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New Patient Test Could Suggest Whether Therapy or Meds Will Work Better for Anxiety

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Like many psychological disorders, there's no one-size-fits-all treatment for patients with anxiety. Some might benefit from taking antidepressants, which boost mood-affecting brain chemicals called neurotransmitters. Others might respond better to therapy, and particularly a form called cognitive behavioral therapy, or CBT.

Figuring out which form of treatment works best often requires months of trial and error. But experts may have developed a quick clinical test to expedite this process, suggests a new study published in the journal Neuropsychopharmacology.

Researchers at the University of Illinois at Chicago have noted that patients with higher levels of anxiety exhibit more electrical activity in their brains when they make a mistake. They call this phenomenon error-related negativity, or ERN, and measure it using electroencephalography (EEG), a test that records the brain's electric signals.

“People with anxiety disorders tend to show an exaggerated neural response to their own mistakes,” the paper’s lead author, UIC psychiatrist Stephanie Gorka, said in a news release. “This is a biological internal alarm that tells you that you've made a mistake and that you should modify your behavior to prevent making the same mistake again. It is useful in helping people adapt, but for those with anxiety, this alarm is much, much louder.”

Gorka and her colleagues wanted to know whether individual differences in ERN could predict treatment outcomes, so they recruited 60 adult volunteers with various types of anxiety disorders. Also involved was a control group of 26 participants with no history of psychological disorders.

Psychiatrists gauged subjects’ baseline ERN levels by having them wear an EEG cap while performing tricky computer tasks. Ultimately, they all made mistakes thanks to the game's challenging nature. Then, randomized subjects with anxiety disorders were instructed to take an SSRI antidepressant every day for three months, or receive weekly cognitive behavioral therapy for the same duration. (Cognitive behavioral therapy is a type of evidence-based talk therapy that forces patients to challenge maladaptive thoughts and develop coping mechanisms to modify their emotions and behavior.)

After three months, the study's patients took the same computer test while wearing EEG caps. Researchers found that those who'd exhibited higher ERN levels at the study's beginning had reduced anxiety levels if they'd been treated with CBT compared to those treated with medication. This might be because the structured form of therapy is all about changing behavior: Those with enhanced ERN might be more receptive to CBT than other patients, as they're already preoccupied with the way they act.

EEG equipment sounds high-tech, but it's relatively cheap and easy to access. Thanks to its availability, UIC psychiatrists think their anxiety test could easily be used in doctors’ offices to measure ERN before determining a course of treatment.

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science
What Pop Culture Gets Wrong About Dissociative Identity Disorder
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From the characters in Fight Club to Dr. Jekyll and Mr. Hyde, popular culture is filled with "split" personalities. These dramatic figures might be entertaining, but they're rarely (if ever) scientifically accurate, SciShow Psych's Hank Green explains in the channel's latest video. Most representations contribute to a collective misunderstanding of dissociative identity disorder, or DID, which was once known as multiple personality disorder.

Experts often disagree about DID's diagnostic criteria, what causes it, and in some cases, whether it exists at all. Many, however, agree that people with DID don't have multiple figures living inside their heads, all clamoring to take over their body at a moment's notice. Those with DID do have fragmented personalities, which can cause lapses of memory, psychological distress, and impaired daily function, among other side effects.

Learn more about DID (and what the media gets wrong about mental illness) by watching the video below.

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Scientists Reveal Long-Hidden Text in Alexander Hamilton Letter
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Age, deterioration, and water damage are just a few of the reasons historians can be short on information that was once readily available on paper. Sometimes, it’s simply a case of missing pages. Other times, researchers can see “lost” text right under their noses.

One example: a letter written by Alexander Hamilton to his future wife, Elizabeth Schuyler, on September 6, 1780. On the surface, it looked very much like a rant about a Revolutionary War skirmish in Camden, South Carolina. But Hamilton scholars were excited by the 14 lines of writing in the first paragraph that had been crossed out. If they could be read, they might reveal some new dimension to one of the better-known Founding Fathers.

Using the practice of multispectral imaging—sometimes called hyperspectral imaging—conservationists at the Library of Congress were recently able to shine a new light on what someone had attempted to scrub out. In multispectral imaging, different wavelengths of light are “bounced” off the paper to reveal (or hide) different ink pigments. By examining a document through these different wavelengths, investigators can tune in to faded or obscured handwriting and make it visible to the naked eye.

A hyperspectral image of Alexander Hamilton's handwriting
Hyperspectral imaging of Hamilton's handwriting, from being obscured (top) to isolated and revealed (bottom).
Library of Congress

The text revealed a more emotional and romantic side to Hamilton, who had used the lines to woo Elizabeth. Technicians uncovered most of what he had written, with words in brackets still obscured and inferred:

Do you know my sensations when I see the
sweet characters from your hand? Yes you do,
by comparing [them] with your [own]
for my Betsey [loves] me and is [acquainted]
with all the joys of fondness. [Would] you
[exchange] them my dear for any other worthy
blessings? Is there any thing you would put
in competition[,] with one glowing [kiss] of
[unreadable], anticipate the delights we [unreadable]
in the unrestrained intercourses of wedded love,
and bet your heart joins mine in [fervent]
[wishes] to heaven that [all obstacles] and [interruptions]
May [be] speedily [removed].

Hamilton and Elizabeth Schuyler married on December 14, 1780. So why did Hamilton try and hide such romantic words during or after their courtship? He probably didn’t. Historians believe that his son, John Church Hamilton, crossed them out before publishing the letter as a part of a book of his father’s correspondence. He may have considered the passage a little too sexy for mass consumption.

[h/t Library of Congress]

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