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Anxiety - Common Symptoms of Social Anxiety Disorder - By Chris Gearing

Monday, July 08, 2013

Watch Dr. Sylvia Gearing describe some of the most common symptoms of Social Anxiety Disorder and when to seek professional help - click here.

Social Anxiety is the fourth most common mental health diagnosis in the United States.

It is a very common, often misunderstood psychological issue that affects up to 12% of the U.S. population or 15 million Americans. Here are some important points to keep in mind:

Gender Bias:

Women develop Social Anxiety at twice the rate of men. However, women are less likely than men to report Social Anxiety as an ongoing issue.

Defined By Shyness:

Social Anxiety tends to develop in childhood or adolescence and the most common age of appearance is between 11 and 16 years old. If it goes unaddressed, it can become a defining part of many important stages of life including high school, college, and early work experience. It can rob your child of wonderful social opportunities and limit their ability to experience the world.

Contradictory Experiences:

Surprisingly, those who are socially anxious often have excellent social skills when they are one-on-one. In a group, they may present as somewhat shy or reserved, but they are actually extremely socially capable and have a lot of skills interpersonally. They continue to search for evidence every moment of every day that they are somehow compromised socially.

Family Tree:

You are ten times more likely to develop Social Anxiety if you have a relative who also has a form of Social Anxiety. The early life family system reinforces social withdrawal as normal and not a serious mental health issue. Over the years, they become convinced that they lack the social skills to reach out and develop connections to those around them.

Here are some of the more common symptoms of Social Anxiety:

  • A persistent fear of one or more social or performance situations
  • Fear of exposure to unfamiliar people or to possible scrutiny
  • Regularly worrying that they will humiliate or embarrass themselves
  • Fear of exposure to social situations
  • Panic attacks that are confined only to social situations
  • Avoidance or endurance of social or performance situations
  • Intense anxiety or distress during social or performance situations
  • Anxious anticipation of social or performance situations
  • Significantly changing their routines to avoid social activities or relationships

Social Anxiety Disorder is a very serious condition. If you think someone you know may have Social Anxiety, please seek the assistance of a clinical psychologist.

Sources:

“Treatment Plans and Interventions for Depression and Anxiety Disorders, Second Edition” by Robert Leahy, Stephen Holland, and Lata McGinn

Belzer et al. 2005

Chapman, Mannuzza and Fryer, 1995

Fiuieira and Jacques, 2002

Grant et al. 2005

Merikangas, Lieb, Wittchen and Avenevoli, 2003

Rapee, 1995

Anxiety - What Is Social Anxiety? - By Chris Gearing

Friday, July 05, 2013

Watch Dr. Sylvia Gearing describe what social anxiety is, some of the signs of social anxiety, and when to seek professional help - click here.

Have you ever been struck with fear when you walked into a crowded room?

Do you begin to feel overwhelmed with panic and anxiety right before a party or public presentation? You may be suffering from social anxiety if you regularly experience significant dread before or during social situations due to a fear of being humiliated or embarrassed. Social anxiety is a very common, often misunderstood psychological issue that affects up to 12% of the U.S. population or 15 million Americans.

Social Anxiety is the fourth most common mental health diagnosis in the United States.

Sufferers tend to narrow their lives in an effort to preserve any sense of safety and predictability. Over time, the social anxiety usually becomes more entrenched and more profound. They shape their lives to avoid any anxiety-producing social situation and to avoid any social settings that may make them feel vulnerable and nervous.

In fact, they often avoid professional treatment due to the overwhelming anxiety.

They usually only begin treatment once there has been an event in their lives that forces them to face the problem. Typical examples include professional responsibilities that require public performance or even family responsibilities like being a leader in their child’s PTA or other activities. For them, romantic relationships are a true struggle and they often avoid dating of any kind.

Instead of addressing the problem head on, most sufferers build a new life that helps them avoid social situations that trigger their anxiety.

They may begin to accept the loss of friends and family since their anxiety is too overwhelming to be involved. In the end, they truly collapse their lives around them until they are safe, secure, but ultimately alone.

Social Anxiety Disorder is a very serious condition. If you think someone you know may have Social Anxiety, please seek the assistance of a clinical psychologist.

Sources:

“Treatment Plans and Interventions for Depression and Anxiety Disorders, Second Edition” by Robert Leahy, Stephen Holland, and Lata McGinn

Belzer et al. 2005

Chapman, Mannuzza and Fryer, 1995

Fiuieira and Jacques, 2002

Grant et al. 2005

Merikangas, Lieb, Wittchen and Avenevoli, 2003

Rapee, 1995

OCD - Living With Obsessive-Compulsive Disorder - By Chris Gearing

Wednesday, June 26, 2013

Watch Dr. Sylvia Gearing describe what it's like living with OCD and some signs that you may have OCD - click here.

Obsessive Compulsive Disorder or OCD affects about 2 percent of the American population every single day.

Sufferers are flooded with intrusive, recurrent thoughts that appear spontaneously and are highly upsetting or disturbing. Obsessions are usually paired with a compulsion or required behavior that soothes their anxious mind.

So, what is it like to live with OCD?

Camouflage of Normal:

Many OCD rituals are subtle and can often be hidden from others. Other people often see them as somewhat normal or a part of the person’s need to be perfect. However, compulsions cross the line when they become repetitive and are used intentionally to soothe anxiety. For instance, washing your hands before and after a meal may be normal, but an OCD sufferer may wash their hands 10 times in a row because they didn’t properly check one of the locks on the front door.

Acting For Relief:

Most of us complete tasks to accomplish a goal. We wash the dishes every night so we have clean dishes for tomorrow, and we make sure that the oven is turned off to avoid any nasty surprises while we are sleeping. OCD sufferers don’t necessarily engage in behaviors to accomplish something. They are often acting to relieve their anxiety or fear of what will happen next. These fears are often unrelated to the task or they are an extreme case of what might happen. For instance, they may say a particular prayer every time they turn off a lamp so that the devil doesn’t appear in the dark room.

Higher Burdens:

As obsessions and compulsions become more entrenched over time, they become harsher and more demanding masters. They may have to engage in compulsions more regularly or increase the scale of their compulsive acts to meet the new requirements for relief. For instance, they may have once calmed themselves by slowly counting to ten, but now they must count to 187 before they feel relief.

Reinforcing Cycle:

Many OCD sufferers have more than one type of obsessive thought or compulsive behavior. They may have to wash their hands five times in a row to avoid a terminal illness, but they also have to recite a poem every two hours to make sure a meteor doesn’t fall on their mother’s house. As they add more and more tasks to soothe their troubled minds, they are often physically exhausted and more vulnerable to new anxious thoughts. The cycle starts over again once those anxious thoughts create new obsessions and new compulsions to relieve the anxiety.

Self-Fulfilling Prophecies:

At some point in the OCD cycle, they may begin to believe that their compulsive behaviors really do work. They believe that their actions are the only thing standing between them and disaster. Since they become far too agitated and anxious if they are denied the ability to perform their compulsive behaviors, they never find out what would happen if they didn’t follow through on their compulsions. As long as they keep up with their tasks, they can be sure that everything and everyone will be OK. Why should they tempt fate by not completing one of their tasks?

Obsessive Compulsive Disorder is a very serious condition. If you think someone you know may have OCD, please seek the assistance of a clinical psychologist.

SOURCES:

"Overcoming Obsessive Thoughts" by Christine Purdon, Ph.D. and David Clark, Ph.D.

“Treatment Plans and Interventions for Depression and Anxiety Disorders” by Robert L. Leahy, Stephen J.F. Holland, and Lata K. McGinn, 2012

The Allure of Bad Boys - By Chris Gearing

Saturday, June 22, 2013

Watch Dr. Sylvia Gearing describe why bad boys are so tempting and how to know if you're bad boy has a heart of gold - click here.

It’s a question as old as time. Why are bad boys so irresistible?

This kind of situation can be a parent’s worst nightmare – even if they don’t own a motorcycle. So, why are bad boys so attractive?

Viewed from afar, these guys can seem very attractive. They are often glamorous, soulful, artistic, romantic, and they ooze self-confidence. He’s spontaneous, lives for today, and is full of adventure. Unfortunately, most bad boys see you or your child as the next target. They are often hoping to use you today and be gone tomorrow.

But it’s not all bad. There are some good men in bad boy packages. Think of Johnny Cash, Brad Pitt, Jay-Z, or David Beckham. They were wild when they were younger, but they became dedicated husbands and fathers down the road.

Here are some signs that you may have landed a keeper in a leather jacket:

Live By A Code:

If your bad boy is controlling or regularly cheats, he’s a poor bet for a sudden reform. However, if he is conscientious, values family and other people around him, and genuinely cherishes you or your child, you might give him some time. He may just be growing up.

Longer To Mature:

Recent research found that the male brain doesn’t fully mature until men are forty-three years old. That’s eleven years more than their female counterparts! Again, try to cut him some slack. See if he is willing to meet you in the middle and act like an adult.

Watch For Warnings:

Always be aware of the warning signs that it may be time to leave. Men who use intimidation or violence to get what they want usually end up turning on you at some point. When they start trying to frame the world as “us against them,” that’s a red flag that they may want you to be dependent on them. Also, don’t let them radically change your life. If it’s meant to be, they love you for who you are today and they don’t need you to change.

Source:

"The Primal Teen" by Barbara Strauch

The Importance of Parents In "Man of Steel" - By Chris Gearing

Monday, June 17, 2013

Watch Dr. Sylvia Gearing discuss why Superman's parents were so important in "Man of Steel" and why parents are important for all of us - click here.

Our parents are central to how we think, feel, and act as a child and what kind of person we become as adults.

In the new summer blockbuster “Man of Steel,” Superman’s two sets of parents take center stage. His parents on Krypton give him a sense of protecting those around him, fighting for good, and believing in ideas that are bigger than one man. His parents on Earth teach him right from wrong, how fear can make good men do bad things, and what it means to be human. Both sets of parents have a strong influence on Superman and the choices he makes in the events of “Man of Steel.”

Parents teach us the way of the world and can make the difference between a life of struggle and hardship or a life of success and happiness. Research has revealed how different types of parents affect their children and their development. Here are some of the more common types of parents and their potential impact on their children:

Super-Achieving Parents:

This style of parenting emphasizes appearance and achievement. Kids grow up knowing that they must look good, perform well, and win. Money, position, and power are all heavily emphasized. These parents imbue their kids with a strong work ethic, ambition, and the children often make excellent entrepreneurs and leaders. The down side is that kids often feel disconnected and misunderstood by a parent who wants them to “run with the bulls,” at the expense of the finer points of relating and living. These kids have difficulty establishing separate identities from their overbearing parents and often prefer to live a life that values the welfare of others.

Time-Bomb Parents:

This style is based on fear, intimidation, and emotional instability. Without hesitation, the parent will lash out toward others and these outbursts are terrifying for kids of all ages. Threats of neglect, abandonment, and emotional and physical violence are common. Keeping the peace and managing the parent is all that matters to the child, and these kids often develop into masterfully perceptive people since they had to manage their parent so carefully. These children are hypersensitive to the emotions and needs of others, and they have to develop their own ability to protect their interests with others who try to take advantage of them.

Passive Parents:

This kind of parent showed love through their actions, not through relating or through verbal statements. They were stable, consistent, hard working, calm, and emotionally reserved. This parent would never engage in unkind behavior, and they often surrender their power to the other parent and become a peripheral member of the family. Emotional distance is the hallmark of this type of parent. Children of this type of parent doubt their ability to communicate emotionally and to have deep relationships. Like their parent, they understand the importance of commitment and hard work, and they are generally stable, temperate, and reliable. However, learning to understand and manage their emotions can be a lifelong challenge.

Absent Parents:

The absent parent is "missing in action" and has abdicated their role and interest in their children. Parental rejection is horrific for the child’s sense of worth. These kids often harbor life long pain and resentment. Even when a marriage ends in divorce, a child wants their parent to fight for them. If they walk away without a fight - no matter what the rationalization may be - the child is deeply impacted. The upside is that these kids learn the value of loyalty, support, and commitment to others and can become extremely committed to social welfare and justice. Careful to not create dissension, they may be overly accommodating with others in negotiations and in their personal relationships. Slow to trust, they often develop very intense, lifelong relationships with a small, elite inner circle. Some of our greatest presidents and world leaders have experienced this kind of parent and have transformed adversity into a triumphant life of contribution.

Compassionate-Mentor Parents:

Think Jonathan Kent or Jor-El in “Man of Steel” and you have a pretty good idea of the gifts of the compassionate-mentor parent. Although this is the mom or dad we all want to have, few of us are ever gifted with this kind of parent. This kind of parent is astute in reading others, committed to values greater than themselves, and they hold themselves and their children to ethical, loving standards. They spend time with their children, nurture them with attention and understanding, and they are, above all else, emotionally connected. They empower their children to pursue their dreams, triumph over setbacks, and to envision their success. Children feel safe, understood, and adored. These children are fully capable of healthy, balanced, and compassionate lives and often engage in a life of contribution to society. They are excellent partners and parents since they learned from a young age to value themselves, to handle their emotions responsibly, and to engage in life fully.

Many parents are a blend of these different typologies, and they often evolve from one parenting style to another as they grow and mature over the life cycle. Hopefully, we can all embrace the best parts of our parents and prepare our own children for their own happy and successful lives.

Source:

“The Father Factor: How Your Father's Legacy Impacts Your Career” by Stephan B. Poulter

Suicide - Is This Generation More Depressed or More Aware of Suicide? - By Chris Gearing

Friday, June 07, 2013

Watch Dr. Sylvia Gearing examine why the rate of teen suicide is continuing to climb even though we know more about teen suicide than ever - click here.

According to the Centers for Disease Control and Prevention, one in five US teenagers considers suicide every year.

Psychologists know more about suicide than ever, but the rate of teen suicide has climbed steadily over the generations and is now the third leading causing of death for Americans from 15 to 24 years of age. So, why does the rate of teen suicide continue to grow even though Americans are taking more action than ever to stop suicides?

Epidemic Depression:

Part of the answer is that teen depression and anxiety are reaching epidemic levels. Research has found that teen depression has increased tenfold over the last century and it strikes a full decade earlier than it did fifty years ago. That means that this generation is ten times more likely to reach clinical levels of depression, and they will likely become depressed when they are still children. In addition once depression and anxiety have set up shop in your child’s mind, they are more likely to return in the future. Severe depression reoccurs about 50% of the time.

Swept Under The Rug:

Even though suicide attempts indicate very serious mental health issues, very few suicidal teens actually receive professional treatment. According to research, 60-80% of American teens who attempt suicide do not seek out professional treatment until after the second suicide attempt. Their friends and family downplay the suicide attempt and try to make it a temporary anomaly. Hopefully, they don’t wait until it’s too late.

Deadly Differences:

Eighty-four percent of completed suicides, or attempts that end in death, are committed by boys. Girls are much more likely to attempt suicide, but boys tend to use much more violent and lethal means in their attempts. They may use a gun, intentionally wreck their car, or even jump off of buildings. Girls tend to use much less violent methods such as poison or overdosing.

If you are worried about your teen, here are some suicide warning signs to watch out for:

  • Stressful life event or loss like a relationship breakup
  • Easy access to lethal means
  • Lack of effective coping skills
  • Family history of suicide
  • History of depression or other mental illness
  • Alcohol or drug use
  • Exposure to the suicidal behavior of peers or acquaintances
  • Increased withdrawal from others
  • Increased rate of angry outbursts
  • Increased need for sleep
  • Low appetite
  • Dramatic mood swings
  • History of previous suicide attempts

Clinical depression and suicide are very serious issues. If you are worried about someone you know, please seek the assistance of a clinical psychologist.

Sources:

"Learned Optimism" by Martin Seligman, Ph.D.

"Unraveling the Mystery of Suicide" by By Tori DeAngelis, American Psychological Association

"Suicide Among Pre-Adolescents" by Michael Price, American Psychological Association

"Teen Suicide is Preventable" published by the American Psychological Association

American Association of Suicidology, www.suicidology.org

National Institute of Mental Health, nimh.nih.gov

Suicide - The Rising Rate of Teen Suicide - By Chris Gearing

Wednesday, June 05, 2013

Watch Dr. Sylvia Gearing discuss the rising rate of teen suicides, why American teens need more help than ever, and some of the warning signs of teen suicide - click here.

According to the CDC, one in five US teenagers considers suicide every year.

The American Psychological Association reports that teen suicide is the third leading cause of death for people who are 15 to 24 years old. So why would a teenager with every thing to look forward to in life choose a permanent solution such as suicide?

Most teen suicides begin with a perfect storm of upsetting events, like getting dumped by a significant other or losing a family member, that leads to overwhelming depression. If they lose hope and think that their life will never change for the better, they may begin to think about committing suicide. At a basic level, these adolescents lack the necessary coping skills to think accurately about temporary setbacks and how to overcome adversity.

There are several factors that can lead to teen suicide:

No Hope For The Future:

Suicide becomes an option for a young person when all hope is lost. In fact, hopelessness is the best predictor for a suicide attempt. Hopelessness is the most common emotion in those who attempt to end their lives.

Escaping Unsolvable Problems:

The motivations for either attempting or completing suicide are complex. In most cases, they are trying to escape depression and loss, debilitating anxiety, or a situation they regard as being unsolvable such as being bullied or abused. The older the child is, the greater the likelihood that their suicide is connected to interpersonal conflicts.

Hidden Mental Illness:

Mental illness, such as clinical depression or general anxiety disorder, is the top risk factor in suicide and accounts for 90% of all suicides. Clinical depression is the most common disorder linked to suicide. Children and adolescents are particularly skilled at hiding their mental health challenges since they do not know how to fully describe their thoughts and feelings. Since they are confused about what is going on inside of their minds, they don’t know when they need to ask for professional help.

Masking Their Pain:

Adolescents will not always articulate their pain because they often don’t understand the serious nature of their feelings. In fact, they may even present a happy façade. Psychologists describe this condition as a “smiling depressive” since they are hiding their clinically depressed thoughts behind a mask.

A lack of emotional coping skills combined with overwhelming situational stress can drive children and teens toward suicide. If you are worried about someone you know, please seek the assistance of a clinical psychologist.

Sources:

"Learned Optimism" by Martin Seligman, Ph.D.

"Unraveling the Mystery of Suicide" by Tori DeAngelis, American Psychological Association

"Suicide Among Pre-Adolescents" by Michael Price, American Psychological Association

"Teen Suicide is Preventable" published by the American Psychological Association

American Association of Suicidology, www.suicidology.org

National Institute of Mental Health, nimh.nih.gov

OCD - What is Obsessive-Compulsive Disorder? - By Chris Gearing

Wednesday, May 29, 2013

Watch Dr. Sylvia Gearing describe what Obsessive-Compulsive Disorder is, how it begins, and when it may be time to seek professional help - click here.

Does your mind obsessively focus on the same thought?

Do you find yourself worrying about a task or chore that shouldn’t be bothering you? Does calming down involve performing senseless rituals such as checking locks, washing hands, or counting items?

You may be one of the millions of people who suffer from obsessive-compulsive disorder or “OCD”. Approximately 90% of individuals with OCD experience obsessive thoughts and perform compulsive acts. Around two thirds of individuals with OCD experience multiple obsessions and perform many types of compulsive acts.

Men and women develop OCD at approximately the same rates. However if OCD begins in childhood, boys tends to develop it at a higher rate than girls. Most cases develop in late adolescence between 18 to 24 years of age.

Here are some important points to keep in mind:

Imagined Horrors:

OCD symptoms begin with obsessive thoughts. Your mind creates an intrusive, horrific thought that appears without warning. The thought is often totally at odds with your current situation and often is some form of catastrophic thinking. The thoughts are almost always disturbing since they usually involve some type of natural disaster, unimaginable crime, or world shaking event occurring.

Simple Penance:

The OCD mind offers a solution to the obsessive worry. The compulsive behavior is the mind’s solution to preventing disaster. If you only check the door locks again or clean the bathroom several more times, the imagined disaster can be avoided. Compulsions are usually either mental rituals like obsessively counting or behavioral sequences like cleaning your hands multiple times in a row.

Undertreated Disorder:

Millions of people struggle with OCD every single day, and the relentless pattern can torture sufferers for years. Many people are embarrassed about the disorder and are reluctant to seek professional help. According to the Harvard Medical School Health Guide, around 10% of OCD patients are ultimately cured and about 50% of OCD cases improve but still struggle with their symptoms every day.

Obsessive-compulsive disorder can be a very serious condition. If you think someone you know may have OCD, please seek the assistance of a clinical psychologist.

Sources:

"Brain Lock: Free Yourself from Obsessive Compulsive Behavior" by Jeffrey Schwartz and Beverly Beyette, 1997

E.B. Foa, and M.J. Kozak, 1995, DSM IV, Field Trial, Obsessive Compulsive Disorder. American Journal of Psychiatry, 152. 90 to 96.

"Overcoming Obsessive Thoughts: How to Gain Control of Your OCD" by David Clark and Christine Purdon

How To Talk To Kids About Deadly Oklahoma Tornadoes - By Chris Gearing

Tuesday, May 21, 2013

Watch Dr. Sylvia Gearing discuss how to explain the deadly tornadoes in Oklahoma to your children and how to make sure they feel safe - click here.

Anxiety - What Is Generalized Anxiety Disorder? - By Chris Gearing

Wednesday, May 15, 2013

Watch Dr. Sylvia Gearing describe what Generalized Anxiety Disorder looks like and what you can do to help - click here.

Generalized Anxiety Disorder affects over 6 million Americans every day.

They live with constant worry, unending concerns, and ongoing apprehension about the future. To escape their crushing anxiety, they withdraw from other people and avoid the things that make them anxious.

Generalized Anxiety Disorder, or G.A.D., grows over time and is built on every negative experience in a person’s life. Since it often begins in childhood, most sufferers wait 25 years before reaching out for professional help.

Here are a few important points about Generalized Anxiety Disorder:

Paired Disorders:

Ninety percent (90%) of G.A.D. sufferers have some kind of co-existing mental health disorder. Around 42% of people suffering with G.A.D. also have issues with depression, and one disorder usually is more prominent than the other.

Double Trouble:

Women tend to develop generalized anxiety at twice the rates of men. The rates of depression and anxiety double for girls around puberty, so their anxious thinking habits are more likely to take root in their teens and grow over time.

Suspicious Minds:

One of the principle features of generalized anxiety disorder is the tendency to worry and ruminate. Worry is a prominent characteristic of G.A.D. and occurs in 40 to 60% of cases. The worry creates a vicious cycle - we worry to soothe our own anxiety, which only makes the fear grow. If your mind is tied up with worrying all the time, you have little energy to rest, learn, or implement more effective ways of coping.

Intolerable Uncertainty:

Anxious minds cannot tolerate uncertainty or ambiguity. They have difficulty with leaving loose ends or having a lack of closure. They lack confidence in their ability to handle adversity or the unexpected, so they worry constantly to prepare for anything.

Generalized Anxiety Disorder can be a very serious condition. If you are worried that someone you know may be living with an anxiety disorder, please seek the assistance of a clinical psychologist.

Sources:

Treatment Plans and Interventions for Depression and Anxiety Disorders: Robert Leahy, Stephen J.F. Holland and Lata McGinn, Guilford Press, 2012.

Wittchen, H. U., Zhao, S., Kessler, R. C., and Eaton, W.W. 1994, DSM III-R Generalized Anxiety Disorder in the National Comorbidity Survey, Archieves of General Psychiatiry, 51/(5), 355-364

Rubio, G. and Lopez-Ibor, J.J. 2007, Generalized Anxiety Disorder: A 40 year follow up study. Acta Psychiatrica Scandinaviaca, 115 (5), 372-379

Blazer, D., George, L., and Winfield, I. 1991, Epidemiologic data and planning mental health services: A tale of two surveys. Social Psychiatry and Psychiatric Epidemiology, 26, 21-27.

Breslau, N and Davis, G.C., 1985, DSM-III generalized anxiety disorder: An empirical investiagation of more stringent criteria. Psychiatry Research, 15, 231-238.

Kessler, R.C., Walters, E.E. and Witchen, H.U. 2004, Epidemiology. In R.G. Heimberg, C.L. Turk, and D.S. Mennin (Eds) Generalized Anxiety Disorder, Advances in research and practice (pp29 to 50). New York: Guildord Press.

Butler, G, Fennerll, M., Robson, P and Gelder, M. 1991, Comparison of behavior therapy and cognitive behavior therapy in the treatment of generalized anxity disorder. Journal of Consulting and Clinical Psychology, 59, 167-175.

Rapee, R.M. 1991, Psychological Factors involved in generalized anxiety. In R.M. Rapee and D. H. Barlow (Eds.) Chronic Anxiety: Generalized Anxiety disorder and mixed anxiety depression (pp. 76-94). New York: Guilford Press.

Intolerance of Uncertainty and Problem Orientation n Worry, Michael Dugas, Mark Freeston, Robert Ladouceur, Cognitive Threrapy and Research, Vol 21, no 6, 1997, pgs. 593-606


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