You may find that many of the suggestions in this book work well for you and that you don’t need a health-care practitioner. Still, it’s wise to at least have a practitioner available in case you need an objective reaction to your situation. Although the belief remains that people should be able to handle their own problems, in reality they can’t always. Think of yourself as being mature and smart for recognizing when you need help and getting it.
Doug used many of the methods and techniques discussed in this book and found them useful, but when he lost his job in a merger, his anxiety increased and he sought out a counselor to help him through it. Through counseling he learned how to plan out how he was going to approach job interviews, something he hadn’t faced in twenty years. He started to write in a journal about his feelings, found a massage therapist, and started taking yoga classes.
As you can see from Doug’s example, you may need to take a multifaceted approach to your anxiety.
Situations That Probably Require Therapy or Counseling
There are several situations that are best handled in long-term psychotherapy or counseling. One is the recall of traumatic events. Another is feeling anxious and not being able to connect current events with this feeling. A third is when feelings emerge that are too upsetting or anxiety-provoking for you to handle.
Traumatic Events
Starting to reexperience the effects of traumatic events can be anxiety-provoking, especially when you don’t have an understanding of what’s happening. You may have little or no recollection of the actual traumatic event, but it is affecting you nevertheless. Sometimes, if the traumatic event occurred in childhood, raising your own children can bring forth the anxiety associated with the event.
Twyla exemplifies this situation. She seemed to be perfectly fine until her daughter reached the age she was when a stranger lured her from the bus stop with candy. He drove her around and apparently didn’t touch her before bringing her back to where he’d picked her up. Now Twyla experiences extreme anxiety whenever her daughter leaves the house. Until she contacted a therapist and started to talk about her life, she didn’t become aware of this early experience and how it was still affecting her.
Sometimes the trauma is something that happened to you in adulthood, like rape, or observing a life-threatening occurrence. Todd, a sergeant in the army, newly returned from Iraq, and Cynthia, a woman who had been repeatedly raped by her ex-husband, exemplify this kind of situation.
The anxiety these experiences evoke can be intense and may be combined with panic. Your mind can block out the recollection to protect you. It’s not a conscious choice. It’s an automatic process, but it’s only a temporary solution because the real cause can be set off by current events and take you by surprise.
With an experienced therapist or counselor to help you stay calm, healing is facilitated as you gradually become aware of the source of your pain. The source of your anxiety becomes clearer and clearer. Talking to a therapist about your memories, feelings, and thoughts aids in the process of recall and resolution. Once that is accomplished, you will be ready to use some of the approaches suggested in this book.
Stressful Current Events
Sometimes you may not be able to identify what is making you feel anxious. You’re sure you haven’t had any traumatic events in your life, but still you feel that something’s wrong. You may just need somebody who can stay objective and guide you to uncover the source. This person would probably be a therapist or counselor. This person would ask you questions like, “What happened today right before you started feeling anxious?” and “What else was going on when you started to feel anxious?” As you begin to examine what happened, you’ll start to make connections between your day and your feelings. Making these connections requires your willingness to start talking about what happened, to put your feelings and experiences into words, and to try to clarify connections between events in your life and your feelings.
When you first start therapy, you probably won’t have any notion why you feel as anxious as you do. Just talking about stressful events enables you to begin to make connections between them and your anxiety, but it can also temporarily raise your anxiety. Sometimes this process happens quickly. Other times, it requires a lot of soul searching.
Anxiety-Provoking Feelings
You may have uncomfortable anxiety after a particular experience, even a pleasant one, and have no inkling why. Sarah is a good example of this—
Sarah was watching a movie one night and started to feel extremely anxious. She couldn’t sleep that night, and the next day, upon advice of a friend, made an appointment with her friend’s therapist. In just one session Sarah was able to make the connection between a tender scene in the movie between the father and daughter and her anxiety. Her father had been distant and critical, and she’d always yearned for a better relationship. When she saw the actors on the screen, it put her in touch with her conclusion that something was terribly wrong with her because her father was so unaffectionate. With support from the therapist, she was able to talk with her father and make her need for affection known. Although her father had a tough time with it, he was able to join her in a session with the therapist and tell his daughter that he did care about her, he just had a hard time showing it. Sarah’s anxiety receded, and after that she had no difficulty watching films featuring affectionate fathers.
Types of Practitioners
Psychotherapist is a term that applies to different types of practitioners. When choosing a psychotherapist, it’s helpful to know something about the education and training of practitioners in the most common disciplines
Psychiatrists
All psychiatrists are MDs, but not all medical doctors are psychiatrists. To enter medical school an individual must complete a four-year degree such as bachelor of science (BS) or bachelor of arts (BA). Each medical school has its own specific requirements, but a strong science background is essential. Once admitted, medical students spend four years studying medicine, and the last two years usually includes practice in basic medical procedures with patients, under the supervision of other student doctors, called residents.
After graduation some medical students pursue a psychiatric residency of three to four years. After completing this residency, a physician is qualified to practice as a general adult psychiatrist (child and adolescent psychiatry requires another year or two of training). Psychiatrists take a qualifying test known as a state board exam that includes a written portion and a practical portion that tests for clinical competency with patients. To keep up with the latest information, psychiatrists must earn continuing-education credits to keep their medical license. They can obtain these credits by attending workshops, giving presentations, or writing journal articles or books.
Because of their knowledge of physiology and anatomy, they can find problems of the heart, lung, and nervous systems that may influence your anxiety. Psychiatrists are mostly concerned with prescribing and monitoring medications. Rather than conduct ongoing therapy, most psychiatrists these days work in conjunction with other mental-health professionals who provide psychotherapy.
Nurses
Most nurses complete a three-to-four-year nursing program before earning a bachelor of science in nursing (BSN) or BS in nursing. Nurses who provide psychotherapy also have a master’s degree. In most states, a nurse with a master’s degree is known as a Clinical Nurse Specialist (CNS) or Psychiatric/Mental Health Nurse Practitioner (ARNP or PMHNP). Both have two or more years of education beyond the bachelor’s degree and are educated to treat their clients using a more holistic method than their master’s-prepared counterparts in psychology or social work (discussed below).
Most states allow CNSs and ARNPs, or PMHNPs to write prescriptions, often under the guidance of an approved supervisor with whom they have a written practice agreement.
Because of their broad education CNSs, ARNPs, and PMHNPs are also responsible for crisis intervention, client education, medication management, coordinating aspects of care, physical examinations, and mental status exams. Many CNSs perform psychotherapy, too, after having spent two years studying growth and development, theories of clinical practice, and psychiatric mental health nursing approaches and applying what they’ve learned with individuals, families, and groups, under supervision of more experienced nurse clinicians. Many programs require that students complete a thesis, which is a research study that focuses on a specific aspect of clinical practice. CNSs may specialize in an adult or child practice.
Once they complete their master’s degrees, they continue to be supervised by a more experienced nurse psychotherapist for several thousand hours before they can take a national certifying exam to become a certified CNS, ARNP, or PMHNP. Certification is required for master’s-prepared nurses who wish to practice in certain settings.
Psychologists
Psychologists complete a bachelor’s degree before entering advanced training. They are educated at either the master’s (MA, MS) or doctorate level (PhD, PsyD, or EdD). Some states will only license psychologists for independent practice if they are prepared at the doctorate level. Students may work in a hospital, outpatient mental health clinic, school, or any other type of facility that provides the type of work that interests them.
A psychologist with a master’s degree has completed two years of advanced training in both course work and clinical work focused on personality development, abnormal psychology, tests and measurements, and theories of clinical practice. A field placement in a clinical setting is required in many programs. These students see patients under supervision and are observed by seasoned clinicians.
After graduation, a master’s-prepared clinician must practice under an approved supervisor for two years, then take a national licensing exam.
Doctoral students can choose from a wide array of specialties (not all of which prepare them to be a psychotherapist), including social, industrial, school, or experimental psychology, as well as counseling and clinical practice. No matter which specialty area they choose, each student must conduct a research study, then write about it in a formal paper called a dissertation, which can take from two to seven years to complete.
After completing their degree, most schools require doctoral-level psychologists to complete 2,000 hours of work under a qualified supervisor and pass a national examination before they are licensed to practice independently.
Like psychiatrists and psychiatric mental health nurse specialists, psychologists assess, diagnose, and treat individuals seeking help. They also conduct formal personality, thought, mood, and other cognitive tests. Most states do not allow psychologists to prescribe or monitor medications.
Social Workers
Social-worker psychotherapists generally obtain a master’s degree. They may have a BA in social work, but many have a degree in psychology, nursing, or education. Most advanced programs take two years and include both course work and clinical work. Specialties include clinical work and administration.
Many social-work programs consist of an ecological or systems model of treatment that focuses on an individual in the family, school, work, church, or community setting. This is similar to the advanced registered nurse practitioner model, but very different from the psychologist or psychiatrist models, which tend to focus on the individual.
Clinical social workers who become psychotherapists earn the designation Licensed Independent Clinical Social Worker (LICSW) and must complete their degree, meet all field requirements, practice for 2,000 hours under a qualified supervisor, and pass a national exam.
Clergy
Many people turn to clergy, such as their minister, pastor, or priest, for assistance with anxiety. Not all clergy are trained to treat anxiety or act as psychotherapists. Those who aren’t may tend to offer you standardized advice that doesn’t really relate to your specific concerns and your goals. A competent member of the clergy will refer you to a mental-health professional when the situation requires.
If you choose to work with clergy, ask about their training and credentials. Therapists hang their diplomas and licenses on the wall. Read them. Ask questions.
Types of Therapies
Although there are more than fifty types of therapies, this section will provide a brief overview of the more common ones.
Psychoanalysis
Psychoanalysis is based on the research and clinical experience of such major theorists as Sigmund Freud, Harry Stack Sullivan, Karen Horney, Alfred Adler, or C. G. Jung.
Although psychoanalysis acknowledges biological factors, it emphasizes internal conflicts (Freud), interpersonal issues (Sullivan), environmental and cultural factors (Horney), helplessness and inferiority complex (Alfred Adler), or spirituality, archetypes, and mythology (Jung).
To benefit from psychoanalysis, you must be able to describe and interpret your symptoms in interpersonal terms—for example, “I get anxious when my husband pressures me,” or “I can’t commit to a relationship with somebody because I’m afraid of getting rejected.”
Psychoanalysis generally requires several sessions a week for many years. There is often little direction given by a psychoanalyst, who may say very little to you, except to make an occasional interpretation or to ask you to discuss whatever comes to mind. Relationships with important figures from your childhood are often reenacted in therapy and this transference becomes a focus of the work. It is called resistance when you don’t discuss your problems in therapy.
Person-Centered Therapy
Person-centered, or client-centered, therapy was developed by Carl Rogers in the 1940s. While psychoanalysis places the analyst in the role of expert, client-centered therapy views the client as the expert and assumes you can understand yourself, and change unhealthy thoughts, feelings, and behaviors into healthier ones.
Rogers firmly believed that all people are basically trustworthy, resourceful, insightful, and capable of living effective and productive lives. Rogerian therapists provide the following characteristics during sessions, which are believed to help clients move forward in a positive manner: warmth, empathy, genuineness, and trust. Person-centered therapy focuses on the power of the therapeutic encounter. That relationship is the core of therapy. The therapist reflects back the essence of the client’s feelings. For example, “I am picking up the deep sense of loss and sadness you are feeling about your husband.” The person-centered therapist also opens up new areas of exploration. For example, “I’m also picking up your feeling of anger about being abandoned. Tell me more about that.”
Unlike the psychoanalyst, the therapist isn’t distant but appreciates your state of upset, is willing to relate to you on a more personal level, and shows unconditional positive regard for you. Psychotherapists who practice using this format do not give advice or feedback, or challenge your experience. The length of treatment varies.
If you are psychologically minded, insight-oriented, and motivated to make personal changes in your life, person-centered therapy may work well for you. If you need help with establishing goals and a treatment plan, this kind of therapy may not be for you.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) was developed at the University of Pennsylvania in the 1960s by Aaron Beck, PhD. The main tenet of CBT is that thoughts determine feelings and behavior, and anxiety increases when you misinterpret situations and act on them in dysfunctional ways.
The goal of CBT is to help you test the accuracy of your perceptions and change the dysfunctional ones into more helpful ones. CBT is highly structured and directive, unlike psychoanalytic and person-centered therapies. You work with the therapist to determine your goals for treatment. You will be assigned homework between sessions to help you apply the new ways of thinking, acting, and feeling you learn in sessions. A course of CB therapy typically lasts between eight and twenty sessions.
Marriage and Family Therapy
Marriage and family therapists take a systems view of issues such as anxiety. They believe that one family member’s problems are the result of unhealthy communication patterns, family roles, or family relationships within the community. Your therapist will probably ask your entire family to attend sessions, or will at least take a family view of your condition. The goal of treatment is to help your family return to a healthy state. Your therapist will be active during sessions, guiding you to help facilitate change during sessions and assigning homework between sessions to help family members practice new behaviors they need to implement.
Brief Therapy
Brief therapy is any therapy of twenty sessions or less. Any of the therapies already discussed may be brief if the therapist is trained to work in this fashion. Other names for brief therapy include “time-limited,” “solution-focused,” or “problem-oriented.” A therapist who uses a brief-therapy approach will assess your problem, usually within the first three sessions, by asking specific questions. You will be helped to identify specific behavioral goals for treatment and be actively guided and directed toward change.
Some questions a brief therapist may ask you are:
Depending on how you answer, the therapist may also help you to acknowledge your feelings by helping you take a look at your defenses and the connection between your thoughts and feelings, point out mixed feelings you may have toward significant people in your life, find your buried feelings and the traps they create for you, ask if you think therapy will be helpful, place responsibility for change with you, and point out important issues for you to focus on. No advice or support is provided, but you can learn something more valuable—how to commit yourself, be clear, take action, and face painful issues.
Short-term therapists are constantly asking, “How do you feel about being here with me today?” Which helps speed up the bonding process between therapist and client. Short-term therapists will also ask questions to help you with intimacy, or with being who you really are.
These questions are intended to allow the therapist to find out your own perception of your problems, as well as to give you a sense of where your anxiety came from, how you use defenses instead of facing your problems, and some idea of what you have to do to resolve your anxiety.
What Qualities Make for a Good Therapist?
Researchers have studied the therapeutic process and concluded the following about therapist qualities:
If you have other considerations, like the sexual orientation of a therapist or his or her views on therapy, the best thing to do is to call and ask prior to scheduling an appointment.
What Happens in Therapy or Counseling?
You probably have your own ideas about what happens in a psychotherapy or counseling session. No matter what kind of practitioner you choose—mental health nurse practitioner, social worker, psychologist, or psychiatrist—keep the following facts in mind. Your therapist or counselor
As the client, you may
Try to
If you choose a practitioner who uses a short-term model of treatment, four key elements will be apparent:
If you choose a cognitive-behavioral therapist you may be asked to
Holistic/Complementary Therapists
Much of the daily ins and outs of anxiety involve self-care. If you face high anxiety, panic attacks, or strong phobias or obsessions, you may need a supportive practitioner. There are no anxiety specialists, although maybe there should be, but there are practitioners who can look at the broad spectrum of medical and holistic/complementary approaches.
You may start your search with your primary-care physician, or you may go directly to a therapist or counselor. Keep in mind that proper assistance may require nutrition, exercise, psychological, holistic/complementary, herbal approaches, and more. If you can find a holistically oriented general practitioner or mental-health practitioner, that’s even better, because you will receive an integrated approach that includes conventional and alternative therapies, or at least referral to complementary practitioners.
I bumped into Jessica at a local library book signing. This fifty-one-year-old Sunday school teacher told me she was disappointed in her traditional physician, who gave her no time to ask questions about the medication he had prescribed for her anxiety. She asked me for some ideas. Over tea the next day we discussed her options, from types of practitioners to deciding if she wanted to switch health-care providers.
Types of Holistic/Complementary Practitioners
As a holistic/complementary practitioner myself, I believe you should have at least one holistic practitioner on your team, because anxiety responds best to a multifaceted approach. The clients I work with are grateful for my holistic approach, which helps them integrate alternative methods into their traditional approach.
Constantly changing physicians and specialists will probably not be to your advantage. Find one or more holistic/complementary practitioners who meet your criteria for service. While you’re at it, check with your insurance provider to see if your visit is covered, or at least partially reimbused. It is up to you to be responsible, get educated, and learn the keys to a wellness approach to your anxiety. Some of the types of complementary practitioners available for you to consider appear below.
Acupressure Practitioners
There are various schools of acupressure, but they all involve the same pathways, or meridians, used by acupuncturists. Qi, or energy, is believed to flow along these pathways, energizing and nourishing the body, mind, and spirit. By using the hands to work these points, tensions are released and the flow of qi is enhanced.
Jin shin do practitioners teach clients how to hold specific points, and how to use breathing techniques and visualization to release distressing feelings and address neck, shoulder, back tension/pain, headache, chest problems, menstrual difficulties, pelvic tension, digestive stress, respiratory difficulties, insomnia, joint problems, creative blocks, muscle spasms, stress-related difficulties, cerebral palsy, and developmental difficulties. Because it is gentle and the recipient is clothed, jin shin do can provide safe physical touch in cases where physical or sexual abuse has occurred. For more information go to www.jinshindo.org.
Jin shin jyutsu practitioners also teach their clients self-help methods by placing the three middle fingers on “safety energy locks” in specific sequences, called “flows,” to restore balance. No massage or manipulation is involved. The practitioner merely holds the lock and waits to feel the rhythmic pulsation indicating that balance has been restored. For more information, go to www.jinshinjyutsu.com. Shiatsu is the Japanese version. The whole hand is used to massage, press, and pull. In some situations, even the feet are used.
Acupuncturists
Acupuncturists insert thin, solid, usually stainless-steel needles, at precise anatomic locations—classic acupuncture points, motor points, and areas of tenderness on your body. You may wish to observe and inquire whether sterilized needles are used. An acupuncturist may manipulate these points by hand or through attached electrodes, using various wave forms and intensities of voltage. You may smell burning herbs if moxabustion is used, or feel a cupping sensation if the acupuncturist uses small jars to create a vacuum. Magnets may also be used. Acupuncturists usually learn their specialty at colleges of acupuncture and Oriental medicine (www.aaom.org), or through the American Academy of Medical Acupuncture (www.medicalacupuncture.org).
Guided Imagery Specialists
Imagery is a natural thought process that uses one or more of the five senses and is usually associated with emotions. Imagery is how your right brain conceptualizes, and it is the bridge between the conscious and subconscious mind. It is simply one way your mind thinks. Just as we all dream, we all use imagery to picture a scene in our mind’s eye, or to play a pleasant memory or song back to us. For nearly 20,000 years, imagery has been an integral ingredient in healing practices, for it is the basis for the spiritual level of healing.
Holistic practitioners from many disciplines practice guided imagery. To find certified practitioners, contact the Academy for Guided Imagery at 800-726-2070, or www.academyforguidedimagery.com.
Herbal Practitioners
Herbology is the study of the science and artful use of healing plants, or herbs. Every culture has at some point used healing plants as the basis for its medicine. Even modern American medicine has its roots in the use of herbs. Until fifty years ago, nearly all entries in the pharmacopeias described herbs. When modern drug companies began selling synthetic medicines, the values of botanical medicines weren’t preserved. Today most of the important herbal research is conducted in Europe. While traditional medicine treats specific organs (heart, mind, lungs, etc.), herbal medicine practitioners recognize that the body is an integrated system, the whole being greater than the sum of its parts. Herbalists also realize that the whole herb is greater than the sum of its parts.
Herbal preparations are only as vital as the quality of the herbs used to prepare them. Herbs are either specifics (used to treat acute conditions and used for days or weeks) or tonics (used to support and nourish body processes for months).
Since the quality and processing of herbs are hard to standardize, you should use them with caution. Consult an herbalist who has spent years getting to know the qualities, energies, and properties of herbs so that you can be matched to the herbs or combinations that best suit you. To find an herbalist, consult the American Herbalists Guild, at www.americanherbalistsguild.com.
Holistic Nurse Practitioners
Holistic nurse practitioners will not only take a complementary approach to your process, but are usually able to prescribe medications, should they be needed. They have a master’s degree in nursing. More and more nursing programs are providing master’s programs in holistic nursing. Many nurses with a master’s degree in mental health combine a holistic approach with basic nursing knowledge. Look for a nurse practitioner who has been board certified as a holistic nurse (HNC), or, better yet, as an advanced holistic nurse (AHN-BC). These initials mean they have demonstrated their ability to work with clients in a holistic fashion. You can find certified holistic nurses by going to www.ahna.org, e-mailing info@ahna.org, or contacting the American Holistic Nurses’ Association by phone at 800-278-2462.
Holistic Physicians
Like holistic nurse practitioners, holistic physicians focus on you as a whole person and on how you interact with the environment, not on illness, disease, or specific body parts. A number of medical doctors (MDs) and a larger percentage of osteopaths (DOs) practice holistic medicine and follow holistic principles. You can contact holistic physicians at the American Holistic Medical Association; for their free online directory, go to www.holisticmedicine.org.
Hypnotherapists
Hypnosis is a state of inner focus and a high degree of mental and physical relaxation during which you are more open to suggestion. Hypnotic suggestions may consist of direct commands, ideas, and mental imagery to help overcome fears and visualize the successful accomplishment of a goal. The American Society of Clinical Hypnosis provides a list of certified professional hypnotherapists at www.asch.net.
Massage Therapists
There are many kinds of massage. Neuromuscular therapy (NMT) is a form of soft-tissue massage that includes a muscle-by-muscle examination of all soft tissues that may be associated with a particular injury or pain syndrome. NMT addresses the following six factors that create or intensify pain:
Swedish massage includes effleurage (stroking), petrissage (kneading, friction, or rubbing), tapotement (percussion), and vibration. Skilled practitioners work with a great sensitivity of touch rather than a mechanical routine. Smooth, long, and flowing strokes are performed with palms, finger pads, or forearms, like waves gliding and rippling over the body, bringing fresh blood, oxygen, and nutrients and taking away waste products. Short and rapid percussive movements include hacking with the outside edge of the hand, tapping with fingertips, cupping or clapping with cupped palms, pummeling with loose or tight fists, and plucking between the thumb and forefinger. Circular, linear, or transverse strokes made with the thumb, fingertips, palm, or heel of the hand provide friction that spreads muscle fibers and frees muscle from adhesions and scar tissue developed after an injury or surgery. In kneading, the practitioner lifts muscle away from bone, then squeezes, rolls, and presses it with both hands or alternates thumbs in a milking motion that flushes out fluids and metabolic byproducts. Practitioners use one hand or the fingertips to create vibration, a rapid, trembling, shaking sensation that stimulates nerves and relaxes tight muscles. The Touch Research Institute at the University of Miami School of Medicine has conducted dozens of clinical trials demonstrating that massage can facilitate growth, increase attentiveness, alleviate pain, improve immune function, and reduce stress.
Find a massage therapist through the American Massage Therapy Association (www.amtamassage.org), the Association of Bodywork and Massage Professionals (www.healthydoctors.com), or the National Association of Nurse Massage Therapists (www.nanmt.org).
Naturopathic Physicians
Naturopathy is a distinct profession of primary health care, emphasizing prevention, treatment, and optimal health using the body’s self-healing processes. Doctors of Naturopathy (NDs) are general practitioners who
Naturopaths use many modalities, including nutrition, herbs, naturopathic manipulative therapy, counseling, minor surgery, homeopathy, acupuncture, and natural childbirth. Find a naturopath at the Naturopathic Medicine Network (www.pandamedicine.com.)
Reflexologists
Reflexology is based on the theory that there are reflex areas in the feet and hands that correspond to all of the glands, organs, and parts of the body. The thumbs and fingers are used to apply specific pressures to these reflex points to relieve stress, improve blood supply, relieve nerve blockages, and help the body rebalance. Clients typically express relief from tension and pain and feel a heightened sense of well-being and increased energy after a treatment. Because there are 7,200 nerve endings in each foot and each has extensive interconnections through the spinal cord and brain, all areas of the body can be treated by working with the feet.
Some form of reflexology existed in ancient Egypt at least as far back as 2300 B.C., but it was an American, Dr. William H. Fitzgerald, who discovered the Chinese method of zone therapy now known as reflexology. To find out more about the procedure and to find reflexology practitioners, go to www.reflexology.org.
Relaxation Therapists
Progressive muscle relaxation (PMR) training is a simple and effective form of treatment for helping people learn to relax. The procedure can be used as a primary treatment to complement medical care. It was developed by Dr. Edmund Jacobson in 1929. Jacobson discovered that by using a prescribed system of tensing and releasing of muscles, deeper levels of relaxation could be reached than by sitting quietly and trying to relax. He based his treatment on the theory that the body responds to anxiety and stress by producing muscle tension, which creates anxiety. He believed that deep muscle relaxation was incompatible with anxiety. The two could not exist at the same time.
In PMR you are taught to tense and release muscles or muscle groups (for example, your leg) while being helped to focus on the difference between tension and relaxation. This prepares you to more easily relax your muscles at will. You may even be asked to repeat a calming phrase, such as, “I am relaxing.” PMR can usually be learned in one to three weeks if practiced as recommended. There are no cautions, although if the tensing of muscles is overdone, cramping can result. If you’re taking a tranquilizer, PMR may enable you to decrease your dosage. To find a therapist, go to the Directory of Approved Natural Health Practitioners at www.nchm.net/DANHP/relax.htm.
Tai Chi Instructors
Tai chi is a series of slow, gentle movements designed to enhance mind and body function. It is usually practiced outdoors and is a kind of moving meditation. Each move has a symbolic meaning. Many Chinese practice it every morning, and it is believed to be the most widely practiced exercise in the world. Because of its gentle nature, it is appropriate for any age. Research studies show the movements improve awareness of different body parts and have positive effects on the heart and blood vessels, the bones, the muscles, and even the nervous system. Its tranquil nature reduces stress and stress-related conditions. To find a tai chi teacher, go to www.thetaichisite.com/tai-203.htm.
Yoga Teachers
Yoga in Sanskrit means “union of the different aspects of a person.” Hatha yoga is a way of controlling the mind through mastery of the body, using postures and breathing conducive to meditation and bodily control. Yogic body postures make up the majority of hatha yoga, which has been found to help relieve high blood pressure, depression, and osteoporosis and to aid in menopausal discomfort. Each posture was inspired by the natural surroundings of ancient India, and they are named for them—for example, the tree pose, the cobra pose, etc. When the posture is said aloud, asana is often added, which means calm, steady state or seat. Asana also implies that each posture is a prelude to the ultimate goal of hatha yoga, being comfortable and healthy.
A qualified instructor is recommended, especially if health issues need to be addressed. Go to the website of the American Yoga Association (www.americanyogaassociation.org) or the International Association of Yoga Therapists (www.iayt.org).
Choosing a Practitioner
You probably spend a lot of time finding a good accountant, dentist, insurance company, baby sitter, or auto mechanic. Make sure you make at least as much effort finding your health-care practitioner. Prior to looking for a practitioner, decide on the qualities that are important to you.
Gender
Consider whether you’d rather work with a male or female practitioner. Female physicians tend to spend more time with their patients than their male counterparts, according to a study conducted at the University of California and published in the Journal of the American Medical Women’s Association. The results provide evidence that female physicians spend a significantly greater proportion of visits on preventive services and counseling than male physicians do, and that male physicians devote more time to technical practice behaviors and discussions of substance abuse.
A review of studies done between 1967 and 2001 concluded that medical visits with female physicians averaged two minutes (10 percent) longer than those with male physicians. Female physicians engaged in significantly more communication that could be considered patient-centered. They engaged in more active partnership behaviors, positive talk, psychosocial counseling, psychosocial questioning, and emotionally focused talk. Patients of female physicians spoke more overall, disclosed more biomedical and psychosocial information, and made more positive statements to their physicians than the patients of male physicians. Only in the field of obstetrics and gynecology did male physicians demonstrate higher levels of emotionally focused talk than their female colleagues.
Race
There hasn’t been a lot of research done on race and its effect on how you’re treated, but one study showed that African-American consumers who visit physicians of the same race rate their medical visits as more satisfying and participatory than those who see physicians of other races. Race-concordant visits are longer and characterized by more positive patient feeling. The association between race concordance and higher ratings of care is independent of patient-centered communication, suggesting that other factors, such as patient and physician attitudes, may be at work.
Another study examining referrals to specialists found that white physicians were more likely than black physicians to rate previous experience with the specialist and board certification to be of major importance. White physicians were somewhat less likely than black physicians to rate patient convenience to be of major importance.
Physician Practice Style
Style of physician-patient interaction has been shown to have an impact on health outcome. Researchers at Case Western Reserve University observed 2,881 patients visiting 138 family physicians for outpatient care in 84 community family practice offices in northeastern Ohio. Physicians with person-focused style rated highest on four of five measures of quality of the physician-patient relationship and patient satisfaction. Physicians with a high-control style were lowest or next to lowest on outcomes. Physicians with a person-focused style granted the longest visits, while high-control physicians held the shortest visits, a difference of two minutes per visit on average. The differences could not be explained away by patient and physician age and gender.
Physician Communication Style
Physician communication style is important to your health. Studies have shown that when patients are informed and involved in decision making, they are more apt to follow medical recommendations and to carry out more health-related behavior changes. A major study reported in the Journal of the American Board of Family Practice provided a review of studies done from 1975 to 2000 that evaluated the office interactions between primary-care physicians and patients, using neutral observers who coded what they saw or heard. The researchers concluded that physicians should focus on patient satisfaction, understanding, empathy, courtesy, friendliness, reassurance, support, and encouragement, on answering questions, giving explanations, and reinforcing good feelings about patient actions. Physicians ought to listen, provide health education, summarize patient statements, talk on the patient’s level, and clarify what they mean. Patient satisfaction after a visit was decreased by excessive biomedical questioning, as well as by instances of doctors interrupting patients when they were speaking. Physicians ought to avoid being unduly dominant, angry, nervous, and directive. Several researchers also emphasized the importance of patients being involved in decisions about their care.
A study conducted at the Johns Hopkins University School of Hygiene and Public Health examined communication patterns of primary-care physicians. The researchers found five distinct communication patterns:
Biomedically focused visits were observed more often with sicker, older, and lower-income patients attended by younger male physicians. Physician satisfaction was lowest in the narrowly biomedical pattern and highest in the consumerist pattern, while patient satisfaction was highest in the psychosocial pattern.
Referral to Specialists
In most cases, your primary-care physician will refer you to a specialist. What do primary-care physicians consider to be important criteria in the specialists to whom they’re referring you? One study found that the most important were medical skill, appointment timeliness, insurance coverage, the doctor’s own previous experience with the specialist, quality of specialist communication, specialist efforts to return patient to primary physician for care, and the likelihood of good patient-specialist rapport.
Similarity to Other Practitioners
A study of family physicians (FPs) and naturopathic practitioners (NPs) found that patients perceived no difference in patient-centered care between FPs and NPs. The same was true of nurse practitioners and physicians. In a study conducted at the University of Texas at Arlington, clinic patients perceived no difference in health and satisfaction with care whether the care was given by a nurse practitioner or a primary-care physician.
Consumer Beliefs
Effective communication is a critical component of quality health care. A study at Texas A&M University examined the relative control exerted over the practitioner-consumer relationship by practitioners and consumers. Patients who preferred shared control were more active, expressing more opinions, concerns, and questions than consumers oriented toward physician control. Physicians used more partnership building with male patients. Approximately 14 percent of patient participation was prompted by physician partnership building, and 33 percent of physician partnership building was in response to active patient participation. In other words, if you ask more questions and express more opinions and concerns, you’re more apt to evoke partnership building in your practitioner.
Cost/Coverage
Many holistic and complementary practitioners are not covered by health-maintenance organizations (HMOs) or insurance plans. You may have to decide whether you’re willing to pay additional money or a copayment to work with one.
Credentials
Many practitioners display their credentials conspicuously on their office walls, but you have a right to ask practitioners where they went to school and what specific things they studied, as well as what continuing education courses they took that could make them especially helpful to you.
Experience/Success
In addition to education, practitioners’ experience may be important to you. Feel free to ask how many highly anxious people they’ve worked with and their success rate.
Certification
Being board certified means that a practitioner has had clinical experience and passed a competency exam in a particular area of expertise. If this is important to you, ask practitioners you’re considering whether they are board certified. Although board certification doesn’t guarantee that a practitioner can help you, it is one measure you can use to evaluate their preparation.
Disciplinary Action
You may want to know if a practitioner has had any disciplinary actions taken against him or her. In some states you can find this information about physicians and nurse practitioners on the state’s health department website. Do an Internet search using terms such as “Department of Health, Florida” (or whatever state you live in).
Flexible Hours
If you work or have other time constraints, a practitioner’s office hours may be important to you. Call prior to making an appointment to find out hours of practice and if home visits are possible.
References
You may want to talk to other consumers who’ve used the practitioner’s services. Ask for references, then call or e-mail them to ask whatever you’d like to know about the practitioner.
Screening Practitioner Candidates
Once you’ve decided on the type(s) of practitioner(s) with whom you want to work, ask around. Friends, family, and other health-care professionals can provide the names of practitioners they recommend. Ask them what they like and don’t like about a practitioner and what their experiences have been with that individual.
When you’ve narrowed down your choices to a short list, start calling the practitioners, speak with the office manager or practitioner and ask the following questions. Add any others you may have.
If you can’t get answers to these questions and any other information you require to make an informed decision, move on to another practitioner. A relationship with a health-care practitioner who refuses to respect your right to be involved in decisions about your care isn’t in your best interest.
When you’ve eliminated most practitioners based on this process, you may want to visit a practitioner’s office and/or set up an appointment with a practitioner to learn more. Be aware that you may be charged for this visit. Many of your questions (maybe most) can be answered by observing the practitioner and staff in action. The information you gather will help you decide which health-care practitioner best suits your needs. Here are some other things to ask before settling on a practitioner:
Also observe: Do staff members…
Does the practitioner…
When you return from your first visit, reevaluate your selection. If you’re not comfortable, motivated, and feel you’ve not been treated well, visit another practitioner on your list.
Communicating with Your Practitioner
You are the one most interested in reducing your anxiety and the best person to keep track of all your health-care records. Ask for copies, not a handwritten summary, of all notes and tests (laboratory and otherwise) and provide a stamped self-addressed envelope so the office manager knows you’re serious. Keep all information, organized by date, in a loose-leaf notebook. Use dividers to separate the notebook by lab work, consultation, X-ray reports, and so on, for easy reference.
Keep track of dates of visits to practitioners, as well as of injections, vaccinations, special treatments, diagnostic procedures, dosage levels of medication (and when begun and ended), blood-test results, diagnosed diseases, surgeries, hospitalizations, major emotional and physical stresses, and your own progress notes (life changes, how they affect your anxiety, nutrition/stress management/herbal and other actions taken to reduce anxiety, which ones work and which ones don’t).
Preparing for Appointments
Time is money for practitioners, so if you go to your health-care appointments well organized, you’re more likely to be treated with respect. To have a successful visit:
As you gather information about practitioners, rate each item according to its importance to you, then compare practitioners, choosing the one(s) who most closely resemble your required qualities.
Practitioner Checklist
Remember that your health practitioner needs to be your partner in wellness decisions. Find a compassionate, informed person who will work with you, not dictate to you, so that together you can find the right solutions for you.