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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by Dinah on April 27, 2013, at 14:44:14
How do you all manage those "rate your anxiety (or depression or whatever)" from 1-5 or 1-10? I hate those. It's been a big part of therapy lately since we've been doing CBT emetophobia therapy.
Do you start with panic attack being 10, and 5 as being half as anxious as that? Because that, to me, would put most of my anxiety at less than one, since panic attacks are soooo awful.
My therapist suggests that if the thought of panic attacks makes rating my anxiety impossible, that I rate anxiety from one to ten, and consider a panic attack to be outside the range. Maybe a 100. That helps. But I'm not sure this kind of anxiety feels the same as other types of anxiety, so I still feel at a loss. There isn't the racing heart and jittery feeling. It's more a feeling of rising tension. I remember seeing my face one time, and it was bright cherry red and my head felt like it was about to explode.
I am thinking of suggesting a scale that has 10 being "a degree of tension and pressure that would ordinarily cause me to get up and run" or maybe a 10 being actually keeling over from a stroke, and an 8 being where I feel an overwhelming urge to flight.
I hate these rating systems. I really do. How am I supposed to know what level it ought to be? I'm the same about pain. Even if I consider a 10 to be the worst pain I've ever had, I need to leave lots of room for the worst sort of pain anyone has ever had, which I'm sure I've never even approached.
Posted by Phillipa on April 27, 2013, at 19:05:18
In reply to 1-10, posted by Dinah on April 27, 2013, at 14:44:14
I honestly don't think you can rate either anxiety or pain with the number system. Did you know that now pain isn't rated from a 1-10? Learned this from spinal doc. Now it's how well functioning and this makes sense to me. As for panic if it's now internalized and comes out as something other than anxiety as you have learned to hide it even from self. How can you? Maybe a how do you feel? I don't know. Phillipa
Posted by alexandra_k on April 28, 2013, at 4:05:46
In reply to Re: 1-10 » Dinah, posted by Phillipa on April 27, 2013, at 19:05:18
i feel the same way about rating systems. i used to refuse to do them but then people got upset. then i got the hang of it. what they want to see from you is for your rating of your anxiety to go down in time. that means the treatment was effective, you see.
ugh.
meaningless waste of time
meaningless
i thought it was my numeracy issue... but now i'm not so sure...
'better or worse or much the same' works pretty well for me.
Posted by SLS on April 28, 2013, at 17:53:52
In reply to Re: 1-10, posted by alexandra_k on April 28, 2013, at 4:05:46
> i feel the same way about rating systems. i used to refuse to do them but then people got upset. then i got the hang of it. what they want to see from you is for your rating of your anxiety to go down in time. that means the treatment was effective, you see.
>
> ugh.
>
> meaningless waste of time
>
> meaningless
>
> i thought it was my numeracy issue... but now i'm not so sure...
>
> 'better or worse or much the same' works pretty well for me.
I have found numeric rating systems to be helpful. They allow my doctors and I to get some idea as to the direction and magnitude of changes in my condition. Self-ratings can take some time and practice to establish a meaningful scale.
- Scott
Posted by Dinah on April 29, 2013, at 7:09:20
In reply to Re: 1-10 » Dinah, posted by Phillipa on April 27, 2013, at 19:05:18
I definitely think that's a factor. I've worked so hard myself to learn to control myself, to maintain at least a bare semblance of normality, that I have to some extent smothered my feelings of anxiety. But that's not so easy to do really.
I understand objectively that what my therapist wants is a way to tell how much any particular item of exposure is bothering me, to see if we need to spend more time on it. But I the numerical scale might actually help him understand me less, not more. I suppose at best, it's a distraction that helps me change my focus.
Posted by Dinah on April 29, 2013, at 7:11:52
In reply to Re: 1-10, posted by alexandra_k on April 28, 2013, at 4:05:46
I'm glad someone hates those scales as much as I do. To be fair to my therapist, I think his intent is to understand better so that he can help me better.
But I am far too precise about words to feel comfortable with it. I not only would need to know precisely what each number meant, but also be able to determine precisely how I felt. Neither is easy for me.
Posted by Dinah on April 29, 2013, at 7:15:12
In reply to Re: 1-10, posted by SLS on April 28, 2013, at 17:53:52
How do you come up with such a scale, and how do you communicate it so that both you and your doctors understand it in the same way?
Perhaps I'm being overly precise, but I don't quite know how not to be.
Posted by SLS on April 29, 2013, at 8:00:24
In reply to Re: 1-10 » SLS, posted by Dinah on April 29, 2013, at 7:15:12
> How do you come up with such a scale, and how do you communicate it so that both you and your doctors understand it in the same way?
>
> Perhaps I'm being overly precise, but I don't quite know how not to be.I understand this dilemma.
I consider my untreated baseline depression to be represented by a score of zero and remission a score of 100%. However, we are talking a relative scale and not an absolute one. An absolute number could be arrived at by using an established clinical rating scale (Hamilton, Burns, Zung, Montomery-Asberg, etc.). If a treatment makes me feel worse than baseline, I use negative numbers. If I become manic, I will attempt to use numbers above 100%. This is an unusual method of scoring that I came up with to make things quick and easy. However, I know what 100% remission feels like. I don't know if this is necessary for this rating system to work. At a time when I really didn't know what remission felt like, I simply chose the number 3 of 10 as my baseline and worked from there. Since depression is a subjective and nebulous experience, I think one must use a more intuitive approach at approximating a score.
You might want to search the Internet for the various depression rating scales and choose one that you feel makes sense to you. You should be able to get a "feel" for the spectrum of severity based upon more concrete criteria.
https://outcometracker.org/scales_library.php
I think that most of these rating scales suck, so I use them only when I am asked to. They are not without utiity, but I find them to be primitive and not always relevant to my symptomatology.
How about making zero represent the worst state you can imagine and making 10 the best? Intuitively, where would you approximate your position along this spectrum?
- Scott
Posted by baseball55 on April 29, 2013, at 19:44:41
In reply to Re: 1-10 » Dinah, posted by SLS on April 29, 2013, at 8:00:24
I think you should randomly choose a baseline score (say 5) and then report on whether symptoms are better or worse than that and how much better or worse. So a lot better might be a 2, a lot worse a 9. 10 is the worst you've ever felt, not the worst someone else has ever felt. It's a subjective scale by definition.
I recently have had hip problems and had to rate my pain for the doctor. I rated it a 5 out of 10. When I told my husband this, he laughed and said, well I don't feel so sorry for you if it's only a 5. But for me a 10 is the worst pain I ever felt which was when I got out of surgery for my ankle. That was so severe, I needed morphine. Compared to that, this pain is minor, but still debilitating.
Posted by Phillipa on April 29, 2013, at 20:16:31
In reply to Re: 1-10, posted by baseball55 on April 29, 2013, at 19:44:41
How well are you functioning both mentally & physically says a lot about me. I like this but also like the 5 as middle for you or self set as the standard and then better than or worse then. This makes sense to me. Phillipa
Posted by Dinah on April 29, 2013, at 20:17:06
In reply to Re: 1-10 » Dinah, posted by SLS on April 29, 2013, at 8:00:24
Mine is for anxiety, so the zero would be a total lack of anxiety, feeling fine, etc.
But if 10 is the worst I've felt, it makes most of the other numbers worthless, since the idea is to rate how anxiety each stimulus (photo, video, audio recording)raises. Then you watch it over and over until you have anxiety rating below 3, or sometimes 0.
Last time, if I rated based on racing heart or fast breathing or even tense muscles, my rating wouldn't really be all that high. But if you go by recurring intrusive images for the rest of the day, it was higher than that. Really, the thing that helped me with the intrusive images was turning my attention (and irritation) to the rating system itself.
Posted by Dinah on April 29, 2013, at 20:22:34
In reply to Re: 1-10, posted by baseball55 on April 29, 2013, at 19:44:41
I had a similar experience. My therapist actually suggested the session before last that I consider whether my phobia isn't as bad as I think it is. Based in part on the ratings I'm giving. And in part because the materials don't always address my actual fears.
It bothered me a bit...
Some people's 5's would be other people's 8's. My mother would always give extreme ratings. I tend to be conservative. It almost seems that ratings can serve to interfere with understanding.
I suppose the important thing is that he understands what I mean when I give something a rating.
Posted by Dinah on April 29, 2013, at 20:23:28
In reply to Re: 1-10, posted by Phillipa on April 29, 2013, at 20:16:31
I suppose that we should figure out what each number would mean. But overall, I'd prefer that he just let me tell him in words.
Posted by SLS on April 29, 2013, at 20:55:57
In reply to Re: 1-10 » SLS, posted by Dinah on April 29, 2013, at 20:17:06
> Mine is for anxiety, so the zero would be a total lack of anxiety, feeling fine, etc.
I see. That makes sense.
Perhaps you can rate yourself based upon your peak anxiety episode of the day.
- Scott
Posted by Phillipa on April 29, 2013, at 21:15:16
In reply to Re: 1-10 » Phillipa, posted by Dinah on April 29, 2013, at 20:23:28
Say 5 is a good day for you and lower Better then words to describe what you are feeling. Higher not a good day and explain why and what you are feeling based on that. So it's individualized to you and only you. Phillipa
Posted by SLS on April 30, 2013, at 3:02:08
In reply to Re: 1-10 » SLS, posted by Dinah on April 29, 2013, at 20:17:06
> Mine is for anxiety, so the zero would be a total lack of anxiety, feeling fine, etc.
>
> But if 10 is the worst I've felt, it makes most of the other numbers worthless, since the idea is to rate how anxiety each stimulus (photo, video, audio recording)raises. Then you watch it over and over until you have anxiety rating below 3, or sometimes 0.
>
> Last time, if I rated based on racing heart or fast breathing or even tense muscles, my rating wouldn't really be all that high. But if you go by recurring intrusive images for the rest of the day, it was higher than that. Really, the thing that helped me with the intrusive images was turning my attention (and irritation) to the rating system itself.Does the Burns Anxiety Inventory work for you?
It would be interesting to take the inventory every day for a few weeks to see how well its results approximate your perceived global states of anxiety. After two weeks of practice in taking the test, you might gain an ability to appraise your global state of anxiety with greater precision, and assign a score along a scale of 1 - 10.
- Scott
Posted by SLS on April 30, 2013, at 3:07:23
In reply to Re: 1-10 » Dinah, posted by SLS on April 30, 2013, at 3:02:08
Try this link:
- Scott
Posted by Dinah on May 1, 2013, at 12:04:47
In reply to Re: 1-10 » Dinah, posted by SLS on April 30, 2013, at 3:02:08
I spoke to him, using more or less the same words I used here.
I think it helped. I think he'll press less for precision when I can't give it. And at the same time we came up with a scale that is meaningful for the work we're doing.
It still astonishes me how effective an honest discussion can be, provided I can come up with the right words to convey my meaning. I'm not sure why it surprises me, but it does.
Posted by SLS on May 1, 2013, at 13:42:03
In reply to I spoke to him, posted by Dinah on May 1, 2013, at 12:04:47
> I spoke to him, using more or less the same words I used here.
>
> I think it helped. I think he'll press less for precision when I can't give it. And at the same time we came up with a scale that is meaningful for the work we're doing.That's encouraging. Nice work.
> It still astonishes me how effective an honest discussion can be, provided I can come up with the right words to convey my meaning. I'm not sure why it surprises me, but it does.
You do an excellent job of putting words together on PB. Are you always less able to do this IRL, or only in front of your T?
- Scott
Posted by SLS on May 1, 2013, at 13:44:28
In reply to I spoke to him, posted by Dinah on May 1, 2013, at 12:04:47
> ...we came up with a scale that is meaningful for the work we're doing.
If you feel comfortable describing it, I would be very interested to know what you came up with.
- Scott
Posted by Dinah on May 2, 2013, at 3:48:22
In reply to Re: I spoke to him » Dinah, posted by SLS on May 1, 2013, at 13:42:03
> You do an excellent job of putting words together on PB. Are you always less able to do this IRL, or only in front of your T?
I have always found Babble an excellent aide to doing this IRL. Not only in crafting the original post but in thinking about the replies. The joys of asynchronous communications. At the moment, I tend to get stuck in my thinking. I'm thinking about the fact that I don't like scales, and wondering how to answer, and feeling resentful about being pressured, and don't have time to think about thinking. If that makes sense.
I don't think I can describe the scale in any real detail. It was too linked to the discussion and to the situation. I'm not sure it would have any general application. However, I think one key may have been my understanding that his interest was not so much in absolutes or placing my experiences globally. So that to some extent, it didn't matter what my answer meant in absolute terms. What mattered to him was how it changed.
Although I still must say that I think it would be far easier for me to simply answer "not as bad as this time, but worse than that time".
Posted by Dinah on May 7, 2013, at 22:18:11
In reply to Re: I spoke to him » SLS, posted by Dinah on May 2, 2013, at 3:48:22
He seems to be satisfied with a narrative, and isn't pressing for a number.
The whole treatment is unpleasant enough without adding a level of anxiety.
Posted by SLS on May 7, 2013, at 22:55:39
In reply to Even better!!, posted by Dinah on May 7, 2013, at 22:18:11
> He seems to be satisfied with a narrative, and isn't pressing for a number.
I'm glad that you found a way to convey information to your doctor in a way that works for both of you.
- Scott
Posted by healing928 on July 7, 2013, at 17:50:21
In reply to 1-10, posted by Dinah on April 27, 2013, at 14:44:14
I am so not good at rating scales. I remember taking the Burns inventory many years ago, and doing that several times helped me with rating scales. To me, if they ask "normal" or "average" that is a statistical term, and who in today's world is average? (could go on a rant about the DSM5).... :-)
I would try the Burns Inventory and see if that is easier rate.http://www.relationshipsincorporated.com/Websites/relationshipsinc/files/Content/2324859/ANXIETY.pdf
~Healing
Posted by Dinah on July 8, 2013, at 13:31:37
In reply to Re: 1-10, posted by healing928 on July 7, 2013, at 17:50:21
He's given up on asking me scales, and is now content enough with verbal descriptions. :) Since it was just for his benefit, to know when to press forward and when to back off, it seems to have been working well enough.
I think it's come down to a "less than" or "more than" sort of thing.
This is the end of the thread.
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