Emotional Concerns and Disorders

06Oct 2017

EMDR: A Power Tool for Healing the Brain

Trauma Recovery & Beyond

By Karin Witte, LMHC

EMDR (Eye Movement Desensitization and Reprocessing) is a powerful therapeutic technique for trauma recovery which has proven success in recovering from distressing, often disabling emotional and psychological distress.

There are 2 major types of trauma. Developmental trauma results from childhood abandonment, abuse, and neglect. Shock trauma results from severe, often violent events at any stage of life. EMDR is highly effective in helping trauma survivors with anxiety, panic, disturbing memories, post-traumatic stress (PTSD) and other emotional problems.

How EMDR Works

EMDR works to specifically target the stored traumatic experiences in the brain. It essentially restarts the frozen or stuck information by accessing the nervous system, which is the basis for the mind/body connection; i.e. fight or flight response when the brain senses danger and tells the body to run.

In trauma recovery using EMDR, memory networks are activated, so that new information can be added to help resolve traumatic experiences in a more productive and positive way by stimulating both sides of the brain through eye movement. This is similar to what happens in REM sleep when we dream – we can allow the brain to release the distressing emotional experiences that are “trapped” in our memory networks.

Simply through eye movement, the brain frees itself up to be able to process the experience in a more functional and less distressing way. As troubling images and feelings are processed, resolution and a more peaceful state are achieved. It’s actually your own brain healing itself while you are the one in control of processing the memory.

What EMDR doesn’t do is:

  • Remove the memory; you still remember it, but at a more distant, vague and less distressing level;
  • Remove any information that is valid or that you need to hold on to for your well-being.

What Happens During EMDR Sessions

EMDR generally starts with several sessions where the therapist will take a thorough history, explain the procedure in detail and address any questions or concerns. These initial sessions are key to the process and allow for a safe trusting working relationship, which is imperative to the deeper work of trauma recovery.

During EMDR, the client focuses on a traumatic event and the accompanying body sensations while following the therapist’s fingers with his or her eyes. The therapist moves her/his fingers back and forth or uses “tappers” that the client holds in his or her hands for tactile stimulation. This process is repeated several times until the client no longer feels distress when thinking about the upsetting memory.

Benefits of EMDR

EMDR specifically targets the area in the brain where distressing information is stored by while also integrating therapeutic methods to promote the mind/body connection. The goal in EMDR is to resolve past trauma while maintaining stabilization in the present. It also helps survivors and those with PTSD to access internal resources to cope with any distressing situations that may arise in the future. The following is a snapshot of EMDR benefits:

Before EMDR After EMDR
  • Individual experiences negative event resulting in:
  • Intrusive images or flashbacks
  • Negative thoughts or beliefs
  • Negative emotions and associated physical symptoms (such as anxiety or panic)
  • Individual experiences adaptive learning resulting in elimination or dramatic reduction of:
  • Distressing memories or flashbacks
  • Negative thoughts or beliefs
  • Distressing emotional and/or physical sensations.
  • Empowered new positive self-beliefs
What Happens: What Happens:
  • Information is stored in a negative way
  • Negative information gets replayed
  • May result in limiting a person’s ability to develope positive coping skills or belief systems
  • Information is processed in a more positive and beneficial way
  • Positive adaptive learning takes place
  • Healthy personal development is facilitated
Negative Consequences: Positive Results:
  • Depression and/or anxiety
  • Low self-esteem and/or self-deprecation
  • A sense of powerlessness, inadequacy, lack of choice and lack of control in managing life and adapting to changes
  • Dissociation (“checking out”)
  • Sense of well-being
  • Ability to use healthy coping skills and beliefs
  • A new understanding of events or experiences
  • Positive behavior change
  • Emergence of adult perspective
  • Self-acceptance
  • Ability to be present in the moment

EMDR & Trauma Recovery – A Personal Experience

My own experience with EMDR reflected this snapshot perfectly. I saw an EMDR therapist to resolve my trauma of losing someone close to me who drowned in the ocean. Prior to these sessions, I suffered with symptoms of PTSD: panic attacks, anxiety and a sense of powerlessness. I was also afraid of my lack of control in the ocean when faced with a strong current. After EMDR, I once again found myself in the midst of an overpowering ocean current and as the current began to take me out to sea, I was able to remain calm and grounded; knowing exactly what I needed to do to get back to shore safely.

It was the positive result of the trauma recovery work I had done in EMDR that allowed me to remain calm and safe in the face of a potentially dangerous situation. I was amazed there was no emotional charge whatsoever! I knew right then I wanted use EMDR to assist other people who suffer from trauma and help them live their best life and reach their full potential.

As I incorporated EMDR into my therapy practice, both my clients and I have experienced significant benefits of this trauma recovery method. As a therapist, the gift of witnessing the positive results that EMDR provides for my clients is one that continues to give; it is my honor to be a guide in the healing of others and I’m privileged to have found such an efficient and effective treatment method.

If you or someone you know has experienced trauma; during childhood or as an adult, and are suffering the negative and lasting effects it has, please know you’re not alone and resolution is possible.

To learn more about trauma recovery and how I can help you in your healing process, please feel free to contact our Center today.

18Sep 2017

Trauma: Recovery and Resolution

The Light at the End of the Tunnel

By Karin Witte, LMHC

Have you ever experienced a scent or sound that reminded you of a particular person or situation in your life? For example, every time I smell a certain perfume, I’m reminded of my paternal grandmother. Or I’ll walk into a restaurant and I’m immediately reminded of my elementary school cafeteria. The former brings back pleasant memories; the latter, not so much – and I usually don’t stay for a meal. These experiences are functionally similar to what happens in the brain when there is trauma and PTSD.

These scents and sounds are stored in the brain and are unconsciously related to either a positive or negative memory or experience. The same is true for psychological trauma, such as abuse or abandonment. When a traumatic experience occurs, it gets stored in the brain with the visuals, the smells, thoughts and feelings that occurred at that time. The good news is that trauma recovery is possible with professional help.

What Exactly Is Trauma?

Many people experience trauma and the lasting negative effects. Trauma may result from growing up in a chaotic environment or not getting our primary emotional and relational needs met during childhood. Or we may be traumatized by experiencing one or more tragic or violent events, resulting in PTSD.

The 2 major types of trauma are developmental and shock trauma.

Developmental Trauma (refers to events that occur during childhood)

  • Generally results from abuse, neglect or abandonment. These events gradually alter the child’s brain and emotional balance.
  • Examples include abandonment or long-term separation from a parent, an unstable or unsafe environment, neglect, serious illness, physical or sexual abuse and betrayal at the hands of a caregiver; even the loss of a beloved pet can be traumatic to a child.
  • Causes disruptions in the child’s natural psychological growth and development.
  • Has a negative impact on a child’s sense of safety and security in the world.
  • Can result in a sense of fear and helplessness (anxiety) if left unresolved.
  • Alters psychological and emotional development, with life-long negative effects.
  • A wide range of current situations (especially relationship issues) may trigger the underlying, unresolved trauma, resulting in symptoms of anxiety, panic, and/or depression.

Shock Trauma (severe, often violent traumatic events during any stage of life)

  • Involves a sudden threat that is perceived as overwhelming and/or life threatening.
  • Examples include serious car accidents, violence, rape, natural disasters, sudden death of a loved one, battlefield assault and war.
  • Usually results in symptoms of PTSD (post-traumatic stress disorder – disturbing memories or dreams, anxiety, flashbacks, depression, irritability and anger, insomnia, and others).

To this day, whenever I see images of the 9/11 attacks or the aftermath of Hurricane Andrew, I’m immediately flooded with emotion and feel tightness in my stomach, chest and throat. These are indications of post-traumatic distress.

Developmental and Shock Trauma – Comparison

Developmental Trauma Shock Trauma
  • Distressing childhood events (parental absence, neglect, abandonment, abuse, family conflict, divorce, being bullied, learning challenges, etc.)
  • Trauma accumulates over time from childhood;
  • Effects of trauma are pervasive and ongoing;
  • Often there are few or no distressing flashbacks;
  • Results in negative beliefs, emotions and body sensations, such as people pleasing, difficulty trusting others, fear of conflict; self-sabotage.
  • A catastrophic, often violent situation or threat;
  • May be a single or multiple event trauma;
  • May be pervasive in the case of multiple single event traumas;
  • Most often involves distressing flashbacks of the event(s);
  • Results in negative beliefs, distressing emotions and/or physical sensations months or years after event;
  • Lasting negative effect on a person’s sense of safety in the world (such as anxiety, panic, phobias, & PTSD).

Resolution and Recovery

There are several therapeutic modalities proven to be effective for trauma recovery. The first step toward resolution is to find a therapist who is educated and trained in trauma recovery.

Medical research shows that EMDR (Eye Movement Desensitization and Reprocessing) is one of the most effective treatment methods for trauma recovery. EMDR is a powerful therapeutic technique which is highly effective in reducing or eliminating anxiety, panic, disturbing memories, post-traumatic stress and other emotional and behavioral problems.

In my therapy practice, I’ve observed many successful outcomes – healing the mind, body and spirit from the negative effects of trauma by integrating EMDR with breath work, guided meditation, mindfulness practices and yoga.

If you or someone you know suffers from trauma, please know there is hope and light at the end of the tunnel. For additional information about trauma, trauma recovery and EMDR, please contact our Center today.

 

16May 2017

Is He a Narcissist?

And How to Deal with Him

By Richard J. Loebl, LCSW, PA

Narcissism is on the rise. Millennials may surpass the “Me Generation” – they are often seen as entitled and self-absorbed. And narcissism is in the news every day: Several powerful world leaders, such as Russia’s Putin and North Korea’s Kim Jong-u are well-known for their narcissistic behavior. Famous entertainers and athletes are almost expected to be narcissistic – and they rarely seem to disappoint.

When people think about narcissism they usually visualize a man. There’s a good reason for that. Studies show that men are about three times more likely than women to show up as narcissists. What about the man in your life? Is he a narcissist? And what can you do about it?

It’s All About Him

Narcissistic men are similar to narcissistic women – but the men tend to be more aggressive, domineering, unethical and socially inappropriate. Many LATE Men are narcissistic. LATE men are Lost, Angry Teenagers – adult men who are developmentally immature (see my articles on LATE Men in this web site). These narcissistic men are lost because they operate on a false, elevated sense of self. But this inflated self, or personality, seems hollow and based in shame and worthlessness. And they’re angry when they don’t get their way – or when they’re “one-upped” by someone else.

The problem is huge. Studies show a dramatic increase in narcissism in the 21st Century. Men are generally more self-absorbed, entitled and grandiose. They’re more arrogant and insensitive to others. Narcissistic men are manipulative and controlling. They use others for their own personal benefit. Relationships and marriages are damaged or destroyed. There’s even been a significant increase in abuse and domestic violence that can be traced to male narcissism. And narcissistic heads of state are insensitive to basic human rights, and dangerous to world peace and stability.

Is He a Narcissist?

√ He’s so self-absorbed that he doesn’t seem to care about your needs or feelings.

He’s selfish – his needs and desires come first.

He complains or protests when you have expectations or make requests.

He always has the right answer. You’re wrong. He knows best.

He has an inflated ego. He’s smarter than others – more talented – the best.

Yet, at times, he seems quite insecure or jealous of others. He always seems to be looking for approval or admiration.

He gets very defensive and argumentative. It’s always your fault (or someone else’s).

He always needs to be in control.

Narcissism can manifest in minor, even subtle ways. This is referred to as narcissistic personality traits. Or it can be a full-blown characterological disorder. NPD (Narcissistic Personality Disorder) is estimated to affect 6% of the population. But men represent about 75% of all individuals diagnosed with NPD. At our Center, we estimate that at least 65% of our male clients (including husbands when we see couples) have at least significant narcissistic traits.

The DSM (Diagnostic and Statistical Manual of the APA) defines NPD as “A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy…”. This is a summary version of the diagnostic criteria:

  1. Grandiosity – exaggerated self-importance and need to be recognized.
  2. Fantasies of unlimited success, power, brilliance, etc.
  3. Views himself as “special” and unique.
  4. Requires excessive admiration.
  5. Entitlement: unreasonable expectations of favorable treatment or compliance with is expectations.
  6. Exploits others – takes advantage.
  7. Lacks empathy: doesn’t recognize or identify with other people’s feelings.
  8. Envious or jealous of others.
  9. Arrogant, haughty attitude.

Does this sound familiar? If someone you know has 5 or more of these symptoms, he may have NPD. Otherwise, he may have narcissistic traits – one or more of the symptoms listed above, though not as extensive, or pervasive. But these traits alone can be very troubling and cause very serious problems.

Self-Esteem, Confidence, or Narcissism?

  • Normal self-esteem and confidence
  • Self-acceptance and self-assurance
  • Goal-oriented or ambitious with work-life balance
  • Appreciates, but does not need, compliments and recognition
  • Mutuality in relationships (give and take)
  • Feels guilty when his mistakes are hurtful to others
  • Appreciates and values contributions by others (a team player)

Narcissistic Traits

  • Over-confident, self-absorbed or selfish at times
  • Sometimes aggressive to get his own needs met
  • Occasionally controlling and demanding
  • Needs recognition and appreciation frequently (underlying insecurity)
  • Sense of entitlement
  • Some ability to be empathetic and compassionate toward others
  • Narcissistic Personality Disorder
  • Similar to narcissistic traits, but more exaggerated and pervasive
  • Grandiose with no sense of humility
  • Excessive focus on his need to be recognized and admired
  • Preoccupied with his special personal qualities and accomplishments
  • Highly competitive – intolerant of anyone who may show him up or is “better than”
  • Lack of empathy or concern for others (and may throw them under the bus to look better himself)
  • Manipulative relationships – to obtain admiration and approval; to advance his own goals; and to maintain power and control over others
  • Deep core of worthlessness, well-hidden from others and himself
  • Over-reactive, defensive, “thin skinned” and argumentative – shifts blame to others

How to Deal with Him

Most narcissists don’t believe they have a problem or that they need to change. Unfortunately, research studies indicate that NPD is very resistant to change. Even the less serious narcissistic traits are stubborn, in part because these men can’t or won’t admit that they might be flawed. The good news is that you have choices, and you can often manage the situation effectively using the following approach:

  1. Emotional detachment from the narcissism, not the man. It’s not about you, and you don’t have to take it personally.
  2. Mindfulness – observe his attitudes and behavior from an objective, detached point of view. Avoid judgments.
  3. Use your mature, Adult self (see “Who’s In Charge?”). Your Adult self is loving and responsible – not reactive or judgmental.
  4. Avoid the Victim Triangle – These are the roles we play when we are emotionally reactive and get caught up in the drama: Victim, Persecutor, Rescuer. The only way out of the drama is Adult love and responsibility.
  5. Set boundaries – know when to say no, dispassionately (without drama).
  6. Self-care – Focus on your own needs, but not in service of avoiding or distancing from him.
  7. Suggest counseling or a men’s therapy group (without pressuring him). Or offer to go with him for “couples counseling.” Most narcissistic men can be taught to develop Adult ego skills and strategies. He can learn that it’s in his own best interest to learn how to work and play well with others!

If you would like additional information about narcissism, the LATE Men, coaching and counseling services for men, please contact us today. We’d like to hear from you about your personal experience, and we value your feedback.

28Jul 2016

Illus-TrappedMind-Blog

Perfectionist, Control Freak, Worrywart, Fanatic, Nag

The Many Faces of OCD

By Richard J. Loebl, LCSW, BCD

Charlene is a very bright, successful marketing professional in her mid-thirties. When she started therapy with me she told me she was OCD. She struggled with distressing levels of anxiety and worry, and she described herself as a perfectionist and a “control freak”. Charlene didn’t fit the most “typical” clinical description of OCD because she didn’t have compulsive “rituals” – repetitive, irrational patterns of behavior such as frequent hand washing. Nor did her obsessive ruminations meet the diagnostic criteria for OCD or Obsessive-Compulsive Personality Disorder. In fact, after many years of treating and studying OCD, I’ve found there are many types or faces of OCD.

Traditional Definitions & Descriptions of OCD

OCD in all of its variations is far more common than previously thought. Medical research also shows that there is a strong genetic basis for the disorder. Anxiety and worry is a prominent feature of OCD – and the compulsions are behavioral attempts to manage or control the anxiety and the distressing thoughts.

Obsessive-Compulsive Disorder

1. Obsessions are “Recurrent and persistent thoughts, urges, or images that are experienced… as intrusive and unwanted…” and cause anxiety, worry and distress (DSM-5, American Psychiatric Association). Attempts are made to ignore or suppress the thoughts.

2. Compulsions are… “Repetitive behaviors or mental acts” (like checking behavior and counting) in response to the thoughts. These behaviors are not rational or realistic, and are often excessive.

3. The thoughts and behaviors are often very time consuming and cause severe distress.

Obsessive-Compulsive Personality Disorder

1. This type of personality is rigidly and excessively focused on rules, organization, perfectionism and control (individuals with OCD, the anxiety disorder mentioned above, may not have this type of personality).

2. These individuals may be “workaholics” – they are generally preoccupied with details, lists and schedules, and excessively concerned with morality and ethics.

3. They may be “hoarders” who cannot dispose of unneeded objects without a great deal of anxiety and worry.

4. This personality may lose sight of productive goals and balance in life due to their rigid standards.

The Many Faces of OCD

o The Perfectionist – Charlene was indeed a perfectionist. She worked long hours and was never quite satisfied with the results. She told me once that when she entered a room at home she would immediately inspect the floor to see if there were specks of dirt or dust to be picked up. She rarely enjoyed her beautifully decorated home because of her “OCD”. She constantly experienced anxiety and worry about making mistakes or being seen as less than perfectly well put-together.

o The Control Freak – Charlene’s husband referred to her as a Control Freak – and she agreed with him. She washed the dishes immediately after every use and rarely used the dishwasher – the knowledge of soiled dishes in there made her nervous. She required a level of organization and cleanliness that was disturbing to her husband.

o The Worrywart – This version of OCD is similar to Generalized Anxiety Disorder, but these individuals stay in their heads with obsessive worry while they struggle to work out solutions that are evasive and usually impossible to achieve. The worrywart doesn’t discriminate – he or she worries about everything, regardless of the level of importance.

o The Fanatic – Ironically, Charlene’s husband had his own OCD tendencies. He was an admitted fanatic about politics and sports. Charlene said he was a bore. He was obsessively focused on national politics and watched hours of cable TV news shows. He knew all of the NFL players and statistics, and at social gatherings he would monopolize conversations with his knowledge and opinions. Sports and politics were always on his mind and he would become antsy if he was away from his computer or TV for more than a few hours.

o The Nag – aka The Complainer – It looks and sounds like chronic complaining or incessant nagging. But when you look below the surface, there may be OCD tendencies or traits. The Nag may be someone who struggles with anxiety and worry – and distressing obsessive thoughts that result in a compulsive need to complain.

o The Anal Retentive – This type of OCD is characterized by rigidity, a need to keep things orderly and excessively organized, and a personality that’s fussy, scrupulous, and fastidious to a fault.

OCD in Relationships

Individuals with OCD – either the formal anxiety disorder itself or a personality type – struggle with anxiety and worry that can be very distressing, even overwhelming at times. And it can be equally difficult and challenging to live with someone who suffers from OCD. Patterns of emotional reactivity can develop in this type of relationship, leading to a great deal of relationship distress. Charlene’s husband would be triggered by her anxiety and her controlling, perfectionistic tendencies. He would react with sarcastic comments and he resisted her attempts to involve him in her compulsive tendencies. Charlene felt unsupported by him, and she reacted to his frustration with anger and withdrawal. During those times when Charlene was the most anxious and obsessive compulsive, the reactive patterns and distress in her marriage became unbearable.

Couples may be unaware of the underlying causes – obsessive thoughts and beliefs; the anxiety associated with them; the controlling, complaining behavior that follows – and partners react emotionally out of frustration. On the surface, it looks like tension and arguments about the kids, money, chores, or even an affair in the past. And those can be troubling issues to be sure. However, the OCD process takes over at times, and becomes a primary source of relationship distress.

Coping Skills for OCD

o Mindfulness and acceptance – Awareness without judgement. Observe and identify the distressing, obsessive thoughts, while letting go of any negative judgments. The judgments create more anxiety and worry which exacerbates the OCD.

o Letting go of the struggle – Don’t argue with the obsessive thoughts. Don’t try to find a rational explanation. It’s like trying not to think about a pink elephant – the more you try the more it feeds the pastel beast in your mind.

o Identify and label the thought as obsessive, annoying, or unproductive (without any judgment). It’s just an annoying thought, and that’s all it is. It’s not about the content of the thought. We get lost believing in the content (my finances, my spouse and what he/she did, the problems with work, the house, the kids). But it’s not about the content – it’s about the OCD, the ruminations, and the anxiety we feel because of the thoughts.

o Thought stop and refocus – Gently tell your mind to stop it, and immediately refocus onto something manageable in the present moment. Keep repeating this process as necessary.

o Exercise and yoga – Proven to reduce anxiety and worry, along with the obsessive thoughts.

o Therapy and medication – If you continue to struggle and there’s no improvement, seek professional help. Counseling and therapy, along with certain medications when necessary, can be highly effective with all forms of OCD.

Contact us today for additional information, or to make an appointment. Our Center specializes in helping individuals and couples who struggle with anxiety and worry, OCD, and similar concerns.

06Jul 2016

Upset married couple sitting on the sofa after a disagreement

Emotional Problems and Disorders in Relationships

Is It a Relationship Problem or Is It Your Partner’s ‘Issue’?

By Richard J. Loebl, LCSW, BCD

Suzanne is taking medication for depression, but her husband still complains that she doesn’t do anything, and there is little affection or sex in their marriage. Rob’s girlfriend believes he has an addiction to marijuana and pornography – she broke up with him several times but keeps coming back when his behavior improves, and they continue to have loud arguments and fights. Julie is fed up with her narcissistic husband (narcissism is one of the personality disorders). She’s tired of complaining about his arrogant attitude, his demanding behavior and his lack of empathy or interest in meeting her needs. He says that Julie exaggerates and distorts the truth.

Are these examples of relationship distress caused solely by one partner who has depression, addiction, or personality disorders? Or is there more to the story? Is the relationship distress due to one individual’s emotional and behavioral problems, or could there be other relationship dynamics created by both partners? In other words, is it one person’s “issue” or is it about the relationship dance?

It’s a complicated picture to be sure. But as a general rule, when there are problems like depression, addiction and personality disorders, there will also be relationship distress. Emotional problems and disorders can trigger relationship distress, but it’s not always a simple cause-effect situation. This article will describe some typical examples, with suggestions for coping with these difficulties.

How These Problems and Disorders Impact Relationships

When there is relationship distress, the most commonly reported emotional problems and disorders are depression, addiction, and personality disorders. Anxiety, OCD, and bipolar disorders are also quite common, and are frequently associated with relationship distress. Three of the most common problems, and the way they manifest in relationships are described below:

* Depression can range from quite mild (dysthymia) to major depressive episodes and bipolar depression. And the impact of depression on marriage and other relationships can range from minimal (such as a general relationship lethargy or dissatisfaction) to severe relationship distress (anger, fighting, distance and affairs). A depressed partner may be unmotivated, isolative, moody, irritable, and disinterested in sex and other pleasurable activities. Anti-depressant medication can also result in lowered libido and lack of sexual response.

And relationship problems can contribute to depression. Some partners may become depressed due to severe and chronic relationship distress. For example, it’s quite common for the spouse of an alcoholic or addict to become depressed. Victims of spousal abuse are often depressed. And to complicate matters even further, depression, addiction and personality disorders may be present in the same person or couple.

Suzanne has felt controlled and demeaned by her husband for over 20 years. She started taking anti-depressant medication about 6 years ago, and she’s been able to return to her part-time job. With the help of couples therapy her husband Tom has become less demanding and critical, but he’s still very concerned. Suzanne tends to withdraw and isolate when she’s depressed, and Tom feels lonely and rejected. Suzanne’s medication may contribute to her low libido, along with her negative self-image and body-image. And when Tom complains about the lack of sex Suzanne feels guilty, inadequate and frustrated. She reacts defensively with more distance, Tom becomes more frustrated, and the cycle repeats itself.

* Addiction is often the primary concern when couples seek therapy. At other times there are other types of relationship distress and addiction is a complicating factor. The most common addictions we see with couples are alcoholism, prescription drug abuse, marijuana dependency, sex and pornography addiction. Addiction problems in relationships are usually very destructive, and couples will not benefit from therapy until there is a period of stable sobriety.

Relationship distress can also contribute to the development of addictive behavior or exacerbate an existing addiction. For example, when Rob quits smoking marijuana he is less tolerant of his girlfriend’s insecurities and demands for attention (he had been “self-medicating” to deal with their relationship problems). He becomes more defensive, and she reacts to the perceived abandonment with clingy and complaining behaviors. When things escalate between them and they start fighting again, Rob may “take refuge” in smoking marijuana again or using pornography. And the cycle repeats itself.

* Personality Disorders, such as narcissism and borderline personality disorder, may be a complicating factor in relationship distress.

Julie believes her husband is narcissistic, and she’s right. David is selfish, and rarely considers Julie’s feelings or needs when he makes decisions. Many narcissistic men, like David, feel entitled, special or unique, and take advantage of their spouse (and others). David can’t seem to understand Julie’s hurt and angry feelings – or he doesn’t seem to care. The more she complains, the more he says that she doesn’t understand or appreciate him – and he expects a great deal of attention and admiration from Julie.

Personality disorders can be very difficult to deal with, and partners or spouses are usually frustrated, angry, and baffled. They can’t win. Another example is borderline personality traits or the disorder itself (generally more common in women). This type of personality is emotionally unstable, and relationships are like roller-coasters. Borderline characteristics include excessive feelings of insecurity and fears of abandonment, impulsivity (addictions are common), self-harm or threats of self-harm, irrational anger and mood swings. The emotionally reactive cycle of relationship distress usually centers around abandonment issues. The borderline partner feels abandoned or unloved, and when she complains, interrogates, or is demanding, the exhausted partner reacts defensively, with anger and/or avoidance, which then fuels more reactivity by the borderline partner. And the cycle repeats itself.

Relationship Coping Skills

There are several tried and true coping skills for dealing with emotional problems and disorders when there is relationship distress – but it’s not always easy, and most couples will need professional guidance and support.

* Acceptance – 12 Step programs offer some of the best advice. Accept the things you cannot change, and remember the “3 C’s” (you didn’t Cause it; you can’t Control it; you can’t Cure it) – this is especially useful with addictions and depression.

* Emotional Detachment – Emotionally detach from the problem, not the person, with love. Know that it’s really not about you – don’t personalize. Especially useful with personality disorders.

* Don’t React – It helps to start with the one deep, centering breath (in through your nose, out through your mouth). Do not react to the drama, the incident, or any provocation. Take that breath, and use your highest self (your most adult or even spiritual self) to determine the best response.

* Use Empathy & Compassion – It’s actually one of the easiest ways to respond. Let your spouse or partner know that you’re really there, and that you do care. Ask them what they need from you right now – is there anything you can do for them (like “How about a hug?”).

* Practice Self-Care – Beware of co-dependent traps like enabling behavior. Remember to take care of yourself. Use a support system (support groups are available for co-dependency, Al-Anon for addictions, and depression support groups). Exercise, meditate or pray, and practice self-love (inner child work is recommended).

* Boundaries – Know what your limits are, and clearly, firmly indicate to your partner where that line is. Boundaries are best expressed in a positive, even caring manner. For example, “Please don’t ask me that or do that behavior. I love you, but that is not okay with me. We can talk about this some time, but for now, please respect my wishes.”

* Forgiveness – Practice letting go by forgiving your partner as an internal process. Do not tell your partner that you forgive them – that will simply provoke an emotional reaction. Tell yourself (journaling is also helpful) that you are forgiving and letting go.

* Know when to stay and when to leave – What is the deal breaker for you? Only you can decide. For more suggestions, see my article “Separation & Divorce – Should I Stay or Should I Go?

* Seek Professional Help from a qualified, licensed counselor or therapist.

The counselors, therapists, and couples therapists at our Center have many years of experience and training in helping individuals and couples. We can help you navigate the troubled waters of depression, addiction, and personality disorders. Contact us today to make an appointment, or to ask any questions.

13Jan 2016

Trauma, Core Beliefs, & EMDR

By Greg Douglas, LMHC

Psychotherapy clients often say “I really want to get to the core of the problem” or “I need to figure out what the core issue is.” This is very insightful, because core beliefs often result from traumatic experiences such as childhood neglect, abandonment or abuse. These beliefs have a greater influence on our lives than we realize. Core beliefs develop early in life – half of them develop before the tender age of 5. Core beliefs can be positive or negative and have a huge impact on how we see ourselves, others, and the world we live in. EMDR is a proven counseling method for changing negative core beliefs.

 

 

Examples of trauma based core beliefs that are addressed in EMDR:

o I am unlovable – not good enough

o Relationships aren’t safe

o I’m a disappointment

o People can’t be trusted

o I’ll be abandoned

o People will hurt me or use me

o I have no control over my life

o Life is too hard, scary, and full of disappointment

A positive, realistic, and accurate system of core beliefs can have a huge impact on the decisions we make on a daily basis. EMDR therapy is an effective way to change negative, trauma-based core beliefs. This type of therapy helps people to challenge their negative thoughts and replacing them with more positive and adaptive beliefs.

How EMDR for Trauma Recovery Changes Core Beliefs

At the heart of EMDR therapy is the reality that we can change negative beliefs about past traumatic experiences. We can reprocess these memories and replace the negative core beliefs with a more positive and productive system of beliefs. During EMDR therapy clients have one foot in the past (to examine past core beliefs) and one foot in the present (to change negative core beliefs and promote healing).

In a typical EMDR session clients identify trauma based memories that have created negative core beliefs. These memories are modified in a more realistic manner leading to a lessened level of distress. Counseling sessions help people to build a positive future template for life success and improved relationships. Typically, after processing negative and traumatic memories people begin to feel more self-assured, empowered, and show an ability to move forward and make the life changes they have always wanted to make.

If your negative core beliefs are holding you back from living the kind of life you desire please call us today and learn more about how EMDR for trauma recovery can put you back on track.

06Jan 2016

Is “Affluenza” for Real?        

Narcissism, Entitlement, and Parental Enabling

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By Richard J. Loebl, LCSW, BCD

Parenting issues are in the news again: North Texas, 2013. Sixteen year old Ethan Couch killed 4 pedestrians after stealing his father’s pickup truck, shoplifting beer from a store, and speeding at 70 miles per hour in a 40 MPH zone. He was driving drunk, at 3 times the legal limit in Texas, while also under the influence of the tranquilizer Valium. It was reported that Couch did not show remorse or empathy for his victims. His behavior was certainly irresponsible, and a psychotherapist might suspect substance abuse – and possibly a personality disorder such as anti-social behavior or narcissism.

Ethan Couch was not punished for his acts. The judge gave him 10 years probation without jail time. Media coverage did not mention a personality disorder, narcissism, or chemical dependency. Parenting issues were discussed during the trial. The family lawyers argued successfully that the teenager was the victim of “affluenza” – an inability to understand the consequences of his behavior as a result of financial privilege. Specifically, they argued that his wealthy parents enabled his irresponsible behavior by pampering and coddling him to the point where he was unable to determine right from wrong. And now, Ethan Couch, with direct assistance from his mother, has broken his probation and fled from justice. He is being detained in Mexico, and mother was booked and jailed in Los Angeles.

Affluenza

Is “affluenza” a real disorder? Is a personality disorder like narcissism a better explanation for this type of behavior? To what extent are parenting issues to blame? The term affluenza was developed by anti-consumerist activists in 1997. They defined affluenza as “a painful, contagious, socially transmitted condition of overload, debt, anxiety, and waste resulting from the dogged pursuit of more” (deGraff, Wann & Naylor). The authors included the following 3 sections in their definition:

1. The bloated, sluggish and unfulfilled feeling that results from efforts to keep up with the Joneses.

2. An epidemic of stress, overwork, waste and indebtedness caused by dogged pursuit of the American Dream.

3. An unsustainable addiction to economic growth.

In 2008, British psychologist Oliver James defined affluenza as “placing a high value on money, possessions, appearances (physical and social) and fame”, which explained an increasing rate of mental illness in English-speaking societies. James indicated that income and material inequality in wealthy nations caused emotional distress and unhappiness. Parenting issues were not mentioned, and affluenza was not defined as a personality disorder.

Affluenza is not recognized by the American Psychiatric Association or any other formally established mental health authority as a mental illness or disorder. The psychologist who testified on behalf of Ethan Couch, Dr. G. Dick Miller, used the term affluenza, and explained that parenting issues were partly to blame. He said that Ethan’s parents spoiled him and never set limits on his behavior. He did not mention any type of personality disorder such as anti-social personality disorder or narcissism.

Alternative Explanations and Disorders

Ethan Couch’s behavior was extreme, dramatic, and the outcome was deadly. Sadly, this case shines a light on some common dysfunctional parenting issues – and too many teenagers and young adults who are entitled, narcissistic, and irresponsible. The concept of affluenza seems to be accurate in describing some aspects of these problems, but there are several alternative explanations and disorders worth considering. (It’s important to note that my observations and analysis regarding Ethan Couch are derived from the limited information available through the media and online. I cannot accurately assess or diagnose someone I’ve not interviewed directly.)

1. Parental enabling, enmeshment and codependency – The news reports on Ethan Couch focused mostly on the family’s affluent lifestyle and the way his parents spoiled him. While this appears to be accurate, it’s insufficient to explain the full extent of the family problem and parenting issues. Many children and teens are spoiled, and most of them do not steal, kill pedestrians, and run from justice. Ethan’s mother is now in custody as a result of her role in their flight to Mexico. It’s apparent that this is a case of parental enabling behavior – mother literally enabled her child to avoid the consequences of his irresponsible behavior. When a parent is unable or unwilling to have enough emotional detachment to set limits on their children, they become emotionally enmeshed and codependent. Codependency means the parent or parents are part of the problem – there’s a lack of appropriate parent-child boundaries, over-involvement or control, and over-identification with an unhealthy alliance.

2. Narcissism and entitlement – Narcissism is a personality disorder that results in a sense of elevated self-importance, grandiosity, and a sense of entitlement. These individuals usually put themselves first, and generally lack empathy or concern for others. They are often attention-seeking and manipulate others for their own selfish needs. A sense of entitlement refers to individuals who believe something is owed to them by life in general; or because they are who they are. Based on published reports, Ethan Couch may have a narcissistic personality disorder – or at least narcissistic personality traits.

3. Anti-social personality – Another personality disorder, based partly in narcissism, is anti-social personality disorder (formerly known as a sociopathic or psychopathic personality). These individuals are recklessly, dangerously irresponsible. They disregard and violate the rights of others, breaking normative social rules and the law. They act impulsively, lie, and disregard the safety of others. This description also seems to fit Ethan Couch.

4. Substance Abuse – Ethan Couch’s behavior may be understood best by a combination of several causes: parenting issues, a personality disorder or traits of narcissism, and possibly substance abuse. Couch was arrested with a blood alcohol level that was more than 3 times the legal limit in Texas. He was also under the influence of a strong tranquilizer, Valium. He fled the country to Mexico with his mother after a video was revealed, showing him at a drinking party with other teenagers, playing beer pong. These incidents are direct evidence of a drinking problem or substance abuse.

The Moral of the Story

The Ethan Couch story is a tragedy. Four innocent pedestrians were killed, and others were injured. Many thousands of dollars were spent by his parents and taxpayers who support our criminal justice system. (Incidentally, it’s unlikely that a black teenager would have been granted the same leniency extended to Ethan Couch.) Can this type of crime be prevented? How would we constructively address these types of parenting issues and personality disorders?

I agree with many others who advocate for comprehensive reform of our criminal justice system and the need for improved funding for mental health services nationally. We can successfully treat personality disorders with a combination of medication when necessary, and various types of psychotherapy. We need to do a better job of identifying people who need treatment – and assertively encourage them to get the help they need. The parenting issues are primary. The challenges facing parents today are greater than ever before. Parents need support, education and guidance to balance the excessive, competing demands on children today (school, social, athletics, and electronic).

We would like your feedback about this article – please let us know about your thoughts and feelings. Our Center specializes in parenting issues and the treatment of narcissism and other personality disorders. Please contact us today for more information about our services.

30Dec 2015

2015 – The Year in Review

An Emotional and Psychological Analysis

Symbol of the scales is made of pebble on the sea coast

Those who do not remember the past are condemned to repeat it.

                                         George Santayana

Ring out the false; ring in the true.

                                         Alfred Lord Tennyson

 

By Richard J. Loebl, LCSW, BCD

2015 was an eventful and remarkable year. It was an emotional year, burdened with anxiety, worry and depressing events – including terrorism, earthquakes, epidemics, and airline disasters. Negative politics reached a new low. These events are rarely examined from an emotional or psychological point of view. What can be learned from such an analysis? My somewhat subjective research and analysis of 2015 resulted in a list crowded with bad news, as expected. What surprised me was an abundance of good news…

But First, the Bad News

I decided to organize my psychological analysis of 2015 into emotional categories. They correspond to the 3 primary negative emotions of Anger, Sadness, and Fear – in sufficient quantities, emotional states symptomatic of depressionFear includes the emotional sub-categories of  anxiety and worry. Another category in this analysis is the state of Relationships in 2015. The final category, Joy, will be covered in the last section.

1. Anger – Demonstrated by word as well as deed, there was a profusion of anger in 2015. Some examples include:

  • Beheadings and terrorist attacks by ISIS and their sympathizers.
  • The Boko Haram massacre – over 2000 killed.
  • Mass killings in the US by psychologically unstable individuals.
  • Destruction of priceless, ancient artifacts and relics in the Middle East.
  • The soaring rate of murders and sexual assault crimes nationally and internationally.
  • Questionable tactics by certain police officers and local forces.
  • Verbal attacks and lies by presidential candidates.

Analysis – Certainly, some violent acts are motivated by political, economic, even “religious” forces. A small number of violent acts are perpetrated by psychopathic individuals who may not be angry, but operate from a lack of empathy or concern for others. However, I believe that the vast majority of violent acts are motivated by angry individuals and groups. Anger is a primary force – and cause – of these destructive acts. Some of these violently angry perpetrators probably have a clinical depression – anger can be a symptom of an underlying depression. It’s unfortunate that our efforts to combat terrorism, mass killings, and other violent acts rarely address emotional or psychological causes.

The great 6th Century Chinese General Sun Tzu, who wrote The Art of War, famously suggested “Know thy self, know thy enemy” and “The supreme art of war is to subdue the enemy without fighting.” Perhaps, if we spent even a fraction of our annual defense budget on a deeper psychological and sociological understanding of groups like ISIS, we could mount a more effective and humane counter-terrorism strategy. I think we experience anxiety and worry about terrorism and mass killings for a good reason – we’re fighting fire with fire (that is, we ineffectively fight anger with anger). We’re very clear that we don’t cure depression by attacking it with negative, punitive self-statements (“I hate that I get so depressed – I hate myself”- isn’t exactly therapeutic).

History is replete with examples of violent uprisings (such as Middle East terrorists) and wars (such as WWII) which were caused, in part, by populations victimized or subjugated by angry countries and leaders who themselves were reacting to angry, violent acts by those they now repress. A never ending cycle of anger and violence – often fueled by anxiety and worry.

Unfortunately, a very human, knee-jerk response to violence is to practice more violence. In some families, when one child hits another child the parental response is to hit the child (is there really a distinction between hitting and spanking?). We know that many children who are hit or spanked repeatedly end up suffering with depression and anger management problems. Politicians often promise that “If they hit us, we’ll hit them back.” Anger begets anger. It’s unreasonable to believe that in the 21st Century we can’t solve our problems with practical applications of technology, an enlightened redistribution of our abundant world resources, and a humanistic, emotionally intelligent, and psychologically sophisticated approach.

We cannot solve our problems with the same thinking we used when we created them.

                                                                Albert Einstein

2. Sadness – I suppose I’m like a lot people when I say that I was more angry than sad about the terrorist attacks and mass murders in 2015. For me, the saddest events of 2015 were natural disasters such as the earthquake in Nepal that killed over 8,000 people. (Assuming they were all natural. When global warming is involved my sadness is chemically transformed to anger.) Another very sad and infuriating event (oops… there’s my anger again) in 2015 was the systematic destruction of irreplaceable, ancient artifacts and relics by ISIS. Other sad events in my idiosyncratic list include:

  •  The passing of B.B. King – King of the Blues (Indeed, “The Thrill is Gone”)
  •  The finding that processed and cured meats may lead to cancer
  • Grateful Dead’s last concert
  •  The death of Leonard Nimoy (Live long and prosper Mr. Spock!)

Analysis – Our society is obsessed with happiness. Maybe not a surprise since our Constitution emphasizes the “pursuit of happiness”. We celebrate the smile, while we denounce sadness and stigmatize depression and anxiety disorders. Our country spends millions on pills to banish the blues, and books on positive psychology have become bestsellers. When I ask my clients about their goals for psychotherapy, many respond by saying “I just want to be happy.” To be clear, I appreciate positive mood states, and I like being happy. But should happiness be the most important goal in life? We can pursue happiness, but can we and should we avoid negative feelings and always insist on happiness?

Happiness is not a goal; it is a by-product.

                                   Eleanor Roosevelt

In my experience, personally and professionally, positive mental health is maintained by a life of meaning and purpose. We’re happy when we accomplish challenging goals, when we pursue excellence in our daily lives, when we practice loving kindness toward others, emotional balance, non-judgment and non-reactivity.

I believe there were events in 2015, like events in our personal lives, that are deserving of our sadness and grief. We pay a price for ignoring or suppressing our sadness. Addiction may be the biggest price we pay – addiction is a national epidemic. We’re addicted to alcohol, drugs, the internet and mobile devices, TV and video games, shopping, and gambling, among others. All are effective pain killers. We try to find happiness by numbing our sadness, shame, anxiety and worry. And we create more clinical depression than any other country in the world. Sadly, I believe that many world leaders in government, politics, business, and some “religious” groups are also addicted – to power, ego, resentment and blame.

3. Fear – 2015 was an exceptionally scary year. This is just a sampling of the many alarming and horrifying events:

  •  Terrorism and mass killings
  •  Outbreaks and epidemics (E. coli, Ebola, and others)
  •  Aviation disasters
  •  “Natural” disasters such as earthquakes, tornadoes, and landslides (many due to global warming)

Analysis – Fear is a primary human emotion – the most vital emotion we have. It is the source of our survival instincts. We need to be afraid. Fear (including anxiety and worry) is our natural, internal alarm system designed to protect us and keep us safe. Unfortunately, most of our fears today result from our own behavior. The cartoon character Pogo said it best 45 years ago:

We have met the enemy, and he is us.

                                                 Pogo, Created by Walt Kelly

We are understandably afraid of terrorism and other forms of violence, disease, and all forms of disaster. Ironically, our fears often result in emotionally reactive behavior that creates more problems for us. Fight or flight is the natural emotional reaction to fear. Our reaction to terrorist attacks seems to fall into those two categories. When we react with anger, we attack with bombs and ground troops. It doesn’t seem to solve the problem (many Middle East experts and military analysts agree that we will not defeat ISIS solely with military action). Equally, the problem isn’t solved by fearfully avoiding the causes (which are highly complicated in the case of the Middle East, and generally not addressed). Interesting that depression often results from an inability to adapt to circumstances – anger and avoidance are mostly maladaptive.

There are reasons to be optimistic. Some enlightened world leaders are working toward a more rational, constructive response to our problems. For example, large numbers of Syrian refugees are being welcomed by several countries. New, potentially effective climate change agreements are slowly emerging. Contagious diseases are more effectively controlled than ever before. It’s also important to recognize that so much of our anxiety and worry about the world may be exaggerated by the 24 hour news cycle which focuses predominately on bad news – along with politicians who garner so much popular support by appealing to our fears. I may propose a new type of reactive depression – CNPD (Cable News & Politics Disorder).

4. Relationships – The state of relationships in 2015 is a mixed bag at best. There is some good news. For example, we have a much better understanding of what makes a relationship work. Excellent research studies reveal how and why some marriages remain happy and healthy. And highly effective forms of marriage counseling, such as EFT (Emotionally Focused Couple Therapy), are helping thousands of couples to repair and improve their relationships. Sadly, there are still many reasons for anxiety and worry – even depression – about the state of relationships today.

  •  Studies show infidelity in the US is increasing
  •  The divorce rate is still very high – over 50% of all marriages end in divorce
  •  Increasing numbers of single fathers
  •  The prevalence of web sites like Ashley Madison, which promote infidelity
  • Ashley Madison hacked – as many as 37 million names and personal data released
  •  Social media has become the leading method for teenagers to flirt
  •  The marriage rate for Millenials (mostly in their 20’s) is dropping
  •  Break-Up of the Year – Miss Piggy and Kermit the Frog

Analysis – Relationships are difficult. Most of us aren’t taught how to do relationship. While growing up we’re rarely taught about identifying and managing ourselves emotionally or in relationships with others. And far too often we learn bad habits from the people we grow up with. We witness destructive fighting, emotional distance and avoidance, separation and divorce – and these things are rarely discussed openly or explained. Or we have parents who struggle with depression, anxiety and worry, and addictions. No wonder we struggle in our own relationships as adults. We look for the “right person”, and we’ll never find this, because there is no one right person. We want to be loved, but we often fail to treat others the way we want to be treated.

We’ve got this gift of love, but love is like a precious plant. You can’t just accept it and leave it in the cupboard or just think it’s going to get on by itself. You’ve got to keep watering it. You’ve got to really look after it and nurture it.

                                                                                            John Lennon

And Now, the Good News!

There was a great deal of good news in 2015. This is my personal list of favorites, in no particular order:

  • Diplomats around the world working for peace (John Kerry, Mohammed Javad Zarif, Pope Francis, Federica Mogherini, and many others)
  • Chancellor Angela Merkel of Germany (who led her country in accepting close to a million war torn Middle East refugees)
  • The U.S. economy in 2015
  • U.S. women’s national soccer team, who won the World Cup in 2015
  • The Washington Redskins – Champions of the NFC East!
  • Gay marriage legalized
  • Mark Zuckerberg the philanthropist
  • McDonald’s all day breakfast
  • Sunday Morning on CBS (good news every Sunday)
  • A new Golden Age of TV (Better Call Saul, The Affair, Ray Donovan, & others)
  • NASA, Pluto, water on Mars
  • The Martian and Star Wars
  • Great movies with psychological significance (Inside Out, Amy, Love & Mercy, Spotlight)

Analysis – At first, I thought there would be more bad news than good news in 2015. Now I’m reminded that there is just as much light as there is darkness. Our perception of events is affected by forces we are often unaware of.

It all depends on how we look at things, and not how they are in themselves.

                                                                      Carl Jung

The depression that runs in my family touches me at times, and affects my point of view. As we approach 2016, there is certainly cause for anxiety and worry. I’ll remind myself to look for the light. I’m glad to know that we have so many new opportunities to make the world a better place in 2016. And to appreciate all of the goodness in the world today.

From everyone at the Relationship Center of South Florida, we wish you a healthy and happy New Year. For additional information about depression, anxiety and worry, please contact us today.

29Oct 2015

Scream Parody

HELP FOR ANXIETY, FEAR & PANIC ATTACKS

 “Anxiety is the dizziness of freedom.”

Soren Kierkegaard

 The modern era has often been referred to as the “Age of Anxiety.” This concept was created by the great poet W.H. Auden. His poem in 1948 dealt with the struggle of meaning, purpose, and identity in a rapidly changing world. Life hasn’t slowed down very much since then. Changes in technology, the economy, and other events continue at a dizzying pace. We have very little control in this changing world – some would say we have no control. I believe this lack of control is the deepest emotional and psychological source of our anxiety – not change itself. When we feel fear, we want to control it – and sometimes we create the conditions that lead to a panic attack.

It’s true that there are several reasons why we experience anxiety, fear and panic. Some of us are biologically programmed to experience higher levels of anxiety. Childhood trauma certainly contributes – abuse, neglect and abandonment. And a personality style that includes perfectionism, obsessive tendencies, and rigidity often manifests in anxiety. There are different types of anxiety and fear:

o Anxiety – We experience anxiety as a nervous feeling, worry, restlessness and apprehension. We feel on edge, our muscles might be tense, and it can interfere with sleep.

o Fear – A distressing emotional state triggered by a real or imagined danger – or threat of danger. Our brains are designed for survival. We have an alarm system in our brains (amygdala) that reacts instantaneously to any threat.

o Panic Attack – Intense fear – either triggered by specific situations, or free-floating (“out of the blue for no reason”) A panic attack usually occurs quite suddenly, and only lasts for a relatively brief period of time (about 10-30 minutes) – although it feels like it’s going on forever. People say they think they’re going crazy or they’re afraid they will faint or die. The physical symptoms are overwhelming – heart palpitations, rapid heart rate, sweating, trembling, shortness of breath, chest pain, and a feeling of being detached from one’s body or from reality.

o Phobias – Excessive, persistent fear and anxiety triggered by specific situations or objects (for example, public speaking, flying, enclosed spaces, heights, reptiles, animals, insects, etc.). People usually experience at least one panic attack associated with the phobia, and the phobic situation is often avoided.

There are many specific types of phobias, such as agoraphobia (a more generalized fear about situations where people feel trapped – in crowds, while traveling, standing in line, etc.), and social phobias (often performance based – sometimes known as “evaluation phobias”). Other “anxiety disorders” include OCD (obsessive-compulsive disorder), PTSD (post-traumatic stress disorder), and GAD (generalized anxiety disorder).

Anxiety disorders are the most common emotional and psychological disorders – more prevalent than major depression. Studies consistently show that about 18% of our population – about 40 million people – has a diagnosable anxiety disorder.

Treatment for anxiety disorders is often effective. The most common treatments are medication and therapy – often, a combination of both medication and therapy is most effective. There are proven therapy techniques that seem to be most effective with anxiety disorders, but the success of any specific treatment varies considerably, depending on the individual. Complicating factors include the personality traits of the patient, and the co-occurrence of significant depression, addiction to alcohol or drugs, and other mental health problems. The most common effective therapies for anxiety disorders include

1. Cognitive-Behavioral Therapy

2. Mindfulness-Based Therapy (especially with a cognitive component)

3. Relaxation Therapy with Systematic Desensitization (including practice sessions where patients willingly enter into anxiety-producing situations while using mindfulness-based relaxation techniques).

I’ve specialized in treating anxiety disorders for almost 30 years. This experience has  taught me that anxiety and fear cannot be controlled or cured. Anxiety is a normal fact of life – we don’t have to like it, but it’s important to accept it. Fear is survival based, even if our fear is a product of creative imagination. We need to face our fears in a determined but gentle manner. And sometimes we need the help of a supportive and knowledgeable professional. More than anything, I’ve learned to we need to learn how to lessen our grip – the more we struggle against reality (and sometimes the reality is our own experience of fear!), the more we create additional anxiety for ourselves. Acceptance, and the daily practice of serenity through meditation or prayer, gives us the gift of true freedom.

07Jul 2015

Staff Therapist, RCSF

Do you find yourself hand washing again and again? Do you repeatedly use sanitizer? Do strange and horrible thoughts get stuck in your head? Are you an over-organizer? Do you hoard objects? Although many of us engage in these behaviors from time to time, when these thoughts and behaviors begin to cause pain and hardship in our lives, they may point to a more serious problem: obsessive-compulsive disorder (OCD).

What is OCD? It’s a disorder characterized by thoughts (obsessions) and/or rituals (compulsions) that are significantly impairing and distressing. The obsessions are recurrent and intrusive thoughts that cause distress while the compulsions are repetitive behaviors or mental acts that reduce distress and anxiety.

Do I have OCD and if so do I need OCD treatment?

Although both the symptoms of OCD are as diverse as the individuals suffering from the disorder, many people with OCD fall into the following categories:

* those who clean and wash repeatedly to escape their fear of germs and contamination

* those who feel the need to repeatedly check various things such as door locks, making sure their ovens are turned off, and even their writing and homework

* those who need to do everything perfectly or feel that something terrible will occur

* those who fear they will harm their loved ones (children, relatives) for no reason

* those who need to organize everything until it feels “just right”

* those that compulsively hoard things they don’t need (newspapers, receipts, etc.)

How do I know if my symptoms require therapy? In general, if you spend more than one hour a day either thinking these obsessive thoughts or doing these compulsive rituals, you may require treatment.

OCD Therapy

The most effective form of OCD treatment is cognitive behavior therapy (CBT) with exposure and response prevention (ERP). This treatment involves the exposure to the anxiety producing situations or objects while preventing the individual from engaging in the triggered compulsions or rituals. ERP systematically habituates the individual to the feared situations, gradually reducing his or her anxiety. ERP significantly reduces OCD symptoms in about 90% of patients.

OCD treatment typically begins with a creation of a symptom hierarchy or rating scale of distressing or obsessive thoughts, objects or situations. This entails rating on a 0-10 scale all of the obsessive fears and avoided situations. The exposures then begin with the lowest-ranking obsessive fear or situation. Often just speaking or writing about the feared situation is the first exposure. “En vivo” or real-time physical exposures are most effective when the therapist first models the desired behavior (e.g. touching the unclean object along with the individual). Throughout the exposure the therapist is aware and diligent in the prevention of any ritualized behavior that may use to reduce anxiety. Generally, the anxiety level should be rated every five minutes. The exposure to the stimulus is typically continued until the distress is reduced by half which may take anywhere from 5 minutes to an hour. Finally, the exposures are continued several times outside of the therapy session.

OCD treatment in Boca Raton FL is available. Our clinical team at the Relationship Center of South Florida is highly trained in this type of OCD treatment. We have seen the tremendous positive changes that often accompany this type of therapy.