Exposure therapy is suggested to be one of the best ways to overcome your anxiety. To master something in life it is necessary first to think about it, and then actually practice doing it. Remember when you first started to learn how to drive. The more you practiced the better you became. This is the basis of exposure therapy. You actually need to go into the situation and think about it in a different way, implement the other skills and knowledge you have to mange your anxiety, and then reflect on how it went.

There is a word of caution here. Some research suggests to 'face the fear and do it anyway'. For some people this may work, however for others it doesn't. Learning the skills and techniques of cognitive therapy and educating yourself on where your anxiety is actually coming from in the first place, prior to exposing yourself to the situation, can often have better outcomes as you can feel more in control before you enter the situation, rather than going in feeling absolutely terrified.

When you feel anxious, it is suggested that you go through it firstly in your mind (realistic thinking/skills of cognitive therapy), and secondly, put yourself in the situation that you fear. This part is called exposure therapy.

If you continue to avoid situations because you are feeling anxious, it only makes it harder to overcome your anxiety. When you avoid doing something, you often convince yourself that there is a very good reason why you are not doing it. If you continue to avoid situations, no amount of thinking about it in another way will actually help you overcome your anxiety in the situations. The more often you do something, the easier it becomes each time. Remember the learning to drive?

There are some helpful techniques suggested to use when engaging in exposure therapy. Ron Rapee in his book, 'Overcoming Shyness and Social Phobia' suggests the following techniques that can also be applied to all types of Anxiety Disorders. These include:

1. One step at a time - don't jump in the deep end first. Take a small step and work your way up to the most uncomfortable situations.

2. Stay in the situation - try not to leave if you suddenly feel anxious. Rather, implement some of the other techniques such as rational thinking, focusing, breathing, and relaxation. Of course, if you absolutely have to leave, then do - it is suggested that you try and do it again as soon as possible. Alternatively, try and back away a little bit, instead of leaving the situation completely.

3. Repeats - doing something once can be interpreted as a fluke! The more often you do something, the more you will start to feel more comfortable (the more techniques you implement, the greater the ability you will have to control your anxiety)

4. Ups and Downs - these are a part of life, and some days you will have good days, and some days you will not have such good days. Try not to beat yourself up on the not so good days by engaging in negative self-talk. Rather, accept it for what it is - a not so good day!! Go back to the drawing board and set your goals a little lower until you are feeling stronger and more confident again.

5. Be aware of avoidance - try and be aware of all your avoidances. By not doing something that you fear, you are only making it harder for yourself. Avoidance is only an excuse and keeps your fears going. If you have engaged in some anxiety education, you will be more aware that it is you who is controlling your anxiety, so it is you who can decrease and manage it as well. It just takes some practice (and patience!!!) It is also important to try and be aware of subtle avoidance when overcoming high levels of anxiety. For e.g. You might go to a party and talk to only a few people you know well, avoiding meeting new people. Or you might travel 10 miles to go to a shop rather than visit the large shopping center 1 mile from your home.

Everyone has different fears and experiences different levels of anxiety in different situations. It is important to try and overcome all your avoidances using the techniques of exposure therapy.

Reference

Rapee,R.M., (1998), Overcoming Shyness and Social Phobia', Chapter 6, pg. 61-75, passim, Lifestyle Press.

Use Diaphragmatic Breathing (stomach breathing) for overcoming high levels of anxiety. Learn the techniques of correct breathing.

When overcoming high levels of anxiety, it is important to learn the techniques of correct breathing. Many people who live with high levels of anxiety are known to breathe through their chest. Shallow breathing through the chest means you are disrupting the balance of oxygen and carbon dioxide necessary to be in a relaxed state. This type of breathing will perpetuate the symptoms of anxiety.

The correct breathing technique is called Diaphragmatic Breathing (stomach breathing). We automatically breath this way when we are born. Diaphragmatic breathing uses the diaphragm muscle ( a strong dome shaped muscle) located under our ribs and above our stomach. When we breath in, we push the muscle down, and our tummy moves forward. When we breath out, the diaphragmatic muscle moves back to resting position and our tummy moves back in. There is little or no upper chest movement.

As we grow older many of us change our pattern of breathing and start breathing through our chest. This can be the result of a number of factors such as the pressure on women to have a flat tummy, certain fashions, poor posture, and of course anxiety.

Diaphragmatic Breathing Exercise

To become aware of your breathing, place one hand on your upper chest and one on your stomach. Take a breath and let your stomach swell forwards as you breathe in, and fall back gently as you breathe out. Try to get a steady rhythm going, take the same depth of breath each time. Your hand on your chest should have little or no movement. Try and take the same depth of breath each time you breath in. When you feel comfortable with this technique, try to slow your breathing rate down by putting a short pause after you have breathed out and before you breathe in again. Initially, it may feel as though you are not getting enough air in, but with regular practice this slower rate will soon start to feel comfortable.

It is often helpful to develop a cycle where you count to three when you breath in, pause, and then count to three when you breath out (or 2, or 4 - whatever is comfortable for you). This will also help you focus on your breathing without any other thoughts coming into your mind. If you are aware of other thoughts entering your mind, just let them go and bring your attention back to counting and breathing. If you practice this technique for ten minutes twice a day, and any other time you are aware of your breathing, you will begin to strengthen the Diaphragmatic Muscle and it will start to work normally - leaving you with a nice relaxed feeling.

Anytime in which you are experiencing anxiety, try and remember to breath in the manner describe above, and your anxiety level will decrease. Remember, you cannot be anxious and relaxed at the same time.

next: EMDR: Treatment for PTSD
~ anxiety-panic library articles
~ all anxiety disorders articles

Purpose: to put a stop to the thoughts that lead to anxiety, and to replace those thoughts with realistic, rational thoughts. Then, when these self-statements are practiced and learned, your brain takes over automatically. This is a form of conditioning, meaning that your brain chemistry (neurotransmission) actually changes as a result of your new thinking habits.

First, use thought stoppage. Be gentle but firm about it.

"STOP! These thoughts are not good for me. They are not healthy or helpful thoughts, and I have decided to move in a better direction and learn to think differently." (You are reminding and reinforcing your brain each and every time you make this rational and realistic statement.)

Then, pick two or three statements from the list below that seem to help you, and repeat them to yourself OUT LOUD each day. (You don't have to believe them fully yet--that will happen later).

When Anxiety is Near:

General Statements

1. I'm going to be all right. My feelings are not always rational. I'm just going to relax, calm down, and everything will be all right.

2. Anxiety is not dangerous -- it's just uncomfortable. I am fine; I'll just continue with what I'm doing or find something more active to do.

3. Right now I have some feelings I don't like. They are really just phantoms, however, because they are disappearing. I will be fine.

4. Right now I have feelings I don't like. They will be over with soon and I'll be fine. For now, I am going to focus on doing something else around me.

5. That picture (image) in my head is not a healthy or rational picture. Instead, I'm going to focus on something healthy like _________________________.

6. I've stopped my negative thoughts before and I'm going to do it again now. I am becoming better and better at deflecting these automatic negative thoughts (ANTs) and that makes me happy.

7. So I feel a little anxiety now, SO WHAT? It's not like it's the first time. I am going to take some nice deep breaths and keep on going. This will help me continue to get better."

Statements to use when
Preparing for a Stressful Situation

1. I've done this before so I know I can do it again.

2. When this is over, I'll be glad that I did it.

3. The feeling I have about this trip doesn't make much sense. This anxiety is like a mirage in the desert. I'll just continue to "walk" forward until I pass right through it.

4. This may seem hard now, but it will become easier and easier over time.

5. I think I have more control over these thoughts and feelings than I once imagined. I am very gently going to turn away from my old feelings and move in a new, better direction.

Statements to use when
I feel overwhelmed

1. I can be anxious and still focus on the task at hand. As I focus on the task, my anxiety will go down.

2. Anxiety is a old habit pattern that my body responds to. I am going to calmly and nicely change this old habit. I feel a little bit of peace, despite my anxiety, and this peace is going to grow and grow. As my peace and security grow, then anxiety and panic will have to shrink.

3. At first, my anxiety was powerful and scary, but as time goes by it doesn't have the hold on me that I once thought it had. I am moving forward gently and nicely all the time.

4. I don't need to fight my feelings. I realize that these feelings won't be allowed to stay around very much longer. I just accept my new feelings of peace, contentment, security, and confidence.

5. All these things that are happening to me seem overwhelming. But I've caught myself this time and I refuse to focus on these things. Instead, I'm going to talk slowly to myself, focus away from my problem, and continue with what I have to do. In this way, my anxiety will have to shrink away and disappear.

Source: Thomas A. Richards, Ph.D., Psychologist

next: Exposure Therapy for Anxiety Disorders, Panic Attacks
~ anxiety-panic library articles
~ all anxiety disorders articles

During stressful times, individuals with anxiety and depression are prone to an intensification of symptoms and oftentimes find themselves in conflict with others. Here are some tips to deal with conflict:

• Act honestly and directly toward others.
• Face the problem openly, rather than avoiding or hiding from it.
• Avoid personal attacks; stick to the issues.
• Emphasize points of agreement as a foundation for discussion of points of argument.
• Employ a "rephrasing" style of communication; to be sure you understand each other. ("Let me see if I understand you correctly. Do you mean??").
• Accept responsibility for your own feelings ("I am angry!" not "You made me mad!").
• Avoid a "win-lose" position. The attitude that "I am going to win, and you are going to lose" will more likely result in both losing. If you stay flexible, both can win - at least in part.
• Gain the same information about the situation. Because perceptions so often differ, it helps to make everything explicit.
• Develop goals which are basically compatible. If we both want to preserve the relationship more than to win, we have a better chance!
• Clarify the actual needs of both parties in the situation. I probably don't need to win. I do need to gain some specific outcome (behavior change by you, more money), and to retain my self-respect.
• Seek solutions rather than deciding who is to blame.
• Agree upon some means of negotiation or exchange.
• Negotiate toward a mutually acceptable compromise, or simply agree to disagree.

Adapted from Your Perfect Right: Assertiveness and Equality in Your Life and Relationships, by Robert E. Alberti, Ph.D., and Michael L. Emmons, Ph.D.

next: Controlling Your Fear
~ anxiety-panic library articles
~ all anxiety disorders articles

Find relief from panic attacks through hypnosis, energy psychology, thought field therapy, and cognitive behavioral therapy.

Hypnosis, cognitive behavioral, other nondrug therapies work

Diane Ulicsni knows all too well how terrifying panic attacks (also known as panic disorder) can be. For more than 12 years, Ulicsni, director of The Hypnosis Center in Lake Oswego, Ore., suffered from chronic panic attacks that led her on a seemingly endless round of doctor and emergency room visits.

Convinced she was having a heart attack — or a nervous breakdown — Ulicsni endured the all-too-common symptoms of panic attacks, which include a feeling of intense fear, sense of doom, or feeling of unreality, accompanied by physical symptoms such as a racing or pounding heartbeat; difficulty breathing or a feeling of choking; sweating, shaking, or flushing; chest pains; dizziness, light-headedness, or nausea; fear of losing control; and tingling or numbness in the hands.

Ulicsni, who finally found relief from panic attacks through hypnosis and is now a board certified hypnotherapist, says that hypnosis — which has been recognized by the American Medical Association since 1958 as a form of treatment — is one of several non-drug approaches that can significantly ease, if not cure, panic attacks.

Hypnosis can strengthen the effect of the mind on the body, says Ulicsni, by changing the way you perceive sensations, narrowly focusing your attention so you're not overwhelmed by the symptoms of a panic attack, and relaxing you physically.

In addition to hypnosis, other nondrug therapies that may (or may not, depending on whom you ask) work for panic attacks include humor, energy psychology such as "tapping" (also known as thought field therapy), and — perhaps the most widely studied, and some would say, most successful — cognitive behavioral therapy (CBT).

Laugh your panic attacks away? That's a good strategy, says Steven Sultanoff, Ph.D., a clinical psychologist in Irvine, Calif., and past president of the American Association for Therapeutic Humor. Sultanoff uses humor visualization with his panic attack patients, asking them to see themselves in a situation where they've laughed uncontrollably. When panic symptoms arise, the patients go back to that image of themselves laughing.

"Humor replaces the distressing emotions of a panic attack," says Sultanoff, "and, if the humor leads to outright laughter, it changes the physiological responses of the attack as well."

When you're anxious, he explains, your serum cortisol — or stress hormone — level rises; laughter is believed to reduce the cortisol levels..

Diane Roberts Stoler, EdD, a licensed psychologist in Georgetown, Mass., has been treating patients with panic attacks with cognitive behavioral therapy and hypnosis for more than 25 years and says that until recently, those were always her first choices. But as she has received training in energy psychology and has seen it work quickly for patients, she says, "I am now a true believer and it is now my first choice for anxiety and panic disorders."

Energy psychology, explains Stoler, includes the tapping of acupuncture (or acupressure) points and can be taught so that a person can do it him or herself. "Each thought we have produces an energy field, which triggers chemical changes in the body," says Stoler. "This chemical change produces behavior changes and bodily sensations, such as racing heart, sweaty palms, dilating eyes, dizziness, and shortness of breath. We then associate these bodily reactions to the sensations, such as fear, anxiety, panic, etc."

Talk therapy, says Stoler, can help you understand why you have these reactions, while psychopharmacology (medication) changes the chemicals in your brain and body. Energy psychology, on the other hand, she says, deals with the "chi" — or energy field — related to the thought, and by tapping specific acupuncture points in a specific order, you can discharge a negative energy with the specific thought. "In other words, the tapping affects the initial energy change that went with the original thought, such as a fear of flying or of heights," says Stoler.

Northern California psychologist Neil Fiore, Ph.D., acknowledges that tapping may have its role in treating the physical symptoms of panic disorder; tapping on the acupressure point that corresponds to the adrenal glands, which control the stress response, may serve some purpose, he says, but in general, he considers tapping "a little out there."

Fiore prefers to use a desensitization approach with panic patients, he says. He begins by asking the patient to imagine herself in a situation that normally causes a sense of panic - in a grocery store or on an airplane are two common scenarios, says Fiore. Then he has the person hold that image for 30 seconds; each time he repeats the exercise, the time increases. "You could call it fear inoculation," he says.

While the patient imagines the scene, Fiore advises that the patient think of the worst-case scenario. "Keep asking yourself, 'What if?'" he says. What if you panic when you're grocery shopping? You can always leave the store. What if you feel faint? Someone will help you. "There's always an answer to 'what if?'" says Fiore.

What desensitization offers is a psychological "safety net," Fiore says. "You learn to face the fear and know that it won't be the end of the world."

Like Fiore, James D. Herbert, Ph.D., associate professor of clinical psychology at MCP Hahnemann University in Philadelphia, is not averse to alternative medicine per se. Approaches such as thought field therapy, or tapping, however, is just "fringe psychotherapy," he says.

"Anecdotally, it may work," he says, "but scientists don't rely on anecdotes. Anecdotes don't really prove anything. We need more controlled studies."

What research has shown to work in treating panic disorder, says Herbert, is cognitive behavioral therapy. "That's my treatment of choice," he says. "It's as effective, if not more so, than medication, and unlike medication, you don't tend to relapse when you're done."

Therapy for panic attacks is not a long, drawn-out affair either, says Herbert. In an average of eight to 16 weeks, you may very well be completely panic-free. The most important elements of cognitive behavioral therapy include:

• Cognitive restructuring, to help you look at your beliefs, and then see whether they're distorted. For example, your heart is racing and you're afraid you're having a heart attack. "Look at the evidence," says Herbert. You've been checked out by the doctor, your heart is fine, you're perfectly healthy. "Restructuring helps correct the 'catastrophizing' thoughts," says Herbert.
• Exposure, to help you face your fears. In vivo (or, in real life) exposure, Herbert says, means you experience the situation where you tend to panic. If you're afraid to go to the grocery store, take someone with you and stay for just five minutes; the next time, go alone and stay for a bit longer; and so on. Interoceptive exposure, says Herbert, means you're exposed to the physical sensations that can trigger a panic attack. If a rapid heartbeat causes you to panic, Herbert will have you run up and down the stairs until your heart is racing; if dizziness causes your panic, he'll spin you around in a chair; if hyperventilating is your trigger, he'll have you breathe through a cocktail straw while holding your nose. "Exposure to the symptoms will help you recognize them for what they are," he says. Most of us, in fact, have a rapid heartbeat, or become short of breath, or get dizzy from time to time. "Our bodies do not remain static," says Herbert. "It's a matter of getting used to the symptoms we all experience."

Herbert admits that cognitive behavioral therapy doesn't work for everybody.

"But there's no scientific evidence — emphasis on the "scientific" — that these other therapies work any better."

next: Medication Effective in Treating Anxiety Disorders in Children and Adolescents
~ anxiety-panic library articles
~ all anxiety disorders articles

Natural therapies and supplements for anxiety disorders - herbs and their effects. Kava, St. John's Wort, aromatherapy, flower essences.

Herbs and their Effects

There are many natural therapies and supplements to relieve anxiety available that have been used throughout the centuries. Your naturopath or nutritionist will be able to advise you further. Some of the common natural therapies for anxiety are listed below.

Kava Kava (Piper methysticum)

Kava Kava is one of the main anti-anxiety herbs. It has a very quick calming effect on the nervous system with an uplifting, euphoric feeling. It is also a muscle relaxant and mild sedative. It is specific for anxiety, tension, stress, irritability and insomnia. Kava is very good for people whose mind races.

St. John's Wort (Hypericum perforatum)

St. John's Wort is a gentle sedative which also has a calming effect on the nervous system with restorative properties as well. It is specific for mild depression, anxiety, tension and irritability. It works by increasing the level of neurotransmitters in the central nervous system such as serotonin and dopamine.

WARNING: BOTH KAVA KAVA AND ST. JOHN'S WORT ARE NOT TO BE USED WITH MEDICAL ANTI-DEPRESSANT DRUGS.

Damiana (Turnera diffusa)

This is a good nerve tonic which also has a restorative property. It can have a good calming effect and is also specific in cases of mild depression and anxiety. Damiana is also well known for its aphrodisiac properties.

Scullcup (Scutellaria lateriflora)

This is a relaxing and gentle sedative for the central nervous system. It is very good for nervous tension and for nervous exhaustion plus neurological and neuromotor problems.

Verbena (Verbena officinalis)

This is a relaxing nervous system tonic which is indicated for a wide range of nervous disorders including nervous exhaustion and stress.

Passionflower (Passiflora incarnata)

This is a non-addictive sedative that relaxes the nervous system. It is especially helpful for nervous disorders such as heart palpitations, anxiety, convulsions, epilepsy, insomnia, and stress.

Withania (Withaniasomnifera)

This is an ayurvedic herb most commonly called Ashwaghanda. It is a very good tonic herb that is especially helpful for debility, and nervous exhaustion due to stress.

Aromatherapy

Bergamot

• helps soothe anger and frustration
• helps people regain self confidence and uplifts and refreshes the spirit
• evokes joy and warms the heart

Cypress

• strengthens an overburdened nervous system and restores calm
• has a soothing effect on anger and apparently cleanses the spirit and removes psychic blocks

Frankincense

• is for FEAR
• it slows down breathing and produces feelings of calm
• it elevates and soothes the mind
• is comforting and restoring for anxious, and obsessional states linked to the past

Jasmine

• helps diminish fear, enhances self confidence and defeats pessimism
• very good for emotional dilemmas especially when they involve relationships and sex
• rub on heart charka and temple

Lavender

• very well known for it's sedative properties
• useful in alleviating stress
• balancing
• good in acute crisis situations
• can promote personal renewal by washing away past habits and opening us up to new possibilities
• helps produce inner acceptance of a painful situation, easing fear and creating strength

Lime

• very refreshing and uplifting
• good for a tired mind or fatigue
• very stimulating and activating for apathy, anxiety or depression

Neroli

• heart felt, it reaches deep down into your soul to stabilise and regenerate
• considered one of the most effective sedative and anti-depressant oils
• provides relief and strength for long standing psychological tension, exhaustion and seemingly hopeless situations

Patchouli

• excellent for anxiety and depression
• very good for dreamers and people who tend to neglect or feel detached from their bodies
• helps ground and integrate energy and keep us in touch with our physical selves

Rose

• refreshes the soul, brings joy to the heart
• very heart felt
• it is harmonising and helps make sorrow easier
• opens the heart and soothes the feelings of anger, fear and anxiety
• addresses sexuality, self-nurturing and self esteem
• good for behavioural problems, emotional stress and anxiety, sadness, grief or disappointment

Ylang ylang

• for ANGER
• has tension relieving properties and is particularly beneficial for nervous depression
• good for women who don't allow themselves to live, who hide their femininity
• helps boost self confidence, eases frustration's and calms nervousness and tenseness

Sandalwood

• calming and harmonising - helps reduce tension and confusion
• builds confidence, and fosters openness, warmth and understanding
• protects the third eye and opens the spirit input
• ideal for nervous depression, fear, stress and a hectic daily lifestyle

Flower Essences

These remedies work on vibrational medicine. They are designed for emergency situations. It is aimed to calm you down and give you the mechanism and strength to cope in any situation.

Bach's Rescue Remedy

• 4 drops under the tongue when needed

Australian Bush Flower Emergency Essence

• 7 drops under the tongue when needed

Source: The information in this section on Natural Therapies and Supplements has been provided by Janet Schloss, a qualified Naturopath and Nutritionist from Brisbane, Australia

next: Relaxation Therapy for Anxiety Disorders
~ anxiety-panic library articles
~ all anxiety disorders articles

Detailed explanation of Eye Movement Desensitization and Reprocessing, EMDR as an alternative anxiety disorder treatment.

Eye Movement Desensitization and Reprocessing (EMDR) is still considered by many mental health professionals to be an "alternative" treatment for PTSD. By alternative, we mean treatments other than the more standard forms of treatment, such as anxiety medication or Cognitive Behavioral Therapy (CBT). These alternative treatments are, for the most part, less well-studied than the standard treatments and have met with varying degrees of acceptance from mental health professionals.

EMDR was developed by Francine Shapiro, Ph.D. in 1987. One day, while walking in a park, Dr. Shapiro made a connection between her involuntary eye movements and the reduction of her negative thoughts. She decided to explore this link and began to study eye movements in relation to the symptoms of Posttraumatic Stress Disorder (PTSD). PTSD is an anxiety disorder that is characterized by the development of symptoms after exposure to a traumatic event. Symptoms can include re-experiencing the event - either in flashbacks or nightmares - avoidance of reminders of the event, feeling jumpy, having difficulty sleeping, having an exaggerated startle response, and experiencing feelings of detachment.

The theory behind EMDR is that traumatic memories that are not processed properly cause blockages and can lead to disorders such as PTSD. EMDR therapy is used to help individuals to process these memories properly and develop adaptive changes in thinking.

The EMDR Process

EMDR is an eight-step process, with steps three through eight being repeated as necessary. The number of sessions devoted to each phase varies on an individual basis.

Step 1: The therapist takes a complete history of the patient and a treatment plan is designed.

Step 2: Patients are taught relaxation and self-calming techniques.

Step 3: The patient is asked to describe the visual image of the trauma as well as the associated feelings and negative thoughts, such as "I'm a failure." The patient is then asked to identify a desired positive thought, such as "I really can succeed," this positive thought is rated against the negative thought on a scale of 1-7, with 1 being "Completely false" and 7 being "Completely true." This process helps create a goal for treatment. The patient then combines the visual image of the trauma with the negative belief, usually evoking strong feelings, which are then rated on the Subjective Unit of Disturbance (SUD) scale. While focusing on the combination of the traumatic image and negative thought, the patient watches the therapist move his hand in a particular pattern causing the patient's eyes to move involuntarily. Blinking lights are sometimes substituted for hand movements, likewise hand tapping and auditory tones may be used instead of eye movements. After each set of eye movements the patient is asked to clear his mind and relax. This may be repeated several times during a session.

Step 4: This phase involves desensitization to the negative thoughts and images. The patient is instructed to focus on the visual image of the trauma, the negative belief he has of himself, and the bodily sensations caused by the anxiety, while at the same time following the therapist's moving finger with his eyes. The patient is asked to relax again and determine what he is feeling, these new images, thoughts, or sensations are the focus for the next eye movement set. This is continued until the patient can think of the original trauma without significant distress.

Step 5: This step focuses on cognitive restructuring, or learning new ways to think. The patient is asked to think about the trauma and a positive thought about himself (e.g., "I can succeed"), while completing another eye movement set. The point of this step is to bring the patient to the point of believing the positive statement about himself.

Step 6: The patient focuses on the traumatic image and the positive thought, and is once again asked to report any unusual bodily sensations. The sensations are then targeted with another set of eye movements. The theory behind this is that improperly stored memories are experienced through bodily sensation. EMDR is not considered complete until the patient can think of the traumatic event without experiencing any negative bodily sensations.

Step 7: The therapist determines whether the memory has been adequately processed. If it hasn't been, the relaxation techniques learned in Step 2 are employed. Memory processing is thought to continue even after the session has concluded, so patients are asked to keep a journal and record dreams, intrusive thoughts, memories and emotions.

Step 8: This is a reevaluation step and is repeated at the beginning of each EMDR session after the initial session. The patient is asked to review the progress made in the previous session and the journal is reviewed for areas that may need further work.

The eight steps may be completed in a few sessions, or over a period of months, depending on the needs of the patient.

Does EMDR Work?

In 1998 an American Psychological Association task force declared that EMDR was one of three "probably efficacious treatments" for PTSD. Nonetheless, EMDR remains a controversial treatment, supported by some and criticized by others. Although originally developed to treat PTSD, some proponents of EMDR have recently begun advocating its use in the treatment of other anxiety disorders. The evidence of its efficacy in these cases is even more controversial than it is for PTSD. There are claims that EMDR is a pseudoscience that cannot be empirically proven to work. Other claims are made suggesting that the eye movements, hand tapping and auditory tones are useless and any success achieved with the treatment can be attributed to its use of traditional exposure therapy. Michael Otto, Ph.D., Director of the Cognitive Behavior Therapy Program at Massachusetts General Hospital, points out that EMDR is a contentious issue. He goes on to say, "There is good evidence that the eye movements offer no efficacy. So without this part of the procedure, what do you have? You have a procedure that offers some cognitive restructuring and exposure."

Many of the studies which have found EMDR to be successful have been criticized for their scientific method, while studies which have found EMDR to be unsuccessful have faced criticism by proponents of the method for not using the proper EMDR procedure. Norah Feeny, Ph.D., Assistant Professor of Clinical Psychology at Case Western Reserve University, explains that conflicting study results are not unique to EMDR and in part depend on varying research methods and how tightly controlled the studies are. Therefore, the results of any single study are less important than the pattern of results that emerge over several well-done studies. Overall, Dr. Feeny says, it looks like EMDR, "works in the short run, but is not better than exposure therapy or other well researched treatment options like cognitive therapy. Moreover, some studies have begun to raise questions about the long-term efficacy of EMDR."

Carole Stovall, Ph.D. is a psychologist in private practice and has been using EMDR as one of her therapeutic tools for more than ten years. She uses the technique to address various types of disorders and traumas and claims that she has had excellent results. She does recommend, however, that consumers make sure that their mental health professional is proficient in more than one type of therapy because, although she feels that EMDR is a "wonderful tool," she admits that it may not be the best treatment for everyone.

As Dr. Feeny has pointed out, "The more effective treatments we have, the better. We just have to be careful and be guided by data."

Source:

• Anxiety Disorders Association of America newsletter

next: Gaining Control of Your Fear
~ anxiety-panic library articles
~ all anxiety disorders articles

Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing ever happened.

--Sir Winston Churchill

Ect.org Videos

The issues

Channel 11 in St. Louis reports on HB134 which would require ECT reporting. (48 seconds)

An interesting clip from 60 Minutes II. (24 seconds)

(CBS had the video removed)

The Extra news show explores the issues surrounding ECT. This segment interviews Liz McGillicuddy, who lost much of her memory from electroshock in 1994. (3:47 minutes)

It also includes interviews with Dr. John Friedberg, neurologist in California, who talks about the fact that the FDA has NEVER required safety testing of the ECT machines, and they interview Harold Sackeim, PhD, shock proponent extraordinaire. In his interview, he *admits* that the famous 1 in 200 statistic is not based in science!

Here, Harold Sackeim admits the truth - the statistic is not based in science! (30 seconds)

Diann'a Loper discusses how a bill she helped create has helped other ECT patients. This kind of >reporting MUST be made mandatory across the USA. Lobby your legislators! (30 seconds)

Part 1

Part 2

More ECT from Gordon Elliot Show

Hope Morgan received ECT when she began suffering from insomnia. Her doctor diagnosed depression. "My life was in a shambles," says Hope, referring to the devastation following the ECT. (3:10 minutes)

Marcia Fink says ECT turned her life around. "I do things anyone else can do." She says the only memory loss she suffered was three months' worth. (1:47 minutes)

Hal Haralson says ECT in the state hospital 40 years ago turned his depression around. (43 seconds)

A doctor from the audience speaks against ECT, and the role of insurance companies. (1:02 minutes)

Charles Kellner

Dr. Charles Kellner blatantly lies about the current stimulus dosing used in today's ECT! BUSTED! (1 minute)

Kellner Busted in a Lie

When questioned about his financial ties to Mecta, one of the shock machine manufacturers, Dr. Charles Kellner attempts to change the subject. (32 seconds)

Here, Dr. Kellner says the tragic experiences of patients like Hope and Diann'a are "unfortunate" and goes on to say that most people will be cured by ECT. He fails to mention the now-admitted high relapse rate, or the need for continuation/maintenance ECT. (30 seconds)

Dr. Charles Kellner misleads the public about the effectiveness of ECT. (1 minute)

Dr. Charles Kellner makes up a story about how ect works. The truth is, nobody knows, and he's CAUGHT ON TAPE fabricating a nice tale. (50 seconds)

Dr. Peter Breggin discusses the role of the FDA in the ECT controversy, and how they dropped the ball. (1 minute)

Dr. Breggin talks about the literature, and why some people become *more* depressed after ECT. (35 seconds)

More Videos from ECT.org

Audio

Tune in every Tuesday at 1 ET (12 Central, 10 am Pacific) for the Mind Freedom Weekly News Hour, hosted by David Oaks.
http://www.progressiveradionetwork.org/

Electroshock as violence against women:
Dr. Bonnie Burstow explores electroshock as a form of violence against women. She is a feminist therapist, an anti-psychiatry and anti-fascist activist. She is also the former co-chiar of the Ontario Coalition Against Electroshock and is the author of Radical Feminist Therapy: Working in the Context of Violence. Listen

Weekly Paul Henri Thomas updates:
WGBB radio has vowed that it will carry weekly updates until Paul Henri is no longer at risk of forced electroshock treatments. You may listen to the show live on the net on Monday nights at 7 pm Eastern time. I will try and record the shows for those who miss them:

• Feb. 26, 2001: WGBB on Long Island, New York carried a GREAT program that featured Sherry Taub, a New York activist, and PAUL HENRI THOMAS! (He's the man at Pilgrim being forcibly electroshocked currently) He's difficult to understand at times due to his French accent and the effects of the THIRTEEN psychiatric drugs he's on, but it's a great interview. A MUST LISTEN! (30 minutes)
• March 5, 2001: The second show featuring advocate Anne Kraus talking about the hearing and the latest news on Paul Henri. (29 minutes)
• March 12, 2001: The third show featuring Sherry Taub and Laura Ziegler talking about the latest legal news concerning Paul Henri. (38 minutes)
• April 2, 2001: Another show, featuring Linda Andre of CTIP and Anne Kraus. (11 minutes)

My interview on CKLN Radio in Toronto, where I discussed ECT, the Kathleen Garrett case, forced ECT and other issues in September, 2000. (25 minutes)

Feb. 26, 2001: KUCI in Irvine, California has a weekly show on Mondays called Mind...Your Own Business, where they discuss mental health issues. I was the guest for this show and talked about ECT, Paul Henri, forced ECT and more. (50 minutes)

Three excerpts from the recent series by Gary Null (www.garynull.com) on ECT and the use of force.

• Gary interviews a number of ECT survivors, who speak about their experiences and talk about the issues surrounding ECT. Listen (45 minutes)
• Gary speaks to psychiatrist Dan Fisher of the National Empowerment Center, who discusses issues, plus talks about why ECT isn't an effective treatment. Dr. Fisher says 50 percent of psychiatrists are opposed to ECT. (The audio on this is a little fuzzy). Gary also discusses the current state of research and does an exhaustive lit review. Listen (22 minutes)
• Gary interviews more ECT survivors and continues his series. Listen (57 minutes)

Dr. Max Fink on informed consent issues and protecting yourself against lawsuits (if you're an ECT doc). (3 minutes)

Dr. Max Fink sums up how psychiatrists are given the power to play god: "The judgment is yours. Society says....YOU'RE the psychiatrist..." (1 minute)

next: Participate In An ECT Evaluation
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"Let the message be very, very clear: We've made health care fraud a major law enforcement priority, and we're going to pursue it as vigorously as we possibly can." Attorney General Janet Reno

What do you think? Sign the guestbook and speak out! (ECT guestbook is now closed thanks to spammers)

1985

Accusations begin to surface that National Medical Enterprises (now called Tenet Healthcare Corporation) was bribing politicians. NME responds: "This company does not engage in illegal and improper conduct. God help anyone that does."

1988

NME memo: "To Clear up misconceptions. Example. We exist as a company to provide a high quality service to our patients (and in some cases society). I have heard individuals within the company make remarks along these lines and it is absolute nonsense. Lets call a spade a spade: We are here for one reason only - to make a profit for the shareholders who put up the money so that we could exist in the first place."

1991

Allegations surface that NME's huge profits are a result of criminal and unethical conduct and exploitation of the people who had come for help. Dr. Robert Stuckey, NME high-ranking official, appears on a Discovery Channel special, The Justice Files, and admits that, among other things, if a person entered one of their hospitals with a diagnosis of alcoholism and the insurance would pay $10,000, but would instead pay $50,000 for depression, the diagnosis would be changed to depression.

Senator Mike Moncrief (Texas) opens a Senate inquiry, and hundreds come forward to speak about the abuse and fraud, as well as the personal misery they had gone through under the care of NME. Texas Attorney General obtains a settlement from NME for $10 million, the maximum penalty allowed. The settlement required that each of NME's hospitals have an ombudsman on staff.

1991-92

Dr. Michael Wynne, a surgeon in Australia begins to gather information and investigate NME as it attempts to move into Australia and Singapore. Legal threats against Dr. Wynne begin, including a defamation action (all suits were eventually dropped and the plaintiffs were ordered to pay court costs).

1991-94

Shareholders begin suing NME, claiming they were defrauded. SEC commences an action and obtains injunctions to restrain NME from engaging in illegal activities. SEC says that unless they're monitored, NME will keep doing what they've been doing.

1992

Dr. Stuckey, the whistle blower who had the longest association with NME's Psychiatric Institutes of America (PIA) and who had dealings with senior staff, dies suddenly, alone on his boat, shortly before he was to give evidence to the US House of Representatives inquiry in 1992.

Led by Congresswoman Pat Schroeder (Colorado), the US House of Representatives opens an inquiry, leading to a report entitled "Profits of Misery." It was shown that children were a potential "gold mine" to hospitals, because insurance would allow up to six months of inpatient treatment. 19 insurance companies begin actions against NME, alleging fraud and NME settles, paying $89 million and $125 million in two separate settlements.

"The introduction of the commercial enterprise mentality to psychiatric care, the abandonment of ethical, scientific principles by many mental health care providers, and the indulgence of greed have allowed these developments to occur. The provision of mental health care, especially as it relates to the psychiatric hospital industry, has largely changed from what was once a professional and caring environment and an honourable part of the medical world, to one that is based on commercialism and profit. The changes that have developed over the past decade are very pervasive, deeply entrenched, and have occurred across the entire United States." Dr. Charles Arnold in his testimony to Congress.

June 1994

Former psychiatric division executive in Dallas pleads guilty to arranging up to $40 million in bribes to doctors and others.

The U.S. government formally announces that it has settled its giant fraud case with National Medical Enterprises, but it said it continues a far-reaching investigation into individuals and businesses suspected of accepting kickbacks and bribes.

The $379 million settlement is the largest in American history. The settlement, which includes a $33-million criminal fine, settles charges that NME paid kickbacks and bribes to doctors, referral services and other people so they would refer patients to the company's psychiatric and substance abuse hospitals in 30 states, then fraudulently billed Medicare, Medicaid and other federal programs for those services. The settlement also includes NME pleading guilty to six counts of paying illegal kickbacks for patient referrals.

Oct 1994

Doctors caught up in the scandal sue patients who complained, charging defamation, slander and libel. But Robert F. Andrews, a Ft. Worth attorney who is named in the psychiatrists' suit, likens the doctors to "a bunch of deer that are caught in the headlights. They have struck out at the only people who they perceive to be weaker than them, which is their former patients."

1994

New NME CEO Jeffrey C. Barbakow: "The number one priority for our board is to drive shareholder value."

1995

NME changes name to Tenet Healthcare

NME official files defamation suit against Dr. Wynne. Wynne makes three court requests to get documents and detailed complaints, but the papers are never produced. Complaint withdrawn and official is ordered to pay Dr. Wynne's legal costs. Three days later, Dr. Wynne is hit with another defamation suit, but it also ends up being dismissed.

Charles E. Trojan a former chief executive of a then-NME-owned psychiatric hospital in Chula Vista is convicted on one felony charge of sending threatening communications to a former top manager of the hospital. In the letter to Clawson, Trojan wrote, in part: "The value of your life decreases every day. We have your address. So expect company one dark night when you least expect it. Your life is worthless now."

1996

Tenet lawyer addresses the governmental investigation: "They treated us like criminals. We had to enter into an agreement with the government. It was a very irritating process for some of us to go through....We have to do background checks and can't hire anybody with criminal backgrounds;...We worry about DFEs (disgruntled former employees) and PWBs (potential whistle blowers) reporting problems on their own..."

Dr. Michael Wynne writes to CEO Jeffrey C. Barbakow about his concerns that Tenet has not changed its corporate policy. Barbakow never responds. "I believe that Tenet's committees inaction in these matters and the company's repeated efforts to ensure my silence speaks loudly for the seriousness and validity of these matters," says Dr. Wynne. Tenet responds with lawsuits.

1998

Ontario government files $175 million suit against Tenet, alleging it defrauded the province and went "trolling" for patients to ship into Wisconsin in order to milk the Ontario health plan. The suit claims that Tenet employees referred to the health plan as the "Canadian gravy train."

Feb 2000

Federation of American Hospitals issues statement calling for a grassroots movement to oppose an expanded Whistleblower's Act. The Federation is a powerful lobbying group dominated by the two largest healthcare corporations, one of whom is Tenet. They have an entire "do-it-yourself grassroots" section that tells corporations how to recruit employees to start campaigns that will benefit their goals.

"Since 1966, The Federation, through its dedication to a market-driven philosophy, has evolved into one of Washington's most influential health care policy advocacy organizations."

The Washington Post recently printed a story about the growth of "grassroots movements" that are actually implemented by huge corporations.

"It's ethically problematic when a company creates entities but then tries to pass them off as authentic and spontaneous grass-roots organizations," said Thomas Murray, president of the Hastings Center, a nonprofit group that examines medical ethics. "What bothers me is the deceptiveness."

Aug 2000

Mrs. Kathleen Garrett of St. Louis receives shock treatments that she has repeatedly said she doesn't want. Her son contacts activists in the area who spring into action. A public campaign against the treatment is waged, and Tenet-owned Des Peres Hospital calls Mrs. Garrett's son, Steve Vance to announce they will release her the following day.

A celebratory welcome is planned to welcome Kathleen back to freedom, but that morning, her son learns that she has been shocked again.

Upon arrival to the hospital, Mrs. Garrett tells her son that they were trying to coerce her into signing a statement saying she wanted more shock. "I don't want it," she tells her son. "Please."

Mrs. Garrett returns home and receives phone calls from a "home health care aide" from Des Peres who want to visit. Concerns are raised that the hospital will show up and take her away for more shock while Steve is at work. He changes her phone number. A home health care aide shows up at Mrs. Garrett's residence, but per strict instructions, they are turned away and not allowed to see Mrs. Garrett.

Sept 2000

Juli Lawrence, owner of Shocked! ECT/ect.org (this website) receives a letter from a law firm that claims it represents Tenet Healthcare Corporation. Their demands include removing all items from the website with "notoriety and prominence," and they threaten legal action if she does not comply.

Ms. Lawrence responds with a letter asking for detailed information, but does not receive a reply. She fully expects to be hit with a SLAPP (Strategic Lawsuit Against Public Participation) lawsuit, and is standing by. She vows that she will not be silenced.

She suggests, as the Shocked! ECT book of the month: QBVII by Leon Uris.

Feb 2001

Tenet finds itself at the edge of controversy once again when federal and state officials threaten to shut down its SouthPointe Hospital in St. Louis because of conditions and treatment in its psychiatric unit. SouthPointe is one of the hospitals involved in forcibly electroshocking Kathleen Garrett in the summer of 2000.

SouthPointe Hospital in St. Louis is under investigation by state and federal authorities because of numerous incidents that threatened the safety, health and privacy of its psychiatric patients.

A listing of psychiatric facilities in St. Louis. Tenet-owned hospitals are in red.

SouthPointe Hospital in St. Louis will remain open -- for now -- while state investigators assess the hospital's plan to correct conditions they say put psychiatric patients in danger.

Missouri Health Department officials have approved SouthPointe Hospital's plans for correcting conditions that government inspectors said endangered psychiatric patients. The approval averts a shutdown of the south St. Louis hospital.

Bedlam at SouthPointe: You might expect hefty fines for such shocking breeches of federal and state regulations. You might expect heads to roll at SouthPointe Hospital, where it all happened in the psychiatric ward. You might expect the hospital's psychiatric unit to be shut down, at least for an hour or two. You might, but most hospital administrators wouldn't. They know better.

More Info

Be sure and sign the guestbook. I'll be putting quick updates there about Mrs. Garrett and the case (because it's quick and easier than actually writing out some HTML)

Read some of the news stories about NME's exploits.

The horrors of being a patient at NME: She had agreed as a 17-year-old to enter the hospital, expecting a brief respite from troubled family relationships. But once the doors closed, Ms. Stafford said, she remained inside for 309 days, many of them behind blackened windows in cruel darkness.

Has Jeffrey Barbakow changed Tenet's stripes? Critics don't think so; they think his policies hurt patients; employees resent his grandiose salary and bonuses. Claim he's "not sharing the wealth."

Owner admits kickbacks: One of the nation's largest psychiatric hospital chains yesterday pleaded guilty to kickback and health care fraud charges and agreed to pay a record $379 million in penalties for illegal conduct in hospitals in New Jersey and 29 other states.

Medical firm to plead guilty: A division of National Medical Enterprises will plead guilty to charges of Medicare fraud and conspiracy and pay a record fine of $362.7 million to settle a sweeping federal investigation, company officials said Tuesday.

Ex-psychiatric exec pleads guilty: A former Dallas hospital executive confessed Monday that he bought patients with at least $20 million in bribes to referring physicians and other health care professionals.

61 sue NME: Sixty-one plaintiffs sued National Medical Enterprises Inc. on Monday, alleging that they were "lured or forced" to its psychiatric treatment centers as part of a fraudulent scheme.

American health care. Mishap in the operating theatre: From the Economist (UK), an informative article about the economics of the health care business. Included is a paragraph about Tenet, formerly known as NME.

Ontario sues Tenet Healthcare; says Tenet employees called Ontario health system the "Canadian gravy train."

next: Psychologist Jailed 2 Years For Sex With His Patients
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Overcoming Travel Anxiety

Hi again friends!

I've had major personal accomplishments this summer with regards to  my anxiety disorder  and travel; dealing with my travel anxiety.

For several years, I've found every excuse in the world to avoid trips to Los Angeles and New York. (I used to go to both places quite a lot.)

This summer, I've gone to L.A. on four separate business trips, and last week, I am proud to say, I did New York! It was the first time I took on New York City in more than three years.

For a long time, I avoided New York due to fears: claustrophobia in tunnels, heavy traffic, and general fear of immobility. I avoided L.A. for the heavy traffic. However, I've learned that I can do business in these two critical cities, I just have to do it, "my way."

Here's how I dealt with travel anxiety and did it "my way."

1. Flew in and out of these cities at non-prime times.
2. Did the driving at off peak hours.
3. Convinced myself that I could do it if 10 million others can do it.
4. Came to the realization that no traffic has ever been "stuck" forever. Every traffic jam in U.S. history eventually "moved!"
5. Allowed the juices inside me to "embrace" the experiences, and I began to "enjoy" and become excited about New York and L.A.
6. Treated myself to the great feeling of enjoying great restaurants and being with business associates and friends in places that were really "cool."
7. Took deep breathes when needed, got my exercise, and relaxed when I needed to do so. (THERE are places to relax even in NY and LA !)
8. Made note of highway conditions when they were NOT overcrowded. Traffic is NOT horrible all the time, as I had imagined or "remembered" from several years ago.
9. Pretended I don't have anxiety disorders. I'm "just like everyone else."
10. Focused on my business - the reason I was there!

What a terrific feeling. By ridding myself of travel anxiety, I've eliminated some major limitations in my business and personal life. I can do New York and L.A., so long as I do it, "my way." It can work!

Keep Fighting the Good Fight,

David B.

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