TYPES OF ANXIETY

1. TYPES OF ANXIETY Enduringmind Counselling in Twickenham

2. A summary of anxiety • 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.

3. Definitions of Anxiety • 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.

4. 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 How Anxiety Works

5. Some common Facts • 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.

6. Symptoms of anxiety 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

7. Common Causes • There is no one cause for anxiety disorders. Several factors can play a role • 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.

8. Types of Anxiety Disorders • Generalized Anxiety Disorder • Post-Traumatic Stress Disorder • Panic Disorder • Obsessive-Compulsive Disorder • Phobias

9. Post-Traumatic Stress Disorder • 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; • Avoidance behaviours: in which the sufferer avoids certein activities, situations, people and/or conversations which he/she associates with the trauma; • General numbness: and loss of interest in surroundings; • Hypersensitivity: inability to sleep, anxious thoughts and feelings, overactive fight/flight response, hypervigilance, irritability and outbursts of anger.

10. Generalized Anxiety Disorder • 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.

11. Generalized Anxiety Disorder • 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.

12. Panic Disorder • 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 • Need to escape • Heart Palpitations • Sweating • Trembling Sensation • Shortness of breath • Feeling of choking/smothering • Chest pain or discomfort • Nausea or abdominal 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

13. Panic Disorder 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.

14. Obsessive-Compulsive Disorder 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: • 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

15. Obsessive-Compulsive Disorder • 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. • Excessive Cleaning - repeatedly washing their hands, showering, or constantly cleaning their home • Constant Checking - individuals check several or even hundreds of times to make sure that stoves are turned off and doors are locked • Repetitive Behaviours - individuals repeat an action, name or phrase over and over again • Slowness - individuals may take an extremely slow and methodical approach to daily activities; organizing & arranging objects • 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

16. Social Phobias • 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.

17. Social Phobias • The most common anxiety provoking social situations are: • 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

18. Specific Disorder Facts • Generalized Anxiety Disorder • Women are twice as likely to be afflicted than men. • Very likely to exist along with other disorders. • Obsessive Compulsive Disorder • 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

19. Physical Reaction to Anxiety 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.

20. Physical Reaction to Anxiety 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.

21. Physical Reaction to Anxiety 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.

22. Physical Reaction to 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.

23. Social Effects of Anxiety • Feelings 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

24. Medications • 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

25. Cognitive Behaviour Therapy • 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

26. Psychodynamic therapy • 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.

27. Exercise • 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

28. Meditation • 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

29. Nutrition and Diet • 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

30. Self Care • 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