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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5334
Experience:  Dr. Mark is a PhD in psychology in private practice
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Customer Question

I AM 61 YEARS OLD AND PHYSICALLY VERY ACTIVE AND WOULD LIKE TO CONTINUETHAT WAY. i DO HAVE TROUBLE WITH ANXIETY AND DEPRESSION, SO NEED TO EXERCISE REGULARLY. uNFORTUNATELY I DO HAVE ONE OR TWO ARTHRITIS PROBLEMS, BUT THE ONE THAT DOES WORRY ME, ALTHOUGH I TRY NOT TO LET IT IS, A SEVERELY (so the xrays say) arthritic big toe joint. I have always made it work and keep trying to make and keep it bending although there is restricted movement and it does hurt. I broke it while windsurfing, but it has been coming on since my late 30s. I am a member of bupa, so presumably i could have an operation, but what would that entail and would it curtail my kite and windsurfing and aeobic classes. At the moment I grin and bear it and its not too noticeable during excersise but i certainly feel it afterwards. Thankyou.
Submitted: 5 years ago.
Category: Mental Health
Expert:  Dr. Mark replied 5 years ago.

Hi! You know, to give you the best answer, I think I should ask you a few questions first that will help define the problem and the situation.

Your question sounds like it might be a medical question rather than a mental health question. Is that the case?

If so, would you like me to send it to the moderator to move it to the medical forum?

If you would like to stay in the mental health forum, is there some way I can help you with your depression and anxiety?

Are you interested in a behavioral treatment program for your depression/anxiety?

Any extra information that will help, feel free to share.

Dr. Mark

Customer: replied 5 years ago.

Did you receive my last reply? i would like help with my anxiety and depression and could you please ask a medical doctor about my previous question. Thanyou,

Sandra Unite

Expert:  Dr. Mark replied 5 years ago.
Sandra, I'm not sure how you might best proceed here. I have not received any reply other than the one you see above this posting I'm making to you.

Perhaps you want to continue here in this thread in Mental Health by describing more your anxiety and depression and what question about those problems I can help you with.

And then start a new question in the Medical forum for the medical questions.

Does that seem like a good solution?

Dr. Mark
Customer: replied 5 years ago.

Thankyou. I TAKE PAROXETINE 20MG AND ATENELO FOR HIGH BLOOD PRESSURE, WHICH IS UNDER CONTROl. My anxiety and depression , which is probably linked to a social phobia and ocd is longstanding. The tablets do help. I also take diazepam occasionally, say 2 or 3 times a week, I know the dangers of addiction.I feel reasonable at the moment as my husband is alive, although he is 75, and i cannot imagine how I would cope without him. I have no children, although we have fostered for 13 years. I am or rather was a trained nurse, although because of my shyness orselfconsiouness, I wasnt able to carry on after I qualified. I wouldnt have been able to deal with alot of people at once. Im o.k. on a one to one basis. My ocd concerns germs and is under control, although people probable think im a bit odd, washing my hands before going to the toilet and and after and trying to get out without touching anything. Cutlery is also a problem. I use alot of handwash.hope this gives you some insight. Thankyou

Expert:  Dr. Mark replied 5 years ago.
Sandra, that does give me insight: you're a courageous and spirited woman. You have two problems that would make most people totally go "hide under the covers": OCD and social phobia. But you persevere and keep on persevering. Good for you.

Could you keep on sharing about yourself: in what specific area can I help?

I don't want to give an answer that might not address what you're really looking for; so, feel free to frame a question or questions, okay?

I'm in the US and I have a heavy patient load today, so depending on when you reply I may not be able to answer until tomorrow evening US time.

Dr. Mark
Customer: replied 5 years ago.

I would like to be a stronger, less sensitive person. Unfortunately for me I worry about animals alot, those that are suffering etc, I would like help with that. I have mentioned cognitive behavoural therapy to my doctor, but maybe he dosnt think I am bad enough.Would it help in you opinion. I also think constantly about becoming ill and planning ways on my exit. Ive though about moving to Oregon, where I understand doctors are helpful ther. Im o.k. at the moment, but constantly try and arrange the future for myself. Thanks again

Expert:  Dr. Mark replied 5 years ago.

Hi, Sandra! Thanks for the extra information.

First let me say that I can't speak to whether the doctors in Oregon will be better than the doctors in the UK where you are now. I can only tell you that for OCD and social phobias, medications are not the first line of treatment. There are specific psychotherapies developed to treat them. I know that in the US insurance covers these therapies without problems; I've heard that the NHS is very skimpy on psychotherapies. So that would be my only thought on that question, okay?

I'd like to reinforce, though, what I just said above. There are indeed therapies that are quite specifically oriented to these issues. You have done a remarkable job on your own but you clearly do need professional help to deal with the Obsessive Compulsive Disorder as the primary treatment focus at first and the phobia as secondary until the OCD is relaxed more. The reason I say this is that there is only a certain amount of work you can do at once without overloading with anxiety. And certainly, the anxiety is acute already. So I will also 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 or obsessive thoughts and behaviors. It's not a cure, but it's an important anxiety reducing tool.

The pharmacological treatments for OCD today are much better than in the past. I don't know if you need more than the Paroxetine you're getting now. But still, the most effective way to deal with OCD and anxiety disorders with phobias is Behavioral Therapy and Cognitive Behavioral Therapy. I don't know if you are restricted to what's available through the NHS or you have private doctors and psychologists available to you. If private, then interview the psychologists to make sure you feel confident in their experience with these therapies and working with OCD or anxiety disorders.

OCD responds best to Behavioral Therapy that is specifically oriented toward the obsessions and compulsions. It's based on exposure and response prevention. You've already come a long way on your own. So treatment with someone who's very experienced I would think would be very helpful to you. I've worked with mild OCD because when I see a patient with extreme symptoms, I know that he/she needs someone whose practice focuses on OCD. So look for someone who's "a specialist".

Phobias are a similar type of work but require more exposure therapy and guided imagery. This is best done with someone who specializes in CBT therapy (The OCD specialist will probably also be a CBT therapist). So start with finding someone to work on the OCD with and they will probably be able to help you with the phobia as well.

I want to give you some books you can use to help you work on this on your own as well. Now here is the important part: you can't expect OCD to get better suddenly. It is going to take methodical work and effort on your part to deal with the behavioral changes you are trying to make. So the key in OCD work is to not get frustrated because it is slow going. But to keep working at it and to keep trying and to keep using the techniques. Okay?

Here are the books:

Stop Obsessing:? How to Overcome Your Obsessions and Compulsions by Foa and Wilson. Make sure to get the revised edition. Dr. Edna Foa is a renowned expert.

The OCD Workbook by Hyman and Pedrick. The exercises here are excellent.

Brain Lock: Free Yourself from Obsessive Compulsive Behavior by Schwartz. He's purely cognitive in approach and I've had some people really like his approach though some find it a little too vague. See what you think.

Tormenting Thoughts and Secret Rituals by Osborn. Dr. Osborn has OCD. The book is based on his group therapy and the techniques may appeal to you very much.

Now, I want to give you a tool to use for when the obsessing is overwhelming or there is anxiety. 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 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?


  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.


Dr. Mark and other Mental Health Specialists are ready to help you
Customer: replied 5 years ago.

Thankyou for your help. I will order the book by Dr. Osbourne and try and concentrate on my breathing etc. I will also ask my doctor about some therapy. I think it is only limited to people who are really ill, but i do have private medical insurance, so i will see if i can do something with that. I think it is the future I dread, and want to be able to forget about it as there is nothing i can do. Im rushing around most of the time to keep my mind occupied. I used to be able to read a book, but now would find it very difficult unless it was forced on me. I feel I have to filllevery waking moment, constantly on the go. Anyway, theres no need to reply. I only meant to say thankyou for your help

Kind regards

Sandra Unite

Expert:  Dr. Mark replied 5 years ago.

Get your doctor to treat you as ill, partially treated. So that you can get the therapy. Okay?

Just because you've been heroic in your efforts shouldn't disqualify you.

All the best, XXXXX XXXXX

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