Psychiatry Archives - Promises Healthcare
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Anxiety and The Body

Anxiety and The Body

Anxiety refers to a state of anticipation of alarming future events. Anxiety is usually a normal transient response to stress and may be a necessary cue for adaption and coping, the body’s protective mechanism known as the ‘fight or flight response’.

However, anxiety can become pathologic, where it is excessive and inappropriate to the reality of the current situation. It is often described by many as a distressing experience of dread and foreboding. 

 

Anxiety is manifested in the affective, cognitive behavioural and physical domains. The affective states could range from edginess and unease to terror and panic. Cognitively, the experience is one of worry, apprehension and thoughts concerned with emotional or bodily danger. Behaviourally, anxiety triggers a multitude of responses concerned with diminishing or avoiding the distress. 

 

Physical Manifestations of Anxiety

Stimulating the autonomic nervous system results in an array of bodily perturbations.

List of Anxiety symptom

Several nervous system structures are involved in fear and pathologic anxiety.

The amygdala is responsible for initiating the fight-or-flight response. When activated, the amygdala triggers a series of changes in brain chemicals and hormones that puts the entire body in anxiety mode.

Left untreated, over time the affected individual’s body physically responds more frequently and intensely to worries. Co-morbid depression often sets in. One’s ability to meaningfully function academically, occupationally and socially gets hampered, leading to a deterioration in the quality of life. 

 

Treatment of Pathologic Anxiety

The first point of contact for many patients would be their general practitioners or even the hospital Accident & Emergency department. It is important to evaluate and rule out underlying medical illnesses that may mimic an anxiety disorder, such as thyroid disorders, heart rhythm disturbances, gastrointestinal diseases or alcohol withdrawal. The doctor may order some basic investigations, such as a thyroid function blood test or an electrocardiogram (to check one’s heart rhythm). Once medical causes have been excluded or identified and treated, persisting anxiety symptoms would warrant a psychiatric consultation. 

A prescription of anti-depressants such as Selective Serotonin Re-Uptake Inhibitors (SSRIs) to aid in the balancing of the brain neurotransmitters may be suggested. Anxiolytics such as benzodiazepines e.g. Clonazepam may be used in the initial phase of treatment, and thereafter only short courses are prescribed to reduce the risk of dependency. 

Cognitive-Behavioural Therapy (CBT) involves cognitive restructuring and anxiety symptom management. Cognitive interventions are aimed at challenging and correcting the inaccurate and maladaptive thought patterns that maintain anxiety disorders. Symptom management techniques e.g. relaxation and breathing re-training procedures, help to eliminate anxiogenic bodily reactions. 

 

Tips to control anxiety

 

Lifestyle adjustments to one’s hectic pace of life need to be made to break the vicious cycle of stress and worry. Developing a healthy routine with regularly scheduled self-esteem-raising activities, ensuring adequate rest and nutrition as well as maintaining social connections are pivotal for mental wellness. 


 

References

Massachusetts General Hospital, Handbook of General Hospital Psychiatry, seventh edition, chapter 13: Anxious Patients. 

Kaplan & Sadock’s Concise Textbook Of Clinical Psychiatry, fourth edition, chapter 6: Anxiety Disorders.

Anxiety symptoms stem from the very helpful ‘fight or flight response’. CBT4Panic. (n.d.). Retrieved December 1, 2022, from https://cbt4panic.org/anxiety-symptoms-stem-from-the-very-helpful-fight-or-flight-response/

The fight or flight response symptoms. CBT4Panic. (n.d.). Retrieved December 1, 2022, from https://cbt4panic.org/the-fight-or-flight-response-symptoms/

How Does Anxiety Affect Your Brain? (n.d.). Retrieved from https://www.xcode.life/genes-and-health/how-anxiety-affects-brain/

Hundreds of anxiety symptoms explained. AnxietyCentre.com. (2022, November 20). Retrieved December 1, 2022, from https://www.anxietycentre.com/anxiety-disorders/symptoms/

Psychreg. (2022, July 30). Anxiety disorders: Causes and treatments. Psychreg. Retrieved December 1, 2022, from https://www.psychreg.org/anxiety-disorders-causes-treatments/

Bipolar and Schizophrenia – Symptoms, Treatment and Recovery

Bipolar and Schizophrenia – Symptoms, Treatment and Recovery

Written by: Dr. Joseph Leong Jern-Yi

Understanding Bipolar & Schizophrenia

Both bipolar disorder and schizophrenia were considered severe mental illnesses with no recovery in the past. This is not true in modern psychiatry as we have developed more effective treatments such as medications (psycho-pharmacology) and psycho-social interventions (psycho-therapy and psycho-social rehabilitation) which help patients improve their quality of life as well as reduce symptoms and restore function.

Bipolar disorder and schizophrenia may have similar symptoms which are disturbances in thinking, feelings and behaviour. The major difference is that bipolar disorder is classified as a mood disorder whereas schizophrenia is classified as a psychotic disorder. Mental healthcare professionals make diagnoses based on reports of patients, caregivers, or other information sources as well as observations made during the assessment interview.

Experts have also formulated that schizophrenia and bipolar disorder may be a spectrum disorder with schizophrenia on one end and bipolar disorder on the other end with schizoaffective disorder in the middle of the spectrum.

What is more important however is not the exact diagnosis alone but rather the identification of symptoms so that treatment can be effectively targeted at the relief of the symptoms, restoring function and improving quality of life. This targeted symptom approach has proven to be one of the most effective ways of helping persons recover from these brain conditions.

Let’s discuss some of the common symptoms –

Delusions, which are untrue, unshakable, and unshared beliefs which can exist in both brain conditions.

For example, delusions of persecution which are beliefs of being targeted, being followed, being sabotaged (persecutory) are common in schizophrenia while delusions of grandiosity such as believing that they are particularly important persons and have special powers or ability to save the world (grandiose delusions) are more common in bipolar disorder. For persons with schizoaffective disorder, they might have both persecutory and grandiose delusions at the same time. It also has an underlying co-occurring mood disorder.  

Hallucinations which are perceptual disturbances such as hearing voices which are not heard by others, seeing, smelling, tasting or feeling things which are not present are more likely to happen in schizophrenia.

Severe mood swings and manic episodes where the person has fast speech and high energy levels are associated with abnormal spending, socialising, exercising, or expanding businesses with the need for very little sleep over a few days and weeks are more likely to happen in bipolar disorder.

More than half a century ago, most persons suffering from these brain conditions were isolated and confined to asylums as there were no effective treatments until the discovery of medications that can change brain chemistry. Neurotransmitters which are chemicals responsible for brain and other bodily functions were discovered. Noradrenaline, serotonin, and dopamine disturbances were more likely causes in bipolar disorder while dopamine imbalance was a more probable cause of schizophrenia. See https://dana.org/article/neurotransmitters/

 

The Help Of Modern Medicine

Modern psychopharmacology offers an array of medications which can act on various neurotransmitter sites in the brain. Several medications and several rounds of adjustment and fine-tuning may often be needed to achieve stabilisation with medications with relief of symptoms. This is best done collaboratively with the patient, psychiatrist, and caregiver at the consultation with all the medications brought in for review.

Adjusting to a new medication through an effective therapeutic trial may take at least 2 weeks, starting with the lowest dose and increasing dosing to a maximised symptom relief dose over 2 months. 

Medications need to be taken daily to be effective, and this is best done using a pill box and with supervision from a loved one. Medications are served by nurses in the inpatient hospital setting who ensure that the correct dose is directly observed to be taken by the patient – however, this is often lacking in the outpatient setting leading to the return of the symptoms causing distress and dysfunction.

 

Bipolar & Schizophrenia Treatment Methods

Comparing bipolar disorder and schizophrenia to other brain conditions may be helpful in understanding how one can better achieve remission and recovery. 

Epilepsy is a brain condition where there are electrical firing of neurons causing disturbances in thinking, feeling and behaviour. To stay in control of oneself, the doctor may recommend various combinations of anti-epileptic medications to prevent another seizure. In fact, the model of kindling in epilepsy has been used to understand mental health treatment in this highly readable resource essay – https://aeon.co/essays/should-the-kindling-concept-direct-mental-health-treatment

If you speak to someone with experience with epilepsy, they will tell you about ‘warning signs’ and the ‘confusional state’ after a breakthrough seizure.

Similarly, for those struggling with bipolar disorder and schizophrenia, one becomes more aware of ‘warning signs’, and ‘confusional states’ through direct feedback from loved ones who are observant and psycho-educated by healthcare professionals. Charting, monitoring and sharing your experience are key to success in achieving remission and recovery. Use this mood chart and share it with your mental healthcare professionals for more in-depth analysis – https://loricalabresemd.com/wp-content/uploads/2017/12/Personalized-Mood_Chart.pdf

Symptoms management starts with monitoring your symptoms and the response to the treatment – what makes it better, what makes it worse, whether it is mild, moderate or severe. The frequency, intensity and severity can be charted so that effective treatment of psycho-pharmacology (active use of medications) and psycho-social interventions (psycho-therapy and psycho-social rehabilitation) can be targeted to achieve the best outcome for you.

 

Recovery Is Possible

Your mental healthcare professional can coach and pace you so that it will not be overwhelming. Recovery starts with taking it one day at a time. Be gentle with yourself. Learn to trust and entrust your healing to people who care about you. Learning from feedback as well as charting, monitoring and sharing your experience with loved ones – trusted family or friends or co-workers greatly enhance effectiveness.

Atomic habits by James Clear is an excellent book which illustrates the importance of charting, monitoring and shaping your habits, on the premise of improving 1% daily leading to more than 365% improvement in one year. This is Youtube illustrates how that can happen – “How to become 37.78 times better at anything”. 

There are many services available at Promises Healthcare and Community Partners which can help reduce symptoms, restore function, and improve quality of life. Recovery is possible and becomes a reality with appropriate support and adequate skill training. With the right help and support, persons in recovery can live meaningful and satisfying lives.

Here are some real stories that illustrate many facets of mental health and recovery:

The Neurobiology of TMS

The Neurobiology of TMS

Written by: Dr. Sean David Vanniasingham

Principles of Transcranial Magnetic Stimulation (TMS)

In the 1800s, world-renowned English physicist Michael Faraday discovered the principles of electromagnetic induction. Fast forward to the 21st century, Faraday’s discovery was harnessed into the clinical practice of transcranial magnetic stimulation (TMS) for the treatment of mood disorders. Based on Faraday’s Law, TMS can stimulate brain neuronal circuits with tiny electrical currents induced by a changing magnetic field.

 

Application of TMS in Singapore 

In Singapore, the practical application of TMS is employed in the form of repetitive transcranial magnetic stimulation (rTMS). In rTMS, magnetic pulses are delivered in trains at specific frequencies. “Fast” (high frequency e.g. 10Hz) stimulation increases cortical excitability for the treatment of depression. Whereas “slow” (low frequency e.g. 1Hz) stimulation reduces cortical excitability for treating anxiety disorders. Furthermore, TMS can be targeted at focused regions of the cortex for superior precision treatment of specific conditions e.g. rTMS at 1Hz to the right orbitofrontal cortex (OFC) reduces intrusive obsessions in obsessive-compulsive disorder (OCD).

Mood disturbances such as depression are increasingly understood as disorders of connectivity in neural networks linking cortical and subcortical grey structures of the brain. Functional brain imaging has shown dysfunction in cortical regions such as the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC), as well as deep grey matter structures including the amygdala, nucleus accumbens, hippocampus and hypothalamus. These brain circuits are pivotal for executive functioning, regulation of emotions, reward processing and preservation of memory and cognition. They also link the nervous system to the endocrine system, which mediates the body’s response to stress. 

 

Neuroplasticity and TMS

Evidence suggests that TMS induces neuroplastic changes in these circuits. Neuroplasticity is the ability of the brain to reorganize itself by forming new neural connections. TMS helps readjust neurotransmitter (e.g. serotonin and dopamine) levels in a variety of brain regions. TMS also appears to exert a neuroprotective effect on the brain. Research has shown that TMS decreases brain inflammatory factors reducing oxidative stress on the brain. TMS also boosts the levels of brain-derived neurotrophic factor (BDNF), encouraging neuronal growth in regions such as the hippocampus which is vital for learning and memory. It is postulated that the anti-depressant properties of TMS may also help in normalizing the body’s neuroendocrine stress response system.

 

rTMS has achieved its place on international treatment guidelines as an augmentation treatment modality to be strongly considered in treatment-resistant depression. It is reported that 30-40% of depressed patients may have inadequate responses to anti-depressant medication treatment. The direct neuronal effects of rTMS may explain why rTMS may work for this group of patients. 

 

rTMS for OCD Treatment and other neurological disorders

In May 2022, the U.S. Food and Drug Administration (FDA) approved the use of the NeuroStar TMS system as an adjunct for treating adult patients suffering from OCD. Promising research is ongoing for the clinical application of TMS in treating Post-Traumatic Stress Disorder (PTSD), addictions, chronic pain, insomnia and many other neurological disorders.

 

TMS and recovery

With further advancements in TMS research and the incorporation of TMS in routine clinical practice, there is strong hope for recovery and the regaining of optimal functioning for patients afflicted by complex neuropsychiatric conditions.

 


References

1) Transcranial Magnetic Stimulation

Clinical Applications for Psychiatric Practice

2018 American Psychiatric Association Publishing, First Edition

2) The Science of Transcranial Magnetic Stimulation 

William M. Sauvé, MD; and Lawrence J. Crowther, Meng

Psychiatric Annals, Vol44, No.6, 2014

3) Repetitive transcranial magnetic stimulation increases serum brain-derived neurotrophic factor and decreases interleukin-1b and tumour necrosis factor-a in elderly patients with refractory depression 

Xiangxiang Zhao, Yanpeng Li, Qing Tian, Bingqian Zhu and Zhongxin Zhao

Journal of International Medical Research 2019, Vol. 47(5) 1848–1855

4) What is repetitive transcranial magnetic stimulation and how does it actually work?

Paul Fitzgerald, Professor of Psychiatry, Monash University

The Conversation AU, published May 13 2021

This elderly man with Alzheimer’s killed his granddaughter. He says he doesn’t remember

This elderly man with Alzheimer’s killed his granddaughter. He says he doesn’t remember

CNN Digital spoke with Dr Jacob Rajesh to give his views regarding a case that shocked the nation of Japan where a teenage girl was stabbed to death by her elderly grandfather.

Here’s his quote:

Jacob Rajesh, a senior forensic psychiatrist at the Promises Healthcare facility in Singapore, said in cases of rapidly progressing Alzheimer’s “it will be difficult to provide an accurate account of what actually happened.”

“There is also the question of fitness to stand trial – is a person fit enough to give evidence on the stand and plead guilty or not guilty?” he said.

Crimes involving dementia patients are also extremely complex, experts said.

Follow this link to read the whole article:

https://edition.cnn.com/2022/06/11/asia/japan-man-grandfather-alzheimers-murder-crime-intl-hnk/index.html

Dr Jacob Rajesh Speaks with Expat Living on the misconceptions of psychiatric medication

Dr Jacob Rajesh Speaks with Expat Living on the misconceptions of psychiatric medication

Psychiatry Questions … Answered!

What are some commonly used psychiatric medications?

Depression is a very common disorder, affecting between five to ten percent of people, so we use antidepressants quite often. The medications we’ve been using for the past 25 years are called Selective Serotonin Reuptake Inhibitors (SSRIs). These newer generation drugs have much fewer side effects than those used in the past.

They do have some side effects though, the most common being gastric distress, nausea, headaches and insomnia. Some people also report sexual dysfunction and decreased libido. However, these side effects can be managed once the medication and dose is adjusted. SSRIs are usually more tolerated than older antidepressants.

Another group of drugs is the antipsychotics, which are used to treat schizophrenia and bipolar disorders. The second generation antipsychotics have fewer side effects than older ones, along with fewer cognitive effects and extrapyramidal side effects such as causing tremors or stiffness. However, side effects such as weight gain, increased blood sugar and increased cholesterol can occur with some of these drugs; these side effects need to be screened for on a regular basis

promises healthcare psychiatric medicine and antidepressants

Is psychiatric medication an alternative to therapy? Or do they work hand in hand?

Medication and therapy usually work hand in hand. Being medication-compliant is another important part of the mental health recovery treatment as it helps bring stabilisation to the chemical and biological changes in the sufferer that cause the disorder.

For depression, we prescribe medication for moderate or severe symptoms if it’s causing impairment or distress. We also recommend psychotherapy in its various forms: cognitive behavioural therapy, dialectical behaviour therapy, acceptance and commitment therapy, interpersonal therapy or family therapy, depending on the psychosocial stressors.

For bipolar disorder or psychotic conditions like schizophrenia, medications are the mainstays of treatment. However, psychotherapy methods can also help with regulating emotions and give handles to help regulate distorted thoughts when mild symptoms occur. Psychological therapy also plays a role for Obsessive-Compulsive Disorder (OCD) and eating disorders. Here, psychotherapy has a much more important role.

What are some of the misconceptions people have about psychiatric medication?

The most common misconception is that all psychiatric medications make you feel like a zombie – you can’t function, you can’t go to work, your mental faculties are affected. While some of the older generation antipsychotic medications can cause mental fogginess, there are newer ones with fewer side effects. Some people also believe that if they start taking medication, they might become addicted. It is usually the benzodiazepine class of drugs that are addictive in the long term; antidepressants aren’t addictive in the long term. We also see many patients who’ve been taking medication on a long-term basis, but we work with them to minimise side effects. We do this by adjusting the dosage, changing the class of drugs used and lifestyle modification. It’s also worth mentioning that psychologists cannot prescribe any of these drugs, only psychiatrists can.

Can you tell us more about new techniques like Transcranial Magnetic Stimulation?

Transcranial Magnetic Stimulation (TMS) uses electromagnetic waves to stimulate the brain. Unlike electroconvulsive therapy, which is more for people with severe psychotic depression, TMS doesn’t require any sedation. The patient simply sits in a chair and has a device placed at specific parts of the brain where it sends small electromagnetic waves. It is an outpatient procedure and there aren’t usually any side effects.

TMS is used primarily for people with depression who haven’t responded to antidepressants or have severe side effects from medication. It’s not usually a first-line procedure.

Is it as effective as antidepressants?

It works in combination with them. If that alone isn’t helping, TMS can augment the medication. It can also help by itself, but once the treatment stops the patient can relapse, so it’s better to take medication along with it.

What are some psychiatric issues that people may not realise they have?

Many people don’t realise that depression or anxiety disorders are mental illnesses. They think it’s a weakness in their own personality or the result of external stressors they can’t handle. The stigma of mental disorders also plays a big part. People tend to be quick to seek help for physical issues but still feel uncomfortable seeing a psychiatrist. I think it’s becoming more accepted though. There’s a misconception that psychiatrists just provide medication.

What else do they do?

Psychiatrists work in teams. The team-based approach is very important because we have psychiatrists who are qualified doctors along with psychologists who are trained in psychotherapy. We also have social workers, case managers and occupational therapists.

It’s a misconception that psychiatrists cannot do therapy. There are many psychiatrists who are trained in many forms of therapy, but the psychologists are the professionals who study these critical areas in depth. We refer the patients to them because it is their area of expertise.

What would you tell someone who is unsure about seeking help?

Don’t be ashamed of your symptoms or be self-critical. Many feel their symptoms stem from a weak personality or an inability to handle stress. People need to understand that mental health issues can occur for people who’ve done everything right – people with a good job, a good family life, good support and no financial issues. Depression is a biological response and it can happen without any external stressors so there is no shame in seeking help.

Dr Rajesh is a Senior Consultant Psychiatrist at Promises Healthcare, a provider that offers a wide range of psychiatric and psychological services for patients of all ages. Promises is also the only private centre in Singapore to offer Transcranial Magnetic Stimulation.

For more information on psychiatric medication and treatments offered by Promises Healthcare, click here.
#09-22/23 Novena Medical Center | 6397 7309

This article first appeared in the February 2022 edition of Expat Living and was published on their website. 

 


Dinesh Ajith

Dinesh is a seasoned writer and editor with seven years of experience covering travel, restaurants and bars. His interests include film photography, cheesy 90s monster flicks, and scouring the island for under-the-radar craft beer bars.

The Power of Physical Presence in Therapy

The Power of Physical Presence in Therapy

Therapy is an indispensable tool to recovery, or in helping one gain deeper insights and achieve self-actualisation. In light of the ongoing COVID-19 pandemic, traditional face-to-face therapy has been forced to take on various forms, including sessions conducted via telephone or through video-calling platforms. Of course, therapy serves the same purpose, regardless of whether it is conducted in person or otherwise. However, there is definitely something restorative about being able to connect with a therapist physically. Humans are innately social creatures after-all, and sometimes when things get tough, a little more human interaction and comfort can go a long way. 

 

Physical presence in therapy certainly provides a deeper sense of connection, in contrast with virtual therapy where one might feel more distant and detached. It may seem bearable at the very beginning, but as you progress through the sessions, having to interact with your therapist through a screen all the time can get frustrating. Similar to how students may have trouble coping with online school and home-based learning, virtual therapy has some form of hindrance when it comes to relationship-building with your therapist. For most psychotherapy methods, it is indeed possible to shift them online. However, for others such as psychodrama, it may not be entirely ideal. How expressive and comfortable can you get, when you’re struggling to follow your therapist’s directives through the small screen and having to deal with technological lags? 

 

Seeing your therapist in person also allows for him/her to detect any subtle body language and somatic movements. These are all non-verbal cues that may be lost through telecommunication. Non-verbal cues are just as important as verbal ones, and can provide your therapist with greater insights. Non-verbal signals can serve to convey your feelings along with what is being said, and can either reinforce or contradict verbal messages. Ignoring them would be very much a failure to be fully engaged in a conversation. Moreover, seeing you in person provides therapists with the ease to identify any form of dissociation. During the session, clients may not necessarily attune well, and may not be fully present in the moment. The client may be engaging with the therapist, but seemingly thinking about something else that is going on in their life at the same time. This does not mean that the session is unhelpful or “boring”. While this could simply be attributed to the lack of presence, it could also point towards other concerns regarding the client’s state of mind. Fragmentation can occur especially when one is recovering from a past trauma and can be brought to the forefront, causing incomprehensive emotional reactions when triggered. Fragments of self are usually suppressed, often attributed to the lack of a sense of safety when it comes to expressing their inner needs or desires. When these feelings start to show during therapy, therapists can identify them through common tell-tale signs such as a switch into dissociation, noticeable body movements (twitching, scrunching of fingers or toes etc.). Body language is not definitive, but can offer clues about one’s thoughts and feelings. With telecommunication, it is more often than not impossible to see the client below shoulder-level, thus making it difficult for therapists to assess any somatic movements that may be occurring. 

 

Another issue with telecommunication is the lack of control over the therapeutic environment.  In a traditional face-to-face session, the clinician has considerable control over the environment, and is able to ensure a private, safe and quiet space for the entire duration of the session. This limits the number of distractions and allows for both the therapist and the client to concentrate on psychotherapy. Moreover, in a clinical setting, furniture is often set up in particular ways to facilitate clinician-patient interactions. For instance, seats may be arranged such that the clinician would be facing the client at an angle of 45 to 90 degrees, and approximately 2 to 3 feet away. Facing the client directly can feel somewhat threatening for some, and this angle allows for the client to feel more at ease. Additionally, it allows for both parties to break eye contact naturally (intermittently) without seeming antisocial or distracted by having to do so actively. In contrast, having a session online or through telephone allows for less control over interactions and the client may be more exposed to external distractions or undesirable interruptions. This also leads us to our next point, where teleconsultations also increase the risks of privacy breaches. 

 

Due to the lack of environmental control, having a consultation via telecommunication methods can be a challenge especially for those who do not have access to their own private space. For individuals living with others, there could be situations that compromise client confidentiality, including potential eavesdropping or having others walk in on them. Not only does this make the session extremely disruptive, it can be a huge concern for many considering that mental health concerns are sensitive topics. Clients must make the extra effort to find a suitable place and time for them to speak with their therapists freely and with ease. As such, physical presence in a controlled clinical setting may have the upper hand.

 

Nevertheless, this article in no way aims at undermining the efficacy of tele-health, nor to allude that tele-therapy is ineffective or pointless. Considering the need for physical distancing during the pandemic, telecommunication is undeniably crucial in limiting the spread of the virus. Putting that aside, traditional in-person therapy can have its barriers too, limiting people from attaining the mental health support they need. Individuals with disabilities may find accessibility to be a significant problem at hand, and find it difficult to travel for therapy without having others to rely on. Others include parents who are unable to find suitable childcare options, all while juggling work and mental health care. For those struggling with social anxiety and agoraphobia, it can also be extremely intimidating and overwhelming for them to step out. In fact, some research has shown that virtual and in-person therapy, depending on the treatment goal, can be equally effective. In adults, cognitive behavioural therapy was shown to be similarly effective both in vivo and virtually (Khatri et al., 2014). There is also evidence that youth with anxiety disorders respond positively via telehealth (Khan et al., 2020). Traditional face-to-face therapy and tele-therapy both have their perks, and we acknowledge that it also boils down to individual preferences. If you’re unsure as to which treatment option to opt for, do feel free to contact us.

 

References:

  1. Brenes, G. A., Ingram, C. W., & Danhauer, S. C. (2011). Benefits and Challenges of Conducting Psychotherapy by Telephone. Professional psychology, research and practice, 42(6), 543–549. https://doi.org/10.1037/a0026135 (Accessed 06/09/2021)
  2. Khatri N., Marziali E., Tchernikov I., Shepherd N. Comparing telehealth-based and clinic-based group cognitive behavioral therapy for adults with depression and anxiety: A pilot study. Clinical Interventions in Aging. 2014;9:765. (Accessed 09/09/2021)
  3. Khan, A. N., Bilek, E., Tomlinson, R. C., & Becker-Haimes, E. M. (2021). Treating Social Anxiety in an Era of Social Distancing: Adapting Exposure Therapy for Youth During COVID-19. Cognitive and behavioral practice, 10.1016/j.cbpra.2020.12.002. Advance online publication. https://doi.org/10.1016/j.cbpra.2020.12.002 (Accessed 09/09/2021)
  4. https://www.nataliarachel.com/articles-practitioners/shifting-to-tele-therapy-attuning-without-physical-presence (Accessed 07/09/2021)