Chronic Pain

By: Sarah Bond

From an evolutionary perspective, pain serves to warn us of potential injury to avoid subsequent danger.  Although acute pain affords a short-term advantage, its long-term persistence can lead to significant distress and suffering. According to the American Academy of Pain Medicine (2013), 100 million Americans are afflicted with chronic pain. Chronic pain can be defined as an uncomfortable feeling set off in the nervous system that persists for weeks, months, or even years. Although its onset may be attributed to injury, chronic pain can also occur without any predetermined indication.

The National Institutes of Health (NIH, 2006) found that the most common chronic pain complaints include: lower back (27 percent), head (15 percent), neck (15 percent), and facial (4 percent). Although the physical effects are evident, the psychological pain is equally burdensome for many. The implications of such physical pain can lead to emotional distress and discomfort.  In turn, emotional distress can also exacerbate the experience of physical pain.

Individuals may feel as though their pain prevents them from leading a ‘normal’ life. They feel as if they cannot partake in activities they found enjoyable in the past. This withdrawal may result when chronic pain is associated with a particular movement/activity (Dahl, Wilson, & Nilsson, 2004). In fact, lower back pain is the most common cause of disability among Americans under 45-years-old (The American Academy of Pain, 2013). When people refrain from participating in what gives them a purpose in life, it can have detrimental effects upon their psychological well-being.

Treatment for chronic pain patients can be challenging. Although 41 percent of those who take over the counter medications and 58 percent of those who take prescription medications reportedly express pain relief, there are many who do not benefit from pharmacological interventions (The American Academy of Pain, 2013). Thus, it is critical to consider other options when addressing chronic pain. 

Research suggests that psychotherapy is an effective method for treating chronic pain. Specifically, cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT)address the psychological factors that accompany physical pain (McCracken, Vowles, & Eccleston, 2005; Dahl et al., 2004). If the emotional factors are ignored, they can exacerbate the physical pain. Similarly, if the physical factors are ignored, they can exacerbate emotional pain. Therefore, it is important that both the psychological and physical factors are treated appropriately.

If you or someone you know suffers from chronic pain, professional support is available. If you are in the San Diego area and would like to speak to a professional at CSAM who specializes in CBT and ACT, please contact us. 

References

Dahl, J., Wilson, K.G., & Nilsson, A. (2004). Acceptance and Commitment Therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: A preliminary randomized trial. Behavior Therapy, 35, 785-801.

Institute of Medicine. (2011). Report from the Committee on Advancing Pain Research, Care, and Education: Relieving pain in America, a blueprint for transforming prevention, care, education and research. The National Academies Press. Retrieved from http://books.nap.edu/openbook.php?record_id=13172&page=1.

McCracken, L.M., Vowles, K.E., & Eccleston, C. (2005). Acceptance-based treatment for persons with complex, long standing chronic pain: a preliminary analysis of treatment outcome in comparison to a waiting phase. Behaviour Research and Therapy, 43(10), 1335-1346.

National Centers for Health Statistics. (2006). Chart Book on Trends in the Health of Americans 2006, Special Feature: Pain. Retrieved from http://www.cdc.gov/nchs/data/hus/hus06.pdf.

The American Academy of Pain Medicine. (2013). Retrieved from http://www.painmed.org/patientcenter/facts_on_pain.aspx.

Tags: Cognitive Behavioral Therapy, pain, chronic pain, headache, back, ache, somatic

Emotional Eating: My Temporary Escape

By: Sarah Bond

Can you recollect the last time that you indulged in your favorite comfort food?  Maybe you were nervous about an upcoming interview, a project at work, or the health of a family member.  You are definitely not alone!  When we feel stressed or anxious, many of us turn to foods that were given to us for comfort by our early caregivers during childhood (Cherylynn Glaser, M.A., personal communication, May 2013).  Although eating food may feel soothing and provide short-term relief, dealing with our emotions this way can be detrimental.  In fact, it can lead to an unhealthy cycle of eating that provokes us to eat more due to the associated guilt we feel after eating something that we regret (Cherylynn Glaser, M.A., personal communication, May 2013). 

As a result, many of us gain weight and desperately turn to “crash” diet plans and supplements in hope of instantaneous weight loss results.  Despite the great intentions and efforts of dieters, research suggests that most diets are ineffective in the long-term.  It is reported that two-thirds of Americans are overweight and/or obese (Ogden, Carroll, Kit, & Flegal, 2012).  Unfortunately, this epidemic leads to many health problems that can significantly impact quality of life and happiness.

Although it is recognized that there are many social, cultural, and genetic factors that can influence an individual’s body weight, the problem of emotion regulation is often overlooked.  Emotional eaters eat more than they would normally eat in response to negative emotions (Wallis & Hetherington, 2004).  Research indicates that this behavior is not partial to individuals who are overweight.  Rather, emotional eating is also prevalent among “chronic dieters” and healthy individuals (Evers, Stok, & Ridder, 2010). 

It is speculated that this overeating occurs as a means of escaping stressors.  It is believed that individuals avoid dealing directly with their stressors by focusing their attention on food (Wallis & Hetherington, 2004).  Thus, the underlying reason why overeating takes place among emotional eaters is because individuals do not have the psychosocial resources needed to properly cope with their feelings. 

The good news is that cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) are evidence-based treatments that have been demonstrated to be effective methods of treatment for problems associated with emotion regulation.  If you or someone you know suffers from emotional eating professional support is available. If you are in the San Diego area and would like to speak to a professional at CSAM who specializes in CBT and ACT, please contact us.     

References

Evers, C., Stok, F., & Ridder, D. (2010). Feeding your feelings: Emotion regulation strategies and emotional eating. Personality and Social Psychology Bulletin, 36(6), 792-804.

Ogden, C. L., Carroll, M. D., Kit, B.K., & Flegal, K. M. (2012). Prevalence of obesity and trends in body mass index among U.S. children and adolescents. Journal of the American Medical Association, 307(5), 483-490.

Wallis, D.J., & Hetherington, M.M. (2004). Stress and eating: The effects of ego-threat and cognitive demand on food intake in restrained and emotional eaters. Appetite, 43(1).

Tags: emotion regulation, emotional eating, obesity, overweight, binge eating

Warning Signs of Mental Illness

by Sarah Bond

Living in a Western society, it is considered part of our yearly routine to visit our primary care physician, dentist, and optometrist for yearly check-ups. While the aforementioned doctors are important and play an active role in managing our health, it is crucial that we do not minimize the significance of other medical professionals, such as those in the field of mental healthcare. Unfortunately, there are many people who are living with distressing symptoms without an awareness that they are afflicted with a mental disorder.

A mental illness can be defined as a “health condition that changes a person’s thinking, feelings, or behavior (or all three) and that causes the person distress and difficulty in functioning” (NIH, 2005, p. 1).  According to the NIH (2005), approximately one in four Americans are known to be impacted by mental illness. Thus, it is likely that either you or someone close to you has suffered from the symptoms of a mental illness in some way. Data indicate that mental disorders account for four of the 10 most predominant causes of disability in America (National Institutes of Health, 2005).

While the symptoms vary in intensity from one person to another, ranging from mild to severe, they cause unnecessary problems for people that can be managed or treated with appropriate care. Thus, it is critical to raise awareness about mental healthcare, so that more individuals will take action and seek the care from mental health professionals that can alleviate unnecessary distress from their daily lives. Although mental disorders each have their own set of specific symptoms, the NIH (2005) has created a list of “general warning signs” that can be used as a guide to help you determine whether someone should seek professional help (p. 1).

“Warning Signs” from the NIH (2005):

• Marked personality change
• Inability to cope with problems and daily activities
• Strange or grandiose ideas
• Excessive anxieties
• Prolonged depression and apathy
• Marked changes in eating or sleeping patterns
• Thinking or talking about suicide or harming oneself
• Extreme mood swings—high or low
• Abuse of alcohol or drugs
• Excessive anger, hostility, or violent behavior

If you or a loved one has experienced any of the previously mentioned “warning signs,” or if you are interested in learning more about your current state of mental health, then contact a local mental healthcare professional. If you are in the San Diego area and would like to speak to a professional at CSAM who specializes in stress and anxiety problems, please contact us.

Reference

National Institutes of Health. (2005). The science of mental illness. Retrieved from http://science.education.nih.gov/supplements/nih5/mental/other/copyright.htm

Tags: anxiety, CBT, psychologist in san diego, mental health tips, therapy in san diego, PTSD san diego, warning signs

Encouraging Family & Friends to Seek Psychotherapy

by Jill Stoddard 

It is difficult to see friends and family members suffer. Even if you are a great friend or relative, always lending an ear and your support, there is only so much that you can do. If you have a friend or family member who is suffering from anxiety, depression, or other mental health concerns, it may be best to encourage your loved one to seek professional help. Remember that any time that you think your loved one is a danger to him or herself, or to someone else, it is crucial that you seek immediate medical attention to ensure everyone's safety. But in the event that your friend or family member has no intention of harming anyone, but is exhibiting psychological symptoms that are interfering in his/her functioning, the best thing to do is gently encourage the individual to seek psychotherapy.

This can be a very difficult process, as such attempts are sometimes met with resistance or even hostility. To your friend/relative, it may feel like you "think they're crazy," or, "don't know what you're talking about." But in the end, therapy can help your loved one get his/her symptoms under control so s/he can live a fuller, happier life.  Although it may take some time, patience, and hard work, the benefits of therapy will certainly outweigh the costs. 

When encouraging a friend or family member to seek psychotherapy, here are some important things to keep in mind:

DO begin by emphasizing how much you care and how worried you are. It is not that you are tired of listening, but that you recognize your limits, and are concerned that you are not proiding the appropriate care. 

DO NOT confront them or shout at them regarding some of their behavior or choices, as this will only lead to the person feeling ashamed, cornered, and defensive. Instead, keep the emphasis on your concern for them and your desire for them to live a happy life. 

DO get the advice of local professionals, and consult their research or pamphlets when considering how to express your concern. Local support groups, psychotherapy clincs, and community centers are almost always willing to help.

DO NOT take this approach for the wrong reasons. Are you genuinely concerned about this person's welfare, and not trying to put him or her down in any way? Are you upset about how this person's behavior is affecting his or her life, or merely your life? Make sure you have sorted out your own motives before attempting to talk to this person. If not, they will likely see through your attempt, and it may damage your relationship.

DO realize that this is not the least-confrontational course of action, and may impact your relationship if the individual does not take the suggestion well. This is a serious solution, however when necessary it is a crucial one. Mentally and emotionally prepare yourself--try going through the different ways that the conversation could play out, and consider your response in each case.  

DO NOT be impatient. Even if your friend has a non-negative reaction to your suggestion, he or she may not reach out for help right away.  Be supportive, keep listening, and be patient.  Continue to encourage your loved one, even if s/he doesn't feel totally ready.

DO offer to help this person seek therapy, whether that means finding a doctor, booking an appointment, or just giving him or her a ride to an appointment. The support of a loved one will encourage the individual to follow through. 

If you are in the San Diego area and would like to speak to a professional at CSAM about helping a loved one seek therapy, please contact us.

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Tags: anxiety, anxiety therapy san diego, ocd therapy, anxiety therapy, acceptance and commitment therapy, Cognitive Behavioral Therapy,psychotherapy

Holiday Stress Management

by Anna Remus 

As the holiday season approaches, many of us express feelings of stress surrounding the festivities. With the changes in routine, influx of family members and visitors, and increases in sugar and alcohol intake, it's no wonder that these next few months often seem so stressful. On top of all of these changes, the weather is cold and dark, further contributing to bad moods and even depressive thoughts. But despite all of these negative influences, we feel the need to increase our activity levels and put more pressure on ourselves; we worry about preparing for holiday parties, gift exchanges, and New Year's resolutions. It's easy to feel overwhelmed and find it difficult to enjoy what should be a peaceful, happy time to enjoy the company of loved ones.

 The good news is that with a little self-TLC, you can enjoy the holiday season and not get caught up in all the bustle. Here are some tips to help you enjoy the upcoming holidays:

• Take Care of Yourself Before Others

If you're stressed about the cookies not being done, or yelling at your spouse about picking something up for a Christmas party, you certainly aren't enjoying the holidays any more than those around you. The truth is, you are not fun to be with if you do not take time for yourself to relax, even if that just means taking 5 minutes at the start of each day to remember what you are celebrating and what it means to you. Above all, start with a good foundation--eat well, get a healthy amount of sleep each night, and make sure to pencil-in some time for physical exercise. 

• Don't Over-Do It

When we're celebrating, it seems easy to justify that extra glass of wine or few more Christmas cookies--afterall, if not now, then when? But the truth is that more tonight can make for morestress tomorrow. Overindulgence, including over-spending, is one of the prime sources of discontent after the holidays are over--as the long-term effects of embarrassment, weight gain, and debt last longer than the few hours of enjoyment that such intakes bring. To prevent yourself from going too far, form a plan ahead of time and stick to it--make a budget of what is realistic to spend given your income, and don't let advertisements steer you otherwise; before attending a party, plan to have only a certain number of alcoholic beverages or sweet treats--you'll thank yourself the next day!  

• Plan for Family

Spending time with family can be a joy, but too much of any good thing is stressful. If you're spreading yourself too thin with family visits, it may be time to come up with a new solution. Limit the number of parties you throw, simplify the parties you throw, or limit the number of time that you attend each party. It can be difficult to say "no" to family members, but this is often a necessary part of maintaining a health holiday schedule. If you have difficulty interacting with some of your family members, try visualizing discomforting interactions before they potentially happen. Purge worry by imagining what you'd really like to say to that nosy aunt of yours, then imagine a more effective way to handle the situation. You'll be prepared for the worst, and ready to embrace the best!

• Try Something New

Whether due to negative past experiences, or recurring feelings of being overwhelmed or unfulfilled, many people hold onto negative feelings surrounding the holidays. To get out of this emotional rut, try changing your holiday routine. Instead of spending time at home, try taking a vacation and experiencing a change of scenery. If you have feelings of loneliness or unfulfillment, consider volunteering your time to a charity to help you remember what this season is really about. Accept feelings of sadness or loneliness, but consider getting help if they persist or begin to interfere with your usual functioning.   

From all of us here at CSAM, Happy Holidays! 

Mirror, mirror on the wall, who’s the scariest of them all? ANXIETY!

by Dr. Janina Scarlet

In honor of Halloween, I would like to discuss one of the scariest topics, anxiety. You might be cringing just by reading about it because the topic sounds so frighteningly familiar or you might be rolling your eyes, as if to say, “Anxiety? That’s not scary! Monsters are scary.” Anxiety can in fact become a monster. Just like Freddy Krueger, it can take over your life and even your dreams. Have you ever had a nightmare about being late to class or an important meeting, dying in a plane crash, or showing up to your interview in your pajamas? That’s because anxious thoughts can even manifest themselves in our nightmares or interrupt sleep altogether.

So, why is that? Why is anxiety so overpowering? After all, it’s just an emotion, right? Shouldn’t you be able to just “get over it”? In reality, it’s not so simple. While anxiety is in fact an emotion, it does not act alone. When an intimidating event is lurking in the nearby future (such as having to do a presentation at work or school, having to drive on the freeway, or fly on an airplane), you might begin to notice some anxiety-provoking thoughts, where you imagine the worst possible scenario, such as “If I try this, I will fail,” “I’m going to lose control, or pass out, or go crazy,” “I’m going to do a terrible job and everybody will judge me,” “What if this plane crashes,” “What if I get fired?” These thoughts are often self-propagating, which means that they cause more of such thoughts to occur, and soon enough you’re flying in a tornado of terrifying thoughts that you cannot control. To make matters worse, these thoughts trigger uncomfortable physiological sensations that come along with the emotion of anxiety, such as increased heart beat, shallow breath, sweating, muscle tension, and other sensations. And what happens to your thoughts as these physiological sensations increase? You guessed it, they get worse. Thus, the thoughts and feelings (both emotional and physical), affect one another and result in you wanting to escape from the feared situation by cancelling, calling in sick, rescheduling, procrastinating, taking a Xanax, the list goes on. Initially, you might feel very relieved after escaping from the hairy anxiety monster. However, what happens long term, what are the costs of avoidance? For many people the cost is reduced ability to live a meaningful life. For example, if you keep avoiding social events, or driving/flying, this might result in you having fewer personal connections or fewer employment opportunities.

So how do you battle the anxiety monster? There are many treatments that exist for reducing anxiety and/or learning to live a meaningful life despite your anxiety. Different treatments work for different people, so you might want to do some additional research (or email us with questions) to figure out which treatment will work better for you.

 Several treatment modalities are supported by research to help people with anxiety disorders. Cognitive Behavioral Therapy (CBT) works by directly challenging anxious thoughts, such as “If I fly today, my plane will crash,” as well as by teaching you techniques to break the vicious cycle where thoughts and feelings feed off of each other. Finally, it focuses on changing your behaviors to reduce your fears, anxious thoughts, and physical sensations.  Acceptance and Commitment Therapy (ACT) focuses on reducing avoidance and increasing mindfulness, awareness of thoughts, and increasing behaviors that are in line with your personal values, allowing you to live a more meaningful life.