All Posts Tagged: anxiety

Why Words Are so Important in Psychiatry

Why Words Are so Important in Psychiatry

As reviewed in a past article, the field of Psychiatry is unique among medical specialties. At present, medical technology has yet to provide adequate imaging or laboratory testing that would allow for more objective assessment of a patient’s symptoms and concerns. A person with chest pain, fatigue and a racing heartbeat can rest assured that a carefully designed testing protocol will clarify the nature of the problem. Cardiac enzymes, electrocardiogram, chest x-ray and even cardiac catheterization will provide objective evidence to either rule-in or rule-out a cardiac event. Or the severe sore throat that makes swallowing difficult can be objectively clarified by obtaining a throat culture and consequently help the physician chose an antibiotic if indicated.

So how to proceed with such limited biomedical test resources? The art of listening is the answer. Listening will not be successful unless the patient knows that he/she can freely tell their story. First, the patient needs to hear a simple question. “How can I be of help?” After their reply the telling of their story is most important. For this to be successful there needs to be an open and accepting attitude that promotes this storytelling.

Once the story begins to unfold it is often necessary to backtrack and clarify aspects of the story. The words that the patient use become critical. What one individual means by the word “anxiety” may be quite different from that of others. I have discovered that behind the initial complaint of “I am anxious” will often be a core depressive illness that has an anxiety component. It is not uncommon for major depressive illnesses to contain a whole host of anxiety symptoms.

What of the individual with a true primary anxiety disorder. It is not sufficient to accept the word anxiety at face value. That is because anxiety is a more complex disorder and cannot be explained by a single word. Simply speaking, anxiety can be best understood by two of its components. One is best described as “somatic” or physical. Symptoms can include rapid heartbeat, sweating, gurgling stomach, headaches, tight muscles, shortness of breath etc. This individual is persistently or episodically physically uncomfortable and restless. They feel like they do not have control over their bodily sensations.

The other major component of anxiety is more mental or “psychic”. Such individuals spend excessive time with non-stop worrying. They get stuck with “what if this and what if that” thinking. They ruminate. They cannot turn off their brains. Sleep becomes difficult because of a busy head, Their thinking often is catastrophic, taking their worries down a path much farther than would be based on the current situation. Catastrophic thinking fuels the rumination and a vicious cycle ensues.

I am making a big deal of such language because treatment is often influenced by the specific type of anxiety. There are different medications to address somatic anxiety than that of psychic anxiety. Psychotherapies also differ depending upon the clarification of the anxiety explanation. So this is much more than a semantic intellectual exercise.

It is then most important to clarify the context of the individual’s symptoms. The goal is to try to determine how much the person’s difficulties are due to a reaction to a life situation. I have reviewed in past articles the difference between a core biologically-based psychiatric problem that definitely requires medication, a life based problem that would benefit from talking therapy and the hybrid situation in which a life stress induced problem triggers an underlying biological response that would require a combination of both types of treatment. One cannot get answers to such questions unless the dialog between physician and patient allows for a careful analysis of their story.

I have found that there is an added benefit of this approach. When a patient clearly knows that their physician is carefully listening and actively asking questions to clarify the specific aspects of their problem, a stronger therapeutic alliance develops. All too often I hear patients tell me that they were frustrated in the past with their doctor because they felt that he/she was not listening to them. This is so unfortunate because listening is a fundamental and easy process. Teasing apart the meaning of the words used in the story can be more challenging. Once the patient understands the importance of words, they can better appreciate the treatment plan and thus actively participate as a partner in the therapeutic process.

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LGBTQ Mental Health

Studies have shown that people who identify as lesbian, gay, bisexual, transgender, or questioning (LGBTQ) suffer from higher levels of anxiety and depression than the general public. In fact, approximately 30 – 60 % of the LGBTQ population have anxiety and depression and, as a whole, the LGBTQ community faces disproportionately high rates of suicide, self-harm, substance abuse and addiction. While there are many things that can influence a person’s mental and emotional wellbeing, prejudice and discrimination add additional trauma to LGBTQ mental health concerns.

Factors that Affect LGBTQ Mental Health

In and of itself, simply being LGBTQ does not affect a person’s mental health condition. Identifying against a cultural norm, however, exposes an LGBTQ person to prejudice and discrimination that their heterosexual counterparts don’t generally face. Some factors that affect LGBTQ mental health are:

  • Bullying
  • Homophobic societal attitudes
  • Hate crimes against LGBTQ people
  • Minority stress, which is a constant need to be “on guard” and to watch out for potential threats
  • Negative self-image and self-loathing due to societal attitudes
  • Lack of awareness of where to find positive role models
  • Media coverage that is beginning to embrace the LGBTQ culture on one hand, but shows detrimental news stories about the treatment of the community on the other
  • Worry about showing their true selves at work for fear of losing clients or promotions
  • Fear of being denied housing
  • Discrimination against transgender people within the LGBTQ community

Despite the fact that society is slowly becoming more accepting of the LGBT community, an uphill battle still remains. LGBTQ people have heard from birth that being something other than heterosexual or identifying with the gender you were born into is wrong. For example, although gay marriage was recently legalized, federal law still allows for legal discrimination in the workplace because it doesn’t protect people based on sexual orientation or gender identity. People can still legally be evicted from housing, fired from their job, or refused public or private services because of their LGBTQ status. Additionally, it is all too common for family members to reject someone who comes out to them.

Up to 65% of LGBT people suffer from some level of homophobia themselves (the belief that being LGBTQ is wrong). Hearing throughout their lives that they are somehow flawed causes many people to internalize those negative thoughts. Those who don’t have family or peer support have a harder time, as do those individuals who tend toward more negative personalities or have gone through adverse experiences, such as rejection or bullying.

On the other hand, even LGBTQ people who have supportive family and friends can end up feeling that their sexual or gender identity is somehow wrong. Often, people who love them want to help, but have no idea how to do so, and end up suggesting “cures” or a laundry list of worries (“you’re going to get AIDS”). These things contribute to the person’s feeling of being unworthy or hopeless. When the individual internalizes this shame from a young age, it often leads to long-term mental and emotional consequences.

Compassionate Care is Needed

For LGBTQ people, talking about their problems can feel like they are reinforcing the damaging stereotype against the gay and transgender community. Many individuals have been kicked out of their homes or shunned by family members and friends after they’ve come out. As an example, it’s estimated that about 40% of the homeless population in Southern California consists of homeless LGBT youth.

Compassionate care is needed to help the LGBTQ community recover from its serious mental health issues. Obviously, mental health providers should approach and treat their LGBT patients in the same manner as they would any other patient. However, they also need to understand how oppression and other factors contribute to anxiety and depression in these patients.

We Can Help

Our mental health professionals provide caring, compassionate LGBTQ mental health services. For more information, contact The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida. Call us today at 561-496-1094.

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Can Using Medical Marijuana Increase Anxiety and Depression?

As of this writing, 30 states, Guam, the District of Columbia, and Puerto Rico all have approved the broad use of medical marijuana. Additionally, other states allow limited medical use and 8 states (and the District of Columbia) allow recreational use of the drug. Even though the use of pot and weed is becoming more acceptable, the Drug Enforcement Administration (DEA) still considers marijuana to be a Schedule I substance, meaning it is likely to be abused and it completely lacks medical value. This classification also means there hasn’t been much research into the efficacy of the drug for medical conditions and, in particular, we lack long-term studies that would tell us whether it is safe and/or effective when used over a long period of time.

What we do know is that, in clinical practice – both in our practice and in discussions with colleagues in other practices – mental health professionals are seeing an increase in the number of incidents of anxiety, panic attacks, depression, and even psychotic reactions now that marijuana use has become more mainstream.

Did you know that:

  • THC, the primary chemical in marijuana, is believed to stimulate areas of the brain responsible for feelings of fear.
  • According to available scientific literature, people who use weed have higher levels of depression and depressive symptoms than those who do not use cannabis.
  • Frequent or heavy use in adolescence can be a predictor of depression or anxiety later on in life – especially for girls.
  • Even if using cannabis seems to alleviate symptoms in the short-term for some users, it can lead to delay in getting appropriate treatment.
  • Scientific evidence suggests cannabis use can trigger the onset of schizophrenia and other psychoses in those already at risk of developing it.
  • A 2015 study found that university-aged young adults are more likely to have a higher risk of developing depression from heavy marijuana use.
  • Numerous research studies show that marijuana is an addictive substance. The more you use it, the more you need to use in order to get the same “high.”

Medical Marijuana vs. Recreational Marijuana

Whether it’s used recreationally or medicinally, both forms of pot are the same product. The medical version contains cannabinoids just like recreational marijuana. Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are the main chemicals found in the medical form.

Although medical marijuana is used for many conditions (among them: multiple sclerosis (MS), cancer, seizure disorders, and glaucoma), its efficacy hasn’t been proven. “The greatest amount of evidence for the therapeutic effects of cannabis relate to its ability to reduce chronic pain, nausea and vomiting due to chemotherapy, and spasticity [tight or stiff muscles] from MS,” says Marcel Bonn-Miller, PhD, a substance abuse specialist at the University of Pennsylvania Perelman School of Medicine.

Mental Illness and Psychoactive Substances

As noted above, there aren’t many studies on the relationship between marijuana use and mental illnesses, such as anxiety, depression and bipolar disorder yet. However, research done in 2017, examined marijuana use in conjunction with the depression and anxiety symptoms of 307 psychiatry outpatients who had depression (Bahorik et al., 2017). This study found that “marijuana use worsened depression and anxiety symptoms; marijuana use led to poorer mental health functioning.” In addition, the study determined that medical marijuana was associated with reduced physical health functioning.

Part of the problem with using marijuana either recreationally or medically is that there is no way to regulate the amount of THC you’re getting, because the Food and Drug Administration (FDA) doesn’t oversee the product. This means not only the ingredients, but the strength of them can differ quite a lot. “We did a study last year [2016] in which we purchased labeled edible products, like brownies and lollipops, in California and Washington. Then we sent them to the lab,” Bonn-Miller says. “Few of the products contained anywhere near what they said they did. That’s a problem.”

Another area of concern is that, as we know from regulated psychiatric medications, one dose may affect you differently than it affects your sibling or a friend. People are unique – each person’s reaction to a medication will vary, which is why psychiatric medications are monitored by the prescribing doctor so that the dosage can be adjusted for your specific needs.

Be Careful with Marijuana Use

In summary, if you choose to use marijuana either medically or recreationally, be careful. Talk to the doctor who authorized it, or speak with a mental health professional if you find yourself experiencing the symptoms of depression or anxiety, or if you have panic attacks that begin or worsen while you are using pot. Additionally, be sure your doctor knows your psychiatric history before they authorize medical marijuana for you, especially if you have been diagnosed with anxiety, depression, panic attacks, bipolar disorder, or psychosis.

Do You Have Questions?

We can help! The mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida can answer your questions about how medical or recreational marijuana use can affect your anxiety, depression, or other condition. For more information, contact us or call us today at 561-496-1094.

Resource:  Bahorik, Amber L.; Leibowitz, Amy; Sterling, Stacy A.; Travis, Adam; Weisner, Constance; Satre, Derek D. (2017). Patterns of marijuana use among psychiatry patients with depression and its impact on recovery. Journal of Affective Disorders, 213, 168-171.

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For My Anxiety or Depression: Should I Use Medication or Therapy? (Webinar)

About the Webinar:

Dr. Andrew Rosen, Board Certified Psychologist, founder and director of the Center for Treatment of Anxiety and Mood Disorders and Dr. David Gross, Board Certified Psychiatrist, and medical director of the Center recently held a webinar on using medication versus therapy for anxiety and depression with The Anxiety and Depression Association of America. Some of the topics covered in the webinar include: What are the roles of medication and therapy? How can my psychiatrist (or primary care doctor) and my therapist work together as a team? How soon can I expect to see results from medication? How soon can I expect to see results from cognitive-behavioral therapy (CBT)? Are there situations where medication and CBT can work great together?

 

Watch the webinar here:

Recorded on April 21, 2017 for the Anxiety and Depression Association of America (www.adaa.org) © ADAA 2017

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How to Overcome Extreme Fear of Doctors

When the thought of getting health care makes you sick.

Scared patient in the waiting room.

Not knowing what will happen at the doctor can frighten some anxious patients.

By July 1, 2014 | 8:57 a.m. EDT

If you’re like most people, you don’t exactly love visiting the doctor. But for some, the anxiety they experience is so overwhelming they avoid any form of health care whatsoever – in some cases for decades.

Beyond Reluctance

David Yusko, clinical director at the University of Pennsylvania‘s Center for the Treatment and Study of Anxiety, treats patients with iatrophobia ​– the medical name for fear of doctors. He says the phobia probably affects about 3 percent of the population.

Such people can be helped by exposure therapy – in which they’re gradually confronted with medically related images, items and scenarios in rising order of fear-provoking power.

When Yusko treats these patients, he says their anxiety is obvious: “They’ll wring their hands; they’ll cross their arms or legs; or they’ll try to turn their body away from the image or hide their eyes from it. They’ll talk about their heart beating quickly, their hands getting sweaty and feeling dizzy or nauseous.”

Cascade of Fear

The biggest fear for many patients is fear of the unknown, says Andrew Rosen,​ director of The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida. Needle phobia is also common, Rosen says, above and beyond the distaste most people have when faced with an injection or blood draw. When he talks patients through exaggerated fears, it often turns out they’ve imagined excruciating pain that could last for hours.​

“The person doesn’t know what’s going to happen to them once they step in the door. Usually a person who’s anxious fills in the blanks with bad things: ‘I’ll be hurt.’ ‘I’ll be mistreated.’ ‘I’ll be diagnosed with some terrible disease,’” Rosen says. “It’s the fear of pain, bad news, cancer, the hospital.” It’s a cascade in which a patient could go “from A to Z in two seconds,” he adds.

Anticipation Equals Dread

Doctor anxiety wasn’t an issue for Virginia Lounsbury​, of Gulf Stream, Florida, until 2009, when she was hit with a debilitating illness at age 38. She underwent a barrage of treatments and multiple hospitalizations until the life-changing diagnosis – postural orthostatic tachycardia syndrome, or POTS, a rare genetic condition – came 2.5 years later.

By then, she had developed a full-blown fear of doctors and health care facilities. It reached the point where she needed help managing her anxiety, which brought her to Rosen’s center.

Rosen walks Lounsbury through scenarios in advance, starting with her rising anxiety as the car enters the parking lot and she approaches a medical center. “It’s a building – it’s concrete,” she recalls him saying. “You can’t be afraid of concrete.”

Because she’s claustrophobic, spending 90 minutes in an MRI tube is among her least favorite experiences. But for Lounsbury, the waiting room is the hardest part. “All those TVs [are] on – any doctor you go to,” she says. “And it’s all this medical news, which is never good.” She describes hearing dire cancer statistics emanating from a TV as she once waited her turn for a mammogram.

​To cope with future visits, she and Rosen came up with a plan: Pack a bag with items for distraction, find a quiet waiting room corner away from the intrusive TV and read, do needlepoint or check email.

Ah, the Dentist

One underlying cause of doctor fear is the increasingly impersonal nature of health care, according to Rosen. But when it comes to dental care, the experience may be too personal.

“If I’m going to work on you as a dentist, I’m going to get pretty close,” says Matthew Messina,​ consumer advisor for the American Dental Association. “There’s kind of that invasion of personal space aspect. So I have to respect that in patients.”

With extremely phobic patients, he says, most have had some bad experience recently or in the past, perhaps with a dentist or while in the hospital, and the memory could be long repressed. “They may have been restrained in the emergency room,” he says. “Those kinds of things can create very deep-seated fears where dentistry and medicine all sort of get lumped together.”

Messina, who has a private practice in Fairview Park, Ohio, says he wishes dentist avoiders would put aside their fear long enough to sit down in his office – just to talk. “We have to confront the fear and name it,” he says. “Then we can have a chance at overcoming it.’”

Motivation to Change

Getting someone with extreme fear back into the health care system is a hard sell. Rosen recalls a patient in her 50s who hadn’t had a breast cancer screening or seen a gynecologist in 25 years.

For some patients, it takes a crisis like a heart attack or appendicitis to accept treatment. Others finally acknowledge the need for preventive care and routine screening. Yusko says he’s had several cases of women whose plans to eventually have children motivated them to overcome their medical fears.

Exposure Therapy in Action

With exposure therapy, Yusko says patients confront a hierarchy of anxiety in the safe, supportive environment of his center. Images – of stethoscopes or syringes, for instance – would be lower-hierarchy items. From there, therapy could move on to viewing videos or TV shows like “Grey’s Anatomy” that feature medical procedures.

Next, the patient might stand outside the hospital in the parking lot. Actually seeing a needle, or being in the same room as a needle, would be another step. And because a nurse works in the center, Yusko says patients get a chance to come face to face with a medical professional.

Other Treatment Options

Different types of talk therapy and relaxation techniques may also help. While medications can ease short-term anxiety, they don’t address the root of the doctor phobia and most often aren’t needed, physicians say.

With dentistry, the situation is somewhat different. Messina says some patients may benefit from techniques including medication, biofeedback and hypnosis. For procedures like wisdom-tooth removal, sedation may be warranted, he says, but there is a risk-benefit ratio involved, and “using sedation to clean someone’s teeth [is] probably a higher level of medical risk than we’d like to take on.”

Dealing With It

Of their patients who’ve gone through exposure therapy, the vast majority can now manage their anxiety and receive medical care, Yusko and Rosen say.

Lounsbury, who’s started a foundation to help others with her condition, says she’s coping better with her anxiety. Acupuncture works for her (for those scared of needles, laser acupuncture or acupressure are alternatives). To people who share her fears, she offers these words of encouragement: “The main point is, wherever you are, it’s only temporary. Nobody’s ever gone to the doctor forever.”

Reference: http://health.usnews.com/health-news/patient-advice/articles/2014/07/01/how-to-overcome-extreme-fear-of-doctors

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