Class 4- Partnering with persons experiencing Mood, Anxiety, Obsessive Compulsive Disorder (OCD), Post-Traumatic Stress Disorders (including trauma related conditions)

Key topics covered for each mental health condition

• Diagnostic Criteria 

• Neurobiology

• Pharmacotherapeutic interventions

• Non-Pharmacotherapeutic interventions (CBT, DBT, MI, SFT, MBSR))

• Nursing assessment, planning, and intervention

• Cultural perspectives/experiences of mood, anxiety, and trauma-related conditions

Mood disorders

Nearly 1 in 5 people will experience a major depressive episode at some point in their lives 

Mood disorders are prevalent and disabling, with high economic burden for society 

Types of Mood Disorders (DSM-5, 2013) 

• Major Depressive Disorder (MDD) 

• Bipolar I Disorder 

• Bipolar Disorder 

• Persistent depressive disorder (dysthymia) 

• Cyclothmic disorder 

• Premenstrual dysphoric disorder 

Mood disorders: Neurobiology

• Genes 

• Psychosocial adversity in childhood 

• Ongoing or recent psychosocial stress 

• Monoamine neurotransmitters

Norepinephrine (Monoamine neurotransmitters- Mood disorders:Neurobiology)

• excitatory, generating and maintaining mood states, bipolar disorder more epinephrine

• Thought to play a role in anxiety

Serotonin (Monoamine neurotransmitters- Mood disorders:Neurobiology)

 excitatory, emotions, sensory perception, plays role in anxiety

Dopamine (Monoamine neurotransmitters- Mood disorders:Neurobiology)

excitatory, stimulates natural feel good mechanisms, see in schizophrenia and parkinson's disease

How is a diagnosis of clinical depression different from sadness

• It is sadness + 

• Depends on how long 

• Lack of feeling enjoyment 

• Change in lifestyle 

• Can display happiness during depression 

• Physiological changes

Major Depressive Disorder: diagnostic criteria (DSM-5, APA)

• An individual must be experiencing five or more symptoms during 2 week period at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure in the same 2-week period 

• Symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning 

• Episode not attributable to physiological effects of a substance or another medical condition 

• Episode not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other psychotic disorder 

• No history of manic hypomanic episode 

Symptoms (Major Depressive Disorder: diagnostic criteria DSM-5, APA)

An individual must be experiencing five or more symptoms during 2 week period at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure in the same 2-week period 

• Depressed mood 

• Loss of interest/pleasure

• Weight loss or gain 

• Insomnia or hypersomnia 

• Psychomotor agitation or retardation- increase or decrease in psychomotor activity i.e fidgeting, or sluggishness 

• Fatigue 

• Feeling of worthlessness or excessive/inappropriate guilt 

• Decreased concentration 

• Thoughts of death/suicide 

Depression: pharmacotherapeutic interventions: Antidepressants 

• Increase activity of neurotransmitters in the brain which help to lessen the symptoms of depression and anxiety 

• Work best when combined with psychotherapy, social support and self care 

• Two in three people with MDD eventually achieve lasting symptoms remission with conventional antidepressants and therapy 

Dopamine (Depression: pharmacotherapeutic interventions: Antidepressants)

• influences decision making, influences motivation , influences arousal, signals pleasure and reward 

Norepinephrine (Depression: pharmacotherapeutic interventions: Antidepressants)

•  influences alertness, influences motor function, regulates blood pressure, regulates heart rate 

Serotonin (Depression: pharmacotherapeutic interventions: Antidepressants)

• regulates mood, regulates appetite, regulates sleep, regulates social behaviour, regulates sexual desire

SSRI (selective serotonin re uptake inhibitors) (Drugs to treat Mood, Anxiety, Trauma Disorders)

• Sertraline

• Fluoxetine

• Paroxetine

• Citalopram

SNRI(serotonin,norepinephine reuptake inhibitor)(can be selective)(Drugs to treat Mood, Anxiety, Trauma Disorders)

• Venlafaxine

• Duloxetine

• Desvenlafaxine

• Levomilnacipran

Non selective cyclics( inhibit serotonin and norepinephrine reuptake along with other neurotransmitters(Drugs to treat Mood, Anxiety, Trauma Disorders)

• Amoxapine

• Amtriptyline

• Imipramine

• Doexpin

MAOI(Monoamine oxidase inhibitor (Drugs to treat Mood, Anxiety, Trauma Disorders)

• Isocarboxazid

• Phenelzine

• Tranycypromine

• Selegline

NDRI(Norepinephrine-dopamine reuptake inhibitor) (Drugs to treat Mood, Anxiety, Trauma Disorders)

• Bupropion

NaSSA(noradrenergic and specific serotonergic antidepressant): (Drugs to treat Mood, Anxiety, Trauma Disorders)

• Mirtazapine

SARI(Serotonin antagonist and reuptake inhibitor)(Drugs to treat Mood, Anxiety, Trauma Disorders)

• Trazodone 

• Nefazodone

Mood disorders Pharmacotherapeutic interventions

• Antidepressants 

• Ketamine infusion 

• Esktamine Treatment

Drugs to treat Mood, Anxiety, Trauma Disorders

• SSRI (selective serotonin re uptake inhibitors) 

• SNRI(serotonin,norepinephine reuptake inhibitor)(can be selective)

• Non selective cyclics (inhibit serotonin and norepinephrine reuptake along with other neurotransmitters)

• MAOI(Monoamine oxidase inhibitor)

• NDRI(Norepinephrine-dopamine reuptake inhibitor):

• NaSSA(noradrenergic and specific serotonergic antidepressant):

• SARI(Serotonin antagonist and reuptake inhibitor):

SSRI (selective serotonin re uptake inhibitors) (Side effects of Antidepressant Medications by class)

• nausea

• vomiting

• diarrhea

• weight gain

• dry mouth

• headaches

• anxiety

• sedation

• decrease in sexual desire and response

SNRI(serotonin,norepinephine reuptake inhibitor)(can be selective): (Side effects of Antidepressant Medications by class)

• nausea

• drowsiness

• dizziness

• nervousness

• fatigue

• loss of appetite

• decrease in sexual desire and response

• increase in blood pressure 

Serotonin syndrome (Side effects of Antidepressant Medications by class)

• should go away after couple of days

• agitation and restlessness

• high bp

• intense nightmares

• dialated pupils

• loss of muscle control

• insomnia

• heavy sweating

• shivering and goose bumps 

• Can happen if you wean of drug to quick, or take new dosage 

Non selective cyclics( inhibit serotonin and norepinephrine reuptake along with other neurotransmitters) Side effects of Antidepressant Medications by class)

• dry mouth

• tremors

• constipation

• sedation

• blurred vision

• difficulty urinating

• weight gain

• dizziness

MAOI(Monoamine oxidase inhibitor) (Side effects of Antidepressant Medications by class)

• orthostatic hypotension

• insomnia

• swelling

• weight gain

• Note: drug (e.g some cold and allergy) and food interactions (tyramine)

NDRI(Norepinephrine-dopamine reuptake inhibitor)(Side effects of Antidepressant Medications by class)

• jitteriness

• insomnia

NDRI(Norepinephrine-dopamine reuptake inhibitor) (Side effects of Antidepressant Medications by class)

• drowsiness

• weight gain

SARI(Serotonin antagonist and reuptake inhibitor)(Side effects of Antidepressant Medications by class)

• nausea

• weakness/tiredness

• dizziness

• nightmares

• dry mouth

• changes in appetite or weight

• blurred vision

• stuffy nose 

• Some side effects are good if goal is to get sleep 

Ketamine infusion (Mood disorders: pharmacological interventions)

• An invasive treatment for treatment resistant depression that stimulates a rapid increase in glutamate 

• Glutamate helps strengthens and restore vital neural connections and pathways in the regions of the brain that are most impaired by depression 

• New connections help induce beneficial changes in brain circuit function 

• is administered IV in subanesthetic doses (0.5 mg/kg over 4 min) in an anesthetic care unit under medical supervision 

Benefits of Ketamine Infusion (Mood disorders: pharmacological interventions)

• Offers fast acting symptom relief (within hours).

• Has anti-sucidal properties

• Well tolerated and safe 

Drawbacks of Ketamine Infusion (Mood disorders: pharmacological interventions)

• Requires access to operating theater

• Common side effects may include high blood pressure and slowed breathing

• Serial inclusions may be required to maintain treatment effect

Esketamine Treatment (Mood disorders: pharmacological interventions)

• A non-invasive treatment for individuals with treatment resistant depression who have failed to antidepressant trials of adequate dosages and durations 

• increases connections/synapses between brain cells 

• Administered intranasally in an outpatient setting under medical supervision 

• Provides a rapid acting anti-depressive response that can last 3-14 days 

Benefits of Esketamine treatment (Mood disorders: pharmacological interventions)

• Producers rapid acting anti-depressive response 

• Has anti-suicidal properites

• Antidepressive response lasts an average of 3-14 days 

Drawbacks of Esketamine treatment (Mood disorders: pharmacological interventions)

• Common side effects include temporary sedation, trouble with attention, judgement and thinking 

• Initial treatment involves 6 infusions spread out of 3 weeks 

• May require repeated treatments to maintain anti-depressive and anti-suicidal effects in continuation phase of treatment 

Bipolar & related disorders

• Type 1 Bipolar disorders

• Type 2 Bipolar disorder

Type 1 Bipolar disorder

• Manic episodes 

• Distinct period(s) elevated mood + energy 

Type 2 Bipolar disorder

• Depressive episodes

• Hypo-Mania

Bipolar I Disorder: diagnostic criteria (DSM-5, APA) 

• Distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increase goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day 

• During the period of mood disturbance and increased energy or activity 3 or more of the following symptoms:

• The mood disturbances is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features  

• The episode is not attributable to the physiological effects of a substance 

Symptoms (Bipolar I Disorder: diagnostic criteria DSM-5, APA)

During the period of mood disturbance and increased energy or activity 3 or more of the following symptoms:

• Inflated self-esteem or grandiosity 

• Decreased need for sleep 

• More talkative than usual or more pressure to keep talking 

• Flight of ideas or subjective experience that thoughts are racing 

• Distractability 

• Increase in goal-directed activity 

• Excessive involvement in activities that have high potential for painful consequences 

Bipolar II Disorder: diagnostic criteria (DSM-5, APA) 

• Criteria have been met for at least one hypomanic episode or at least one major depressive episode 

• There has never been a manic episode 

• The occurrence of the hypomanic episode (s), and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder or other specified or unspecified schizophrenia spectrum  and other psychotic disorder

• The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomanic caus e clinically significant distress or impairment in social, occupational or other important areas of functioning 

Bipolar 1 and 1 disorders: pharmacotherapeutic interventions: mood stabiliizers

• Naturally occurring

• Anticonvulsants

• Adjective anticonvulsants 

Naturally occurring (Bipolar 1 and 1 disorders: pharmacotherapeutic interventions: mood stabilizers )

• Lithium

Anticonvulsants (Bipolar 1 and 1 disorders: pharmacotherapeutic interventions: mood stabilizers )

• Carbamazepine

• Divalproex

• Lamotrigone 

• Helps to slow rapid cycling experienced during manic episodes 

Adjective anticonvulsants

• Gabapentin

• Topiramate

Lithium (side effects of frequently used mood stabilizers for Bipolar 1&2)

• Common side effects include increased thirst  and urination, nausea, weight gain, fine trembling of the hands 

• Less common side effects can include tiredness, vomiting, and diarrhea, blurred vision, impaired memory, difficulty concentrating, skin changes, slight muscle weakness, thyroid and kidney function changes

Divaproex/Valproic (side effects of frequently used mood stabilizers for Bipolar 1&2)

• Common side effects include drowsiness, dizziness, nausea and blurred vision

• Less common side effects are vomiting, mild cramps, muscle tremor, mild hair loss, weight gain, bruising or bleeding,  liver problems, changes in menstrual cycle in people who identify as women 

• Important to track blood levels-too high means more side effects 

Carbamazepine(side effects of frequently used mood stabilizers for Bipolar 1&2)

• Common side effects include dizziness, drowsiness, nausea and blurred vision, confusion, muscle tremor, nausea, vomiting or mild cramps, increased sensitivity to sun, skin sensitivity  and rashes and poor coordination 

• A rare bur dangerous side effect is reduced blood cell counts, soreness of the mouth, gums or throat, mouth ulcers or sores and fever or flu like symptoms can be a side effect 

• Important to track blood levels- too high means more side effects 

Lamotrigine (side effects of frequently used mood stabilizers for Bipolar 1&2)

• Common side effects include fever, dizziness,  drowsiness, blurred vision, nausea, vomiting or mild cramps, headache and skin rash 

• A rare but dangerous side effect is a severe skin rash 

Mood disorders: Non-pharmacological interventions

• Electroconvulsive Therapy (ECT)

• Transcranial Magnetic stimulation (TMS)

• Cognitive restructuring

• Eye movement Desensitization & Reprocessing (EMDR)

Electroconvulsive Therapy (ECT) (Mood disorders: Non-pharmacological interventions)

• An invasive treatment for severe mania, severe depression, treatment refractory depression, catatonia and treatment resistant schizophrenia 

• Small electric currents are passed through the brain intentionally triggering a brief seizure while an individual is under anesthetic 

• ECT brings about neurophysiological and neurochemical changes in the brain 

• The procedure takes about 5 to 10 minutes, with added time for preparation and recovery 

• The changes in brain chemistry can result in improvement after as few as 6 treatments

Benefits of Electroconvulsive Therapy (ECT) (Mood disorders: Non-pharmacological interventions)

• Mood stabilizing property is superior to pharmacotherapy for depressive episodes, manic episode and mixed episode in bipolar disorder 

• Can return to usual activity a few hours after the procedure 

• Can result in rapid symptom improvement 

• Can be offered for inpatients and outpatients 

Drawbacks of Electroconvulsive Therapy (ECT) (Mood disorders: Non-pharmacological interventions)

• Requires sedation with anesthesia in hospital 

• May cause low mild transient side effects including confusion, retrograde amnesia, nausea, headache, jaw pain or muscle ache

• May cause medical complications associated with anesthesia 

Transcranial Magntic Stimulation (TMS) (Mood disorders: Non-pharmacological interventions)

• A non-invasive treatment for treatment refractory depression and bipolar disorder 

• Uses targeted magnetic pulses, similar to those used in an MRI machine to activate parts of the brain involved in mood regulation in the dorsolateral prefrontal cortex

• During a secession, a helmet containing an electromagnetic coil is placid on the head to stimulate targeted regions of the brain 

• Most people see dramatic improvements in depressive symptoms after four weeks- six weeks 

Benefits of Transcranial Magntic Stimulation (TMS) (Mood disorders: Non-pharmacological interventions)

• Well tolerated- not painful or disruptive 

• No hospitalization or anesthesia required 

• Nu systemic side effects 

• No memory loss 

Drawbacks Transcranial Magntic Stimulation (TMS) (Mood disorders: Non-pharmacological interventions)

• Common side effects may include headache, scalp discomfort at the site of stimulation, tingling and light headedness spasms of facial muscles 

• Uncommon side effects can include seizures and mania in people with bipolar disorder 

• Treatment may not be effective for everyone 

Psychotherapy: Mood disorders: Non-pharmacological interventions

• Cognitive therapy

• Behavioural therapy

• Cognitive behavioural therapy

• Psychodynamic therapy 

Cognitive therapy (Psychotherapy: Mood disorders: Non-pharmacological interventions)

• Short term 

• Focused on changing negative thought patterns (cognitive distortions) that contribute to depression

Behavioural therapy (Psychotherapy: Mood disorders: Non-pharmacological interventions)

• Short term

• Focused on changing behaviours that contribute to depression

Cognitive behavioural therapy (Psychotherapy: Mood disorders: Non-pharmacological interventions)

• Short term

• Focused on addressing negative thought patterns and behaviors that contribute to depression

Psychodynamic therapy (Psychotherapy: Mood disorders: Non-pharmacological interventions)

• Longer term 

• Focused on exploring unconscious conflicts often originating from childhood and the impact they have on depression

Types of common cognitive disorders

• Mind reading 

• Negative focus 

• Catastrophizing 

• Labelling

• Should-thinking

• Overgeneralizing

• Emotional reasoning

• Fortune telling

• Personalization

• Owning the truth

• Just-world thinking

• Control fallacy

Should-thinking (Types of common cognitive disorders)

• when you have rules or expectations how things or people should be/ act

Overgeneralizing (Types of common cognitive disorders)

• when a single negative event occurs and you believe it is a pattern

Emotional reasoning (Types of common cognitive disorders)

• when you believe that how you feel is evidence or reflects reality

Personalization (Types of common cognitive disorders)

• when you feel personally responsible or guilty for things you can’t control

Owning the truth (Types of common cognitive disorders)

when you are certain you are right and your opinion is the truth

Just-world thinking (Types of common cognitive disorders)

• when you assume that everything in the world will be balanced fairly 

Control fallacy (Types of common cognitive disorders)

• When you assume you can control everything that happens in your life 

Mood disorders: Nursing Assessment

• Screening 

• Assessment 

• Mental status examination 

• Suicide risk assessment 

Screening (Mood disorders: Nursing Assessment)

• Quick inventory of depressive Symptomatology self report (QIDS-SR) 

• General behaviour inventory (GBI) 

Assessment  (Mood disorders: Nursing Assessment)

• Mood disorder questionnaire (MDQ)

• Beck Depression Inventory 

• Hamilton Depression Rating scale (HAM-D) 

• Patient Health Questionnaire (PHQ-9)- can be used as to view how things change

Nursing interventions (Mood disorders)

• Psychoeducation 

• Facilitating individual psychotherapy 

• Monitoring service delivery 

• Skill teaching-illness self management 

• Facilitating group psychotherapy- making sure these are only done with proper education 

• Medication monitoring, management & administration 

• Supportive counselling 

• Individual & system level advocacy 

• Resource matching and referring 

• Family support & education 

• Crisis prevention & intervention 

Cultural perspectives & Experiences (Mood disorders)

• Culture affects tee way we express our thoughts emotions and behaviours 

• There are cultural differences in the way depression is manifested and treated 

• One of the main differences seen across cultures is the way depression and mania are expressed

Anxiety disorders

Most prevalent psychiatric disorders associated with a high burden of illness 

Nearly 1 in 4 people will experience an anxiety disorder at some point in their lives

Prevalence of different types of anxiety disorders (DSM-5,2013) 

• Specific phobia (9.1%)

• Panic disorder (6%)

• Social anxiety disorder (2.7%) 

• Agoraphobia (0.9%) 

• Generalized anxiety disorder (2.2%) 

• Separation anxiety disorder (4%) 

Neurobiology (Anxiety disorders & PTSD)

• Genes

• Psychosocial adversity in childhood 

• Ongoing or recent psychosocial 

• Norepinephrine

• Serotonin 

• Dopamine 

Specific phobia: Diagnostic criteria (DSM-5,APA)

Extreme anxiety experienced when anticipating exposure or being exposed to feared stimulus 

Five categories of specific phobias: 

• Animal type (spiders,snakes, dogs)

• Natural environment type (tornadoes, heights, water, fire) 

• Blood injection type (needles, medical procedures) 

• Situational type (flying on a plane, enclosed spaces) 

• Other type (phobias that do not fit into the previous four categories 

Panic disorder: Diagnostic criteria (DSN-5,APA) 

Extreme surge of fear and discomfort due to perceived loss of control 

Physical symptoms may signal the presence of a panic attack including: 

• Dizziness 

• Nausea 

• Racing heart 

• Shaking trembling

• Sweating 

• Chills 

• Unsteadiness 

• Shortness of breath 

• Sensation of choking 

• Chest pain 

• Abdominal pain 

• Fear of losing control 

• Fear of dying 

Social anxiety disorder; diagnostic criteria (DSM-5,APA) 

• Extreme fear of social situations 

• Extreme fear of criticism or scrutiny by others in social interactions

• Intense fear often leads to avoidance of the social situation 

• Intense fear can cause impairments in school, work, relationships

Obsession (What is OCD?)

• Recurrent persistent intrusive unwanted thoughts 

Compulsions (What is OCD?)

• Repetitive behaviours or mental acts that the person is driven to perform in response to the obsessive thought 

Types of OCD

• Body dysmorphic 

• Hoarding 

• Trichotillomania- Hair pulling disorder

• Excoriation- skin picking

Obsessive compulsive disorder defined

• Behaviours or mental acts are aimed at preventing or reducing anxiety or distress,* or preventing some dreaded event or situation, however these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive 

Obsessive compulsive disorders: Diagnostic criteria

• The obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social, occupational or other important areas of functioning 

• The obsessive compulsive symptoms are not attributable to the physiological effects of a substance 

• Recurrent and persistent thoughts, urges or images that are experienced, at some time during the disturbance as intrusive and unwanted that in most individuals cause marked anxiety or distress 

• The individual attempts to ignore or suppress such thoughts urges or images to neutralize them with some thought or action 

Manifestations of OCD

• Repetitive behaviours (hand washing, ordering, checking) or mental acts (praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly 

SSRI (selective serotonin reuptake inhibitors)  (Drugs to treat anxiety disorders & PTSD)

• Citalopram (Celexa) 

• Sertraline (Zoloft) 

• Fluoxetine (Prozac) 

• Paroxetine (Paxil) 

• Citalopram (Celaxa) 

• Fluvoxamine (Luvox)

SNRI (serotonin,norepinephine reuptake inhibitor)(can be selective)  (Drugs to treat anxiety disorders & PTSD)

• Venlafaxine (Effexor) 

• Cympalita (Duloxetine) 

TCA (Tricyclic antidepressant) (Drugs to treat anxiety disorders & PTSD)

• Comipramine (Anafranil)

• Imipramine (Tofranil) 

• Desipramine (Norpramin) 

Bensodiazepines (Drugs to treat anxiety disorders & PTSD)

• Clonaspam (rivotril)

• Alprazolam (XANAX)

• Lorazepam (Ativan)

Other medications (Drugs to treat anxiety disorders & PTSD)

• Buspirone (Buspar) 

• Anticholergics 

• Beta blockers 

Side effects of benzodiazepines 

• Common side effects include drowsiness, sedation, dizziness and loss of balance 

• Effects are more serious when combined with alcohol or with other sedative medications 

Non-pharmacological interventions (Anxiety disorders) 

• Cognitive behaviour therapy

• Exposure & Response Prevention

Cognitive behaviour therapy (Non-pharmacological interventions: Anxiety disorders)

• the evidence-based treatment of choice for people living with anxiety disorders

• The aim is to help the client to become aware of inaccurate or negative thinking so that they can view challenging situations more clearly and respond to them in a more effective way

• can be helpful either alone or in combination with other therapies

Benefits of Cognitive behaviour therapy (Non-pharmacological interventions: Anxiety disorders)

• Helps individuals with illness self -management

• Has a role in preventing relapse of symptoms of anxiety

Drawbacks of Cognitive behaviour therapy (Non-pharmacological interventions: Anxiety disorders)

• Individuals may feel emotionally uncomfortable at times when they are exploring painful feelings, emotions and experiences

• Individuals may feel physically drained, cry, get upset or feel angry during challenging sessions

Exposure therapy (Non-pharmacological interventions: Anxiety disorders)

• An evidence-based treatment for people living with obsessive compulsive disorder, panic disorder and agoraphobia

• consists of habituating the client degree by degree to the feared situations in imagination and then in vivo

• The aim is to obtain a habituation of emotional responses and the extinction of avoidance behaviors which are reinforced by anxiety

• treatment is most effective when used in combination with antidepressants

Benefits of Exposure therapy (Non-pharmacological interventions: Anxiety disorders)

• Exposure to feared situations in imagination before being exposed to them in vivo reduces anxiety responses

Drawbacks of Exposure therapy (Non-pharmacological interventions: Anxiety disorders)

• Completion of homework exercises between sessions is important to optimize treatment benefits

• Services may not be available through publicly funded health care system

Cognitive Restructuring (Non Pharmacological interventions: Mood disorders) 

An evidence-based therapy for anxiety disorders

Therapy has four key components:

• Breathing retraining to help to control the physiological sensations resulting in panic attacks

• Teaching abdominal breathing (Valsalva technique) to control tachycardia

• Cognitive restructuring to modify misinterpretations of bodily sensations and challenge the “danger” cognitive schemata

• Graded exposure through behavioural experiments to modify agoraphobia

Treatment typically includes 15 to 20 sessions