Treatments and Conditions Glossary
Adjustment Disorder
An adjustment disorder is a debilitating reaction to a stressful event or situation, leading to problems in a person’s social, occupational, or educational lives. It usually occurs within three months of the stressful situation.
An adjustment disorder occurs when a person feels overwhelmed by the demands of a stressful situation. This can be a single event such as a road traffic accident, it can be ongoing such as pressures at work, or it can be chronic such as a child living with parents who are constantly in conflict.
There are many sub types including adjustments disorders with:
• Depressed mood
• Anxiety
• Mixed anxiety and depressed mood
• Unhelpful behavior which leads to relationship problems
• Employment problems, physical complaints, social withdrawal
• Chronic pain without obvious organic cause which nevertheless affects the person’s life
Adjustment disorders are different from PSTD (Post Traumatic Stress Disorder). The latter only occurs after a life threatening event and can last longer.
Psychological therapy with or without non-habit forming anti-depressant treatment is recommended for adjustment disorder. Treatment is likely to include cognitive behaviour therapy (CBT) or EMDR, relaxation and mindfulness strategies and help with structuring daily activities, problems at work or any other difficulties the person struggles with.
In cases where the stressful event is chronic and involves other members of the family, they may also be involved in some therapy sessions when the patient/client gives permission for that to happen.
Anxiety
Anxiety can be defined as a normal short term reaction of heightened arousal to perceived threat or danger. When a person is anxious they have feelings of fear, panic, and apprehension. They may also experience unpleasant physical sensations such as palpitations, sweating, a rapid heart rate, chest pain, faintness, dizziness and an increase in muscular tension.
These physical symptoms are partly caused when the person’s perception of danger triggers the “fight or flight” survival response. Stress hormones such as adrenaline is released into the blood stream which helps the heart, lungs and other parts of the body work harder to prepare for action.
Anxiety can become problematic if it continues in the absence of a stressful situation for no apparent reason, if it leads to avoidance of activities so as to try and get rid of the anxiety, or if it persists over time.
Anxiety can be classified as follows, depending on the type of symptoms:
• Panic disorder with agoraphobia (When anxiety is so acute, for example hyperventilation, that the person misinterprets their symptoms and thinks they are having a heart attack. Or the person fears the anxiety so much that they withdraw from the outside world and prefer to remain at home)
• Phobias (such as travel anxiety or travel phobia)
• Generalised anxiety disorder (Doing a lot of worrying and expecting the worst to happen most of the time)
• Obsessive compulsive disorder (Checking repeatedly that the door has been locked, not getting rid of repetitive thoughts or fears, compulsive hand washing etc.)
Anxiety responds well to CBT and, if it is a symptom of PTSD, to EMDR.
Chronic Pain
Chronic pain can be defined as pain that lasts for more than three months despite medical intervention and treatment.
There is now widespread acceptance that the body and mind work very closely together and that the experience of physical pain cannot be separated from emotions, thoughts and behaviour.
Pain is influenced by our thoughts and behaviour, and in turn influences emotion and behaviour. Low mood and anxiety serves to heighten pain, completing a vicious circle of pain and emotion.
Referral for psychological treatment when suffering from chronic pain is not an indication that pain is "in the imagination". It provides a holistic approach, treating the whole person rather than the symptom alone. Such treatment is meant to help the person manage their pain in ways which will help them lead as normal a life as possible.
Depression
Depression is the "common cold" of emotional problems. 25% of women and 12% of men will suffer a major depressive episode during their lifetime. Less serious depressive episodes (mild or moderate depression) are even more common. It involves a number of different symptoms such as loss of energy, loss of interest in activities and in life, sadness, loss of appetite, increase or decrease of weight, difficulty concentrating, self criticism, feelings of hopelessness and withdrawal from other people, irritability, indecisiveness, and sometimes suicidal thinking. Many people who are depressed also experience symptoms of anxiety.
Clinical depression can vary from mild to severe. Not all individuals experience all the symptoms of depression and at the same intensity.
A number of different factors can cause depression. These can be biochemical, interpersonal, behavioural or cognitive (thought-based). Therefore depression may run in a person's family or it may result from conflict or loss, long term stress or negative thinking styles.
Depressed people tend to engage in fewer activities and often become inactive. Thus they miss out on rewarding behaviour or activities that give them pleasure. Sometimes people get depressed because they have difficulty asserting themselves, solving problems or dealing with new demands. Feeling out of control is another trigger for depression.
CBT is a very effective treatment for depression. If depression is severe, people often “self treat” by using alcohol or recreational drugs. In fact, anti-depressant medication prescribed by a consultant psychiatrist or a general practitioner is not addictive and less harmful than either alcohol or recreational drugs.
Generalised Anxiety Disorder (GAD)
Generalised Anxiety Disorder (GAD) is found in 3-5% of the general population. It is often difficult to diagnose as symptoms are so common. Nearly everybody worries and some people find this can be difficult to control. Those suffering from GAD generally do not present with panic attacks but do worry excessively, more than objective facts can justify. They are often unable to relax, they may become easily tired and may appear irritable to others.
For more than half the time during at least a six month period the person experiences excessive anxiety and worry about several activities or events and has trouble controlling these feelings.
The person has 3 or more of the following symptoms which cause significant distress and/or impair occupational, social or personal functioning.
• Feelings of being restless or edgy
• Tiring easily
• Trouble concentrating
• Irritability
• Increased muscle tension
• Sleep difficulties (insomnia, unrefreshing sleep)
GAD responds to a combination of relaxation, mindfulness and CBT.
Obsessive-Compulsive Disorder (OCD)
OCD (Obsessive Compulsive Disorder) affects 2% of the general population. It involves obsessive thoughts or images which occur irrationally and spontaneously, causing the person distress. These compulsions may involve actions and ritualistic behaviours which the person feels they have to carry out in order to prevent a feared outcome.
One frequent example is the constant washing of hands due to a fear of germs or bacteria.
OCD can be treated successfully with CBT with or without specific non-addictive drugs.
Panic Disorder
Panic Disorder involves repeated episodes of intense fear accompanied by physiological sensations. These are called panic attacks. Some panic attacks are triggered by specific situations such as a crowded supermarket; others may occur spontaneously and suddenly, escalating rapidly. It is maintained by irrational, negative thought processes which accompany the physical sensations, worsening them.
People suffering panic attacks report a severe fear or discomfort that peaks within 10 – 20 minutes. This is normally accompanied by four or more of the following symptoms:
• Chest pain or discomfort , heart pounding, racing or skipping beats
• Chills or hot flushes, sweating, dizziness, lightheadedness, faint or unsteady feelings, trembling
• Choking sensation, nausea or abdominal discomfort Shortness of breath or a smothering sensation
• Derealisation (feeling unreal) or depersonalisation (feeling detached).
• Fear of dying or loss of control
• Fearing being amongst other people in trains, theatres and busy shopping centers.
Panic disorder responds well to CBT, relaxation and mindfulness exercises
Phantom Limb Pain
Phantom limb pain is common and enduring. Up to 90% of all amputees experience painful sensations in their phantom limbs which can persist continuously or intermittently for more than 20 years. Phantom limb pain varies and may include burning, stabbing, crushing or shooting sensations. Pain in the extremities of missing limbs, in phantom fingers and toes, is common. Amputees report phantom digits that are fixed in painful clawed positions or they experience the phantom limb as shorter than the original. Co-morbidity is common: depression, loss of identity and of self worth. Self medication is an attempt to search for respite from this seemingly untreatable condition.
The theory underlying EMDR hypothesizes that pain can be triggered by memories of painful events - for example by losing a limb in a traumatic accident. The physiologically stored memories of the painful event contain images, emotions, cognitions and physical sensations experienced during the painful event. Such fragmented memories are hypothesized to contribute greatly to the distress experienced by the patient. EMDR can in most cases to greatly reduce and/or eliminate phantom limb pain in fewer than 8-10 sessions of treatment.
Post-Traumatic Stress Disorder (PTSD)
People with Post Traumatic Stress Disorder (PTSD) have been involved in a traumatic event during which time they thought that they or a loved one may either die or be significantly affected, such as losing a limb. Anyone can get PTSD. Road traffic accidents (RTAs) are the most common cause of PTSD in the UK. Other traumas may include accidents at work, assaults, train or plane crashes, war, natural disasters, rape, torture and sexual or physical abuse. Some of the symptoms of PTSD are:
- Intrusive memories, recollections or "flashbacks" of the event(s)
- Persistent avoidance of reminders of the event(s)
- Increased arousal - being constantly on the lookout for new danger, leading to symptoms such as increased heart rate, sweating, rapid breathing, anxiety and panic
- Feeling emotionally numb and experiencing a loss of interest in daily activities or other people such as loved ones and/or work colleagues
- It is not uncommon for depression and/or anxiety to also be present in people with PTSD
Moving Minds' specialists use well-researched and established psychological questionnaires and an interview to determine whether PTSD is present and to establish its severity.
PTSD is best treated soon after the trauma, before symptoms become chronic.
Extensive research in the UK, US and Europe shows that PTSD responds best to EMDR (Eye Movement Desensitisation and Reprocessing) or trauma focused CBT (Cognitive Behaviour therapy). Counselling is recommended against by NICE (The National Institute for Health and Clinical Excellence) and so is Human Givens, psycho-analytical or psychodynamic therapy and other approaches.
In EMDR and Trauma-focused CBT it is required that the traumatic event is revisited in a very focused way to help the person to work through or "process" the trauma. In some cases individuals may have some of the symptoms of PTSD but they do not satisfy the full criteria for a clinical case definition of PTSD.
Stress
The term stress is used very widely for a number of symptoms including depression and anxiety.
Stress is one of the biggest health issues in the workplace today. It is exacerbated by the reluctance of sufferers being prepared to admit suffering from stress, or seeking help for it.
The Health and Safety Executive (HSE) defines stress as "the adverse reaction people have to excessive demands or pressures, when they try to cope with tasks, responsibilities or other types of job related pressures but find it difficult; a strain or worry in doing so." This adverse reaction can take the form of anxiety, depression and/or physical conditions.
The HSE recently estimated that 60% of absence from work can be attributed to stress-related illness and workplace problems. According to the CBI, the UK's economy loses 23 million "people days" through accidents and an amazing 360 million through stress. Almost 6 out of 10 working adults in the UK have suffered stress in some way over the last 3 years. 30% of those who have experienced significant levels of stress feel that it has lessened their commitment to their employers.
The following are common symptoms of stress, affecting different areas of people's lives
Physical
Nausea, headaches, weight loss or gain, skin problems, backache, digestive complaints or raised blood pressure.
Mental
Worrying, muddled thinking, persistent negative thinking, concentration problems.
Behavioural
Increased drinking or smoking, unsociability, loss of interest, restlessness.
Emotional
Tension, moodiness, job dissatisfaction, nervousness, loss of confidence, low self esteem, worry, low mood and anxiety.
Once people start feeling stressed and less able to cope than before, they often keep this to themselves rather than discussing it with a relevant person at work or their doctor. They may then reach a point where they feel unable to continue, face work or their manager, and are then signed off sick. Absence from work can be helpful. It could, however, also result in making it harder for individuals to return to their place of work and face colleagues or managers. Postponing the return to work can create a situation where the person starts getting used to a different lifestyle and their temporary sick leave becomes permanent.
There are a number of helpful ways of learning to handle stress. If a person is off work it is often helpful to have CBT, relaxation and anxiety management skills training, mindfulness training or in some cases EMDR. If absent from work, it is best to agree a staged return to work with the HR department or Occupational Health professionals whilst being supported by a mental health professional.
Travel and Other Phobias
Phobic Anxiety can be triggered by an exposure to a specific object, event, circumstance or situation. The anxiety is maintained as sufferers often go to great lengths to avoid the feared object or situations. Examples of phobias are animals, storms, heights, blood, airplanes, being closed in confined spaces, lifts, spiders or leaving the house. The biggest reason for the continuation of phobias is avoidance. It may lead to temporary lessening of anxiety but tends to make the it worse.
A specific phobia is an unreasonable fear of a situation or object which leads to avoidance in order not to feel the fear and anxiety exposure to the situation or object brings. After road traffic accidents, one in seven people will still suffer from travel phobia three years after a road traffic accident. Treatment of phobias entails exposure to the feared situation or object firstly in a safe situation (the office of the clinician) and later in real life (getting back into the car and driving). Phobias, despite being very distressing and potentially disabling, respond very well in 6-8 1 hour sessions to CBT or EMDR.
Cognative Behavioural Therapy (CBT)
CBT is a short term therapy (weeks or months rather than years), that is particularly useful in treating problems such as depression, anxiety, phobias, panic attacks and post traumatic stress disorder (PTSD).
CBT was created after research showed the role that thoughts and pre-conceptions play in determining a person's mood and behaviour. CBT focuses on a person's thinking patterns, identifying unhelpful thinking patterns and challenging them with more helpful and positive thinking patterns. CBT is also interested in unhelpful behaviours and the feelings people have when they think or behave negatively.
In CBT the client is expected to play an active role in their therapy. The client is assisted by the therapist in identifying their unhelpful thinking and behavioural patterns.
Collaboratively the client and therapist then work out which thoughts, feelings and behaviours may be more helpful and the client is asked to practice new behaviours. The client will often be given “homework” to try out new thoughts and behaviours until they find more helpful strategies which make them feel much better and more in control.
Trauma focused CBT (TF CBT) is used for PTSD. Apart from the above, the therapist also helps the patient to write an account of their trauma or make a recording of what happened. Repeatedly reading or listening to this whilst being supported by the therapist leads to “desensitisation”, i.e. the person becomes increasingly less distressed until the memories become neutral
Some clinicians recommend or use a combination of CBT and EMDR. Although this is not usually harmful, it is unnecessary as both treatments are independent and in different ways address the patient’s troublesome problems. Splitting session time may mean that, in some cases, patients are not adequately prepared for EMDR treatment.
Counselling
Counselling is a term that is often used quite loosely to apply to all mental health professionals providing therapy. For some people it feels more acceptable than receiving psychological therapy. However, counselling by definition is talking over problems with a client so that they can come to a resolution themselves. It is often very supportive and can be very helpful for everyday problems of living, such as worries about children or relationships.
One problem with counsellors is that their training can range from only weeks to years of extensive training and these differences are not always clear to users of their services.
Research has suggested that Counselling, or talking over problems, is not an effective way of treating post traumatic stress symptoms, especially soon after the incident. This can actually make things worse later on.
The National Institute of Health and Clinical Excellence (NICE) recommends eye movement desensitisation and reprocessing (EMDR) or trauma-focused cognitive behavioural therapy (TF CBT) as the best methods for treating PTSD, and CBT for depression, anxiety and chronic pain. (www.nice.org)
EMDR
Eye Movement Desensitisation and Reprocessing (EMDR) is a focused psychological therapy that has been highly successful in treating trauma, particularly post traumatic stress disorders (PTSD). It is also successful in treating anxiety, phobias, performance fears and chronic pain and is used in a variety of other conditions.
Initially, after it was discovered in 1987, EMDR was used on war veterans and survivors of childhood sexual abuse suffering from PTSD, with rapid and lasting success. It is now also used for victims of road traffic accidents and is now internationally recognised as one of the best methods of treating trauma symptoms. The National Institute of Health and Clinical Excellence (NICE) recommends EMDR as one of the two treatments of choice for PTSD.
During EMDR the patient is asked to recall the worst part of the traumatic memory, identify the concurrent negative thoughts and upsetting emotions and locate their distress in their bodies. By using bi-lateral brain stimulation through horizontal eye movements or bilateral sound, EMDR directly influences the way that the brain functions. EMDR helps to restore normal ways of dealing with problems, (i.e. information processing). The patient finds that distress diminishes and they increasingly feel more able to cope with memories of the traumatic event. Following successful EMDR treatment, memories of the event are no longer painful when brought to mind. What happened can still be recalled, but it has become neutral. EMDR appears to mimic what the brain does naturally on a daily basis during dreaming or REM (Rapid eye movement) sleep. EMDR can be thought of as an inherently natural therapy, which assists the brain in working through distressing material.
EMDR is not hypnosis. Patients stay awake and present. If a person is well prepared for EMDR, understands what happens and receives treatment from a FULLY trained mental health practitioner such as a clinical psychologist, they usually find EMDR very helpful indeed. 8-12 hourly sessions are generally required for PTSD.