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Email: info@csamsandiego.com

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7860 Mission Center Ct, Suite 209
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858.354.4077

At The Center for Stress and Anxiety Management, our psychologists have years of experience. Unlike many other providers, our clinicians truly specialize in the diagnosis and treatment of anxiety and related problems. Our mission is to apply only the most effective short-term psychological treatments supported by extensive scientific research. We are located in Rancho Bernardo, Carlsbad, and Mission Valley.

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Mental Health Awareness Month: Fitness #4Mind4Body

Jill Stoddard

by Annabelle Parr

May is Mental Health Awareness Month. Every year, Mental Health America designates a particular theme for the month to highlight an important aspect of mental health. This year’s theme is Fitness #4Mind4Body, and it focuses on acknowledging the connection between mental and physical wellbeing. #4Mind4Body explores the role of nutrition, exercise, the gut-brain connection, sleep, and stress in our overall wellbeing and examines the ways each of these areas impact our functioning. Below is a summary of the topics covered in the Mental Health Toolkit from Mental Health America.

Diet and Nutrition

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Eating a well-balanced, nutritious diet is an integral part of health. Diets high in processed, fried, and sugary foods can increase the risk not only for developing physical health problems like diabetes, heart disease, obesity, and cancer, but are also linked to mental health problems, including increased risk for depression symptoms. A healthy diet consists of a variety of fruits, vegetables, legumes, whole grains, fish, nuts, and olive oil. Maintaining a balanced, nutritious diet is linked with a lower risk for depression and even an improvement in depression symptoms.

Exercise

Regular exercise not only helps control weight, increase strength, and reduce the risk of health problems like high blood pressure, cardiovascular disease, and some cancers, but it also helps boost endorphins and serotonin, among other important proteins and neurotransmitters that impact mental health. Endorphins serve to mitigate pain in the face of stress and increase pleasure in the body. Serotonin affects appetite, sleep, and mood, and is the target of SSRIs, a class of antidepressant commonly used to treat anxiety and depression. Just thirty minutes of exercise per day can help improve mood and mental health.

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The Gut-Brain Connection

The gut, also known as the “second brain,” communicates directly with the brain via the vagus nerve and via hormones and neurotransmitters. The communication goes both ways, so anxiety, stress, and depression can impact the gut and result in gastrointestinal symptoms, but changes in the gut microbiome can impact the brain and mood, exacerbating or even resulting in symptoms of anxiety and depression. Eating a nutritious diet that includes prebiotics and probiotics is an important part of maintaining a healthy gut and a healthy mind. 

Sleep

Quality of sleep impacts the immune system, metabolism, appetite, the ability to learn and make new memories, and mood. Good sleep for adults means getting between 7-9 hours of mostly uninterrupted sleep per night. Problems with getting good quality sleep can increase the risk of developing mental health symptoms, and symptoms of anxiety and depression can negatively impact sleep, creating a negative cycle. Cognitive Behavioral Therapy for Insomnia (CBT-I) can help clients reestablish healthy sleep patterns through addressing negative thoughts and worries as well as behavioral patterns that are impacting sleep habits.

Stress

Stress is a normal part of life, and the body is equipped with a fight or flight response designed to help mobilize internal resources to manage stressors. After the stress has passed, the body can return to its regular equilibrium state. However, when stress becomes chronic, it can cause inflammation, impaired immune system functioning, muscle aches, gastrointestinal problems, sexual dysfunction, changes in appetite, and increased risk for heart disease. Too much stress can also impact mental health.

Mental health involves a complex interplay between numerous factors, including but certainly not limited to the areas listed above. Furthermore, though maintaining a healthy diet, regular exercise routine, good sleep habits, and utilizing stress management techniques can help prevent or improve existing mental health symptoms, if you are struggling with mental health issues, it can be difficult to attend to these areas.

If you are struggling with anxiety, stress management, depression, chronic illness, or insomnia, seeking professional assistance can be helpful. Evidence based therapies like Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) can help to address problematic thoughts and behaviors that are contributing to emotional distress. Therapy offers a warm, supportive, safe environment to explore painful issues. A therapist can also provide support in helping the client to develop good self-care habits, like those mentioned above.

This year’s mental health awareness theme reminds us of the importance of recognizing the multiple avenues through which we can approach mental health, and the variety of tools we have at our disposal to improve overall wellbeing.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, depression, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

References

Mental Health America. (2018). 2018 Mental Health Month Toolkit. Retrieved from http://www.mentalhealthamerica.net/sites/default/files/Full_2018_MHM_Toolkit_FINAL.pdf

Finding the Right Therapist for You

Jill Stoddard

by Annabelle Parr

Therapy can be incredibly helpful and healing in the midst of struggle, but it’s not “one size fits all” and sometimes it can be challenging to find the right fit. If you have tried therapy before and been frustrated by a lack of progress, it’s possible you haven’t found the right therapist for you. Having some knowledge about therapy and the different options available can help when you are seeking out help.

What do therapists do?

A therapist’s role is to provide you with empathy, help you learn healthy coping methods and give you tools to manage your emotions constructively. They are there to help you connect with your personal values and get in touch with your own internal strength, while offering you compassionate support and understanding along the way. They are like “training wheels” to help you learn to engage in life in a new way.

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What don’t therapists do?

They are not there to pass judgement, minimize your feelings, or offer you advice. No advice means that they are not there to make decisions for you, such as whether or not to stay in a relationship or a job; they can, however, assign you homework to help you make progress and teach you coping mechanisms.

If you ever feel judged or like your therapist is minimizing your feelings, discuss this with them. This will allow you to discern whether you misunderstood their message or whether maybe they are not the best fit for you. It is important to talk with your therapist about the therapeutic process itself, especially if something feels off.

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Note: therapy can be helpful and it can be hard.

Therapy is challenging. It requires active work on the part of the client and it requires facing uncomfortable and painful emotions, and likely making difficult changes. As James Hollis (1998) notes, “no one enters the therapist’s office whose adaptive strategies are still working.” So sometimes, clients may feel worse before they feel better because change is inherently uncomfortable. This kind of “feeling worse” is a vital part of the growth process, not a further descent into the same struggle that brought you into the office.

If it feels like you have tried various therapies or therapists, and have not progressed despite your commitment to finding help and engaging in the therapeutic process, you may not have found the right therapist yet. Here are some things to look for when seeking therapy.

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  1. Connection with the therapist. Therapy requires that you let another person in on your innermost thoughts and feelings. This is not an easy thing to do, so it is important that you feel comfortable with the person you choose. Research shows that the therapeutic relationship itself is the most important aspect of therapy – accounting for about 30% of the variance in treatment outcome, which is more than any other factor including the technique the therapist uses. So make sure that the therapist you choose to see is someone you trust and whom you are willing to talk to. If it doesn’t feel like the right fit, it probably won’t be.
     
  2. The therapist’s areas of expertise. While the relationship is the most important piece of therapy, specialization and technique are still very important pieces of the puzzle. When looking for a therapist, make sure to search for someone who has experience working with individuals dealing with your particular concerns. Otherwise, you may end up wasting time and money working with someone who might not conduct a proper assessment, or who does not have experience working with your particular issue. Ask them about their experience working with others who have concerns similar to yours, including the techniques they use and the degree of progress and healing that they typically see in their clients.
     
  3. Evidence based treatments. There are lots of different treatment options out there; a good place to start is searching for a therapist with true training in modalities that are supported by solid research (such as Cognitive Behavioral Therapy or Acceptance and Commitment Therapy). Ask questions about their training and choice treatment modalities, what a typical session will look like, how your individual needs will be addressed, whether you will receive homework, what will be required of you in the process, how your progress will be evaluated, and what steps will your therapist take if they find that your progress has prematurely plateaued.

If you are struggling and considering reaching out for help, this knowledge can help you navigate choosing a therapist and can help you recognize sooner rather than later if it’s not the right fit. If you have tried therapy before and have been frustrated by a lack of progress, you are not alone. Remember, effective help is available when you know what to look for.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com

References: 

Hollis, J. (1998). The eden project: In search of the magical other. Toronto, ON: Inner City Books.

5 Myths About Anxiety

Jill Stoddard

By Trevor McDonald
edited by Annabelle Parr

People are talking about mental illnesses, like anxiety disorders, more often and more openly. Social media and access to digital content has helped facilitate the conversation. However, there is still a stigma surrounding mental illness, and while easy access to content can help reduce shame, stigma and misunderstandings about mental illness, it can also spread mistruths and foster outdated myths. This hurts those who suffer from mental illnesses as well as those trying to understand and support them. So let’s clarify some things about anxiety.

According to the National Institute of Mental Health (NIMH), anxiety disorders are the most common American mental illness, affecting 40 million adults – 18% of the population. Despite this substantial figure, the Anxiety and Depression Association of America (ADAA) estimates that only 33 percent of those suffering will receive treatment.

Anxiety is a blanket term. We all know what it feels like to feel anxious. But when we talk about anxiety as a mental illness, we may be referring to any number of disorders, from generalized anxiety disorder to social anxiety disorder to panic disorder to a specific phobia. Though all of these things fall under “anxiety,” each manifestation looks and feels a bit different.

Fortunately, anxiety disorders can be treated. Having a supportive network that includes mental health professionals and ideally, understanding loved ones, is critical. The first step toward encouraging and facilitating treatment is dispelling myths and providing education for both those struggling with anxiety and the people around them. Here are five of the biggest myths about anxiety disorders:

1. “You don’t really have anxiety. Everyone gets anxious/nervous!” Of course, everyone feels anxious or stressed sometimes. But according to the DSM V, when someone has an anxiety disorder, they feel excessively anxious about a number of things more often than not, and it significantly impairs their ability to function in a major area of their life. We must understand that there is a big difference between feeling anxious about a particular event or challenge, and feeling the chronic anxiety that comes with an anxiety disorder. Furthermore, it’s important not to toss around statements such as “I’m so OCD” when all we mean is that we like our desk organized. Minimizing an anxiety disorder in these ways undermines the challenge that something like generalized anxiety disorder or OCD can pose to people who are struggling with them.

2.  “You can get over anxiety with yoga, taking a walk, or meditation.” While taking a holistic approach to wellness is smart, and such activities can help with the symptoms of anxiety, taking a yoga class won’t “cure” an anxiety disorder any more than it will spina bifida. Though it can be tempting to offer advice to try to help those struggling with anxiety, it’s important not to minimize their experience or assume that you have a solution to offer them. Only a mental health professional should be offering any kind of “prescription” or suggestion for treatment.

3. “Anxiety means a person is weak, or they must have had a really bad childhood.” The former is never true; the latter could be part of the foundation for an anxiety disorder, though this is certainly not always the case. Trauma can kick start an anxiety disorder, but it’s not the only source. A big reason people with mental illnesses don’t talk about their condition is because they don’t want to be seen as weak or feeble, even though they’re not. It takes tremendous strength to live with any disorder. Invisible disabilities can be especially trying because people can’t “see” the disorder a person is battling.

4. “Anxiety isn’t that big of a deal.” Everything is relative. Anxiety disorders exist on a spectrum. If you know someone with anxiety, you can’t gauge how severe their disorder is. But unless you are a therapist, psychiatrist, or doctor, it’s not your job to gauge the severity of someone else’s anxiety. What you need to know is that anxiety is a big deal to the person suffering from it, no matter where they fall on the spectrum. Further, unlike a broken leg, anxiety can’t be seen on the outside.  So someone may appear perfectly put together on the outside, but is suffering in silence on the inside.

5. “I won’t be able to relate to someone with anxiety.” This myth is usually based on a person’s fear that they won’t know what to say when someone is struggling with anxiety. It’s human nature to want to “fix” things, but anxiety can’t be fixed that easily, especially by a non-professional. Remember that it’s not your job to “fix” someone’s anxiety or make it go away. All they really need from you is empathy. And listening well is far more important than knowing what to say. So when talking to someone with anxiety, let them lead the conversation, don’t judge them, and don’t try to fix it. Let them know that you want to understand and that you hear that they are struggling.  You might also offer to help them connect with professional help.

We’ve come a long way in our understanding of anxiety disorders. Psychological research has given us a solid understanding of anxiety and how to treat it effectively. Of course, there is always more to learn, but now the bulk of our work lies in sharing our understanding with the community and eliminating the damaging and unnecessary stigma that still surrounds mental illness. Working to un-learn false claims and myths of the past is a big step in the right direction. Doing your part to educate yourself and others will make a big difference in the lives of everyone with an anxiety disorder.

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

Misophonia: A “Rarely Known” Conditioned Aversive Reflex Disorder

Jill Stoddard

by Annabelle Parr

Most of us can probably agree that it’s very unpleasant to hear nails scraping a chalkboard. Other sounds that tend to make us cringe include a woman’s scream, a disc grinder (think construction site), and a baby crying. This is because we are genetically wired to respond to a baby’s cry, so any other sound similar in frequency tends to be upsetting (Dozier, 2015).

There are sounds that are almost universally annoying, and then there are those sounds that get to each of us individually. But for some of us, a specific sound can be more than simply annoying or unpleasant; it can be intolerable. Do you find yourself experiencing a particularly extreme or adverse reaction to a sound or stimulus that seems strange or out of proportion? If so, you may be encountering a misophonic reaction.

What is misophonia?

Misophonia is a condition characterized by an extreme, immediate, involuntary emotional response accompanied by a reflexive physiological reaction to a specific, commonly occurring sound or visual stimulus (Dozier, 2015).

Tom Dozier, director of the Misophonia Institute, describes misophonia as a Conditioned Aversive Reflex Disorder. Though misophonia is most commonly identified by the emotional response – typically anger, rage, disgust and even hatred - there is almost always a physiological response that occurs as well. Tom’s research suggests that it is actually the physical response that lies at the heart of misophonia. When a person hears (or sees) their trigger, the autonomic nervous system elicits a reflexive physical reaction. It could be contracting of a particular muscle group or it could be an internal reaction, varying from nausea to a numbing sensation to constriction of the esophagus. Because the intense emotional reaction follows so quickly, the physical response often goes unnoticed. But it appears that the emotional reaction is directly related to the physical reaction. In individuals with misophonia, the connection between the autonomic nervous system and the limbic system (emotional center) becomes hypersensitized (Bernstein, Angell, & Dehle, 2013), such that the trigger stimulus elicits the physical reflex which then elicits the extreme emotions and fight or flight response.

What misophonia is NOT.

Misophonia is not a sensitivity to the volume of the sound; it is not a fear of a sound; it is not becoming upset by a continuous, loud, intrusive, irritating sound; and it is not a logical response to the meaning behind a sound (for example, responding to a baby’s cry is a natural response to address the infant’s distress). It IS the emotional and physiological response to a single occurrence of the trigger, regardless of how loud or noticeable the trigger is.

What are some common triggers?

There is an enormous range regarding potential trigger stimuli. However, some common examples include the eating or chewing sound, breathing sounds, coughing, swallowing, pen clicking, whistling, typing, and a dog barking. A trigger can be any repeating sound or sight. Triggers tend to be most strongly associated with one particular person, but they do have the ability to generalize. For example, the original trigger might be the sound of a sibling chewing. This will likely remain the strongest trigger, but it could also generalize to the sound of any person chewing.

How common is misophonia?

Not very many people know about misophonia, doctors and therapists included. Many people with misophonia struggle with feelings of guilt for their reaction, as they are aware that it is both out of proportion and irrational. They may also feel isolated in their experience. But if you struggle with a misophonic reaction, you are far from alone. It is not a rare disorder, but rather a “rarely known” disorder. Based on several studies and surveys, it is estimated that misophonia affects about 15% of the population (Dozier, 2015), compared with Major Depressive Disorder which, according to the Anxiety and Depression Association of America (2016), affects about 6.7% of the population above the age of 18 in a given year.

How does misophonia affect people?

Misophonia can range from manageable to debilitating. If a person’s trigger is fairly uncommon, it may hardly affect him or her at all. However, if a trigger is very common and the reaction is severe, it can lead to avoidance of situations and serious strains on relationships.

Can I get help for misophonia?

If you think that you may be struggling with misophonia, you don’t have to continue to try to handle it alone, particularly if it is something that has begun to impair your day-to-day functioning or affect your relationships. Misophonia can continue to increase in severity if it is left unaddressed, so it is important to know that help is available.  However, because there is not a widespread awareness of misophonia, it can often be misdiagnosed as anything from oppositional defiant disorder to ADHD to anxiety or OCD. So if you are struggling with what sounds like misophonia, it is important to find a professional who understands what you are experiencing and knows how to help.

For more information about misophonia, how it is treated, and related resources, please visit http://misophoniainstitute.org. If you think you or someone you love may be struggling with misophonia, CSAM’s Dr. Michelle Lopez offers specialized treatment at our Rancho Bernardo office. If you would like more information…

CSAM IS HERE TO HELP

Please contact us at (858) 354-4077 or at csamsandiego@gmail.com if you or someone you love might benefit from treatment for misophonia. We also offer acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, and would be happy to provide more information about our therapy services.

References:

Anxiety and Depression Association of America. (2016). Facts & statistics. Retrieved from: https://www.adaa.org/about-adaa/press-room/facts-statistics

Bernstein, R. E., Angell, K. L., & Dehle, C. M. (2013). A brief course of cognitive behavioural therapy for the treatment of misophonia: A case example. The Cognitive Behaviour Therapist, 6(10), 1-13. doi:10.1017/S1754470X13000172

Dozier, T. H. (2015). Understanding and overcoming misophonia: A conditioned aversive reflex disorder. Livermore, CA: Misophonia Treatment Institute.

Anxiety in the Courtroom

Jill Stoddard

Witness Preparation Services

by Annabelle Parr

Have you ever felt especially nervous before a big presentation? Do you find your heart racing and palms sweating when you have to speak in front of a large group of people? You’re not alone. On average, people rate their fear of public speaking higher than their fear of death. Potentially one of the highest pressure, highest stakes public speaking situations is on the witness stand in a courtroom or during a deposition. Even the most experienced witnesses can feel anxiety, which left unaddressed can hinder their testimony. Anxiety is the number one communication obstacle in legal proceedings (Pitera, 2013).

Source URL: http://www.utahcriminallaw.net/what-happens-if-a-witness-lies-in-court/

Source URL: http://www.utahcriminallaw.net/what-happens-if-a-witness-lies-in-court/

Witnesses typically have very specific fears related to testifying. Some common witness fears include, but are not limited to, a fear of letting people down, losing their job, making a mistake, looking incompetent, being embarrassed, judged or blamed, or having to reveal private, personal information. Witnesses also tend to take on more responsibility for the outcome of the case than is necessary or realistic (Pitera, 2013).

Though the source of a witness’s anxiety may be completely unrelated to their credibility or honesty, jurors tend to judge witnesses more on the basis of behavior than testimonial content (Afremow, 2011). Therefore, a testimony could be flawless and completely true, but if it is delivered poorly the concrete verbal content may not matter.

Typical anxious behaviors that jurors tend to interpret as signs of unreliability include non-verbal cues such as poor eye contact, fidgeting, appearing tense, and inconsistency of demeanor or tone (Afremow, 2011). Helping witnesses to become conscious of these subtle reactions as well as the sources of their anxiety before testifying can help them to manage the visible cues thus increasing their perceived credibility.

Meeting with a licensed psychologist who specializes in anxiety management is a great way to help prepare witnesses and allow them to address their anxiety before taking the stand. Using cutting edge, evidence-based, cognitive-behavioral techniques, the therapist can help witnesses modify their anxiety, bringing it into an optimal range for peak performance.

Source URL: http://www.everydayhealth.com/smoking-cessation/living/coping-with-the-urge-behaviorally-and-mentally.aspx

Source URL: http://www.everydayhealth.com/smoking-cessation/living/coping-with-the-urge-behaviorally-and-mentally.aspx

Therapeutic techniques that can help prepare witnesses include:

  • cognitive reappraisal, which involves changing catastrophic cognitions that fuel anxiety and lead to poor performance
  • grounding, mindfulness, and relaxation
  • reduction of safety seeking, avoidance, or anxiety driven behaviors such as lack of eye contact, speaking too softly, fidgeting, talking too much or too little, or looking to the attorney for reassurance
  • video-taped feedback, which can help reduce anxiety by showing the witness that they don’t look as anxious as they feel, as well as helping them to notice and address visible safety behaviors

A therapeutic setting offers a safe space to practice testifying and receive non-judgmental, constructive feedback and tools that the witness can apply in court and during depositions. If you or your client are preparing to stand as a witness, know that feeling anxiety is normal, but that it doesn’t have to determine the tone of the testimony.

CSAM IS HERE TO HELP

If you or someone you know might benefit from witness preparation services for anxiety or stress, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

Afremow, J. (2011). Witness this: Behavioral science in the courtroom. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/trust-the-talent/201110/witness

Pitera, M. J. (2013). Witness tip: Anxiety is the #1 barrier affecting communication. Litigation Insights. Retrieved from http://www.litigationinsights.com/witness-preparation-2/witness-tip-anxiety-is-the-1-barrier-affecting-communication/