PATIENT CONTROL IN ANXIETY THERAPY

ENG302 III BLOG5

PATIENT CONTROL IN ANXIETY THERAPY

WHAT?

The results of a recent study demonstrate the power of patient participation and control during therapy sessions to treat anxiety disorders.  Anxiety is a state of fearfulness and apprehension frequently accompanied with a feeling of doom.  The number of people with anxiety disorders has increased during the last several years and as a result the disorder is getting more attention.   

    WHAT THEN?

Psychotherapy (talk sessions) with a counselor traditionally has been the way to deal with this disorder.  This method often required long periods of time and of course it could be very expensive.  But the key point is that the patient was not involved in the therapy and often did not know if he or she was improving.  Frequently, after the therapy ended, the patient would return with the same symptoms.  Cognitive Behavior Therapy (CBT) is a method that involves the patient with his or her own control and input.

  

HOW DOES IT WORK?

The central premise of CBT is that the cognitive part of your brain can dominate over the emotional part.  The counseling sessions teach the patient how to do this.  It involves learning how to think correctly about situations and events and what the appropriate response should be.  A very important part of the therapy is for the patient to document (homework) all the perceived stressors, disruptions to personal harmony and other negative inputs and record responses to these perturbations.  These are then discussed with the therapist to help teach the patient a healthy response.  Over time, the patient will “learn” appropriate responses and this “learning” will become part of the normal thought process.

WHAT IS THE CATCH?

This approach requires dedicated participation by the patient.  It is hard work.  The patient must attend all sessions and perform the tedious homework assignments.

DOES IT WORK?

Studies have shown it has a high success rate.  This is particularly true when adjustments to results are made based on initial severity, ethnicity and gender.  The payoff is that it gives the patient more control over symptoms and feelings with the power to apply corrections.

 

DOI:10.1037/a0033403

Puberty and Adolescent turmoil

http://articles.washingtonpost.com/2013-07-08/national/40435953_1_early-puberty-psychiatric-epidemiologist-behavior

ENG302  BLOG4

 

 

 

 

PUBERTY AND ADOLESCENT TURMOIL

Puberty is a stressful time for adolescents.  There are mental changes that are happening and the more obvious physical changes.  Boy’s voices, sexual parts and growth patterns change.  Girls experience breast development, menstruation and an increased awareness of their appearance.  Both boys and girls suffer from acne when they are the most self conscious. Added to this, are the changes that occur in the brain as they transition from childhood into adulthood.  Neural connections change drastically from the configuration of the learning requirements of children (much breadth with little depth) to those of adults (increased depth to specialize).
 

Where do we go from here?

It has been long been known that children who enter puberty at an early age (8 or 9 versus 10 or 11), have social and psychological problems.  These include difficulty in getting along with others and disorders such as depression.  It was thought that early puberty was the main correlation for these behavior problems.  The results of a recent study of a group of Australian children show that this may not be the case.  These children who began puberty early experienced problems.  However, these same children showed indication of problems when they were 4-5 years old.  This was published in a paper in the Journal of adolescent health.  This study challenges the assumption that puberty is the cause of these behavior problems.

 

 

 

 

 

 

 What next?

Further studies should be undertaken to examine what might be the source of these problems.  Is it the genetic luck of the draw that some children are predetermined to suffer from this situation in the same way some people are asthmatic or have a predisposition to diabetes.  Could this be a social or environmental phenomenon?  Is our expectation of earlier academic performance combined with high tech gadgets skewing natural child development?  Are there real consequences to issues such as clean air, pure water or atmospheric heating?

 

Childhood Maltreatment Can Leave Scars In The Brain : Shots - Health News : NPR

Childhood Maltreatment Can Leave Scars In The Brain : Shots - Health News : NPR



Blog III

 

CHILDHOOD MALTREATMENT CAN LEAVE SCARS IN THE BRAIN

What do we mean by maltreatment and what are the behavior problems?

 

  We as human beings are built to instinctually respond to fear situations by rapid changes in the body and brain that in more primitive times might have meant death or survival.  In the more civilized environment that we live in now, there are some situations that might require this response. For example, as a driver of a vehicle this primitive response might allow you to have temporarily more strength in your arms and legs to wrestle with the steering wheel and more forcefully apply the brakes. Your brain will suspend all cognitive functions except those associated with the emergency at hand.  Instinct and emotions dominate over cognitive abilities.  Maltreatment for this discussion includes physical abuse, sexual abuse and neglect.  For children and adolescents who have been subject to maltreatment, the response to situations that would cause a response such as the one described above happen  routinely. Their reaction to everyday stressors generates a fear and a fear response that is inappropriate.

 

What is the mechanism that causes this? 

 

 Psychiatrists, through brain diagnostics, have been able to determine that in these adolescents the connection between the prefrontal cortex (PFC) and the hippocampus and the PFC and the amygdala are weak.  The hippocampus’ function is to assess a situation and tell the PFC how serious (level of fear to be generated) it is.  The PFC then controls the appropriate emotional response from the amygdala.  With weak connections among the three, the amygdala (not tempered by the PFC) generates emotional responses that may be over amplified for the situation.  The result is that these adolescents who have been subject to abuse generate fear at the slightest provocation.
 

What can we do about this?

 

  In the same that diagnostics are used to assess physical abnormalities, diagnostics should similarly be used to identify these abnormal brain developments.  Then subsequent treatment can be prescribed in the same way treatment for physical ailments are prescribed.  This might avoid subsequent tragedies.

Do it yourself Depression Therapy

 BLOG2

 

Why consider this?

  Depression is a debilitating disorder that for the individual results in unhappiness, misery, despair and in the extreme, self harm.   For the loved ones around these individuals it causes concern, anxiety and a feeling of helplessness. Many people exhibit symptoms for only short periods of time because they are related to a situation that goes away.  For a very large and growing number, this is a lifetime battle.  Adolescents are particularly vulnerable, because not properly treated depression as youths will emerge again when they are adults.

Why Do It Yourself? 

Health plans do not cover the number of visits to a mental health professional that may be required.  For most of the current plans, the number of covered visits is six.  This is sufficient for those with a temporary condition.  For those with chronic depression, it does not come close.  Prescribing pharmaceuticals often mitigates the symptoms but they frequently are not enough.

 

What can be done?

  A proven clinical technique is Cognitive Behavior Therapy (CBT).  This approach uses the fact that the cognitive part of our brain can overrule the emotional part of the brain and replace appropriate interpretations with inappropriate interpretations.  When supervised by a mental health clinician, the participant must keep data relating to thoughts, interpretations and responses.  CBT has been shown to be beneficial in group therapy.  Individuals derive value from meeting in groups of peers with similar issues.  The Affordable Care Act (ACA) requires additional mental health coverage.  It will provide additional covered visits but not enough for an individual to receive individual care for the required length of time.  CBT lends itself to protracted self administered therapy. (The cognitive behavioral workbook for depression: a step-by-step program by Knaus, William J. , Oakland, CA: New Harbinger Publications, c 2006.)  It also lends itself to Group therapy.  This approach could be monitored by a professional mental health clinician.  This approach would require fewer individual visits and much longer therapy time since a provider’s charges would be spread over a larger number of patients.     


Where do we go from here?

 

 

Poor Little Rich Kids

 BLOG 1

REFERENCE:  Luthar, Suniya S. Phd, “The Problem with Rich Kids” Psychology Today, December, 2013

   

Well known, are the problems associated with youth in poverty and are accepted.  They include ignorance, poor education, stress and behavioral problems.

So what? 

 This is contrasted with adolescents with white collar and educated parents whose incomes are $150,000 per year and above.  It would seem that children from this group are well adjusted, experience minimum stress, and are on a path to normal adulthood. 

So what is the problem?

Increasingly, this group of youth is experiencing emotional and behavioral problems.  Stereotypically, the girls are suffering from anxiety and depression and the boys are looking for sexual conquests to fill their self esteem needs.  Both sexes are engaging in binge drinking, drug use, academic cheating, and petty theft. 

  What is causing this behavior?  There is high pressure for achievement within this group.  A child of this group is the offspring of materially successful parents and is expected to uphold the standards.  This includes performing well in high school, being accepted to a prestigious college and securing a position with a high salary. Unlike the youth in poverty these kids are enrolled in good school systems, relatively safe environments,  resources that their parents can provide and therefore have little excuse for performing poorly. 

What is happening?

 This pressure is transmitted within the environment that adolescents create for each other as well as from the expectations of their parents.   For girls, it is academic achievement, being part of the right group and more importantly appearance.  For boys, it is academic achievement, athletic achievement and sexual control. 

 The ultimate goal is to be materially successful and have money as do their parents. This future seems to be difficult for them to attain.  In their minds, the road to happiness is by being well-to-do and in control.  Lost in this quest is self knowledge, decency, peace of mind, kindness and self worth.  For boys it typically results in narcissism, ego and dissatisfaction with self.  For girls it typically ends in low self esteem, depression and anxiety.

  The problems are compounded by increased competition for admission to good colleges and an economy that is not providing the opportunity that it once did.

What can we do to help the poor little rich kids?