Just Keeping Up With Things

Keeping up with what's relevant and useful to each of us can often seem like something out of that classic book Future Shock by Alvin Toffler.

In the book, Toffler talked about how more and more choices were providing an ever-changing landscape in our lives where the simple became the complex.

Consider the incredible array of cereals that confront you when you go to the market. If you're there with a small child, it can turn in to a tug of war as your child insists on one cereal and you select a different one.

When I go to the market I'm in the same situation no matter what I want to buy. If I want oatmeal, I now have at least 15 to 20 in one store and another, an organic market, makes me dizzy with the number of choices in oatmeal alone. Go without a specific list and you're a goner. Go when you're hungry and you are going to spend more than you wanted and you'll get things you may wonder, later, why on earth you bought that.

So, it is much the same as I try to keep up with what's going on in the world of neuroscience and psychology. One of my favorite blogs has to be Anxiety and Panic Gazette which gives me one-stop shopping in terms of food for thought on anxiety and panic disorder.

Recently, they referred me over to an MIT site (Technology Review) which talked about everything from getting high, urban myth there, on holiday food spices to peeking inside the brains of people with PTSD. I love it. Imagine being able to physically see what's happening to the brain after someone has been in therapy for awhile?

We know that the brain changes with experience and that it is constantly reshaping itself, but how? Can thinking positive thoughts actually cause important changes in some of the brain's wiring? I know it can. Some medications cause sprouting and help the brain do its work more efficiently while calming us and helping us to enjoy life. It brings back that old expression that people are always using, "It's all in your head." You bet it is and now we can see it with MRIs, PET or CAT scan and even more sophisticated methods on the way.

I remember being in a major research lab in California one year. They were doing CAT scans of people with dementias and anxiety of various types. I also saw colorful videos of how the brain lights up as it does its work while a patient did a simple math exercise.

So, as I read, I feel that glow that indicates we are on the brink of a new era of discovery in that vast universe located just between our ears. Spock and Kirk may have thought the final frontier was outer space. Me, I know it's inner space.

Related Topics:

Positive Thinking May Affect Pain Relief, 'Just Do It' Attitude Works With Exercise

Technorati Tags: positive thinking, lifestyle change

WHITE COAT SYNDROME

The White Coat Syndrome is enough to make many people have second thoughts about a trip to their physician. It's often something that they fear may happen at the office or, in some cases, it's the attitude of the office staff and that's what I noticed today in a major medical center.

Despite the nice decor, I knew there were women who were practically going into panic when they came to this place. A good number of people with blood and needle phobias or just phobias about being placed into small, tightly cramped machines were trying to steel themselves to remain healthy with regular check-ups like this.

I was seated in a very attractively furnished suite waiting for a benign test that I'd had done before and for which I had no anxiety. As I sat there, I saw women of all ages coming in, some with their husbands, some alone. The women at the front desk cheerily handed them clipboards with forms on top and provided pens for completing the forms. Everything seems to be going swimmingly.

Being a half hour early for my appointment, I had a chance to look around and noticed that the large glass doors leading into the suite were painted about one-quarter of the way up with flowers and a white picket fence design that would have, in my mind, been more suited to a kindergarten classroom entrance. I really didn't like it. In a few minutes I would know why I didn't like it and something I didn't like equally as well would happen.

"Lucy," the woman called out from a side door, clipboard in hand. Lucy was a woman of about 80 who had arthritis and walked slowly as she left her husband's side to follow the woman's call. I thought to myself that this wasn't right. This woman had earned the right to be called not by her first name, but her full name. The woman calling her wasn't an acquaintance, co-worker or friend. She was someone who was going to lead her to the room where the evaluation would take place.

Within the time I sat there, each woman was called by her first name, whether she were in her 30s or her 80s. Perhaps the staff thought this, like the childish painting on the door, would create a feeling of warmth and friendliness. I didn't see either that way.

These women were coming to a place which might give them very bad news or good news, but most of them would dread the bad news and not give the good news much thought. They were anxious, but calling them by their first names, to me, didn't dispel anxiety, but created a sense of a lack of respect for them as women. They were being treated like "girls" and the painting on the door certainly gave that warning to anyone entering here. It should have taken a line from Dante Inferno where it reads "abandon all hope ye who enter here." The hope, of course, was of being treated like a respected adult. It's a component of that all-important bedside manner we hear so much about.

Bedside manner begins not at the desk or the bedside. It begins after that first step into any medical waiting room and it is first practiced by the reception staff, nurses, technicians and added to by their air of professionalism.

The next thing to which I objected, and told the technician, was her request that I sign a form which had a blank line indicating "Recommendations." I was to sign beneath this line and beneath my signature was the physician who had reviewed my form.

I told the technician that this was like signing a blank form and wasn't legally correct because there were no "recommendations" and the physician hadn't read my form. She, nicely, informed me that was the doctor wanted and I told her to tell the doctor, nicely, that this was both questionable on ethical grounds and seemed bordering on the illegal to ask me to sign a form that would have recommendations inserted later. It would appear as though I had seen the recommendations and agreed by placing my signature beneath them. Not so.

So, I signed the form and put a large arrow to the margin where I indicated "signed without recommendations on this form." Wonder how the physician will see that.

Related Topics: Personal Reporter: Answers about High Blood Pressure/White-Coat Syndrome, Making the Most of Doctor Visits

Tags: fear, anxiety, doctors appointment

Relaxation Breathing Put to the Test

Relaxation breathing is something I've always recommended as one of the first things anyone with anxiety or panic might try. It's a great self-help method to controlling anxiety and it can be done anywhere, at any time.

Now, it seems, the National Institutes of Health have decided to explore which, if either, of two breathing regulation methods is more effective in individuals with Panic Disorder. The two interventions are one to raise CO2 and one to lower CO2 and one group, called the control group, which will not have either of these "treatments." One hundred people will be randomly assigned to one of the two groups and they expect to complete the trials in June 2007.

The study is called, simply, Respiratory Therapeutic Procedure in Panic Disorder and anyone interested in more information, or in being considered for the trial can contact NIMH and go to www.clinicaltrials.gov and look for Identifier: NCT00183521.

The idea behind relaxation breathing is that the brain has received inaccurate information in its "suffocation monitor" and it signals back a warning that begins a process of hyperventilation. The effect is an attempt to keep us breathing in life-threatening situations, but there's no threat here. Once the level of CO2, which seems to trigger this alarm, is stabilized, breathing returns to normal. So relaxation breathing, which involves holding the breath for a very short time, is a means of changing this CO2 level.

The study is looking at both people with PD and those who don't have it and it will run for four weeks for each individual.

Related Topics: Feeling Nervous in Social Situations, Chronic Stress: The Mental Connection

Technorati Tags: stress, anxiety, relaxation breathing

Hair Loss and Stress

Hair, it's often said, is a woman's crowning glory and so it seems that when hair is lost, it is a major stressor for women, but the same is true for men. For while we may not say it, hair is as important to men as it is to women.

I remember taking a psychology course many years ago and the professor made a point of indicating that, if you wanted to remove one of a person's most personal displays of their personality, you cut their hair all off. Remember what they did to female Nazi collaborators during WWII? They shaved their heads as a sign of shame and to mark them as pariahs. So, when you remove the hair and the style that goes with it, you do something to the person under the hair.

What causes hair loss and why is it so important and what made me think of it, anyway? I was watching the evening news and Dana Reeve, the widow of actor Christopher Reeve, was at the annual dinner for the foundation named for her late husband. She had long, flowing reddish-brown hair and she looked radiant. I knew that she had been diagnosed with lung cancer and that her treatments were working, but I didn't give her hair a second thought until she was interviewed.

The actress laughed and touched her hair as she told the interviewer that she had very little of her own hair left right now and she was wearing a wig. Then I remembered one of the last quotes from the late ABC anchorman, Peter Jennings. Jennings, who was being interviewed about his lung cancer, laughed and said he asked his doctors when "the hair will go." How many TV anchors can you recall who were bald? Not that bald is bad, but TV likes hair on those guys' heads.

Outside of medical treatments, there are things that can cause hair loss in any of us. Among them are extreme stress, the use of certain birth control pills and some medications, genetic hair loss, medical conditions, dietary deficiencies and probably a few others. One of the treatments for hair loss is actually a medication that was formerly used for regulating blood pressure. The researchers noticed that it had an unexpected side effect; hair growth.

Cancer patients, who certainly have their share of stress, should all be advised that reducing their stress is good for their overall health because they need a strong immune system. Stress saps the immune system of its ability to protect us. If you want to read up on this, find a layman's book on psychoneuroimmunology, simply referred to as PNI.

So, while you exercise, maintain a good diet and your weight, remember you're not only doing it to reduce stress, you may be doing it to keep your hair.

Related Topics: Coping with the Pain of Hair Loss, Treating Hair Loss Naturally

Technorati Tags: hairloss, stress

Surgery and Psychiatry

I'm taking a break right now because one of my computers (yes, I have a few) has just reminded me how infuriating they can be when you want to put in one little piece of new hardware. It never works out the way the ads say and although I always know to expect frustration, I live in hope that it will go smoothly.

This computer, which I call "The Monster," is really quite nice and I have great hopes for it. I once had another which I called "Mrs. Robinson" after the character in "The Graduate." That computer was always trying to seduce people into thinking it could do things it couldn't. Yes, it was a Mrs. Robinson, if ever there was one. Did I ever whisper "plastic" to it? No, but I know it knew about plastic because it had plastic ersatz "walnut" covering its keyboard area.

So, while I allowed myself to calm down from this latest computer glitch, I turned to my news reader and found it had actually caught more good items than I had expected. Pleasant surprise for me and, hopefully, interesting news for you.

One item, which appeared on the website called Red Herring, carried a piece about the latest efforts in psychiatry to use surgery and implantable stimulators to help people with intractable depression. In this instance, it would be anyone who had "failed" at trials of at least four different antidepressant meds. If it helps in depression, perhaps it could be useful for those who have incredible anxiety such as OCD that prevents them from enjoying life. Let's proceed cautiously here.

The company that is making the device, a vagal nerve stimulator, has decided to stop three clinical trials and the psychiatrists on a listserv where I am a member wondered what this meant. I don't know, either.

I do know that this new technology is called neuromodulation and it is estimated to be a multi-billion dollar field. Nerve stimulation devices are or will be used for everything from seizure control, pain management, depression and, possibly, Alzheimer's disease, provided that is, that the research lives up to the expectation of patients and providers. I recall all too well how early 20th Century psychiatrists willingly had their patients' teeth pulled, hysterectomies performed and even extensive nasal surgeries were ordered to cure psychiatric problems.

Some of the research is mixed and, if the stimulators don't exactly do the job, they aren't all that easy to remove. The body, you see, has a way of wrapping protective tissue around things it finds irritating, sort of like oysters that coat bits of sand and, in the process, turns them into pearls.

So, will surgery be the new psychiatry? Maybe for some it will provide the relief they haven't found in anything else, but not for all.

Related Topics: Treatments for Depression, Group Attacks Depression Device


Technorati Tags: VNS, neuromodulation, neurostimulator

Coffee or Booze on Your Break?

Coping with stress and anxiety is difficult, no doubt about that as many of you can agree. We are, by the nature of our culture, social creatures who go to work, do our jobs, interact with our co-workers and supervisors, return home and prepare for another day. Some of us, however, have more problems coping with the daily grind than others and whether it's because of social anxiety disorder or the particularly harsh and stressful demands of our jobs, too many people seek comfort in all the wrong substances.

The coffee break was first instituted by companies that discovered the pick-me-up effect of caffeine, or so I'm told. It wasn't really intended to give workers a break so much as to wake them up to return to their work a bit refreshed. For some workers, coffee just hasn't been doing enough and they choose the solace of old John Barleycorn before they go to work or on their coffee break.

A survey of 2,800 adults in 48 states found that some of the respondents often drank before they went to their workplace. The researchers from SUNY Buffalo, NY, who published their findings in The Journal of Studies on Alcohol, estimated that 1.8 percent of workers actively engage in drinking an alcoholic beverage prior to going to work. The lunch hour, of course, was the most likely time for drinking to occur and they estimated that 7 percent of workers drank then.

The most likely fields to have daytime drinkers were sales, entertainment, sports, media and maintenance. All of these fields, in my opinion, are high stress, even maintenance because these workers often bear the brunt of everyone else's displeasure on any given day. Maybe that's why the maintenance worker on the TV series "Scrubs" is perpetually trying to put one over on his least-favorite resident.

I once had a job where I interacted with a sales force during the day and one of the most talented, successful salesmen never left the office sober, nor did he return from lunch sober. He pleaded with people to go have a "quick one" before he boarded his train home, drank in the bar car on the train and I can only imagine what happened when he got into his car at the station. He finally was fired for being drunk on the job. It was an inglorious end to a very successful career.

Related Topics: Take Charge of Your Stress, Working Solutions to Stress


Technorati Tags: stress, anxiety, career, alcoholism

Curing PTSD

PTSD (Post Traumatic Stress Disorder) was a term that I first became familiar with shortly after the Vietnam War. I recall getting a small book that had been written on treatments for the veterans of this war who suffered with this new variant of an anxiety disorder. During WWI and WWII, we had the term "shell shock" and I recall a friend's uncle who had been drafted in WWII, landed in France and was immediately shipped back to the States. He lived the rest of his life within the confines of his home and even had the barber come to his house to cut his hair. Two of his cousins, both brothers, also developed agoraphobia and were home confined.

During my residency, the term took on a broader meaning when it became a diagnosis associated with car accidents, then sexual assault and, most recently, 9/11 and its consequences. Throughout all these years, the feeling has been that there might be a way to help these patients, if only the process could be short-circuited in some way.

It is well-known in medicine that there are medications that cause amnesia after surgery so that the patients have no memory of anything. This may have provided the key to the thinking for work now being done at McGill University in Canada and Harvard University in the US. An AP article (Marilynn Marchione, AP Medical Writer, 1/14/2006) on the work appeared in the World of Psychology blog recently.

The thinking is that traumatic events are particularly strongly embedded in memory by a special hormone or set of hormones that are resistant to normal forgetting processes. If talking about the event doesn't help to obliterate the memory, then perhaps a medication can do the needed work.

So it is that research on memory formation and the eradicating of it has sprouted, especially since the US Government is aware of the $4 billion a year mental health price tag associated with troops returning from the war in Iraq. Work is also being done by Drs. McGaugh and Cahill at the Center for Neurobiology of Learning and Memory at UC Irvine.

One med that has proven especially interesting to the researchers is propranolol, a medication for hypertension that been useful in various types of anxiety disorders, including performance anxiety and now PTSD. One of the interesting thoughts here is that PTSD is actually a disorder that keeps replenishing its place in memory through the symptoms it causes in patients. Each time the symptom recurs, the memory is reinforced chemically and resists memory decay. Blunting the symptoms quickly may do an end-run around this reinforcement and cause the fading that brings relief. Let's hope it does work for many, many people.

Related Topics: Forget Something? We Wish We Could, Researchers Probe Link between PTSD and IQ

Technorati Tags: PTSD, medicalresearch, trauma

Am I Crazy?

Am I Crazy?

There must be something wrong with me because I'm having a really major problem deciding how I should approach my next book. Should it be the new "fiction as non-fiction" approach to my subject or should it be just called nonfiction when, in fact, it's largely fictionalized? Tough question for a psychologist these days. We've seen some of these "psychologists" unmasked as people having no advanced degrees and yet selling zillions of books. These guys have become millionaires and convinced a lot of people that they were actually "experts" when they weren't anything but con artists.

This latest imbroglio reminds me of all those newspaper reporters who made up their sensational stories about junkie kids and teen prostitutes and who received honors and accolades. They got caught in the end because someone was a bit concerned that they were getting so much good stuff so easily. As a psychologist, I know about this shooting yourself in the foot business because I watch it from afar and see it by the carload on TV each evening.

The rush to get out blockbuster books and sell them on major TV shows seems to have caused something akin to an "oh well, everyone doing it" approach to writing. I, for one, find this dishonest. I don't care who's doing it, it's just plain dishonest and when we see that both major personalities and publishers are engaging in this, it causes me some concern.

I was concerned as everyone when the Korean research baloney hit the fan and now I'm wondering if there's more out there about which we don't know. Who's telling the truth these days and who's really offering self-improvement advice based on real experience with real people? I wonder. This is what makes life exciting, in a way. You watch when the rascals get caught and you just recall that Just World Hypothesis you learned about in grad school. It's an optimistic approach to life that says the bad guys get caught in the end. Nice thought.

I find myself, once again, aligning myself with the curmudgeons of this culture and wondering what happened here. I guess big business has a different view of things than I do and maybe I'm a throwback to an age we will never see again, but I live in hope.

Related Topics: The Internet and Pop Psychology, Pop Culture and Your Kids


Technorati Tags: psychology, writing, nonfiction, culture

Cell Phone Deprivation

Not being able to be alone used to be a sign of a possible personality disorder. Today, not being able to be alone appears to be a sign of the times. How many people have you seen interminably connected via cell phone to some other similarly afflicted individual? The conversations run, mostly in my experience, from the inane to the extremely banal. "Hon, I just got on the bus. Oh, yes, we're turning onto the street now and I'll be in the terminal in just a few minutes." Is this a man who has had an awful experience that has left him with a need to be connected to someone who will comfort him or does his "hon" suffer from separation anxiety of the adult type? I don't know, but I'm beginning to wonder.

So, I think it's time to come up with a new "disorder" of sorts and I think I'll call it Cell Phone Deprivation Syndrome. Why should I wait for someone else to snatch up this catchy phrase and run with it to all the talk shows?

I wonder if the task force currently working on the latest iteration of the Diagnostic & Statistical Manual of Mental Disorders is considering adding some sort of new category to the Personality Disorders or to the Anxiety Disorders. It will be interesting to find out because cell phones have proliferated like those little creatures on that Star Trek series.

As I write, I've got all those nifty little motivational phrases running through my kopf. Remember sitting in school and hearing, "The early bird catches the worm," or "The race is to the swift," or "Close but no cigar." Did they really motivate you? I'm not so sure. Perhaps they were supposed to scare you into action. Maybe, but I don't think so there, either.

Maybe cell phones have somehow gotten into that little anxious area we all have and they have increased our anxiety about always being connected. Does it help? I don't think it helps any more than checking helps people who have a compulsive need to check to handle their anxiety. The ritual begins simply and grows in complexity; all in the service of handling anxiety. It doesn't, but what it does do is cause an inability to either leave the house or walk quietly down a street or go about the ordinary activities of life. Checking is always there.

To satisfy my curiosity, I did a PubMed search and found 118 entries for cell phones. What did they reveal? Mostly, they talked about exposure to radiation or the incidence of accidents while using a cell phone in the car, but there were some that actually looked at how cell phones may be involved in our lives in other ways. Some talked about the effects of cell phones on the sleep-producing substance, melatonin. Others investigated cell phone use and reproductive ability or how they might put kids at risk, but they didn't truly address the social aspects of cell phone use. The problem was, I surmise, that I was looking at the medical literature, not the social psychology literature and that's where it might be. To be continued, my friends.

Okay, I'm waiting for the studies and I'll keep looking because someone somewhere is looking for a dissertation topic and this might be it.

Related Topics: Cell Phone Safety, Confronting Your Phobias

Technorati Tags: cellphones,research,anxiety,webmd

Comfort in Numbers

Corporations, over the past two decades, have been restructuring themselves in order to better compete in world markets. In doing so, they have reordered corporate culture as we know it and, possibly, created a sense of aloneness that has never been felt before in corporations.

People need people, as the song goes, and while they may not be the luckiest people in the world, the sense of belonging and of organization may be what lies between anxiety and context. So, as I thought about it, I wondered how the internet might be involved in retaining this sense of community that may be lost in our new corporate culture.

Sure enough, there's something out there where a guy named Jerry Michalski has set up something called "The Brain," a series of things he has noted during the past year and which you can search.

I searched and I found "Meatball" which is an on-line community devoted to helping others do whatever it is they're doing. Sounded like a good concept to me and I explored a bit more. I found that you would be called a "wikizen" in this new community and that the basic mission was to combat powerlessness, boredom and to create a sense of community. It appears to be the basis for providing that social glue I always think about in my quiet moments.

People in all walks of life are starting not only blogs, but newer types of internet communities where they can share their experiences and form "friendships" as it were on the internet. I feel it's almost like it must have been when people first began using planes in a big way for fun rather than business trips.

Where will it go? As far as the wikizens want, I guess. Let's wait and see.

Technorati Tags: community, communityindicators,society,friendship,webmd

Telephone Approach to Therapy

How can you get mental health care when there doesn't seem to be adequate local resources?  The question is a good one and I've had students who have told me that, in their part of the country, they are the only therapist for 50 miles.  So, aren't there any other ways to get an assessment and help besides traveling that long a distance?

The December 2005 issue of Archives of General Psychiatry, in an article by Rollman et al., details their study of telephone-based interventions.   This study is especially timely since there has been a growing internet presence for therapy and both psychologists and psychiatrists are becoming aware of its need.

The Rollman study carefully screened individuals for panic disorder and of the 191 people recruited, 116 were put into the telephone-based care-management intervention and 75 were given the usual assignment of notifying the PCPs and patients of their diagnosis.  

The telephone-based care patients were offered one of three treatment options:  a workbook with self-management skills and follow-up care with a care manager who reviewed the lesson plans with them, "a guideline-based trial of anxiolytic pharmacotherapy to be prescribed by the primary care physician; or referral to a community mental health specialist.

"Based on those preferences, a treatment recommendation was made to the primary care physician, who was free to accept or reject recommendations," an article in Psychiatric News, January 6, 2006 indicated.  

The result was a reduction "in anxiety and an improvement of quality of life" in those patients in the collaborative care (telephone-based) intervention.  There were significantly less trips to the ER and fewer missed days of work.    

One of the other interesting findings was that 80 per cent of the telephone study participants, when given a choice, used the self-management workbook and an SSRI/SNRI.  Twelve months after the study began, there were significant reductions in scores of depression, while those who chose "usual care," meaning those who did not get the telephone intervention and workbook, had two or more trips to the ER.

The study seems to be pointing to the power of self-help anxiety management with, when necessary, medication as a very potent approach to treatment.  This approach also provides patients with a sense of self-empowerment, something I have always felt is an important component of any healthcare treatment.

Related Topics: Finding the Right Therapist, Short on Shrinks

Technorati Tags: findingatherapist, mentalhealthcare, telephonetherapy

The Ugly Twins

Reading is a passion of mine and it does run in my family. Many of us can be found at all hours of the day or night trying to get in yet one more chapter in whatever book we happen to be reading at the time. It's a pleasure and a wonderful stress reliever, to my mind. It has opened up my mind to the world of reality and fantasy, led me to ask new questions of my profession and allowed me to more fully understand those who share this good earth with us.

Currently, I am reading two books by the actor/writer/entertainer Spalding Gray whose untimely death a few years ago shocked me. Gray was a man of talent and complexity, but obviously there was a great deal of pain in his life, pain he managed to keep to himself and it was depression that drove him to take his life.

As a psychologist, I've come to know that the old idea that there are definite warning signs that alert everyone to impending suicide just isn't so. I've seen it in my years in clinical work and here it was again in the death of Spalding Gray.

Gray did all the things I've come to know are often seen in someone who is bent on suicide. He made plans for a ski trip, went about his usual life activities and then, suddenly, just before the trip, disappeared. No one knew where he was, but they hoped he would just be hanging out with friends and too involved in something to contact them. It wasn't so. They found him weeks later in the Hudson River. Here was a man who was a wonderful raconteur, writer and, from what I've read, devoted father who found life was impossible for him.

Depression and anxiety, or the "Ugly Twins" as I call them, cloud our ability to see solutions to problems and I think of how many others must feel this way, too. Any psychological/psychiatric disorder can bring about this clouding and make ending it seem almost like a good thing. To say it's a shame doesn't make a strong enough case against it, but I understand their feeling of hopelessness and their resolve to end their pain.

In a world that now offers so many treatments for both depression and anxiety, there would seem to be help for all of these people. Yet, in many parts of our country and the world, there are few resources. Even when the resources are available, they may not be used because of the fear of stigma or a lack of funds to pay for the help. The duty of all of us now is to raise the level of awareness of everyone that these illnesses are treatable and that help does exist, even in cases of financial distress.

No one wants to lose another person to the Ugly Twins, so let's not let them win any more of these tortured battles for life.

Related Topics: Beyond Depression, How to Maximize Life Satisfaction

Tags: anxiety,depression,suicide,spaldinggray,webmd

One Size Does Not Fit All

Dr. Kevin (a physician blogger) recently wrote that he is concerned about how certain approaches to medication are being related to patients. I agree with him. We are complex creatures and the one size fits all approach to treatment just doesn't fit at all.

I see this on my message board where I respond to questions on anxiety and panic more times than I can count at this point. Searching for a quick answer to relieve their symptoms, affirms that patients and physicians, too, can engage in simplistic thinking.

There's nothing simple about anxiety, panic or depression. It's not as simple as a chemical imbalance and treatment requires skill on a number of levels. First, there is the skill to adequately assess the level of one or more of these disorders. Next, there's a need to know the patient and what will or won't work with them. This requires a good working relationship with the patient and a true partnership is an absolute necessity. Patients or physicians working at cross odds or not really listening to each other can result in poor response to treatment.

I visited a dermatologist the other day. He is an extremely skilled physician and, as I know and his nurse said to me, "When he's with you, he's with you." That is my kind of a physician. He has also made it a point to explain to patients all the possible treatments for any condition, what is involved and how long it will take. What's more, he encourages questions and provides materials to read. There's never a rush.

I understand that many patients find it difficult to accept that they have something that has anything to do with a mental condition and they want to get it remedied right away.

The research into the most effective treatments for anxiety, panic and depression all points to a combination of cognitive therapy and medication, when needed. They've looked at one treatment and both treatments combined and the results all point to a two-pronged approach. The quick fix isn't it.

This does not mean that a patient has to feel they have to bare their soul when they go into therapy because cognitive therapy focuses on problems and solutions, not early toilet training. It's a therapy that should be symptom-oriented, usually short in its course and leave the patient with new tools to use on their own to handle anything that comes up in their lives.

Some members of my board have indicated they've had no success with therapy and I answer that it may have been because they went to someone who either didn't specialize in their disorder or didn't practice cognitive therapy. Yes, you could say I have a preference here, but it's to one I know works and works well.

Related Topics: Therapy as Good as Drugs for Depression, The Art of Self-Examination

Tags: anxiety,panic,depression,cognitivetherapy,,webmd

Do You Smoke?

Do you smoke? I used to smoke many years ago when it was the thing to do among my peer group. I stopped smoking because I really didn't like it very much and because I saw a TV commercial for cigarettes that make smoking look like a silly thing to do. I saw these people running down a beach toward each other and ending up "enjoying" a cigarette almost as soon as they met. What, no "hello, how are you?" No, just a simple cigarette to the mouth and an obliging flip of a lighter.

I was one of the lucky ones and I only began to really realize that when I worked in a psychiatric hospital where they decided to impose a "no smoking" rule. Patients, who we know from the research evidence, are heavy, habitual smokers, were told they could have cigarettes outside the building, rain or snow, at something like one to three-hour intervals. It resulted in threats, punches and a near fatality at another hospital. Cigarettes in the hospital were the currency with which you could obtain many of the things you wanted and matches were sold for $1 each. After all, how good is a cigarette if you can't light it? Some patients took to lighting their cigarettes on electric hand dryers in the restrooms.

What made psychiatric patients such heavy smokers, I wondered and it wasn't long before the professional literature was beginning to give us answers. Nicotine, a substance that has natural receptors (think of little landing pads) in the nervous system, is a wonderful drug. It can be used medically for a variety of new uses now in clinical trials and it is a mild anti-anxiety drug. This is probably why people in psychiatric hospitals are such heavy smokers; it's very stressful and they are under a great deal of internal stress from their illnesses.

So, smoking is more than just "something to do with my hands" as someone once told me when I asked why she didn't stop smoking. She was actually annoyed that I had stopped because it made her feel uncomfortable to be in someone's company who didn't smoke. I held my ground and never went back to smoking.

Whenever you consider smoking cessation, as it is called, remember that it's a two-pronged approach because part of the problem is biological and part of it is stress induced. Ever notice where most of the smoking is done? It's usually at parties, in bars, or dinner parties, all social situations. Or at least it used to be. The recent increased awareness of the health risks of smoking to both the smoker and the second-hand receiver of that smoke (including children) is making it very difficult for smokers.

Smoking is an indication of stress and it has to be treated as such. Manage the stress, get some medication to help with the nicotine withdrawal and it can be done.

Related Topics: Quit Smoking: Strategies and Skills, Panic Attacks More Common in Smokers

Tags: quitsmoking,addiction,stress,webmd