Therapy Tools Local therapist creates a "toolbox" for professionals. Ruthan Brodsky Special to the Jewish News arolyn Daitch's intent for writing Affect Regulation Toolbox was to provide professional therapists with a technique they could use when working with over-reactive clients. "I developed a number of concrete strategies that help clients retain a degree of mastery of their thoughts, feelings and communications skills that they found while in session with a therapist," says Daitch, a Ph.D., licensed psychologist and director of the Center for the Treatment of Anxiety Disorders in Farmington Hills. Daitch found that her focus on anxiety disorders and relationship issues in her private practice could be applied to a variety of issues related to over-reactivity and painful for many people. She uses the term "over-reactivity" to describe respons- es that are distorted and unnecessarily intense and overwhelming. "Many people are aware of their behavior problems and come to therapy to fix their pres- ent and work on the future, not to fix the past;' says Daitch. "But insight isn't enough and clients need tools to transfer what they learn in the office to their everyday lives. That's when the Toolbox functions as an adjunct Carolyn to therapy. It helps people gain control over their emotions:' The study of emotion and the affective domain has a long history in psychology. Affect regulation, or controlling one's emo- tions, is a term frequently used in therapy when dealing with such issues as excessive feelings and behaviors. "The affective domain refers to emo- tions as well as to their outward expres- sion," says Ruby Kushner, clinical social worker with a private practice in Farmington Hills. "Although lay people often use the words interchangeably, the affect is the expression of the emotion, the action that accom- panies an emotion and is the observable part of the emotion." Daitch Daitch's Toolbox provides tech- niques to control and normalize those excessive and emotions. Chapter 1 and 2 are explanations of over-reactivity, how it impacts lives and how the interdis- ciplinary field of neuroscience supports alternative approaches to talk therapy. Chapter 3 provides therapists guidelines for using the tools, including how to man- age roadblocks, such as resistance and poor response. Chapters 4 through 7 present the Toolbox itself, which is divided into four tiers: • Tier 1 — fundamentals of the Toolbox including the Time Out tool • Tier 2 — how to establish or deepen a state of calm • Tier 3 — descriptions of the tools with scripts • Tier 4 — rehearsal and transfer Chapters 8-11 apply the tools to a variety of case studies covering common and severe anxiety disorders, couples in conflict and other interpersonal relation- ships. Chapter 12, the final chapter, deals with roadblocks and challenges, such as The Facts About Degenerative Lumbar Stenosis Degenerative Lumbar Stenosis is a narrowing in the lumbar spinal canal, a very small space in the lower spine that carries nerves to the legs. After many years, this space can become even smaller, if the surrounding bone and tissue begin to grow. Neural Claudication is relatively easy to diagnose. Physicians can usu- ally determine if a patient has the condition by asking a battery of questions. However, special tests and x-rays of the spine are often required. Arthritis, falls, accidents and wear and tear on the bones and joints in the spine also play a part in Stenosis. As the lumbar spinal canal shrinks, the nerves within it become squeezed and can cause chronic back and leg pain, as well as leg weakness. STENOSIS VS. RUPTURED DISC: "Many patients confuse Stenosis with a ruptured disc," says Dr. Radden. "However, they are not the same thing." A ruptured (or herniated) disc usually pinches one or two nerves at a time. The resulting pain, called Sciatica, is caused by a pinched nerve in the lumbar spine and causes back pain that shoots down one leg. This pain can happen any time, not just when standing up or walking. The pain and weakness associated with Stenosis is usually described as a burning or prickly feeling which begins in the buttocks and spreads down to the feet when standing up, walking or exercising. Unfortunately, many adults suffer from this condition. OTHER FACTORS: "Legs might also feel cramped, tired, or weak," says Dr. Louis Radden, D.O., a St. Joseph Mercy Oakland orthopedic surgeon. "This usually points to a condition known as Neural Claudi- cation of the legs. For patients with Stenosis, the Claudication starts when standing up. Pain may worsen when walking, but will most likely get better when walking stops." Also, crouching down or lying in a fetal position has been shown to re- lieve symptoms, since it's believed that these positions open the lum- bar canal and take the pressure off the nerves that go to the legs. 52 TREATMENT OPTIONS: Several treatment options are available for Stenosis and Neural Claudication, depending on the extremity of symptoms. If the pain is mild and hasn't been present for long, an exercise or physical therapy program to strengthen back muscles and improve posture is usually effective. A physician may also prescribe medication for inflammation in the backbone. Dr. Radden notes that with severe back pain and Neural Claudication, however, spinal surgery may be required to take the pressure off the nerves in the lower spine. 6621 W. Maple Rd. West Bloomfield SPINE SPECIALISTS OF MICHIGAN P.C. 248-661-4700 RECONSTRUCTIVE SPINE SURGERY September 27 2007 Dr. Louis N. Radden 30055 Northwestern Hwy. Suite 270 Farmington Hills 248-865-4262