Category: Anxiety

Being born and raised in a major urban area is associated with greater lifetime risk for anxiety and mood disorders. Until now, the biology for these associations had not been described. A new international study, which involved Douglas Mental Health University Institute researcher Jens Pruessner, is the first to show that two distinct brain regions that regulate emotion and stress are affected by city living. These findings, published in Nature may lead to strategies that improve the quality of life for city dwellers.

"Previous findings have shown that the risk for anxiety disorders is 21 percent higher for people from the city, who also have a 39 percent increase for mood disorders," says co-author Jens Pruessner, a Douglas researcher. "In addition, the incidence for schizophrenia is almost doubled for individuals who are born and brought up in cities. These values are a cause for concern and determining the biology behind this is the first step to remedy the trend."

Distinct brain structures

Pruessner, with his colleagues from the Central Institute of Mental Health in Mannheim, looked at the brain activity of healthy volunteers from urban and rural areas. In a series of functional magnetic resonance experiments involving the Douglas' previously developed 'Montreal Imaging Stress Task',(MIST) protocol, they showed that city living was associated with greater stress responses in the amygdala, an area of the brain involved with emotional regulation and mood. In contrast, urban upbringing was found to be associated with activity in the cingulate cortex, a region involved in regulation of negative affect and stress.

"These findings suggest that different brain regions are sensitive to the experience of city living during different times across the lifespan," says Pruessner. "Future studies need to clarify the link between psychopathology and these affects in individuals with mental disorders.These findings contribute to our understanding of urban environmental risk for mental disorders and health in general. They further point to a new approach to interface social sciences, neurosciences and public policy to respond to the major health challenge of urbanization."

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Journal Reference:

1. Florian Lederbogen, Peter Kirsch, Leila Haddad, Fabian Streit, Heike Tost, Philipp Schuch, Stefan Wüst, Jens C. Pruessner, Marcella Rietschel, Michael Deuschle, Andreas Meyer-Lindenberg. City living and urban upbringing affect neural social stress processing in humans. Nature, 2011; 474 (7352): 498 DOI: 10.1038/nature1019

 Just like everyone else, people with panic disorder have real stress in their lives. They get laid off and they fight with their spouses. How such stresses affect their panic symptoms hasn't been well understood, but a new study by researchers at Brown University presents the counterintuitive finding that certain kinds of stressful life events cause panic symptoms to increase gradually over succeeding months, rather than to spike immediately.

"We definitely expected the symptoms to get worse over time, but we also thought the symptoms would get worse right away," said Ethan Moitra, a postdoctoral researcher in the Department of Psychiatry and Human Behavior at the Warren Alpert Medical School of Brown University.

But even if the events don't seem to trigger an immediate panic attack, said Dr. Martin Keller, professor of psychiatry and human behavior and principal investigator of the research, patients, family members, or their psychiatrists need to keep their guard up.

"If they have the event and they are not feeling much different then maybe the vigilance on the individual's part decreases somewhat," Keller said. "With the knowledge we have, you may need to stay vigilant for three months or maybe longer. This is something you have to watch for."

In their study, published in advance June 11 in the Journal of Affective Disorders, lead author Moitra, Keller, and their co-authors also found that panic symptoms did not seem to increase in advance of stressful life events, even if they were predictable, such as a divorce becoming official.

The study is based annual assessments of 418 adults with panic disorder or panic disorder with agoraphobia, who were enrolled in the Harvard/Brown Anxiety Research Project (HARP) between 1998 and 2004. Research staff asked the volunteers detailed, standardized questions about important events in their lives and their levels of anxiety.

A statistical analysis of the results found that for stressful life events in the categories of "work," such as a demotion or layoff, or "friends/family/household," such as a family argument, panic symptoms that had meandering severity before the event, increased steadily but gradually for at least 12 weeks afterward.

Stressful events in seven other categories, such as "crime/legal" or "deaths" did not seem to affect panic symptoms at all.

While the findings about the effect of some stressful life events on symptoms of people already diagnosed with panic disorder are new, other researchers have connected stress to panic attacks before. Stressful events are associated with the onset of panic disorder in the vast majority of cases, Moitra said.

Moitra said a possible biological explanation for the association is that stressful life events might exacerbate an underlying proclivity in people with panic disorder to perceive oncoming bouts of hyperventilation, which in turn lead to panic responses.

But while some stressful events have proven to be associated with changes in panic symptom levels, more research is needed to determine what kind of causal role stressful events may have.

"This may be one of those reasons why panic disorders can get worse," Moitra said.

In addition to Moitra and Keller, other authors include Brown psychiatry and human behavior researchers Ingryd Dyck, Courtney Beard, Andri Bjornsson, and Nicholas Sibrava. Author Risa Weisberg is also affiliated with the Alpert Medical School's Department of Family Medicine. The National Institutes of Health funded the research.

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Journal Reference:

1. Ethan Moitra, Ingrid Dyck, Courtney Beard, Andri S. Bjornsson, Nicholas J. Sibrava, Risa B. Weisberg, Martin B. Keller. Impact of stressful life events on the course of panic disorder in adults. Journal of Affective Disorders, 2011; DOI: 10.1016/j.jad.2011.05.029

 A person scanning baggage or X-rays stands a better chance of seeing everything they're searching for if they aren't feeling anxious, according to a new laboratory experiment.

Duke psychologists put a dozen students through a test in which they searched for particular shapes on a computer display, simulating the sort of visual searching performed by airport security teams and radiologists.

Stephen Mitroff, an assistant professor of psychology and neuroscience who led the experiment, says this area of cognitive psychology is important for improving homeland security and healthcare. He's begun collaborating with the Transportation Security Agency at RDU airport and radiologists at Duke.

In earlier studies of this type, Mitroff's team had wondered if the anxiety produced by being visible to a long line of frustrated travelers or having to interpret an image in a medical emergency might change a person's performance on these sorts of tasks.

To simulate a stressful situation in this study, the researchers told the participants they might receive an unpredictable electrical shock for half of the trials that would be unrelated to their performance. Annoying but not painful electrical shocks are a well-established means of inducing anxiety in the lab. Only tests run without a shock were analyzed, focusing the research on the anxiety produced by anticipating a negative event. On the other half of the trials, participants heard a harmless tone.

Subjects performed about the same when searching for a single object whether anxious or not. But when the researchers added a second target, participants were more likely to miss the second object when anxious, despite spending the same amount of time looking at the image.

Missing a second target is a well-known issue called "satisfaction of search," Mitroff said, and it's believed to account for about 40 percent of radiology misses. A person finds the first object and then simply fails to see the second one, even though they're still looking.

Anxiety heightened the satisfaction-of-search problem, a finding which has important implications for the way we train and test searchers, Mitroff said.

The research was published online June 13 in Psychological Science. It was supported by the Army Research Office and the Institute for Homeland Security Solutions.

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Journal Reference:

1. M. S. Cain, J. E. Dunsmoor, K. S. LaBar, S. R. Mitroff. Anticipatory Anxiety Hinders Detection of a Second Target in Dual-Target Search. Psychological Science, 2011; DOI: 10.1177/0956797611412393

Freedom and personal autonomy are more important to people's well-being than money, according to a meta-analysis of data from 63 countries published by the American Psychological Association.

While a great deal of research has been devoted to the predictors of happiness and life satisfaction around the world, researchers at the Victoria University of Wellington in New Zealand wanted to know one thing: What is more important for well-being, providing people with money or providing them with choices and autonomy?

"Our findings provide new insights into well-being at the societal level," they wrote in the Journal of Personality and Social Psychology, published by APA. "Providing individuals with more autonomy appears to be important for reducing negative psychological symptoms, relatively independent of wealth."

Psychologists Ronald Fischer, PhD, and Diana Boer, PhD, looked at studies involving three different psychological tests — the General Health Questionnaire, which measures four symptoms of distress (somatic symptoms, anxiety and insomnia, social dysfunction and severe depression); the Spielberger State-Trait Anxiety Inventory, which tests how respondents feel at a particular moment; and the Maslach Burnout Inventory, which tests for emotional exhaustion, depersonalization and lack of personal accomplishment. Altogether, they examined a sample of 420,599 people from 63 countries spanning nearly 40 years.

Fischer and Boer statistically combined the results of the different studies, noting that their analysis was somewhat unusual in that the key variables were collected from different sources and that no single study included the two variables they were considering, i.e., wealth and individualism. (Participants only answered questions regarding one of the dependent variables of general health, anxiety or burnout.)

"Across all three studies and four data sets, we observed a very consistent and robust finding that societal values of individualism were the best predictors of well-being," the authors wrote. "Furthermore, if wealth was a significant predictor alone, this effect disappeared when individualism was entered."

In short, they found, "Money leads to autonomy but it does not add to well-being or happiness."

Previous research has shown that higher income, greater individualism, human rights and social equality are all associated with higher well-being. The effect of money on happiness has been shown to plateau — that is, once people reach the point of being able to meet their basic needs, more money leads to marginal gains at best or even less well-being as people worry about "keeping up with the Joneses." These patterns were mostly confirmed in their findings.

Overall, more autonomy and freedom as indexed by societal level individualism are associated with more well-being, but the road to well-being is bumpy at times. In more traditional and collectivistic societies, increases in individualism can be associated with anxiety and lower well-being. In more individualistic European countries, in contrast, greater individualism leads to more well-being.

"These increases in well-being with higher individualism, however, leveled off toward the extreme ends of individualism, indicating that too much autonomy may not be beneficial … but the very strong overall pattern was that individualism is associated with better well-being overall," they wrote. This means that in some of the most individualistic societies (such as the United States), the greater independence from family and loved ones appears to go together with increased levels of stress and ill-being."

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Journal Reference:

1. Ronald Fischer, Diana Boer. What is more important for national well-being: Money or autonomy? A meta-analysis of well-being, burnout, and anxiety across 63 societies.. Journal of Personality and Social Psychology, 2011; DOI: 10.1037/a0023663

— Offering Multiple Sclerosis sufferers emotional support through group therapy sessions could improve their quality of life and save the NHS almost £500 per patient, a study at The University of Nottingham has discovered.

Researchers are now planning a larger multi-centre study into the issue to establish whether psychological therapy should be incorporated into the MS services currently provided by the NHS.

The study, funded by the MS Society, was led by Professor Nadina Lincoln, of the University's Institute of Work, Health and Organisations. She said: "These are very encouraging findings as many people with MS have problems with depression and anxiety and there are few treatments provided in NHS clinical services to address these. It is important that the psychological effects of MS are fully recognised as they can have a devastating effect on people's lives."

Depression and anxiety are common among sufferers of MS, a disabling neurological condition that affects around 100,000 people in the UK.

Previous studies have suggested that depression in MS can lead to patients failing to take their medication and a reduced quality of life. National Institute for Health and Clinical Excellence (NICE) guidelines also recognise that many people with both MS and depression or anxiety would prefer not to take antidepressants and recommends that psychological therapies should be offered as an alternative.

For the Nottingham study researchers recruited MS patients currently attending clinics run by Nottingham University Hospitals NHS Trust, as well as inviting referrals from specialist MS nurses and placing adverts in publications produced by the MS Society.

The volunteers were asked to complete questionnaires about how MS affects their daily lives and the extent to which they felt in control.

The patients were then randomly divided into two groups of just over 70 people. One group received all the usual care offered to MS and were put on a waiting list to receive group therapy at the end of the study.

The other group were invited to attend a course of six two-hour sessions of group therapy attended by up to eight participants at a time. Each session was led by a research psychologist, supervised by a qualified clinical psychologist with experience of working with people with MS.

Each session focussed on a topic, such as worry, gloom and relationships and was followed by practical exercises in strategies to cope with emotional problems and group discussion. They finished with relaxation exercises and group members were given tasks centred on practising coping strategies between sessions.

To assess the effectiveness of the sessions, questionnaires were sent to the participants at both four and eight months later and the results of those who received treatment were compared to those on the waiting list only.

The researchers found that those MS sufferers who attended the group sessions had fewer problems with anxiety and depression, the impact of the disease on their daily lives was reduced and their quality of life improved.

In terms of potential savings to the NHS, the researchers have also collected information on cost, which will be submitted for a future publication. They found that costs were reduced by £470 per patient for those who attended the therapy sessions compared with usual care. It was shown to almost halve the cost of visits to the GP, falling from £11,340 at the start of the study to just £5,832 at the eight month follow up. The costs of outpatient hospital visits were also slashed from £32,592 at the beginning of the study to £21,534 at the eight-month follow-up.

The next stage of the research will be to assess whether the group therapy approach works equally well in other centres through a larger study with the hope that the treatment could potentially be provided through NHS services for those with MS.

Dr Susan Kohlhass from the MS Society said: "Knowing group-based sessions can reduce anxiety and depression is a strong development towards improving the quality of peoples' lives with MS. We are committed to funding work that will imminently benefit people with the condition and this is a great example. The next stage will be to find if this approach is as effective in other areas of the country."

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Journal Reference:

1. N. B. Lincoln, F. Yuill, J. Holmes, A. E. Drummond, C. S. Constantinescu, S. Armstrong, C. Phillips. Evaluation of an adjustment group for people with multiple sclerosis and low mood: a randomized controlled trial. Multiple Sclerosis Journal, 2011; DOI: 10.1177/1352458511408753

— Women who have higher levels of the appetite-controlling hormone leptin have fewer symptoms of depression, and this apparent inverse relationship is not related to body mass index (BMI), a new study finds.

The results are being presented at The Endocrine Society's 93rd Annual Meeting in Boston.

"Animal data suggest that leptin may reduce anxiety and improve depression. Our study in women suggests that leptin may indeed have antidepressant qualities," said the study's lead author, Elizabeth Lawson, MD, of Massachusetts General Hospital and Harvard Medical School in Boston.

Leptin, the product of fat cells, signals satiety, or fullness. It is low in thin women and high in obese women, according to Lawson. She also said there is an increased prevalence of anxiety and depression in certain conditions in which leptin levels are typically low. These include the eating disorder anorexia nervosa, in which there is abnormally low weight and body fat, and functional hypothalamic amenorrhea, in which women have stopped menstruating despite having normal weight.

"It is unknown whether low leptin levels contribute to the development of mood disorders in these women," Lawson said.

She and her co-workers studied the relationship between leptin levels and symptoms of anxiety and depression in 64 women. Fifteen of the women had anorexia nervosa, 12 were normal weight with hypothalamic amenorrhea, 20 were normal weight and in good health, and 17 were overweight or obese but still healthy.

All subjects were asked questions to assess symptoms of depression and anxiety, with high scores indicating more symptoms. Besides measuring leptin levels in the blood, the researchers assessed the women's BMI, a measure of weight for height.

They found that higher leptin levels were linked to decreased symptoms of anxiety and depression. The relationship between leptin and depression symptoms was independent of BMI. This finding indicates that leptin may mediate symptoms of depression and that this effect is not a function of low weight, Lawson said.

"Further research administering leptin to humans will be important in understanding whether this hormone has a potential role in the treatment of depression," she said.

The current study received funding from Bioenvision in New York City and from the National Institutes of Health.

Fatigue and poor health, anxiety and depression (physiological, affective and cognitive factors) may have a major impact on patients with functional dysphonia (FD), leading to time off work, reduced activity, and social withdrawal, all of which could further perpetuate and/or cause anxiety, low mood, fatigue and reduced voice use, according to new research published in the June 2011 issue of Otolaryngology — Head and Neck Surgery.

Functional dysphonia (FD) is a voice disorder in which an abnormal voice exists with no vocal pathology, either structural or neurogenic. According to study results, the current literature on dysphonia has a tendency to paint a rather homogenous picture of distress plus repression as the main pathogenic factor in vocal dysfunction.

"The primary aim of the study was to investigate whether FD patients did experience fatigue in addition to their voice problems, and to ascertain if, as in other fatigued populations, this was also associated with perfectionism," said study author James O'Hara, FRCS. "Our hypothesis was that FD patients would have higher levels of fatigue and perfectionism than matched healthy controls in a cross sectional survey."

The majority of the patient population included patients with functional dysphonia from the Freeman Hospital in the United Kingdom. An 11- point fatigue questionnaire, previously validated on a normal population, was analyzed, with a score above 4 on the bimodal system implying substantial fatigue. A 35-point perfectionism questionnaire was also completed and analyzed for "healthy" and "unhealthy" perfectionist traits.

There were 75 cases and 62 controls. The mean fatigue score in patients with functional dysphonia was 17.0 and 14.4 for the controls. Using the bimodal scoring system, the mean fatigue scores in functional dysphonia (5.10) and controls (3.01) were also significantly different. The mean perfectionism scores were 98.9 for patients with functional dysphonia and 91.2 for controls.

The evidence in the study suggests that patients with functional dysphonia are both more fatigued and perfectionist than healthy controls. Author James O'Hara, FRCS, writes, "Understanding how these factors play into the illness experience of people with this condition can help us improve our understanding of how FD develops and how we can practically improve the treatment of those affected by it."

 While most people have a great deal of difficulty in dieting and losing weight, particularly if a diet extends over many months or years, individuals with anorexia nervosa can literally diet themselves to death. In fact, this disorder has a very high death rate from starvation. A new study sheds light on why these symptoms occur in anorexia nervosa.

Perhaps the most puzzling symptom of anorexia nervosa — a disorder that tends to occur in young women — is the refusal to eat, resulting in extreme weight loss. While most people have a great deal of difficulty in dieting and losing weight, particularly if a diet extends over many months or years, individuals with anorexia nervosa can literally diet themselves to death. In fact, this disorder has a very high death rate from starvation. A new study, now online in the journal International Journal of Eating Disorders, sheds light on why these symptoms occur in anorexia nervosa.

Most people find eating to be a pleasant and rewarding experience. In contrast, people with anorexia nervosa often say that eating makes them more anxious, and food refusal makes them feel better. Research over the past decade has provided new insights into the brain mechanisms that are associated with the rewarding aspects of eating. One of these brain chemicals is dopamine, which is released when people or animals eat tasty foods.

A study led by Walter Kaye, MD, professor of psychiatry and director of the Eating Disorder Treatment and Research Program at the University of California, San Diego School of Medicine, used a brain imaging technology called positron emission tomography (PET), which permits visualization of dopamine function in the brain. In order to provoke dopamine levels in the brain, scientists administered a one-time dose of the drug amphetamine, which releases dopamine in the brain.

In healthy women without an eating disorder, amphetamine-induced release of dopamine was related to feelings of extreme pleasure in a part of the brain known as a "reward" center. However, in people who had anorexia nervosa, amphetamine made them feel anxious, and the part of the brain that was activated was, instead, a part of the brain that worries about consequences.

"This is the first study to demonstrate a biological reason why individuals with anorexia nervosa have a paradoxical response to food," said Kaye. "It's possible that when people with anorexia nervosa eat, the related release of the neurotransmitter dopamine makes them anxious, rather than experiencing a normal feeling of reward. It is understandable why it is so difficult to get people with anorexia nervosa to eat and gain weight, because food generates intensely uncomfortable feelings of anxiety."

Importantly, this study was of people who have recovered from anorexia nervosa for at least a year, suggesting that the feeling provoked may be due to pre-existing traits, rather than a response to being at an extremely low weight.

In terms of impact on treatment strategies, there are no currently proven treatments that reduce core symptoms in anorexia nervosa, such as eating-induced anxiety. According to the researchers, even though food is accompanied by severe anxiety, it is still critical to eat and gain weight in order to effectively treat this disorder.

Contributors to the study include Ursula F. Bailer, MD, Medical University of Vienna and UCSD Department of Psychiatry; Vikas Duvvuri, MD, PhD, UCSD Department of Psychiatry; and Rajesh Narendran, MD, W. Gordon Frankle, MD, Michael L. Himes and Chester A. Mathis, PhD, University of Pittsburgh School of Medicine. These results have been published on line in the International Journal of Eating Disorders.

The study was supported in part by the National Institute of Mental Health and the Prince Foundation.

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Journal Reference:

1. Ursula F. Bailer, Rajesh Narendran, W. Gordon Frankle, Michael L. Himes, Vikas Duvvuri, Chester A. Mathis, Walter H. Kaye. Amphetamine induced dopamine release increases anxiety in individuals recovered from anorexia nervosa. International Journal of Eating Disorders, 2011; DOI: 10.1002/eat.20937

There is no doubt that undergoing infertility treatment is stressful, with high rates of anxiety and depression reported by many patients. Mind/body therapies designed to help women reduce stress earlier in the treatment process result in higher pregnancy rates, but little is known specifically about the impact of these therapies on women undergoing in vitro fertilization (IVF).

A new study published June 1 in Fertility and Sterility, a publication of the American Society of Reproductive Medicine, shows that women who participate in a mind/body program for stress reduction while undergoing IVF treatment have a significantly higher pregnancy rate than those who do not (52% versus 20%).

"The intersection of stress and fertility is a controversial one, but we do know that stress can reduce the probability of conception," said principal investigator Alice Domar, Ph.D, OB/GYN, Beth Israel Deaconess Medical Center and Executive Director of the Domar Center for Mind/Body Health at Boston IVF.

In 1987, Domar introduced the Mind/Body Program for Infertility at the BIDMC main campus in Boston, later moving it to Boston IVF in Waltham in 2002. The goal of the program is to help couples learn effective relaxation and stress management strategies while attempting to conceive. The 10-week stress management program focuses on "cognitive behavior therapy, relaxation training, negative health behavior modification and social support components."

To study the effects of the Mind/Body Program on IVF pregnancy outcomes, Domar's team approached women who were about to begin treatment at Boston IVF and who met the study criteria: 40 years or under with normal hormonal levels. None of the participants had previously participated in a mind/body group.

Participants were randomized into a study group that entered the Mind/Body Program for Infertility or a control group who received no mind/body intervention. All patients underwent IVF treatment. Domar tracked the groups through two IVF cycles.

In the first cycle, there was no difference in conception rates between the study group and the control group. "We noticed that only half of the study group had begun the Mind/Body Program and those who had started the program were only a couple of sessions in," said Domar. "This seemed to rule out the possibility of a placebo affect. The mere suggestion of help with stress, it seems, does not increase the pregnancy rate."

In the second cycle, the majority of the patients in the study group had at least five sessions under their belts. "By that point, they had acquired some real life skills to deal with their stress," said Domar. "And that's when we saw the significant increase in pregnancy rates."

Domar found that 52 percent of the women participating in the Mind/Body Program for Infertility became pregnant compared with 20 percent of the control group participants, a statistically significant difference.

"The study supports the theory that psychological distress may be an important detriment to IVF outcome," the authors write.

"We worked with a small group, about a 100 women total, so we'll need to continue with a larger group of patients to see if the results bear out," said Domar. "But there is a strong indication that stress levels and IVF outcomes are linked and that intervening with mind/body therapies can help."

The study was funded through a grant by Johnson & Johnson Consumer Companies, Inc.

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Journal Reference:

1. Alice D. Domar, Kristin L. Rooney, Benjamin Wiegand, E. John Orav, Michael M. Alper, Brian M. Berger, Janeta Nikolovski. Impact of a group mind/body intervention on pregnancy rates in IVF patients. Fertility and Sterility, 2011; DOI: 10.1016/j.fertnstert.2011.03.046

Thinking happy thoughts, focusing on the good and downplaying the bad is believed to accelerate recovery from depression, bolster resilience during a crisis and improve overall mental health. But a new study by University of Washington psychologists reveals that pursuing happiness may not be beneficial across all cultures.

In a survey of college students, Asian respondents showed no relationship between positive emotions and levels of stress and depression. For European-American participants, however, the more stress and depression they felt, the fewer positive emotions they reported.

The study indicates that psychotherapies emphasizing positive emotions, which can relieve stress and depression in white populations, may not work for Asians, who make up 60 percent of the world population.

The findings have implications for helping the Japanese recover from natural disasters and subsequent nuclear crisis in March, and for Chinese coping with post-traumatic stress following the 2008 Sichuan province earthquake.

"If we are to relieve some of the trauma from the tsunami and earthquakes, we have to be careful of imparting Western therapies," said Janxin Leu, UW assistant professor of psychology. "I worry that if a therapy which relies on positive emotions and thinking is used with Asian patients, it will not be effective and may even make patients feel worse."

Mindfulness therapies that encourage patients to pay attention to the good and the bad will likely work better, she said.

Co-authors of the paper are Jennifer Wang and Kelly Koo, both UW psychology graduate students. The journal Emotion published the study online March 28.

The researchers asked 633 college students — a mix of Asian immigrants, Asian Americans and European Americans — to rate how much stress and depression they felt and how often they've been in a sad mood, felt worthless or had sleep or appetite changes.

The participants also rated the intensity of the positive emotions that they felt, including feelings of serenity, joy, confidence and attentiveness.

For European-American participants, there was a strong correlation showing that the more positive emotions they expressed, the less depression or stress they reported. The correlation was more subtle among Asian-Americans, but for Asians, there was no correlation between positive emotions and depression and stress.

The findings show that Asians interpret and react to positive emotions differently in regards to their mental health.

Upon winning an award, for instance, the researchers said that a typical response would be "I'm so happy that I'm afraid." The award would trigger feelings of happiness for the achievement combined with concern that others would be jealous.

This blend of emotions is common among Asians, Leu said, and it may be shaped by Buddhist beliefs that happiness either leads to suffering or is impossible to obtain.

"Happiness signals that something bad will happen next; happiness is fleeting," she said. Similarly, yin-and-yang attitudes may instill views that life is a natural balance of good and bad.

For Asians with depression, therapies likely to work the best are those that encourage patients to "observe when they feel good and bad and notice that both will disappear. Everything passes," Leu said.

The UW's Institute for Ethnic Studies in the United States funded the research.

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Journal Reference:

1. Leu, Janxin; Wang, Jennifer; Koo, Kelly. Are positive emotions just as 'positive' across cultures?Emotion, 2011; [link]