All Posts Tagged: cbt

Can Virtual Reality Therapy Treat Eating Disorders?

Eating disorders affect a person’s physical and psychological functioning differently than any other mental health disorder. Once thought to be a problem of the wealthy, eating disorders are now known to impact various cultures, socioeconomic statuses, ages, and genders, and can be found worldwide.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) characterizes people with eating disorders as having “pathological eating habits and a tendency to overestimate their weight and body shape.” Eating disorders are not to be taken lightly: patients with an eating disorder faces a high risk of medical and psychological effects, along with the possibility of death if their condition becomes severe enough.

Eating disorders are also more common than you might think. In fact, a 2007 survey by Hudson, et al., noted that about 1.5% of American women (0.5% of men) experience bulimia nervosa, about 0.9% of women (0.3% of men) have been diagnosed with anorexia nervosa, and roughly 3.5% of women (2% of men) struggle with binge eating disorder.

Until recently, eating disorders have been treated mainly through cognitive behavioral therapy (CBT). New advances in the emerging field of virtual reality therapy (VRT), however, are being combined with traditional therapy and show promise for more effective treatment.

How Does VRT Work?

Virtual reality therapy is a high tech approach to helping people learn effective ways to cope with the fearful situations they dread. During VRT, you wear a virtual reality headset that looks similar to the type you’d use when playing video games. The therapist plays a simulation program that displays avatars in a variety of anxiety-provoking settings, such as in a restaurant or a store dressing room for those with an eating disorder. These settings are low stress to begin with, then stress levels are increased as you become more desensitized to the worrisome scenario.

You use a virtual “body” during VRT. Although this avatar isn’t really “you”, studies show that people feel a close enough association to the avatar that they emotionally respond as if they were in the actual setting. In this way, they can address their eating disorder and work through their body-image issues in a safe, controlled environment. The psychologist listens in during the session to coach, help with relaxation techniques and provide coping skills. They also can control the environment and either stop the program or lower the stress level if you become too upset.

How Effective is VRT for Eating Disorders?

Virtual reality exposure therapy gives people an experience that is just real enough to trigger an emotional response to their eating disorder, but is it effective?

In 2017, DeCarvalho, et. al., did a systematic review of several studies that used virtual reality therapy for binge eating and bulimia nervosa (BN) treatment. One of the studies they analyzed was done by Perpina, et. al., and focused on treatment with a combination of VRT and cognitive behavioral therapy (CBT) versus treatment with CBT alone. The study found that the “VR treatment group showed more BI [body image] improvement than CBT and greater improvement in the behavior clinical measures. At post-treatment, the VR group improved on body attitudes, frequency of negative automatic thoughts on BI, body satisfaction, discomfort caused by body-related situations and BN symptoms (measured by Bulimic Investigatory Test; BITE). These results were maintained or continued to improve (body attitudes, frequency of negative automatic thoughts on BI) at one-year follow-up.” All participants improved in the eating disorders measures and it was also maintained at follow-up.

In a different study, a body-swapping illusion was used in conjunction with virtual reality. Women with body image anxiety were asked to estimate their own body size before participating in two different body-swapping scenarios. In both illusions, the women were shown a virtual image of themselves with skinny stomachs.

The theory was that it may be possible to modify a person’s allocentric memory (a type of spatial memory in which the person mentally manipulates objects from a stationary point of view) for the positive. Indeed, after going through the virtual scenarios, the women in the study reported a decreased estimated body measurement and assessed their body size more accurately than before participating in the illusion.

Get Help for Eating Disorders

Eating disorders impact a person’s biological and psychological functioning in ways unlike other mental health disorders. If you are struggling, we can help through both traditional and virtual reality therapies. Talk to the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida today. For more information, contact us or call us today at 561-496-1094.

Reference:

Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007 Feb 01;61(3):348–58. doi: 10.1016/j.biopsych.2006.03.040. http://europepmc.org/abstract/MED/16815322. [PMC free article] [PubMed] [Cross Ref]

De Carvalho, M. R., Dias, T. R. de S., Duchesne, M., Nardi, A. E., & Appolinario, J. C. (2017). Virtual Reality as a Promising Strategy in the Assessment and Treatment of Bulimia Nervosa and Binge Eating Disorder: A Systematic Review. Behavioral Sciences, 7(3), 43. http://doi.org/10.3390/bs7030043

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Midlife Anxiety

Patient in need of In Vivo Exposure Therapy.A 2014 study by the British government found that while most people of all age levels are generally content with their lives, those in the middle age years – between the ages of 45 and 59 – are the least happy. These respondents reported low ratings of overall happiness and life satisfaction and a sharp increase in midlife anxiety. Interestingly, even adults aged 90 and older reported being happier and more satisfied than the middle aged group.

What Causes Anxiety in Middle Age?

The U. K. study, done by the Office of National Statistics, analyzed data from more than 300,000 respondents during a three-year period from 2012 to 2015. It generated average scores for specific areas including happiness, life satisfaction, anxiety, and the feelings of being worthwhile. The scores showed that anxiety levels were highest for people between the ages of 40 and 60. The peak anxiety levels were noted in those in the 50 – 54 age group.

Many things can cause midlife anxiety, ranging from underlying health problems to financial concerns. In women, even the fluctuating hormones of menopause and perimenopause can change the chemistry in their brain and bring on anxiety and panic attacks.

For men, while many are aware that anxiety disorders exist, very few realize how often anxiety affects them. Men often refuse to admit to themselves or others that they might have a mental health issue and may seek out unhealthy ways to cope (example: alcohol use) rather than admit to the concern.

There is no one specific trigger that causes midlife anxiety. Instead, people who experience anxiety in middle age are often burdened with simultaneous stressors that other generations aren’t facing: the raising of children, while at the same time trying to hold down jobs and care for elderly parents. Top this off with the financial pressures of putting children through college, empty nest syndrome, and facing worries of possibly not having saved enough for a retirement that is drawing ever closer, and stress rises even higher.

Midlife Anxiety Treatment

Self-help:

One of the best ways to manage anxiety is to reduce your stress. There are several things you can do to accomplish this and a side benefit is that they are also good for your overall health:

  • Get daily exercise. The newest research recommends that we all do some type of aerobic exercise at least 30 minutes a day, a total of 5 days per week. Regular physical exercise causes the brain to release serotonin, the “feel-good” neurotransmitter. Serotonin helps to reduce stress, improve your mood, and gives you more energy. Low-impact exercise, such as swimming, yoga or walking are great examples of workouts that will help raise your serotonin levels.
  • Make time for relaxation. When your days are filled with rush, rush, rush – getting the kids to school, getting yourself to work, finishing projects, taking the kids to after-school activities – relaxation time can be hard to come by. Yet, relaxing is crucial to reducing anxiety and stress levels. Try to set aside time every day, just for yourself. Relaxation can come from simple activities that you look forward to, such as soaking in a warm bath at the end of your day or taking a few minutes to read, meditate or listen to some soothing music.
  • Silence your phone and put away your laptop or tablet (or at least turn off all but the most important alerts). Limit your use of social media and reduce the amount of time you spend reading the news. We’re so used to having our electronics with us at all times, but getting constant notifications and reading endless news reports about crime, wars, and world problems can keep you from truly relaxing. Give yourself an electronic break every day.
  • Visualize yourself in a peaceful setting. Your brain can’t distinguish between a real setting and one you visualize, so reduce your stress by imagining yourself on a tranquil beach or in a beautiful forest. Smell the salt air at the beach or the pine trees in the woods, imagine the sound of the waves on the sand or the birds singing in the forest. Being as specific as you can and really trying to imagine all the aspects of the setting can take you away from your stressors and help you unwind.

Professional help:

When you have anxiety, it’s easy to become overwhelmed by your emotions. When that happens, people tend to react to certain aspects of their lives in a more negative way. It is common to begin to avoid the situations or experience that make you anxious, but that avoidance can actually increase anxiety.

If self-help to reduce your midlife anxiety isn’t working any longer, consider seeing a mental health professional, particularly if your anxiety is causing you extreme distress or disrupting your daily life. Anxiety is treatable and the majority of people who seek help are able to improve, reduce or eliminate their anxiety symptoms after working with a psychologist to address their own, specific concerns.

Cognitive behavioral therapy (CBT) is a form of psychotherapy that is very effective for treating anxiety in middle age. CBT helps you understand how your own negative thoughts contribute to your anxiety symptoms. By learning to recognize these negative thought patterns, you can change them, which allows you to manage your symptoms. Additionally, cognitive behavioral therapy teaches you skills and techniques for coping with your midlife anxiety.

CBT is often used in conjunction with exposure therapy. Exposure therapy allows you to gradually confront your fears in a safe environment and in a way that gives you control. When you face your fears without harm, you reduce your anxiety by learning that the outcome you feared is unlikely to happen.

Get Help for Midlife Anxiety

If you’re feeling overwhelmed and facing midlife anxiety, we can help. Talk to the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida today. For more information, contact us or call us today at 561-496-1094.

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Adult ADHD

Attention Deficit Hyperactive Disorder or ADHD is a medical disorder involving abnormalities in brain function. Often, this disorder can be passed genetically through families from one generation to the next. The condition is generally diagnosed in childhood, however we now know that ADHD commonly continues into adulthood. Although the hyperactivity component usually subsides in adults, attention and concentration problems often persist. If not caught in childhood, adults often become suspicious they may have adult ADHD when their children is diagnosed, and they recognize the same set of symptoms in themselves.

The Centers for Disease Control (CDC) estimates that approximately four percent of adults have the disorder. The risk increases in those people who have close blood relatives (parents, siblings, etc) who also have ADHD, in people who were born prematurely or were exposed to environmental toxins, or those who were born to mothers who smoked, drank alcohol, or abused drugs during their pregnancy.

Signs of ADHD in Adults

The following can be warning signs of adult ADHD:

  • Reckless driving or frequent traffic tickets or accidents
  • Problems paying bills on time
  • Job hopping or habitual unemployment, being late to work frequently, trouble staying on task if you’re distracted by emails or phone calls
  • Alcohol or substance abuse problems
  • Some marital troubles, especially if your partner grumbles that you don’t listen to them or that you don’t honor promises you made to them
  • Frequently forgetting appointments, forgetting to run errands or do things like getting gas or picking up something from the grocery store on the way home
  • Underestimating the amount of time it will take to complete a task
  • Making impulsive or irrational decisions
  • Having trouble starting or completing projects at work or at home
  • Being tense or edgy or being prone to angry outbursts, even over minor problems

ADHD Symptoms in Adults

The signs that are so telling for ADHD in children are often more subtle when you reach adulthood. The Centers for Disease Control (CDC) has a comprehensive list of criteria for adult ADHD symptoms. If five or more of the symptoms on each list are present now and were noticeable before the age of twelve, if they have persisted for more than six months, and if you are age 17 or older, you may have adult ADHD:

  1. Inattention: Five or more symptoms of inattention for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
    • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
    • Often has trouble holding attention on tasks or play activities.
    • Often does not seem to listen when spoken to directly.
    • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
    • Often has trouble organizing tasks and activities.
    • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
    • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
    • Is often easily distracted
    • Is often forgetful in daily activities.
  2. Hyperactivity and Impulsivity: Five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
    • Often fidgets with or taps hands or feet, or squirms in seat.
    • Often leaves seat in situations when remaining seated is expected.
    • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
    • Often unable to play or take part in leisure activities quietly.
    • Is often “on the go” acting as if “driven by a motor”.
    • Often talks excessively.
    • Often blurts out an answer before a question has been completed.
    • Often has trouble waiting his/her turn.
    • Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:

  • Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
  • Several symptoms are present in two or more setting, (such as at home, school or work; with friends or relatives; in other activities).
  • There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
  • The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.

Adult ADHD Treatment

Since the focus of attention deficit hyperactive disorder is normally on children and helping them learn to function through their challenges, if you’ve reached adulthood without an ADHD diagnosis, it may seem silly to consider treatment. However, it is still very important that you address your condition. As noted above, untreated adult ADHD can cause ongoing disruptions in your life, such as workplace or relationship problems, and alcohol or substance abuse.

Adult ADHD treatment can be very effective and can help turn your life around. A combined approach works best. This includes prescribing appropriate ADHD medications to help balance and boost the brain’s neurotransmitters, as well as psychotherapies like Cognitive Behavioral Therapy. CBT teaches life skills in time management and organizational development and provides aids that may allow some people to eventually discontinue their medication. Additionally, couples therapies can be used to help improve communication skills and teach your significant other ways to understand and help with your Adult ADHD condition.

Help for Adult ADHD

It is challenging to have adult ADHD, so don’t go through it alone. The mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida are here to help. For more information, contact us or call us today at 561-496-1094.

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Children’s Mental Health – Psychiatric Help for Children

While we tend to think of childhood as a carefree time of life, the fact is that many children suffer from mental conditions and disorders, just the same as adults. Among other things, children’s mental health concerns can include emotional, behavioral, and mental disorders such as eating disorders, learning and developmental disabilities, Attention Deficit Hyperactive Disorder (ADHA), and autism. And, similar to adults, children can be impacted by conditions like anxiety, depression, Obsessive Compulsive Disorder (OCD) and Post-traumatic Stress Disorder (PTSD). Additionally, as children grow and mature into young adults, they can develop other problems associated with adolescence, such as underage drinking and substance abuse.

Left untreated, any of these conditions or disorders can result in difficulties with making friends, and behavior issues in school and at home. What is most troubling, however, is that research has shown that a majority of adult mental disorders start early in life. This makes it critical that children’s mental health conditions be caught promptly and treated appropriately.

Symptoms of Child Psychological Disorders

Child psychological disorders and conditions can affect any ethnic group, and income level, and those living in any region of the country. In fact, the Centers for Disease Control (CDC) cites a study from a National Research Council and Institute for Medicine report that estimates about 1 in 5 children across the United States will experience a mental disorder in any given year.

Symptoms often change as a child grows and matures, so the signs of a problem may be difficult to spot in the early stages. Often, parents are the first to recognize that there is an issue with their children’s emotions or behavior, however problems may also be brought to your attention by your child’s educators or another adult who knows your child well. Some general signs to look for include:

  • Marked decline in school performance
  • Strong worries or anxiety that causes problems at home or at school
  • Random, frequent physical aches and pains, such as headaches or an upset stomach
  • Difficulty sleeping, nightmares
  • Marked changes in eating habits
  • Feeling hopeless
  • Having low or no energy
  • Aggressive behavior, disobedience, and/or confrontations with or defiance of authority figures
  • Temper tantrums or outbursts of anger
  • Thoughts of suicide or thoughts of harming themselves or others

Psychiatric Help for Children

  • Please get immediate assistance if you think your child may be in danger of harming themselves or someone else.  Call a crisis line or the National Suicide Prevention Line at 1.800.273.TALK (8255).

Getting psychiatric help for children, in the form of early diagnosis and receiving the correct treatment, is essential for your child’s well being, both now and throughout their life.

If your child’s problems persist across a variety of settings (for example: home, school, and with peers), some of the steps to get help include:

  • Talk to your child about how they are feeling. Find out if they would like to discuss a problem with you or another adult. Actively listen to their responses and concerns.
  • Talk to your child’s pediatrician, school counselor or school nurse, or a mental health professional if you see behaviors or problems in your child or teen that worry you.
  • Seek evaluation from a specialist who deals with children’s mental health concerns.
  • Ask the specialist if they have experience with treating the problem or behavior you see in your child.
  • Don’t delay in seeking help – early treatment generally gives better results.

Children can be treated in a variety of settings that range from one-on-one (or with a parent) sessions with a mental health professional to a group setting with a therapist and the child’s peers. Talk therapy can help change behaviors and may be used in combination with other treatments. Cognitive Behavioral Therapy (CBT) has been shown to be very effective in helping children learn coping strategies so they can change unhealthy behavior patterns and distorted thinking. Additionally, medications may be recommended for disorders such as ADHD or may be given for other types of severe or difficult cases.

Need More Information on Children’s Mental Health?

If you have questions or need more information about psychiatric help for children, we can help. The professionals at our child-focused department, The Children’s Center, specialize in child psychiatry and psychology, and other services related to children’s mental health. For more information, contact The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida or call us today at 561-496-1094.

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Complex PTSD

 

The majority of us have heard about PTSD (Post-Traumatic Stress Disorder), the condition that can occur when someone is exposed to a situation over which they had little or no control and from which there was little or no hope of escape. It is often associated with members of the military who have witnessed the horrors of battle, or with people who have endured an extreme physical or emotional trauma. PTSD can occur after experiencing even just one threatening situation, such as being involved in a car accident. But, what about those who have gone through long-term exposure to a continuing, intense level of stress?

Recently, mental health experts have begun to realize there are more layers to the emotional suffering experienced by people who have been through long-lasting stressors like childhood sexual abuse, for example, or years of domestic violence. In cases like these, a PTSD diagnosis partly addresses their condition, but doesn’t adequately define the severe psychological harm that has resulted from the trauma. Therefore, some mental health professionals now believe there should be a new category added to the PTSD diagnosis – one that will encompass this emotional scarring from long-term, chronic trauma: Complex PTSD (C-PTSD).

Even with this new classification, it is important to note that the victims of chronic trauma can have both PTSD and Complex PTSD simultaneously. Here is an easy way to see the differences between the two conditions:

  • A child witnessing the death of a friend in an accident may show some symptoms of PTSD
  • A child who has lived with years of sexual or physical abuse may have symptoms of C-PTSD in addition to PTSD.

CPTSD Symptoms

People who have gone through a long-standing, extremely traumatic situation may exhibit both physical and emotional symptoms related to their ordeal.

Emotional symptoms may include:

  • Rage displayed through violence, destruction of property, or theft
  • Depression, denial, fear of abandonment, thoughts of suicide, anger issues
  • Low self-esteem, panic attacks, self-loathing
  • Perfectionism, blaming others instead of dealing with a situation, selective memory
  • Loss of faith in humanity, distrust, isolation, inability to form close personal relationships
  • Shame, guilt, focusing on wanting revenge
  • Flashbacks, memory repression, dissociation

Victims of C-PTSD may also have physical symptoms, such as:

  • Eating disorders, substance abuse, alcoholism, promiscuity
  • Chronic pain
  • Cardiovascular problems
  • Gastrointestinal problems.
  • Migraines

Help for Complex PTSD

With Complex PTSD, healing cannot happen on its own because the survivor keeps reliving the trauma through flashbacks and dreams. People who suffer from C-PTSD may go for years before making the connection between their symptoms and the chronic stress and trauma they have been trying to cope with. Once they do, healing can begin and many people have been able to overcome their past to find a more meaningful and healthy present.

Cognitive Behavioral Therapy (CBT) has been shown to be highly effective in treating both PTSD and Complex PTSD. This therapy works to change unhelpful thinking and behaviors. It challenges deep-seated patterns and beliefs. CBT therapy helps replace “errors in thinking” (for example: magnifying negatives, minimizing positives, and overthinking) with more realistic and effective thoughts. This serves to decrease both emotional distress and self-defeating behaviors.

EMDR (Eye Movement Desensitization and Reprocessing) is a fairly new therapy that helps specifically in the treatment of trauma recovery and Post Traumatic Stress Disorder/CPTSD. It has been shown to help trauma survivors heal faster than through traditional therapy. In fact, EMDR can be successful in as few as 3-12 treatment sessions. This means that relief from your pain is not only possible but it can be obtained in a relatively short amount of time.

We Can Help

Complex PTSD can be debilitating. Those who suffer from CPTSD may be at greater risk of substance abuse or of deliberate self-harm in order to cope with their emotional pain. We can help! To learn more, contact the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida at 561-496-1094 or email The Center today.

 

 

 

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