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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10547
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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I have had on and off anxiety for a while. Over the past month

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I have had on and off anxiety for a while. Over the past month or so it got significantly better and now I'm feeling right back to where I started. My OCD thoughts seem to be concentrated on me having a heart attack. i just had my yearly at the cardiologist and the ECG, EKG and event monitor all came back clear. He said I'm good to go but for some reason I'm unable to get rid of the fear. Today I'm unable to distract myself out of the thoughts. When I'm at work I'm a bit better because of the distraction. I usually take ativan when the anxiety is bad i took it today but it only seems to be partially working. I have been working with a therapist for about 10 months.

DoctorZ :

Hello I believe I can help you with your concern

Customer:

hello

DoctorZ :

I am sorry that you are going through this anxiety, I can imagine how distressing it is for you

Customer:

it's very distressing

Customer:

when I'm fully distracted I feel normal

Customer:

when I'm not i feel pretty bad

DoctorZ :

Have you and you therapist figured out a reason why you are concentrated on having a heart attack?

Customer:

eh so so, she thinks when my work stress/outside stress kicks up my mind goes to look for something internal that could be causing the mental anguish that would make sense like something having to do with my health

Customer:

for as long as I can remember I would fixate on certain illnesses (well since about age 14 or so) but then those would go away but years down the line something else would come up and then I could go years without anything

Customer:

this one has been the most persistent

DoctorZ :

Okay and what type of therapy are you currently in? (e.g. CBT, DBT, etc...)

Customer:

CBT

DoctorZ :

Okay and have you used the thought record to help you with these negative thoughts?

Customer:

yes they are literally immediate as soon as I get up in the morning so mornings are usually uncomfortable

Customer:

it's always "what if I have a heart attack"

Customer:

and then I start to scan and focus on my heart rate

Customer:

or what If I'm alone and I have a heart attack

DoctorZ :

Alright so it seems like the CBT therapy helps somewhat, but the persistent and compulsive thoughts may be too much for therapy to be as effective as it can be

Customer:

I agree with that

DoctorZ :

You mentioned taking Ativan, but it is only partially working. What dosage are you taking?

Customer:

.5 mg if I start to get really panicked

Customer:

they have offered zoloft but I'm not overly thrilled with the idea

DoctorZ :

Well Zolofot helps a lot with OCD behavior, so it can help with the compulsive thoughts

Customer:

the ativan works well when I'm doing a project and distracted and need something to take the edge off. On a weekend day it doesn't work as well

Customer:

the zoloft idea is definitely on the table

Customer:

I haven't shut the door on it but when I started to feel very good over the past couple of months I figured I may be on a good path

Customer:

and now I've had a resurgence

DoctorZ :

The Ativan is definitely a low dose, you can ask your physician if you can take it at a higher dose during the weekend.

DoctorZ :

Why do you think you had the resurgence?

Customer:

does that help with thoughts

Customer:

well I'm juggling a lot right now professionally and socially

DoctorZ :

Ativan will help with anxiety and can help lessen the persistent thoughts

Customer:

sometimes when My mind is going a lot of different ways my anxiety kicks up

Customer:

I have to work hard to compartmentalize the different pieces so that they seem less like obstacles

DoctorZ :

So you are stressed and that is what led to the resurgence?

Customer:

when I write tasks down the stress lessens

Customer:

perhaps

Customer:

sometimes I feel like this is something that's just going to be part of me and I have to deal with it

Customer:

I don't know if something necessarily causes it

DoctorZ :

Well stress causes an increase in cortisol, which can lead to an increase in anxiety.

Customer:

yeah

Customer:

but why the focus on the heart attack?

Customer:

I think that's such a weird fixation

Customer:

I haven't had anyone around me have one of those

Customer:

or anything

Customer:

and I am not at a risk at all I'm 32, 5'1 with low cholesterol, 100 lbs, non smoker, non drinker and normal blood pressure

Customer:

perhaps the uncertainty is upsetting

Customer:

I'm not great with uncertainty

Customer:

I'm a very careful , safety conscious person

Customer:

and diligent about my health

DoctorZ :

Well you mentioned that you have always had a fixture of thoughts on health concerns since a young age, you could have saw a young person have a heart attack on tv and that has subconsciously created these recurring thoughts to cause your anxiety of this one particular issue. Because you are sensitive to health concerns, there are a lot of triggers out there that can cause your anxiety.

Customer:

got it

Customer:

you are right I am sensitive to health concerns

DoctorZ :

I am surprised that the thought record has not helped you more because you said when your write things down it usually helps

DoctorZ :

I think an increase in your medication may help you respond more to the CBT therapy

Customer:

well my record is just writing down the negative thoughts and then I review them

Customer:

is there a next step I should take

DoctorZ :

Yeah there is a next step, let me show you a link to one of my thought records and see if it is similar

Customer:

ok

DoctorZ :

You put the negative thought on paper, the emotion accompanying, the evidence to support it, and the evidence against it. Then I want you to come up with an alternative thought for the situation (more positive and plausible). This will help you change your way of thinking to be able to think more positive and not automatically go to a negative type of thinking.

DoctorZ :

Coming up with the alternative thought is very important to a thought record because that is what helps transform your automatic negative thinking to be more positive

Customer:

what would be an alternative thought for I think I'm having a heart attack?

Customer:

"It's probably not a heart attack, but my anxiety again"

Customer:

(as it usually is)

DoctorZ :

Does that seem more probable then having a heart attack?

Customer:

it's more probable because that's been the way its been for a year plus I've gotten a clean bill of health from the cardiologist after running all the tests

Customer:

so yes

DoctorZ :

And there you just put evidence to support your alternative thought and evidence against the original negative thought. You do have great insight on your mental health and you can recognize that it is your anxiety, but this thought record is supposed to help your subconscious get that insight too. Once this becomes routine to you, your subconscious (e.g. that first thought of a heart attack in the morning) will not longer think negative thoughts and your anxiety will lessen.

DoctorZ :

Did you therapist teach you any relaxation techniques to help when you are really anxious, like deep breathing and visualization?

Customer:

ah ok so that is the right way to fill it in

Customer:

so this? becomes clear to my sub conscious

Customer:

I'd like to get out of this thought loop

Customer:

it's super distressing

DoctorZ :

Yes this is the best and most complete way to fill in a thought record.

Customer:

ok great

DoctorZ :

It will take time to get out of the thought loop, but it will happen

Customer:

ok and do you see distraction as also being a good method

Customer:

at least for some relief

DoctorZ :

Distraction is a good method for temporary relief

Customer:

yeah

Customer:

today I couldn't find much distraction

Customer:

even when iwas out

DoctorZ :

Here is a link for other relaxation techniques for temporary relief at the moment too

Customer:

but sometimes the tv helps

Customer:

thanks

DoctorZ :

TV can help definitely, so can taking a walk or a jog too. Sometimes listening to music helps as well.

Customer:

yes for sure

Customer:

I love music

Customer:

thank you for all of your help. I really appreciate it. It is extremely annoying to be a successful functioning person but to be dealing with this in the background of my life

DoctorZ :

I understand, but so far you are taking the right steps by going to CBT therapy and getting some medication help as well. Like I said it will take some time and effort, but I am confident that you will get a hold of this and you feel immensely better for the long term.

DoctorZ :

I am glad that I was able to help you today

Customer:

Thanks so much!!!

Customer:

you were

Customer:

I will give you a great rating

Customer:

and may reach out again in the future

DoctorZ :

If you ever have any other questions or concerns, please feel free to contact me again at anytime

Customer:

have a good weekend

Customer:

thanks!!

DoctorZ :

Thank you and I wish you the best of luck

DoctorZ :

Have a great rest of your weekend too

Dr. Z and other Mental Health Specialists are ready to help you