Cognitive-Behavioural Therapy

Depressive disorders come in different forms, just as is the case with other illnesses such as diabetes, cancer or heart disease. This article briefly describes three of the most common types of depressive disorders.
However, within these types there are also variations in the symptoms, their severity and duration. Major depression causes symptoms i.e. excessive fatigue, relentless pessimism, hopelessness etc. that interfere with your ability to work, study, sleep, eat, and enjoy activities that were once pleasurable.
This type of depression can be disabling and may occur once but more commonly occurs several times in a lifetime. A less severe type of depression, dysthymia, generates longer-term, chronic symptoms that do not disable, but prevent you from functioning optimally or feeling enthusiastic when you should.
Many also experience major depressive episodes sometime in their lives. Another form of depression is bipolar disorder.
This serious and often devastating disorder is characterized by mood changes that cycle in and out or on and off- severe highs (mania) and lows (depression). Occasionally, the mood switches are dramatic and rapid, but usually they are slower and gradual.
When in the depressed cycle, one can have any or all of the symptoms of depression. When in the manic cycle,however, you may be overactive, over-talkative and manifest too much energy.
Mania often affects your thinking, judgment, and social behavior in ways that cause serious problems, anger and embarrassment. For example, once in a manic phase you may feel elated and full of grand schemes that might range from unwise business decisions to romantic or promiscuous sprees.
Left untreated, this disorder can literally ruin your life and even cause a deterioration into psychosis. Medical treatments typically used, depending on the condition type and severity, include anti-depressant medications, anti-psychotics, psychotherapy and mood stabilizers.
The best psychotherapeutic treatment is cognitive-behavioral therapy which treats how your thinking processes affect your mood and behavior.
Unfortunately, sometimes patients inappropriately drop-out of medication therapy, rather than follow-through because of side effects which could have been ameliorated had they stayed in treatment.
Wonder if you are getting the correct treatment for your depression? The following recommendations are based on a review of the scientific literature regarding the use of psychotherapy, counseling and medication in treating depression.
Take heed:
1. The treatment of first choice for your depression should be cognitive behavioral or interpersonal psychotherapy. This is because of their superior long-term outcomes; they also pose fewer medical risks than using drugs or combined treatments. However, you should consider medications, combined treatment, or other types of psychotherapy if you do not respond appropriately.
2. You should not undergo insight-oriented psychotherapy by itself because studies suggest that it may produce poorer outcomes.
3. It is important that psychotherapy or counseling be included in your treatment program when anti-depressants are prescribed; you are at a higher risk for relapse if you use medication by itself.
Generally, the best results are achieved by the combined use of cognitive-behavioral therapy and medication.
4. Everything else being equal, when starting medication, a single medication administered with psychotherapy should be used.
5. Everything else being equal, when using an anti-depressant, you should use the lowest, safest therapeutic dose for the shortest possible duration. This minimizes the risk that you may experience any possible side effects, cardio-toxicity, potential suicidality or even drop-out of treatment prematurely.
6. If you are hospitalized, antidepressants should be only very cautiously prescribed, especially if you have cardiac vulnerabilities, because of the risk of sudden death.
7. If you have been suicidal, you should take antidepressants only if there is a vigilant monitoring plan in place to prevent over-dose.
8. Everything else being equal, you should be very reluctant to have ant-depressants prescribed for your children because there is no compelling evidence that they are effective for them and little is known about the health risks they pose for this population.
9. Caution should be used in prescribing antidepressants to elderly people because of possible hypotensive and side effect risks.
10. You should avoid taking regular minor tranquilizers alone for your depression because they have resulted in worse outcomes than no treatment at all.
11. It is crucial to hire the right professional for the right task. Clinical psychologists receive most of their training in psychology, counseling and psychotherapy.
Psychiatrists receive most of their training in medicine. Choose a psychologist for counseling and therapy; go to a psychiatrist for medication.

As a psychotherapist in private practice for over a decade, I certainly have seen it all: watching my clients suffer through anxiety and stress, watching them go from medication to medication looking for “the right pill”, and rarely finding it, spending inordinate amounts of money desperately trying to find the correct method to make their stress go away.

Can Anxiety Be Cured By A Pill or through Mental Health Counseling?

Anxiety is a complex issue…not just something that can be cured through popping a pill, or through one or two visits to a mental health counseling professional. And while a combination of both medication and counseling can be effective, unfortunately it can take years to see results…and often a lot of money.

If I Do Decide To Take Medication And See A Therapist, What Is The Best Type Of Therapy And Medication I Should Take To Help My Anxiety?

I can’t answer that for you specifically, because every one is different (for example, you may have an allergy that precludes you from using a certain type of medication; Or you may not take well to a specific model of psychotherapy). That said, I can say that I have seen many of my clients do pretty well with what is known as “Cognitive Behavioral Therapy”, in combination with a medication that their psychiatrist prescribed.

Isn’t There Any Way To Get Rid Of My Anxiety Right Away, Instead Of Waiting The Years It Can Take For Medication and Counseling to Kick In?

Yes. For every year it takes to go through therapy and anti-anxiety medication, people can actually learn to make their anxiety disappear in 10 to 15 minutes. That doesn’t mean that counseling and medication aren’t viable options…but they are not the end-all cure-all for anxiety…they are merely supplements to help you get better. The majority of the work is done by “you”. Not to mention…you save a great amount of your money and time.

Why Don’t Psychiatrists Ever Tell You That You Can Learn to Make Your Anxiety Disappear On Your Own?

Bottom line: Because they need to make a living. If you did not see them for visits, these docs would not be in business. Don’t get me wrong…there are some darn good professionals out there in the field of psychiatry.

As Fibromyalgia (FM) sufferers we are often made to feel like our pain is “all in your head”, but research has consistently proven that Fibromyalgia is not a form of depression or hypochondria. IT IS REAL!  However, there is a connection between FM and other chronic pain conditions to depression and anxiety.  Treatment is important because both can make FM worse and interfere with symptom management.

There is some debate by medical and mental professionals about what causes what.  The “What came first?  The chicken or the egg” debate translates into “What came first?  The chronic pain or the depression?”  TRUE Fibromyalgia experts, researchers and others know that the chronic pain of FM & overlapping conditions leads to depression and anxiety. 

Fibromyalgia is a common condition in which a person suffers from chronic musculoskeletal pain. There are points called tender points, sometimes all over the body, and these tender and painful points are used as part of the diagnosis of FM. Individuals with FM may also be more susceptible to pain in general. Whenever the tender points are simply touched, they can send sharp pain impulses. Many Fibromyalgia sufferers experience pain all over and some experience pain only in specific regions. It can involve the muscles and the joints. Sometimes, there is so much pain that it is hard to pinpoint exactly where the pain originates.  Fibromyalgia is often accompanied by other overlapping conditions such as chronic myofascial pain (CMP), chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), restless legs syndrome (RLS), migraine & tension headaches, interstitial cystitis (IC), mitral valve prolapse (MVP), cognitive dysfunction, depression, anxiety and more.  The symptoms of Fibromyalgia, alone, are wide-ranging and debilitating.  Do they really think that depression and anxiety is the CAUSE for ALL of the above?

Depression is a mental illness characterized by feelings of profound sadness and lack of interest in enjoyable activities. It is a constant low mood that interferes with the ability to function and appreciate things in life. It may cause a wide range of symptoms, both physical and emotional. It can last for weeks, months, or years. People with depression rarely recover without treatment and if you have Fibromyalgia, you may have to fight it for the rest of your life.

Anxiety is a normal state of apprehension, tension, and uneasiness in response to a real or perceived threat.  Although anxiety is considered a normal response to temporary periods of stress or uncertain situations, prolonged, intense, periods of anxiety may indicate an anxiety disorder. Other indicators of an anxiety disorder are anxiety that occurs without an external threat and anxiety that impairs daily functioning.

What can cause depression & anxiety?  Stressful life events, chronic stress, low self-esteem, imbalances in brain chemicals and hormones, lack of control over circumstances (helplessness and hopelessness), negative thought patterns and beliefs, chronic pain, chronic physical or mental illness, including thyroid disease & headaches can ALL cause both.  Little or no social  and familial support can be a main factor in depression for FM patients. Family history of depression & anxiety can also be a factor.

Lack of quality sleep is also believed to have an influence on depression.  Since FM & Chronic Fatigue Syndrome patients tend to have insomnia and/or other sleep disorders, it stands to reason that poor sleep can lead to depression.

There is a wide variety of medications, vitamins, minerals, herbs and therapies that can help ease the impact of pain, anxiety and depression.  With so many out there, you and your doctor may have to go through the process of trial and error to find what works best for you!

Exercise is not only good for FM, it is also highly beneficial for depression and anxiety.  Recent studies suggest exercise can change your brain chemistry. Exercising can boost your level of serotonin, a brain chemical that is effects mood and pain perception. It can also stimulate the production of endorphins, natural painkillers that can give you an overall feeling of well-being.

Exercise is a great for stress, too. It relieves muscle tension and it gets the heart rate up. The combination makes us more relaxed and alert, which helps us deal with our problems in a calmer and more controlled way.

There are several other methods you can use to combat stress, including: meditation, deep breathing exercises, progressive muscle relaxation, mental imagery relaxation, relaxation to music, biofeedback, counseling – to help you recognize and release stress. 

You can learn more about this topic, medications, supplements, alternative therapies and more at my website AND I will be writing more articles – so check back here!

As Fibromyalgia (FM) sufferers we are often made to feel like our pain is “all in your head”, but research has consistently proven that Fibromyalgia is not a form of depression or hypochondria. IT IS REAL!  However, there is a connection between FM and other chronic pain conditions to depression and anxiety.  Treatment is important because both can make FM worse and interfere with symptom management.

There is some debate by medical and mental professionals about what causes what.  The “What came first?  The chicken or the egg” debate translates into “What came first?  The chronic pain or the depression?”  TRUE Fibromyalgia experts, researchers and others know that the chronic pain of FM & overlapping conditions leads to depression and anxiety. 

Fibromyalgia is a common condition in which a person suffers from chronic musculoskeletal pain. There are points called tender points, sometimes all over the body, and these tender and painful points are used as part of the diagnosis of FM. Individuals with FM may also be more susceptible to pain in general. Whenever the tender points are simply touched, they can send sharp pain impulses. Many Fibromyalgia sufferers experience pain all over and some experience pain only in specific regions. It can involve the muscles and the joints. Sometimes, there is so much pain that it is hard to pinpoint exactly where the pain originates.  Fibromyalgia is often accompanied by other overlapping conditions such as chronic myofascial pain (CMP), chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), restless legs syndrome (RLS), migraine & tension headaches, interstitial cystitis (IC), mitral valve prolapse (MVP), cognitive dysfunction, depression, anxiety and more.  The symptoms of Fibromyalgia, alone, are wide-ranging and debilitating.  Do they really think that depression and anxiety is the CAUSE for ALL of the above?

Depression is a mental illness characterized by feelings of profound sadness and lack of interest in enjoyable activities. It is a constant low mood that interferes with the ability to function and appreciate things in life. It may cause a wide range of symptoms, both physical and emotional. It can last for weeks, months, or years. People with depression rarely recover without treatment and if you have Fibromyalgia, you may have to fight it for the rest of your life.

Anxiety is a normal state of apprehension, tension, and uneasiness in response to a real or perceived threat.  Although anxiety is considered a normal response to temporary periods of stress or uncertain situations, prolonged, intense, periods of anxiety may indicate an anxiety disorder. Other indicators of an anxiety disorder are anxiety that occurs without an external threat and anxiety that impairs daily functioning.

What can cause depression & anxiety?  Stressful life events, chronic stress, low self-esteem, imbalances in brain chemicals and hormones, lack of control over circumstances (helplessness and hopelessness), negative thought patterns and beliefs, chronic pain, chronic physical or mental illness, including thyroid disease & headaches can ALL cause both.  Little or no social  and familial support can be a main factor in depression for FM patients. Family history of depression & anxiety can also be a factor.

Lack of quality sleep is also believed to have an influence on depression.  Since FM & Chronic Fatigue Syndrome patients tend to have insomnia and/or other sleep disorders, it stands to reason that poor sleep can lead to depression.

There is a wide variety of medications, vitamins, minerals, herbs and therapies that can help ease the impact of pain, anxiety and depression.  With so many out there, you and your doctor may have to go through the process of trial and error to find what works best for you!

Exercise is not only good for FM, it is also highly beneficial for depression and anxiety.  Recent studies suggest exercise can change your brain chemistry. Exercising can boost your level of serotonin, a brain chemical that is effects mood and pain perception. It can also stimulate the production of endorphins, natural painkillers that can give you an overall feeling of well-being.

Exercise is a great for stress, too. It relieves muscle tension and it gets the heart rate up. The combination makes us more relaxed and alert, which helps us deal with our problems in a calmer and more controlled way.

There are several other methods you can use to combat stress, including: meditation, deep breathing exercises, progressive muscle relaxation, mental imagery relaxation, relaxation to music, biofeedback, counseling – to help you recognize and release stress. 

You can learn more about this topic, medications, supplements, alternative therapies and more at my website AND I will be writing more articles – so check back here!

(GAD) if you often feel anxious about your family, health or work even when there are no signs of trouble. Anxiety is a natural reaction that prepares us for danger, or important events. The problem with those who suffer from GAD is that their feelings interfere with their work and life.

Someone with GAD may have a good job, a happy marriage and well-adjusted kids, but worries constantly that it is all going to fall apart. Constant worrying may result in chronic physical symptoms, such as aches and pains, irritability and fatigue. GAD may be diagnosed when exaggerated worrying lasts for more than six months.

One major approach to treating GAD is cognitive behavioral therapy.

1. Understand how you feed your negative

thoughts- Therapists can teach you how to

change your anxious reactions.

2. Reality-test your thinking- For example,

you’re doing well at your job but constantly

worry you’ll be fired. Using cognitive

behavior therapy, a therapist may start by

analyzing the facts, such as whether you’ve

gotten a good review lately and whether others

in your company are really being fired.

3. Engage in a five-minute worry session- Using

this technique twice a day can give you time

to be worried, but not let it affect the rest

of your life. You can worry all that you

want, type your feelings into the computer, or

record yourself. By giving your worry an

outlet, you can begin to refocus your thinking

and change your perspective.

4. Learn basic stress-management techniques- It

is important to know how to unwind when you

are anxious, and learn to prevent a build-up

before it begins.

If cognitive behavioral coping skills fail to control your condition, counseling and/or medication can be considered. Medication will not necessarily stop the worry, but can ease it. Medications prescribed for GAD may have troublesome side effects, so make sure to monitor your intake with your doctor. Use the proper steps to help you get your anxiety under control before it controls you.

Everyone feels anxious and under stress occasionally. Situations such as time pressures, important business responsibilities or driving in heavy traffic often bring about anxious, nervous and stressful feelings. On the one hand, anxiety may help you become more alert and focused when facing threatening circumstances.
However, persistent anxiety often causes severe distress over time and can seriously disrupt your life to the point it becomes debilitating. However, with effective treatment, you can lead a better than normal life.
What are the major anxiety problems?
Some people have recurring fears or worries and often have a persistent sense that something bad is just about to happen. This often involves health, relationship or money issues. Although the specific cause for the anxiety may be difficult to identify this nervousness is very real and often interferes in ones ability to concentrate.
An attack of sudden, intense and unprovoked dread characterizes panic disorder. Sufferers generally develop strong persistent apprehension about when and where the next attack of panic will occur, and they often restrict their activities in an illusory attempt to cope.
Persistent, uncontrollable, unwanted feelings or thoughts (obsessions), routines or rituals characterize obsessive-compulsive disorder. Sufferers engage in compulsive, almost involuntary rituals to try to prevent themselves from feeling intense anxiety. Examples of common rituals include washing hands or showering excessively for fear of germs, or checking locks abnormally to prevent an imagined break-in.
Post-traumatic stress disorder causes emotional trauma which often results from a natural disaster, serious accident or victimization by a violent crime. Serious anxieties or fears are triggered by reminders of the event, sometimes months or even years after the trauma.
Shortness of breath, disturbing heart palpitations, trembling, even dizziness often accompanies certain anxiety disorders. These symptoms may begin at any time, but they often start in adolescence or early adulthood. There is also some evidence that a genetic or family predisposition may be responsible.
It is important to seek treatment.
Anxiety disorders can have serious consequences if left untreated. A common consequence for sufferers of panic disorder is to scrupulously avoid putting themselves in a situation that may trigger an attack of dread.
Such avoidance behavior frequently creates problems by interfering with employment responsibilities, family obligations or other required tasks of everyday life.
Those who suffer from anxiety disorders are prone to depression and have a greater tendency to abuse alcohol and other mind-altering substances. Relationships with family, friends and coworkers can often become very strained and job performance sometimes suffers.
Effective treatments are available for anxiety disorders and they can be treated successfully by appropriately trained health, mental health and counseling professionals.
Research has demonstrated that both therapy and counseling can be highly effective in treating anxiety. One effective approach is behavioral therapy which involves the use of techniques to reduce or stop the undesired behavior or feeling. For example, one approach involves training patients in relaxation techniques to reduce any agitation or hyperventilation (rapid, shallow breathing).
Through cognitive interventions, patients discover how their thoughts contribute to the symptoms of anxiety and how to modify them to reduce the likelihood of re-occurrence. The individual is often taught through simulation and experience to tolerate fearful situations in an environment that is controlled, gradual and safe.
Proper and effective medications may also have a role in treatment along with psychotherapy. Clinical
psychologists are uniquely qualified to diagnose and treat anxiety disorders. Sufferers should seek one who is skilled in the use of psychotherapy and cognitive and behavioral therapies.
How long does psychological treatment take?
Treatments for anxiety disorders do not work over-night and you must be comfortable with the therapist with whom you are working. The patient’s cooperation is crucial, and there must be a strong sense that you and your therapist are collaborating together.
Treatment must be customized to your very individual needs and you should begin to notice improvement within eight to ten sessions.
The prospects for your long-term recovery are very good. You can regain control of your feelings and thoughts — and your life.

People with generalized anxiety disorder (GAD) go through the day filled with exaggerated worry and tension, even though there is little or nothing to provoke it. They anticipate disaster and are overly concerned about health issues, money, family problems, or difficulties at work.
People with GAD cannot get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They are unable relax, startle easily and have difficulty concentrating.
Physical symptoms that often accompany the anxiety include, but are not limited to, fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath and hot flashes.
GAD affects about 6.8 million Americans and about twice as many women as men. It comes on gradually and can begin across the life cycle, though the risk is highest between childhood and middle age.
It is diagnosed when someone spends at least 6 months worrying excessively about a number of everyday problems. There is evidence that genes play a modest role in GAD.
Other anxiety disorders, depression, or substance abuse often accompany GAD, which rarely occurs alone. It is commonly treated with medication an/or cognitive-behavioral therapy.
Treatment of Anxiety Disorders
Anxiety disorders are typically treated with medication, specific types of psychotherapy, or both. Treatment choices depend on the problem and the persons preference.
Before treatment, a doctor must conduct a careful diagnostic evaluation to determine whether the symptoms are caused by an anxiety disorder or a physical problem. If an anxiety disorder is diagnosed, the type of disorder must be identified, as well as any coexisting conditions, such as depression or substance abuse.
Sometimes alcoholism, depression or other coexisting conditions have such a strong effect on the individual that treating the anxiety disorder must wait until the coexisting conditions are brought under control.
People with anxiety disorders who have already received treatment should tell their current doctor about that treatment.
If they received medication, they should tell their doctor what medication was used, what the dosage was at the beginning of treatment, whether it was ever increased or decreased, what side effects occurred and whether the treatment helped them significantly. If they received psychotherapy, they should describe the type of therapy, how often they attended sessions and how much the therapy helped.
Often people believe that they have failed at treatment or that the treatment did not work for them when, in fact, it was not given for an adequate length of time or was administered incorrectly. Sometimes people must try several different treatments or combinations before they find the one that works for them.
Medications
Medication will not cure anxiety disorders, but it can keep them under control while the person receives psychotherapy, often from a psychologist. The principal medications used to treat anxiety disorders are antidepressants, anti-anxiety drugs and beta-blockers which control some of the physical symptoms.
With proper treatment, many people with anxiety disorders can lead normal, fulfilling lives.
Antidepressants
Antidepressants were developed to treat depression but are also effective for anxiety disorders. Although these medications begin to alter brain chemistry after the very first dose, their full effect requires about 4 to 6 weeks before symptoms start to fade. It is important to continue taking these medications long enough to let them work.
SSRIs
Some of the newest antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. SSRIs alter the levels of the neurotransmitter serotonin in the brain, which, like other neurotransmitters, helps brain cells communicate with one another.
Fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil) and citalopram (Celexa) are some of the SSRIs commonly prescribed for panic disorder, OCD, PTSD, and social phobia. These drugs are also used to treat panic disorder when it occurs in combination with OCD, social phobia or depression.
Venlafaxine (Effexor), a drug closely related to the SSRIs, is also used to treat GAD. These medications are started at low doses and gradually increased until they cause side effects or produce a beneficial effect.
SSRIs have fewer side effects than older antidepressants, but they sometimes produce slight nausea or jitters when people first start to take them. These symptoms fade with time, however.
Some people also experience sexual dysfunction with SSRIs, which may be helped by adjusting the dosage or switching to another medication.
Tricyclics
Tricyclics are older than SSRIs and work as well as SSRIs for anxiety disorders other than OCD. They are also started at low doses that are gradually increased.
They sometimes cause dizziness, drowsiness, dry mouth and weight gain, which can usually be corrected by changing the dosage or switching to another medication.
Tricyclics include imipramine (Tofranil), which is prescribed for panic disorder and GAD and clomipramine (Anafranil), which is the only tricyclic antidepressant useful for treating OCD.
MAOIs
Monoamine oxidase inhibitors (MAOIs) are the oldest class of antidepressant medications and the ones most commonly prescribed for anxiety are phenelzine (Nardil), followed by tranylcypromine (Parnate) and isocarboxazid (Marplan), which are useful in treating panic disorder and social phobia.
People who take MAOIs cannot eat a variety of foods and beverages (including cheese and red wine) that contain tyramine or take certain medications, including some types of birth control pills, pain relievers (such as Advil, Motrin and Tylenol, cold and allergy medications and herbal supplements; these substances can interact with MAOIs to cause dangerous increases in blood pressure.
MAOIs can also react with SSRIs to produce a serious condition called serotonin syndrome, which can cause confusion, hallucinations, increased sweating, muscle stiffness, seizures, changes in blood pressure or heart rhythm and other potentially life-threatening conditions.
Anti-Anxiety Drugs
High-potency benzodiazepines combat anxiety and have few side effects other than drowsiness. Because people can develop a tolerance to them and may need higher and higher doses to get the same effect, benzodiazepines are generally prescribed for short periods of time, especially for people who have abused drugs or alcohol or who become dependent on medication easily.
One exception to this rule, however, is people with panic disorder, who can take benzodiazepines for up to a year without harm. Clonazepam (Klonopin) is used for social phobia and GAD, lorazepam (Ativan) is helpful for panic disorder and alprazolam (Xanax) is useful for both panic disorder and GAD.
Some people experience withdrawal symptoms if they stop taking benzodiazepines abruptly instead of tapering off, and anxiety can return once the medication is stopped. These potential problems have led some physicians to shy away from using these drugs or to use them in inadequate doses.
Buspirone (Buspar), an azapirone, is a newer anti-anxiety medication used to treat GAD. Possible side effects include dizziness, headaches, and nausea. Unlike benzodiazepines, buspirone must be taken consistently for at least 2 weeks to achieve an anti-anxiety effect.
Psychotherapy
Psychotherapy involves talking with a trained mental health professional, such as a psychologist, social worker, or counselor, to discover what caused an anxiety disorder and how to deal with its symptoms.
Cognitive-Behavioral Therapy
Cognitive-Behavioral Therapy (CBT) is very useful in treating anxiety disorders. The cognitive part helps people change the thinking patterns that support their fears and the behavioral part helps people change the way they react to anxiety-provoking situations.
For example, CBT can help people with panic disorder learn that their panic attacks are not really heart attacks and help people with social phobia learn how to overcome the belief that others are always watching and judging them. When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties.
People with OCD who fear dirt and germs are encouraged to get their hands dirty and wait increasing amounts of time before washing them. The therapist helps the person cope with the anxiety that waiting produces; after the exercise has been repeated a number of times, the anxiety diminishes.
People with social phobia may be encouraged to spend time in feared social situations without giving in to the temptation to flee and to make small social blunders and observe how people respond to them. Since the response is usually far less harsh than the person fears, these anxieties are lessened.
People with PTSD may be supported through recalling their traumatic event in a safe situation, which helps reduce the fear it produces. CBT therapists also teach deep breathing and other types of exercises to relieve anxiety and encourage relaxation.
Exposure-based behavioral therapy has been used for many years to treat specific phobias. The person gradually encounters the object or situation that is feared, perhaps at first only through pictures or tapes, then later face-to-face.
Group therapy is particularly effective for social phobia. Often homework is assigned for participants to complete between sessions.
There is some evidence that the benefits of CBT last longer than those of medication for people with panic disorder, and the same may be true for OCD, PTSD, and social phobia. If a disorder recurs at a later date, the same therapy can be used to treat it successfully a second time.
Medication can be combined with psychotherapy for specific anxiety disorders, and this is the best treatment approach for many people.
Taking Medications
Before taking medication for an anxiety disorder:
1. Ask your doctor to tell you about the effects and side effects of the drug.
2. Tell your doctor about any alternative therapies or over-the-counter medications you are using.
3. Ask your doctor when and how the medication should be stopped. Some drugs cannot be stopped abruptly but must be tapered off slowly under a doctors supervision.
4. Work with your doctor to determine which medication is right for you and what dosage is best.
5. Be aware that some medications are effective only if they are taken regularly and that symptoms may recur if the medication is stopped.
How to Get Help for Anxiety Disorders
If you think you have an anxiety disorder, the first person you should see is a psychologist, psychiatrist or your family doctor. It must be determined whether the symptoms that alarm you are due to an anxiety disorder, another medical condition or both.
If an anxiety disorder is diagnosed, the next step is usually contracting with a mental health professional to provide treatment. The practitioners who are most helpful with anxiety disorders are psychologists and therapists who have training in cognitive-behavioral therapy and/or behavioral therapy and who are open to using medication if it is needed.
You should feel comfortable talking with the mental health professional you choose. If you do not, you should seek help elsewhere.
Once you find a mental health professional with whom you are comfortable, the two of you should work as a team and make a plan to treat your anxiety disorder.
Remember that once you start on medication, it is important not to stop taking it abruptly.
Certain drugs must be tapered off under the supervision of a doctor or bad reactions can occur. Make sure you talk to the doctor who prescribed your medication before you stop taking it.
If you are having trouble with side effects, it is possible that they can be eliminated by adjusting how much medication you take and when you take it.
Most insurance plans, including health maintenance organizations (HMOs), will cover treatment for anxiety disorders. Check with your insurance company and find out.
If you do not have insurance, the Health and Human Services division of your county government may offer mental health care at a public mental health center that charges people according to how much they are able to pay. If you are on public assistance, you may be able to get care through your state Medicaid plan.
Ways to Make Treatment More Effective
Many people with anxiety disorders benefit from joining a self-help or support group and sharing their problems and achievements with others. Internet chat rooms can also be useful in this regard, but any advice received over the Internet should be used with caution, as Internet acquaintances have usually never seen each other and false identities are common.
Talking with a trusted friend or member of the clergy can also provide support, but it is not a substitute for care from a psychologist or other mental health professional. Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of their therapy.
There is preliminary evidence that aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs and even some over-the-counter cold medications can aggravate anxiety disorders, they should be avoided.
Check with your physician or pharmacist before taking any additional medications. Also, the family is very important in ones recovery. Ideally, the family should be supportive and should not trivialize the disorder or demand improvement without treatment.

The most obvious dysfunctional behaviors you will be helped to eliminate are panicking at the first sign of trouble, indulging a pessimism that seems to have a life of its own, using irrational stubborn behavior and having a mindset of HAVING to be right!
Some other defense mechanisms to avoid include blaming others, losing your temper, talking more than listening and using mind-altering substances to reduce anxiety.
It will take work and deliberate effort to remove them from your life but if you do not work on changing these behaviors now you will be prolonging your treatment time.
If you would like more rapidly successful therapy, develop a chart to monitor your progress in reducing these behaviors and work it seriously. Counseling and therapy are often associated with a person who is troubled but intelligent and desirous of enhancing his or her quality of life.
The IQs of those entering therapy are sometimes much higher than those who do not. Similarly, counseling for adults can be easier than for teens; the latter have dysfunctional ways of coping of which they are unaware and sometimes their ability to reflect on their emotions is limited or seems overwhelming.
In some serious cases, patients have to take anti-depressant or anti-anxiety medication along with their counseling and psychotherapy. The most popular kind of counseling today is called cognitive-behavioral.
This type of therapy can sometimes achieve positive results in 3 to 6 months. Patients are taught to become aware of their subconscious thoughts that cause painful feelings or behavioral symptoms.
Also, reviewing your familys history of problems can speed things up by helping you to become even more aware of thoughts and behaviors that have been passed down from generation to generation in your family. Some of your resulting insights will be startling.
How about a technique that could help you replace the family symptoms with more constructive behavior? Sound good? Well, cognitive re-structuring will help you with that.
This technique inventories the subconscious thought patterns you received inadvertently from your family that cause your rage, depression and anxiety to rear their ugly heads. The therapist helps you to discover these unhealthy thought patterns and helps you to almost magically transform them so that your rage, anxiety and depression are eliminated.
This counseling technique is also safe, because it is drug-free and when used by a professional counselor, it virtually has no side effects. Writing your thoughts down two or three times a day, then discussing them with your counselor or psychologist can help minimize and re-shape, if not eliminate, these unhealthy thinking patterns and the anxiety that is caused by them.
Also, practicing time-tested relaxation exercises can help if you are having serious anxiety problems, such as panic attacks or irrational fears. It is likely that genes can play a not insignificant role in the development of your vulnerability to episodes of anxiety or depression.
Some researchers believe that there are certain genes that affect a persons likelihood of developing emotional problems. Some believe that the connection is how certain people metabolize various chemicals and hormones that are related to emotional reactivity; rates and efficiency of their metabolism may be impaired in these people, causing more emotional discomfort.
Stress is clearly related to anxiety and is something that cannot be avoided. It is an everyday circumstance and may arise in any given situation.
Though the link between severe stress and heart attack is established, other dysfunctional behaviors have recently been linked to it: chronic rage and anger.
Although the relationship is somewhat hazy, researchers are learning more about it.
One theory is that anger causes the bodys nervous and circulatory systems to prepare to fight danger, causing blood vessels to constrict, blood pressure to increase and the heart to work harder. This might cause cardiac stress which would be sufficient to lead to a heart attack.

One of the foremost challenges facing counselling professionals is to understand the complex role that client diversity plays in their work. In counselling, each client’s needs and objectives need to be considered and used to guide the counselling process. These needs vary for each individual according to factors such as personality, culture, gender and age.Counselling with Difference

It is vital that counsellors working with issues of difference recognise the unique needs of their client and plan intervention accordingly. The counsellor must decide on the approach that will provide better responsiveness from the client, and therefore lead to a constructive outcome.The Impact of Prejudice on Self-Esteem

Clients affected by systems of inequity in our culture are frequently subjected to acts of discrimination and prejudice. Counsellors need to understand the impact of such in order to analyse the depth to which a client may be culturally traumatised. The impact of prejudice on self-esteem may evoke imbalances in a client’s wellbeing. They may experience feelings of being left out of the larger group, feelings of powerlessness, loneliness and hopelessness.

Furthermore, the risk of developing hatred against ‘opposing’ groups of the society can perpetuate negative behaviour – a kind of traumatic response to what has been perceived as a threat to the individual. Recognising value in the individual is part of the process of developing the client’s self-confidence through providing a supportive environment during counselling sessions.A Case Study: Applied Stress Management

When working with clients with disabilities, counsellors usually face varied challenges according to each particular case. For this purpose, case studies provide valuable information about tools and strategies that have been used with a client.

In a recent case study of Applied Stress Management, a client with a disability was facing several stress problems, triggered by both internal and external factors. The client had a moderate intellectual impairment and cerebral palsy. He had good expressive and receptive language skills relating to familiar concepts. He also used a wheelchair to mobilise independently and worked in a supported employment setting on a full-time basis.

The client’s increasing stressful condition was related to the abusive behaviour of his flatmate; overweight issues affecting his self-esteem; and the ramification of these two main triggers into several other problems (inability to move over long distances due to fatigue, irritation due to mental impairment, incapacity of responding to the environment, etc).

Within the Cognitive Behaviour Therapy Approach, the following strategies were applied to help the client cope more effectively with the identified internal and external stressors:

a) Relaxation Training

b) Affirmations

c) Creative Visualisations

Due to the client’s intellectual impairment the following strategies were also adopted to assist him to understand the process, goals and guidelines of counselling; and to learn and retain stress management skills:Visual language systems

Such as using sign language or other symbols to convey shared meaning.Audio taping

For learning and repetition of concepts and skills.Rehearsal and Role Play

To allow for practice within the safety of the counselling environment.Modelling

To demonstrate how a specific skill or technique may be utilised.

The client showed competence at using the visual calming system (a set of images used to diverge his attention from stressful situations) independently and reported reduced stress levels as a result of the system. After this, the client’s improvement was monitored in follow-up and discussion sessions. This is a classic example of the impact specific tools/strategies provide when applied by counsellors in order to assist clients with mental and/or physical challenges.Conclusion

Effective counsellors develop a comprehensive awareness of their clients’ circumstances. This not only means becoming aware of the client’s immediate concerns, but also conceptualizing those concerns into the broader context of the client’s social and cultural environments.Subscribe to our FREE eZine.

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Emotional stress is someth ing that we all experience when we have to cope with the many demands and responsibilities of home and work. Stress can be defined as an intense emotional and physiological reaction to a situation or the mental representation of a situation as a memory or anticipation. Chronic stress is produced when stress reactions do not resolve themselves and become habitual. The sustained physiological effects of chronic stress can have a serious effect on the body and lead to an increased risk of disease. The psychological effects of chronic stress produce fatigue, poor concentration and an impaired ability to perform tasks, which leads to more stress. Stress produces a general feeling of helplessness and negativity, both of which reinforce the stress reactions. This produces a lack of vitality, enthusiasm and creativity and many people describe chronic stress as a heavy blackness that covers everything and in its severe form, chronic stress leads to depression. Chronic stress can result in an increased chance of accidents as well as reducing work performance. Chronic stress also reduces our listening and learning skills and this reduces the quality of communication in our personal relationships and family.

It is well recognized that stress reactions are learned and originate from the influence of our own mental outlook and from belief patterns acquired from our parents, family and culture. Stress always contains both an objective component and a subjective component and in most situations, it is the habitual subjective emotional reactivity that generates the emotional tension and physiological characteristics of stress. There is pain and there is suffering. Pain is the objective component that is often inevitable or unavoidable, but suffering is a subjective reaction that we generate and add to the pain. The Buddha described this subjective suffering as dukkha and not surprisingly, mindfulness, which is one of the central teachings of the Buddha, was and continues to be very relevant for working with and resolving emotional stress.

The other major source of stress comes from unresolved traumas that result from physical injury, assault, domestic abuse and violence. In general this kind of trauma-related stress results from experiences and associated emotional reactions that we cannot process, because they are outside of our normal range of experience. These unresolved wounds become repressed and submerge into the subconscious mind where they continue to simmer and generate a generalized anxiety. This is described as post-traumatic stress disorder (PTSD). Occasionally, in severe cases of PTSD resulting from war or other intense situations, the stress reactions will erupt as nightmares and flashbacks in which the individual re-lives the trauma.

Whatever the source of the stress reactions, it is important to understand that each reaction has an internal structure in the form of negative thoughts and beliefs and associated emotional energy that gives power to these thoughts. It is often very helpful to examine these negative thoughts and try to change them. This is the approach taken in Cognitive Behavioral Therapy. Another approach is to change the emotional energy that empowers the thoughts and beliefs, because without this compulsive charge, the beliefs will have no power to generate stress. This is the approach taken in MMT. Through careful attention and investigation of the emotion through mindfulness, we can uncover the internal structure of the emotion and discover what needs to change. As the structure changes, so does the emotion. Resolve this and you will neutralize the stress reactions.

OVERCOMING STRESS REACTIONS: THE FOUR Rs

Stress is generated by habitual emotional reactions to external events and internal beliefs. These patterns of negative thinking can be changed by the application of the four Rs, which are the primary focus of MMT. These are: RECOGNITION, REFRAMING, RELATIONSHIP, RESOLUTION.

RECOGNITION

All habitual emotional reactions rely on two key elements: ignorance and emotional energy. The first task in MMT is to learn to recognize our stress reactions as they arise in stressful situations. We train ourselves to watch very carefully for any impulse to react. This counteracts the automatic and mechanical part of what makes reactions habitual. The maxim of MMT is that all change begins with mindfulness and mindful-recognition is the first and most important step. You know what pushes your buttons. It might be in your personal relationships with your partner or with your children or perhaps with your parents. One of the most important steps you can take on the path of self-transformation is to take the initiative to examine what stressors cause you to react and to learn to recognize your impulse to react. This is very empowering and changes your attitude from being a victim to being a warrior. For most of the time, most of us react out of habit and have no awareness of what is happening while it is happening. We are simply seduced into the same automatic patterns of reactive thinking over and over again. Clearly, the first step is to break this pattern of ignorance and know what is happening as it happens. This is the fundamental first part of mindfulness. Mindfulness means to be present for experience as it is unfolding.

REFRAMING

Now you are learning to recognize anger reactions, disappointment and frustration reactions, fear and anxiety reactions as they arise in real-time. This new awareness can be very transformational by itself by simply making you conscious of what you are doing. It is a truth that what you don’t see is what has the greatest power over you. Awakening to what is happening is therefore the first step to change.

The next step that paves the way for transformi ng the emotional energy that powers stress reactivity is to change your relationship to the emotion. Our usual response is to say I am angry or I am afraid or I am upset and we literally become the emotion. Contrast this to saying I notice anger/fear/upset in me. Now the emotion becomes reduced to an object, not me, that I can relate to with mindfulness. This simple reframing of how we perceive an emotional reaction – as me or as an object that has arisen in me is itself transformational.

RELATIONSHIP

However, what keeps a reaction alive is the associated emotional charge, without which the reaction would have no power to cause stress. MMT teaches us how to form a non-reactive relationship, the Mindfulness Based Relationship, with this underlying emotional energy that compels us to react. This is the RELATIONSHIP phase of MMT.

The mindfulness relationship is very important. This is where we allow ourselves to open our awareness and investigate the emotional energy, which is quite different to our usual reactions of ignorance, avoidance or aversion. We choose to be fully present with the inner feelings behind the stress reactions, rather than getting sucked into the content and story line. Just as in personal relationships, it is the quality of our PRESENCE, our ability to listen with an open mind and heart that is most important. Now we are learning to cultivate this same presence for our inner emotional stress. The nature of the mind is such that if you allow things to change, they inevitably will. If you allow things to change and unfold into this safe spaciousness of the mindfulness-based relationship, things will change in a beneficial direction that will transform and resolve the inner conflict and pain. It is the habitual reactivity that stops this natural healing and as we learn to disengage from the patterns of reactivity we create the right conditions in which emotional tension will resolve itself.

RESOLUTION

Mindfulness creates a therapeutic space that allows the emotion to unfold and undergo transformation. If you give it space it will change. This is one of the great discoveries made by the Buddha, 2500 years ago and which we are rediscovering today. It is not what we do that matters as much as how we relate to our emotional stress. When this relationship is based on the receptivity and openness of mindfulness, then we create the best possible conditions in which emotional tension can resolve itself.

Resolution can be understood as the process in which a stress producing emotion like anger or anxiety or disappointment undergoes a process of unfolding and differentiation. When we investigate anger with mindfulness, we begin to see that the anger is actually an assembly of more subtle content – the inner structure – in the form of feelings, memories, sensations and often some form of inner imagery that pulls all these parts together into the form of an emotion. The anger differentiates into feelings of sadness, emptiness, fear. With intense stress reactions resulting from trauma, we will likely notice vivid inner imagery. It is by uncovering the internal structure of the emotions and associated imagery that change becomes possible and mindfulness provides one of the best ways of cultivating a safe relationship with painful content by teaching you how to stay present and avoid becoming reactive to what you are uncovering.

Through becoming conscious of the inner structure of the emotions that power our stress reactions, the emotional energy will change and resolve. Without this emotional power, there is nothing to sustain the emotional reactions and life-long patterns of stress producing reactivity begin to dissolve, leaving you free from their compulsive grip. Like the petals of a lotus bud that were previously held and constrained so tightly, the mind begins to explore a new freedom with all its possibilities and choices. This is the freedom that the Buddha talked about and that is possible for all of us to discover through the practice of mindfulness. MMT teaches you how to apply mindfulness to resolve your patterns of habitual reactivity so that you can realize your full potential and enjoy your life and relationships to the full.

Peter Strong, PhD is a scientist and Buddhist psychotherapist who specializes in the study of mindfulness and its application in Mindfulness Meditation Therapy. Peter teaches mindfulness meditation (vipassana) and works with individuals and couples using Mindfulness Meditation Therapy for resolving difficult emotional problems including anxiety, depression, phobias, grief and trauma and the management of anger and stress. Besides face-to-face work, Peter also works with individuals and couples online via email and web conferencing. To learn more visit http://www.mindfulnessmeditationtherapy.com/

Email enquiries welcome.