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Hey there everybody and welcome to this video on practices for addressing health anxiety and somatic symptoms i’m your host dr donnelly snipes now obviously the title of this is evidence-based practices however doing the research on pubmed unfortunately there was a devastating lack of
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research on evidence-based practices for treating these issues so we’ll talk about what i did find and we’ll talk about what i have learned over 20 some odd years of clinical practice unfortunately much of the literature still refers to somatic symptom disorders
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as symptoms which have no physical cause and that is not true anymore and i mean this was even after the dsm 5 was released that the research especially from in medical journals was focused on symptoms that have no identifiable medical cause
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the dsm-5 defines somatic symptom disorders though as one or more physical symptoms that result in clinically significant distress it says nothing about whether there is or is not a physiological cause and we need to really underscore that doctors must get away from assuming that something
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is all in people’s heads when they cannot identify a cause fibromyalgia for the longest time pots hyperparathyroid and chronic fatigue syndrome have all fallen into that category where for years decades people were told that hey there’s no underlying physiological cause for your
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complaints therefore nothing must be wrong and it must be all in your head and now we know that hey there actually is physiological um markers there actually are physiological markers and something is actually a miss in the body factory you just didn’t know what to look for before um and it’s
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important for us as behavioral health clinicians and social workers to also really guard against invalidating people’s experiences we want to help them improve their quality of life we don’t live in their skin so invalidating their experiences is not helpful
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one of the analogies i make sometimes if you’ve ever worked with somebody who has a psychotic disorder when they are in a psychotic episode no amount of telling them that their perception of what’s going on is wrong is going to do any good it’s actually going to
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break the relationship it’s important to join them in their reality their perceptions now i am by no means saying that people with somatic symptoms are psychotic no i am not i’m saying their symptoms their perceptions their feelings the way they are experiencing life is very
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real and just because we don’t experience it that way doesn’t mean it’s not real to them we’ve learned over the years that there are a lot of people with sensory integration and sensory gaiting difficulties for example that experience things very differently what you may experience
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as lukewarm they may experience as scalding the temperature objectively is the exact same but their nervous system their sensory response is very very different and by ignoring that we are causing trauma we are causing them to feel invalidated hopeless and
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helpless and we’re promoting emotional dysregulation think about people who well let me go on with this before i before i make another analogy physical interventions for somatic symptom disorders this person is having physical symptoms it’s going to be difficult to
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address anything cognitively until we have the facts so they’ve probably already had a physical and blood work in order to provide evidence of what is or is not going on that we can measure at this point in time so let’s get that data
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this can help people rule out for example catastrophic physical concerns if they’re concerned that they’ve got cancer for example you know let’s get the information that says we don’t see any evidence of that right now doesn’t mean you’re not having symptoms but let’s rule out
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anything that we can um relatively easily i’m not talking about sending people to you know 16 different specialists but that can help us when we get to the cognitive interventions because it gives us some foundation to evaluate so for example if somebody is having
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pain in their back and i will use my example my mother died of kidney cancer for months she thought that she had pulled a muscle in her back at the gym turns out it was kidney cancer and that freaked me out um so then when i started having pain
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in my back i got concerned and then i got some blood work that was a little bit off i got even more concerned but then i looked at the blood work and i looked at all of the other tests of kidney function and white blood cells and everything else and they were all within normal parameters
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so what was the take home and we’re going to talk more about occam’s razor in a minute the take-home or the most um logical explanation the simplest explanation was hey it’s probably your scoliosis or you probably pulled a muscle in your back which
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i do a lot you know working out on the farm moving bales of hay and those sorts of things cognitive interventions now if somebody is having somatic symptoms we are not necessarily going to be able to address those very much what we are
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going to need to look for is how can we improve your quality of life emdr i have on the top of the list why is that a lot of people not everybody but a lot of people with somatic symptoms have a history of trauma and vander kulk said it best that a lot of times trauma is remembered as
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a sensation or a feeling as opposed to a thought or a memory and emdr may be able to help untangle or identify a connection between a traumatic experience and a somatic symptom so emdr can be very helpful people can also develop health anxiety and after
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a traumatic experience where a loved one dies of an illness or after they have a particular physical health problem like a heart attack then they may become hyper vigilant to any sort of cardiac symptoms or any sort of related symptoms so emdr can be really helpful at
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helping people integrate these memories in a way that it doesn’t always trigger their fight or flight response it doesn’t trigger their anxiety at least not to the same extent improving health literacy is very very helpful and there was a little research on this the more
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people feel educated about a particular illness or condition the more empowered they feel to either protect themselves from getting it or to deal with it if it happens the key is where do you how do you improve health literacy and it’s really difficult in
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today’s day and age of the internet where not everything is a hundred percent accurate and a lot of things are written so generally that it can actually promote more anxiety improving health literacy especially in people who already have health anxiety or somatic symptoms
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in my opinion can best be done through guidance from a case manager a social worker a counselor or a medical professional who can gather the information that is appropriate and accurate for that person without providing them information that might trigger
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unnecessary anxiety and we’ll talk about that a little bit more in a minute cognitive processing and this is where that physical comes in cognitive processing encourages people to get away from emotional reasoning emotion-based reasoning i feel scared therefore something must be wrong
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and look at the facts what are the facts for and against my belief that i’m in danger of getting this condition or that i have this condition now cognitive processing doesn’t work as well with somatic symptoms because the facts are the facts
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if the person is experiencing a symptom that’s what they’re experiencing and even if there’s no medical cause or if there is it doesn’t matter for our purposes as behavioral health clinicians if they’re experiencing a reduction in their quality of life as a result of a physiological symptom
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then it is so what facts might we look at well we’re going to talk about backward chaining in a minute but we might look at facts such as what makes it worse and what makes it better control what aspects of this situation can you control once you’ve identified what makes it worse
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and what makes it better then you can identify ways to try to reduce the intensity of the symptoms once you’ve identified the risk factors for getting an illness then what aspects can you control what can you do to keep from getting it or if you have it what can you do to help
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yourself recover from it or live a high quality of life with it and p stands for probability and we need to recognize it and again it’s really important not to invalidate people’s perceptions but we also need to recognize if based on the facts that i have and if i do the
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things that are within my control what is the probability i can have a high quality of life cognitive behavioral interventions those come up a lot i think it’s probably because it’s one of the easiest things to do a study on quite honestly but addressing distortions can be very helpful
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all or none thinking i’m either sick or i’m not sick i can either have a horrible quality of life or a good quality of life jumping to conclusions like i said i have a back egg therefore it must be catastrophic all right let’s look at the facts and same thing for emotion-based reasoning looking at
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the facts and thinking you know what are three other explanations for why my back might hurt or why i might feel like you know my chest is a little tight besides something catastrophic living in the and and heartiness are also interventions that can be very helpful recognizing
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again that sometimes people have symptoms somatic physical symptoms that met current medical knowledge can’t fully explain or can’t explain the intensity of the symptom however they’re having it so how can they have their highest quality of life and be experiencing this symptom
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people with chronic illnesses face this all the time how can i have a rich and meaningful life and cope with the symptoms of my particular condition similar to living in the and is hardiness and we’ve talked about this in other videos
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heartiness is comprised of commitment control and challenge commitment means helping people recognize all of the things in their life to which they are committed all of the things in their life that bring it meaning and richness and each one of those things is like a bean in a jar or a
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slice of a pie however you want to think about it recognizing that any one point in time all of the pieces of your pie may not be going perfect but focusing or at least acknowledging those things that are going right that you’re committed to can be helpful control what can you
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do to continue to experience good things and the things that are going right and what things can you do to maybe improve the things that are going crappy right now and challenge you know sometimes life just keeps throwing us curveballs or lemons or whatever your life throws at you
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and yes it sucks we can view these things as barriers that keep us from having the life we want and just kind of sit down and go i give up or we can view them as obstacles things that we need to either get over around under or through in order to get to that quality of life that we want
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now take drawing from dialectical behavior therapy we have backward chaining radical acceptance and distress tolerance many people who have somatic symptoms or who have health anxiety have experienced invalidation from significant others from health care providers even from
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mental health providers and therefore they may feel very hopeless helpless demoralized it’s important to give them a place where they can say this is what i’m experiencing and be heard and believed we’re not saying you’re making it up we recognize we may not be able to
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explain why you’re feeling it but we recognize you’re feeling it so let’s backward chain and see what was it or what things may have added together to trigger this flare up to trigger this particular um symptom episode that you’re having and this is something that lenahan
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really promotes with people who have borderline personality disorder and emotional dysregulation however it’s very very helpful for people who also experience what i’ll call somatic dysregular dysregulation helping them identify what is causing this symptom
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for them at this point in time it provides an immense amount of personal control to be able to say okay i can see a couple of things that i might be able to do to prevent this in the future radical acceptance is recognizing that hey i have this symptom maybe there is no medical
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explanation or maybe there is and i can’t get rid of it for some reason like pots or chronic fatigue syndrome radically accepting i’ve got this so back up to living in the end how can i have my highest quality of life possible and also have this condition this symptom this fear
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distress tolerance is another skill that can be helpful when people start feeling a symptom not saying that it doesn’t exist okay i’m not saying that it doesn’t exist what i’m saying is when they start feeling the symptom just like we do with anxiety sort of
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developing a relationship with it and saying all right you’re back again well crap on a cracker once a person is able to tolerate the distress they don’t have to like it but being able to tolerate it can prevent rushes of anxiety floods of adrenaline that can potentially
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exacerbate or make make their symptoms worse so distress tolerance can be helpful when they’re having a flare-up being distress tolerant for most symptoms that people present with can be helpful because when we get stressed it triggers that stress response system and it can
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increase inflammation it can impair sleep it can impair gi functioning it can cause all kinds of symptoms that can make the original symptom even worse so distress tolerance can be a helpful tool again and i know i’ve said this like 16 times already i’m going to say it again
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this is not to say the person is not experiencing xyz symptom it’s just help them recognize okay i’m experiencing this symptom it is what it is what can i do next instead of getting angry and starting to fight with it and try to get rid of it even though they know they can’t
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another technique that can be helpful for people especially with health anxiety is to schedule in worry what i call worry checking or research time depending on their particular diagnosis if they have health anxiety tabling their worry tabling their focus on doing research to try to
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figure out what’s going on to a prescribed 30 minute period during the day can feel somewhat liberating because then they don’t have to think about it the rest of the day when they start worrying about it they can jot it down in their journal or on a little piece of paper
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and say okay i will worry about this this evening right now i’m going to focus on these other things checking during this time if they are concerned about particular issues instead of spending a whole lot of time checking things scheduling time to do it or research
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and research again can be a little bit dicey because people can find out not so good or not so hopeful information i am not encouraging people to ignore acute intense symptoms if they’re having them it is important to
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find that happy medium environmental interventions turn off the tv turn it off if you are hearing stuff on the tv that is triggering your health anxiety triggering your somatic symptoms then turn it off this was super
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true during the pandemic i almost didn’t watch tv during the pandemic and even like um prime time tv especially when they started integrating the pandemic into the storyline i quit watching it i’m like when i am watching tv i am trying to escape i don’t want this continually thrown in my face
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i’ll do the same thing when i’m watching a show and they insist on weaving in this theme of some character in the store and in the show having cancer there was a period there it seemed like every single show i was watching somebody had cancer i’m like this is not what i want to have
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to think about right now now obviously that was shortly after my mother had passed from cancer and i’m like no i don’t want to have to think about that i don’t want to worry about that so turn off the tv or find something that you know is safe to watch
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a comedy a you know some other show where that’s not going to be woven in avoid and yes there’s a term for it now cyberchondria many very benign as well as not so benign conditions share similar symptoms like fatigue
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people may go on and and start searching for what would be causing my persistent ongoing fatigue and there is literally everything in the alphabet that can cause fatigue but a person with health anxiety is often going to hone in on the uh most catastrophic explanation oh my gosh it could be
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this well okay how likely let’s go back to facts control and probability what is the probability out of the 37 things it could be what is the probability it’s the one catastrophic thing there’s a a theory i don’t know what to call it called occam’s razor which says basically often
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the simplest explanation is the most accurate explanation so think you know if you have a backache if you have a neck ache if you have um an itch what is the most likely cause of it and then explore explore that and and that can really help allay some of your anxiety
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and recognize click bait click bait is there and this is true for the media too they’ll put out these little teasers but click bait and television teasers are there to motivate you to go to their site to hear what they have to say so they can get advertising revenue
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and it’s important to recognize that so they are going to probably put some very generic benign stuff out there that everybody has or everybody can relate to because they’re trying to trigger your anxiety people are more motivated when they feel like there’s a problem
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if they’re saying oh watch this video of this this happy dog running around they’re not going to get as many people to click on it as if they say watch this video that may um help you identify five early warning signs of this catastrophic something something
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um so do recognize click bait for what it is a organization’s desire to increase their views and relational interventions limit exposure to people who dwell on their symptoms or people’s disorders
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many of us know people who are very very focused on these things and they want to talk about these things constantly their friend’s xyz disorder or their xyz symptom or the possibility of getting xyz condition and when you are immersed in that when it’s constantly
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bombarding you just like every time you turn on the tv it can feel inescapable and you can feel uh powerless and unsafe because you’re constantly being presented with the worst case scenario and rarely are you hearing okay well here are all the other factors here are all the
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ways to prevent it here’s the probability that it’s going to be an issue for you so if you need to limit exposure to what i call chicken littles the one the people who want to focus on the sky falling that is a healthy boundary to set find a trusted provider
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mental health social work medical ideally medical that can help you get your get answers to your questions somebody who can point you in the direction of accurate understandable health literacy information
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communicate with your significant others how they can best help you with your distress and this goes back to some degree to those secure attachments being responsive to you when you’re in distress reminding you of distress tolerance skills maybe helping you by turning off that tv you know what
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this seems to be triggering your anxiety so let’s turn this off and go do something else and not perseverating sometimes it’s important to remind people in your life that hey that’s too much for me to hear i don’t want to hear about whatever it is validation of your perception
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it’s important for people to understand that your reality is your reality they don’t have to agree with it they don’t have to be experiencing it themselves but your reality is your reality when um we’re at my house my my body temperature runs very different than everybody else in my
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household and i can be like sweating to death and they’re all walking around in sweaters does it mean that i’m not actually hot no clearly i am i’m sweating but their perception is very different they’re like i don’t know how you can be hot or walking around in shorts in this weather
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i am it just is the way i am is how i’m experiencing the world right now so validating your perception and in our household i validate that hey you know i can see your cold by the fact that you’re wearing a sweater i’m not going to be critical you do what you need
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to do i do what i need to do and empathy empathy can be really helpful now that doesn’t mean um encouraging perseverating on the symptoms but empathy about how frustrating and disempowering it must feel sometimes not to have answers and i was just having a discussion with one of my friends
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the other day about how liberating it can be even if you are diagnosed with a chronic illness how liberating it can be to finally have a diagnosis that says this is what you’ve got and even if there’s not a treatment for it at least you know at least you have
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something to call it at least you have you know an avenue that you can look for clinical trials or something if you feel like you need to do that but it’s very liberating as well because a lot of times unfortunately i know i’ve gone
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through this entire presentation and harped on the fact that your reality is your reality but a lot of our loved ones and providers and other people don’t understand and if they don’t have a diagnosis it’s hard for them to be willing to empathize and the same thing is true
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in terms of getting reasonable accommodations at work unless you have a diagnosis of some sort a lot of times it’s really difficult to get reasonable accommodations so there can be a additional reason why somebody may be really wanting a diagnosis just
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tell me what’s wrong or tell me what i’ve got that way i can get what i need to get in order to have my highest quality of life there is a disturbing lack of research into the interventions to help improve the quality
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of life of people with somatic symptom disorders and health anxiety the majority of interventions discussed in this presentation are those that i have used in clinical practice and or used personally one of the most important factors in addressing
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somatic symptom disorders and health anxiety in my opinion is to balance awareness of the current facts with the reality of the presenting symptoms for that person and focus on helping them do what they can to improve their quality of life