Mental Health Archives - Page 4 of 16 - Lindner Center of HOPE

By Angela Couch, RN, MSN, PMHNP-BC

Psychiatric Nurse Practitioner, Lindner Center of HOPE

Anxiety is a common symptom. Anxiety is a part of everyone’s lives, we have all experienced it to one degree or another. Believe it not, anxiety serves some useful purposes. Anxiety can help give you the drive to make a change, or complete task on time.Anxiety can activate the fight or flight instinct, in a “potentially” dangerous situation, giving you the drive to get out of there, or do something to prevent harm. Anxiety can occur when you are enduring multiple stressors, or there is uncertainty, and it’s not entirely unexpected.

For instance, say you hear layoffs are coming in the company, and you’re not sure if your department will be affected. You may experience physical symptoms of anxiety (which could include racing heart, nervous stomach, sweating, tremor, nausea, shortness of breath, and more), and you might also experience worry. COVID-19…yup, that can cause some anxiety, or worry, too! Situational anxiety is a part of life, and often can be managed by rational self-talk, problem-solving, and various positive self-care strategies. (For more on that, see some of our other recent blog articles, for lots of helpful ideas!) So how do we know when the anxiety is more than just “normal” or to be expected, and when to seek help?

According to the National Comorbidity Study Replication, about 19.1% of U.S. adults will have had an anxiety disorder in the past year, and 31.1% experience an anxiety disorder in their lifetime. In other words, it’s pretty common! There are various types of anxiety disorders, and most have an underlying common thread– difficulty in accepting uncertainty in some form. So how do you know if you may need to seek further assessment or help for anxiety, if it’s really so common? If everyone gets it, is it really a problem that requires treatment? The answer is yes, it might. Some symptoms that may indicate problematic anxiety include:

* Feeling “paralyzed” by fear.

* Anxiety is causing you to avoid things you used to be able to do without anxiety, or things that are important to you (this could include social activities, leaving your house, going to your job, driving, engaging in spiritual activities, etc.).

* You have difficulty staying present “in the moment”, which may repeatedly distract you from attending to conversations, being able to complete work or school tasks because of lack of focus.

* You are having difficulty with sleep or eating due to excessive worry or anxiety.

Anxiety is causing significant physical symptoms.

* You cannot determine a cause for the anxiety and the symptoms are persistent or very bothersome.

* You worry about “everything” or “all the time”.

* The anxiety/worry you are experiencing about situations seem excessive.

* You need to engage in compulsive or repetitive behaviors, or do things in a certain way, in order to avoid significant anxiety/worry.

* Anxiety is causing you to turn to self-medication with alcohol or substances.

So you’ve determined you should seek help, now what? Psychotherapy can be helpful for anxiety, and is a very important component of treatment. Psychotherapy may include several modalities such as cognitive behavioral therapy, addressing faulty beliefs contributing to anxiety, psychoeducation about anxiety and worry, problem-solving, exercise and wellness activities/lifestyle changes, addressing sleep hygiene, skills for time management and stress reduction, or exposure therapy, just to name a few.

How do you know if psychotherapy is enough to manage the symptoms? Medication can be a helpful component in treatment of anxiety, particularly if symptoms are not improving with other psychotherapeutic interventions mentioned above. Medications alone are rarely enough to treat anxiety disorders adequately. Medication can often make it easier to engage in meaningful psychotherapy, to make those helpful lifestyle changes, or try new ways of coping with the anxiety/worry. If you are experiencing suicidal thinking or significant depression, medication should be a consideration. If the anxiety symptoms are preventing you from being able to work or do other essential tasks, medication may be indicated. If your therapist suggests a medication consultation, you should consider it.

The important things to remember are, everyone has some anxiety, not all anxiety is bad, and when anxiety does become problematic or excessive, there are evidence-based treatments to help, so don’t be afraid to reach out for help!

CBT and Psychosis

Many think that psychosis cannot be targeted with cognitive behavioral therapy, but that is not the case. There is a specific form of therapy that was developed for psychosis called CBTp. One important point to mention is that the symptoms are only targeted when they are distressing to the client and they interfere with their functioning or safety, not because one believes them to be untrue or abnormal. The main tenet is to join with the client and build rapport while not directly challenging their psychosis, which is referred to as working within their belief system. Once this is established, gradually helping them think differently about some of their experiences or beliefs is possible, but not in all cases. In some cases, the cognitive therapy is used to help them live their life and meet their goals in spite of their experiences or beliefs.

Combatting Stigmatization

One useful technique with this therapy is to help them feel less stigmatized and normalize some of their experiences. There are specific websites out there that detail stories and list famous people out there who have struggled with psychosis, which can be very helpful for the client to read about. One such website is intervoiceonline.org.

Effective Coping Strategies

Another very practical technique is helping them set smart and realistic goals. This can be done by asking what their goals are and developing a shared goal that can be accomplished. For example instead of “wanting the voices to stop” a smart goal could be “by the fourth session I will have learned and used two different coping strategies that reduce how much distress the voices cause from 100% to 75%”.

Other strategies that CBTp utilizes are coping strategy enhancement. First you figure out what they already are using to cope and figure out if they need to be refined or improved. Helping them figure out the time of day to use these strategies is important. They are likely to be most helpful when their voices are triggered, such as certain times of the day, a specific place, a certain smell, or certain feeling. Some strategies that can be useful to use before their voices are triggered include progressive muscle relaxation, deep breathing, and practicing mindfulness of the present moment such as identifying things in the room. Strategies that can be helpful once the voices are already triggered include: using an ipod and listening to a feel good songs playlist; playing the look, point and name; using sub vocal speech or singing under one’s breath which can interrupt the voices; focusing on voices (hearing out in order to change relationship with voice); entering into dialogue with them, and setting specific times for listening to voices.

CBTp Objectives and Techniques

When targeting voices in sessions, there are several main goals. One is to help the client understand how their beliefs and thoughts relate to the voices and influence their feelings, mood, and coping. Another is to help them identify their beliefs about their voices. Helping them explore evidence for and against their distressing beliefs is important. One can also develop behavioral experiments to test out the reality of their belief. Helping them generate alternative explanations and thoughts about their voices is also helpful. Providing behavioral interventions to reduce distress associated with their voices is key as well. Lastly, helping them change their relationship to their voices is important.

As you can see, there are many strategies that can be useful in psychosis treatment for this presenting problem.
The key it to present it in a way that is collaborative with the client and doing so in a trusting professional relationship. Meeting the client where they are at is important. It is also helpful to keep in mind that these techniques take some time to work and for the client to be able to use them, so patience is key as well.

Nicole Bosse, PsyD

Staff Psychologist, Lindner Center of HOPE

Established in 2008, Lindner Center of HOPE has stood as a beacon of support for countless individuals grappling with mental health issues or addiction. Contact the Lindner Center of HOPE today to learn more about our comprehensive suite of mental health treatments and services, our environment fosters enduring recovery. Powered by our dedicated psychologists, the Lindner Center of HOPE is wholly devoted to instilling hope and guiding you on your personal journey to wellness.