01.05.2012 Anxiety

Act to Beat Anxiety

Stop fighting anxiety and promote positive behaviours to overcome it, says Dr Simone Hughes

Anxiety is a normal human emotion that readies the body to take action. It is a necessary emotion that keeps the human body alive. For example, you need a certain level of anxiety to make sure you look both ways before you cross the street!

Anxiety is experienced differently by different people. Anxiety is both inherited and can form a part of a person's temperament (it is thought that up to 70% of anxiety is inherited) or it can be learned through 'modelling' - children model anxiety based on their parent's response to danger. For example, if a young child hears a loud bang it will not look to the source of the bang, it will look first to its mother to gauge her response. Depending on the mother's response of fear or ease, the child will mirror and model the mother's response.

I often tell my clients that your mind is not your best friend; it is a survival machine. Anxiety acts via the 'fight or flight' mechanism, which is a primitive system at the level of thinking but complex at the level of biochemistry. In our modern society it is not appropriate that we 'flee' or 'fight', so where does the energy raised up in the physical system go? It remains diffuse and is experienced as anxiety.

Anxiety is often expressed as irritability or a failure to cope. If people appear to be overly stressed or bothered by the daily hassles of everyday life then they are not coping. Relationships, finances, and work-related pressures are the most common stressors, so if a friend or family member appears not to be coping then they may need to seek help. At least 12% of Australians are experiencing severe stress according to a recent Australian Psychological Society survey, but I suspect the figure is much higher. Everyday life can be a severe stress!

In the extreme form, anxiety can be uncomfortable and distressing. People often avoid feeling anxiety at all costs. Unfortunately, this avoidance only maintains and worsens anxiety. There is both a positive and negative form of anxiety - positive anxiety is excitement! Negative anxiety is discomfort, or fear, and in the extreme form, unchecked anxiety can lead to 'panic attacks': individual episodes characterised by palpitations, flushes, a feeling of choking, breathlessness, among many other pretty awful physical sensations.

At a physiological level, oxygen raises the physical system up for action; carbon dioxide lowers the system down - with anxiety, you want to increase your carbon dioxide levels. Contrary to popular opinion, deep breathing will not generally help in the case of acute panic. Instead, you need to cup your hands over your mouth and rebreathe the expelled CO2 to increase its concentration in your body. This is the popular 'breathe into a paper bag' idea.

Anxiety disorders are heightened levels of anxiety that impede a person's level of daily functioning, either in their social relationships, at home or at work. The most common forms of anxiety disorders are Panic Disorder with or without Agorophobia (which is the avoidance of situations that may lead to a panic attack), Social Phobia, Specific Phobia (eg of elevators, snakes, even vomiting!), Obsessive-Compulsive Disorder, Post Traumatic Stress Disorder, and Generalised Anxiety Disorder.

Who is at risk?

Children of school age, who are not yet able to understand the complexities of emotion.Women who are often more vulnerable to mental disorders more generally.People with a high level of perfectionism - the belief they need to get things 'just right' and who put unhealthy levels of pressure on themselves to be or act in a certain way.
Women fail to acknowledge to themselves what they are experiencing at times. They may fail to acknowledge how time-poor they are, or how they are burning the candle at both ends, or it might be that they are conducting their lives with little meaning, automatically instead of meaningfully.Young adults (18-25 years) are statistically more likely to have problems with anxiety.

How do you combat anxiety?
Many different approaches are used in clinic practice to treat anxiety, depending on the personality and the interests of the client. Often psychologists will use a mixture of Cognitive Behaviour Therapy (CBT), Acceptance and Commitment Therapy (ACT), Dialectical Behaviour Therapy (DBT), Schema-focused Therapy, Mindfulness-approaches and Creative Arts Approaches, including art therapy and narrative therapy in clinical practice.

The first step in anxiety management is to stop fighting it. Increase your knowledge about the myths of anxiety. Avoidance maintains anxiety. Passive approaches such as ruminating and not doing anything to address the underlying stresses in life are passive coping styles and they maintain anxiety. You need to be active. You need to approach anxiety in at least three areas:

1. By investigating and increasing your tolerance for the emotion
2. By changing and promoting positive behaviours
3. By managing your 'automatic' thoughts that are unhelpful and maintain anxiety.

The dominant model at the moment in treating anxiety is Cognitive Behaviour Therapy. The premise of this model is that your mood follows your thoughts so if you change your thoughts you can change the way you feel. As part of CBT you learn about maladaptive thinking styles and how your mind can get you into trouble. The common cognitive error (unhelpful thought) in anxiety is 'catastrophising'. That is, believing the worst will happen despite evidence to the contrary!

In Cognitive Behaviour Therapy you learn how to use an evidence-based model to challenge your thoughts, and you devise positive actions for behavioural change. You learn how to defuse your thinking and how to bring down your levels of stress, fear and anxiety. You can adopt healthy strategies for relaxation, too.

Breath retraining is a powerful tool for managing acute anxiety. If you learn about and experience your breathing consciously (rather than automatically), you can train your mind by attending to the automatic thoughts as they occur and then continue to anchor your mind through the breath.

'Mindfulness' skills - being present in the moment rather than constantly being pulled this way and that - are excellent for the management of anxiety. Mindfulness is a lifestyle change. It involves tuning in to what you are doing, and in so doing, living life more meaningfully. Mindfulness is also about increasing awareness of what you value in life. Living life meaningfully...

There are many skills that people can learn to manage their anxiety more specifically. For example, challenging the negative automatic thoughts behind their anxiety and better understanding their 'life traps', the beliefs they carry that tend to get them into trouble. This involves looking at how you 'filter' your experience. What are your particular negative filters and how do these relate to how you experience life?

Creative therapies provide experiential opportunities and promote a client's learning about their emotional experience. Creative arts therapies including art/craft based therapies and narrative therapies allow for emotional defusion. That is, decreasing the enmeshment with unhelpful anxiety and increasing the distance between you and the emotion so that you can see it clearly and respond to it consciously rather than passively. Creative arts therapies also allow for self related/identity and self compassion related exploration, all positives when it comes to anxiety!

Under the mental health care plan arrangements set in place by the Government, a person can see a GP and if anxiety is an issue then you can get a referral from your GP to see a clinical psychologist. This means you will receive a Medicare rebate for up to 10-16 sessions per calendar year. You can also use private health. From a coping point of view, it is difficult to do it alone. Far better to get some good knowledge, some good coping skills, and a solid plan to see you come out of the problem, positively, learning about your own self-care needs along the way.

Don't suffer alone and don't suffer needlessly. Help is available.

Dr Simone Hughes

Dr Simone Hughes is a clinical psychologist

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