All about Anxiety Therapy

on June 22 | in Blog | by Rachel Cooke | with 1 Comment

When healthy Stress turns into unhealthy Stress or Anxiety: all about Anxiety Therapy

Challenging situations we encounter day to day can make us feel stressed or anxious. Anything from an exam to getting ill, from a blind date to confronting our boss can be a source of stress. It is normal to feel tense in situations which we know we cannot fully control. Stress occurs when we feel threatened; it’s the body’s natural response to danger. This sort of stress is called acute stress.

Acute stress is adaptive, meaning that it helps us to make beneficial decisions. The biochemical signpost of acute stress is the release of adrenaline from the adrenal glands. When everyday stresses begin to accumulate and snowball, they can lead to what’s called chronic stress. High levels of adrenaline over an extended period, coupled with the release of the stress hormone cortisol, can cause or exacerbate severe health problems such as heart disease, high blood pressure, obesity and a compromised immune system. Chronic stress can also increase the risk of developing depression.

There is nothing wrong in feeling anxious from time to time, but with some people the level of stress becomes so overwhelming that it shadows every aspect of the daily life. Once stress takes over and starts interfering with relationships, work and general life then it’s likely that it has turned into an anxiety disorder. The brain experiences stress and anxiety in slightly different ways, although they do share some of the same properties. Stress is more akin to frustration while anxiety is closer to fear. There are now numerous separate anxiety disorders which include: generalised anxiety disorder, phobias, obsessive-compulsive disorder (OCD), panic disorder, panic disorder with agoraphobia, separation anxiety, post-traumatic stress disorder (PTSD) and childhood anxiety disorders.

The signs and symptoms for anxiety disorders are highly different from one person to another since the disorders are a group of related conditions, each having its own properties. There is one common primary symptom they all share: severe distress in situations in which the majority of people would feel comfortable. Besides this, people suffering from anxiety disorders usually present several of the following symptoms:

• Extremely irritated by the smallest things

• Anticipate and think about worse case scenarios; “what if such and such bad thing happens?”

• Even when performing ordinary tasks tend to feel tense and jumpy

• Feel constantly restless

• Always on the lookout for signs of “danger”

Besides the emotional symptoms mentioned above, people with anxiety disorders often experience significant physical symptoms. People with anxiety can go to a lot of trouble trying to find out what physical condition is causing their bad state of health, when, in fact, it is their mind which is causing the problem. Common physical symptoms of anxiety include: headaches and migraines, fatigue, insomnia, frequent urination, diarrhoea, shortness of breath, muscle tension and excessive sweating.

Types of anxiety disorders

Generalised anxiety disorder (GAD) involves chronic nervousness, worrying and tension. The GAD is diffuse; there is no particular object, person or situation which triggers the worrying process, but there is a comprehensive feeling of unease which dominates the person’s life. This anxiety can last long periods of time and makes it impossible to live and enjoy a normal life. People suffering from generalised anxiety disorder may constantly worry about common things in life like money, family matters, quarrels with the boss.

Michael K came to therapy when he realised his behaviour was destroying his relationship with his best friend. Michael had gotten to the stage where he was calling his friend repeatedly to make sure everything was okay. Some days he’d leave twenty messages, begging him to call back and confirm he was fine. No matter how many times the friend called and messaged Michael back he continued. When the friend finally emailed to say he’d had to change his phone number and did not want to hear from Michael again, he was forced to recognise that he had a problem and needed professional help.

Emotional and physical symptoms of Generalized Anxiety Disorder:

• Constant worries

• Feeling helpless when it comes to controlling the worrying

• Inability to deal with uncertainty; the urge to know what is going to happen in the future

• Inability to relax, sometimes even to sleep for several nights

• Feeling restless and jumpy

• Difficulty concentrating

• A constant feeling of being overwhelmed

• Body and muscle aches

• Stomach issues, nausea, diarrhea

Panic Attacks or Panic Disorder

A panic attack is a sudden overwhelming feeling of anxiety or panic. Your heartrate increases and you feel as though you cannot breathe, these symptoms can last a few seconds or many minutes. A lot of people experience panic attacks before or during important, stressful, unfamiliar situations. Emotional and physical symptoms of Panic Disorder include:

• Frequent panic attacks which may or may not be related to specific circumstances or situations
• Anticipatory anxiety – the fear of fear; being constantly afraid of having another panic attack
• Phobic avoidance – avoiding places, situations, persons which had to do with a previous panic attack

Obsessive-Compulsive Disorder (OCD)

A person suffering from obsessive-compulsive disorder  or OCD experiences repetitive, unwanted thoughts and strongly feels the need to perform repetitive, ritualised behaviours. The mind becomes stuck and the obsessive person repeats them over and over. The majority of people suffering from OCD fall into one of these categories:

• Washers – people who are afraid they will be contaminated and feel the need to clean and wash their hand and/or bodies constantly.

• Checkers associate certain things with danger or disasters, so they are checking on things such as doors to make sure they’re locked, stoves to be sure they’re turned off.

• Doubters are afraid they will be punished or something bad will happen because they didn’t do everything right.

• Counters and arrangers obsess over symmetry and order. They usually have a lot of superstitions related to numbers, colours or positions of certain things.

• Hoarders – people who collect articles or items because they are afraid something bad will happen if they throw them away.

Phobias

A phobia is an intense feeling of fear in relation to something which in reality does not present much of or any danger. The person with the phobia generally realises that it is illogical but still cannot control it. The most common phobias are related to closed-in places, heights, insects, snakes and needles. Phobias commonly develop during childhood as the objects are related to danger or a feeling of insecurity. Many phobias develop during adulthood as well, at any stage of life.

Ruth is afraid of flying. She read the statistics; she knows it is one of the safest means of transport in the world, but cannot overcome her fear. Her job requires her to fly quite regularly, so weeks before the trip she starts developing the sense of anxiety and getting tense, missing hours of sleep and becoming more irritable. On the day she is supposed to fly she throws up repeatedly. On board the plane she vomits in the toilet multiple times. Ruth had been suffering this for three years when she finally had the courage to tell her superior she would only be accepting assignments within driving distances.

Social anxiety disorder or social phobia

This involves fear of social circumstances, especially of those involving interaction with a large number of strangers. The person suffering from social phobia is constantly afraid he is being watched and judged by others. They become tense thinking people might think badly of them, and that they will not perform as well as expected. Some of the most common symptoms include:

• Excessive self-consciousness and tension in everyday social situations

• Extreme fear of being watched, judged, misunderstood or misinterpreted

• Fear of embarrassment or humiliation caused by not acting properly in given social situations

• Constant fear that people around will notice their fear and nervousness

Physically, the social phobia can manifest through blushing, redness of the neck and chest, shortness of breath, nausea, shaking or trembling, sweating or heart flushes, fainting or feeling dizzy. The behaviour of people who suffer from social anxiety disorder often changes. They always need to bring a friend to social events. It is common that they avoid events altogether and end up staying at home.

Post-traumatic stress disorder (PTSD)

PTSD can develop following a traumatic, unexpected or uncontrollable event in someone’s life. It is most commonly associated with soldiers, but the truth is any overwhelming life experience can be a trigger for PTSD. After a traumatic event, the body and mind go into shock, and it takes time to process everything that happened in order to learn how to cope. Every person reacts differently, and there is no definite line where one can say “it’s too much”. What happens with post-traumatic stress is that the mind becomes trapped and cannot find a way to get out of the psychological shock.

Among the most frequent triggers of post-traumatic shock are war, death of a loved person, natural disasters, major surgery, rape, kidnapping, childhood abuse and assault. PTSD can happen to the person directly involved, to the members of his family or even to witnesses such as police officers. While symptoms usually develop in the immediately following the traumatic event, it can sometimes take a long time, from weeks to years until they reveal themselves.

Whilst everyone experiences PTSD differently, there are 3 main types of symptoms:

1. Re-experiencing the traumatic event
2. Avoiding reminders of the trauma and feeling numb
3. Increased anxiety and emotions

Re-experiencing the traumatic event

• Distressing, intrusive memories of the event
• Feelings of intense discomfort when reminded of the trauma
• Flashbacks
• Nightmares
• Physical reactions to reminders of the event such as racing heartrate, rapid breathing, nausea, muscle tension or perspiration

Avoidance and numbing

• Avoiding places, activities, situations, thoughts, or feelings that remind you of the trauma
• Feeling detached from others and/or emotionally numb
• Inability to remember even major details of the trauma
• Loss of interest in activities and life in general
• Sense of a limited future (the person doesn’t expect to live a normal life span, get married, have a career)

Increased anxiety and emotions

• Irritability or outbursts of anger
• Difficulty falling or staying asleep
• Feeling jumpy and restless
• Difficulty concentrating
• Hypervigilance (on constant “red alert”)

Other common symptoms of PTSD

Anger and irritability Aggression and violence Physical aches and pains Guilt and/or shame Feelings of mistrust and betrayal

Depression and hopelessness Suicidal thoughts and feelings Feeling isolated Substance abuse

Treatment options for anxiety disorders

Anxiety disorders respond very well to treatment and typically don’t take a long time to be resolved. Evidently, it depends on the disorder, its causes and severity. In general, anxiety disorders are treated with behavioural therapy, medication, or a combination of the two. Nowadays the path of Mindfulness meditation is becoming more and more popular. It is important to know that many people suffering from anxiety disorders develop some level of depression. Since each condition exacerbates the other, it’s vital to find a treatment that addresses them both.

Basic Cognitive Therapy deals with understanding the conditions which provoke the anxiety and respond to it with actions based on reasonable expectations. The first step is to recognise the anxious thoughts. One way of doing this is by keeping a journal for reporting anxiety attacks and situations, environment, feelings and thoughts associated with them. Clients receive assignments to help them change their behavior. Someone who suffers from social phobia, for example, may be asked to buy something and return the object the next day while observing any disturbing thoughts and unrealistic fears they might experience. The ultimate goal is to make the patient acknowledge that the assumptions causing the anxious behavior are false and unnecessary and establish new behavioural patterns associated to those premises.

Systematic Desensitisation is a technique which breaks the link between the anxiety-provoking cause and the anxious response to it. This requires the client to confront the subject of his fear gradually. The treatment is used mostly for phobias and PTSD. The process has three main stages: relaxation of the patient, compiling a list of feared situations and objects by degree of the anxiety they provoke and ultimately the desensitisation procedure in which the patient is confronting the list, starting with the least feared object or situation.

Exposure and Response Treatment generates anxiety on purpose by exposing the client repeatedly to the feared object or situation, either literally or using imagination and visualization. This technique is different than Systematic Desensitisation as it does not involve a relaxation process, neither a gradually approach to the anxiety sources. This is not successful for everyone but some have found it very effective.

Mindfulness helps the client to come back to the present moment, rather than worrying about the future. Many of the P-Therapists use Mindfulness and MBCT (Mindfulness-Based Cognitive Therapy), teaching clients to practice focussed awareness, cultivating calm and better ways to understand and cope with anxiety. Contact P-Therapy to find out more!

« What is Bereavement Counselling or Grief Counselling and how could it help me to cope better? What does Depression really mean and is Depression Therapy something for me? »