Anxiety

Let’s begin with a simple graphic explanation of anxiety. First, consider the concept offear,
which must be distinguished from anxiety. If you were sitting in a room and suddenly a large
rattlesnake crawled through the door, you would have good reason to be afraid.
That’s fear because it refers to an actual threat. Fear, in some cases, can be healthy because it
often keeps us alive.

But if you were always worried that a rattlesnake might crawl into the room, even if no
rattlesnakes were anywhere in sight, that’s anxiety. Anxiety is most often not helpful because
the threat is imaginary, and a lot of time and energy can be wasted worrying about things that
might—but not necessarily will—happen.

The psychological basis for anxiety can usually be located in childhood experiences that
lack clear explanations and guidance from parents who tend to be disinterested, critical,
or abusive. Hence the children grow to dread circumstances that have unknown or
unpredictable aspects.

Some individuals live with a constant, general sense of worry and anxiety, as in Generalized
Anxiety Disorder. Typical symptoms are tension, restlessness, fatigue, irritability, sleep
disturbance, and difficulty concentrating.

Other persons feel a more focused anxiety, as in a Panic Attack, where their heart beats faster
and faster, and there is a sudden onset of apprehension, terror, or impending doom, to such an
extent that they might feel they are going crazy—or having a heart attack. In fact, it’s quite
common for patients to appear in hospital emergency rooms complaining of having a heart
attack when they are really experiencing a panic attack.

Furthermore, some persons have such anxiety that they develop Agoraphobia orSocial Phobia.

• Agoraphobia, sometimes referred to as a fear of open spaces, really is more a fear of fear
itself. That is, the agoraphobic tends to avoid situations which might cause fear—and
eventually so many situations are avoided that the agoraphobic cannot even leave the house.
A common consequence of agoraphobia is depression, and common associated symptoms
are drug or alcohol use, as self-medication.
• Social Phobia involves a persistent fear of situations which might involve being scrutinized
by others. Common social phobias are a fear of public speaking, of participating in
meetings, of using public restrooms, of eating in front of others, of interacting with
strangers, and of interacting with authority figures. Unfortunately, a fear of interacting with
authority figures can make it very difficult to seek treatment for a social phobia.
Specific Phobias are also a form of anxiety (although they are sometimes mixed with fear).
There are many kinds of phobias, including anxiety about animals, natural events, blood or
injury, situations (such as elevators, tunnels, heights, flying, etc.), or germs and illness.

All specific phobias have three basic elements:

1. Excessive fear cued by the presence or anticipation of a specific object or situation.

2. Exposure to the object or situation provokes an immediate anxiety response.

3. The object or situation is avoided (or tolerated with intense distress).

Thus, because the anxiety comes and goes with the situation, it would be possible, for example,
to have a phobia about encountering persons who are blind, but it would be impossible to have
a phobia about becoming blind. You might develop a phobia about specific objects or situations
that could cause blindness, but a general fear about injury to your own body would not be a
psychiatric disorder; instead, it would be considered psychoanalytically to be a form
of castration anxiety.

Psychologically, many phobias can derive from conflicts and terror about one’s dark inner
reality.

For example, in one case, a man had a fear of heights. His life tended to follow the status
quo and he avoided taking any creative risks to improve himself. Hence his fear of
heights: he was afraid to “rise above himself.”

In another case, a man had a fear of crossing bridges and going through tunnels. He had
been preparing all his life for a career in sports, and then suddenly he had an injury that
ended his dreams of how he wanted his life to be. Yet he didn’t know what to do with his
life thereafter. He felt like he was in the dark, not knowing where he was going, and he
was afraid to make any changes. Hence, his fear of “dark tunnels” and of “crossing
bridges.”

For information about desensitizing phobias, see my page on Self-

administered Systematic Desensitization.

For more information about the fear of flying, see my page onFear of Flying and its
associated page, Basic Principles of Aircraft Flight.
In Obsessive-Compulsive Disorder (OCD) anxiety takes the form of
either obsessions or compulsions.

• Obsessions are recurrent and persistent thoughts, impulses, or images which are experienced
as intrusive or inappropriate.
• Compulsions are repetitive behaviors (e.g., hand washing) or mental acts (e.g., repeating
words) which a person feels driven to perform in response to an obsession.

Compulsions should not be confused with disorders of impulse control, in which a person
fails to resist a temptation. In some ways, this distinction can seem confusing, yet the DSM-
IV [1] makes it anyway. The point is that an Impulse Control Disorder can be diagnosed only
if the the lack of impulse control occurs apart from any other DSM-IV disorder.
Thus, Intermittent Explosive Disorder is characterized by discrete episodes of failure to
resist aggressive impulses such that serious assaults (often as domestic violence) or
destruction of property results; Kleptomania is characterized by recurrent failure to resist
impulses to steal objects not needed for personal use or monetary value; Pyromania is
characterized by a pattern of fire setting for pleasure or relief of tension;Pathological
Gambling is characterized by recurrent and persistent maladaptive gambling behavior;
and Trichotillomania is characterized by recurrent pulling out of one’s hair.

The underlying dynamic of obsessive-compulsive behavior is usually the unconscious attempt

to neutralize feelings of guilt that derive from hidden experiences of angerwhich are perceived
by the afflicted person as objectionable and shameful. (In contrast, a disorder of impulse
control often involves blatant acts of hostility, destructiveness, danger, or risk.)

In this regard, psychological research into early infant development has shown that experiences
of rage, and subsequent feelings of guilt, happen to us all right from early infancy. Every
parent will make mistakes in empathic bonding with a child, and every child will feel
emotionally hurt by those mistakes and will crave the satisfaction of revenge: to hurt the other
“as I have been hurt.”

These impulses to hurt others are universally human and do not mean that anyone
experiencing them is “bad.” As adults, anyone—even those we care about, and even innocent
babies—can irritate us. As such, we experience thoughts of resentment, hostility, or violence
because we feel injured, insulted, obstructed, or hurt in some emotional, physical, or material
way. OCD, however, is a neurotic way of coping with feelings of guilt that seem too “bad” to
admit to anyone—not even to yourself.

The solution to all of this is amazingly simple (and is actually a form of cognitive-behavioral
treatment): admit those frightening thoughts to yourself openly, rather than try to deny them;
then tell yourself that even though some part of you finds them satisfying, you have no
intention of actually carrying out any of those impulses; then resolve to act with kindness
and forgiveness. Remember, the fact that you can have “bad” impulses does not mean that
you are “bad.”

But if you try to hide your frightening thoughts and impulses, they will get driven into
your unconscious where they will turn into unconscious anger. So there’s an irony: if you admit
those frightening thoughts to yourself, and deal with them gracefully, it’s proof you love others,
but if you try to hide those thoughts and impulses in fear of them your drive them into anger—
and that unconscious anger is what harms others and causes you to feel so guilty.

OCD should not be confused with Obsessive-Compulsive Personality Disorder, which is

characterized by a pervasive pattern of preoccupation with orderliness, perfectionism,
and mental and interpersonal control. Such apersonality can be inflexible, rigid,
stubborn, and miserly.

The underlying dynamic of excessive orderliness is usually the unconscious desire to

see justice for the offenses committed against you. Thus you cannot tolerate anything
crooked or out of place because the yearning for “law and order” preoccupies your mind
in the context of unresolved emotional hurt from childhood.

Anxiety can also be the basis for mental disorders after exposure to a traumatic event such as
abuse, an accident, a crime, a natural disaster, etc. which involved death or serious injury,
whether actual or threatened. If symptoms persist for several days and cause a serious
impairment in normal daily functioning, a diagnosis of Acute Stress Disorder may be made.

Posttraumatic Stress Disorder (PTSD) may be diagnosed if symptoms persist for longer than
one month and fall into the following characteristic categories:

• Abnormal arousal (e.g., difficulty sleeping, irritability)

• Avoidance/Numbing (“spacing out,” avoiding situations associated with the trauma)

For more information, see my page on Trauma and PTSD.

Also, trauma can affect one’s sense of identity, and the trauma of severe child abuse can lead to
the development of multiple personalities or of self-mutilating behaviors. Finally, you might
want to know something about the controversy surrounding the concept of repressed
memories of trauma, and you might be interested in some trauma support groups that have
sites on the Internet.

Depression and Mania

Most people experience periods of depression off and on throughout life. We all have days
when we feel “blue” or “down,” and these distressing times usually pass. Also, the death of
someone close can involve feelings, called bereavement, that are similar to symptoms of
depression.

Major Depressive Disorder is another matter, and it usually requires psychological treatment.
Characteristic of this disorder is at least one Major Depressive Episode (see below). Although
most episodes of Major Depression (unipolar depression) usually resolve in about six months,
even without treatment, those six months or so can be quite difficult—work and family life can
be seriously disrupted, and there is a high risk of suicide.

Though a Major Depressive Episode can be treated psychologically without medication,

sometimes medication can be especially helpful. If your psychologist believes
that medication might be helpful as an adjunct to psychotherapy, he or she will discuss the
matter with you and perhaps make a referral to a physician (generally a psychiatrist) for a
medication evaluation.

As with any psychological complaint, it is advisable that psychological treatment for

depression not begin until you have had a thorough medical exam and blood test to rule
out obvious medical causes of depression. For example, depression can be caused by
elevated TSH (Thyroid Stimulating Hormone) levels resulting from a hypothyroid
disorder. Vitamin deficiencies (such as a lack of Vitamin D3) can also contribute to
depression.

The good news is that psychiatric medication for depression, if required, can often be
discontinued (on the advice of the prescribing doctor, of course) after several months when
lifestyle changes (such as brisk exercise; managing negative thoughts; caffeine
reduction; stress management and anger management techniques) can incorporated
through psychotherapy while taking the medication.

A Major Depressive Episode has the following characteristic symptoms:

• Depressed mood. Note, however, that children and adolescents tend to show signs
of irritability rather than depressed mood.
• Anhedonia; i.e., a lack of interest in usually enjoyable things
• Weight loss or loss of appetite (although some individuals overeat because of depression)
• Trouble sleeping
• Psychomotor Changes:
Retardation (e.g., slowed speech, thinking, or movement)
Agitation (e.g., inability to sit still; pacing)
• Fatigue, or lack of energy (e.g., staying in bed most of the day)
• Feelings of extreme worthlessness or guilt
• Trouble concentrating
• Thoughts of death, or feeling suicidal

Exogenous depression is a term which describes depression triggered by obvious external social
losses and problems. Endogenous depression is a term which describes depression that appears
to happen for “no apparent reason” and so is commonly said to be genetic and chemical in
nature, but, in my opinion, every symptom has an unconscious cause, although persons
untrained in the psychology of the unconscious will not be able to recognize unconscious
causes.

Dysthymic Disorder is a form of depression, less severe than Major Depression, in which a
person feels depressed most of the time but is still able to function socially and occupationally.
A Dysthymic Disorder usually does not require medication, but it is becoming quite
fashionable, sadly, to take the newer SSRI drugs (Prozac, Zoloft, Paxil, etc.) anyway. Even
though there can be a biological aspect to any form of depression, the psychological cause of a
dysthymic disorder often has its roots in unexpressed emotions regarding social situations.
Many persons, however, cannot even identify their own emotions, so psychotherapy may be
needed, first to learn to recognize your inner experiences, and then to learn to express
them openly and appropriately.

A Dysthymic Disorder has the following characteristic symptoms:

• Depressed mood for most of the day, for more days than not. Note, however, that children
and adolescents tend to show signs of irritability rather than depressed mood.
• Poor appetite; or overeating
• Insomnia; or hypersomnia (sleeping too much)
• Low energy or fatigue
• Low self-esteem
• Poor concentration or difficulty making decisions
• Feelings of hopelessness

“Double Depression” refers to a Major Depressive Episode superimposed onto Dysthymic

Disorder. So even though a person may recover from the severe effects of the Major
Depression, he or she may rarely feel “not depressed.”

“Postpartum Depression” is sometimes used as a popular term, but it isn’t really a DSM-
IV [2] disorder. The phrase “With Postpartum Onset” can be used as a specifierfor any of the
depressive disorders or manic disorders. Nevertheless, the idea of a postpartum depression
deserves some mention. In case you haven’t guessed, postpartum refers to childbirth, and it
often happens that a woman will feel depressed soon after giving birth. And here things can get
complicated. On the one hand, the nature of a woman’s labor can significantly affect her
emotional state after delivery. If a woman perceives a low level of support from her family or
the hospital staff, if there are elements of blame or being blamed involved in the pregnancy
(especially if it was unwanted or unplanned), or if she perceives a lack of control or high levels
of fear for her own well-being during the course of the labor, she can experience some of the
symptoms (including depression and anxiety) characteristic of Posttraumatic Stress
Disorder (PTSD). [3]

On the other hand, “postpartum depression” need not be a clinical depression, and it need not
even be associated with childbirth. In fact, many events in life, when successfully completed,
can bring on a sense of temporary “depression.”

I myself felt sick and “depressed” when I successfully passed all my comprehensive exams
on the way to my PhD; the same thing happened when I passed my licensing exams for
my psychologist license. And on the very afternoon that I passed my flight exam for my
private pilot’s license I developed flu symptoms that lasted for two days of misery. All of
this really relates to the existential experience of investing tremendous energy to achieve
something—and then, when it is finally achieved, feeling a profound inner void. I now
understand that this is a spiritual problem, for when we fail to live with devout humility
and emptiness of self—as I sadly failed to do in those years—we are blind to any
grounding in spiritual stability, and we instead skip from one social accomplishment to
another, with gaps of despair in between.
Bipolar Disorder can take several forms. Bipolar I Disorder hinges on the history of at least one
Manic Episode (see below) with several variations regarding the most recent episode, which
can be Manic, Depressed, Mixed, or Hypomanic. Bipolar II Disorder hinges on the presence (or
history) of a Hypomanic Episode (see below) and the presence (or history) of a Depressive
Episode (see above). The old diagnostic term, Manic-Depressive Disorder is not used in the
DSM-IV [4]; it referred to the clinical presence of both mania and depression—not both at the
same time, of course; usually, the depression follows the mania.

Some of the following can help to distinguish bipolar depression from unipolar depression.

• History of treatment resistant to antidepressants

• Family history of bipolar disorder
• Psychotic symptoms
• Symptoms such as hyper-somnia (excessive sleeping), extreme fatigue, and increased
appetite

Click here for a short discussion about treatment for mania.

A Manic Episode refers to a period of elevated, expansive mood, lasting about a week.
A Hypomanic Episode refers to a period of elevated, expansive mood, lasting a shorter time
than a manic episode, but that can lead to an intense manic episode of severe grandiosity,
delusions, being out of control, and poor judgment. Both consist of some of the following:

• Inflated self-esteem or grandiosity

• Decreased need for sleep
• More talkative than usual or pressure to keep talking
• Less shy or inhibited
• Overly optimistic
• Surging feelings of lust
• Flight of ideas, or subjective experience that thoughts are racing
• Distractibility
• Irritability and impatience
• Increase in goal-directed activity or psychomotor agitation
• Spending too much money

Cyclothymic Disorder is to Bipolar Disorder what Dysthymic Disorder is to Major Depressive

Disorder; that is, similar in nature, but far less severe. It involves numerous periods of
depressive symptoms alternating with hypomanic episodes (see above). The most common
treatment (that is, aside from intensive psychotherapy) for a cyclothymic disorder, like a
bipolar disorder, is often a mood-stabilizing medication.

Family Issues

Many family conflicts can best be treated in family therapy because, curiously enough, the
family’s own attempts to solve a problem can actually cause new problems.

For more information, see my page on Family Therapy.

Health Issues

Many health issues can be addressed through the use of psychology. In fact, the field of Health
Psychology is a new and fast-growing application of psychology. Following are several
treatment applications of this field.

Addictions. The word addiction is actually a popular term which tends to get applied to either of
the two DSM-IV [5] diagnoses regarding Substance-Related Disorders.
Substance Abuse is an indication of a serious growing problem in someone, and it refers to a
maladaptive pattern of substance use leading to clinically significant impairment or distress
characterized by such things as

• Recurrent substance use resulting in failure to fulfill major role obligations (e.g., work,
school, family);
• Recurrent substance use in situations in which it is physically hazardous (e.g., driving an
automobile);
• Recurrent substance-related legal problems;
• Continued use of the substance despite having persistent problems caused by its use.

Substance Dependence reflects a grave problem more serious than Substance Abuseand refers
to a maladaptive pattern of substance use leading to clinically significant impairment or
distress characterized by such things as

• Tolerance (a need for increased amounts of a substance to achieve the desired

effects, or diminished effect with continued use of the same substance);
• Withdrawal (see below);
• Taking the substance in larger amounts or over a longer time than was intended;
• Persistent desire or unsuccessful efforts to cut down the substance use;
• Spending a great amount of time in activities necessary to obtain the substance;
• Giving up or reducing important social, occupational, or recreational activities because of
substance use;
• Continuing the use of the substance despite knowledge that its use is causing problems.

Withdrawal refers to

• The development of a substance-specific syndrome due to the cessation of, or reduction in,
substance use that has been heavy and prolonged;
• The substance-specific syndrome causes clinically significant distress or impairment in
important areas of functioning.

By the way, it should be noted that, in regard to withdrawal, stopping nicotine “cold
 turkey” can be a nuisance, and stopping heroin “cold turkey” can be grueling, but
stopping alcohol “cold turkey” can be fatal. Therefore, withdrawal from alcohol requires
proper medical supervision—that is, if you want to survive the process.

If you can answer “Yes” to any of the Substance Abuse items, you may be headed for serious
trouble unless you get help. If you can answer “Yes” to three or more of the Substance
Dependence items, you’re already in over your head and need help immediately.

Treatment

Alcohol and street drugs are often used as self-medication for undiagnosed psychiatric
problems such as depression, mania, or anxiety, so any substance abuse treatment should look
carefully for other underlying disorders.

Although the initial treatment for an addiction to drugs or alcohol is usually undertaken in an
inpatient detoxification treatment program, a psychologist can be of help in the later stages of
recovery. Psychological treatment can be a cognitive-behavioral form of support to maintain a
healthy lifestyle, or (after recovery is well established) it can focus on the
underlying despair which fueled the addiction in the first place.

The core of any addiction involving intoxication or euphoria is your feeling so deprived of your
primal desire—real love from your parents, especially through the lack of yourfather—and
so angry about it, that you use the addiction to wash away the “stain” of the anger. Thus you
settle for any satisfaction of excitement and intensity, and then, because the intensity of the
satisfaction is short-lived, you crave it all the more.

Addictions draw their strength from your lack of believing in anything greater than yourself.
When you lack having something greater than yourself to define the addiction as harmful, and
when despair is therefore the unconscious essence of your life, then nothing in you can stand up
to the overwhelming urge for momentary pleasure and say, “Wait! This isn’t right.”

Note that the 12-Step abstinence programs can be useful adjuncts to psychological treatment
for recovery from addictions to alcohol, drugs, and gambling. Of course, total abstinence from
food is not an option for recovery from bulimia (see below). And then, for sexual addictions,
sexual abstinence is often rejected outright. “I’ll die if I can’t have sex,” people say. And then,
sadly, many die because of it.

Alcoholism as a Disease

It’s true that some persons have a genetic predisposition (a) to craving alcohol as a defense
against emotional vulnerability or (b) to becoming addicted to alcohol once it is used as such a
defense. And once addicted, such persons can be subjected to changes in body chemistry that
are beyond their conscious control.

Still, if alcoholism is a disease, it’s an unusual one. A person with brain cancer, for example,
can’t just wake up one morning and say, “You know, I’m sick of this illness. Today I’m going
to stop having cancer.” Yet an alcoholic has to do almost precisely that. He or she has to say,
“Today I’m going to stop drinking. And if I can’t do it myself, I will get into a treatment
program that will force me to stop drinking.” In other words, treatment for alcoholism is
behavioral. If you’re an alcoholic, your behavior has to change. You have to stop drinking.
And, once you get clean and sober, in all likelihood you will have to continue to refrain from
drinking thereafter. It’s all a matter of personal choice, regardless of genetics or brain
chemistry.

Dentistry. Many persons get anxious just thinking about a visit to the dentist, and they become
terrified of major dental procedures. Imagine how nice it would be to sit comfortably in the
dental chair, completely relaxed, and free of pain. Sure, you could use “laughing gas,” but why
not use the resources of your own mind to stay calm? When I visit a dentist, I can even stop
bleeding when my dentist requests. More and more today, dentists and their patients are
utilizing the services of a psychologist to learn these remarkable techniques.

Eating Disorders. Two common eating disorders are Bulimia Nervosa and Anorexia Nervosa.

In Bulimia Nervosa, a person binge eats and then uses compensatory behavior to control
weight.

• A person with the Purging Type of bulimia engages in self-induced vomiting or misuses
laxatives or enemas.
• A person with the Nonpurging Type of bulimia uses fasting or exercise to control weight.

In Anorexia Nervosa, a person fails to maintain a minimally normal body weight and exhibits a
fear of gaining weight or becoming fat. As she looks at herself in a mirror, she may even see
herself as fat, even though she may be so thin as to be near death.

• A person with the Restricting Type of anorexia does not regularly engage in binge-eating or
purging behavior; thinness in maintained by restricting food intake or by excessive exercise.
• A person with the Binge-Eating/Purging Type of anorexia regularly engages in binge-eating
or purging behavior while also restricting food intake or exercising excessively.

The dangers of Anorexia Nervosa are very real: loss of the menstrual period is a warning
for women, and loss of bone mass and sudden cardiac arrest can be unfortunate
consequences of the disorder.

Family conflicts, with issues involving identity and self-esteem, influenced by a desire to control
feelings of anger— usually at a father who is lacking in gentleness and guidance because he is
manipulative or controlling—are core factors of anorexia. In addition, the inability to
understand one’s emotions—technically called alexithymia—can be a complicating factor.
When anger, frustration, sadness, fear, and so on get confused with hunger, then the stage is set
for disaster. Note that anorexia can be anoccupational hazard for dancers, actresses, and
models who must adhere to the ideal of a thin body type and at the same time cannot manage
emotional setbacks very well.

Obesity does not get classified by the DSM-IV as a true eating disorder because “it has not been
established that it is consistently associated with a psychological or behavioral syndrome.”
Thus the DSM-IV treats obesity as a general medical condition.

Calculate your Body Mass Index (BMI)

The general facts about weight gain, however, are governed by a simple law of physics: if you
consume more calories than you expend in exercise, you will gain weight. There are two points to
consider in this regard:

• Some persons have—or through yo-yo dieting have created—a metabolism that tends to
store food intake as body fat, and for such persons it can be a trial—but not impossible—to
maintain a normal body weight.
• Some obese persons will claim, in all seriousness, that they do not eat very large meals. But,
if their eating habits are examined closely, it is often discovered that they “nibble” or
“snack” almost constantly throughout the day. All of this points to the way that you
can unconsciously deceive even yourself about your true behavior.
Psychological factors, therefore, can play a role in obesity, either as a primary cause, or
as secondary causes underlying a medical condition.

Anger. Unconscious anger can generate feelings of victimization, guilt, and self-loathing.
Consider the following examples:

• Some individuals will resist physical exercise and disciplined eating habits (saying that it’s all “too
much trouble” or “unfair”) because they lacked protection and guidance as children.
• Some individuals will use food as a way to stuff down feelings of irritation and resentment because
they don’t know what to do with those feelings.
• Some individuals will eat to compensate for their emotional “hunger” for acceptance from their
mother, a mother who criticized, neglected, or rejected them.
• Some individuals will overeat as a way to punish themselves, saying to themselves, “I don’t care
how much this harms my body; I don’t deserve any better.”
• Some individuals will derive a certain satisfaction, and pride, from “throwing their weight around” as
compensation for their feelings of social and emotional helplessness.

Body Armor. Some individuals, usually women who have been sexually abused as children, use
body fat unconsciously as a sort of body armor to deflect the sexual desires of others.
Deadened Emotional Awareness. Some individuals, usually because of the emotional emptiness
of growing up in dysfunctional families, have so deadened their emotional awareness, as a
psychological defense, that they perceive all emotions as hunger. Anger, frustration, fear,
sadness, loneliness—it all feels like hunger. But, at its psychological depth, it’s really a hunger
for emotional acceptance, not for food.
Deprivation. Some individuals who felt deprived of emotional or material resources as children
will, as adults, resist the self-restraint of healthy eating because it feels like another form of
deprivation.
Reward. Some individuals have grown up in families that use food as a reward for being
“good,” and so, as adults, they can use food for self-soothing when they feel “bad.”

Hypertension (High Blood Pressure). Medical research [6] has demonstrated the efficacy of
nondrug interventions in preventing and controlling high blood pressure (HBP).

The following are some behavioral life-style changes that can help reduce HBP:
• Lose weight.
• Increase physical activity.
• Eliminate alcohol intake, or limit it to 1 ounce per day.
• Reduce sodium (salt) intake to less than 1 teaspoon per day.
• Stop smoking.
• Consume adequate potassium (about 3.5 grams per day).
• Reduce “stress” by practicing a relaxation technique such as Progressive Muscle
Relaxation or Autogenics. (We know that a stressful environment can produce a tendency
toward HBP, and we know that relaxation techniques can lower HBP at least temporarily,
but we have no conclusive evidence yet that any relaxation technique, by itself, can produce
a lasting decrease in blood pressure. But dedicated practice of a relaxation technique in
conjunction with the other items above may allow you to reduce your blood pressure
without medication.)

Note. If you are having trouble meeting the 155/95 limits for blood pressure,and have
already altered your diet, exercise, and relaxation strategies, you might be interested to
know that MD Systems, Inc. is marketing a technology, derived from military aviation
research, that can help lower blood pressure without medication. For more information,
see their website.

Illness. Although a physician will be the primary care provider for any illness, a psychologist
can assist with the treatment through hypnosis, guided imagery, biofeedback, and stress
management to help with nausea and vomiting from chemotherapy, to help bolster the immune
system, and to enhance communication and assertiveness regarding one’s own treatment.

Aside from illness whose cause is clearly physiological, there are several Somatoform
Disorders whose basis is largely psychological (and unconscious):

• Somatization Disorder describes a condition of many physical complaints (including four

pain symptoms, two gastrointestinal symptoms, one sexual symptom, and one
pseudoneurological symptom) which cannot be fully explained by a known general medical
condition.
• Undifferentiated Somatoform Disorder describes a condition of one or more physical
complaints (such as fatigue, loss of appetite, gastrointestinal or urinary complaints) which
cannot be fully explained by a known general medical condition.
• Conversion Disorder refers to symptoms involving voluntary motor function or sensory
function which cannot be explained by a general medical condition. These symptoms (such
as paralysis of an arm, or blindness or deafness) are preceded by psychological conflicts or
“stress.”
• Hypochondriasis refers to a preoccupation with fears of having a serious disease. This fear is
usually based on bodily symptoms which are really perceived but misinterpreted.

Pain Management. Psychologists often serve on Pain Teams in hospitals, as I have done, to
make sure that acute (“new”) pain is properly managed. In addition, psychologists can help
individuals cope with chronic (on-going) pain, especially when other forms of treatment have
been ineffective

Note, however, that whether the psychologist uses psychological methods of pain management
or assists in the behavioral administration of pain medications, the goal is not to eliminate pain
but to reduce it to a level which permits a functional life. In other words, though we must all
bear afflictions, we don’t have to be overcome by them.

Smoking Cessation. Psychologists can be of special help with overcoming the addiction to
smoking.

For more information, see my page about how to stop smoking.

“Stress” Management. With modern life becoming more and more fast-paced and demanding,
techniques for relaxation are becoming more of a necessity. Rather than rely on tranquilizers, a
person can get help from a psychologist to cope with the excessive “stress” of daily life.

Wellness. In contrast to the medical focus on illness, some persons now focus on the concept of
wellness. This refers to the idea that health and well-being can be actively maintained. A
psychologist can offer assistance in learning how to maintain this new kind of focus.

Performance Enhancement

Sports Psychology got started by helping athletes improve their competitive performance by
mentally rehearsing their routines. Now almost every world-caliber athlete uses these
techniques.

Performance Enhancement—as in autogenics training—can be used as well by non-athletes to

improve concentration and composure in any area from work to recreation: test taking,
speeches, presentations, stage fright, and so on.

Sometimes, quite a bit of the work of enhancing performance involves overcoming past
“negative hypnosis.”

Spiritual Issues

Many, if not most, psychological problems have roots in issues such as coming to terms with
mortality, finding personal meaning in life, and general life satisfaction and direction.
Psychology, as a science, can only point out to a person that these “deeper” issues raise
questions that somehow need answers. Although psychology cannot provide those answers, it is
possible, from within the framework of psychotherapy, to discuss and explore spiritual
aspirations.