Treatment
INTRODUCTION & BACKROUND
HOW TO BEST USE THIS SECTION: To make it easier
for you to benefit from reading this section on treatment, there
are several key points to keep in mind:
- The text is fairly lengthy and therefore, has been partitioned
into two main sections: Introduction & Background (what you
are now reading) and Overview of the Treatment Program. The Overview
itself is very short but offers a user friendly guide to the material
contained in the body of the treatment program. This material
includes the five components (highlighted in blue, shown at the
bottom of the page entitled “Overview of the Treatment Program.”
You can of course, read the entire section or simply click onto
the links corresponding to your particular area of interest. If
you want detailed information, however, it is better to read the
entire treatment section. This will give you a more comprehensive
understanding of the various methods I use to treat anxiety disorders.
- For ease of reading and purposes of illustration, all “Case
Studies” are written in bold,
plum – colored letters. A number of examples
are included to supplement the material presented. I sincerely
hope this improves the quality of the website, while making it
more interesting, enlightening and educational!
You can access each case by simply clicking onto the case # (which
contains a description of the case), found on the home page. Or
by reading the text of each component, as shown in the overview
page, which includes the case in the body of the text.
My name is Dr. Lance C. Pulver and I specialize in the treatment
of anxiety disorders. These include:
- panic attacks,
- agoraphobia,
- simple phobia (e.g., driving phobia, fear of flying, etc),
- social phobia,
- obsessive-compulsive disorder (OCD),
- generalized anxiety disorder, and
- performance anxiety (e.g., public speaking anxiety).
Before hearing about my treatment program, I thought you might
find it helpful to know a little about my personal struggles with
anxiety over the years. Although I have felt anxious at other times,
what I’m presenting here represents some of the instances
that stand out in my mind. If this is not of interest
to you, however, please click onto one of the other sections of
the treatment program (components I – V, as listed in the
overview screen).
My first encounter with anxiety actually occurred when I was about
five years old. Although it was quite a long time ago, I remember
it well. One day I was in the car with my mom, and we were driving
down one of the main roads in our neighborhood.
Suddenly, I asked her the question, “Mom, how will I know
where to go when I’m old enough to drive?” Thinking
back, I imagine she must have been quite puzzled by my question.
More than likely, she wondered why her five year old son would
be asking her about something that would not happen for some ten
years! The answer – though neither of us realized it at the
time – is that I was displaying a form of anxiety: (The concept
of anxiety is explained in detail in the section, WHAT
IS ANXIETY).
In this instance, my anxiety reflected the uncertainty I felt about
knowing my destination, at some future time. But remember, we’re
talking about something that I would not even have to think about
for at least ten years. So what conclusion do I draw from this?
Well, in reflecting on the event, it is obvious to me that, unfortunately,
I started my worrying at a very early age! The
good news is that I do know where to go when I’m driving.
So, I worried for nothing. And while I seldom worry excessively
about things, I do become concerned at times, and take whatever
measures I can to address the situation at hand.
Another time anxiety intruded into my life was 1974, when I was
a senior in college at the University of Florida. I was enrolled
in a communications class and the assignment for that day required
students to stand in front of the class and talk about themselves.
As my turn approached, I could feel a sense of uneasiness stirring
in my stomach. Most people call this the “butterflies.”
My case, however, was a bit more serious. It felt like there were
not a few, but rather, a cadre of butterflies that had gathered
themselves together for a game of badminton.
I was so nervous! I did get through the assignment, but I was shaking
like a leaf. This was the first time in my life that I had experienced
public speaking anxiety.
Needless to say, my confidence was more than a little shaken after
this less than stellar performance. Fortunately, however, there
is some good news. Though I struggled with public speaking anxiety
for a period of many years, I eventually discovered how to overcome
it. It took some time (more than was necessary because I worked
on the problem alone), but it was well worth it. As a result of
my efforts, I am now able to speak in public with complete confidence.
And it truly doesn’t matter whether I am addressing a group
of psychologists and physicians or a class of 6th graders. I am
comfortable either way.
What’s more, on some occasions I give talks on my favorite
subject, anxiety. I look forward to giving these talks, rather than
feeling a sense of dread, as I did in the past, and usually receive
complimentary feedback. Interestingly, I do find that just prior
to beginning the presentation I generally experience a tinge of
uneasiness. The sensation is very mild, however, and only lasts
about a minute or so. Afterward, I feel composed and ready. Most
important, this slight, anticipatory
anxiety that brushes me momentarily is really
not a problem at all. Why? Because compared to what I went through
giving that first oral class presentation, and later ones (e.g.,
case presentation during internship), the discomfort I now feel
is like a walk in the park!
Much to my surprise, I experienced a second major anxiety episode
while I was a senior in college. At the time, I was taking my first
statistics class, and during the exam found myself confused, uncertain
and completely unable to think clearly.
For some reason, I was not able to access the knowledge that I
had learned in class. Afterwards, I visited the professor and reviewed
my exam with him. The result stunned me. Not only had I failed the
test – which had never happened before – but the paper
was badly smudged and contained many erasure marks. In fact, it
was such a mess that it was almost impossible to make any sense
of what I had written!
Upon reflecting on this experience, I came to what seemed an obvious
conclusion: I had, rather suddenly, developed apparent severe test
anxiety. From that point on, I realized that
each time I took an important test I would become very anxious (both
days before and during the exam).
So if anyone should ever comment to you that test anxiety isn’t
a real problem, you can respectfully disagree. You can add that
not only is it very real indeed, but on occasion, test anxiety can
seriously interfere with intellectual or academic performance.
Finally, my last major experience with anxiety was undoubtedly
the most severe: I experienced a full blown panic attack. Do you
know what this means? For those of you who do not know, or know
little about them, let me put it this way: A panic attack
is without question, one of the most frightening and unpleasant
forms of mental discomfort that a human being can endure. It is
a dreadful experience that gives rise to feelings of extreme terror,
confusion, severe emotional distress and physical depletion. (Please
see the section on PANIC ATTACKS for a
full discussion of the subject). I was lucky; I had only one major
attack – though I did have some minor ones. Many people, who
are less fortunate than I was, experience numerous panic attacks,
sometimes over a period of years.
What is worse, in some instances panic sufferers end up in hospital
emergency rooms. Their usual presenting complaint is that they are
having a heart attack or fear a sense of loss
of control. (If you’ve seen the movie “Something’s
Gotta Give” starring Jack Nicholson, then you know that people
sometimes misinterpret bodily/physical sensations, such as rapid
or shallow breathing or tightness in the chest, as indications of
a heart attack). What the movie portrayed (realistically) is that
these symptoms often presage the onset of a panic episode. Obviously,
panic attacks are a serious matter and not to be taken lightly.
Thankfully, my last panic episode occurred over 25 years ago. I
have not had a panic attack since that time, and in the interim,
have learned a great deal about their causes and the specific treatments
that have the greatest efficacy. Moreover, having personally experienced
a severe panic attack, I can quite readily empathize with others
who have suffered through them. This enables me to better “connect”
with and be of significant help to them. Sometimes, when I feel
it would be beneficial, I share my experience with clients. The
result seems to be very positive. Knowing that they are not alone
– or unique in a pejorative sense – somehow gives them
a sense of comfort. It also reassures them that I understand what
they are going through. Most importantly, they realize that just
because they have had a panic attack does not mean they are “emotionally
weak” or have “weak character”.
Rather, it suggests to them that panic attacks can happen to almost
anyone, including a therapist, who happens to specialize in the
treatment of anxiety disorders!
Well, I have shared some of my personal travails with you. It is
my sincere wish that this has been helpful. Perhaps now you may
truly believe that you are not alone. If you have any questions,
or want more information about anxiety-related suffering, please
feel free to contact me either by phone or email.
OVERVIEW OF THE TREATMENT PROGRAM
My formal treatment program consists essentially of five components.
They are:
- Psycho-Education (PE)
- Cognitive-Behavioral Therapy (CBT)
- Exposure/Practice (EP)
- Relaxation, Imagery & Breathing (RIB)
- Connection (C)
My method of treating anxiety-related problems also relies on extensive
research, clinical experience, and intuition. Since my orientation
to psychology is humanistic, I am usually
quite interactive in my work with clients. I also use a fairly eclectic
approach and, therefore, feel comfortable treating the various anxiety
disorders referenced earlier.
Each of the five components shown above is discussed in detail
in different portions of the treatment section. If you wish to review
a particular treatment component simply click on to the corresponding
link shown below.
Following is a listing of where to find a discussion of each treatment
component:
Component 1 is discussed in Part
I
Components 2&3 are discussed in
Part II
Component 4 is discussed in Part III
Component 5 is discussed in Part IV
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