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Posts Tagged ‘cognitive behaviorial therapy’

Fibromyalgia sufferers were once told their pain was all in their head. But in recent years, the medical community has found evidence that fibromyalgia is in fact a physiological disorder. However, that doesn’t mean that talk therapy has no place in treatment of fibromyalgia. In fact, cognitive behavioral therapy or CBT, has been found to be useful in addressing insomnia and some of the side effects of fibromyalgia symptoms.

According to Dr. Dorothy McCoy from PsychNetUK:

In a recent study, CBT offered an alternative approach that demonstrated clinically significant improvement within six weeks (Edlinger, 2001). In another study, on chronic fatigue syndrome, the researchers compared standard treatment with cognitive therapy and standard treatment without cognitive therapy. “Seventy-three percent of the cognitive group were spending less time in bed and functioning normally after a year” (WebMD Health). Only 27% of the other group experienced the same gains. Flemming (1997) suggests amplifying standard treatments’ efficacy by including bodywork and relaxation. According to the eminent wellness physician, Dr. Andrew Weil, guided imagery tapes are useful in reducing pain and speeding the healing process. Patients are relieved to discover they have a legitimate medical disorder and the pain is not imaginary.

In a study on low back pain, researchers found that relaxation response training was effective in reducing pain severity. Twenty-eight of the patients also had fibromyalgia. Many of the study subjects reported reduced pain and a reduction in other symptoms, as well as “improved function and general health” (Millea, 2001). One panel of experts concluded that relaxation techniques were helpful in managing chronic pain. Furthermore, the techniques were valuable in managing the stress inherent in living with a chronic pain disorder. Yet anther study suggests that patients who believe they have little control over their symptoms report more severe and chronic fatigue. CBT is helping patients to change their inaccurate, self-defeating beliefs and regain a sense of control over their lives. A belief in one’s ability to manage one’s disorder frequently becomes a self-fulfilling prophecy.

According to the University of Maryland Medical Center website:

Studies show that fibromyalgia patients feel better when they deal with the consequences of their disorder on their lives. Cognitive-behavioral therapy (CBT) enhances a patient’s belief in their own abilities and helps them develop methods for dealing with stressful situations. CBT, also called cognitive therapy, is known to be an effective method for dealing with chronic pain from arthritic conditions. Evidence also suggests that cognitive-behavioral therapy can help some patients with fibromyalgia.

Although the effects of CBT and other non-medication treatments for fibromyalgia do not always last over the long-term, they may help certain groups of people, particularly those with a high level of psychological stress.

CBT may be particularly useful for addressing insomnia, one of the hallmark symptoms of fibromyalgia. In studies, patients who received CBT for insomnia woke up 50% less often at night, and had fewer symptoms of insomnia and improved mood.

The Goals of CBT. The primary goals of CBT are to change any unclear or mistaken ideas and self-defeating behaviors. Using specific tasks and self-observation, patients learn to think of pain as something other than a negative factor that controls their life. Over time, the idea that they are helpless goes away and they learn that they can manage the pain.

Cognitive therapy is particularly helpful for defining and setting limits, which is extremely important for these patients. Many fibromyalgia patients live their lives in extremes. They first become heroes or martyrs, pushing themselves too far until they collapse. This collapse reverses the way they view themselves, and they then think of themselves as complete failures, unable to cope with the simplest task. One important aim of cognitive therapy is to help such patients discover a middle route. Patients learn to prioritize their responsibilities and drop some of the less important tasks or delegate them to others. Learning these coping skills can eventually lead to a more manageable life. Patients learn to view themselves and others with a more flexible attitude.

The Procedure. Cognitive therapy usually does not last long. It typically consists of 6 – 20 one-hour sessions. Patients also receive homework, which usually includes keeping a diary and trying tasks they have avoided in the past because of negative attitudes.

A typical cognitive therapy program may involve the following measures:

  • Keep a Diary. Patients are usually asked to keep a diary, a key part of cognitive therapy. The diary serves as a general guide for setting limits and planning activities. Patients use the diary to track any stress factors, such as a job or a relationship that may be improving or worsening the pain.
  • Confront Negative or Discouraging Thoughts. Patients are taught to challenge and reverse negative beliefs. For example, “I’m not good enough to control this disease, so I’m a total failure” becomes the coping statement, “Where is the evidence that I can control this disease?”
  • Set Limits. Limits are designed to keep both mental and physical stress within manageable levels, so that patients do not become discouraged by getting in over their heads. For example, tasks are broken down into incremental steps, and patients focus on one step at a time.
  • Seek out Pleasurable Activities. Patients list a number of enjoyable low-energy activities that they can conveniently schedule.
  • Prioritize. Patients learn to drop some of the less critical tasks or delegate them to others.

Patients should learn to accept that relapses occur, and that over-coping and accomplishing too much too soon can often cause a relapse. Patients should respect these relapses and back off. They should not consider them a sign of failure.

Research also shows that patient education can be effective in treating fibromyalgia, especially when combined with CBT, exercise, and other therapies. Educational programs can take the form of group discussions, lectures, or printed materials, although there isn’t any clear evidence on which type of education works best.

Support Organizations and Group Therapy

Cognitive therapy may be expensive and not covered by insurance. Other effective approaches that are free or less costly include support groups or group psychotherapy. In one study, educational discussion groups were as effective, or even more so, than a cognitive therapy program. Such results are not typical in all centers. Therapeutic success varies widely depending on the skill of the therapist.

Resources

References

Abeles M, Solitar BM, Pillinger MH, Abeles AM. Update on fibromyalgia therapy. Am J Med. 2008;121:555-561.

Arnold LM, Goldenberg DL, Stanford SB, Lalonde JK, Sandhu HS, Keck PE, et al. Gabapentin in the treatment of fibromyalgia: a randomized, double-blind, placebo-controlled multicenter trial. Arthritis & Rheumatism. 2007;56:1336-1344.

Geisser ME, Glass JM, Rajcevska LD, Clauw DJ, Williams DA, Kileny PR. A psychophysical study of auditory and pressure sensitivity in patients with fibromyalgia and healthy controls. J Pain. 2008;9:417-422.

Guedj E, Cammilleri S, Niboyet J, Dupont P, Vidal E, Dropinski JP, Mundler O. Clinical correlate of brain SPECT perfusion abnormalities in fibromyalgia. J Nucl Med. 2008;49:1798-1803.

Gusi N, Tomas-Carus P. Cost-utility of an 8-month aquatic training for women with fibromyalgia: a randomized controlled trial. Arthritis Res Ther. 2008;10:R24.

Harris RE, Clauw DJ, Scott DJ, McLean SA, Gracely RH, Zubieta JK. Decreased central u-opioid receptor availability in fibromyalgia. J Neurosci. 2007;27:10000-10006.

Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58:26-35.

Mannerkorpi K, Henriksson C. Non-pharmacological treatment of chronic widespread musculoskeletal pain. Best Pract Res Clin Rheumatol. 2007;21:513-534.

Matsushita K, Masuda A, Tei C. Efficacy of Waon therapy for fibromyalgia. Intern Med. 2008;47:1473-1476.

McCabe CS, Cohen H, Blake DR. Somaesthetic disturbances in fibromyalgia are exaggerated by sensory-motor conflict: implications for chronicity of the disease? Rheumatology. 2007;46:1587-1592.

Rooks DS, Gautam S, Romeling M, Cross ML, Stratigakis D, Evans B, et al. Group exercise, education, and combination self-management in women with fibromyalgia. Arch Intern Med. 2007;167;2192-2200.

Schweinhardt P. Fibromyalgia: a disorder of the brain? Neuroscientist. 2008;14:415-421.

Targino RA, Imamura M, Kaziyama HH, Souza LP, Hsing WT, Furlan AD, et al. A randomized controlled trial of acupuncture added to usual treatment for fibromyalgia. J Rehabil Med. 2008;40:582-588.

Van Koulil S, Effting M, Kraaimaat FW, van Lankveld W, van Helmond T, Cats H, et al. Cognitive-behavioural therapies and exercise programmes for patients with fibromyalgia; state of the art and future directions. Ann Rheum Dis. 2007;66:571-581.

Verbunt JA, Pernot DH, Smeets RJ. Disability and quality of life in patients with fibromyalgia. Health Qual Life Outcomes. 2008;6:8.

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The holidays can be stressful. Shopping, parties, family obligations, and of course, extra traffic, can all lead you to feel a little anxious. But what happens when that stress produces a full blown anxiety attack? Read on to find the latest treatments for panic disorders and some simple fixes you can do for stress and anxiety…even if you don’t have full blown panic attacks! (Hint: Cutting down caffeine really helps curb anxiety.)

Excerpted from High Anxiety by Joseph Hart in Experience Life

40 million Americans who have been derailed by what psychiatrists call “anxiety disorders.” It’s a broad medical diagnosis that includes several distinct categories:

Obsessive-compulsive disorder, which consists of intrusive thoughts (obsessions) combined with repetitive behaviors (compulsions), such as excessive hand washing, that the sufferer performs to avoid the obsessive thoughts.

Panic disorder refers to recurring episodes of intense physical fear, without an obvious or immediate source of fear. These episodes, also called anxiety attacks, are commonly characterized by heart palpitations and may be accompanied by chest pains. It might also be difficult to breathe, and you may feel like you are choking (symptoms that can make the situation even more frightening and further ratchet up anxiety).

Posttraumatic stress disorder (PTSD) follows a severe traumatic event that threatens actual harm.

Social anxiety disorder describes the condition of people who suffer overwhelming anxiety when faced with everyday social interactions.

Generalized anxiety disorder is a catchall category that describes any chronic anxiety or exaggerated worry that lacks an obvious cause.

While these diagnoses, symptoms and distinctions sound clear-cut on paper, in practice they are anything but. In part, this is because separating the typical from the pathological isn’t always easy. The human brain, it seems, is hardwired to worry even under the best of conditions.

“Because we humans have prefrontal lobes, we can anticipate the future and make up a scenario that is harmful
to us,” says Melissa Blacker, MA, a psychotherapist and associate director of the Stress Reduction Clinic at the University of Massachusetts Medical School’s Center for Mindfulness.

Some degree of anxiety and fear are normal responses to life. “Healthy anxiety is part of our fight-or-flight response system,” says Jonathan Abramowitz, PhD, director of the Anxiety and Stress Disorder Clinic at the University of North Carolina, Chapel Hill. “As a basic emotion, it is helpful. In fact, we would all be dead without it, because it protects us from harm.”

So where does a healthy emotional response to stress leave off and an anxiety disorder begin? “Anxiety is a response to the perception of threat,” Abramowitz explains. “When we’re talking about a real danger, that’s healthy stress and anxiety, but when the perception of threat is based on either a misinterpretation of the severity of the threat or the likelihood of harm, then we’re talking about a disorder.”

Mind-Body Connections

The biological processes triggered by anxiety — sweaty hands, shallow breathing, increased heart rate, dizziness — are hardwired human responses to stressful situations. Most of these responses serve some biological purpose, such as preparing our bodies to react (fight or flee), or they are the byproduct of the chemicals, such as cortisol and adrenaline, that such a reaction might require. It’s when we perceive a major threat in situations where, objectively speaking, there is little or none — for example, in a crowded elevator (claustrophobia), crossing a bridge (fear of heights), leaving the house (agoraphobia) or at an office mixer (social anxiety) — that anxiety is classified as a disorder.

The more frequently or dramatically an unwarranted response occurs, and the more it interferes with a person’s daily life, the more severe that classification is likely to be.

Although pharmaceutical drugs can help moderate our bodies’ physical response to stressful thoughts or stimuli, nonpharmaceutical treatments — like cognitive behavioral therapy (CBT) — are beginning to replace drugs as the preferred treatment for anxiety disorders.

Unlike medications that attempt to suppress our physiological responses to perceived threats, CBT is aimed at correcting our perception of those threats, and thus encouraging a self-moderating response.

The first goal of CBT is simply education, says Abramowitz. “We teach people about their symptoms,” he explains. “We explain that when you feel nauseated, it’s not because you’re going to throw up; when your heart races, it’s not because you’re having a heart attack.” For many, just recognizing the symptoms of anxiety for what they are — and realizing that they do not represent an immediate danger — can prevent an attack from worsening.

The second phase of CBT focuses on exposure and response protection. Some CBT therapists actually place the sufferer in the situation that causes him or her fear — whether that situation is external, like playing with a large dog, or internal, like experiencing an accelerated heart rate. “When a person repeatedly confronts their fears, they learn that the outcomes they worry about aren’t nearly as likely as they think,” Abramowitz explains.

Moreover, they learn that the initial fight-or-flight response is transitory; anxiety eases when you’re able to stay in a situation and your fears aren’t realized.

It can take 10 to 15 sessions of CBT to produce lasting results, says Abramowitz, and the success rate is fairly high — as many as 70 percent of patients conquer their anxieties. (To find a cognitive-behavioral therapist near you, visit the National Association of Cognitive-Behavioral Therapists at http://nacbt.org/searchfortherapists.asp.)

Anxiety as a Physical Condition

The physical aspects of anxiety — our fight-or-flight response — are governed by the sympathetic nervous system. CBT works by essentially reprogramming our involuntary activation of this system. But other treatment approaches focus on the body’s parasympathetic nervous system, which regulates the healing, recharging part of the nervous system and helps shut off the fight-or-flight response.

Patricia Gerbarg, PhD, MD, a clinical psychiatrist at the New York Medical College and coauthor of How to Use Herbs, Nutrients, and Yoga in Mental Health Care (Norton, 2009), is studying how to activate the parasympathetic nervous system to quiet anxiety. She and her colleagues have discovered that some ancient practices are highly effective.

In particular, yoga breathing induces a very calm, clear-minded state — the opposite of the anxious fight-or-flight state of the sympathetic nervous system. “When you change the pattern of breathing,” explains Gerbarg, “it changes what happens in your emotion centers and thinking centers,” slowing the fight-or-flight actions of the amygdala and quieting the areas of the cortex that process worry.

Gerbarg and her colleagues have been able to quantify the effects of breathing techniques on the parasympathetic nervous system, and they are using what they’ve learned to train patients to interrupt anxiety with breathing. “We have seen some very rapid effects,” she says. “In five minutes, people may go from severe anxiety to complete relaxation.”

Psychotherapist Kathryn Templeton, who spent 20 years working with soldiers suffering from PTSD at the National Center for Posttraumatic Stress Disorder at the U.S. Department of Veterans Affairs and now works with abused children, uses breathing and yoga extensively in her treatments. She has her patients begin by inhaling slowly for three counts and exhaling for six counts, a practice that cultivates awareness of their breathing patterns. “Breathing creates resiliency and releases tension,” she explains. It is physically impossible to breathe deeply and feel anxious at the same time.

The power of breath to reduce symptoms of anxiety helps illustrate how anxiety lives in both brain and body. Because anxiety is as much a physical condition as a mental one, a variety of physical activities can offer relief.  Exercise in particular, writes Edward Hallowell in Worry: Hope and Help for a Common Condition (Random House, 1998), “is a terrific antidote for worry.”

Exercise quiets the anxiety response, not by changing the situation that is causing anxiety, he explains, but by changing “the vessel of your worry, the physical state of your body and brain.” He notes that exercise produces a variety of chemicals, such as endorphins, corticosteroids and neurotrophins, as well as various neurotransmitters like serotonin that can help soothe the worried mind.

If you start to feel anxiety welling up and you have even just a few free minutes, a couple treks up and down the stairs or a brisk walk around the block can work wonders, says Hallowell. You won’t always have the opportunity to break into a sprint when you feel your anxiety spiking, but, he continues, “A regular exercise program — exercise three or four times a week — will almost always cut down on worry. Exercise should be incorporated into any plan to reduce anxiety and control worry.”

Finally, no approach to anxiety management can be optimally successful unless it is supported by proper nutrition. Our brains require certain fats, proteins and nutrients to function normally and regulate mood — and no amount of yogic breathing or CBT can compensate for a mineral or omega-3-fat deficiency. (To learn more about what to eat to reduce anxiety and stabilize mood, see “Comfort Food for Your Brain.”) It is also important to limit your intake of stimulants such as caffeine, which prime the body and brain for heightened anxiety.

Mix Your Own Cure

Ultimately, regardless of whether or not you choose to treat your anxiety with medication, it makes sense to avail yourself of the full spectrum of other interventions, too — from good nutrition and regular exercise, to yoga, deep breathing and psychological approaches like CBT.

“Not every person will use every [approach],” writes Hallowell. “But every [approach] should at least be considered in order to achieve the best results.” That’s because, he notes, in almost all cases, no single approach alone will provide optimal results. Every individual has to find his or her own right mix.

In any life, anxiety is bound to come and go. But when it comes on strong enough to impede our health and happiness, it’s comforting to know that the remedies of modern science, ancient wisdom and simple self-care can all offer relief — and smart ways to keep future anxieties at bay.

The Big Chill-Out

Common signs of an anxiety attack include rapid heart rate, sweating, shaking, shortness of breath, nausea, dizziness, chest pain, numbness in limbs or face, difficulty thinking clearly, and fear of losing control.

Whether or not you are currently experiencing any of these symptoms, here are some top techniques for quickly and effectively reducing anxiety when it rears its ugly head:

Take a deep breath: Perhaps the single most effective way you can get your anxiety under control quickly is to breathe deeply and slowly into your diaphragm. Start simply by closing your eyes, breathing in deeply for a count of three and then exhaling for a count of four. Do it for a minute or two at a time, repeating until you feel calmer.

Pay Attention: Worries and anxieties tend to grow more powerful when we allow them to accumulate in our subconscious. You can interrupt the accumulation of anxieties by bringing them into the forefront of your mind and acknowledging their presence. Don’t worry about trying to talk yourself out of your worries. Just take a minute to step back and observe yourself being anxious. Note any physical symptoms (clenched muscles, shallow breathing, racing heartbeat) and ask yourself: Are my fears appropriate to my current actual level of danger? Simply taking stock of your anxiety and consciously seeing uncomfortable sensations for what they are (vs. indications that you are in physical danger) can make them feel less intense.

Get a Move On: If you feel anxiety rising, quit what you’re doing and take a quick walk, do some pushups, or climb a few flights of stairs. It may be enough to clear your body of accumulating stress chemicals and give your mind a chance to reframe troubling thoughts. Going forward, build some exercise time into your schedule. Regular exercise (most experts recommend vigorous activity three to four times a week to help keep anxiety symptoms at bay) helps your body balance its supply of neurochemicals and hormones and also helps increase your overall resilience. Many people find that yoga provides special anxiety- quelling benefits.

Connect With Nature: If you can step outside, or even focus on a tree, cloud or horizon line you can see from your window, do it. Numerous studies have shown that exposure to natural scenes and environments, even painted views of landscapes, measurably lowers anxiety and reduces perceptions of pain. Spending time in nature also improves mood and reduces reactivity in many people. So make a point of regularly getting outdoors, allowing images, scents and sensations of nature to help you calm your jangled nerves before they get out of control.

For more suggestions on managing anxiety, and a more complete list of symptoms and their causes, check out the Anxiety Disorders Association of America, online at www.adaa.org/GettingHelp/AnxietyDisorders/PanicAttack.asp.

Resources
WEB
Anxiety Disorders Association of America
(www.adaa.org) provides information about anxiety disorders, treatments, how to choose a therapist, self-tests and more.

The National Association of Cognitive-Behavioral Therapists (www.nacbt.org) provides information about CBT and how it works.

The Midwest Center (www.stresscenter.com/mwc) is a leading provider of self-care and coaching programs for people who suffer from stress, anxiety and depression.

BOOKS
Natural Relief for Anxiety: Complementary Strategies for Easing Fear, Panic & Worry by Edmund J. Bourne, Arlen Brownstein and Lorna Garano (New Harbinger, 2004)

When Panic Attacks: The New, Drug-Free Anxiety Therapy That Can Change Your Life by David D. Burns, MD (Broadway, 2007)

Living Well With Anxiety: What Your Doctor Doesn’t Tell You That You Need to Know by Carolyn Chambers Clark (HarperCollins, 2006)

Worry: Hope and Help for a Common Condition by Edward Hallowell, MD (Random House, 1998)

The Relaxation & Stress Reduction Workbook by Martha Davis, Matthew McKay and Elizabeth Robbins Eshelman (New Harbinger, 2008)

Panic Attacks Workbook: A Guided Program for Beating the Panic Trick by David Carbonell, PhD (Ulysses Press, 2004)

Excerpted from High Anxiety by Joseph Hart in Experience Life

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