Smart Rehab Corinne Mioche

06/02/2017

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20/02/2016

A Typical Case Scenario Of Anxiety Disorder

Mrs. K was involved in a motor vehicle accident while the car was damaged, she was not hurt. She was referred to me by her GP because she had developed driving anxiety however, this was 8 weeks after the accident. Mrs. K reported that whenever she got in the car either as a driver or passenger that she would experience the following symptoms; palpitations, racing heart, sweating, dizziness, light-headedness, difficulties breathing. Mrs. K responded to the CBT aimed at addressing her fear of having another accident and although this helped put the risk/vulnerability/control ratio into perspective, she continued to experience anxiety whenever she was in a car. Because she originally had a fear of having an accident her guard was up which caused the increased release of noradrenaline a natural hormone that we release to deal with a real life threatening situation. The problem was that "what if" is not a real life situation and she was constantly putting her body into panic alert ready to deal with a 'what if' situation that wasn't happening (What if I have a car accident?) wasn't happening. As a result of constantly putting her body on high alert mode she developed an anxiety disorder - "panicking about having a panic attack" She replace her fear of having an accident with the fear of having a panic attack that she believed was mainly triggered by driving. By explaining to her that anxiety was a normal defence mechanism and that it was her fear of having an anxiety attack that brought it on every time and that the best way to manage the severity of an anxiety attack was to control her breathing every time she got in the car, and that even though anxiety might at the time make her feel like she's not incontrol, that it cannot cause her to lose her senses and her ability to deal with a 'what if" situation if it was to occur, on the contrary it is meant to make you more aware, more efficient and better prepared to deal with a situation.i explained to her that it is her focus on her symptoms and what is happening physically while she is having an attack, that is affecting her concentration and that if she concentrated instead on her deep slow breathing exercises 1 hr before and during her driving that she will learn to control the anxiety and get to a point where she will no longer fear anxiety that was affecting her confidence in driving. Many of my clients say that they experience the weird physical symptoms of anxiety at the time and worry about 'losing it' but as I explain to them - for example if they are having an anxiety attack at a check out they might be feeling like they're out of it but still able to greet the checkout person and pay. The reason they are feeling weird at the time is because their brain has released more adrenaline than necessary and it's free floating in their body not being used and unfortunately if you fear the sensation at the time and your concentration is being used on focusing on these sensations then you will feel as though you can't concentrate on what your doing at the time. Corinne Mioche

18/02/2016

A Typical Case Scenario Of Anxiety Disorder

Mrs. K was involved in a motor vehicle accident while the car was damaged, she was not hurt. She was referred to me by her GP because she had developed driving anxiety however, this was 8 weeks after the accident. Mrs. K reported that whenever she got in the car either as a driver or passenger that she would experience the following symptoms; palpitations, racing heart, sweating, dizziness, light-headedness, difficulties breathing. Mrs. K responded to the CBT aimed at addressing her fear of having another accident and although this helped put the risk/vulnerability/control ratio into perspective, she continued to experience anxiety whenever she was in a car. Because she originally had a fear of having an accident her guard was up which caused the increased release of noradrenaline a natural hormone that we release to deal with a real life threatening situation. The problem was that "what if" is not a real life situation and she was constantly putting her body into panic alert ready to deal with a 'what if' situation that wasn't happening (What if I have a car accident?) wasn't happening. As a result of constantly putting her body on high alert mode she developed an anxiety disorder - "panicking about having a panic attack" She replace her fear of having an accident with the fear of having a panic attack that she believed was mainly triggered by driving. By explaining to her that anxiety was a normal defence mechanism and that it was her fear of having an anxiety attack that brought it on every time and that the best way to manage the severity of an anxiety attack was to control her breathing every time she got in the car, and that even though anxiety might at the time make her feel like she's not incontrol, that it cannot cause her to lose her senses and her ability to deal with a 'what if" situation if it was to occur, on the contrary it is meant to make you more aware, more efficient and better prepared to deal with a situation.i explained to her that it is her focus on her symptoms and what is happening physically while she is having an attack, that is affecting her concentration and that if she concentrated instead on her deep slow breathing exercises 1 hr before and during her driving that she will learn to control the anxiety and get to a point where she will no longer fear anxiety that was affecting her confidence in driving. Many of my clients say that they experience the weird physical symptoms of anxiety at the time and worry about 'losing it' but as I explain to them - for example if they are having an anxiety attack at a check out they might be feeling like they're out of it but still able to greet the checkout person and pay. The reason they are feeling weird at the time is because their brain has released more adrenaline than necessary and it's free floating in their body not being used and unfortunately if you fear the sensation at the time and your concentration is being used on focusing on these sensations then you will feel as though you can't concentrate on what your doing at the time.

29/01/2016

29/01/2016

Symptoms of Depression

27/01/2016

For those of you who know someone suffering from Depression - this should help you better understand them.

27/01/2016

WHAT TO SAY TO A LOVED ONE WHO IS SUFFERING FROM DEPRESSION
- tell them that you understand that it isn't something they chose to have, that it is a serious condition.
- tell them that you will help them through it and that they are not alone.
- encourage them to seek counselling and self-help.
- show them the statistics to show them how serious and common this condition is
- tell them that it's symptoms not weaknesses that are stopping them from functioning
- understand the symptoms yourself so that you can understand what makes them behave the way they do
- tell them how much they mean to you in your life

27/01/2016

EMOTIONAL EATING
Have you ever known exactly what it is you have to do to lose weight but have had a problem committing to your weight loss program? There are a few good reasons for this: Firstly, you have to want to do it for yourself and not for anyone else. Even with enough pressure from your partner or a parent for example, isn't going to be enough to want to commit if you aren't ready to commit. Secondly, if you're doing to attain Confidence then you're likely to do it, but once the attention from friends and family die down after they have desensitised to your new look, your likely to go back to your old habits of eating. This is a common problem for some people who go through Weight Watches for example. Thirdly, if your life does not have balance and there are more negatives than positive things going on then you will find that you will have a high urge to want what you have attached a positive to, that is what you believe will pick up your mood, which in this case is usually food. High levels of stress, boredom, or depression or a lack of pleasurable activities to look forward are some of the most common factors that can interfere with your goal of losing weight. Fourthly, if you use words like diet, you will find it a lot harder to stick if the word diet to you means punishment. You see we are programmed to seek reward and pleasure rather than punishment. So using the word healthy eating is going to be a lot easier to accept especially if you believe that healthy food makes you feel better. One way to convince yourself that healthy food is rewarding is to educate yourself about food and the negative health effects unhealthy food has not only on hormones and chemicals (mood) in your body but also on your organs. It's a catch 22 situation - if you eat healthier you'll feel emotionally better because you are feeding your body with the nutrients it needs to release the 'happy' hormones and therefore your energy will increase, but if your energy and moods are low you will find it hard to commit to eating healthy. The best way to approach any diet is to slowly introduce the changes - start for example, by reducing rather than eliminating certain foods completely while making the changes in your life to increase more pleasure and reduce the negatives. Ask yourself before you start to diet, what can I change to improve my mood that I have control over. And don't be so hard on yourself - losing weight is a lifestyle change that can take a long time to achieve and if you have the right intention you'll do it. Getting some counselling to identify the barriers can also help if you continue to struggle, especially in identifying the factors preventing you from putting balance in your life.

25/01/2016

PERSONALITY DIFFERENCES
How much is our personality innate and how much is formed by the conditioning we receive by the significant people in our life like parents, teachers, friends etc. In my practice I often have children as young as 5 referred to me to address "defiant behaviour, focus and concentration issues and supposedly learning difficulties". In most of these cases I find that these kids are normal kids who are just either creative or suffer from anxiety and misunderstood as being defiant, difficult children with learning difficulties. The common patterns of behaviour and traits in creative children can include; dis organisational skills except for important the things, messy and untidy, easily distracted by more interesting things at the time, dress practically, pay and notice attention to detail, visual demonstrative learners, tend to zone out (the kid that gets in trouble for staring out the window), difficult to motivate, leave assignments to the last minute, doesn't always follow instructions, asks a lot of inquisitive questions, prefers to watch movies than read, very deep, prefers close small number of friends, more mature than their peers, tend to put more effort in their work for teachers they like, love to eat especially when they are bored or unhappy, listen to alternative music to the majority of their peers, mostly motivated by consequence or passion rather than reward, live in the moment, non-materialistic and don't like small talk, to mention a few. Creative Children brought up by structured parents can end up later in life with a confused identity and anxiety usually because they fear rejection from others. Many of these children grow up ostracised by their peers for being different. They are often misunderstood. They can grow up feeling uncomfortable in life because they feel like they can't fit in to society's expectation of them. They are often not understood by others as to why they don't want a career, or work towards an OP 1 when they are capable, why they spend hours gaming instead of getting out and about, why they are not motivated or get over things quickly. The problem is, that they don't have a problem but society does. It's not about fitting into society and life, it's about life fitting your personality. Happiness is about finding your own identity and the things in life that suit your identity. Surrounding yourself with similar people who understand you and who don't try to change you, and doing what you are passionate about, and living life the way you are designed to is healthier than going against your grain and feeling out of place. People and society need to accept that there is not just one mould that everyone has to fit in. So if your child is struggling with his/her school work maybe they're just a visual learner who understands better when something is taught in a demonstrative way and not just verbally. So the teaching style needs to change and trialled before making an assumption that the child may have a learning problem. Creative children are very intelligent and need constant stimulation that sometimes they feel they can't get from school - hence the attraction to gaming especially strategic computer gaming.

21/01/2016

FEAR OF FAILURE
Many people who suffer from self esteem issues fear failure and therefore avoid anything where there is a risk of failing which can stunt personal growth. There are two important things to consider before you put yourself down for failing at something. First, have you assessed what factors contributed to that negative outcome in the first place. Second, have you considered that maybe experience in some cases is an essential factor in success? Every failed outcome is caused partly due to Internal factors ( that is factors you actually had control over) and External factors ( factors you have absolutely no control over). The percentage of split between internal and external contributions depends on the goal you set out to achieve. For example. You don't have 100% control over how your child turns out in the end because while you may have control over your parenting style (internal) you don't have control over their personality or the influences that their friends might have over them ( external). So if you meet all the internal criteria and the outcome is a negative one in the end and that was due to something beyond your control then you can say it was a failed outcome but you can't say you're a failure.

Some projects or goals require experience that unfortunately can only be obtained through experience. So you might try to fix the engine in your car and it fail not because you don't have the intelligence or skills but because you don't have the knowledge needed that you can only have gotten through training and practice. I remember not doing so well treating my first client not because I didn't have the capability to but because I needed the experience that time, guidance from my supervisor and practice eventually helped me achieve. So as a child who was constantly criticised for failing something but not been given the training or chance to practice - you now know that you didn't deserve that then. Remember that before you criticise yourself next time make sure you assess if you failed ( internal factors) or it was just a failed outcome ( external) and nothing to do with what you did. If it's you who failed then accept responsibility and learn from it but don't put yourself down for it.

23/12/2015

HOW ANTIDEPRESSANTS WORK

The SSRIs (selective serotonin reuptake inhibitors) are the most commonly prescribed class of antidepressants. They act on a chemical in the brain called serotonin. The SSRIs include drugs such as Prozac, Zoloft, and Paxil. Neurotransmitters (the brain chemicals that communicate information throughout our brain and body), relay signals between nerve cells , called “neurons.” The brain uses neurotransmitters to tell your heart to beat, your lungs to breathe, and your stomach to digest. They can also affect mood, sleep, concentration, weight, and can cause adverse symptoms when they are out of balance. Neurotransmitter levels can be depleted many ways. As a matter of fact, it is estimated that 86% of Americans have suboptimal neurotransmitter levels. Stress, poor diet, neurotoxins, genetic predisposition, drugs (prescription and recreational), alcohol and caffeine usage can cause these levels to be out of optimal range.

There are two kinds of neurotransmitters – INHIBITORY and EXCITATORY. Excitatory neurotransmitters are what stimulate the brain. Those that calm the brain and help create balance are called inhibitory. Inhibitory neurotransmitters balance mood and are easily depleted when the excitatory neurotransmitters are overactive.

Inhibitory Neurotransmitters

SEROTONIN is an inhibitory neurotransmitter – which means that it does not stimulate the brain. Adequate amounts of serotonin are necessary for a stable mood and to balance any excessive excitatory (stimulating) neurotransmitter firing in the brain. If you use stimulant medications or caffeine in your daily regimen – it can cause a depletion of serotonin over time. Serotonin also regulates many other processes such as carbohydrate cravings, sleep cycle, pain control and appropriate digestion. Low serotonin levels are also associated with decreased immune system function.

GABA is an inhibitory neurotransmitter that is often referred to as “nature’s VALIUM-like substance”. When GABA is out of range (high or low excretion values), it is likely that an excitatory neurotransmitter is firing too often in the brain. GABA will be sent out to attempt to balance this stimulating over-firing.

DOPAMINE is a special neurotransmitter because it is considered to be both excitatory and inhibitory. Dopamine helps with depression as well as focus.

Excitatory Neurotransmitters

DOPAMINE is our main focus neurotransmitter. When dopamine is either elevated or low – we can have focus issues such as not remembering where we put our keys, forgetting what a paragraph said when we just finished reading it or simply daydreaming and not being able to stay on task. Dopamine is also responsible for our drive or desire to get things done – or motivation. Stimulants such as medications for ADD/ADHD and caffeine cause dopamine to be pushed into the synapse so that focus is improved. Unfortunately, stimulating dopamine consistently can cause a depletion of dopamine over time.

NOREPINEPHRINE is an excitatory neurotransmitter that is responsible for stimulatory processes in the body. Norepinephrine helps to make epinephrine as well. This neurotransmitter can cause ANXIETY at elevated excretion levels as well as some “MOOD DAMPENING” effects. Low levels of norepinephrine are associated with LOW ENERGY, DECREASED FOCUS ability and sleep cycle problems.

EPINEPHRINE is an excitatory neurotransmitter that is reflective of stress. This neurotransmitter will often be elevated when ADHD like symptoms are present. Long term STRESS or INSOMNIA can cause epinephrine levels to be depleted (low). Epinephrine also regulates HEART RATE and BLOOD PRESSURE. (http://www.neurogistics.com/thescience/whatareneurotransmitters)

The SSRIs (selective serotonin reuptake inhibitors) medication block the pump that re-uptakes (recycles) unused Serotonin that is released by the neurotransmitter so that this 'feel good' chemical remains long enough to increase its chance of being used. For example, you'd have a higher chance of catching a fish in a pond full of fish than you would otherwise.

23/12/2015

ANTIDEPRESSANTS AND DEPRESSION

Approximately 80% of the clients referred to me by their Doctor for treatment of Depression are not on antidepressants. Some of my clients are concerned about taking medication due to the side effects. Clients that have been hypersensitive to medication I've noticed are usually people who typically don't like taking medication even for a headache. While it is possible to treat Depression using just therapy without medication, for severe cases where the client has a difficult time concentrating and focusing, medication can help by boosting concentration enough for therapy to be taken on board. Otherwise the client walks out of the session somewhat feeling better but comes back 'deflated' after having forgotten what was covered in the previous session. While the human body is designed to naturally create and release the necessary chemicals needed to function, if the mind (thinking) is negative then 'feel good' chemicals needed to physically and mentally feel good are less likely to be released. Of course, while its easy for some to say "all you need is to think positive" for someone suffering from Depression it's not easy to "just think positively when their thinking patterns are stuck on thinking negatively". Changing negative thinking is difficult and may require the help of a psychologist. Irrational negative thinking can be a habit that has been reinforced by years of thinking in the same unhealthy way. And unfortunately for a lot of cases negative thinking can be a result of misinterpreting what's really happening around you and coming to inaccurate conclusions based on assumptions and not facts. For example, reading someone's negative behaviour and assuming that it has something to do with you when in actual fact it's unrelated. Or, reading someone's mind and drawing a conclusion without collecting the facts. If for example, 90% of what you could have misinterpreted as negative were actually positive instead, think how many 'feel good' chemicals your brain would release instead. Don't come to any conclusion based on assumptions, always get your facts before coming to a conclusion.

23/12/2015

DEPRESSION - FEELING TRAPPED
I often hear clients who suffer from Depression described it as a 'feeling of being trapped and lost". The reason for this is that it does trap you in that it stops you from living a fulfilling life by affecting the areas that can feed that including, social, hobbies, relationships, and work. When you're perception of yourself is low or., you have a poor self-esteem, being yourself and relaxed in a social situation is not going to be easy when you fear rejection from someone that you 'perceive' to be 'more worthy of you' even though that is not the case. You're also not going to try that class you are keen to take 'if you think you are going to fail it'. Fear of rejection often results in 'over pleasing' behaviour that only causes you to disempower you more when used with the wrong people who are already taking advantage of you. Fear of failure only leads to not trying at anything and not growing personally or professionally. These fears force you to stay in your comfort zone - hence why people who suffer from Depression feel "trapped'. But not only does it do this but it also makes you feel Lost. When you don't grow with the opportunities presented in life and not comfortable being your true self - you are likely to adapt your personality to that of others. When you keep changing yourself to suit the personality of the person you are with you cannot develop your own sense of identity. Depression however isn't always caused by self-esteem issues, although in the many years of treating clients that appears to have been the most common cause, depression can also be caused by something else that can make you feel trapped - for example, a physical injury causing you a limitation that restricts you eg. Back injury, a controlling person in your life, perfectionistic tendencies, financial restrictions or certain situations you might be stuck in. These cause Secondary Depression or Situational Depression meaning that once that stressor is removed you're mood should improve. People in this situation are usually resilient people who might have healthy coping skills prior to sustaining an injury. However in the case of someone suffering from Depression because of self esteem issues, these people may have resilience but don't usually have healthy ways of coping with life stressors which is essential to have to prevent Depression. This is why seeking counselling to specifically develop self-esteem is an important step in treating depression and living a quality life.

20/12/2015

ANXIETY: IDENTIFYING THE TRIGGER
Identifying the trigger causing your Anxiety can be difficult. And if you have suffered from Anxiety for a long period of time, you may have forgotten what initially triggered the first Anxiety Attack. In a lot of cases the initial attack is caused by something that you fear. Whether that fear is real eg., conflict with someone or not being able to meet a deadline or motor vehicle accident; or an unrealistic fear eg., catastrophising that something is going to happen but doesn't, that fear can bring on an anxiety attack if you're fear is that intense that it causes your brain to release too much adrenaline. That initial anxiety attack can frighten you that much that you're fear of having another anxiety attack can become the new trigger that maintains the cycle of panicking about having a panic attack. To break the cycle, you must first apply the Deep Breathing Technique on a mild attack to develop confidence in being able to manage the symptoms and therefore no longer fear them, and once you have mastered this, identifying the trigger (fear) which may be real or unreal with a psychologist as there can be many different triggers and every case is different. For some people it might be self esteem issues, others over commitment issues and others specific fears eg., driving after having had a car accident, or having experienced trauma. That's why working through this with a psychologist can help speed up the recovery.

17/12/2015

SELF-ESTEEM AND DEPRESSION

Self Esteem is usually destroyed by childhood negative experiences. When you are a child you don't have the reasoning ability to rationalise criticism that you take on board and personalise. When you endure continuous long term criticism you develop an inaccurate perception of yourself - ie. Low perception where you believe you possess more weaknesses than strengths. When you compare yourself to others and believe that you don't measure up to them you get anxiety because you believe that they will reject you which will only confirm that you aren't worthy when that is not the case. Learning the skill of screening criticism is the first step to addressing self esteem issues . Screening involves assessing the criticism whether it's self criticism or a criticism from someone objectively that is, only accepting the criticism if it is backed up by facts evidence. A criticism whereby a number of people have made throughout your life is constructive criticism for example, if a number of people throughout your life have said that you are disorganised then chances are they're probably right. But if only one or two people criticise you and many others who have had an opportunity to assess that skill in you have either not criticised you or have instead complemented on being organised then obviously the person who made that criticism is not only wrong and criticised you to manipulate you or put you down. People who put others down typically have low self esteem themselves. The bully at school will always bully someone who is passive and won't retaliate but that also has something the bully resents them for eg. Smart or good looking or good at sports or popular because they're a nice person. Schools now a days are full of students with critically low self esteem.

17/12/2015

ANXIETY AND DEPRESSION

I'm a psychologist - Anxiety is usually triggered by fear that can often be caused by a number factors but most commonly, self esteem issues - going to therapy to specifically address self esteem can help. Understanding Anxiety too - fear causes your brain to prepare to deal with something -flight/fight and to do this it releases Adrenaline when too much adrenaline is released to causes the symptoms of Anxiety (choking, nausea dizziness shaking tight chest etc) adrenaline tenses every muscle in your body so the muscles around your neck for example become tense which causes that sensation the muscles tighten around your chest due to adrenaline too) all the symptoms of Anxiety are a normal response aimed at getting you out of a dangerous situation the physical symptoms are happening to make you more efficient and effective to deal with a real situation what's not normal is when unrealistic fear (what if) triggers the adrenaline (turbo fuel) that doesn't get used because the fear is not real. So the adrenaline just sits in your body until it goes away with time. To treat anxiety you need to go see a psychologist to address the Unrealistic fear and in the meantime deep slow breathing will send the msg to your brain that you want to relax and your brain will close the tap of Adrenaline and instead release relaxing hormones that will relax your muscles. But the What if?? Needs to be addressed it can be caused by self esteem issues or bad habits of excessive worrying/over analysing. A psychologist should focus on treating the cause not just the symptoms.

17/12/2015

ANXIETY

The more you focus and worry about your symptoms the more you're brain thinks there is something wrong and it will release more adrenalin that will aggravate your symptoms. You just need to accept that while it feels uncomfortable the symptoms will pass and do some deep slow breathing when you get the first symptom or two to prevent the symptoms from escalating. The more you fear the symptoms the longer you'll remain in the cycle of panicking about having a panic attack. The more you do the deep breathing and become confident in managing them the more you'll manage your anxiety. But check with a psychologist to identify the triggers there's so many but the most common is low self esteem.