Hoarding and Cognitive Behavioral Therapy

By: Sarah Bond 

Within the past couple years, the issue of hoarding has become polarized by the means of reality television shows and late night pundits.  Although this media attention has contributed to an increased public awareness, interest, and concern, the long-term implications that hoarding can have are often overlooked.  While hoarding has been associated with the diagnosis of obsessive-compulsive disorder (OCD) and obsessive compulsive personality disorder for many years, it was not until the recent publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that it became its own diagnosis. 

Hoarding is characterized by collecting possessions that create clutter and serve minimal functional purpose (Tolin, Frost, & Steketee, 2007).  Anything living or non-living can be hoarded.  “Clothes, newspapers, and books” are reportedly the most common items hoarded (International OCD Foundation, 2010, p. 1).  However, fifty-percent of hoarders choose to amass complimentary items, such as bubble wrap and fast food containers, and some even acquire large numbers of living animals. 

Hoarding may result in the impairment of functioning and create significant distress.  The disorder can pose additional health risks associated with sanitation and an increased risk of fire (Tolin et al., 2007).  Aside from the physical hazards, it can also have immense social and psychological ramifications.  For instance, hoarding will affect the lives of those who share living spaces and may adversely impact interpersonal relationships.  Its clinical repercussions interfere with daily routines that many take for granted.  Simple tasks, such as cooking and showering, may be hindered by the unnecessary accumulation of items hoarded.  Thus, it is understandable as to why hoarders are commonly diagnosed with elevated rates of depression (Tolin et al., 2007, p. 1461). 

Hoarders usually do not realize that they have a problem (International OCD Foundation, 2010).  Many have trouble with organization and decision making.  Thus, they find it difficult to arrange their possessions in a manner that makes efficient use of their living space.  Additionally, hoarders often have an emotional attachment to their objects, which makes it challenging for them to discard or give away their possessions (International OCD Foundation, 2010).  It may provoke a sense of fear in anticipation of losing the objects that are important to them.  Thus, hoarders may arrange their items compulsively to help alleviate distress (International OCD Foundation, 2010).  Hoarders do not typically exhibit ritualistic tendencies and the accumulation of items tends to be passive in nature.  This differs from OCD, in which individuals deliberately seek to rid themselves of unwanted emotions by actively seeking out behaviors or rituals that provide comfort (International OCD Foundation, 2010).

 If you or someone you know experience symptoms similar to the aforementioned, it is important to consult a professional.  Although there is still a lot to be learned about the disorder, interventions such as cognitive behavioral therapy (CBT) can be effective.

 Please contact CSAM if you are interested in speaking with a professional in the San Diego area who specializes in CBT.

References

International OCD Foundation. (2010). Hoarding. Retrieved from http://www.ocfoundation.org/hoarding/

Tolin, D.F., Frost, R.O., & Steketee, G. (2007). An open trial of cognitive behavioral therapy for compulsive hoarding. Behavior Research Therapy, 45(7), 1461.

Tags: CBT, Cognitive Behavioral Therapy, OCD, hoarding

The Importance of Clinical Research

By: Sarah Bond

Clinical research is fundamental to the advancement and understanding of the field of psychology.  It is important not to underestimate the significance that clinical research has had upon the development and implementation of psychological interventions.  This is accomplished by randomly selecting a subset of the population to serve as a sample in which the potential effect(s) of a given variable are observed.  Clinical research provides practitioners and researchers with insight into the effectiveness of the associated variable(s) under study.  It helps us examine isolated factors that may not be clearly evident outside of a controlled setting.  For example, we may examine the clinical treatment outcome of a specific intervention to determine whether or not it is an effective treatment for a given disorder.

In order to further advance standards of care, we must compare current treatment options to novel interventions.  This challenges us to continuously advance our understanding of the most relevant and beneficial treatments available for our clients.  We have an ethical obligation to ensure that we understand how a given intervention will likely influence the treatment outcome prior to determining the best approach to utilize when helping a client.

Clinical studies provide findings that allow practitioners to analyze data and generalize interpretations to help their clients.  For instance, both cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) have been indicated by clinical research to be efficacious treatments for anxiety disorders as well as many other conditions (e.g., depression, chronic pain, eating disorders).  Clinical research provides a means for psychologists to determine the best type of treatment for their clients.

Most clinical studies utilize human participants.  There are strict ethical guidelines set forth by the American Psychological Association (APA) that must be ensured prior to and throughout administration.  For this reason, all academic research studies must submit a research proposal to be reviewed by the respective university’s Institutional Review Board (IRB).  In doing so, the IRB is obligated to determine whether or not a given study is ethical prior to implementation.  During the study, participants are asked to sign an informed consent, which is similar to a contract.  It thoroughly explains the intention and potential risks associated with the study.  If any deception is used, it is mandatory to debrief participants following administration.

In essence, clinical research is important to providing optimal client care.  It not only deepens our understanding of current practices, but it also helps us advance and learn about new treatment options that can potentially improve treatment outcomes.  We depend upon clinical studies to help us understand how different variables influence our daily lives.

If you are interested in being a participant in clinical research, you can visit https://www.facebook.com/Paidresearchsandiego.

Tags: San Diego, psychology, psychologist, research, clinical research

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