March 27, 2009

Publication: Easy Health

Date: Wednesday, April 1, 2009 Page: 46

Author: Ann Bracken

Headline: Anxiety: When worry is more than just a worry

Counselling Psychotherapist Ann Bracken, outlines how to recognise when worry has turned into anxiety- how to manage the symptoms and support yourself through the fear barrier We all experience varying degrees of worry at different times in response to challenging situations and relationships.  These worries may be related to financial insecurity, relationship difficulties, challenges at work or following a traumatic event and it is normal to reflect on ways to overcome these challenges. However, when this worry persists and causes ongoing unhealthy emotional, physical and behavioural responses, this worry may have progressed into anxiety.

There are various types of anxiety disorders and a doctor or mental health professional usualfy diagnoses the presenting anxiety type after assessing the symptoms. Anxiety causes the individual significant distress and impacts negatively on social, occupational and other important areas in an individual's life. The most common anxiety disorders include the following:

Generalised Anxiety Disorder (GAD)

Symptoms include an excessive amount of anxiety and worry for the majority of an individual's time. It usually includes anxious predictions for the future, an over-reflection on the past, and a belief that negative outcomes are probable for themselves and others. This worry is difficult to control and the person is usually restless and may be irritable On a physical level, there is muscle tension; sometimes tension headaches, restlessness and dizziness may accompany GAD. Sleep disturbance is also common, as is a difficulty concentrating (mind goes blank). Panic attacks When levels of worry become increased or there are recurrent stressful life events,

an individual may develop Panic attacks.

Panic attacks usually include negative automatic thoughts about particular situations and are accompanied by physiological symptoms that can be very frightening to experience

Symptoms of panic attacks include: palpitations, pounding heart or pain in the chest, trembling or shaking, shortness of breath and a feeling of choking. Many people who experience panic attacks believe that they are having a heart attack,

Obsessive Compulsive Disorder (OCD)

This form of anxiety includes obsessions or compulsions that have a strong behavioural response to worries. This can include checking rituals where a consistent worry is present relating to safety, eg. checking all doors are closed or locked, checking cookers are switched off or constantly checking that the plugs are switched off. It may also include an intense fear of contamination – checking and re-checking food or drink before ingesting due to a fear that it has been contaminated by others. OCD may also relate to performance – compulsively checking and re-checking work due to an excessive worry that a mistake has been made and an excessive negative belief relating to the outcome of such a mistake (known as 'awfulismg' 

Anxiety: When worry is more than just a worry 'catastrophising' in CBT terms). It is wise where there is concern about the heart and chest pains that further assessment is given by your doctor.

Phobias Phobias are very specific intense fears and excessive worry relating to everyday things or situations. Phobias may include agoraphobia – a fear of leaving a familiar place or being in a crowded place (can develop anytime though usually after a fearful event, where the person felt they had no control, is experienced),

claustrophobia – fear of confined spaces, needle or injection phobia, animal or insect phobias or anxiety related to being in high places.

PTSD – Post Traumatic Stress Disorder PTSD is a form of anxiety that usually develops after an individual has witnessed or been involved in a traumatic event eg. after a physical or sexual attack, environmental disaster or serious car accident. This traumatic event usually includes a major threat to the individual's safety or that of others. PTSD symptoms include intrusive images, distressing recollections of the event or intrusive negative thoughts relating to the event. This can then trigger a physiological experience of feeling that the event is happening again, particularly if the individual is reminded of the event – this can happen if in similar surroundings, by smell, or hearing a 'trigger' sound and causes intense distress for the individual experiencing a sense of reliving their trauma,

Health anxiety Health anxiety can arise when a person has overcome a serious operation and then has a 'fear of fear' that the same may happen again or where a person experiences a somatic response to their anxiety and then overly focuses their attention on the physical symptoms of the anxiety itself. As the anxiety increases, the somatic response to anxious thoughts also increases leading to a misinterpretation of these symptoms as a sign of illness. Anyone who has experienced a panic attack (which can accompany health anxiety) will know that the symptoms are very real and accompanying pains in the chest are very frightening. However, those who experience health anxiety will usually have excessive rituals relating to their health and this may involve constant visits to their doctor for reassurance and they also maintain unhealthy bodily checking rituals, thus maintaining their preoccupation with physical signs and symptoms.

Understanding anxiety Anxiety symptoms may develop from early life experience where the individual had feelings of being unsafe, which >n later life have manifested into a series of self-doubts, negative evaluations and negative predictions. The physical expression of these thoughts include a range of feelings including; unsteadiness, dizziness and tightness in the muscles or chest. 'Unsafe' feelings can arise from being in an unsupportive environment for prolonged periods of time eg. having experienced excessive criticism, being bullied or experiencing emotional, physical or sexual abuse, or being in an environment where one or both parents/carers were addicted to alcohol, drugs or prescribed drugs. Such negative early life experiences may lead to feelings that things are out of control, which can lead to anxiety either then, or later in life. In the individual's attempts to eliminate a sense of impending danger, survival behaviours that may have supported the child, grow into a desperate attempt to minimise all risk-taking. There is an attempt at striving towards a world of 100% certainty and an obsessive striving for perfection in all areas, In contrast, the 'safety behaviours' that accompany this belief do not invoke a sense of being safe but add to the 'evidence' that the feared catastrophe is more likely. In addition, by focusing on the 'negative' aspects of the person's environment, the individual gives excessive attention and meaning to 'prove' that there is a danger – eg. a person who is socially anxious will focus more on their internal self-negating dialogue whilst being hyper vigilant – relating the actions of others to evidence of their negative self-belief, eg others in conversation could be perceived as people 'who are ignoring them' thus ignoring all other evidence and variables. This leads to self-negating and negative conclusions without looking at all the evidence Recovery Recovery from all forms of anxiety involves exploring negative beliefs and assumptions about the individual or situation and corresponding Negative Automatic Thoughts (NATSI. Within the Cognitive Behavioural Therapy (CBT) therapeutic model, these NATs are then reality tested and a set of questions/questionnaires begin to prompt the individual to find more realistic and supportive thinking structures. A course of treatment als
o involves 'homework1 between therapy sessions to encourage the individual to be mindful of their NATs, particularly in relation to episodes of anxiety. The individual becomes aware of repeated unhelpful thinking patterns, the effect of negative thoughts on emotions, and the effect of finding more resourceful ways of thinking.

In addition to cognitive techniques and working with modifying negative automatic thoughts and anxious predictions, reducing, then dropping safety behaviours helps to disprove anxious thoughts and reduce levels of anxiety In some treatments ol Anxiety (such as HMDR therapy), specific negative self-beliefs are replaced with more positive, realistic self-beliefs that minimise or remove anxious associations – anxious feelings become less intense and no longer have the power to overwhelm the individual as the belief underpinning the anxiety is no longer true. The pharmacolog cal treatment recommended by the World Health Organisation (WHO) includes the use of anti-depressants for GAD and other anxiety disorders.

WHO states that "Venlafaxine is best documented for generalized anxiety disorder, while the antidepressants SSRIs have a much better documentation for panic, post-traumatic stress, social anxiety and obsessive-compulsive disorders." Other psychotherapeutic therapies, eg. Person Centred & Integrative approaches, will also explore the 'core beliefs', where these negative self-beliefs originate from, and support the individual in their letting go of unhelpful feelings through a self- actualization process which releases these root causes -the individual realises their 'core' or true self rather than believing the self-negating internal dialogue they have had previously, especially when they understand it from within the context of their early life experiences.

Most therapeutic models also integrate Relaxation Techniques to reduce the anxiety held in the body also, a relaxed body helps to promote a relaxed mind and vice versa. As with any emotional or psychological challenge it is a unique experience and though there are symptoms that may be common to mild, moderate or severe anxiety, an individual treatment approach where your specific needs are met is the most appropriate for long lasting recovery

Accessibility