WHEN DO ANXIOUS PEOPLE USUALLY COME IN FOR TREATMENT?

menatlhealth.org.uk

The point at which an anxious person seeks help often depends on the specific anxiety disorder, the person's personality, and what's going on in the environment. Here are some general observations:

1.    A person having a panic attack often seeks treatment in response to the attack, thinking she is either losing her mind or having a heart attack. She will typically rush to the emergency room to have it checked out and treated, without recognizing the problem as an anxiety disorder until it is diagnosed. People with panic attacks don't go long without seeking help.

2.    By contrast, people with obsessive-compulsive disorder may go years without seeking help, feeling ashamed of the problem and keeping it a secret.

3.    People with generalized anxiety disorder often accept their worrying as normal. Sometimes they develop somatic symptoms—body symptoms that are manifestations of anxiety. They might feel tension headaches, upset stomachs or bowels, muscle aches, tightness in their chests, and shallow breathing, all of which may be signs of anxiety. Many people who wouldn't see a doctor for worry will see one for somatic symptoms. Often, when a worrier has a particularly difficult life challenge or dilemma, the somatic symptoms are triggered.

4.    People with specific phobias may not seek treatment until the phobia clearly interferes with functioning in a more profound way. For example, someone with a fear of flying may not come in for help until he knows he must fly somewhere for his job.

5.    People with social phobias can have a very troublesome time getting help, as they are fearful of doing things in front of others that will cause them humiliation.

6.    Whether people seek help for acute stress disorder or posttraumatic stress disorder depends on how disruptive the symptoms are to their functioning. Just the thought of talking or thinking about the trauma again can be extremely unsettling, so people avoid seeking help. Often, PTSD sufferers initially attend treatment at the urging of loved ones—more to satisfy someone else than themselves.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

PEOPLE TELL ME THAT I THINK TOO NEGATIVELY. WHAT'S THAT ABOUT AND HOW CAN I CHANGE MY THINKING?

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Many people are in the habit of thinking negatively, but this habit can be altered. Diminishing negative thinking takes a willingness to question old, unhelpful, inaccurate ideas, and practice new, more helpful, accurate ones. Rational Emotive Behavior Therapy (REBT) and Cognitive Therapy , the two main foundations for cognitive-behavioral therapy, provide detailed explanations about the influence of overly negative thinking, as well as strategies for change.

REBT, developed by Albert Ellis, identifies 4 main types of irrational beliefs that all humans hold. These irrational beliefs generate extreme negative emotions and lead to more harmful behaviors. People do better when they challenge their irrational beliefs and develop more rational thinking (see chart ).

Cognitive therapy, founded by Aaron Beck, also holds that all people regularly make “thinking mistakes” known as cognitive distortions. Sticking with distorted thinking tends to make feelings worse; developing more realistic, balanced thinking tends to improve emotions and problem-solving. Here are some of the common thinking mistakes identified (source: Cognitive Therapy: Basics and Beyond by Judith Beck), with examples and alternatives:

Irrational Beliefs(lead to anxiety, panic, anger, rage, fury, and depression with less effective problem-solving) Demandingness  I should not have anxiety. The world should be fair and easy. Global Self/Other Ratings I'm no good. He's a jerk. Low Frustration Tolerance Because I don't like this, I can't stand it. Awfulizing  Because I don't like feeling anxious, that means it's awful, terrible, and horrible.

Rational Alternatives(lead to concern, irritation, sadness, or disappointment, with more effective problem-solving) Preferences  I wish I didn't have to struggle with anxiety, but I can face it. I wish the world were fair and easy, but it doesn't have to be. Behavior Ratings (Not Judging the Worth of a Person I made a bad decision; I'm not bad. He behaved poorly during our talk. Improved Frustration Tolerance I don't like this, but I can stand it. De-awfulizing Dealing with anxiety is a nuisance, but not horrible or awful.

All-or-Nothing Thinking: You see things in only two categories (good/bad, right/wrong, anxious/not anxious) without considering that there are “gray areas” or “in-betweens.”

Being anxious means being miserable vs. Being anxious is inconvenient.

Catastrophizing: You assume that the worst will happen without realizing that other, less upsetting outcomes might be more likely.

I'll never learn to manage my fears vs. I can learn to manage my fears if I work at it.

Emotional Reasoning: You think something is true just because you feel it is true (this is actually a very strong belief that you hold and you're sure you're right even if there is no evidence for your belief).

I know he's going to break up with me vs. He's told me he's very happy with me. There's no evidence that he wants to break up at this time.

Mind-Reading: You assume you know what someone else is thinking even without them telling you.

They think I'm a loser vs. I have no way of knowing what they're thinking.

Personalization: You think you are the reason that something bad happened or someone reacted negatively without taking other more likely explanations into account.

He didn't say hello because I've upset him in some way vs. He didn't say hello because he was distracted by his work.

Should/Must Statements: You have a “demand” for how things should be (e.g., your behavior, someone else's behavior) and you exaggerate how bad it is if things don't go the way you expect them to.

I shouldn't be this anxious—it's awful vs. Feeling anxious is often a hassle, but I can still enjoy my life.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

I CONSTANTLY TRY TO FIGURE OUT WHY I'M SO ANXIOUS. DO I NEED TO KNOW WHY IN ORDER TO MAKE THINGS BETTER?

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It's not surprising that you would want to understand why you feel so anxious. All people are information-processors—we like to comprehend the reasons behind events so that our world feels more predictable and manageable. Insight into “why” can help you identify old patterns and let them go. You could pursue an insight-oriented type of therapy (psychodynamic or psychoanalytic) and explore sources of anxiety in your personal history and relationships, which may help heal old wounds and free up energy for behavior change. The downsides to this approach are the time it takes and the cost. So, the question may really be, “How much insight do you need before making changes in your thinking and behavior?”

The alternative is to directly address the thinking and behaviors that are causing you problems (which can be done in cognitive-behavioral therapy, or CBT). This approach takes less time and asserts that, even if you completely understand the why behind your anxiety, you still need to make changes in your thinking and behaviors in order to get better.

Regarding your “why” question, we have found that people are anxious because of a combination of factors. Some of those factors include:

1.    Biological predisposition to emotional disturbance

2.    Family history of anxiety

3.    Individual temperament or personality characteristics

4. Social learning history (e.g., overprotective parents; unpredictable, volatile household)

5.   Environmental factors/stress (e.g., troubled marriage, job loss, illness)

6.Thinking (e.g., “I can't cope; I have no control; something terrible is going to happen.”)

7.Behaviors (e.g., avoiding problems, not getting adequate sleep, not speaking up for yourself, overextending yourself)

Perhaps the above list will help you identify some of the sources of your anxiety and free you to move forward with doing something about your anxiety. For many people, constantly asking “why?” is a distraction or avoidance technique that keeps them from facing the responsibility of making changes. Sometimes insight comes after you make changes! Ultimately, it is up to you to decide how much energy and time you want to put into exploring the “why” question. Remember, however, insight is important, but it is rarely enough for an improved quality of life.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

HOW DO I KNOW IF MY THERAPIST IS QUALIFIED?

netdoctor.co.uk

Mental health professionals can be identified in two different ways: (1) by level of education, and (2) by type of license. The level of education is usually represented by the letters directly following the person's name, and includes the following abbreviations (average years of education beyond college in parentheses):

MD: Medical Doctor (8-10 years)

DO: Doctor of Osteopathy (8-10 years)

PhD: Doctor of Philosophy (4-8 years)

PsyD: Doctor of Psychology (4-6 years)

MA: Master of Arts (2-4 years)

MS: Master of Science (2-4 years)

MSW: Master of Social Work (2-4 years)

MEd or EdD: Master/Doctor of Education (2-4 or 4-6 years)

MDiv/MMin or DDiv/DMin: Master/Doctor of Divinity/Ministry (2-4 or 4-6 years)

BSN or RN: Psychiatric Nurse (0-4 years)

The second set of initials after the professional's name refers to the license that person holds. In order to obtain a license, professionals are required to obtain a certain number of hours of supervised experience, to demonstrate an understanding of the ethical requirements of their profession, and to pass a test showing their competence in the field. Whereas MDs and DOs do not typically code their license in a second set of initials, those who have completed psychiatry residency and board certification identify themselves as psychiatrists You can ask any doctor which “boards” he or she is certified by. A doctoral degree from a graduate school (i.e., PhD) is usually required for licensure as a psychologist.

Here is a sampling of the license names and abbreviations associated with other professions:

Licensed Clinical Social Worker: LISCW

Licensed Marriage And Family Therapist: LMFT

Licensed Professional Counselor: LPC

Certified Pastoral Counselor: varies (check the website for the American Association of Pastoral Counselors at aapc.org).

This list does not cover every license issued to therapists. These vary by state, as do the titles and abbreviations for the license.

Beyond these quick indicators, it is up to you to find out the professional's areas of expertise and reputation, and to be honest with yourself about whether you trust and like your therapist. Usually a therapist will frame the first session or sessions as a “consultation” for the purpose of evaluating your problems as well as the “fit” between client and therapist. Sometimes people check out a few therapists before making a decision. Also, keep in mind that the “letters” after a clinician's name do not always indicate their expertise or qualification to treat a certain problem—you want to know what experience the clinician you see has in treating anxiety disorders in general, and your specific disorder in particular. Also, clinicians in supervised training programs may provide excellent service. Explore your options carefully.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

HOW MUCH DOES PSYCHOTHERAPY COST?

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The costs of psychotherapy vary according to the discipline of the professional and the insurance policy held by the patient, as well as the region of the country. Usually psychiatrists (medically-trained physicians) have the highest fees, followed in sequence by doctoral-level psychologists, master's-level psychologists, counselors, social workers, and psychiatric nurses. We say usually because the clinician's experience and reputation also factor into the equation and can compensate for differences in education. Psychiatrists have a medical degree and can conduct physical exams, order lab tests, and prescribe medicines. Not all psychiatrists provide psychotherapy-many refer patients to other mental health professionals for this treatment. On the other hand, there are some psychiatrists who refer patients out for medication management and focus exclusively on providing psychotherapy.

Health insurance companies differ in the amount of mental health coverage they provide, so it is wise to look at your specific plan. Most policies limit the number of sessions they will pay for per year. Twenty to twenty-six appointments per year is a common number, but every policy is different. If you rely on a managed care network, you may need to choose your therapist from a list of approved providers.

Fees may range from $50 to $200 a session, where each session lasts 45 to 60 minutes. When insurance does not cover the cost of therapy, some clinicians offer what they call a “sliding fee scale,” which bases your fee on your income. Other low-cost alternatives may be available, including university counseling centers, nonprofit clinics, and therapy training centers. It is always helpful to find out about your insurance coverage and your therapist's payment policies before starting treatment. This will save you any uncomfortable surprises, and help your therapy to progress more smoothly.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

HOW LONG DOES PSYCHOTHERAPY USUALLY TAKE?

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Psychotherapy for an anxiety disorder usually involves weekly sessions and can often be completed within a few months. Some therapies are shorter still, and others may take a year or more. The length is dependent on the type of therapy and the type of anxiety disorder, as well as the presence of complicating factors. Here are some factors that affect therapy length:

1. The cognitive-behavioral therapies are typically shorter than the psychodynamic ones. This is because cognitive-behavioral approaches focus on direct changes in thinking and behavior, whereas psychodynamic approaches take a broader approach and help resolve conflicts leading to problems.

2. The more longstanding the anxiety disorder, the longer it may take to have success.

3. If a patient has medical or additional psychiatric disorders, the therapy may take longer. When the anxiety co-occurs with a personality disorder, treatment might be more complicated and require a longer duration.

4. If consistent attendance at therapy sessions is a problem due to financial limitations, social or professional obligations, or the illness itself, the therapy may take longer.

One good predictor of therapy duration is how well the patient and the therapist get along with one another after two or three meetings. If they are comfortable with one another, the therapy is often more efficient and successful. It is also very important to develop a goal list with your therapist in the beginning stages of your meetings. What are you expecting to accomplish by attending therapy? The more specific your answer to this question, the better. A concrete goal list can serve as a roadmap for showing you what your targets are in therapy. Monitoring progress as you attend your therapy sessions is also vital.

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD

WHAT TYPES OF PSYCHOTHERAPY ARE MOST COMMONLY USED TO TREAT ANXIETY?

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The research consistently favors cognitive-behavioral therapy (CBT) as the most effective treatment for the various anxiety disorders. Psychodynamic therapy has a long history, but less research backing. A newer therapy called Eye Movement Desensitization and Reprocessing (EMDR) remains controversial, but is recognized as a treatment option for trauma-based anxiety disorder. Group therapy has also been used extensively with trauma victims as well as socially phobic individuals. Other approaches include clinical hypnosis and marital and family therapy. Whereas numerous other therapies exist, the above are most often discussed in the literature.

Because of its relevance to anxiety disorders, we will discuss CBT in more detail here.

Cognitive-behavioral therapy focuses on changing the thoughts (cognitions) and behaviors that maintain anxiety. The “cognitive” part involves the identification and modification of irrational, unhelpful thoughts (“It's terrible!”) that contribute to anxiety. Once the client learns to evaluate perceived threats more realistically, and through practice adopts more accurate beliefs (“It's inconvenient, but I can deal with it”), she can reduce her level of anxiety. An important foundation of CBT is the idea that our feelings and behaviors are not determined by actual events, but rather by our beliefs or thoughts about the events. Much of the work of CBT also focuses on addressing behaviors and providing exercises and assignments to help the client make changes in his day-to-day life (e.g., less avoidance, more pleasurable activities).

One of the most potent techniques in CBT is exposure therapy This approach involves exposing the client—in gradual steps—to whatever it is that is triggering his anxiety (e.g., traumatic memory, phobic stimulus). At each step, the client's anxiety is allowed to peak and then diminish before advancing to the next step, until the client can be in the presence of the trigger with little or no anxiety. Research has consistently found exposure to be a key element in the effective treatment of anxiety.

Therapies that focus on interpersonal relationships , such as couples', family, and group therapy, may also be valuable. With these types of interventions, people come to better understand how to communicate clearly and resolve differences better. Individuals may also be taught some specific skills to ease anxiety in social situations.

Therapists who use a psychodynamic approach help you become aware of secret and forbidden wishes, as well as the hidden defenses you use to repress these wishes. This approach may take several months to years. The forbidden wishes (meaning we think punishment will happen if we think or feel or act on them) are thought to be part of all of us and to generate anxiety when we become aware of them. Psychodynamic therapists believe that we can reduce anxiety and assume more control over our decisions by reevaluating and accepting these forbidden wishes. The psychodynamic approach, which draws its support from case studies, parent-child observation, and conventional wisdom, is much less structured and thus difficult to research.  

Source: The Anxiety Answer Book by: Laurie A. Helgoe, PhD, Laura R. Wilhelm, PhD, Martin J. Kommor, MD