Therapy and Counseling For Anxiety

Agoraphobia

Agoraphobia

Agoraphobia is a type of anxiety disorder that can sometimes co-occur with panic disorder. Its prevalence rate in the population is low, occurring in only about 1.1% of the population. Agoraphobia is hallmarked by a fear of leaving the house or other safe place. This often cooccurs with panic attack or panic disorder because a person has experienced a panic attack and then fears that they may have one again or that they will experience some other feared situation such as traveling on a bridge, going through a tunnel, or being stuck in a crowd of people. In some situations, the person may be able to encounter the feared situation, but they do so with such dread that the activity and many other parts of life lose their joy and peacefulness, which can even lead to depression and other psychiatric disorders. In some instances agoraphobia can be diagnosed without a history of panic disorder.

The criteria for Agoraphobia are as follows:

1. A fear or anxiety about being in places or situations where escape may be challenging. This fear is often surrounding being unable to quickly escape if the sufferer has a panic attack and could become trapped or unable to leave.
2. The fear of being unable to leave leads to an avoidance of said situations which can result in restriction of travel or in some instances the situations are endured but only with a certain safe person or friend.
3. This specific phobic avoidance is not accounted for by another disorder such as social anxiety or post traumatic stress disorder.

A person who has experienced a panic disorder may state “ Before I sought treatment and recovered from agoraphobia, I rarely left my apartment for 2 years. It all started when I was walking down a crowded street in downtown Pittsburgh and suddenly I had hot flashes, I was sweating and couldn’t breathe, the pain in my chest became so bad that I ran for help and reached for the lady next to me and told her to ‘Help, call 911!’ When I was diagnosed as having a panic attack the hospital I couldn’t believe it, everything changed for me then. I wanted to avoid having another episode and the only place I felt better was at home. I avoided everyone and even did my grocery shopping online. It became so bad that I started to feel anxious when I thought about leaving home for anything.”

A person with agoraphobia suffers greatly, their ability to function in life is limited including socially, emotionally, and psychologically. Treating panic disorders can be extremely difficult because the person may not want to leave their home even to seek help, fortunately treatment using distance or online counseling is now an option. The best treatment for Agoraphobia is psychotherapy, a counseling or therapy approach which uses exposure therapy and cognitive behavioral therapy. Medication or Pharmacological therapy including anxiolytic medications and SSRI’s are often used effectively to treat Agoraphobia too, medication is often used in conjunction with counseling or psychotherapy.

Generalized Anxiety Therapy

Generalized Anxiety

Generalized anxiety disorder is a mental health concern which brings many people into therapy each year. As many as 1/4^th of people who seek treatment in counseling centers each year do so as a result of wanting to manage symptoms related to Generalized Anxiety Disorder or (GAD). Signs and symptoms of Generalized Anxiety Disorder are free floating thoughts and worries that are not related to a real imminent danger. Those who experience generalized anxiety disorder may find it difficult to distinguish between thoughts and fears which are related to a real possible danger or threat and one that is not. The thoughts, fears, and worries of Generalized Anxiety Disorder co-occur with physical somatic responses such as elevated heart rate, fatigue and restlessness, and or difficulty falling and staying asleep. Individuals who are experiencing this anxiety disorder may also be prone to irritability and may too have a higher incidence rate of other mood and mental health disorders including other anxiety disorders, or depression and substance abuse disorders.

A woman suffering from GAD may say something like “I was always on edge, it was difficult to pin point when the worrying started but it felt like it was one thing after the next. I was worried about getting into college, then how I would manage student and work life after, each test and paper caused me endless worry. It wasn’t just with school either, everything from traffic, to my parent’s health, I wasn’t even able to see the way it was effecting me until things became so bad that I wasn’t sleeping well and started to really feel down. Then I found a therapist and started working on treating my anxiety and along with that I was able to identify how much it had taken over my life.”

Some of the diagnostic criteria for GAD according to the Diagnostic and Statistical Manual, are as follows; Excessive worry for at least 6 months.

The person experiencing the anxiety is not able to control the worries or change the focus of their thoughts. Additionally these worries are accompanied by physical sensations or somatic responses including at least 3 of the following; Restlessness, Fatigue, Concentration difficulties, Irritation of Mood, Tightness in the Muscles, Sleep Cycle Disruptions including Difficulty staying or falling asleep. Remember these symptoms cause significant distress in social, family, or work life and are not caused by another disorder or use of substances. Only a licensed professional counselor, psychologist, or psychiatrist can help you to discern whether you are exhibiting or experiencing the full range or concerns which may mean you qualify for a diagnosis which will then help to guide the treatment for the anxiety disorder.

Treatment for generalized anxiety disorder often involves many therapy and counseling options. Many forms of psychotherapy including, cognitive behavioral therapy, psycho-dynamic therapy, brief solution focused therapy, acceptance therapy, gestalt therapy, rational emotive behavior therapy, are all valid methods to treat anxiety disorders and manage the symptoms associated with it. In other instances, counseling may be used alongside medication therapy, integrative medicine, including mindfulness and meditiation, to achieve a significant and long lasting reduction in the symptoms of anxiety.

Counseling and Wellness Center of Pittsburgh and Monroeville

830 Western Avenue

Pittsburgh Pa 15233

2539 Monroeville Blvd

Monroeville PA 15146

Post Traumatic Stress Disorder Therapy and Counseling

Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder is a form of anxiety disorder which stems from exposure to a traumatic event or situation which caused real or threatened injury to and this can also be caused by the witnessing of an event or situation which injured or threatened injury to another person. According to the DSM IV, there is a lifetime prevalence rate of about 8% for the development of PTSD. Muggings, rape, terror, hostage attacks, natural disasters, car accidents, are situations that can increase the likelihood that a person may develop PTSD.

As a therapy practice which also specializes in marriage and family counseling, we support the research which suggests that individuals who have experienced an infidelity in their relationship may also go on to develop symptoms of PTSD or Acute Stress Disorder.

There are certain occupations which put people at risk for developing Post Traumatic Stress Disorder by exposing them to frightening and dangerous situations. Those who work as military/armed forces, policeman, fireman, and detectives may be particularly vulnerable for developing PTSD. Finally, there is a second form of PTSD, Vicarious or Secondary trauma, this form of trauma is caused by exposure to information related to traumatic events and is commonly seen in therapists, social workers, attorneys, judges and persons who offer support and services to those who have had trauma.

The Diagnostic Criteria for PTSD are;

• The person has witnessed, was confronted with or in some way threatened with death or serious injury to the self or others.
• The response to this event or threat was intense fear, horror, anxiety, and or helplessness.

1. The events is then continually and persistently re-experienced in the form of imagery, thoughts, perceptions, the person may also experience frightening and recurrent dreams related to the traumatic event. The person will then attempt to avoid any associated triggers of the event and have an over all numbing and or a hyper-vigilance meaning they become hyper-aroused when exposed to triggers for the trauma. They also may have difficulty falling asleep, concentrating, regulating mood, and have an increased startle response. Individuals exposed to trauma may too are also at increased risk to develop mood disorders such as depression and are also at increased risk for developing substance abuse.

Treatment for Post-Traumatic Stress Disorder often involves Trauma Focused therapy with a licensed professional counselor or therapist as well as medication therapy in certain instances. Another form of therapy which has proven effective in clinical models is EMDR.

Obsessive Compulsive Disorder OCD, Therapy and Counseling

Obsessive Compulsive Disorder

Obsessive compulsive disorder is a type of anxiety disorder which afflicts .5-2.5% of the population. The disorder greatly effects the quality of life for the sufferer and becomes a consuming pattern of anxieties and rituals which are centered around both obsessional worries and compulsive behaviors. Most of the individuals who have this disorder at one time or another acknowledge or have insight that their worry is excessive or disproportionate to the actual fear or anxiety. An example of someone who may be experiencing Obsessive Compulsive disorder is that “It started when I was in my mid 20’s, I was always worried that I would get something wrong, I made lists so I could try to manage my daily living tasks. Soon lists became my life, I would write a list of everything that I needed to do while I was in the shower, then I would check the list 3 times after writing it, to be sure that I did get everything right. Then I would reread my list again 2 times before entering the shower and read it out loud, If I didn’t perform this task I was simply unable to take my shower for the day because I would lapse into such overwhelming anxiety.”

Some examples of symptoms and behaviors association with this disorder are as follows

according to the Diagnostic and Statistical Manual;

That the individual has either obsessions or compulsions and which the definition of these are;

1. Thoughts which are recurring and persistent including images or impulses, these impulses are distressing and cause impairment including anxiety.
2. These impulses, thoughts and images are not related to a threat or worry about a real life problem.
3. There is an attempt to repress and ignore the distressing images, impulses and thoughts.
4. The person who is suffering from this disorder is in recognition that these fears are in fact a product of his or her own thought process.

Compulsions are defined as

1. Repetitive behaviors (e.g., checking, cleaning, cleaning,) and also cognitive acts such as (ie, ritualized prayer, tracing in the mind, taking count of objects or steps) the person feels compelled to enact the behavior in response to the obsession in a system of self created rules.

Obsessive compulsive disorder is a treatable anxiety disorder, the best form of therapy often involves both pharmacology including SSRI’s delivered in conjunction with long-term psychotherapy. Cognitive behavioral therapy has proven effective in managing the symptoms associated with this diagnosis as well as Behavioral Therapy such as Exposure therapy are all effective treatment or counseling models to progress beyond this disorder and take back control over life.