Anxiety

What is it?

Anxiety manifests in many different forms and on a spectrum from low-level stress to loss of functioning requiring hospitalization. Anxiety is physical, mental, emotional tension that keeps a person on edge. It comes from fear of something, usually something that is not present and does not pose immediate danger. Anxiety is an umbrella term that covers disorders such as phobias, Posttraumatic Stress Disorder, and Panic Disorder, among others.
Anxiety comes in many different shapes and sizes. It can show up as difficulty sleeping, eating too much or too little, difficulty being around others, irritability with loved ones, worrying all the time, headaches, stomachaches, tense muscles, and difficulty concentrating.

Long-term anxiety can result in poor relationships with friends and family, difficulty at work, health problems, and stress. Many people who experience anxiety on a regular basis have difficulty taking care of their own needs. They worry constantly about their children, their romantic partners, their parents, or their friends, without taking the time or effort to be sure that their own needs are met. Others worry so much about their own health and success that they find it difficult to take care of their children or other significant people in their lives. They find themselves relying on others to make them feel better, which makes them feel even less adequate.

Quality of work can decline when a person is anxious, sometimes because of difficulty concentrating, sometimes because of anxiety that the work is never good enough, which results in spending too much time on one project or giving up before it is finished. Work relationships can suffer when a person is anxious about pleasing others at their own expense or is pre-occupied with anxious thoughts.

The body and the mind are inter-connected and affect each other. Thus, when a person feels anxious, it is often expressed physically. For example, when a person is anxious about something, they often forget to breathe. As odd as this sounds, when a person is anxious, breathing becomes secondary to dealing with whatever the person feels threatened by.

In order for blood to flow to muscles and to the brain, we have to breathe. When a person stops breathing, or breathes only shallowly, the muscles tense up and the brain does not get enough oxygen, which leads to headaches. Other health problems include hypertension (which can lead to heart attacks and strokes), ulcers, and more minor health problems like the common cold.

Anxiety is a natural response to anything that is frightening. For example, if a big dog snarls at you and you believe it can and will bite you, fear is a likely response. Your heart rate increases, which allows you to get the blood to your lungs and muscles that are necessary for either running away or fighting the dog off.

Physical Symptoms

• Tense shoulders
• Headaches
• Stomachaches
• Backaches
• Pounding Heart
• Racing Pulse
• Shallow Breathing
• Difficulty Falling or Staying Asleep
• Lack of Appetite
• Irritability
• Difficulty Concentrating
• Avoidance of Situations that are associated with anxiety
• Long-term anxiety can lead to serious physical conditions, such as heart disease,
  strokes, ulcers, and more.

Stress

Stress is a low-level anxiety that can affect long-term mental and physical health. Changing the way you perceive your life and the events in it can help you decrease the stress in your life. Daily meditation practice gives you a chance to experience peace and a few moments of tranquility, which decreases the overall stress in your life. Also, prioritizing your life and using reminders, support, and calendars to help remind you of your priorities can help to decrease the extra “stuff” in your life that creates excess stress. The art of feng shui utilizes the power of your environment to help create calm and decrease stress by de-cluttering your living spaces, which “de-clutters” your mind. A nice, relatively simply, solution to decreasing stress is organization, both of your environment and your time. Some people find, however, that the stress in their lives is so ingrained that they need more intensive work around alleviating it. This is when it helps to contact a counselor or therapist for help.

Phobia / Fear

Phobia is extreme, incapacitating fear of something that interferes with a person’s health, happiness, or well-being. An example of a common phobia is “arachnophobia,” or fear of spiders. I will use this phobia as an example, but be advised that there are many different subjects that a phobia can focus on, including non-physical subjects like the fear of open spaces (known as “agoraphobia”). A certain level of fear of spiders is healthy- avoidance of a poisonous spider keeps you from getting sick or dying if you are bitten- but fear of harmless, common house spiders can interfere in life. If you avoid going to the park because you are afraid you might come into contact with spiders, if you spend far more than a normal amount of time cleaning in the hopes that spiders will not live in your house, it is possible that you are experiencing a phobia of spiders.

If you truly wish to rid yourself of a phobia, the treatment is simple, clear, and backed by research. It is called prolonged exposure therapy, or desensitization. It starts with relaxation techniques and cognitive skills to help you learn how to respond without fear to a situation that holds no real danger. The therapist then gradually works in visualization of spiders (or whatever it is that your phobia is focused on) in various situations and proximity, taking care that you are not pushed past a very low level of anxiety. Once the visualization is successful, you begin a gradual process of physical proximity to the object of your fears. The idea is to get you to the point where you are beginning to feel a little bit of the tension that precedes a full-blown panic attack, give you a chance to utilize the relaxation techniques until you have control over yourself again, then gradually increase the stimulus. Eventually, someone with a phobia of spiders can actually hold one on her hand without any panic at all.

Some examples of phobias:

• Acrophobia: fear of heights
• Agliophobia: fear of pain
• Agoraphobia: Fear of open spaces or of being in crowded,
  public places like markets. Fear of leaving a safe place,
  which often leads to people being afraid to leave home
• Automysophobia- Fear of being dirty
• Aviophobia or Aviatophobia- Fear of flying
• Chiroptophobia- Fear of bats
• Claustrophobia- Fear of confined spaces
• Coprophobia- Fear of feces
• Cynophobia- Fear of dogs or rabies
• Felinophobia- Fear of cats. (Ailurophobia, Elurophobia, Galeophobia, Gatophobia)
• Emetophobia- Fear of vomiting
• Gerontophobia- Fear of old people or of growing old
• Hemophobia or Hemaphobia or Hematophobia- Fear of blood
• Homophobia- Fear of homosexuality or of becoming homosexual
• Iatrophobia- Fear of going to the doctor or of doctors
• Lygophobia- Fear of darkness
• Ophidiophobia- Fear of snakes
• Panthophobia- Fear of suffering and disease
• Polyphobia- Fear of many things
• Somniphobia- Fear of sleep
• Topophobia- Fear of certain places or situations, such as stage fright
• Urophobia- Fear of urine or urinating
• Xenophobia- Fear of strangers or foreigners

Note: I copied these phobias from the Phobia List. For an exhaustive list of phobias, see this site: www.phobialist.com/index.html

Posttraumatic Stress Disorder

Posttraumatic Stress Disorder is a response to an event, or situation that is unusually stressful (trauma). This event or situation involves actual or threatened harm to oneself or someone close to you. A single event could be anything from a car accident, being physically or sexually assaulted, to seeing someone killed in front of you or losing a friend or family member to a sudden illness. The key to the single event is that it is unexpected and is either deadly or a real or threatened assault on physical integrity. The word, “situation” is used to stand for a situation such as a war zone, a natural disaster, a violent relationship, or a neighborhood or family with physical abuse, sexual abuse, or neglect. The key to the situation is that it is unstable, unpredictable, or unsupportive and often includes constant or continuing danger to self or others. It is normal to respond to a situation like this with some or all of the symptoms noted below. For most people, the symptoms fade or decrease over time. For someone experiencing Posttraumatic Stress Disorder, the symptoms either fail to decrease, increase over time, or show up at a later date, sometimes even decades later.

The posttraumatic response to trauma is characterized by three major categories: Avoidance, Hyperarousal, and Re-experiencing. In English, Avoidance means physically, emotionally, or mentally attempting to forget that the event or situation ever happened. It is experienced by things like refusing to talk about it with anyone, avoiding places that remind you of it (like a Veteran avoiding restaurants that serve food from a country in which they were deployed), or attempting to shut out memories of the trauma with drugs, alcohol, risky behaviors, or constant stimulation (like watching television to keep the mind numb).

Hyperarousal includes hypervigilance, increased and exaggerated startle response, and lack of concentration. Hypervigilance is the increased awareness of your environment, experienced as hearing every leaf moving on the tree outside your window, every tick of the clock, or the emergency vehicle sirens across town, usually while trying to sleep or relax in some way. Every new situation is assessed for the possibility of danger, exits are noted before someone enters a building, and the person always sits at the back of the auditorium, so that no one is behind him. People experiencing hyperarousal startle easily, have more intense reactions, and take minutes to hours to calm down, whereas a normal startle reaction is gone in seconds. These are the veterans who dive to the ground if they hear a sudden, loud noise. Because a person experiencing hyperarousal is distracted by the many small noises, actions of others, or other possible “threats” he or she has difficulty concentrating. This can occur on the job, at home, or in social situations, interfering with personal interaction or focus on work or school projects.

Re-experiencing symptoms include intrusive memories, nightmares, flashbacks, and the physical feelings associated with the trauma. Intrusive Memories are thoughts, memories, and emotions that return at unexpected moments to remind a person of the trauma. The person might be unable to keep the look on the face of the attacker out of her head, the sound of his voice out of her mind. She might find herself replaying the attack over and over in her head. She might have nightmares at night, reliving the experience. A person experiencing a flashback will feel as if she is in the middle of her traumatic experience again, including sight, sound, smell, taste, and physical sensation. She might respond as if she were back in that situation, acting out as if she were there again. Flashbacks are frightening and often make a person feel that she is going crazy. The last re-experiencing symptom is the physical sensation of being in the traumatic situation again. She might suddenly be overcome with panic, feeling like she has to “get out of here,” but with no real idea why she feels this way.

Depression

Depression and Anxiety are often linked. Someone who is anxious might also find herself feeling some of the symptoms of depression. It is also possible that the anxiety is masking a deeper depression.

Depression is more than a feeling of being “down in the dumps.” It includes things like loss of pleasure in things that a person normally enjoys, poor sleep – either too much or too little – poor eating –either too much or too little- and thoughts, plans or attempts at suicide. Hopelessness, low energy, and loneliness are common, as well. It is normal for people to feel down every now and then. Most people respond to certain events in their lives with some symptoms of depression. The clinical diagnosis, however, involves more symptoms lasting for much longer than the normal depressed response to something like losing a job or a relationship.

Luckily, Depression is generally very responsive to treatment. Your doctor would likely be quite happy to help you out with a prescription – be sure to ask about the side effects before you choose a medication- which can alleviate some of the symptoms until you feel able to take control of your life again. Since I am not a medical doctor, I generally prefer the non-chemical treatments, which have been shown to be just as effective (or more so) for alleviating Depression. Some of these effective treatments include Cognitive Therapy, Cognitive-Behavioral Therapy, and Depth- based Therapy, like Existential therapy and Self-Psychology (links). Some people are able to utilize these treatments immediately and find that their symptoms recede and that they are able to respond to any future bouts using the techniques they learned, thus decreasing the intensity with each successive episode. Others, however, need the boost in their energy and outlook that medication can give them before they are able to utilize therapeutic techniques. If you attempt suicide or are close enough to that brink that you are hospitalized, you will be medicated in the hospital. It is the fastest, easiest way to help someone who no longer feels capable of helping himself.

My favorite treatment for Depression is Cognitive-Behavioral Therapy. Many times, what begins as one negative thought or overwhelming emotion can quickly spiral into a deep Depression. One method of stopping the spiral is to look at which situations, thoughts, and emotions lead you into that abyss. Once you have some idea of which triggers, thoughts, and emotions send you in that direction, we can utilize a thought record (link to a sample thought record) to help you target those thoughts and behaviors that are continuing the cycle, then change them to more helpful thoughts and behaviors. As you practice this technique, you will find that you are able to recognize unhelpful thoughts and change them before they become problematic.

This is a useful technique for most people. Some, however, find that it is only a band aid and does not solve the underlying loss of meaning in their lives that led to the depression in the first place. For these people, I generally go deeper into the meaning of various events and people in their lives, looking at their triggers and analyzing how we might help you find more positive meaning in your life. This is the kind of work that is not easily described or defined; how we approach it depends entirely on the individual and how his or her mind works.

Sleep Difficulties

Otherwise known as Insomnia, sleep difficulties play a role in many disorders and can affect daily functioning dramatically. When speaking of insomnia, psychologists usually specify “onset” insomnia, “sleep interruption,” and “early waking.” The kind of insomnia you experience can give your therapist a clue as to the cause of the insomnia, as well as give her a hint as to how to help you deal with it. When we do not get enough sleep, our brains do not get the chance to fully reset for the day, leading to reduced attention and concentration, fatigue, irritability, and increased mood swings. Of course, when attention and concentration is reduced, memory is poor. How can you remember what you were not paying attention to in the first place? Irritability and mood swings can affect functioning in relationships, in the workplace, social situations, and in personal relationships with family and partners..

The current widespread use of caffeine complicates this picture. Rather than attempting to alleviate fatigue with a nap or going to bed earlier, many people rely on their daily cup(s) of coffee, cola, or tea to get them past the hump. Caffeine has a half-life of approximately 12 hours, which means that it stays in your system. If you drink your caffeine in the afternoon, it is quite possible that the caffeine will then interfere with your sleep in the evening, continuing the cycle of poor sleep/caffeine/poor sleep/more caffeine. As with other stimulants, the use of caffeine also tends to increase irritability and impatience. I have often heard people say that they can drink a cup of coffee right before bed and sleep fine. If you do not have insomnia and find that you enjoy your caffeine, by all means, keep it up. I would never advocate removing life’s little pleasures if they do not interfere with your health or well-being. It is something to consider, however, if you do experience insomnia..

Sleep Hygiene:

If you have difficulty sleeping, you can try some of the following techniques.

Treatment

Treatment depends on the specific manifestation of the anxiety. For most forms, however, relaxation techniques, coping skills, and understanding of the cause of the anxiety can help a person to decrease the intensity of the anxiety. Of course, eliminating the cause of the anxiety will often eliminate the anxiety, as well. For many forms of anxiety, cognitive therapy is useful. Cognitive therapy consists of learning about your thought patterns, noticing which thoughts are useful for you, and which are not, then working to replace the unhelpful thoughts with more helpful ones. Another treatment, particularly if the anxiety is deep-seated or originated in childhood, is a depth-oriented treatment (link), such as psychoanalysis, ego-based treatment, existential therapy, psychodynamic therapy, or feminist therapy. Anxiety is often amenable to treatment, but shows up in so many diverse forms that it is helpful to figure out the source of the anxiety before attempting to work with it...

Medication:

Some people find medication very helpful for anxiety. It is particularly useful if you are having difficulty pinpointing the triggers that cause panic attacks or if you are unable to sleep due to the anxiety. Always talk to your doctor about all of your symptoms before asking for medication, so that she or he will be able to prescribe the best medication for your situation. It is often helpful to see a psychiatrist (a medical doctor with special training in this area) who will be very familiar with the various treatments available for you, as well as the best course of medication (short-term, in conjunction with psychotherapy, or long-term). Never stop a medication without consulting your doctor. Some medications need to be tapered off for best results, while others can be stopped without tapering, but your doctor will be the best source of information about your medication...

Exposure Therapy

(link) consists of choosing a specific traumatic memory and going over it in minute detail. Similar to the description of treating a phobia, the patient is first taught relaxation techniques and is carefully monitored to keep any anxiety at a manageable level. The therapist guides the patient through this process slowly, one bit at a time so that it does not become overwhelming. This therapeutic model is based on the idea that the brain is already attempting to process the trauma in this manner. The therapist provides tools for helping the patient through this process as well as support and guidance...

EMDR (www.emdr.com)

is similar in that it goes back over the traumatic memories. It is most effective for those who have several specific memories of trauma, such as living in a war zone for several months, versus one instance, such as a motor vehicle accident. Rather than focusing intently on one event, the therapist guides the patient to lightly skim over several events, while providing a stimulus such as something for the patient to focus his eyes on, a tone, or a tap. The idea is that the brain is given a new, neutral, non-painful association with that memory. The research on this therapy has shown that it is effective. Researchers do not agree on the importance of the actual eye-movement aspect of it, however. Some researchers have argued that the effectiveness of this treatment is due to the non-EMDR aspects of the treatment, which are similar to many other types of therapy. Some patients have found this treatment helpful. If you choose to try this treatment modality, be sure you find a therapist with certification. This is a specialty that requires special training...

Developmental Model:

This model involves looking at the entire life of a person. Beginning with the community within which a person was born, the relationship between his parents and the larger cultural beliefs within which they operate, the therapist takes a client through their childhood, young adulthood and current lives. The therapist encourages the client to look at all aspects of their lives, including the effects of the family on the person, experiences at home and at school, and any activities. The person is encouraged to explore religious or spiritual views and experiences, experiences in and out of school, social life, and development of romantic interest. A tool that I’ve found useful when working with traumatic experience is called the “Three-sided mirror.” This looks at childhood, the environment and experience during the time of the trauma, and the life of a person after the trauma. In this way a person can see how she has changed, what strengths helped her to get through the traumatic experience, and how she might still be the same. This can then be utilized to realize that the person has become stronger in some way by making her way through the traumatic experience...

Resources

“Mind Over Mood,” a workbook by Dennis Greenberger, PhD and Christine Padesky, PhD is very useful for changing your way of thinking about situations that would normally increase your anxiety....

For veterans experiencing symptoms of PTSD, the Operational Stress Injuries Clinic is available for assessments, treatment, and further support. They offer therapy, medication management, psychiatry, and various health-related services. You can reach them at: (403) 216-9860 or toll free at: (866) 398-9860. ...

National Center for Posttraumatic Stress Disorder specializes in research, assessment, and treatment for Posttraumatic Stress Disorder in veterans. They provide extensive therapeutic programs, including several modalities of treatment. Their websites:...

Yoga Classes:

• Hot Yoga on 17th Ave. They offer classes and workshops on meditation.
  (403) 686-9642 www.hotyogaon17th.com
• Bodhi Tree Yoga Centre offers classes and workshops on meditation. (403) 270-0219
• You can search for other yoga classes and centers using the following website: www.yogacalgary.ca

Meditation Classes:

• Centre for Spiritual Living has classes every Wednesday evening at 6:30.
  They are free to the public.

Here are links to the websites for a few of the Buddhist Centres in Calgary:

• www.calgarybuddhistmeditation.ca
• www.meditationalberta.org
• Avatamsaka Buddhist Monastery www.avatamsaka.org

Guided Meditation

Guided meditation compact discs can be helpful. Beth Hedva, a local psychologist offers various workshops, which include meditation techniques. She has cd’s available for most of her workshops at: www.hedva.com. You can also email her at: beth@hedva.com