Download - Understanding Anxiety Slides
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Understanding anxiety and managing it
without drugs
with Joe Griffin
BSc (Hons) Psych., M.PHIL. (Psych), AFBPsS, FHGI
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STRESS
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Stress is on the increase
40 million working days are lost every year due to stress overload
Cost of stress to employers is estimated at between £7–9 billion annually
Every day some 270,000 people are taking time off due to a stress related illness
Up to 60% of employees suffer from excessive stress at some point
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There has been up to a 90% increase in mental and psychological claims to health insurance over the past 5 years
Doctors and teachers are prominent among claimants
10% of the population have suffered in the past year from Panic/Anxiety Disorder (6 million people)
Stress is on the increase
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Symptoms of stress include:
Insomnia Drug abuse Migraines Skin complaints Burn out Increased risk of certain cancers Increased risk of hypertension Anxiety disorders Depression
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Human Givens
Human givens are what we are born with. In other words, they are nature’s endowment to each one of us.
These givens come in two kinds: The physical and emotional needs evolution has programmed into us, which seek their fulfilment through our interaction with the environment.
The resources (or tools) nature provided us with to help us get those needs met.
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These templates for instinctive behaviours are genetically programmed into us during REM sleep in the womb
They seek completion in the environment by means of metaphorical pattern matching – the ‘inner’ connecting to the ‘outer’
This is nature’s solution to the need for mammals to be flexible and adaptable
Our instinctive endowment is protected by another human given – dreaming
Human Givens
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Emotional needs include:
The need for meaning (which stretches us) A sense of our own achievements and competence The need for intimacy (emotional connection to
others) Being part of a wider community The need for attention (to give as well as receive it) Privacy – time to reflect upon and consolidate
experiences Status – respect (connected to community) Having a sense of autonomy and control Security – safe territory, the space to grow N
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Resources we have evolved include:
The ability to develop long-term memory patterns
Imagination, which can allow us to focus our attention away from our emotions in order to problem solve more objectively
The ability to understand the world and other people through metaphor – pattern matching
An observing self – that part of us that can step back, be more objective and recognise itself as a unique centre of awareness
The ability to empathise and connect with others
Emotions and instincts
A rational mind that can check out emotions
A dreaming brain N
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Cortex and neo-cortex (Human)
Limbic system (Mammalian)
Brainstem and cerebellum (Reptilian)
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What dreaming does for us
Dreams are metaphorical translations of unfulfilled expectations (positive or negative)
Expectations that cause emotional arousal which is not dispersed by being acted upon or resolved another way, become dreams
Dreams deactivate the emotional arousal – which frees the brain to respond afresh to each new day
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Dreaming is Nature’s way of de-stressing us.
Fundamental principle
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A healthy sleep pattern does much to reduce stress and allow
the mind to relax and look at problems from other
points of view.
Fundamental principle
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However, if the dreaming mechanism is put under too
much stress, our mental stability is affected.
Fundamental principle
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Psychotherapy vs. Medication for anxiety disorders
Results of a nationwide study of Alprazolam, compared with exposure therapy and placebo for panic disorders with Agrophobia which also included a 6 month drug-free follow-up, showed that patients receiving Alprazolam began improving by week 2, but showed no further improvement and worsening symptoms by week 4.
After 8 weeks follow up therapeutic gains were lost.
1/2
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Exposure therapy was twice as effective as the drug therapy and improvements were maintained.
Marks, I. M. et al British Journal of Psychiatry (1983) 162, 776–787
Psychotherapy vs. Medication for anxiety disorders 2/2
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Behaviour therapy versus antidepressants for panic disorder with agoraphobia
A recent meta-analysis suggests that there is no specific advantage in adding drug therapy to effective behaviour therapy
Adding behaviour therapy to antidepressant drugs increases success rate from 60% to 90%
Tranquillisers may diminish the effectiveness of behaviour therapy
Danton, Antonuccio, The Therapist, Autumn 1997
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Perception of danger in anxiety disorders
Life threatening –– PTSD
Stressful life change –– Adjustment disorder
Feared situation/object –– Phobias
The world/chronic apprehension –– GAD
Intense autonomic symptoms –– PD
Intrusive thoughts/imagined harm –– OCD
EXTERNAL TRIGGERS
INTERNAL TRIGGERS
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Psychic symptoms Worry Apprehension Anticipation Forgetful Fear Irritability Loss of sense
of humour
Physiological symptoms
Cognitive symptoms Hyper-vigilance Fuzzy perception Poor concentration/judgement Cynicism
Behavioural symptoms
Heart pounds Tension Cold or sweaty palms Indigestion Nausea Diarrhoea Can’t relax Hold breath Skin rashes Poor sleep & fatigue
Avoidance Inhibition
Nervousness Disorganised
ANXIETY PANIC
Features of anxiety N
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Criteria for panic attack
A discrete period of intense fear or discomfort in which four (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes: palpitations, pounding heart or accelerated heart rate sweating trembling or shaking
1/3
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sensations of shortness of breath or smothering, feeling of choking
chest pain or discomfort
nausea or abdominal distress
feeling dizzy, unsteady, light-headed or faint
Criteria for panic attack 2/3
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derealisation (feelings of unreality) or depersonalisation (being detached from oneself)
fear of losing control or ‘going crazy’
fear of dying
paraesthesia (numbness or tingling sensations)
Criteria for panic attack 3/3
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Dying from a heart attack Dying from suffocation Having a stroke Going to faint Having a nervous breakdown – going crazy Losing control Feeling weak Believing you are going to be embarrassed
or humiliated
Beliefs that fuel panic attacks
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Light headedness Giddiness Dizziness Shortness of breath Heart palpitations Numbness Chest pain
Dry mouth Clammy hands Swallowing difficulty Tremors Sweating Weakness Fatigue
Symptoms of hyperventilation
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The client should over-breathe for 1.5 minutes
Pay attention to any sensations
If too uncomfortable client can stop but try to get them to complete the test
After the test the client should place the brown paper bag over their nose and mouth allowing as little air to escape as possible until symptoms remit
List all the sensations they had during the test to see if they need breathing retraining
Test for hyperventilation
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Hold your breath to prevent the dissipation of carbon dioxide. A period of 10–15 seconds, repeated a few times, is sufficient
Breathe in and out of a brown paper bag to quickly restore the normal blood PH level
Vigorous exercise while breathing in and out through your nose
Deep diaphramatic breathing – slow deep breathing to the bottom of the lungs
4 ways to stop hyperventilation
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Agoraphobia
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Accept the anxiety
Watch and scale your anxiety
Act with the anxiety
Repeat the above three steps
Expect the best
The AWARE technique
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Fear of public speaking
Fear of eating in public
Fear of urinating in public
Fear of blushing
Social phobia
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Life Style Changes Questionnaire
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The person recognises that the fear is excessive or unreasonable
The phobic situation(s) is avoided or else is endured with intense anxiety or distress
The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person’s normal routine, occupational functioning, or social activities or relationships, or there is marked distress about having the phobia
In individuals under the age of 18 years, the duration is at least 6 months
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Post Traumatic Stress Disorder
Disturbing flashbacks or memories Disturbing dreams about traumas Avoids stimuli such as people associated with
the trauma
» TWO OF THE FOLLOWING: hyperventilation, anger, insomnia,
exaggerated startle response
» Symptoms must be present for more than one month
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The rewind technique: The one session cure for trauma and phobias
also known as The Fast Phobia cure
or the V/K Dissociation Technique V = Visual K = Kinaesthetic (feelings)
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Dissociation separates the ‘observing self’ from the ‘feelings’. Watching yourself doing something is a 1st position dissociation
A 2nd position dissociation occurs when you watch yourself watching yourself doing something on TV. This increases the separation between the ‘observing self’ and the feelings and makes feelings appear much less intense
The one session rewind cure for trauma and phobias
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Removing the trauma or phobia
Deeply relax the patient using guided imagery of a safe, peaceful place special to them
Ask the client to imagine a TV/VCR with a remote control in the special place
Get the client to imagine they are watching the TV screen. Now have them float out of their body, to one side and watch themselves watching the film of the traumatic event
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Repeat until they can do this calmly
Have client float into the film at the end of it, when the client knows they are safe, and run it backwards as a fast rewind
When they have done that ask them to watch the film pressing the fast forward button
Repeat steps 5 & 6 several times until the scenes evoke no emotion
Removing the trauma or phobia
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Obsessive Compulsive Disorder (OCD)
Anxiety about dying
Anxiety about childbirth
Sexual anxiety
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The five most effective techniques for reducing anxiety
The 7/11 breathing technique
New metaphors – eg. Smoke alarm
The AWARE technique
Guided imagery
The fast trauma cure
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Thank you for your time and effort.
We look forward to seeing you again soon.