Evelyn Goodman, Psy.D.  Newsletter, September 27, 2006

Welcome to the 2nd newsletter!

Stages of Recovery

      Recovery from an anxiety disorder (or depression, an eating disorder,  or chemical dependency) usually
happens in stages. The first stage is learning how to cope with anxiety or panic attacks. This is done by learning
breathing techniques, relaxation or calming exercises, effective and supportive self-talk, as well as learning how
not to be afraid of, and controlled by, the anxiety and panic. Life-style changes, such as diet and exercise,
as well as stress management strategies of time management,  limit-setting, assertive communication and
expression of anger are also anxiety coping skills. Learning how to desensitize to avoidance patterns is part
of the learning process for those people with phobias due to the fear of anxiety or panic attacks. Understanding
how one developed the anxiety condition is also a necessary step to working one's way out of the cycle of
anxiety because it helps makes sense of the problem and points to the areas of emotional vulnerability that
triggered the anxiety in the first place.

     Understanding one's vulnerabilities to anxiety may happen concurrently with the first stage of treatment
(especially when working with me in therapy) or may take place at a later time, especially if one has had
relapses. In this second stage one learns the roots of their fears and difficulties, understanding how one's
experiences growing up interacts with one's temperament coupled with current stressors can lead to an
overload of stress and consequently severe anxiety. Sometimes traumatic experiences need to be reprocessed
emotionally. Sometimes one needs to mourn the losses of their childhood and adolescence in order to let go
of the pain of the past. This second stage can take a long time, months or years, as unresolved issues tend
to be repeated throughout adult development.

     The third stage of recovery is about self-awareness and self-acceptance. By this stage one has an
evolved understanding of who they are and the role anxiety plays in their life. It is understood that anxiety
is a signal leading to inner exploration. Self-acceptance replaces shame; self-awareness replaces the fear
of the anxiety. Life's challenges are confronted with courage and hope. The meaning and purpose of one's
life usually takes center stage. Not surprisingly, this stage often coincides with mid-life.

     It is important to remember these stages are not independent of each other; they often overlap. Our areas
of vulnerability are sometimes triggered throughout the life cycle; anxiety (sometimes coupled with depression)
are the signals that this has happened. And we continually have the opportunity to strive toward balanced
mental health and well-being.

The Placebo Effect

     We all have heard about the placebo effect, especially when it comes to the use of psychotropic medication.
More recently, using PET scanners and MRIs to look into the brains of people responding to sugar pills, it has
shown that belief in the treatment leads to changes in brain chemistry. Researchers at Columbia University
found that when people with certain pain were given a placebo the brain started making more of its own pain-
relieving opiates.  Brain scans of Parkinson's patients showed increases in the chemical dopamine, which
leads to improvement in symptoms. In clinical trials of antidepressant medication it has been shown repeatedly
that a significant percent of the group receiving the placebo felt relief of symptoms.

     This leads to a real appreciation of the power that the mind can have over the body and the desire to
learn how to tap into these unconscious responses. At UCLA a placebo-treated group of volunteers were
hooked to EEGs(which records the brain's electrical activity). After a week of placebos, the volunteers were
then given either more placebos or an actual antidepressant. They weren't told which they received. Eight
weeks later brain waves were recorded and scrutinized and the researchers discovered something interesting.
The people who got the most benefit from the actual medication had a specific pattern of brain waves when they
were taking the placebo. This study leads to the idea that patients might be screened with an EEG to
determine who is most likely to respond to antidepressant medication.

     The goal is to harnass the understanding of the placebo response so patients may learn to use it to help
themselves feel better in some way. It seems that part of what happens in the brain is an expectation, and
the placebo response is a manipulation of expectation. The next challenge is to learn how to consciously
think in ways that would have the same effect on the brain without the use of sugar pills to fool the brain.

     This makes me think of biofeedback treatment, only in this case an MRI would be feeding back the
information the brain is receiving by our thoughts and how the brain is responding to those thoughts. It may
be an exciting step in mind-body medicine.

Trauma, War and Children

     A world filled with fears of terrorism and war is particularly difficult for children, and sometimes leads to
traumatic reactions, even weeks or months after the event. Reactions to trauma vary according to age:

     Children 5 years and younger:  Typical reactions can include a fear of being separated from the parent,
                                                       crying, whimpering, trembling, excessive clinging. Children may also
                                                        return to behaviors exhibited at earlier ages (i.e. regressive) such as
                                                        thumbsucking. At this age children are very strongly affected by the
                                                        parents' reactions to the traumatic events.

     Children 6 - 11 years:  Reactions seen are extreme withdrawal, disruptive behavior, and inability to pay
                                         attention. Regressive behaviors, nightmares and sleep difficulties, fears, anger
                                         outbursts, fighting, and refusal to go to school are common. Child may complain of
                                         headaches, stomachaches, or other bodily symptoms. Depression, anxiety, and
                                         emotional flatness are often present as well.

     Adolescents 12 - 17 years: May exhibit symptoms listed above, as well as those that are similar to those
                                               of adults:flashbacks, substance abuse, avoidance of reminders of trauma,
                                               anti-social behavior and suicidal thoughts. The adolescent may feel guilt over
                                               not being able to prevent injury of loss of life and may harbor revenge fantasies.

     Some youngsters are more vulnerable to trauma than others. It seems that the impact of a traumatic event is likely to be greatest in the child or adolescent who had previously been the victim of child abuse or some
other form of trauma,  or who already has a mental health problem. Children who lack family support are at most
risk for a poor recovery.

     Parents should stay aware of their childrens reactions. Maintaining a consistent routine and reassuring
the child of their safety, as well as lots of shows of love and affection, can help children feel calmer in these
very stressful situations. It is also important that the parents get the assistance they also need so they can
stay attuned and comforting to their children. Children take their cues of trust and safety from the adults around
them.

Book Recommendation

This months book recommendation is Stand Like Mountain, Flow Like Water: Reflections on Stress and
Human Spirituality by Brian Luke Seaward, Ph.D.  I have heard Dr. Seaward give a presentation on the subject
of stress, growth, and well-being from a spiritual perspective. He is a dynamic and witty presenter whose ideas
I found inspiring and illuminating. I bought this book after hearing him speak about stress from his unique
perspective.

Parting Words

From Anthony Robbins: "The purpose of your being is to expand. The purpose of problems is to cause you
                                     to expand."
 

Counseling and Psychotherapy
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