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Clinical depression, or Major Depressive Disorder (MDD), is characterized by at least two weeks of either depressed most of the day nearly every day or a marked loss of interest or pleasure, along with several other symptoms, such as changes in weight or appetite, changes in sleep patterns, physical agitation or slowing down, fatigue or loss of energy, feelings of worthlessness or excessive guilt, diminished ability to think or concentrate, thoughts of death or suicidal ideation (DSM-5-TR).

Cognitive Behavioral Therapy (CBT) is an empirically validated treatment for clinical depression. Typically, treatment consists of both examining and changing maladaptive thought patterns that tend to result in depressed mood, as well as increasing behavioral engagement in valued and meaningful activities. The combination of these strategies results in individuals feeling better about themselves and the situations that were associated with distress when depressed. Other strategies, such as problem solving, mindfulness techniques, assertiveness skills training, self- compassion, and others, may also be utilized to support improvements and healing from depression. Please see the link below for more information about the efficacy of CBT as a treatment for clinical depression.

https://www.webmd.com/depression/cognitive-behavioral-therapy-for-depression

Generalized Anxiety Disorder (GAD) is characterized by excessive anxiety and worry, more days than not for at least 6 months, about a number of different events or situations. People who suffer from GAD have a hard time controlling their worry, and suffer from several other symptoms, such as restlessness or feeling on edge, being easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbances (DSM-5-TR).

Cognitive Behavioral Therapy (CBT) is an empirically validated treatment for Generalized Anxiety Disorder. Typically, treatment consists of examining and changing maladaptive thought patterns that contribute to catastrophizing and the experience of anxiety and worry, as well as gradually increasing exposure to activities and situations that are objectively safe but might be avoided due to anxiety. Other strategies, such as relaxation techniques, mindfulness techniques, self-compassion, and acceptance of internal experiences, may also be utilized to support improvements in managing anxiety. Please see the link below for more information on CBT and anxiety.

https://www.psychiatryonline.org/doi/10.1176/appi.focus.20200045

Obsessive-Compulsive Disorder (OCD) is characterized by the presence of obsessions and/ or compulsions that are time-consuming and distressing. Obsessions are defined by the DSM-5-TR as “recurrent and persistent thoughts, urges, or images” that are experienced as intrusive and unwanted, while compulsions are “repetitive behaviors… or mental acts… that the individual feels driven to perform in response to an obsession.” Individuals with OCD often get stuck in a cycle of obsessional worry and ritualistic behaviors (overt, mental, or avoidance) that aim to reduce distress or prevent a feared consequence from happening. While compulsive behaviors may alleviate distress temporarily, they tend to take on a life of their own and become increasingly excessive, disruptive and impairing.

Exposure with Response Prevention (ERP), a form of CBT, is a gold standard for treatment of OCD. Exposure targets obsessions by teaching individuals that they can tolerate and cope with their distressing thoughts without needing to eliminating them. Ritual Prevention targets compulsions by gradually reducing an individual’s reliance on their rituals and avoidance, reinforcing their ability to tolerate the discomfort brought on by obsessions. Other strategies, such as cognitive techniques, acceptance of internal experiences, and self-compassion, may also be utilized to support individuals as they practice ERP. Please see the link below to find more information about OCD and its treatment.

https://iocdf.org/

A panic attacks is experienced as a sudden surge of intense and highly uncomfortable symptoms that can be disruptive and fearful, and tend to peak within about 20 minutes. Panic attacks may cause fear that one is having a heart attack or other catastrophic medical event, and sufferers will often discover that their experience is one of panic and not of a serious medical event after a visit to the emergency room or medical doctor. For a surge of symptoms to be considered a “panic attack,” at least 4 of the following typical symptoms of a panic attack need to be present, according to the DSM-5-TR:

– heart palpitations or accelerated heart rate

– sensations of shortness of breath

– feeling dizzy or light-headed

– feelings of choking

– chest pain or discomfort

– sweating

– numbness or tingling sensations           

– trembling or shaking

– chills or heat sensations                         

– nausea or abdominal distress                

– derealization or depersonalization       

– fear of losing control or “going crazy”  

– fear of dying

While isolated panic attacks are not uncommon, panic disorder occurs when panic attacks are recurrent, result in persistent worry or concern about having further panic attacks, and lead to significant maladaptive changes in behavior related to avoiding the attacks. Panic disorder is thought of as manifesting a fear of the symptoms of fear itself.

CBT is an empirically validated treatment for panic disorder. Typically, treatment consists of learning about the nature of panic and the cycles of panic and avoidance, learning new skills to help flexibly manage and cope with panic and avoided situations, and gradual and repeated practice in facing both the internal sensations and external situations that are avoided due to fears of panic (“exposure”). Other strategies, such as determining one’s values and commitments, self-compassion, and acceptance of internal experiences, may also be utilized to support improvements in tackling panic disorder. For more information on panic disorder, please see the link below.

https://www.abct.org/fact-sheets/panic-disorder/

Agoraphobia is characterized by extreme fear or anxiety in situations that are public and either in open spaces (such as sidewalks or bridges) or enclosed spaces (such as public transportation or shops). Agoraphobic situations may also include either being in a crowd or being outside the home alone. These situations elicit fear of having a panic or other symptom attack that would make it difficult for one to escape or get help, typically resulting in active avoidance of the agoraphobic situation or enduring it with intense anxiety. Agoraphobia can gradually restrict one’s ability to function in the world by making progressively more areas of one’s life feel like they are “off limits” due to the impairing anxiety that accompanies these settings.

CBT is an empirically validated treatment for agoraphobia. Typically, treatment consists of learning about the nature of agoraphobia, panic or other feared symptom attacks, and avoidance patterns; learning cognitive and breathing skills to help cope with panic or feared symptom attacks and avoided agoraphobic situations; and gradual practice in facing both the feared internal sensations and external situations that are avoided due to one’s fears. Other strategies, such as determining one’s values and commitments, self-compassion, and acceptance of internal experiences, may also be utilized to support improvements in tackling agoraphobia. The ultimate goal in agoraphobia treatment is to achieve an adaptive level of functioning and enable one to live one’s life unimpeded by agoraphobic fears and anxieties.

Health anxiety, or Illness Anxiety Disorder, is characterized by excessive concern and worry over one’s health, illness, disease and death. Some individuals with health anxiety worry without having any physical symptoms present, while others may have physical symptoms that are unexplainable. Often, those with health anxiety are told by their physicians that there is no physical explanation for their felt symptoms or that they shouldn’t worry as much about their health, but the worries and fears about health persist. The preoccupation with illness concerns can lead to frequent reassurance seeking from either loved ones or medical professionals and excessive medical testing and/ or research on symptoms and feared illnesses. Or the opposite can occur- avoidance of medical appointments for fear that something terribly wrong might be found. Prominent anxiety and emotional suffering is usually present, and can have disabling impacts on one’s life functioning.

Cognitive Behavioral Therapy (CBT) is an effective treatment for health anxiety, as it is for anxiety-related problems generally. Treatment follows a similar trajectory to that of other anxiety disorders- psychoeducation to help one understand their own illness anxiety patterns; examining and changing maladaptive thoughts that contribute to catastrophizing and the experience of anxiety and worry; identifying and altering behaviors that have unintentionally reinforced anxiety. Gradual exposure to activities and situations that are objectively safe but have been avoided due to anxiety is also utilized to help individuals face and conquer their illness-related fears. Other strategies, such as relaxation techniques, mindfulness techniques, self-compassion, and acceptance of internal experiences, are also used to support coping with and tolerating anxiety. Please see the link below for more information about illness anxiety disorder and its treatment.

https://www.mayoclinic.org/diseases-conditions/illness-anxiety-disorder/diagnosis-treatment/drc-20373787

Blood, injection, and medical phobias are characterized by fear and/ or avoidance of medical or dental procedures, or any situations that might include exposure to blood or injury cues. Medical phobias may include fear of going to one’s family physician or dentist for regular check-ups, avoidance of routine or required blood tests, visiting family members in the hospital, and watching medical scenes on TV or in movies. A significant proportion of individuals with medical phobias have a vasovagal syncope, or fainting response, to the medical cues they fear. These phobias are often endured until a medical or dental procedure is unavoidable, such as a medically necessary surgery, root canal, or pregnancy.

CBT is an effective treatment for medical phobias. Components of therapy typically include psychoeducation about phobias and vasovagal syncope; learning applied tension, a technique by which fainting can often be prevented; and gradual exposure to avoided medical situations until the individual is able to tolerate such situations without fainting and with reduced anxiety.