Post-Traumatic Stress Disorder (PTSD)

What is PTSD?

Post-traumatic stress disorder (PTSD) is an anxiety disorder that develops after experiencing or witnessing a traumatic event or learning that a traumatic event has happened to a loved one. PTSD is most often associated with veterans and wartime involvement, but there are many experiences that can cause PTSD. Some examples are:

-Threat of death or serious injury
-Sexual abuse, violence and rape
-Chronic physical abuse, severe emotional abuse and neglect
-Living through natural disasters such as earthquakes, hurricanes, floods, or fires
-Community violence like attacks at a local school
-The suicide of a friend or family member

Post-traumatic stress disorder often accompanies other anxiety disorders, mood disorders like depression, or substance use. Women are twice as likely as men to develop PTSD. People with PTSD often relive traumatic events through flashbacks, nightmares, and intrusive memories which can be almost as stressful as the original event. Although people do develop PTSD from experiencing natural disasters, trauma caused by other people is more likely to result in the development of post-traumatic stress disorder.

The Difference between ‘Everyday’ Anxiety and PTSD

Anxiety often serves as a warning system that alerts us to threats. Anxiety helps protect us from harm and helps us react quickly when we are in danger. When anxiety becomes excessive and is no longer beneficial, it may become an anxiety disorder such as PTSD.

In the case of PTSD, people re-experience the traumatic event that originally triggered their symptoms even when no actual threat is present. People suffering from PTSD experience a cycle of distressing intrusive memories and states of high anxiety. Behaviors, such as isolation, can emerge to avoid triggering anxiety. People experiencing the symptoms of PTSD often describe themselves as overwhelmed.

Signs and Symptoms of PTSD

Post-traumatic stress disorder is diagnosed after a person experiences symptoms for at least one month following a traumatic event. However, symptoms do not always appear quickly. It can take months, or even years, for PTSD symptoms to manifest.

-Post-traumatic stress disorder is characterized by four main types of symptoms:
-Reliving a traumatic event through intrusive recollections, anxiety attacks, flashbacks, and nightmares
-Emotional numbness
-Avoidance of normal daily activities and other people
-Feeling cut off from others and negative mood and thought patterns
-Increased reactivity and difficulty sleeping, feeling jumpy, easily irritated and angered

Psycho-education
PSYCHO-EDUCATION

Psycho education is a means of providing people being treated for mental conditions with information about the causes, symptoms, prognosis, and treatments of their diagnosed condition.

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Counselling Process
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Relaxation Techniques
RELAXATION TECHNIQUES

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Counselling Process
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Anger Management
ANGER MANAGEMENT

How angry are you?
Anger is a universal experience.
Anger doesn’t just affect your mental state. Your physical health is linked to your psychological state and suffers too. Anger can cause insomnia, body tension, anxiety, depression and poor quality of life. Managing anger in healthy ways is something few individuals do well. An individual who can manage his anger productively minimizes destructive conflicts. This workshop is for anyone interested in exploring and understanding their anger, as well as discovering the necessary tools to safely manage and transform their anger effectively. You will develop an accurate profile of your own anger and stress levels, thereby giving you valuable information and insight into what triggers your reactions.

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Group Therapy
GROUP THERAPY

Intimate partner violence, grief counseling, drugs and alcohol addiction, gambling addiction, internet addiction, sexual addiction, postpartum depression, suicide/depression

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Family Therapy
FAMILY THERAPY

Family therapy is a type of psychological counseling (psychotherapy) that can help family members improve communication and resolve conflicts.

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Couple Therapy
COUPLE THERAPY

Couples therapy is a type of psychotherapy in which a therapist with clinical experience working with couples helps two people involved in a romantic relationship gain insight into their relationship, resolve conflict and improve relationship satisfaction utilizing a variety of therapeutic interventions.”Studies show that, in the hands of a good counselor, marriage counseling is successful 70- 80% of the time,” says William Doherty, PhD, LCSW.

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Individual Therapy
INDIVIDUAL THERAPY

Is a psychotherapy implemented by a trained professional, usually a therapist or psychologist, to help a client work through a problem.

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Schizophrenia
What is Schizophrenia?

Schizophrenia is a chronic mental disorder that affects how a person thinks, feels, and behaves. The causes and symptoms can vary among individuals. Schizophrenia affects about one percent of the population, appearing in both men and women equally, though symptoms tend to begin earlier in men. The disorder is present in all ethnic groups. In extremely rare cases, children under the age of 16 have been diagnosed with schizophrenia.

Phases of Schizophrenia

The phases of schizophrenia are prodromal, active, and residual. At CooperRiis, we include ‘recovery’ on this list because we believe recovery is possible.

Prodromal Phase

People with schizophrenia are often misdiagnosed in the prodromal phase because of the wide array of symptoms that can be present and their subtlety. Symptoms in the prodromal phase include:

• Withdrawal from family and social life
• A preference for being alone
• Confusion
• Outbursts of anger
• Depression
• Loss of interest in normal activities and apathy
• Anxiety
• Odd behavior

Active Phase

Over time, symptoms worsen and the active phase of schizophrenia begins. Symptoms in this phase will be obvious to family and friends and include:

• Hallucinations
• Paranoid delusions
• Disorganized speech
• Disorganized behavior
• Confusing thought patterns
• Trouble concentrating

Residual Phase

Symptoms in the residual phase resemble those in the prodromal stage. While alarming symptoms of the active stage have mostly subsided, symptoms such as low energy, listlessness, and withdrawal can still be present.

Recovery Phase

With treatment, most people with schizophrenia will improve with time. Most of our patients come to us in the active or residual phases of schizophrenia, but regardless of where they are, our goal is always the same – to help patients move into the recovery phase by achieving the highest level of fulfillment and functioning possible.

What is a dual diagnosis?

Someone diagnosed with a mental health disorder and substance abuse disorder has what is variously termed a dual diagnosis, co-occurring disorder, or dual disorder. In this article, these three terms are interchangeable. Substance abuse includes addiction to or dependence on alcohol and/or drugs, as well as process addictions, which are addictions that is related to actions. These include gambling, television, the internet, video games, sex and porn, and shopping and spending money.

A dual disorder can be difficult to diagnose for a number of reasons:

• Complexity and severity of symptoms
• Symptom overlap
• Those seeking treatment have often been misdiagnosed
• People diagnosed with a mental health disorder do not realize or believe that their substance use is related to their diagnosis
• Substance abuse symptoms can veil symptoms of mental illness
• Symptoms of mental illness can be easily confused with symptoms of addiction

It is important that both the mental illness and substance abuse be addressed simultaneously. Dual disorders affect one another and impact the success of treatment.

Statistics on Dual Diagnosis

• About one third of all people experiencing mental health issues and about one half of people living with severe mental health issues also experience substance abuse.
• Around one third of all those who abuse alcohol and more than one half of all those who abuse drugs report experiencing a mental illness.
• Men are more likely to develop a co-occurring disorder than women.
• Individuals of lower socioeconomic status, military veterans, and people with physical illnesses are at higher risk. (NAMI)

Signs and Symptoms of Dual Diagnosis

The signs and symptoms of dual diagnosis vary greatly depending on which mental health disorder is diagnosed and the substance being abused.
Personality, demographics, and the mental illness identified often influence the drug of choice. For instance, an anxious person will often abuse drugs that make him or her feel calm. Someone with low, slow energy will use substances that give them energy. Older people tend to drink, while younger people are more likely to use hallucinogenic drugs. Background also determines the chosen drug. If a child observed their parents drinking alcohol, they are more likely to choose alcohol over other drugs as an adult.
Some generalizations can be made about the signs and symptoms of dual disorders, although they are not always applicable.

• If mental health symptoms worsen even while receiving treatment, it is often a sign a latent substance abuse issue is present.
• If alcohol or substance use problems seem resistant to treatment, there may be an unidentified mental health disorder.

Holistic/Intergrated Treatment

Research shows that those with a history of dual disorders are best treated when attention is paid to both mental health and addiction disorders. Thus, the most effective long-term treatment is integrated treatment: both diagnoses are treated at the same time, by the same treatment team, in the same environment.
Imagine for a moment that you want to lose weight and you have three experts to help you: a nutritionist, a personal trainer, and a doctor. Now imagine that these three people never speak to one another. The doctor knows that you have problems regulating your insulin, but never shares that with your nutritionist. Your nutritionist puts lots of fruit on your dietary plan not knowing that this may make your insulin regulation problem worse. Finally, you arrive at the gym with your blood sugar shooting sky high, or dipping too low, and your personal trainer doesn’t understand why your energy levels vary so much. You may make some headway on your goals, but you also may give up, frustrated with how terrible you feel. Now imagine an entirely different scenario where these three experts are communicating vital information with one another. It’s much more likely you’ll have success with your weight loss goals when everyone who is helping you has all the information needed. This example illustrates why integrated treatment works well for dual diagnoses.

What are the building blocks of Integrated Treatment?

• Coordinated treatment for multiple diagnoses
• All healthcare professionals cooperate and share information
• Bundled interventions (A bundle is a small, straightforward set of evidence-based practices that, when performed collectively and reliably, have been proven to improve outcomes.)
• No division between treatments

Why is Integrated Dual Recovery Important?

• Integrated treatment has been proven consistently more effective
• Recognizing the relationship between the diagnoses can help recovery planning
• Treating one without the other usually leads to relapse of both
• There is no evidence that one disorder causes the other
• To be aware of the risks of returning to use
• Integrated treatment is often less expensive than separate treatments

Holistic Treatment at AMHRTF: Treating the Whole Person

At AMHRTF, we apply the findings of evidence-based research to the care of patients with dual diagnosed disorders. And, most important, we ask questions and listen when patients tell us their needs. Some people thrive in group therapy sessions, while others benefit more from one-on-one therapy. Overall, we strive to provide a safe, healing environment with minimal triggers for relapse.
We offer all of the traditional treatments for dual diagnosis such as:
• Psychopharmacology
• Individual therapy and addictions counseling
• Weekly Dual Diagnosis Support Group (run by patients)
• Weekly Dual Diagnosis Psychoeducation & Process Support Group (run by the clinician)
• Weekly Addiction Education Group, including nicotine cessation
• AA group meets weekly
• Relapse prevention and sobriety resources
• Milieu Therapy within a Supportive Community
During dual diagnosis groups, patients talk about the substance and mental health aspects of their recovery. They discuss triggers, coping skills, and how mental health conditions and substance abuse affect each other. They also share stories and support each other, fostering a sense of community. It is helpful for patients to hear others’ stories to understand that they are not alone, and to appreciate that other people have similar challenges.
AMHRTF is focused on the whole person, we put a great deal of emphasis on all aspects of a person’s health. We call this the Seven Domains of a Whole, Healthy Person:

Seven Domains of a Whole, Healthy Person

1. Physical wellness
2. Emotional and psychological health
3. Spirituality
4. Intellectual creativity and learning
5. Social and community connectedness
6. Purpose, productivity, and fulfillment
7. Empowerment and independence
We know that if a person is suffering in one of the areas above, even if it is not directly related to their diagnosis, it will be difficult to focus on healing. Our community work and service programs give patients a sense of purpose, productivity, and fulfillment. Work and service also aids our patients in feeling connected to the community.

Anxiety Disorders
What are Anxiety Disorders?

Fight or flight! Almost everyone has heard of this essential reaction of the body. Anxiety, the subjective experience of the fight or flight response, is an entirely normal reaction to stress and can be beneficial in some situations. When your fight or flight response is working correctly, it alerts you that there is danger without over-stressing the body. Danger is perceived and you either leave the situation as quickly as possible, or you stand your ground and fight. Once the danger is past, the body relaxes once again into its normal. When the fight or flight response isn’t working properly, an anxiety disorder can develop in which excessive feelings of fear, nervousness, and anxiety flare up when there is no discernible danger.

Anxiety disorders affect nearly 30 percent of adults at some point in their lives. In any given year the estimated percent of U.S. adults with some of the specific anxiety disorders are:
• 7-9% a specific phobia
• 7% social anxiety disorder
• 2-3% panic disorder
• 2% agoraphobia
• 2% generalized anxiety disorder
• 1-2% separation anxiety disorder

Women are more likely than men to experience anxiety disorders. (Above data from the American Psychiatric Association)

Anxiety Disorders Signs and Symptoms

Because the signs and symptoms of anxiety disorders are so varied and imitate so many diseases, anxiety is often misdiagnosed. Anxiety symptoms can affect almost any area of the body.
The most common signs and symptoms of anxiety include:

Common Emotional Symptoms of Anxiety:

• Excessive and irrational fear
• Excessive and irrational worry
• Always anticipating the worst
• Feeling tense and/or jumpy
• Inability to stay calm
• Irritability
• Nervousness
• General uneasiness
• Feelings of apprehension or dread
• Constantly watching for signs of danger
• Difficulty concentrating

Common Physical Symptoms of Anxiety:

• Sweating
• Dizziness
• Headaches
• Rapid heartbeat
• Stomach upset/diarrhea/nausea
• Frequent urination
• Shortness of breath
• Dry mouth
• Muscle tension or twitches
• Trembling
• Insomnia/issues with sleep
• Inability to be still
• Cold, sweaty, numb or tingling hands or feet (Paresthesia)

This list of the most common symptoms of anxiety is by no means exhaustive. Anxiety manifests in hundreds of ways and combinations and is unique to the individual.
Since anxiety can manifest in many ways, there are several types of anxiety disorders:

Generalized Anxiety Disorder

People suffering from generalized anxiety disorder feel excessive, persistent worry with little or no reason. This constant worry interferes with daily activities and can have a negative impact on personal relationships. With generalized anxiety disorder, everyday life is overwhelming and often exhausting.

Panic Disorder

Those diagnosed with panic disorder experience recurrent panic attacks. During a panic attack, the intensity of anxiety disorder symptoms is heightened for a short period of time – usually 10 minutes or less. The intensity of the symptoms during a panic attack can be so extreme that people believe they are having a heart attack or other life-threatening issues.
Common symptoms of a panic attack include:

• Surges of overwhelming panic and/or terror
• Heart palpitations or chest pain
• Sweating
• Trembling or shaking
• Difficulty breathing or hyperventilation
• Choking sensation
• Nausea or upset stomach
• Feeling dizzy, faint, or lightheaded
• Hot flashes or chills
• Feelings of unreality or being detached from oneself
• Fear of losing control or “going crazy”
• Fear of dying

Phobias, Specific Phobia, and Irrational Fear

A specific phobia is an intense and persistent fear of a specific object, situation or activity that is generally not harmful. Those with phobias often know that their distress is disproportionate, but they still cannot overcome it. People suffering from a phobia will go to extremes to avoid whatever frightens them.
One common phobia caused by anxiety which greatly interferes with normal activities is agoraphobia. Agoraphobia is the fear of being outdoors or of being in a situation from which one either cannot escape or from which escaping would be difficult or embarrassing.

Social Anxiety Disorder

Everyday social situations and interactions are a landmine for people with social anxiety disorder. Those suffering from this disorder are preoccupied with the possibility of being embarrassed, ridiculed, judged, or rejected in social situations. As a result of this fear, they avoid social situations and often miss out on connecting with friends and family.

Separation Anxiety Disorder

A person with separation anxiety disorder experiences excessive fear of losing the person they are closest to. They are extremely anxious when separated from the people to whom they are attached and may refuse to be separated from the people who are the focus of their attachment. These extreme feelings of anxiety and fear last beyond established norms for children (4 weeks) and adults (6 months).

Substance-Induced Anxiety Disorder

A substance-induced anxiety disorder is directly caused by the effects of an ingested substance. Symptoms can result directly from the intoxication or may be due to withdrawal from alcohol, drugs, caffeine, and related substances.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is an anxiety disorder that develops after experiencing or witnessing a traumatic event or learning that a traumatic event has happened to a loved one. PTSD is most often associated with veterans and wartime involvement, but there are many experiences that can cause PTSD.

What is Major Depressive Disorder?

Sadness is a part of life. Occasional feelings of melancholy, listlessness, or ‘the blues’ are just a few of the many feelings we experience as healthy individuals in response to our world. Clinical depression, however, is different, and is considered a serious mental health condition. A Major Depressive episode is defined by an incessant feeling of intense sadness and lack of interest in formerly enjoyable activities that goes on for an extended period. Major Depressive Disorder (MDD) impacts both mood and behavior. People with Major Depressive Disorder often have trouble performing and participating in everyday activities and sometimes feel as if life isn’t worth living.

Major Depression is surprisingly common. The Journal of the American Medical Association states that the lifetime incidence of depression in the United States is more than 20-26% for women and 8-12% for men.

The median age for the onset of clinical depression is 32 (U.S. Census Bureau Population Estimates by Demographic Characteristics, 2005).

Types of Depressive Disorder
Seasonal Affective Disorder (SAD)

Depression directly caused by the time of the year. It occurs most often in the winter months when sunlight is not as readily available, typically going away in the spring and summer.

Persistent Depressive Disorder

Depression that lasts for two years or longer.

Psychotic Depression

Depression accompanied by psychotic symptoms such as hallucinations, delusions, and paranoia

Postpartum Depression

Depression that develops in the weeks or months after childbirth.

Premenstrual Dysphoric Disorder (PMDD)

Depression experienced by women prior to the start of each period. Other symptoms can include fatigue, anxiety, mood swings, change in appetite, change in sleep patterns, difficulty concentrating, irritability, and feeling overwhelmed.

Situational Depression

Usually a short-term, stress-related type of depression that develops in response to a traumatic event. Common events that can trigger situational depression include the death of a loved one, divorce, and illness. Situational depression is also called ‘stress response syndrome’.

Signs and Symptoms of Depression

To be diagnosed with major depression, you must be suffering from five or more of the following symptoms for two weeks or longer, and at least one of the symptoms must be loss of interest in activities or a depressed mood. Symptoms may vary depending on what kind of depression has been diagnosed.

•Feelings of sadness and/or irritability
•Loss of interest in once enjoyable activities
•Significant change in weight (loss or gain)
•Changes in sleep patterns – trouble falling asleep, insomnia, or the need to sleep more than usual
•Feeling and appearing restless and agitated or slowed down
•Fatigue or loss of energy
•Feelings of worthlessness and guilt
•Inability to focus/difficulty in thinking
•Thoughts of death or about suicide

(Adapted from DSMV)

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