There are several distinct disorders included in the domain of anxiety disorders. Posttraumatic Stress Disorder and Obsessive-Compulsive Disorder are discussed in separate sections of this website. Some of the more common Anxiety Disorders include Panic Disorder, Agoraphobia, Specific Phobias, Social Phobia, and Generalized Anxiety Disorder. Cognitive Behavioral Therapy has received extensive scientific evidence as being an effective treatment for this wide array of Anxiety Disorders.
Anxiety is one of the most common reasons that cause people to seek psychotherapy. Cognitive Therapy has proven to be extremely successful at alleviating anxiety. When compared to medications, Cognitive Therapy is the only therapy to consistently produce results equivalent to medications. Perhaps more important, in terms of relapse when treatment stops, Cognitive Therapy is significantly superior to medications. Individuals who complete a full course of psychotherapy typically maintain their improvements when treatment ends much more effectively then individuals who receive only medications.
Scientific research has shown that anxiety is related to inaccurate thinking. Individuals who have problems in these areas make certain unique errors in thinking that are readily identifiable. Cognitive therapy involves learning skills that allow you to see the connection between thoughts and feelings of anxiety, to appraise the accuracy of these thoughts creating anxiety, and if they are inaccurate, to make them more accurate. If thoughts are accurate and anxiety provoking problem solving is then employed.
ADHD is a neurobiological disorder that is unrelated to psychopathology, intelligence, laziness or aptitude. People with ADHD have problems with three primary symptom categories involving poor attention, high impulsivity and high levels of activity (hyperactivity). Some people with ADHD have more problems with one category than another. ADHD begins in childhood (some symptoms present before the age of 7) but often continues into adulthood. The good news for individuals struggling with ADHD is that effective treatment has been developed that has received solid research supporting its efficacy. A treatment developed by a team of Harvard University researchers led by Steven A. Safren, Ph.D. has been shown to benefit the management of ADHD symptoms beyond the effects of medication. Since ADHD is a neurobiological disorder, medications are considered to be the first order treatment but this program provides effective coping skills that support substantial further improvement beyond the effects of medication. his evidence based treatment program is utilized by Dr. Oakley as a core ingredient of managing ADHD and involves learning coping skills for improved organization and planning, addressingprocrastination, and managing distractibility.
Chronic pain is comprised of many factors, some of which may be behavioral in nature (e.g. what we think, feel, and do). Stress is perhaps one of the most common behavioral factors that interacts with physical factors in the perpetuation of pain. When a person is stressed, the reaction is physical as well as behavioral. Furthermore, the experience of pain is stressful so every chronic pain patient experiences stress to some degree. Research has also shown that mood states such as anxiety and depression influence how pain signals are processed and amplify the sensations of pain.
Bio behavioral pain control is a six session treatment designed to teach control over pain by controlling physical reactions to stress and pain through relaxation, stress reduction, and chronic pain management techniques. These skills can be applied to a wide range of pain problems such as low back pain, cancer pain, arthritic pain, temporomandibular dysfunction (TMJ), neck pain, and headaches. Bio behavioral pain control maximizes the learning of effective pain control without medication.
The term Bipolar Disorder has traditionally been known as manic‑depression. This diagnostic category actually encompasses a broad spectrum of affective symptoms that include depression, agitation, euphoria, impulsiveness, irritability, and in more extreme cases, psychotic ideation._
The natural course of Bipolar Disorder is episodic and frequently entails relapses. It has been historically a recalcitrant syndrome to manage. While medications are considered to be an essential first‑order approach to treatment, at least half of the population have been shown to not respond or relapse quickly after an early response to pharmacotherapy (Gitlin, Swensen, Heller, & Hammen, 1995). Fortunately, there has been a surge of recent scientific support for the role of Cognitive‑Behavioral approaches to the effective management of this difficult disorder.
Depression is one of the most common reasons that cause people to seek psychotherapy. Scientific research has shown that depression is related to inaccurate thinking and maladaptive behavior patterns. Individuals who have problems in these areas make certain unique errors in thinking that are readily identifiable. Cognitive therapy involves learning skills that allow you to see the connection between thoughts and feelings of sadness and/or depression, to appraise the accuracy of these thoughts creating sadness and/or depression, and if they are inaccurate, to make them more accurate. Therapy also involves addressing behavioral patterns that cause and maintain your depression. There are actions that you can take immediately that will begin to make you feel better.
Cognitive Therapy has proven to be extremely successful at alleviating depression. When compared to medications, Cognitive Therapy is the only therapy to consistently produce results equivalent to medications. Perhaps more important, in terms of relapse when treatment stops, Cognitive Therapy is significantly superior to medications. Individuals who complete a full course of psychotherapy typically maintain their improvements when treatment ends much more effectively then individuals who receive only medications.
Cognitive therapy has been shown to improve depression regardless of how severe or chronic the depression. Studies evaluating factors that predict improvement have demonstrated that it does not seem to matter how severe the depression is or how long they have suffered with it. Everyone seems to have the same good chance for improvement. Similar results have more recently been obtained for anxiety disorders. Within 20 sessions of individual therapy, numerous research studies have demonstrated that approximately 75% of patients experience a significant decrease in their symptoms. Furthermore, most patients maintain their improved mood two years after therapy is concluded.
Health anxiety includes a spectrum of disorders including hypochondriasis. Health anxiety is characterized by excessive anxiety about one’s health. Health anxiety develops and is maintained by a tendency to misinterpret physical symptoms in a catastrophic manner. The prevalence of Hypochondriasis is estimated to be approximately 5% of the population although more mild presentations are much more common. Health anxiety can be treated effectively in similar ways that other forms of anxiety are treated. In addition to Cognitive Therapy to identify and correct inaccurate thinking that underlies and maintains health anxiety, general stress management strategies that have been successfully utilized in Behavioral Medicine approaches are also very helpful.
When we experience stress, anger, or other strong emotions our body responds in a characteristic way that has been termed the “Fight or Flight” response. Our body prepares for action by increasing heart rate, blood pressure, and muscle activity so that the body is ready to deal with the crisis at hand. Normally, these physiological activities return to normal once the crisis is over. However, we can often experience these emotions repeatedly so that the body stays in a more perpetual state of readiness. This program has been designed to provide you with a variety of skills to combat stress in the “heat of your everyday battles”. Dr. Oakley’s treatment has been published in a well regarded mainstream scientific journal.
The essential characteristics of Obsessive Compulsive Disorder are recurrent obsessions or compulsions that are severe enough to cause significant impairment with a person’s normal routine or occur for more than I hour per day. Obsessions are recurrent and persistent thoughts, impulses or images that are experienced as intrusive, inappropriate, and cause marked anxiety or distress. Compulsions are repetitive behaviors or mental acts that are intended to prevent or reduce distress from a dreaded event or situation. Exposure and Response Prevention(ERP) with Cognitive Therapy are effective treatment strategies with OCD. An average of approximately 83% of patients who undergo treatment show a moderate to marked improvement (generally defined as a 30% reduction in symptoms).
The most recent scientific evidence suggests that many of the symptoms a person experiences for the first month after a trauma are normal. These symptoms can include sleep disturbance, decreased concentration, anxiety, sadness, anger, irritability, hypervigilence, re experiencing of traumatic events, and disruptions in social and work related functioning. In the first four weeks following a trauma, psychological interventions should be limited to “first aid” type treatments. These efforts may include encouraging the traumatized individual to contact those people who might provide a normal source of support and comfort in their life and to facilitate contact with loved ones, nearby and far away. Any discussion of the trauma in the initial four weeks should include only what the individual wants to talk about. If symptoms persist beyond four weeks, Exposure therapy and cognitive therapy are two recommended therapies considered effective for PTSD. Exposure therapy for PTSD involves a gradual and graded confrontation of images and situations associated with the trauma that are avoided because of the anxiety they elicit. Recent research establishing the importance of cognitive factors in the development and persistence of PTSD support Cognitive Therapy approaches for PTSD that test beliefs about the long term effects of the trauma and that help the person to organize and complete their memory of the trauma. (Ehlers & Clark, 2000.) These procedures appear to help individuals with PTSD to process and appraise the traumatic experience in a more integrated and less distressing manner.
It is common that surgical outcomes have varied degrees of “success” even in those patients where the spinal surgery is perfectly performed. Fortunately, numerous scientific studies of surgical patients have isolated certain psychological and medical variables that if identified and addressed, can reduce the risk of unsuccessful surgical outcomes. Pre-surgical Psychological Screening (PPS) in those patients identified as being at risk can significantly reduce the risk of post-surgery complaints. A system for determining when to consider a referral for a Pre-Surgical Psychological Screening is outlined below:
REFERRAL CRITERIA FOR PRE-SURGICAL PSYCHOLOGICAL SCREENING (PPS):
- Exaggerated or inappropriate signs and symptoms of spine injury.
- Suspected clinical depression or high anxiety level.
- Severe sleep disturbance.
- Unrealistic expectations about surgical outcome.
- High level of Marital Distress or unexplained sexual difficulty.
- History of physical or sexual abuse (with women).
- Emotional lability or mood swings.
- Extended period of disability (> 3 months)
- Any substance abuse or large dosages of narcotics or anxiolytics.
- Evidence of financial gain or litigation related to spine injury.
- Poor work attitude (anger toward employer) or vague return to work plan.
- Previous “unsuccessful” surgeries.
|0–1 items||Not necessary to refer unless desired by patient|
|2–3 items||Consider referral for PPS|
|4+ items||Strongly consider referral for PPS|
CRITICAL POINTS TO EMPHASIZE WITH PPS REFERRAL:
(SEE PATIENT INFORMATION HANDOUT BELOW)
- The PPS is a mental health (psychological) evaluation.
- The PPS is a routine procedure, like any other medical test, to assist in developing the most effective treatment plan.
- The PPS is a critical procedure, as important to surgical decision as any medical test.
- The PPS will help determine if the patient is ready for surgery.
- The PPS will help determine those patients who are likely to not report satisfactory improvement following a successful surgery.
- Upon referral, the physician emphasizes that the patient has a legitimate injury and that the pain is real but that emotional factors influence how pain is processed by the body and ultimately experienced.
- The PPS can identify factors that if treated, improve surgical outcome.
PATIENT INFORMATION HANDOUT
PRE-SURGICAL PSYCHOLOGICAL SCREENING:
- Pre-Surgical Psychological Screening (PPS) is a routine procedure that like other medical tests assists in the development of the most effective treatment plan. It is a critical procedure as important as any medical test to making surgical decisions.
- Your physician recognizes that you have a legitimate injury and that the pain you experience is “real”.
- The PPS is a psychological evaluation that identifies both psychological and medical variables that will determine if you are ready for surgery.
- Although your pain is real and there is a medical basis for the pain you experience, certain psychological variables influence the intensity, frequency and duration of your pain. The PPS identifies these variables if they are present.
- Identification and treatment of psychological factors increases the probability of a satisfactory surgical outcome.
- The results of the PPS will be discussed in detail with you and your surgeon.
You are being referred to Mark E. Oakley, Ph.D. for a Pre-Surgical Psychological Screening. Dr. Oakley is a recognized expert in Cognitive-Behavior Therapy with extensive research and clinical experience with Chronic Pain. Dr. Oakley is a Full Clinical Professor at UCLA, Department of Psychology, where he trains advanced Clinical Psychology Graduate Students. He is also the founder of The Center For Cognitive Therapy in Beverly Hills, CA., where he continues to maintain his private practice helping individuals with a wide range of difficulties, including the management of chronic pain.
Feel free to contact Dr. Oakley at any time if you would like any further information or to schedule a PPS. Dr. Oakley would also be happy to meet with your staff for a free in-service training about the value of Pre-surgical Psychological Screening with your surgical candidates.
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Insomnia is extremely common with over 10% of the general population experiencing chronic insomnia. Over 30% of primary care patients experience chronic insomnia. Medical and psychiatric conditions can cause insomnia and persist even when the condition is resolved. Insomnia creates functional impairment, decreased quality of life, increased risk of accidents, and higher health care costs. Furthermore, it has been demonstrated that medical and psychiatric conditions often improve with alleviation of insomnia. Sleep medications do not address the most important factors of chronic insomnia: behavioral and psychological factors. Major advances and recent controlled research results have shown that Cognitive Behavioral Therapy (CBT) are more effective than sleep medications alone in both short and long term sleep improvement. A review and meta analyses of CBT approaches to insomnia show that 70% to 80% of patients with insomnia show benefit including a 50% reduction in time getting to sleep, number of awakenings and early morning awakenings with improvements in total sleep time and sleep quality. There are robust findings across clinical trials of CBT that are well maintained over time (up to 36 months from treatment completion). This sustained improvement is a clear advantage over medication treatments.
This brief 4 session protocol is designed for the busy executive or others who experience uncomfortable levels of anxiety or stress, but who may not meet the full diagnostic criteria for an Anxiety Disorder. This brief but broad spectrum approach has been shown to be effective in medical populations and is the same treatment outline utilized by Dr. Oakley in previous research showing that individuals with Hypertension (high blood pressure) could reduce medication requirements.
Sport and Performance Psychology is an approach that includes a collection of techniques designed to provide the athlete with a set of mental skills to maintain and enhance focus during performance with competitive intensity. Sport Psychology is a completely different endeavor from the general field of Psychology and, in particular, Psychotherapy. Athletes who seek consultation from a Sport Psychologist are typically high functioning individuals with no significant problems psychologically or emotionally. In fact, a psychologist who is working with an athlete while focusing upon emotional difficulties (athletes are human of course) is not doing Sport Psychology. Sport Psychology, a sub category of Performance Psychology, involves acquiring a specific set of mental skills that optimize performance in competitive circumstances.