What is Panic Attack?

Panic attack is an anxiety disorder in which one is suddenly and regularly affected by a feeling of panic or fear.

Almost everyone can experience feelings of anxiety and panic at certain times. This feeling is a natural response to tense, stressful or dangerous situations.

However, for a person suffering from panic attack disorder, feelings of anxiety, worry, panic, and stress occur both regularly and often for no apparent reason.

Panic Disorder is a mental disorder associated with panic attacks. Unexpectedly recurring panic attacks are observed as anxiety caused by the expectation of these attacks occurring, and difficulty in adapting to the natural flow of life due to the anxiety of dying or being harmed due to the symptoms occurring during the panic attack.

Panic Attacks in Children

Panic disorder is more common in adolescents and teenagers than in young children. However, dealing with panic attacks can be a difficult experience, especially for children and teenagers.

Severe panic disorder can affect their development and learning. Children showing symptoms of panic attacks should definitely be taken to a physician.

The physician will review the child's medical history and perform a comprehensive physical examination to determine if there is any physical cause for the symptoms.

Screening for other anxiety disorders may also be necessary to help determine what is causing panic attacks in children, so a general physical examination will then make a referral to an appropriate specialist for further evaluation and treatment if necessary.

Reasons

What are the Causes of Panic Attacks?

As with many other mental health conditions, the exact cause of panic attacks is not fully understood. However, it is thought that the condition is probably linked to a traumatic or very stressful period in life, such as bereavement, or an imbalance of neurotransmitters in the brain, or similar factors.

symptoms

During a panic attack, the person experiences various physical and mental symptoms as well as anxiety. These symptoms can appear for no apparent reason and occur quite quickly. Panic attacks can be a very frightening and stressful situation for a person.

Among the symptoms of panic attacks, the symptoms listed below are observed.

Sudden need to go to the toilet
hot flashes,
dizziness,
feeling faint,
feeling of suffocation,
Feeling of terror or fear of dying
General Tremor,
chest pain,
rapid heartbeat,
ringing in the ears,
dry mouth,
Nausea,
Shortness of breath,
Tingling in fingers,
Sweating,
cold,
Numbness or pins and needles sensation,
Feeling disconnected from the body.
In a panic attack, at least four of the above symptoms are observed simultaneously. Situations where fewer are observed are called limited panic attacks. Although panic attacks usually last between 5 and 20 minutes, cases lasting up to an hour have been observed.

The number of panic attacks may vary depending on the severity of the situation. While some individuals experience this condition once a month, other individuals may experience panic attacks several times a week.

Although a panic attack is scary, it is not dangerous. The symptoms seen do not directly harm the person. At the same time, many of these symptoms can easily be caused by other conditions. For example, low blood pressure can cause an accelerated heart rate.

Diagnostic Methods

Panic Attack Diagnosis

Diagnosis of panic attack can only be made by an expert psychologist. First of all, the patient's medical history is taken and the necessary physical examinations are performed. There is no direct laboratory test to diagnose panic attacks. However, physicians may order some tests to find out whether the attacks are caused by another underlying disease or a panic attack.
In particular, symptoms such as the frequency of attacks, whether you experience shortness of breath, dizziness, numbness or sweating are very important for diagnosis.

A heart (ECG) may be requested first to clarify the diagnosis of panic attack and to rule out other diseases. It is investigated whether the palpitations occur as a result of a different heart disease. Afterwards, some blood tests may be requested by the doctor to measure the level of thyroid hormones and to determine whether there is a hormonal imbalance.

Treatment Methods

What is Panic Attack Treatment?

If an individual is experiencing symptoms of panic disorder or panic attack, they should consult a doctor. When reviewing the individual's medical history, the doctor will ask about the symptoms experienced, how often the attacks occur, and how long they have continued.

He or she will also perform a thorough physical examination to see if there are any other health causes for the symptoms. In case of recurrent panic attacks, a diagnosis of panic disorder may be made.

Panic disorder is a treatable and full recovery condition. For this, it is best to seek medical help as early as possible.

Without medical help, panic disorder can escalate and become very difficult to cope with. At the same time, avoiding places where panic attacks occur,It may also put you at risk of developing other mental health conditions, such as agoraphobia.

While the treatment of panic disorder aims to reduce the number of panic attacks, the treatment of panic attacks aims to alleviate the symptoms. Main panic attack treatments consist of psychological treatment and medications. Depending on the symptoms observed, one, another, or a combination of these treatments may be used.

During psychological treatment, cognitive behavioral therapy can be benefited from by directly consulting a therapist consultant. At this time, the therapist can explain to the counselor how one reacted and what was thought during the attack, and the therapist can recommend breathing techniques that will help stay calm during an attack.

If the doctor and the patient think that it will be beneficial, prescription drugs can be used. Antidepressants, selective serotonin reuptake inhibitors and other similar drugs may be given to the patient during this period.

It should not be forgotten that antidepressants begin to show their effects between two and four weeks and show their full effect from the eighth week. Even if you feel that the medication is not working, use should be continued unless the doctor advises you to stop taking the medication.

If symptoms do not improve after cognitive behavioral therapy or medication, the patient may be referred by the doctor to a mental health professional, such as a psychiatrist or clinical psychologist.

What to Do During a Panic Attack?

Don't fight the attack.
Stay where you are if possible.
Focus on positive, peaceful and relaxing places.
Remind yourself that the attack will pass.
Remember, this is not a threat to your life.
Breathe slowly and deeply.
What Can You Do Yourself to Prevent Panic Attacks?

Self-help books for anxiety based on the principles of cognitive behavioral therapy can be read.
In addition to healthy lifestyle sports such as pilates or yoga, calming massages or aroma therapies can be used.
Breathing techniques can be learned to help relieve symptoms.
Regular physical exercise can be done to reduce stress and tension.
The use of sugary foods and drinks, alcohol, caffeine and cigarettes can be reduced as they can worsen attacks.
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Addiction, alcohol addiction, gambling addiction, substance addiction. London psychiatrist. Psychiatry Turkish London

What is Addiction?

Addiction is a state of irrepressible desire, desire and passion for alcohol and drugs that develops as a result of impulse control disorder caused by chemical imbalances in the brain due to many factors, traumas that threaten the self, negative beliefs about the self, impaired behavior , character and personality. Although alcohol and substances come to mind when addiction is mentioned, a person can also become addicted to an object such as money, a phenomenon such as love or a behavior such as shopping, sex, gambling, or a person such as a lover or mother. . Therefore, for the first time, these addiction-related behaviors were included in the "Substance Related Disorders and Addiction Disorders" category in DSM V under the name "Behavioral Addictions" (Özkök, 2013).

Addictive behavior is the state of a person's addiction to any activity, substance, object or behavior in a way that excludes other activities of his / her life or causes physical, mental or social harm to himself / himself and others. That is why, in addition to compulsive behaviors that are accompanied by substance abuse, compulsive behaviors that are not accompanied by substance abuse (such as pathological gambling habits, shopping, eating, sex, work, sports, games, internet, social media) have also taken their place in the addiction classification. However, this article will focus more on alcohol and substance addiction.

What is Addiction?
What are the Causes of Addiction?
Post-Traumatic Stress Disorder (PTSD) Negatively Affects the Clinical Course of Addiction
The Most Important Problem in Addiction Treatment is Relapse
Treatment of Alcohol and Substance Addiction
Addiction Treatment Process
Hospital Admission Process
Naltrexone Implant Treatment (Chip Application)
New and Effective Drug Treatments in Addiction Treatment
How is Naltrexone Implant (Chip) Applied?
3-Month Depot Injection Treatment for Cocaine Addiction (Vanoxerin Depot Injection)
3 Monthly Injection Forms for the Treatment of Heroin, Alcohol and Marijuana Addiction
Treatment Plan After Chip or Injection Treatment
Post-Hospital Program
Studying Traumas That Cause Addiction
An Effective Method in Addiction Treatment: EMDR Therapy
Quadruple Approach to Treatment
source
What are the Causes of Addiction?

Many studies have been conducted on the causes of addiction and many theories have been developed. According to psychodynamic theories, substances are a defense mechanism used against a psychological conflict that creates anxiety. Addiction is a sign of impaired ego function. The person loses the power to cope with the realities of the outside world and tries to survive by holding on to an object of addiction. In this sense, it is the result of the theory of "self-medication", that is, the search for "self-treatment" in order to relieve the suffering experienced by the person. For example, abusing alcohol for panic and anxiety, opiates to relieve anger, and amphetamines to relieve depressive symptoms is a so-called "self-treatment" behavior (Bozkurt, 2016, p.616).

Addiction does not always occur as a compulsive behavior. It can sometimes develop as an extension of operant conditioning, as an object that suppresses emotions such as pain, anxiety and disgust, and sometimes as an object that increases joy and fun (euphoria) in social environments. The so-called positive interaction experienced here (such as being happy, relieving distress, etc.) can create a reward effect in the person and make the person addicted to the substance through conditioning. As a result, the materials, people and places used in substance use can act as a reminder or even a provocative effect (Bozkurt, 2016).
Especially individuals deprived of family and social support may enter drug-using communities in order to satisfy their urge to belong and to be accepted. Peer pressure, emulating a peer, or a peer using substances looking for companions can pave the way for substance addiction. As a matter of fact, when we examine the starting stories of drug addicts, we see that the majority of them started with the encouragement of friends. Most people first purchase the substance from a close friend, not from a direct seller or dealer. After being caught up in the vortex of addiction, he learns to get help in other ways. In other words, peer pressure or peer influence is the most important addiction factor, especially in young people. Peer interaction is the biggest factor why addiction is so common (Bozkurt, 2016). With this mechanism, every person who drinks impersonates a potential seller or marketer.

One of the important factors in addiction is genetics. Twin studies have shown that genetic interaction is especially high in alcohol addiction. Although there is some influence of genetics on the use of other substances, the interaction there is environment, that is, culture, rather than heredity.

(Bozkurt, 2016).

It is often observed that alcohol abuse, referred to as "social drinking", becomes continuous after a while and turns into a ritualistic experience for the person. In this way, alcohol use evolves into a habit, and regular and continuous use causes a disruption in the alcohol receptor balance in the brain, which causes addiction. A similar interaction also manifests itself in substances such as cocaine, marijuana and heroin. In particular, marijuana use is perceived as harmless by the person and is introduced into the daily routine. This brings addiction after a while.

Another factor is the presence of another psychiatric disorder that is added to the addiction or to which the addiction is added. Studies have shown that 50% of addicted individuals have another psychiatric disorder such as schizophrenia, depression, panic disorder, obsessive-compulsive disorder, phobic disorders, social phobia, and behavioral disorders. Antisocial behavior has been observed in 35 to 60% of addicted individuals. However, the majority of them do not have antisocial personality disorder and exhibit destructive behavior under the influence of substances. Those with antisocial personality disorder are more prone to use illegal substances, are frequently involved in criminal events, commit crimes, and have a provocative and isolated life pattern (Bozkurt, 2016, p. 621).

Depression is the most important factor in substance abuse. Depressive disorder was observed in one-third of those with opioid abuse/dependence and in 40% of those with alcohol abuse/dependence. Naturally, the risk of suicide is quite high in this population. The amount of deaths due to suicide in addicted individuals is 20 times that of the normal population. 15% of those with alcohol abuse/dependence die due to suicide. Substance-related suicides rank second after major depression (Bozkurt, 2016).

Another factor that stands out more than these classical factors in terms of causality is psychological traumas. When we look at the life stories of addicted people, we see that they mostly encountered traumas or that the process leading to addiction occurred after a trauma. Research also supports this. As a matter of fact, it has been shown that two-thirds of those who abuse substances have experienced a trauma in the past, and half of them meet the criteria for PTSD. A history of one or more substance abuse was detected in 34% of individuals with PTSD. PTSD co-morbidity was determined to be 45% in addicted individuals. Alcohol addiction was reported in 28% of women and 52% of men with PTSD, and substance abuse was reported in 27% of women and 35% of men with PTSD (Kessler, 1995). The risk of alcohol and substance addiction was found to be 3 times higher in those who were sexually abused or raped. The most striking results revealing the relationship between trauma and addiction were obtained with the "ACE Study". In this study, the Adverse Childhood Experiences ACE Scale was used. 5 personal (physical, verbal, sexual abuse, physical and emotional neglect) and 5 related to family members (parent with addiction, witnessing domestic violence, family member in prison, family member with mental disorder, separation/divorce, death or trauma (abandonment) was also examined (Felitti et al., 1998). It has been determined that cigarette addiction is 250% (2.5 times) higher in those with an ACE score of 6 and above, alcohol addiction is 500% (5 times) higher in those with an ACE score of 4 and above, and heroin addiction is 4600% (46 times) higher.

The "self-medication" mechanism, which is seen as the most common reason for the formation of addiction, is mostly activated after psychological traumas or PTSD. Severe complaints such as anxiety, insomnia, irritability, agitation, guilt, shame, poor attention and concentration, nightmares, insomnia, flashbacks, dissociative episodes, self-mutilation, anergy, demoralization and mental pain experienced in PTSD lead the person to despair, hopelessness and It leads to the thought of not being able to cope. In this process, the person who discovers a way to relax with alcohol and substances becomes a habit and, in the future, addiction. As a matter of fact, in clinical experience, it is often seen that many addiction cases are triggered after a trauma such as separation from girlfriend/boyfriend or loss of a loved one. All these data reveal that there is a clear relationship between addiction and psychological traumas.

Post-Traumatic Stress Disorder (PTSD) Negatively Affects the Clinical Course of Addiction

In addition to being a major factor in addiction, PTSD also negatively affects the clinical course of addiction. PTSD has been found to be closely associated with treatment discontinuation, relapse, and coping difficulties (Flanagan, 2016). For example, it has been reported that the craving reaction of substance abuse patients with PTSD in response to trauma-related issues is higher than those with only PTSD (Quimette, 2010).

Every addiction is a unique experience pattern.

It has . Naturally, uncontrolled experiences experienced under the influence of the substance during the addiction process create records that we call addiction memory (Hase, 2008). For example, a severe withdrawal, intoxication or craving reaction can turn into a traumatic memory. This memory itself can cause PTSD. As a result, PTSD can be both a cause and a consequence of addiction. In this context, craving reactions, withdrawal experiences, relapses, hospitalizations and what happened during that time, substance-related intoxication situations, substance-related medical conditions, addiction-related legal events (such as being caught with the substance), fear, panic, derealization experienced during first use, Conditions such as depersonalization can have a traumatic effect, and as a result, PTSD may develop. As an extension of this, all kinds of topics that remind the substance, materials related to the substance, people and places where drugs are consumed, drug dealers, thoughts of the drug, emotions such as sadness, distress, fear that lead to addiction, physical sensations such as palpitations and tension, situations such as the thought of addictive material. They can create an effect that provokes and triggers substance use. Similar interaction may also manifest itself in other addictive behaviors. For example, in gambling addiction, the person's possession of money or a credit card and provocative messages coming from gaming sites can have a triggering effect.

The Most Important Problem in Addiction Treatment is Relapse

Although thousands of studies have been conducted on addiction and many pharmacological and therapeutic approaches have been developed, relapse is the biggest problem we face in treatment. The relapse rate within one year for alcohol, nicotine and substance addiction is 85% (Brandon, 2007). In other words, positive results can be obtained from only 15% of addictions with general treatment approaches. Many factors have been identified in research on the reasons for this high risk of recurrence. The most important of these is that addiction treatment focuses only on medication, hospitals and detoxification processes, and the person's past story, traumas, problems, way of thinking, perception of himself and the world are not adequately addressed. The effects of psychological traumas on the cause, clinical course and treatment failures are still not adequately taken into account. Moreover, the traumatic pattern created by addiction experiences is ignored. However, research indicates that traumatic interactions are the most important reason for reuse. Therefore, it is necessary to focus more seriously on individual and group therapy programs that address psychological traumas, which are one of the most important causes of addiction, along with classical treatments (Schafer, 2017). Another important factor that increases the risk of relapse is the distressing situations experienced during the addiction process. Excessive cravings, intense cravings, obsessive thoughts about the substance, and negative emotions are important reasons for reuse. Severe cravings are an important predictor of both discontinuation and relapse. The craving response has been found to be associated with high CRH hormone levels, and it has been thought that PTSD exacerbates craving reactions through this mechanism. Not only experiencing craving reactions, but even remembering them causes a desire to use that is difficult to control (Norman et al., 2012). One of the important reasons for relapse is deprivation experiences. Like craving, withdrawal has been associated with high CRH. High CRH causes hypersensitivity and thus aggravation of withdrawal, thus increasing addiction to the substance. Again, the "anticipatory anxiety" created by withdrawal, that is, the anxiety of re-experiencing this severe withdrawal situation, prevents detachment from the substance and triggers relapses (Norman et al., 2012).

One of the obstacles to quitting the substance is that the strong and seemingly positive experiences experienced during the addiction process are perceived as positive by the person. These experiences, called “Positive Dysfunctional Memories” or “Fake Happiness Memories”, create an effect that reinforces addiction in the person (Knipe, 2010). For example, the relaxation experienced when smoking marijuana, feeling strong and free, and the feeling of being energetic and euphoric when taking ecstasy are perceived by the person as a gain, and the person clings to the substance even more in order not to lose it. “It is a grass, it has no sin.” This dynamic lies behind such thoughts. Far from quitting the substance, the person becomes a tireless advocate of it.

All these data reveal that the treatment of addiction is not uniform, that the addicted individual must be supported not only by medication but also psychotherapeutically and psychosocially, and therefore treatment is possible with a holistic approach.

Treatment of Alcohol and Substance Addiction

We can classify the approaches in addiction treatment as follows:

General Treatment Approaches in Addiction:

hospital treatments

drug treatments

Adding Trauma-Focused Approaches to General Treatment Approaches

Addiction Treatment Process

Addiction treatment first begins with getting away from the substance. Getting away from substances is not an easy task. It is extremely difficult for people, especially those who are highly addicted to drugs, to get away from substances voluntarily. There is an approach, both among the public and in the medical community, that addicted people must first ask for treatment in order to receive treatment. Of course, the most important element of the treatment is that the person wants to quit and is determined to do so. However, making a person who has difficulty in this regard and who is faced with a resistance mechanism in his brain want to do this is also a part of the treatment. In other words, making the person want to quit even if they don't want to do so requires a strategy. Most individuals with addiction problems are forced into treatment without the desire or consent to quit. Therefore, if necessary, while presenting the general treatment approach, interviews aimed at convincing the person and overcoming resistance should not be neglected. Because the priority in any treatment is to develop a relationship based on trust and sincerity with the person experiencing addiction. Approaching the addict in a monotonous, rote and cliché way will quickly alienate him from treatment and cause the belief and desire that has emerged within him to fade away. For example, direct hospitalization of every addicted person without the risk of suicide, intoxication, or dangerous withdrawal, or treating every addicted person as a person who needs to be hospitalized may increase the person's resistance to treatment. Therefore, it should not be forgotten that each individual's story is unique and the treatment should be personalized. If the person does not need to be hospitalized urgently, the first step of the general treatment approach should be to increase the person's desire and belief in treatment, either on an outpatient basis or in a hospital setting if necessary. This approach will also increase the effectiveness and success of general treatment methods.

Treatment processes should begin under the leadership of a psychiatrist experienced in addiction, the person's psychiatric condition should be evaluated, the addiction history should be taken in detail, and an interview should be held with the family. After the preliminary evaluation, the necessary tests should be requested. In addition to the general medical evaluation with blood and urine tests in addicted people, brain functions such as attention-concentration and impulse control level must also be measured. In the light of examination and clinical evaluation, the person's addiction severity and needs are determined and treatment planning is made accordingly.

Mild addictions can be monitored externally without hospitalization if the person's general condition and social support are suitable. The primary goal of all treatments is to remove the person from the substance and ensure compliance with the treatment. This principle also applies to outpatient treatment. The person is first kept away from the substance and substance-related triggers. Along with this, stabilizing drug treatments are arranged, and a purification treatment and psychotherapy program is started with serum and vitamin supplements.

There are supportive drug treatments that will reduce the psychiatric problems, anxiety and concern of the person experiencing addiction, alleviate withdrawal and craving reactions, strengthen impulse control, regulate sleep and encourage the person to quit. For example, antidepressants for depressive complaints, mood stabilizers for impulse control, anxiolytics for anxiety, worry and panic, and sleep regulators increase treatment compliance by enabling the person to go through the withdrawal process in a healthy way.

In recent years, drugs have been discovered to directly reduce withdrawal and craving in heroin, cocaine, alcohol, marijuana and methamphetamine addictions. These injection form drugs, which are effective in preventing the risk of drinking again, can be administered both externally and in hospital procedures.

If external treatment is not interrupted and compliance with the treatment continues, this continues. However, if the person cannot break away from the substance, is provoked by external factors and reaches a point where he or she can harm himself, hospitalization should be planned.

Hospital Admission Process

Naltrexone Implant Treatment (Chip Application)

Hospitalization is an extremely advantageous process in detaching the person from the substance and stabilizing it until it is released. Many addicted people experience hospital procedures with anxiety and avoid them. However, in periods when addiction is severe and high dosages of substances are used, the safest place for the person is a healthy hospital environment. Today, many beautiful hospitals designed to meet the needs of addicted people have been established. In these clinical environments, experienced healthcare personnel and medical facilities are available to meet all the needs of addicted individuals. In such an environment, the person is under 24-hour supervision and experiences withdrawal, cravings and withdrawal phases.

Outbursts and anxiety can be taken under control instantly, and in case of any adverse event, intervention can be made in a short time. Therefore, the safest places during the quitting phase are clinical environments that are patient-oriented and have modern equipment.

On the first day of hospitalization, the substances used by the patient and their concentration in the blood are determined and the detox process, that is, cleansing the blood and purifying it from substances, is initiated. During this process, drug treatment is prescribed for the patient's craving and withdrawal reactions, and psychiatric disorders such as paranoia, depressive complaints, and panic, if any. The detox period is at least 5 days and can extend up to 14 to 21 days. However, this period may vary depending on the body's response to the treatment, the severity of the substance addiction and the person's needs.

Some people and families expect everything to be over during this detox phase. However, addiction treatment is not just a detox process. Detox application is one of the first steps of treatment. However, it is a big step towards escaping addiction. The biggest gain of the hospital process is that the person has started this journey. The aim is to start the match with a 1-0 lead. Because we know that everyone who sets out on this path eventually gets rid of addiction.

Some people may develop severe psychiatric disorders such as substance-induced paranoia, extreme suspiciousness, hallucinations, aggressive behavior, severe depression and suicidal thoughts. In such cases, treatment protocols such as TMS (transcranial magnetic stimulation) or ECT (electroconvulsive therapy) can be added to drug therapy. ECT is a method usually applied in a hospital. It is applied in severe depressions and psychotic disorders. TMS is a method that can be applied on an outpatient basis and has been approved especially for the treatment of depression and obsessive-compulsive disorder. Recently, studies have been published showing that TMS has a reducing effect on the craving reaction in addicts (Enokibara et al., 2016). In particular, publications on the effectiveness of Deep TMS in addiction have become more frequent (Malik et. al., 2018; Ceccanti et. al., 2015). In TMS treatment, which is a reliable method in terms of side effects, magnetic stimulation is generally given to the left frontal region of the brain to activate the brain's magnetism and eliminate drug resistance, if any. During the hospital period, in addition to drug treatment, individual and group therapies are also started.

New and Effective Drug Treatments in Addiction Treatment

In recent years, in addition to drug treatments that support addiction treatment, drug treatments have also been developed to reduce symptoms directly related to addiction and prevent withdrawal and cravings. These drug treatments with very satisfactory results are as follows:

Naltrexone Implant Treatment (Chip Application)

In "Naltrexone Implant Treatment", popularly known as "Chip" treatment, the drug called "naltrexone" used in heroin addiction is administered through a long-acting pellet form (chip) placed under the skin through an incision small enough to require one or two stitches (Nunes et. al., 2018). The function of the chip is to ensure that the medicine slowly mixes with the blood and dissolves. Its effect lasts for 8-10 weeks and is renewed when necessary. Naltrexone; It is an opioid antagonist that blocks the effects of opioid substances such as heroin. In other words, it is the antidote to heroin. If a person uses a substance while under the influence of naltrexone, he cannot feel the pleasurable effect of the substance, thus the desire to use the substance decreases and the person does not continue using the substance. Naltrexone also reduces excessive desire for substances called craving. Naltrexone implant is produced in various countries and can be prescribed from the imported pharmaceutical branches of the Turkish Chamber of Pharmacists. It can be applied both in the hospital and on an outpatient basis.

How is Naltrexone Implant (Chip) Applied?

It is applied to the subcutaneous tissue in a suitable area, usually around the navel, under local anesthesia on a hospitalized person. Studies have shown that naltrexone implant treatment (chip treatment) added to supportive medications is much more effective than treatments with supportive medications alone. Naltrexone implant; The success rate increases even more when used for a year, repeated every 2-3 months, and given psychosocial support.

Chip therapy can only be used in morphine, alcohol and heroin addicts. The patient with a chip placed in his body experiences side effects such as nausea and vomiting when he uses the substance. This creates an aversive and deterrent effect against the substance. However, if substance intake is repeated repeatedly, the chips lose their function and have to be inserted again. The revision period for a chip is on average 3 months. Sometimes blood tests may be repeated and a new calibration may be required in patients who attempt to use it.

3-Month Depot Injection Treatment for Cocaine Addiction (Vanoxerin Depot Injection)

"Vanoxerin", also known as the "addiction injection", is a drug used to prevent cocaine use. Cocaine creates pleasure and pain in our brain.

It rapidly and briefly increases dopamine in the brain regions that control impulse, thus causing addiction. “Vanoxerine” prevents cocaine from increasing dopamine levels further by ensuring a slow, long-term and moderate increase in dopamine in related brain circuits. Thus, it prevents the addictive effect of cocaine. “Vanoxerine Consta” is a slow-release injection form. "Vanoxerine", which is specially produced for use in the treatment of cocaine addiction, is used to prevent the recurrence of cocaine addiction (Kadric et. al., 2019). In order for Vanoxerin to be administered to a cocaine addict, his body must be free of cocaine. Vanoxerin Consta is administered intramuscularly every 3 months. Studies have shown that Vanoxerin helps to stay clean, is well tolerated and safe (Preti, 2000).

3 Monthly Injection Forms for the Treatment of Heroin, Alcohol and Marijuana Addiction

In recent years, a new drug has been developed that will prevent "chip" treatment. “Nalmefen”, the injection form of this drug, just like the chip, neutralizes the effect of the drug when it enters the body and prevents the person from returning to addiction (Quelch et. al., 2017; Ohgi, 2020). In addition to heroin, it can also be used in the treatment of alcohol, morphine and marijuana. Kadric et. al., 2019). “Nalmefene Consta” is injected intramuscularly every three months. It is recommended to perform this application every 3 months for at least 1 year. In order for this medication to be administered, the person must be free from heroin and alcohol.

These drugs contribute to the patient's ability to overcome withdrawal processes more easily, reduce the amount of medication to be used, and prevent substance reuse. However, it should not be forgotten that no drug treatment will be sufficient in addiction treatment without a comprehensive psychotherapy and psychosocial rehabilitation program.

Treatment Plan After Chip or Injection Treatment

According to the observations and findings made during the purification period, the level of the patient's desire to use is determined and the patient's stay in the hospital may be extended depending on its severity. In mild addictions, the person can be discharged after a 4-5 day detox and then with chip or depot injection treatment. However, if there is a very severe addiction, an intensive psychotherapy program should be applied in addition to detox, chip implantation or depot injection treatment. In addition, psycho-educational programs should be organized for families, the person's environment outside the hospital should be designed and risks should be minimized. In this case, hospitalization periods may be slightly longer, but the ideal treatment is to bring the person back to life as soon as possible.

Post-Hospital Program

Following the decontamination and drug treatment applied in the hospital environment, people are made aware of the problems they may experience outside, the necessary training is given to families on how to approach them, and the person is prepared for discharge. After the hospital, you may experience a desire to use it for a while, withdrawal-like symptoms and triggers. Therefore, the person should be followed closely after hospitalization, and the medication and psychotherapy program started during the hospital period should be continued meticulously.

In psychotherapies, interventions are made for both direct addiction and the person's psychological traumas, psychological problems and triggers. We know that in those who have experienced trauma in childhood, events such as losing a relative such as a mother or father, breaking up with a girlfriend/boyfriend, falling into economic crises such as bankruptcy can easily lead the person to addiction. That's why trauma-focused approaches must be included in addiction treatment programs.

Studying Traumas That Cause Addiction

Focusing on the person's traumas, along with general treatment approaches in addiction treatment, has been found effective in reducing not only the trauma-related symptoms of individuals with substance addiction, but also the addiction-related symptoms. In addicted individuals, a vicious circle occurs in which the traumas that occur during the addiction period exacerbate the addiction, and the addiction exacerbates the traumas. This is called the “cycle of addiction”. After all, one of the key components of the addiction cycle is trauma. General treatment approaches (TAU) focus on the physical and psychological symptoms of addiction, namely its consequences, rather than this vicious circle. However, in addiction treatment, it is necessary to focus on the causes as well as the results. Studies conducted for this purpose have reported that trauma-focused therapies added to TAU are effective in eliminating the addiction cycle. Adding trauma-focused therapies such as "Prolonged Exposure", "Trauma-Focused CBT" and EMDR to TAU has been found effective in reducing not only trauma-related symptoms but also addiction-related symptoms (Norman et al., 2012; Berenz, 2013). Approaches such as Prolonged Exposure and Trauma-Focused Imaginal Exposure are at least

It has been shown to be beneficial in addiction by reducing PTSD symptoms (Mills 2012). There are many therapy methods that focus on trauma. However, the approach that has come to the fore recently is "EMDR" therapy. In addition to processing past traumas of addicted individuals and freeing them from their influence, EMDR therapy also helps eliminate complaints that prevent quitting, such as craving and deprivation (Brown et al., 2015). Studies have found that EMDR therapy in addition to general treatment approaches (TAU) is much more effective in reducing the PTSD symptoms of addicts with substance co-morbid PTSD than treatments with TAU alone. EMDR achieved this by reducing both the symptoms of PTSD and the addictive behavior attempted to regulate these symptoms, resulting in a decrease in substance-related symptoms (Rougemont, 2012). The effectiveness of EMDR therapy in PTSD has been proven (Cusack, 2016), but more intensive research is needed on its effectiveness in addiction. However, the data obtained so far are extremely promising and all have positive results (Abel, 2012).

An Effective Method in Addiction Treatment: EMDR Therapy

According to the Adaptive Information Processing Model (AIP), the brain processes and functionalizes the information that reaches it through each new experience, through a physiologically based system (such as REM). Information such as emotion, thought, sensation, image, sound, smell are processed and integrated by connecting to related memory networks. Thus, learning related to that experience occurs. The information we acquire is stored to appropriately direct our reactions in the future (Saphiro, 2016). If there is a problem in the system and the trauma cannot be processed, it is stored as it was experienced. Learning about that event does not occur. It is as if the person is constantly reliving the event and negative emotions, thoughts, behaviors and personality traits develop. Records that cannot be processed in this way and cause negative redirects are called dysfunctional or non-functional records. In addicts, both the unprocessed traumas they have experienced in their past and the traumatic experiences that occur during the substance use process (craving, withdrawal, intoxication, hospital processes, etc.) create a high state of hyperarousal and many dysfunctional records are formed. According to AIP, memory records related to this overstimulation are stored together with emotions, physical sensations and beliefs and virtually impose negative experiences on the person. EMDR is an approach used to identify unprocessed dysfunctional records, transform them into processed functional records, and normalize hypersensitivity that has already occurred (Saphiro, 2016). It does this within the framework of past, present and future. It processes past traumas, desensitizes us to triggers that remind us of them today, and reprocesses the pattern of perception and behavior we want in the future (Future template).

It is possible to divide past traumas in addiction into three groups: pre-addiction traumas, traumas that trigger addiction, and traumas caused by addictive experiences. Pre-addiction traumas are not directly related to addiction, but are traumas that form the basis of addiction. For example, parental fights, parental separations, losses at a young age, sexual traumas such as harassment and rape, physical and emotional neglect and abuse are such traumas. Traumas that trigger addiction include failures in business and academic life, separation from a loved one, and the loss of a parent or someone from the close circle. Traumas that trigger addiction are generally disappointing events such as breaking up with a girlfriend/boyfriend, losing a relative, or being cheated on, abandonment, bankruptcy, or failure. Traumas directly related to addiction are reactions such as fear, panic, derealization, depersonalization experienced during the first use of the substance, intoxications, cravings, withdrawals, and experiences of substance-related medical problems.

In the EMDR approach to addiction, there are also triggers in addition to past traumas. These are actually reminders in a sense. Triggers are today's topic and determine the daily interactions that exacerbate a person's addiction process. Any situation that reminds you of past events or the mood of events can create a triggering effect. Therefore, after working on past traumas, we come to today's topic, the triggers. Because triggers both create a reminder effect and create a sensitivity themselves. That sensitivity also needs to be eliminated. Triggers related to past traumas include stress such as success-themed experiences, competitive environments, conflicts with authority figures, excessive responsibilities, palpitations, tremors, facial flushing, shortness of breath, dizziness, nausea, feeling of numbness and numbness in the head, blurred vision, numbness in hands and feet. symptoms, insomnia and tension

There may be differences. Triggers of drug-related experiences are situations such as people, places, drug dealers, the thought of the drug, invitations from friends, receiving money or a credit card in gambling addiction, situations that evoke addiction materials and phenomena such as gaming sites, and bonus messages from gaming sites.

Quadruple Approach to Treatment

Medication alone is not enough to treat addiction. That's why the quadruple treatment approach increases the chances of success:

GENERAL MEDICATION TREATMENT: Antidepressants, antipsychotics and drugs to increase impulse control should be used to treat mental conditions such as addiction-related depression, paranoia, panic, obsession, insomnia and irritability.

DRUG TREATMENTS FOR ADDICTION SYMPTOMS (CHIP OR NEEDLE): Chip or three-monthly depot injections are used to eliminate craving and withdrawal. The biggest reason for not being able to get rid of addiction is craving and withdrawal symptoms. Taking these conditions under control increases the success of treatment.

TMS TREATMENT: TMS treatment, which is effective in craving and withdrawal, can be effective in both reducing the severity of the clinic and eliminating treatment resistance. If the person has severe cravings, depression and obsessive thoughts, TMS treatment may be recommended.

EMDR THERAPY: With EMDR therapy, working on both the traumas that cause addiction and the traumas caused by addiction increases the success of treatment. EMDR therapy is also highly effective in desensitizing the person to craving and deprivation and helping the person go through the purification process more easily.

As a result, with this holistic (quadruple) approach, it is possible to increase the success of treatment in addiction much higher than the success rates obtained from today's general approaches.

My wishes to get rid of addictions and live a free life...

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Mahmut Bektaş graduated from Çukurova University, Department of Psychological Counseling and Guidance in 1999. Then, he graduated from Mersin University, Department of Sociology in 2004. Bektaş, who completed his master's degree in Psychological Counseling and Guidance in 2007, completed his doctorate at Dokuz Eylül University in 2018. He is currently doing his other doctoral study on Film Design.

Between July 1999-September 2000 at Mersin Private Karekök Dört Private Course Center, between September 2000-September 2003 at Gaziantep 25 December Primary School, between September 2002-September 2003 at Mersin Yusuf Bayık Primary School, between September 2003-September 2003 at Mersin Yusuf Bayık Primary School. Between May 2004 at İzmir Kemalpaşa Mopak Anatolian Technical and Industrial Vocational High School, between May 2004 and June 2008 at İzmir Bornova Vedide Baha Pars Primary School, between June 2008 and January 2009 at Samsun Vezirköprü Gömlekhisar Village Primary School, between February 2009 -At İzmir Konak Fatih Mehmet Primary School between June 2011, as a part-time teacher at Dokuz Eylül University between September 2012-July 2013, at İzmir Buca Lawyer İlhan Ege Kindergarten between June 2011-January 2015, between January 2015-June 2016. He worked as a Psychological Counselor and Guidance at Karabağlar Consultancy and Research Center between June 2016 and July 2020, at İzmir Buca Çamlıkule Şehit Ömer Sarı Primary School between June 2016 and July 2020, and as a part-time teacher at Dokuz Eylül University between September 2019 and July 2020.
What is TMS? This method, which we also call Transcranial Magnetic Stimulation (TMS) or Transcranial Magnetic Stimulation (TMS), is a treatment method in which magnetic stimulation is given from certain points of the head to reach the brain directly. The aim here is to reach some structures in the brain from the outside and correct the neurochemical and electrical functioning there by magnetic effect. With this treatment method, we can reach some structures and regions of the brain and create a magnetic effect there, without the need for any surgery or electrodes. This magnetic effect is also effective in correcting the chemical and electrical functioning in those areas of the brain. TMS treatment improves drug resistance.
Treatment resistance
Effect of TMS on the brain
Session durations and session frequencies in TMS treatment
TMS treatment response time
Duration of effect of TMS treatment
Side effects of TMS 
People to whom TMS should not be applied
Advantages of TMS
Quitting medications with TMS therapy
TMS treatment in heart patients
TMS treatment in the elderly
TMS treatment was previously used for diagnosis and research purposes in neurology, especially in muscle diseases. However, since the late 20th century, it has begun to be used in psychological disorders such as resistant depression.

Diseases where TMS treatment is effective

Depression
Schizophrenia with Negative Symptoms
Disorders with hallucinations
Dependence
Obsessive compulsive disorder
Other refractory psychiatric disorders
In cases where drug use must be restricted; pregnancy, breastfeeding mothers, heart patients, liver diseases, the elderly.

TMS treatment is recommended as a very effective option in cases of resistant depression that have gone through many treatment stages and that we have seen algorithmically no longer respond to any drug treatment. In particular, the FDA in 2008 and the APA in 2010 recommended TMS treatment in the treatment of depression that did not respond to medication in their published guidelines. It is an FDA-approved treatment method, especially for depression. However, TMS treatment is used not only in treatment-resistant depression patients, but also in other psychiatric disorders that do not respond to treatment. In recent years, there have been studies in the research phase on negative symptom schizophrenia, addictions, obsessive-compulsive disorder (OCD) and other resistant psychiatric disorders, and these report very promising results. As a result, it is not a correct approach to limit the mechanism of action of TMS treatment only to depression-related processes. The disorder on which the effectiveness has been proven and the most studies has been done is resistant depression.
TMS treatment improves drug resistance

TMS treatment also has the effect of eliminating drug resistance. Resistance to treatment is not a situation we only encounter in depression. We may encounter treatment resistance in many psychiatric disorders.

Treatment resistance

It refers to situations where the drug we give does not affect the brain cells at the receptor level and the treatment effect cannot be achieved. Just like insulin resistance. In cases of insulin resistance, there is enough insulin in the body or it is given to enough people, but since the tissues develop resistance to insulin, they do not accept insulin and as a result, they act as if there is no insulin. This causes sugar to rise. The same thing happens in disorders where receptor sensitivity is impaired, such as depression, schizophrenia and addiction. In this process, although the medication is given in sufficient dosage and duration, the treatment effect cannot be achieved and the complaints do not regress. In addition to its direct therapeutic effect, TMS treatment is also effective in opening drug resistance. Therefore, it can be used to break drug resistance in all kinds of psychiatric disorders that are resistant to treatment. However, the FDA has currently approved TMS treatment only for resistant depression. TMS is also used in situations where medication use must be restricted or medication use is not appropriate. It is used during pregnancy, breastfeeding mothers, heart patients, liver patients or the elderly, and its effects are benefited from.

Effect of TMS on the brain

TMS specifically interferes with the cellular electrical conduction of the brain. There is an electrical and chemical transmission system in the brain. The connections in the human brain transmit signals to each other through chemical and electrical conduction, thus performing brain functions. In some psychiatric disorders, electrical or chemical conduction problems occur in these connections. TMS treatment reveals positive effects at the point of treatment by opening this chemical and electrical conduction blockage through magnetic stimulation. It creates a strong but short-acting magnetic field without giving an external electric current and thus contributes to making those connections functional again. As a result, it creates a stimulation effect in that area that we call neuronal depolarization. TMS treatment is based on the principle of making the pathways in the brain that cannot be stimulated chemically or electrically on its own work with magnetic stimulation.
Session durations and session frequencies in TMS treatment

TMS treatment has its own protocols. The duration of the sessions is generally between 20-25 minutes. The number of sessions generally varies between 10-15 sessions. It is recommended to continue for at least 10 sessions to achieve the desired effect. However, in some resistant cases, it is possible to increase the number of sessions. It is possible to apply it in larger numbers, especially in pregnant patients who have problems using medication, the elderly, and patients with medical problems that restrict medication use. The physician determines this depending on the severity of the client's illness and general medical condition. Sessions can be applied 6 days in a row or 3-4 days a week. In some cases, applications can be made in the form of a morning and evening protocol. However, the general practice is to apply 1 session every day, six days a week.

TMS treatment response time

The person begins to recover on the 5th or 6th day after starting treatment. This improvement increases slightly on the 10th day. However, this may not always happen. Just because this doesn't happen doesn't mean TMS treatment isn't effective. It suggests that resistance is high and the treatment period should be extended a little more. If the desired point is reached in the treatment, that is, if the person's complaints have significantly decreased, continuing after the 10th session is not considered. However, by the 10th session, if there is interaction but the desired level is not reached and the person is desired to be a little better, additional sessions may be required. Ultimately, the number of sessions; It is determined by the patient's follow-up, interaction and clinical response. Sometimes sessions can be continued for 2-3 weeks. However, generally 10 sessions of application are sufficient.

Duration of effect of TMS treatment

Studies provide different information about the duration of the effect of TMS treatment. According to some research, its effect lasts a very short time. In other words, whether it accelerates the effect or continues its effect for a long time is not yet clear. However, it contributes both directly to the drug treatment the person is currently using and indirectly by increasing drug resistance. Once resistance to treatment is eliminated, the person continues drug therapy and the classical protocol. TMS treatment alone is not a recommended approach. The aim of TMS treatment is to strengthen and accelerate existing treatment.

Side effects of TMS

There are no unpleasant side effects in TMS treatment, except for a mild headache or a small mechanical interaction that occurs during application. However, there are some points that should be taken into consideration during the treatment. For example, it should be observed whether there are sudden changes such as acceleration in the clinical condition of the person receiving TMS treatment for resistant depression. Therefore, it is extremely important for a clinician to see a person every 5-6 sessions during TMS treatment or for the person administering it to submit a report.

The most feared side effect of TMS is epileptic seizure. However, with appropriate protocols, this risk is almost non-existent.

There are some cases where TMS causes hearing loss in some people who previously had hearing problems. A study reported that there was no significant change in hearing threshold. This is not a situation we see in clinical practice. This situation should also be taken into consideration in the elderly and those with deafness problems.

People to whom TMS should not be applied

There is absolutely no medical or psychological condition that prevents the application of TMS treatment. There are situations that need to be taken into consideration and are not recommended for now because there is not enough research. One of these situations is people with a history of epilepsy. It is necessary to be very careful with these people. In addition, any publication regarding its application in people with dental implants, dental prostheses, vagus nerve implants, ear implants, any prosthesis, pacemakers, cardiac stents, insulin pumps, people who have had heart valve replacement, or people who have had shunt surgery due to any brain disorder, There is no research involved. Therefore, it should not be used in such people. Other than that, there is no situation where its use is strictly prohibited.

Advantages of TMS

It has almost zero side effects. The most common side effect is a mild headache.

The therapeutic effect begins quickly. It is possible to see the positive effect of TMS treatment within a week.

There is no direct intervention to the body. In other words, it is not an invasive and disruptive approach.

It does not require anesthesia. It can be applied on an outpatient basis. Hospitalization is not mandatory. However, in severe psychiatric cases requiring hospitalization, it provides a great advantage as it can be performed without the need for any anesthesia during hospitalization.

In depression-related treatments, there is a chance to achieve specific, pinpoint results since direct magnetic stimulation is given to the disorder in the area that causes depression. For example, in depression, there is a functioning problem in the left front region of our brain. TMS treatment is also given from the left frontal brain region in depression.

The treatment protocol can be started and finished in a very short time. The required treatment is completed within 2-4 weeks.

It also has the advantage of both rapid results and short duration of treatment.

It is an important advantage that it provides therapeutic benefit as well as treatment effect in people who are resistant to treatment. Because people experience a great work-life imbalance in those resistant situations. People's environmental, professional and family functionality decreases significantly. In drug treatment, it is necessary to wait for a certain period of time for the effects of the drugs to occur. After waiting, a certain period of time is required to decide whether the person is resistant to that drug and to determine whether to switch to another protocol or another treatment. Naturally, in cases that are resistant to treatment, the person must wait a certain period of time to overcome the resistance in drug treatment. During this period, the person's functionality is extremely affected. The fact that it has an accelerating effect on treatment in these resistant cases makes TMS treatment an extremely useful and useful treatment tool.

There is no need for the person to abandon the current treatment protocol during TMS treatment. He continues to use whatever drug he is using. If he is receiving therapy, he continues his therapy. There is no need to cut or replace them. In addition to these treatments, it contributes greatly to the person's treatment process.
TMS treatment reveals its treatment effect not only in major depressive disorder, but also with its protocol specific to bipolar disorder. Likewise, in Bipolar Disorder, medication requires a certain amount of time to take effect. During the excitation period, the person's functionality is almost completely impaired. There is a risk of harming oneself, one's environment, and the outside world. Therefore, in order for the person to be treated and get out of this situation, hospitalization and treatment with a drug protocol are often required. Shortening this period is one of the important effects of TMS treatment.

One of the most important situations in cases requiring hospitalization (major depressive disorder, schizophrenia, addiction and other psychiatric conditions requiring hospitalization) is the long duration of hospitalization. The longer the hospital stay, the more likely it is that the disease will have a greater impact in the future. Naturally, one of our important issues is to reduce hospital stay to a minimum. TMS treatment makes a great contribution at this point. One purpose and contribution of TMS treatment is to shorten hospital stays.

One of the important features of TMS is that the patient can quickly realize that he or she is getting better in a short time. This awareness is not easy in drug treatments. Since it occurs over a very long period of time, 2-3 weeks to 4 weeks later, the person may not feel the healing effect. However, feeling this change after 5-6 days of TMS treatment becomes an extra source of morale and motivation for people. People's self-confidence and belief that they will recover increases. It is possible to see this as a psychotherapeutic effect as well as direct electrical and chemical effects. TMS treatment is also an effective method in this sense.

Quitting medications with TMS therapy

The person who will decide on the application of TMS treatment is the physician. Generally, neurologists and psychiatrists make the decision to apply this treatment. However, since its main area of use is psychiatry, the people who will generally decide on TMS treatment are psychiatrists. A psychiatrist is the person who decides whether a patient will be treated with or without medication. No treatment method should be considered as an alternative to another treatment. It is necessary to act within a holistic approach to treatment. In other words, each treatment tool has a different contribution to the treatment. At this point, if there is a serotonin deficiency in the human brain that will cause depression, the approach that will eliminate this serotonin deficiency is definitely medication. TMS treatment should be added to the protocol on the basis of a classical drug treatment. It is not a medical and ethical approach to discontinue drug treatment and proceed with TMS alone. The contribution of TMS treatment is to reduce the dose of medication required for treatment rather than stopping the medication. Because, especially in resistant depressions, the drug dose is given at very high levels. Opening the resistance means that the dose required for treatment decreases and therefore side effects decrease.
It is worth repeating: TMS treatment is not an alternative treatment method. It is a complementary and contributing approach. It should be applied on the basis of medication and psychotherapy, without neglecting the general treatment approach.

If the person gets sick again after recovering and becoming functional, can TMS treatment be applied again?

Applicable. TMS treatment is a reliable treatment that can be applied at any time, in any period, in any recurrence. TMS treatment, in addition to its own effect, also has an accelerating effect on the current situation.

What are the differences between magnetic stimulation therapy (TMS) and electroconvulsive therapy (ECT)?

There are huge differences between Electroconvulsive therapy (ECT) and Magnetic Stimulation Therapy (TMS) in terms of functioning.

In ECT, a very short voltage electrical stimulation is given. Meanwhile, a high level of excitation occurs in all areas of the brain. If an anesthetic is not administered, an epileptic seizure occurs. Therefore, ECT must be performed in a hospital environment and under general anesthesia.

TMS treatment can be applied on an outpatient basis, without the need for any anesthesia or analgesia. The person can receive the treatment very comfortably from where he/she sits. There is no discomfort in the treatment other than a slight headache or a small mechanical interaction that occurs during the application. In other words, the patient does not need to be hospitalized for TMS treatment. He can also receive outpatient treatment in a very healthy way. In TMS, the patient is awake. He can talk. There are no restrictions.

It does not cause weakness, fatigue or sedation. The patient receives the session and can go to work.

The sedation effect that we see with antidepressants or some antipsychotic drugs or some cognitive problems that may affect driving (forgetfulness, attention problems) do not appear.

There is a temporary forgetfulness in ECT, but there is no such forgetfulness or attention problem in TMS treatment. In fact, the opposite state of alertness is evident.

TMS treatment has been frequently used as an alternative to ECT in recent years. Because there are huge differences in terms of convenience between the conditions of applying ECT and the conditions of applying TMS treatment. TMS treatment is not a treatment that will be given at the first encounter with a person.

TMS treatment is not an alternative to ECT. Because ECT is a very effective method. It is a life saver when used appropriately. In other words, rather than choosing TMS over ECT, it is necessary to evaluate the patient's current situation and decide which one will be more meaningful. Of course, the decision here belongs to the doctor.

TMS treatment in heart patients

If the person has not had a heart valve or prosthesis, or if there is no prosthesis in his body, TMS treatment can be applied in a very healthy and reliable way for such people. There are no side effects or changing effects on blood pressure, heart rate or body functioning during TMS treatment. Therefore, it can be used successfully in all kinds of diseases, as well as in heart patients.

TMS treatment in the elderly

One of the areas where TMS treatment is used is elderly depression. Elderly depression is a very variable condition and is difficult to treat due to the limitations of being old. In depression in the elderly population, patients' medical conditions, low drug tolerance and slowdown in their metabolism do not allow them to use every drug. Therefore, treatment success is slightly lower in the elderly population. There is some research on the application of magnetic stimulation therapy in such cases. Very satisfactory results have been obtained from these studies. Because, as we said before, TMS treatment is an application that not only increases the treatment effect but also the drug effectiveness, helps eliminate the receptor resistance of the drugs, and also helps reduce the dose of the drug to be used. In the elderly, the use of medication along with minimal TMS treatment increases the effectiveness of the treatment.

There are also studies showing that TMS treatment has been successfully used in Alzheimer's patients in recent years, especially in the initial phase, when cognitive impairment is just beginning. Because the neuroplasticity effect of TMS treatment is also emphasized. In other words, it is thought that TMS treatment creates some new connections in the brain.Turkish psychiatric services in London
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Panic attack crises and treatment methods
Panic attack disease, which is more common with stressful lives, comes with seizures. If left untreated, it can last for years and lead the person to depression. Panic attacks are more common in people with anxiety!

Panic attacks are seizures that occur unexpectedly, last relatively short, and are accompanied by physical symptoms such as palpitations. People feel intense distress without fully understanding why. In addition, this distress is accompanied by some physical symptoms. Panic attacks have sudden and unexplained symptoms. The lifetime prevalence of panic attacks in the general population is between 1-3 percent. 7 out of every 100 people may experience a panic attack once in their lifetime. This rate is twice as high in women as in men. Research shows that this disease is more common in women between the ages of 20-45. In addition, in recent years, the incidence has increased in young and middle-aged women and men due to the effect of stressful living conditions. Panic attacks are more common in people who are meticulous, nervous, easily excited, have low anxiety thresholds and are anxious. Symptoms such as excitement and timidity usually begin a few months before.

How are panic attacks seen?

Panic attacks occur in two different ways. Danger in one; It comes from outside, in the other case it occurs through a subconscious association. The brain reacts the same in both situations. A lot of adrenaline is released for defense purposes. Within seconds, rapid heartbeat begins, while breathing becomes frequent and deep. When the source of fear coming from outside is known, the person can ward off the danger and take precautions. In the second case, the heart begins to beat rapidly even though there is no identifiable reason, and the person feels that he is breathless even though he is breathing frequently, and he becomes frightened. After these, it progresses as a serious and medical condition with its metabolic table biochemistry and physiological changes. People experiencing this condition are taken to the emergency room with concerns of having a heart attack.

Are panic attacks genetic?

The disorder has a moderate genetic burden. There are many studies showing the relationship between childhood anxiety and what occurs in adult life. In other words, it is stated that restricting behavior during childhood is a risk factor for the development of anxiety. The person believes that the symptoms occurring during the attack may be physically or psychologically dangerous or even fatal. In other words, these people are afraid of fear and focus their attention on their bodies. This causes increased anxiety and excessive focus on bodily sensations. With this vicious circle, panic attacks occur.

How long does panic attack treatment take?

Panic attacks can last for years if left untreated. In later periods, it may cause depression in people as a result of hopelessness and helplessness. Panic attacks can be easily treated with cognitive behavioral therapy. In addition to drug treatment, psychotherapy aims to help the person know what his illness is and its causes, breathing exercises, and changing his negative thoughts. Therapy may last up to 6-12 sessions. If a relative of yours has this kind of problem, you should first try to understand him. Avoid false sentences that will increase his anxiety. Also, support him/her in consulting a mental health professional as soon as possible.

What is Panic Attack?

Panic attacks are strong psychological and physical attacks that occur with sudden, temporary feelings of fear against non-threatening situations. Panic attacks, which occur with symptoms such as palpitations, rapid heartbeats, pain in the chest, sweating and shaking, cause the person to think that he is having a heart attack and to experience fear of death.

It occurs along with physical symptoms and frightening thoughts. During a panic attack, the heart beats faster and palpitations may occur. Along with the feeling of pain in the chest, sweating and tremors may also be observed. In addition, fainting, dizziness and shortness of breath may also accompany these.

What Causes Panic Attacks?

Panic attacks occur due to the survival instinct and this emotion sends false alarms from the brain to the body. Panic attacks, which are psychological disorders, can be caused by traumatic situations such as stress, grief, and neurotransmitter imbalances in the brain. Factors such as thyroid and heart rhythm disorders, which are also considered medical conditions, are also among the causes of panic attack disorder. In addition, the following situations are among the causes of panic attacks:

Difficulty expressing yourself
suppressed emotions
Traumas experienced in childhood
Depression
social phobia
seeing blood
Dog, cat, height, elevator, insect, plane, etc. fear of
Fear of closed spaces (claustrophobia)
Agoraphobia
Palpitations that wake up at night as a panic attack during sleep
difficulty breathing
Feeling like you're drowning
Genetic predisposition in the family, stress, sexual assault, excessive use of cigarettes and caffeine, divorce, and chronic diseases can also be listed as causes of panic attacks.

What are the Symptoms of Panic Attacks?

Conditions such as rapid heart palpitations, sweating, tremors, shortness of breath, chest pain, nausea, dizziness, fear of death are defined as symptoms of panic attacks. The most common symptoms of a panic attack, which can occur suddenly, be devastating, and begin to subside within a few minutes, are as follows:

Sudden and intense fear
rapid heartbeat, palpitations
pain in chest
Hot flushes and chills
Nausea
Sweating
difficulty breathing
Tingling and numbness in fingers or toes
muscle tension
Dizziness, fainting, or shaking
Feeling like you've lost control
Losing the sense of reality
dry mouth
In addition, fear of having a panic attack is also among the symptoms of panic attacks.

Panic Attack Symptoms in Children

Symptoms of panic attacks in children are similar to those seen in adults. The most common panic attack symptoms in children and adolescents are; fainting, sweating, palpitations, headache, flushing and shortness of breath are observed.

Agoraphobia, which is the fear of being in an environment where it may be difficult to get help, is caused by panic attack disorder in children. This condition is linked to stress, anxiety and mood disorders.

What are the Effects of Panic Attacks?

While panic attacks have physical effects such as sweating, palpitations, flushing and nausea, they also have psychological effects such as fear, anxiety and stress. Although people who have panic attacks may fear death during the attack, this situation does not pose a risk. Panic attacks can have psychological and physical effects. These are explained as follows:

Psychological Effects of Panic Attack

Among the psychological effects of a panic attack, the person experiencing this situation experiences intense anxiety, a feeling of panic, various fears, dizziness, and a feeling of going crazy. This anxiety is experienced at the beginning of a panic attack, which triggers the sympathetic nervous system, and can reach its peak within 10 minutes. The psychological effects of panic attacks are listed as follows:

Intense anxiety in the person
state of panic
Feeling crazy
don't feel dizzy
Do not experience fear of death
Physical Effects of Panic Attack

Physical effects of a panic attack include shaking, sweating, shortness of breath, chest pain, sweating, chest pressure, and dizziness.

What are the Types of Panic Attacks?

Types of panic attacks vary depending on the environment and situation. Panic attacks can be divided into three types:

Spontaneous panic attack: It may occur suddenly. At its core is panic disorder.
Situational panic attack: It occurs when a person feels that he or she will have a panic attack. It can be seen in social phobia, post-traumatic stress disorder, and sleep terror.
Situationally predisposed panic attack: It is a type of panic attack that occurs in a specific situation and does not always recur.
What are the issues that pose the risk of panic attacks?

Strong tea, coffee, cigarettes and alcohol can create a risk of panic attacks and trigger them. In addition, stopping some medications suddenly increases the risk of panic attacks. Rapid breathing depending on the environment is also among the causes of panic attacks. Factors that create the risk of panic attacks are listed as follows:

genetic factors
exposure to stress
Experiencing a traumatic event
Predisposition to negative emotions and thoughts
Caffeine and cigarette use
How to Diagnose Panic Attack?

Before diagnosing panic attacks that mimic problems such as heart attack or shortness of breath, it is necessary to look at the person's health history and examine the diseases in the family. For this reason, people may first have a blood test, ECG, thyroid test and respiratory function check.

Not everyone who experiences panic attacks has this disorder. In this case, help can be obtained from an expert psychologist. An expert psychologist can perform applications such as panic attack tests on the person. It is also possible to carry out this process online. You can prevent panic attacks with online psychologist service.

How to Treat Panic Attacks?

Panic attacks can easily be relieved with cognitive behavioral treatment through therapy and counselling. In addition, medication can be administered and breathing exercises can be given to the person to heal with psychotherapy techniques. Ways to have a panic attack are listed as follows:

Get Consultation

Cognitive-behavioral therapy aims to change the perspective of people who have panic attacks. It aims to help you find a new approach to the physical and mental symptoms you experience.

Take Deep Breaths

Although rapid and deep breathing is a symptom of a panic attack, deep breathing can reduce panic symptoms during an attack. When you can control your breathing, you are less likely to experience other symptoms and situations that can make a panic attack worse.

Recognize When You're Having a Panic Attack

People who think they are having a heart attack but are actually experiencing a panic attack at that moment will feel better when they realize this, accepting that it is temporary. Although it is not always possible to avoid the factors that trigger a panic attack, knowing what triggers it makes you aware that you are experiencing a panic attack.

Close Your Eyes

A panic attack may occur when you are in a fast-paced environment with a lot of stimuli. Close your eyes to reduce stimuli during a panic attack. Doing this blocks out extra stimuli and makes it easier to focus on your breathing.

Use Muscle Relaxation Techniques

Muscle tension is seen as a symptom of a panic attack. Progressive muscle relaxation aims to release tension in a group of muscles simultaneously to relax the entire body. In this way, muscle relaxation techniques allow you to control the body's response to a panic attack as much as possible.

Imagine Your Happy Place

Thinking of a place where you are most comfortable and happy helps reduce stress and anxiety and is effective without causing a panic attack. Imagine yourself in your happy place, focus on the details.

What is the treatment of panic attacks?

Panic attack treatment aims to reduce the number of attacks and relieve symptoms. For this purpose, both drug treatment and psychotherapy can be applied.

Medication

A doctor who specializes in drug treatment may prescribe SSRI antidepressant and benzodiazepine type medications depending on the person's needs. A person experiencing a panic attack may continue to take medications even if they feel well. The dosage and duration of use are decided by a specialist psychologist or psychiatrist.

Psychotherapy

Psychologically, the basis of treatments is cognitive behavioral therapy (CBT). With cognitive behavioral therapy (CBT), the person learns how to cope with the situation and prevent attacks. In this way, he can get rid of panic attacks. In some cases, medication and therapy can be carried out together.

Precautions That Can Be Taken Against Panic Attacks

Realize that panic attacks are a state of mind
Remind yourself that you are not alone
Meet other people who have had panic attacks
Do not avoid places where you have panic attacks
Focus on one place instead of closing your eyes during the attack
Try to reduce your breathing rate
do sports
Pay attention to your sleep patterns
Follow a regular nutrition program
Focus on living your day to the best of your ability, without thinking about tomorrow.
Frequently Asked Questions About Panic Attacks

Which doctor to see for panic attacks?

Panic disorder affects the body physically and mentally. In such cases, after appropriate examinations, you may be referred to a specialist psychologist or psychiatrist.

How should someone who is experiencing a panic attack be treated?

It is important to approach the person experiencing a panic attack calmly and empathetically. You can take the following approach towards people experiencing attacks:

Tell the person clearly that they are having a panic attack
Keep your cool
Provide a safe and quiet space (reduce environmental disturbances)
Make suggestions to the person (such as 'I know you can deal with this', 'remember that it is temporary')
What can be done to prevent panic attacks?

To prevent panic attacks, it is necessary to pay attention to your daily routines, exercise regularly and eat regularly. Try to live in the moment by focusing on the day, relax your mind by reminding yourself that you are not alone. These applications are considered among the things that are good for panic attacks.

Do panic attacks cause different psychological diseases?

Panic attacks that are left untreated and become chronic over time can cause depression, alcohol and substance addiction, and various psychiatric problems. It can lead to psychological diseases such as panic disorder, anxiety, social phobia, post-traumatic stress disorder, and compulsive disorder.

How long do panic attacks last?

Panic attacks can start suddenly and become severe. Panic attacks, which reach their peak within 10 minutes, last between 10-30 minutes and may pass on their own. This period varies from person to person.

At what age does panic attack begin?

The onset of panic attacks, which are more common in young people and women, is between the ages of 15 and 20. Panic disorder can also occur in young children. There may be differences in symptoms from person to person and according to age.

Are panic attacks chronic?

Panic disorder is a psychological disorder that occurs throughout a person's life and can become chronic if left untreated.

Do panic attacks damage the heart?

Panic attacks, which can be a risk factor for heart diseases, do not harm the heart, but can be triggered if the person has heart disease.

Can panic attacks kill?

There is not a single person on record who is thought to have died due to panic attacks.

Are panic attacks a mental illness?

Panic attack is a condition caused by panic disorder. The body develops panic attacks as a defense mechanism.

BPS Chartered Counseling Psychologist & Psychotherapist

I have been working as a clinical psychologist for more than 10 years and I am actively involved in both training clinical psychologists in the field and treatment processes. After graduating from Ege University, Department of Psychology in 2009, I completed my master's degree in Health-Oriented Clinical Psychology and my doctorate in Clinical Psychology. In 2017, I completed my doctoral internship at the University of Central Lancashire, and during this time, I completed my research project on the mental health of immigrant women living in England. Apart from this, I took part in many international projects. I am currently taking part as a researcher in the project called Multi-Sectoral Responses to Child Abuse and Neglect in Europe, which continues with the participation of 34 countries. I earned the title of associate professor in the field of Clinical Psychology in 2023. As a Chartered Psychologist registered with the British Psychological Society, I have been serving in England since 2023.
As the Deputy Coordinator of Psychological Support Studies in Disasters of the Turkish Psychologists Association, I provide training to psychologists who volunteer to serve in disasters and voluntarily take part in the field coordination after the Kahramanmaraş Earthquake. I also provide supervision to clinical psychology graduate students. I have expertise that extends beyond the therapy room on trauma, anxiety and stress-related issues, adverse childhood experiences, and the mental health effects of experiencing interpersonal violence. With over a decade of clinical experience in this field, I offer my knowledge and expertise to support individuals on their journey to recovery and resilience. I believe in a holistic approach that combines evidence-based treatments with a personalized understanding of each individual's unique circumstances, and I shape my clinical practice in this context.

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Childhood is an important period that directly affects the personality development of individuals and leaves meaningful traces on their future lives. The fact that the roots of many psychological problems that occur in older ages are traced to childhood has caused families to start observing their children's behavior at an early age and feel the need to seek professional help in case of a possible problem.

In response to this need, the branch of Child Psychology aims to support individuals with therapies developed for children on issues such as behavioral problems, social skills, mental and spiritual health, developmental problems and trauma by examining the mental, physical, spiritual and social development of children from birth to adolescence. In therapies with children, art therapy is applied through painting, sculpture, music, drama and stories, which are therapy techniques appropriate to the age group and mental development of the children. By revealing children's behavioral patterns in play, their place in the family, their emotional states, and the beliefs and attitudes they acquire from their environment, it gives clues to the Specialist about what kind of relationship he should establish with the child. Therefore, in addition to art therapies, "Play Therapy" is a good therapy technique for establishing a therapeutic relationship between the client and the counselor.

Who can get help with Child Psychology?

All families who think that their children cannot get out of the situation they are in without professional help can get help for themselves and their children. Therapies developed for children are effective in various conditions and disorders such as learning disabilities, attention deficit and hyperactivity disorder, parental separation, adoption, accidents, earthquakes, self-harm, physical and emotional abuse, domestic violence, irritability, irritability and lying. Parents who want to get support on these issues and most importantly to understand their child's internal dynamics can apply.

How long does child psychology therapy last?

Although the number and duration of therapy sessions for children are the same, their content varies. Short Term Therapies start from 6 sessions and can be planned up to 15 sessions in appropriate cases. Additionally, sessions with children often take less time to complete than with adults, depending on the children's age and focus span. While 30-40 minutes of the 50-minute individual counseling session is based on individual therapy with the child, the remaining time is spent in the form of family information.

“Whatever a child can do collaboratively today, he can do it alone tomorrow.”

Lev Vygotsky

Family, as the smallest organism of society, is vital for a healthy society and a healthy individual. Family relationships deeply affect the mental health of individuals, because this is the first place where the individual feels belonging, reveals his identity, and acquires social behavior patterns when he is born. In cases where individual therapies are not sufficient and where there is more than one client, family and couple therapies are preferred. The focus of family counseling is to identify interactions, cycles, and unhelpful behavioral patterns that negatively impact functionality within the family and attempt to replace them with positive, cooperative, and protective attitudes for the family. Systemic Psychotherapy, used in family counseling, sees the family as a system within itself and the individual is the smallest part that reflects the system. He believes that the problem in the smallest part of this system harms the entire system. Therefore, Systemic Psychotherapy can be carried out successfully with the participation of parents, siblings or just one individual within the family, even if the entire family cannot participate in therapy, while in a therapeutic relationship with the family. However, it should not be forgotten that the increase in the participation rate of family members increases the effect and benefit of the therapy. Family therapies are carried out in accordance with the ethical code and standards of the Association for Family Therapy and Systemic Practice, UK.

Who can apply to a Family Counselor?

Families and individuals who want to get professional support for family conflicts and problems can apply to the Family Counselor. Family counseling can be obtained for many psychological situations such as separation, divorce, disagreement, relationship problems between spouses, difficulties of being a parent and dysfunctional parenting attitudes, illness, mourning, behavioral disorders in children, difficulties in adolescence, and important life changes. The important thing to consider when deciding to receive Family Counseling is to ensure that the consent of the family members who will receive therapy is obtained and that they participate voluntarily.

How long does Family Counseling take?

Family counseling varies depending on the number of individuals attending the sessions and the subject receiving help, but it can last from a Short-Term therapy of 6 Sessions to a Long-Term therapy of 20 Sessions. Sessions last between 50-90 minutes, depending on the number of individuals. chiFT therapy generally ends in 70 minutes.

“I believe that when I know how to heal the family, I can also heal the world.”

Virginia Satir

What is an eating disorder?

It is the behavior of undereating or overeating that can harm health. The body, emotional and social life of a person with an eating disorder is damaged due to abnormalities in eating behavior. A person's daily life is not affected by the way he eats, but the way he eats affects his daily life.

Nutrition and eating disorders;

Pica
Regurgitation (rumination) disorder
Avoidant/restricted food intake disorder
Anorexia nervosa
bulimia nervosa
binge eating disorder
Another identified feeding or eating disorder
It is considered an unspecified feeding and eating disorder.
What are the causes of eating disorders?

An eating disorder is very different from dieting. While a diet is a balanced diet followed by a person to achieve a healthy body, an eating disorder is a psychologically based disease that affects a person's life physiologically, psychologically and sociologically. No specific cause for eating disorders is known. Nutrition and eating disorders greatly affect the lives of the individual, his family and close circle. It is thought that one of the main reasons for eating disorders is lack of self-confidence. Basically, the person with a feeding and eating disorder tries to control his life and emotions by eating or not eating. This situation is often related to how insecure the person feels about his life and what is happening around him. The fact that eating disorders are more common in women also emphasizes the importance of femininity psychology.

Pica

It is the person's constant consumption of a non-nutritious substance (paper, hair, paint, soap, ash, clay, etc.) that has no nutritional value for at least a month. The attitude of eating non-nutritious and non-nutritious substances is not compatible with the developmental level of the person. Although it is more common in children, it can be seen in all age groups.

Regurgitation (rumination) disorder

It is a condition in which a person frequently purges the food he or she eats for at least a month. The expelled food can be re-chewed, re-swallowed or spit out. Frequent regurgitation does not develop due to an accompanying gastrointestinal disease or another health condition (reflux, pyloric stenosis, etc.).

Avoidant/Restricted food intake disorder

It is the state of significant weight loss, significant lack of weight, or dependence on enteral (with the help of a tube) nutrition and oral nutritional supplements. As a result, the person's psychological and social functionality decreases significantly.

bulimia nervosa

Having recurrent episodes of binge eating and a binge eating episode is the eating of clearly more food than most people would eat in a similar period of time under similar circumstances, and during this period there is a feeling of loss of control over eating (the feeling that the person cannot stop eating).

It is the state of a person engaging in repetitive and excessively compensatory behaviors such as self-induced vomiting, misuse of laxatives, diuretics or other medications, eating almost nothing, or exercising excessively in order to avoid gaining weight. The evaluation criterion for the diagnosis of bulimia nervosa is that both binge eating attacks and compensatory behaviors occur at least once a week for three months.

People affected by bulimia nervosa, bulimia, or binge eating and vomiting addiction are usually of normal weight, appear athletic, and appear to eat very healthily. Bulimia is less noticeable based on body weight than other eating disorders. Those affected suffer from regular, uncontrollable binge eating. They take weight-reducing measures for fear of gaining weight after binge eating. Those affected usually alternate between phases in which they eat very controlled foods and exercise a lot, and phases in which they have episodes of cravings and vomiting. In addition, those affected are very attached to their appearance. Feelings of shame, disgust, and guilt also often play a role. Binge eating serves to regulate unwanted emotions such as fear, frustration, or anger.

Anorexia nervosa

It is the person's fear of gaining weight or becoming fat, or the person engages in behaviors that make it difficult to gain weight, despite having a significantly low body weight. There is a disturbance in how a person perceives their body weight or shape. When evaluating oneself, a person may never understand the importance of low body weight or attach undue importance to body weight and shape.

Affected people feel very fat even though they are thin. Being thin can also be very dangerous for the body. Cardiac arrhythmias, electrolyte and hormone balance disorders, organ damage, osteoporosis and infertility are often the result of anorexia. This makes anorexia one of the deadly diseases.does. Therapy is always necessary. Many patients refuse treatment due to lack of insight into the disease.

binge eating disorder

Recurrent binge eating episodes occur at least once a week for three months. It is when a person eats clearly more food than most people would eat under similar circumstances and for a similar period of time. Eating more quickly than usual, eating until you feel uncomfortably full, eating when you don't feel physically hungry, and eating on your own because you are ashamed of how much you have eaten, and then feeling intense guilt are often the thresholds. Binge eating is not accompanied by inappropriate compensatory behaviors as in bulimia nervosa, so being overweight is a typical outcome. This can promote the development of diabetes and cardiovascular diseases.

Other Identified Feeding and Eating Disorders

night eating disorder

These are recurrent attacks of night eating, manifested by waking up from sleep and eating or consuming excessive food after dinner.

Unspecified feeding and eating disorder

It is a category that causes clinically significant distress or impairment in functional areas but does not fully meet the diagnostic criteria for any of the feeding and eating disorders diagnostic cluster.

How are eating disorders treated?

Treatment is carried out under the leadership of a psychiatrist and a specialist psychologist, in cooperation with internal medicine and other medical branches, depending on the condition of the disease. Body mass index, determined by weight and height ratio, is used to diagnose eating disorders. A low BMI is typical for anorexia, while a high BMI is typical for binge eating disorder. People with bulimia usually have a normal BMI. Supportive psychotherapy meetings, family participation in treatment and cooperation with the family are important. Patients are often aware of their eating disorder, but do not realize the illness until late and may refuse treatment. The first goal in treatment is to ensure that the patient, who is usually closed to treatment, cooperates with the treatment.

Cognitive behavioral therapy is one of the methods that show good results in the treatment of eating disorders. Because people with eating disorders respond to stress and emotional situations with disturbed eating behavior, therapy aims to teach them alternative coping strategies. It is important to include family relatives in therapy, especially in young patients. Nutritional therapy that specializes in eating disorders can also be helpful, as it provides information about healthy eating, structured meals, and portion sizes.

The later eating disorder treatment is started, the more difficult it can be to treat. Eating disorder treatment is time-consuming.

What diseases can eating disorders cause?

Eating disorder is malnutrition; It can cause muscle wasting, brittle bones, hair loss, lack of menstrual periods, or loss of strength. A malnourished body is also less able to defend itself against infections. Constant vomiting can damage teeth and esophagus. Eating disorders, especially anorexia nervosa, can be fatal. Overweight people who overeat may experience joint pain, high blood pressure or diabetes. Depression can also accompany an eating disorder.

Autism support centers
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I came to the UK in 2010 after studying psychology in Istanbul, Turkey. I completed a masters degree in counseling and worked with children and young people during my university placement. Working over ten years in a mental health charity, in therapist and management roles, I had one to one and group work with adults with severe mental health disorders. During this time, I completed a diploma program in psychotherapy.

Having started my private practice in 2020, I am also currently working part-time in the NHS talking therapy service. I started my clinical training in psychoanalysis and psychotherapy at CFAR (Centre for Freudian Analysis and Research) in 2015 and I still continue my formation as a psychoanalyst which also involves going through my own analysis. I work with a Lacanian orientation.

I am an accredited member of the BACP (British Association of Counseling and Psychotherapy). I work in accordance with BACP ethical framework https://www.bacp.co.uk/media/3103/bacp-ethical-framework-for-the-counselling-professions-2018.pdf and CFAR Code of Ethics and Code of Practice https://cfar.org.uk/code-of-ethics/.

I offer sessions in English and Turkish. I conduct therapy sessions in English or Turkish.

London Turkish Psychologist, Reliable Psychologist, Psychiatry, child psychology, adolescent psychology, marriage counselor, couple therapy

Who Can Provide Education to People with Autism?
Students diagnosed with autism spectrum disorder constitute the group of students with special needs who benefit least from special education efforts, not only in Turkey but almost all over the world. Special education teachers who will work with students diagnosed with autism spectrum disorder must have basic general and special education knowledge and skills (e.g., individualization, classroom management, effective teaching, etc.).
Special qualifications that special education teachers who will work with students diagnosed with autism spectrum disorder must have are as follows:
(a) characteristics and needs of students diagnosed with autism spectrum disorder,
(b) methods of teaching social interaction skills (e.g., social stories, video modeling, etc.),
(c) methods of teaching communication skills (e.g., PECS, line teaching, etc.),
(d) methods of teaching independent living skills (e.g., activity schedules, community-based teaching, etc.),
(e) sensory and environmental adjustments (e.g., visual strategies, routines, etc.),
(f) positive behavioral support.

Educational studies for students diagnosed with autism spectrum disorder, especially those other than those with Asperger syndrome, may require working in very different formats and contents. For example, many children make the fastest progress when they receive one-on-one, intensive, and uninterrupted behavioral training at a very early age. Or, very intense one-on-one behavioral training may need to be provided within the group. All these features require teachers to have very special equipment to work with students diagnosed with autism spectrum disorder.
In Turkey, there is no undergraduate or graduate program to train teachers or specialists for students diagnosed with autism spectrum disorder. Therefore, teachers of mentally disabled people also have to work with students diagnosed with autism spectrum disorder. However, as stated above, the educational needs of students diagnosed with autism spectrum disorder differ from the needs of other special education groups. For this reason, teachers of mentally retarded people face important problems when working with students diagnosed with autism spectrum disorder.
Does your child have the right to education or special education? What do the laws and the state say about your child's education?
Does your child have the right to education or special education? What do the laws and the state say about your child's education?

Like every child, your child has the right to food, shelter, play, medical care and education. Your child's right to education is determined and guaranteed by the constitution and laws. Article 42 of our Constitution states that 'No individual can be deprived of the right to education and training. This also applies to your child. Articles 41, 42, 49, 50, 60 and 61 of our Constitution outline the regulations regarding disabled individuals. Our state is obliged to provide free education for every child (including your child) that best suits their needs.

The Road Map to Follow to Benefit from Special Education Services
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If you suspect that there is something wrong with your child's development, you should get an expert opinion regarding your suspicions as soon as possible. You can share these doubts with your pediatrician, health center staff, or directly consult child mental health specialists or pediatric neurologists.

In our country, the people who can diagnose autism are child psychiatrists and child neurologists. These experts make a detailed evaluation and determine whether your child has autism, the degree of autism, and their intelligence and development levels.

If your child is diagnosed with autism, you should apply to a health institution authorized to issue a Disability Health Board Report. The next step is to plan the training. Like every child, your child has the right to education. In order to benefit from this right, you should contact the Guidance Research Center (RAM) closest to where you live and get an opinion on which educational environment would be appropriate for your child to receive education. Here, your child will be subjected to educational evaluation and diagnosis by the Special Education Evaluation Board and it will be decided to place your child in an appropriate educational environment.

educational environments

1. Inclusion: Inclusion is the education of children requiring special education.They continue their education in public or private schools attended by normally developing children. Inclusive education can be received in pre-school, primary and secondary education institutions. Inclusive education can be planned as full-time (spending all of the time at school with typically developing peers) or part-time (spending some of the time at school in a special education class).

2. Special Education Class: These are classes opened for students requiring special education within public and private schools. Classes for children with autism should have a maximum of 4 people.

3. Autistic Children Education Center (OÇEM): These are centers opened for autistic children who are at the age of compulsory education and are unable to attend normal primary education programs. The upper age limit in these centers is 14.

4. Autistic Children Job Training Center: Individuals with autism who have completed their primary education, are unable to attend general and vocational secondary education programs, and are under the age of 21 can attend autistic children job training centers. These centers include business training practices as well as academic knowledge and skills.

What are the basic features that an effective education program for an autistic child should have?

There are many education and treatment methods used in autistic children. In these programs, it is possible to see almost all of the features listed below:

Early age: Starting education before the age of three. Intensity: Providing education five days a week and at least 25 hours, 12 months a year.

Session duration: Organizing short training sessions of 15-20 minutes, especially when working with young children. Individuality: Including one-on-one and small group training to meet the individual needs of the child.

Program content: Giving great importance to the acquisition of functional communication skills, social skills and game skills and reducing inappropriate behaviors. Inclusion: Providing togetherness with normally developing children, even for certain periods of time.

Evaluation: Continuously evaluating the child's development, in other words, the effectiveness of the education provided.

Families: Actively involving families in the education process.

Covering Special Education Expenses

Education provided in official educational institutions in our country is free and covered by the state. However, special education services provided in private private education institutions are subject to a fee. A certain part of this fee is covered by the state. You must apply to RAM for your child to receive education from a private, special education course and for the cost of this service to be covered by the state. You can receive support allowance for individual and group education with the Special Education Evaluation Board Report prepared by RAMs.
Autism Special Education Program

Education programs developed to meet the educational and social needs of individuals as they differ significantly from their peers in terms of their developmental characteristics and educational qualifications, and the education provided in a suitable environment by expert personnel trained in the field, is called an autism special education program.
Individuals' daily life, self-care, academics, reasoning and gaming activities; Fulfillment, sustainability and development targets have been adopted.
Autism Special Education Program Specialists use family-centered and collaborative work to help develop and maximize these skills.
Our goal is for the individual to be independent in daily life, academic and social activities.
Our Autism Special Education Program Specialists continue to work to increase the functions and productivity of individuals with the following disorders, differences and restrictions.

Specific Learning Disability
Autism Spectrum Disorder
Down Syndrome
Lack of Stimulus
Superior mind
Cognitive Impairment
Developmental Delay
Autism Special Education Program application; It includes observation, evaluation, training process and consultation.

Our core skills we work on
When you contact NP Feneryolu Medical Center to receive Autism Special Education Program service, your child will be evaluated for the Autism Special Education program. Throughout this evaluation, Autism Special Education Program Specialists collect information from the family, use a variety of standardized assessments, and find out the child's basic skill levels in his or her strengths and limitations. After the evaluation, the Autism Special Education Program Specialist provides you with a detailed report about the child's condition and his/her recommendations. If your child is eligible for Autism Special Education Program services, you will be referred to a treatment program with one of our expert Autism Special Education Program Teachers.
Our Services and Programs

Cognitive Development
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Gross and Fine Motor Skills
Hand-Eye Coordination Skills
Receptive Language Skills
Expressive Language Skills
Concrete and Abstract Concept Studies
Reading and Writing
Maths
Behavior Problems
Game Playing Skills
Game Making Skills
Turn-Taking and Turn-Waiting Skills
Adaptation Skills to Social Areas
SPConducting and Starting a Conversation Skills
Problem Solving and Reasoning Skills
Conditions for Benefiting from Treatment Services
autism spectrum disorder
Attention disorder and hyperactivity (ADHD/ADD)
mental retardation
learning disability
Cerebral palsy
Down Syndrome
Growth and developmental delay
Genetic diseases / Birth defects
Neurodevelopmental disorders
neurological differences
Behavior Problems
Superior mind
Play and socialization problems
Problems with self-care skills
Having a Child with Autism

What is Autism?

Autism is a lifelong developmental disorder that occurs with communication and social interaction problems, limited interests, and repetitive behaviors. It occurs in the first three years of life. It is possible for families who seek the answer to the question of what autism is at an early age to minimize the effects of the disorder with the rehabilitation program they implement in early diagnosis. Although scientists have not yet been able to pinpoint the exact cause, there is a strong belief that it is a genetic disorder.
Main Symptoms of Autism

After the question of what autism is, another most curious issue is the symptoms of autism. The child cannot make eye contact with others, does not look when called by name, acts as if he does not hear what is said, says some words over and over again in irrelevant environments, cannot play with toys, cannot point to something with his finger, is uninterested in the games played by his peers, lags behind in speaking compared to his peers, sways, struggles or Being overly active, having your eyes fixated on one point, turning objects around, arranging them in order, overreacting to changes in routine, not reacting to people who want to hug them but not turning towards them are the main symptoms of autism.

When these symptoms are observed, a specialist should be consulted for evaluation in terms of autism. Research shows that autism can be diagnosed as early as 14 months of age, and early treatment methods that will reduce the effects of the disorder can be applied as early as 2 years old.

Having a Child with Autism

Although autism is a difficult condition for parents to accept, very positive results are achieved with early diagnosis and treatment. The common wrong answer to the question of what autism is is that it is a disease. Autism is a disorder, not a disease. The social support factor is important in the process of accepting the disorder and in the treatment of autism. In addition to the support received from experts, the social support factor that shows ways to cope with the problem makes it easier for both parents and children with autism to adapt to their situation.

Having a child with autism, which is a condition in which social and family relationships are completely changed, causes families to experience emotional, financial and psychological difficulties from time to time. Parents' anxiety about the future is intense for children with autism who are completely dependent on their parents. At this stage, the social support factor is an important support for parents to continue their healthy lives with their children with autism. It is also important for parents to inform their close circle about what autism is to raise public awareness on this issue.

It's not your fault!

Autism is the most common neurological disorder encountered today, and according to the data of the Centers for Disease Control and Prevention, 1 in every 150 children had autism in 2006, while according to the latest information given in 2018, 1 in every 59 children had autism. Autism is seen in.

It is emphasized that autism can be seen in all races, ethnic groups or groups with different social status, and that there is no connection between the family's income level, lifestyle and education level and autism spectrum disorder.

Although there is different incidence information regarding gender, the common opinion is that it is more common in boys than girls.

Many children diagnosed with autism may also have varying degrees of learning difficulties and mental retardation.

Autism is a special education category that has been heard very frequently in our country, as well as all over the world, in recent years. The term autism has been replaced by the term autism spectrum disorders (ASD) over time. Major facts related to the concept of autism spectrum disorder can be listed as follows;

It is thought that autism spectrum disorder is caused by neurological reasons. A significant portion of individuals diagnosed with autism spectrum disorder (approximately 35%) experience abnormal electrical movements in the brain; seizure, involuntary movements, loss of consciousness, etc. Neurological problems may also occur.
Autism spectrum disorder is not a mental illness; However, its symptoms may remind some mental illnesses.
Scientific research has shown that autism spectrum disorder has no relationship with child-rearing characteristics or the socio-economic characteristics of the family.
There is evidence that autism spectrum disorder may be hereditary; However, the gene or genes that cause this have not yet been found.
In previous years, autism spectrum disorderWhile the death rate is considered to be one in 500, according to the latest data, autism spectrum disorder is thought to affect approximately one in every 59 children. Additionally, its prevalence in boys is 4.3 times higher than in girls.
Contrary to popular belief, most individuals diagnosed with autism spectrum disorder have varying degrees of mental retardation. Additionally, in intelligence tests, certain areas may be much lower than other areas.
A very small number (about 10%) of individuals diagnosed with autism spectrum disorder have very strong memory, musical talent, etc. Superior features are found.
According to the guide published by the American Psychiatric Association (DSM-V), Autism is called "Disorder within the Scope of Autism" and is manifested by deficiencies in two areas (APA, 2013):
1) Difficulties in Social Communication and Interaction

Difficulty establishing and maintaining relationships
Inability to make eye contact
Inability to express emotions
Difficulty initiating and maintaining interactions
2) Limited-Repetitive Behavior Patterns (Repetitive Behaviors)

Stereotyped and repetitive motor movements
Insistence on sameness, strict adherence to routine
Limited and intense interest
Sensory under or over stimulation
Autism Treatment Methods

The most important factor affecting the success of autism treatment is early diagnosis. Since the intensity of autism effects varies from child to child, treatment strategies are designed accordingly. Findings after treatment show that children with autism respond better to treatment with personalized education. There must be a family factor in education, and communicative, social and behavioral adaptive treatment methods should be applied to the child with autism. The most effective form of education in recent times is behavioral training and management. The aim is to improve the communication skills of the child with autism, help him/herself and improve his/her social skills.

The special therapy method aims to improve speech and physical abilities. Speech therapy is especially important in improving the child's communication skills. It is a treatment aimed at improving motor skill deficiency and speech retardation and gives extremely good results. Medications are therapeutic medical support that minimizes the effects of hyperactivity, anxiety, depression and obsessive-compulsive.

The social support factor is an important support in the fight against autism for both parents and children.

If your child has not yet been diagnosed with autism, which institutions and experts can you apply to?

You can apply to university hospitals that have a Child Mental Health and Diseases Department.
You can apply to state hospitals affiliated with the Ministry of Health that have a child psychiatrist or child neurologist.
If your child is diagnosed with autism, you must obtain a 'Child Special Needs Report' (ÇÖZGER). As Paksoy Special Education and Rehabilitation Center, you can get free information about the report and training process from us. We are waiting for you in our institutions with our expert teachers, psychologists, family counselors and therapists. Don't waste any more time. Early diagnosis and taking action are the most important factors in the development of an individual diagnosed with autism.

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What is occupational therapy?
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Child development counselors are people who examine and follow the mental, physical and social development of children. Child development experts evaluate children according to infancy, play, school and adolescence; It guides not only children but also parents. In addition to the actions of their age, children are also affected by the behavior of people in their social environment and family. Child development consultants take all these factors into consideration and provide constructive and healthy guidance for the child. Child development consultants provide counseling not only to healthy children, but also to children who develop differently from normal and have special needs due to their disabilities. At this stage, child development counselors not only provide psychological counseling to children, but also help them regain or improve their physical skills. Child development counselors also deal with children who are hospitalized and receiving treatment. Children's psychology is very important for treatment during the hospital period, and our expert child development consultants provide services at this stage. Child development consultants, who aim to raise healthy children who can take care of themselves as they transition into adulthood, work diligently to raise the right child. The solution is not only communication with the child, but also family support. is also very important. Parents and teachers have a big role in the treatment process. It is necessary to communicate with the child, act consistently, listen to him, spend time with the child, and most importantly, support the child during this treatment process. Child development consultants also apply intelligence and attention tests to children within the scope of their duties. Mental ability tests are important to measure what level children are at. If children are in school, programs that will support their success at school are also added to these tests. Counselors also follow these tests and programs carefully. If the child is at play age, counselors also help families choose toys. The toys chosen are those that will accelerate children's development and educate them. Adolescence, in particular, causes concern for many mothers and fathers. Child development consultants provide advice to families in order to support children's behavior or physical changes. It is important to know how to treat the child and how to react during this process.
What Diseases Does a Child Development Consultant Look at?

Each child may have different problems. It is very important to get support from child development consultants for problems that arise following the follow-up of families and teachers. The situations that child development consultants deal with are as follows:
Ongoing emotional or behavioral problems
lie
Fear
sleep problems
bedwetting
Toilet training
don't talk late
aggressive behavior
fear of school
sibling jealousy
finger sucking
obsessions
introversion
Lack of attention
learning disability
difficulty speaking
Difficulty reading or writing
developmental delay
eating problem
hyperactivity disorder
course failure
Depression
substance abuse
Obesity
exam anxiety
social phobia
Inability to cope with stress
Inability to control anger
Anorexia
Process management in special situations (after divorce, adoption, etc.)
Children with Special Abilities or Disabilities

Another point where a child development consultant should be consulted is if the child has special abilities or disabilities. In both cases, a different educational map must be determined; In this respect, professional guidance is very important. With the consultancy received, some skills can be developed, acquired and guided correctly. If the child has different or superior abilities, families must do what is necessary in this regard. That skill should be worked on further under the supervision of counselling. The consultancy support to be received during all these processes is to ensure that children develop in a healthy way, both spiritually and physically. Strengthening children's relationships within school, social environment and family with the right infrastructure will be very important for them in later ages.
Child development is an area that requires sufficient care and sensitivity in order for children to step into adulthood in a healthy way. For this reason, it is very important that the development of children is followed by experts. In addition to healthy children, the developmental process must be kept under control in children with special needs who develop differently from normal due to some diseases. In this process, it is very important to get support from child development experts in order to identify problems that cannot be noticed by families and to complete development in the healthiest way.

What Problems Do Child Development Specialists Deal With?
Child development experts, 0-18 age group normal developmentIt provides services for the mental and physical needs of children with special needs, acute and chronic diseases or at risk, as well as children with disabilities. Child development specialists, who follow the development of children in all developmental areas (cognitive, language, psycho-social, self-care and motor development), prepare a development chart and continue the necessary follow-ups. It also provides education and counseling to parents. In addition, child development specialists conduct developmental and educational activity studies with patients in inpatient pediatric departments of hospitals. Supporting children to develop their verbal, kinetic, personal, social, visual, logical and musical intelligence is also in the field of interest of child development experts.

Children with language and speech disorders, learning difficulties, reading and writing problems, emotional and social adaptation problems, mental disabilities, physical disabilities, special and gifted children should be evaluated by child development specialists. Families whose children have problems such as bedwetting, aggression, antisocial personality, eating problems, fear of school, stealing, lying, attention deficit can get support from child development experts.

Developmental Screening Tests
If they deem necessary, child development specialists may apply some tests to make a developmental evaluation of the child and identify possible problems in any area of development.

DENVER LL DEVELOPMENTAL SCREENING TEST

Denver II Developmental Screening Test, which was developed to detect possible developmental problems in young children between the ages of 0-6, consists of 4 subsections and includes 116 questions in total. The test, performed together with parents and the child, enables the identification of suspicious situations regarding child development. Before the test, some information about the child is obtained from the parents and questions are asked to the mother during the test.

AGTE (ANKARA DEVELOPMENT SCREENING INVENTORY)

AGTE, another test used to examine the development of children between the ages of 0-6; It allows the examination of language development, small and large muscle development, motor skills, self-care skills, social development and mental skills in children. The inventory contains 154 questions answered with yes, no and I don't know. During the test, questions are also asked to parents. The skills the child has are measured through observation.

GESELL DEVELOPMENT TEST

Gesell Developmental Test is a developmental test that is applied to children between the ages of 3-10, but provides more accurate results in the preschool period. It is also a performance assessment test and allows the child's performance to be measured in areas such as motor skills, visual memory and perception, muscle skills, and hand and eye coordination. By examining the findings obtained as a result of the test, it can be determined whether the child's biological and physical development meets the requirements of his age.

PEABODY PICTURE VOCABULARY TEST

This test, applied to children between the ages of 2.5 and 18, aims to measure language development. 50 cards with 8 pictures on each are given to the child and the child is asked to find the desired picture among 4 pictures on each side of the card and show it. There is no time limit.

METROPOLITAN SCHOOL MATURITY TEST

The Metropolitan School Readiness Test, which measures whether children in the preschool period are ready to start school, investigates whether children have reached the physiological, psychological and mental development required for school. The test asks the child to complete the steps in understanding the sentence given to him/her, associating it with the pictures given, finding the desired one from the pictures given, and understanding the concept of numbers and shapes. The score obtained gives information about whether the child is ready to start school.

GIDR (DEVELOPMENT MONITORING AND SUPPORT GUIDE)

The Development Monitoring and Support Guide (GİDR), which has been used in many studies examining child development in recent years, conducts research to identify developmental problems in children as well as investigations to learn about family concerns. It can be applied in written or oral form and consists of open-ended questions.

Attention and Perception Tests
It may be necessary to resort to attention and perception tests to diagnose and determine the level of attention deficit problem, which is common in children and young people.

BENDER GESTALT VISUAL MOTOR PERCEPTION TEST

This test, developed by L. A. Bender, is applied to children between the ages of 5-11. The purpose of this test is to measure the level of visual perception, in a sense visual intelligence. As a result of the test, it is determined whether there is any delay in the child's visual motor perceptions, whether these perceptions fully function, or whether there is organic brain damage.

BENTON VISUAL MEMORY TEST

This test was developed by Benton in 1974 and is suitable for use in children aged 8 and over. It can be used in several different ways to measure spatial and visual memory.is applied. Benton Visual Memory Test; Drawing by looking at shapes is practiced by drawing the shape in mind after looking at it for a while, identifying the desired shape among the shapes and drawing it.

BURDON ATTENTION TEST

The purpose of the test is to diagnose this problem in children who are thought to have attention deficit disorder and to measure the level of attention deficit, if any. It can be applied to children and young people between the ages of 10-20. During the test, secondary school students are given 3 minutes, and high school children are given 2 minutes, due to differences in personal development levels. When the applications are checked, if the child's performance is good at the beginning of the test but his performance decreases towards the end of the test, attention deficit is diagnosed. At the end of the test, the aim is to detect attention deficit and treat it.

FROSTIG DEVELOPMENTAL VISUAL PERCEPTION TEST

Dr. It is a test developed by M. Frostig and aims to detect visual perception. Determining that children with learning difficulties also have problems in visual perception, Frostig aims to solve the learning difficulty based on visual perception. It can be applied individually or as a group.

Intelligence Tests
In children who are thought by their environment to have different skills than their peers, various tests are applied to measure the level of intelligence if the specialist deems it necessary.

CATELL 2A-3A INTELLIGENCE TEST

This test, developed by R. B. Cattel, consists of 3 forms: 2A, 2B and 3A. It was developed to measure intelligence to be applied in all societies. It can be applied to all individuals over the age of 4. The person whose intelligence level is to be measured according to his age group is given an appropriate form and asked to complete the test within a certain period of time. Evaluations are made based on the results.

PORTEUS LABYRINTHS TEST

This test, which can be applied to children between the ages of 7-14, is an individual intelligence test with no time limit. It was developed by S. D. Porteus and is used to measure intelligence level like other intelligence tests. As the name suggests, it is a labyrinth escape test. Its difference from other tests is that it is used to determine the general ability of the individual and to measure the level of planning ability.

WISC-R INTELLIGENCE TEST

It is an intelligence test that can be applied to children between the ages of 6-16 and helps measure the mental performance of the individual. This test, which was initially applied to adults, was developed over time and began to be used on children. The purpose of the test is to determine the child's developmental level by measuring his/her mental development among his/her peers.

STANFORD BİNET INTELLIGENCE TEST

The test used in schools in France to detect children with mental retardation has been developed over time and has survived to the present day. In this test, which consists of 30 questions, the child is asked questions from easy to difficult and scored according to the number of correct answers. The intelligence level is determined according to the score received. It is suitable for use in children between the ages of 4-12.

You can also go to a health institution with your child and meet with a child development specialist and get information about the adequacy of your child's development. If a problem with your child's development is detected as a result of the tests, you can solve this problem early with the help of experts and ensure that your child can step into a healthy and successful adult life in the future.

Child development is an area that requires sufficient care and sensitivity in order for children to step into adulthood in a healthy way. For this reason, it is very important that the development of children is followed by experts. In addition to healthy children, the developmental process must be kept under control in children with special needs who develop differently from normal due to some diseases. In this process, it is very important to get support from child development experts in order to identify problems that cannot be noticed by families and to complete development in the healthiest way.

Medical Park Editorial Board contributed to the development of this content. Page content is for informational purposes only. The page content does not include items containing information regarding therapeutic health services. Be sure to consult your doctor for diagnosis and treatment.
What Does Child Development Specialist Mean?
Child development specialist is the professional title given to the person who closely follows all development areas of children between the ages of 0-12 and directs them by taking into account educational services.
What Does a Child Development Specialist Do? What are their Duties and Responsibilities?
Child development specialists provide consultancy services to families regarding children's development and educational lives. It serves not only individuals but also some institutions and organizations. Some of the duties of child development specialists are as follows:
To follow the psychology of sick children and provide information to families,
Providing psychological support to children before surgery,
computer dependentDealing with problems such as Internet access and excessive internet use,
Providing guidance for children who have problems such as nail biting, thumb sucking, lip sucking and lip biting,
To monitor and guide babies and children with speech problems,
To provide psychological support and guidance services to the family in cases where social class differences affect child psychology.
What training is required to become a child development specialist?
People who graduate from the Child Development Department of vocational high schools and universities can become child development specialists. It is possible to enter universities through exams from the relevant departments of vocational high schools. Apart from this, you can also take part in distance education programs or applied courses that provide training certificates and take an initiative in the profession.
Qualities a Child Development Specialist Should Have
Child development specialists generally work in hospitals and schools. Companies have certain expectations from child development experts. The expectations of companies are as follows:
Likes to communicate with children,
To organize fun events by collaborating,
Being proficient in Microsoft Office programs,
Always be open to development and learning,
Having the ability to evaluate and reach correct conclusions,
Being fun and smiling.

What is paediatric speech and language therapy
Paediatric speech and language therapy involves working with children aged 0 – 18 years, who have a range of conditions and problems to support and develop their speech, language and communication skills. Some conditions that the children we work with include specific language impairment (SLI), autism spectrum disorder. (ASD), cerebral palsy and learning disability. We work to improve skills such as understanding spoken language, developing vocabulary use, producing speech sounds and developing a safe swallow.

Our aim is to enable your child to be able to communicate effectively with others to the best of their ability. We work together with you and your child to develop individual goals that are meaningful to you and your child.

By providing therapy that is significant, fun and motivating, children are more likely to willingly engage in activities and make lasting improvements.

As children develop and grow, they may experience some developmental difficulties that may be the result of an existing diagnosed condition, environmental or biological factors. Children may not be achieving their developmental milestones at the same time as their peers, or they may be struggling to follow directions from adults, this can make parents very concerned. Our speech and language therapists can relieve parents' concerns by assessing your child's skills and developing an individualized therapy program.

Our paediatric speech and language therapy service offers you
Private children's speech and language therapy.
A choice of clinic, home and school visits for observations, assessment and therapy.
Highly skilled and friendly experienced therapists.
U.K. wide cover.
No waiting lists.
High quality service based on the latest clinical evidence and approaches.
A happier, more confident and social child.
What is Speech and Language Therapy?
Language and speech therapist; He is a healthcare professional who deals with the prevention, evaluation and rehabilitation of language, speech, voice, swallowing and feeding disorders. Language, speech, voice, swallowing and nutritional disorders can affect individuals from childhood to old age. Although the field of language and speech disorders is a branch of science with its own professional autonomy, in certain cases it requires multidisciplinary work with different fields.
In Which Fields Does a Speech and Language Therapist Work?

Swallowing Disorders

In swallowing disorders, medically known as dysphagia, food cannot be swallowed easily while passing into the stomach after chewing, and this creates a problem for the person's health. These problems may occur in the form of a delay in the passage of the food into the stomach, its obstruction, or its escape into the windpipe by following a wrong path. Due to dysphagia; Problems such as weight and fluid loss, malnutrition, and pneumonia due to aspiration (food getting into the trachea) may occur. Speech and language therapists who are involved in the management of patients with swallowing disorders (Dysphagia); Provides services including assessment, diagnosis and rehabilitation. Swallowing disorders can occur in patients of all age groups due to neurogenic, mechanical, myogenic (muscle diseases) and psychological reasons. While dysphagia can affect any age group, it is mostly seen in the elderly. In order to plan the treatment of swallowing disorders, a detailed evaluation must first be made. Evaluation is made in the form of instrumental and/or non-instrumental swallowing evaluation. Screening tests used in non-instrumental evaluation aim to determine whether patients are at risk for dysphagia and whether instrumental evaluation is needed. In instrumental evaluation, Fiberoptic Endoscopic Swallowing Evaluation and Modified Barium Swallowing Study (Videofluoroscopy) are the most frequently preferred methods in swallowing evaluation.
Nutritional Disorders

The basis of growth and development is nutrition. Whether an infant or child is fed orally or through a feeding tube, he or she needs proper and adequate food intake. Nutrition directly affects the child's brain activity, abilities, fine and gross motor skill development, and general health. Learning to eat skillfully and comfortably is based on the sensory experiences of eating and the development of motor skills that enable an infant or child to suck, swallow, bite, and chew. Feeding skills and abilities include social, communication, and interactive skills that integrate with mealtime skills. Pediatric feeding disorders are conditions in which a child avoids eating or limits what, how much, and how to eat. Nutritional disorders lead to conditions such as weight loss, malnutrition, need for nutritional supplements, or problems with daily functioning. These disorders often limit the child's ability to participate in normal social activities, such as eating with others, and negatively impact health and social interactions with the family. Children with feeding disorders often chewThey show me disorders. Chewing disorders affect children's growth and overall health. For this reason, children who do not get enough nutrition may experience various health problems. Chewing disorders seen in children can also negatively affect parents. Extended feeding time and difficulties in making food suitable for the child can cause a negative interaction between the child and the caregiver.
Voice Disorders

The larynx contains vocal cords, which are two muscles that vibrate to produce sound. Sound occurs when air coming from the lungs creates vibration in the vocal cords. Many things can damage the vocal cords. Talking too much, shouting, making too many phone calls during the day, constantly clearing the throat or smoking can cause hoarseness. In addition, these activities can cause problems such as nodules, polyps and cysts in the vocal cords. Other causes of voice disorders include infections, laryngoesophageal reflux, vocal cord bleeding, Reinke's edema, muscle tension dysphonia, puberphonia (mutational falsetto), cancer and diseases that paralyze the vocal cords. If there are features in voice production that are not appropriate for the age and gender of the individual and/or If the voice quality deteriorates and there are changes in the characteristics of the voice such as pitch, intensity, resonance and duration that limit the individual's communication, this person may have a voice disorder. If your voice has been hoarse for more than three weeks, you should definitely consult an ear, nose and throat physician, especially if you have not had a cold or flu. Although voice disorders are generally seen in adults, they can also occur in children. In the evaluation and treatment of voice disorders, ear, nose and throat physicians and language and speech therapists work in cooperation. The medical diagnosis of the underlying problem of voice disorders is made by an ear, nose and throat physician. Language and speech therapists are responsible for applying voice therapy to people who have problems with their voice. Voice therapy is given by language and speech therapists, and the duration and frequency of therapies may vary depending on the voice disorder and voice characteristics of the patient. Voice therapy can be applied to all patients with voice disorders, but the underlying cause of the voice disorder must be known in order to plan the treatment correctly. In some cases, only surgical interventions are required for the treatment of voice disorders, sometimes only voice therapy may be required, and in some cases, pre-surgical and/or post-surgical voice therapy may be required.
Delayed Language and Speech

The child's inability to demonstrate age-appropriate language and speech skills is called delayed language and speech. The developmental process of each child is different, but certain periods are seen as critical periods for language and speech development. The child's inability to demonstrate the necessary skills during these critical periods may indicate that he needs support. Depending on their developmental period, a 24-36 month old child is expected to use an average of 50-100 words and have 50-80% intelligibility; It is expected that a child around the age of 4 will be able to form long sentences, be able to describe his experiences, and show nearly 100% intelligibility. If you think that your child has a delay in language and speech development, you should definitely get a detailed evaluation from a language and speech therapist. After a detailed evaluation, the language and speech therapist can give you ideas on how you can support your child's language development and additionally determine whether your child needs language and speech therapy.
Speech Sound Disorders

Speech sound disorders can be seen in individuals of all ages, but are often seen in children. It is normal for young children who are just learning language skills to have difficulty saying sounds correctly. This is part of the learning process; Speaking skills improve over time. They master certain sounds at every age. By around the age of 5-6, most children have learned to master all word sounds. However, some children have speech sound disorders. This means having difficulty saying certain sounds and words beyond the expected age. This can make it difficult to understand what the child is trying to say. Speech sound problems include articulation disorder and phonological disorder. Articulation disorder is the problem of producing certain sounds, the child has not yet acquired this sound. Phonological disorder is a pattern of sound errors. Even if the child completes the acquisition of most sounds, he may have difficulty producing the sounds in the right place in the word. In both cases, it can reduce the child's speech intelligibility and cause difficulties in social, emotional and academic development. Most of the time, there is no known cause for a speech sound disorder. However, some speech sound errors can be caused by:
Neurological Problems
developmental delay
Problems with hearing or hearing loss, such as past ear infections
Cleft palate or cleft dphysical problems that affect speech, such as lameness
Disorders that affect the nerves involved in speech
Developmental disorders such as autism
genetic disorders such as Down syndrome
Nervous system disorders such as cerebral palsy
It is important to diagnose speech sound disorders in children. To do this, your child must first undergo a detailed hearing screening. If your child does not have a hearing problem or if an intervention has been made to address the problem, you can consult a speech and language therapist. The speech and language therapist can evaluate your child's speech and language skills in detail, determine whether he or she has a speech sound disorder, and create the necessary therapy plan.
Fluency Disorders

The term fluency disorders includes problems defined as stuttering and slurred speech. The most common fluency disorder is stuttering. Stuttering is a speech disorder characterized by repetition of sounds, syllables or words, prolongation of sounds and pauses (blocks) during speech. The person who stutters knows exactly what he wants to say, but has difficulty producing and maintaining a normal flow of speech. These speech interruptions may be accompanied by secondary behaviors such as rapid blinking or trembling of the lips.
Resonance Disorders

Resonance disorder is considered if the sounds produced during speech are distorted due to blockage or closure in the nose or mouth area. Resonance disorders are often observed in the course of certain health problems such as cleft palate, enlarged tonsils or neurological diseases.
Acquired Language Disorders

Aphasia: When the parts of the brain responsible for language are damaged, acquired language skills are lost and a language disorder called aphasia occurs. Aphasia can occur suddenly, usually following a stroke or head trauma, or it can develop gradually as a result of a brain tumor or a progressive neurological disease. Aphasia may also occur along with speech disorders such as dysarthria or apraxia of speech resulting from brain damage. Receptive language, expressive language, reading and writing disorders can be mild or severe. Speech and language therapists work with individuals with aphasia and aim to restore lost skills. In the first stage of treatment, the therapist conducts a detailed assessment to identify weakened skills related to language, speaking, reading and writing, and then begins appropriate treatment.
Motor Speech Disorders

Motor speech disorders include two basic conditions: dysarthria and apraxia of speech. In these cases, the connection between the brain and the speech mechanism is disrupted or interrupted due to damage to the central nervous system and/or peripheral nervous system or both systems. This condition makes it difficult to control and/or coordinate the muscles of the face, tongue, or larynx for speaking purposes. Dysarthria and/or apraxia of speech can occur in children and adults. They are associated with conditions such as cerebral palsy, multiple sclerosis, muscular dystrophy, myasthenia gravis, Parkinson's disease, dementia, stroke, or traumatic brain injury. Dysarthria symptoms vary depending on the type of dysarthria and the location of the brain lesion. Symptoms may include slurred speech, change in speech rate (too fast or too slow), soft or whispered speech, change in speech sound quality (strained voice), or difficulty moving the tongue and facial muscles. Symptoms of apraxia may be more consistent from person to person. These include inconsistent speech sound errors, difficulty producing multisyllabic words, difficulty repeating words accurately, struggling to produce a sound/word, and problems coordinating the muscles of the face, tongue, and larynx. A number of treatments are available to treat motor speech disorders. Treatment options are available. Dysarthria treatment aims to strengthen the muscles involved in speech production, change the rate of speech, increase respiratory and vocal support of speech, and increase the acuity of speech production. Apraxia treatments include techniques to improve coordination and vocal alignment.

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Our services

We update our therapy services regularly and have good relationships with many other businesses in the local area. If we cannot provide the service you need, we can give you advice or refer you to a local organization that can provide you with the service you need.

Family counselling
Individual Therapy
Couples Therapy
Child and Adolescent Therapy
Language and Speech Therapy
nutritionist
Occupational therapy
Career Mentoring
Room Rental
Online Therapy
Psychiatry
Report Services

Mindfulness Based Therapies
Cognitive Behavioral Therapy
Person Centered Therapy
Sexual Therapy
Solution Focused Therapy
Emotion Focused Therapy
EMDR Therapy
Gottman Couples Therapy
Integrative Therapy
Play Therapy
Psychodynamic Therapy
Somatic Experiencing
Existential Therapy
Trauma Focused Therapy

In Which Areas Do We Work?

0-6 Years Development Tracking
Discrimination
Family Conflict
Peer Relationships
Alcohol Use
Dependence
Coping Skills
Self respect
Bipolar disorder
Borderline, Borderline Personality Disorder
Divorce
Couple Relationship and Problems
Sexual Abuse
Sexuality Problems
Problems in Children and Adolescents
Behavior Problems
Depression
Attention Deficit Hyperactivity Disorder (ADHD)
Dissociative Disorders
Down Syndrome
Impulse Control Disorders
Thinking Disorders
Mood Disorders
Parenthood
Men's Problems
Satisfaction from Marriage
Developmental Disorders
Immigration Problems
Pregnancy, Prenatal, Postnatal Problems
Hypochondriasis (Hypochondriasis)
HIV/AIDS
hypnotherapy
Communication Problems
Relationship Problems
Internet And Game Addiction
Suicide Attempt or Thought

Women's Problems
Cancer Psychology (Psycho-oncology)
Sibling Jealousy
Career Mentoring
Anxiety Disorders
Loss and Grief Counseling
Self-Harm
Identity Issues
Personality Disorders
Fears and Phobias
Gambling Addiction
LGBTQIA+ Counseling (Individuals, Couples and Families)
Substance Abuse
mindfulness
Narcissistic Personality Disorder
Obsessive-Compulsive Disorder (OCD)
School Problems
Autism
Anger management
Specific Learning Disability (dyslexia-dyscalculia)
Self-Confidence Issues
Panic Disorders
Passive Aggressive Behaviors
Psychosis
Stress
Harassment and Abuse
technology addiction
Tourette(Tic) Syndrome
Public Speaking and Presentation Anxiety
Post Traumatic Stress Disorder
trichotillomania
Sleep Problems
Existential Crises
Body Dysmorphic Disorder
Loneliness
Life Transitions
Eating disorders
Tyranny

We offer services on many other topics.

Why Clients Use Psychologist London Therapy Platform Prefer?

Turkish-speaking mental health experts in the UK
We are one platform.

To understand your complaint and direct you to the right psychologist before starting the psychotherapy session free consultancy We offer the service.

Our clinicians have adopted various schools of thought in their fields and have been working for years.

In our clinic, we offer online or face-to-face therapy in Turkish, English, Kurdish, Azeri and Persian.

Including Bupa UK Foundation, AXA PPP Healthcare, WPA, Nuffield Health, Aviva, Vitality awith six different insurance companieswith We must agree.

Our Blog Posts

Apr 3

Support Communication Development in Autism with Language and Speech Therapy

The communication difficulties of individuals on the autism spectrum and the specialized support provided by HCPC registered therapists are

Apr 3

EMDR Therapy: Re-Journey to Your Mental Health

EMDR is an effective short-term therapy that helps process traumatic memories.

Apr 3

Healing in a Timeline: A Deep Healing Journey with Hypnosis and Regression Therapy

Deep inner exploration and emotional healing are possible with hypnosis and regression therapy to live freely and get rid of the traces of t

Apr 3

Sexual Difficulties in Men

Sexual difficulties in men are normal, couples may decrease intimacy, and consult a therapist and doctor for a solution.

Apr 3

A Good Marriage

For a good marriage, it is important for couples to value their independence, create common values and provide mutual emotional support.

Apr 3

Sexual Difficulties in Women

Sexual difficulties in women arise from a variety of biological and psychological factors, and therapy or medical support may be sought for

Apr 3

Rules of Constructive Discussion

Constructive discussion rules: Confrontation, timing, taking seriously, not criticizing, listening, compromising, apologizing.

Apr 3

Low self esteem

Lack of self-confidence can develop as a result of negative experiences and pressures; It is important to think positively and set realistic

Apr 3

Death and Loss

Death and loss are a difficult fact of life, the grieving process varies, support groups, therapy and personal methods can help.

Institutions and Organizations of which our Clinic or Clinicians are Members

The only platform in the UK where Turkish-speaking mental health professionals come together !

You can fill out the form below to start the therapy process without a waiting period. They will call you as soon as possible for a free initial consultation.

- Yasemin İnan

Shared publicly on Google Comments.

Our services

In Which Areas Do We Work?

We offer services on many other topics.

Why Clients Use Psychologist London Therapy Platform Prefer?

Turkish-speaking mental health experts in the UK

We are one platform.

​

To understand your complaint and direct you to the right psychologist before starting the psychotherapy session free consultancy We offer the service.

​

Our clinicians have adopted various schools of thought in their fields and have been working for years.

​

In our clinic, we offer online or face-to-face therapy in Turkish, English, Kurdish, Azeri and Persian.

​

Our Blog Posts

You can fill out the form below to start the therapy process without a waiting period.

They will call you as soon as possible for a free initial consultation.