Transcript Anxiety - Enduringmind

Enduringmind
Counselling in Twickenham
 What
is Anxiety?
 What
are different types of anxiety disorders?
 What
are the causes of anxiety?
 What
are the symptoms of anxiety?
 What
are the treatments?
 Professional
& Self-Help Resources.
 Anxiety
is a feeling of apprehension or
fear. It may be experienced intensely or
as an underlying complaint. The source of
this uneasiness is not always known or
recognized, which can add to the distress
you feel.
 According
to the DSM IV Anxiety Disorders
are a group of psychiatric conditions that
involve excessive and prolonger anxiety.
Fear is an intensely powerful emotion. It has a deep impact on the
mind and body because it is one of our natural survival responses –
causing a fight or flight response. It tells you what to do in an
emergency, like when you are being attacked. We can also feel fear
when faced with less dangerous situations, like exams, public
speaking, a new job, a date, or even a party. It is a natural response
to something that a person feels is a threat. Anxiety is a type of fear
associated with an externally perceived threat or something going
wrong in the future, rather than happening right now. When you feel
seriously anxious, your mind and body speed up.
• heart beating faster or irregular
• breathing faster
• muscles feel weak or tense
• hot and cold sweats
• stomach is churning or your bowels feel loose
• hard to concentrate on anything else
• feel dizzy
• feel frozen to the spot or need to flee
• dry mouth

1 in 6 adults experienced some form of ‘anxiety problem’ in the previous week (1)

More than 1 in 10 people likely to have a ‘disabling anxiety disorder’ in their life (2).

13% of the adult population will develop a specific form of anxiety known as a
phobia at some point in their life (3).

2.5% of people are likely to experience OCD at some point in their life (4 & 5)

A recent World Health Organization (WHO) study compared depression with angina,
asthma, diabetes and concluded that the impact of depression on a person’s
functioning was 50% more serious than the impact of any of the four physical
conditions (6).

At present 40% of disability worldwide is due to depression and anxiety (7).

Psychiatric Morbidity Survey indicates 6 million people in the UK (approximately 3
million with depression as their primary problem and 3 million with an anxiety
disorder) (8).

1.7% more of the population of England were experiencing an anxiety-related
mental health disorder in 2007, compared to 1993.(9)

Anxiety is highly treatable (up to 90% of cases), but only 1/3 receive treatment

People with an anxiety disorder are three-to-five times more likely to go to the
doctor and six times more likely to be hospitalized for psychiatric disorders.
Anxiety is associated with some of the above
feelings as well as long-term effects, such as:
 stress
or a more nagging sense of fear
 Irritability and mood swings
 trouble sleeping
 headaches
 trouble getting on with work or planning for
future
 problems having sex
 loss of confidence and self-esteem

There is no one cause for anxiety disorders. Several
factors can play a role

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Genetics
Brain biochemistry
Overactive "fight or flight" response
 Can be caused by too much stress
Life circumstances
Personality

People who have low self-esteem and poor coping skills may be more prone
Certain drugs, both recreational and medicinal, can lead
to symptoms of anxiety due to either side effects or
withdrawal from the drug.
 In very rare cases, a tumor of the adrenal gland
(pheochromocytoma) may be the cause of anxiety.

Generalized
Anxiety Disorder
Post-Traumatic Stress Disorder
Panic Disorder
Obsessive-Compulsive Disorder
Phobias

Exposure to traumas such as witnessing or surviving a serious
accident, natural disaster, war or criminal assault can result in
PTSD. When the aftermath of a traumatic experience
interferes with normal functioning, the person may be suffering
from PTSD.

Symptoms of PTSD:
Re-experiencing: the traumatic event (flashbacks), which can
take the form of intrusive thoughts and recollections, or recurrent
dreams;
II. Avoidance behaviours: in which the sufferer avoids certein
activities, situations, people and/or conversations which he/she
associates with the trauma;
III. General numbness: and loss of interest in surroundings;
IV. Hypersensitivity: inability to sleep, anxious thoughts and
feelings, overactive fight/flight response, hypervigilance,
irritability and outbursts of anger.
I.

Excessive overwhelming worry or concern about
everyday things. This constant worry negatively
affects daily functioning and can cause physical
symptoms – such as heart palpitations.

Generalised Anxiety Disorder - GAD can occur with
other anxiety disorders, depressive disorders, or
substance abuse.
 The
focus of GAD can shift, usually focusing
on issues like job, finances, health of both self
and family; but it can also include more
mundane issues such as: tasks, shopping,
leaving the house or being late for
appointments.
 The
intensity, duration and frequency of the
anxiety are disproportionate to the actual
threat.

The abrupt onset of an episode of intense fear or
discomfort, which peaks in approximately 10 minutes,
and includes at least four of the following symptoms:
• Feeling of imminent danger/dread • Nausea or abdominal discomfort
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Need to escape
Heart Palpitations
Sweating
Trembling Sensation
Shortness of breath
Feeling of choking/smothering
Chest pain or discomfort
• Dizziness or lightheadedness
• A sense of things being unreal,
depersonalization
• A fear of losing control or going crazy
• A fear of dying
• Tingling sensations
• Chills or hot flushes
Three types of Panic Attacks:

Unexpected - the attack ‘comes out of nowhere’
without warning and no discernible reason.

Situational - situations in which an individual always
has an attack, for example, upon entering a tunnel.

Situational - Predisposed - situations in which an
individual is likely to have a Panic Attack, but does
not always have one. An example of this would be
an individual who sometimes has attacks while
driving.
Characterized by uncontrollable urges, obsessions
and compulsions which the sufferer recognizes as
being excessive or unreasonable.
Obsessions with recurring thoughts or impulses that
are intrusive or inappropriate and cause anxiety:
I.
II.
III.
IV.
Thoughts about contamination when an individual fears
coming into contact with dirt, germs or "unclean" objects
Persistent doubts about whether or not one has turned
off the iron or stove, locked the door or turned on the
answering machine
Extreme need for orderliness
Aggressive impulses or thoughts being overcome with
the urge to yell ‘help' in a crowded shopping centre


Compulsions are repetitive behaviours or rituals performed by
the sufferer in the belief that performance of these rituals will
neutralize the anxiety caused but relief is only temporary.
I.
Excessive Cleaning - repeatedly washing their hands, showering,
or constantly cleaning their home
II.
Constant Checking - individuals check several or even hundreds
of times to make sure that stoves are turned off and doors are
locked
III.
Repetitive Behaviours - individuals repeat an action, name or
phrase over and over again
IV.
Slowness - individuals may take an extremely slow and
methodical approach to daily activities; organizing & arranging
objects
V.
Hoarding – individuals are unable to throw away useless items,
such as old newspapers, junk mail, even broken appliances
If OCD diagnosed the obsessions/compulsions must take up at
least one hour every day & interfere with normal daily routines

Social anxiety disorder is also known as social
phobia, which is an intense fear response to social
situations. This fear is aroused when individuals
believe that they may be judged, scrutinized,
humiliated or intruded upon by others.

Individuals with social phobia are acutely aware of
the physical and psychological signs of their
anxiety; fearing that others will notice, judge them,
and think badly of them.

In extreme cases this intense uneasiness can
progress into a full blown panic attack and an
intense need to flee.

The most common anxiety provoking social situations
are:
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public speaking
talking to people in authority
developing intimate or close relationships
answering a phone call
interviews
attending and participating in groups
speaking to strangers
meeting new people
visiting, eating or drinking in public
using public bathrooms
shopping

Generalized Anxiety Disorder
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
Obsessive Compulsive Disorder

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
Women are twice as likely to be afflicted than men.
Very likely to exist along with other disorders.
It is equally common among men and women.
One third of afflicted adults had their first symptoms in
childhood.
Panic Disorder


Women are twice as likely to be afflicted than men.
Occurs with major depression in very high rates.
2003 Anxiety Disorders Association of America
Auditory and Visual Stimuli:
sights and sounds are processed
first by the thalamus, which filters
the incoming cues and shunts
them either directly to the
amygdala or to the other parts of
the cortex.
Olfactory and tactile stimuli:
Smells and touch sensations
Bypass the thalamus altogether,
Taking a shortcut directly to the
Amygdala. Smells, therefore,
Often evoke stronger memories
Or feelings than do sights or
Sounds.
Thalamus:
The hub for sights and sounds,
The thalamus breaks down
Incoming visual ques by size,
Shape and color, and auditory
Cues, by volume and
Dissonance, and then signals
The appropriate part of the
Cortex.
Cortex:
It gives raw sights and sounds
meanings, enabling the brain
to become conscious of what it
Is seeing or hearing. One
region, the prefrontal cortex,
may be vital to turning off the
anxiety response once a threat
has passed.
Amygdala:
emotional core of the brain, the
amygdala has the primary role
of triggering the fear response.
information that passes through
the amygdala is tagged with
emotional significance.
Bed Nucleus of Stria Terminalis:
unlike the Amygdala, which sets
off an immediate burst of fear,
the BNST perpetuates the fear
response, causing the longer
term unease typical of
anxiety.
Locus Ceruleus:
It receives signals from the
amygdala & is responsible
for initiating many of the
classic anxiety responses:
rapid heartbeat, increased
blood pressure, sweating &
pupil dilation.
Hippocampus:
This is the memory center,
vital to storing the raw
information coming in from
the senses along with the
emotional baggage
attached to the data during
their trip through the
amygdala.
 Feelings
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
of depression
Withdrawing from family & friends
Low intensity of feelings or numbness
Lack of pleasure in life
Low energy levels
Lack of motivation
Feelings of despair & hopelessness
Mood swings
Deep sadness

Unable to convey to a person how you are feeling

Fear and avoidance of situations where previous
attacks occurred
 Citalopram
is shown to be effective but
usually takes 2-3 weeks to take effect
 Benzodiazepines:
include Xanax and
Valium which act rapidly and successfully
but can be addictive and lose
effectiveness over time
 Side
Effects:
heart
palpitations,
dizziness, headaches, nausea, impaired
memory & suicidal thinking

CBT teaches clients to become aware of the triggers
for anxiety and respond differently to situations and
bodily sensations that cause anxiety – creating a
greater window of tolerance

CBT helps the client to understand how conditioned
thinking patterns contribute to arouse the symptoms

Patients learn that by changing how they perceive
feelings of anxiety which decreases their intensity

Example: writing down triggers for anxiety/fears and
performing one of them once/week. After awhile
clients learn to cope with the negative feelings
aroused and associated with them; replacing them
with positive ones

Psychodynamic therapy is a therapeutic approach
which try to get the client to bring their unconscious
feelings and thoughts to the surface, so they can
experience and understand them – bringing insight.

Psychodynamic therapy employs the basic assumption
that everyone has deeply held feelings in the
subconscious (from childhood) which are too painful
to be faced. We then come up with defences (such as
denial) to protect ourselves knowing about these
painful feelings.

Psychodynamic therapy assumes that these defences
have caused us to become ‘stuck’ and are causing
more harm than good, making you seek help. It tries
to change the way we process them, with the
intention that once you gain insight of what is really
going on you will gain greater tolerance for them
and the feelings will not be as painful.

The benefits of exercise are:
physical
pleasure
and
symbolic meaning of the
activity, as a distraction from
everyday worries, mastery of
a sport effects on self image
&
biochemical
changes
associated with exercise.

Helps to dispel negative
emotions,
cortisol
and
adrenaline out of your body
in order to enter a more
relaxed state to deal with
issues and conflicts

Cultivate a calm environment and practice
breathing techniques to clam heart rate and
create a sense of control over life

Practice by sitting quietly in an upright position
and comfortable to you. Take a few slow, deep
breaths to calm your heart rate and relax the
tension in your muscles. Next choose a calming
phrase (with personal significance), silently repeat
the word or phrase for 10 -15 minutes
Foods to Eat: whole grains and nuts, bananas,
asparagus, garlic, brown rice, green and leafy
veggies, soy products, yogurt
 Foods to Avoid: coffee, alcohol, sugar, dairy
products, gluten, strong spices, highly acidic
foods, foods with white flour
 Keep a diary of the foods you eat and the
occurrence of your anxiety attacks; after awhile
you may be able to see a correlation and remove
certain foods from your diet
 East small and frequent meals, long before
bedtime

Self-care is the most important holistic treatment
you can provide: talking to others,
 Laugh: being able to laugh at yourself and with
others increases endorphin levels and decreases
stress hormones
 Let go of frustrations through reflection
 Do not judge yourself or expect more from
yourself than others
 Accept your faults and mistakes are part of life’s
journey and learning
