A six year (6.17 average) follow-up was reported from Queensland Australia for anxious children and teens who were treated with CBT. Fifty-two clients (aged 14 to 21 years) who had completed treatment an average of 6.17 years earlier were reassessed, using diagnostic interviews, clinician ratings, and self- and parent-report measures. After receiving CBT, 85.7% no longer had any anxiety disorder. These gains held at both 1 year follow-up, as well as after 6 years. Both CBT, as well as CBT plus family management were equally effective at the follow-ups.
This study strongly supports the long-term effectiveness of using CBT in treating children and adolescents with anxiety disorders. As other research shows that most anxious adults were first anxious children, this is very good news. Further, treating these conditions early on would prevent years of misery and often, medical treatment.
Two excellent books written FOR kids are What to Do When You Worry Too Much: A Kid's Guide to Overcoming Anxiety by Dawn Huebner and Bonnie Matthews and What to Do When You're Scared and Worried: A Guide for Kids by James J. Crist. An excellent book for parents is If your Adolescent has an Anxiety Disorder by Edna Foa and Linda Wasmer Andrews. These books are recommended whether or not the child is receiving counseling.
Many kids respond quickly to CBT counseling. When presented in a more concrete way than to most adults, kids can understand which thought makes them “feel bad” and which thought makes them “feel good,” as an eight year old boy said to me today. Helping them develop mastery over their emotions can be powerful, to all involved.
The original study was by Barrett PM, Duffy AL, Dadds MR, Rapee RM and was titled “Cognitive-behavioral treatment of anxiety disorders in children: long-term (6-year) follow-up.” It was reported in the Journal of Consulting and Clinical Psychology, 2001 Feb; 69 (1): pp. 135-41.
Best wishes,
Mike
Wednesday, April 15, 2009
Friday, March 13, 2009
Emotional fasting
We are now in the Lenten season. This is when Jesus went into the wilderness, fasted for 40 days, and resisted temptations. Many Christians have emulated this and give up chocolate and the like during this time. Most of the other religious traditions also have times of fasting. Many find this a meaningful spiritual. Regardless of whether you are Christian or an athesist, consider a fast in this season.
Rather than giving up chocolate (or in addition to it), consider working on giving up negative and catastrophizing thoughts. If your intent is to emulate Jesus (or Mohammed, Buddha, etc.), letting go of negativity will be much more spiritually cleansing than forgoing chocolate.
How would one do this? The first step is to become more aware of your automatic thoughts. Catch yourself saying things like, “Why even try. It won't work anyway!” or “What if everyone laughs at my efforts?” These automatic thoughts will generally fall into one or more of the following categories:
1.All/None thinking “It's perfect or it is crap!”
2.Overgeneralization “Nothing EVER works out!”
3.Mental filter You focus ONLY on problems and ignore the 99% of when there are no problems.
4.Discounting the positive Someone offers you a compliment and you deny it.
5.Jumping to conclusions “I KNOW that things won't work!”
6.Magnification and minimization “I mess up EVERYTHING.”
7.Emotional reasoning “I FEEL the test will show cancer, therefore, I HAVE cancer.”
8.Should statements “They SHOULD be competent if they work here!”
9.Labeling “I'm a loser.”
10.Blame Instead of problem solving, you blame yourself or others.
Once you identify that you frequently use any of the categories, begin to monitor yourself for those type of thoughts. For example, monitor yourself for “What if” thoughts, should worry be a problem. Don't be concerned that there is often overlap between the categories. Two good books that elaborate on this approach are Feeling Good and the Feeling Good Handbook, both by David Burns.
Best wishes,
Mike
Rather than giving up chocolate (or in addition to it), consider working on giving up negative and catastrophizing thoughts. If your intent is to emulate Jesus (or Mohammed, Buddha, etc.), letting go of negativity will be much more spiritually cleansing than forgoing chocolate.
How would one do this? The first step is to become more aware of your automatic thoughts. Catch yourself saying things like, “Why even try. It won't work anyway!” or “What if everyone laughs at my efforts?” These automatic thoughts will generally fall into one or more of the following categories:
1.All/None thinking “It's perfect or it is crap!”
2.Overgeneralization “Nothing EVER works out!”
3.Mental filter You focus ONLY on problems and ignore the 99% of when there are no problems.
4.Discounting the positive Someone offers you a compliment and you deny it.
5.Jumping to conclusions “I KNOW that things won't work!”
6.Magnification and minimization “I mess up EVERYTHING.”
7.Emotional reasoning “I FEEL the test will show cancer, therefore, I HAVE cancer.”
8.Should statements “They SHOULD be competent if they work here!”
9.Labeling “I'm a loser.”
10.Blame Instead of problem solving, you blame yourself or others.
Once you identify that you frequently use any of the categories, begin to monitor yourself for those type of thoughts. For example, monitor yourself for “What if” thoughts, should worry be a problem. Don't be concerned that there is often overlap between the categories. Two good books that elaborate on this approach are Feeling Good and the Feeling Good Handbook, both by David Burns.
Best wishes,
Mike
Monday, February 16, 2009
Are All Anti-depressants created equally?
Historically, it has been reported that the overall effectiveness of the newer and older anti-depressants were all about equally effective, differing in their side effects. A very recent article in The Lancet disputes this, comparing the effectiveness of 12 of the newer anti-depressants for Major Depression in adults. It looked at side effects, as well.
A summary of their findings found the following to be more effective:
Remeron
Lexapro
Effexor
Zoloft
They also reported the following to be less effective:
Cymbalta
Prozac
Luvox
Paxil
Edronax (least efficacious)
Lexapro and Zoloft were found to have significantly fewer discontinuations due to side effects.
This does NOT mean that if you are taking one of medications found to be "less effective" and it is working, that you should change. Nor does it mean if you are taking one of the "more effective" medications and are having difficult side effects, that you need to continue that medication.
Any medication is the Best medication for one person and the Worst for another. It is imperative that you consult and work closely with your prescribing physician.
An earlier post of mine Drugs vs. Therapy (9/5/08) compared the effectiveness of each. Here is a summary:
Many of the studies with depression, even severe depression, show them to be about equally effective. Therapy has been shown to have greater durability, with lower relapse rates following the end of treatment. There are also lower drop-out rates for therapy, due to medication side-effects. It is common practice for people to receive both treatments. One might think this to be more potent than either treatment by themselves. Some studies do support this, but other studies do not.
Best wishes,
Mike
For a Summary of the article: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60046-5/fulltext
A summary of their findings found the following to be more effective:
Remeron
Lexapro
Effexor
Zoloft
They also reported the following to be less effective:
Cymbalta
Prozac
Luvox
Paxil
Edronax (least efficacious)
Lexapro and Zoloft were found to have significantly fewer discontinuations due to side effects.
This does NOT mean that if you are taking one of medications found to be "less effective" and it is working, that you should change. Nor does it mean if you are taking one of the "more effective" medications and are having difficult side effects, that you need to continue that medication.
Any medication is the Best medication for one person and the Worst for another. It is imperative that you consult and work closely with your prescribing physician.
An earlier post of mine Drugs vs. Therapy (9/5/08) compared the effectiveness of each. Here is a summary:
Many of the studies with depression, even severe depression, show them to be about equally effective. Therapy has been shown to have greater durability, with lower relapse rates following the end of treatment. There are also lower drop-out rates for therapy, due to medication side-effects. It is common practice for people to receive both treatments. One might think this to be more potent than either treatment by themselves. Some studies do support this, but other studies do not.
Best wishes,
Mike
For a Summary of the article: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60046-5/fulltext
Monday, February 9, 2009
Get on Your Feet
If you are dealing with anxiety and/or depression, exercise is something that you should begin, increase, or continue. There is 40 years of research that exercise is not only be very helpful, but some studies indicate they work better than anti-depressant medications, especially in follow-up studies! The self-help group Recovery, International (formerly Recovery Inc.) has taught for over 70 years that when depressed to "move your muscles.” Sleep quality and insomnia often improve with exercise.
It is best to consult with your physician before beginning a mild to moderate exercise program. Often, walking is a great place to begin. No special equipment is necessary and you can do this year round. In winter, many go to indoor malls to walk. Start at a comfortable pace and don't over do. Even 10 minutes has been shown to be beneficial.
The trick is to find something that you don't hate and preferably enjoy. Studies generally utilize 20 to 60 minute sessions at least three times a week, although you may not be ready to begin at that length of time. Nor do you necessarily have to join a gym. Finding someone to exercise with can be very helpful, but should not be an excuse to not exercise. Consider walking with your spouse or a friend. Bike ride with your kids. Consider exercise classes.
Having different things that you sometimes do can help keep things from getting boring. However, if you say love and want to primarily do one activity, Great! Changing where you walk, run, bike, etc. can also help keep things more fresh. Another advantage of sometimes doing different things is using different muscles.
Exercise is not guaranteed to beat your anxiety or depression alone, but it frequently is very helpful.
Best wishes,
Mike
It is best to consult with your physician before beginning a mild to moderate exercise program. Often, walking is a great place to begin. No special equipment is necessary and you can do this year round. In winter, many go to indoor malls to walk. Start at a comfortable pace and don't over do. Even 10 minutes has been shown to be beneficial.
The trick is to find something that you don't hate and preferably enjoy. Studies generally utilize 20 to 60 minute sessions at least three times a week, although you may not be ready to begin at that length of time. Nor do you necessarily have to join a gym. Finding someone to exercise with can be very helpful, but should not be an excuse to not exercise. Consider walking with your spouse or a friend. Bike ride with your kids. Consider exercise classes.
Having different things that you sometimes do can help keep things from getting boring. However, if you say love and want to primarily do one activity, Great! Changing where you walk, run, bike, etc. can also help keep things more fresh. Another advantage of sometimes doing different things is using different muscles.
Exercise is not guaranteed to beat your anxiety or depression alone, but it frequently is very helpful.
Best wishes,
Mike
Sunday, February 8, 2009
What is Your Recovery Plan for Anxiety and Depression?
What is your recovery plan? What is it that you will do to get past your depression, anxiety, or whatever? This may be a foreign concept to you. Many may wonder, “What is it that I CAN do to improve my anxiety, mood, or whatever? Non-medication possibilities include (but are not limited to) exercise, self-help reading, tracking and challenging negative thoughts, self-help group involvement, facing your fears, affirmations, diet, spiritual practices, relaxation exercises, yoga, and journaling.
Whether or not you are seeing a therapist, generally, the more you do the kind of things just mentioned, the more quickly you get better. If you are working with a therapist, it is best to check your activities with them. Most of the time, you will get encouragement and possibly tips. Many to most therapists will gladly make suggestions of thing they think you will find helpful.
If you have experienced a lot of trauma and/or very severe trauma, then trying to recall memories and some self-help reading may take you at a faster pace than you can manage. In these cases, it is better to go too slow than too fast. However, it does not preclude you from doing most of the other activities listed above.
Activities that are often suggested and helpful are to think about different things related to what you want to change, to notice the times when things are actually better, as well as trying to picture in your mind how you would like things to be.
Best wishes,
Mike
Whether or not you are seeing a therapist, generally, the more you do the kind of things just mentioned, the more quickly you get better. If you are working with a therapist, it is best to check your activities with them. Most of the time, you will get encouragement and possibly tips. Many to most therapists will gladly make suggestions of thing they think you will find helpful.
If you have experienced a lot of trauma and/or very severe trauma, then trying to recall memories and some self-help reading may take you at a faster pace than you can manage. In these cases, it is better to go too slow than too fast. However, it does not preclude you from doing most of the other activities listed above.
Activities that are often suggested and helpful are to think about different things related to what you want to change, to notice the times when things are actually better, as well as trying to picture in your mind how you would like things to be.
Best wishes,
Mike
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