Lenny Gallo, Licensed Clinical Social Worker, LCADC

Collectively, anxiety disorders are the most common mental health issues diagnosed in the United States -- even more common than depression. Women are more likely than men to be diagnosed with anxiety, and it is extremely common for a person with anxiety to have another illness at the same time, such as depression, a physical illness, or substance abuse.

Treatment for anxiety usually involves medication and psychotherapy together. Medications used may include antidepressants (which also work for anxiety), anti-anxiety medications, or beta blockers (which can be used to control the physical symptoms of anxiety). Psychotherapy can be useful to teach patients new ways of thinking and reacting so that they can manage their feelings of worry and fear. Support groups can also be very effective for anxiety, and they can be a form of treatment themselves for social phobias. Stress management, relaxation techniques, and meditation all help reduce feelings of anxiety or of being out of control. Finally, having a strong support network of family and friends is an excellent way to help manage the difficulties of life with anxiety.

During an EMDR therapy session, patients are encouraged to access upsetting memories and to reprocess them. Reprocessing is achieved by repeated and rapid bilateral (side to side) eye movements, tapping one's chest and face, and auditory and visual stimulation. These techniques can desensitize patients to their traumatic memory. By reframing how a patient interprets a memory, EMDR is believed to weaken the fight-or-flight response and to rebalance the nervous system. For patients with PTSD, EMDR can treat recurring flashbacks and triggers by reducing the hyperarousal response and promoting emotional regulation.

EMDR patients are first asked to identify a specific memory to reprocess, called the ?target event.? Patients can discuss their feelings, sensations, and beliefs about the event, and may share a picture or use descriptive imagery. Therapists usually employ a set of measurements called the Subjective Units of Disturbance (SUD) scale to assess the patient's distress. Later on, therapists and patients may compare the patient's initial SUD score to their score following an EMDR session. Unlike other forms of therapy, EMDR patients are not prompted to analyze and reflect on details of their traumatic memory at length.

With a target event having been selected, therapists may begin the desensitization process. They instruct patients to perform eye movements, body taps, or sounds while capturing the target event in their mind. These techniques are called dual attention bilateral stimulation (BLS) and can help a patient feel calm and aware, while simultaneously invoking the brain's processing system. Patients may continue these techniques until their SUD distress level has decreased. Patients are then asked to derive a positive thought or affirmation about the target event, and to repeat or strengthen it until it feels sincere. A final ''body scan'' is where patients focus on both the target event and positive cognition to evaluate their physical response and identify any remaining distress. If the traumatic incident is not fully processed in one session, patients are asked to contain the memory and to avoid returning to it until their next EMDR session.

EMDR may greatly improve quality of life in people who suffer from latent trauma and adverse life experiences. EMDR may also be effective for those whose prior experience with talk therapy was unsuccessful.

• Frequent intense sexual fantasies, urges, and behaviors that feel involuntary or beyond an individual's control
• Numerous unsuccessful attempts to stop or reduce sexual behaviors
• The use of sexual behaviors as an attempt to deal with other problems, such as loneliness or depression
• Feeling guilt or remorse after engaging in repeated sexual behaviors
• The inability to stop engaging in sexual behaviors despite negative consequences such as contracting a sexually transmitted infection, damaging important relationships, losing a job, or developing financial or legal problems
• Continuing to engage in repeated sexual behaviors despite receiving little or no satisfaction from them

Compulsive sexual behavior can occur regardless of an individual's gender or sexual orientation, though it may be more common in men. The risk of compulsive sexual behavior may also be higher for people who have alcohol or drug use disorders, other mental health disorders, or childhood traumas, including sexual abuse.

While the causes of compulsive sexual behavior remain unknown, theories of possible causes include:

• Imbalance of brain chemicals affecting mood: certain chemicals in the brain, such as serotonin, dopamine, and norepinephrine, help control mood. When these chemicals are out of balance, sexual desire and behavior could be affected.
• Altered brain pathways: over time, compulsive sexual behavior might cause changes in the brain's pathways, especially in areas of the brain related to reinforcement. Eventually, more intense sexual content and stimulation are usually needed to obtain satisfaction or relief.
• Conditions that affect the brain: some health conditions, such as dementia, epilepsy, or bipolar disorder, may cause damage to parts of the brain that affect sexual behavior. Also, certain medications used to treat Parkinson's disease may cause compulsive sexual behavior.

There is ongoing debate among mental health experts over how to classify compulsive sexual behavior. The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, serves as the predominant guide for diagnosing mental health conditions in the United States and does not include compulsive sexual behavior as a diagnosis. However, the condition may sometimes be diagnosed as part of another mental health condition, such as an impulse control disorder or a behavioral addiction. In contrast, the World Health Organization recently identified compulsive sexual behavior disorder as a diagnosis, which it includes among impulse control disorders.

Determining if sexual behaviors have become a problem is not always straightforward, and more research is required to establish standard guidelines for diagnosis. Nevertheless, whether hypersexual behavior is a compulsion or an addiction, there are individuals engaging in these behaviors who would like to receive help with managing their behavior. There are mental health professionals who specialize in treating addictions, including and compulsive sexual behaviors. Compulsive sexual behavior may be treated with:

• Psychotherapy: essentially, a mental health professional will help individuals identify and manage factors that might trigger compulsive sexual behaviors. Psychotherapy may be provided in individual sessions, as well as sessions with families or couples. These sessions may take place in person or online.
• Medications: while there is currently no medication specifically approved to treat compulsive sexual behavior, some medications used to treat other conditions may be prescribed, such as antidepressants, anti-anxiety medications, or mood stabilizers. These medications act on brain chemicals linked to urges and behaviors. They can lessen sexual urges and brain-chemical rewards that certain behaviors might provide. The medications that are most appropriate for an individual depends on that individual's circumstances, including any other mental health conditions.
• Support groups: these groups can help individuals learn about compulsive sexual behavior, receive support and understanding, identify treatment options and coping techniques, and prevent relapse. Support groups are often modeled after the 12-step program of Alcoholics Anonymous. Mental health professionals may be able to recommend particular groups that meet locally or online.

The principal goal of treatment for compulsive sexual behavior is to help individuals manage urges and reduce problematic behaviors while still enjoying healthy relationships.