Dr. Thomas W.C. Blash, PSY D

Concerned Parent, Anxiety is a general term used to describe heighten arousal, uncomfortable and painful emotional reactions, avoidant behavior (or the wish to avoid certain contexts) and physical symptoms usually associated with a sense of fear and dread. Such reactions can be context specific, such as only witnessed at the playground, school, or in the presence of certain individuals, or, witnessed across contexts. The child experiences fear and reacts as if something bad is or might happen to her / him in many day-to-day situations. If the child can explain to her / his parents what is going on, and, what frightens the child, this information can be communicated easily to therapists and behavioral experts who deal specifically with younger children. Experts who help younger children usually work with the child individually and with the participation of the childs parents or those adults raising the child. Providing the child with a sense of safety while assisting the adults raising the child to participate in the process of reducing fears while building skills helps significantly. Thorough treatments which help the child to feel greater competence and self-confidence when dealing with those situations which elicit apprehension and fear are typically within the range for most children. As in any treatment format, having a greater grasp of knowing what is going on within the child and the behaviors which are generated by the childs apprehensions and fears is very helpful. It is very valuable to those adults responsible for the childs sense of well-being and the development of their emotional and social skills.

Hello Concerned Mom, There are a number of approaches to the treatment of anxiety in children. Although I treated the developmental spectrum during the course of my career, I have not treated school-aged children for quite some time. So, you may want to check out my suggestions with those professionals who are actively treating children at this time who will be using the latest developed strategies and techniques. The first considerations are the age and natural temperament of the child. In todays two-working-parent families and single parent families, the youngest of children can have a strong aversion to separating from their parent(s) for long interims, with the parents hoping their child and children will get use to it. If the child and parent(s) have long separations this may be a prominent genesis for anxiety on the part of both the child and parent. A child and / or Family therapist may provide counseling and helpful recommendations, and, with written authorization to do so, consult with the day-care or pre-school personnel to be most helpful. With early school-aged children, anxiety can be general, that is, manifested across contexts, or, specific, that is, limited to certain contexts or in the presence of certain peers and adults. For those young children suffering from generalized anxiety, those with highly sensitive and reactive temperaments, a comprehensive format which enables learning to help the child self-soothe and calm themselves, with training designed to provide the child a sense of competence and self confidence when in the contexts which elicit anxious responses, help the child cope more adaptively. There are very simple self-soothing and self-relaxing game-like techniques children can do to help them feel less physically anxious. Having a range of social and emotional skills designed to help the child cope with circumstances or others which trigger anxiety invites the child to conquer anxiety with their own set of skills, which become more effective as they practice them. I like therapists and counselors who work with the child and the parent(s) in the following way. Having the child have some alone time with the therapist or counselor and some time with parent and child working together. The older children become and the more intense the anxiety, it is a wise parent that tries to obtain help. Usually, the experience of therapist/counselor and chemistry between client(s) and therapist/counselors are the two factors which contribute to a more successful outcome.

Addictions are scourges. There are no aspects of life unaffected. Most sadly, all relationships and life activities become secondary to compulsive use. Successful treatment is possible, but, very difficult. Frequent relapses occur. Such failures discourage one from trying again. But, not giving up is an essential feature of successful liberation from addictions. In my experience four components are most important. (1) How long has one been addicted? Typically, the longer one has been addicted, the more difficult defeating compulsive use. (2) Greater intensity; the more frequent one uses the addictive substance(s), the more difficult to rid oneself of the associated habits. (3) Does the person's social life revolve around others so afflicted? If so, the person addicted needs to develop new relationships, rarely easy, and entertain themselves in different contexts, which some individuals seem unable or unwilling to do. It is most difficult to liberate oneself if one's social life revolves around other addicted individuals who use when they gather. Naturally, if the love of one's life indulges in addictive habits when recreating, successful liberation from addiction(s) threatens this powerful relationship. Failure to succeed can easily happen when an individual in love feels as if they cannot give up the love of their life, even though the individual greatly treasures the idea of being liberated from addiction. (4) Many of the wonderful support groups, AA, NA and others, place a great amount of emphasis on life's journey, obviously very important. What I find significantly important is the intoxicant or mind altering substance used provides immediate, or near immediate gratification, and, therefore, cements a very powerful association, in and of itself, minus the history. I need, I want, I have to have . . . and the substances that, if not laced with any lethal contaminants, delivers what is expected almost every time. The child within loves to get what is expected / wanted. In an unfair world where struggle and disappointment are so pervasive, isn't it great to have experiences which are uplifting, relaxing, satisfying or a combination of these? Individuals attempting to be treated successfully for addictions must commit to some very difficult changes in life style. There are biological, psychological, emotional and social influences which make combating addictions more like a war than just a few battles. Treatments can include pharmaceutical agents which can make one sick or block the impact of the substances abused. Psychotherapy and Behavior Therapy can assist in the process, as well as the use of support groups such as Alcoholics and Narcotics Anonymous (AA & NA). In my experience using these Groups are most successful for adults; when one finds a group which is a good match for the individual who choses to attend. Do not attend a Group where the only thing you have in common with the Group is your addiction. Give the Group 3 to 5 attempts. If you feel its not a good fit, find another AA or NA Group with individuals you feel as if you have more in common. Many times I have referred patients to a Group with which the individual feels as if the Group "doesn't work." If the individual find another AA or NA Group composed of individuals whose life journey and backgrounds mesh, the individual feels much more comfortable. People with addictions deal with self-centeredness, frequently. It is most important to ensure one goes to AA and NA to help others not just oneself. The genuinely motivated individual who is addicted welcomes a Sponsor. Those I've treated resistant to having a Sponsor are going through the motions to make it look like they are committed to cease using. When resistance occurs, I confront the person's lack of authentic commitment to change. Why resist having a Sponsor, when the Sponsor is extra help 24/7, who has suffered or is suffering from an addiction(s). Those in the community of alcohol and drug treatment specialists will likely become distressed if they read what is to follow. Although a fan of Groups for adults, it has been my experience such Groups backfire when participants are teens. Just as Adult Medical Specialists are not Pediatricians and Gerontologists, I do not believe the downward extension of AA and NA approaches work with those individuals who have not become adults. Observing early and late teens in AA & NA Groups, what I witness is not misgivings but "can You top this." Within the context of a Group, even conducted by seasoned Group Leaders, are teens bragging about how much toxic substance they have consumed or the crazy things the individual has done under the influence. Most Adult Leader of Teen Groups interject what is wrong, but, what this Group Leader interjects is rarely spontaneously offered by teen participants, which is lamentable. If You are an addicted teen or the loving Care Giver of an addicted teen, I would think twice before having my teenager participate in such Groups. But, most inpatient, intensive outpatient (IOP) and Specialty practices believe Group is a staple of teens so afflicted. If you share what I have written the Drug & Alcohol Specialist will be repelled and state "that guy doesn't not know what he is talking about, he never treated teens, he's not a Drug and Alcohol Specialist, he's just an old coot!" He or she may be correct, I am an Old Coot. But, I have practiced my trade almost 46 years. I've had years in practice when I treated teens exclusively. I have working experiences in diverse contexts, inpatient, Residential, IOP and Private Practice. But it is true, I plead guilty to being an Old Timer. However, the aforementioned opinions were formed when I was much younger in my career, and, unfortunately, has gotten worse. Mental and Behavioral services have deteriorated ever since Managed Care (Really Managed Cost) took over the funding of all health care. The fact reimbursements for many mental health care services are pitiful has resulted in my impression many of those individuals who run Groups are not trained to the level of sophistication required, especially if the participants carry a dual diagnosis, that is, addiction and another major Mental Health Disorder. Teens usually don't have the opportunity to pick a wider range of peers. The saying is "the three easiest places to score are prisons, drug rehab centers and retreats. and schools." Parents, Care Givers, Concerned Teachers and Adults can ensure the genuine dangers of using are real. There are educational videos showing the death of teens due to fentanyl. It is important to keep the tone factual not hysterical. There are 'cool kids' who use all the time, unsupervised gatherings, peer pressure, and the possibility your young lady or young man loves someone who uses. Separation from peers who are dealers, developing a new hobby or activity the young person might enjoy, something which demands being in better mental / physical shape, and, a weekly Teens and Parents Group lead by the teens, not the Parents, designed to teach parents what is going on in their schools and when the teens recreate can be quite enlightening. The aim of the group is focused on Adult awareness, not teen shame and punishment. Information shared stays within the Group, providing the Parents with information of what is going on in the lives of their daughters and sons. The adults ask the teens how to help, and what the adults can do to to help can be a better way of helping instead of scaring the teens they are going to die, will end up in jail, or a treatment center where adults only act as participant observers within the framework crafted by the facility. The Teens and Adults create their own information sharing gathering where the purpose, format, rules and guidelines are formed by the teens and adults together. Each item has to be voted on and be accepted by 100% of the participants, This process is difficult setting the stage for the reality this type of working together is not easy, even when the objectives are shared by everyone. The adults have to be tolerant, control their emotions, and treat all equally. The teens have to be honest, have the adults listen and correct the adults politely when the adults don't want to accept what is shared, and, learn to share power in decision making requires responsibility, not abrogation of responsibility to adults because they are adults. Is it possible to treat addictions, Yes. Is it easy, No. Best of luck liberating yourself from the poison of your choice.

There are a number of interventions for compulsive substance use, even if the afflicted individual verbalizes she / he wishes to. Many individuals are motivated to stop drinking when they encounter the criminal justice system or their spouses and family members want to enforce a separation. Many afflicted individuals have minimal to no motivation to engage in their own treatment or drinking cessation program. Without commanding ownership of their drinking problems, spirited motivation and unyielding fidelity to the desired outcome, those people who are spectator-participants will relapse frequently. These individuals usually blame the Addiction In-Patient and Specialty Centers, the treatments, AA, their Counselors and their Therapists for the reason(s) they continue to drink too much. Some addicted individuals seek treatment and participate in a perfunctory fashion because an attorney tells them to, or, they wish to appease others to get off my back. Painful self-awareness and considerable courage are required to acknowledge, I love alcohol so much. I cannot control how much I drink. For many individuals it is more difficult to admit this problem to themselves than to say to others, I gotta stop drinking! We live in a culture in which many citizens see no problems with alcohol misuse and abuse. Intoxicated individuals at bars / restaurants / gatherings are funny. Alcohol is a social lubricant which reduces inhibitions and promotes camaraderie. In general, the sooner in life an individual starts drinking to intoxication and the longer the individual has had this problem the more difficult it is to treat. Cessation is harder to do when many of the individuals extended family members share this same predilection. Successful outcomes are stymied by having too many friends who enjoy drinking to excess. There are pharmaceuticals which are antagonists, which make the consumption of alcohol physically unpleasant. Participation in AA meetings and being sponsored are helpful. There is no financial cost to the individual except her / his time and the emotional fidelity to help others. One does not have to embrace every aspect of AA philosophy, but, authentic participation, helping others, completing the steps, and welcoming a Sponsor are essentials. There are Certified Addiction Counselors, Doctoral-Level Professionals, and Physicians who specialize in treating addictions. There are residential treatment centers, hospitals and specialty treatment practices. Treatment can be inpatient/residential, intensive outpatient and outpatient. Addiction to any intoxicating substance is terrible for the addict and those who love her / him. The pain suffered by those who love the addicted individual is not shared by the addict until she / he engages in repetitive self-denial to achieve that state of consciousness facilitated by a bottle without a nipple or a six pack or both.

Depends on a number of factors. Differentiate anxiety vs panic attacks. Panic attacks have a shorter duration but the intensity is far greater. I have read a healthy percentage of individuals who go to ERs for what they believe is a heart attack, is a panic attack. Individuals feel as if they are dying. Individuals with both attacks suffer, but, the experience of panic attacks is worse. Individuals with anxiety attacks typically are aware of their experience of unrelenting anxiety symptoms, but, do not feel as if they are dying. Medical professional conduct testing to hunt for possible physical causes since attacks can be caused by medical conditions. After ruling out medical factors, or ruling medical factors in, treatment proceeds with a combination of treatment for possible medical causes, psychiatric medication and behavioral interventions / psychotherapy. The accuracy of the contributing diagnostic factors, the intensity of symptoms, and the duration of the symptoms have a direct impact on how long it takes to treat panic attacks successfully. Those specialist who provide treatment and interventions should be able to provide feedback and estimates of length of treatment based upon individuals they have treated successfully who have similarities with you, your lifestyle, intensity of symptoms, and how long (chronicity) you had the condition before you started treatment.

Attention Deficit Hyperactive Disorder (ADHD) has 3-subtypes, inattentive, impulsive, and inattentive-impulsive (combined-type). There are a number of approaches to managing the symptoms associated with ADHD based upon age and the way the symptoms generated impact on functioning. There are different approaches to treating the symptoms of this disorder including medication, teaching your daughter different compensatory strategies and techniques for different learning and social-behavioral contexts, supportive counseling and having the family learn more about this disorder so family members can understand and support your daughter. The most comprehensive approach involves a pediatric Neuropsychological one. This approach involves rather exhaustive assessments, including Neuropsychological Testing, thorough measurement of academic achievement, a deduction about your daughters learning styles and behavioral measurements of her conduct at home, in class, and in less structured playful contexts with peers. This approach is the most expensive and 3-rd party payers, insurance companies and/or her school district, prefer approaches which are less exhaustive and expensive. If your daughter has an IEP (Individual Educational Plan) the school district is responsible for those conditions (symptoms) which interfere with your daughters performance in school. In the good old USA, children have no right to treatment, but, they have a right to education, so some of the expenses of treatment can be shouldered by your daughters school district. I highly advise parents to get a copy of the Federal Right to Education Act and your Commonwealths or states version of this federal law so you can understand how to be the best advocate for your daughter. If you have no objections to trials of medication for symptom management, more intense impulsivity or significant problems with attention, concentration, and vigilance (sustaining attention and concentration for longer intervals), one difference I have experience in girls treated successfully with medication during pre-pubescence, the same medications might not work in post-pubescence. ADHD is best treated with a comprehensive approach. Even though school districts are supposed to provide remedial services for symptoms which interfere with learning as identified by the individuals IEP, it is preferable to also have an experienced clinician who does not work for the school district work with your daughter individually. In addition to symptoms management parents should become familiar with the Federal Right to Education and join a Parents advocacy group which focuses on students rights and the parents of children with ADHD share knowledge and support each other.

Anxiety attacks are different from individual to individual. Do the attacks occur in specific contexts or do they occur across contexts. Context specific attacks disappear when one leaves the context trigger ( what occurs / associated with that specific context). General attacks are not necessarily associated with specific contexts, but, can grow worse in specific contexts, and, are more characteristic of individuals who experience heightened nervousness most of the time. Treatment and / or counter-conditioning can help. Once the causal factors are identified, change in anxiety attacks can be approached based upon the identified causative factors.

There are a number of activities which can lesson the impact of anxiety. Getting lost in activities you love, aerobic exercises, many different types of controlled breathing techniques, and engaging in activities which improve your sense of competence. Such activities help anxiety in the mild to moderate range. More severe anxiety makes engaging in these activities much more difficult. With more severe anxiety, which is the most debilitating, it is prudent to talk about your condition with your Primary Care Physician (PCP) and / or a Mental Health Specialist.

Psychotic Disorders are the most difficult to treat. Schizophrenia, Mania, and Bipolar-1 have severe symptoms, most notably hallucinations, delusions, odd and strange behaviors which scare and repel others and are terrifying for those afflicted. The collection of disorders housed under the diagnostic umbrella of schizophrenia involve significant resources, medication, behavior management, therapy, and the support and understanding of family and friends.

All medicines have side-effects. There are both common side-effects and those which can be unique to the individual taking the medication. If One has been taking anti-depressants, two of the most important considerations are for how long and at what dose? In most cases, the longer the time interval and the higher the dose the more time it takes to diminish the dose over a period of time with the help of the prescriber. Within our own neurochemistry there are naturally occurring agents designed to help fight anxiety and depression. When these agents are overwhelmed prescriptive medicines help to fight psychiatric symptoms. Our natural neurochemistry designed to fight anxiety and depression can become sluggish while we take the medicines prescribed. As we lesson the dose of prescriptive medicines the intent is to re-awaken our natural brain chemistrys ability to take on depression. The benefits of eventually eliminating an anti-depressant usually have a direct impact on side-effects including enhancing libido, making sleep more restorative and re-setting appetite since weight gain can become a problem while taking antidepressants. Reducing the dose and eliminating the antidepressant should only be completed with the help of the prescribing physician.

Addictive / Compulsive habits require consideration of how long the compulsive behavior has existed and to what degree of intensity. Someone who has had the compulsion for 20 years has more difficulty shedding the compulsion than someone who has experienced the compulsion for a year. Someone who mortgages their home multiple times is not the same as one who blows a paycheck but no more. There are many other factors which can fan the flames, including delayed consequences or having family members and friends bail out the compulsive gambler. In my experience, anyone who does not command formidable self-motivation to extinguish this compulsion will not do it no matter how much support or help they receive. Gamblers Anonymous provides help but the participant has to follow the principles and be lucky enough to have a dedicated sponsor. The compulsive gambler has to stop lying to themselves and others and confront themselves and their associated behaviors in rigorous ways. Addicts tend to build a social network of individuals who have the same compulsions. Relinquishing an addiction may require one to give up their circle of friends and those activities on which they entertain themselves where gambling is seamless with the activities enjoyed. Coming to grips with the fact that gambling produces a neuro-chemical rush which is elating within a context of friends who also enjoy betting on activities which are tailored to facilitating betting makes giving up gambling a formidable challenge. The number of life changes required to extinguish the gambling addiction is a great deal of work within a culture that encourages relapses all the time. Getting help from someone who has had the same addiction and beat it, joining GA, accepting a GA sponsor and having a good deal of personal motivation bolstered by a great deal of luck provides the pathway. Even with all of these things in your favor, expect regressions and a good deal of time before you are able to become free of this addictive, self-reinforcing compulsion.

Conceptually, the presentation of individuals suffering from Schizophrenia can be viewed from many perspectives. The history of diagnoses of this condition is divided into various subtypes. Therefore, there are a group of sub-types of this disorder which collectively are called the Schizophrenias. Schizophrenia is a psychotic disorder in which a combination of hallucinations and delusions dominate. The frequency and intensity of hallucinatory experiences, hearing voices, seeing things which have no environmental origin, and, the type and depth of thought disorders experienced, create conditions which are very challenging to manage and treat. Most individuals who have been diagnosed with Schizophrenia, experience catastrophic fear, especially of other people. Such individuals become self-isolating and very withdrawn. A cardinal feature of individuals suffering from Schizophrenia is disorders thinking. The abilities to check what an individual suffering from Schizophrenia believes, or, the deductions made due to the hallucinations experienced, compromise their capacity to test reality. Many times if the individuals suffering from Schizophrenia are challenged by others trying to help, with rational interventions, their belief systems become less, not more, adaptive. This feature also makes Schizophrenia very challenging to treat. Another factor is the contributions of structural and functional brain irregularities. Research on the impact of anti-psychotic medicines on the symptoms of Schizophrenia indicate that the favorable impact of anti-psychotic medicines diminish when there are more notable anatomical and electro-chemical aspects of the brain which deviate from what is considered within the normal range. In my experience, the treatment of all psychotic disorders require medicines designed to mitigate the impact of hallucinations and delusions with a combination of psychotherapy plus behavioral management. In my experiences, it is a superior approach to have someone else besides the psychotherapist to be cast in the role of behavioral manager, since individuals afflicted with psychotic disorders require a therapist who creates a safe context in which the suffering individual experiences unconditional acceptance. Fear is reduced, and, the therapist does not have to focus on behavioral compliance but on understanding and acceptance. Thus the one suffering feels safe expressing their genuine thoughts, feelings, and experiences, rather than telling the therapist what the sufferer believes the therapist wants to hear and / or to refuse to participate in a psychotherapy designed to change behavior but minimizing the notion there is a suffering person attached to what are the behavioral objectives. The sentiments aforementioned do not mean seasoned therapists experienced working with individuals afflicted with psychotic disorders cannot be the Behavioral Manager. And, the designated Behavioral Manager can provide many of the therapeutic benefits experienced in psychotherapy. My experience is the person suffering seems to have an easier time if the roles of psychotherapist and behavioral manager are split between two different professionals treating the individual. Schizophrenia is a very serious disorder which causes misery for individuals and their loved ones. Optimally, the best treatment team would include a Psychiatrist who prescribes anti-psychotic medicines designed to reduce or eliminate hallucinations and delusions, a seasoned Psychotherapist who has experience treating psychotic disorders, and a Behavioral Manager charged with facilitating adaptive behavioral changes, including helping the person suffering to engage in social activities. In todays fractured healthcare systems one is lucky to have a psychiatrist, an experienced psychotherapist, and behavioral specialist to help one recover and / or manage their symptoms. Based on the severity of symptoms, it may be most prudent to have at least one professional involved who can prescribe medication. The chores of the psychotherapist and / or behavioral specialist are extremely difficult if the individual they are treating is actively experiencing hallucinations and delusions.

Panic attacks are incredibly scary. Many people believing they are experiencing heart attacks go to the ER and are diagnosed as experiencing panic attacks. There are differences between genuine panic attacks and attacks of anxiety. Panic attacks do not have just one cause. Since they can be caused by a variety of factors there is no single treatment. Various relaxation techniques, including breathing techniques, are used to help individuals reduce anxiety. Genuine panic attacks feel life threatening. It would be a rare individual who had mastered a breathing technique sufficiently to stop or reduce the severity of a genuine panic attack. Treating panic attacks typically includes medication in the acute phase with behavioral interventions. It is prudent to receive thorough physical / medical examinations and behavioral assessment and treatment.

There are all kinds of breathing techniques designed to promote relaxation, one of the behavioral techniques to help cope with anxiety. The one best for another might not be best for you. Search a number of relaxation techniques, see what appeals to you, choose two or three and discover what seems best for you by way of practice and trying them out.

Hello, As you probably know, anxiety is associated with symptoms which can range from mild to severe. The fight / freeze / flight response can be provoked by external threats to your sense of well being and your own thoughts / feelings / conduct making one struggle within, and, frequently a combination of external and internal factors. Anxiety can be context specific or generalized across contexts. Anxiety responses vary due to individual differences. Also, the way a person responds to the idea of taking medication varies from. am I so messed up I need medication, to its just another pill, so what. Both therapy and medication can be effective. Sometimes an individual will be treated by both. With respect to individual difference, do you prefer one over the other? Medications help alleviate symptoms. Therapy helps you to garner coping strategies and techniques. If the symptoms are in the milder range you can take anti-anxiety medications PRN (as needed), try to learn effective coping skills through self help, or talk to a trained professional. Moderate to severe anxiety typically requires both medication and therapy. Severe anxiety disorders, such as Generalized Anxiety Disorders, Obsessive-Compulsive Disorders and Post Traumatic Stress Disorders are usually treated with anti-depressants not anti-anxiety medications. Anti-anxiety medications do not have to reach a steady state in your circulatory system but can cause dependency. Anti-depressants have to be taken consistently but are not addictive. Cutting research is showing the positive impact of hallucinatory agents to reduce the symptoms of PTSD. The decision to try medication depends on the severity of symptoms, Are your symptoms situation-specific or ever-present? In general, are you for, neutral, or, against taking medications? Are you the type of person who wants symptom alleviation or would you prefer to learn skill sets to combat your symptoms. Our governments reaction to the opioid crisis makes physicians less inclined to prescribe not only pain-killers but any medications which are habit forming. Anti-anxiety medications can be habit forming. Anti-depressants are not. Many individuals find it difficult to schedule appointments with Primary Care Physicians, let alone specialists, like Psychiatrists. Many Psychiatrists do not accept insurance. Before the industrialization of health care, whether the prescribing physician was a generalist or a specialists, individuals were scheduled frequently in the beginning of treatment with medication so the prescribing physician could observe, listen to testimony, judge the impact of the initial dose and fine-tune the dosage. Practitioners, in general practice, usually cannot provide the time to fine-tune and Specialists who do not accept insurance can be quite expensive. It is recommended the aforementioned factors are considered when one is deciding to weigh the medication option. Intolerable symptoms across contexts which significantly degrade functional competency favors trying medication. If you have a positive relationship with your general practitioner, discuss the options and do your own research. I know this proposed course of action is onerous but it will help you make the more prudent decision when it comes to trying the medication option.