managing your anxiety
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Managing your anxiety
Fleur-Michelle CoiffaitFiona Gellatly
Trainee Clinical PsychologistsUniversity of Edinburgh & NHS Lothian
Monday, 14 May 2012
Welcome
IntroductionsHousekeepingOutline of 2 sessionsExpectations
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Who gets anxious?
Research shows that almost 1 in 5 of us will suffer from anxiety at any one time
In Edinburgh alone there will be 22,305 people suffering from anxiety
We all get anxious but it becomes a problem if we can’t cope with it
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14 Most common signs reported by people in the
Worry Anger Poor sleep Tiredness Feeling irritable Feeling worthless Waiting for the
worst to happen
Feeling on edge Unable to switch off Poor concentration Tearful Drinking too much Feeling hopeless Panic attacks
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How anxiety can affect us
Thoughts
Body
Behaviour
Emotions
Anxiety
Environment
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Group exercise
Take some post-it notes On each one, write one example of
how anxiety affects you E.g. Anxiety makes me go out less
Anxiety means that my heart races
15 mins
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Break
15 minute break
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Fight / flight / freeze
Instinct (e.g. animals) Stress/anxiety is an instinct Alerts mind and body to threat Keeps us ‘on alert’ until danger passes Ancient survival mechanism Example: walking alone at night Sensing danger -> adrenaline
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Adrenaline
Body’s activator -> energy Adrenal glands in our kidneys Carried through bloodstream, affects
autonomic nervous system (ANS) ANS controls functions such as our heart
rate, pupil dilation, and secretion of sweat and saliva
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Fight / flight / freeze
Adrenaline
Pupils dilate
Bladder/bowels
Sweating
Heart rate
Muscle tension
Breathing and oxygen
Heightened awareness
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Fight / flight / freeze
This reaction does not wear off instantly
Our bodies are concerned the threat may return
Hot, flushed, tired Calm much later We don’t decide to react this way
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However…
Today the threats we experience often do not require us to fight or flee
Now there is less focus on survival but more on social factors such as our own and others perceptions of ourselves.
We will consider ways of combating this later.......
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How anxiety can affect us
Thoughts
Body
Behaviour
Emotions
Anxiety
Environment
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How anxiety can affect our: Behaviour
Avoidant Behaviour Negative Behaviour
Making decisions Speaking too fastDriving Unable to sit at peaceShopping Poor performanceSocialising Always rushedStaying alone Smoking/drinking moreTalking to neighbours Accident proneReading about illness Irritable, StammeringUsing buses/trains Nail bitingResponsibility
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How anxiety can affect our: Behaviour
Anticipate we will cope badly Common sense is ‘stressed? then avoid it!’ Unfortunately, this is not helpful No easy way around this Stress can often be invisible Visible in our behaviour Often aware of our reaction, self-conscious
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How anxiety can affect our: Body
Sleep
Numb
Jellylegs
Choking Nausea
Breathless
Shaking
Faint
Bladder/Bowel
Anxiety
Drymouth
Unreal
Pins &needles
Tired Sweating
Musclepain
Chestpain
Headache
Heart rate
Anxiety
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Break
15 minute break
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How anxiety can affect our: Thoughts
Thoughts can be a bit like a football commentator
Whether we pay attention depends on many things
No two people worry about the same thing, although there are common themes
How we feel can affect the strength and type of thought we have
How we think affects how we behave
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Fearful Thoughts Can include fears of:
Looking foolish Worry Madness Poor concentration Illness/disease Irritability Challenges Feeling keyed up Losing control Nightmares Being alone Loss of interest Being criticised Feeling ‘cut off’ Rejection Easily startled Meeting people Self criticism
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Worrying about worrying: A vicious circle
Notice symptoms
Worry about worrying
Symptoms increase
Worry
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Emotions
Worried Sad Guilty Fear Angry Insecure Resentful Unreal
Despair Frustration Injustice Low Let down Helpless Flat Jealous
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What causes anxiety?
Personality factors/genetic make-up Childhood experiences Modelling Perception Life events Changes or breaks in routine
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Reducing anxiety: Breathing exercise
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Quick strategy to reduce bodily symptoms, can be used in any situation:
Breathe in through nose on a count of 4 Hold for 2 seconds Release slowly over 6 seconds Say the word “relax” as you breathe out
Calming breath
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End of day one
Thank you very much
See you tomorrow – same time, same place!
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Day two
General discussion
Any thoughts or issues that came up overnight that you would like to share?
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Day two
Maintaining factors and how to intervene in the vicious cycle
Progressive muscle relaxation General questions
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Anxious thoughts
They often happen out of the blue You may be unaware of them Although they are not necessarily ‘true’
people believe them at the time The thoughts often appear when you least
want them They are usually about the near future If other people believed the thoughts, they
would become anxious
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Anxious thoughts increase due to other changes…
Self-esteem and self-confidence
drop
Become more and more self-conscious
Feel threat from all sides
Question your ability to cope
Worry becomes second nature
Problems keep coming
Brings out the worst in you
Body reacts easily, or for no
reason
Anxious thoughts increase
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Understanding our thoughts: Unhelpful thinking
Catastrophising Black and white thinking ‘Shoulds’ and ‘musts’ Jumping to conclusions Mental filter Emotional reasoning Over-generalisation Personalisation
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Break
15 minute break
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Distraction
Dwelling on worries leads to more worries
1. Try mantras, e.g. “I am calm”
(flashcard) “Relax”
“I am in control”
Close your eyes and slowly repeat the words
2. Describe everything you can see or hear in detail
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Exercise and activity
Anxiety gives you lots of energy Reduce the anxiety by burning up the
excess energy Cardiovascular exercise is best:
E.g. walking, swimming, jogging, fitnessclasses, sports
Exercise gets you out of the house and meeting others
Added benefit of improved health
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Avoidance
Common sense says if doing something makes you more tense, you should avoid it
So-called common sense can be unhelpful!Face up to your problems If you ignore them they will feed the
anxiety and may get biggerThis may be hard in the short-term, but it
will help in the long-term
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Alcohol Some physical symptoms of anxiety (nausea,
sweating, shaking) may be related to too much alcohol
Heavy drinking makes anxiety worse, and can cause slowed breathing and heart-rate in the short-term
We all need at least two days a week without alcohol
Consider reducing drinking or stop altogether
Driving Limit 80mg in 100ml of blood – not easily translated into a number of
drinks, depends on age, weight, gender, metabolism
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Caffeine
Strong links between intake of caffeine and anxiety
You find caffeine in: Tea and coffee Fizzy drinks, e.g. coke, diet coke, red bull Chocolate Cold and flu remedies/painkillers Caffeine tablets, e.g. pro-plus
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Progressive muscle relaxation
PMR teaches you how to relax your body and mind
Allows you to become aware of how anxiety affects your body
Relaxation is a skill and benefits from practice Lets have a go
Prevention is better than cure
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Break
15 minute break
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Strategies to manage anxiety Prepare yourself
work out which situations cause you anxiety
use relaxation before you have to face up to them
Stay in control and face the anxiety you now have a way of fighting back
when anxiety threatens
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? Questions ?
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Handouts
‘25 ways to cope’ Problem solving Sleep problems PMR Breathing Unhelpful thinking styles
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What Next???
Online Resources Bibliotherapy Voluntary Organisations Stress Control Group
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