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Anxiety: Top Tips To Calm You Down NOW

peace-thoughtsSOURCE CREDIT: PsychCentral
9 Ways to Reduce Anxiety Right Here, Right Now
September 14, 2013 at 10:35 am
Written by Margarita Tartakovsky, M.S.

When you’re feeling anxious, you might feel stuck and unsure of how to feel better. You might even do things that unwittingly fuel your anxiety. You might hyperfocus on the future, and get carried away by a slew of what-ifs.

What if I start to feel worse? What if they hate my presentation? What if she sees me sweating? What if I bomb the exam? What if I don’t get the house?

You might judge and bash yourself for your anxiety. You might believe your negative, worst-case scenario thoughts are indisputable facts.

Thankfully, there are many tools and techniques you can use to manage anxiety effectively. Below, experts shared healthy ways to cope with anxiety right here, right now.

1. Take a deep breath.

“The first thing to do when you get anxious is to breathe,” said Tom Corboy, MFT, the founder and executive director of the OCD Center of Los Angeles, and co-author of the upcoming book The Mindfulness Workbook for OCD.

Deep diaphragmatic breathing is a powerful anxiety-reducing technique because it activates the body’s relaxation response. It helps the body go from the fight-or-flight response of the sympathetic nervous system to the relaxed response of the parasympathetic nervous system, said Marla W. Deibler, PsyD, a clinical psychologist and director of The Center for Emotional Health of Greater Philadelphia, LLC.

She suggested this practice: “Try slowly inhaling to a count of 4, filling your belly first and then your chest, gently holding your breath to a count of 4, and slowly exhaling to a count of 4 and repeat several times.”

2. Accept that you’re anxious.

Remember that “anxiety is just a feeling, like any other feeling,” said Deibler, also author of the Psych Central blog “Therapy That Works.” By reminding yourself that anxiety is simply an emotional reaction, you can start to accept it, Corboy said.

Acceptance is critical because trying to wrangle or eliminate anxiety often worsens it. It just perpetuates the idea that your anxiety is intolerable, he said.

But accepting your anxiety doesn’t mean liking it or resigning yourself to a miserable existence.

“It just means you would benefit by accepting reality as it is – and in that moment, reality includes anxiety. The bottom line is that the feeling of anxiety is less than ideal, but it is not intolerable.”

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3. Realize that your brain is playing tricks on you.

Psychiatrist Kelli Hyland, M.D., has seen first-hand how a person’s brain can make them believe they’re dying of a heart attack when they’re actually having a panic attack. She recalled an experience she had as a medical student.

“I had seen people having heart attacks and look this ill on the medical floors for medical reasons and it looked exactly the same. A wise, kind and experienced psychiatrist came over to [the patient] and gently, calmly reminded him that he is not dying, that it will pass and his brain is playing tricks on him. It calmed me too and we both just stayed with him until [the panic attack] was over.”

Today, Dr. Hyland, who has a private practice in Salt Lake City, Utah, tells her patients the same thing. “It helps remove the shame, guilt, pressure and responsibility for fixing yourself or judging yourself in the midst of needing nurturing more than ever.”

4. Question your thoughts.

“When people are anxious, their brains start coming up with all sorts of outlandish ideas, many of which are highly unrealistic and unlikely to occur,” Corboy said. And these thoughts only heighten an individual’s already anxious state.

For instance, say you’re about to give a wedding toast. Thoughts like “Oh my God, I can’t do this. It will kill me” may be running through your brain.

Remind yourself, however, that this isn’t a catastrophe, and in reality, no one has died giving a toast, Corboy said.

“Yes, you may be anxious, and you may even flub your toast. But the worst thing that will happen is that some people, many of whom will never see you again, will get a few chuckles, and that by tomorrow they will have completely forgotten about it.”

Deibler also suggested asking yourself these questions when challenging your thoughts:

  • “Is this worry realistic?
  • Is this really likely to happen?
  • If the worst possible outcome happens, what would be so bad about that?
  • Could I handle that?
  • What might I do?
  • If something bad happens, what might that mean about me?
  • Is this really true or does it just seem that way?
  • What might I do to prepare for whatever may happen?”
CLICK IMAGE TO READ REVIEWS AND MORE

CLICK IMAGE TO READ REVIEWS AND MORE

5. Use a calming visualization.

Hyland suggested practicing the following meditation regularly, which will make it easier to access when you’re anxious in the moment.

“Picture yourself on a river bank or outside in a favorite park, field or beach. Watch leaves pass by on the river or clouds pass by in the sky. Assign [your] emotions, thoughts [and] sensations to the clouds and leaves, and just watch them float by.”

This is very different from what people typically do. Typically, we assign emotions, thoughts and physical sensations certain qualities and judgments, such as good or bad, right or wrong, Hyland said. And this often amplifies anxiety. Remember that “it is all just information.”

6. Be an observer — without judgment.

Hyland gives her new patients a 3×5 index card with the following written on it: “Practice observing (thoughts, feelings, emotions, sensations, judgment) with compassion, or without judgment.”

“I have had patients come back after months or years and say that they still have that card on their mirror or up on their car dash, and it helps them.”

7. Use positive self-talk.

Anxiety can produce a lot of negative chatter. Tell yourself “positive coping statements,” Deibler said. For instance, you might say, “this anxiety feels bad, but I can use strategies to manage it.”

8. Focus on right now.

“When people are anxious, they are usually obsessing about something that might occur in the future,” Corboy said. Instead, pause, breathe and pay attention to what’s happening right now, he said. Even if something serious is happening, focusing on the present moment will improve your ability to manage the situation, he added.

9. Focus on meaningful activities.

When you’re feeling anxious, it’s also helpful to focus your attention on a “meaningful, goal-directed activity,” Corboy said. He suggested asking yourself what you’d be doing if you weren’t anxious.

If you were going to see a movie, still go. If you were going to do the laundry, still do it.

“The worst thing you can do when anxious is to passively sit around obsessing about how you feel.” Doing what needs to get done teaches you key lessons, he said: getting out of your head feels better; you’re able to live your life even though you’re anxious; and you’ll get things done.

“The bottom line is, get busy with the business of life. Don’t sit around focusing on being anxious – nothing good will come of that.”

Margarita Tartakovsky, M.S. is an Associate Editor at Psych Central and blogs regularly about eating and self-image issues on her own blog, Weightless.
APA Reference Tartakovsky, M. (2013). 9 Ways to Reduce Anxiety Right Here, Right Now. Psych Central. Retrieved on September 14, 2013, from http://psychcentral.com/lib/9-ways-to-reduce-anxiety-right-here-right-now/00017762
Last reviewed: By John M. Grohol, Psy.D. on 12 Sep 2013 Published on PsychCentral.com. All rights reserved.

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September 15, 2013 Posted by | Acceptance and Commitment Therapy, anxiety, brain, Cognitive Behavior Therapy, Mindfulness, mood, Resources, therapy | , , , , , , , , , , , , , | 3 Comments

Just Moody Or More? Are Your Child’s Moods Normal?

imagesSource Credit:
Are your child’s moods normal? Lisa Meyers McClintick, USA TODAY Guide to Kids’ Health, USATODAY 8 Sept. 2013

Any parent knows: An evening can go to heck in a matter of minutes.

Our 9-year-old daughter pipes up suddenly that she needs a pink dress to play Sleeping Beauty in class the next morning. It has to be pink. It has to be pretty. And she needs it now!

Any sort of reasoning—like the suggestion to wear a wedding-worthy yellow dress—won’t work. Frustrations explode into shouting, timeouts and all-too-familiar rants of “this family sucks,” followed by heartbreaking rounds of “I hate myself!”

The next morning, when nerves calm, the yellow dress is perfectly fine and our daughter cheerfully chatters about Belle’s ball gown in Beauty and the Beast.

The difference? The anxiety attack is over.

Sneaky and insidious, anxiety seizes our daughter like a riptide pulling her out to sea. Her negative thoughts build like a tsunami, and it’s useless to swim against them with problem-solving logic.

Like a real riptide, the only escape seems to be diagonally. A surprise dose of humor—tough to summon in the midst of a blowup—can spring her free. As one therapist explained, “You can’t process anger and humor at the same time.”

It’s taken years of keen observation and research, plus the support of educators and psychologists to help our kids, ages 9 to 13, cope with mental health issues that also include Attention Deficit Hyperactive Disorder (ADHD) and depression.

Recognizing that something isn’t right and pursuing help isn’t an easy journey. But it’s necessary. In the same way you’d pursue cures and solutions to manage chronic physical conditions like cancer and diabetes for your child, you have to advocate for your child’s emotional well-being. It requires being proactive, persistent and patient.

“If you can intervene early and get proper treatment, the prognosis is so much better,” says Teri Brister, who directs the basic education program of the National Alliance on Mental Illness.

KNOW THE SIGNS

“One of the most difficult-to-recognize issues is anxiety,” says John Duby, director of Akron Children’s Hospitals Division of Developmental and Behavioral Pediatrics. “(Children) won’t say, ‘Hey, you know, I’m worried.’ You have to be tuned in.”

All-consuming worries—about parents’ safety, bullies or natural disasters, for instance—can look like a lack of focus at first. Some kids ask frequent questions about “what’s next” for meals or activities. Changes to the daily routine (a substitute teacher or a visit to a new doctor) can trigger headaches, stomachaches or a sleepless night.

At its most extreme, anxiety induces panic attacks. Kids break into sweats, have trouble breathing and feel their heart racing.

Depression may cause similar symptoms to anxiety with headaches, stomachaches, not being able to sleep or sleeping more than usual. “They may withdraw socially,” says Duby. Kids may head to their room after school and not emerge until morning. Some kids are constantly irritable and angry.

“We often think depression doesn’t happen in children, but it does,” he says.

GET HELP

Step 1: Trust your instincts

If you’re worried about your child’s mood, trust your instincts as a parent, recommends Brister.

The red flags of mental health disorders tend to pop up during school years when children have to navigate academic expectations, make friends and increase responsibilities at home.

“You have to look for (behavior) patterns,” says Brister. These can include impulsive acts, hyperactivity, outbursts, an inability to follow directions or recurring ailments that may impair how the child performs in class, extracurricular activities or simply sitting through dinner with the family.

Most concerned parents start with a visit to the pediatrician. (PETER’S EDIT For Australian parents your family GP is a good place to start) The family physician can help you analyze symptoms and understand whether there might be an underlying condition such as food allergies or a chronic lack of sleep.

Step 2: Seek professional help

(PETER’S EDIT: In Australia a referral from a GP to a psychologist via a mental health care plan or ATAPS will ensure an informed, appropriate and timely assessment.  If the issue is developmental, a referral to a paediatrician may be preferred or if your GP has a serious concern a referral to a child psychiatrist may be made. Wait times for each option should be relatively short in the private sector.) 

When our son was 5, we sought testing for ADHD with a referral from our pediatrician. Unfortunately, we couldn’t even get on a waiting list for a psychology appointment. We were told the list had backed up to a two-year wait, so it was eliminated. We had to call weekly and hope for an opening.

When our daughter needed help as her anxiety escalated, it took a school district triage nurse to get us an appointment with a psychiatric nurse.

This is, unfortunately, not an uncommon scenario for parents. You need to use all the leverage you have to access experts in the school system or mental health clinics to help with your situation. Stay persistent and be pleasant rather than pushy.

And when you do get an appointment, make the most of it by consistently tracking the concerns you have about your child’s behavior and putting them in writing for the physician to read. Have a list of questions ready, and always ask about additional resources you can tap into, from support groups to books.

Mental health practitioners will also be gathering resources and information about your child from report cards, checklists and questionnaires. These can help pinpoint whether a child has anxiety, depression, ADHD, bipolar disorder, is on the autism spectrum or may have a combination of these. “It allows us to have a more objective view,” says Duby.

Step 3: Find your normal

Once there is a diagnosis, families can decide how to move forward. That might mean trying medications, working with a psychologist or setting up an Individualized Education Program (IEP) at school.

Additional services that may help include occupational therapy, which can identify specific movements, such as swinging, spinning or brushing outer limbs with a soft brush that may help your child’s brain process and integrate sensory information.

These tools and approaches can help families be proactive about preventing and managing mental meltdowns. It’s also essential to help children feel a sense of belonging at school and in community groups. Families need to build up their children’s strengths so they have the self-esteem and confidence to move forward, says Duby.

And parents should stay on top of the situation, watching for changes in behavior and mood, especially as children get older, says Brister.

Hormones may help or worsen conditions, which makes it important to have a diagnosis and support network before the teen years hit.

“I can’t emphasize enough how essential it is to recognize symptoms early and treat them,” she says.

Click Image to read reviews and for more info about this terrific workbook

Click Image to read reviews and for more info about this terrific workbook

SIGNS OF DEPRESSION AND ANXIETY

Signs in children may differ from the symptoms we commonly associate with adults who have the disorders. Depression in kids may look like irritability, anger and self-criticism, says the National Alliance on Mental Illness. It could be as subtle as her making less eye contact with you than in the past.

School performance is another important indicator. Grades can drop off dramatically; students may also visit the school nurse more frequently with vague complaints of illness.

Children who suffer from an anxiety disorder may experience fear, nervousness and shyness, according to the Anxiety and Depression Association of America. They may worry excessively about things like grades and relationships with family and friends. They may strive for perfection and seek constant approval.

HOW TO CALM IT DOWN

Whether a child has mental health struggles or not, emotions inevitably boil over—especially as preteen dramas escalate. Here are ways to help de-escalate the situation and restore calm to your family life.

• Keep your body language non-threatening and stay as even-keeled as possible. Don’t get in the child’s face or use a raised voice.

• Teach kids how to breathe slowly through the nose, then exhale gently through the mouth as if cooling a hot bowl of soup.

• Create an “away space,” a place to cool down and take a break. Consider a quiet nook in a bedroom, a spot on the stairs for kids who don’t like separation or a backyard corner for those who find comfort in nature.

• Let kids know they can’t hit others, but it’s OK to punch a pillow or punching bag or to squeeze putty or a squishy toy.

• Figure out what’s physically comforting—feeling the softness of a blanket or stuffed animal, nuzzling the fur of a family pet or piling under heavy blankets.

• Listen to favorite tunes on a music player.

• Provide a journal for writing out frustrations or doodling when the words won’t come.

• When emotions simmer down, sit side by side to talk through how the situation could have been handled differently and work on solutions together.

ONLINE RESOURCES

(PETER’S EDIT:  AUSTRALIA:

HeadSpace: headspace National Youth Mental Health Foundation Ltd is funded by the Australian Government Department of Health and Ageing under the Youth Mental Health Initiative Program. A great resource for parents and teens.

BeyondBlue : Resources for young people section )

OTHER:

HealthyChildren.org from the American Academy of Pediatrics has a section dedicated to “Emotional Problems.” Parents can tap into great information on how to help their child. Audio segments recorded by experts in the field can be used as a launching point for family discussions.

TheBalancedMindFoundation.org, founded by the mother of a daughter with bipolar disorder, provides help for families. Online, private support groups offer 24/7-support and online forums are a way for parents to connect.

WorryWiseKids.org, a service of the Children’s and Adult Center for OCD and Anxiety, has a wealth of information about the different types of anxiety disorders children can have, how to understand them and how to seek treatment for them.

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September 11, 2013 Posted by | Adolescence, anxiety, Child Behavior, Children, depression, diagnosis, Education, happiness, mood, Parenting, research, Resilience, Resources, self harm, Suicide, Teens, therapy | , , , , , , , , , , , , | 3 Comments

Social Anxiety: Half A Dozen Research Backed Hints To Fight The Fear

Social-Anxiety-3-224x300Source Credit:

Tartakovsky, M. (2013). 6 Ways to Overcome Social AnxietyPsych Central. Retrieved on September 9, 2013, from http://psychcentral.com/lib/6-ways-to-overcome-social-anxiety/00017631

“For some people social anxiety is pretty pervasive,” said Justin Weeks, Ph.D, an assistant professor of psychology and director of the Center for Evaluation and Treatment of Anxiety at Ohio University. For others, the anxiety arises in specific social situations, he said.

The most common example is anxiety over public speaking. Making small talk, eating in front of others and using public restrooms also can trigger worry and unease for some.

Some people engage in what Weeks called “covert avoidance.” For example, they might go to parties but instead of mingling, they hang back in the kitchen, he said.

Social anxiety is defined as anxiety anticipating a social situation or anxiety during or after that situation, Weeks said. “At the heart of social anxiety is the fear of evaluation.” And it’s not just negative evaluation that people worry about; it’s positive evaluation, too.

Weeks’s research suggests that people perceive negative consequences from a social situation whether they do poorly or well. (Here’s one study.) For instance, people who do well at work might worry about the social repercussions of outshining their coworkers, he said.

In other words, people with social anxiety simply don’t want to stand out. “They want to be as inconspicuous as possible.”

Anxiety about social situations lies on a spectrum. “The consensus among the experts is that shyness and social anxiety disorder are all part of one continuum,” Weeks said. “It’s a question of severity.”

How much does social anxiety interfere with your life?

For instance, you might wish that you were more comfortable when interacting with people, Weeks said. But “you don’t feel like it’s holding you back,” in terms of your personal or professional goals.

“Social anxiety is more severe.” A person might avoid going to college because schools require passing a public speaking course and interacting with new people. They might want a romantic relationship but worry so much about rejection that they avoid potential partners.

Below, Weeks shared his suggestions for overcoming social anxiety.

1. Try a self-help manual.

Self-help manuals are designed to supplement therapy, but they’re also good tools for working on your own, Weeks said. He suggested the Managing Social Anxiety workbook. (PETER’S NOTE: For Teens I highly recommend The Shyness and Social Anxiety Workbook for Teens: CBT and ACT Skills to Help You Build Social Confidence )

2. Work with a therapist.

If social anxiety is stopping you from doing things you want or need to do, or you haven’t had much success with self-help, seek professional help. Find a therapist who specializes in anxiety disorders. You can start your search here.

The Workbook Recommended by Dr Justin Weeks

The Workbook Recommended by Dr Justin Weeks. Click Image To Read Reviews and View Content

3. Practice deep breathing every day.

It’s helpful to engage in deep breathing before an anxiety-provoking social situation, Weeks said. But practice this technique every day. This way it becomes second nature, and you don’t hyperfocus on deep breathing and miss an entire conversation, he said. Here’s more on deep breathing.

4. Create an exposure hierarchy.

An exposure hierarchy is a list – akin to a ladder – where you write down situations that cause you anxiety, in order of severity. Then you perform the easiest behavior, and keep moving up the list.

To create your own hierarchy, list 10 anxiety-provoking situations, and rate them on a 100-point scale (zero being no anxiety; 100 being severe anxiety). Your list might start with asking a stranger for directions and end with joining Toastmasters.

This website features a link to various worksheets on coping with social anxiety, and includes “the fear and avoidance hierarchy.” (Look for “managing social anxiety: workbook.”)

5. Create objective goals.

People tend to disqualify the positive when they feel anxious, Weeks said. They might do well, even great, but because of their anxious feelings, they see their performance as abysmal. That’s why therapists encourage clients to create objective behavioral goals, he said.

These are behaviors that anyone in the room would be able to observe. It doesn’t matter how you feel or whether you’re blushing or sweating (which you can’t control anyway) in a social situation.

For instance, if you’re working in a group setting, the objective behavior would be to make three comments, Weeks said.

This also gives you a good barometer for judging your progress. Again, you’re not focusing on whether you felt nervous. Rather, you’re focusing on whether you performed the actual behavior.

My Recommended Workbook for Teens

My Recommended Workbook for Teens. Click Image To Read Reviews and View Content

Also, avoid focusing on others’ reactions. It doesn’t matter how your colleagues received your idea in the meeting. What matters is that you actually spoke up. It doesn’t matter whether a girl or guy said yes to your dinner invite. What matters is that you actually asked. It doesn’t matter how your child’s teacher reacted when you declined to volunteer for yet another school trip. What matters is that you were assertive and respected your own needs.

As Weeks said, “You did what you wanted to in a situation. We can’t control what another person is going to do.”

6. Keep a rational outlook.

Dispute both bleak thoughts that undermine your performance and fuel your anxiety, and equally unrealistic thoughts that are irrationally positive, Weeks said.

For instance, if you’re giving a speech, you might initially think, “I’m going to bomb.” But if you’ve given speeches before and done well, then this isn’t a rational or realistic perspective. You might say instead, “I’ve given speeches before. I’m prepared, and I’ll give it my best shot.”

If you’re asking someone out, it’s not rational to think, “They’re definitely going to say yes.” But it is rational to consider, “They might,” according to Weeks.

If social anxiety is sabotaging your goals and stopping you from living the life you want, seek help and try the above strategies. Social anxiety is highly treatable, Weeks said. You can get better, and grow in the process.

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September 11, 2013 Posted by | Acceptance and Commitment Therapy, Adolescence, anxiety, Cognitive Behavior Therapy, Education, Health Psychology, research, therapy | , , , , , , , , , | 5 Comments

Depression: Young People Respond Well To Computer Based Intervention

Source: BMJ

Read The Original Research Article Here

A computerized self help intervention may help adolescents who suffer from depression. The specialized computer therapy acts much the same way as they do from one-to-one therapy with a clinician, according to a study published on BMJ.

Depression is common in adolescents, but many are reluctant to seek professional help. So researchers from the University of Auckland, New Zealand, set out to assess whether a new innovative computerized cognitive behavioral therapy intervention called SPARX could reduce depressive symptoms as much as usual care can.

SPARX is an interactive 3D fantasy game where a single user undertakes a series of challenges to restore balance in a virtual world dominated by GNATs (Gloomy Negative Automatic Thoughts). It contains seven modules designed to be completed over a four to seven week period. Usual care mostly involved face-to-face counseling by trained clinicians.

The research team carried out a randomized controlled trial in 24 primary healthcare sites across New Zealand. All 187 adolescents were between the ages of 12 and 19, were seeking help for mild to moderate depression and were deemed in need of treatment by primary healthcare clinicians. One group underwent face-to-face treatment as usual and the other took part in SPARX.

Participants were followed up for three months and results were based on several widely used mental health and quality of life scales.

Results showed that SPARX was as effective as usual care in reducing symptoms of depression and anxiety by at least a third. In addition significantly more people recovered completely in the SPARX group (31/69 (44%) of those who completed at least four homework modules in the SPARX group compared with 19/83 (26%) in usual care).

When questioned on satisfaction, 76/80 (95%) of SPARX users who replied said they believed it would appeal to other teenagers with 64/80 (81%) recommending it to friends. Satisfaction was, however, equally high in the group that had treatment as usual.

The authors conclude that SPARX is an “effective resource for help seeking adolescents with depression at primary healthcare sites. Use of the program resulted in a clinically significant reduction in depression, anxiety, and hopelessness and an improvement in quality of life.” They suggest that it is a potential alternative to usual care and could be used to address unmet demand for treatment. It may also be a cheaper alternative to usual care and be potentially more easily accessible to young people with depression in primary healthcare settings.

Read The Original Research Article Here

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April 21, 2012 Posted by | Adolescence, Bullying, Child Behavior, depression, mood, research, Technology, therapy | , , , , , , , , , , , | 6 Comments

Anxiety & Depression: Self-Help Internet Interventions Work!

A little while ago I posted a list of free interactive self-help web sites, all research based, which have been shown to effective in the treatment of anxiety & depression. A recent study adds to the body of evidence which supports web based intervention as a viable treatment option or adjunct.

Cognitive behaviour therapy (CBT) via the internet is just as effective in treating panic disorder (recurring panic attacks) as traditional group-based CBT. It is also efficacious in the treatment of mild and moderate depression. This according to a new doctoral thesis soon to be presented at Karolinska Institutet.

Read the original research thesis here (PDF)

“Internet-based CBT is also more cost-effective than group therapy,” says Jan Bergström, psychologist and doctoral student at the Center for Psychiatry Research. “The results therefore support the introduction of Internet treatment into regular psychiatry, which is also what the National Board of Health and Welfare recommends in its new guidelines for the treatment of depression and anxiety.”

It is estimated that depression affects some 15 per cent and panic disorder 4 per cent of all people during their lifetime. Depression can include a number of symptoms, such as low mood, lack of joy, guilt, lethargy, concentration difficulties, insomnia and a low zest for life. Panic disorder involves debilitating panic attacks that deter a person from entering places or situations previously associated with panic. Common symptoms include palpitations, shaking, nausea and a sense that something dangerous is about to happen (e.g. a heart attack or that one is going mad).

Click image to read reviews

It is known from previous studies that CBT is an effective treatment for both panic disorder and depression. However, there is a lack of psychologists and psychotherapists that use CBT methods, and access to them varies greatly in Sweden as well as in many other countries. Internet-based CBT has therefore been developed, in which the patient undergoes an Internet-based self-help programme and has contact with a therapist by email.

The present doctoral thesis includes a randomised clinical trial of 104 patients with panic disorder and compares the effectiveness of Internet-based CBT and group CBT within a regular healthcare service. The study shows that both treatments worked very well and that there was no significant difference between them, either immediately after treatment or at a six-month follow-up. Analyses of the results for the treatment of depression show that Internet-based CBT is most effective if it is administered as early as possible. Patients with a higher severity of depression and/or a history of more frequent depressive episodes benefited less well from the Internet treatment.

Jan Bergström works as a clinical psychologist at the Anxiety Disorders Unit of the Psychiatry Northwest division of the Stockholm County Council. This research was also financed by the Stockholm County Council.

“Thanks to our research, Internet treatment is now implemented within regular healthcare in Stockholm, at the unit Internetpsykiatri.se of Psychiatry Southwest, which probably makes the Stockholm County Council the first in the world to offer such treatment in its regular psychiatric services,” says Jan Bergström.

Read the original research thesis here (PDF)

Credit: Adapted from materials provided by Karolinska Institutet.

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April 18, 2010 Posted by | anxiety, Books, Cognitive Behavior Therapy, depression, diagnosis, Education, Internet, research, stress, Technology, therapy | , , , , , , , , , , , , , , , , , , , | 10 Comments

Compulsive Collecting: Finding Hope In The Misunderstood Mess of Hoarding

Compulsive collecting or Hoarding is a misunderstood and debilitating mental health issue. Many psychologists and counsellors never see someone with this condition as they very rarely present for help. This article from an Australian newspaper provides an excellent overview of the condition and issues underlying hoarding, and I have included links to two brilliant books co-authored by the researchers discussed in the article, who have developed a wholistic and novel approach to it’s treatment.

Credit: Kate Benson, Sydney Morning Herald April 8 2010

They may dress well or hold down a good job. But hoarders are unhappy people who suffer from a debilitating condition.

Every suburb has one. The elderly woman weaving through an overgrown backyard full of cardboard boxes, old tyres and discarded furniture. Cats perch on every surface; kittens roll about among the rusted drums and long grass.

Inside, behind closed curtains, the rooms are piled high with papers, cups, plates and bottles. Broken toys, old clothes and shopping bags spill across kitchen benches and floor, smothering the stove and filling the sink, neither of which has been used in years.

The stench of cat faeces, urine and food scraps fill the house.

To her neighbours, she is an oddity. Or a pest, bringing down house values and encouraging vermin.

But to therapists she is one of a growing band across Australia suffering from a debilitating condition known as compulsive hoarding, where people feel a need to collect and store items that seem useless to others.

Their homes become havens of insurmountable clutter and junk, often leaving them unable to sleep in their beds or use appliances. Many end up with electricity or gas supplies disconnected or their fridge and washing machines unusable because they fear their lifestyle will be revealed if they contact a tradesmen to make repairs.

This secrecy and shame make it difficult to know exactly how many people have the disorder.

Some experts think between 200,000 and 500,000 Australians compulsively hoard, but others put the figure closer to 800,000.

“It’s a sleeping giant,” Chris Mogan, a clinical psychologist and expert on hoarding, says. “There is no systematic estimate of how many hoarders there are in any Australian setting. I suspect there are many, many more out there than we are aware of.”

Louise Newman, the president of the Royal Australian and New Zealand College of Psychiatrists, agrees.

Click image to read reviews

“I’ve only seen one case in my career [because] these people usually only come to light when the council steps in and orders a clean-up. Hoarders desperately want to keep hoarding. They don’t want to be stopped.”

There is little research on the condition in Australia and not much in the way of funding or treatment programs, but experts are hopeful hoarding will be included in the next (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders, the bible used by mental health experts to diagnose psychiatric conditions.

Many sufferers fall between the cracks because hoarding is not a clinical diagnosis in its own right, but is seen more as an offshoot of obsessive compulsive disorder, muddled with depression, anxiety, panic disorder and low self-esteem.

“But it is different to OCD and once we get it in the DSM-V, therapists, psychiatrists, psychologists and social workers can then be trained in the management of it [and] we can attract funding for research,” Mogan says.

Jessica Grisham, a clinical psychologist who specialises in obsessive compulsive disorder, also believes compulsive hoarding should be included in the next edition as it requires specialised treatment.

She cites recent neural imaging studies in the US that showed that different parts of the brain were activated in hoarders than in obsessive compulsive disorder patients.

Mogan and Grisham agree that cognitive behaviour therapy, where sufferers are slowly taught to change their thought patterns, is more effective than medication alone.

But hoarders responded better to a specially adapted version of the therapy, developed by the American hoarding experts Gail Steketee and Randy Frost. It had been achieving success with about 60 per cent of hoarders – far more than standard cognitive behaviour therapy.

“But it has to be a long-term project. You don’t go in to someone’s place and do a sudden excavation against their will,” Grisham says.

“That’s a violation and it’s very traumatic for them. It might make great TV, but it’s not good clinically.”

Mogan agrees. A pay TV show, Hoarders, was damaging to the public’s understanding of the illness, because it focused on forcefully cleaning houses in three days.

“Within six to 12 months that house will be recluttered because it is a compulsion … they suffer a lot of grief after things are taken away.”

Mogan makes weekly home visits to hoarders, and focuses on getting them to reduce the associated dangers by ensuring their home has two exits for safety, and working appliances and smoke alarms.

“Just as we do with drugs and alcohol, we’re into harm minimisation. Once the house is safe, we gradually set more goals. If they are comfortable with that, they will continue to stay in touch and not reject us.”

Sometimes the problem extends beyond mounds of paperwork and clothes. Mogan and Grisham know patients who hoarded urine or fingernail clippings. Some stored their own faeces or collected one particular item, such as bicycles. One sufferer was hoarding so much junk, the only access to the house was a 30-centimetre gap at the top of the front door.

But for Allie Jalbert, of the RSPCA, the most distressing hoarders are those who keep scores of cats and dogs, all battling for attention and food on a crowded suburban block.

She has been calling for years to have hoarding classified as an illness in its own right to allow more people to receive treatment and put an end to the 100 per cent recidivism rate.

“Often, we find that hoarders might be treated for peripheral symptoms such as anxiety or depression, but their core problem, the hoarding, is not addressed. So once we have cleaned out the house, they reoffend, which is very, very frustrating for everyone involved,” Jalbert says.

Some people threatened suicide and had to be removed by police when faced with the prospect of giving up their animals or clutter.

“There’s a mixed bag of emotion when you deal with hoarders. Firstly, there is the concern for your personal safety but there is also a degree of empathy because often these people are quite emotional and attached to the animals. But it’s quite frustrating to see animals living in such horrific situations,” she says.

“I’ve seen bathtubs full of faeces and rubbish, sinks that no longer work, homes with no heating or cooling. Sometimes it’s quite an overwhelming experience.”

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Who develops the condition and why?

Some studies have shown that many hoarders have been brought up in households where chaos reigned. Some were neglected as children and witnessed pets being treated poorly.

Mogan accepts the aetiology is mostly unknown, but cites an Australian study that found sufferers reported failing to connect with their parents or growing up in households lacking emotional warmth.

“The lack of attachment causes them to become ambivalent about their identity and about other people. As a compensatory mechanism, they link with things, which they find more compelling, more predictable and dependable and less rejecting.”

But Grisham believes there is no real trigger, apart from children of hoarders being rewarded for saving things and getting punished for discarding. “Sometimes there is a traumatic head injury but those cases are very rare.”

The condition affects slightly more women than men but is found across all occupations, age groups and ethnicities. “And they are in relationships,” Mogan says. “Albeit strained ones.

“Some are going out to work, but they make sure no one comes to their house. They’re not agoraphobic. On the contrary, many hoarders go out a lot to escape. But their children’s lives can’t be normalised because they can never sit down for a meal or find space to do homework. It’s a real impost on the family experience.”

Mogan runs group therapy sessions in Melbourne and says that many patients do want to be cured.

“This condition is a disability and the source of quite a lot of human suffering and neglect. A lot of these people are quite relieved to get help.”

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April 10, 2010 Posted by | anxiety, Books, Cognitive Behavior Therapy, diagnosis, Identity, research, Resources, therapy | , , , , , , , , , , , , | 9 Comments

Exercise DOES Help Improve Mood! And Just 25 Minutes Worth Will Decrease Stress & Increase Energy

Having an Honors degree in Human Movement Studies and working in gyms in a former life while studying for my Clinical Masters degree, I have seen this to be true.  Of course it seems self evident, but these researchers have used great science with an excellent and now research-proven written program and workbook. These, along with their recent meta-analytic research review, show just how effective exercise can be in improving mood.

Credit: PhysOrg.com) — Exercise is a magic drug for many people with depression and anxiety disorders, according to researchers who analyzed numerous studies, and it should be more widely prescribed by mental health care providers.

“Exercise has been shown to have tremendous benefits for mental health,” says Jasper Smits, director of the Anxiety Research and Treatment Program at Southern Methodist University in Dallas. “The more therapists who are trained in exercise therapy, the better off patients will be.”

The traditional treatments of cognitive behavioral therapy and pharmacotherapy don’t reach everyone who needs them, says Smits, an associate professor of psychology.

“Exercise can fill the gap for people who can’t receive traditional therapies because of cost or lack of access, or who don’t want to because of the perceived social stigma associated with these treatments,” he says. “Exercise also can supplement traditional treatments, helping patients become more focused and engaged.”

The Program used in the study is available from bookstores-Click Image to view description

Smits and Michael Otto, psychology professor at Boston University, presented their findings to researchers and mental health care providers March 6 at the Anxiety Disorder Association of America’s annual conference in Baltimore.

Their workshop was based on their therapist guide “Exercise for Mood and Anxiety Disorders,” with accompanying patient workbook (Oxford University Press, September 2009).

The guide draws on dozens of population-based studies, clinical studies and meta-analytic reviews that demonstrate the efficacy of exercise programs, including the authors’ meta-analysis of exercise interventions for mental health and study on reducing anxiety sensitivity with exercise.

“Individuals who exercise report fewer symptoms of anxiety and depression, and lower levels of stress and anger,” Smits says. “Exercise appears to affect, like an antidepressant, particular neurotransmitter systems in the brain, and it helps patients with depression re-establish positive behaviors. For patients with anxiety disorders, exercise reduces their fears of fear and related bodily sensations such as a racing heart and rapid breathing.”

After patients have passed a health assessment, Smits says, they should work up to the public health dose, which is 150 minutes a week of moderate-intensity activity or 75 minutes a week of vigorous-intensity activity.

At a time when 40 percent of Americans are sedentary, he says, mental health care providers can serve as their patients’ exercise guides and motivators.

The patient workbook which accompanies the program - Click image to view description

“Rather than emphasize the long-term health benefits of an exercise program — which can be difficult to sustain — we urge providers to focus with their patients on the immediate benefits,” he says. “After just 25 minutes, your mood improves, you are less stressed, you have more energy — and you’ll be motivated to exercise again tomorrow. A bad mood is no longer a barrier to exercise; it is the very reason to exercise.”

Smits says health care providers who prescribe exercise also must give their patients the tools they need to succeed, such as the daily schedules, problem-solving strategies and goal-setting featured in his guide for therapists.

“Therapists can help their patients take specific, achievable steps,” he says. “This isn’t about working out five times a week for the next year. It’s about exercising for 20 or 30 minutes and feeling better today.”

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April 5, 2010 Posted by | anxiety, Books, brain, Cognitive Behavior Therapy, depression, Exercise, Health Psychology, Positive Psychology, research, Resilience, Resources, stress, therapy | , , , , , , , , , , , , , , , , , , | 4 Comments

Binge Eating: A 12 Week Self-Guided Program Gets Great Results

Kaiser Permanente Center for Health Research, Press Release

Short-Term Program for Binge Eaters Using “Overcoming Binge Eating” by Dr. Christopher Fairburn Has Long-Term Benefits

PORTLAND, Ore. — A new study finds that a self-guided, 12-week program helps binge eaters stop binging for up to a year and the program can also save money for those who participate. Recurrent binge eating is the most common eating disorder in the country, affecting more than three percent of the population, or nine million people, yet few treatment options are available.

But a first-of-a-kind study conducted by researchers at the Kaiser Permanente Center for Health Research, Wesleyan University and Rutgers University found that more than 63 percent of participants had stopped binging at the end of the program — compared to just over 28 percent of those who did not participate. The program lasted only 12 weeks, but most of the participants were still binge free a year later. A second study, also published in the April issue of the Journal of Consulting and Clinical Psychology, found that program participants saved money because they spent less on things like dietary supplements and weight loss programs.

“It is unusual to find a program like this that works well, and also saves the patient money. It’s a win-win for everyone,” said study author Frances Lynch, PhD, MSPH, a health economist at the Kaiser Permanente Center for Health Research. “This type of program is something that all health care systems should consider implementing.”

“People who binge eat more than other people do during a short period of time and they lose control of their eating during these episodes. Binge eating is often accompanied by depression, shame, weight gain, loss of self-esteem and it costs the health care system millions of extra dollars,” said the study’s principal investigator Ruth H. Striegel-Moore, PhD, a professor of psychology at Wesleyan University. “Our studies show that recurrent binge eating can be successfully treated with a brief, easily administered program, and that’s great news for patients and their providers.”

Binge eating has received a lot of media attention recently because the American Psychiatric Association is recommending that it be considered a separate, distinct eating disorder like bulimia and anorexia. This new diagnosis can be expected to focus more attention on binge eating and how best to treat it, according to the researchers. It also could influence the number of people diagnosed and how insurers will cover treatment.

This randomized controlled trial, conducted in 2004–2005, involved 123 members of the Kaiser Permanente health plan in Oregon and southwest Washington. More than 90 percent of them were women, and the average age was 37. To be included in the study, participants had to have at least one binge eating episode a week during the previous three months with no gaps of two or more weeks between episodes.

Click image to read reviews: Book helps achieve results in this research study

Half of the participants were enrolled in the intervention and asked to read the book “Overcoming Binge Eating” by Dr. Christopher Fairburn, a professor of psychiatry and expert on eating disorders. The book details scientific information about binge eating and then outlines a six-step self-help program using self-monitoring, self-control and problem-solving strategies. Participants in the study attended eight therapy sessions over the course of 12 weeks in which counselors explained the rationale for cognitive behavioral therapy and helped participants apply the strategies in the book. The first session lasted one hour, and subsequent sessions were 20–25 minutes. The average cost of the intervention was $167 per patient.

All participants were mailed fliers detailing the health plan’s offerings for healthy living and eating and encouraged to contact their primary care physician to learn about more services.

By the end of the 12-week program 63.5 percent of participants had stopped binging, compared to 28.3 percent of those who did not participate. Six months later, 74.5 percent of program participants abstained from binging, compared to 44.1 percent in usual care. At one year, 64.2 percent of participants were binge free, compared to 44.6 percent of those in usual care.

Everyone in the trial was asked to provide extensive information about their binge eating episodes, how often they missed work or were less productive at work, and the amount they spent on health care, weight-loss programs and weight loss supplements. Researchers also examined expenditures on medications, doctor visits, and other health-related services.

The researchers then compared these costs between the two groups and found that average total costs were $447 less in the intervention group. This included an average savings of $149 for the participants, who spent less on weight loss programs, over-the-counter medications and supplements. Total costs for the intervention group were $3,670 per person per year, and costs for the control group were $4,098.

“While program results are promising, we highly encourage anyone who has problems with binge eating to consult with their doctors to make sure this program is right for them,” said study co-author Lynn DeBar, PhD, clinical psychologist at the Kaiser Permanente Center for Health Research.

Study authors include: Lynn DeBar, John F. Dickerson, Frances Lynch and Nancy Perrin from the Kaiser Permanente Center for Health Research in Portland, Oregon; Ruth H. Striegel-Moore and Francine Rosselli from Wesleyan University; G. Terence Wilson from Rutgers, The State University of New Jersey; and Helena C. Kraemer from the Stanford University School of Medicine.

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April 4, 2010 Posted by | Books, Eating Disorder, Girls, Identity, Resources, therapy | , , , , , , , , , , , , , , | 5 Comments

Martin Seligman: Author Of “Learned Optimism” Speaks About Positive Psychology And Authentic Happiness

Martin Seligman was originally best known for his classic psychology studies and theory of “Learned Helplessness” (1967) and it’s relationship to depression.

These days he is considered to be a founder of positive psychology, a field of study that examines healthy states, such as authentic happiness, strength of character and optimism, and is the author of “Learned Optimism”.

This is a terrific talk on Positive Psychology and what it means to be happy. It’s about 20 mins. long but definitely worth a watch!

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April 1, 2010 Posted by | anxiety, Cognitive Behavior Therapy, depression, Health Psychology, Mindfulness, Resilience, Resources, Technology, therapy, video | , , , , , , , , , , | 2 Comments

Self Help For Anxiety & Depression: A List Of FREE Interactive Self Help Websites

Today I wanted to get around to doing what I have been meaning to do for a while and post a list of free access interactive and/or educational websites which I have come across. These sites are fantastic resources and each one offers a different way to get involved with your recovery. Please note I am not affiliated with any of these sites and they are not affiliate sites. I hope you find one or more useful as I know many of my clients have.

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Self Help / Educational Websites

Updated 27th March 2010

There you have it! Check them out and let me know what you think. Know of any others? (No affiliate sites please).

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March 24, 2010 Posted by | Acceptance and Commitment Therapy, anxiety, Cognitive Behavior Therapy, depression, Dialectical Behavior Therapy, Education, Internet, Mindfulness, Positive Psychology, Resilience, Resources, Technology, therapy | , , , , , , , , , | 8 Comments