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So, heightened anxiety triggers alternate emotional regulation, with traits like pro-avoidance behavior. To me this is not necessarily dysfunctional. It may al

So, heightened anxiety triggers alternate emotional regulation, with traits like pro-avoidance behavior. To me this is not necessarily dysfunctional. It may also go hand-in-hand with motivating heightened deliberation. I can see how one can fall into regressive patterns like distracting ourselves away from critical path actions, especially if a particular person only uses one of two strategies, 1) try going on as before or 2) try forgetting we need to go this way. I take a more neutral approach on the finding and don’t yet assume this is something that is best medicated out of. They show that even mild emotional challenges can saturate FPl neural range, which to me is simply a greater sensitivity that can be easily overloaded (like when you put the voltmeter on a more sensitive setting). Exposure Therapy is a methodical, deliberate, routine heavy strategy. ET doesn’t simply get us to re-engage, it gets us to re-engage with new and different behavior, which may be essential to success.

psychphysic 3y ago
The paper suggests rTMS to disrupt the disruptive activities. The emotional challenge in this study was that you had a joystick and sometimes you pulled that joystick towards you when you saw an unhappy face. That's what was paralysing emotional challenge was for highly anxious people. Meaning it's unlikely their PFl could have any control in real life scenarios. It's important to note that in both anxious and non-anxious people the PFl was highly excitable. It's the pattern of its activity that makes a difference. Cognition is hard work and the truth is you can't reason about your entire life and expect much success. Like driving a car as a learner your whole life, I remember the first driving lesson I had, I couldn't even focus with the radio on. Imagine if every time you got in you had less intuition about how to drive. Think of the absence of fpi as a lack of intuition you get once you learn to drive. CBT +/- an SSRI for 6months is a small price to pay to regain intuition.
- riazrizvi 3y ago
  I think we might each be talking to different ends of the extreme here. > recruitment of FPl when controlling emotional behavior fails in patients with emotional disorders I won’t comment on people who have emotional disorders, or who have operated in this modality for very long periods of time. I’m more interested in it as a transient mechanism in people without disorders.
  - psychphysic 3y ago
    Ah I'm not sure you can extend this study to high anxiety circumstances in otherwise non-anxious people. The executive functions that highly anxious people need to engage are precisely the functions that high stress levels disrupt. This is about low stress situations in anxious people. Not high stress situations in non-anxious people. It's not likely that we can extrapolate between the two. And it's likely under those scenarios a third or more mechanism comes into play (flight, fight, freeze). Not to mention the control were all men so we do need better sample for replication before we consider extrapolation.
    - riazrizvi 3y ago
      It’s hard to say where the boundary of application lies, I believe. The paper is naturally concise, and experiments typically select potent examples to clarify the phenomena, economically. Without the authors’ clarifying contextual anecdotes, I believe there is a lot of room to interpret.
- deleted 3y ago
  [deleted]
- Aeglaecia 3y ago
  [flagged]
  - psychphysic 3y ago
    Eh? I don't understand what you're saying.
    - Aeglaecia 3y ago
      journey not the destination
    - deleted 3y ago
      [deleted]
  - kdmccormick 3y ago
    > institutionalized gaslighting Quite an accusation. Have you done CBT?
    - Aeolun 3y ago
      I can sort of see how you get there? “I know you are afraid of walking through a crowd of people, but think of how many people do that every day. Think of all those times when you were 15 when you did it without any problem.” E.g. your problem isn’t real, it’s all in your mind. Which of course it is, that’s kind of the point :)
      - 121789 3y ago
        No not really. Gaslighting has an intent to deceive someone to pull them away from reality. CBT starts with the assumption by both people that the patient is away from reality and gives them tools to bring them closer. Gaslighting is like trying to convince a healthy person they’re fat (and giving them an eating disorder in the process) while CBT is like giving a fat person practices to manage appetite.
        3y ago
- fellowmartian 3y ago
  One potential problem with this approach is that a person might not actually fear driving a car but dying in general, and this fear spills over into all parts of life. I don’t think you can CBT your way out of it.
  - psychphysic 3y ago
    I think that's just the type of problem CBT practitioners love to work on.
    - fellowmartian 3y ago
      I think it’s a “if all you have is a hammer” situation. In my experience and from talking to different therapists CBT is ill-equipped to deal with existential problems because it doesn’t embrace them or helps patients learn from them. Existential therapy or other forms of psychoanalysis is better suited, in my opinion.
      - kenjackson 3y ago
        I agree with your take on CBT and existential problems (although CBT is incredible for many other types of issues). Do you have more details on therapies that are useful for existential types of problems?
- xtiansimon 3y ago
  > “Like driving a car as a learner your whole life, I remember the first driving lesson I had, I couldn't even focus with the radio on.” This reminded me of starting to ride a motorcycle (again) in 2021. Lots of anxiety and stress. Two years later I’m not as stressed. But, each near-accident I’ve had was following not paying attention. Thinking about this on a ride over the weekend, I mused about solo-jet fighter pilots and Olympians. I recalled breathing exercises are supposed to help. Reading the abstract, I’m reminded of awkward social situations and inexperience in primary school. I’m thinking the biggest lesson was trying, and realizing failure is not life threatening. But it didn’t stop me from developing some bad habits for cheating on tests, and waiting until the last 48 hours to write my papers. I think getting a job at 16 helped a lot. It was at a comic book shop. I held that job for seven years.
  - elwell 3y ago
    > realizing failure is not life threatening That doesn't hold true when it comes to riding a motorcycle though. Maybe the fear is warranted.
    - xtiansimon 3y ago
      Life is complex. It’s not a platitude to say PPE #1 is your mind. Are you fit to ride? And not in a relative-manner (“I’m the least drunk here!”), but in your own objective sense. If you’re not, then don’t start. If you started, then you should stop—sort of thing.
    - OkayPhysicist 3y ago
      "Fear is the mind killer". Focus spent worrying about the potential consequences of failure is focus not spent on avoiding failure altogether.
      - huimang 3y ago
        Failure in this case ranges from life-altering disabilities or death outright. The emotional toll on your friends and family. The waste of medical resources on you. Yeah, people should have a healthy amount of fear for needlessly dangerous things.
Aurornis 3y ago
> To me this is not necessarily dysfunctional. If it wasn’t dysfunctional, it wouldn’t be a diagnosed with mental health condition to begin with. I think this is a concept that is getting lost in mainstream mental health discourse: There is a big difference between anxiety the emotion and anxiety the mental health disorder. Similar story for depression and concentration struggles. It’s normal to feel anxious at times. It’s not healthy when anxiety becomes so dominant as to interfere with normal activities of life, manifesting as the type of pervasive avoidance behavior described in this study. This is becoming a huge problem among the young people I’ve mentored recently; They will go through phases where they become convinced, often by TikTok or Reddit, that they have ADHD, anxiety, and/or depression because they aren’t perfect robots who do marathon study sessions with a smile every day. I feel like I’m always explaining to them that it’s normal and healthy to feel some discomfort as they learn and grow. It’s not reasonable to expect everything in life to come easy. Of course, there are students who struggle with mental health issues as well, but the difference between someone struggling with lifelong ADHD and someone who just learned about ADHD through a serious of TikToks a few weeks ago and now thinks they have it is obvious when you’ve been working with them both for a long time. > I take a more neutral approach on the finding and don’t yet assume this is something that is best medicated out of. The study doesn’t say that this is “best medicated out of”. It specifically highlights exposure therapy as being effective in normalizing this in individuals who respond to it: > and exposure therapy has been shown to restore frontopolar function in those PTSD patients that benefit from treatment. I think this is another issue permeating pop culture discussion of mental health issues: The assumption that strong medications are the default response. Every medical professional I know prefers lifestyle interventions and therapy modalities to prescribing medications, but patients often arrive convinced that they need medication. If the provider recommends therapy or lifestyle interventions they often get angry that at the perception that the provider is being dismissive or not taking their problem seriously.
- BoxFour 3y ago
  > The assumption that strong medications are the default response. Every medical professional I know prefers lifestyle interventions and therapy modalities to prescribing medications Moreover, these two aspects nearly always coincide: Every credible institution will require you to engage in therapy in tandem with commencing medication. Often, once your condition improves, the discourse shifts towards the possibility of gradually decreasing your medication (though this is obviously a conversation, not a mandate).
isykt 3y ago
> I take a more neutral approach on the finding and don’t yet assume this is something that is best medicated out of. Is it possible for an individual to do ET, or indeed other therapy in combination with medication, to study the change in this response? I tend to agree that we (collectively) should not look at these results and immediately look for a drug to change it; after all, that’s how we arrive at a popular culture that thinks depression is a chemical imbalance (it’s not), so it would be nice to be able to use these findings in conjunction with therapies that focus on a person’s ability to change their own mind.
Aerbil313 3y ago
I can't see the point of those studies. They simply state the obvious. Ever had a person in your life who is chronically stressed? You'd know this.

psychphysic 3y ago

The paper suggests rTMS to disrupt the disruptive activities. The emotional challenge in this study was that you had a joystick and sometimes you pulled that joystick towards you when you saw an unhappy face. That's what was paralysing emotional challenge was for highly anxious people. Meaning it's unlikely their PFl could have any control in real life scenarios. It's important to note that in both anxious and non-anxious people the PFl was highly excitable. It's the pattern of its activity that makes a difference. Cognition is hard work and the truth is you can't reason about your entire life and expect much success. Like driving a car as a learner your whole life, I remember the first driving lesson I had, I couldn't even focus with the radio on. Imagine if every time you got in you had less intuition about how to drive. Think of the absence of fpi as a lack of intuition you get once you learn to drive. CBT +/- an SSRI for 6months is a small price to pay to regain intuition.

riazrizvi 3y ago
I think we might each be talking to different ends of the extreme here. > recruitment of FPl when controlling emotional behavior fails in patients with emotional disorders I won’t comment on people who have emotional disorders, or who have operated in this modality for very long periods of time. I’m more interested in it as a transient mechanism in people without disorders.
- psychphysic 3y ago
  Ah I'm not sure you can extend this study to high anxiety circumstances in otherwise non-anxious people. The executive functions that highly anxious people need to engage are precisely the functions that high stress levels disrupt. This is about low stress situations in anxious people. Not high stress situations in non-anxious people. It's not likely that we can extrapolate between the two. And it's likely under those scenarios a third or more mechanism comes into play (flight, fight, freeze). Not to mention the control were all men so we do need better sample for replication before we consider extrapolation.
  - riazrizvi 3y ago
    It’s hard to say where the boundary of application lies, I believe. The paper is naturally concise, and experiments typically select potent examples to clarify the phenomena, economically. Without the authors’ clarifying contextual anecdotes, I believe there is a lot of room to interpret.
deleted 3y ago
[deleted]
Aeglaecia 3y ago
[flagged]
- psychphysic 3y ago
  Eh? I don't understand what you're saying.
  - Aeglaecia 3y ago
    journey not the destination
  - deleted 3y ago
    [deleted]
- kdmccormick 3y ago
  > institutionalized gaslighting Quite an accusation. Have you done CBT?
  - Aeolun 3y ago
    I can sort of see how you get there? “I know you are afraid of walking through a crowd of people, but think of how many people do that every day. Think of all those times when you were 15 when you did it without any problem.” E.g. your problem isn’t real, it’s all in your mind. Which of course it is, that’s kind of the point :)
    - 121789 3y ago
      No not really. Gaslighting has an intent to deceive someone to pull them away from reality. CBT starts with the assumption by both people that the patient is away from reality and gives them tools to bring them closer. Gaslighting is like trying to convince a healthy person they’re fat (and giving them an eating disorder in the process) while CBT is like giving a fat person practices to manage appetite.
      - 3y ago
fellowmartian 3y ago
One potential problem with this approach is that a person might not actually fear driving a car but dying in general, and this fear spills over into all parts of life. I don’t think you can CBT your way out of it.
- psychphysic 3y ago
  I think that's just the type of problem CBT practitioners love to work on.
  - fellowmartian 3y ago
    I think it’s a “if all you have is a hammer” situation. In my experience and from talking to different therapists CBT is ill-equipped to deal with existential problems because it doesn’t embrace them or helps patients learn from them. Existential therapy or other forms of psychoanalysis is better suited, in my opinion.
    - kenjackson 3y ago
      I agree with your take on CBT and existential problems (although CBT is incredible for many other types of issues). Do you have more details on therapies that are useful for existential types of problems?
xtiansimon 3y ago
> “Like driving a car as a learner your whole life, I remember the first driving lesson I had, I couldn't even focus with the radio on.” This reminded me of starting to ride a motorcycle (again) in 2021. Lots of anxiety and stress. Two years later I’m not as stressed. But, each near-accident I’ve had was following not paying attention. Thinking about this on a ride over the weekend, I mused about solo-jet fighter pilots and Olympians. I recalled breathing exercises are supposed to help. Reading the abstract, I’m reminded of awkward social situations and inexperience in primary school. I’m thinking the biggest lesson was trying, and realizing failure is not life threatening. But it didn’t stop me from developing some bad habits for cheating on tests, and waiting until the last 48 hours to write my papers. I think getting a job at 16 helped a lot. It was at a comic book shop. I held that job for seven years.
- elwell 3y ago
  > realizing failure is not life threatening That doesn't hold true when it comes to riding a motorcycle though. Maybe the fear is warranted.
  - xtiansimon 3y ago
    Life is complex. It’s not a platitude to say PPE #1 is your mind. Are you fit to ride? And not in a relative-manner (“I’m the least drunk here!”), but in your own objective sense. If you’re not, then don’t start. If you started, then you should stop—sort of thing.
  - OkayPhysicist 3y ago
    "Fear is the mind killer". Focus spent worrying about the potential consequences of failure is focus not spent on avoiding failure altogether.
    - huimang 3y ago
      Failure in this case ranges from life-altering disabilities or death outright. The emotional toll on your friends and family. The waste of medical resources on you. Yeah, people should have a healthy amount of fear for needlessly dangerous things.

Aurornis 3y ago

> To me this is not necessarily dysfunctional. If it wasn’t dysfunctional, it wouldn’t be a diagnosed with mental health condition to begin with. I think this is a concept that is getting lost in mainstream mental health discourse: There is a big difference between anxiety the emotion and anxiety the mental health disorder. Similar story for depression and concentration struggles. It’s normal to feel anxious at times. It’s not healthy when anxiety becomes so dominant as to interfere with normal activities of life, manifesting as the type of pervasive avoidance behavior described in this study. This is becoming a huge problem among the young people I’ve mentored recently; They will go through phases where they become convinced, often by TikTok or Reddit, that they have ADHD, anxiety, and/or depression because they aren’t perfect robots who do marathon study sessions with a smile every day. I feel like I’m always explaining to them that it’s normal and healthy to feel some discomfort as they learn and grow. It’s not reasonable to expect everything in life to come easy. Of course, there are students who struggle with mental health issues as well, but the difference between someone struggling with lifelong ADHD and someone who just learned about ADHD through a serious of TikToks a few weeks ago and now thinks they have it is obvious when you’ve been working with them both for a long time. > I take a more neutral approach on the finding and don’t yet assume this is something that is best medicated out of. The study doesn’t say that this is “best medicated out of”. It specifically highlights exposure therapy as being effective in normalizing this in individuals who respond to it: > and exposure therapy has been shown to restore frontopolar function in those PTSD patients that benefit from treatment. I think this is another issue permeating pop culture discussion of mental health issues: The assumption that strong medications are the default response. Every medical professional I know prefers lifestyle interventions and therapy modalities to prescribing medications, but patients often arrive convinced that they need medication. If the provider recommends therapy or lifestyle interventions they often get angry that at the perception that the provider is being dismissive or not taking their problem seriously.

BoxFour 3y ago
> The assumption that strong medications are the default response. Every medical professional I know prefers lifestyle interventions and therapy modalities to prescribing medications Moreover, these two aspects nearly always coincide: Every credible institution will require you to engage in therapy in tandem with commencing medication. Often, once your condition improves, the discourse shifts towards the possibility of gradually decreasing your medication (though this is obviously a conversation, not a mandate).

isykt 3y ago

> I take a more neutral approach on the finding and don’t yet assume this is something that is best medicated out of. Is it possible for an individual to do ET, or indeed other therapy in combination with medication, to study the change in this response? I tend to agree that we (collectively) should not look at these results and immediately look for a drug to change it; after all, that’s how we arrive at a popular culture that thinks depression is a chemical imbalance (it’s not), so it would be nice to be able to use these findings in conjunction with therapies that focus on a person’s ability to change their own mind.

Aerbil313 3y ago

I can't see the point of those studies. They simply state the obvious. Ever had a person in your life who is chronically stressed? You'd know this.