Dear Members, participants of the Program have now commenced a new Carer and Family Support Group which is running at the Peppercorn ARCVic’s OCD & Anxiety Disorders Week 2001 promotional Club - first Thursday of each month at 7.30 pm. All carers and activities were a great success, providing forums which focused family members are welcome to attend this group. The next on the needs and experiences of people with anxiety disorders, Family and Carer Program will commence in February next year and enabling the community to access a wide range of – see the Bulletin Board for details. knowledge and views from the professionals and members who presented talks on the latest research, treatment interventions The recent tragic events of September 11 th have affected all of and life experiences. More than 200 people attended the us. Some have experienced the loss of loved ones, others carry seminars, and many more people were able to access an on-going fear and concern for family and friends who information through the promotional and media activities currently live in areas surrounding the terrorist attacks and other undertaken in Melbourne and in regional areas of Victoria. A parts of the world affected by the current military response. Our professional video was produced of our seminar on 11 th August sympathies to any of our members who are so directly affected – ‘Prevention, Early Intervention and Management of Anxiety at this time. The fears and worries of many people with anxiety Disorders’, and will be available soon for purchase. We are disorders may also be heightened and exacerbated by these sincerely thankful to all of our speakers and volunteers for events – as we become more focused on issues of vulnerability, helping to ensure the success of OCD & Anxiety Disorders aggression and harm. Mental health professionals who work in Week 2001. America have reported that the most significant expected rise in mental health problems following the attacks will be in the area Our first Carer and Family Program received very positive of anxiety disorders. We would urge any of our members who evaluations from the 11 participants. In response to the feel that their anxiety symptoms may have been worsened by evaluation question ‘How much has the Carer and Family the recent world events to discuss this with their therapist or Program assisted you to care more effectively for someone who doctor, or contact the OCD & Anxiety HelpLine to discuss your has OCD’, on a scale of ‘0 = not at all’ to ’10 – a lot’ – the concerns with a supportive telephone counsellor. average rating was 8.7, with many participants rating a 9 or 10. One participant stated that “the series was conducted in a very I look forward to seeing many of our members at our December professional and friendly manner and exceeded my wildest Special Events – our Annual General Meeting and Question and expectations … I trust that other carers are given a similar Answer Seminar on December 6 th , and our End of Year Supper opportunity … attending the carers group has reinforced my on December 20 th . It will be a very special time to celebrate our determination to provide on-going encouragement and support achievements for the year and the strong supportive network of to [my] sufferer, showing the necessary determination of our members and volunteers that continues to be the heart and ultimately leading a near normal and fulfilling life”. Our thanks to soul of ARCVic. I hope you enjoy this Spring Edition of the our two consultant psychologists Barbara Jones and Iris I’Anson Newsletter. for developing such a high quality and effective program. The Regards, Kathryn I’Anson, Director/Editor

Greetings to all members, Although I have written for this newsletter in the past, this is my first contribution as President. For those of you who are unfamiliar with me, I have been a member of the organisation since 1993. A long-standing member of the Committee of Management, I have previously served as Vice-President and I have been convenor of the organisation’s Social Group. I am currently co-convenor of the Social Group, together with Jessica Bernales. As this is my first official letter in the Newsletter, I would like to take the opportunity to extend a huge thank you to our former President Edwin Belfield. After being an active and dedicated member of many former Committees of Management – and President for many of those years – Edwin chose to not re-nominate for a further term and is currently enjoying semi-retirement. Edwin has continued in his roles as group leader at our Hawthorn and East Bentleigh Support Groups, and his desire to help others, without reward, is commendable. Congratulations to Kathryn I’Anson, the Director of ARCVic, for achieving her full registration as a psychologist at the beginning of this year. Kathryn has been with the organisation for more than a decade, and brings a special combination of clinical, management and creative skills to her work. Kathryn continues her role as Director and I thank her for her commitment and dedication. Thank you to all our volunteers, and Committee of Management team, who give so much to support ARCVic and people with anxiety disorders and their families. And thank you to all our members – your continued support for ARCVic is greatly valued and appreciated. Kindest regards, John Geros, President

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 1 BUlletin board

FAMILY & CARER SUPPORT GROUP New ARCVic Support Group The Family & Carer Support Group MERALD NXIETY ISORDERS UPPORT ROUP has reconvened – running on the EEEMERALD AAANXIETY DDDISORDERS SSSUPPORT GGGROUP first Thursday of each month, at For people with anxiety disorders, their families and friends the Inner East Support Group, 7.30 th First meeting – Monday 12 November 2001, 7.30 pm – 9.30 pm pm, at The Peppercorn Club, 584 Venue: Emerald Community House (in the Hall), Glenferrie Road, Hawthorn. This 354 – 356 Main Street, Emerald. group has been organised by Regular meetings will be held on the second and fourth Monday of each month. several carers who attended the Enquiries to the Group Coordinator – Dianne Legge – 5968 4795 or contact the first OCD Carer and Family OCD & Anxiety HelpLine – 03 9576 2477 Program.

December Special Events Volunteers needed for Inner East Support Group ARCVic’s Inner East Support Group meets at the Hawthorn December 6th Peppercorn Club and runs on the first and third Thursday of ANXIETY DISORDERS & DEPRESSION : each month. It is a popular and growing support group – and QUESTION & ANSWER SEMINAR includes a new people’s group, a goal focused group, and a Dr Michael Kyrios, Dr Scott Blair-West, Dr Nick Allen ‘regulars’ group. A Family and Carers Group also meets on Time: 7.30 pm the first Thursday of each month. We will soon be Venue: The Peppercorn Club commencing a new anxiety group specifically for people with Entrance Fee: Members - $3.00, Non-members - $5.00 panic disorder, social anxiety disorder and generalised anxiety disorder. Due to the large number of people attending this December 6 th group, there is generally quite a bit to do to set up the venue ARCV IC ANNUAL GENERAL MEETING prior to people arriving. This includes setting up and manning Venue: The Peppercorn Club the information table, setting up the supper and chairs, and Time: 6.45 pm welcoming people as they arrive. Edwin Belfield and John Geros, the Group Coordinators, are interested to hear from any December 20th member who attends this group on a regular basis, who would END OF YEAR SUPPER be able to assist with any of the setting up activities for this Time: 7.30 pm group. If you would be able to offer your assistance at one or Venue: The Peppercorn Club both of the monthly meetings during the next 6 – 12 months, and are able to arrive at the meeting by 7.00 pm, please speak Cost: $7.00 Adults, Children Free to Edwin and/or John at the group meeting. Your help and Gourmet catered supper, music, Santa Claus, support will be greatly appreciated. delicious food hamper raffle.

ARCVic Family & Carer Group Program --- OCD

7th Feburary – 14 th March 2002 For parents, husbands, wives, siblings and other relatives living with a person with obsessive compulsive disorder. A six week skills and support program. Share in a positive and rewarding experience with other carers and family members. Be encouraged and empowered! Program dates : Thursday evenings, 7.00 – 9.00 pm - February 7 th – 14 th March 2002. Venue – Southern Carer Respite Centre. Led by Iris I’Anson and Barbara Jones, Psychologists Funded by the Southern Carer Respite Centre, for carers residing in the Southern Metropolitan Region Booking Required – Brochure enclosed in this Newsletter – or contact ARCVic to register interest – 03 9576 2311.

RECOVERY PROGRAMS

Social Anxiety Disorder Recovery PrProgramsograms Panic Disorder Recovery Programs Register for the next programs, commencing March 2002 Contact the HelpLine (9576 2477) for a Registration of Interest Form. Enquiries to Recovery Program Coordinator on 9576 2311

2 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria Articles & Research

The RIGHT Stuff Obsessive Compulsive Personality Disorder: A Defect of Philosophy, not Anxiety by Steven Phillipson, PhD. Center for Cognitive-Behavioural Psychotherapy, New York, USA. Reprinted with permission. Source: www.ocdonline.com

Obsessive Compulsive Personality Disorder (OCPD) is a For those who have OCD, reading this paper will be very pervasive characterological disturbance involving one's provocative. Not only are some of the characteristics similar to the generalised style and beliefs in the way one relates to themselves population at large but there is going to be an unsettling degree of and the world. Persons with OCPD are typically deeply similarity between OCD and OCPD. If you have OCD, please do entrenched in their dysfunctional beliefs and genuinely see their not read this paper and attempt to diagnosis yourself. It is not in way of functioning as the "correct" way. Their overall style of the surface similarities that the distinction is made between the relating to the world around them is processed through their own two conditions. Instead the distinction lies within the underlying strict standards. While generally their daily experience is such that rationale of these key elements. It requires vast training and "all is not well," they tend to be deeply committed to their own clinical experience to distinguish the subtle but drastic contrast beliefs and patterns. The depth of ones belief that "my way is the between the two conditions. Making an accurate diagnosis is correct way" makes them resistant to accepting the premise that it therefore best left up to a qualified specialist. The purpose of this is in their best interest to let go of "truth owning." Yet letting go of paper is to qualify aspects of this condition so that those who see truth is paramount in their recovery. For the purposes of this glaring similarities to themselves or significant others may be article "truth" is defined as a person's rigidly held belief which s/he better informed and possibly seek treatment. OCPD is a pervasive feels is universally applicable. Most often, blame for ones internal condition involving ones life philosophy where the characteristics strife, is placed on external circumstances or the environment. are vast and complicated. To qualify for a diagnosis of OCPD one OCPD and Obsessive Compulsive Disorder (OCD) are often need not possess all of the following manifestations nor is one or confused as they are thought of as being similar. There is, two similarities sufficient. A combination of the following however, a great difference between the two conditions. Persons dispositions in an extreme form is generally grounds for a with OCD experience tremendous anxiety related to specific diagnosis. preoccupations, which are perceived as threatening. Within the Generally two hallmark thinking styles are pervasive for persons condition of OCPD it is one's dysfunctional philosophy which who suffer this condition. The primary manifestations of OCPD produces anxiety, anguish and frustration. It has been well entail either a bent toward perfectionistic standards or righteous established that OCD is a condition in which people perform indignation. Along with perfectionism comes relentless anxiety elaborate rituals to avoid or escape anxiety. Repetitive rituals are about not getting things perfect. Getting things correct and performed to undo the threat. Their overall genuine nature tends avoiding at all costs the possibilities of making an error is of not to be affected by the condition and in the vast majority of the paramount importance. This perspective produces procrastination cases they recognize that the concerns are irrational. A person and indecisiveness. The second factor entails the rigid ownership with washing rituals due to fears about contracting aids from a of truth. This feature produces anger and conflict. Persons with public door knob might still be very willing to sky dive or go white OCPD generally lean toward one of these perspectives or water rafting. This suggests that a person's inclination toward risk another. In some cases both perspectives are of equal magnitude. taking is not affected by their anxiety about germs. Rituals, on the other hand, often play a relatively small part in this This paper will attempt to convey a personality style that has complex syndrome of perfectionistic mannerisms, intense anger devastating effects on one's emotional wellbeing, work and strict standards. Their way is the correct way and all other productivity and interpersonal relationships. Although there is a options are "WRONG". Anger and contempt are rarely held at bay moderate overlap between OCPD and OCD in regard to similarity for those who disagree. of rituals, the pervasive differences might justify a relabelling The Diagnostic and Statistical Manual of Mental Disorders (DSM (such as perfectionistic personality disorder) of this condition. III-R, the bible for persons in the mental health profession) OCPD wreaks havoc within a person's life due to a dysfunctional suggests that persons with OCPD display a pervasive pattern of perspective. The movie "As Good as It Gets" unfortunately orderliness, perfectionism, and/or mental and interpersonal portrays a muddled combination of these two conditions, although control, at the expense of flexibility, openness, and efficiency. It is it was touted as the OCD movie. The main character engages in a further suggested that persons with this condition tend to resist variety of OCD rituals, yet his overall demeanour is that of an the authority of others while simultaneously demanding that others angry, belligerent, intolerant loner who clearly has an exaggerated conform to their way of doing things. The DSM III-R's pervasive form of OCPD as his main handicap. focus relates to the person's inability to attain completion of tasks

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 3 due to the inordinately high standards, which are placed on almost in some students having multiple majors during their four year all aspects of living. stint. Changing colleges, due to emerging complications and Clients tend not to enter therapy for the express purpose of being disillusionment, is also a possible manifestation of OCPD. treated for OCPD. Typically a diagnosis will be made by the The need for an occupational exact fit, can also bring long term clinician after other topics have been explored. Why seek out the investment in a career choice to a screaming halt. Many aspects help of others when one possesses ultimate knowledge. Perhaps of any career can seem very appealing in their conceptualisation. this trend will now change due to an increasing awareness of the Things can always look great from afar. As one becomes more manifestations of this condition. Three pervasive rationales for thoroughly educated about any school, career or person, through entering therapy have entailed: seeking treatment for OCD rituals, experience, the pitfalls become more apparent. Since perfection is which are becoming burdensome; a generalized dysphoric often sought, the emerging defects of any career choice often experience thought to be related to depression or social isolation; deter a prolonged investment in any specific area of focus. Making and/or marital discord where they have received an ultimatum a definitive choice and changing jobs can become stymied due to from their spouse to "get help or get out." the endless pursuit of figuring out which of the available options is best. ASSOCIATED FEATURES Aspirations for perfection can play themselves out in interpersonal relationships as well. Since all humans carry a significant amount Associated features, according to the DSM III-R, often entail, of emotional baggage it typically doesn't take long in a dating or distress related to a tremendous amount of indecisiveness, marital situation to discover our partners' flaws. For someone with difficulty expressing tender feelings and a depressed mood. From OCPD choosing a partner who lives up to their unreasonably high my own clinical observations it seems that emotional and standards is very difficult, if not impossible. Remaining invested in cognitive rigidity are the hallmark indices suggesting the existence a relationship without bouts of volatility over the long haul is highly of OCPD. When events stray from what a person's sense of how unlikely. For those who do remain in long term relationships things "should be," bouts of intense anger and emotional discord chronic discord tends to be pervasive. are characteristic. Emotional Rigidity : In a world where being in control is of Indecisiveness : When almost all decisions seem to take on the paramount importance, dealing effectively with the volatility of same paramount importance and being correct is imperative, emotions is extremely difficult. Since emotionality is associated making even simple choices can become a nightmare. Persons with spontaneity and upheaval (i.e. loss of control), responding to with OCPD can become stymied in life due to an inability to emotions effectively and appropriately places an abundance of establish with certainty which choice is the correct one. Not pressure on the OCPD to keep them constricted. Exerting effort to unusual would be for someone to spend over ten minutes contain "out-bursts" of emotion is an everyday phenomenon. It attempting to choose the correct pair of socks which best matches seems however that there is one emotion which exists in their tie. They tend to place a great deal of pressure on abundance. The expression of anger tends to come out naturally themselves and on others to not make mistakes. Within OCPD the and in excess. Anger, as an emotion, is one of the most basic and driving force is to avoid being wrong. In contrast, the underlying easily triggered of human reactions. Anger is only seconded by rational for someone with OCD would typically be to make the anxiety in its primitive nature. Vulnerability, (one of the most correct decision so that nothing superstitiously bad would happen. advanced of human emotions), as seen through the eyes of the Since continuously making the correct choices in life, seems to be OCPD sufferer, compels people to act in silly ways and expose an impossible task for us humans, there is a regular source of themselves to the possibility of rejection. Emotional constraint is discontent available for OCPD sufferers. exerted to prevent the possibility that one may act in a regrettable This indecisiveness can have devastating effects on academic, way. The result of this emotional constraint is that all displays of professional and interpersonal relationships. From early emotion sometimes becomes compressed into an expression of adolescence, through college, perfectionism can take an flat affect. Anxiety and happiness can be perceived as the same otherwise straight "A" student and bring him to the brink of failure on the receiving end. It is not uncommon for persons with OCPD due to incomplete assignments. Having to get the term paper to have their humour often mistaken for seriousness. Jokes or exactly correct makes for an almost impossible task. An extremely sarcasm (seen by the deliverer as obvious) are mistaken for difficult time making decisions (always looking for the correct insults and political incorrectness. choice) contributes to procrastination. Frequently even starting a Depressed Mood : Although rarely observed by others, the task seems impossible, due to a need to sort out the priorities experience of inner turmoil within this syndrome is immense. As correctly. If it takes an hour to complete the first paragraph of a much as others are often victimized by OCPD's oppressive and report, because revision after revision never seems to get it demanding style, the high standards often apply two fold within perfect, imagine the anguish experienced when contemplating the the OCPD sufferers' expectations directed toward themselves. It is completion of a two thousand word essay. The time it could take not uncommon for a person with OCPD to feel deeply entrenched to complete a ten page report might be multiplied by five due to in the belief that they are a "Good Person." This belief can checking or rewording so that it is just so. paradoxically often lead to feelings of depression and Imagine a college student who has to choose a major and in doing disappointment. The high standards which a "Good Person" is so be convinced that she is completely correct in her choice. The expected to live up to are often far beyond the capacity for any expression of this, "need", to have a perfect academic fit is seen human being to consistently fulfill. A belief such as "I know that I'm

4 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria a good person, but I hate myself for doing so many wrong things" then go off and spend a great deal of time and effort at coming up is not uncommon. This self-hatred along with tremendous with an even more correct idea. This effort may produce a disappointment can easily lead to feeling of depression. Since modicum of improvement at the expense of efficiency and ones humanness prevents an OCPD sufferer from living productivity. according his own high standards, a tremendous amount of self- Hoarding : Hoarding involves the excessive saving or collecting hatred is imposed. Recent research has documented that as of items (typically thought of as junk), such that it intrudes on the much as seventy percent of depression can be attributed to quality of life for the hoarder or those living with such a person. feelings of low self-esteem and inadequacy. In my work with (Research at the Center for Cognitive-Behavioral Psychotherapy helping persons manage the challenges of self-esteem I have has begun to gain further insight into the relationship between found it much more difficult to have persons who are "Good" come hoarding and OCPD.) In a significant percentage of cases, people to find acceptance in being "human" than helping those with low lack the insight that they are behaving in an unhealthy manner. self-worth rise up to the possibilities of self-acceptance. When persons are not cognizant of the irrational nature of this Another contributor to depression within the OCPD population is a condition it is referred to as overvalued ideation (ego-syntonic cognitive style characterized by dichotomous thinking. OCD). Typically this form of OCD involves a poor prognosis since Dichotomous thinking is the tendency to categorize all aspects of the individual is rarely willing to confront the challenges offered by life into one of two perspectives -- "All good" or "All bad." The the treatment. This lack of willingness to see one's own culpability world is viewed predominantly through clearly defined black and has a very adverse impact on the quality of life for those around white realms. All that is pure and wholesome is valued. It can take her. Many hoarders, however, are well aware of the adverse only one stain or blemish to have the person completely find impact of this condition and suffer tremendously as a justification in discarding anything which evidences a flaw. Within consequence of seeing all free space within their living their own being these rigid standards can be devastating to one's environment occupied. Renting extra storage space to pick up the self image. Fault finding in one's own world produces a regular overflow of ones own living environment is not uncommon. source of conflict in maintaining the high standards of life. Where hoarding is a component of OCPD, the justification for saving items typically involves one of the following rationales. In ACCOMPANYING RITUALS many instances there is a deep commitment related to the "sinfulness of waste." A father may say to his wife, "Why throw out Common rituals, which accompany the OCP syndrome typically, the diapers when they're still in perfectly good shape," referring of involve (1) perfectionism, (2) hoarding, and (3) ordering. course to their 15 year old daughter's leftover diapers. "Who Perfectionism : Perfectionism as expressed by the OCPD is not knows? Maybe when she's a new parent the baby will be able to the admirable quality often sought by the world at large. As a use these diapers." Another perspective which supports the ritualistic aspect of this condition the OCP perfectionism entails hoarder's resistance to throwing out items is the possibility that the checking and rechecking "completed" tasks to be absolutely sure item may come in handy at some point in the future. Throwing that there are no imperfections. It could literally take upwards of away four year old TV guides would cause a tremendous 10 to 20 minutes to fill out a check or mail an envelope due to a upheaval since Mom may want to see which program was on rigid need to ensure that there are absolutely no mistakes. It is as NBC 9:00 pm Thursday 1994. Another determinant for hoarding if, to make a mistake which might be noticed would ruin ones involves the endless projects on the "to do list." Perfectionism reputation for life. Perfectionism could also take the form of a often stymies the OCPD's ability to complete tasks. Rather than need for over completeness -- reading and rereading material until abandoning projects, they become piled up and the fantasy is a sense of absolute clarity exists. Not only is it extremely time maintained that some day they will be gotten to. consuming but the overall content of the story is lost. The forest is Ordering : A telltale sign of OCPD is ordering gone haywire. It missed while examining each leaf, of each branch, of each tree. would not be unusual for a person's cabinets or refrigerator to This disposition can also have an adverse impact on one's have the items placed in exactly their proper spot. The closet or conversational style. In the course of a conversation sometimes drawers would tend to be aligned exactly as they "should be" information is sought which involves such minutiae that the while shirts and shoes pointed in the same direction. A client who questioned person becomes lost and frustrated. Slight had this manifestation of OCDP once mentioned that his wife inconsistencies or mistakes, within another's conversation, are often played the following game. She would go in the bedroom often perceived by the OCPD sufferer. These details, no matter alone and move his shoelace an inch or adjust the angle of the how peripheral to the conversation, must be brought out into the phone an eighth of an inch. When she would finally call him in, it open and clarity must be achieved. would literally take him only 10 seconds to locate every item she In some cases the corporate environment rewards a person's had slightly adjusted. perfectionism. It is not uncommon for persons with OCPD to reach For persons who are impaired by the ritual of ordering, there tends high levels on the corporate masthead because their productivity to be an overwhelming need to be in control of one's environment. was not sufficiently impaired while their high standards seemed to If the items on one's desk are not put away exactly in their proper reflect the company's dedication for quality. How often do we find spot the world might be a much more threatening place. Imagine subordinates complaining about the tyrant at the top? But more on the unpredictable and threatening nature of the universe if things this subject latter. Occasionally the OCPD sufferer may tended to not be just where they were left. With ordering as a acknowledge that other ideas are also functionally correct, but manifestation of OCD and OCPD it is not uncommon to find a

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 5 person placing and replacing items over and over again until they every minute the quagmire becomes deeper and deeper. It is feel they have gotten it exactly right. Ordering also entails the almost as if the mere effort to find resolution is a punishable placement of items in geometric symmetry. Parallel lines and even offence. In a close relationship, encountering this zone of spacing seem to be of paramount importance. A client used to contempt is bewildering and frightening. All one wants to do is to euphemistically refer to his stacks of items as "anal piles," bring this controversy to an end, and then, you are punished for amusingly recognizing his own need for obsessive structure. not being willing to deal with the issue at hand. Within this zone, Symmetry can also be sought after in an obsessive way. Having the person with OCPD feels a great need to bring about absolute to keep the world perfectly balanced can lead to rituals where clarity for the issue to be resolved. Once again this need for the items would need to be perfectly and evenly spaced. Touching perfect resolution creates a seemingly never ending tweaking of both sides of an object or ones right and then left leg are also the issues. Agreeing to disagree is rarely a reasonable solution other examples of symmetry. and often not in the scope of the OCPD's world.

OWNING TRUTH INTERPERSONAL RELATIONSHIPS We all periodically have such confidence in what we are saying For many who have close contact with an OCPD sufferer there that statements such as "I'm sure of it" or "The fact of the matter can be a pervasive experience of being ill at ease, while in the is..." play a natural part of our everyday vocabulary. For persons company of someone with OCPD. Often, being with persons who with OCPD, facts and confidence are all too often turned into "I'm evidence this diagnosis, feels like walking in a field of land mines. RIGHT and you’re WRONG." "The way I see it represents the way One never knows when your going to step on one and pay a it is, end of story". For others, refusing to yield to the "correct heavy emotional price for crossing the rigid standards. This ever perspective" often entails encountering tension and discord. This present threat creates a tremendous amount of trepidation, manifestation of OCPD entails one's adamantly guarding his resentment, and tension. These land mines can present dogmatic beliefs to such a degree that casual conversation often themselves in association with seemingly random topics. converts minor disagreements into heated debates. The relative Within marital or familial relationships the divisiveness of this importance of any topic (i.e. comparing the effects of regular gas condition is most felt. Since ideology and correctness is placed vs. high test on a particular car's performance) rarely is of before love and loyalty, divisiveness can break familial ties. consequence in determining the degree of the intensity expressed Spouses can be subjected to daily scrutiny and given repeated in the midst of the debate. feedback in a non-loving or supportive manner. The standard Perhaps there are a few variables on this planet, which are bearer must run his or her house like a tight ship -- from the beyond debate in their apparent universal truthfulness. "Humans children being kept in line (seen but not heard) to the outside are a living organism when there is a heart beat and/or brain appearance of the house, well manicured and tidy. The activity" or "Rocks eventually tend to drop in a downward direction expression, both physically and emotionally, of tender feelings for when released into the air." For the person who experiences "loved ones" is often painfully absent. Corporal punishment is not OCPD, abstract ideals and moral standards become rigidly held unusual since the mentality of "spare the rod and spoil the child" is truths. An example belief would be that "The Mormon's practice of even endorsed in the Bible. Wreaking humiliation seems to be just marrying more than one woman is illegal and absolutely wrong." punishment since it closely approximates the inner experience of The ideology that all-religious practices are subject to the OCPD sufferer's reaction to being wronged. In 1985 I was interpretation and not a matter of right or wrong is often working in a university outpatient clinic with a child who's overlooked and rarely considered. It is not unheard of for academic performance had lapsed far behind his intellectual someone with OCPD to feel that he is flexible due to an capacity. Near the end our successful treatment I brought in the occasional shift in his beliefs. If one listens carefully, the shift in father of my client. My objective was to see if I might transfer the position can be dramatic and equally dramatic is the degree to positive changes, which had occurred in the course of treatment, which the new truth is held as fact. The knowledge that abortion is to the home. Near the end of the session I asked the father "murder" can be converted to the fact that the freedom to chose whether he was proud of his son for bringing up his grades so represents every woman's "God Given" right to make decisions dramatically. I'll never forget the father's response in front of this about her own body. Most examples of this particular cognitive child. "There's nothing to celebrate, these are the grades he shift would tend to go in the opposite direction. SHOULD have gotten all along!" It would not be unusual for an OCPD sufferer to literally take In interpersonal relationships we all tend to hope for a little leeway delight in being wronged, since it affords them, what they in being given feedback for mistakes that we make. Persons with perceive, as the justified opportunity to deliver a steep OCPD tend not to find it within themselves to provide a nurturing punishment. The term "righteous indignation" was probably environment where being human and fallible is expected. Instead conceived with this perspective in mind. Crossing a person with they feel put upon by others' mistakes and take license in OCPD provides her the license to hold a grudge and forever hold extracting a heavy toll for even an initial infraction -- "Person's your mistake over your head. should know better and mistakes are just not to be tolerated." In a conflict with someone who has OCPD, the non-OCPD person Often others in the presence of an OCPD sufferer find themselves might be motivated to desperately seek closure. In the process of embroiled in heated conflict over issues which pertain to attempting conflict resolution, the non-OCPD might discover that seemingly trivial topics. It is not uncommon to become convinced

6 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria that the OCPD sufferer actually takes delight in the heated nature and risk taking. Often the chain of command from above of conflict. For those familiar with the OCPD's style, bailing out of reinforces or ignores this style, since it appears that the manager a conversation and avoiding future areas of debate, is a pervasive is just being vigilant and instilling the company's commitment to response pattern. Not surprisingly this style of interaction has excellence. devastating effects on the great majority of relationships persons Friendships (how ever long lasting they may be) are often tenuous with OCPD have. Fault finding is the tendency for OCPD's to at best. Persons with OCPD, at the more extreme end of the chronically pick out the flaws in others, especially those close continuum, project an air of consternation and rigidity. The enough to them to mention it. "You always misuse the word affect eventual breakdown of casual relationships comes as a in stead of saying effect!" "Your hair is always so messy; don't you consequence of chronic tension and failed expectations. The have any self respect?" It seems as if through criticism the internal schema (style of viewing life circumstances) of the receiver of the feedback will be inspired to get their act together. sufferer is incapable of learning from these repeated failures due For the OCPD sufferer, it is not uncommon for him to seek out the to the dogged conviction that the other person was at fault, and company of a significant other where his partner's personal therefore the termination of the relation was justified. disposition is that of being passive and non-conflictual. For a long- term significant relationship to survive with this diagnosis, it is almost essential for the partner to have great depths of resilience STRICT MORAL STANDARDS or dependency. Many OCPD relationships involve a clear "Premarital sex is wrong and it means that persons are tainted if distinction between the domineering and controlling spouse and they have ever engaged in it." "Girls who wear make up are loose the passive-dependent spouse. Mail order brides have sometimes and promiscuous." "Men who allow their wives to work are provided an outlet for otherwise frustrated men who have found it inadequate providers." difficult to cope with the ever-evolving power structure of women Moral righteousness and preaching morality as a dogmatic within today's western society. necessity is not an uncommon expression of OCPD. The Isolation due to rigidly held high standards is also a common avoidance of discussing religion or politics is certainly wise in the result of OCPD. When perfectionistic standards are applied presence of the OCPD sufferer. Both of these realms are steeped toward a partner's minute bodily defects or quirky personal style, in the potential for the OCPD sufferer's truth to override the devastation wreaked within intimacy is astounding. I have all consideration and respect. In 1986 I flew with a client to Boston to too often worked with clients who have legitimised ending aid him in his fear of flying. While at the airport in Boston we relationships due to such minutiae as a significant others bad walked past a booth representing some very conservative breath, small shoe size, or eyebrow thickness. An article written in organization (Linden LaRouch I believe). Out of nowhere, my 6'4" New York Magazine , a few years ago, portrayed a satirical male client reached over the booth and grabbed the innocent conversation which went something like this: "She's a Ph.D., fellow by the collar. My client proceeded to yell about the toxic expert skier, loves children and animals, and encourages me to ideology that this booth represented. In that moment this client spend as much time out with the guys as possible... it's just a graduated from fear of flying and commenced with a long year of shame she speaks French with a southern dialect". When this work related to helping him let go of truth and anger. One of our aspect of OCPD is manifested there is typically a pattern of failed agreed upon goals was for him to become more available to his relationships. The sufferer tends to consistently withdraw from a friends, who had expressed that they were afraid to discuss any relationship soon after the development of intimacy. The topic which he disagreed with. Our successful outcome boiled awareness of the defect in one's partner as time goes on down to my client's willingness to replace "truth" with expressing becomes so magnified, that after a while, the slight flaw which his opinion in terms of degrees of confidence. was not even noticed initially, becomes the only feature which is Excessive religious observance as in, strict adherence to ritualistic seen. aspects of daily or weekly routines, is a potential component of Poor social skills are often a consequence of a life-long pattern of OCPD. If a child would ask for rationales for following through with rigid thinking. Being motivated to attend to subtle cues within certain age old traditions the OCPD parent may respond with "You one's social environment is lost due to the overriding perspective just do it and never question the relevance". Often persons with that "my way is the right way." Taking liberty to disclose radical this form of OCPD, believe in literal interpretations of the Bible or opinions or facts, which are of an extreme nature, in the presence Koran. Adamantly endorsing the idea that the world was created of a novel relationship or non-intimate acquaintances is a common some 5864 years ago, despite the existence of rocks carbon characteristic. Whereas in a novel social setting, decorum dated to over a million years ago, would not be unexpected. Using pressures persons to withhold extreme positions, the OCPD the Wrath of God as a means of modifying behavior is often an sufferer feels that a lack of genuineness is wrong and being totally unfortunate component of OCPD. Of course, religious intolerance open, no matter what the consequence, is the only option. "If is not surprisingly a derivative of this style of thinking. Finding fault others are offended by what I say, too bad for them." with different views or creating fractions within divergent religious In professional relationships, subordinates of many OCPD's are sects is not uncommon. The existence of hundreds of subsets often intimidated and frequently berated. Staff may experience amongst the Baptists and the ever-fractionalizing Hasidic (ultra- tremendous inhibition in speaking freely about topics where there orthodox Jewish) community is evidence of religious leaders is not absolute certainty regarding the correctness of the owning their interpretation of the Bible too rigidly. One of my statements. This environment facilitates the stifling of creativity favorite recollections of a female OCPD in discussing her

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 7 spirituality was her reassurance that her observance of Eastern is unfortunately not excluded. Therapists may well be advised to philosophy was the "True Buddhist" expression. The paradoxical forewarn all persons with OCPD that at some point in the course humor is that letting go of truth is a spiritual goal of Buddhism (as I of therapy the clinician will inadvertently behave in a manner understand it). which will violate the client's perfectionistic standards. Rather than The treatment of OCPD is incredibly complex and lengthy. responding by terminating the relationships, this juncture provides Therefore, any depth in relaying the specifics of this treatment go the client with an opportunity to learn how to manage the conflict. well beyond the scope of this paper. Generally speaking the focus Playing out conflict resolution in the course of therapy can be a of Cognitive-Behavioral treatment for OCPD entails helping these powerful therapeutic tool. Being real and available to the client is individuals develop a greater tolerance to the notion that the world critical. Once rapport has been established, giving honest and is exclusively made up of gray, not the clearly defined black and immediate feedback about the dynamics within the therapeutic white lines of rigidly held beliefs. As is the case with all treatments relationship is imperative. Keeping the channels of communication there is an utmost emphasis on developing rapport and trust open so that at the point where the client most desires ending the within the therapeutic relationship. Educating the client about the relationship, becomes the point where effective communication diverse nature of this condition offers the sufferer the option to can take place to strengthen the foundation of the partnership. In identify those aspects of OCPD which are most salient to their all honesty, approximately 50% of OCPD clients remain on board own lives. Having the client identify that these dispositions are a for the long haul. Rather than seeing the actual conflict within the handicap at all is a monumental achievement. The treatment therapeutic relationship as the unavoidable manifestation of why would most likely focus on breaking down and intervening on they came into therapy in the first place, many bail prematurely specific individual aspects within the spectrum of OCPD. A due to the overwhelming sense of outrage that the doctor has standard cognitive-behavioural intervention might deal with the made a mistake. hoarding (using exposure and response prevention methods), This paper represents a radical departure from the style of most of while social skills training and role-playing might help facilitate a my previous writings. I am aware that there is an emphasis on the more effective style in relationships. Assertiveness training would aftermath within oneself and on others, rather than a primary facilitate one's ability to make requests or provide feedback such focus on understanding and compassion. I strongly believe that that the receiver of the information not be alienated. Overriding all through being informed about this condition's manifestations, of the specific interventions would be a sensitivity to helping the people can better seek appropriate treatment. Living out the sufferer relinquish their dogmatic belief system. Letting go of "truth patterns of OCPD for oneself and for others around you is owning" and relating to one's world without needing to be "right" is devastating. If you are at the end of your rope and these a tremendous ambition. The dividend it pays is incomprehensible. characteristics are relevant, I strongly suggest you seek new As has been previously stated, the existence of OCPD has paths. devastating effects on relationships. The therapeutic relationship

Being Female and Anxious: Anxiety Disorders in Women By Stephanie Sampson, M.A. Published by the Anxiety Disorders Association of America, ADAA Reporter, Vol XII, 3, June/July 2001. Reprinted with permission.

We all accept that there are differences between girls and boys, but one difference, in particular, may be surprising. Once a girl reaches puberty, her chances of developing anxiety and mood disorders are double that of the boy she sits next to in school (22.6% vs 11.8%). Simple phobias, social phobia, and generalised anxiety disorder are the most common. Her risk remains double that of males for another 35-40 years, a lifetime risk longer than that of almost any other psychiatric or physical illness. Moreover, during their lifetime women are more likely to have multiple psychiatric disorders than are men. The most common psychiatric illness to co-occur with anxiety (in both sexes) is depression. VIVE LA DIFFERENCE "True, although we are making progress, we don't know as much as we'd like about why rates of anxiety are so high in females. But we do know what anxiety disorders can do to a woman's life and health and how we can help her," says Jerilyn Ross, President and Chief Executive Officer of the ADAA. Only about one-third of those with an anxiety disorder have been diagnosed and are in treatment. "If your fears or worries are interfering with your life, get help. It's the best thing you can do for yourself and your family." Researchers are investigating the role of brain chemistry, hormones, gender roles, trauma, social support, and socio-economic status in females' vulnerability to anxiety disorders. Little is known about how these factors interact, and each may confer both risk and protection for an individual woman, according to experts. BRAIN CHEMISTRY Differences in brain chemistry may account for at least part of the difference. The brain system involved in the 'fight or flight' response is activated more readily in women and stays activated longer than in men, partly as a result of the action of estrogen and progesterone. For

8 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria example, if a man and a woman suffer the same traumatic event and both develop PTSD as a result, it is likely that the woman will suffer from the effects of the disorder for a longer period of time than the man will.

Prevalence of Anxiety Disorders in Women Disorder Lifetime Prevalence 12-Month Prevalence (in %) (in %) Panic disorder 5.0 3.2 Agoraphobia without panic 7.0 3.8 Social phobia 15.5 9.1 Simple phobia 15.7 13.2 Generalised anxiety disorder 6.6 4.3 Any anxiety disorder 30.5 22.6

SOURCE: Kessler, Ronald C, et al, "Lifetime and 12-Month Prevalence of DSM-III- R Psychiatric Disorders in the United States: Results from the U.S. National Comorbidity Survey," Archives of General Psychiatry, 51 (January 1994).

The neurotransmitter serotonin may also play a role in stress responsiveness and anxiety. Anti-depressants are effective in treating anxiety because they affect the activity of serotonin in the brain. There is some evidence, however, that the female brain does not process serotonin as quickly as the male brain. While the female hormone oestrogen enhances the amount of serotonin in the brain, during her premenstrual phase a woman, especially an individual with naturally low serotonin levels, may suffer anxiety and increased irritability because of changes in hormone levels. That there is a link between hormones and anxiety is made clear by studies done with pregnant women. A woman with panic disorder who becomes pregnant may experience a decrease in the frequency of her panic attacks while pregnant and breast feeding, that is, when levels of both oestrogen and progesterone are particularly high. GENDER ROLES The symptoms and course of anxiety disorders also differ by gender. Men with panic disorder and agoraphobia, for example, are more likely than women with the same diagnosis to abuse alcohol. Women with panic and agoraphobia are more likely to relapse than men. Psychosocial factors may also play a role in the higher rates of anxiety in females. Several studies support the notion that having some "masculine" traits can protect against anxiety. "It is plausible that an assertive, goal-oriented, competitive style may lead a person to be less avoidant and therefore less anxious," says Katherine Shear, M.D., writing in Gender and Its Effects in Psychopathology (Ellen Frank, Ph.D., ed., American Psychiatric Press, 2000). Shear also hypothesises that the changing roles of women - their greater social equality and increased participation in the workforce - may be leading to the observed decline in the ratio of women to men with agoraphobia (from 4:1 in 1970s to 2:1 in 1990s). SOCIAL RELATIONSHIPS Men and women have distinctly different "goals" in pursuing relationships, a phenomenon described in a series of popular books, for example, Men are from Mars, Women are from Venus. Men's relationships focus on pursuing common activities and interests, while women focus on establishing mutual understanding and intimacy. Women also seek supportive social relationships, and when they are troubled by their relationships, they tend to experience more distress than men. "In our clinical samples, we found interpersonal problems in women were consistently related to symptoms of somatic anxiety, anxiety sensitivity, worry and agoraphobic avoidance; the more severe the interpersonal problem, the more severe the anxiety," says Shear. However, Shear cautions, the reverse may also be true: having more anxiety symptoms may lead to more problems in women's relationships. SOCIO-ECONOMIC STATUS Results from the landmark National Comorbidity Survey confirm that the prevalence of all psychiatric illnesses goes down as an individual's education and income go up. Interestingly, the data show that lower socio-economic status is more strongly correlated to anxiety disorders than mood disorders. Lack of education and financial hardship may lead to chronic stress and inability to find and take advantage of both information and treatment resources. Lower socio-economic status combined with single motherhood has also been shown to increase the risk of having an anxiety disorder.

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 9 Anxiety and Eating: The Relationship between Anxiety DisordDisordersers and Eating Disorders Published by Anxiety Disorders Association of America, ADAA Reporter, Vol X11, No 3, June/July 2001. Reprinted with permission. Those suffering from eating disorders often food, and then purge through the use of It is unclear whether the eating disorder is have psychiatric symptoms as well, such laxatives, diuretics, enemas or self-induced a response to the heightened level of as depression, anxiety disorders, and vomiting. Women with restrictive AN tend anxiety associated with sufferers of PTSD. obsessive compulsive behaviour. Anxiety to have high rates of OCPD. The need to According to Timothy Brewerton, M.D., of disorders very often pre-date, and are control food intake coincides with the the Medical University of South Carolina comorbid with, the eating disorder and, if inflexibility and perfectionism displayed and one of the principle researchers in the not treated, can remain after recovery. with that particular personality disorder. National Women's Study, “purging, as Anorexia Nervosa (AN) is generally OCD seems to be specific to sufferers of opposed to bingeing, seems to be the key characterised by the refusal to eat enough both types of AN, and there may be a behaviour linked to PTSD." One calories to sustain oneself, while Bulimia biological reason for this. According to Dr. explanation for this, according to Dr. Nervosa (BN) is characterised by bingeing Lilenfeld, both disorders are associated Brewerton, is that the act of purging has a on food and then purging oneself. with elevated levels of serotonin, one of numbing effect, and many bulimics report The relationship between anxiety and the neurotransmitters associated with that they feel more relaxed and less disturbed eating has been the subject of anxiety and depression. Another reason anxious after purging. It is interesting to several studies. It is hypothesised that for the connection may be that, as with note, however, that women with BED are social fears, discomfort with the thought of OCPD, the obsessive nature of the eating less likely to also have PTSD than women being judged in social settings, or disorder coincides with the nature of the with BN and that there is no higher rate of generalised anxiety may be an important anxiety disorder. The anxiety usually victimisation among these women. first step to developing an eating disorder, comes first, with age of onset in childhood, Women with BED also recover from PTSD particularly AN. With both AN and BN while the onset of the eating disorder is more quickly than bulimics, according to there may be genetic determinants that usually in adolescence. Dr. Brewerton, the purging and subsequent play a role in the connection with anxiety. malnutrition that is characteristic of bulimia Social Anxiety Disorder and Panic Disorder affects the ability to recover. Lisa Lilenfeld, Ph.D., of Georgia State are also prevalent in women with AN, University, is taking part in a large although Panic Disorder usually manifests Although much research has been focused international collaborative study, funded by itself after the onset of the eating disorder. on bulimic women who have experienced the Price Foundation, which is As mentioned above, anxiety about social childhood sexual trauma, whether or not investigating genetic factors that may situations is not surprising in anorexic they have PTSD, it is clear that women contribute to the development of eating women who, studies have shown, tend to who have PTSD from any type of trauma disorders. According to Dr. Lilenfeld, exhibit shyness, avoid dating, attending (for example, aggravated assault, "Eating disorders are substantially parties, and public speaking. emotional abuse or bereavement) have a mediated by genetic factors," and this higher risk for BN. PTSD is the risk factor study is working to determine what those BULIMIA NERVOSA AND POST for developing BN, not childhood sexual genes might be. TRAUMATIC STRESS trauma. SYNDROME The evidence indicates that certain anxiety Websites for more information on eating disorders: In the National Women's Study over 3,000 Eating Disorders Foundation of Victoria Inc. disorders are more prevalent with eating www.eatingdisorders.com.au disorders in general, and specific anxiety women were questioned about their history National Association of Anorexia Nervosa and of aggravated and sexual assault, PTSD, Associated Disorders at www.anad.org disorders can be linked to specific eating and both Bulimia Nervosa and Binge disorders. Sufferers of AN were found to BINGE EATING DISORDER have higher rates of Obsessive Eating Disorder (BED). It was found that there were much higher rates of Binge Eating Disorder (BED) is marked by Compulsive Disorder (OCD), Obsessive recurrent episodes of binge eating without the aggravated and sexual assault in women Compulsive Personality Disorder (OCPD), purging afterwards as is seen in Bulimia as well as Generalised Anxiety Disorder who had developed BN. In the majority of Nervosa. People who binge lack a sense of (GAD), social phobia, and simple phobia. bulimic women the assault and subsequent control and eat considerably more in a given Women diagnosed with BN have higher development of PTSD predated the eating time period than others would eat, that is, excessive consumption. The binge must take rates of Post Traumatic Stress Disorder disorder, this suggests that victimisation contributed to the development of the place within a discrete period of time, continual (MD) and OCD. eating or snacking throughout the day is not eating disorder. The odds of developing ANOREXIA NERVOSA AND considered a binge. Bingers usually eat very BN are greater for women with PTSD, ANXIETY DISORDERS quickly, eat until they feel uncomfortable, eat even if the trauma resulting in the PTSD when they are not hungry, and eat alone to There are two subtypes of Anorexia was not assault. Even when PTSD has avoid detection; they also tend to feel guilty, Nervosa. The first is the restricting type, been diagnosed and treated these women depressed and self-disgust afterwards. For a BED diagnosis, binge episodes must occur at least which is characterised by dieting, fasting or are at a higher risk of developing BN than twice a week (on average) for a period of no excessive exercise. The second is the women who have not been assaulted and less than six months. binge-eating/ purging type in which the subsequently developed PTSD. individual will eat, usually small amounts of

10 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria A Special Case: Women and Trauma By Stephanie Sampson, M.A. Published by the Anxiety Disorders Association of America, ADAA Reporter, Vol XII, 3, June/July 2001. Reprinted with permission.

Researchers have investigated several gender differences in the few months. However, if symptoms persist or seem to get worse prevalence and etiology of Post Traumatic Stress Disorder after three months, professional help is strongly recommended," (PTSD). By definition, PTSD occurs after an "adverse life event," says Feeny. ranging from the unexpected death of a loved one to natural Sexual assaults are vastly under-reported by women. Only one- disasters to criminal assault (for example, a rape, mugging, or half to one-third of women who have been assaulted disclose their stabbing. experience to someone (such as a friend or family member). Even Women are twice as likely as men to develop PTSD after a in the doctor's office women are often not diagnosed with PTSD traumatic event. This prevalence appears to be related to a because they do not disclose their symptoms unless directly woman's increased vulnerability to developing PTSD after suffering asked. Avoidance, however, may perpetuate symptoms of PTSD. a physical assault, according to Naomi Breslau, Ph.D., Research "A woman may inadvertently reinforce a fear by not confronting it. Director at the Henry Ford Health Systems in Detroit, MI. Although it is natural to avoid painful memories, such avoidance Compared with men women have a higher risk of PTSD after a interferes with processing the event," says Feeny. Research has rape (49% vs. 0%), sexual assault other than rape (24% vs. 16%), shown that expressing one's feelings - talking about the trauma or mugging (17% vs. 2%) and after being beaten up (56% vs. 6%). writing down one's thoughts - aids in recovery. Difference in gender was not significant for other categories of Untreated PTSD can have adverse effects on women's physical as PTSD-inducing trauma, such as a severe injury or learning of the well as psychic health. Headaches, gastro-intestinal problems, death of a relative or friend. and sexual dysfunction are a few of the physical effects reported Women who have been the victims of physical assault experience after trauma. "At the University of Pennsylvania's Center for certain symptoms more often than men, including being more Treatment and Study of Anxiety, the average time between onset sensitive to stimuli that remind them of, or symbolise, the trauma. and seeking treatment was seven to eight years," reports Feeny. The course of their illness is also longer, according to Breslau. "Our message to women is: Don't wait. Effective treatments exist When she looked at traumas experienced directly, Breslau found for PTSD that will likely help you recover." the median duration of illness increases to five years for females In summary, individuals who have experienced a trauma should: e xpect a and two years for males. reaction; talk with someone about the experience; get help. RECOVERING FROM PTSD Additional Resources for Professionals and Consumers The majority of women who experience a trauma will have The ADAA's website at www.adaa.org, click on Consumer Resources. symptoms of PTSD in the short run, according to Nora Feeny, PTSD Alliance at www.ptsdalliance.org Facts for Health at www.factsforhealth.org, a new comprehensive Ph.D., Assistant Professor of Clinical Psychology at Case Western resource to help identify, understand and treat social anxiety disorder and Reserve University in Cleveland, OH. "This is a normal response post-traumatic stress disorder. to a very stressful event, and usually the symptoms disappear in a

Post-traumatic Stress Disorder (PTSD) Defined PTSD can occur at any age, from childhood to old age, and traumatic stress can be cumulative over a lifetime. Responses to trauma include feelings of intense fear, helplessness and/or horror. Symptoms usually begin within three months of a trauma, although there can be a delayed onset and six months can pass between trauma and the appearance of symptoms. There are three types of generally recognised stressors:
Threatened death or serious injury to one's person;
Learning about the death, near death or serious injury of a family member or close friend;
Witnessing the death, near death or serious injury of another person. For post-traumatic stress disorder to be diagnosed symptoms must be present for more than one month and be accompanied by a drop-off in the ability to socialise, work, or other areas of functioning. Symptoms of PTSD are:
Re-experiencing the event, which can take the form of intrusive thoughts and recollections, or recurrent dreams;
Avoidance behaviour in which the sufferer avoids activities, situations, people, and/or conversations which he associates with the trauma;
A general numbness and loss of interest in surroundings, this can also present as detachment;
Hypersensitivity, including: inability to sleep, anxious feelings, overactive startle response, hyper-vigilance, irritability and outbursts of anger.

If you or someone you know is experiencing these symptoms, get help. PTSD is treated with cognitive-behavioural therapy as well as with medication. Talk to your doctor about what treatments are available.

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 11

Let go To “let go” does not mean to stop caring. it means I can’t do it for someone else. To “let go” is not to cut myself off, it’s the realisation I can’t control another. To “let go” is to admit that the outcome is not in my hands. To “let go” is not to enable, it’s to allow learning from natural consequences. To “let go” is not to try to change or blame Another, is to make the most of myself.

To “let go” is not to care for, it’s to care about. To “let go” is not to judge, it’s to allow another to be a human being. To “let go” is not to be in the middle arranging all the outcomes, it’s to allow others to affect their destinies. To “let go” is not to be protective, it’s to permit another to face reality. To “let go” is not to deny, it’s to accept. To “let go” is not to nag, scold or argue, it’s to search out my own shortcomings and correct them. To “let go” is not to criticise and regulate anybody, it’s to try to become what I dream I can be. To “let go is not to regret the past, it’s to grow and live for the future. To “let go” is to fear less, and love more. Anonymous

Believe in Yourself Believe in yourself and in your dream, though impossible things may seem Someday, somehow you’ll get through, to the goal you have in view. Mountains fall and seas divide, before the one who is in their stride. Take a hard road day by day, sweeping obstacles away. Believe in yourself and in your plan, say not – I cannot – but I can. The prizes of life we fail to win, because we doubt the power within. Anonymous

12 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria

Therapist ’s Notebook &

Getting Help For Family Members Who Refuse OCD Treatment By Dr. Herbert L. Gravitz, Ph.D. OCF USA, www.ocfoundation.org

Many people have expressed great concern about family disorder; your body will adjust to the side effects; you will be more members who are either reluctant to enter treatment, remain in creative; your true self will be more present). Also, mental illness treatment, or take medications. The problem of getting a family still has much stigma attached to it, so you might try "speaking to member into treatment or getting the person to take medication the stigma." (e.g., it takes a courageous person to know when they isn't unique. Nor is it a simple matter. Because I have received need help; only strong people seek help). numerous requests about this issue recently, I would like to It has also been my experience that family members become more provide a generic response. Fortunately, the OCD sufferer will unreachable when they are abusing alcohol or some other often respond positively if approached in a straight-forward, loving substance. And ironically more family members than we might way with accurate, non- judgmental information. When the person want to realise use drugs to blunt their pain. If you suspect your doesn't, it is often because he or she has some missing or family member is abusing drugs, the substance abuse must be inaccurate information which creates fear. addressed before any productive movement will occur. Get This fear (my favourite definition of fear is False Evidence professional help/coaching if necessary. Appearing Real) blocks the person from receiving help (e.g., only When a loved one is either a danger to self or others, including the crazy people need treatment/medication; the person doesn't need family, it may become necessary to insist that a family member treatment/meds; treatment/meds won't help; the medication is enter treatment or take medication. You may need to intervene by dangerous; it is a crutch; the treatment/meds will in some other calling the police, the local crisis intervention team, or, the way harm them; treatment/meds is a sign of weakness; or the person's doctor if he/she has one. This may seem harsh, but life medication is addictive or will foster dependence; it will rob them of often demands us to take difficult actions. OCD can be a horrible creativity; or it will in some way rob the person of his or her unique disorder, but it is no excuse to allow oneself or loved one to live a personality). bizarre life. Sometimes, too, people are afraid of the side effects of medications. Less frequently, but still possible, the person is Sometimes, of course, there is nothing you can say that will matter afraid to give up the role she or he has had. (The latter is the most and then you must take care of yourself and, if needed, get help problematic blocking fear.) for you. In my experience I have found that one of the most difficult parts of a family members' recovery is the conscious decision to These fears and worries are normal and natural and must be leave the loved one to her or his own fate and accept their fate as addressed. What often helps in all of these situations is to "speak family members of a person with a chronic and sometimes severe to the fear," not the person refusing treatment or medication -- illness. (e.g., you are not crazy; you have a diagnosable and treatable

FALSE

EVIDENCE

APPEARING

REAL

M.C. Escher

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 13 Managing Sexual Side Effects By Michael Jenike, MD OCF USA, www.ocfoundation.org

Although the positive effects of SSRIs, patient. These inconsistent effects may be incidence of anorgasmia, partially reversed clomipramine, and monoamine oxidase explained by activation of certain receptors sertraline-induced anorgasmia in a 31- inhibitors are now well documented, there in some, but not all, patients (Seagraves et year-old man at a dose of 100 mg per day; is a cost in terms of side effects. It is clear al, 1996). lower doses were not helpful. At 150 mg that more than 35% of patients on these The above effects can sometimes be taken 60 minutes before intercourse, he drugs experience difficulties with sexual reversed by medication like had a return of normal sexual functioning. functioning. These problems usually cyproheptadine, a drug with anti- At 6 months follow-up, the patient had no ill involve diminished libido (although the serotonergic action, as shown in a number effects from the occasional addition of opposite occasionally occurs) and/or of case reports (McCormick et al, 1990; nefazodone to his continuing sertraline orgasm problems in both sexes. In males, Arnott & Nutt, 1994; Seagraves, 1991; therapy. Reynolds noted that nefazodone inability to maintain an erection or even Feder, 1991; Goldbloom & Kennedy, 1991) has a relatively short half-life of only 2 to 4 complete impotence may occur. and in one double-blind study (Steele & hours and reaches peak serum levels 1 If the clinician does not specifically ask Howell, 1986). However, cyproheptadine hour after oral dosing. about sexual difficulties, it may appear that can reverse the antidepressant effects of A recent approach to the management of they are quite rare since patients are often SSRIs (Feder, 1991) and probably anti- sexual difficulties involves the use of drug embarrassed or more commonly, they do obsessional effects as well. In addition, it holidays where patients are allowed to omit not think to blame medication for these has significant sedative properties. medications on the weekends to allow problems and may attribute them to Recent reports (Norden, 1994; Seagraves sexual activity. This practice may work difficulties in their relationships. Sexual et al, 1996) suggests that adding when drugs that have a short half-life, such difficulties may be an unspoken cause of buspirone, a partial agonist of the 5-HT1A as sertraline, paroxetine, clomipramine, treatment non-compliance, and knowledge auto-receptor, may have a beneficial effect and fluvoxamine are used, but will not work of the patient’s sexual life may be a critical of decreasing or reversing sexual with drugs that have a very long half-life, variable in drug compliance. dysfunctions induced by SSRIs. such as fluoxetine. To illustrate the magnitude of these Yohimbine, an alpha-2 adrenergic A number of patients with drug induced problems, Montero (1987) studied antagonist, has also been reported to be sexual dysfunction can be helped by a little clomipramine and found that 96% of helpful for anorgasmia precipitated by known technique of injection of the patients who took the drug developed SSRIs. It is probably best not used in prostaglandin alprostadil into the corpus anorgasmia. However, when a sexual patients with comorbid panic disorder, cavernosum of the penis (Caverject dysfunction questionnaire was given, only excessive agitation, or hypertension Upjohn). This can produce an erection in 36% of the 96% reported any type of (Seagraves, 1994; Seagraves et al, 1996). some men with erectile dysfunction. Most sexual problem. When fluoxetine, men claim that this injection with a small Bupropion is thought to have a sertraline, and paroxetine were first bore needle is almost painless. However, a predominantly adrenergic mechanism of introduced, the reported incidence of recent report of using a pellet or micro- action, and it has been reported to be sexual dysfunction was 2% to 9%; after suppository formulation that is used successful in reversing fluoxetine-induced careful questioning and better reporting of intraurethrally (MUSE [Medicated Urethral cases, the incidence is now 30% to 40%. anorgasmia. On interest, it has been found System for Erection] - Vivus) suggests that that bupropion increases the sexual this technique may work as well without It is not completely clear what the fantasy life in a cohort of women with the need for injection. This is marketed as mechanism of these sexual difficulties is, hypoactive sexual desire and that using a sterile foil pouch containing a pellet 1.4 but most of the evidence for anorgasmia the drug may also have a central effect mm in diameter and 3 or 6 mm long within supports the hypothesis that increased that enhances libido as well as a peripheral serotonergic activity is inhibitory to the stem of a hollow applicator, which is effect that reverses SSRI-induced sexual inserted 3 cm deep into the urethra. ejaculation and orgasm. The various dysfunction (Seagraves et al, 1996). In Pressing a button pushes the pellet into serotonin receptor subtypes may have various case reports, dextroamphetamine, the urethra. In a double-blind controlled different effects on sexual functioning; in methylphenidate (Bartlik et al, 1995), trial, of 461 alprostadil-treated patients, particular, 5-HT2 receptors are probably amantadine (Balogh et al, 1992; Balon, 299 (65%) reported that they had achieved inhibitory while other subtypes may be 1996; Masand et al, 1994-95), and even excitatory. This could account for the successful intercourse at least once, ginseng have all been reported as useful compared to 95 (19%) of 500 patients who paradoxical effect of spontaneous orgasm drugs for reversing anorgasmia inserted placebo pellets. Results were in a small number of patients who have (Seagraves et al, 1996). taken fluoxetine and clomipramine, even similar regardless of age or cause of though both of these drugs cause extreme Reynolds (1997) reported that nefazodone impotence (Padma-Nathan et al, 1997). difficulty with ejaculation in the typical (Serzone), a drug with less than a 1% MUSE comes in four strengths that range

14 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria in dose from $114 to $138 for 6 units (The as needed basis and may be worth a try. then which approach will help them Medical Letter, 1997). The physician must Bupropion, given at a dose of 75-100 mg function. Several drugs and combinations determine the minimal effective dosage daily may correct SSRI-induced sexual may have to be tried. It is also important to and check for hypotension before dysfunction. If for some reason the patient monitor any concomitant medical problems prescribing the drug for home use as there cannot tolerate bupropion, trazodone, 50- or other medications that may have an is about a 3% incidence of hypotension 100 mg given daily can be used, especially effect on sexual functioning. when the agent is first used. for patients who have difficulties in REFERENCES In terms of patient management, some developing and maintaining an erection Monteiro WO, Noshirvani HF, Marks IM, et al: guidelines can be crystallised from the (Seagraves et al, 1996). Anorgasmia from clomipramine in obsessive- compulsive disorder: A controlled trial. Br J Psychiatry available literature. First, it is crucial to Sometimes combinations of these agents 151:107-112, 1987. elicit a reasonable sexual history and ask are used. For example, one report Seagraves RT, Thompson TL, Wise T: Sexual dysfunction and antidepressants. J Clin Psychiatry: directly about difficulties with libido (sexual (Seagraves et al, 1996) advocated using Intercom: The Experts Converse. August 17, 1996. drive), orgasm, erection, and satisfaction bupropion starting at 37.5 mg given on a Seagraves RT: Reversing anorgasmia associated with sexual activity. Be clear with patients regular basis (not as needed) and with serotonin uptake inhibitors [Questions and Answers]. JAMA 266:2279, 1991. up front that anti-obsessional and anti- increasing the dose to 75 mg daily, Seagraves RT: Treatment of drug-induced depressant medications are often sometimes in combination with yohimbine anorgasmia. Br J Psychiatry 165:554, 1994. McCormick S. Olin J, Brotman AW: Reversal of associated with sexual difficulties. When 5.4 mg given daily. They also give fluoxetine-induced anorgasmia by cyproheptadine in identified, sometimes sexual problems can methylphenidate 10 mg daily on occasion, two patients. J Clin Psychiatry 51:383-384, 1990. Goldbloom DS, Kennedy SH: Adverse interaction of be lessened with simple dose reduction. with beneficial results. Others recommend fluoxetine and cyproheptadine in two patients with Occasionally, these side effects diminish pemoline instead of methylphenidate as an bulimia nervosa. J Clin Psychiatry 52:261-262, 1991. over time, but by no means in the majority adjunct, because it often reduces orgasm Feder R: Reversal of antidepressant activity of fluoxetine by cyproheptadine in three patients. J Clin of patients. Since there are now a number problems and has a half-life of 10 to 12 Psychiatry 52:163-164, 1991. of effective anti-obsessional drugs, it may hours. Caverject and MUSE systems may Arnott S, Nutt D: Successful treatment of fluvoxamine-induced anorgasmia by cyproheptadine. be worth trying a switch to another drug, be helpful for some patients. Drug holidays Br J Psychiatry 164:838-839, 1994. but if patients have had a good response, are being advocated more and more for Steele TE, Howell EF: Cyproheptadine for they may be reluctant to do this. Patients the shorter acting agents. imipramine-induced anorgasmia. J Clin Psychopharmacol 6:326-327, 1986. may have sexual difficulties on one or two There are recent reports that ginkgo Norden MJ: Buspirone treatment of sexual anti-obsessional agents, and perform dysfunction associated with selective serotonin re- biloba, a botanical derived from tree bark, uptake inhibitors. Depression 2:109-112, 1994. normally on others. may allow for better sexual functioning for Masand S, Reddy N, Gregory R: SSRI-induced sexual dysfunction successfully treated with If for some reason you do not want to people taking SSRI's and other amantadine. Depression 2:319-321, 1994-95. change medication, several possible antidepressants. One article (Cohen, 1997) Balogh S, Hendricks SE, Kang J: Treatment of antidotes exist. Yohimbine is useful for stated that "in an open trial of various fluoxetine-induced anorgasmia with amantadine. J Clin Psychiatry 53:212-213, 1992. anorgasmia except in patients with panic formulations, ginkgo was found to be Balon R: Intermittent amantadine for fluoxetine- disorder, excessive agitation, or effective in 84% of patients with sexual induced anorgasmia. J Sex Marital Ther (in press), 1996. hypertension and can be given at a dose of dysfunction induced by antidepressants". Reynolds RD: Sertraline-induced anorgasmia treated 10.8 mg (2 tablets) approximately an hour It is now theoretically possible the new with intermittent nefazodone. J Clin Psychiatry 58:89, before intended intercourse. Others have 1997. drug, Viagra, may also be useful. Above Padma-Nathan H, et al. N Engl J Med. 336:1, 1997. recommended chronic use of yohimbine at all, it is important to note the empirical The Medical Letter. Intraurethral alprostadil for 5.4 mg given three times a day (Seagra es impotence.39:32, 1997. nature of treating sexual difficulties and the Cohen A: authored a journal article in "Drug Topics", et al, 1996). Cyproheptadine can also be need for flexibility. Multiple approaches, 1997, Volume 141, page 33....entitled "BOTANICAL used on an as needed basis, but it often COULD IMPROVE SEX LIFE OF PATIENTS ON including biological and psychosocial, in an SSRI's". puts patients to sleep. There is also the alliance with the physician, patient, and theoretical concern that it may reverse sexual partner are required. There is no anti-obsessional and anti-depressant drug way to determine in advance which effects. Amantadine has been used on an patients will have sexual difficulties and

On Time Management …

“Let’s start with a confession: time management is impossible! … what we are really exploring are ways of managing yourself and your surroundings … time management is actually self- management”. Dr David Lewis, ’10-Minute Time and Stress Management, 1995, Piatkus

‘If I had nine hours to cut down a tree, I would spend six hours sharpening the axe.” Abraham Lincoln

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 15 Recovery Skills &

Four Basic Skills for Reducing the Symptoms of Anxiety Extracts from: Anxiety, Phobias and Panic: A Step by Step Program for Regaining Control of Your Life, by Reneau Z. Peurifoy. Warner Books: New York, 1995.

1. Cue-Controlled Relaxation Aim: to develop a conditioned response that induces a state of relaxation Common Examples – ‘Mum’s cooking tastes best’; advertising ‘Coke is Life’ – ‘Oh what a feeling – Toyota’; smells; tastes; songs etc. When a person experiences high anxiety, the various sensations and events present during the time that the person is anxious tend to become a conditioned response stimuli. For example, if a person has a panic attack while driving, simply being in a car may trigger mild anxiety symptoms. Anxiety generated by this form of conditioned response learning plays a subtle but very important role in maintaining panic disorder. Even though a person may understand the nature and cycle of panic disorder, he or she will continue to experience anxiety generated by conditioned response learning. This type of conditioned response learning can be reversed through a process called desensitisation or by using cue-controlled relaxation. Cue-controlled relaxation refers to relaxation triggered by a cue in a conditioned response manner. The actual cue can be anything. Commonly used cues include a word such as ‘relax’, an imaginary scene, or a physical cue such as putting your thumb and finger together. Step 1 : Learn a method of relaxation. Step 2: Decide on a cue and begin associating it with the relaxation response you are practicing. Step 3: Use the cue every time you do relaxation. Do it frequently for short periods.

2. Diaphragmatic Breathing Place one hand on abdomen and breathe in such a way that it moves up and down in a relaxed manner. Practice for one minute, long enough to take four to five relaxed and comfortable diaphragmatic breaths. Do not make it hard work. Avoid over-breathing – keep breaths slow and gentle. Practice lying down first – in bed before sleep and upon awakening. Then practice two or three times a day while standing. Then practice two or three times a day while sitting. With consistent practice, relaxed diaphragmatic breathing will become habitual. Whenever the first symptoms of panic are felt, check breathing. Take 3 to 4 slow, relaxed diaphragmatic breaths. This will help to prevent the onset of hyperventilation symptoms.

3. Coping self-statements Feelings and thoughts triggered by a particular situation are the result of conscious and unconscious interpretation of the situation. This interpretation process is usually based upon automatic, habitual thinking patterns. Thoughts are words and sentences you say to yourself – often called ‘self-talk’. Since emotions are partly controlled by conscious interpretation of the situation, statements that calm and tranquillise can help a person to reinterpret a situation so it is not as frightening. Examples of negative self-talk include: ‘this is terrible’, ‘I can’t breathe’, ‘I shouldn’t be feeling this way’, ‘I can’t handle this’, “This is stupid – why can’t I handle this simple thing’, “I can’t do this’, ‘I’ve got to get out of here’. Each of these statements is either false or expresses an irrational fear. Decreasing the amount and intensity of this type of negative self-talk is one of the keys to reducing anxiety. One way to do this is to repeat coping self-statements whenever tension or anxiety manifests – with time and pratice the negative messages will begin to be replaced with the more realistic and positive messages. Using coping self-statements assist with challenging fears, helping person to focus on the task at hand, act as a reminder to use anxiety-reducing skills, and increase attention to problem solving rather than on symptoms and inadequacies. Coping self-statements – “Anxiety is NOT dangerous - just uncomfortable. I've survived feeling like this and worse before.” “I can be anxious and still function effectively - stay focused on the task at hand.” “Trigger your relaxation response, take three or four relaxed diaphragmatic breaths then distract yourself.” “There is no need to fight what I am feeling. Even though it's uncomfortable, it's just adrenaline and will pass.” “Check your breathing. Now focus on and describe what is going on around you. Externalise and distract.” “Relax and go slowly.” “My current symptoms are just a type of conditioned response. They will become less as I desensitise myself.” 16 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria Prepare several statements and write them on a card – choose or make up ones that are meaningful. Practice reciting the statements until they can be recalled from memory. Repeat the coping self-statements whenever anxiety arises.

4. Distraction Distraction is the process of shifting or diverting attention from one activity to another. Shifting attention toward something neutral or positive is always easier than shifting it away from something negative. Trying to reduce anxiety by thinking or saying things like “Don’t be anxious’, or “I must not be anxious”, rarely works. This focuses your attention on the anxiety and usually causes it to increase. Turning the attention toward something that is positive or neutral is a more effective method of distraction from anxiety. An important feature of many forms of distraction is externalisation. Externalisation is the act of focusing attention on sensations originating outside the body. It is the opposite of internalisation – focusing attention on sensations originating inside the body. Distracting attention away from the body and focusing externally prevents the initial alarm reaction that triggers the anxiety/panic cycle. Using distraction after the cycle has been triggered helps calm you by interrupting negative self-talk and breaking the cycle of escalating fear over self-generated symptoms. Methods of distraction – Simple externalisation – the use of one or more senses to focus on some external sensation:
observing carefully (read signs, examine design of a nearby wall, observe activities of people, observe surrounding scenery);
listening attentively (listen to random conversations or background noises);
feeling textures (feel clothing, paper, steering wheel);
tasting or smelling (focus on the various odours in the environment); do repetitive activities (count floor tiles, lights or cracks, tap a finger rhythmically, fold a piece of paper in a systematic manner);
change surroundings or activities (if inside, go outside – if sitting, stand and walk – if in living room go into kitchen).

Simple tasks that require concentration – recalling the words to a song, adding up numbers, timing how long it will take to get somewhere, recalling an event that arouses positive emotions.
Conversation – actively speak to another person – on a topic unrelated to anxiety symptoms or current situation.
Work – common form of distraction – household chores, gardening, work at job – most distracting when work activities are interesting, pleasurable or involve competition.
Play – anything that is interesting and pleasurable – crossword puzzles, video games, dancing, working at hobbies, sports activities.

“There’s an old story of two men walking along the street and one man keeps stopping every few steps to bang his head on the side-walk. Finally, his friend can’t stand it anymore and says, “Will you stop hitting your head on the sidewalk?” The first man answers, “I can’t, it keeps the crocodiles away.” His friend says, “But there are no crocodiles here!” The first man smiles and says, “See”. from “Helping Your Anxious Child: A Step-by-Step Guide for Parents”, by Ronald Rapee, Susan Spence, Vanessa Cobham and Ann Wignall, 2000.

PORTLAND Anxiety Disorders Support Group Meets on the 3 rdrdrd Tuesday of each month, 12.00 pm at ASPIRE 47 Gawler street, Portland. For more information contact Sally Gilmore 5521 7203 or Merrilyn Risk 5523 4000

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 17 Mental Health &News

World Health Report ––– Mental Health: New Hope, New Understanding

The World Health Organisation released beginning of a new public health era in the that large mental institutions no longer the 2001 World Health Report "Mental field of mental health," she added. represent the best option for patients and Health: New Understanding New Hope" on A lack of urgency, misinformation, and families. Such institutions lead to a loss of 4 October, 2001. The report marked the competing demands are blinding policy- social skills, excessive restriction, human highpoint of WHO's year long campaign on makers from taking stock of a situation rights violations, dependency, and reduced mental health. For the first time in WHO's where mental disorders figure among the opportunities for rehabilitation. Countries history, World Health Day in April and the leading causes of disease and disability in should move towards setting up World Health Report were both dedicated the world, says WHO. Depressive community care alternatives in a planned to a single topic - mental health. disorders are already the fourth leading manner, ensuring that such alternatives cause of the global disease burden. They are in place even as institutions are being EXTRACTS FROM WORLD HEALTH REPORT are expected to rank second by 2020, phased out. MEDIA RELEASE - GENEVA , 4 OCTOBER behind ischaemic heart disease but ahead "Science, ethics and experience point to One in four people in the world will be of all other diseases. clear paths to follow. In the face of this affected by mental or neurological The report invites governments to make knowledge, a failure to act will reflect a disorders at some point in their lives. strategic decisions and choices in order to lack of commitment to address mental Around 450 million people currently suffer bring about positive change in the health problems," said Dr Benedetto from such conditions, placing mental acceptance and treatment of mental Saraceno, Director of WHO’s Mental disorders among the leading causes of ill- disorders. The report says some mental Health and Substance Dependence health and disability worldwide. disorders can be prevented; most mental department. Treatments are available, but nearly two- and behavioural disorders can be The policy directions have never been so thirds of people with a known mental successfully treated; and that much of this clear, says WHO. Governments who are disorder never seek help from a health prevention, cure and treatment is just starting to address mental health will professional. Stigma, discrimination and affordable. Despite the chronic and long- need to set priorities. Choices must be neglect prevent care and treatment from term nature of some mental disorders, with made among a large number of services reaching people with mental disorders, the proper treatment, people suffering from and a wide range of prevention and says the World Health Organisation mental disorders can live productive lives promotion strategies. WHO’s message is (WHO). Where there is neglect, there is and be a vital part of their communities. … that every country, no matter what its little or no understanding. Where there is The responsibility for action lies with resource constraints, can do something to no understanding, there is neglect. governments, says WHO. Currently, more improve the mental health of its people. In a new report entitled "New than 40% of countries have no mental What it requires is the courage and the Understanding, New Hope" the United health policy and over 30% have no mental commitment to take the necessary steps. Nations’ health agency seeks to break this health programme. Around 25% of The report is part of a year-long campaign vicious cycle and urges governments to countries have no mental health on mental health. For the first time, seek solutions for mental health that are legislation. … The poor often bear the multiple events at WHO including its already available and affordable. greater burden of mental disorders, both in premier report, technical discussions at the Governments should move away from terms of the risk in having a mental World Health Assembly and World Health large mental institutions and towards disorder and the lack of access to Day, have all focused on one topic–mental community health care, and integrate treatment. Constant exposure to severely health. A product of NMH Communications. World mental health care into primary health care stressful events, dangerous living Health Organisation, Geneva, 2001. and the general health care system, says conditions, exploitation, and poor health in OVERVIEW OF THE WORLD HEALTH REPORT - WHO. general all contribute to the greater MENTAL HEALTH : NEW HOPE , NEW vulnerability of the poor. The lack of "Mental illness is not a personal failure. In UNDERSTANDING access to affordable treatment makes the fact, if there is failure, it is to be found in This landmark World Health Organisation course of the illness more severe and the way we have responded to people with publication aims to raise public and debilitating, leading to a vicious circle of mental and brain disorders," said Dr Gro professional awareness of the real burden poverty and mental health disorders that is Harlem Brundtland, Director-General of rarely broken. of mental disorders and their costs in WHO, on releasing the World Health human, social and economic terms. At the Report. "I hope this report will dispel long- The report says new knowledge can have same time it intends to help dismantle held doubts and dogma and mark the a tremendous impact on how individuals, many of those barriers particularly of societies and the public health community stigma, discrimination and inadequate deal with mental disorders. We now know 18 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria services which prevent many millions of especially in situations where psychosocial better used. In addition, interventions people worldwide from receiving the interventions and highly skilled should take account of age, sex, culture treatment they need and deserve. professionals are unavailable. and social conditions, so as to meet the In many ways, The World Health Report 3. Give care in the community needs of people with mental disorders and their families. 2001 provides a new understanding of Community care has a better effect than mental disorders that offers new hope to institutional treatment on the outcome and 6. Establish national policies, the mentally ill and their families in all quality of life of individuals with chronic programmes and legislation countries and all societies. It is a mental disorders. Shifting patients from Mental health policy, programmes and comprehensive review of what is known mental hospitals to care in the community legislation are necessary steps for about the current and future burden of is also cost-effective and respects human significant and sustained action. These disorders, and the principal contributing rights. Mental health services should should be based on current knowledge and factors. It examines the scope of therefore be provided in the community, human rights considerations. Most prevention and the availability of, and with the use of all available resources. countries need to increase their budgets obstacles to, treatment. It deals in detail Community-based services can lead to for mental health programmes from with service provision and planning; and it early intervention and limit the stigma of existing low levels. Some countries that concludes with a set of far-reaching taking treatment. Large custodial mental have recently developed or revised their recommendations that can be adapted by hospitals should be replaced by community policy and legislation have made progress every country according to its needs and care facilities, backed by general hospital in implementing their mental health care its resources. psychiatric beds and home care support, programmes. Mental health reforms should The ten recommendations for action are as which meet all the needs of the ill that were be part of the larger health system reforms. follows. the responsibility of those hospitals. This Health insurance schemes should not 1. Provide treatment in primary care shift towards community care requires discriminate against persons with mental health workers and rehabilitation services disorders, in order to give wider access to The management and treatment of mental to be available at community level, along treatment and to reduce burdens of care. disorders in primary care is a fundamental with the provision of crisis support, step which enables the largest number of 7. Develop human resources protected housing, and sheltered people to get easier and faster access to employment. Most developing countries need to services. It needs to be recognized that increase and improve training of mental many are already seeking help at this 4. Educate the public health professionals, who will provide level. This not only gives better care; it cuts Public education and awareness specialized care as well as support the wastage resulting from unnecessary campaigns on mental health should be primary health care programmes. Most investigations and inappropriate and non- launched in all countries. The main goal is developing countries lack an adequate specific treatments. For this to happen, to reduce barriers to treatment and care by number of such specialists to staff mental however, general health personnel need to increasing awareness of the frequency of health services. Once trained, these be trained in the essential skills of mental mental disorders, their treatability, the professionals should be encouraged to health care. Such training ensures the best recovery process and the human rights of remain in their country in positions that use of available knowledge for the largest people with mental disorders. The care make the best use of their skills. This number of people and makes possible the choices available and their benefits should human resource development is especially immediate application of interventions. be widely disseminated so that responses necessary for countries with few resources Mental health should therefore be included from the general population, professionals, at present. Though primary care provides in training curricula, with refresher courses media, policy-makers and politicians reflect the most useful setting for initial care, to improve the effectiveness of the the best available knowledge. This is specialists are needed to provide a wider management of mental disorders in already a priority for a number of countries, range of services. Specialist mental health general health services. and national and international care teams ideally should include medical 2. Make psychotropic drugs available organizations. Well-planned public and non-medical professionals, such as awareness and education campaigns can psychiatrists, clinical psychologists, Essential psychotropic drugs should be reduce stigma and discrimination, increase psychiatric nurses, psychiatric social provided and made constantly available at the use of mental health services, and workers and occupational therapists, who all levels of health care. These medicines bring mental and physical health care can work together towards the total care should be included in every country's closer to each other. and integration of patients in the essential drugs list, and the best drugs to community. treat conditions should be made available 5. Involve communities, families and whenever possible. In some countries, this consumers 8. Link with other sectors may require enabling legislation changes. Communities, families and consumers Sectors other than health, such as These drugs can ameliorate symptoms, should be included in the development and education, labour, welfare, and law, and reduce disability, shorten the course of decision-making of policies, programmes non-governmental organisations should be many disorders, and prevent relapse. They and services. This should lead to services involved in improving the mental health of often provide the first-line treatment, being better tailored to people's needs and communities. Non-governmental

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 19 organisations should be much more determine trends and to detect mental develop more effective interventions. Such proactive, with better-defined roles, and health changes resulting from external research should be carried out on a wide should be encouraged to give greater events, such as disasters. Monitoring is international basis to understand variations support to local initiatives. necessary to assess the effectiveness of across communities and to learn more 9. Monitor community mental health mental health prevention and treatment about factors that influence the cause, programmes, and it also strengthens course and outcome of mental disorders. The mental health of communities should arguments for the provision of more Building research capacity in developing be monitored by including mental health resources. New indicators for the mental countries is an urgent need. indicators in health information and health of communities are necessary. World Health Organization, 1211 Geneva 27, reporting systems. The indices should 10. Support more research Switzerland include both the numbers of individuals Fax: (41-22) 791 4870, Email: [email protected] with mental disorders and the quality of More research into biological and Copies of this publication can be ordered from: their care, as well as some more general psychosocial aspects of mental health is [email protected] The full World Health Report can be viewed at measures of the mental health of needed in order to increase the http://www.who.int/mental_health/ communities. Such monitoring helps to understanding of mental disorders and to

ConsuConsumermer Perspectives On Managing Multiple MedicinesMedicines The Pharmaceutical Health and Rational involved more than 110 consumer • unexplained changes to their medicines use of Medicines Committee (PHARM) organisations: some large state-based • ineffective pharmacy labels is about to release its report - Consumer consumer groups, others smaller self-help • inappropriate attitudes and poor Perspectives on Managing Multiple and specialist community groups whose understanding of medicine use Medicines. The report describes a series members have chronic conditions • poor access to information of consultations with consumers who take necessitating the use of multiple • inadequate communication multiple medicines on a long-term basis. medicines. The consumers talked about • cost issues The consultations sought ideas and the problems they face in managing their • inappropriate prescribing. feedback on: multiple medicines. They identified a The findings of this report- along with those • the problems consumers face in range of factors that prevent or make it of other consumer consultations and managing multiple medicines difficult for them to be active partners in the research - must be considered if • the possible solutions needed to address use of their medicines and to act wisely successful strategies are to be developed those problems when using them. They also discussed to improve the quality use of medicines possible solutions for the problems they The consultations were conducted by the raised. Many of the problems the Consumer Sub-Committee of PHARM and consumers experienced were due to:

Media Watchdog on Mental Health Issues --- National Award Reprinted from ARAFEMI News – Volume 8, Issue 3, September 2001

SANE StigmaWatch- an Internet-based it’s vital that TV programs, journalists and attention recently when SANE Australia watchdog to monitor the Australian advertisers get it right’. Stigma and launched a public campaign condemning media’s reporting of mental health- was prejudice are the number one concern of as ‘outrageous and unacceptable’ its named winner of the Gold Award for the those affected, according to research ridiculing of people with a mental illness Best Mental Health Promotion Program at conducted by SANE. Stigma is also a as ‘a twisted little tribe of freaks’, ‘nutters’ The Australian and New Zealand Mental major factor in people not seeking help and ‘maniac killers’. Health Services (TheMHS) Conference. and receiving treatment when they Following discussions with SANE StigmaWatch monitors print and electronic develop a mental illness. Australia, the Managing Director of Sony media, as well as advertising, for cases of Recent targets of StigmaWatch include Computer Entertainment Australia, stigma. Cases of inaccurate or offensive Channel Seven’s Today Tonight; Michael Ephraim, has confirmed that: material relating to mental illness and Twentieth Century Fox- who agreed to • all promotional material for the game has suicide are detailed on SANE’s website remove offensive wording from the Me, been removed from the PlayStation and those responsible are encouraged to Myself and Irene video cover- and website. report more accurately in future. Samboy Chips- who dumped their ‘Psycho • the October 2001 launch has been The StigmaWatch program has received Strength’ chips after a complaint from cancelled wide acclaim with the Federal SANE. • the game has been withdrawn from the Government recently announcing major The most recent victory is the withdrawal Sony PlayStation catalog. funding to expand the program. Receiving of a controversial PlayStation game after • content will be revised in consultation the award in Wellington, SANE Australia’s public campaign by SANE. The with SANE Australia before eventual executive director, Barbara Hocking said: PlayStation game - Twisted Metal: Black- release. ‘Australians get most of their information was originally planned to be launched in For more details visit the StigmaWatch about mental illness through the media, so October 2001. The game captured media log at www.sane.org

20 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria

Media Watch &

4 Part Series – Beyond Depression by the Age Newspaper online at www.theage.com.au/issues/index.html

SIX IN 10 GP PATIENTS HAVE MENTAL ILLNESS : STUDY

Sixty percent of people who visit general practitioners have a mental disorder, according to a ground-breaking study of 46,000 patients. The findings, by Professor Ian Hickie and a team of scientists at the University of NSW’s School of Psychiatry, point to higher rates of mental illness than have been acknowledged to date. The research showed GPs consistently underestimated their patients’ mental disorders. In those with severe symptoms, doctors failed to recognise a problem in just under half of cases. Where the symptoms were less severe, GPs recognised even fewer cases. They were least likely to do so if the patient reported somatic symptoms, rather than psychological distress. While more than half the patients were suffering some mental disorder, only half of these would need immediate medication or psychological therapy. The rest would require close monitoring. The research showed that screening – using a questionnaire filled out in the doctor’s waiting room – could reveal psychological conditions that would otherwise go unnoticed. Professor Ian Hickie said a screening program should be rolled out next year, after Medicare is changed to allow doctors to spend longer with depressed patients. Sydney Morning Herald

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 21 A crippling disorder nearly ruined Melissa’s life – until the TV talk show queen put a name to it.

Woman’s Day April 2001

Aussie actress Melissa Tkautz credits an episode of The Oprah Winfrey Show for turning her life around. Melissa, 27, was fighting chronic depression when she saw Oprah talking to people with psychological conditions such as obsessive compulsive disorder and agoraphobia. “It was as if I were listening to the story of my own life,” Melissa says. “Suddenly, I had names for what was wrong with me. “The next day, I saw my doctor and got a referral to a psychiatrist and she worked with me on and off for two years, just letting me talk out what had been happening to me and listening to my fears.” Melissa now believes her troubles began when she was 13. “Virtually overnight, I was obsessed with neatness and cleanliness. Before I went to school, I would make my bed three or four times, until there wasn’t a crease anywhere.” Melissa’s obsessions grew, including a fixation with doing things by uneven numbers. For instance, she’d have to look at a stranger on the street three times. “I felt if I didn’t look at them three times, any troubles the other person had would be transferred to my own family. I was lost in a confused world of my own making,” she says. When Melissa began work on E Street , playing Nikki Spencer, the obsessive behaviour suddenly stopped. “I was only 15 or 16, but I guess the discipline of learning lines, new friendships and the pressure of work sorted out that bout of strange behaviour,” she says. “I took time off television to start a successful singing and Read My Lips was a smash hit. I was very much in demand and for two years I worked virtually non-stop.” Then she began suffering panic attacks. “I lost confidence completely and I didn’t want to face the world anymore or meet anyone,” she says. “I just wanted to stay home. I was full of fear and crying all the time, and the worst part was, I didn’t know why.” Melissa now puts this confidence crisis down to career pressures and says that facing her illness has made her much stronger. “I’m on top of the world now – self-assured and ready to face any challenge,” she says. “I hope that anyone with an emotional crisis who reads this will do what I did – realise that they are not alone and that, with help, they can free themselves of the nightmare their life has become and start living again.”

Story: Jerry Fetherston

22 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria

New Research & Projects

WebWeb----basedbased prevention of mental health problems the MoodGYM training program Helen Christensen, Senior Fellow, The Centre for Mental Health Research, The Australian National University. Originally published in Ausinetter, Newsletter of the Australian Network for Promotion, Prevention and Early Intervention for Mental Health, Issue 13, September, No. 2/2001. Reprinted with permission.

One of the important conclusions from the Mental Health understanding of an individual’s belief system (for example, the Promotion and Prevention National Action Plan (1999) was that person’s preferences for medical compared to alternative or treatment approaches by themselves would not be sufficient to lifestyle preferences), the individual’s motivation for change address the high burden of disability associated with mental health (whether they are ‘ready’ to learn lifestyle changes) as well as problems. This recognition points to the importance of developing knowledge of the most effective prevention strategies. The effective prevention programs that can be readily accessed by the person’s immediate circumstances and level and type of community. vulnerability also require assessment. Prevention programs in mental health have been found to be One approach to this challenge may be to harness the capabilities effective when targeting ‘at risk’ groups or risk factors such as of the internet (and internet technologies, including its associated alcohol abuse, postnatal periods (selective prevention) and software) to deliver such prevention programs. The internet may individuals with symptoms (indicated prevention). In the area of be a preferred method to deliver prevention programs because it youth depression there have been successful interventions provides twenty four hour, self paced access to mental health directed towards ‘at risk’ school age individuals (Jaycox, Reivich, interventions, has the capability of supporting software that can be Gillham and Seligman, 1994) and undergraduates at university tailored for individual needs and is informed by medical informatics (Seligman, Schulman, DeRubeis and Hollan (1999). These (Eysenbach, 2000). The latter discipline is likely to provide specific interventions have used cognitive behaviour therapy (CBT), a form information about the types of approaches that will lead to faster of therapy that is effective when delivered face to face by a knowledge uptake and satisfaction by users. The net is already therapist, via self-help books (bibliotherapy) and through computer established as a major source of health related information administration. suggesting that internet based prevention of mental health In areas other than mental health, a wide range of prevention problems will be well accepted. Information about the person’s programs have been conducted in the last decades directed at experience of the program and their responses to assessment worksites, communities and schools to change risk factors such as questions can be recorded and used to evaluate the effectiveness smoking, high-fat diet consumption and thus prevent diseases of the programs. such as cardiovascular disease and cancer. Sorensen, Emmons, Although there are now outcomes showing the effectiveness of Hunt and Johnston (1998) reviewed these findings and noted that using the internet as a means of delivering effective prevention in the next ‘generation of community-based interventions’ (p 379) many areas including dietary changes, smoking and exercise should be tailored to the needs of individuals, involve communities (Tate, Wing, and Winette, 2001), there are very few prevention in the planning of the intervention and be targeted at multiple programs using the internet that have been employed in mental levels. They noted that different disciplines brought knowledge that health. However, Stanford University’s Student Bodies program is could be used at a range of levels from the micro (biomedical) an example of a successful prevention program that used the through to the macro (society and health) level. The focus of these internet to change risk for eating disorders. Educational content, a levels suggest different but complementary mechanisms for newsgroup, and structured weekly readings, assignments and implementing prevention programs. Other research from the postings improved body dissatisfaction (Winzelberg, Taylor, mental health area has pointed to the importance of the recognition Altman, Eldredge, Dev, 2000). and acknowledgment of the needs of ‘at risk’ groups and the The Centre for Mental Health at the Australian National University importance of protective factors to increase resilience. has recently developed an internet prevention program for ‘New generation’ prevention programs in mental health (and in the depression in young people. The program uses CBT, and aims to area of depression specifically) will need to take into account these increase the accessibility of this proven prevention intervention. considerations. Incorporating these issues is challenging because Young adults are an age group not easily reached by existing the process is new and the knowledge may not yet be developed. services. They are dispersed across a multiplicity of home, work, Customised tailoring for depression intervention requires an recreational and learning settings. The internet provides a practical

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 23 solution to the problem of disseminating preventive CBT programs. the significance of interpersonal relationships to people of this age, Recent ABS figures reveal that young adults accessed the net Module 5 deals with separations and break-ups. more than any other age group. Approximately 75% of all 18 to 24 The initial development of the package was based on action year olds accessed the internet in the 12 month period prior to research involving input and feedback from young people, mental November 1999. Overall, an estimated 6.4 million adults (46% of health professionals with expertise in CBT, and a formal advisory Australia's adult population) used the internet in the 12 months to board comprising relevant experts and stakeholders. The program May 2000 compared with 5.5 million adults (40%) in the 12 months is currently being pilot tested at the Australian National University to May 1999. Moreover, the interactivity and multimedia and the University of Canberra. In 2002 a randomised controlled possibilities afforded by standard web browsers offer the potential trial will be undertaken in the community. to engage the target population in ways that are not possible using conventional delivery methods. To our knowledge, MoodGYM is MoodGYM was launched officially by the ACT Minister for Health, th the only CBT depression prevention program on the web. Housing and Community Care, Mr Michael Moore, on the 17 July 2001 at the National Museum of Australia. In the week of the MoodGYM consists of five modules: an interactive game, anxiety launch, the site had 83,000 hits. and depression assessments, downloadable relaxation audio, a workbook and feedback assessment. It includes individualised MoodGYM can be accessed at http://moodGYM.anu.edu.au. assessments of anxiety and depression, dysfunctional thinking, life-event stress, parental relationships and the scheduling of References activities, for which we have collected community norms. The Commonwealth Department of Health and Aged Care (1999). Mental Health graphics of MoodGYM have been professionally designed to Promotion and Prevention National Action Plan. appeal to this age group. Users register on the site, complete Eysenbach, G. (2000). "Consumer health informatics ." British Medical Journal, 320: 1713-1716. anxiety and depression ‘quizzes’, meet the site characters Jaycox, L. Reivich, K., Gillham, J. and Seligman, M.E.P. (1994). "Prevention of (Noproblemos, Elle, Cyberman and others), and start module 1. depressive symptoms in school children." Behaviour Research and Therapy , 32: 801-816. Module 1 is an introduction to the principles of CBT, and Seligman, M.E.P., Schulman, P., DeRubeis, R.J. and Hollan, S.D. (1999). "The demonstrates through flashed diagrams and online exercises the prevention of depression and anxiety." Prevention and Treatment , 2: Article 8, posted December 21, 1999. . Last relationship between emotions and thoughts. There are a number accessed June 2001. of exercises where users can come to grips with their own Sorensen, G., Emmons, K., Hunt, M.K and Johnston, D. (1998). "Implications of the emotions and the 'warpy' thoughts that might accompany them. results of community intervention trials." Annual Review of Public Health , 19: 379-416. Module 2 continues the theme with the recognition of thoughts and Tate, D.F, Wing, R.R., and Winette, R.A. (2001). Journal of the American Medical their consequences. Module 3 introduces users to other Association, 285: 1172-1177. Winzelberg AJ, Eppstein D, Eldredge KL, Wilfley D, Dasmahapatra R, Dev P, techniques than thought-contesting to gain perspective on their Taylor CB. (2000). "Effectiveness of an Internet-based program for reducing risk emotions and how to handle them. Module 4 deals with stress, factors for eating disorders." Journal of Consulting and Clinical Psychology , 68: pleasant events, scheduling, relaxation and meditation. Because of 346-50.

Victorian Research Projects selection criteria will participate in a research disorder (OCD), panic disorder, social phobia Swinburne Univeristy of interview. Later, they will attend a second or depression, we need your help. Two Technology --- interview. All participants will receive feedback, different research studies are currently being and will have an opportunity to follow up any held at the University of Melbourne to explore Is the migration experience comments or reactions they have. All thinking styles associated with anxiety and associated with Social Anxiety? participants will have the option of an 8-week depression. Is the migration experience associated with group treatment program. Information by Study 1 examines the changes that take place social anxiety? Mariel Sanchez-Rockliffe, a individual participants will be kept confidential. during cognitive behavioural treatment of OCD. doctoral student of counselling psychology at You are free to withdraw your consent and This study involves 16 weeks of individual Swinburne University of Technology, is discontinue participating at any time. For cognitive behavioural treatment of OCD. In conducting research that will explore the link further information phone Mariel Sanchez- order to participate, you must have a current between social anxiety and the migrant Rockliffe on 9429-2903 or 0413 537 282, or diagnosis of OCD. Please contact Ms Celia experience. Many migrants feel that they have email [email protected]; or contact her Horden on (03) 8344 5572 for more details. to re-invent themselves in their new country. It supervisors, Dr Glen Bates (9214-8100), and Study 2 explores the involvement of identity is almost as if they become a different person. Dr Emiko Kashima (9214-8206), School of and self-concept in anxiety and depression. It The experience can often be stressful, even Social and Behavioural Sciences, Swinburne involves a 45 minute interview and some traumatic; and may give rise to social anxiety University of Technology. questionnaires. In order to be eligible for this or exacerbate an existing tendency. If you are study, you must be suffering from an anxiety or a migrant who can relate to this, and wish to University of Melbourne --- mood disorder. Please contact Mr Sunil Bhar participate in her research, Mariel would like to on (03) 8344 5572 or hear from you. Those wishing to participate in Thinking styles associated with [email protected] for more details. the study will first complete self-report scales anxiety and depression. relevant to emotional reactions, and will attend If you are suffering from an anxiety or mood an interview. Next, those who meet the disorder such as obsessive compulsive

24 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria RMIT University --- consequences of different types of teasing – will be asked to complete a questionnaire, performance or appearance related, and which can be sent out and returned by mail. Investigating the relation between whether the level of social anxiety experienced The questionnaire will take approximately 30 teasing and social anxiety varies as a function of the individual’s minutes. If you would like to participate phone This research is being undertaken by Laura relationship with the teaser. Finally the ARCVic on 9576 2311 or 9576 2477 and Williams, Master of Psychology student, research will investigate whether interpersonal request a copy of the questionnaire to be sent supervised by Dr David Smith. The research support plays a mediating role between teasing to you. For further information contact Laura will consider the possible role of teasing in the and social phobia. Laura is seeking people Williams on 9925 7376 (RMIT Psychology development of social anxiety and impact on who have social anxiety disorder to participate Dept.). self-esteem. It will also look at the in her research project. Interested participants

International Research UpDate on OCD Selected and abstracted by Bette Hartley, M.L.S., and John H. Greist, M.D., Madison Institute of Medicine. The following is a selection of the latest research articles on OCD and related disorders in current scientific journals. From www.ocfoundation.org Long-Term Treatment Of Obsessive- to the recurrence of OCD in most patients (23- symptoms were associated with core eating Compulsive Disorder After An Acute 89%). The aim of this study was to determine disorder symptoms in females, but not in males. Response: A Comparison Of Fluoxetine whether OCD patients initially responding to Gender-Related Clinical Differences In Versus Placebo drug therapy and who relapsed upon drug Obsessive-Compulsive Disorder Journal of Clinical Psychopharmacology, 21: 46 - discontinuation would respond again when European Psychiatry, 14:434-441, 1999, F. 52, 2001, S. Romano, W. Goodman, R. Tamura, J. Bogetto, S. Venturello, U. Albert et al. Gonzales and the Collaborative Research Group given the same drug at the same daily dose. Of This study investigated the gender-related (sex- Few controlled studies have evaluated the long- 183 patients responding to treatment with related) differences in a sample of 160 patients term continuation of drug therapy for relapse Clomipramine (Anafranil), fluoxetine (Prozac), with OCD. Researchers found three interesting prevention in patients with OCD. This study fluvoxamine (Luvox) or paroxetine (Paxil), gender-related features of OCD. The first assessed effectiveness and safety of fluoxetine 44.8% relapsed within 6 months of drug concerns the onset of the disorder: males have (Prozac) versus placebo in preventing relapse discontinuation. In the majority of these an earlier age at onset and precipitant events of OCD during a 52-week period in responders patients, OCD symptoms returned within the appear less likely to trigger the disorder. to short-term, 20 weeks, fluoxetine therapy. second month of discontinuation with the Females more often reported at least one life Patients who continued treatment with exception that most patients who were on event or one severe event prior to OCD onset. fluoxetine at 60 mg/day had significantly lower fluoxetine relapsed after the third month of Childbirth was the most frequently reported rates of relapse than those who we reswitched discontinuation. Results indicate that patients event. In 25% of the women versus 2.6% of to placebo. Patients who responded to whose symptoms recur after drug men, childbirth preceded OCD onset. The fluoxetine doses of 40 or 20 mg/day and discontinuation respond again when the same second interesting finding is that OCD occurs in continued those doses also had low overall drug used previously (at the same dosage) is a high proportion of males who already have rates of relapse, but the difference in relapse used, but the degree of response was less for phobias and/or tic disorders. The third finding is rates between fluoxetine-treated and placebo- some patients. This implies that some patients that an episodic course (marked by symptom treated patients was not statistically significant. were more resistant the second time around free intervals) of OCD is more frequent in Analyses of adverse effects, vital signs and and suggests that the increasing resistance females (35.7%) than in males (13.2%). clinical laboratory data indicated that fluoxetine may be a product of the passage of time in was safe and well-tolerated over the 52-week OCD or, alternatively, a product of additional Hypochondriasis And Its Relationship period. The current study represents the largest episodes. Researchers suggest that their To Obsessive-Compulsive Disorder findings of possible lowered response after Psychiatric Clinics of North America, 23:605-616, drug therapy relapse prevention trial to date. 2000, B.A. Fallon, A.I. Qureshi, G. Laje et al. discontinuation and high relapse rates upon The fact that continued treatment with Hypochondriasis is a disorder characterized by discontinuation support continuing medication fluoxetine did not reveal increased response the fear or belief that one has a severe illness treatment in OCD over the long term. beyond the point reached during the first 20 based on physical signs or symptoms. weeks of treatment, suggests the benefit of a Symptoms Of Eating Disorders In Determination by a physician after a thorough multimodal therapeutic approach. Based on the Obsessive-Compulsive Disorder evaluation that one is not medically ill fails to Acta Psychiatrica Scandinavica, 102: 449-453, findings of this study, consideration should be result in sustained reassurance ... the given to administering fluoxetine for up to 1 2000, H. J. Grabe, A. Thiel and H.J. Freyberger Previous studies have found high rates of obsessions with disease return. This article year to those patients who responded to initial obsessive-compulsive symptoms or personality compares hypochondriasis and OCD, and treatment with addition of cognitive behavioural traits in patients with eating disorders. It has discusses the possibility that hypochondriasis is treatment to increase response, if skilled also been hypothesized that eating disorders a subtype of OCD. Response to similar cognitive behavioural therapists can be found. are related to OCD as part of the obsessive medications supports the concept of hypochondriasis as an OC spectrum disorder, Relapses After Discontinuation Of Drug compulsive spectrum. Eating disorder symptoms and OCD symptoms are compared but differing comorbidity patterns (other Associated With Increased Resistance disorders occurring at the same time) supports To Treatment In Obsessive-Compulsive between 61 patients with OCD and 288 healthy control subjects. The OCD patients were found the concept of hypochondriasis as a distinct Disorder disorder from OCD. International Clinical Psychopharmacology, 16: to have significantly more eating disorder 33-38, 2001, G. Maina, U. Albert and F. Bogetto symptoms than controls. The results also The majority of follow-up studies of OCD identified a gender difference in that OCD patients indicate that drug discontinuation leads

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 25 The Challenge Of Obsessive- Effectiveness Of Exposure And Ritual "real" patients being seen outside research Compulsive Disorder Hoarding Prevention For Obsessive-Compulsive trials. Primary Psychiatry, 8:79-86, 2001, D.D. Disorder: Randomized Compared With Christensen and J.H. Greist Family Distress And Involvement In Nonrandomized Samples Relatives Of Obsessive-Compulsive Information is presented on individuals with Journal of Counseling and Clinical Psychology, OCD with prominent hoarding who were 68:594-602, 2000, M.E. Franklin, J.S. Abramowitz, Disorder Patients M.J. Kozak et al. Journal of Anxiety Disorders, 14:209-217, 2000, N. inquiring about or were included in a 12-week Amir, M. Freshman and E.B. Foa The efficacy of behaviour therapy (exposure self-help behaviour therapy study. There was a OCD affects the lives of relatives as well as and ritual prevention) for reducing symptoms of poor response to the behaviour therapy, which patients. This study examined the relationship OCD has been demonstrated in several is consistent with anecdotal clinical experience. between family members' reactions to the randomised controlled studies. Critics have Patients with hoarding do not seem to habituate patient's illness (e.g., assistance with rituals, argued that experimental control procedures easily to exposure therapy. Prominent hoarding modification of family routine, rejection of the used in these studies influence the treatment is rarely included on published lists of factors patient) and patient's severity of OCD and outcome and the results cannot be generalized contributing to poor response in OCD, and the response to treatment. The patient's severity of to results that would be found in typical clinical authors suggest its inclusion. Also discussed OCD was not related to the family's reactions to practice. In this study the treatment outcome are characteristics of OCD hoarders in this the illness, but the patient's response to from 110 patients receiving behaviour therapy study. Common characteristics included: (1) behavioural treatment was affected by family on an outpatient fee-for-service basis were significant others insisted that the patient obtain accommodation and modification of routine. compared with the findings from four help; (2) there was significant denial, Researchers conclude that while family randomised controlled studies. Patients were rationalization and low personal motivation for members should be told that their coping not excluded because of treatment history, change; (3) treatment was passively resisted, behaviours (e.g., helping the patient carry out medications being taken, comorbid disorders, with procrastination in doing homework rituals, etc.) are not likely to have worsened the age or OCD severity. The OCD patients behaviour therapy exercises; (4) expressions of patient's OCD, they should also be told that to receiving outpatient behaviour therapy achieved intention to try harder and do better were continue such misguided help during treatment OCD and depressive symptom reductions common; (5) marked indecision was seen; (6) may hinder the patient's improvement. there was a seeming desire to please the comparable with those found in controlled trials. researchers with obvious overestimation of It appears that the encouraging findings for improvement on self-assessment scales; and exposure and response prevention from (7) treatment outcome was poor. controlled studies can also be achieved with

A parable – very loosely adapted from the dialogue of “The West Wing” - a popular TV Program featuring The White House, The President & his staff in the West Wing.

“THE BIG BLACK HOLE”

“………. One day, this fellow was walking along the footpath, not looking where he was going, when he fell into this big black hole in the pavement. It was very deep, and very dark in there, and he wondered how he was ever going to get out. He started calling out in the hope someone might hear him, and come to his rescue. After some time, there was a response to his call for help – a total stranger. Realising there was nothing he could do for the poor fellow in the hole, he pulled out a big roll of notes, and threw a couple of them into the hole to him, and went on his way. ‘What on earth can I do with this money’, the fellow wondered – ‘it’s of no use to me down here’. He continued calling out, and eventually a priest heard him, and said, “What can I do for you my son?” The fellow in the hole replied that he needed help to get out of the hole. “I’m sorry my son, there’s nothing I can do, but perhaps these will help you”, and he threw down a set of Rosary Beads into the hole. This was a small comfort for him, but didn’t solve the problem of getting out of the hole. Finally, a friend of his heard his cries and came to the rim of the hole to see what it was all about. When he realised the situation, he jumped right in to join his friend in the hole! “Why did you do that?” asked the fellow, “now we’re both stuck down here!” “I know”, said his friend, “but I’ve been here before, and I can show you the way out!………..”

Contributed by an ARCVic member, name and address supplied.

26 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria

important treatment strategies that directly resource that contains pertinent theoretical benefit clinicians, OCD sufferers, and their loved approaches and relevant examples in a format ones . Ben Greenberg, M.D., Ph.D., Chief of the Adult designed for quick comprehension and review. OCD Research Unit, NIMH, USA. $35.30

Life on a Roller-Coaster: Living well Emotional Claustrophobia: Getting over with depression and manic depression your fear of being engulfed by people or Madeleine Kelly, AUS, 2000 situations I want to give readers information and ideas they can use as a starting point in recovering Aphrodite Matsakis, USA, 2000 the losses of relationships, jobs, homes, I feel suffocated, trapped like I might disappear money, credibility and self-determination that entirely. Then I either go into a panic or feel are often sustained through manic depression. dead inside, or sometimes I feel one way, then the other, and all I want to do is get away. This is a terrific new book on manic depression, Fear of engulfment – emotional claustrophobia bipolar, melancholia – call it what you will – by a – is not a psychiatric diagnosis, but it does have survivor, former medical student and ‘mental repercussions for a lot of people at work and in health activist’ Madeleine Kelly. Her first seven their personal relationships. The feeling of chapters concentrate on the medical approach being overwhelmed by people, of being to manic depression, and subsequent chapters suffocated by certain people or situations has tackle the period immediately following a crisis; its roots inside the family as well as a result of a step-by-step method of limiting and harmful events like experiences with extreme or preventing damage from recurring episodes; rigid organisations and belief systems. The information and ideas about education and anxiety-provoking effects of emotional Information on Eating Disorders for employment, money, adult relationships, claustrophobia are dealt with by a creative families, partners and friends children and spirituality. This is an evocative, synthesis of cognitive, behavioural and dynamic Emma Gilbert, Eating Disorders Foundation of funny and practical book. $24.95 therapies. They teach overwhelmed, guilt- Victoria Inc, AUS, 2000 ridden people how to achieve trust and This booklet is a brief introduction providing Help Yourself: Move out of depression intimacy, manage their bodies' sensations, take information about some of the common issues and anxiety charge of their minds, and devise a plan to gain surrounding eating disorders. It is written for Helga Rowe, AUS, 2001 psychological freedom – and then live by that families, friends or other support people who In twelve simple steps this program will help constructed formula. $33.50 are concerned about someone who has an you become the person you would like to be. eating disorder and require information, The strict step-by-step program outlined in this The Assertiveness Workbook: How to suggestions and ideas about how to provide book by Helga Rowe relies on a positive express your ideas and stand up for effective support. The book is divided into two commitment from the participant. Rowe is strict yourself at work and in relationships parts with part one: Discovery, providing an about the daily process of treatment and the Randy Paterson, USA, 2000 overview of eating disorders, how eating graded, sequential nature of the program. This workbook is based, in part, on a group disorders develop, their impact and treatment. Combined with a sensible diet, exercises and assertiveness training course conducted at Part two: Recovery, focuses on issues and relaxation, Rowe is convinced that we will gain Vancouver Hospital as part of Changeways , a skills involved in providing support. The book greater enjoyment of life. Step 1 involves depression treatment program that was was published by the Eating Disorders replacing negative thoughts with positive ones, developed by the author. It is a thorough Foundation of Victoria (Inc), (EDFV). To obtain and ends with Step 12: Have realistic program that counsellors will find of immense a copy of this publication contact the EDFV on expectations. This proactive approach is filled value, complete with self-assessments, (03) 9885 0318, email: with effective strategies for change – such as exercises and practical session advice. It [email protected] , website: goal-setting, positive self-talk and letting go-and targets specific aspects of assertiveness www.eatingdisorders.org.au includes self-scoring record sheets. $33.00 training such as the need for even acceptance

of compliments. From the publishers of the Obsessive Compulsive Disorder: The Major Depressive Disorder: The latest highly acclaimed Self-Esteem and The latest assessment and treatment assessment and treatment strategies Relaxation & Stress Reduction Workbook. strategies Anton Tolman, USA, 1995 $37.50 Gail Steketee, Teresa Pigott & Todd Major Depressive Disorder is part of the Schemmel, USA, 1999 compact clinicals series. Written in clear, Part of the compact clinicals series for concise language this book provides a thorough practitioners this book is written in a non- and up to date review of assessment and Books available from Open Leaves academic style with easy-to-read treatment treatment information for depression. The Bookshop, 79 Cardigan Street, Carlton, Vic., descriptions and examples outlining the latest assessment section outlines commonly used 3053. assessment and treatment strategies for diagnostic and assessment techniques such as Telephone 03 9347 2355 Obsessive Compulsive Disorder. Each chapter clinical interviewing, use of self-report Fax 03 9347 1430 begins and ends with a fictional account that measures and psychometric instruments and email [email protected] . personalises the disorder by providing discusses the value of each. The section on Note – mail order is available – prices apply to Open anecdotes illustrating a typical client’s viewpoint treatment provides an overview of a variety of Leaves Bookshop and may not reflect prices in other about their experience of the disorder and the treatment options including cognitive therapy, bookshops. therapist’s “File Notes” which address psychodynamic approach, group therapy, Some reviews provided by Open Leaves assessment, diagnosis and treatment electro-convulsive therapy, and Bookshop. considerations for the client. $35.30 psychopharmacology. Each treatment strategy Accessible and extremely helpful guide! This presented is followed by a brief review of its guide to obsessive compulsive disorder offers efficacy. This book is a comprehensive

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 27 Book Review . ObsessiveObsessive----CompulsiveCompulsive Disorders: A Complete Guide To Getting WellWell And Staying Well By Fred Penzel, Ph.D. Review by Patricia Perrin, Ph.D. Reprinted from OC Foundation USA Newsletter, Fall 2000 Dr. Penzel's book is a and impulsions, including examples of hierarchies of each and comprehensive, scholarly, yet examples of specific exposures. HRT is detailed, starting with a highly readable resource on preliminary step of destigmatising oneself, followed by the treatment of, obsessive compulsive traditional awareness training, breathing and relaxation training, disorder (OCD) and its spectrum disorders, as well as a labor of competing response training, and a welcome section on love. Fred Penzel, Ph.D. is one of the most experienced augmenting HRT. The latter includes lists of suggestions specific psychologists and behaviour therapists treating obsessive- to the different types of inputs that influence an individual’s TTM, compulsive spectrum disorders (OCSD's) today. Dr. Penzel skin picking, or nail biting. Relapse prevention is addressed for all chooses to focus on OCD and four disorders considered in the the disorders discussed. field to be part of the OCD spectrum, excluding others The chapter on children will assist parents and clinicians with early (e.g.,Tourette’s Disorder and hypochondriasis). He aims to reach identification of symptoms of OCSD's. as many sufferers of OCD, body dysmorphic disorder (BDD – imagined ugliness), trichotillomania (TTM – compulsive hair- Dr. Penzel alerts the reader to the role of Paediatric Autoimmune pulling), compulsive skin picking, and nail biting as possible, with Neurological Disorders Associated with Streptococcal infections practical tools, in order to provide hope and a path to recovery. (PANDAS), which can trigger the onset of OCD and tic disorders. Simultaneously, he provides the clinician a fly on the wall view of Finally, he tells how to tailor behaviour therapies for children, e.g., by adding rewards to maintain motivation. how he treats OCSD’s. He shares tried and true ways of communicating the rationale for treatment, how behaviour therapy I have been reluctant to use the term “recovery” in discussing works, how to motivate individuals to undertake treatment, how to relapse prevention with patients, in order not to imply that OCSD's recognise the effectiveness of treatment, and how to prevent are addictions. Dr Penzel's chapter on recovery and acceptance relapse. He comes up with gems, for example, in treating has prompted me to revise that position. He suggests that since it obsessions, “If you want to think about it less, think about it more,”; is rare that one’s symptoms go away permanently, one must and in describing the effect of behaviour therapy, when a real shift accept that “OCSD’s are a potential you will always carry with you.” occurs, “It's like a spell has lifted.” Maintaining one’s recovery, therefore, requires: Dr. Penzel uses the term OCSD's to refer to OCD and a group of a) accepting what cannot be changed, e.g., having an OCSD, disorders not currently classified together in traditional diagnostic having setbacks, and experiencing anxiety, while schemes (i.e., the Diagnostic and Statistical Manual of Mental b) changing what we can, e.g., doing exposures, blocking Disorders, Fourth Edition [DSM-IV]). This grouping is currently compulsions, using competing responses, increasing tolerance, considered in the field to make sense, since these disorders share and dispensing with perfectionism. He reminds therapists, who characteristics ranging from compulsive to impulsive. They also often become obsessed with change, that we must accept that not have similarities in their neurobiological aetiology, and in their everything can be changed. Tweaking failed behavioural responsiveness to behaviour therapy and, particularly, to techniques alone may not be enough to succeed. Helping the serotonergic medications. Considering these disorders together patient remove blocks to acceptance, e.g., perfectionism, over should have implications for understanding and treatment of control, and an excessive need for certainty, can completely shift OCSD's. Dr. Penzel describes how to implement two types of the patient’s awareness, and that may constitute the real change. behaviour therapy. Exposure and response prevention (E & RP) Dr. Penzel also includes in this book a thorough review of is used to treat OCD and BDD, and habit reversal training (HRT) is medication and alternative remedies, a chapter about family used for TTM, skin picking, and nail biting. Dr. Penzel's 18 years members, an entire chapter on obsessions, and one on of experience are clearly demonstrated in his creative and plentiful compulsions. He also differentiates OCD from obsessive examples of how to approach obsessions, compulsions, and compulsive personality disorder and discusses common disorders impulsions. (He uses “impulsion” to refer to an urge or a call to accompanying OCSD's. There is an outstanding chapter on the action which seemingly cannot be ignored, and is acted on if it is biological and environmental causes of and contributing factors to gratifying, like grooming impulsions, but not acted on if it is OCSD's. Finally, Dr. Penzel includes a list of helpful resources, repulsive, as in aggressive impulsions. Unlike compulsions, they evaluation instruments that can help in assessing OCSD's, and an do not serve to reduce anxiety.) 18-page glossary of terms. This book may seem excessively long, The longest chapter, on self help, and the chapter on treating about 400 pages, but it doubles as an encyclopaedia of OCSD's children are particularly useful in describing the specifics of and a treatment guide. If you are a sufferer of OCSD's or a implementing E & RP and HRT. Here the reader will be treated to clinician, I believe you will find this book enlightening, uplifting, and detailed outlines of how to do E & RP for compulsions, obsessions, potentially life changing.

28 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria The Opening Door &

Shirley B. – the Story of an Agoraphobic Agoraphob ia Published by the Anxiety Disorders Association of America, ADAA Reporter, Vol XII, 3, June/July 2001 Often, but not always, comorbid with panic disorder, agoraphobia is As I am writing this I am a 46 year-old recovering agoraphobic. Whew! characterised by a fear of having a I never thought I could say that, let alone write it. But three weeks panic attack in a place from which after I first admitted it in therapy, I crossed the street eight times on escape is difficult. Many sufferers my own. Some people would say "That is no big deal." No, it's not a big refuse to leave their homes, often for years at a time. Others develop a fixed deal - it's a MIRACLE! I wanted to shout, 'Hello again world, I'm back. route, or territory, from which they It's me, Shirley B.!!!" Living is what I do now. Not as fully as I plan to, cannot deviate, for example the route but it is so much more than just being. I am still struggling but that’s between home and work. It becomes okay. It took some time to be where I was, and it will take some time to impossible for these people to travel get to where I am going. I look forward to the future. I have plans. I beyond what they consider to be their safety zones without suffering severe hope this article helps someone suffering from agoraphobia, or helps anxiety. someone to understand what agoraphobia is. There isn't much I can say about how I became agoraphobic. I just slipped a little day by day. When I noticed something was wrong, I didn't know how to stop it, and I was ashamed to ask for help for fear that someone would know my secret. I was ashamed to yell or scream for help, so I slipped and slipped away, deeper into my shell, my well, my pain. I wanted to talk, but I was ashamed to say some of the things that were on my mind. I did not want to be judged. I hid in my home and inside myself. I really wanted to find a big rock and hide under it. I neglected my health and ceased to care for myself. I hurt so deeply in my heart and soul that I felt the pain would never end. I thought life was something for other people, not for me. My understanding of existence was just to be, nothing more than just to be. My daughter Nadeen was always by my side on those rare occasions when I ventured outside, forced to leave my home when I needed medical attention. In the past my fear kept me at home with all sorts of physical pains and ailments, as horrific as the pain was, the pain of facing the outside world was greater. When I had two abscessed teeth and my jaw was swollen to twice its normal size I was in such excruciating pain that I had to go to the dentist So with my legs wobbling, my heart pounding, my hands sweating, and my throat choking, to the dentist I went. After examining my x-rays, the dentist said he wouldn't be able to do anything with my teeth because they were so infected, he prescribed medication for the pain and infection and said that I must return in ten days, not in two years. I felt as though those ten days were a countdown to my own execution. Each day passed at lightning speed like a clock ticking away. The fear grew stronger and stronger. I had to walk around with my hand on my heart to keep it from jumping so hard, as if I were pledging allegiance, which I was - to my fears and phobia. I asked God to please give me strength to go back to the dentist. When the day came, I knew that my preparations would take me a little over four hours. I had to leave time, not just to bathe and dress, but to debate with myself about going. When the dentist saw me, I was sweating profusely and trembling. He spoke with me for a few minutes, explaining what he was going to do, and said that I should relax. He also said that he felt I was depressed and maybe I should talk with someone about it. I don't know how he knew, but he knew. I was being found out. My secret was not as safe as I thought it was. I thought about how three months earlier my medical doctor had also said that I seemed depressed. He thought that perhaps I should be on some antidepressants. Unfortunately, antidepressants were not the answer for me. I felt hopeless again until Dr. L. told me that people can be treated in many different ways, there were several options and not to lose hope. There were other forms of treatment. I thought that I didn't know where to begin not realising that wanting to change was a beginning itself, my first step toward recovery. I told my daughter that I needed help. She looked at me with love and tears in her eyes and said "Mom, I'm trying to help you in every way I know how. I don't know what else I can do." I told her that I needed a professional to show me how to help myself.

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 29 I was shaking so badly as I went to meet Dr. Beth Halpern that Nadeen had to hold my arm, but I also felt hopeful. Dr. Halpern and I talked for quite awhile. I couldn't believe that I was saying all the things that I was saying. I found myself asking her questions, such as: "Do you think I can be helped?" She said "yes." I decided to ask the question that frightened me most of all. I asked if she thought I was crazy. Dr. Halpern bent toward me and said, "Shirley, you are not crazy, you are not crazy." I smiled and sighed with relief. As I write these words on paper, my heart fills with gratitude for all the people who have helped me towards my recovery. My first therapist, Jennifer Cantor, helped me lay the foundation for all of the therapy to follow. She had to actually teach me how to breathe properly, which is essential to relaxation. I know that after each session I had with Ms. Cantor, I walked away feeling stronger. At the end of our sessions Ms. Cantor gave me a homework assignment. My final assignment was to make a list of all the accomplishments I had made since starting treatment. I started my list and before I knew it I had written nearly to the end of the page: going to the supermarket alone, riding a bus, going to therapy and returning home alone. I felt proud and strong, but at the same time I realised that I still had work to do. I began my treatment with my new and current therapist, Ms. Alex Bloom. Ms. Bloom suggested that I come up with one thing that I would like to do. I had an idea of what that might be - writing an article about my treatment. Ms. Bloom thought it was a fantastic idea. I wasn’t scared on the subway that day (not very much anyway) as I thought about writing my article. I realised that I was smiling. Each week that followed I had at least two chapters written. I would start each session by reading the chapters I had written. Ms. Bloom said she could tell that my writing was helping me and she felt sure it would be of some help to others. She said that perhaps we could get my story typed and distributed to some people - it might help. I was overjoyed. Ms. Bloom's faith in me and in what I was doing was invaluable. If you are reading this, then my wish has become a reality. I hope this helps someone - anyone in some way. I no longer hide inside that deep dark hiding place, but my struggle continues. There are more challenges to conquer. I will not hide any longer in the shadow. I choose to walk toward my fears with the strength of the accomplishments I have made and with faith in my heart.

Silly thoughts through my head

Silly thoughts through my head, Feeling ashamed alone and scared. I didn’t really know what to do, Until I reached the age of 22.

I said to my mum “Please don’t hate me” Something was wrong, I needed help, she could see. I went to a psychiatrist, feeling scared and alone, I didn’t really know what was going on.

And as this lovely man sat and spoke to me, He lifted the burden I seemed to carry for eternity. As I sat on his chair, the tears streaming down my cheeks, He gently explained, “You have what they call OCD”. From that moment on, it was the turning point for me.

Terri Staggard Member ARCVic, August 2001

30 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria ARCVic Seminar December 2001

Question & Answer Seminar: Anxiety Disorders & Depression

Presented by

Dr Michael Kyrios Clinical Psychologist, Senior Lecturer, Dept. Psychology & Psychiatry, University of Melbourne Dr Scott Blair-West Psychiatrist, Private Practice & Consultant Psychiatrist to North-West Mental Health Area Service, Royal Melbourne Hospital Dr Nick Allen Clinical Psychologist, Senior Lecturer, University of Melbourne

Date: Thursday 6th December Time: 7.30 pm - 10.00 pm

Venue: The Peppercorn Club 584 Glenferrie Road Hawthorn

Entrance Fee : Members - $3.00, Non-members - $5.00 Booking is not required

December Special Events

ARCVic Annual General Meeting 2001

Date: Thursday 6th December Time: 6.45 pm Venue: The Peppercorn Club 584 Glenferrie Road Hawthorn

All are welcome to attend the ARCVic Annual General Meeting 2001. The AGM will be followed by the Question and Answer Seminar: Anxiety Disorders & Depression commencing at 7.30 pm.

End of Year Supper

Join us for our End of Year Supper to be held at the

Peppercorn Club, 584 Glenferrie Road, Hawthorn

Date: Thursday 20 th December Time: 7.30 pm

Cost: $7.00 Adults, Children Free

We look forward to sharing with you a gourmet catered supper, music, and good company. Santa will be there with a sack of goodies for the children and a delicious food hamper will be raffled for the adults!

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 31

OCD & Anxiety HelpLine 03 9576 2477

Monday - Friday 10.00 am - 4.00 pm Message Bank – 24 hours – NB. The Message Bank operates if the telephone counsellor is currently taking another call – this is to avoid callers constantly getting an engaged signal, and allows a message to be left. Please leave a message – the counsellors always attempt to return calls as soon as possible. The HelpLine team provide counselling, information and referral advice to people with OCD and Anxiety Disorders, and their families.

Important Phone Numbers – ℡ LifeLine 13 1114 ℡ LifeLine Suicide HelpLine 1300 651 251 ℡ CareRing 136 169 ℡ Kids Help Line 1800 55 1800 ℡ ParentLine 13 2289 ℡ Grief Line 9596 7799

Jenny, would like to Clair would like to make Debbie, a mother of 2 correspond with other contact with fellow OCD children with OCD, would Pen Pal people who have OCD. sufferers in her area (Nth like to contact or write to She is 25 years of age Qld) or elsewhere. other OCD sufferers or Network (#907) (#908) carers. (#906)

Janet would like to write Jayde, a ten year old girl, to people who have Social is interested in making Phobia, Panic Attacks, Joel, a 14 year old boy, phone contact or writing Agoraphobia or anyone would like a phone/pen-pal to other people of her age who feels lonely or who has OCD. who have OCD depressed. Write to: (#910) (#909) Janet, PO Box 436, Golden Square, Vic, 3555

I am Interested in contacting other people A penpal is being sought who are wanting to talk A 15 year old boy would by a 13 year old girl who about music from the 30’s like a penpal in his age has OCD. & 40’s, jazz, birdwatching, group who has OCD. (#912) and green left politics. (#911) Contact “elwood” at email: elwood_pdowd@hotmail. com.au (#913)

If you would like to Kathy would like to write Laura is 22 years of age respond to any of these Janelle is interested in establishing phone to people who experience and would like to write to requests please contact contact with other people panic attacks and other people in her age Jessica on the ARCVic who have OCD. depression and are in the group who experience panic Office Line 03 9576 2311 (#914) mid-thirties to forties attacks and depression. for further details, or send age group. (#915) (#916) your name and address by mail to ‘Pen Pals’, Katrina would like to ARCVic, Bryan is 21 years of age contact by phone or write PO Box 358, and is interested in to other mothers who Mt Waverley, Vic, 3149, contacting people in his have a child under 10 and indicate which person age group who have OCD. years of age with OCD. (#918) you would be interested in (#917)

contacting (by name and/or code number).

Note- each Pen Pal Request will be published in three editions of the Newsletter, unless a notice to delete the Request is received from the person who initiated the Request. ARCVic does not accept responsibility for any outcome, resulting from any written or verbal correspondence entered into, in relation to these Requests.

32 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria

ARCVic

For further information Social Group please contact the Social Group Calendar Coordinators on 03 9576 2311

2001

SATURDAY 24 th NOVEMBER Umago Café ––– PastPastaa & Pizza All You Can Eat Banquet Come and join us at Umago’s for a delectable selection of all you can eat gourmet pastas and pizzas.

Location: Umago Café, 171 Brunswick Street, Fitzroy - (Melway Ref: 2C A 9) Time: 6.30 pm Cost: $16.50 *Bookings preferred for this event - Please register by phone on 9576 2311 or in person – see John or Jessica

SATURDAY 15 th DECEMBER Half Moon Bay Fish & Chippery Feast on freshly prepared fish and chips, in an outdoor dining setting with sea views, seagulls and the smell of salty air.

Location: Half Moon Bay Foreshore, Beach Road, Black Rock - (Melway Ref: 85 H 2) Time: 6.00 pm - Meet at the Half Moon Bay Fish & Chippery, adjacent to the Black Rock Yacht Club

Information for family members, friends and others about “being a carer the carer experience A carer is a relative or when someone close to you is living with mental illness friend who provide unpaid practical help Developed by Carerlinks Eastern About this booklet … and emotional support “This booklet is for people with a relative or friend who has experienced serious mental illness: it is a to someone affected by starting point for understanding and dealing with the many emotional and practical effects of illness, injury or everyone’s life … [the booklet will] help carers: disability. identify needs and understand how to begin getting these needs met, For every person who support the person living with mental illness, directly experiences work with professionals and organisations.” (from the booklet) mental illness, many family members, The booklet includes sections on: Being a Carer; About Recovery; Taking Care of Yourself; Supporting the Person Living with Mental Illness; Getting the Best from the Mental Health System; friends, workmates and Resources: Some Starting Points. others are affected in some way. Life To order: Contact Carerlinks Eastern on 9852 7455 or freecall 1800 059 059 changes a lot for those - or write to Sandra Abbe, Villa Maria Carer Services, Locked Bag 20, Kew, Vic 3101 close to the person.” Booklet is available free of charge to unpaid carers of people with mental illness living in the Eastern The carer experience, 2001 metropolitan region of Melbourne – otherwise $5.00 per copy.

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 33 Support for people and families living with anxiety disorders

Anxiety Recovery Centre Victoria --- Support Groups & Branches

Inner East – 2 support group meetings each month. Families, Carers & Friends Venue: The Peppercorn Club – 584 Emerald Support Group Glenferrie Road, Hawthorn. Time: 7.30pm Venue: Emerald Community House, 354 – A support group for families, carers and – first and third Thursday each month. 356 Main Road, Emerald. Time: 7.30 pm, friends of people with an anxiety disorder. second & fourth Monday each month. Venue : The Peppercorn Club – 584 Enquiries – Dianne Legge - 59684759. South East Glenferrie Road, Hawthorn. Time: First Venue: East Bentleigh Community Health Thursday of each month. Centre, Gardeners Road, East Bentleigh. Moe-Narracan Time: 7.30 pm, second Monday each Venue: Moe-Narracan Community Health Parents’ & Adolescents’ Support month. Centre, 42-44 Fowler Street, Moe. Network Time: 10.00 am, Mondays fortnightly. A support network for adolescents with Werribee Enquiries – Catherine Ashford 03 5127 OCD - 11-16 years old, and their parents. Venue: Werribee Community Centre, 5555. Ring 9576 2477 for more information. 4 Synnot St, Werribee. Time: 7.30 pm, last Thursday each month. Outer East Social Anxiety Disorder Support Enquiries: HelpLine (03) 9576 2477. New group will be commencing in Box Hill in 2002. Contact ARCVic to register Group Ballarat interest in attending. A support group for people with Social Venue: 137 Albert Street, Ballarat. Time: Anxiety Disorder and families. Venue: 7.30 pm, first Wednesday each month. Waiora Community Mental Health Centre, Enquiries - Heather Pruis (03) 53 332 663, Bunyip 600 Orrong Rd, Armadale. Time: Last 4.30 - 8.30 pm, weekdays. Venue: Bunyip Community Centre, Wednesday each month, 7.30 pm. A’beckett Road, Bunyip. Time: 7.30 pm – Wodonga last Wednesday each month. Social Groups Enquiries – Nina – 5629 6081 Venue: Get Together House, Wodonga Monthly social events, including dinners, Enquiries: Wendy Malcolm 02 60 594 176 bowling, picnics, cinema and so on. All Time: 7.30 pm, second & fourth Tuesdays Shepparton ages welcome. See Social Group each month. Venue: North Shepparton Community House, Calendar in this Newsletter. Olympic Avenue, Shepparton. Geelong Time: 6.00 pm – 8.00 pm, first Wednesday of Group in recess – phone support available each month. - Susan Bassett 03 52 434 790 after 4 pm. Enquiries: Justin - 5822 2341

Community Organisations & Groups

Panic & Anxiety Disorders Support Attention Deficit Disorder Support Carer Respite Centre – Southern Region Group Geelong & Surfcoast Group Network Victoria 03 9276 6400 After Hours Emergency Wally or Thea 03 5278 3496, Lori 03 5277 03 5442 7897, Fax: (03) 5442 6827, Respite 1800 059 059 1303, Ildi (03) 5243 8812 ADDVic 03 9801 7185, Prahran Mission Second Story Panic & Anxiety Support Group – ACTIVE Inc. 03 9650 2570 03 9521 2711 Merinda Park Community Centre National Network of Adults & Grow 5996 9056 Adolescent Children who have a 03 9890 9846 Panic & Anxiety Disorders Association Mentally Ill Parent Mental Health Legal Centre Victoria 03 9889 3095Carers Support Group - 9629 4422 03 9889 7355 / 03 9889 6760 Mood Disorders Support Group Mental Health Foundation Victoria Anxiety Disorders Association Victoria 03 9427 0406 03 9427 0406 03 9853 8089. YOUTHWORKS – Young Adults Mental Eastern Region Mental Health The Australian Mental Health Health Project Association (ERMHA) Consumers Network 9752 5665 or 0419 312 549 03 9769 5599 041 110 9942 Women’s Health East Inner East Mental Health Services Eating Disorders Foundation Victoria Info Line – 1800 069 967 Association 03 9885 0318 SANE Australia 98909248 ARAFEMI – Association of Relatives 03 9682 5933 Southern Mental Health Association and Friends of the Emotionally and Carerlinks Eastern and Carer Respite Centre Mentally Ill 03 9852 7455 03 9553 5274 03 9889 3733

34 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria

Treatment Programs and Clinics for Anxiety Disorders

Anxiety Recovery Centre Victoria ANXIETY DISORDERS RERECOVERYCOVERY PROGRAMS 600 Orrong Road, Armadale, 3143 ARCVic Recovery Programs are aimed at supporting participants to gain knowledge, skills and strategies that will assist them to recover from their anxiety disorder and achieve a better quality of life. The programs are conducted in a group setting. The sessions combine cognitive-behaviour therapy, anxiety management, psycho-drama, relaxation training and self-help techniques. The focus of the programs is on anxiety symptoms and the range of other issues which affect recovery - self-esteem, social and conversation skills, relationship and communication difficulties, beliefs, and negative thinking. Phone Jessica Bernales, Recovery Program Coordinator on 03 9576 2311 or 03 9576 2477 for further information. Register now for Recovery Programs for Social Anxiety Disorder and Panic Disorder commencing in early 2002.

University of MelboMelbourneurne PSYCHOLOGY CLINIC 9TH Floor, Charles Connibere Building, Royal Melbourne Hospital, Flemington Road, Parkville, 3050. Ph: 9344 5572 The University of Melbourne Psychology Clinic specialises in the treatment of anxiety disorders and depression. The clinic operates on a fee-for service basis (based on income). The Clinic provides assessments, individual and group cognitive-behaviour therapy. Admission requires a doctor’s referral.

Monash Medical Centre OBSESSIVE COMPULSIVE DISORDER CLINIC Department of Child and Adolescent Psychiatry, 246 Clayton Road, Clayton, 3168 A treatment program to help young people (8 - 18 years old) to more effectively manage OCD. Time-limited cognitive behavioural treatment either with or without medication; assessment, treatment and follow-up phases; includes the young person and his/her parents; cost-free; a research component focuses on the evaluation and efficacy of the treatment programme. N.B. The OCD Clinic is currently seeking further funding to continue providing services, and the treatment program may be limited at the present time. For further information contact Rod Carne, Clinical Psychologist, on 9594 1300.

The Melbourne Clinic ANXIETY DISORDERS (C(CBT)BT) PROGRAM (Private Health Insurance Recommended) Day programs are provided by the joint facility of The Melbourne Clinic and the University of Melbourne – Anxiety Disorders Unit. The programs available include – Anxiety Disorders (inpatient) Program, and Anxiety Disorders Day Programs – Social Phobia Program, Panic and Agoraphobia Program, Obsessive Compulsive Disorder Program, and Group and Personal Skills Program. These programs are based on long-established and proven programs at the Clinical Research Unit for Anxiety Disorders at St. Vincent’s Hospital in Sydney. Clinical Director : Christopher Mogan. Program Charge Nurse : Kerryn Addison. Enquiries - (03) 9420 9225.

PADA (Panic and Anxiety Disorders Association) Victoria PANIC & ANXIETY DISODISORDERSRDERS TREATMENT CENTCENTRERERERE Rear 1423 Toorak Road, Burwood. Telephone 03 9889 6760. Fax 03 9889 1022 Treatment programs include: education, relaxation training and breathing control, letting go of fear, changing fearful thinking and beliefs, building self- esteem, handling emotions, controlling panic attacks, assertiveness skills, supported gradual exposure. The Centre does not use prescribed drugs in their treatment program. Groups for people with social anxiety disorder are run for 8 two hour evening sessions – commencement of the next group will be in October. For further information ring Gwenda Cannard, Director, PADA on 9889 7355.

Wavecare Counselling Service ANXIETY MANAGEMENT PROGRAMS 155 Coleman Parade, Glen Waverley, 3150. Phone 9560 6722 Regular Anxiety Management Programs, including ‘Facing Your Fears’ - 5 x 2 hour workshops for people with general anxiety, panic attacks, phobias and obsessive compulsive disorder; Assertiveness programs; and Stress Management Programs. Contact Wavecare for details of coming programs.

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 35

ARCVic Links

PaNDa ––– Post & Ante Natal Depression Association Inc

PaNDa’s mission is to support and inform women, and their families who are affected by post and ante natal mood disorders; and educate health care professionals and the wider community about post and ante natal mood disorders. PaNDa is a Victorian, statewide, not for profit association. PaNDa’s support network is run by dedicated staff and volunteers, many of whom have experienced depression or psychosis and/or are trained to provide support to others facing these difficulties. PaNDa services include telephone support, information and advocacy for sufferers and families, debriefing following difficult birth experiences, resource and referral information, education and training seminars for professionals and community groups. PaNDa also provides literature on antenatal and postnatal depression and psychosis, and assistance in setting up support groups for women experiencing these difficulties, their partners and families. PaNDa is located at 90 High Street, Northcote and service hours are between 9.30 am – 4.30 pm, Monday – Friday. For further information contact

PaNDa on (03) 9482 9400 Phone, (03) 9482 9420 Fax, [email protected] email, or visit the PaNDa website at http://www.vicnet.net.au/~panda .

Aspire ––– A Pathwa y to Mental Health Inc Aspire provides a cost free support service to people with a psychiatric disability, their families and carers in the south-west region of Victoria. Aspire Inc. is a non-profit, non-government community organisation. Aspire has a team of support workers who work with individuals in developing their own clear, achievable goals and objectives to increase independence, self-esteem and quality of life. This service can provide individuals with support in a number of ways which include accommodation, home

based outreach, financial, employment, recreation, leisure, health, planned respite, relationships, self- esteem and more. Aspire also has a service for carers - Sage Hill Carers Service, which provides a

supportive confidential service for the carers of people with a mental illness including support groups, information, referral, advocacy, drop-in, and respite. Aspire services are located in Warrnambool, Portland, Camperdown and Hamilton. For enquiries contact Aspire on (03) 5560 3000 Phone, 03) 5561 6193 Fax, [email protected] email.

Gambler’s HELP Eastern Gambler’s HELP Eastern Gambler’s Help is a free and confidential community service that provides problem gambling counselling and financial counselling for anyone adversely affected by gambling, either personally or through their family or friends. Gambler’s Help services also include self help and support groups, multicultural counsellors, community education and information sessions for the general public and community organisations, professional training and consultancy services to community, business and other professional industries, youth and indigenous specific project work and gambling and gaming industry liaison. Gambler’s Help Eastern has a number of locations in the cities of Boroondara, Knox, Manningham, Maroondah, Monash, Yarra Ranges and Whitehorse. For further information, assistance and appointments contact Gambler’s Help Eastern on 1300 131 973 , Monday - Friday, 9.00 am – 5.00 pm.

36 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria

Resource for people and families living with obsessive compulsive disorder

‘speaking from experience: obsessive compulsive disorder’ is a new video produced for people with OCD and their families. The video provides information about OCD from the perspective of six people who have lived with OCD for many years. The video includes segments on early signs of OCD, diagnosis and reaction, the symptoms of OCD, understanding OCD, other mental health issues, impact on life, family and relationships, telling other people, treatment, support and recovery. Produced by Tribal with the assistance of the Anxiety Recovery Centre Victoria. (Duration 43 minutes). Cost $29.95 plus p&h - to order use ARCVic Publications Order Form in this Newsletter.

Mental Health WEB Resources

Anxiety Disorders ––– First Steps to Freedom – e-group for (Including all anxiety disorders) mutual support and self-help – email Anxiety Disorders Association of America [email protected] – www.ada.org The OC Foundation of California - The Anxiety Network International www.ocdhelp.org/ HomePage – www.anxietynetwork.com Obsessive Compulsive Anonymous – Anxiety – Mental Health Net - members.aol.com/west24th/ http://anxiety.mentalhelp.net/ Trichotillomania – Fairlight Consulting – Association of Relatives & Friends of the Centre for Anxiety and Stress Treatment - www.fairlite.com/trich/ Emotionally & Mentally Ill (ARAFEMI) – www.stressrelease.com/ New chat group for people with www.vicnet.net.au/~arafemi The International Anxiety Network - trichotillomania – TTM- Carers Association Victoria – www.anxietynetwork.com/ [email protected] - for www.carersvic.org.au Anxiety And Panic Hub (Panic Anxiety further information contact Andrea on 9527 Victorian Mental Health Awareness Education Management) - 2686 Council – www.paems.com.au/index.html www.yarra.vicnet.au/~vimiac/home.htm Support for Support People – Information Depression Mental Health Net – www.cmhc.com and Support for family and friends of those Reach Out! A resource for young people Better Health Channel – with anxiety disorders – going through tough times www.betterhealthchannel.com.au www.pacificcooast.net/~kstrong/ www.reachout.asn.au An interactive youth Headroom – Australian site promoting The South African Anxiety Disorders suicide prevention service positive mental health – Support Group – www.anxiety.org.za/ Here for Life – Australian site of “Here for www.headroom.net.au Life” a Youth Suicide Prevention Yellow Ribbon Program – a help Obsessive Compulsive Disorders organisation – www.hereforlife.org.au seeking/peer support program aimed at OCD-Scrupulosity - Beyond Blue – site of the National young people – www.yellowribbon.org.au www.slbmi.com/articles.htm Depression Initiative – Australian Centre for Health Promotion – Again and Again - OCD Web-sites - www.beyondblue.org.au www.achp.health.usyd.edu.au www.interlog.com/~calex/ocd/ Depression Central – Dr Ivan Goldberg’s Australian Infant, Child, Adolescent and OCD OnLine – www.ocdonline.com (Dr clearinghouse for information on all types Family Mental Health Association – Phillip Stephenson’s Web-Site) of depressive disorders – www.aicafmha.net.au OCD Server - www.fairlite.com/ocd/ www.psycom.net/depression.central.html US National Alliance for the Mentally Ill – National Institute of Mental Health (USA) – Pendulum resources – a bipolar disorders extensive information on approaches to www.nimh.nih.gov/publicat/ocd.htm portal – www.pendulum.org advocacy, education, research and The Obsessive Compulsive Disorder support in mental health – www.nami.org Resource Centre – Mental Health Australian health information and expert www.ocdresource.com/ Sane Net – www.sane.org medical advice – www.myDr.com.au Obsessive Compulsive Foundation (USA) - Mental Health Branch (Commonwealth) – Transcultural Mental Health – www.ocfoundation.org/ www.mentalhealth.gov.au www.vtpu.org.au

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 37 Web Resources 0 Spotlight

AUSTRALIA WIDE SERVICES FOR ANXIETY ANXIETY NETWORK AUSTRALIA & SOCIAL ANXIETY AUSTRALIA Anxiety Network Australia & Social Anxiety Australia are two Australia Wide Services founded and established by Sue Cleland to provide easily accessible information, education and support to the 15% of Australians whose lives are presently affected by high levels of anxiety, their carers, relatives and health professionals. In the privacy of their own home, 24 hours a day, 365 days of the year, consumers can search these sites for information on Panic Disorder, Agoraphobia, Social Anxiety Disorder, Generalised Anxiety Disorder, Specific Phobia’s, Obsessive Compulsive Disorder and Post Traumatic Stress Disorder. The services offer relevant and local information on causes, treatments and therapies, local support groups and community organisations, workshops, where to find a practitioner, resources, personal stories, poetry corner, links, and much more. The services are free to all and the first of their kind in Australia. Be empowered and visit Anxiety Network Australia at www.anxietynetwork.com.au and Social Anxiety Australia at www.socialanxiety.com.au or contact Sue Cleland on 07 33 696 090 or email [email protected] for more information or to contribute to these Australia Wide Services.

DEPRESSIO NET .COM .AU DepressioNet.com.au is an independent Australian Internet site providing information, help and support for people with depression and their family and friends. The site aims to reduce the impact of depression on the lives of Australians. The site is produced by Australians who have experienced depression. DepressioNet.com.au includes a chat room and message board to communicate with others; the opportunity to share your experiences and read about the experiences of others; professional help and support groups in your area; information about relevant, helpful and interesting events, news, articles, research and more.

YOUTH WEB -SITES Australian Infant, Child, Adolescent and Family Mental Health Association – www.aicafmha.net.au The overall aim of the association is to actively promote the mental health and well being of infants, children, adolescents and their families and carers. Focus: Promoting Effective Practice in Child and Adolescent Mental Health – www.rcpsych.ac.uk/cru/focus FOCUS was launched in 1997 to promote clinical and organisational effectiveness in child and adolescent mental health services. Child and Youth Health – www.cyh.com.au A web-site full of information for 12 – 25 year olds. The website includes information on mental health, relationships, families, general health and sexual health. Headroom – www.headroom.net.au An innovative Australian web-site designed by young people promoting positive mental health. The Child & Adolescent Bipolar Foundation – www.bpkids.org The Child & Adolescent Bipolar Foundation is a newly-founded, not for profit organisation of families raising children diagnosed with bipolar disorder.

On humour…. FROM “T HE CHEER -FUL TIMES ” – C.H. E.E.R. S PROJECT – WWW .CHEERSPROJECT .COM

“Against the assault of laughter nothing can stand.” - Mark Twain “A smile is the curve that sets everything straight.” – Phyllis Diller “Even if laughter were nothing more than sheer silliness and fun, it would still be a precious boon. But we now know it is far more than that, that it is, in fact, an essential element in emotional health.” – Steve Allen “Homour is another of the soul’s weapons in the fight for self-preservation. It is well known that humour more than anything else in the human makeup, can afford an aloofness and an ability to rise above any situation, even if only for a few seconds.” – Victor Frankl

38 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria ARCVic Publications 7 Order Form

• Nine, Ten, Do It Again : A Guide To Obsessive Compulsive Disorder . By Kathryn I’Anson, Director, OCADF, 1997. 2 nd Ed. • OCD & Anxiety Disorders Information Package . For Professionals and Mental Health Services (Information For Clients). A Range of Information Sheets, Pamphlets, Booklists, Self-Help Strategies, and Information for Carers. Covers OCD, Hoarding, Trichotillomania, Body Dysmorphic Disorder, Social Anxiety Disorder, Panic Disorder and Agoraphobia, Specific Phobias + Overview Of All Anxiety Disorders. Free copy of latest ARCVic Newsletter included. • Social Anxiety Disorder: Theory & Management . A Collection of papers derived from the 1 st Australian Summit On Social Anxiety Disorder, Melb., 1996. Edited & produced by OCAD Foundation Victoria (ARCVic). • ‘Speaking From Experience: Obsessive Compulsive Disorder’ . A video produced for people with OCD and their families. The video provides information about OCD from the perspective of six people who have lived with OCD for many years. The video includes segments on early signs of OCD, diagnosis and reaction, the symptoms of OCD, understanding OCD, other mental health issues, impact on life, family and relationships, telling other people, treatment, support and recovery. Produced by Tribal with the assistance of the Anxiety Recovery Centre Victoria. (Duration 43 minutes).

I wish to order :  Nine, Ten, Do It Again : A Guide To Obsessive Compulsive Disorder. Number of Copies …………..… @$10.00 each $ ……………….………..

 OCD & Anxiety Disorders Information Package Number of Packages ……….……… @$20.00 each $ ……………………….  Social Anxiety Disorder: Theory & Management Number of Copies …………..… @$18.00 each $ …………………….……  ‘Speaking from Experience: Obsessive Compulsive Disorder’ Number of Copies ……..……… @$29.95 each $ …………………….……

Post and handling within Australia: Total P&HP&HP&H Post and handlinhandlingggg $ …………………….…… $1 ——— 101010 $3$3$3 $11 ——— 404040 $5$5$5 $41 ——— 909090 $10$10$10 $91 ——— 200200200 $15 TOTAL AMOUNT $ ______

PAYMENT DETAILS  PURCHASER DETAILS My cheque/money order for $ ……………….….. made payable to ARCVic is enclosed. Organisation ………………………….………………………. Please charge my credit card. Name …………………………………………………………...  Bankcard  Visa  Mastercard  Amex  Diners Address …………………………………..…………………… Card Number ………………………………………………..……….………… [ | | | | | | | | | | | | | | | ] Phone ………………………… Fax ………………………... Email …………………………………………………………... Amount $ ………….…… Expiry Date …../…..  SEND TO Cardholder’s Name ( caps) ARCVic PO Box 358 Mt Waverley Victoria 3149 Australia ………………………………………….………………………… Office Line 03 9576 2311 email [email protected] Signature Fax 03 9576 2499 ………………………………………………………..……………

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 39

Friends of the Foundation & Anxiety Recovery Centre Victoria

These persons, professionals, and organisations have been awarded a ‘Friend of the Foundation / Anxiety Recovery Centre Victoria certificate, in appreciation and recognition of significant and valued contributions (educational forums, articles, conference papers, donations, sponsorship, organisational services, provision of specialised professional services) which have supported the aims, services and development of the Anxiety Recovery Centre Victoria / Obsessive Compulsive & Anxiety Disorders Foundation Victoria.

Dr. Nick Allen Prof. Michael Jenike Dr. Hilary Schofield Dr. David Ames Professor Gordon Johnson Dr. Jeffrey Schwartz Mr. Edwin Belfield A/Prof. Fiona Judd Dr. Issac Schweitzer Mr. Nigel Bennett Mr. John Julian Mr. Phillip Smith Dr. Scott Blair-West Ms. Barbara Jones A/Professor Sue Spence Prof. Graham Burrows Mr. David Kennan Dr. Eng Seng Tan Mr. Rod Carne A/Prof. Neville King A/Prof. John Tiller Dr. Sally Coburn Mr. Fredrick Krasey Mr. Robert Tomlian Mr. Rocco Crino Dr. Michael Kyrios Mrs Judy Tomlinson Prof. Jonathan Davidson Dr. Lisa Lampe Mr. Michael Tomlinson Mr Robert Doyle MP Dr. David Leonard Prof. Bruce Tonge Mr. Ian Farnbach Mrs Wendy Malcolm Mrs Lois Van Dyk Dr. Peter Farnbach Dr. Peter Marriott Mr. John Walker Dr. Rosemary Fawns Mr. Campbell McComas Ms. Robyn Weir Ms. Evelyn Field Dr. John McEncroe Mrs Lynn Williams Mr. David Forbes Professor Sandy McFarlane Mr. Robin Flintoft Mr. Tony McHugh Mrs Judy Fraiia Dr. Rowan McIntosh Mr. John Geros Mr. Chris Mogan Mrs Poppy Geros Prof. Stuart Montgomery ORGANISATIONS : Mr. Chris Grace Dr. Kate Moore Eli Lilly Australia P/L Ms. Jan Gray A/Prof. Phillip Morris Ciba-Geigy Ms. Annie Hayball Dr. Trevor Norman Pfizer P/L Mrs Marina Heinze Ms. Vanessa Potter Revelation Enterprises Professor Ian Hickie Dr. Sheila Parks Roche Products Pty. Ltd Dr. Paul Holman Professor Ron Rapee Glaxco SmithKline A/Prof. David Horne Ms. Kamila Raniga The Melbourne Clinic Ms. Kathryn I’Anson Prof. Steve Rasmussen Upjohn P/L Ms. Lindsay Image Mr. Justin Robinson Professor Basil James Dr. Des Roman Dr. Don Jefferys Ms. Jerilyn Ross

40 SPRING 2001 Newsletter : Anxiety Recovery Centre Victoria Notes 5

Newsletter : Anxiety Recovery Centre Victoria SPRING 2001 41