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Specializing in Anxiety Treatment, Depression and Trauma Therapy (EMDR, Polyvagal Theory in Psychotherapy)

Anxiety
Anxiety
Overview

Occasional anxiety is a normal part of life. Many people worry about things such as health, money, or family problems. But anxiety disorders involve more than temporary worry or fear. For people with an anxiety disorder, the anxiety does not go away and can get worse over time. The symptoms can interfere with daily activities such as job performance, schoolwork, and relationships.

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, social anxiety disorder, and various phobia-related disorders.

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Signs and Symptoms
Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) usually involves a persistent feeling of anxiety or dread, which can interfere with daily life. It is not the same as occasionally worrying about things or experiencing anxiety due to stressful life events. People living with GAD experience frequent anxiety for months, if not years.

Symptoms of GAD include:

  • Feeling restless, wound-up, or on-edge

  • Being easily fatigued

  • Having difficulty concentrating

  • Being irritable

  • Having headaches, muscle aches, stomachaches, or unexplained pains

  • Difficulty controlling feelings of worry

  • Having sleep problems, such as difficulty falling or staying asleep

 
Panic Disorder

People with panic disorder have frequent and unexpected panic attacks. Panic attacks are sudden periods of intense fear, discomfort, or sense of losing control even when there is no clear danger or trigger. Not everyone who experiences a panic attack will develop panic disorder.

During a panic attack, a person may experience:

  • Pounding or racing heart

  • Sweating

  • Trembling or tingling

  • Chest pain

  • Feelings of impending doom

  • Feelings of being out of control

People with panic disorder often worry about when the next attack will happen and actively try to prevent future attacks by avoiding places, situations, or behaviors they associate with panic attacks. Panic attacks can occur as frequently as several times a day or as rarely as a few times a year.

 
Social Anxiety Disorder

Social anxiety disorder is an intense, persistent fear of being watched and judged by others. For people with social anxiety disorder, the fear of social situations may feel so intense that it seems beyond their control. For some people, this fear may get in the way of going to work, attending school, or doing everyday things.

People with social anxiety disorder may experience:

  • Blushing, sweating, or trembling

  • Pounding or racing heart

  • Stomachaches

  • Rigid body posture or speaking with an overly soft voice

  • Difficulty making eye contact or being around people they don’t know

  • Feelings of self-consciousness or fear that people will judge them negatively

 
Phobia-related disorders

A phobia is an intense fear of—or aversion to—specific objects or situations. Although it can be realistic to be anxious in some circumstances, the fear people with phobias feel is out of proportion to the actual danger caused by the situation or object.

People with a phobia:

  • May have an irrational or excessive worry about encountering the feared object or situation

  • Take active steps to avoid the feared object or situation

  • Experience immediate intense anxiety upon encountering the feared object or situation

  • Endure unavoidable objects and situations with intense anxiety

There are several types of phobias and phobia-related disorders:

Specific Phobias (sometimes called simple phobias): As the name suggests, people who have a specific phobia have an intense fear of, or feel intense anxiety about, specific types of objects or situations. Some examples of specific phobias include the fear of:

  • Flying

  • Heights

  • Specific animals, such as spiders, dogs, or snakes

  • Receiving injections

  • Blood

Social anxiety disorder (previously called social phobia): People with social anxiety disorder have a general intense fear of, or anxiety toward, social or performance situations. They worry that actions or behaviors associated with their anxiety will be negatively evaluated by others, leading them to feel embarrassed. This worry often causes people with social anxiety to avoid social situations. Social anxiety disorder can manifest in a range of situations, such as within the workplace or the school environment.

Agoraphobia: People with agoraphobia have an intense fear of two or more of the following situations:

  • Using public transportation

  • Being in open spaces

  • Being in enclosed spaces

  • Standing in line or being in a crowd

  • Being outside of the home alone

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People with agoraphobia often avoid these situations, in part, because they think being able to leave might be difficult or impossible in the event they have panic-like reactions or other embarrassing symptoms. In the most severe form of agoraphobia, an individual can become housebound.

Separation anxiety disorder: Separation anxiety is often thought of as something that only children deal with; however, adults can also be diagnosed with separation anxiety disorder. People who have separation anxiety disorder have fears about being parted from people to whom they are attached. They often worry that some sort of harm or something untoward will happen to their attachment figures while they are separated. This fear leads them to avoid being separated from their attachment figures and to avoid being alone. People with separation anxiety may have nightmares about being separated from attachment figures or experience physical symptoms when separation occurs or is anticipated.

Selective mutism: A somewhat rare disorder associated with anxiety is selective mutism. Selective mutism occurs when people fail to speak in specific social situations despite having normal language skills. Selective mutism usually occurs before the age of 5 and is often associated with extreme shyness, fear of social embarrassment, compulsive traits, withdrawal, clinging behavior, and temper tantrums. People diagnosed with selective mutism are often also diagnosed with other anxiety disorders.

 

More information from National Institute for Mental Health.

https://www.nimh.nih.gov/health/topics/anxiety-disorders

Depression
Depression
Overview

Depression (also called major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working.

To be diagnosed with depression, the symptoms must be present for at least two weeks.

There are different types of depression, some of which develop due to specific circumstances.

  • Major depression, which includes symptoms of depression most of the time for at least 2 weeks that typically interfere with one’s ability to work, sleep, study, and eat.

  • Persistent depressive disorder (also called dysthymia), which often includes less severe symptoms of depression that last much longer, typically for at least 2 years.

  • Perinatal depression, which occurs when a woman experiences major depression during pregnancy or after delivery (postpartum depression).

  • Seasonal affective disorder, which comes and goes with the seasons, typically starting in late fall and early winter and going away during spring and summer.

  • Depression with symptoms of psychosis, which is a severe form of depression where a person experiences psychosis symptoms, such as delusions (disturbing, false fixed beliefs) or hallucinations (hearing or seeing things that others do not see or hear).

Individuals with bipolar disorder (formerly called manic depression or manic-depressive illness) also experience depressive episodes, in which they feel sad, indifferent, or hopeless, combined with a very low activity level. But a person with bipolar disorder also experiences manic episodes, or unusually elevated moods in which the individual might feel very happy, irritable, or “up,” with a marked increase in activity level.

Examples of other types of depressive disorders newly added to the diagnostic classification of DSM-5 include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (PMDD).

 
Signs and Symptoms

The Centers for Disease Control and Prevention (CDC) has recognized that having certain mental disorders, including depression and schizophrenia, can make people more likely to get severely ill from COVID-19. Learn more about getting help and finding a health care provider on NIMH's Help for Mental Illnesses webpage.

If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:

  • Persistent sad, anxious, or “empty” mood

  • Feelings of hopelessness, or pessimism

  • Feelings of irritability, frustration, or restlessness 

  • Feelings of guilt, worthlessness, or helplessness

  • Loss of interest or pleasure in hobbies and activities

  • Decreased energy, fatigue, or feeling "slowed down"

  • Difficulty concentrating, remembering, or making decisions

  • Difficulty sleeping, early morning awakening, or oversleeping

  • Changes in appetite or unplanned weight changes

  • Thoughts of death or suicide, or suicide attempts

  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause that do not ease even with treatment

  • Suicide attempts or thoughts of death or suicide

Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment as well. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.

 
Risk Factors

Depression is one of the most common mental disorders in the U.S. Research suggests that genetic, biological, environmental, and psychological factors play a role in depression.

Depression can happen at any age, but often begins in adulthood. Depression is now recognized as occurring in children and adolescents, although it sometimes presents with more prominent irritability than low mood. Many chronic mood and anxiety disorders in adults begin as high levels of anxiety in children.

Depression, especially in midlife or older adults, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. These conditions are often worse when depression is present, and research suggests that people who have depression and another medical illness tend to have more severe symptoms of both illnesses. Sometimes medications taken for these physical illnesses may cause side effects that contribute to depression. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.

Risk factors include:

  • Personal or family history of depression

  • Major life changes, trauma, or stress

  • Certain physical illnesses and medications

 
Treatment and Therapies

Depression, even the most severe cases, can be treated. The earlier treatment begins, the more effective it is. Depression is usually treated with medicationspsychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.

Quick Tip: No two people are affected the same way by depression and there is no "one-size-fits-all" for treatment. It may take some trial and error to find the treatment that works best for you.

 
Medications

Antidepressants are medicines commonly used to treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.

Antidepressants take time – usually 4 to 8 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before deciding whether it works.

If you begin taking antidepressants, do not stop taking them without talking to your doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.

Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug Administration (FDA) also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

If you are considering taking an antidepressant and you are pregnant, planning to become pregnant, or breastfeeding, talk to your doctor about any increased health risks to you or your unborn or nursing child.

To find the latest information about antidepressants, talk to your doctor and visit the FDA website.

 
Psychotherapies

Several types of psychotherapy (also called “talk therapy” or "counseling") can help people with depression by teaching new ways of thinking and behaving and how to change habits that contribute to depression. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). More information on psychotherapy is available on the NIMH Psychotherapies webpage.

 
Brain Stimulation Therapies

If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. Based on the latest research:

  • ECT can provide relief for people with severe depression who have not been able to feel better with other treatments.

  • Electroconvulsive therapy can be an effective treatment for depression. In some severe cases where a rapid response is necessary or medications cannot be used safely, ECT can even be a first-line intervention.

  • Once strictly an inpatient procedure, today ECT is often performed on an outpatient basis. The treatment consists of a series of sessions, typically three times a week, for two to four weeks.

  • ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course. Advances in ECT devices and methods have made modern ECT safe and effective for most patients. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment before giving your informed consent to undergoing ECT.

  • ECT is not painful, and you cannot feel the electrical impulses. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. Within one hour after the treatment session, which takes only a few minutes, the patient is awake and alert.

Other more recently introduced types of brain stimulation therapies used to treat medicine-resistant depression include repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS). Other types of brain stimulation treatments are under study. You can learn more about these therapies on the NIMH Brain Stimulation Therapies webpage.

 
Natural Products

FDA has not approved any natural products for depression. While research is ongoing, some people find natural products, including vitamin D and the herbal dietary supplement St. John’s wort, to help depression. Do not use St. John’s wort or other dietary supplements for depression before talking to your provider. For more information, visit the National Center for Complementary and Integrative Health website.

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For more information go to https://www.nimh.nih.gov/health/topics/depression

Trauma
Trauma
Types of Trauma

Acute trauma reflects intense distress in the immediate aftermath of a one-time event and the reaction is of short duration. Common examples include a car crash, physical or sexual assault, or the sudden death of a loved one.

Chronic trauma can arise from harmful events that are repeated or prolonged. It can develop in response to persistent bullying, neglect, abuse (emotional, physical, or sexual), and domestic violence.

Complex trauma can arise from experiencing repeated or multiple traumatic events from which there is no possibility of escape. The sense of being trapped is a feature of the experience. Like other types of trauma, it can undermine a sense of safety in the world and beget hypervigilance, constant (and exhausting!) monitoring of the environment for the possibility of threat.

Secondary or vicarious trauma arises from exposure to other people’s suffering and can strike those in professions that are called on to respond to injury and mayhem, notably physicians, first responders, and law enforcement. Over time, such individuals are at risk for compassion fatigue, whereby they avoid investing emotionally in other people in an attempt to protect themselves from experiencing distress.

Adverse Childhood Experiences (ACE) cover a wide range of difficult situations that children either directly face or witness while growing up, before they have developed effective coping skills. ACEs can disrupt the normal course of development and the emotional injury can last long into adulthood. The loss of a parent; neglect; emotional, physical, or sexual abuse; and divorce are among the most common types of Adverse Childhood Experiences.

 
Effects of Trauma

Disturbing events activate the amygdala, a structure in the brain responsible for detecting threats. It responds by sending out an alarm to multiple body systems to prepare for defense. The sympathetic nervous system jumps into action, stimulating the release of adrenaline and noradrenaline and stress hormones that prepare the body for a fight-flight-or-freeze response. Short-term fearanxiety, shock, and anger/aggression are all normal responses to trauma. Such negative feelings dissipate as the crisis abates and the experience fades from memory, but for some people, tthe distressing feelings can linger, interfering with day-to-day life.

Sufferers of long-term trauma may develop emotional disturbances, such as extreme anxiety, anger, sadness, survivor’s guilt, disassociation, the inability to feel pleasure (anhedonia), or PTSD (post-traumatic stress disorder). The amygdala become hyperactive, its over-reaction to minor perturbations leading to an outpouring of stress hormones. Living in defense mode, and ever-vigilant to the possibility of threat, people may experience ongoing problems with sleep or physical pain, encounter turbulence in their personal and professional relationships, and feel a diminished sense of self-worth.

Positive psychological changes after trauma are also possible when people acknowledge their difficulties and see themselves as survivors rather than victims of unfortunate experience. These can include building resilience, the development of effective coping skills, and development of a sense of self.-efficacy. Some people may undergo post-traumatic growth, forging stronger relationships, redefining their relationship with new meaning and/or spiritual purpose, and gaining a deeper appreciation for life. It may sound contradictory, but post-traumatic growth can exist right alongside PTSD.

 
Treatment for Trauma

Left unaddressed or untreated, trauma can undermine relationships and wreak havoc on personal and professional lives. There are multiple avenues of treatment available for people experiencing from short- or long-term trauma symptoms.

Lifestyle changes are an early treatment option to consider. Eating healthy, exercising, avoiding alcohol and drugs, getting enough sleep, seeing loved ones regularly, and emphasizing self-care can help relieve trauma symptoms.

Psychotherapy can help a person build resilience, develop coping skills, and address unresolved feelings that are keeping them stuck. Exposure therapy and cognitive reappraisal therapy are two of the more reliable treatments for trauma and PTSD.

Trauma-informed care treats the whole person, recognizes past trauma and the maladaptive coping mechanisms that the individual may have adopted to survive their distressing experience.. Trauma-focused cognitive behavioral therapy is frequently used to address the destructive effects of early trauma, proving particularly helpful to youth with PTSD and mood disorders resulting from abuse, violence, or unresolved grief.

Psychedelic-assisted psychotherapy with MDMA (aka Ecstasy or Molly) is a promising form of treatment for deep-seated trauma. Under a therapist’s supervision and support, PTSD patients are given MDMA to help them talk in depth about disturbing traumatic experiences and learn to control their reactivity. The MDMA appears to speed up the therapeutic process for patients.

Ketamine (special K) may also be used to expedite recovery. It is injected under a therapist’s supervision prior to a talk therapy session. Research has shown it to be effective.

 
Controversies About Trauma

There are many myths about trauma that impede understanding and care. For example, there is a popular assumption that all childhoods are traumatic, which causes people to mistake ordinary hardship or distress for genuine trauma. While this view of trauma may seem initially validating of a difficult experience, it can quickly lead individuals to question their own experiences growing up and the adequacy of their caretakers.

Another common misconception about trauma is that it will destroy your life forever. Some people who experience trauma assume the identity of a victim, expecting the world to harm them and seeing slights where they don't exist; this tendency has helped to create a culture of victimhood that does more harm than good by ignoring people's capacity for growth through challenge. Letting go of the victim label can enable people to see themselves instead as survivors, allowing them to grow and feel optimistic about the future.

It is generally assumed that talking about negative emotions and experiences leads to healing. However, with traumatic events, especially large-scale disasters or wars that impact thousands of people, data show that rehashing painful memories can be dangerous. As a result, treatments such as psychological debriefing are best deployed carefully and on a case-by-case basis. Everyone’s journey through trauma will be different.

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For more information go to https://www.psychologytoday.com/us/basics/trauma

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