talking about anxiety disorders - Learn With Unite (PDF)

talking about anxiety disorders 62856 Anxiety.indd 1 62856 Anxiety.indd 1 15/1/08 22:29:09 15/1/08 22:29:09  2 This booklet refl ects many discussions, suggestions and comments made by health professionals, professional bodies, lay and voluntary organisations, people with anxiety disorders and their friends and family. Health Scotland would like to thank all of those who contributed in any way to the development of this booklet, for so willingly giving their time, and sharing their expertise and experience. All the quotes in this booklet are from real people. Disclaimer Every effort has been made to ensure that this publication is as up-to-date and accurate as possible. However, new research can sometimes mean that information and recommendations change very quickly. Changes and alterations will be made at the next reprint to refl ect any new information. While the booklet represents the consensus of good practice, please remember that different circumstances and clinical judgement may mean that you have slightly different experiences. If you have any doubts, worries or fears, then do not hesitate to contact your doctor for reassurance and further explanations. Published by Health Scotland. Edinburgh Offi ce Woodburn House, Canaan Lane, Edinburgh EH10 4SG Glasgow Offi ce Elphinstone House 65 West Regent Street, Glasgow G2 2AF © NHS Health Scotland, 2006, 2008. ISBN: 1-84485-347-0 Health Scotland is a WHO Collaborating Centre for Health Promotion and Public Health Development. Original text: Geraldine Abrahams Research: Scott Porter 62856 Anxiety.indd 2 62856 Anxiety.indd 2 15/1/08 22:29:10 15/1/08 22:29:10  1 introduction We are all used to feeling anxious from time to time. When we are facing a job interview, or the possibility of redundancy, or awaiting the results of an important medical test, we can feel worried about what might happen and perhaps tense and anxious about how we will be affected. We may think about things that are worrying us all the time and fi nd it hard to concentrate on anything else. The strain can show itself in different ways. We may have diffi culty sleeping or lose interest in food as a result. Often the fact that we are under pressure spurs us on to do our best and to rise to the occasion. In most cases, the tension will go away once the stressful situation is over. However, some people experience such strong feelings of anxiety that they are unable to cope with their day-to-day life. Often the cause is a clear problem but sometimes, for no clear reason, we become deeply troubled. We can feel highly anxious and it can last for days or weeks, or even longer. Anxiety affects us all but becomes a problem when we can’t relax at times when we should be able to; when it appears for no clear reason; when we can’t switch off the worry no matter how hard we try; when our lives start to centre round anxiety (for example when we avoid going places or doing things due to fear of what might happen). It is normal to worry – we all do it, but when we start to worry about worry it is time to try to sort it out. This booklet is written for people who are experiencing this sort of anxiety, and for their family and friends. It sets out to provide some basic information about anxiety disorders and suggests some sources for further help including references to other reading material and to organisations. The internet is a useful resource for people needing help for their (or someone else’s) anxiety and a selection of useful websites has been included. 1 62856 Anxiety.indd Sec1:3 62856 Anxiety.indd Sec1:3 15/1/08 22:29:11 15/1/08 22:29:11  2 what is anxiety? Anxiety is remarkably common. Men and women of all ages and from all backgrounds can be affected by it. There are several different aspects to anxiety. We can have anxious thoughts that cause us to have worries and fears, where we go over things again and again in our mind in a way that does not actually help resolve it. It can begin to link in with panicky thoughts and fears that something catastrophic and deeply threatening is happening right now. We feel sure we will faint or collapse, suffocate, have a stroke or a heart attack, or perhaps do something very embarrassing. Our feelings and emotions can become altered with anxiety too, ranging from milder feelings of emotional tension through to worry and anxiety, to very high states of panic that occur during panic attacks. Physical symptoms that occur with anxiety can include milder levels of tension like muscle tension, tiredness, pain, a slight jittery feeling, disrupted sleeping patterns, and hot and/or cold sweats. As the symptoms of anxiety increase and move towards panic, a full fi ght or fl ight adrenaline response occurs. In normal times, our minds and bodies have built ways of protecting us and saving us in times of threat. For example, when we step out into the road and a car hoots at us, we jump back on the pavement and notice that our hearts are racing, and we are sweaty, clammy, and shaky or our muscles are taut. We may feel on edge, breath faster and feel hot. Those reactions are all part of the standard fi ght or fl ight adrenaline response. Adrenaline helps prepare our bodies either to run away or to be poised and 62856 Anxiety.indd Sec1:4 62856 Anxiety.indd Sec1:4 15/1/08 22:29:11 15/1/08 22:29:11  33 ready to react. Such physical responses can save our lives in threatening circumstances and once the threat has passed we are usually able to carry on with our lives as normal. So, anxiety is a common human reaction to a stressful situation or event. It can be a positive thing and if we did not experience a certain amount of anxiety, we would fi nd it diffi cult to keep going. Some of us, however, experience very high levels of anxiety and such strong feelings of distress that we are unable to manage everyday tasks as usual. We may fi nd we are so anxious and edgy that we avoid situations we would usually cope with and even enjoy. It is as if we are always living on a knife-edge and the feelings of fear can seem unbearable. Each person will experience anxiety in his or her own particular way, but there are a number of symptoms people often describe. Tense muscles can cause headaches or pain in the neck, shoulders or back. A dry mouth can make it hard to swallow. We may get breathless and dizzy, or feel faint from breathing more rapidly. We may experience indigestion, butterfl ies, constipation or diarrhoea because adrenaline causes blood to be taken away from the digestion to the heart and muscles. Our heart may beat alarmingly quickly. • • • • • 62856 Anxiety.indd Sec2:5 62856 Anxiety.indd Sec2:5 15/1/08 22:29:11 15/1/08 22:29:11  4 We may experience panic as the fi ght or fl ight adrenaline response occurs. We may fi nd it hard to concentrate on anything and become very irritable with other people. We may feel weepy and emotional, thinking may become negative. We may experience diffi culties sleeping and as a result we end up exhausted. Anxiety can also cause us to have feelings of depression, fear, terror and hopelessness. Our world becomes more and more restricted, and it can be hard to see a way out. If this applies to you, or someone you know, you may wish to read the separate booklet on depression (see Talking about Depression). Some people may be anxious about the future, perhaps because someone close to them is ill, or because of fi nancial problems, or perhaps because the children are leaving home. Some people may be anxious about their past. We tend to think that anxiety comes from being too busy and pressured, but it can be just as diffi cult to cope when we are in a situation where we do not have enough to do. • • • • “I could never relax, I was tense and wound up all the time. It was hard to focus on anything else. I felt really shaky and on edge.” “I felt paralysed by worry. Unable to do anything. Unable to imagine things ever changing. It really began to pull me down.” 62856 Anxiety.indd Sec2:6 62856 Anxiety.indd Sec2:6 15/1/08 22:29:12 15/1/08 22:29:12  55 Being unemployed or in a boring job which we don’t enjoy, for example, can make us frustrated and anxious and we can fi nd ourselves at a low ebb. The key factor of anxiety is that it has an impact on how we are able to live our lives. Some days are better than others – it can come and go often for no obvious reason. When we have anxious fears, we tend to avoid doing things we perceive or judge as being scary or anxiety provoking. So we will avoid conversations or meeting people if we are anxious in these situations. We will avoid going to shops if we have panic attacks in shops or on buses, and put off tackling diffi culties and challenges at work and at home. This results not only in our avoiding of situations but also potentially in our turning to others to sort out our problems. Anxiety can make us become dependent on other people and look to them to provide answers for us. The problem with this is that although it might make us feel better in the short-term, in the long-term it can undermine our confi dence still further. It can be very hard to explain how we feel to other people. Our worries may seem unreasonable and we may feel under pressure to put on a brave face and behave as other people expect. This worry about how others may judge us adds to our distress and makes us even more tense. We may try using caffeine, alcohol, cigarettes or drugs to help us get by. This may make us feel less anxious for a time, but in the longer term it can make the anxiety worse and impact on our health. 62856 Anxiety.indd Sec2:7 62856 Anxiety.indd Sec2:7 15/1/08 22:29:12 15/1/08 22:29:12  6 There can also be a physical impact of anxiety. Our body’s resistance to infection can become weakened and we’re more likely to experience ill health. It can become a vicious circle. We worry about what is happening to us, and become more anxious and distressed. The most diffi cult step can be to accept there is a problem and to seek help with it. There are different types of anxiety disorder: Generalised Anxiety Disorder (GAD), where we feel worried for much of the time. We turn worrying thoughts over and over in our minds, but in a way that does not solve them. We worry about what we have done, or not done, about what might happen in the future or what has happened in the past. This worry is associated with anxious feelings, and physical changes such as tension, tiredness, and poor sleep. We may go off our food, and feel on edge, jittery, irritable or tired. We may become easily upset and tears will not be far away. “You can lose so much. For years I cut myself off from friends and neighbours. I didn’t go out.” “It would’ve been easier if I’d had my leg in a plaster. Then people would’ve known I wasn’t right. But they just couldn’t understand what was wrong with me.” “I wish somebody had sat down with me years ago and told me, you don’t have to be like this. I didn’t know other people had been through it too.” 62856 Anxiety.indd Sec2:8 62856 Anxiety.indd Sec2:8 15/1/08 22:29:12 15/1/08 22:29:12  77 Panic disorder. A person with a panic disorder has panic attacks and is afraid that a panic attack might occur for no clear reason. Panic disorder can become very disabling as sufferers avoid situations where previous panic attacks have occurred maybe even becoming housebound. Panic attack. During a panic attack symptoms of anxiety rise quickly to a peak, and these are associated with feelings of terror and fear of catastrophe – that something really terrible will occur. You might have a fear of collapse, of fainting or suffocating, of having a heart attack, stroke or of dying or a vague sense of dread. Sometimes the person fears that a terrible mental event will occur, for example, losing control. More often however panic attacks occur during generalised anxiety, depression, drink problems and virtually any other mental disorder. Not everyone who experiences a panic attack will develop a panic disorder. Many people have only one episode. No one forgets their fi rst panic attack – they fi ll you with terror and you fi nd yourself fearing having another. Indeed, you may centre your life around trying to avoid having one. Phobic disorders. A person with a phobia avoids or restricts activities because of fear. This fear appears persistent, excessive and unreasonable and is of specifi c things like heights, spiders or busy places. It can lead to an increasingly restricted life and an undermining of confi dence. 62856 Anxiety.indd Sec2:9 62856 Anxiety.indd Sec2:9 15/1/08 22:29:13 15/1/08 22:29:13  8 Obsessive-compulsive disorder (OCD). Sometimes a person’s anxiety leads to their feeling they must carry out certain actions again and again. This obsessive-compulsive behaviour might involve repeatedly checking that the door is locked, or endlessly cleaning the house. Many people can identify with this sort of behaviour – going back to check that the gas is switched off for example – however for people with OCD no matter how often we repeat the same behaviour, it never seems to quell the anxiety within us and we begin again. The same can apply to ideas or thoughts, which go round and round in our heads, tormenting us and never giving us a moment’s peace. The disturbing, persistent thoughts or images are called obsessions. Compulsions are the rituals formed to try and prevent or get rid of them. understanding the causes of anxiety Most of us feel anxious for clear reasons such as facing life stresses and hassles. It is not always possible to say what causes someone to develop anxiety. It may be an event like childbirth, an illness, bereavement or being made redundant that triggers it. It could follow on from a major upheaval like moving house. Even when it is something we’ve chosen to do, it can create a lot of worry and disruption in our lives. On other occasions, we may have experienced a gradual build-up of pressure in our lives which makes us particularly vulnerable. Things may not be going well at work or in an important relationship. We may be trying to juggle many different demands on us and satisfy them all. This is particularly the case for women who are working and at the same time trying to provide care for their children. 62856 Anxiety.indd Sec2:10 62856 Anxiety.indd Sec2:10 15/1/08 22:29:13 15/1/08 22:29:13  99 It is not only recent events which can contribute to anxiety. Memories of things that happened in our past that worry or upset us can continue to affect us later. We still have the feelings of fear and distress, although we cannot identify what led us to feel this way. Often, too, we become set in a way of looking at the world which confi rms our worst fears and can feed our anxieties. The horrors we see on the news may convince us further that we are quite right to feel frightened. If things go wrong in our own lives, this only confi rms our worst expectations and reinforces our anxiety. There is an increased risk of experiencing anxiety for those whose parents or close relatives have anxiety. However, that does not mean automatically that we will have the symptoms. Some medical conditions can cause symptoms of anxiety or panic. Usually our doctor or healthcare practitioner will ask additional questions to help identify the problem, which may stem from the thyroid gland, diabetes or other medication. In high doses caffeine produces effects similar to anxiety, disrupts sleep and can make panic attacks more likely. People who experience anxiety should reduce their daily intake to 300mg or less (about four cups of strong coffee). “I just couldn’t switch off. I used to just worry and worry even about silly little things. It was like I’d no space in my head to think of anything else.” 62856 Anxiety.indd Sec2:11 62856 Anxiety.indd Sec2:11 15/1/08 22:29:13 15/1/08 22:29:13  10 Energy drinks (for example, Red Bull) and tablets (ProPlus) contain caffeine and may be best avoided altogether. Illegal drugs such as cocaine and amphetamines may also cause strong feelings of tension and anxiety. Although alcohol can act quickly to relieve feelings of anxiety, long- term alcohol misuse often increases anxiety levels. This can lead people into a destructive cycle of increasing alcohol use. what you can do Anxiety can make it hard for us to cope with day-to-day demands. We may become isolated from other people, we may feel very frightened at what is happening to us, yet don’t know how to change. It can be very draining to be so tense and fraught all the time. More will be said later about getting help from other people, but there are steps we can take ourselves to reduce our anxiety. There are no magic pills or cures for anxiety, you will have to work hard at this day after day. It may be that whatever action we take will make us more anxious to begin with. This should decrease with time, but in the early stages we may fi nd that we need to use support from other people to help us keep up our own efforts. “Before, I didn’t realise I had any choices. I found I had to work out for myself what my limitations were. What’s important now is that I’m in control of getting myself right.” “I needed space to put all my energy into getting better fi rst. Then I was able to look at why it happened. Not to blame anybody, but so I could stop it happening again.” 62856 Anxiety.indd Sec2:12 62856 Anxiety.indd Sec2:12 15/1/08 22:29:13 15/1/08 22:29:13  11 11 What helps may be different for each of us, but other people have said they found these things useful: Read self-help material for information and skills on how to address anxiety. Try to concentrate on the ‘here and now’ and not concern yourself too much with ‘what if…’. When you fi nd someone you can talk to about how you feel try to avoid the danger of becoming too dependent on them or looking for them to solve problems for you. Work out whether there are any specifi c situations you fi nd particularly alarming. Set yourself targets so that you can gradually work at facing these situations and getting the better of them in a planned step-by-step way. Set your own pace. No one can force you to do anything. You’ll fi nd you gradually gain confi dence in your ability to cope. Control your symptoms by learning and practising breathing and relaxation techniques. This can help you control the level of anxiety you experience so that it is manageable. You can fi nd out more about relaxation techniques from your doctor or counsellor, or from the organisations listed later. Your local library may be able to supply books or tapes. • • • • • • “I never realised the others at work felt the same way until we talked about it. It was much easier to talk to the manager about it when it wasn’t just yourself.” 62856 Anxiety.indd Sec2:13 62856 Anxiety.indd Sec2:13 15/1/08 22:29:14 15/1/08 22:29:14  12 Allow yourself a breathing space. Do something you really enjoy or treat yourself. Perhaps there’s something you used to like doing but haven’t done for a while. Take a step back and think about how you live your life. If you’re overloaded, work out what’s most important to you, and shed what is not important. If someone else is making too many demands on you – your boss or a family member perhaps – try to work out a plan for talking to them about it without blaming them. It may help to do this with other people who are affected too, so you can deal with it together. Exercise has been shown to benefi t generalised anxiety disorders, phobias and panic attacks. Taking up walking, swimming or yoga can help relieve tension. Review your diet, caffeine intake, alcohol and smoking intake, try to eat healthily and take a moderate amount of exercise. If you use illegal drugs then plan to reduce and cut these out. You may fi nd it helpful to discuss ways of reducing smoking, drinking and illegal drug use with your doctor. Identify and challenge exaggerated worries and pessimistic thoughts. Talk about your anxiety problems with other people such as trusted family members, friends or at self-help groups. • • • • • • • 62856 Anxiety.indd Sec2:14 62856 Anxiety.indd Sec2:14 15/1/08 22:29:14 15/1/08 22:29:14  13 13 SEVEN THOUGHT CHALLENGE QUESTIONS What would I tell a friend who said the same thing? If I wasn’t feeling like this, what would I say? Am I basing this on how I feel rather than the facts? What would other people say? Have I heard different opinions from others about the same thought? Am I looking at the whole picture? Are there any other ways of explaining the situation that are more accurate? What would I say about this looking back six months from the future? Do I apply one set of standards to myself and another to others? by Chris Williams, 2005. Taken from www.livinglifetothefull.com • • • • • • • Asking ourselves the following questions might be helpful in challenging anxious fears: Some people fi nd it is not important to look for answers about what caused them to become so anxious. 62856 Anxiety.indd Sec2:15 62856 Anxiety.indd Sec2:15 15/1/08 22:29:14 15/1/08 22:29:14