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Talk Therapy

   PTSDHotline.Com believes that Talk Therapy is an extremely important component of PTSD & Substance Abuse Treatment. Unfortunately Insurance Companies are veering away from Talk Therapy in favor of more and more drug therapy

     An article below digs into this subject. Veterans are very fortunate to have programs at the VA that deal primarily with Talk Therapy methods.  Make sure you take advantage of the programs like the PTSD & Substance Abuse Program.

     At the VA you can receive a combination of Talk and Drug Therapy. Over the long haul Talk Therapy is much more affective. Learning how to control depression and anxiety within yourself is far better than relying on drugs.

Input from a VA Professional:

     With medication vs. talk therapy the problem is cost.  It is quicker, faster, and generates more money to re-write a script (30 day supply) than to sit down for an hour (1x week) and talk with 1 person.  This is similar to a dentist office: You have an appointment at 9am… with 30 other people at the same time. This is also why a lot of insurance companies won’t cover extended therapy sessions. Some cover a few and others will cover up to 12 sessions –  just enough time to really establish a therapeutic alliance and start working on stuff. Then unfortunetly insurance runs out and nothing gets resolved so it ‘appears’ that talk therapy is not successful.

     At the VA we have the ability to go way beyond 12 sessions  This creates what is called ‘evidence based treatment’ proving that Talk Therapy does work well.


     From my point of view, I think people are stressed enough and to take an hour a week (out of pocket expenses) is more stressful. Sometimes. The fact that getting a script written in a 5 min session with a psychiatrist (covered by insurance) is much faster and easier to do so they can get on with whatever it is they are doing. This also begs the question: Is this persons defense mechanisms preventing them from seeking individual therapy? This, however cannot be determined until they are in individual therapy… a bit of a paradox!


Talk vs. Drug Therapy for Depression

Survey Shows Antidepressants' Side Effects More Common Than Package Labels Indicate

By Jeanie Lerche Davis
WebMD Health News

      Whether it's talk therapy or drug therapy, getting help for depression or anxiety helps, Americans say. But one appears to work faster, while the other may be more effective.

The survey is a snapshot of the common American's experience with mental health therapy -- and the second such survey published by Consumer Reports. The 1995 report "has been cited in textbooks and is considered a landmark study with worldwide impact," said Joel Gurin, Consumer Reports executive vice president, in a news teleconference today.

     "We think this newest study is just as important," he added.

     "We hope our study will call attention to the need for further research of a large-selling category of drugs, one that millions of people are taking." Gurin said. "Depression, anxiety, and other mental health problems can be as debilitating as any serious physical illness. But there really is not enough information about the risks and benefits of different treatments."

     During the past decade, "the biggest change ... has been the dramatic shift from talk therapy to drug therapy for mental health problems," he noted. "In 1995, less than half of people getting mental health treatment -- 40% -- got drug therapy. Now 68% get drug treatment, and 80% of those treated for depression or anxiety get drug treatment."

However, the drugs "have some serious side effects ... that seem to be much more common than people realize ... much more common than you might think from seeing drug ads and from reports on drug studies," Gurin said.

     The link between antidepressants and suicide rates among children and adolescents is "a very serious issue" that both Congress and the FDA are investigating in hearings, he noted. An FDA panel is meeting next week to determine if there is an increase in suicide and suicidal thoughts among kids taking antidepressants. The agency sent out a warning to doctors last year to be on the lookout for worsening depression or suicidal thoughts in these kids.

Another problem: "Many managed care programs limit mental health treatment to 10 sessions... which may deprive people of the treatment they need."

     Researchers based the report on surveys completed by more than 3,000 Consumer Reports readers, and is published in the magazine's October issue.

Specifically, it shows that:

      A combination of talk therapy and drugs worked best for treatment of depression and anxiety. But those whose treatment consisted of mostly talk therapy did almost as well if they had 13 or more visits with the therapist.

  • Treatment consisting of mostly drug treatment was also effective for many people. Drugs had a quicker impact on symptoms than talk therapy, but it often took trial and error to find a drug that worked without undesirable side effects.
  • More than 50% of survey respondents who took antidepressants tried two or more drugs; 10% tried five or more. "It really does have to be a process of trial and error... because there's no predicting people's response to [antidepressants]," says Nancy Metcalf, a Consumer Reports senior editor and author of the survey.
  • Side effects were much more common than noted on the medications' package information: 40% said they experienced a loss of sexual interest or performance, and almost 20% said they gained weight. Why the discrepancy? In clinical trials, people are not asked specifically about certain side effects, Metcalf tells WebMD. "They were expected to volunteer the information, and they may not be as willing to do that."
  • Treatment from primary care doctors was effective for people with mild problems, but less so for people with more severe ones. Treatment by mental health specialists yielded significantly better results for people who started out in poor shape.
  • Health insurance plan limits on therapy visits and costs kept some people from getting the best treatment.
  • Consumers who did their own research and monitored their own care reported better results.
  • ∑ More than 80% of survey respondents said they found treatment that helped.

     Another finding: Nearly one in five people said their health plans don't cover mental health. "That's an odd statistic to us, because we know that almost all employer-provided health care plans have mental health coverage," says Metcalf. "Either people were too shy to seek reimbursement or were having trouble accessing it."

Many Routes to Good Care

     "What comes through overall -- there are many routes to good care, but it takes flexibility and persistence to get there," says Metcalf. "The more committed to your own care, the better off you'll be -- whether that means finding a different therapist, cutting through red tape with your mental health coverage, or applying what you learn in therapy to your life."

     "Some companies do what's called a 'carve-out' mental health coverage, which means they contract it other to another company," she tells WebMD. "If you call the 800 number on your health plan card, you may get someone who doesn't know very much about your mental health coverage. That's where persistence pays off. You really need not give up until you find someone who knows about your health plan. Mental health coverage is often very different from health coverage."

     Important note: Under the American Disabilities Act, an employer cannot discriminate against an employee getting mental health care, Metcalf adds. "There are also restrictions as far as how much information your therapist can turn over. Your health care plan knows about drugs you are taking, and very generally about your condition. But they do not have access to personal notes made by your doctor -- the most private information. That is legally protected."

     Also encouraging is "there has been a lot of effort in the last five or 10 years to bring primary care doctors up to speed about depression, and either treat [patients] or refer them to a mental health professional," Metcalf says. "The most important point is to get help somewhere ... and get it promptly."

Many types of mental health professionals can provide excellent therapy, she notes. The survey showed that whether they saw a psychiatrist, a psychologist, or a social worker, patients had equally good results. How to choose your therapist? "It's largely personal preference," Metcalf tells WebMD. "Just keep in mind, if you go to see a psychiatrist, you are much more likely to get medication. Psychologists and social workers provide talk therapy ... and they can be more cost-effective if you pay out of pocket, which many of our respondents did."

     "Many insurers refuse to allow psychiatrists to do anything but prescribe drugs, except for the most severely ill patients," notes Bruce Schwartz, MD, in the report. He is associate professor of clinical psychiatry at Albert Einstein College of Medicine in New York City and one of two consultants who helped design the survey and interpret the results.


High-Intensity Exercise Best Way To Reduce Anxiety,

University Of Missouri Study Finds

ScienceDaily  COLUMBIA, Mo.

     Cardiovascular disease is the leading cause of death in the United States. The amount of stress and anxiety a person experiences is a major factor in cardiovascular disease. For the past three decades experts have vacillated in their recommendations concerning the amount and intensity of exercise required to alleviate stress and anxiety.

     Recently, most experts have agreed that a moderate to low amount of regular exercise can ease personal tension and stress. However, a new study by researchers at the University of Missouri -       Columbia shows that a relatively high-intensity exercise is superior in reducing stress and anxiety that may lead to heart disease. Moreover, the researchers found that high-intensity exercise especially benefits women.

      Conventional wisdom says that exercising for 30 minutes at a moderate exercise intensity is more effective in reducing anxiety than either a low or high intensity dose,” said Richard Cox, professor of educational and counseling psychology and leader of the study. “This conclusion, however, is deceptively simple because reductions in anxiety are not always observed immediately following a high intensity bout of exercise.”

     In the study, female participants, ages 18 to 20 and 35 to 45, completed three experimental sessions. Each session started with a test to determine the anxiety level of the participant. Following the test, the women either did not exercise (control condition) or exercised at a moderate or high-intensity level for 33 minutes. After the session, Cox measured anxiety levels at 5, 30, 60 and 90 minutes post-exercise.

     Although all three exercise conditions, including the control condition, showed a decline in anxiety over time, Cox found the high-intensity level experienced the sharpest decline. Cox said the intensity of exercise conditions did not differ in anxiety levels at baseline or immediately after exercise, but a difference favoring the high intensity level emerged at 30, 60 and 90 minutes post-exercise.

Results also showed that when the iron status of the women was taken into consideration, the beneficial effect of high-intensity exercise was greater for the older women.

     “This is a relationship that needs to be further explored,” Cox said. “It appears to suggest that after controlling for iron status, the beneficial effects of exercise on anxiety may only apply to older women and not to younger women.”

     Cox believes this study, which is scheduled for publication in the Research Quarterly for Exercise and Sport, will prove beneficial to medical practitioners in the fight against heart disease.


Mental Health Providers Should Prescribe Exercise More Often for Depression, Anxiety, Research Suggests

ScienceDaily (Apr. 6, 2010)Exercise is a magic drug for many people with depression and anxiety disorders, and it should be more widely prescribed by mental health care providers, according to researchers who analyzed the results of numerous published studies.

     "Exercise has been shown to have tremendous benefits for mental health," says Jasper Smits, director of the Anxiety Research and Treatment Program at Southern Methodist University in Dallas. "The more therapists who are trained in exercise therapy, the better off patients will be."

     Smits and Michael Otto, psychology professor at Boston University, based their finding on an analysis of dozens of population-based studies, clinical studies and meta-analytic reviews related to exercise and mental health, including the authors' meta-analysis of exercise interventions for mental health and studies on reducing anxiety sensitivity with exercise. The researchers' review demonstrated the efficacy of exercise programs in reducing depression and anxiety.

     The traditional treatments of cognitive behavioral therapy and pharmacotherapy don't reach everyone who needs them, says Smits, an associate professor of psychology.

     "Exercise can fill the gap for people who can't receive traditional therapies because of cost or lack of access, or who don't want to because of the perceived social stigma associated with these treatments," he says. "Exercise also can supplement traditional treatments, helping patients become more focused and engaged."

     The researchers presented their findings March 6 in Baltimore at the annual conference of the Anxiety Disorder Association of America. Their workshop was based on their therapist guide "Exercise for Mood and Anxiety Disorders," with accompanying patient workbook (Oxford University Press, September 2009).

     "Individuals who exercise report fewer symptoms of anxiety and depression, and lower levels of stress and anger," Smits says. "Exercise appears to affect, like an antidepressant, particular neurotransmitter systems in the brain, and it helps patients with depression re-establish positive behaviors. For patients with anxiety disorders, exercise reduces their fears of fear and related bodily sensations such as a racing heart and rapid breathing."

     After patients have passed a health assessment, Smits says, they should work up to the public health dose, which is 150 minutes a week of moderate-intensity activity or 75 minutes a week of vigorous-intensity activity. At a time when 40 percent of Americans are sedentary, he says, mental health care providers can serve as their patients' exercise guides and motivators.

     "Rather than emphasize the long-term health benefits of an exercise program -- which can be difficult to sustain -- we urge providers to focus with their patients on the immediate benefits," he says. "After just 25 minutes, your mood improves, you are less stressed, you have more energy -- and you'll be motivated to exercise again tomorrow. A bad mood is no longer a barrier to exercise; it is the very reason to exercise."

     Smits says health care providers who prescribe exercise also must give their patients the tools they need to succeed, such as the daily schedules, problem-solving strategies and goal-setting featured in his guide for therapists.

     "Therapists can help their patients take specific, achievable steps," he says. "This isn't about working out five times a week for the next year. It's about exercising for 20 or 30 minutes and feeling better today."


Regular Exercise Reduces Patient Anxiety

by 20 Percent, Study Finds

ScienceDaily (Feb. 28, 2010) —

     The anxiety that often accompanies a chronic illness can chip away at quality of life and make patients less likely to follow their treatment plan. But regular exercise can significantly reduce symptoms of anxiety, a new University of Georgia study shows.

     In a study appearing in the Feb. 22 edition of the Archives of Internal Medicine, researchers analyzed the results of 40 randomized clinical trials involving nearly 3,000 patients with a variety of medical conditions. They found that, on average, patients who exercised regularly reported a 20 percent reduction in anxiety symptoms compared to those who did not exercise.

     "Our findings add to the growing body of evidence that physical activities such as walking or weight lifting may turn out to be the best medicine that physicians can prescribe to help their patients feel less anxious," said lead author Matthew Herring, a doctoral student in the department of kinesiology, part of the UGA College of Education.

     Herring pointed out that while the role of exercise in alleviating symptoms of depression has been well studied, the impact of regular exercise on anxiety symptoms has received less attention. The number of people living with chronic medical conditions is likely to increase as the population ages, he added, underscoring the need for a low-cost, effective treatment.

     The researchers limited their analysis to randomized controlled trials, which are the gold standard of clinical research, to ensure that only the highest quality data were used. The patients in the studies suffered from a variety of conditions, including heart disease, multiple sclerosis, cancer and chronic pain from arthritis. In 90 percent of the studies examined, the patients randomly assigned to exercise had fewer anxiety symptoms, such as feelings of worry, apprehension and nervousness, than the control group.

     "We found that exercise seems to work with just about everybody under most situations," said study co-author Pat O'Connor, professor and co-director of the UGA Exercise Psychology Laboratory.         Exercise even helps people who are not very anxious to begin with become more calm."

     Exercise sessions greater than 30 minutes were better at reducing anxiety than sessions of less than 30 minutes, the researchers found. But surprisingly, programs with a duration of between three and twelve weeks appear to be more effective at reducing anxiety than those lasting more than 12 weeks. The researchers noted that study participants were less likely to stick with the longer exercise programs, which suggests that better participation rates result in greater reductions in anxiety.

     "Because not all study participants completed every exercise session, the effect of exercise on anxiety reported in our study may be underestimated," said study co-author Rod Dishman, also a professor of kinesiology. "Regardless, our work supports the use of exercise to treat a variety of physical and mental health conditions, with less risk of adverse events than medication."


Cutting & Self Injury

Though rare in Battlefield PTSD these conditions can be found in subjects who experienced childhood truma prior to military service.

Self-harm (SH) or deliberate self-harm (DSH) includes self-injury (SI) and self-poisoning and is defined as the intentional, direct injuring of body tissue without suicidal intent. These terms are used in the more recent literature in an attempt to reach a more neutral terminology. The older literature, especially that which predates the DSM-IV-TR, almost exclusively refers to self-mutilation. The term is synonymous with "self-injury."

The most common form of self-harm is skin-cutting but self-harm also covers a wide range of behaviors including, but not limited to, burning, scratching, banging or hitting body parts, interfering with wound healing, hair-pulling (trichotillomania) and the ingestion of toxic substances or objects. Behaviors associated with substance abuse and eating disorders are usually not considered self-harm because the resulting tissue damage is ordinarily an unintentional side effect. However, the boundaries are not always clear-cut and in some cases behaviours that usually fall outside the boundaries of self-harm may indeed represent self-harm if performed with explicit intent to cause tissue damage. Although suicide is not the intention of self-harm, the relationship between self-harm and suicide is complex, as self-harming behavior may be potentially life-threatening. There is also an increased risk of suicide in individuals who self-harm to the extent that self-harm is found in 40–60% of suicides. However, generalizing self-harmers to be suicidal is, in the majority of cases, inaccurate.

Self-harm in childhood is relatively rare but the rate has been increasing since the 1980s. Self-harm is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as a symptom of borderline personality disorder. However patients with other diagnoses may also self-harm, including those with depression, anxiety disorders, substance abuse, eating disorders, post-traumatic stress disorder, schizophrenia, and several personality disorders. Self-harm is also apparent in high-functioning individuals who have no underlying clinical diagnosis. The motivations for self-harm vary and it may be used to fulfill a number of different functions. These functions include self-harm being used as a coping mechanism which provides temporary relief of intense feelings such as anxiety, depression, stress, emotional numbness and a sense of failure or self-loathing. Self-harm is often associated with a history of trauma and abuse, including emotional abuse, sexual abuse, drug dependence, eating disorders, or mental traits such as low self-esteem or perfectionism. There is also a positive statistical correlation between self-harm and emotional abuse. There are a number of different methods that can be used to treat self-harm and which concentrate on either treating the underlying causes or on treating the behavior itself. When self-harm is associated with depression, antidepressant drugs and treatments may be effective. Other approaches involve avoidance techniques, which focus on keeping the individual occupied with other activities, or replacing the act of self-harm with safer methods that do not lead to permanent damage.


Article by:Russell B. Lemle, Ph.D


Russell B. Lemle, Ph.D. is an¬ Associate Clinical Professor in the  Dept of Psychiatry, University of California San Francisco, Chief  Psychologist San Francisco VA Medical Center and supervisor of couples  and process-oriented psychotherapies. His publications pertaining to  relationships have appeared in the Journal of Marriage and the Family and the¬ Journal of Community Psychology. He was the recipient of a 2005 American Psychological Association  Presidential Citation and the 2011 Harold Hildreth Award of the APA  Division 18 (Psychologists in Public Service). In his private  practice at the Couples Center of San Francisco, he focuses primarily on couples/marital therapy.

How Threat Emotions Cause Us To Misread Our Partner

 The Mindset of Anxiety and Anger

Published on March 24, 2012 by Russell B. Lemle, Ph.D. in From Me-First to We-First

 Just how well do we read our intimate partners? As long as we're composed,  we're generally pretty good at it. But whenever our threat emotions  (i.e. anxiety and anger) are triggered, accuracy goes right out the window.

Emotion-driven misinterpretations spell trouble for relationships. They lead to  escalating accusations, disappearing trust and constricting hearts. If  only we could recognize how emotions shape perceptions, we could restore close connections with our partner. That's the aim of this primer.

The Alerted Brain

Running unconsciously in the background, our brain has an alarm system alert  for threats to physical and psychological needs. At the instant we  register a threat, a host of coping responses commence. Cortisol and  adrenalin are secreted. Breathing and heart rate quicken, sending oxygen and sugar to our limbs to ready us for fight or flight. Neural activity increases in the brain's limbic section, generating threat-countering  emotions and additional interpretations of danger. These processes work  together and impact one another. Thoughts directly affect emotions (a  link that is the focus of Cognitive Therapy). The equally important reverse direction - how threat emotions influence our thinking - is the subject this article addresses.

The function of anxiety and anger is to viscerally warn of a danger  so that we take self-protective measures. To succeed at this task, we're designed to over-estimate threat. The only surefire guarantee that  actual risks are never missed is giving ambiguous threats the same credence as definite ones. Better to be safe than sorry. This evolutionary adaptation was vital  for survival on the savannah, but it's another story entirely with our  relationships.

Misinterpreting Our Partner When We're Anxious/Angry/Hurt

Because we're profoundly dependent on our partner for basic psychological  needs, we're easily triggered in intimate relationships. Nowhere else do we feel quite so attached - or rejected, quite so respected - or  unvalued. Whenever these needs seem jeopardized, our limbic system can  flare, and anxiety, anger and hurt arise. Such emotions dramatically  color our interpretations whereby we automatically - and often  erroneously - tend to view our partner as untrustworthy, uncaring,  unfair or disrespectful. Here, in greater detail, are 9 overlapping ways that happens.

1. When we feel anxious or angry, we're certain there's a legitimate basis

Anxiety is nature's indicator that peril lurks. When it appears, we're  convinced in our gut that we're endangered. The emotion itself is  regarded as proof that a bona fide peril exists. "If I feel upset with  my partner, s/he must have done something."

But that's not  necessarily the case. While the experience of anxiety or anger is  indisputably real, the cause we attribute may or may not be. We're fully capable of feeling anxious even when our partner's actions have nothing to do with danger.

-- Donna got a text from a male customer. When Gareth noticed, he immediately became anxious. He took his fear as evidence there was a romantic interest in her life.

-- Any time Juanita got suspicious, she believed this was a sign that  Alvaro was up to something fishy. She was certain her intuitive "sixth  sense" correctly detected his wrongdoing.

2.¬ When we feel hurt, we believe it was intended

When we feel hurt by our partner, we presume it was deliberate. Taking  things personally is an adaptive aspect of our fight/flight reflex since it mobilizes us to act protectively.

Even if we're a bit unclear  whether our partner purposely meant to harm us, we nonetheless suppose  s/he was perfectly willing to. After all, s/he is well aware of our  desires or sensitivities yet callously ignored them. It seems  implausible that it could have been accidental. What we forget is that  we can feel upset or wounded without our spouse intending that outcome.

-- Because she was chastised throughout childhood, Jan was determined to never repeat that behavior when raising her own  family. When she and her teenage daughter started arguing, her husband  Michael commented that she was too critical. Jan felt stung and thought  he meant to hurt her, given that this was a sore spot of hers.

Mistakenly¬ assuming ill will is all the more likely because we're limited in our capacity  to know another person's motives. Since what's going on in our partner's mind can't be directly observed, we fill in the blank to correspond  with our misgivings.

Limbic activation is - unfortunately - why we hesitate to trust our partner's favorable deeds in the aftermath of  conflicts. If we're still on alert when s/he extends an olive branch or  complies with our requests, and we can't see into her/his heart, we  doubt that positive responses are earnest.

-- Following a  tense interaction, Paul became demonstratively soft and caring towards  Jean. But Jean folded her arms across her chest and scoffed that Paul  was disingenuous.

The hidden quality of motives leads to  another misinterpretation we make when threatened. That's suspecting  that anything our partner isn't overtly revealing is being deliberately withheld. We warily question what our spouse is not disclosing and why it's concealed.

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