Anxiety disorders are the most common mental health problem, affecting around one in four people in their lifetime. Anxiety can present in many ways, from panic attacks, social anxiety, frequent worry, obsessive compulsive disorder, phobias, and more. But, they all share a common factor of a sympathetic nervous system activation that leads to fear of and avoidance of something: thoughts, physical sensations, activities, objects, or people. Luckily, due to their ubiquity there is plenty of research that has produced some excellent evidence-based therapies that can work as well as, better than, and in tandem with, anxiety medications, depending on the disorder.
Depression is a mood disorder, and is the second most common mental disorder, experienced by around one in five people in their lifetime. It often co-exists with an anxiety problem. Decades of research has provided some excellent evidence-based therapies for depression that work well on their own or in tandem with antidepressant medications. Therapy for depression involves understanding the negative depressive spiral and how to start reversing it through your actions, your ways of engaging with your thoughts, the world, and others. Most people can make a good recovery from depression and therapy can help speed this up and equip you with skills to manage stressful events in the future to reduce the chance of a relapse.
GRIEF AND BEREAVEMENT
The universal experience of grief can be a real challenge to a person's sense of self and can lead to bleak predictions of what life will be like in the future. Some people become stuck with grief, with it staying raw and real for months stretching into years. It can look a lot like depression, and can affect our lives to the same extent. Grief cannot be erased or magicked away, but the goal is that a person can live their life around the grief, and eventually their life will extend out further than the grief, meaning it fills less of our time, even though it persists. Interpersonal Psychotherapy is an evidence-based therapy with a special focus on grief which can help for extended complicated grief.
ADJUSTMENT TO CHRONIC ILLNESS, LOSS OF MOBILITY, OR INCREASED CARE NEEDS
Chronic illness and disability can take hold at any time of life, and is increasingly common as people age. Rates of depression and anxiety are significantly elevated following heart attack and stroke, and recovery from surgery can be complicated with infection and ongoing mobility and/or pain issues. This can drastically change the activities a person can perform and some people may be facing increased care needs at home or a move to a retirement village or rest home. Some people may need to stop driving for medical reasons. These adjustments can be hard and may come on top of other recent losses such as bereavement. A person may need help in evaluating what their options are, and finding new ways of meeting their values and goals. Expectations may need to change and self-compassion may be required. These things may be usefully worked on as part of a therapy relationship.
DISSATISFACTION AND DISCONNECTION
Perhaps you have difficulty accessing life goals, or you have attained the things you thought you should but you feel disconnected, unfulfilled, and are wondering what the point is. It could help to discuss your life circumstances, expectations, and relationships and to identify your values to determine what might help you to move closer to what you want in life.
MAKING A DECISION / SOLVING A PROBLEM
Some life decisions are difficult and don't have an easy answer. These decisions could be around relationships, work and career, work/life balance issues, or health and wellbeing goals. Discussing these with a therapist can help to define the problem, generate and evaluate solutions, and make a plan for a preferred course of action. Having some external motivation provided by an encouraing therapist may also assist in moving through the problem solving process to get to your goal.
MANAGING LIFE TRANSITIONS
As we move through life we are confronted with a number of choice points that can lead our lives in vastly different directions. There is often not an easy answer and it can be a time of worry. Some of the more common transitions are starting or stopping study, moving out of the family home, starting or ending relationships, job or career decisions, issues regarding sexuality or gender identity, becoming a parent, caregiving for family members, moving to an assisted living facility, losing a partner or spouse, or retirement.
Life transitions often require a reconfiguring of our lives that can be painful and accompanied with feelings of loss, instability, and anxiety. These emotions can make it hard to see the opportunities and positive aspects of change. Talking with a therapist about these changes can help in processing emotions and in identifying and trying new coping strategies to help in managing the life transition.
ADULT ADHD AND ASSOCIATED PROBLEMS
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that first presents in early childhood (sometimes from as early as two years old). Over more recent years researchers have found that ADHD persists into adulthood far more than it was intially believed to. Around 70% of children or adolescents diagnosed with ADHD will persist with clinically significant symptoms into adulthood. ADHD affects one of our most important grouping of brain functions, broadly described as executive functions. You can think of executive functions as forming the chief executive of your brain, whose job it is to coordinate information from lower brain regions to form organised and sustained responses to the tasks of daily living.
The problems associated with ADHD affect self-control, focusing and maintaining attention on tasks (especially boring ones), distractability, hyperactivity, problems with impulse control, increased sensitivity to negative emotions, anger and frustration, poor time concept and time management, and are associated with other developmental difficulties such as learning disabilities, dyspraxia, and austim, among others. It's not surprising that these difficulties can often lead to problems with depression, anxiety, low self-esteem, poor educational attainment, poor work performance, relationship difficulties, financial issues, drug and alcohol abuse, and criminal justice issues. Unfortunately ADHD also puts people (males especially) more at risk of car crashes, accidental and early death, and even unplanned parenthood. Please see this
link for more information on symptoms.
For adults, hyperactivity tends to become less physically obvious (less running, climbing on furniture and constant motion which would be seen in young children with ADHD) and can be felt more internally as a restless energy and difficulty in relaxing (including when trying to fall asleep). Adults can also develop sophisticated ways to manage some of the other symptoms (e.g. by use of schedules, alarms, and by outsourcing organisation to other people). But receiving diagnosis and treatment can still be immensely useful both for understanding why a person is the way they are, and in the ability to access effective treatments. There is a heriditary component to ADHD, with some adults not realising they may have ADHD until their child is themselves diagnosed. It's never too late to get a diagnosis in order to receive treatment.
Thankfully the idea of ADHD persisting into adulthood is increasing in the medical community and it is slowly becoming easier to obtain assessent and treatment. However, there is still a bottleneck in assessment which means that most adults will need to access assessment privately rather than through the public health system.
Diagnosis in NZ must be performed by a psychiatrist or psychologist (most likely a clinical psychologist). Only psychiatrists can obtain the special authority number required to prescribe stimulant medications (i,e, Ritalin), but a psychologist assessment can be used to obtain medication through the public health system in a fast-tracked system through a person's GP. There are also behavioural treatments for managing ADHD which focus on teaching organisation and time management skills through external means (e.g. by utilising automated reminders and developing routines).
In summary, ADHD is a serious usually lifelong disorder which can have a number of negative and disabling consequences to the affected person, and consequences for their family and loved ones. A range of effective treatments are available, but the first step is assessment and diagnosis. If you are interested in pursuing assessment please see the
Adult ADHD Assessment page for information about the service I can provide.
DISORDERED EATING AND BODY IMAGE
It's pretty impossible to escape cultural expectations about body shape and size. Desires to fit a certain body standard can lead to bad relationships with food and exericse. Negative thoughts about appearance and body size can be frequent and vicious and can lead to unhelpful and potentially dangerous behaviours such as food restriction, binge eating, excessive exercise, and vomiting or excessive laxative use. In general, the more we think about something, the more we think about it, and thoughts can become obsessive and intensely distressing.
There are effective treatments for eating disorders, particulary for bulimia nervosa and binge eating disorder. Anorexia nervosa is more challenging, but changes in eating behaviour can still occur. Medical and / or nutritional oversight may be required in order to manage an eating disorder. Psychotherapy can help with understanding the influences on expectations of shape and weight, can seek to unearth and challenge unhelpful thinking, and make real changes to unhelpful behaviour. Disordered eating is often shrouded in emotions of shame, guilt, disgust, and embarrassment. These emotions and fear of judgement can prevent people from seeking help and allows the condition to continue for longer than it needs to. Once you've made a commitement to change, unhelpful eating behaviours can change in a matter of weeks.