# Treatments?



## testing (Mar 10, 2008)

Hi,
Which treatments are the most effective, apart from taking medications. Does it depend on the individual?

I am thinking of hypnosis, but feel a bit nervous about it.

Any advice appreciated.


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## yeah_yeah_yeah (Mar 27, 2007)

Hypnosis is not very useful IMO for SA - I teied it a few times and I never saw the use. CBT however was massively effective. If you add meds to CBT that is the 'turbo' route.

Ross


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## beasty (Mar 3, 2004)

testing - I tried hypnosis. The first time it had a definite effect that lasted 14 days. The second time it did nothing. I am not sure about its safety though.

Ross - I read somewhere that meds is a two-way street when it comes to CBT. The shortterm effects should be a "boost" as you put it but apparantly the long-term effects are neglible because its very difficult to distinguish between whether the improvement is due to CBT or meds. When the inevitable adaption to the medication sets in (or medication is stopped) many find themselves back at square one. This is one of the reasons I never tried meds. 
What is your take on this?

A link:

http://www.psychiatrictimes.com/display ... 68/1147676


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## yeah_yeah_yeah (Mar 27, 2007)

Hm well tough to say because the article you have put there is for panic disorder - which has a different etiology, treatment and prognosis from SA.

My view is that meds speed the uptake of therapy - but the problem comes in the judgement on the therapists behalf on what constitites 'cured'. Meds with CBT should be continued, IMO, until the patient has shown sympton reduction for some months on the combined two, and THEN the meds should be removed. After this the patient should remain in therapy for monitoring. At this stage it will become clear if genuine, deep belief change has taken hold, and this will only have occurred if the patient has received enough 'behavioural' to make the lessons sink in. At this point a relapse prevention plan should be formulated, and check up appointments scheduled down the line. In addition, for very serious depressions, the influence of black mood and inability to provide any kind of lift in the early stages can make the start of CBT very laborious. Meds can enable the patient to see 'the light at the end of the tunnel', and to use a cheesy phrase, to start to walk towards it. Conditions that respond to this regime are Dysthymia and BPD.

Regards the "back to square one": Quite simply, the therapist terminated too soon - the progress was due to medications only and deep belief change had not occurred. Thats why the monitoring phase is needed - because the patient shoud remain in therapy WITHOUT MEDS to ensure exactly this problem has not occurred. This would happen in the UK, but some places still subscribe to "CBT as shorrt term therapy" which in fact it has evolved to NOT BE. It is patient specific. However, I am coming to realise that - in the US, CBT is not controlled as it is in the UK. Here you must recieve a minimal level of training and experience and then be registered with the babcp - it seems in the US anyone can do a course and call themself a CBT therapist and so they can run it however they damn well please. Buyer beware ... 

Whats really needed is a study on the long term effects of meds on neuroplasticity and synaptic pairing, and whether or not the amygdalian suppression during med use can become a factor in relapse one this organ comes 'online' without meds. Also you would need to define WHAT meds - SSRI's? SNRI's? Stimulants? Benzodiazepines? MAOI's? Neuroleptics? Antipsychotics? What treatment group are you referring to? Borderline Personaility Disordered patients with SA symptoms? Bipolar individuals that display anxiety during their depressive phase and who may well be on Lithium? Learning disorderered paitents with potential organic roots but psychologically induced low-self esteem? 

At this point it becomes clear that "Treating SA" in this day and age is too narrow a term, and as we push out of the age of the DSM-IV and into the age of schema based psychology, the ability to define "what works for SA" will finally seem as meanignless as it actually is. A cursory glance round this site will reveal the MULTITUDE of psychological disorders that present with SA symtpoms. You cannot possibly take a cross section of such a mixed group and verify the effectiveness of anything - because you have not started with the same controls. As the schema approach and neuroscience unfolds it is becoming clearer - because of neurodiversity - that symptoms are not necessarily so easily groupable into 'disorder' - and this is why the Psychological Community is currently involved in what could turn out to be a total burning of the DSM-IV. Instead there will be a spectrum of disorder and realted symptoms, based on Schema proliferation and compartmentalisation.

Ross

PS Yeh I made that really wordy for fun


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## beasty (Mar 3, 2004)

hehe it was wordy. I liked it 

Not really much to add apart from "good points". I dont see the diversity and differnce on these boards, though. To me people in here all have pretty much the same coreconflicts. I met up with two sa'ers today on a café and though the symptoms between the 3 of us are a bit different the coreconflicts also seems identical. I believe if those coreconflicts were adressed the symptoms, no matter how diverse, would evaporate. Colud be wrong, though.
Anywho. Have a good one. Whatever your doing (;


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## CoconutHolder (Oct 13, 2007)

I often wonder about long term antidepressant use and its long term effect on our neurotransmitters. If the brain becomes used to the effect of antidepressants and therefore ends up having even more trouble regulating itself without the meds. 


Who knows.


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## yeah_yeah_yeah (Mar 27, 2007)

The main problem is 'upregulation', otherwise known as poop out. The brain has a tendency towards homeostasis - wanting to remain at a fixed level - and so after a long term of drug use ut will become less responsive to the drug.

Boo to this really.


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## ardrum (May 13, 2007)

Hmm... if only the mechanism that regulates this homeostasis could be discovered. Or maybe it has, but that tinkering with it would lead to serious problems.


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