Physical, Psychological, or Both?

By Dr. Doug Seiden

You’re stressed out. You can’t remember your last good night’s sleep. Chronic pain is getting you down. Your heart races when you’re not in an actual race. So what do you do? If you’re like many people, you go to your doctor. Good decision.

It is crucial to find out whether there are indeed physical causes for your emotional or physical symptoms, such as mood swings due to hypoglycaemia, anxiety due to hypothyroidism, or racing heart due to mitral valve disease. However, in some cases, the real culprit may be whether you have the proper tools to cope with stress. And while there are medications that are effective for insomnia, pain reduction and panic, there are behavioral health treatments that provide superior long term results without the side effects.

The interaction between physical and psychological experience is bidirectional, each influencing the other. Often, we worry about or lament a very real health problem that we have been diagnosed with. This is known as “health anxiety”. For example, if we have a genetic predisposition to obsessive compulsive disorder, we may not just worry, we may obsess. Sometimes a real physical problem, such as heart palpitations due to mitral valve syndrome, can interact with obsessive compulsive disorder, leading to thinking about one’s heart rate way too much. This, in turn, could interact with Panic Disorder, in which excess attention to heart rate itself causes worry, anxiety and increased heart rate, leading in a positive feedback loop to panic and avoidance of situations in which the initial randomly occurring palpitation occurred.

In the other direction, prolonged stress about anything at all may cause health problems such as heart disease, obesity, headaches, accelerated aging and premature death. In addition, stress can also trigger or make worse physical problems such as asthma, diabetes, gastrointestinal problems and Alzheimer’s disease. Similarly certain behaviors that are exacerbated by stress, such as hair pulling or skin picking, can lead to dermatological conditions.

So should you see your doctor for psychological issues? Yes, as it is important to determine whether the cause is a physical problem that requires a medical solution. It would be ineffective and frustrating to spend time and money on therapy for anxiety, only to find out 6 months later from your doctor at your next checkup that your anxiety is due to hypothyroidism and will easily respond to medication.

Whether or not your doctor finds a physical cause for your problem, make sure to ask whether he or she thinks that it could respond to cognitive behavioral therapy instead of or in addition to medication. Given an alternative, most doctors would prefer not to prescribe certain types of medication, with sleeping pills and pain killers at the top of their list due to the risk of addiction, and other medications due to their potential side effects.

If your doctor feels that your condition could potentially respond to therapy instead of or in addition to medication, some effective psychological therapies for common problems include:

  • CBT for depression (including cognitive restructuring, behavioral activation and mindfulness/meditation)
  • CBT for anxiety (including cognitive restructuring, relaxation techniques and mindfulness/meditation)
  • Exposure therapy for panic disorder
  • Exposure and response prevention for obsessive thoughts and/or compulsive behaviors
  • Very specific CBT protocols for each of the following: stress/anxiety/panic/OCD/low mood/depression/skin picking/hair pulling
  • A specific CBT protocol for insomnia
  • Psychological treatment for chronic pain using the “Open Focus” technique, a combination of CBT and mindfulness strategies