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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 5032
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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Hello! I have a series of questions related to mental health.

Resolved Question:

Hello! I have a series of question's related to mental health. Instead of writing my life story I listed my biggest concerns as follows:

- Relationships
(Anti social and social, concerned with my behavior when around others, recently quite smoking(1 year ago) moderate alcohol in my past I was excessive now in low moderation(1X-2X per month but can go months without craving), in my past I have used as courage which alleviated any awkward moments but no longer depend on but may have had a reverse effect. Have become a bit shy and not social when in groups and not as brave when encountering strangers as I once was extremely social and not approachable.
- Mood shifting occurs often and expressed in my surrounding environment. I have been told my facial expression is angry and not approachable. I am concerned and sometimes cannot tell if I am giving off this vibe. I am happy in nature but my mental state has deteriorated which I cannot control and am not happy nor pleased with.
- Anxiety - Fear of failure, over thinking and possible OCD.
- Motivation -Stuck in a rut, out of work, not progressing in life struggling with career choices as I keep changing or giving up. Pretty big issue as I am in the middle of my life but have a financial safety net for the time being.
- Medication or Not?

I have no prior experience with a Mental Health Professional nor have I ever had any conditions as the above listed until the past 5-6 years. Without any assistance I have managed to use the gym as a source of Therapy. In excellent physical health as I am always working out 5-7 days/ week and eating healthy meals consistently and taking vitamins or fruit smoothies/juices.

My biggest concern is if I visit a Psychologist will they record my visit and do I need to disclose in my medical records? I am looking for answers as I am sure I am a quick fix and do not believe in medicating myself as I am extremely healthy and do not want to experiment.

Thanks in advance!
Submitted: 10 months ago.
Category: Mental Health
Expert:  Dr. Z replied 10 months ago.

Dr. Z :

Hello I believe I can help you with your concern

Dr. Z :

I am so sorry that you are going through these issues currently, I can imagine how this would disconcerting for you

Dr. Z :

I would like to ask you a couple questions to get some more information, so that I can better assist you tonight, but first did want to alleviate that is you did see a psychologist or therapist, you do not need to disclose the visit in your medical records if you do not choose to. This is because medical privacy laws allow for the separation of mental health and medical services for privacy consideration unless in an emergency situation

Dr. Z :

You talked a little bit about mood shifting, can you describe that in more detail for me?

Customer:

Hello! In regards XXXXX XXXXX shifting I seem to be in high spirits but when confronted I automatically give off a different vibe. Sometimes angry, puzzled almost as if I cannot control the emotions my face is expressing and the worst part is I am not trying.

Dr. Z :

Okay, and when you interact with others, do you maintain good or poor eye contact?

Customer:

I have good eye contact but sometimes with an angry facial expression. Pisses me off.

Dr. Z :

Well the facial expression could be a subconscious reaction to the anxiety that you are feeling and it may lessen once your anxiety lessens. I believe you most likely have a disorder called Social Anxiety Disorder, which is very common and also very treatable too.

Customer:

Do you think alcohol played in role in increasing my behavior?

Dr. Z :

I would recommend seeing someone who specializes in Cognitive Behavioral Therapy (CBT) as this is the most evidence based therapy to treat anxiety and is very effective. CBT has a premise that your symptoms are caused by negative thoughts, so if we change your thought process to be more positive and objective as well, then your symptoms will lessen.

Dr. Z :

Alcohol probably did not increase your behavior, but may have numbed it to a point where it was not noticeable. And then when you started to cease the alcohol use, it would cause your body and anxiety to go unchecked as you were not mentally prepared to handle it.

Customer:

On a scale from 1-10 do you think this is curable and if so would I need meds?

Dr. Z :

Oh this is very curable and I would say with the right treatment a 10 for curable. You can use medications if you want, but it is not necessary. The medications will give you quicker relief, but it is not a cure, it only lessens the symptoms, while therapy is the only true cure. I can recommend some good CBT techniques to help you and self-help books as well

Dr. Z :

I can also recommend medications as well to give you a broad treatment plan

Dr. Z :

So this link may help you, it contains a technique I use with patients called a thought record. It will help you keep track of any negative thoughts you have. 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 objective 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.

Dr. Z :

In addition, these two worksheets are very good at helping lessen anxiety symptoms. It can help you focus on the big picture and the objective/positive thoughts and outcomes.

Dr. Z :

Also individuals with anxiety have a poor coping mechanism, so this worksheet will help you develop a better coping strategy to manage your symptoms better.

Dr. Z :

These two books are also really effective in helping manage anxiety as well.

Dr. Z :

This is a link for something called Progressive Muscle Relaxation that can help you create a long term calm by using muscle tension and release techniques; it can help manage your anxiety and is very similar to a style of meditation.

Dr. Z :

Since you seem like a healthy person and you like supplements I would also like to recommend St. John Wort, Glutamate, Valerian Root, KAVA, and Omega-3 as these all have anti-anxiety benefits too.

Dr. Z :

For medication, the use of an SSRI antidepressant, I would recommend Lexapro at 10-20mg or Zoloft at 150-200mg, in combination with the use of benzodiazepine (e.g Ativan, Xanax, and Klonopin) are effective in managing anxiety disorders.

Dr. Z :

The benzodiazepines are usually effective within hours of use at calming you down and the SSRI antidepressant starts to be effective in 2-3 weeks of use and its maximum benefits are seen in 6-8 weeks. The benzodiazepines are physically addicting and should only be used as needed and preferably at low doses

Dr. Z :

I think working with a CBT therapist/psychologist would be beneficial to help you with these techniques and also can help you be more approachable as well with the facial expressions too and once again it is private and anything you say to the therapist/psychologist is completely confidential. A psychologist though typically has more stringent privacy criteria then a master's level therapist

Dr. Z :

Do you have any questions or concerns?

Customer:

I wrote other concerns? Not sure how this works?

Dr. Z :

You can ask about those here if you like, I just wanted to address the social anxiety aspect since that seemed to be the chief concern of yours.

Dr. Z :

I also addressed the privacy consideration as well if you saw a psychologist/therapist as well

Customer:

Yes.

Dr. Z :

So what specifically are your other concerns that you would like to discuss?

Customer:

Relationships.

Dr. Z :

Well I am sure once we deal and treat the social anxiety issues, your relationships with others will improve, but what did you want to ask about relationships?

Customer:

Ok. I think the social anxiety issue is the root of all. For example, I had a falling out with a family member it seems I may have overlooked my actions and am seeing a pattern. I sometimes act without consciously thinking of the ramifications which results to disconnect and ruining a life long relationship. Not certain if this makes sense>

Dr. Z :

It is possible you act without thinking of the ramifications because of your anxiety and this causes your thought process to be slightly impaired.

Dr. Z :

Most likely once your anxiety lessens this will help you tremendously and CBT is the best treatment protocol for effectively treating anxiety

Customer:

Ok. I think you nailed it. So now I find a CBT Psychologist for treatment?

Dr. Z :

I think that would be the most helpful, but of course you can use the techniques and books by yourself if you do not feel comfortable going to a therapist/psychologist that specializes in CBT

Customer:

Thanks but I thank you for the links for reading. I think I need Professional assistance.

Dr. Z :

I think that is the best for you as well a CBT psychologist can be very effective, I just wanted to give you all your options. And also those techniques are what your therapist will give you as well, so you can practice them now until you see the psychologist.

Dr. Z :

Would you like me to search for a CBT psychologist in your area?

Customer:

Sure. What do you need from me?

Dr. Z :

I just need your zip code

Customer:

91326

Dr. Z :

Okay, give me a few minutes to compile a list for you

Customer:

no problem take you time.

Dr. Z :

I think these psychologists are good as they specialize in CBT and with treatment of anxiety disorders as well

Dr. Z :

Is there anything else I can assist you with?

Customer:

Quick question ? When picking a CBT Psychologist what do you recommend I use to determine the best for me?

Dr. Z :

Well I picked those because of their experience with anxiety disorders and their training in CBT, but you want someone who will focus on the goal and objective thought process. You do not want someone who will do all the talking, but instead someone to talk only to help guide you to the proper conclusion.

Dr. Z :

If you pick a CBT psychologist give it at least 4 sessions to see if you like him or her, as it usually takes that long to gauge a person correctly. Now if you do not feel comfortable with the psychologist based on their personality, you can choose to seek another one as some patients and psychologists are just not good fits.

Customer:

OK. Thanks for your guidance.

Dr. Z :

Anytime, I am always happy to help. I hope that your anxiety lessens very swiftly. My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime.

Customer:

Thank you!

Dr. Z :

You are most welcome :)

Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 5032
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
Dr. Z and 3 other Mental Health Specialists are ready to help you

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