TREATED ISSUES
ANXIETY: CAUSES, SYMPTOMS AND TREATMENT
Anxiety is a natural and healthy reaction that emerges when we are faced with a danger. When we are afraid, our organism carries out a series of reactions (physical, mental, behavioral) which have the purpose of protecting us and therefore of surviving. The problem arises when our body prepares to face a danger that does not exist or that is perceived as greater than what it actually is. It is as if we react but out of context. When this happens, anxiety can limit our daily life, it can put a strain on our relationships, our work and even on our free time. I will never get tired of stressing, that excessive anxiety can be cured, in a short time, with sessions of psychotherapy. But what are the causes, symptoms and treatment of excessive anxiety? Let's look at them together.
CAUSES
Hereditary factors:
Some genetic studies have shown that, in about 50% of cases, people with anxiety have at least one family member suffering from a similar condition.
Biological factors:
Human brain studies have found that anxiety could be caused by alterations in the amount of some neurotransmitters. Excessive production of norepinephrine (stress hormone) and low production of serotonin (feel-good hormone) and GABA (inhibitory neurotransmitter) have been found.
Psychological Factors:
According to some studies, the psychological mechanisms of anxiety could derive from our style of interpreting stressful events. In particular, anxiety is accentuated when we have a cognitive model that makes us feel situations beyond our control.
Other scholars think that the quality of relationships established in childhood (child-parent) can influence the presence of pathological anxiety in adulthood.
A third view finds its basis in the psychoanalytic model. Anxiety is seen as an internal conflict that is kept at bay by defenses such as avoidance, displacement and repression.
SYMPTOMS
General:
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sense of fear and imminent danger
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fear of dying or losing control or going insane
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inability to relax
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apprehension
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hypervigilance
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restlessness
Psychological:
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excessive preoccupation with secondary issues
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tendency to catastrophism
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irritability and impatience
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difficulty concentrating and poor attention
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feeling of loss of one's own person
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memory impairment
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sleep disorders
Physical:
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difficulty in breathing
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chest tightness
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rapid breathing
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feeling of suffocation
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sense of light-headedness
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dizziness, imbalance
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fainting
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tingling
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hot or cold flashes
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rapid heartbeat
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sense of weakness and fatigue
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muscle tension, excessive sweating
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diarrhea and vomiting
TREATMENT
When a patient with anxiety arrives, the first aspect I evaluate is the level of functioning. If the functioning is seriously compromised (perhaps the person is so anxious that he/she cannot come to therapy) then I take into consideration a pharmaceutical support. This rarely happens but sometimes it is necessary. Medicines, in my opinion, are like a plaster that is used immediately to cure the wound but which must be removed quickly to allow the wound to heal.
Once an initial evaluation has been made, we set goals for our journey together.
During the first sessions I provide practical help on how to manage anxiety (breathing techniques, distraction, relaxation techniques, nutrition, etc.). Once the symptoms have been kept at bay, if desired, in the following sessions we try to understand if there are reasons for anxiety in the patient's life. I do this in a situation of safety and relaxation within the therapeutic relationship. The goal is to understand the origins and meanings of one's symptoms and behaviors and therefore be able to keep them under control.
I n particular:
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I observe and connect feelings, thoughts and behaviors.
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I gently point to something the patient does not want to accept or cannot see.
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help put into words things that are difficult to say.
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I encourage to elaborate, with open questions, information on a topic introduced by the patient.
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I empathize with the patient's emotions.
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I value and praise the patient's resources.
If we see anxiety as a state of dispersion where the person's contours are pitted, part of the job is to redesign and then strengthen this contour so that the anxiety can be contained.
The final purpose is to bring out everything that represents the uniqueness of the person and his unrepeatability. I support my patients throughout the journey, not replacing them in the search for solutions, but helping them to find within themselves the necessary tools to build their own psychological and emotional well-being in the relationship with themselves and with others.
OBSESSIVE DISORDERS: CAUSES, SYMPTOMS AND TREATMENT
What I consider as obsessive disorders are all those situations where the person has ideas, thoughts, images or recurring stimuli (obsessions) that trigger a state of anxiety and where, in some cases, to allay this anxiety, people have an urgent need to do something (compulsions). When I refer to obsessive disorders I also include those circumstances where there is only the presence of intrusive thoughts that automatically come to occupy a large part of the mind and of which the person does not have control. Let's see the causes, symptoms and treatment.
CAUSES
Hereditary factors:
Studies carried out on twins have shown that obsessive disorders could have a genetic basis. Studies done on families of patients have shown that family members have 3 to 12 times more chances of developing an obsessive disorder.
Biological factors:
Studies on neurotransmitters (of patients with obsessive disorders) have found that one of the neuromoderators is compromised (the one that has to do with serotonin), and this could create a predisposition to obsessive disorders.
Psychological factors:
A behavioral theory thinks that by chance a neutral stimulus (such as touching a handle) can be associated with the fear of getting sick. Once this association has been established, the individual can realize that the anxiety deriving from touching the handle can be reduced by washing the hands. If this continues over time there could be an onset of the disorder.
Another theory speculates that the cause of obsessive thoughts is related to the way people relate to their thoughts. These people would be too worried about the nature of their thoughts. They struggle to see the difference between thinking about a thing and actually doing it.
Psychodynamic psychology argues that an exaggerated sense of responsibility and a marked fear of guilt could give way to obsessive disorders. It has been observed that some characteristics present in the parents of these patients could favor the onset of obsessive disorders. For example, the lack of spontaneity and emotional expression of parents, excessive indulgence in the first years of life and the high moral standards, unrealistic demands for maturity and responsibility, inhibition of the expression of emotions, over-control and excessive demands, use of punishments to name some.
SYMPTOMS
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anxiety
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tendency to order and organization through the use of lists, schemes and programs
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attention to detail
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perfectionism
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guilt when the person believes that they have not met their work or ethical standards, when they believe they have behaved irresponsibly or think they have done wrong or caused harm to other people
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difficulty completing tasks or making decisions
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liabilities
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control
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rigidity
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dedication to work and productivity
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conscientiousness, scrupulousness and inflexibility in terms of morality and ethics
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inability to throw objects
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reluctance to delegate and collaborate
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avarice
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difficulty expressing emotions and moods
TREATMENT
When an individual arrives with obsessive symptoms, I evaluate the level of functioning, that is, how much the symptoms are damaging the person's daily life (work, relationships, etc.). I then take into consideration the time factor (how long) the person has been having the symptoms to assess whether the malaise has become chronic or not. Finally we outline the goals for our journey together. Once this is done, if the symptoms are severe, I evaluate the need for pharmacological support which is a useful plaster that stems but doesn't cure.
If the symptoms are somewhat manageable I provide practical methods to deal with them (distraction, exposure, etc.). I also use the therapeutic relationship as a starting point, to investigate why the individual is experiencing such symptoms, how to manage them and prevent any bad relapses.
Some recurring themes, which I notice in my patients, are:
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the rigidity of the style of thinking
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the distortion of the experience of autonomy
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the loss of reality.
Discussing these topics can help to modify or / and smooth out those aspects that have favored the onset and maintenance of obsessive disorders.
HYPOCHONDRIA: CAUSES, SYMPTOMS AND TREATMENT
Hypochondria is a disorder characterized by the obsessive and completely unfounded worry of having a serious illness. People with hypochondria misinterpret physical symptoms, seen as signs of serious illness, without a medical justification. There is a close link between anxiety and hypochondria. Anxiety disorders cause a sense of unease, similar to uncontrollable and long-lasting fear or worry. Hypochondria is analogous to anxiety in that it is a health anxiety.
CAUSES
The precise causes are currently unclear. I share what we know.
Some psychologists have observed that patients with hypochondria have a frail, vulnerable, and weak self-image with reduced immune defenses. On this belief the hypochondriac builds a sense of his own identity. It was also observed how this self-image could originate in the relationship with one's parents during childhood. For example, patients with hypochondria may have had a parent who reflected weakness and gave explicit messages and overprotective attitudes.
According to other psychologists, the body has a role of a point of contact with the outside world, so the fragility of the body would be directly connected with the mental fragility of the individual.
Furthermore, hypochondria is often accompanied by the fear of death, an ancient fear shared by all humanity that the patient would try to control through continuous medical examinations to reassure himself and to remove the fantasies concerning his own vulnerability.
RISK FACTORS
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Having suffered, in adolescence, from a very serious illness, which left an indelible mark on the person's mind.
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The acquaintance of individuals (friends / family) with serious pathologies.
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The death of a loved one.
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Suffering from anxiety.
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Being convinced that being well means not having any physical discomfort.
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Living with a family member with hypochondria.
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Parental neglect in adolescence.
SYMPTOMS
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Unmotivated fear of having a serious illness.
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Conviction that every little physical discomfort is due to a serious illness.
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Book visits and periodically undergo magnetic resonances, echocardiograms etc.
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Talk to relatives and friends only and exclusively about the imaginary illnesses you think you have.
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Do ongoing research on serious diseases.
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Continuously measure your pulse and blood pressure.
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Read about a serious illness and convince yourself that you suffer from it.
TREATMENT
Part of the work with hypochondria is teaching individuals to:
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recognize unfounded concerns and fears and not be swayed by them.
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replace the idea that the symptoms experienced are generated by a serious illness, building an alternative hypothesis that is more adequate and closer to reality.
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identify the mechanisms of maintenance of the disorder in order to modify them.
Another important aspect of therapy with hypochondriac patients is, not so much to reassure them that they will not contract new diseases, but to invite them to become aware of the inevitability of these events. I think that only through the acceptance of our destiny as living beings (no one is omnipotent!) Can we return to understand and appreciate life as a whole.
I also provide practical tools to control the anxiety that comes from the thought of having contracted an illness (distraction, breathing, etc.).
Common mechanisms in hypochondriacal patients are:
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selective attention (attention to one's body),
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reasoning dysfunctions (devaluing the importance and truthfulness of medical results)
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the tendency to avoid situations that could expose to contracting diseases,
Part of the work is focused on healing the body-mind circuit. Sometimes an excessive attention to the body can express a desire for self-knowledge. For this I help patients to shift the attention from the physical to the psychic one.
We consider the symptoms that run through our body, not as fatal events, but as signs of life. A life to change or renew where the stressful hypochondriac condition will no longer be needed.
DEPRESSION: CAUSES, SYMPTOMS AND TREATMENT
Depression is a psychiatric condition that can affect people of all ages. It has both psychological and physical symptoms. It is good to distinguish between the various forms of depression in order to set up the most appropriate treatment plan. The different forms of depression are: major depression, dysthymic disorder, and bipolar disorder. Let's see what the causes may be.
CAUSES
Genetic factors : There is a lot of empirical evidence that proves the important hereditary component in depression. In short, some people are born with a greater genetic predisposition towards depression.
Biological factors : Depression results from an alteration in the function of monoaminergic systems (noradrenaline, serotonin). Because of this, a whole range of functions are impaired such as mood modulation, affect regulation, control of certain cognitive functions, sleep and appetite regulation, and motivation.
Psychological factors : The stressful events that favor the onset of depression are experienced by the person as irreversible, irreparable and as total losses. Some of these can be:
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physical illnesses
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marital separations
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difficulties in family relationships
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severe conflicts with other people
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major changes (home, work, role)
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layoffs
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business or economic failures
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be the victim of a crime or abuse
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mourning
People with depression feel unable to cope with situations and feel inferior to others and therefore see themselves as incapable of all existence (past, present and future).
SYMPTOMS
Somatic :
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loss of energy
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difficulty concentrating
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agitation and nervousness
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lack or increased appetite
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absence of sexual desire
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physical pains
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nausea
Emotional :
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low self-esteem
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sadness
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anguish
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despair
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sense of guilt
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emptiness
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lack of hope in the future
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loss of interest
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irritability and anxiety
Behavioral:
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reduction of daily activities
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avoidance of people and social isolation
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passive behaviors
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reduction of sexual activity
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suicide attempts
Cognitive :
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ideational slowdown
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inability to make decisions
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impaired concentration and memory
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depressive rumination
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negative thoughts about yourself, the world and the future
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ideas of guilt, unworthiness
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self-depreciation
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self-pity
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altered perception of time
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perception of the current state of mind as an endless condition
TREATMENT
When dealing with depressed patients the first thing I do is to carefully evaluate the patient's functions. Does he take care of himself on a physical level (does he wash, comb his hair, etc.)? Can she get out of bed in the morning? Does he have any ideas about harming himself? After an initial evaluation, if the functions are seriously compromised, I evaluate if a drug treatment is needed. Remember that drugs are like a band-aid. They patch the wound but do not heal the scar.
The next step is to outline goals. Some goals may have to do with improving the way you feel, improving your interpersonal relationships, helping you cope with stress, and getting through painful times. Part of the work together will be to become more aware of the internal mechanisms that could create suffering. As you become more aware of your internal workings, you will learn to recognize the patterns that affect you and you will be able to learn new ways of thinking about yourself, your relationships and your problems.
Psychodynamic psychotherapy is often needed to provide understanding of certain internal factors that have caused depression, facilitating this process of growth and awareness. The therapy not only helps resolve depressive episodes, it also helps patients live a freer and more vibrant life.
RELATIONAL DIFFICULTIES: CAUSES, SYMPTOMS AND TREATMENT
When I talk about relationship difficulties I mean all those problems (often repeated) that I encounter in my intimate relationships with friends, relatives, boyfriends, etc. Am I too detached? Am I ambivalent? Do I ignore or am I too attached? I am anxious? Each of us knows more or less what kind of bond he is able to establish with the surrounding people. Sometimes it is very frustrating to always find ourselves with the same problems (betrayal, jealousy, etc.) and not being able to find a solution to break the cycle. We see these problems evolving before our eyes and we don't know how to change them. This is where psychodynamic psychotherapy can really help. Psychodynamic psychotherapy helps to heal and repair the very mechanisms that keep us trapped in unsatisfactory and painful relationships. What could be the causes of these relationship difficulties?
CAUSES
Relationships start from the first moment we come into the world. When we are children, our most significant relationships are usually with mom or dad. If a brother or sister is born, we begin to broaden the circle, and then move on to friends, to 'school' and so on. In short, we live in a world of relationships. Relationship with ourselves, with others, with objects, with animals, with nature and with the world. It is for this reason that having a rich and satisfying ability to relate becomes fundamental for our psychophysical well-being.
Many scholars affirm that relational difficulties begin to structure themselves in the first three years of life with the first separations from the mother (or from other significant figures). The reactions we have to these early separations (determined by the type of relationship between parent and child) are defined as attachment behaviors. It is now recognized that the attachment style acquired in childhood also accompanies us in our adult relationships. I want to clarify that the attachment patterns acquired in childhood can be repaired and therefore modified.
The causes may be related to:
parents : abuse, neglect, depression (or other psychiatric pathologies), addictions
baby : difficulty in temperament, premature birth, or prenatal or perinatal problems
environment : marginalization, poverty, poor living conditions, abuse, violence, aggression
The result is that attachment styles can be safe or insecure. Among those insecure we find the avoidant, the disorganized and the ambivalent. Each of these styles has particular characteristics which are now well confirmed by scientific research.
For example, dysfunctional and not elaborated or correct attachment patterns can lead to poor sentimental choices. In the case of emotional dependence, the style found is the ambivalent insecure one (sense of self undeserving of love, sees the other as unreliable, fear of abandonment, controlling behaviors, continuous search for reassurance, emotional hypervigilance).
Let's see some symptoms together to get an idea.
SYMPTOMS
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Inability to express emotions adequately
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insecurity in relationships with others
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excessive restlessness
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apathy
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aggression as a response to frustrations
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jealousy
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difficulty in comparison
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difficulty in questioning oneself
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avoiding responsibilities towards other people
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deny aspects of reality
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do not leave the comfort zone
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feeling judged, misunderstood, under pressure
EXAMPLES OF ATTACHMENT IN ADULT AGE
Secure Attachment: Secure love
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recognizes the people to bond with
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works alongside people who clearly demonstrate their feelings
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shares joy and sadness in a communicative way
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creates non-obsessive bonds of love, based on mutual trust
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use of partner as a secure base to depend on without feeling limited
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in times of crisis, the ability to seek more suitable methods for overcoming these
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usually has stable and lasting relationships
Anxious Attachment: Obsessive love
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gets carried away by passion (every encounter is lived as "I found the right person")
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idealizes people who have traits that the individual hates
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realizes mistakes in evaluating the other
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when positive self-models prevail, the individual feels loved and respected by his partner
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when negative self-models prevail, the person feels vulnerable, unworthy of love
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drawn into the vortex of jealousy becoming obsessive, possessive and authoritarian
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violent reactions
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remains constantly in the phase of falling in love
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gets anxious when he has to separate from her partner
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recognizes love only if it is overwhelming, illusory and dramatic
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afraid of being abandoned
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needs constant confirmation
Avoidant Attachment: Cold and detached love
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think they are unworthy of being loved
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feel they can only rely on themselves
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afraid of being emotionally involved
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idea that life is based on the desire to conquer autonomy and self-sufficiency
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excludes the other (considers him unreliable, someone you cannot count on)
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does not tolerate feeling rejected and therefore suppresses his emotions
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the ability to love and be loved is constantly blocked by the fear of encountering the suffering of childhood in life
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prefers superficial relationships
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does not seek intimacy
Disorganized Love: Pathological love
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distorts interpretations of reality
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has a catastrophic vision
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inability to choose reliable partners
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gets involved in destructive and violent relationships
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creates toxic bonds
TREATMENT
When dealing with patients who have relationship difficulties, I am aware that our therapeutic relationship will be the basis of therapy and therefore of healing. It is precisely in the therapeutic relationship that the patient will have an emotionally restorative experience. It is through the therapeutic relationship that he will be accepted, not judged, supported, comforted and helped to manage his difficulties.
The individual will be offered ways (other than those known) in which he can feel seen, protected and learn to feel competent in expressing his emotions and in making specific choices for his own well-being.
I always feel very responsible for the well-being of my patients. With those who have relationship difficulties ... a little more, because I am aware of the importance that our therapeutic alliance will have on the success of our journey together. And in that relationship I am there with my whole being.
Through psychotherapy it is possible to aim at improving the awareness of one's resources to intensify the sense of effectiveness and autonomy. You will be able to work on the defensive aspects, understand their specific meaning based on family history and the style of attachment with parental figures. In short, a journey that repairs and frees.
Dysfunctional and unprocessed attachment patterns can lead to poor sentimental choices. Interesting to observe that In cases of emotional dependency, the attachment style is the ambivalent /insecure one.
Attachment allows detachment, addiction prevents it.