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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
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Experience:  Dr. Mark is a PhD in psychology in private practice
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Im in college, so far the semester has been really good. Ive

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Im in college, so far the semester has been really good. I've taken care of business and done my part, but over the passed few weeks its all falling apart. I'm feeling depressed, panicked from way too much homework, I've got a minor family crisis, and my partner is in the hospital right now for appendicitis and fluid in her pelvic region. She had surgery after checking into the ER last night. I'm worried about her, and terrified everything I've worked so hard to accomplish is going out the window. I've literally been thinking about checking into the ER for anxiety because its consuming me right now. I have so much that needs to be done by Wednesday and I don't know if I can handle it
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Mark replied 1 year ago.

Hi! I believe I can be of help with this issue.


First let me say that I can imagine how distressing and worrisome and even scary this situation must be for you. You are indeed dealing with a lot. And the temptation when we're not trained to deal with crises is to panic. That's true, but as you know and are worried about: panic is not a good response to overwhelming situations.

The first thing is to step back from panic. Panic is like a zone we enter. So you have to take a step back, okay? To that end, I will at the end of the posting give you a technique you can use on your own as well for when you are in the throes of anxiety and worries. It's not a cure, but it will help you to take a step back and consider the next step.

I'm also concerned with your taking Valium. Valium is a benzo and it does help reduce anxiety. But it doesn't help in your decision making. And you don't want to lose any edge in making your decisions. For exmaple:

Right now, you are correcdt: your girlfriend's health is crisis number one. You've got to be there for her. You've also got a family situaiton happening. Therefore, you need to make appointments with your professors and inform them of your situaiton. Discuss with them what's going on and ask them for advice on how to best deal with all the pressures you have. Ask what you can delay, what you need to take with you to the hospital when you're with your girlfriend, what you can do online, etc. In other words, get them involved in coaching you through this. They're your professors, right? So be strategic.

Go to the student clinic or whoever the doctor who prescribed your meds was. Ask if maybe Xanax or Ativan would be better choices as they are benzos that act more quickly and shorter term than Valium. And you can take them more only when you have to, when the panic is starting to overwhelm you. That's also a better strategy.

And now, let's work on some ways you can begin to build a behavioral program for yourself: diet, exercise, spiritual life, motivational reading and psychotherapy. The first four are to help you feel more involved and in control of yourself and what's going on inside. The psychotherapy can actually teach you skills and give you tools for managing your symptoms. This is serious for you as you need to reprogram your thinking about yourself. Spiritual life, diet and exercise are great ways to begin such a reprogramming.

Diet: cut out coffee, sugar, white flour. That may be tough. But you will see results as some of the newer research shows. And lean meats only. No fast food restaurants, no fatty foods. See what I mean about getting involved in controlling what's happening? With diet changes you are treating your problem with respect: you are acknowledging you need to make changes to get your body feeling better.

Vitamins can be useful for moods. A good quality daily vitamin, for example. One of the most important supplements is Omega 3 fatty acids, either in fish oil or capsules or in flax seed oil. Buy good quality. The clinical dosage is 1,600-3,000 mg daily. All these things you should get at the biggest and most frequented health food store and ask them for the best brands they trust in terms of quality.

Exercise: 5 days a week moderate exercise, to include 3 days of strength training as you get more used to it. Pretty amazing isn't it? I told you it would require work, but what you put in to it you will get out of it. Your doctor will verify the research results showing the benefit. You're young so you're going to need to up the intensity to counteract anxiety.

Spiritual life: the medical literature is now rather overwhelming about the benefits to so many different areas of physical health of regular religious and spiritual practice. Going to church, meditation, etc. are all shown to produce benefits to the physical body. What about our mental health? Well, you will see that meditation is now a regular part of psychotherapy interventions. I don't know if you're a religious person or not. But if not, this may be a good time in your life to tune up your spiritual life. If you do not believe in G-d, that's not a barrier to your own spiritual life. Just thinking about the meaning of your life, of life in general, and studying spiritual texts and practices will help with the anxiety. And that will help with dealing with your girlfriend's situation.

Then along with exploring the spiritual part of life, I want you to get really into motivational videos and books. Here's a simple YouTube search I put together for you on "motivational speakers":

http://www.youtube.com/results?search_query=motivational+speakers&aq=f



Some like Tony Robbins are the classic big guys. Some are newer. Watch them all. Get inspired. Buy a book or two. Here are some possibilities, but they are only suggestions as there are so many good ones.

The first book is the father of all these type of books. How to Win Friends and Influence People by Dale Carnegie. There are classes in these books now! It was written in the 1930s and still has something to say to us today that is very worthwhile.

I think very highly of the second book on my list, which is a real classic: The Seven Habits of Highly Effective People by Stephen Covey. It is the book that has helped more people than probably any other.

The third book is by Anthony Robbins. He's one of those speakers who fills up huge auditoriums. For a reason. He's a terrific speaker and writer. The particular book (if you like it, try his others): Awaken the Giant Within.

Which brings us to psychotherapy. You need to find a psychologist or psychotherapist to help you manage the anxiety. Fortunately, anxiety is among the most researched disorders in terms of effective treatments. And the therapies today are very effective. The preferred form of treatment today is Cognitive Behavioral Therapy to learn skills.

If your doctor isn't able to refer to anyone, here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful (they show you a photo of the therapist!) look at the listing and see if they list CBT therapy in their orientations and anxiety disorders as one of the areas they work with.

http://therapists.psychologytoday.com/rms/


If you want someone who isn't as structured as a pure CBT therapist, consider seeing if the therapist also lists humanistic and/or psychodynamic therapy in their orientation.

Okay, that should help you get working on these symptoms and get some relief. I wish you the very best!

Now, I want to give you a tool to use for when the worry and panic is overwhelming. Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from depression or anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.

I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in anxiety states is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX


INSTRUCTIONS:

  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

  • A comfortable place.
  • Some privacy.
  • A few minutes.

Again:

My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

Customer: replied 1 year ago.

I wrote a reply, did you get it?

Expert:  Dr. Mark replied 1 year ago.
I'm so sorry; as you can see, the only reply I have from you is your question. You'll have to try again.


Thanks,

Dr. Mark
Customer: replied 1 year ago.

Strange, the system must not have sent it.


 


Firstly I want to thank you for answering my question with the level of detail you've provided. I've actually been seeing a Psychiatrist that specializes in CBT for about 2 years, and I'm not totally unfamiliar with most of what you mentioned.


 


I've spent the last hour speaking with family and friends and thats really helped. To sum up the response that didn't go through, I was asking for a quick fix just to get through the week. Its a pivotal point in the semester and I need to be able to function. Even if I'm operating at 100% I'll still be a bit behind, and this overwhelming anxiety is making it very difficult to function at even 10%. I plan on seeing Dr. Nezhad regularly starting this week, but in the event the panic becomes overwhelming, are there services available to defuse that bomb? Basically, I suppose I'm asking about mental health triage. Is the ER an option? Because I literally feel like I'm at the apex of this episode, and it has come at the worst possible time. Its pompous to ask for quick fixes i think, but I just need a little help to soldier on. Any recommendations?

Expert:  Dr. Mark replied 1 year ago.
Thanks for clarifying.


The ER is an option. But if you go, you may not get more than one dose of meds as the benzodiazepines are tightly controlled substances now and the ER docs are monitored like all other doctors in prescribing them today.


A better option is to call Dr. Nezhad as you already have a doctor/patient relationship and see if he will prescribe Xanax or Ativan for you for the short term for you to use as needed. That means when the panic is overwhelming. So that you don't have to go to the ER. This is a better option than the ER because of wait time and he may be more willing to prescribe.


The other option may be the student clinic. If they have a doctor on staff that you can see, you may have a better chance of getting a prescription than at the ER. Again, the ER may only give you enough for that night only or the next day. So, Dr. Nezhad by phone would be the first choice, the student clinic, and then the ER.


I wish you the very best!


My goal is for you to feel like you've gotten Great Service from me and the site. If we need to continue the discussion for that to happen, then please feel free to reply and we'll continue working on this. If the answer has given you the help you need, please remember to give a rating of 5 (Great Service) or 4 (Informative and helpful), or even 3 (Got the job done) button. This will make sure that I am credited for the answer and you are not charged anything more than the deposit you already made by pressing any of these buttons. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "For Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, Dr. Mark
Customer: replied 1 year ago.

Perhaps I didn't articulate the urgency of the matter well enough, but most of what you said could have been found on Mayo Clinic or a google search. I really do appreciate your time, and I'm sorry to give you a less than stellar rating, but I don't feel the service rendered was worth $50. Continue to help people, I'm sure you are great at what you do, but I feel like you saw 'anxiety' and I got a textbook response.

Expert:  Dr. Mark replied 1 year ago.
Certainly I'm sorry that you don't feel that I've helped you enough yet. But I don't understand why give a poor rating?



Share with me what question you are hoping to get answered. Because there was no question other than how to deal with your panic and anxiety that you asked. What are you hoping to get help with?


Dr. Mark
Expert:  Dr. Mark replied 1 year ago.
Hi. I haven't heard back from you yet. And as you know, in the online environment, a negative rating is something we take seriously as I am proud when I can help. So please let me know in what ways you didn't receive the help you needed so that you might feel comfortable reversing the rating to a positive rating.

Thanks, Dr. Mark

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Dr. Mark is a PhD in psychology in private practice