TREATMENT OF SPECIFIC ANXIETY-BASED PROBLEMS

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Personality, emotions, and health

 Psychological factors are involved in causing and in healing many ailments of the body. We are just discovering these connections scientifically, although Chinese medicine was based on this idea 3000 years ago. A public television series and a book by Bill Moyers (1992), Healing and The Mind, document in an interesting way the new mind/body methods of treating pain, stress, cancer (at least the emotional aspects of having cancer), etc. The impact of our emotions on our physical health is called Mind-Body medicine (Siegel, 1989). We are just beginning to learn about emotions influencing our body, e.g. sexually abused women develop a smaller hippocampus (which is involved in memory). Psychotherapy and self-help, if effective, produce physical changes... we may not know where the changes are but there are no ghosts in the body.

 What does "no ghosts in the body" mean? It means that real, physical events carry out or mediate these mind-body connections. Most scientists believe that no thought, no feeling, and no mental change ever occurs without something physical changing in the body. For example, when long-term stress weakens an organ in the body, like the heart, the stress is physically present for months in some form in the brain, in the general nervous system, and in the weakened organ. Likewise, when a discussion in therapy or use of a self-help method improves some physical condition, the change mechanism between talk (or method) and the illness takes place physically somewhere in the body--nerves associated with thoughts change in the brain, messages are sent in the nervous system, conditions of the muscles change, hormones flow, the immune system activates or shuts down, etc. There is no mystical magic here. It may seem like magic to you when you are able to influence your thoughts, i.e. neuronal action, which in turn may affect our feelings, then your physical health, then your psychological health, etc. But every action has a physical component (no ghosts) and is lawful and potentially understandable.

 In case you are thinking that psychological factors are a minor part of "medicine" or health care as we currently know it, consider this: the seven top health risks are behavioral--smoking, over-eating, drinking & drugging, injuries, suicide, violence and sexually transmitted diseases. Seven of the nine leading causes of death, such as auto accidents, have important behavioral components. Health is a complex matter and the current professionals on both sides are ill prepared to understand both mental and physical health. Changes are needed! Perhaps we need a new profession that understands both psychological/relationship problems and physical illnesses. Perhaps we need to automate the initial psychological/medical diagnostic evaluation, so that everyone can easily get an annual check up. Perhaps everyone also needs to educate themselves so that self-diagnosis and self-care is much more thorough and effective.

 A fascinating 1995 finding from the 1921 Terman study of 1,528 bright California children: going through your parents' divorce as a child (before 21) and/or going through a divorce yourself as an adult may shorten your life by perhaps as much as four years! In addition, certain personality traits, such as conscientiousness vs. irresponsibility, are also powerfully related to longevity (Friedman, et al, 1995). Stress and personality factors influence how long we live as much as blood pressure, cholesterol level, or exercise-diet factors. These are not minor factors in your life.

 Likewise, a survey of 6,307 HMO patients found that 10% had anxiety that had not been treated (15% had been treated for anxiety). These untreated anxiety patients (80% also had untreated depression) had suffered marked reductions in general functioning, health, and well-being, resulting in their utilizing a high level of primary medical care (Fifer, et al., 1994). Science can't yet calculate how much the millions of untreated psychological disorders are costing us.

 Current thinking is: if we can express our emotions, talking openly or acting out our feelings, we can sometimes improve our health. If we can relax, meditate, let ourselves be touched by others, or establish warm, caring relationships with others, sometimes we get better or get worse more slowly. Heart disease has been reversed by diet, exercise, meditation, and a support group. Women with breast cancer meeting with a support group lived twice as long as similar women who were not in such a group. We need human contact, with it we live longer, e.g. married cancer patients survive longer than unmarried ones. NB: Don't get the idea that relaxation and supportive human contact can cure cancer or clean out a blocked artery.

 Between 10% and 30% of patients diagnosed as having psychological disorders are later found to have a physical or neurological problem (Bondi, 1992). This highlights the need for referrals by psychotherapists to medical specialists. Likewise, physicians should refer many of their patients to psychological-psychiatric specialists. For decades family physicians have estimated that 2/3rds of all the illnesses they treat are psychogenic, i.e. caused by psychological factors or stress. A 1995 report said 75% of complaints brought to MD's were psychological. It has been found that stress contributes to heart disease, strokes, cancer, breathing problems, accidents, cirrhosis of the liver, suicide, and many other leading causes of death. So, why is the treatment of most illness, physical and mental, still in the hands of very expensive MD's who have little training in dealing with psychological factors? Because our old laws and health insurance companies have enabled doctors to continue to monopolize health care and because science, until recently, has shown relatively little interest in treating psychogenic disorders. But anyone can see the importance of learning more: our annual medical bill totals $400+ billion, and 25% of the U.S. work force miss 16 days per year due to stress, costing $8,000 per worker. There is clear evidence that psychological treatment is the best treatment for many stress-related disorders--and, of course, for prevention--and should save billions and billions once we start using psychology.

 Physical complaints can be, of course, clues to physical disorders, but pain and fatigue can be clues to psychological problems too. In this section, we are dealing with stress and other psychologically caused disorders in the body. The pain is just as severe, regardless of whether the cause is physical or psychological. In the sections above about sources and effects of stress, we observed the stress-health connection. It works both ways: stress causes physical problems and physical factors cause emotions, e.g. the hormones in PMS cause tension, irritability, sadness, etc. PMS can be reduced by psychological self-help (Lark, 1995) and chemicals. In chapter 6 we will likewise see that depression is related to physical tiredness and sleep disorders.

 Hippocrates, 400 years before Christ, thought certain personal-emotional traits were related to specific diseases. We are getting more and more scientific evidence for this. Dependable and conscientious young people live as much as four years longer than impulsive, undependable, self-centered people (Friedman, et al.,1995). People more prone to cancer tend to be depressed and/or worriers; they suppress their anxiety and hostile feelings, avoid conflict, act unassertively (overly patient) and feel hopeless; they long for closeness but feel abandoned in important relationships or at work, and just don't handle stress well (Temoshok, 1992). People prone to get heart disease tend to be angry, impatient, and aggressive but sometimes avoid expressing their anger openly; they have repeatedly been annoyed and upset with people opposing them or getting in their way, and they resent not having the power to remove such people; they are suspicious and cynically distrustful, feeling no one cares; they are often trying to get away from someone who has hurt or disappointed them (Eysenck, 1988). Both the cancer-prone and the heart disease-prone persons feel tense and fearful. Many bad, unhappy things have happened in their lives which they think they were unable to prevent.

 A few simple questions about these traits can supposedly identify the cancer or the heart disease prone person. Moreover, Eysenck says that psychotherapy--and I'd add perhaps self-help--can change a person's personality enough that serious disease can be prevented! Wonderful! What are we waiting for? Eysenck (1988) and Ronald Grossarth-Maticek provided "treatment" designed to help these patients (1) express their feelings, (2) learn to relax and handle stress, (3) overcome their passive-dependent nature, and (4) gain greater self-control. Both kinds of "at risk" patients were taught to relax and overcome their fears (via desensitization), to be more confidently assertive but less angry and aggressive, to see themselves as able and actually be more in control (less passive-dependent or helpless), to express and release pent up feelings, and to know how to handle difficulties in their lives. The individual therapy involved 30 hours, but groups and shortened therapy lasting only 6-8 hours were also tried. The results of this therapy were impressive--the death rates 13 years later in the untreated groups are twice as high as in the treated groups. If 6 to 30 hours spent learning psychotherapy or self-help methods can reduce stress and increase the happiness and length of life, then we had better develop world-wide training programs for everyone soon.

 There is accumulating evidence that optimistic-pessimistic thinking (attitude) is also related to health. Pessimists explain a bad event, such as breast cancer, in different ways than optimists do, e.g. pessimists say the cancer is "probably incurable," "a sign of terrible future health, ruining all of my life," and "caused by my genes...smoking habit...hopeless attitude...." Optimists would say, the cancer "can be removed," "won't influence my future very much," and is "caused by X-rays at work...air pollution...a virus...." The pessimist's thinking is "the outcome will be bad," "everything else is going to hell too," and "I am at fault." The optimist's thinking is the opposite: "I can become healthy and strong" and "I can handle the pain." Positive thinking, especially a belief in your ability to control an illness, is associated with good health and good performance in school and at work (Peterson, Seligman, & Vaillant, 1988; Seligman, 1991). Pessimists can learn to change their thinking (McGinnis, 1990); some will need professional help.

  For decades, the psychoanalysts have thought that complaining and psychological sickness were due to an excessive need for love and attention, stemming from feelings of neglect or criticism as a sensitive, needy child. Most psychodynamic therapists would try to uncover these old, still unsatisfied needs for love and bring them to the light of day, then they will go away (or can be handled better rationally).


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