For each area below, we've explained the problem and outlined common symptoms. Then we've desribed "state of the art" treatment methods. Although your problems may feel overwhelming to you, there are counseling approaches that can help you restore balance and happiness to your life.
›› Depression›› Anxiety Disorders
›› Bipolar Disorder
›› Anger Management
Depression
Description of the problem
20% of adults in the US will have at least one major depressive episode in their lifetime. Depression, often called the "common cold" of mental disorders, is the most widespread and most easily treated mood disorder, yet it is usually misdiagnosed or under-diagnosed. Unfortunately, if ignored, a single episode of depression can lead to a life-long struggle with recurring bouts. Although everyone feels "down" once in a while, a major depressive episode dominates the life of the sufferer and often interferes with day to day living. Loss of interest in normally pleasurable activities, sleep disturbances, weight loss or gain, decreased energy and fatigue, and a general feeling of sadness are some of the most common characteristics of depression, but "atypical" depression may be characterized by excessive anger or irritability, agitation and worry, even physical symptoms like back pain or muscle soreness. In extreme cases, you may feel suicidal or even plan and carry out a suicide attempt. Some depressions are triggered by external problems: losing a job or a partner, financial issues, and so on. In these cases, a normal emotional reaction to stress becomes exaggerated and goes on longer than it should. Other episodes of depression seem to be more purely biological in nature-you may become despondent or gloomy when there are no special problems in your day-to-day life.
Treatment approaches
In extreme cases - when you are so suicidal that you have just made an attempt or cannot control your impulses to kill yourself - hospitalization may be necessary for depression. However, most of the time that's not necessary or helpful, and outpatient therapy works very well to combat most depressive episodes. We use a combination of techniques to transform depression, depending on the individual's special needs and make-up. These techniques include:
- cognitive-behavioral therapy designed to help counteract the low self-esteem and negative thinking that often comes with depression
- solution-focused techniques to get at the real-life issues that either trigger depression or, conversely, are actually caused by depression (e.g., poor job performance, relationship problems)
- psychodynamic techniques to uncover painful or self-defeating patterns that may have originated in childhood
- referrals for medication evaluation: antidepressant medication is another "first-line" treatment for depressive episodes; we have medication specialists we work with routinely, or we can work in conjunction with another professional of your own choosing
- recommendations for holistic approaches combining body work, herbal remedies, exercise, and so on
Anxiety Disorders
Description of the problem
Some disturbances of mood result in excessive anxiety. Many people seek treatment for generalized anxiety disorder, characterized by vague worries and anxiety that persist throughout the day, may attach itself to many different thoughts and occurrences without any apparent rationale, and often can disturb sleep. If you suffer from generalized anxiety, you may have fearful responses to a large number of things, and the issues that preoccupy you may change from day to day or even minute to minute. On the other hand, if you suffer from panic attacks you may feel fine most of the day, but have dramatic episodes of anxiety that can include shortness of breath, a feeling of suffocation, rapid heartbeat and pulse, and chest pains. In fact, panic attacks can be so frightening many people seek treatment in hospital emergency rooms, thinking they are having a heart attack- only to be told that there is no physical cause for these symptoms. Attacks can occur regularly, and may or may not have clear "triggers."
Obsessive-compulsive disorder (OCD) is characterized by intrusive, fearful thoughts, and compulsive, ritualistic behaviors designed to "ward off" harm. Some one suffering from OCD may feel compelled to perform elaborate rituals, like repeatedly washing their hands, or ordering everything in a very specific way, to feel safe. Other rituals may be much more subtle, involving only tiny movements or even thoughts summoned up to counteract the fear. Eventually, the OCD sufferer may severely limit their life in order to avoid fear-provoking situations. Phobias are fears of specific things or activities; the most common are fear of public speaking and fear of flying. Both OCD and certain phobias can lead to agoraphobia, a disorder in which the agoraphobic restricts their activities in order to avoid anxiety producing places, objects, or activities, until eventually they cannot leave home.
Treatment approaches
The first-line psychotherapy treatments for anxiety - those techniques with proven success - almost always involve cognitive-behavioral counseling. This therapy focuses less on your past - the reasons why the anxiety started - than it does on here-and-now methods to conquer fear. For example, if you suffer from generalized anxiety disorder you may learn to combat worrisome thoughts by "rebutting" them in your head, and you may be taught special breathing techniques that calm your body. If you have a specific phobia, you will be gradually "desensitized" to the phobia both through visualization exercises in the office and real-life exposure. Obsessive-compulsive disorder is treated with a regimen that includes gradual exposure to feared objects while preventing enactment of the ritual. No matter what form your anxiety takes, you will probably be helped to identify "triggers" to anxiety so that you can manage these situations appropriately, and undergo some relaxation training so you can maintain freedom from your problem long after treatment has ended. Medication is often helpful in conjunction with psychotherapy, and often the same drugs that are used for depression work for some types of anxiety disorder. If we think medication will help you, we will recommend one of our colleagues or work with your own medication specialist.
Bipolar Disorder
Description of the problem
Though less common than depression or anxiety disorders, about 1% of the population suffers from bipolar disorder, characterized by periods of drastic mood swings that can last hours, days, or months. There are two main types of bipolar disorder. Bipolar I, commonly called "manic-depression," is actually the less common of the two types, but is more severe and dangerous. During a manic episode, your behavior may become impulsive, wild, and erratic: you may engage in risky sexual activities, uncontrolled spending, inappropriate public displays of exhibitionism, uncontrolled rage, or acts of daring. At the extreme, manic episodes can resemble psychosis: you may have delusions of grandeur or paranoia. In these more extreme ranges, hospitalization is sometimes required to protect the person from highly dangerous actions. Depressive episodes can have a sudden onset and be quite severe: suicide is relatively common among people with Bipolar I, and hospitalization can be required during a depressive episode as well.
Bipolar II occurs more frequently than Bipolar I, but it is the least known form of bipolar disorder and often undiagnosed even by therapists, counselors, and psychiatrists. People who suffer from this may have rapid thoughts and increased energy during their "up" periods (called hypomania), but they usually appear to others as simply effective, high-energy people, because they don't exhibit the more dramatic behaviors associated with Bipolar I. Individuals with Bipolar II most commonly seek treatment during a depressed period, and the most common misdiagnosis is actually major depression. Both Bipolar I and Bipolar II sufferers usually alternate between manic or hypomanic episodes and depression, but the episodes often last a very long time, and one or the other may predominate. A less common but also serious form of bipolar disorder is called "rapid cycling": in this form manic/hypomanic episodes alternate with depressive periods often several times per day or even per hour. Although all types of mood disorders probably have biological roots, bipolar disorder is truly a "brain disease": often sufferers find that once their disorder is under control they are relatively free of psychological problems.
The common misdiagnosis of bipolar disorder causes unnecessary suffering at the minimum and, at worst, can make the disease more severe. Sometimes bipolar patients are dismissed by therapists as suffering from borderline personality disorder, generally considered untreatable. Other times, especially with bipolar II, the person will be given SSRI antidepressant medication that can actually worsen the disease. For these reasons, half the battle in combating bipolar disorder is obtaining an accurate assessment.
Treatment Approaches
IPG therapists have extensive experience working with bipolar disorder, and therefore we are highly skilled in both diagnosis and treatment. Early treatment for bipolar disorder is very important because of a phenomenon called the "kindling effect." Small episodes of "cycling," if untreated, can trigger large-scale episodes that occur more often, are more severe, and are more resistant to treatment, just as a raging forest fire can be started from a single match and dry tinder. Medication is almost always necessary to treat any form of bipolar disorder, and so we have long-standing working relationships with a select few psychopharmacologists who are expert in treating this disease.
However, medication alone is rarely enough. If you suffer from any type of bipolar disorder, we will help you and your family understand the disease and its significance and come to grips with the fact that you have a condition that may require lifelong medication. We can help you identify your own "cycling patterns" so that you prevent the extreme ranges of your mood swings and/or know when it's time to get your medication fine-tuned. Structure and routine in daily life activities help to manage bipolar disorder, and so we focus on helping you make changes in your life that stabilize you. If you have bipolar disorder, we will help you lead a perfectly normal and productive life despite your disease; indeed, research indicates that people with this condition are often more creative and imaginative than the average person.
Anger Management Problems
Description of the Problem
Increasingly people seek our help because they exhibit frequent outburts of anger that may include emotional and/or physical attacks on their surrounding environment or people near them. If you are a "rageaholic," you may be unable to control or even to recognize your angry feelings; it may take little to precipitate your anger, and each episode may appear perfectly justifiable to you. Over time, angry outbursts may appear "normal," to you. Your anger may subside as quickly as it appears, and you can be left feeling baffled as to why others seem so upset with you. However, if you have an anger problem you will probably eventually your family or love relationships, your friendships, careers, and health- anger is directly correlated with Coronary Heart Disease. The "rageaholic" often does not acknowledge his or her problem until an angry or violent episode produces consequences that force them into treatment: your partner may threaten to leave, their boss may discipline or fire you, or you may develop high blood pressure or even suffer a heart attack. Road-rage, abuse of co-workers, and domestic violence are some common examples of the effects of anger management problems.
Treatment Approaches
If you have a problem with excessive anger, you may come to treatment primarily because someone else - your boss, your wife, the legal system - wants you there. If this is the case, the first step in treatment is to help you to see yourself as others see you and come to terms with the effects your anger has on others. Next, in treatment we will teach you to identify situations and events that precipitate and escalate your feelings. Anger often has a "point of no return," when you truly do lose control over your outbursts. Therefore, we will help you to notice the earliest "warning signals," the tiny physical and mental changes that indicate that your anger is brewing, before you become fully enraged and the anger becomes too difficult to control. We will teach you techniques to help you calm yourself in these circumstances, like taking "time outs," and changing your thought processes by reasoning through your anger and developing alternative strategies for dealing with discomfort. Ironically, people with anger problems often are unable to be appropriately assertive, so assertiveness training may be part of your treatment. We believe that anger is usually a secondary emotion; often what underlies anger is hurt or fear, and in general expressing these emotions is more productive than expressing rage. We will teach you to identify and deal with these feelings - anger, pain, or fear- in safe and non-destructive ways that can radically transform your relationships and overall quality of life.
