Panic, depression , trauma, insomnia, and

coping with medical illness.

Anxiety and Panic

Panic attacks are episodes of intense physiological arousal accompanied by a fear of dying, going insane, or losing control. Panic attacks are the form of anxiety that I have had the greatest success treating. They are often treated ineffectively when standard protocols are applied.

Most Panic Attacks Can be Easily Controlled

Equipment in my office give me the ability to monitor the physiology of the person experiencing panic attacks. The key variable is usually the way in which carbon dioxide is expelled from the body prior to , and during, a panic attack. Once this variable is identified the problem can be corrected rather easily with a simple breathing technique, but it is not the one usually taught to patients.

Phobias and obsessive-compulsive disorder require additional treatment components. Most notable is ERP or exposure with response prevention. Avoiding or escaping situations that give rise to anxiety symptoms is the best way of making those symptoms stronger. First they are taught how to relax, become mindful of one’s building anxiety. Then they are able to actually reduce the anxiety with self-control techniques. This prepares the individual to become gradually exposed to situations, thoughts, or bodily sensations that tend to produce their anxiety symptoms. By gradually increasing the exposure to what some call “triggers” the symptoms begin to decrease. They are essentially starved or extinguished due to lack of reinforcement.

Depression

Depression is a thief that constantly robs you of the joy of living. Major depression is a biochemical problem that may require a combination of medication and psychotherapy. Cognitive therapy has an excellent track record in treating depression. Cognitive therapy for depression involves a combination of behavioral activation, a systematic re-engagement of the individual in activities (exercise, those found to be pleasurable previously and others) and cognitive restructuring. Cognitive restructuring examines the negative or otherwise unhelpful thoughts that lead to negative feelings, especially about self. These thoughts are brought to light in order to examine their accuracy. I do not believe that major depression is brought on by negative or incorrect thinking. I do believe that it is a complex biochemical condition in which these types of thoughts serve to perpetuate and worsten. If an individual is taking antidepressant medication cognitive therapy can help to reduce the dosage needs and the time during which medication is required.

Trauma

We all face challenges in our lives but sometimes our experiences are overwhelming. Trauma can cause lasting changes in people, including changes in brain activity. There is no pill for trauma or grief. Compassionate treatment which supports the individual emotionally while helping them integrate the traumatic experiences into the totality of their life experience is often the most effective approach. Combining non-judgemental listening with relaxation, meditation and even biofeedback help the individual develop the emotional resilience required to develop a new perspective. Sometimes panic or symptoms of depression must be targeted first as they will perpetuate the traumatic response and impede recovery.

Insomnia

In recent years there have been significant advances in the use of cognitive therapy in the treatment of chronic insomnia. Before beginning any treatment for insomnia the possibility of physical illness, anxiety or depression should first be assessed. Cognitive therapy is usually brief and addresses one or more of the following factors: arousal levels, activity levels, the sleep environment, pre-bedtime activities, attitudes and beliefs about sleep, exercise and stimulant use, and what to do if sleep does not come as desired. Treatment may also address anxiety and/or depression if present.

Coping with Chronic Illness

Coping with Cancer

Receiving a diagnosis of cancer is a shock for any patient or family member. In many cases it is no longer as bleak of a prospect as it once was. Each year treatment improve and new medications are developed to help manage the side effects of treatment. We are often anxious to begin treatment immediately. Sometime we are asked to struggle with a whole new world of treatment options – with little upon which to base our diagnosis, or even our questions.

Coping with Injury and Disability

Early in my career I worked in the area of rehabilitation psychology, specifically with individuals who had sustained severe traumatic brain injury and spent months in coma. Working with these people after they emerged from coma required a very different approach. They needed coaching, not analysis. They often had hidden strengths, skills, and mindsets that were crucial in supporting them as they re-learned everything from how to walk to social skills. Learning how to cope with a chronic illness like multiple sclerosis or autoimmune disorders can require similar support along with help to see that a life with limitations is still worth living.