Avista offers several means by which to address emotional/ psychological distress. You are invited to explore all of the options for treatment available, and to contact the office with any further questions not specifically addressed.

Psychotherapy:
There are many forms of psychotherapy (aka ’ talk therapy’) available to patients, each with certain definable benefits, dependent upon the symptoms that one is experiencing or the mechanism by which such symptoms have become manifest. Therefore, it is extremely important for one to have a formal evaluation that clearly defines the nature of the problems at hand. From that point forward, decisions can be made in association with one’s doctor or therapist as to which form of psychotherapy may be most helpful in addressing the conflicts or issues with which one is dealing. Studies have consistently shown that the combination of psychotherapy and medication is generally the most effective way of confronting mood and anxiety symptoms. Several methods of psychotherapy are available at Avista.

One method of psychotherapy is psychodynamic therapy, a method that addresses developmental/childhood origins of problems as well as how such patterns are repeated in current relationships. This form of therapy can be very effective in treating irrational fears and inhibitions, as well as destructive patterns of interaction which often lead to significant depression or anxiety, among other problems.

Another method is cognitive-behavioral therapy, which utilizes the unique relationship between one’s thoughts, feelings, and actions to empower patients to change negative thought patterns and problematic reactions to personal circumstances. It can be utilized to treat a wealth of mood and anxiety issues, as well as to address any number of associated conditions, including repetitive self-destructive behaviors such as addictions and impulse control disorders.

A third method, which incorporates simple coping strategies to daily pressures is supportive therapy. It can be a very helpful method if one is not able for any reason, including very acute distress, to participate in other forms of therapy. It can effectively help one feel less alone in any given difficulty and can strongly reduce feelings of hopelessness.

All methods above are those available at Avista, and active encouragement is given to patients in utilizing these tools in their recovery. Of course, forms of therapy other than those mentioned can be equally helpful, and referrals are available upon request.

Psychopharmacology [Medication Management]:
Effective medications are now available for the treatment of most emotional/behavioral difficulties. It is key for any patient to have a thorough evaluation in order to determine the potential utility of medication in addressing such issues in each individual case. At Avista, extensive focus is placed on accurate diagnosis so that appropriate medications may be selected.

For unipolar depressive symptoms or anxiety, several classes are available including Selective Serotonin Reuptake Inhibitors and variant medications [i.e Prozac, Paxil, Zoloft, Luvox CR, Celexa, Lexapro, Viibryd, and Brintellix], Selective Serotonin/Norepinephrine Reuptake Inhibitors [i.e. Pristiq, Effexor XR, Cymbalta, and Fetzima], Atypical antidepressants [i.e. Wellbutrin XL, Remeron], Tryclic antidepressants [i.e. Clomipramine, Nortriptyline, etc.], and Monoamine Oxidase Inhibitors [i.e. Nardil and Parnate].  Any patient’s given personal and family history can be extremely important in informing the selection of agents from such a voluminous list.

Monotherapy [utilizing one medication alone] is helpful for many with depression, if dosed appropriately.  However, in cases of more chronic or resistant depression, other agents may be used for augmentation in order to more effectively control symptoms.  Examples of such techniques include combinations of the above antidepressants, addition of mood stabilizers such as Lithium, the addition of stimulant medications, augmentation with thyroid hormonal preparations, addition of methylated folate, or addition of atypical dopamine blockers such as Seroquel XR, Abilify, or Rexulti.  Treatment of anxiety disorders may also involve augmentation of a primary agent with benzodiazepines, such as Xanax, Klonopin or Ativan, or addition of medications such as Buspar.  Such combinations are closely monitored for effect and safety, and represent a true benefit of seeking psychiatric consultation.

For bipolar disorder, several agents have been helpful as alternatives to or in addition to older mood stabilizers [i.e. Lithium, Depakore, Tegretol, etc.].  Such agents include Lamictal, Abilify, Seroquel XR, Risperdal, Geodon, Zyprexa, Symbyax, Saphris, Latuda, and Vraylar.  It is critical for the clinician to carefully titrate such medications to effect while avoiding unwanted side effects, and therefore to work closely with patients in order to receive frequent feedback on the effectiveness of a chosen regimen.  Monotherapy is usually much less effective in the treatment of bipolar disorder than combination treatment.

For schizophrenia and similar disorders, more treatments are available now than ever before.  Newer medications with efficacy, but lesser side effect profiles, can make a meaningful difference for patients.  Though there are multiple selections now available, two promising newcomers have arisen in just the past year, Rexulti and Vraylar [at adjusted dosing].  Plus, there are several formulations now available for similar medications, including solutions, orally dissolving tablets, sublingual (under the tongue) preparations, as well as injectables for many of the medications in this arena.

For attentional disorders such as ADHD, there are likewise augmentation methods available that can render any stimulant medication more effective, or stand alone as effective medications in their own right. There are multiple formulations of stimulants of different release formulations as well as half-lives, which allow the careful construction of a regimen that addresses symptoms along with flexibility to extend or shorten duration based on a patient’s individual needs.

Though there are too many diagnoses to effectively address here, there are many pharmacologic interventions available for a host of other difficulties including, but not limited to, substance dependence disorders, impulse control disorders, developmental disorders and eating disorders.

Regardless of the issues about which an individual seeks help, it is imperative that assessment and treatment be initiated by a professional specializing in these areas. At Avista, each person’s unique experience is valued and treatment is initiated in a ‘team’ perspective, wherein each person is informed of all potentially helpful medications and selections are made by patient and doctor together.

Hypnosis:
As a natural state of focused concentration, hypnosis represents a very real and effective way of addressing many emotional/behavioral issues that often cause a great deal of distress for many people. Hypnotic techniques have been known since ancient times, but have been used medically since the mid 1700s by many well known figures in medicine, including Josef Breuer and Sigmund Freud among others specifically in the practice of psychiatry. It stands as a very powerful way of treating many unconscious inhibitions and bothersome repetitive behaviors that often elude effective treatment by other means. It has been formally recognized by the American Medical Association and the American Psychiatric Association as an effective therapeutic tool in both medicine and psychiatry since 1960.

Often an extremely relaxing and fulfilling experience for those experiencing it, effective hypnosis involves the scientific use of natural physiological patterns to reach deeper areas of mental processing. Predictably, it often does so more quickly and sometimes more effectively than either medication or methods of psychotherapy. Although each individual exhibits their own aptitudes in hypnotizability, most people are able to benefit from what hypnosis offers.

Although certain issues are very keenly sensitive to hypnosis as a therapeutic tool, such as phobias and repetitive negative habits such as trichotillomania (hair pulling) and smoking, hypnosis often can be an effective intervention in other areas as well. Some common treatment areas are trauma/grief, stress management, self-esteem issues, weight reduction and fitness, performance anxiety, and chronic pain management, among others.

Hypnosis is available for the above issues, as well as many others not specifically mentioned. Questions about the application of this tool in such areas are indeed welcomed and encouraged. For the person interested in non-pharmacological methods of intervention to a multitude of various difficulties, it stands as a time-tested and safe means of treatment.

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