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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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I'm not thur I'm afraid I might end up in Moccasin Bend

Customer Question

I'm not thur I'm afraid I might end up in Moccasin Bend
Submitted: 4 months ago.
Category: Mental Health
Expert:  Dr. Mark replied 4 months ago.

Hi! I'll be glad to help you with this question. You know, to give you the best answer, I think I should ask you for a little more information first that will help us define the problem and the situation.

The Moccasin Bend you mention, I assume is the psychiatric hospital in Chattanooga, is that correct? Have you ever been a patient there or some other mental health facility?

And then, why are you afraid you might end up in a hospital? Share with me what's going on.

And finally, share with me what might help you, do you think, so I know how I should focus my answer.

I'll await your reply,

Dr. Mark

Customer: replied 4 months ago.
I can not go out in public I keep to myself I do work but I have the office by myself I clock in when I'm not around nobody I see nobody all day long I clocked out where there's nobody I do no shopping my husband does it all for me, Mom Dad attacks a really bad really nervous crying jerking I'm not in control if I get out of my pattern I don't know what to say my daughter died I've had him for 15 years and then they give me 5 days the cut them off, no I've never been in a mental institution but I believe this is going to drive me to one, I live im Sparta Tennessee there's no way I can go to Chattanooga if you could find me somebody in Cookeville Tennessee that can help me out but everybody I've called will not help me
Expert:  Dr. Mark replied 4 months ago.

Thank you for the added information. It helps a lot. I believe I can now be of help with this issue.

First let me say that I can imagine how overwhelming and frustrating this situation must be for you. You are suffering from social phobia, a type with what's called agoraphobia. You can look it up and just having a word for it can give you a little relief so that you can begin to work on this. Rest assured that agoraphobia is not treated in a hospital or inpatient setting; rather, agoraphobia is treated by working with a psychotherapist in therapy sessions and then putting into practice the strategies you work on in those sessions.

Feeling isolated, unworthy of love and afraid of people and life itself is a part of the phobic disorder and there are also medications that can help with the anxiety you are experiencing so that your therapy work can be more successful and show results more quickly.

There is strength as well, however, I see in you. You work so there is potential. And so importantly, you are married. These are accomplishments that are SO difficult to achieve with agoraphobia. That tells me a lot.

The treatment that is most effect is most effective we have is behavioral treatment. You have to learn to change your learned behavior that you have made so much your own personal truth. This is done by someone who practices CBT therapy and specializes or works very often with phobic disorders including agoraphobia.

This is really what you need to be referred to: ***** ***** or psychotherapist who is familiar with treatment for agoraphobia along with negative self talk and negative self view. You can see, my focus in therapy for you is very practical. I think that has to be the focus of your seeking a referral: an appropriate type of psychotherapy.

I'll give you some techniques you can work on at home to help with the agoraphobia and to get you started. I'll also at the end of the answer give you a behavioral technique to get started with this. You can use this technique throughout the day when you are having anxiety. It is not a cure; it is something you can use to help yourself.

After you have a therapist in place, ask your doctor to refer you to a psychiatrist. But you need to know: a psychiatrist focuses on medications. And medications for phobias do not address the actual phobia. It only addresses the anxiety that comes from the phobia. But the ability to manage the agoraphobia is what you have to work on and meds won't address that. The other problem is that with phobias, I've rarely seen patients who found that meds did more than just help with the panic they feel. They still can't deal with the social interactions. So they're pretty much at square one.

So let's work on the type of therapy you need to undertake to get this phobia under control and managed. That's first. Second, we're going to use the technique I'm giving you at the end of my answer called Progressive Muscle Relaxation. Let's get started:

I want you to picture yourself and other people in a social situation (SS). As soon as the anxiety rises, as you're picturing the SS I want you to start practicing the PMR, okay? It needs to be really familiar to you.

So at first I want you to slowly imagine yourself going to an SS, like going into a restaurant instead of the drive thru. Start at home in your imagination getting ready to go, then going out the door, getting into the car, driving or riding, getting out of the car, going in the door. Get the idea? Step by step.

And with each step, you pay close attention to what you're feeling. And when you feel anxiety, you do your PMR. And you tell yourself your feel good statement: It will soon be over and I can go have a treat. (Whether that treat is relaxing on the couch, an iced coffee, whatever.) You can make your own feel good statement. It just has to be something that makes you feel a little brighter.

Then you continue with the imagining of the steps. You keep going until you've imagined all the way to leaving the SS. This may take a few times or a lot of times before you can imagine all the different steps without having overwhelming anxiety. But keep working at it. This is phobia work.

If there's a function or event coming up that you can use for this, even better. Or use it to actually go inside a restaurant first. Because as you can imagine: the next step will be to not just imagine the SS but to actually go. And to do your PMR in the car, etc. as you are actually having the experience. And then eventually, you will become less and less anxious as you gain experience with this.

This is what you will be doing with a psychotherapist to help with this.

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/

Okay, that should help you get working on these symptoms and get her some relief.

I wish you the very best!

Now, I want to give you a tool to use for when the anxiety is present for you. It is quite easy to do almost anywhere. My patients suffering from 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 so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before 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. 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, ***** *****

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. 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, ***** *****

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Expert:  Dr. Mark replied 4 months ago.

Hi. I'm checking in to see if the reply was helpful or if you need more follow up. I would be very interested in hearing back from you on whether you thought my response was helpful or if we need to continue with further discussion. 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.

Thanks,

Dr. Mark

Expert:  Dr. Mark replied 4 months ago.

Hi. I'm checking again to see if you would like more follow up or if you are ready to rate the answer. Thanks,

Dr. Mark

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