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Behavioral Approaches to Health Problems

Health psychology, or behavioral medicine, is a specialty area of psychology dedicated to promoting a philosophy of health through the application of a variety of self-initiated activities and techniques. Use is made of behavioral and biomedical knowledge for the prevention, treatment and rehabilitation of illness and dysfunction.

Some of the areas in which behavioral medicine interventions have proven useful include: obesity, smoking, stress, hypertension, headaches, insomnia, chronic pain, asthma, peripheral vascular disease, coronary prone behavioral, gastrointestinal disorders, arthritis, diabetes, exercise compliance, and cancer. Behavioral medicine intervention in many of the above areas requires that the psychologist's efforts be coordinated with the efforts of the physician and other health care providers.

How do I find someone to help me with behavioral approaches to health problems?

In general, psychologists trained in health psychology and behavioral medicine can be located in the yellow pages under psychologists or by contacting local or state psychological associations.

While behavior therapy has achieved a reputation for effectiveness in treating anxiety disorders, most practical therapists have learned how to combine behavioral techniques with other approaches. Systematic desensitization, the standard behavioral treatment for phobias, involves applying relaxation skills to feared situations. The client learns to relax, and then tries to maintain a relaxed state while imagining anxiety-provoking situations. Influenced by hypnosis, many therapists are finding that images of competence or of being loved by kind caretakers may be more effective than a relaxed state in countering anxiety for some phobias.

Another effective imagery technique is imaginal exposure, in which anxious clients are guided to vividly face intense feelings or situations that have triggered their fear of losing control. An obsessive-compulsive might be led through a prolonged session imagining being harshly criticized for making a mistake. Surviving this type of session can lead clients to gain comfort with feelings (such as anger) that they have feared. Adding elements of gestalt therapy and psychodrama, an imaginal exposure session can flow naturally into an opportunity for anxious clients to express long-denied or avoid emotions.

To be completely successful, any treatment of an anxiety disorder must include in vivo exposure. Agoraphobics who have feared highway driving must drive previously avoided roads before they'll feel sure that they have overcome their problem. For the obsessive-compulsive who has had to shower for hours before feeling clean enough to go out, treatment must include brief showers followed by normal socializing and activity. Therapists have discovered that in vivo behavioral techniques may lead previously “resistant” clients to develop greater insight into the psychological roots of their problems. An example is the agoraphobic client who after being pushed to drive outside their neighborhood for the first time in years, can sit in the car and clearly recall how she learned in childhood to stay home and protect her mother from an abusive father.

Clients presenting severe anxiety disorders have often lived restricted lives for years before coming to a therapist. While behavioral or experimental techniques may dislodge the phobia or compulsive habit relatively quickly, the client may still be left with lingering problems such as depression or the need for families to reorganize to fit the client's new competence. These problems can require a great deal of patience and time for a therapist and client.
 
 

Managing Chronic Pain

Every year 40 million American adults experience chronic debilitating headaches, 100 million more will have problems with back pain, and 90 million more will have pain from arthritis. Our pain response when functioning normally saves us from injury. In chronic pain, the person's pain response is not able to be shut off. Often with traditional treatment, chronic pain sufferers will fall into a vicious cycle with excessive medication, loss of sleep, fear of physical activity, frustration and depression, which all make the original pain worse. Many times, difficulty in finding a solid physical cause for the pain may cause health care professionals to dismiss the pain complaints and state that the person's pain is all in their head. For many people, chronic pain takes over as the central focus for their lives. In seeking treatment for chronic pain it is important to find specialists who have experience in treating chronic pain. In general, the treatment of chronic pain is seen as needing a multi-disciplinarian approach. Physicians, psychologists, and physical therapists generally work together to assist a patient to develop a program to manage their pain.

If you have been in pain for a number of months, it is important to seek experienced treatment. If the source of your pain is unknown, you may want to seek assistance at a comprehensive pain center that has many specialists on staff.

Two recent directories are published in the United States and Canada. These are the APS/AAPM 1989 Directory of Pain Management Facilities. It is available from the American Pain Society and the American Academy of Pain Management. Cost is $30.00 for non-members. The address is APS, P.O. Box 186, Skokie, IL 60076. The second directory is the Directory of Pain Treatment Centers in the United States and Canada, published by ORYX Press and costs $64.00. The address is ORYX Press, 2214 Northcentral at Encanto, Phoenix, AZ 85004-1483. These directories list pain centers. The Commission of Accreditation and Rehabilitation Facilities publishes a list of clinics they have accredited. This list is available from CARF, Suite 226, 2500 North Pantano Rd., Tucson, AZ 85715. There are a number of support groups available for individuals experiencing chronic pain; an excellent one is the National Chronic Pain Outreach Association, 4922 Hampden Ln., Bethesda, MD 20814. Also, the National Institute on Neurological and Communicative Disorders and Stroke at the National Institute of Health has free brochures on chronic pain and on headache pain. The address is NINCDS, Building 31, Room 8-A-16, Bethesda, MD 20892. In addition, your local psychological and medical associations can provide information about practitioners who specialize in the treatment of chronic pain.
 
 

Depression

What is depression?
Clinical depression is more than just the "blues". If a "down" mood lasts for more than a couple of weeks, it may well be clinical depression.
What are the symptoms of depression?
  • loss of interest or pleasure in usual activitie
  • feeling sad, blue, down in the dumps, or low
  • sleep problems, either difficulty sleeping or sleeping too much
  • low energy level or chronic tension
  • feelings of inadequacy or low self-esteem
  • decreased effectiveness at work, school, or home
  • social withdrawal
  • irritability or excessive anger
  • pessimism about the future
  • tearfulness or crying
  • recurrent thoughts of death or suicide
How common is depression?
Depression is said to affect 10 million Americans each year. It affects people of all ages. One eight of all men and a quarter of women experience depression at some point in their lives. At any time, six percent of adults are depressed. In addition, six to seven percent of teenagers and two percent of children are depressed at any time.
Is all clinical depression the same?
Some people experience only one episode of depression, while others may experience several. For some, a depressive episode begins for no apparent reason, while for others the onset of a depressive episode is associated with a life situation or stresses. Some persons are bi-polar. That is, their mood cycles between extremes of depression and heightened activity.
What about treatment?
Eighty to ninety percent of people suffering from depression can be helped. The most common and effective treatments are psychological therapy and medication, which is also usually combined with psychotherapy.
Where can I get help?
Professionals experienced in the treatment of depression can be located in the yellow pages under psychologists, psychiatrists, and social workers, and mental health centers. State and local psychological and medical associations can also provide names of professionals experienced in the treatment of depression.
 
 

Signals That Your Child is Using Drugs

  • Repeated, unexplained depression and lethargy or euphoria and hyperactivity.
  • Hostility to requests, criticism, or questions on where they have been.
  • Loss of motivation in school; poor performance, increased absenteeism.
  • New friends who aren't introduced.
  • Confusion.
  • Slow thought processes.
  • Short attention span.
  • Forgetfulness.
  • Sleep and appetite disturbances.
  • Physical symptoms, such as blood-shot eyes or droopy lids, persistent illness, for example coughing and sniffling, frequent nose bleeds, a decline in grooming and hygiene.
If you suspect that your child is using drugs, it is important to acknowledge the problem, try to find out which drug(s) your child is using, and learn everything you can about those drugs. Then plan a private, non-interrupted time to discuss your suspicions with your child calmly and objectively. Never confront a child while he is under the influence of drugs. State what you know then ask questions to get a conversation going. It's usual to expect to hear denial and lies, as these are part of the drug abuse syndrome. Don't take them at face value. Then take steps to remove the child from the circumstances where drug use might occur. Restrict access to money and transportation and get professional help for both you and your child.
 
 

Controlling Headaches

Headache (Cephalgia) is not a disease by itself but is a symptom of some other problem. It is estimated that every year close to 80% of the population suffers at least one headache and 10-20% see a doctor with a headache as their primary complaint. Headaches are the most common neurological symptom and one of the most common medical complaints.

Headaches are often caused by a number of factors, and often people have more than one type of headache. No matter what the cause, psychological stresses usually worsen headaches.
CAUSES
Headaches can be a result of alcohol, nicotine, and caffeine abuse, and can be a side effect of several classes of prescribed medications including tricyclic antidepressants, monoamine oxidase inhibitors, antiarrhythmics, insulin, several anti-inflammatories, and bromides. They can be symptoms of disease such as sinusitis, colds, hay fever, and other allergies, and early symptoms of many infectious diseases ranging from polio, meningitis, and measles to the flu. They can be caused by brain tumors, high blood pressure, head and neck injuries, anemia, menstruation and menopause, temporomandibular dysfunction (TMJ), bruxism (teeth grinding), and also cold, hunger, lack of sleep, and overexertion.
CLASSIFICATION
Numerous types of headaches have been identified. These include: Vascular headaches (migraine type) which include classic or common migraine, cluster headaches, and lower-half headaches. Also nonmigranious vascular headache, muscle contraction (tension) headache, combined vascular-muscle contraction headache, nasal vasomotor reaction headache, psychogenic headaches, psychotic (delusional) headaches, traction headaches, headaches secondary to cranial inflammation, and headaches secondary to disease of other cranial or neck structures including dental, ocular, aural, nasal, and sinuses.

Two types of headaches account for the majority of headaches for which persons seek treatment. These are migraine and tension (muscle contraction) headaches.
TENSION HEADACHES
Tension (muscle contraction) Headaches may occur to some degree in about 80% of the population during periods of emotional stress. It is estimated that 7 out of 10 headaches can be classified as tension headaches.

In these headaches it is thought that stress is associated with prolonged contraction of the head and neck muscles, which over an extended time may cause constriction (tightening) of the blood vessels and result in restricted blood flow.

These headaches are usually characterized by a dull, aching pain that may spread over the head and sometimes feels like a tightening band. The head may be tender to the touch, the headache is usually on both sides of the head and is not usually associated with nausea and vomiting. Anxiety and depression are frequently associated wit tension headaches. They may be brought on by psychological pressures, posture, or a job that demands a fixed head position, or by an injury such as whiplash.
MIGRAINES
Migraine headaches may first occur at any age but are usually first seen between the ages of 10 and 30. They are most often seen in women than men. There is a family history of migraines in more than 50% of cases.

The typical or classic migraine headache is preceded by some sort of prodromal (preceding) symptoms such as changes in the field of vision, flickering before the eyes, flashes of light, or blacking out of part of the vision, depression, irritability, or restlessness. These symptoms may disappear shortly before the headache or merge into the headache symptoms. Migraines are almost always one-sided, and are frequently accompanied by nausea and vomiting and sensitivity to light. Symptoms may vary in less typical cases.

While the cause is unknown, it is generally believed that migraines are due to disturbances in the functioning of the vasomotor centers of the cerebral cortex. Apparently the blood vessels in a branch of the internal carotid artery constrict (get smaller) which leads to ischemia (poor blood flow) which is thought to cause the classic beginning signs. The external carotid arteries later dilate (get larger) causing edema (swelling) and tenderness around the artery and the typical throbbing headache.
TREATMENT
It is important to seek treatment for headaches when the headache does not disappear after the condition which you thought caused it has been corrected, or when the headache is accompanied by other symptoms such as fever, nausea, vomiting, or visual difficulties, or when the headaches occur often, are severe, or seem to be increasing in intensity, duration, or frequency.

Treatment for headaches depends on its correct diagnosis. Depending on the type of headache, relief may be obtained by over-the-counter pain relievers or by a variety of prescription medications. For chronic headaches a combination of medical and behavioral approaches is usually most effective.

Particularly for migraine and tension headaches biofeedback has proven to be very useful. In biofeedback the person is taught various relaxation and control techniques which help them to prevent or control the headache. Changes in diet can be particularly useful in treatment of migraine headaches. In some cases ice, heat, and massage can be very useful. Psychotherapy is frequently recommended to assist the individual in identifying the sources of the headaches and in controlling them.
 
 

Marital Therapy

The relationships with one's spouse and family members are among the most important in our lives. These are, however, also the relationships in which we experience the most conflict. It is estimated that conflict occurs weekly in most "normal" marriages and daily in marriages in distress.

Whether you are looking to increase your skills in conflict resolution, help your relationship to grow, to increase harmony, to enhance each partner's personal satisfaction, or are seeking to resolve long-term conflicts, marital therapy can be useful.
How do I know if we need marital therapy?
While the reasons people seek marital therapy are as varied as couples are, in general it is a good idea to seek marital therapy if conflicts are ongoing and the couple does not know how to change the situation. In addition, if most of your interaction with your spouse is hostile, or if you find that you are not able to relate to your partner with love and understanding, or if you simply want to improve the quality of your marital relationship, you will find marital therapy useful.
What happens in marital therapy?
In marital therapy first an assessment is completed by the therapist. During this evaluation, the therapist will talk to both spouses and may often ask to meet with each spouse individually. The goal of the evaluation phase of marital therapy is to identify what, if any, are the conflicts in the relationship and to identify a treatment plan. The therapist will generally explore the history of the marriage and of each individual.

After the assessment, the treatment plan is implemented. The actual therapy will vary depending on the treatment plan. In most cases the couple will meet together with the therapist and discuss strategies, conflicts, and skills needed to resolve conflicts.

Often homework assignments will be given to the couple to continue the work of the sessions outside of the psychologist's office.
How long will it take?
The length of time that marital therapy takes depends primarily on the couple and their goals. Some couples can be helped immensely by one or two visits, but for other couples marital therapy may be an ongoing process. It is important to ask about length of treatment. Many couples contract for a particular length of time and then evaluate their progress with the therapist before contracting for more sessions.
What about confidentiality?
Confidentiality is central to any form of therapy. No information about the treatment will be released without the written consent of the parties. It is important to discuss confidentiality with the therapist prior to treatment. Any exceptions to this confidentiality, such as might be required by law should be discussed.
Will marital therapy save my marriage?
Some couples only seek marital therapy after they have reached the point of no return. That is, they are both so angry and hurt that they are unwilling to open up and make the necessary effort for successful therapy. For some couples successful therapy may culminate in a more amicable divorce. In many circumstances, marital therapy can save a marriage that is moving towards divorce.
 
 

Obsessive-Compulsive Disorder

Obsessive-compulsives have confused and frustrated their families, their doctors, and themselves. Their symptoms seem bizarre at first glance. They may fear hurting relatives they actually like. They can be convinced that their spouses will have car accidents unless they tap their feet in certain "magic" patterns. Some may have to wash their hands 100 times a day to avoid feeling contaminated. Others may have to check dozens of times to make sure they locked the door. We are just beginning to understand how to make sense of these symptoms and most important, how to help people overcome them.

One feature of obsessive-compulsive disorder (OCD) is the obsession. Obsessions are persistent unwanted thoughts or feelings that OCD sufferers usually know are senseless. Common obsessions include fear of dirt or contamination (like "cooties"), fear of harming someone, fears of disasters such as houses burning down, and extreme concern with having everything in order. Obsessions tend to make a person feel more anxious.

To reduce this anxiety or distress, people with OCD get in the habit of performing compulsive rituals. They may shower for three hours to get rid of a dirty feeling. Others with OCD might drive around the block to make sure they didn't hit a pedestrian. Still others will compulsively think of a "good" number to counteract thoughts of "bad" numbers.

Researchers have looked at several factors that may be involved in causing OCD. Some have noted genetic and biological forces. OCD seems linked to an imbalance involving serotonin, a neurotransmitter that sends messages from one nerve cell to another. Psychodynamic therapists have speculated that compulsive rituals are attempts to deal with unacceptable impulses that make us feel guilty. For example, someone might be angry at their mother. If they can't accept this anger, they could become obsessively fearful of harming their mother and have to wash every time they have such scary thoughts. Cognitive therapists see OCD as an extension of irrational perfectionistic or excessively self-punishing thinking. Behaviorists point out that compulsions, such as repetitively checking to make sure the stove is really off, are reinforced when they seem to succeed at preventing the house from burning down.

While it is possible for some people with OCD symptoms to get over their problems on their own, help from therapists may be necessary for those with severe symptoms. A therapist can keep a client motivated through the harder phases of treatment, and can firmly help them face their worst fears while also showing patience and compassion. Family members may be too close to be calm and objective as helpers in the treatment process.

Mental health professionals have come up with two promising approaches to treating OCD. One approach involves medications. Several medications have been shown to relieve OCD symptoms. Behavior therapy, the second promising approach, involves work and committment by both therapist and client, but may offer more lasting results. Medications and behavior therapy are often used together.

To begin behavior therapy, the client must first identify, list, and describe in detail each of their obsessions and compulsions. Keeping a diary for a few days can help with this. This assessment should include the real-life situations that trigger obsessions; for example, driving downtown, passing pedestrians. It should also include the disasters that the client fears; for example, being found guilty of hit-and-run after running over a pedestrian.

Behavior therapists plan methods of exposing obsessive-compulsive clients to the situations they fear. This can be done in real life and by using imagination. Real life exposure techniques for a compulsive washer might include purposefully rubbing dirt or other relevant "contaminating" substances on the client's hands. For a checker, real life exposure might involve forcing himself to leave the house without checking the door lock, and staying out of the house for a long period of time. Bydirectly facing these situations, the client learns that their anxiety or distress only lasts a finite length of time and then is lessened to a tolerable level. This process, called habituation or extinction by behaviorists, is similar to how we tend to adapt to initially bothersome sounds, like a highway near our home, until we hardly notice them.

Imagination can help the obsessive-compulsive client get over their fear that something terrible will happen unless they engage in compulsive rituals. The client in behavior therapy is guided to imagine being in an anxiety-producing situation, and having their worst fear come true. Someone who compulsively hoards empty containers would imagine having thrown away all their boxes and jars, encountering a situation in which they needed one, feeling upset with themselves for not having it, and hearing others criticize them for having thrown it away. This imaginal exposure helps them realize that their fears are irrational. With prolonged focusing on their "disastrous" images, the client's anxiety drops or extinguishes.

While the client is exposing himself to what he has feared, he must also stop himself from using any compulsive rituals. As long as the client clings to these rituals, he cannot learn that the anxiety-producing situations are harmless. A compulsive washer might have to limit his showers to once a week or wash hands just once a day to stop the compulsive ritual habit. The compulsive secretary who takes 30 minutes to make sure that the typewriter has been turned off must leave work promptly without any checking.

The medications that seem most effective in controlling OCD symptoms are drugs that are also used as anti-depressants. Anafranil (clomipamine) has received the most favorable reviews in research. Prozac (fluoxetine) has also helped many people get over OCD, sometimes with fewer side effects. Fluvoxamine and sertraline, newer drugs that also act on the serotonin neurotransmitter system, offer promise as well. All these medications may take several weeks to have an impact. One way they can help is by lowering obsessive anxiety enough to allow the client to engage in the sometimes difficult exposure techniques used in behavior therapy.

It's hard to overcome OCD by yourself. Family and friends can help a lot, if they know how. They should be non-judgmental and should never force the OCD client to do anything they feel unready to face. They should be firm in preventing compulsive rituals, but caring in reassuring clients that they will be all right even without their rituals.
 
 

Effective Therapy for Severe Anxiety Disorders

Severe anxiety disorders have never been more treatable. Physicians are routinely prescribing several anti-depressant medications that can make it easier for phobics, panic-disordered clients, and obsessive-compulsives to overcome disorders that had drastically restricted their lives for years. Cognitive behavior therapists are also finding more success than ever in working with these problems, as they refine a variety of useful methods.

These more effective treatments are arising from our increasing understanding of the origins of anxiety disorders. While we have always perceived anxious clients as emotionally or interpersonally over-sensitive, we are now realizing that some of those with panic and obsessive-compulsive disorders may be physiologically over-sensitive. They seem to have neurotransmitter system imbalances that predispose them to react to stress in an extreme manner. Anti-depressant medications may act to correct these imbalances.

We are also understanding more about how children may learn to play roles in their families that lead to anxiety disorders in their adult years. Overprotected children come to see themselves as fragile. They won't feel confident of their ability to handle intense emotion or anxiety, and may fear that a psychotic break, a heart attack, or a fainting spell will result from having these feelings. In dysfunctional families with alcoholic, physically ill, or emotionally unstable parents, children will understandably worry a great deal about their safety, but will try to avoid showing this anxiety for fear of further alienating their caretakers. This style of hiding your anxiety can produce a panic disorder in which you fear and avoid any situation that might lead you to be noticed as anxious. Compulsive washers may have been raised in shame-inducing families that left them feeling dirty, and compulsive checkers can sometimes recall growing up with a fear of making mistakes.

Seen from a broader perspective, anxiety disorders tell us that our traditional stereotypical gender roles can be unhealthy. The housebound agoraphobic woman can be understood as on strike, remaining safe at home (a woman's place), while refusing to venture out into the man's world outside. Panic-prone men often fear showing any emotion or sign of anxiety that would not fit with the traditional strong and silent male role.

While behavior therapy has achieved a reputation for effectiveness in treating anxiety disorders, most practical therapists have learned to combine behavioral techniques with other approaches. Systematic desensitization, the standard behavioral treatment for phobias, involves applying relaxation skills to feared situations. The client learns to relax, and then tries to maintain a relaxed state while imagining anxiety-provoking situations. Influenced by hypnosis, many therapists are finding that images of competence or of being loved by kind caretakers may be more effective than a relaxed state in countering anxiety for some phobics.

Another effective imagery technique is imaginal exposure, in which anxious clients are guided to vividly face intense feelings or situations that have triggered their fear of losing control. An obsessive-compulsive might be led through a prolonged session imagining being harshly criticized for making a mistake. Surviving this type of session can lead clients to gain comfort with feelings (such as anger) that they have feared. Adding elements of gestalt therapy and psychodrama, an imaginal exposure session can flow naturally into an opportunity for anxious clients to express long-denied or avoided emotions.

To be completely successful, any treatment of an anxiety disorder must include in vivo exposure. Agoraphobics who have feared highway driving must drive previously avoided roads before they'll feel sure that they have overcome their problem. For the obsessive-compulsive who has had to shower for hours before feeling clean enough to go out, treatment must include brief showers followed by normal socializing and activity. Therapists have discovered that in vivo behavioral techniques may lead previously "resistant" clients to develop greater insight into the psychological roots of their problems. An example is the agoraphobic client who after being pushed to drive outside her neighborhood for the first time in years, can sit in the car and clearly recall how she learned in childhood to stay home and protect her mother from an abusive father.

Clients presenting severe anxiety disorders have often lived restricted lives for years before coming to a therapist. While behavioral or experiential techniques may dislodge the phobia or compulsive habit relatively quickly, the client may still be left with lingering problems such as depression or the need for families to reorganize to fit the client's new competence. These problems can require a great deal of patience and time for therapist and client.
 
 

Sleep Disorders

One third of all adult Americans, that is approximately 50 million people, complain about their sleep. Some complain that they sleep too little, some sleep fitfully, and some sleep too much. Since one third of our lives are spent in sleep, sleep disorders represent a significant problem.
How long do we need to sleep?
Most adults sleep between 7 and 8 hours a night. No one really knows how much sleep we need. People who are "natural short sleepers" may sleep only 3 to 4 hours a night and feel worse if they sleep any more. "Long sleepers" may need more than 10 hours a night. "Variable sleepers" may need more sleep at times of stress and less sleep during peaceful times.

The amount of sleep we need is often effected by age. Newborn infants often sleep more than 16 hours a day, adolescents may need 9 to 10 hours of sleep, and elderly people may need only 5.
How do I know how much sleep I need?
You should feel sleepy about the same time each day. If you find that you are frequently having trouble staying awake during the daytime, you may not be sleeping long enough. You are sleeping as much as you need if during your waking hours you are alert and have a sense of well-being.
What is Insomnia?
Insomnia is a symptom, not an illness. Insomnia is the most common sleep complaint and is characterized as the feeling that you haven't slept well enough or long enough. Most often, insomnia is charac-terized by difficulty in falling asleep, that is taking more than 30 or 40 minutes to fall asleep. Insomnia can also be characterized as awakening frequently during the night or waking up early and being unable to get back to sleep.

Poor sleep is often a sign of some malfunction, and it may signal either a major or minor medical or psychiatric disorder.

Insomnia can begin at any age and may last anywhere from a few days to indefinitely.
What causes insomnia?
Transient, or short-term insomnia, may be triggered by such things as stress, or by jet travel that involves rapid time-zone changes. Short-term insomnia, which lasts up to 3 weeks, may result from anxiety, nervousness, and physical and mental tension. Long lasting distress over lack of sleep is sometimes caused by the environment, such as living near an airport or on a noisy street. Working a night shift can also cause problems, but most often long-term insomnia stems from such medical conditions as heart disease, arthritis, diabetes, asthma, chronic sinusitis, epilepsy, or ulcers. Long-term impaired sleep can also be brought on by chronic drug or alcohol use, as well as by excessive use of beverages containing caffeine and abuse of sleeping pills. Many persons with long-term insomnia may also be suffering with underlying psychiatric conditions such as depression.
Do sleeping pills help?
Taken for a brief period and under a doctor's guidance, prescription sleeping pills may help you sleep better, but insomnia cannot be corrected with pills. At best, sleeping pills have only limited usefulness. They provide a temporary solution to insomnia.
What other sleep disorders are there?
SNORING
Snoring is a sign of impaired breathing during sleep. The older you get, the more apt you are to snore. Almost 60 percent of males in their 60's and 45 percent of females are habitual snorers, in all, 1 in 8 Americans. Snoring that is loud, disruptive and accompanied by extreme daytime sleepiness or sleep attacks should be taken seriously. It may be a sign that a person is suffering from a life threatening condition called sleep apnea, a blockage of breathing during sleep.
SLEEP APNEA
Sleep apnea was discovered only recently. It is believed to affect at least 1 out of every 200 Americans. Seventy to 90 percent of those affected are men, mostly middle aged and usually overweight. The condition can afflict both men and women at any age. People with this disorder actually stop breathing while asleep, often hundreds of times, without being aware of the problem. During an apnea attack, the snorer may seem to gasp for breath when the oxygen level in the blood may become abnormally low. In severe cases, a sleep apnea victim may actually spend more time not breathing than breathing and may be at a risk for death.

Sleep apnea can be recognized by a number of symptoms. As mentioned, loud and intermittent snoring is one warning signal. A person who has sleep apnea may experience a choking sensation, early morning headaches, or extreme daytime sleepiness as well. His bed partner or roommate might comment on his excessive body movements or his snorting or gasping for breath during sleep. If the condition is suspected, professional help should be sought.
NARCOLEPSY
One out of every 100 Americans is affected by narcolepsy. Between 50 to 80 percent of those people remain undiagnosed, however. People with narcolepsy suffer from sleep apnea more often than the general population, although apnea is not a necessary feature of narcolepsy. During a narcoleptic attack, a person may find it physically impossible to stay awake and sleep for periods ranging from a few seconds to half an hour. Sudden attacks of sleep can strike at any time during any activity. Narcolepsy, which is believed to be caused by a defect in the central nervous system, has no known cure, however, after proper diagnosis the disorder can be effectively managed with medications.
NOCTURNAL MYOCLONUS (Unusual movement during sleep)
Nocturnal myoclonus is characterized by episodes of repetitive leg muscle jerks or muscle twitches and is followed throughout the night by hundreds of related awakenings and may involve involuntary movements. People with nocturnal myoclonus may have involuntary movement in their leg in addition to twitches while trying to relax. It's most common in middle aged or older people and may be inherited. Often a bed partner or roommate must call attention to the characteristic repeated muscle jerks in which the big toe extends while the ankle, knee, and occasionally the hip locks. Upon awakening, some people with nocturnal myoclonus complain of an itching, crawling sensation in their legs like "current going through them".
What kinds of treatments are available for sleep disorders?
If your sleep is continually disrupted, you should seek professional help. There are a number of treatments available for sleep disorders, once a disorder is appropriately diagnosed. Treatment is most often provided by mental health specialists such as psychologists or psychiatrists, sleep clinics or sleep disorder centers. Generally, sleep clinics are set up as part of hospitals and sleep disorder centers may be associated with hospitals, medical centers, universities, or neurologic institutes. Special sleep facilities are scattered throughout the country. Your psychologist, physician, or local hospital should be able to help you locate the nearest sleep clinic or center.
Where can I get more information?
You can write to:
 
The Association of Professional Sleep Society
604 2nd Street SW
Rochester, MN 55902
 
The American Narcolepsy Association
P.O. Box 1187
San Carlos, CA 94070
 
Narcolepsy Network
155 Van Brackle Rd.
Aberdeen, NJ 07747
 
 
 

Choosing a Therapist

What kinds of professionals provide psychotherapy and mental health services?
 
Psychologists
While the field of psychology includes many specialties, those psychologists who conduct psychotherapy and work with individuals, groups, or families to ... Read more
 
Psychiatrists
A psychiatrist is a medical doctor who is licensed to practice medicine and has completed specialty training in psychiatry.
 
Social Workers
A social worker has a master's degree in social work and has completed field placement programs designed to train them in basic techniques.
 
Psychiatric Nurses
Psychiatric nurses are registered nurses who have advanced academic degrees at the master's degree level or above. They have specialized training in prevention, treatment and rehabilitation of mental health related problems.
 
Mental Health Counselors
In some states mental health counselors also use other titles such as licensed professional counselors. They have at least a master's degree and several years of clinical supervision.
 
Psychotherapists
Psychotherapist is a term used to refer to mental health professionals who treat patients. Some people who call themselves psychotherapists do not have adequate training. If you doubt the credentials of a therapist, check with state licensing agencies.
 
How do I get the name of a good therapist?
Professional associations usually have state or local chapters which can help in finding an appropriate professional in the community. Mental health associations provide information about mental health resources available in your community. You may also want to ask for a referral from a trusted professional or friend. Ministers and school counselors are also often good sources for referrals. You may also look in the yellow pages of your local telephone book under Psychologists, Physicians, Social Workers, Marriage, Family, and Individual Counselors.

In an emergency situation (e.g. suicidal threat, violent behavior), call the police, or an ambulance to get to a hospital. You can also contact a mental health hotline or a suicide prevention center.
How do I tell if the person I have chosen can help me?
Effectiveness depends on you and the therapist. It's important to share your concerns in a serious, sincere, and open manner. There are times when you may not "click" with a particular person and someone else or some other method may be more suitable for you.

You need to ask questions of the potential therapist. Remember when you are seeking psychotherapy you need to act as an informed consumer. It is alright to ask about training and experience. Ask the therapist how many people they have treated with the same or similar concerns. Ask them about success rates. You should expect that the therapist can provide you with a reasonable plan of treatment that you can understand.

If you do not feel like there is a good fit between you and the therapist you have chosen, you can ask your therapist for a referral to another mental health professional.
What about confidentiality?
Confidentiality is basic to therapy and the patient has the right to control access to information about treatment. Some insurance companies require certain information from the therapist as a condition of payment - but that information still can only be released if the patient gives written permission. You should expect your therapist to explain the confidentiality of the treatment to you.
What if I do not have adequate personal finances, medical insurance, or hospital coverage?
In such circumstances you may want to contact your publicly funded mental health center. Such centers are funded by state and local governments and the costs of treatment are generally calculated by what you can afford to pay.
Where can I get more information?
 
National Mental Health Association, Inc.
1021 Prince Street
Alexandria, VA 22314-2932
 
National Alliance for the Mentally Ill
1901 North Fort Myer Drive, Suite 500
Arlington, VA 22209
 
Public Inquiries, Room 15C05
Office of Scientific Information
National Institute of Mental Health
5600 Fishers Lane
Rockville, MD 20857
 
 
For psychologists:
American Psychological Association
1200 17th Street, NW
Washington, DC 20036
(202) 955-7600
 
For social workers:
National Association of Social Workers
7981 Eastern Avenue
Silver Spring, MD 20910
(301) 565-0333
 
For psychiatrists:
American Psychiatric Association
1400 K Street, 20005
Washington, DC 20036
(202) 682-6000
 
For mental health counselors:
American Mental Health Counselors Association
5999 Stevenson Avenue
Alexandria, VA 22304
(703) 823-9800, Ext. 383
1-800-354-2008
 
For psychiatric nurses:
American Nurses' Association
2420 Pershing Road
Kansas City, MO 64108
(816) 474-5720