Here is additional information on common problems addressed in my practice and therapy approaches which I have found helpful.
For a psychologist depression means more than low mood. A psychologist would diagnose depression only if you have several symptoms over a period of at least two weeks, including sad mood, loss of interest or loss of pleasure.
Other symptoms of depression include sleep disturbance, increase or decrease in appetite, feeling agitated or fatigued, loss of self-esteem, guilty feelings, problems concentrating or making decisions, hopelessness, loss of motivation, or recurring thoughts of death.
When people are depressed they have difficulty processing information accurately and keeping a balanced perspective. Their attention may become focused on the disappointing and frustrating aspects of their lives. Depressed individuals tend to magnify their problems, have many pessimistic thoughts, or blame themselves for problems which they see as unsolvable.
Factors which increase risk for depression include:
- encountering too many stressful events in a brief time
- not having a good social support network
- a severe medical illness
- problems with self-esteem
While depression is painful, it is usually treatable. Research indicates that at the present time cognitive-behavoural therapy and anti-depressant medication are the treatments of choice for depression. Some clients do well with either cognitive-behavioural therapy or medication alone, while others use a combination of the two treatments.
Cognitive-behavioural therapy for depression involves identifying and changing maladaptive thinking patterns. Depressed clients are also taught coping strategies to help them regain their confidence and to better manage stressful events and difficult relationships.
Anxiety is a common feature of modern day living. A little anxiety is actually beneficial and is often associated with effective problem solving and achievement. However, when anxiety increases and persists, it can interfere with people’s lives.
There are many kinds of anxiety problems, and understanding the kind of anxiety you have is important.
Panic attacks are brief periods of very intense anxiety and fear accompanied by alarming physical symptoms, such as shortness of breath, chest pain and choking sensations. The individual becomes frightened of losing control, going insane or dying.
Agoraphobia is persistent fear or avoidance of places where escape may be difficult and embarrassing, or where the person anticipates there may be no help available if he/she has panic attacks. Certain situations are completely avoided or are only endured with severe distress, such as being outside of the home alone, being in crowds, or using public transportation.
Obsessive-Compulsive Disorder involves being distressed by repetitive, unwanted thoughts (obsessions) which seem uncontrollable and which cause anxiety. People with this disorder feel driven to engage in repetitive behaviours (compulsions), such as cleaning, counting, and checking in attempts to relieve their anxiety.
Generalized anxiety involves persistent and excessive worry and apprehension about numerous events and activities. The worry interferes with concentration and is difficult to stop.
Specific Phobias involve very intense fears of certain objects (e.g., spiders) or situations (e.g., heights, enclosed spaces). The individual usually does whatever he/she can to avoid these objects and situations.
Social anxiety is severe anxiety in social interactions (e.g., a conversation) or public performance situations (e.g., giving a lecture, being on stage). Social anxiety involves a fear of being embarrassed or of being judged in a negative manner by others.
Post-traumatic Stress Disorder is a persistent emotional reaction which follows an extremely traumatic event. Individuals with this problem psychologically re-experience the traumatic event and try to avoid anything associated with it.
Some individuals have several anxiety problems. Moreover, anxiety and depression often co-occur.
Cognitive-behavioural therapy is usually an effective treatment for anxiety, and for many anxiety problems it is the therapy of choice. In many cases people also benefit from taking medication prescribed by their physicians in combination with cognitive-behavioural therapy.
In a cognitive-behavioural therapy model, anxiety is viewed as having four components:
- behaviour (e.g., avoidance)
- thought (e.g., perceptions of danger)
- emotion (e.g., fear)
- physical symptoms (e.g., racing heart beat)
Clients learn coping strategies and adaptive ways of thinking in order to make changes in all four aspects of anxiety.
Stress can become a problem when we have to deal with too many demands, conflicts or unwanted events (e.g., problems at work, divorce). Stress symptoms include:
- poor concentration
- muscle tension
- sleep disturbance
When high levels of stress persist, individuals often become fatigued, and lose the energy to exercise and to prepare healthy meals. They may fall back to old habits for temporary relief, such as cigarette smoking and overeating. This is when high stress levels begin to place a person’s health at risk.
When people are highly stressed they become less able to solve problems in a flexible manner. They often find it more difficult to carry out work and family responsibilities.
In cognitive-behavioural therapy clients are educated about the mental and physical aspects of stress. Clients also learn effective ways of dealing with stress, so that they can reduce their stress symptoms. This often involves changing routines so that there is time to pace activities and to take effective relaxation breaks. In addition, clients often need to learn to be more assertive in dealing with the demands of others and less perfectionistic in their own expectations.
As therapy progresses, clients are also taught how to detect early signs of stress and how to take preventative action before stress gets too high. A variety of relaxation and imagery techniques can be utilized as part of stress management .
Coping with the death of someone you love is one of life’s most difficult adjustments. Experiencing a deep sense of grief after such a loss is completely natural. There are no set rules as to how long grief will continue or how painful it will be.
People can benefit from grief counselling if they find their grief has become complicated by persistent depression, guilt or anger, or if they have ongoing problems resuming everyday activities.
Individuals also can benefit from grief counselling if they have no one to confide in for support, or if they have continuing difficulty taking on roles previously occupied by their loved one.
People who have problems with self-esteem have difficulty accepting themselves. They may underestimate their abilities, or have difficulty recognizing that their own needs are important. They often see themselves as less accomplished than others or have a tendency to be harshly self-critical.
When people with low self-esteem encounter conflicts in their relationships or stress at work they tend to blame themselves and magnify the problems. They are often vulnerable to depression and anxiety.
Both cognitive-behavioural therapy and insight-oriented psychotherapy can be helpful in developing healthier self-esteem.
Cognitive-behavioural therapy helps clients to identify recurring problems in their thinking which maintain low self-esteem and to change their thinking so that it is more adaptive.
Some clients find insight-oriented psychotherapy helpful to develop a deeper understanding of how past and present relationships and events have contributed to their low self-esteem. When this is more clearly understood, these clients often find that they can make better use of cognitive-behavioural therapy strategies to make positive changes in their thinking.
People who have problems with assertiveness have difficulty identifying their needs and communicating them effectively to others. They may think their own needs are unimportant and find that they have difficulty saying no when other people make demands.
Problems with assertiveness are often associated with low self-esteem and social anxiety. Unexpressed feelings may build up to the point where the unassertive person becomes angry or aggressive; this usually leads to conflicts rather than resolutions.
Assertiveness training is multi-faceted;
- One component of treatment involves improving awareness and acceptance of needs, and working to develop improved self-confidence.
- Clients learn to change ways of thinking that interfere with assertiveness, such as learning not to magnify the negative impact of saying no to others.
- Rehearsing effective communication, role playing and practice of new skills between sessions are typical aspects of treatment.
Individuals with emotional concerns or medical illness often face problems in their relationships:
- Depressed individuals often believe they are not contributing enough to their relationships and feel let down by others.
- Anxious individuals often need repeated reassurance in their relationships and this can tax the resources of loved ones.
- Many depressed, anxious, and highly stressed individuals have difficulty being assertive, and this can interfere with conflict resolution.
- Medically ill individuals are often unable to carry on former roles in the family and this may lead to arguments and resentment.
A combination of cognitive-behavioural therapy and insight-oriented psychotherapy can help individuals with these kinds of relationship problems.
Cognitive-behavioural therapy can help individuals achieve more balanced expectations of others and learn to communicate more effectively. Insight-oriented psychotherapy can help individuals recognize historical family patterns which are repeating in current relationships and which magnify emotions.
In some cases it is also helpful to have spouses or other family members attend a few sessions to receive education about emotional concerns or to learn strategies to support the medically ill client.
There are many different patterns of sleep disturbance, such as difficulty falling asleep, frequent wakening, early morning awakening, and sleep deprivation. Numerous factors contribute to sleep problems, including:
- medical conditions (e.g., sleep apnea)
- chronic pain
- inadequate diet
- frequent work shift rotations
- mood problems (e.g., anxiety, depression)
- poor bedtime routines
A psychologist can often help clients to improve their sleep:
- Relaxation and imagery techniques can help to reduce anxiety and worry at bedtime, inducing feelings of well-being which facilitate sleep.
- Cognitive-behavioural therapy can also help clients make changes in key habits, such as drinking caffeine and overeating at night, which can significantly improve sleep quality.
- Clients are taught to re-organize their pre-bedtime routines, so activities, such as work, studying, and internet use are replaced by less stimulating activities.
- Psychological pain management strategies can help to reduce headaches and other pain conditions which interfere with sleep.