Cognitive-Behavioural Therapy

Panic Disorder is a serious problem and a condition recognized by the American Psychiatric Association that affects millions of Americans. This condition takes a panic attack a step further. Not only must you have experienced two or more attacks, you must also have had those attacks followed by a prolonged period of excessive worry over the possibility of another attack occurring. 

Anxiety attacks don´t occur because you are obsessing over something but rather they happen spontaneously, out of the blue, in places and among people you wouldn´t ordinarily associate with extreme apprehension. That is what makes these episodes so scary, the sheer unpredictability can be very troubling and cause the worry that turns these isolated instances into a disorder. 

The loss of control and fear are major contributing factors in turning isolated attacks into a disorder. Once you have panic disorder, your worry over another anxiety attack becomes pronounced and helps to foster an environment and feeling where attacks may only increase. 

In addition, avoidance tactics to prevent episodes may cause extreme harm to the normal functioning of your life.  Some of the symptoms associated with this disorder include:

Racing heart

Feeling faint or dizzy

Numbness

Hot or Cold Flashes

Excessive fear of losing control, dying or losing your mind

Muscle pain and discomfort

Chest pain and discomfort

These are just some of the symptoms and certainly if you have this problem you could be experiencing some, all or different sets of problems than what are listed here. Many people with this problem consult doctors, which is a smart course of action.

These symptoms can be very scary and they may be an indication that you have a serious medical problem. Getting checked out by a doctor is important to rule out any physical problems and provide some small measure of peace of mind about your suffering.

While consulting a doctor may rule out the need for multiple bypasses, it does not solve your problem. Panic attacks are still ruining your life. You can pay big bucks for psychological treatment or prescription medications to treat your anxiety and depression.

However, these options are not appealing to many people. There are alternatives. There are relaxation techniques that can be utilized to calm the overactive nerves and release the tension.

Many people are able to achieve positive results through a consistent exercise program where they work off accumulated stress and fill the body with endorphins, creating a positive feeling for a body and mind so sorely in need of it.

Many people also find that mind exercises such as meditation work to channel the anxiety into more positive pathways and release the negative build up. Meditation is a great way to control your panic attacks because it is fully portable. It can be done anywhere, at anytime and it soothes a worried mind and releases a lot of angst.

Meditation is something that anyone can learn and it really just requires practice and focus to become proficient. Using alternative techniques to relieve your worry is a great way to avoid the side effects and expense of prescription medications and therapy.

Panic Disorder is a serious problem and a condition recognized by the American Psychiatric Association that affects millions of Americans. This condition takes a panic attack a step further. Not only must you have experienced two or more attacks, you must also have had those attacks followed by a prolonged period of excessive worry over the possibility of another attack occurring.Anxiety attacks don´t occur because you are obsessing over something but rather they happen spontaneously, out of the blue, in places and among people you wouldn´t ordinarily associate with extreme apprehension. That is what makes these episodes so scary, the sheer unpredictability can be very troubling and cause the worry that turns these isolated instances into a disorder.The loss of control and fear are major contributing factors in turning isolated attacks into a disorder. Once you have panic disorder, your worry over another anxiety attack becomes pronounced and helps to foster an environment and feeling where attacks may only increase.In addition, avoidance tactics to prevent episodes may cause extreme harm to the normal functioning of your life. Some of the symptoms associated with this disorder include:? Trouble breathing? Racing heart? Feeling faint or dizzy? Numbness? Hot or Cold Flashes? Excessive fear of losing control, dying or losing your mind? Muscle pain and discomfort? Chest pain and discomfort? Bowel TroublesThese are just some of the symptoms and certainly if you have this problem you could be experiencing some, all or different sets of problems than what are listed here. Many people with this problem consult doctors, which is a smart course of action.These symptoms can be very scary and they may be an indication that you have a serious medical problem. Getting checked out by a doctor is important to rule out any physical problems and provide some small measure of peace of mind about your suffering.While consulting a doctor may rule out the need for multiple bypasses, it does not solve your problem. Panic attacks are still ruining your life. You can pay big bucks for psychological treatment or prescription medications to treat your anxiety and depression.However, these options are not appealing to many people. There are alternatives. There are relaxation techniques that can be utilized to calm the overactive nerves and release the tension.Many people are able to achieve positive results through a consistent exercise program where they work off accumulated stress and fill the body with endorphins, creating a positive feeling for a body and mind so sorely in need of it.Many people also find that mind exercises such as meditation work to channel the anxiety into more positive pathways and release the negative build up. Meditation is a great way to control your panic attacks because it is fully portable. It can be done anywhere, at anytime and it soothes a worried mind and releases a lot of angst.Meditation is something that anyone can learn and it really just requires practice and focus to become proficient. Using alternative techniques to relieve your worry is a great way to avoid the side effects and expense of prescription medications and therapy.

Anxiety disorders are one of the most common psychiatric illnesses affecting both children and adults.  There are about 40 million known cases in the United States alone.  These disorders usually develop from a complex set of risk factors which may include personality, brain chemistry, genetics, and life events.  Though anxiety disorders may be derived from so many factors, they are highly treatable.  However, perhaps because of the stigma attached to anxiety disorders, only about one in three people afflicted actually receive any type of treatment.

It is important to know that the phrase “anxiety disorder” is an umbrella term for more specialized disorders including Generalized Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), Panic Disorder, Posttraumatic Stress Disorder (PTSD), Social Anxiety Disorder (Social Phobia), and Specific Phobias.  Regardless of what specific anxiety disorder a person has, they can be quite debilitating with a variety of symptoms.  In most cases, anxiety disorders present themselves with other mental disorders such as depression.

The symptoms of anxiety orders may manifest themselves at an early age or start suddenly, perhaps after a triggering event.  During high stress periods, anxiety disorder symptoms may present themselves more frequently or with greater severity.  Symptoms include sweating, headache, muscle spasms, hypertension, palpitations, fatigue, and exhaustion to name a few.

As mentioned, anxiety disorders are highly treatable.  Patients suffering from anxiety orders may be treated by psychosocial therapies, medication, or a combination of both.  Psychosocial therapies are usually attempted first and include Cognitive-Behavioral Therapy (CBT), anxiety management, relaxation therapies, exposure therapy, and psychotherapy.  These therapies always involve working closely with a mental health professional, usually a psychiatrist, psychologist or social worker.  During such therapies, patients and professionals discover what the source of the anxiety disorder is and how to deal with it.

Cognitive-Behavioral Therapy is one of the most useful of the therapies for anxiety disorders.  CBT actually helps people change their thinking patterns so that their reactions to anxiety-provoking situations become less severe.  Successful CBT can make patients understand that their panic or anxiety attack is not really a heart attack

Many times, anxiety disorders are treated with not only psychotherapies but also with medications.  The drugs most commonly associated with anxiety disorder treatment include SSRIs, which are selective serotonin reuptake inhibitors, beta blockers, benzodiazepines, tricyclic antidepressants, and MAOIs, which are monoamine oxidase inhibitors.  Medication alone will not cure anxiety disorders, but will help keep them under control.

The most successful treatments of anxiety disorders involve the combination of medication and psychotherapy.  Many doctors will prescribe medication shortly after diagnosis so that the symptoms are alleviated quickly (usually within 4 to 6 weeks) and allows the psychotherapy protocol time to become effective.

Anxiety is a feeling of unease. Anxiety is only considered to be a mental health problem when it is prolonged, severe and is interfering with everyday activities. Fortunately, most anxiety disorders are highly treatable with psychotherapy, drugs, or a combination of both. There are at least nine identified types of anxiety disorders, include generalized anxiety disorder, social anxiety, obsessive compulsive disorder, panic disorder, post traumatic stress disorder, specific phobia, separation anxiety, school avoidance, and agoraphobia. Anxiety disorders in children can range from a simple adjustment disorder to more difficult and debilitating disorders such as panic disorder and posttraumatic stress disorder. It’s normal to feel anxious when facing something difficult or dangerous, and mild anxiety can be a positive and useful experience. Excessive anxiety is often associated with other mental health problems, such as depression. Unfortunately, many people with anxiety disorders don’t seek treatment because they do not believe they have a legitimate illness, or they fear the reaction of family and friends.

Sometimes anxiety can be associated with a physical illness, such as thyroid disorder. For this reason it’s advisable to see your GP in order to rule out a physical cause. Symptoms occur with varying frequency and intensity but may include all of those listed above as well as trembling, chest pain, nausea, and fear. You may fear you are going crazy or dying. Some people may also have a sense of being detached from reality. Anxiety can be a long-term disorder where you feel worried most of the time about things that might go wrong. Cognitive behavioral therapy is often used, as is psychotherapy and stress management techniques. Drugs used to treat anxiety include selective serotonin reuptake inhibitors, tricyclic antidepressants, beta-blockers, and monoamine oxidase inhibitors. Often, a combination of therapies works best.

What are the types of Anxiety disorders?

There are several major types of anxiety disorders:

1. Generalized Anxiety Disorder (GAD): People with Generalized Anxiety Disorder feel anxious nearly all of the time, though they may not even know why.

2. Phobias: A phobia is an unrealistic or exaggerated fear of a specific object, activity, or situation that in reality presents little to no danger. Common phobias include fear of animals such as snakes and spiders, fear of flying, and fear of heights.

3. Social Phobia: Social anxiety disorder can be thought of as extreme shyness.

4. Obsessive Compulsive Disorder (OCD): It is characterized by unwanted thoughts or behaviors that seem impossible to stop or control.

5. Separation Anxiety: Separation anxiety is a normal part of child development.

6. Panic Attacks and Panic Disorder: Panic disorder is characterized by repeated, unexpected panic attacks.

Symptoms of Anxiety:

The symptoms can include:

1. Abdominal discomfort.

2. Rapid heartbeat or palpitations.

3. Shortness of breath.

4. Frequent urination

5. Feeling worried or uneasy all the time

6. An inability to concentrate

7. Depersonalisation.

Treatment For Anxiety disorders:

The treatment will depend upon which type of anxiety you are experiencing and how severe it is. Cognitive-behavior therapy is very effective in the treatment of anxiety disorders. Tranquilisers, such as benzodiazepine tablets, may help to relieve some short-term stress-related anxieties. However, they shouldn’t be taken for long periods because of the risk of addiction. For this reason they aren’t usually prescribed. Antidepressants can treat certain anxiety disorders such as generalised anxiety disorder, social phobia, OCD, and anxiety associated with depression.

Panic attacks are frightening! They are worse than being chased by Mike Meyers or pursued by Freddy Krueger. These acute episodes are particularly frightening because they can strike so unexpectedly. 

The symptoms and effects of severe anxiety can mirror actual medical problems, leading you to fear for your very life. Moreover, you lose control during an attack and can easily become the source of ridicule. The humiliation that people who contend with this problem feel is one of the main reasons that their lifestyles are so dramatically affected by this condition.

Stop avoiding activities, people and opportunities because you are afraid of having a panic attack. You can retrain your body and mind to confront difficult or disturbing stimuli with a calm demeanor instead of massive apprehension. 

While this certainly sounds good, actually achieving these results takes work, determination and practice. If you are willing to work at it, you can avoid prescription medication and deal with your anxiety through relaxation techniques.  While prescription medication and therapy can help with severe worry, they also have drawbacks. Prescription medications are addictive and have side effects. Both medications and therapy can be expensive and many people don´t like the idea of spilling their cuts on someone´s couch. 

There are tools, methods and activities that can be used to assist you in coping with panic attacks. You need to redirect the negative, worrisome thoughts that are plaguing your mind and manifesting in your physical body, with more positive attitudes. 

It´s a simple premise, but it takes work to achieve. You can conquer your fears; you have the power as long as you have the willpower. 

The secret to dealing with panicked thoughts is to retrain your mind to focus on the positive aspects of a situation rather than heighten the negative aspects. Panic attack sufferers tend to blow everything out of proportion. Their mind fills with one thought after another, each more disturbing than the last to the point where their mind and body become overwhelmed. The body goes into survival mode because the mind is telling it there is real danger. The sensations that course through our body cause even more worry and fear, heightening the possibility for subsequent attacks. 

There are alternatives to prescription medications, especially for mild and moderate anxiety sufferers. The key is releasing the tension in the body and trying to initiate the relaxation response in the body.

By initiating the relaxation response, you are taking the body out of survival mode. This allows sensation to return to your extremities, allows blood to flow more evenly and slowly throughout the body and enables your breathing to return to normal. 

Panic attacks affect and interfere with every facet of a person´s life. They make you afraid to try new things, take advantage of new opportunities and experience life to its fullest. Don´t let panic attacks beat you down and affect your life. Find outlets for your worry and start your recovery by finding ways to trigger the relaxation response.

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.

There are so many people suffering with one form or another of a group of disorders that don’t fit neatly into any category and for which there is no one current effective treatment. Relatively little is known about Obsessive Compulsive Disorder (OCD), Body Dysmorphic Disorder (BDD) and the range of Eating Disorders such as Anorexia and Bulimia.” More is known about the eating disorders but still they persist as a real problem for many people”. Just lately I’ve noticed an increase in the number of people asking him to help them with one of these conditions. Any of these can cause major disruption to the life of the sufferer, and that’s just what they do…suffer. Some people find help with drug treatments or with Cognitive Behavioural Therapy (CBT) but these approaches do not work for everyone. I got into this profession to help people, and so I have spent many long hours studying and searching out all that is known about these conditions and their treatments. I have been working with a young man with severe Body Dysmorphic Disorder (BDD) and found the therapy to be helping him to gradually strip away his feelings of being ‘ugly’ and ‘disgusting to look at’ and to form a new image of himself. It’s early days yet, but so far results in all the above mentioned conditions are very encouraging. BDD – Body dysmorphic disorder – is a term used to describe a condition which involves feeling bad about some aspect of the body, the way it looks, smells or sounds, BDD gives rise to, for example, ‘my ears are too big’, my nose is too small’, my skin is too spotty’, I sweat too much’, ‘my voice sounds silly’ I just don’t like the way I look, etc. These ‘bad feelings’ generated by BDD can be very exaggerated and tend to give rise to a large range of coping mechanisms and ’safety behaviours’, depending upon the intensity of the feelings. For example, people with BDD will repeatedly check the way they look in the mirror or reflective surfaces such as shop windows, apply excessive makeup, or attempt to mask their appearance, constantly asking for reassurance from family, friends and sometimes even lesser known acquaintances. To Stop the BDD, four basic techniques are used during treatment. Firstly people who have suffered from body dysmorphic disorder are taught to relax and distress. This helps more than most people imagine. They are gently introduced to hypnosis and to the many therapeutic techniques that can be effectively employed to help them. Secondly, a brief look at the feelings and emotions causing this challenge for a person are softened in a symbolic and non-threatening way (a bit like a pre-wash cycle on a washing machine).. Third, people are taught how to get out of those obsessive loops of thought which have given rise to the feelings which have in turn given rise to the behaviours. This involves literally re-training the conscious mind how to think differently. And the Subconscious mind how to set up new, alternative, or better thought patterns. we use a range of hypnotherapeutic models to re-pattern the behaviours at a deeper unconscious level. Fourth, people are helped to project themselves and their new positive and confident self image into the future. The estimated number of sessions for the treatment of BDD is 6 – 10, and theses sessions will be weekly for sessions 1 – 4. Further sessions will normally be scheduled at two weekly intervals. The first session is 120 minutes and all following sessions are normally 60 – 90 minutes. Alan is very happy to provide free consultations to anyone interested in finding out about his work and how this form of Clinical Hypnosis might help them. They can then make an informed discussion after perhaps checking back with their GP or consultant. Any Clinical Hypnotherapists not conversant with these conditions can also contact Alan for an update about his methods.

 Definitions & clinical picture:

The characteristic features of obsessive compulsive disorder (OCD) are the presence of obsessions and compulsions which interfere with the patient’s ability to cope with their daily life.

Obsessions: are unpleasant or distressing thoughts, images or impulses that come to mind over and over again despite conscious efforts to stop them. We all become preoccupied by particular thoughts at times, or have the experience of an irritating tune running again and again through the mind. These normal thought processes are distinguished from obsessional thoughts because it is possible to distract oneself by thinking or doing something else, and because the thoughts do not interfere with normal functioning. In OCD obsessional thoughts are rarely this innocuous. Common themes for the thoughts include violence, sex, contamination and blasphemy. Obsessional images may be of violent or gory scenes that come vividly to mind again and again, and cannot be ignored or suppresses. An obsessional impulse might be a recurrent impulse to hurt someone, usually someone the sufferer would not consciously wish to hurt. For example, a man might have the obsessional impulse to stab his wife, despite having no wish to harm her and finding the impulse distressing. It is uncommon for people to act on obsessional impulses. It is important to distinguish obsessional thoughts from thought insertion, a first rank symptoms of schizophrenis, in which the patient believes they are experiencing thoughts that are not their own. In contrast, obsessional thoughts are always recognized as arising from the patient’s own mind (ego-syntonic vs. ego-dystonic).

Compulsions: are the behavioural counterparts of obsessions, with a strong urge to perform an action or complex serious of actions (overt or covert) repeatedly, even though they are recognized as unnecessary. Compulsions can often be resisted for a short periods, but that can only be relieved by performing the compulsive act. Compulsions can take very many forms, but the commonest are:

Complex rituals incorporating many of these compulsive acts may be developed and can be very handicapping (may take up to 12 hours a day!)

The clinical picture n OCD is very variable. Patients may have obsessions only, compulsions only, or combination of both. There is a very close relationship with depressive disorders. About 70% have at least one episode of depression at some time in their life, and the two disorders can co-exist (comorbidity). More commonly, patients with depressive disorder can develop obsessional symptoms without having the full blown OCD. In these cases treatment of the depressive disorder is usually enough to resolve the obsessional symptoms completely without other more specific treatments.

Epidemiology:

OCD is relatively common, with a lifetime prevalence of 2 to 3 %. Unusually for the neurotic disorders it is equally common in men and women. It tends to begin in adolescence and occasionally in childhood.

Aetiology:

There are many theories about the aetiology of OCD but like other mental illnesses it is properly multi factorial and bio-psycho-social:

Management:

A full psychiatric history, mental state examination, rating scales (the Yale-Brown), physical examination and investigations are required in all cases. Some differential diagnoses are: (‘psychiatric’ or ‘organic’)

1. Pharmacological treatment:

Antidepressant which act on serotonin, such as SSRIs and the tricyclic clomipramine are effective in some cases, even if there is no depression. If one SSRI fail, one could try a different one (unlike depression). Also unlike depression, it takes usually longer time and higher doses for the medications to work.

2. Psychological treatment:

It is often helpful to begin first with drug treatment before embarking on psychological treatments, as it may allow the patient to work more effectively with the therapist.

Despite the psychoanalytical theories about aetiology of OCD, psychodynamic psychotherapy is generally of little benefit (lack evidence based support). Cognitive behavioural therapy; on the other hand; has a strong evidence based support and despite that it is not as effective as in depression or anxiety disorders, it is still has a good response rate.

3. Psychosurgery:

Still an option in severe cases. Done in specialized centers. Extremely sophisticated and use laser and Gamma knife in very specific and targeted brain areas. Can be life saving, improve quality of life dramatically. Rarely used.

4. Social treatment:

OCD can be a chronic and very disabling condition that can result in social isolation, unemployment and financial problems. It is important to consider these issues, and where appropriate involve an occupational therapist or social worker in patient’s care.

Course & prognosis:

OCD tends to be a chronic illness, with fluctuations in severity. If treatment is effective it is important to consider the long-term prevention of relapse. Education of the patient and their family about the disorder, and identification of the early signs of relapse with rapid reintroduction of treatment is helpful.

References:

1. Stevens L, Rodin I, Psychiatry: An illustrated colour text, Churchill Livingstone 2001

2. Steple D. Oxford Handbook of Psychiatry, Oxford University Press, 2006

Treating agoraphobia is difficult because you have to face your fears and who wants to do that?

The best way to confront it is a two-part program called cognitive behavior therapy. Cognitive behavior therapy seeks to help you understand the origins of your fear and face that fear head on.

By learning the factors that trigger your particular panic attacks and how to control them you can work with breathing exercises and relaxation techniques to help you battle through the symptoms or prevent them altogether.

Another part of therapy is facing your fears head on. If you are afraid to go to the supermarket, then you need to go but go with a safe person. The person you go with will be there for reassurance and to help you if you experience panic symptoms. Simply knowing that you have assistance if something were to happen is often enough to prevent a panic attack.

As time goes by you go to more and more places and realize that panic attacks are either not as severe or not occurring at all. You can then wean yourself from the safe person that has been accompanying you. Your mind and body have been trained and have learned that fears don´t come true and that anxiety can be diminished or go away entirely over time.

Addressing your panic attacks is the key to either preventing agoraphobia or managing and eliminating it if it has already developed. Good ways to cope and care for yourself while dealing with this disorder include:

1.  Don´t avoid fearful situations. The more you avoid fearful situations, the more you enforce that fear. Try to go to places that cause anxiety or fear because by confronting that fear your mind realizes, that the place or situation that seemed so fearful really isn´t. 

2.  Learn calming skills. Taking yoga, participating in meditating, learning relaxation or deep breathing techniques can all be helpful in terms of getting your mind and body in a place where it is not responding as forcefully to anxiety producing situations. 

3.  Practice relaxation techniques. Relaxation techniques include yoga, meditation and breathing but also include imagery techniques and positive thought redirection. 4.  Find Support. Talk to people about what you´re going through, you may realize that there are more people than you thought struggling with fear, anxiety, panic attacks and agoraphobia. Support groups are also a great help.

5.  Avoid alcohol and illegal drugs. A lot of people who suffer from agoraphobia turn to excessive alcohol or illegal drug use to ease the disturbing feelings that they have to cope with every day. You need to change your lifestyle, your habits and even some of your thought processes to make an impact and change your life. 

Agoraphobia treatment can include both medications and therapy or it can be treated with just therapy alone. If you´re on prescription medication, follow the instructions and take them as directed. The drugs that you might have been prescribed include Prozac, Paxil or Zoloft. 

Even if you have a prescription, more likely than not, it will not be the cure all you were looking for. The problem with drugs is that they have side effects and can eventually trigger dependency issues. However, for some people with acute problems, they may be the only answer to get short term relief. 

Relief over the long-term comes from changing your lifestyle and your thinking to better enable you to confront the situations that inspire such fear and anxiety and walk through the anxiety, realizing that you can handle it and come out the other side. 

Once both your body and mind realize that you can survive and manage the panic, the fear of them lessens, the need for avoidance decreases, the stresses and anxiety naturally diminish and you will find yourself able to go places and do things you weren´t able to before without having an attack or even worrying that you are going to have one.