Ask the Doctor: Pastoral Counseling; Difficulty Concentrating; Alpha Blockers and Sleep Trouble

Q: My sister has recently been going through some difficult times, including a divorce and retirement from a job she loved. She is getting counseling through her church, but would traditional therapy be better for her?

A: Faith-based counseling, often referred to as pastoral counseling, is a widely used option that incorporates spiritual beliefs and standard psychological therapy. Usually, a spiritual leader receives mental health training and education before taking on a more formal role as a pastoral counselor. Some of these individuals are licensed psychologists, therapists or social workers.

If pastoral counseling is providing your sister with the strategies to deal with her emotional struggles in a healthy, positive way, then that approach may be a good fit for her. Mental health counseling can take on many forms, and not every type of therapy is right for everyone. For therapy to be effective, the individual must be comfortable with the therapist and the form that treatment takes. Some people aren’t at ease in a clinical setting. If you are concerned about your sister’s therapy, ask her how it’s going and what she feels she is gaining from her sessions. She may find that she needs a different approach, perhaps the services of a psychiatrist who can prescribe medications. Or she may thrive with psychotherapy rooted in the practices and beliefs of her faith.

Q: In the past several months I’ve noticed that I have a harder time concentrating. I’m in pretty good health, and haven’t had a head injury or stroke. And I don’t have any signs of dementia. Could it be my imagination?

A: There are actually many conditions that can lead to problems with concentration, including some of the ones you mentioned. Poor sleep is an especially common cause of concentration difficulties. Disorders such as depression and anxiety can also make it tough to concentrate and make decisions. If you have signs of depression or anxiety, talk with a mental health professional.

In some cases, concentration challenges may be related to medical conditions that may not seem to have anything to do with thinking skills. Menopause and other hormonal changes can temporarily interfere with your concentration abilities. An underactive thyroid and anemia are also associated with poor concentration and fuzzy thinking. The same is true for low vitamin B12 levels. Fortunately, these are conditions that can be diagnosed, in some cases with nothing more than a blood test. Trouble concentrating is a symptom, so addressing the underlying condition may help you feel mentally sharper.

Q: I was recently prescribed an alpha blocker for high blood pressure, but I have noticed that I’m having trouble sleeping since I started taking the medication. Any suggestions?

A: Alpha blockers, which are also prescribed to treat benign prostatic hyperplasia and Raynaud’s disease, are among several common types of medications that can disrupt sleep. Other blood pressure medications, including angiotensin-converting enzyme (ACE) inhibitors and beta blockers, are also known to cause sleep disturbances in some people. Individuals who experience side effects from alpha blockers may have better luck with calcium channel blockers. These blood pressure-lowering drugs tend to be less likely to interfere with sleep, but are often just as effective as alpha blockers at lowering blood pressure. A good night’s rest is too important to your cognitive and physical health to ignore medication side effects that keep you from getting enough sleep. If you experience sleep problems or any side effects from a new medication, tell your doctor. There may be an alternative medication or another type of therapy that may be just as effective without the other complications.

—Editor-in-Chief Dr. Maurizio Fava, MD

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