Burn Out

[Monocles]

What is the forum`s opinion about tele-psychiatry`s impact on burnout? I find it against the nature of our work and a barrier to the human contact. I am not finding it as gratifying as in-person sessions. One of the factors that led to my burnout is decreased human contact during the pandemic and add EMR/Charting on to that

I am perceiving myself as a drug rep who is trying to expand the market by reaching out individual clients, especially with 15 minutes med checks over the phone. I am wondering If anybody feels that way? What are the possible solutions to that ?

I looooooove telepsych. Maybe it's my patient population... kids and teens seem a lot more comfortable with the technology and interacting on screens. Some of the more shy ones will just turn off video which makes it easier for then to open up. Much more convenient for their scheduling too, they can just pop in and out of classes in the middle of their school day.

Personally I feel so much more efficient working at home. I dread when all the endless provider meetings will resume in person. With telepsych you can just keep typing notes or check your stocks when other people are droning on about irrelevant topics. Also in case of no shows I can easily stationary bike for 30 min, whereas in person I would be trapped in my office.

Going virtual is probably the most "quantum leap" of improvements in psychiatry of the 21st century, thus far.

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[PikminOC]

I looooooove telepsych. Maybe it's my patient population... kids and teens seem a lot more comfortable with the technology and interacting on screens. Some of the more shy ones will just turn off video which makes it easier for then to open up. Much more convenient for their scheduling too, they can just pop in and out of classes in the middle of their school day.

Personally I feel so much more efficient working at home. I dread when all the endless provider meetings will resume in person. With telepsych you can just keep typing notes or check your stocks when other people are droning on about irrelevant topics. Also in case of no shows I can easily stationary bike for 30 min, whereas in person I would be trapped in my office.

Going virtual is probably the most "quantum leap" of improvements in psychiatry of the 21st century, thus far.

What provider meetings?

 

[Marasmus1]

I looooooove telepsych. Maybe it's my patient population... kids and teens seem a lot more comfortable with the technology and interacting on screens. Some of the more shy ones will just turn off video which makes it easier for then to open up. Much more convenient for their scheduling too, they can just pop in and out of classes in the middle of their school day.

Personally I feel so much more efficient working at home. I dread when all the endless provider meetings will resume in person. With telepsych you can just keep typing notes or check your stocks when other people are droning on about irrelevant topics. Also in case of no shows I can easily stationary bike for 30 min, whereas in person I would be trapped in my office.

Going virtual is probably the most "quantum leap" of improvements in psychiatry of the 21st century, thus far.

Well the understanding of telepsych in my institute is all residents and attending s are in the hospital to resume their clinical and administrative duties over telepsychiatry (15 minutes med checks over the phone and daily administrative meetings over the zoom)

I mean I am still waking up at 8 am, going to hospital, staying there until 5 pm providing full clinical and administrative duties. Only difference is I am seeing the patients over the phone while I am trapped in the hospital.

can that possibly be the reason why I am hating it? I never thought about a setting where I am allowed to see my patients at my home desk. Hmm..

 

[Monocles]

What provider meetings?

Rounds, departmental meetings, clinic admin meetings, QI blah blah, basically institutional BS lol.

 

[Monocles]

Well the understanding of telepsych in my institute is all residents and attending s are in the hospital to resume their clinical and administrative duties over telepsychiatry (15 minutes med checks over the phone and daily administrative meetings over the zoom)

I mean I am still waking up at 8 am, going to hospital, staying there until 5 pm providing full clinical and administrative duties. Only difference is I am seeing the patients over the phone while I am trapped in the hospital.

can that possibly be the reason why I am hating it? I never thought about a setting where I am allowed to see my patients at my home desk. Hmm..

Wow your hospital is doing telepsych wrong lol. I feel like having people go into the office and do 100% of their work virtually is... asinine.

 

[hallowmann]

Wow your hospital is doing telepsych wrong lol. I feel like having people go into the office and do 100% of their work virtually is... asinine.

Our institution is doing the same thing, arguing its the most effective argument against insurance companies that don't want to pay for facility fees. We even have to indicate where we are in the notes (i.e. in the hospital, at a clinic, or at home, presumably with at home being the least recommended). We also have a mix of in-person and 1-2 video visits sprinkled throughout the half days and have completely ended phone visits in the University (VA is still doing them though). Its actually horrible.

If I could even do half the day at home, things would be so much nicer, but I feel like this is the worst of both worlds...

 

[PikminOC]

Our institution is doing the same thing, arguing its the most effective argument against insurance companies that don't want to pay for facility fees. We even have to indicate where we are in the notes (i.e. in the hospital, at a clinic, or at home, presumably with at home being the least recommended). We also have a mix of in-person and 1-2 video visits sprinkled throughout the half days and have completely ended phone visits in the University (VA is still doing them though). Its actually horrible.

If I could even do half the day at home, things would be so much nicer, but I feel like this is the worst of both worlds...

My psych friends are telling me that now they aren't getting paid as much for tele as they did last year during pandemic

 

[allantois]

Telepsych is a disaster with some patients. Elderly can’t figure it out, some kids are even more shy with it. Can’t assess patients for AIMS well and I’ve had people talk to me while driving/shopping/ and yes on the toilet

 

[calvnandhobbs68]

Telepsych is a disaster with some patients. Elderly can’t figure it out, some kids are even more shy with it. Can’t assess patients for AIMS well and I’ve had people talk to me while driving/shopping/ and yes on the toilet

Yeah I’ve about had it with telepsych myself. I think the people who feel they’re still getting great evaluations over video are fooling themselves for their own convenience honestly or have a very high functioning patient load. Crappy connections, patients doing other things during the appointment, patients not being actually ready for the appointment, the pressure that there’s an obligation now to somehow hunt down and call a patient to make sure they got your zoom/doxy link, etc etc. Patients also don’t seem to take telemedicine appointments as seriously as in person visits either just overall. Getting paperwork filled out is a disaster (granted this is an academic center where our EMR sucks ass).

I think maybe a quarter of my patients would be reliable to do telepsych consistently (I could rely on them to actually check their email for a zoom link without having to bug them, be present themselves or have their child present for the appointment, have a decent internet connection that doesn’t require me to repeat questions 3 times, not be out shopping or driving in their car). The rest of them need to come back in person.

 

[Sushirolls]

My practice, I don't 'hunt' down a single patient. They no show, they no show. They got an electronic reminder days in advance. They get a follow message saying they missed and should reschedule. Rest is up to to them.

Personal responsibility.

 

[hallowmann]

Yeah I’ve about had it with telepsych myself. I think the people who feel they’re still getting great evaluations over video are fooling themselves for their own convenience honestly or have a very high functioning patient load. Crappy connections, patients doing other things during the appointment, patients not being actually ready for the appointment, the pressure that there’s an obligation now to somehow hunt down and call a patient to make sure they got your zoom/doxy link, etc etc. Patients also don’t seem to take telemedicine appointments as seriously as in person visits either just overall. Getting paperwork filled out is a disaster (granted this is an academic center where our EMR sucks ass).

I think maybe a quarter of my patients would be reliable to do telepsych consistently (I could rely on them to actually check their email for a zoom link without having to bug them, be present themselves or have their child present for the appointment, have a decent internet connection that doesn’t require me to repeat questions 3 times, not be out shopping or driving in their car). The rest of them need to come back in person.

A lot of the patient's I've seen via telemedicine are rural patients that either wouldn't drive for hours to be seen or workers who wouldn't be able to get time off from work and would just no show. A handful are high functioning or young, but the majority are still coming in person.

I think for the people that would otherwise not have care it's better. I don't think anyone truly believes it's equivalent or better than in person care though.

 

[Candidate2017]

Telepsych is a disaster with some patients. Elderly can’t figure it out, some kids are even more shy with it. Can’t assess patients for AIMS well and I’ve had people talk to me while driving/shopping/ and yes on the toilet

On the toilet or actively driving? Cue Randy Jackson: nah dawg, that's gonna be a no for me.

Telepsych appears to be a boon for high functioning patients, and neutral for low functioning patients (increased access cancels out the negatives) but frustrating to psychiatrists.

 

[Evidence Based]

I've definitely felt that telepsych has worsened burnout for me- access is up (definitely good), but this means our no show rates have cratered and we're seeing way more patients than pre-pandemic w/ less time for notes and other admin work.
I also do a lot of work with folks with SMI, and the quality of care is definitely not as good for these folks. Some people are too paranoid to talk on the phone, access to Zoom etc is much lower, and overall it feels harder to make that connection
On top of all that, I definitely find the work is less rewarding when you're not in the room with a patient. One of my supervisors put it well for us as residents: all the ****ty parts of the job (paperwork, pre-auths, etc) are still here, but there's less of the good stuff to outweigh it.

 

[Monocles]

I think the people who feel they’re still getting great evaluations over video are fooling themselves for their own convenience honestly or have a very high functioning patient load.

Hmm maybe it's this. Based on the area code a vast majority of my patient panel come from upper crust communities with private tutors and resources out the wazoo. Maybe telepsych is better for helping high functioning teens and college kids optimise their mental health, but for the lesser functioning it can be difficult to manage.

 

[Desired Member]

OP, I can't say I experienced burn out in residency. I had to deal with a bunch of crap in residency as well. What especially irked me was when someone shirked from responsibilities and the whole program was punished and I (among others) had to pick up the slack. But as I look back into the past, residency was a wonderful time for me. A part of it was due to a good social life. I became friends with a lot of my co-residents. I dated quite a bit. The other part was due to looking forward to the future. I knew things were going to be better and I enjoyed imagining what the possibilities could be.

But once I finished residency and entered the real world, life wasn't as exciting as it thought it would be. I got bored and discontent. I would frequently go on long walks and wonder if this will be the rest of my life. I started to ask myself, "Is there something else I would rather be doing?"

A year ago, the answer was yes. So I made it happen and pursued the something else.

I sill ask myself the same question today: Is there something else I would rather be doing? Today, the answer is no.

Burning out and being bored are two sides of the same coin: you aren't doing work that is congruent with your values. In residency, you don't have much options so you have to look to something outside of residency for fulfillment (e.g. social life or future in my case). You'll have more options once you finished residency. In the meantime, prepare yourself for attending-hood. Examine yourself to see what brings you contentment. For me, it is being a linchpin so I can call the shots at work and customize how I work (e.g. 30 minutes for outpatient follow ups instead of 15 or 20 minutes, doing psychotherapy inpatient if needed) and being paid well for the work I do and having enough but not too much time alone to get lost in my thoughts so I can better understand God and the world and think of new ways to evolve my life. These fit my values as I am highly independent (highly disagreeable) and a workaholic (highly conscientious).

If you don't have an answer as to what will bring you contentment, then do anything. Then ask yourself, "Is there something else I would rather be doing?" If yes, eliminate your current option and pivot to something else. You may stumble across your answer through process of elimination.

If you do have an answer, then go after it.

P.S. Some good skills to develop are 1) how to detach yourself from work, especially when you're off from work, and 2) how to sleep well.

Feels like you are very similar to me based on your description. Since you profess to be content with work currently, I was wondering what your general work situation is currently?

 

[Marasmus1]

Bump.

So my question to senior psychiatrists in the thread; burn-out ,especially during residency, is more common than we even think of.

Many posts say that it gets better once you are an attending. How so? ( Besides a bigger check)

What would an attending do once he/she gets bullied by the administration ?
What would an attending do once the system does not allow him/her to practice best psychiatry he/she knows of ?
What would an attending do if he/she goes through discrimination or workplace harassment ?
What would an attending do if he/she is forced to work with ancillary staff who is not caring, rude and incompetent ?

 

[PikminOC]

Bump.

So my question to senior psychiatrists in the thread; burn-out ,especially during residency, is more common than we even think of.

Many posts say that it gets better once you are an attending. How so? ( Besides a bigger check)

What would an attending do once he/she gets bullied by the administration ?
What would an attending do once the system does not allow him/her to practice best psychiatry he/she knows of ?
What would an attending do if he/she goes through discrimination or workplace harassment ?
What would an attending do if he/she is forced to work with ancillary staff who is not caring, rude and incompetent ?

Is there burn out for residents now who just work shifts? Pass the cases on to night shift? Their hours and responsibility is so attenuated

 

[Monocles]

Bump.

So my question to senior psychiatrists in the thread; burn-out ,especially during residency, is more common than we even think of.

Many posts say that it gets better once you are an attending. How so? ( Besides a bigger check)

What would an attending do once he/she gets bullied by the administration ?
What would an attending do once the system does not allow him/her to practice best psychiatry he/she knows of ?
What would an attending do if he/she goes through discrimination or workplace harassment ?
What would an attending do if he/she is forced to work with ancillary staff who is not caring, rude and incompetent ?

Not an attending yet, but in theory you have more power and leverage as an attending, and can make decisions based on rational economic decisions.

As a trainee, how matter how miserable your training situation is, you have little/no power to walk away unless you want to switch programs or not complete and commit career suicide. PDs (and all residencies in general) hold a lot of power over trainees, which is why terrible working conditions for low pay is accepted as the norm.

When you're an attending the only thing shackling you down to a terrible job is the paycheck and/or health insurance. Good news is there are plenty of options in the market for psychiatrists. Also if you are diligent in financial planning, you can have some "FU" money saved up to feel comfortable walking away from any terrible job that you would otherwise stick through as a trainee.

 

[Bartelby]

I agree with the above, in residency quitting isn't really an option (or at least carries a high risk of life-derailing consequences). As an attending your employer really needs you, and you can easily find a different job elsewhere. That means headaches and hassles still come up, but you aren't trapped. You can negotiate with real leverage, and if you don't like the deal on offer it is realistic to go elsewhere.

 

[AD04]

Feels like you are very similar to me based on your description. Since you profess to be content with work currently, I was wondering what your general work situation is currently?

Big Box Shop ROL

Some one posted some where about what are the Big Box shops. I can't find that post to reply there, so here is a new thread. In the spirit of the system we know well by students and residents who ask for advice, "Help me rank my programs!", let's collectively define the best of the Big Box...

forums.studentdoctor.net

 

[vistaril]

Is there burn out for residents now who just work shifts? Pass the cases on to night shift? Their hours and responsibility is so attenuated

huh? this is psych we are talking about......

it's not like a medicine/ICU case you check out to.

 

[PikminOC]

huh? this is psych we are talking about......

it's not like a medicine/ICU case you check out to.

With the number of hours being so much less now, continuous care is decreased

 

[TexasPhysician]

Has anyone utilized the Maslach Burnout Inventory? I saw it mentioned in this article - Rx Life. I like the general physician tips to avoid burnout, but I’m wondering if anyone has experience using this inventory?

 

[Stagg737]

Well the understanding of telepsych in my institute is all residents and attending s are in the hospital to resume their clinical and administrative duties over telepsychiatry (15 minutes med checks over the phone and daily administrative meetings over the zoom)

I mean I am still waking up at 8 am, going to hospital, staying there until 5 pm providing full clinical and administrative duties. Only difference is I am seeing the patients over the phone while I am trapped in the hospital.

can that possibly be the reason why I am hating it? I never thought about a setting where I am allowed to see my patients at my home desk. Hmm..

I'm actually the opposite and having patients return to in-person has been causing more burnout (other than at our CMHC, pretty neutral there). It's probably largely d/t the way our clinics are set up, but could also just be the apathy for outpatient I'm feeling for outpatient and that it's easier to be more emotionally detached when the person is not sitting right in front of you.

Wow your hospital is doing telepsych wrong lol. I feel like having people go into the office and do 100% of their work virtually is... asinine.

I go in because I know I would do a terrible job if I worked from home. Even did this when we were 100% virtual. It's just another nice way to keep the mental barrier between work and the rest of my life.

Our institution is doing the same thing, arguing its the most effective argument against insurance companies that don't want to pay for facility fees. We even have to indicate where we are in the notes (i.e. in the hospital, at a clinic, or at home, presumably with at home being the least recommended).

We recently had to start doing this as well, which is annoying but understandable if reimbursement from insurance is the argument.

 

[Monocles]

Has anyone utilized the Maslach Burnout Inventory? I saw it mentioned in this article - Rx Life. I like the general physician tips to avoid burnout, but I’m wondering if anyone has experience using this inventory?

Our residency used the Maslach one year... they saw the results and never did it again.

 

[sloh]

I'm actually the opposite and having patients return to in-person has been causing more burnout (other than at our CMHC, pretty neutral there). It's probably largely d/t the way our clinics are set up, but could also just be the apathy for outpatient I'm feeling for outpatient and that it's easier to be more emotionally detached when the person is not sitting right in front of you.

Why the apathy for outpatient?

 

[Stagg737]

Why the apathy for outpatient?

Lot's of reasons. I think part of it is that between the recent election and the pandemic, it's been a bizarre year that has brought out an exceptional number of patients who either have terrible or no coping mechanisms. I also find primary anxiety disorders as the primary problem are my least favorite conditions to treat, making outpatient in this particular era miserable at times.

 

[clausewitz2]

I also find primary anxiety disorders as the primary problem are my least favorite conditions to treat, making outpatient in this particular time miserable at times.

I had a very similar experience with anxiety disorders for much of PGY3 until I started getting seriously into third-wave therapies for this (ACT mainly) and incorporating the basic principles into structuring my interactions during appointments. Once I started trying to ally with the part of the person that is tired of having anxiety make their decisions for them. They don't like their anxiety any more than I do and once they start to realize that feeling better is not a great primary goal if doing better is on the table, the whole dynamic shifts and it becomes very rewarding. Just like when someone who can't fall asleep actually does the sleep restriction thing and mirabile dictu, they can fall asleep now for the first time in years.

That said I still feel quite deskilled when dealing with the type of anxiety that a lot of people recovering from substance use problems talk about that they can't describe and do impulsive things to not experience. I encountered the concept of "hyperkatifeia" in the chronic pain literature (a sort of emotional counterpart of hyperalgesia) and whatever you think of the etymology it really nails my experience with this entity. It does not feel the same as garden-variety kind of anxiety and I have a harder time getting people on board with prioritizing other values over immediate comfort. It feels significantly more "medical", by which I mean that intuition that I think all of us get sometimes but couldn't put a rigorous definition to in a million years.

 

[FlowRate]

Lot's of reasons. I think part of it being that between the recent election and the pandemic, it's been a bizarre year that has brought out an exceptional number of patients who either have terrible or no coping mechanisms. I also find primary anxiety disorders as the primary problem are my least favorite conditions to treat, making outpatient in this particular time miserable at times.

That and literally everyone thinks they have ADHD but it's actually just that working from home is not easy.

 

[clausewitz2]

That and literally everyone thinks they have ADHD but it's actually just that working from home is not easy.

'i can't focus. I work all day doing something boring and then after dinner when i have to watch lectures for my MBA on things I don't care about i can't pay attention. Also I am two glasses deep into box wine by then and sometimes a few puffs of weed.'

 

[Stagg737]

I had a very similar experience with anxiety disorders for much of PGY3 until I started getting seriously into third-wave therapies for this (ACT mainly) and incorporating the basic principles into structuring my interactions during appointments. Once I started trying to ally with the part of the person that is tired of having anxiety make their decisions for them. They don't like their anxiety any more than I do and once they start to realize that feeling better is not a great primary goal if doing better is on the table, the whole dynamic shifts and it becomes very rewarding. Just like when someone who can't fall asleep actually does the sleep restriction thing and mirabile dictu, they can fall asleep now for the first time in years.

That said I still feel quite deskilled when dealing with the type of anxiety that a lot of people recovering from substance use problems talk about that they can't describe and do impulsive things to not experience. I encountered the concept of "hyperkatifeia" in the chronic pain literature (a sort of emotional counterpart of hyperalgesia) and whatever you think of the etymology it really nails my experience with this entity. It does not feel the same as garden-variety kind of anxiety and I have a harder time getting people on board with prioritizing other values over immediate comfort. It feels significantly more "medical", by which I mean that intuition that I think all of us get sometimes but couldn't put a rigorous definition to in a million years.

I’d like to get more experience with ACT, but unfortunately I haven’t really had much exposure to it and likely will not this year. I may end up doing a psychotherapy elective if I don’t find something else to do.

 

[hebel]

I had a very similar experience with anxiety disorders for much of PGY3 until I started getting seriously into third-wave therapies for this (ACT mainly) and incorporating the basic principles into structuring my interactions during appointments. Once I started trying to ally with the part of the person that is tired of having anxiety make their decisions for them. They don't like their anxiety any more than I do and once they start to realize that feeling better is not a great primary goal if doing better is on the table, the whole dynamic shifts and it becomes very rewarding. Just like when someone who can't fall asleep actually does the sleep restriction thing and mirabile dictu, they can fall asleep now for the first time in years.

That said I still feel quite deskilled when dealing with the type of anxiety that a lot of people recovering from substance use problems talk about that they can't describe and do impulsive things to not experience. I encountered the concept of "hyperkatifeia" in the chronic pain literature (a sort of emotional counterpart of hyperalgesia) and whatever you think of the etymology it really nails my experience with this entity. It does not feel the same as garden-variety kind of anxiety and I have a harder time getting people on board with prioritizing other values over immediate comfort. It feels significantly more "medical", by which I mean that intuition that I think all of us get sometimes but couldn't put a rigorous definition to in a million years.

I had a very similar experience with anxiety disorders for much of PGY3 until I started getting seriously into third-wave therapies for this (ACT mainly) and incorporating the basic principles into structuring my interactions during appointments. Once I started trying to ally with the part of the person that is tired of having anxiety make their decisions for them. They don't like their anxiety any more than I do and once they start to realize that feeling better is not a great primary goal if doing better is on the table, the whole dynamic shifts and it becomes very rewarding. Just like when someone who can't fall asleep actually does the sleep restriction thing and mirabile dictu, they can fall asleep now for the first time in years.

That said I still feel quite deskilled when dealing with the type of anxiety that a lot of people recovering from substance use problems talk about that they can't describe and do impulsive things to not experience. I encountered the concept of "hyperkatifeia" in the chronic pain literature (a sort of emotional counterpart of hyperalgesia) and whatever you think of the etymology it really nails my experience with this entity. It does not feel the same as garden-variety kind of anxiety and I have a harder time getting people on board with prioritizing other values over immediate comfort. It feels significantly more "medical", by which I mean that intuition that I think all of us get sometimes but couldn't put a rigorous definition to in a million years.

..."once they start to realize that feeling better is not a great primary goal if doing better is on the table..."

Could you explain this to me?

As for the hyperkatifeia, I wonder about that too: is it trauma, limbic over-activation, excess glutamate tone, the terror of reality, affect phobia...??

 

[Evidence Based]

I had a very similar experience with anxiety disorders for much of PGY3 until I started getting seriously into third-wave therapies for this (ACT mainly) and incorporating the basic principles into structuring my interactions during appointments. Once I started trying to ally with the part of the person that is tired of having anxiety make their decisions for them. They don't like their anxiety any more than I do and once they start to realize that feeling better is not a great primary goal if doing better is on the table, the whole dynamic shifts and it becomes very rewarding. Just like when someone who can't fall asleep actually does the sleep restriction thing and mirabile dictu, they can fall asleep now for the first time in years.

Also curious to hear about good places to learn ACT principles- I have some patients who have loved it from prior therapists, but I haven't had any formal training in my residency and I don't think we will as far as I know. (Also have some conference days to burn before residency is over)

 

[Bartelby]

I liked both the happiness trap and the confidence gap for learning basic ACT principles (these are written as self-help books but do a great job illustrating the general principles). Amazon product

 

[FlowRate]

Also curious to hear about good places to learn ACT principles- I have some patients who have loved it from prior therapists, but I haven't had any formal training in my residency and I don't think we will as far as I know. (Also have some conference days to burn before residency is over)

I like "ACT Made Simple" by Russ Harris. I haven't read through the whole thing (the case I picked up in residency intending to do/learn ACT had a big crisis and shifted to more supportive work and so I put that book on hold) but it's very readable for a therapy primer.

 

[clausewitz2]

Also curious to hear about good places to learn ACT principles- I have some patients who have loved it from prior therapists, but I haven't had any formal training in my residency and I don't think we will as far as I know. (Also have some conference days to burn before residency is over)

Russ Harris is a good start. He's a FM doc by training and I feel like it sometimes shows in how he thinks about some issues but he's very approachable. I think the ideal second book to read after is Luoma, Hayes and Walser's "Learning ACT". Many things didn't really click until I started reading that.

For patients I sometimes recommend Steve Hayes' Get Out of Your Head and Into Your Life, which is the founder of ACT's stab at a self-help book. It's a little less glib than Harris so some people respond better to it.

 

[clausewitz2]

..."once they start to realize that feeling better is not a great primary goal if doing better is on the table..."

Anxiety by itself is not dangerous. Anxiety does not kill or maim anyone. It is extremely unpleasant but also eminently survivable. Fleeing anxiety is an excellent way to make sure that anxiety is an obstacle for you forever. If someone is going to be motivated to actually face anxiety head-on and get on with what actually matters to them, "don't feel anxious" is not a useful goal.

Useful goals are like "be anxious about commitment and get married" or "be anxious about giving my family AIDS by cooking dinner for them without changing out of my street clothes and get to be the kind of parent/partner I want to be" etc, etc. What does it feel like anxiety is stopping you from doing? Those are probably things you find important. It turns out when people do go after the things that matter to them irrespective of being afraid of it anxiety about thing tends to diminish pretty sharply over time. But in an important way that is just a great bonus side effect of getting on with doing what you want to be doing in your life and not necessarily the goal of treatment.

The feeling is not the problem. It's the impact that it has, the power you let it have over you - that's the real issue. Like that "treatment-resistant depression" case @whopper posted about a while back with the gentleman who was saying he was "depressed" but it didn't seem to be affecting his life in any tangible way, chasing the idea of feeling a very particular way is a recipe for frustration and failure.

 

[SmallBird]

Anxiety by itself is not dangerous. Anxiety does not kill or maim anyone. It is extremely unpleasant but also eminently survivable. Fleeing anxiety is an excellent way to make sure that anxiety is an obstacle for you forever. If someone is going to be motivated to actually face anxiety head-on and get on with what actually matters to them, "don't feel anxious" is not a useful goal.

Useful goals are like "be anxious about commitment and get married" or "be anxious about giving my family AIDS by cooking dinner for them without changing out of my street clothes and get to be the kind of parent/partner I want to be" etc, etc. What does it feel like anxiety is stopping you from doing? Those are probably things you find important. It turns out when people do go after the things that matter to them irrespective of being afraid of it anxiety about thing tends to diminish pretty sharply over time. But in an important way that is just a great bonus side effect of getting on with doing what you want to be doing in your life and not necessarily the goal of treatment.

The feeling is not the problem. It's the impact that it has, the power you let it have over you - that's the real issue. Like that "treatment-resistant depression" case @whopper posted about a while back with the gentleman who was saying he was "depressed" but it didn't seem to be affecting his life in any tangible way, chasing the idea of feeling a very particular way is a recipe for frustration and failure.

Great examples. ACT is a very powerful approach. I am not a skilled 'ACT therapist' but it is not difficult to internalize the core message and then help patients understand how it applies to a range of decisions in their lives and in their treatment. From an ACT perspective you can reframe the goal of medication as to be 'what can we do with medication based treatment to increase the odds that you will make meaningful progress in your functioning' rather than 'how much medication do you need to no longer feel difficult feelings'.

 

[clausewitz2]

Great examples. ACT is a very powerful approach. I am not a skilled 'ACT therapist' but it is not difficult to internalize the core message and then help patients understand how it applies to a range of decisions in their lives and in their treatment. From an ACT perspective you can reframe the goal of medication as to be 'what can we do with medication based treatment to increase the odds that you will make meaningful progress in your functioning' rather than 'how much medication do you need to no longer feel difficult feelings'.

The metaphor I often draw on is that you've fallen overboard at sea. You can just about see the shoreline in the distance and you know what you need to do. Medications for most people are a life preserver that I can toss them in the water. It's probably going to make the task ahead of you easier, you'd probably rather have it than not, and will hopefully keep you from drowning, but most of the time it's not going to swim you to shore all by its lonesome.