Healthcare and Medicine Reference
general level of energy” (p. 6). The authors also warn that Prozac may
actually cause anxiety as a side effect and recommend pinpointing the
cause of the anxiety problem before considering the use of medications.
Although the effects of cognitive-behavioral approaches seem positive,
Lang and Stein (2001) recommend that treatment of anxiety should be
tailored to the individual needs and cognitive abilities of the client.
Anxious clients may find relaxation approaches inappropriate or childish.
Systematic desensitization may be seen as unrelated to their situation or
to the origins of their anxiety, and they may view changes in the way
they are told to perceive life events as dangerous to their survival since
long-held beliefs and behaviors have often served them well in the past.
Being asked to view a situation with clarity and rationality may suggest to
the client that workers believe they are lying about an event. Clients may
discount psychological explanations for their anxiety and prefer to think
that it has a physical origin. All of these cautionary suggestions should be
taken into account when working with anxious clients or one runs the
risk of having psychological treatments dismissed completely.
A suggestion to encourage better acceptance of any intervention is to
give clients reading materials to help them understand the origins of
their anxiety and the approach most likely to help relieve their
symptoms. Testimonials from other clients might also be helpful, or sug-
gestions made by other professionals they trust could help the client
accept treatment. Keep in mind that anxious clients are like all of us.
They may be suffering, but they also fear that accepting new ways of
approaching life may actually increase their level of anxiety. However, as
Lang and Stein (2001) report, there are harmful side effects to the long-
term use of many anti-anxiety medications. While some of the
cognitive-behavioral approaches used in the treatment of anxiety may
not always fit a client's frame of reference, it's wise to let them know
about medical treatments and the potential for harm as one way to
acknowledge that medications have risks that should be considered, just
as there are associated risks in doing nothing.
DIAGNOSING AND TREATING SUBSTANCE ABUSE
The DSM-IV ( American Psychiatric Association, 1994 ) uses the follow-
ing diagnostic markers to determine whether substance use is abusive—a
dysfunctional use of substances causing impairment or distress within
a 12-month period as determined by one of the following: (1) frequent
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