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.

Exposures involve voluntarily bringing on a mild to moderate level of anxiety In other words, exposures show you ways to face the demon, challenge him head on, and kill him once and for all.

There are two keys to exposures:

1. They have to be voluntary (which means that you can’t do them all the time, because you won’t always be in the mood)

2. If you imagine your anxiety from a 0-8 (with 0 being calm and 8 being a panic attack), you want to hit a 4 during any given exposure (because if you go above a 4, the anxiety might get ahead of you and no longer be voluntary and under your control).

Exposures are used to gain mastery over any phobia. They work for panic disorder because the core of panic disorder is usually phobia as well: A phobia to certain physical sensations. Whether it’s a racing heart, dizziness, nausea, a choking sensation, or a certain pain, every panic disorder patient has at least one or two physical symptoms that trigger their panic cycle. Exposures show you how to experience these sensations in such a way that you finally stop being triggered by them. After 1-2 months of exposures, most patients find that coping techniques begin to be effective (i.e. the shield actually starts working). Once patients are good at exposures, they can often use them to actually stop a panic attack that is coming on. In other words, once the demon appears, they can turn the tables on the demon, challenge it, and get it to run scared with it’s tail between it’s legs. After several months of exposures, most of my patients become completely panic free (and can usually be taken off on any panic-related medications they have started).

Exposures are at the heart of Cognitive Behavioral Therapy, and they are by far the most useful techniques for killing the Demon and gaining mastery over panic once and for all.

People who suffer from panic attacks experience symptoms such as heart palpitations, sweating, loss of control, feelings of impending doom, disorientation, and feeling trapped. Although those who suffer from this disorder feel debilitated, it is one of the most manageable syndromes to treat through the use of cognitive-behavioral therapy.

When people first come for cognitive-behavioral therapy, they may indicate that they have received prior counseling, have made innumerable visits to doctors, and have been treated in emergency rooms for symptoms associated with their anxiety. Patients are usually desperate for answers to alleviate their on-going struggle with panic. Patients are relieved to know that their symptoms are treatable through the use of cognitive-behavioral therapy. Often, patients feel that they are going crazy, although they need to be reassured that having “crazy” feelings is a cognitive distortion and is vastly different from those who might be considered clinically crazy.

Most individuals know the time-frame when they first started experiencing panic attacks. There may have been triggering events that fostered the emergence of panic. The patient may be unable to make an association between the panic and a painful triggering experience. Factors such as a significant illness, job stress, family abuse/ trauma, losing a loved one, and lacking emotional expressiveness may create conditions ripe for panic. Once a panic attack erupts, further attacks usually follow if an individual is not aware of the cycle of self-defeating thinking and behavior which sustains the panic process.

The key to curtailing panic is to help people understand that it’s the secondary symptoms that keep the panic alive. In other words, it’s the “panic over the panic” that sustains the panic pattern. With cognitive-behavioral therapy, recovery involves educating the sufferer on ways to respond to their self-defeating thought processes during the onset of their attack. For example, let’s say that you are taking a mid-term exam during college. You open up the test booklet and immediately react by saying, “Oh my God, none of this material looks familiar; there’s no way that I can pass this test; if I flunk this test, I might fail this course for the semester; if my parents find out, there’s going to be hell to pay!” In contrast, you can learn to respond rationally by saying, “Wow, some of this stuff doesn’t look familiar; just take some deep breaths and relax; I guess I better survey the whole test, answer the questions that I can and then go back and work on the other one’s; I can tackle this test, I just need to relax and be patient!”

How one responds to panic determines whether it subsides. Those who fight with their panic by “awfulizing” about their symptoms, intensify their panic. They may say, “Oh my God, here come those unbearable feelings again – I feel like I’m going to die!” However those who accept their panic and respond rationally with thoughts like, “Here comes that panic again – just calm down and take those deep breaths and it will eventually subside. These feelings won’t last forever, they are time-limited – they’ll be gone soon.”

Learning through cognitive-behavioral therapy to go “down stream” with panic is important to its eradication. Those who “catastrophize” about their symptoms intensify panic attacks. Learning to rationally respond to panic diminishes its effect. Trying to figure out what caused an individual’s panic is not necessary to treat it. What is essential is teaching those who suffer from panic to respond with positive self-talk.

People who experience panic attacks tend to feel ashamed of their problem. It is important for sufferers to understand that they are not alone – anxiety is apart of the human condition. Anxiety and panic is not unusual and those who experience it need to learn to be more open and expressive with all of their feelings. Sharing a wide range of emotions with those you can trust is essential to the healing process. Those who hide panic as a shame-based pattern set themselves up to repeat it. When those we trust are aware of our authentic self, which includes our vulnerability, our anxiety problems tend to fade in significance.

Paradoxical interventions can be helpful in dealing with panic disorder. Having a patient schedule a panic time and encouraging them to perseverate can bring humor and assist in breaking the panic cycle. A ruminating patient might be asked to conduct cardiovascular exercises during panic-related chest tightness to try to lighten the moment and break the cycle of suffering. Cognitive-behavioral therapy is a structured, pragmatic approach which assists people in addressing the symptoms of panic by learning to respond to the disorder with a positive approach to their thinking.

Panic and anxiety attacks affect around 5% of the population at some point in their life – usually young people up to the age of 35. Standard medical treatment includes a variety of medication to help ease the affects of the attacks and help gain control at an emotional level.
However if you are not into medication or natural remedies to treat panic attacks, then you may want to try the Three Minute Therapy: a cognitive approach to dealing with panic attacks.
This may be the most logical method of overcoming panic attacks compared to seeing a psychologist or physician. This therapy assists the mental processes that a person goes through when experiencing a panic attack. There are two stages to this: first, identifying the “must do” activities that are driving the panic attack, and secondly disputing these “must do” activities until you overcome the pressure.
Anxiety prone people are more prone to dwell and magnify things that they “must do”. For instance, a mother of small children might think that she “must know” exactly why she feels panicky. She tells herself that she “must” never lose control. She “must” not do something to look stupid. She tells herself that she “must” have a guarantee that she’s not going to make herself panic.
These “must do” activities become an unrealistic obsession, and this develops into feelings of fright, panic, becoming hysterical and ultimately depression. People with these feelings of panic might also want to avoid uncomfortable situations so as to avoid further loss of control.
Using Three Minute Therapy, the panic attack sufferer needs to identify the “must do” activities in their life. Though it is “nice” to avoid discomfort or unwanted situations, it is not entirely a “must have” situation. Being uncomfortable is a perfectly normal human feeling, every once in a while. So you will need to realise that this is part of everyday existence and get on with life.
The second step in Three Minute Therapy is to convince yourself that these “must do” activities are not really that important after all. This will be a real mental battle for some people, as it goes directly against the grain of their thinking. As a sufferer you will need to be persistent and confront these thoughts when they arrive and dispute these “must do” activities until you feel it is natural to let go with the situation.
One method of overcoming panic attacks is to practise doing things that you would otherwise be afraid of doing. This stretches your boundaries and you will be able to demonstrate that discomfort isn’t life threatening, and will tend to diminish in its ability to cause panic the more you face it.
By using Three Minute Therapy you may be able to overcome panic and anxiety attacks without the use of drugs or medication.

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!

Helen Keller has said that “the only way to get to the other side is to go through the door.”  This is certainly true in the work of transforming grief into healing and growth. This process involves allowing ourselves to feel the intense emotions of grief – sadness, anger, despair and other difficult emotions, as well as tapping into our internal strengths and external sources of support and ultimately finding new ways to stay connected to our departed loved ones. Narrative therapy and has been used with a wide variety of difficulties and issues, including grief reactions.  The role of the narrative therapist is as collaborator or co-author with the client.  As such, the narrative therapist partners with the client to explore the stories that give meaning to the client’s life (White, 1995).  Carr (1998) describes the context of narrative therapy as follows:Within a narrative frame, human problems are viewed as arising from and being maintained by oppressive stories which dominate the person’s life….Developing therapeutic solutions to problems, within the narrative frame, involves opening space for the authoring of alternative stories, the possibility of which have previously been marginalized by the dominant oppressive narrative which maintains the problem (p. 468).Narrative therapy is thus an empowering vehicle for “re-authoring lives” (Carr, 1998, p. 468; White, 1995), in which the therapist takes the role of a partner or collaborator with the client, rather than an authority figure (Angell, Dennis & Dumain, 1999).. The narrative therapist partners with the client to create a safe place to feel the emotions of grief, and to explore the stories that give meaning to the client’s life. The use of narrative or story is a useful vehicle for making meaning and sense of difficult experiences in our lives, by allowing us to access alternative cognitions and gain self-knowledge…  A narrative therapy tool that is often used in grief work is the use of written expression, such as journaling and letter writing.  This can be a powerful vehicle for expressing the emotions of grief and accessing the individual’s unique internal resources and strength, as well as a means of enforcing continuing bonds with the deceased and keeping him or her in the bereaved person’s life as an internalized source of strength and guidance.  Accessing Spiritual Beliefs and Strengths through Narrative TherapyThe collaborative approach of the narrative therapist can be useful for accessing the client’s spiritual strengths by respectful inquiry into the client’s worldviews, including his or her beliefs before the loss, and how they may have changed since the loss, and discussing spiritual and existential issues that arise in this context. (Calhoun & Tedeschi, 2000, p. 167). As one gets in touch on a deep level with his or her own suffering and resiliency in the face of that suffering, he or she can begin to get a panoramic view of the human condition and tap into his or her spiritual strength. Religious and spiritual beliefs have been observed to be one way in which individuals create meaning and a sense of order and purpose to the human condition, life and death, as well as creating an ongoing relationship with the deceased (Golsworthy & Coyne, 1999; Calhoun & Tedeschi 2000). My Theoretical PerspectiveThe strength-based and holistic approach I use with my grieving clients, through the use of techniques of narrative and solution-focused therapy, is informed by my Buddhist practice.  In particular, I come to each session with my clients with the ground that each human being possesses inherent wisdom, or Buddha Nature, and that this wisdom can be called upon to access the individual’s strengths and resilience in times of suffering.  As Stephen Levine (1982) notes, grief fully experienced allows us to “plumb the depths” of our souls and to “touch something essential in [our] being….[W]hat is often called tragedy holds the seeds of grace” (pp. 85-86). Those “seeds of grace” are the basic goodness and inherent wisdom possessed by all, and it is my job as a collaborator or partner in the journey of grief to support my clients to get in touch with the strengths that they possess, but which may be obscured by the intensity of their feelings of helplessness and loss.  Through narrative therapy, including the use of literary and other creative forms of expression, clients are able to create some space around that intensity, which in turn gives them some perspective and hope for change and transformation.  The broader perspective that can be reached through narrative therapy techniques can put the client in touch with both the uniqueness of his or her own loss, and the universality of grief and suffering.  Paradoxically, contemplating the universal truth of suffering can open us to acceptance and peace.  As His Holiness the Dalai Lama (1998) observes, “if we can transform our attitude towards suffering, adopt an attitude that allows us greater tolerance of it, then this can do much to help counteract feelings of mental unhappiness, dissatisfaction, and discontent” (p. 140). Through allowing ourselves to experience and express our suffering, we can find a meaningful way to grow, transforming hopelessness into hope and possibility.  The use of journaling and other narrative therapy techniques can foster the realization that grief is an integral component of the human condition.  Through experiencing our own unique grief, we can tap into its universality, lessening our hopelessness and isolation, and deepening our connection with others and the human condition.  This is the transpersonal and transformative work of healing grief.Clinical Application and Discussion“Peggy”:  A Story of Abuse and Resilience“Peggy” came to therapy to deal with her conflicting feelings after the recent death of her mother.  Peggy had been her mother’s caregiver in the last months of her mother’s life.  In our first session, Peggy recounted that her mother was an alcoholic, and that she has a history of alcohol abuse as well.  She also told me of the emotional abuse she experienced at the hands of her father, and her mother’s failure to protect her from that abuse. In addition, Peggy was experiencing distress about her conflicted relationship with her siblings – which is often exacerbated and magnified by the death of a key family member.During our next session, I encouraged Peggy to tell me the story of her relationship with her mother, and how that relationship transformed from one of recrimination over her mother’s failure to protect Peggy from her father’s abuse to one of forgiveness and intimacy.  I was able to get Peggy in touch with the knowledge that her mother’s death does not mean she is no longer a source of support and strength for her. Peggy agreed with my suggestion, as her therapeutic partner, to write a letter to her mother to reinforce her continued attachment to her mother as a source of spiritual strength.The process of writing the letter to her mother yielded some unexpected rewards for Peggy.  She surprised herself by her ability to not only acknowledge her continued love for her mother, but also to finally express anger toward her mother for her mother’s role in perpetuating the alcohol-fueled dysfunction in her family, and thus to let go of her family role of being the “good girl”.  Peggy was empowered by this newfound ability to express herself more authentically.  A key narrative therapy intervention is to affirm the availability of the client’s social network to support his or her grief work.  Part of this process is learning who is a source of support, and who is not.  Peggy has excellent support from friends at her church who share her spirituality, and she realized that it would be far better to turn to them for support at this time, rather than to her family.  At the same time, I acknowledged and validated that giving up the hope that her family can be a source of support at this time was a secondary loss resulting in another experience of grief.  My acknowledgement of this fact was reassuring to Peggy and helped normalize her process.   In addition, I worked with Peggy to link her use of this strength and self-awareness in the past to her current circumstances.  She was thus able to see that she is not a victim of her family of origin, but rather, has some control over the course of her life and the process of her grief.Peggy now has some tools for healing.  She knows on a core level the strengths she has to move forward.  She feels empowered by her mother’s continued supportive presence in her life and has a renewed faith in her spiritual strength and resiliency.  Considerations for the use of Narrative TherapyDespite my successful experience with the use of narrative therapy in accessing continued attachment as a source of strength in grief, other interventions may first need to be used before certain clients have the ability to fully experience the feelings of grief and transform them into healing and growth.    My work with “Frank”, an eighty year old widower, is illustrative.  Frank’s wife “Paula” died after a long bout with dementia.  Frank reported that, despite a long and loving marriage, a byproduct of Paula’s dementia was extreme anger toward him. I attempted to do a life review with Frank to see if he could gain some perspective, but in telling the story of his life with Paula, he consistently berated himself.   I realized that a narrative therapy life review would have been counterproductive at that point, and that narrative therapy interventions would only be useful with Frank if he were able to let go of some of his distress and internalized self-blame.  I therefore used Gestalt techniques to work with Frank to release the power of his wife’s anger, and cognitive behavioral approaches to foster Frank’s self-care and self-esteem and to help him realize that he did not have to hold on to the blame and shame his wife had instilled in him.  I also helped Frank access other avenues of support, such as emotional support from his son, social support at the local senior center and a grief support group.    As a result of continued work with Frank’s feelings of blame and shame and Frank’s availing himself of his sources of support, Frank became less distressed about feeling Paula’s presence.  He found that he was now able to tell the story of his life with Paula without internalizing her anger.  It was only after the use of other interventions that Frank was able to re-author his story, and he came to feel Paula’s presence in his life as his guardian angel.ConclusionNarrative therapy can be an effective tool for working with the emotions and grief and finding new meaning in one’s life.  The process of expression literally takes deep feelings out of the body, externalizing them so that they become workable. Through this process, grieving clients are able to see that they have some control over their lives, and can tap into their strengths and their inherent wisdom.  With my guidance as a partner on the path of healing grief, my clients can discover their unique strengths, resources and resiliency, deepen their spiritual beliefs, and enhance the meaning of their lives in the context of the human condition.

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 who suffer from panic attacks experience symptoms such as heart palpitations, sweating, loss of control, feelings of impending doom, disorientation, and feeling trapped. Although those who suffer from this disorder feel debilitated, it is one of the most manageable syndromes to treat through the use of cognitive-behavioral therapy.

When people first come for cognitive-behavioral therapy, they may indicate that they have received prior counseling, have made innumerable visits to doctors, and have been treated in emergency rooms for symptoms associated with their anxiety. Patients are usually desperate for answers to alleviate their on-going struggle with panic. Patients are relieved to know that their symptoms are treatable through the use of cognitive-behavioral therapy. Often, patients feel that they are going crazy, although they need to be reassured that having “crazy” feelings is a cognitive distortion and is vastly different from those who might be considered clinically crazy.

Most individuals know the time-frame when they first started experiencing panic attacks. There may have been triggering events that fostered the emergence of panic. The patient may be unable to make an association between the panic and a painful triggering experience. Factors such as a significant illness, job stress, family abuse/ trauma, losing a loved one, and lacking emotional expressiveness may create conditions ripe for panic. Once a panic attack erupts, further attacks usually follow if an individual is not aware of the cycle of self-defeating thinking and behavior which sustains the panic process.

The key to curtailing panic is to help people understand that it’s the secondary symptoms that keep the panic alive. In other words, it’s the “panic over the panic” that sustains the panic pattern. With cognitive-behavioral therapy, recovery involves educating the sufferer on ways to respond to their self-defeating thought processes during the onset of their attack. For example, let’s say that you are taking a mid-term exam during college. You open up the test booklet and immediately react by saying, “Oh my God, none of this material looks familiar; there’s no way that I can pass this test; if I flunk this test, I might fail this course for the semester; if my parents find out, there’s going to be hell to pay!” In contrast, you can learn to respond rationally by saying, “Wow, some of this stuff doesn’t look familiar; just take some deep breaths and relax; I guess I better survey the whole test, answer the questions that I can and then go back and work on the other one’s; I can tackle this test, I just need to relax and be patient!”

How one responds to panic determines whether it subsides. Those who fight with their panic by “awfulizing” about their symptoms, intensify their panic. They may say, “Oh my God, here come those unbearable feelings again – I feel like I’m going to die!” However those who accept their panic and respond rationally with thoughts like, “Here comes that panic again – just calm down and take those deep breaths and it will eventually subside. These feelings won’t last forever, they are time-limited – they’ll be gone soon.”

Learning through cognitive-behavioral therapy to go “down stream” with panic is important to its eradication. Those who “catastrophize” about their symptoms intensify panic attacks. Learning to rationally respond to panic diminishes its effect. Trying to figure out what caused an individual’s panic is not necessary to treat it. What is essential is teaching those who suffer from panic to respond with positive self-talk.

People who experience panic attacks tend to feel ashamed of their problem. It is important for sufferers to understand that they are not alone – anxiety is apart of the human condition. Anxiety and panic is not unusual and those who experience it need to learn to be more open and expressive with all of their feelings. Sharing a wide range of emotions with those you can trust is essential to the healing process. Those who hide panic as a shame-based pattern set themselves up to repeat it. When those we trust are aware of our authentic self, which includes our vulnerability, our anxiety problems tend to fade in significance.

Paradoxical interventions can be helpful in dealing with panic disorder. Having a patient schedule a panic time and encouraging them to perseverate can bring humor and assist in breaking the panic cycle. A ruminating patient might be asked to conduct cardiovascular exercises during panic-related chest tightness to try to lighten the moment and break the cycle of suffering. Cognitive-behavioral therapy is a structured, pragmatic approach which assists people in addressing the symptoms of panic by learning to respond to the disorder with a positive approach to their thinking.