A Psychologist Doctor

[sanitex]

Please does any one here know the best psychologist doctor for anxiety or any related to phobia?

I'd be very optimistic to meet the doctor urgently.

[FunFon]

Psychiatry's not very widely used here, but Samitivej apparently has a decent department, and of course Googling brings up a bunch, but I'd definitely see qualified references.

Maybe ask through your embassy?

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edit - found this old thread

Edited March 24, 2013 by FunFon

[Vinny1967]

What area are you in ?

[sanitex]

Any area is conductive for me if you provide any!!!

[Vinny1967]

PM sent

[amykat]

Dr. Sutttipan Takkapaijit

Chiang Mai Ram Hospital

His schedule is 8am to Noon, Mon, Weds, Fridays

053-920300

He speaks fluent English of course.

[Sheryl]

But is the OP in CM? He did not reply to the question on location.

If you start off with a pyschiatrist you are going to be put on medication for sure. Maybe that is unavoidable and maybe not.

It is better to start with therapy with a skilled counselor and let them advise on whether medication is needed in which case they will refer you to someone to prescribe. Even if you must use medication, it should be done in conjunction with therapy, not by itself.

Be aware that many (tho not all) of the medications used for anxiety are addictive and that it is not unusual for people with anxiety disorders to develop drug addicition in the course of treatment which of course multiples their problems.

There is a pinned thread in this forum giving details of counselors in the Bkk area. If you are instead up around CM please specify that and I'll try to advise accordingly.

[sanitex]

Am sorry for not adding the location,I live in Bangkok

[Sheryl]

OK then go to the pinned Mental Health thread in this forum, and get in counseling with one of the resources listed.

Sometimes it is necessary to shop around a bit to find the right therapist for you. The "chemistry" between patient and therapist is important.

Once you have started therapy and the therapist has had a chance to get a feel for your problem, they will refer you to a doctor for meds if they think it is indicated.

Good luck.

[cheeryble]

Hi Sanitex

sorry to hear about your problem, anxiety and phobia can be very nasty.

You are probably desperate to escape the way you feel, it's very understandable.

Remember that these anxiety episodes are usually temporary.

If you are experiencing intense panic attacks always remember the biochemical feedback loop will ease and the real panic will ease off after just a half hour or hour.

If it is a more generalized background anxiety it may last for days or even weeks but will generally be cyclical.

What I'm saying is Sheryl is 100% right about meds.

There are problems with withdrawal from just about everything out there. Even if the drugs are less addictive you are likely to get some sort of rebound.

So as you will only get temporary relief, the point is that now you have one (probably fixable) problem. If you take meds you will have two, and a temporary problem could become very long term indeed.

That said, you may be right to get help from outside.

One or two small things may help:

No coffee.

Ever tried yoga? It's very difficult to perform yoga and worry at the same time.

If possible, spend plenty of time with friends.

Keep your mind occupied on simple practical matters like gardening or whatever.

Exercise as much as possible, it will relax you, you will sleep better. Go swimming.

If you have GAD (generalised anxiety) the worst, most confusing, time is usually the morning after wakeup. It will ease during the day and by evening you may feel quite well.

Again, remember your mind will adjust and things will change and it will be temporary. Like the flu, sometimes we just have to suffer a bit. As the Buddhists say, be like a great river. Problems will come......and go.

If you have phobia, you may like to tell us, it is very treatable, and you could learn a lot just from reading online or answers here. (Not recommending you don't find help outside).

(As for Dr Sutipan in CM I'm on very friendly terms with him and we sometimes talk shop as my wife works in the Ram. I believe he's not an overprescriber and I know of at least one instance of him fully withdrawing a "breakdown" patient from tranquillisers prescribed in previous days by GPs.)

Edited March 25, 2013 by cheeryble

[Groongthep]

"If you start off with a pyschiatrist you are going to be put on medication for sure."

This is nearly always true. As Sheryl has said best results are obtained when medication is used in conjuction with education and therapy.

"Be aware that many (tho not all) of the medications used for anxiety are addictive and that it is not unusual for people with anxiety disorders to develop drug addicition in the course of treatment which of course multiples their problems."

Also true. The drugs perscribed for anxiety and panic disorders are more often than not benzodiazapines, such as diazapam (valium), alprazolam (xanax or xiemed) and clonazapam (klonapin) among others. These drugs may be habit forming if taken in large doses over long periods of time. Generally, upon being prescribed these drugs the patient will feel a euphoric effect (i.e. get "high") from them. This is the dangerous period where the patient must adhere strictly to only the amount perscribed by his/her physician. It is not uncommon for severe addiction to occur and for patients to begin buying additional benzodiazapines by "doctor shopping" or getting more of them illegally on the black market.
If however, the patient is closely monitored and it is made sure that only the small amounts perscribed are not increased these drugs can enormously improve the lives of the patients that need them. The euphoric effect quickly ends over time until he or she no longer feels "high" from these medicines but the intended effect of eliminating anxiety and panic disorder continues and a patient can live a normal happy and relatively anxiety free life. Yes, the patient will usually develop a dependency to these drugs but once the mental side effects of euphoria and lack of coordination dissapate the positive effects of the elimination of the anxiety and panic far outweigh that dependency.
To make a long story short these drugs can be dangerous if abused but if used properly by patients that truly need them they can be life savers.

Too often I see on these boards people who have suffered from addiction from these drugs write that the drugs are evil and should even be made illegal (as they have alprazolam).These statements are almost always made by the people who have increased their dosage without their doctor's knowledge.
When used correctly and only as perscribed they can work wonders. Don't dismiss them out of hand.

Edited March 25, 2013 by Groongthep

[Groongthep]

cheeryble's post makes sense and I would agree with most of it. I would only add that sometimes panic attacks can last much longer than an hour or two and can be extremely debilitating and terrifying.

I was probably still typing my post above as his/hers was added.

[cheeryble]

When used correctly and only as perscribed they can work wonders. Don't dismiss them out of hand.

I think that's true sometimes.

I have a friend.......who was a senior clinical psychologist himself......who was long ago prescribed Ativan for a type of palsy.

It worked, but now years later he is addicted.

We have discussed this and decided that at his advanced age he may as well stay addicted all his life.

Seem to me though that there's no such thing as a psychopharmaceutical free lunch.

The problem is.....unless it's OK to take the drug forever.......that withdrawal will tend to sensitise the psyche for a repeat of the initial problem.

Edited March 25, 2013 by cheeryble

[uptheos]

When used correctly and only as perscribed they can work wonders. Don't dismiss them out of hand.

.

I have a friend.......who was a senior clinical psychologist himself......who was long ago prescribed Ativan for a type of palsy.

It worked, but now years later he is addicted.

We have discussed this and decided that at his advanced age he may as well stay addicted all his life.

One of the most sensible things I've read for ages.

If you are advancing in years and medication gives you a better quality of life, so what if it's addictive?

[Groongthep]

When used correctly and only as perscribed they can work wonders. Don't dismiss them out of hand.

.

I have a friend.......who was a senior clinical psychologist himself......who was long ago prescribed Ativan for a type of palsy.

It worked, but now years later he is addicted.

We have discussed this and decided that at his advanced age he may as well stay addicted all his life.

One of the most sensible things I've read for ages.

If you are advancing in years and medication gives you a better quality of life, so what if it's addictive?

Yes, I think most of the clinical data supports the notion that even if the patient isn't elderly, if the benefits outweigh the side effects, including dependency, then by all means continue the medication. Many people will take heart and diabetes medicine for the rest of their life and be the better for it. Don't fall into the trap of thinking that just because a disorder is of a mental nature that some sort of social stigma should be attached in which the medication for that disorder is somehow "bad" but heart and blood sugar medicines that don't involve behavior aren't.

Edited March 25, 2013 by Groongthep

[Sheryl]

"I.....

Too often I see on these boards people who have suffered from addiction from these drugs write that the drugs are evil and should even be made illegal (as they have alprazolam).These statements are almost always made by the people who have increased their dosage without their doctor's knowledge.

When used correctly and only as perscribed they can work wonders. Don't dismiss them out of hand.

I don't think anyone is dismissing the use of medications out of hand, only urging that they be limited to cases where really necessary and used with caution.

In my experience Thai psychiatrists spend very little time (i.e. minutes) before prescribing. That is simply not long enough to know if a patient really requires medication. Hence the recommendation to start with a therapist (which is needed anyhow) and let the therapist refer for medication if indicated. Unlike the MD, the therapist spends significant time getting to know the patient and is thus better placed to determine the nature and severity of the problem.

[cheeryble]

I don't think anyone is dismissing the use of medications out of hand, only urging that they be limited to cases where really necessary and used with caution.

I'm with you Sheryl.

As for the duration of panic attacks Groonthep

With certain exceptions....(under the influence of stimulants and/or undergoing unfortunate reaction to psychoactives like SSRIs and/or undergoing withdrawal i.e. on rebound).....and excepting psychotic episodes and the like.....ie for "normal" people with panic/anxiety.......true panic with full physical symptoms, not just anxiety, will be self-limiting in time as I mentioned. (Anxiety which is limited in nature can last longer, but I define this as less than true panic).

I first learned this at the Maudsley in London, one of the foremost psychiatric hospitals in the world. It is extremely useful to know that a panic attack will self-limit and will help the patient realise it is temporary and help them not go down a further spiral of despair and fear. Not a great idea to say it's untrue even if you think so as even a belief in it may help a patient, like a placebo. It can be some sort of (justified) hope in a horrible situation.

IMO personal experiences you may have or read about contradicting this are inaccurate, the patient or sufferer is in fact not remembering their own mental states well and is bundling the whole experience as a panic attack whereas it will be in waves of intensity and will generally indeed resolve after time. The very essence of "flooding" type exposure therapy is based on the fact that the panic eventually resolves and the patient stays in the situation and starts to build new more peaceful associations with the situation which previously only had fearful associations. This would not be possible if it took too long.

One thing which may be recommended to the OP by a therapist is to record his SUDS (subjective units of discomfort......ie measure the anxiety on a 1 to 10 scale and note in a little book). Why is it useful? Because again patients tend to think inaccurately.....in this case that they are making no progress or improvement. When the SUDS are recorded however a patient can compare as time goes by and it will almost always improve as long as some effort is made in exposure therapy or CBT or whatever. (This is another example of inaccurate self-assessment in retrospect. Most people will get downhearted thinking they are "getting nowhere" when in fact if they note their SUDS they are in fact improving, a heartening thing to know.)

Edited March 25, 2013 by cheeryble

[orang37]

Sawasdee Khrup, Khun Sanitex,

With the very small amount of information here, about what's bothering you, it's hard to respond specifically, but you've gotten some excellent ideas about where to "look next," and resources.

Please consider that there is the chance that your problem, whatever it is, may be medical in nature, hormonal, or metabolic, aging-related, or even related to a later-life onset allergy, diet-related, etc., and may simply require medical diagnosis and treatment, not psychotropic medications, and not psychotherapy.

Which is why I think a good first step, if you have not already done so, is a complete physical from a good GP, and I'm sure the same resource that Sheryl pointed out to you here on ThaiVisa will have recommendations for GP's in the Bangkok area.

There are very effective "behavioral" therapies for phobias, such as "systematic desensitization," and "flooding," which Cheeryble mentions, that do not involve medication or counselling. There are short-term cognitive therapies that do not involve medication for generalized anxiety.

These therapies have been proven effective, scientifically, and they are part of a movement in medicine, for both body and mind, towards what is now called "Evidence Based Medicine," or "EBM," which has become the "gold standard" in the US and other countries: in the sense that it is those therapies insurance plans will almost always cover, if you have mental health care included in your health insurance.

If you are having "panic attacks," that's very different from a specific phobia, and there, depending on the context (acute ? chronic ? unique in your life history ? related to recent medical problems ? related to social isolation ? related to some form of abuse by others, or trauma, loss, grief, personal setback in love, or work ?, related to substance abuse, or withdrawal from other medications ?), effective help may (or may not) involve use of medications along with some form of psychotherapy.

In addition to the psychiatrist in Chiang Mai already mentioned on this thread, we have an excellent mental hospital in Chiang Mai, Suan Prung, a Royal Project, where I can say from personal experience that the psychiatrists are very helpful, and in no way are "prescription happy" (at least with me). I've been helped there with a chronic sleep-problem (not apnea) probably related to the long-term side-effects of cancer treatment five years ago.

The psychiatrist I see there, is quite familiar with the "MED" (minimal effective dose) strategy/goal in treatment, which just means that you try to find the absolutely minimal dose of any medication you may need to stay on for a longer time, for a chronic condition, and you "test yourself" sometimes by "taking a break" from using it, and observing your reaction. This can vary, of course, depending on how long a given medication takes to develop its therapeutic level in the blood, or to "clear" your system: so some medications, like Prozac, are going to take many weeks to test, a "risk" some people may not want to take.

In any case, best wishes for your health, and peace of mind, For your information, I was, formerly, a trained psychiatric Social Worker, with post-graduate (post M.S.W.) training (a Fellowship) at the National Institute of Mental Health in the U.S., but I changed careers many years ago.

yours, ~o:37;

[orang37]

If you are advancing in years and medication gives you a better quality of life, so what if it's addictive?

Sawasdee Khrup, Khun Uptheos,

I think it all depends on the medication, and its side-effects, and how it affects the quality of your life.

And, the physical and emotional "costs" of stopping (possibly going through some period of withdrawal symptoms), or changing the medication, to you, and the people you live with, or are in relationships with, or who you depend on, or who depend on you.

yours, ~o:37;

[Sheryl]

Please note that the OP does not live in Chiang Mai. He's in Bkk....

[Groongthep]

Sounds like cheeryble knows what he/she is talking about and I defer to his greater knowledge. I would add only that as well as caffiene Thai Visa forums, especially the political ones should be avoided at all cost as they routinely cause intense feelings of great confusion, panic and anxiety.

[selftaopath]

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Cognitive Behavioral Therapy with Keoki