Insomnia and Heart Failure Risk: Something to Lose Sleep Over?

Insomnia and Heart Failure Risk: Something to Lose Sleep Over?

By: Shelley Wood

Clinical Context

Insomnia can lead to activation of the neuroendocrine system, which in turn may promote a higher risk for cardiovascular disease. The authors of the current study previously used the same study cohort to evaluate the risk for acute myocardial infarction (AMI) associated with insomnia. Their results, which were published in the November 8, 2011, issue of Circulation, demonstrated that mild, intermittent sleep problems were not associated with a higher risk for AMI. However, insomnia almost every night and nonrestorative sleep experienced more than once per week were associated with increases in the risk for AMI of more than 40%.

The current study by Laugsand and colleagues examines whether insomnia can affect the risk for incident heart failure.

Study Synopsis and Perspective

Insomnia symptoms in middle age are strongly associated with the subsequent development of heart failure, a large Norwegian cohort study has found[1]. The analysis, which considered over 54 000 men and women, linked insomnia symptoms and heart failure, even in subjects who had never experienced a coronary event.

While the study does not demonstrate causation, researchers led by Dr Lars E Laugsand (Norwegian University of Science and Technology, Trondheim) say their findings have important implications for patient management and, potentially, reducing progression to heart failure.

“If subsequent studies confirm our findings and if causality is better established, the observed prospective association between insomnia and HF [heart failure] risk could have implications for cardiovascular prevention, since insomnia is an easily recognizable and potentially manageable condition,” the authors write.

Speaking with heartwire , Laugsand stressed that the findings do not have immediate implications for physicians, beyond the fact that sleep is important to good health generally.

“I think cardiologists should talk to their patients about sleep problems, but I think it’s a little too early to say that anything should be implemented in the CV [cardiovascular] risk assessment,” he said. “More research is clearly needed to evaluate the possible underlying mechanisms.”

For example, he continued, the chronic activation of stress responses seen in insomnia could be expected to have an impact on the heart. “Patients who are stressed both at night and during the day have increased BP [blood pressure], increased release of stress hormones, increased heart rate, etc, and all of these factors are related to HF, so that’s a potential link between the neuroendocrine system and the sympathetic nervous system. We cannot say this is the case from our study,” but it’s a plausible link, he said.

Community-Based Analysis

Laugsand et al reviewed baseline data relating to insomnia symptoms from the Nord-Trøndelag Health Study on the 54 279 patients enrolled between 1995 and 1997, none of whom had HF at the study outset. By 2008, 1412 patients had developed heart failure.

In a range of analyses that took into account different factors, such as age, cardiovascular disease risk factors, or psychological factors, insomnia symptoms remained strongly correlated with new-onset heart failure, with more symptoms linked with higher risk. For example, subjects who reported having “difficulty initiating sleep” on “almost every night” had a 27% to 66% risk of developing heart failure (depending on the model used), compared with subjects with no insomnia symptoms. By contrast, patients who reported “difficulty initiating sleep” on a frequent basis, in addition to “difficulty maintaining sleep” and feeling that their sleep was “nonrestorative,” had a risk of heart failure that ranged from two to five times higher than in subjects with no insomnia symptoms.

Women were at an increased risk of having heart failure in relation to certain insomnia risk factors and for cumulative measures of insomnia, compared with men, but Laugsand was reluctant to make much of this observation. “You cannot say from these numbers that insomnia is more dangerous for women than men when it comes to having heart failure,” he said. They have a higher relative risk, but that might be due to their lower baseline risk of HF.”

The next step, said Laugsand, would be a trial treating patients for insomnia to see whether such a strategy could mitigate the development of heart failure.

“That would be the ultimate goal, to do a randomized controlled trial. This study is an observational study and saying anything too firm about causality is difficult,” he cautioned. “But from the studies done in insomnia and other sleep problems, we know that sleep problems affect the physiology of the heart.”

References

1. Laugsand LE, Strand LB, Platou, et al. Insomnia and the risk of incident heart failure: A population study. Eur Heart J 2013; DOI: 10.1093/eurheartj/eht019. Available at: http://eurheartj.oxfordjournals.org.

Study Highlights

• Study data were derived from the Nord-Trøndelag cohort, which reflects the general population of Norway. Study recruitment began in 1995. The current study focused on individuals between 20 and 89 years old without a history of heart failure.
• Participants completed a thorough examination at the outset of the study, including questions regarding insomnia and the use of hypnotic medications. The insomnia history focused on difficulty falling asleep (early insomnia), waking during sleep (middle insomnia), and nonrestorative sleep. A laboratory assessment was also part of the initial examination.
• The main study outcome was incident heart failure, which was identified from hospital diagnoses and national death registers.
• The study analyzed the risk for heart failure associated with insomnia, and researchers adjusted their analyses to account for demographic data and traditional cardiovascular risk factors. Researchers also performed an analysis that accounted for patients’ other chronic diseases.
• 54,279 participants provided study data. The rates of severe insomnia in the study cohort varied between 2.5% and 8.1%, depending on which domain of insomnia was being queried.
• Older adults and women were more likely to have insomnia. Insomnia was closely related to depression, anxiety, and the presence of cardiovascular risk factors.
• During a mean evaluation period of 11.3 years, there were 1412 incident cases of heart failure. 408 of these cases were reported from the death registry.
• In fully adjusted analyses, including psychiatric diagnoses, the presence of early insomnia, middle insomnia, or nonrestorative sleep individually did not significantly increase the risk for heart failure, even when these symptoms were severe.
• However, there was a dose-dependent positive effect on the risk for heart failure with a greater number of insomnia symptoms. The presence of 1 insomnia symptom was associated with a hazard ratio (HR) for heart failure of 0.96 (95% [confidence interval] CI, 0.57 – 1.61). Having 2 or 3 of these symptoms was associated with respective HRs of 1.35 (95% CI, 0.72 – 2.50) and 4.53 (95% CI, 1.99 – 10.31).
• The presence of nonrestorative sleep was associated with a higher risk for incident heart failure among women vs men.
• Exclusion of cases of heart failure diagnosed early during follow-up failed to significantly alter the main study outcome.

Clinical Implications

• A previous study of the current cohort of adults found that severe, but not mild, insomnia was independently associated with a higher risk for AMI.
• In the current study by Laugsand and colleagues, only the presence of multiple insomnia symptoms was significantly associated with a higher risk for incident heart failure.

Retrieved from: http://www.medscape.org/viewarticle/781692

what they eyes say about adhd…

Eye May Be Key to More Accurate ADHD Diagnosis

Megan Brooks

SAN FRANCISCO — Examining the retina may aid in the diagnosis of attention-deficit/hyperactivity disorder (ADHD), new research suggests.

A small study by investigators at Albert-Ludwigs University of Freiburg, Germany, showed that patients with ADHD displayed significantly elevated “background noise” on a pattern electroretinogram (PERG) compared with their healthy peers.

Altered visual signal processing may be a “neuronal correlate for ADHD,” study presenter Emanuel Bubl, MD, told Medscape Medical News. “If we can replicate this finding, it would be of great clinical importance because it would be an objective marker of ADHD.”

Dr. Bubl presented the study here at the American Psychiatric Association’s 2013 Annual Meeting.

PERG — which is a kin to an electrocardiogram of the retina — provides an electrophysiologic measurement of the activity of the retinal ganglion cells.

“This technique is an easy-to-apply and already well-established instrument in ophthalmology. With adaption, it could be widely used,” Dr. Bubl said.

Inattention and distractability are core symptoms of ADHD, but a “clearcut neuronal correlate is missing. Any attempt to find objective markers of ADHD would be very helpful in this context,” Dr. Bubl said.

Dr. Bubl and colleagues used PERG to measure the response of the retina to a checkerboard visual stimuli in 20 patients with ADHD and 20 healthy control participants.

“An elevated neuronal noise or background firing has been proposed as an underlining pathophysiological mechanism and treatment target. We found evidence for an early alteration in visual perception or signal transmission in patients with ADHD, with significantly elevated neuronal noise (P < .014),” said Dr. Bubl. In particular, neuronal noise significantly correlated with inattention, as measured with the Conners’ Adult ADHD Rating Scale.

“The results might explain why patients with ADHD are easily distracted,” Dr. Bubl added.

With more study, the results could have potentially important clinical implications. “With ADHD, there is a debate about the existence of the disease on the one hand and a growing concern about overdiagnosing ADHD and prescription of medication on the other,” he said.

With PERG, the diagnosis of ADHD could be “objectified by measurable signals, and this would be dramatically helpful in the controversial public discussion.” Use of PERG might also help in determining the effects of methylphenidate or psychotherapy on ADHD.

The authors report no relevant financial relationships.

The American Psychiatric Association’s 2013 Annual Meeting. Abstract SCR02-2. Presented May 18, 2013.

Retrieved from: http://www.medscape.com/viewarticle/804409?src=nl_topic&uac=184795PG

and more dsm-v controversy…

DSM-V: Past Imperfect

By: Nassir Ghaemi, MD, MPH

 Thoughts on a New DSM

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is here. We might as well pretend that Ronald Reagan is still president. Radical changes were made, with limited scientific evidence, when DSM-III was published in 1980 (the year Reagan was elected); even the tiniest changes, with great scientific evidence, are now the subject of outrage.

For me, DSM-5 is a disappointment. I take no pleasure in making this judgment. I wish I could say that DSM revisions are increasingly scientific and getting us closer to truths. But this simply hasn’t happened.

DSM-5 is a disappointment for me not because it is much different from DSM-IV, but because it is so similar. Almost 2 decades after the fourth revision in 1994, despite thousands of research studies on psychiatric conditions, our profession hardly can bring itself to change anything of importance. The radical bipolar/major depressive disorder (MDD) dichotomy is unchanged and untouchable — the third rail of US psychiatry — despite numerous studies casting doubt on the validity of the MDD definition and providing support for broader definitions of bipolar disorder.

The personality disorder concept was nothing but the description of psychoanalytic speculations in 1980. It has remained basically unchanged, despite little research evidence of validity. Personality traits, one of the most well-proven facts in psychology, were recommended by the DSM-5 task force but vetoed by the American Psychiatric Association Board of Trustees. Science was rejected; psychoanalytic tradition was not.

Clinicians may have assumed that we have scientific validity for most of the approximately 400 diagnoses in DSM-5; we have hardly any validity data for the vast majority of those diagnoses, and we have notable validity evidence for numerous concepts that are excluded.

The claim in the Reagan presidency was that DSM would provide reliability; we could agree on definitions. Then, we would do more research so that definitions would evolve toward better validity. Reliability would lead to validity.

When Bill Clinton was president and DSM-IV was published in 1994, a change happened: DSM became an end in itself. The DSM-IV leadership explicitly stated that unless a very high bar of scientific evidence was reached, no changes were allowed. The bar kept being moved higher and higher for science, and lower and lower for politics. The DSM-IV leadership called it “pragmatism”: DSM changes were made on the basis of what that leadership thought was best for patients, they said, and for the profession.

Reliability had become an end in itself; validity no longer mattered because, in a species of extreme social constructionism, the DSM-IV leadership saw the nosology as a way to influence practice, not as a way to discover causes of and treatments for mental illnesses. (They didn’t bother with the question of how you could practice well if you didn’t find out the causes and treatments of illnesses.)

There were hopes that DSM-5 would be different, with scientifically based changes. But a major backlash came: The DSM-IV leadership opposed changes on “pragmatic” grounds, and many in the larger public criticized DSM on social constructionist grounds, as just a means for psychiatrists to make money and influence people. Major changes became minor, and even the minor ones were often dropped to an appendix for further research, which is likely to be ignored.

After 2 decades of being a loyal follower of DSM, the debates of recent years led me to make a sad but definite conclusion: DSM has caused stagnation in psychiatry. If DSM categories are devised primarily because professional leaders want to achieve some clinical or even economic goals, there is no reason why nature should play along. By being “pragmatic” and not scientific, DSM has doomed biological and pharmacologic research in psychiatry to failure for 2 generations.

Now I see a generational change. The leaders of the DSM-III, -IV, and -5 workgroups are often literally the same people, representatives of the 1970’s/1980’s generation in psychiatry. Some of us in later generations do not venerate DSM as the bible of psychiatry, as it’s often called; we instead question it as theology instead of science. Recently, the leadership of the National Institute of Mental Health (NIMH) reached the same conclusion and stated it forcefully: DSM criteria are not scientifically valid, and patients deserve better.

DSM-5 is out, and clinicians will use it, but unfortunately it represents a failed past. Those of us who grew up in that past, and have seen how it has led us to stand still, are inclined to agree with the NIMH that our future deserves to be different.

Retrieved from: http://www.medscape.com/viewarticle/804102?src=nl_topic&uac=184795PG

Use DSM-5 ‘Cautiously, If at All,’ DSM-IV Chair Advises

By: Pam Harrison

On the eve of the official launch of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Allen Frances, MD, chair of the DSM-IV Task Force and one of the new manual’s staunchest critics, is advising physicians to use the DSM-5 “cautiously, if at all.”

“Psychiatric diagnosis is facing a renewed crisis of confidence caused by diagnostic inflation,” Dr. Frances, Duke University, Durham, North Carolina, writes in a new commentary published online May 17 in the Annals of Internal Medicine.

Unlike the DSM-IV, which held the line against diagnostic inflation, he states, “The DSM-5, the recently published fifth edition of the diagnostic manual, ignored this risk and introduced several high-prevalence diagnoses at the fuzzy boundary with normality.”

For example, the DSM-5 opens the door for patients worried about having a medical illness to be diagnosed with somatic symptom disorder.

Normal grief may be misdiagnosed as major depressive disorder, and the forgetfulness of old age may now be interpreted as mild neurocognitive disorder.

“The already overused diagnosis of attention-deficit disorder will be even easier to apply to adults thanks to criteria that have been loosened further,” Dr. Frances adds.

Other changes in the DSM-5 will allow clinicians to label a child with temper tantrums as having disruptive mood dysregulation disorder, and overeating can now be called binge eating disorder.

Real Danger

The real danger in diagnostic inflation is overdiagnosis and overtreatment of patients who are essentially well, he says.

“Drug companies take marketing advantage of the loose DSM definitions by promoting the misleading idea that everyday life problems are actually undiagnosed psychiatric illness caused by a chemical imbalance and requiring a solution in pill form,” Dr. Frances writes.

“New psychiatric diagnoses are now potentially more dangerous than new psychiatric drugs.”

Quite apart from the risk for overtreatment, however, is the risk of neglecting patients with clear psychiatric illness whose access to care has been sharply reduced by slashed state mental health budgets.

As Dr. Frances points out, only one third of persons with severe depression receive mental health care, and a large percentage of the swollen prison population in the United States is made up of true psychiatric patients who have no other place to go.

More damning, however, is the flawed process by which committee members of the DSM-5 arrived at their expanded diagnoses, in Dr. Frances’ view.

As he states, the DSM-5 did not address professional, public, and press charges that its changes lacked sufficient scientific support and defied clinical common sense.

Field trials produced reliability results that did not meet historical standards, and deadlines were consistently missed, he adds.

The American Psychiatric Association also refused a petition from an independent scientific review of the DSM-5 that was endorsed by more than 50 mental health associations.

Dr. Frances said he personally found the DSM-5 process “secretive, closed, and disorganized.”

“I believe that the American Psychiatric Association (APA)’s financial conflict of interest, generated by DSM publishing profits needed to fill its budget deficit, led to premature publication of an incompletely tested and poorly edited product,” Dr. Frances states.

“The problems associated with the DSM-5 prove that the APA should no longer hold a monopoly on psychiatric diagnosis…. The codes needed for reimbursement are available for free on the Internet.”

The APA declined to comment.

Ann Intern Med. Published online May 17, 2013. Full article

DSM-5: Past Imperfect. Medscape. May 18, 2013.

Retrieved from: http://www.medscape.com/viewarticle/804378DSM-5 Officially Launched, but Controversy Persists

By: Caroline Cassels

SAN FRANCISCO — After more than a decade of development and more than 2 years of frequently searing controversy, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has finally been released.

Here at the American Psychiatric Association’s (APA’s) 2013 Annual Meeting, the APA leadership officially launched the manual, which is widely known by clinicians and patients alike as the “Bible of Psychiatry.”

“This is really an important day. I have been involved with the DSM-5 almost from the beginning, and I have seen the work unfold over the past decade. There have been literally hundreds of people, experts from all over the world, from different disciplines, who have contributed [to the DSM-5],” outgoing APA president Dilip Jeste, MD, told reporters attending a press briefing here.

“What we are seeing is a clinical manual based on the best science available…for today’s patients, this is the best manual that we could develop,” Dr. Jeste added.

Key changes in the new edition include a new chapter organization that shows how mental disorders may relate to one another on the basis of underlying vulnerabilities or symptom characteristics.

In addition, in DSM-5, disorders are organized in the context of age — that is, along a developmental lifespan within each chapter — as well as sex and cultural expectations.

What’s New

According to DSM-5 Task Force chair David Kupfer, MD, although the number of disorders are “about the same” as in the last edition of DSM, several new disorders have been added, including binge eating disorder, disruptive mood dysregulation disorder, and hoarding disorder.

A new section for the manual, Section III, describes several conditions that warrant more research before they can be considered as formal disorders in the main part of the manual.

The changes to the manual are designed to help clinicians more precisely identify mental disorders and improve diagnosis while maintaining the continuity of care.

“We expect these changes to help clinicians better serve patients and to deepen our understanding of these disorders based on new research.”

However, not everyone is as enthusiastic about the manual’s release. Allen Frances, MD, who chaired the DSM-IV Task Force and is among the DSM-5’s staunchest critics, told Medscape Medical News that he is filled with “sadness and worry — and I am not a person usually given to either emotion.”

He added that he is very concerned that the “DSM 5 will result in the mislabeling of potentially millions of people who are basically normal. This would turn our current diagnostic inflation into hyperinflation and exacerbate the excessive use of medication in the ‘worried well.’ ”

“DSM-5 turns grief into Major Depressive Disorder; temper tantrums into Disruptive Mood Dysregulation; the expectable forgetting of old age into Mild Neurocognitive Disorder; worrying about illness into Somatic Symptom Disorder; gluttony into Binge Eating Disorder; and anyone who wants a stimulant for recreation or performance enhancement can claim Attention Deficit Disorder,” he said.

“Don’t Buy It, Don’t Use It”

However, incoming APA president Jeffrey Lieberman, MD, told reporters that the idea that the revisions to the manual will lead to overtreatment is “inaccurate and unwarranted.”

“The DSM is a diagnostic guide that reflects what we currently know about how best to define disorders. How it is applied is something that reflects clinical practice,” he said.

The manual’s diagnostic criteria, he added, are based on the current state of the scientific evidence to “verify the existence of a certain condition that we know to be impairing and distressing and enduring for people,” Dr. Lieberman added.

Dr. Frances also expressed concern that the new manual will divert scarce mental health care resources away from those who need it most.

“While we are overtreating people with everyday problems who don’t need it, we are shamefully neglecting the people with moderate to severe psychiatric problems who desperately do.”

His advice to frontline clinicians regarding the DSM-5? “Don’t buy it, don’t use it, don’t teach it. There is nothing at all official about DSM-5, and the codes for reimbursement are available for free on the Internet or in DSM-IV. APA is price-gouging a badly flawed document, no one need feel captive to it.”

NIMH Blog Not an Indictment of DSM-5?

Dr. Frances is not alone in his criticism of the manual. An April 29 blog post by Thomas Insel, MD, director of the National Institute of Mental Health (NIMH), and published on the NIMH Web site stated that although the upcoming manual is reliable, it lacks validity.

As reported by Medscape Medical News at that time, Dr. Insel pointed out that unlike diagnostic criteria for other diseases, the DSM-5 criteria are based on consensus rather than objective laboratory measures, and he noted that the NIMH will be “re-orienting its research away from DSM-5 categories.”

Toward that end, Dr. Insel went on to announce the launch of the NIMH Research Domain Criteria (RDoC) in a first step toward “precision medicine.”

Following Dr. Insel’s blog post, on May 14, the APA and the NIMH issued a joint statement in which the organizations emphasized the need to work together for the good of patients.

Nevertheless, the statement underscored the fact that the NIMH’s position on the DSM-5 had not changed and that “the diagnostic categories represented in the DSM-IV and the International Classification of Diseases-10 (ICD-10, containing virtually identical disorder codes) remain the contemporary consensus standard for how mental disorders are diagnosed and treated.”

However, Dr. Lieberman, who has since collaborated with Dr. Insel, said that the blog post should not be viewed as an indictment of the DSM-5 but rather as an expression of frustration that psychiatry does not yet have the biologically based diagnostic tools as other areas of medicine.

“Even though his blog was interpreted this way, we don’t think Tom intended to impugn the DSM so much as to say that he wanted to exhort the biomedical research community to try and break new ground that will lead to more dynamic and fundamental changes in psychiatric diagnosis,” said Dr. Lieberman.

The DSM-5 is available immediately in print, and an electronic version will be available later this year.

The American Psychiatric Association’s 2013 Annual Meeting. Opening press conference. May 18, 2013.

Retrieved from: http://www.medscape.com/viewarticle/804410

superman is a fictional character…apparently, so is true pedagogy.

 

Time to Stop Waiting for Superman

Jason Stanford

At some point, we need to stop believing in miracles, at least in education. While we’re still getting over the RICO indictments handed down in the Atlanta cheating scandal, here comes the revelation that the success Michelle Rhee achieved as the “no excuses” superintendent of Washington, D.C.’s public schools was the product of massive cheating.Those asking why Rhee isn’t under indictment just like her former colleague in Atlanta are missing the bigger question: If she’s an example of its success, is the theory behind market-driven education reform valid?

Rhee attracted a lot of attention before getting the top spot in DC. When Mayor Adrian Fenty appointed her superintendent, she went from managing an education nonprofit with 120 employees to running a school system with 55,000 students, 11,500 employees and a budget of $200 million. She’d never even been a principal before, and her only classroom experience was Teach for America.

She did not seem daunted by the stage. She bragged that she only answered to the mayor and put principals on notice to get those test scores up. Rhee fired more than 1,000 teachers and 36 principals who failed to raise test scores and gave $276,265 in bonuses to employees who performed well.

Passing rates rose, and she became the “it girl” for education reform. TIME and Newsweekput her on the cover. Oprah put her on the couch and called her “a warrior woman.” In a 2008 debate, Barack Obama called Rhee “a wonderful new superintendent”, promptingspeculation that she was being considered for Education Secretary, and when Fenty lost reelection, Sec. Arne Duncan intervened in an attempt to keep her on the job because her reforms “absolutely have to continue.” When Rhee quit instead, he issued a press release so laudatory it almost included pom-poms.

“Michelle Rhee has been a pivotal leader in the school reform movement and we expect she will continue to be a force for change wherever she goes,” said Duncan.

Her star rose even further when she went back on Oprah to announce she was creating an education reform project called Students First to spread her reforms to other communities. “I am going to start a revolution. I’m going to start a movement in this country on behalf of the nation’s children,” Rhee told Oprah. Rhee neglected to disclose that her fundersincluded foundations supporting charter school expansion and “parent-trigger” laws.

Meanwhile, the Democratic establishment got over her shabby treatment of teachers. When the documentary Waiting for Superman featured Rhee in a starring role, Los Angeles Mayor Antonio Villaraigosa spoke before a screening at the 2012 Democratic convention, and Newark Mayor Cory Booker headlined a cocktail reception afterward.

All the while some questioned whether her success was illusory. In 2011, USA Todayidentified abnormally high rates of wrong-to-right erasures that coincided with big jumps in test scores in more than half of all DC schools. The resulting federal Department of Education investigation looked less than diligent when Sec. Duncan appeared on a panelwith Rhee.

According to an internal DCPS memo released late last week, it was worse than suspected with evidence of systemic cheating at “191 teachers representing 70 schools.” A DC school official said another investigation into the matter would be “impractical.”

Cheating is nothing new in high-stakes testing. Between 2008-2012, test-cheating scandals have occurred in 37 states and in the District of Columbia, but the cult of Rhee’s success has driven similar reforms in 25 states according to Students First. If Rhee’s success was fake, is there any evidence that high-stakes testing works?

It’s possible that high-stakes testing is best understood as a massive experiment proving theHeisenberg Uncertainty Principle that describes how observing a process can change the process. When it comes to testing, educators have long known that “You don’t get better pork by weighing your pig every day,” as a Texas superintendent said last year. Testing our kids didn’t make them smarter, but it may have changed them.

A new study from The Broader, Bolder Approach to Education out Thursday (grab the summary here) discredits the fundamental assumption that market-based reforms produce results in education. The study, coauthored by a former program manager for Pearson Education, examined the claims of progress in DC and found that test scores regressed and achievement gaps grew in DC relative to other urban school districts.

Where Rhee claimed success, the report found that National Assessment of Education Progress “scores showed minimal-to-no improvement for low-income and minority students, and some losses. Moreover, higher scores were due in most cases not to actual improvements for any age group, but to an influx of wealthier students.”

There was no DC miracle. Browbeating students and teachers into raising scores on state tests only makes them better at taking state tests, and reforming our schools in hopes of replicating an illusion is a petty crime against humanity.  Even George W. Bush was forced to admit there were no weapons of mass destruction in Iraq, and we’ve long since gotten over the shock that Barry Bonds and Mark McGuire were juiced more than a Florida orange grove. We believe lies at our own peril. It’s time to stop waiting for Superman and focus on the hard work of teaching our children the way we know works.

Retrieved from: http://www.huffingtonpost.com/jason-stanford/time-to-stop-waiting_b_3306637.html

common core…the end-all-be all? i think not…

Two Moms vs. Common Core

How an eight-year-old’s homework assignment led to a political upheaval

By  Maggie Gallagher

Indiana has become the first state to retreat from the Common Core standards, as Governor Mike Pence has just signed a bill suspending their implementation.

A great deal has been written and spoken about Common Core, but it is worth rehearsing the outlines again. Common Core is a set of math and English standards developed largely with Gates Foundation money and pushed by the Obama administration and the National Governors Association. The standards define what every schoolchild should learn each year, from first grade through twelfth, and the package includes teacher evaluations tied to federally funded tests designed to ensure that schools teach to Common Core.

Over 40 states hurriedly adopted Common Core, some before the standards were even written, in response to the Obama administration’s making more than $4 billion in federal grants conditional on their doing so. Only Texas, Alaska, Virginia, and Nebraska declined. (Minnesota adopted the English but not the math standards.)

Here is my prediction: Indiana is the start of something big.

Just a year ago Common Core was untouchable in Indiana, as in most other places. Common Core had been promoted by conservative governor Mitch Daniels, and the state superintendent of public schools, Tony Bennett, was a rising GOP education star.

How did the bipartisan Common Core “consensus” collapse?

It collapsed because some parents saw that Common Core was actually lowering standards in their children’s schools. And because advocates for Common Core could not answer the questions these parents raised.

In Indiana, the story starts with two Indianapolis moms, Heather Crossin and her friend Erin Tuttle.

In September 2011, Heather suddenly noticed a sharp decline in the math homework her eight-year-old daughter was bringing home from Catholic school.

“Instead of many arithmetic problems, the homework would contain only three or four questions, and two of those would be ‘explain your answer,’” Heather told me. “Like, ‘One bridge is 412 feet long and the other bridge is 206 feet long. Which bridge is longer? How do you know?’”

She found she could not help her daughter answer the latter question: The “right” answer involved heavy quotation from Common Core language. A program designed to encourage thought had ended up encouraging rote memorization not of math but of scripts about math.

Heather was noticing on the ground some of the same things that caused Stanford mathematics professor R. James Milgram to withhold his approval from the Common Core math standards.

Professor Milgram was the only math content expert on the Validation Committee reviewing the standards, and he concluded that the Common Core standards are, as he told the Texas state legislature, “in large measure a political document that . . . is written at a very low level and does not adequately reflect our current understanding of why the math programs in the high-achieving countries give dramatically better results.”

The Common Core math standards deemphasize performing procedures (solving many similar problems) in favor of attempting to push a deeper cognitive understanding — e.g., asking questions like “How do you know?”

In fact, according to a scholarly 2011 content analysis published in Education Researcher by Andrew Porter and colleagues, the Common Core math standards bear little resemblance to the national curriculum standards in countries with high-achieving math students: “Top-achieving countries for which we had content standards,” these scholars note, “put a greater emphasis on [the category] ‘perform procedures’ than do the U.S. Common Core standards.”

So why was this new, unvalidated math approach suddenly appearing in Heather’s little corner of the world, and at a Catholic school?

Heather was not alone in questioning the new approach. So many parents at the school complained that the principal convened a meeting. He brought in the saleswoman from the Pearson textbook company to sell the parents. “She told us we were all so very, very lucky, because our children were using one of the very first Common Core–aligned textbooks in the country,” says Heather.

But the parents weren’t buying what the Pearson lady was selling.

“Eventually,” Heather recalled, “our principal just threw his hands up in the air and said, ‘I know parents don’t like this type of math but we have to teach it that way, because the new state assessment tests are going to use these standards.’”

That’s the first time Heather had heard that Indiana had replaced its well-regarded state tests, ISTEP (Indiana Statewide Testing for Educational Progress–Plus) in favor of a brand-new federally funded set of assessments keyed to Common Core. “I thought I was a fairly informed person, and I was shocked that a big shift in control had happened and I hadn’t the slightest idea,” she says.

Erin Tuttle says she noticed the change in the math homework at about the same time as Heather, and she also noticed that her child was bringing home a lot fewer novels and more “Time magazine for kids” — a reflection of the English standards’ emphasis on “informational texts” rather than literature.

These standards are designed not to produce well-educated citizens but to prepare students to enter community colleges and lower-level jobs. All students, not just non-college-material students, are going to be taught to this lower standard.

I want to pause and highlight the significance of Heather and Erin’s testimony. Heather Crossin and Erin Tuttle did not get involved in opposing Common Core because of anything Michelle Malkin or Glenn Beck said to rile them up, but because of what they saw happening in their own children’s Catholic school. When experts or politicians said that Common Core would not lead to a surrender of local control over curriculum, Heather and Erin knew better. (Ironically, the leverage in Indiana was Tony Bennett’s school-choice program, which made state vouchers available to religious schools, but only if they adopted state tests — which were later quietly switched from ISTEP to the untried Common Core assessments.)

A STEALTH CAMPAIGN TO BYPASS PARENTS
At first Heather thought maybe her ignorance of Common Core was her fault. Maybe, with her kids (as she imagined) safely ensconced in good Catholic schools, she hadn’t paid attention.

That’s when she and Erin started contacting people — “and we found out something more shocking: Nobody had any idea,” Heather told me.

A friend of Heather’s who is a former reporter for a state newspaper and now a teacher didn’t know. Nor did her state senator, Scott Schneider, even though he sat on the state senate’s Education Committee. (In Indiana, as in most states, Common Core was adopted by the Board of Education without consulting the legislature.) Nor, evidently, did the state’s education reporters — Heather could find literally no press coverage of the key moment when Indiana’s Board of Education abandoned its fine state standards and well-regarded state tests in favor of Common Core.

“They brought in David Coleman, the architect of the standards, to give a presentation, they asked a few questions, there was no debate, no cost analysis, just a sales job, and everybody rubber-stamped it,” Heather said.

So began an 18-month journey in which these two mothers probably changed education history.

One reason the media ignored the implementation of Common Core is that the Indiana education debate was dominated by Governor Daniels’s high-profile effort to expand school choice. But as my colleague at the American Principles Project (APP) Emmett McGroarty pointed out to me, nationalizing curriculum standards quietly knifes the school-choice movement in the back. As McGroarty puts it, “What difference does it make if you fund different schools if they all teach the same basic curriculum the same basic way?”

Common Core advocates continue to insist that Common Core does not usurp local control of curriculum, but in practice high-stakes tests keyed to the Common Core standards ensure that curriculum will follow.

Emmett McGroarty turns out to have been a very important person in the journey that Heather Crossin and Erin Tuttle made to take down Common Core.

Heather and Erin were helped by many people and groups along the way, including the Pioneer Institute’s Jamie Gass, the Hoover Institution’s Bill Evers, and the Heritage Foundation’s Lindsey Burke. Many Indiana organizations played key roles, beginning with the indispensable leadership of the Indiana Tea Party. Other natural allies Heather and Erin contacted and educated in order to build the movement include the state chapter of Americans for Prosperity, the Indiana Family Institute, and the Indiana Association of Home Educators.

But Heather told me that what McGroarty and his colleague Jane Robbins at the American Principles Project did was unique. “I call him the General of this movement,” Heather says. “He strategizes with people in every state. Day or night, Saturday or Sunday, Emmett’s there if you need him.”

The 2012 white paper, co-sponsored by the American Principles Project and the Pioneer Institute, that urged the American Legislative Exchange Council to oppose Common Core became Heather and Erin’s bible. “That white paper is the most important summary; we gave copies to people and said, ‘Read this. If you can’t read the whole thing, read the executive summary.’ Because it covered all the bases, from the quality of the standards to the illegitimate federal data collection to the federal government’s involvement in promoting Common Core,” Heather told me.

But even more influential than its message development was APP’s willingness to give in-depth, hands-on, intensive help whenever Heather and Erin requested it. “Usually you call up a national organization, and they are really nice, they say they are with you, and they send you some helpful research and say, ‘Good luck with that,’” Heather explained. But APP did much more. “All along the way APP has been the greatest source of support mentally, emotionally, and with research that a grassroots organization could have had.”

A big break came in June 2012, when the local tea-party council asked Heather and Erin to develop a flyer that it could use to spread the word to tea-party meetings all across the state; the two women turned to Emmett and Jane to help draft it. The first time Heather and Erin were asked to appear on a local radio show (something they had never done before), they asked Emmett if he would fly in and do the show with them. APP staff would fly out to attend rallies, do local radio shows with Heather and Erin, help them prepare to meet with editorial boards, and act as sounding boards and strategists each step of the way as the grassroots movement grew.

THE FIRST TIME FAILED
In 2012, it looked as if Heather and Erin had failed: Prodded by Governor Daniels, the Indiana legislature voted down a bill to withdraw from Common Core.

Heather was ready to give up. Without hands-on support, she told me, “For sure, I would have given up. But Emmett told me this was just the beginning.”

So Senator Schneider agreed to introduce the bill again, and Heather and Erin went to work crisscrossing the state that summer for rallies and meetings that drew large crowds. The media reluctantly began to take notice.

And then something magical intervened: an election.

Tony Bennett’s reelection as state superintendent of public schools was supposed to be a slam dunk. His opponent, Glenda Ritz, was a Democrat in a deeply Republican state, and she had no name recognition and almost no money; she ended up being outspent by more than 5 to 1 as Bennett’s war chest swelled to $1.5 million with major gifts from Michael Bloomberg’s PAC, Walmart heiress Alice Walton, and other national players.

But Bennett was also the highest-profile public defender of Common Core, while Ritz was raising concerns about it.

When the dust had settled on election day, Bennett had lost, badly. It was the upset of the year.

When Michael Petrilli, executive vice president of the Thomas B. Fordham Institute (which backs Common Core), found out late on election night that Bennett had been unseated by the unknown, underfunded underdog Glenda Ritz, he wasn’t happy: “Tony Bennett! Sh*t sh*t sh*t sh*t sh*t,” Petrilli told Huffington Post writer Joy Resmovits. “You can quote me on that.”

Well, something had clearly hit the fan.

Bennett’s defeat marked a decisive turning point, making every Indiana politician aware how deep voter discontent over Common Core was.

In Indiana, as elsewhere, Common Core proponents have responded to public criticism by accusing the parents of being stupid and uninformed or possibly lying. Common Core, they say, is not a curriculum; it is not being driven by the federal government; it will not interfere with local control of schools.

A few days before Senator Schneider’s anti–Common Core bill passed, the Indiana Chamber of Commerce (which had spent more than $100,000 in ads opposing the bill) lashed out in frustration at the outsized effect Heather and Erin had had on the legislature: “Two moms from Indianapolis, a handful of their friends and a couple dozen small but vocal Tea Party groups. That’s the entire Indiana movement that is advocating for a halt to the Common Core State Standards,” the Chamber of Commerce fumed.

This is not accurate, given the opposition by many education experts, including Professor Milgram, Professor Sandra Stotsky of the University of Arkansas, Professor Diane Ravitch of New York University, Professor Chris Tienken of Seton Hall, and former assistant education secretary Williamson Evers at Hoover.

But never underestimate the power of a mother, especially one who is defending her own child’s future.

What started in Indiana is not staying in Indiana.

Legislation opposing Common Core has been introduced in at least seven other states, and large crowds are turning out at public panels and rallies in states from Tennessee to Idaho. Last month the Michigan state house voted to withhold implementation funding, despite Republican governor Rick Snyder’s support for Common Core; the Missouri senate this week approved a bill calling for statewide hearings on Common Core.

In April the RNC passed a resolution opposing Common Core as “inappropriate overreach to standardize and control the education of our children.”

On April 20, Representative Blaine Luetkemeyer (R., Mo.) sent a letter — co-signed by 33 other congressmen — to Education Secretary Arne Duncan, asking for a detailed accounting of changes in student-privacy policies associated with the new national database the Obama administration is building as part of its Common Core support. The letter pointed out that the Education Department had already made regulatory changes — without consulting Congress — that appear to circumvent the 1974 law that limits the disclosure to third parties of any data collected on students.

“The Common Core places inappropriate limitations on the influence of states and localities, while burdening them with additional, unfunded expenses,” Representative Luetkemeyer told me via e-mail.

Senator Chuck Grassley of Iowa is taking the lead nationally in shining light on the Obama administration’s key role in promoting Common Core. On April 16, Grassley was joined by seven other GOP senators (including major presidential contenders Ted Cruz and Rand Paul), who signed a letter calling on their colleagues to stop funding the implementation of Common Core, which, they point out, appears to violate federal laws that explicitly forbid the Education Department to influence curriculum or assemble a national database. “I voted against the Economic Stimulus Bill that essentially gave the Department of Education a blank check that was used for Race to the Top, and I have been very critical of how the Department of Education used those funds to push a specific education policy agenda from Washington on the states without specific input from Congress,” Senator Grassley told me via e-mail.

The recent announcement by Randi Weingarten, president of the American Federation of Teachers, that the AFT wants to delay implementation of the Common Core tests in New York put a bipartisan nail in the coffin of consensus.

And more moms are following the trail Heather Crossin and Erin Tuttle blazed.

One major objection to the Common Core standards is that they are not evidence-based. Their effect on academic achievement is simply unknown, because they have not been field-tested anywhere in the world.

But moms have a more elemental objection: The whole operation is a federal power grab over their children’s education. Once a state adopts Common Core, its curriculum goals and assessments are effectively nationalized. And the national standards are effectively privatized, because they are written, owned, and copyrighted by two private trade organizations.

“Legislators are incredulous when they learn the standards and assessments are written by two private trade organizations — the National Governors Association Center for Best Practices and the Council of Chief State School Officers. This creates concern why public education is now controlled by two private organizations,” says Gretchen Logue, a Missouri education activist and one of the co-founders of Truth in American Education, a network of activists and organizations opposing Common Core. “They also don’t like that the standards and assessments are copyrighted and cannot be changed or modified by the states.”

So why are so many good conservatives, from Jeb Bush to Rick Snyder, supporting Common Core? Many conservatives signed on to a clever strategy that asked them to endorse, not the specific standards, but the idea of high “internationally benchmarked” national standards. It is a principle of psychological persuasion that, once you act, in however small a manner, you will feel cognitively compelled to justify your action. Many business leaders with no experience or expertise in education reform have come on board.

This is as good an explanation as any for why so many conservatives are aggressively promoting a set of national standards about which we know, for sure, four things:

a) They are not internationally benchmarked. In fact, for math in particular, they are exactly contrary to the kind of national standards used in high-performing countries.

b) The two major experts on content who were on the Validation Committee reviewing the standards backed out and repudiated them when they saw what the standards actually are.

c) State legislatures and parents were cut out of the loop in evaluating the standards themselves or the cost of implementing them.

d) The Common Core standards are owned by private trade organizations, which parents cannot influence.

These objections, among others, led Diane Ravitch to call on her blog for backing out of Common Core, as the standards were “flawed by the process with which they have been foisted upon the nation.”

Ravitch went on: “The Common Core standards have been adopted in 46 states and the District of Columbia without any field test. They are being imposed on the children of the nation despite the fact that no one has any idea how they will affect students, teachers or schools. We are a nation of guinea pigs, almost all trying an unknown new program at the same time.”

I asked Heather how she felt on that historic day she saw the very first anti–Common Core bill in the nation pass. “I was elated!” she told me. “We were up against so many powerful groups with so much money. We fought against all odds, tons of money, a slew of paid lobbyists. All we had was the truth, the facts, and a passion to protect the future of our children. Our victory is proof that our American system of government still works.”

— Maggie Gallagher is a fellow at the American Principles Project. Her work can be read at MaggieGallagher.com.

Retrieved from: http://www.nationalreview.com/node/347973/print

NIMH abandoning DSM V

National Institute of Mental Health abandoning the DSM

In a potentially seismic move, the National Institute of Mental Health – the world’s biggest mental health research funder, has announced only two weeks before the launch of the DSM-5diagnostic manual that it will be “re-orienting its research away from DSM categories”.

In the announcement, NIMH Director Thomas Insel says the DSM lacks validity and that “patients with mental disorders deserve better”.

This is something that will make very uncomfortable reading for the American Psychiatric Association as they trumpet what they claim is the ‘future of psychiatric diagnosis’ only two weeks before it hits the shelves.

As a result the NIMH will now be preferentially funding research that does not stick to DSM categories:

Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. Studies of biomarkers for “depression” might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system.

As an alternative approach, Insel suggests the Research Domain Criteria (RDoC) project, which aims to uncover what it sees as the ‘component parts’ of psychological dysregulation by understanding difficulties in terms of cognitive, neural and genetic differences.

For example, difficulties with regulating the arousal system might be equally as involved in generating anxiety in PTSD as generating manic states in bipolar disorder.

Of course, this ‘component part’ approach is already a large part of mental health research but the RDoC project aims to combine this into a system that allows these to be mapped out and integrated.

It’s worth saying that this won’t be changing how psychiatrists treat their patients any time soon. DSM-style disorders will still be the order of the day, not least because a great deal of the evidence for the effectiveness of medication is based on giving people standard diagnoses.

It is also true to say that RDoC is currently little more than a plan at the moment – a bit like the Mars mission: you can see how it would be feasible but actually getting there seems a long way off. In fact, until now, the RDoC project has largely been considered to be an experimental project in thinking up alternative approaches.

The project was partly thought to be radical because it has many similarities to the approach taken by scientific critics of mainstream psychiatry who have argued for a symptom-based approach to understanding mental health difficulties that has often been rejected by the ‘diagnoses represent distinct diseases’ camp.

The NIMH has often been one of the most staunch supporters of the latter view, so the fact that it has put the RDoC front and centre is not only a slap in the face for the American Psychiatric Association and the DSM, it also heralds a massive change in how we might think of mental disorders in decades to come.

Link to NIMH announcement ‘Transforming Diagnosis’.

Retrieved from: http://mindhacks.com/2013/05/03/national-institute-of-mental-health-abandoning-the-dsm/

transforming diagnosis

http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml.

exhaustion and the american teacher…

http://theeducatorsroom.com/2012/09/the-exhaustion-of-the-american-teacher/

what first amendment?!?!

http://theeducatorsroom.com/2013/03/the-deafening-silence-of-teachers/

pay now or pay later…

The High Cost of Low Teacher Salaries

By DAVE EGGERS and NÍNIVE CLEMENTS CALEGARI

 

WHEN we don’t get the results we want in our military endeavors, we don’t blame the soldiers. We don’t say, “It’s these lazy soldiers and their bloated benefits plans! That’s why we haven’t done better in Afghanistan!” No, if the results aren’t there, we blame the planners. We blame the generals, the secretary of defense, the Joint Chiefs of Staff. No one contemplates blaming the men and women fighting every day in the trenches for little pay and scant recognition.

And yet in education we do just that. When we don’t like the way our students score on international standardized tests, we blame the teachers. When we don’t like the way particular schools perform, we blame the teachers and restrict their resources.

Compare this with our approach to our military: when results on the ground are not what we hoped, we think of ways to better support soldiers. We try to give them better tools, better weapons, better protection, better training. And when recruiting is down, we offer incentives.

We have a rare chance now, with many teachers near retirement, to prove we’re serious about education. The first step is to make the teaching profession more attractive to college graduates. This will take some doing.

At the moment, the average teacher’s pay is on par with that of a toll taker or bartender. Teachers make 14 percent less than professionals in other occupations that require similar levels of education. In real terms, teachers’ salaries have declined for 30 years. The average starting salary is $39,000; the average ending salary — after 25 years in the profession — is $67,000. This prices teachers out of home ownership in 32 metropolitan areas, and makes raising a family on one salary near impossible.

So how do teachers cope? Sixty-two percent work outside the classroom to make ends meet. For Erik Benner, an award-winning history teacher in Keller, Tex., money has been a constant struggle. He has two children, and for 15 years has been unable to support them on his salary. Every weekday, he goes directly from Trinity Springs Middle School to drive a forklift at Floor and Décor. He works until 11 every night, then gets up and starts all over again. Does this look like “A Plan,” either on the state or federal level?

We’ve been working with public school teachers for 10 years; every spring, we see many of the best teachers leave the profession. They’re mowed down by the long hours, low pay, the lack of support and respect.

Imagine a novice teacher, thrown into an urban school, told to teach five classes a day, with up to 40 students each. At the year’s end, if test scores haven’t risen enough, he or she is called a bad teacher. For college graduates who have other options, this kind of pressure, for such low pay, doesn’t make much sense. So every year 20 percent of teachers in urban districts quit. Nationwide, 46 percent of teachers quit before their fifth year. The turnover costs the United States $7.34 billion yearly. The effect within schools — especially those in urban communities where turnover is highest — is devastating.

But we can reverse course. In the next 10 years, over half of the nation’s nearly 3.2 million public school teachers will become eligible for retirement. Who will replace them? How do we attract and keep the best minds in the profession?

People talk about accountability, measurements, tenure, test scores and pay for performance. These questions are worthy of debate, but are secondary to recruiting and training teachers and treating them fairly. There is no silver bullet that will fix every last school in America, but until we solve the problem of teacher turnover, we don’t have a chance.

Can we do better? Can we generate “A Plan”? Of course.

The consulting firm McKinsey recently examined how we might attract and retain a talented teaching force. The study compared the treatment of teachers here and in the three countries that perform best on standardized tests: Finland, Singapore and South Korea.

Turns out these countries have an entirely different approach to the profession. First, the governments in these countries recruit top graduates to the profession. (We don’t.) In Finland and Singapore they pay for training. (We don’t.) In terms of purchasing power, South Korea pays teachers on average 250 percent of what we do.

And most of all, they trust their teachers. They are rightly seen as the solution, not the problem, and when improvement is needed, the school receives support and development, not punishment. Accordingly, turnover in these countries is startlingly low: In South Korea, it’s 1 percent per year. In Finland, it’s 2 percent. In Singapore, 3 percent.

McKinsey polled 900 top-tier American college students and found that 68 percent would consider teaching if salaries started at $65,000 and rose to a minimum of $150,000. Could we do this? If we’re committed to “winning the future,” we should. If any administration is capable of tackling this, it’s the current one. President Obama and Education Secretary Arne Duncan understand the centrality of teachers and have said that improving our education system begins and ends with great teachers. But world-class education costs money.

For those who say, “How do we pay for this?” — well, how are we paying for three concurrent wars? How did we pay for the interstate highway system? Or the bailout of the savings and loans in 1989 and that of the investment banks in 2008? How did we pay for the equally ambitious project of sending Americans to the moon? We had the vision and we had the will and we found a way.

Dave Eggers and Nínive Clements Calegari are founders of the 826 National tutoring centers and producers of the documentary “American Teacher.”

Retrieved from: http://www.nytimes.com/2011/05/01/opinion/01eggers.html?_r=1&

 

 

stop anxiety

Stop Anxiety In It’s Tracks

Michael S. Broader, Ph.D.

Believe it or not, fear can be a good thing. If our ancestors didn’t feel fear and react to it properly, they wouldn’t have protected themselves when they saw a dangerous predator coming after them, and we would not have survived. Thus, the survival mechanism of fear has thankfully survived, or the human species would not have. In our modern society, we rarely — but sometimes — need our fear responses to save our lives, such as when a dangerous person meaning harm is stalking us. Nevertheless, when this happens, we can fortunately use the fear response to fight or flee.

Physiologically, anxiety is identical to fear, resulting in symptoms that may include shortness of breath, sweating, blushing, muscle weakness or tension, butterflies in your stomach, or constriction of the throat and chest. Fear, however, is about something specific that usually makes it rational, appropriate, and helpful in many ways. Anxiety on the other hand, is not connected to any real danger or life-threatening event. Anxiety — as opposed to fear — generally stifles you from taking any action and sometimes causes you to avoid things you wish you could do. Oftentimes, anxiety provokes feelings of shame, while fear is rarely shameful, as it is a protective mechanism. Whether yours is minor worrying or more severe (such as feelings of panic or losing control), if you experience your anxiety as interfering with your ability to function in your daily life, it might be time to take some steps to get it under control. While you may not be able to control what’s happening with the people, places and things around you, you can absolutely learn to control yourreaction to an external event.

What specific things in your life trigger anxiety? Make a list of the things that trigger you on a regular basis. It can be helpful to write down events that occurred the past week that might have set off your anxious feelings. (My book Stage Climbing: The Shortest Path to Your Highest Potential can be a good resource to help you recognize what makes you anxious in the big picture.) Using one item from your list, think about these questions to figure out what you’re telling yourself that may have created your anxiety and then to challenge your thinking. When this situation occurred, what thoughts were you having? What feelings or emotions did you experience? What were you telling yourself at the time? Were you in any real danger? What is the worst thing that could possibly happen to you as a result of the event. Finally, how likely is it that this worst thing will happen?

For example, if you felt anxious when your boss called you into his office, maybe you had the thought that you were going to be fired. It’s possible that you then felt nervous and helpless. Perhaps you told yourself “I won’t ever find another job and therefore I won’t be able to support myself or my family.” In this case, while being laid off might be extremely stressful, it’s not life threatening. If your mind tends to jump to the irrational worst-case scenario, like having to live on the street, this is your anxiety talking, since chances are it’s probably quite unlikely that would happen. Begin to practice writing these questions and answers down as you experience anxiety-provoking situations throughout your week, and/or try this exercise with other items on your list.

What can you tell yourself instead of those things that create and worsen your anxiety? What are some new ways to think about them? A good question to ask yourself is what is a more realistic, rational attitude I could substitute in this situation? For example, if you think you’re going to be fired, you can consider that your boss might have a question for you or even want to praise you for your work. And even if the worst scenario becomes reality, where’s the evidence that you can’t survive it? When you look at your list at a later point after the anxiety has subsided, ask yourself, what does my irrational side say and what does my rational side say? Can I choose to listen to my rational side instead?

Ask yourself what you’d advise someone else whom you cared about do with similar thoughts. If another person thought they’d be fired because they were called into a meeting or that if they were fired, it would be catastrophic, would you agree? If you’re able to think about it rationally for someone else, you can certainly do so for yourself. Another option is to say STOP to yourself aloud or silently when you begin to have worrisome thoughts. While this may seem silly, this simple technique can help shift your attention in the moment away from worrying.

Once you are aware of those things that trigger anxiety, it’s helpful to have a “to do” list on hand you for when you begin to worry. For example, when anxious feelings start, one simple strategy you can try is a deep breathing exercise. Imagine your legs are two giant air balloons. As you inhale, imagine your legs filling up with air. As you exhale, imagine all of the air leaving your body. Try this, breathing in to the count of five and out to the five as many times as necessary to feel the anxiety dissipate.

If you can’t seem to reduce your anxiety, ask yourself if there is purpose your anxiety is serving. Maybe your anxiety keeps you in a relationship or at a job that you’re afraid to leave. If so, face those issues head on, until you are operating according to your choices — not your anxiety!

As you try these various techniques, notice which ones work best for you. The more you practice a particular strategy, the easier it becomes to gain mastery over your anxiety. Feeling more relaxed something you can achieve. If your anxiety continues to affect your life negatively, I encourage you to seek professional help.

For more action steps to reduce your anxiety, download my complimentary audio programOvercoming Your Anxiety.

For more by Michael S. Broder, Ph.D., click here.

For more on emotional wellness, click here.

Retrieved from: http://www.huffingtonpost.com/michael-s-broder-phd/anxiety-tips_b_3177592.html