MORE ABOUT PSYCHOTHERAPY
What is psychotherapy?
A psychologist can help you work through such problems. Through psychotherapy, psychologists help people of all ages live happier, healthier and more productive lives.
In psychotherapy, psychologists apply scientifically validated procedures to help people develop healthier, more effective habits. There are several approaches to psychotherapy — including cognitive-behavioral, interpersonal and other kinds of talk therapy — that help individuals work through their problems.
Psychotherapy is a collaborative treatment based on the relationship between an individual and a psychologist. Grounded in dialogue, it provides a supportive environment that allows you to talk openly with someone who’s objective, neutral and nonjudgmental. You and your psychologist will work together to identify and change the thought and behavior patterns that are keeping you from feeling your best.
By the time you’re done, you will not only have solved the problem that brought you in, but you will have learned new skills so you can better cope with whatever challenges arise in the future.
When should you consider psychotherapy?
Because of the many misconceptions about psychotherapy, you may be reluctant to try it out. Even if you know the realities instead of the myths, you may feel nervous about trying it yourself.
Overcoming that nervousness is worth it. That’s because any time your quality of life isn’t what you want it to be, psychotherapy can help.
Some people seek psychotherapy because they have felt depressed, anxious or angry for a long time. Others may want help for a chronic illness that is interfering with their emotional or physical well-being. Still, others may have short-term problems they need help navigating. They may be going through a divorce, facing an empty nest, feeling overwhelmed by a new job or grieving a family member's death, for example.
Signs that you could benefit from therapy include:
You feel an overwhelming, prolonged sense of helplessness and sadness.
Your problems don't seem to get better despite your efforts and help from family and friends.
You find it difficult to concentrate on work assignments or to carry out other everyday activities.
You worry excessively, expect the worst or are constantly on edge.
Your actions, such as drinking too much alcohol, using drugs or being aggressive, are harming you or others.
*Read the entire article on American Psychological Association website
Do I Need Therapy?
According to Dr. David Sack, contrary to popular misconception, you don’t have to be “crazy,” desperate or on the brink of a meltdown to go to therapy. At the same time, therapy isn’t usually necessary for every little struggle life throws your way, especially if you have a strong support system of friends and family. So how do you know when it’s time to see a therapist?
Most people can benefit from therapy at least some point in their lives. Sometimes the signs are obvious but at other times, something may feel slightly off and you can’t figure out what it is. So you trudge on, trying to sustain your busy life until it sets in that life has become unmanageable. Before it gets to this point, here are five signs you may need help from a pro:
#1 Feeling sad, angry or otherwise “not yourself.”
Uncontrollable sadness, anger or hopelessness may be signs of a mental health issue that can improve with treatment. If you’re eating or sleeping more or less than usual, withdrawing from family and friends, or just feeling “off,” talk to someone before serious problems develop that impact your quality of life. If these feelings escalate to the point that you question whether life is worth living or you have thoughts of death or suicide, reach out for help right away.
When you turn outside yourself to a substance or behavior to help you feel better, your coping skills may need some fine-tuning. If you feel unable to control these behaviors or you can’t stop despite negative consequences in your life, you may be struggling with addictive or compulsive behavior that requires treatment.
#3 You’ve lost someone or something important to you.
Grief can be a long and difficult process to endure without the support of an expert. While not everyone needs counseling during these times, there is no shame in needing a little help to get through the loss of a loved one, a divorce or significant breakup, or the loss of a job, especially if you’ve experienced multiple losses in a short period of time.
#4 Something traumatic has happened.
If you have a history of abuse, neglect or other trauma that you haven’t fully dealt with, or if you find yourself the victim of a crime or accident, chronic illness or some other traumatic event, the earlier you talk to someone, the faster you can learn healthy ways to cope.
#5 You can’t do the things you like to do.
Have you stopped doing the activities you ordinarily enjoy? If so, why? Many people find that painful emotions and experiences keep them from getting out, having fun and meeting new people. This is a red flag that something is amiss in your life.
If you decide that therapy is worth a try, it doesn’t mean you’re in for a lifetime of “head shrinking.” In fact, a 2001 study in the Journal of Counseling Psychology found that most people feel better within seven to 10 visits. In another study, published in 2006 in the Journal of Consulting and Clinical Psychology, 88 percent of therapy-goers reported improvements after just one session.
Although severe mental illness may require more intensive intervention, most people benefit from short-term, goal-oriented therapy to address a specific issue or interpersonal conflict, get out of a rut or make a major life decision. The opportunity to talk uncensored to a nonbiased professional without fear of judgment or repercussions can be life-changing.
You may have great insight into your own patterns and problems. You may even have many of the skills to manage them on your own. Still, there may be times when you need help – and the sooner you get it, the faster you can get back to enjoying life.
Occasional anxiety is a normal part of life. You might feel anxious when faced with a problem at work, before taking a test, or making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The feelings can interfere with daily activities such as job performance, school work, and relationships. There are several different types of anxiety disorders. Examples include generalized anxiety disorder, panic disorder, and social anxiety disorder.
Signs and Symptoms
Generalized Anxiety Disorder
People with generalized anxiety disorder display excessive anxiety or worry for months and face several anxiety-related symptoms.
Generalized anxiety disorder symptoms include:
Restlessness or feeling wound-up or on edge
Being easily fatigued
Difficulty concentrating or having their minds go blank
Difficulty controlling the worry
Sleep problems (difficulty falling or staying asleep or restless, unsatisfying sleep)
People with panic disorder have recurrent unexpected panic attacks, which are sudden periods of intense fear that may include palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath, smothering, or choking; and feeling of impending doom.
Panic disorder symptoms include:
Sudden and repeated attacks of intense fear
Feelings of being out of control during a panic attack
Intense worries about when the next attack will happen
Fear or avoidance of places where panic attacks have occurred in the past
Social Anxiety Disorder
People with social anxiety disorder (sometimes called “social phobia”) have a marked fear of social or performance situations in which they expect to feel embarrassed, judged, rejected, or fearful of offending others.
Social anxiety disorder symptoms include:
Feeling highly anxious about being with other people and having a hard time talking to them
Feeling very self-conscious in front of other people and worried about feeling humiliated, embarrassed, or rejected, or fearful of offending others
Being very afraid that other people will judge them
Worrying for days or weeks before an event where other people will be
Staying away from places where there are other people
Having a hard time making friends and keeping friends
Blushing, sweating, or trembling around other people
Feeling nauseous or sick to your stomach when other people are around
Evaluation for an anxiety disorder often begins with a visit to a primary care provider. Some physical health conditions, such as an overactive thyroid or low blood sugar, as well as taking certain medications, can imitate or worsen an anxiety disorder. A thorough mental health evaluation is also helpful, because anxiety disorders often co-exist with other related conditions, such as depression or obsessive-compulsive disorder.
Researchers are finding that genetic and environmental factors, frequently in interaction with one another, are risk factors for anxiety disorders. Specific factors include:
Shyness, or behavioral inhibition, in childhood
Having few economic resources
Being divorced or widowed
Exposure to stressful life events in childhood and adulthood
Anxiety disorders in close biological relatives
Parental history of mental disorders
Elevated afternoon cortisol levels in the saliva (specifically for social anxiety disorder)
Treatments and Therapies
Anxiety disorders are generally treated with psychotherapy, medication, or both.
Psychotherapy or “talk therapy” can help people with anxiety disorders. To be effective, psychotherapy must be directed at the person’s specific anxieties and tailored to his or her needs. A typical “side effect” of psychotherapy is temporary discomfort involved with thinking about confronting feared situations.
Cognitive Behavioral Therapy (CBT)
CBT is a type of psychotherapy that can help people with anxiety disorders. It teaches a person different ways of thinking, behaving, and reacting to anxiety-producing and fearful situations. CBT can also help people learn and practice social skills, which is vital for treating social anxiety disorder.
Two specific stand-alone components of CBT used to treat social anxiety disorder are cognitive therapy and exposure therapy. Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful thoughts underlying anxiety disorders.
Exposure therapy focuses on confronting the fears underlying an anxiety disorder in order to help people engage in activities they have been avoiding. Exposure therapy is used along with relaxation exercises and/or imagery. One study, called a meta-analysis because it pulls together all of the previous studies and calculates the statistical magnitude of the combined effects, found that cognitive therapy was superior to exposure therapy for treating social anxiety disorder.
CBT may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social anxiety disorder. Often “homework” is assigned for participants to complete between sessions.
Self-Help or Support Groups
Some people with anxiety disorders might benefit from joining a self-help or support group and sharing their problems and achievements with others. Internet chat rooms might also be useful, but any advice received over the Internet should be used with caution, as Internet acquaintances have usually never seen each other and false identities are common. Talking with a trusted friend or member of the clergy can also provide support, but it is not necessarily a sufficient alternative to care from an expert clinician.
Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. While there is evidence that aerobic exercise has a calming effect, the quality of the studies is not strong enough to support its use as treatment. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, avoiding them should be considered. Check with your physician or pharmacist before taking any additional medications.
The family can be important in the recovery of a person with an anxiety disorder. Ideally, the family should be supportive but not help perpetuate their loved one’s symptoms.
Medication does not cure anxiety disorders but often relieves symptoms. Medication can only be prescribed by a medical doctor (such as a psychiatrist or a primary care provider), but a few states allow psychologists to prescribe psychiatric medications.
Medications are sometimes used as the initial treatment of an anxiety disorder, or are used only if there is insufficient response to a course of psychotherapy. In research studies, it is common for patients treated with a combination of psychotherapy and medication to have better outcomes than those treated with only one or the other.
The most common classes of medications used to combat anxiety disorders are antidepressants, anti-anxiety drugs, and beta-blockers (visit Mental Health Medications). Be aware that some medications are effective only if they are taken regularly and that symptoms may recur if the medication is stopped.
Antidepressants are used to treat depression, but they also are helpful for treating anxiety disorders. They take several weeks to start working and may cause side effects such as headache, nausea, or difficulty sleeping. The side effects are usually not a problem for most people, especially if the dose starts off low and is increased slowly over time.
Please Note: Although antidepressants are safe and effective for many people, they may be risky for children, teens, and young adults. A “black box” warning—the most serious type of warning that a prescription can carry—has been added to the labels of antidepressants. The labels now warn that antidepressants may cause some people to have suicidal thoughts or make suicide attempts. For this reason, anyone taking an antidepressant should be monitored closely, especially when they first start taking the medication.
Anti-anxiety medications help reduce the symptoms of anxiety, panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Benzodiazepines are first-line treatments for generalized anxiety disorder. With panic disorder or social phobia (social anxiety disorder), benzodiazepines are usually second-line treatments, behind antidepressants.
Beta-blockers, such as propranolol and atenolol, are also helpful in the treatment of the physical symptoms of anxiety, especially social anxiety. Physicians prescribe them to control rapid heartbeat, shaking, trembling, and blushing in anxious situations.
Choosing the right medication, medication dose, and treatment plan should be based on a person’s needs and medical situation, and done under an expert’s care. Only an expert clinician can help you decide whether the medication’s ability to help is worth the risk of a side effect. Your doctor may try several medicines before finding the right one.
You and your doctor should discuss:
How well medications are working or might work to improve your symptoms
Benefits and side effects of each medication
Risk for serious side effects based on your medical history
The likelihood of the medications requiring lifestyle changes
Costs of each medication
Other alternative therapies, medications, vitamins, and supplements you are taking and how these may affect your treatment
How the medication should be stopped. Some drugs can’t be stopped abruptly but must be tapered off slowly under a doctor’s supervision.
For more information, please visit Medications Health Topic webpage developed by the National Institute of Mental Health (NIMH). Please note that any information on this website regarding medications is provided for educational purposes only and may be outdated. Information about medications changes frequently. Please visit the U.S. Food and Drug Administration (FDA) websitefor the latest information on warnings, patient medication guides, or newly approved medications.