Anxiety and Bipolar

For many people with bipolar anxiety is a bigger problem than mood swings. It is not that unusual for someone with bipolar to report that their first “symptom” of a psychiatric nature was the onset of anxiety early in childhood. Let’s take a look at this information again… 90% of people with bipolar have an anxiety disorder diagnosis. 2/3rds have had …

Acceptance and Commitment Therapy Part 2: Defusion

Defusion is one of the six core processes that make up Acceptance and Commitment Therapy (ACT). These core processes, which also include acceptance (click here to review this process as described in Part 1), present-moment awareness, self-as-context, values, and committed action, are aimed at cultivating psychological flexibility, or the ability to have all of our thoughts and feelings while continuing …

Accepting the Loss

One of my patients wrote to me this morning asking if she could get a medication to help with her anxiety. She has been trying to find a good therapist for quite a while and I think she might have found someone who could really help her. But this is making her feel anxious and irritable. Now she has to wrestle …

Acceptance and Commitment Therapy Part 1: Acceptance and Willingness

I recently attended the Anxiety and Depression Association of America conference in Philadelphia, where I offered a two-hour workshop on Acceptance and Commitment Therapy (ACT) and deepening experiential practices in ACT sessions (largely based on the book The Big Book of ACT Metaphors: A Practitioner’s Guide to Experiential Exercises and Metaphors in Acceptance and Commitment Therapy*). This post is Part …

Herd Instinct in Humans: The Source of Anxiety and Depression?

Jeffrey Kahn has written a fascinating book (Angst: Origins of Anxiety and Depression in Oxford Press) suggesting an evolutionary source for much of human psychopathology. He gave a Grand Rounds presentation at UCLA in February of 2015 that outlined some of his theories and that presentation has been the subject of a vigorous discussion online. In essence, Jeffrey argues that …

THROUGH THE LOOKING GLASS: 2 – Depression Assessment

  …I’m returning to do the test suggested by my therapist in our previous meeting – the Beck Depression Inventory II. Tremendous. Doing a test sounds like something you see in those silly magazines that tell you how good a lover you are are some such other rubbish, but apparently this test is rather serious. So I return that afternoon and Dr Black …

Through the door 1 – Therapy needed

A few years back and I am living in Paris with my Irish wife who works for a large International think-tank based in the city. I work in London and return to Paris on weekends via Eurostar. I have had many ‘episodes’ in the past, but for a while now I’ve been free of them. But I am working hard redesigning a national …

Treating Anxiety – An Update by Kelsey

Treating anxiety is an important part of working with people with depression or bipolar. This update focuses on changes that have taken place in the field in the last five years that might be relevant to many people dealing with depression and anxiety. Imagine that you are taking a nice, peaceful walk in the woods. It is a lovely, warm, clear …

Accepting Uncertainty

We are often trapped more by what we think about how things should be, or “have to be,” than by the reality of the challenges we face.  This week I have been noticing how often the phrase “I can’t stand.XX” precedes a statement that is quite obviously not true.  Someone who has been living with the uncertainty of multiple sclerosis for …

Bipolar Disorders and Exercise: Working Out Can Tone Up Your Neurotransmitters – Arnrow

Neurotransmitters are the chemicals that your brain cells (neurons) use to transmit information, without them we cannot think or act. It is no wonder that too much or too little of any one particular neurotransmitter can have substantial effects on how our body and brain functions. For example, people with mood disorders tend to have low levels of the four major …

Medications for Anxiety

A writer we have been seeing for about a year for depression and bipolar sent me an email yesterday – “I need something for my anxiety…” Often anxiety is the symptom that is of greatest concern to people who have bipolar or depression. Working through my thought process as I tried to come up with an answer for the woman …

Passing on PTSD to Children

At a recent scientific meeting, Rachael Yehada showed that traits that are related to posttraumatic stress disorder PTSD can be passed on to children during pregnancy. Mothers in New York City who were pregnant on September 11, 2001 and developed post-traumatic stress disorder (PTSD) had children with low cortisol in their blood (a sign of PTSD). But if the fathers …

Media Makes PTSD Much Worse

  It was a sunny October day in 1989. Game 3 of the Battle of the Bay baseball World Series between Oakland and San Francisco. Then the largest earthquake in almost a hundred years hit the bay area. I was, as it happens, in my therapist’s office, my wife was at work. I rushed home to make sure that all …

Therapy for Anxiety in Bipolar

Anxiety is very common in people with bipolar moods. In fact, anxiety is typically the first sign of mental health problems (often it is present in childhood) for people who later develop bipolar. As a psychiatrist, I am aware that we have fewer useful long term treatments for anxiety in bipolar than we do for the mood swings of the …