of depression are also rising, and some believe that it’s an increasingly over-diagnosed illness. What do you believe is behind the surge in depression cases?
Of course doctors and mental health workers are more aware of the symptoms of depression than ever before. In fact, increasing numbers of primary care offices provide screening instruments for depression and anxiety. The public has also become more aware of the symptoms of depression due to a bombardment of advertizing, largely paid for by the pharmaceutical industry. For the most part, this increased awareness is a good thing and it has steered many people into earlier treatment of their distress.
At the same time, we have concerns about that the fact that antidepressant medications are today the most prescribed drug for any condition whether mental or physical. We worry that doctors may be prescribing medications for what used to be considered subclinical conditions. People receive prescriptions after breaking up with a boyfriend, being fired from a job and failing to be accepted into a college. Life transitions such as moving to a new city or coping with grief or loss sometimes trigger a trip to the doctor’s office for relief. When emotional reactions to such events are unusually profound or prolonged, medication may be warranted in some cases. However, there’s value in struggling with sadness, worry, and loss. From times such as these, humans develop new philosophies, literature, and creative solutions. We’d hate to see medications used to stifle struggles. Happiness is better appreciated when one has experienced sadness.
One of the continuous controversies surrounding psychiatric disorders is the influence of drug companies on the prescription–perhaps the over-prescription–of certain meds. How large a concern do you think this really is?
The heat has turned up on this controversy in the past few years as increasing numbers of articles have appeared which indicate that pharmaceutical companies have frequently engaged in questionable practices such as holding back negative results from publication. In addition, many authors of medication studies have failed to disclose their substantial financial ties to the pharmaceutical industry. Finally, it appears that many of the authors of clinical practice guidelines have had significant financial arrangements with the pharmaceutical industry.
If you could choose any topic, which would it be for your next Dummies book?
We’d really like to answer this question. However, we’re currently discussing the next project or two with the For Dummies publisher (Wiley). We can say that one of these projects excites us more than any of the others we’ve done to date as we see a huge need for an accessible book on this topic.
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