All Posts Tagged: anxiety

woman wearing facemask amid coronavirus particles

Navigating The Pandemic Paradox

Sometimes it seems as if we’ve all become trapped in a movie that is playing out worldwide. The coronavirus pandemic is like nothing we’ve ever seen before and has indelibly changed our lives. This time last year, people would have laughed if you’d predicted the shuttering of schools and businesses, that face masks would become a fashion statement, or that our normal lives would be turned upside down so completely. Yet, despite this upheaval, there are still good things that have come from the pandemic.

Is There A Pandemic Silver Lining?

One of the things I have been hearing a lot is how the pandemic has allowed people to step back and “reset.” We’re learning what is important to us. In many ways, this “time out” from our day to day schedules has brought us closer together.

One of the most significant changes are the family ties that formed or were remodeled once our hectic lives were halted. Parents and kids have finally been able to spend time as a family without extracurricular activities taking precedence. Parents who are working from home have extra time to interact with their children now that they don’t have to commute. Most children aren’t going off to summer camps or day camps this year, so families are vacationing together.

People have had the chance to start hobbies, adopt pets, and broaden their world by trying new recipes. They’ve been virtually visiting museums and art galleries, and finding creative ways to keep in touch with loved ones.

Carbon emissions are down thanks to reduced commutes. People are rethinking their careers, saving more money, decluttering, and finally working through their to-do lists.

Even silver linings come with stress, though.

The Pandemic’s Harmful Effects On Mental Health

There are clear concerns for people’s mental health as the virus continues to affect the world. Initially, the skyrocketing death rates made everyone anxious that they or a loved one could be the next victim. Then, stay-at-home orders magnified our sense of losing control. We saw this play out in the form of panic buying and hoarding. Lastly, the implosion of the economy and the massive layoffs and job losses have dampened hopes of a quick recovery.

The Centers for Disease Control and Prevention (CDC) reports that the mental health effects of all the stress that has come from coping with the pandemic could include:

  • Disturbances in our patterns of sleeping or eating
  • Problems concentrating
  • Anxiety about our health and that of our loved ones
  • An increase or worsening of mental health conditions
  • Deterioration of ongoing health problems
  • An increase in the use of alcohol, tobacco, or other drugs

There are also physical symptoms of anxiety that can include:

  • Nausea and sweating
  • Muscle tension
  • Shortness of breath or a rapid heartbeat
  • Headaches or an increase in migraines

Not everyone will have experienced these pandemic anxiety concerns because we all react to stress differently, but some people may be dealing with several of these challenges – particularly if they suffered from anxiety or depression before the pandemic.

Self Care For Pandemic Anxiety

  • Try to distract yourself. I know there are restrictions in some areas and more being put back into place, but you have online options for such things as cooking classes, music lessons, learning a language, yoga or meditation. Look up virtual options for visiting the museums you’ve always dreamed of or places you’ve always wanted to see (Google Earth and YouTube are great platforms for this).
  • Don’t scrutinize every physical symptom. This is allergy season, plus there are always summer colds out there. Remember that a cough is likely just a cough and not an indicator that you have COVID-19, especially if you have been cautious and isolating yourself from others.
  • Turn off the news stations. News reports can start catastrophic thoughts racing and dramatically increase your anxiety. By constantly watching news coverage of the pandemic, you never get a mental break. Remember that news reports are designed to make you tense and concerned – it’s what keeps you clicking on the news websites or tuning into to their broadcasts to find out what’s happening.  

Professional Help For Pandemic Anxiety

Sometimes, however, self-care is not enough to get relief from anxiety. If your anxiety seems to be increasing as the coronavirus pandemic continues, you may have developed an anxiety disorder. If your symptoms get worse or continue for longer than two weeks, please speak to one of our trained mental health professionals. We offer both virtual / online and in-office treatment options.

For more information, please contact The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida at 561-496-1094 today. 

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Coping with COVID-19

Coping With COVID-19

The virus pandemic has certainly had an impact on all of us. Not being able to meet with my patients in person has required a major clinical adjustment. Thankfully, telemedicine has provided me with the ability to provide necessary ongoing treatment. But I also know firsthand how difficult and taxing social isolation and sheltering in place can be.

What has made this viral illness so stressful? After all, we have been dealing with annual episodes of influenza for decades. We also successfully made it through the fears of the bird flu, SARS, and swine flu. What makes Covid 19 so special and so scary? Covid 19 is called a novel virus because it is a protein that is totally new to the world’s human population’s immune systems. Our immune systems therefore do not have the capacity to adequately fight off this infection. The elderly and those with chronic illnesses are especially at risk. But 20 to 65 year olds are not immune from infection and risk severe illness if they are not cautious and follow CDC guidelines.

We can all agree that there are reasons to be fearful of this unique virus. We would all agree that sheltering in place and social isolation plays a role in our unease and insecurity. The inability to see loved ones and friends certainly takes a toll. Job loss and the subsequent financial stressors contributes as well. Lack of definitive treatment or a protective vaccine adds to our worries. But the level of emotional unrest seems to be much greater than what these issues would suggest. So what accounts for our level of apprehension?

It is my belief that our emotional upset and fearfulness is being fueled by an incessant level of media exposure, a 24/7 bombardment of our senses by vivid and at times sensationalistic accounts of the impact of this illness on our society. The negativity is inescapable. The drama can be horrifying. I do believe that we are being psychologically traumatized by the effects of this multi-sensory media explosion. Modern theories of post traumatic stress disorder have now implicated the impact of day to day low level traumatic experiences. We certainly deserve to be kept up to date, but non-stop communication of human suffering at this level can be seriously problematic.

So what can we do to minimize the stressors of these times? The answers are rather straight forward and simple. When the world around you seems out of control, frightening and foreign it is important to pay attention to our own personal world and life space. You may not be able to change what is outside of you but you certainly can have the ability to influence your own world. These are some basic guidelines to follow:

  1. Add consistency, structure and predictability to your day to day life.
  2. Go to bed at the same time every night and awaken at the same time the next day.
  3. Schedule exercise, studying, work (if you are lucky enough to still be working), meals, fun etc. at set times.
  4. Get outside while following CDC guidelines on a regular basis, even if it means sitting on a balcony or patio for extended periods.
  5. Do not allow yourself to isolate. Maintain social contacts through phone calls, video chats, emails, etc. Socialize with a friend or family member while maintaining the appropriate safe distance.
  6. Limit your news media exposure. Get the data you need to be adequately informed but don’t give in to the tendency to be a news voyeur. Sensationalistic news coverage can be addicting. Be careful and avoid over exposure.
  7. Attend to your basic activities of daily living that include your appearance and hygiene, maintaining healthy nutrition and caring for your living space.
  8. And most importantly, recognize that this period of difficulty and sacrifice will come to an end.

There will be life after Coronavirus. At some point in the near future, this virus will be treated no differently than the annual influenza virus. The same way that pharmaceutical companies formulate the year’s flu vaccine by taking into account the types of flu viruses prevalent that year, it will also include the coronavirus as part of the vaccine recipe.

The real challenge for the future will consist of what we can learn from this experience. How can we be better prepared? How can we improve our healthcare system and its inequities? How can we maintain the improvement in our environment that has resulted from reduced pollution, crowding overuse of natural resources? How can we return to person to person human contact and minimize communication through digital media only? How can the media learn to balance coverage with more hope and support? I wish that I had the answers. We shall have to wait and see.

For more information , please contact The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida at 561-496-1094 or contact us here.

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Man wearing face mask

Stress Relief For Dealing With COVID 19 Anxiety

The worldwide outbreak of COVID 19 has thrown everyone into chaos. For starters, we’re all worried about catching the virus. Some of us are dealing with financial stressors due to layoffs. Then there is the strain of having kids and spouses at home 24/7. In addition, medical workers are caring for numerous sick and dying patients, as well as the fear of bringing the virus home to their families. For many of us, this sudden upending of the world we knew has led to unprecedented anxiety levels and an inability to cope with it all.

Taking Control Of Your Coronavirus Anxiety

We all have natural reactions to the fears and stressors in our lives. We want to feel better, so we turn to certain behaviors to try to settle ourselves down.

There are, however, both positive and negative coping behaviors. For example, exercise can be a positive coping method, while excessive drinking is a negative response.

How we choose to cope also varies because stress is made up of several components. Each aspect causes us to respond differently, yet they each can affect us deeply.

  • Psychological stress – The fight or flight response is activated under the psychological stress of fear. For some, there may be reactions in the body, such as a pounding heart, racing pulse, or headache. Others experience a cognitive response, including confusion or obsessively thinking or worrying about the stressor.
  • Physical stress reactions -If you have underlying physical conditions (irritable bowel syndrome, migraines, or asthma, for example), you may find those symptoms coming up more frequently when you are under stress. You also might be constantly fatigued or may have difficulty sleeping.
  • Emotional stress response – You may feel numb or, conversely, you might be jumpy or angry and find it difficult to turn off your fearful thoughts. You might also unintentionally withdraw from others as a way to protect yourself emotionally.

Self-Care For Coronavirus Stress

We can actually amplify our own responses by dwelling on our fears. While it is perfectly natural to worry and ask “why” or “what if,” fixating on trying to find the answers only increases our anxiety, which escalates our frustration and emotional responses.

To help reduce your anxiety about COVID 19:

  • Turn off the news – and especially don’t watch it right before you go to bed. If you start watching news coverage then, you are more likely to start your mind running again, which means you may ruminate on the upsetting facts and figures while trying to sleep. Instead, pick a time earlier in the day to watch news updates. Then turn off the news (or shut down the internet) and do something enjoyable to help your emotions settle down.
  • Do the same with emails and social media – try to compartmentalize these activities so that you aren’t constantly going back to them throughout the day. If possible, spend an hour on them earlier in the day (you may need to set a timer!), then shut them down. Don’t go back to them until the following day.
  • If your anxiety is waking you in the middle of the night, get up and write down your thoughts. It can be helpful for you to put pen to paper because the act of writing your fears and worries often makes you feel like you have gotten them out and can let them go.

The antidote to anxiety is to get out of your head and get into your body. Grounding exercises, like those used in mindfulness, can help you settle your physical body down and take your mind (or emotional body) out of the trauma.

By “settling down,” I mean to calm down into your body by turning your attention inward to the feeling of your breathing. In focusing on the physical, you distract yourself from the emotional component of stress.

Things that require the sensation of touch – like knitting, kneading dough, folding laundry, or exercising – can also help to let you turn the upsetting thoughts off so you can let them go.

Here is a simple mindfulness exercise to try:

  • Sit in a straight-backed chair, glasses off, eyes closed or using an unfocused gaze.
  • Put your feet flat on floor.
  • Feel your feet on the floor, noticing the connection between the soles of your feet and the floor.
  • The idea is to engage your senses, so make an effort to feel your legs and back against the chair and your shoulders opening wide.
  • Sit up, but don’t be rigid. Don’t lean forward or push back against the chair, just relax.
  • Breathe slowly and calmly. This activates the relaxation response because slowing your breathing tells your body that there is no reason for alarm.
  • If you notice any pains or twinges, just acknowledge them and let them go. Bring your awareness to just below your navel and try to feel your body from the inside out.
  • As you feel your body and center your thoughts on it, imagine the tension and energy of your racing thoughts coming down into your abdomen.
  • Now, picture this energy sinking down through your legs and feet and flowing out into the floor or ground below you. Simply focus on relaxing and letting go.
  • Let any thoughts that come up float by. Don’t give them any emphasis or attention. Don’t judge yourself for having them.
  • Take a few moments to enjoy the release of your tension. Focus on your slow breathing.
  • When you are ready to tune in to the world again, press your feet gently against the floor, wiggle around slightly, gently shake your hands and then open your eyes.

We Can Help You Feel Safe

If you try these ideas for self-care and are still struggling with anxiety, know that many practitioners are continuing to see patients virtually during the pandemic. If your stress is interfering with your daily life and has continued for longer than two to three weeks, it’s time to reach out and get the help you need.

For more information, please contact Dr. Andrew Rosen and The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida at 561-496-1094 today.  

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Transcranial Magnetic Stimulation

Transcranial Magnetic Stimulation: High Tech Help For Treatment Resistant Mood Disorders

Despite therapy and the use of medications, we occasionally find that the effects of a mental health disorder persist in some people. For these individuals, brain stimulation therapies like transcranial magnetic stimulation (TMS) may provide relief from their symptoms. TMS may also be an alternative for those who cannot tolerate mood stabilizing medications.

The National Institute of Mental Health (NIMH) reports that TMS and other brain stimulation therapies “involve activating or inhibiting the brain directly with electricity.” TMS is the most noninvasive of these treatments and is given via energy pulses that are generated by an electromagnetic coil held near or against the person’s head.

Because these magnetic pulses are given over and over in a repetitive rhythm, the most technically correct term for TMS is repetitive transcranial magnetic stimulation (rTMS).

What Is Transcranial Magnetic Stimulation Used For?

In 2008, the Food and Drug Administration (FDA) approved repetitive transcranial magnetic stimulation to treat major depressive disorders and their associated cases of severe depression and anxiety. It has also been studied as a therapy for psychosis and researchers are looking into how it may help conditions like post traumatic stress disorder (PTSD). Additionally, another form of rTMS, called deep transcranial magnetic stimulation (dTMS), has been FDA-approved for the treatment of obsessive compulsive disorder (OCD).

In 2010, the NIMH funded a clinical trial on the effectiveness of transcranial magnetic stimulation. Initial results showed that the effectiveness of rTMS was around 14 percent compared with a placebo-type procedure, which was only 5 percent effective. However, when participants were put into a second-phase trial, the remission rate of rTMS increased to 30 percent.

How Does A TMS Work?

When you go through a session of rTMS, you will be fully awake. Each session lasts between 40 and 60 minutes and no anesthesia is required. It is an outpatient procedure so you can drive yourself to the appointment and back home again. Typically, a person is treated four to five times per week for between four and six weeks.

During the rTMS session, an electromagnetic coil, which is about the size of your hand, will be passed over your forehead and scalp along the region of the brain thought to regulate mood. This coil produces short electromagnetic pulses similar in strength to the ones generated by a magnetic resonance imaging (MRI) machine. According to the Anxiety and Depression Association of America (ADAA), “The magnetic pulses cause small electrical currents that stimulate nerve cells in the targeted region of the brain.”

As scientists gain more knowledge about how rTMS can help people, they are developing new treatment methods. In fact, the FDA has sanctioned the use of theta burst stimulation, which is a variation of rTMS. In the theta burst procedure, the person only receives transcranial stimulation for about 10 minutes per session, however they still need to have daily sessions for several weeks.

In addition, another form of rTBS, called iTBS or intermittent theta burst stimulation, is now being given in 3 minute treatments. iTBS (also FDA-approved) gives intensive bursts of high frequency stimulation and has shown results comparable to the customary rTMS therapy.

Does TMS Therapy Hurt?

While rTMS therapy doesn’t hurt, the person may feel some mild sensations as the electromagnetic pulses are administered. These sensations might include:

  • A light knocking or a mild tapping feeling on their skull.
  • The muscles in their face, jaw, or scalp tingling when the magnet is applied.
  • These same muscles contracting while the magnet is in use.

Is Transcranial Magnetic Stimulation Safe?

Although most people do very well with it, rTMS does have some temporary, mild side effects for a small number of people. They can include:

  • Mild headaches
  • Lightheadedness
  • Scalp discomfort

Rare, but possible, is the chance of a seizure, however no seizures were reported during the two large studies that have been done on the safety of rTMS, according to the NIMH.

Additionally, Johns Hopkins reports that people who have non-removable metal objects in their head (for example: stents or aneurysm clips) should not receive rTMS. This is because the magnets can cause these objects to move or heat up, which could produce a serious injury or even death.

It’s worth noting that because transcranial magnetic stimulation is relatively new, we haven’t been able to study its long term effects. That said, treatment data has been compiled and studied since the mid-1990s and there have been no long term complications from its use, to date.

We Can Help

If you are struggling with anxiety, depression, or other mental health concerns, consider speaking with the professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida. For more information on how we can help, contact us or call us today at 561-496-1094.

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toddler with social anxiety

Social Anxiety in Toddlers

Toddlerhood is defined as the age range from 12 to 36 months. During this period, a child’s emotional and cognitive development grows by leaps and bounds, as do their social skills. This also coincides with the time when children are likely to go into a daycare environment or head off to preschool. As they engage more often with other children and adults, it may also be the stage when a toddler’s social anxiety begin to emerge.

Just as with adults, some children are comfortable with social interactions while others may not be. Each group of kids will have the social butterfly as well as the “shy” child who quietly observes and doesn’t interact as much. It is one thing to be shy, however, and another to be intensely fearful and anxious in a social setting. Because we know it can show up early in life, a toddler who shows such strong reactions in a social environment is often regarded as having social anxiety.

What causes social anxiety in toddlers?

We aren’t really sure what causes social anxiety in toddlers. Genetics likely plays a role, since it contributes to a child’s temperament and personality. We also know that some genetic traits can influence certain mental health conditions.

A toddler’s environment could also predispose them to social anxiety. For a young child who already has a higher genetic risk, living with trauma or a severe parenting style may be enough to initiate social anxiety. Social anxiety may also be learned from a parent, according to a 2006 study by de Rosnay, et al. Their research focused on indirect expressions of a mother’s social anxiety on their infant. The results showed that, “compared to their responses following their mothers interacting normally with a stranger, following a socially anxious mother-stranger interaction, infants were significantly more fearful and avoidant with the stranger. Infant-stranger avoidance was further modified by infant temperament; high fear infants were more avoidant in the socially anxious condition than low-fear infants.”

Is social anxiety a form of autism?

Studies have shown that social anxiety is not a form of autism, although the two have overlapping indicators, such as separation anxiety and avoiding eye contact. In fact, not only are they two distinct disorders, but the symptoms and diagnostic criteria for each are vastly different.

As the name implies, social anxiety is driven by anxiety. A child who has social anxiety will function within the parameters of their level of unease. For instance, they may simply keep to themselves, avoid other children, or might talk too quietly. Some kids may not talk at all.

On the other hand, a child with autism spectrum disorder doesn’t behave based on their anxiety level. Instead, this child has trouble understanding social cues and the nuances of communication. They might speak too loudly, may push their way into a group of children, or might misinterpret facial expressions or gestures.

Does my kid have social anxiety?

Children who have social anxiety may be branded as difficult kids because their anxiety can show up in forms other than just in social interactions.

Toddlers with social anxiety often show certain signs, such as:

  • Being a picky eater
  • Easily startled by noises
  • Not adapting well to new situations
  • May have a higher sensitivity to tactile sensations
  • Acting shy around new people and fearing strangers
  • Disliking being separated from their parents (separation anxiety) and distraction doesn’t calm them
  • Having strong emotional reactions and difficulty self-soothing
  • Might have sleep issues
  • Seems afraid to interact with peers, both individually or in a group setting
  • Often has other phobias or fears

How to help a child with social anxiety

At home, parents can demonstrate healthy social interactions when their child is with them, so the toddler learns not to be so fearful.

They can also rehearse a new situation with their child before it comes up. For example, a toddler who will be going to daycare for the first time might role-play some of the things they’ll do while they are there. Practicing certain aspects of the day or even dropping by the daycare a couple of times before officially attending can ease fears because the daycare will already be familiar. It would also be helpful to let the teachers or caregivers know about your child’s fears, so they can help build confidence.

Other supportive methods include:

  • Encouraging your toddler, but not forcing them in social interactions
  • Using praise when the child successfully navigates a scary situation
  • Not criticizing them for their fears
  • Being calm and showing the toddler that you are confident
  • Not being overprotective, which only reinforces the idea that the toddler has something to be afraid of
  • Reading books or watching videos that show confident children

Have Further Questions?

If your toddler is experiencing social anxiety, the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida, can help. For more information, contact us or call us today at 561-496-1094.

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Why We Dread Bedtime When We’re Anxious

Why We Dread Bedtime When We’re Anxious

For those who struggle with anxiety and insomnia, lying in bed at night can be dreadful. Before getting into bed for the night, many will describe allowing themselves to have a nice, relaxing evening. They may feel relatively low stress or little to no anxiety. But, as soon as the lights turn off for the night, the brain turns on with a vengeance. Now you’re in bed, wide awake, worrying about any and every possible negative outcome in the days, weeks, months and even years ahead.

What’s more, anxiety at bedtime often becomes anxiety about sleep. The focus then shifts to trying to sleep, which puts us in a frustrating paradox because sleep is an automatic process that we cannot force.

What’s really keeping us awake at night? Why does our anxiety have such a propensity to attack us when we try to sleep?

Read the full post by our very own Dr. Brand here.

Let Us Help

If you are suffering from anxiety, get help from our mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida. To get answers to your questions or for more information, contact us or call us today at 561-496-1094.

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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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