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Symptom scan

22/4/2016

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Now that we’ve realised we are going to be uncomfortable at times while we learn to deal with our anxiety, it’s time to delve a bit deeper into the discomfort.  Why does an anxiety attack feel so terrible, at times almost unbearable?  Remember, anxiety attacks can produce both physical and psychological symptoms.  Physical symptoms are felt as sensations in our body.  Psychological symptoms are felt as perceptions and emotions in our minds.  One of the main psychological symptoms is usually a feeling of fear or terror, which may be accompanied by a feeling of dread or impending doom.  It can feel like a big dark wave approaching, ready to sweep us away.

The symptom scan is one of the most useful tools I have found to deal with anxiety attacks.  It takes this perception of an anxiety attack as one big wave of doom sweeping over us, and breaks it down into its component parts.  The technique is very simple:  scan through your body, noticing each symptom, where it is and how it feels, and then describing it to yourself.  For example:  “very tense abdominal muscles, buzzing sensation in tummy area, rapidly pounding heart, tight feeling in throat, dizzy feeling in head”.  It’s important to actually describe your observations very specifically in words to yourself.  By breaking the overall anxiety attack down into smaller, distinct sensations, our perception of it can change from a single “wave of doom” to a collection of uncomfortable physical sensations in the body.  It also helps move our perception of the attack away from being mainly inside our head, out into the various parts of the body.

Remember that our brain may interpret the physical fear response as emotional fear.  We can learn to reinterpret our fear response as just a collection of uncomfortable physical sensations.  In fact, we can even use these kinds of terms in our self-talk to reassure ourselves and convince our brain that we really are safe and there is nothing to fear.  The pounding heart is just from adrenaline making our heart beat harder and faster.  It’s just a physical symptom producing an uncomfortable sensation.  When we reinterpret what we are feeling in this new way, the “wave of doom” goes away.  By reducing our emotional fear, the intensity of the fear response may be reduced, because we are no longer feeding the anxiety cycle with more fear.  Sometimes, just practising this technique is enough to stop an anxiety attack completely.

One of the difficulties in learning this technique is that you have to go “into” the sensations, when our natural instinct is to avoid and resist them.  By having the courage to really feel the symptoms, we can learn to be more accepting of them.  We also become better at observing what is really going on in the body, rather than being overwhelmed by the perceptions and interpretations our mind puts on the situation. 

So the symptom scan technique can have two benefits.  Firstly, by reducing our interpretation of the anxiety attack as “fear”, we stop feeding the anxiety cycle, and so the intensity of the anxiety attack may be reduced.  Secondly, even if anxiety symptoms persist, by reinterpreting the symptoms as not fear but simply a collection of uncomfortable physical sensations, they becomes easier to accept and more tolerable.  The more you practise this technique, the easier it will get, and the quicker you’ll be able to feel these benefits.

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Get comfortable with discomfort

20/2/2016

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Okay, so you’ve committed to change, and you’re ready to learn new skills and practise them.  The next step is to accept that sometimes during this process you are not going to feel great.  One of the problems with taking medication to remove our anxiety is that it can work too well.  We take the pills, our anxiety goes away, so we feel great!  We stop taking the pills and our anxiety returns, so we feel terrible.  In this scenario we are never going to learn to deal with anxiety, because it is either overwhelming us, or it is absent, so we cannot begin to learn how to deal with it.

Our society has become used to being comfortable at all times.  When we are uncomfortable, we believe something is wrong and needs to be fixed, preferably as soon as possible.  There is a quick fix for everything.  Headache?  Pop a pain pill.  Too cold?  Turn on the heater.  Too hot?  Turn on the air conditioning.  You get the idea.  We can’t stand being uncomfortable even for a minute.  What we need is a shift in our thinking.  Maybe we need to learn that a little discomfort really isn’t that bad.  Sometimes it may even be necessary.

If you want to learn to deal with anxiety (without numbing it away with pills), you are going to be uncomfortable sometimes - maybe for quite a while, because the new skills can take some time to learn.  You need to fully understand that it is all right to be uncomfortable.  Discomfort won’t hurt you - it just feels a bit unpleasant.   I really want to emphasise these points, as they are so important:
  1. Experiencing discomfort may be necessary to the process.
  2. Experiencing discomfort is OKAY.

Important: the discomfort referred to here is that produced by anxiety symptoms.  Some more serious medical conditions could produce similar symptoms, so be sure to get a medical check-up.

Warning: if you are taking medication for anxiety, do not suddenly stop taking it.  See the resources page for a link about this.

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Commitment to Change

28/12/2015

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Someone once said “If you keep on doing what you’ve always done, you’ll keep on getting what you’ve always got”.  We are all hoping for a magic cure for whatever it is that ails us.  We hope that the result we want will be provided for us by our doctor, our medication, our psychologist/therapist/counsellor, the expensive workshop/seminar/retreat/book/CD/whatever-it-is that we bought.  The bottom line is:  nobody can really change you except you.  It all comes down to you making changes, taking some action. 

In general this action will need to be taken repeatedly, in order to build new patterns and habits.  It takes sustained effort.  It doesn’t come in pill form.  Yes, there are pills that can be prescribed for anxiety, but being dependent on a pill is disempowering, and comes with its own set of problems.  Instead you can empower yourself with tools you can carry around inside you for the rest of your life. 

Some people may try to convince you that you have some kind of permanent defect and will need to be medicated for the rest of your life.  Do not buy into this attitude.  You are not broken, and you don’t need fixing.  There is something in your life that is not working well for you, and you want to change it.  This is a learning process.  We don’t send children to school because they are broken and need fixing, we send them to learn, to expand their knowledge and skills.  If you really want to help yourself, then you need to learn new skills and practice using them until they work well for you.  Gaining new skills is incredibly empowering.  Commit to this process as a positive learning experience.

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Breaking the Anxiety Cycle

15/4/2015

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Now let us examine the places in the anxiety cycle where we may be able to interrupt or change it.
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Firstly, and most obviously, removing the trigger will help to remove some of the stimulation to the nervous system.   Some kinds of triggers may be relatively easy to remove, while others may not.  For example, traumatic events that have already occurred cannot be undone, but anxiety-producing thinking patterns may be able to be altered with some effort and practice.

Secondly, the nervous system may be able to be calmed using the opposite of the fear response, the relaxation response.  While the fear response involves the sympathetic nervous system, the relaxation response involves the parasympathetic nervous system.  Invoking the relaxation response can alter the balance of the nervous system away from sympathetic dominance towards a more normal balanced state. 

Thirdly, the link between anxiety symptoms and fear can be removed, or at least reduced.  This link is what Dr. Claire Weekes refers to as “second fear”, the fear of the anxiety itself.  It is this “second fear” that can perpetuate an anxiety disorder long after the trigger has gone.  If we can learn to break this link, we need never fear an anxiety attack again.

Interrupting the cycle at any of these three places will be helpful in reducing anxiety; however addressing all three together will be the most effective approach.  Now that we know where to break the anxiety cycle, we can introduce specific techniques to do this.
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The Anxiety Cycle

13/3/2015

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A sensitised nervous system and anxiety state can be maintained by a cycle of anxiety and fear.  This may continue for many years unless the cycle is broken at some point.  The cycle begins when some trigger stimulates the nervous system to the extreme, producing an extreme fear response and anxiety symptoms.  This may happen suddenly, with a single event trigger, or may build up gradually over time with an ongoing situation being the trigger.  I have already mentioned some of these triggers in the previous post – traumatic events, chronic stress, health conditions, and anxious thinking patterns.  What happens next is crucial to the creation of the cycle.

When anxiety symptoms hit us, two things may happen.  If we have never experienced an anxiety attack before, it can be very frightening, and we may feel confused and panicky, wondering what the heck is happening to us.  Even if we have experienced them before, it can still be frightening, as it feels as if our body is out of control with weird uncomfortable sensations.  As it begins we may feel anticipatory fear (“oh no, not this again”), or we may be afraid of what the attack is doing to our body (“my heart is pounding so hard, what if it is damaging itself?”).  Of course, these anxious thoughts go on to produce even more fear.

The other thing that may happen is that a part of our brain interprets the physical fear response as emotional fear.  That is, a part of our brain understands that the fear response occurs when we are afraid, so when the physical fear symptoms begin, it interprets the response as the fear emotion  (“adrenaline is rushing around my body, my heart is pounding hard, so I must be very afraid”).  This kind of fear is a lot more subtle and tends to happen below the level of conscious awareness.

At this point, we are experiencing anxiety symptoms and adding in even more fear (and anxious thoughts which produce more fear), which of course stimulates the fear response from the nervous system, which produces more anxiety symptoms and so on.  We now have an endless cycle of fear and anxiety, maintaining the nervous system in the ‘sensitised’ state, i.e. sympathetic dominance. 

See the diagram below for a simplified view of the anxiety cycle.  Note that the trigger may be ongoing and continue to feed into the cycle, or the trigger may cease but the cycle continue regardless.  The “fear” step includes both the fear emotion, and anxious thoughts which produce the fear emotion.  Regardless of where the fear comes from, it stimulates the nervous system to produce the fear response.   Next time we will be looking at ways that this vicious cycle can be broken.
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The sensitised nervous system

1/2/2015

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There can be various causes of the nervous system getting into a ‘sensitised’ state of sympathetic dominance.  Some are mainly physical, others may be more psychological in nature.  Some examples are:

  • An extremely stressful or traumatic event (for example: loss of a loved one, job loss, major injury)
  • Severe chronic stress, from an ongoing situation, for example:
    o   ongoing health problems of self or other family member
    o   threat of losing job or home
    o   stressful work situation
    o   career ‘burnout’
    o   relationship problems
    o   separation/divorce
    o   financial problems
  • Some medical conditions, particularly those that affect the nervous and endocrine systems  (e.g. overactive thyroid)
  • Extreme hormonal changes, for example after childbirth (an extreme form of ‘baby blues’) or around menopause
  • Major surgery, particularly abdominal surgery (interrupts normal breathing patterns making hyperventilation more likely), or when there is a lot of blood loss
  • Chronic unhealthy thinking patterns (habitual worry, catastrophizing, resistance, avoidance, negative self-talk)

    Sometimes it can be a case of the ‘perfect storm’ of factors coinciding at a certain time of your life.

    When the nervous system becomes ‘sensitised’, it is more sensitive than normal.  It is hypersensitive, and overreacts to stimuli.  The sympathetic and parasympathetic sides of the nervous system are out of balance – the sympathetic system is too dominant.  The nervous system becomes stuck in ‘fight-or-flight’ mode.  The brain becomes hyper-alert, so even small stimuli can set off a disproportionate reaction, including big surges of adrenaline.  The mind can race or become stuck in obsessive thought patterns.  Sleeping may be difficult and appetite may be reduced or it may be difficult to eat at all.  It can be difficult or impossible to ever feel relaxed or comfortable when in this state.

    Unfortunately this sensitised state can be easily maintained by a vicious cycle of anxiety and fear.  The good news is that this state does not have to be permanent - the cycle can be broken.  More about the anxiety cycle next time.





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What is an anxiety disorder?

14/12/2014

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There are many variations of these patterns, and these are generally diagnosed as some kind of ‘anxiety disorder’.  Doctors use definitions for different kinds of anxiety disorders, such as generalised anxiety disorder, obsessive-compulsive disorder, and so on.  Personally I do not like the term ‘anxiety disorder’ since it implies the person has worried themselves sick, and that the disorder is entirely mental in origin, ignoring physical factors.  While this may be the case for some, there are other causes and for those people the diagnosis of ‘anxiety disorder’ is confusing and makes no sense to them.  I prefer Claire Weekes’s term ‘sensitised nervous system’, or even ‘sympathetic dominance’, a term that is sometimes used to describe the imbalance of the autonomic nervous system.  I believe that so-called ‘anxiety disorders’ are nervous system disorders rather than psychological or psychiatric disorders.  Of course, there is usually a psychological component, which can work to lock us into a self-perpetuating anxiety cycle.  I believe that when addressing these disorders, it is important to include both mental and physical approaches.  We need to find ways to break the anxiety cycle, and to restore the right autonomic balance.



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Causes of anxiety attacks

30/10/2014

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Anxiety attacks can be “one-off” or very occasional events, or may be part of an ongoing pattern.  For example, a friend of mine told me of an experience she had, when she was travelling on a long international flight and had become ill, probably with some kind of ‘flu virus.  By the time she reached her destination, she was feeling exhausted, run-down, sick from the virus, and probably running a fever as well, and psychologically she was probably anxious about becoming sick while travelling to a foreign country.  All of these factors combined together resulted in her having a panic attack at the destination airport.  This kind of event is something could happen to anyone and not necessarily part of an ongoing anxiety disorder.  The situation becomes too much for the person to cope with and the extreme stress triggers the extreme fight-or-flight response.  It usually blows over within about thirty minutes.  This kind of panic attack can occur as a one-off or very occasional event and does not mean the person has an anxiety disorder.

Anxiety attacks can also be part of an ongoing pattern.  Often the nervous system is in a much more sensitive state than ‘normal’ and so panic attacks can be triggered more easily.  Dr. Claire Weekes refers to this state as the ‘sensitised nervous system’.  In this state the nervous system is hypersensitive and overreacts to stimuli.  An extreme fight-or-flight response is triggered when the situation does not warrant it.  There is no angry bear chasing us in reality, but our nervous system reacts as if there is.  For some people, these attacks are triggered by something specific, such as a flight, drive, meeting, speech, test, etc.  For some people, when the nervous system is extremely sensitised, an ongoing anxiety state can exist, like an anxiety attack that continues instead of blowing over within a few minutes like a more ‘typical’ panic attack. 
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What is an anxiety attack?

1/7/2014

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So now we have looked briefly at the normal sympathetic nervous system responses and the normal fear responses, let’s look at anxiety attacks.  Technically an anxiety attack is the same as a panic attack, although personally I think of an anxiety attack as being the milder version and panic attack as the more extreme version.

An anxiety attack or panic attack occurs when these normal responses occur suddenly in an extremely exaggerated way, especially when the situation does not seem to warrant it.  Sometimes there is an obvious trigger, particularly something we are fearful of, but sometimes there is no obvious trigger, or the cause may be something physical that we are not even aware of.

Symptoms of panic attack can be psychological or physical or both.  Psychological symptoms can include a feeling of impending doom or dread, intrusive thoughts, fear of losing control, going crazy or that life as you know it is over, feeling restless or agitated and unable to relax or stay calm.  Physical symptoms include racing and/or pounding heart, feeling hot and/or cold, faintness or dizziness, shakiness or shivering, ‘butterflies’ in the tummy, nausea/vomiting, tightness in the throat, tingling hands, breathlessness, feeling of ‘air hunger’, feeling of vibration in the chest and many more.  Hyperventilation is an abnormal breathing pattern that is often associated with anxiety and panic attacks.  Rather than just a collection of symptoms, the attack can feel like an intense wave of doom sweeping over you, which may invoke feelings of helplessness and despair.

Panic attacks can even mimic heart attacks because hyperventilation can cause constriction of coronary arteries, giving people a sensation of tightness in the chest.  People having panic attacks may call an ambulance or race to their local A&E clinic worried about their hearts.  Doctors can run tests, such as an ECG, to determine whether there is a real heart problem or not.  Also, sometimes the heart can beat in strange rhythms, when it feels as if there are missed beats or double beats.  Some heart arrhythmias are dangerous and others are not, and again doctors can check these out to make sure.  Many people have mild arrhythmias occasionally that are not dangerous and nothing to worry about.

Most of the symptoms of anxiety attacks are caused by the hormone adrenaline (otherwise known as epinephrine).  The sympathetic nervous system communicates to the adrenal glands that adrenaline is needed and it is quickly secreted into the bloodstream and away it goes to every part of the body to do its work.  Remember, we need to run from the threat to our safety, and so adrenaline stimulates our heart to pump harder and faster, and our breathing to increase, our blood vessels to route blood to our skeletal muscles to help us run faster.  Our senses become more sensitive, our brain becomes more alert, our pupils dilate to allow more light in so that we can see better.  Our bodies are preparing for extreme action.  Our bodies can cope with these effects, and they do this normally in situations such as intense exercise at the gym or when running to catch the bus.  When we are on the treadmill at the gym, a pounding heart feels quite normal and expected.   But when we are just sitting at a desk, say, we are not expecting the thumping heart and it feels very strange and uncomfortable and it might even scare us. 

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What is the fear response?  

2/6/2014

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Before going into more detail about anxiety attacks, let’s first take a quick look at the body’s fear response, because anxiety is all about fear.  A fear instinct can be very important to the survival of a species.  When an animal senses danger, the fear response is triggered so that the animal can respond to the danger appropriately.  This is known as the ‘fight-or-flight’ response (or sometimes the ‘fight, flight or freeze’ response).  The animal may flee to safety, or prepare to fight an enemy, or may even ‘freeze’ in an attempt to avoid detection.  In modern-day life we do not often have to run from predators or fight enemies, however the response can still be useful in some situations of physical danger.  

Many present day situations that cause us to feel fear are not about physical danger.  We may feel fear in situations where we are under pressure to perform, such as when taking an examination or giving a speech to a large group of people.  We may also worry and feel fearful about things we have very little control over, such as being a passenger on an aeroplane.  Whatever the trigger, the physiological response is much the same.  The sympathetic nervous system is stimulated.  

In our bodies, the autonomic nervous system (‘automatic’ part of the nervous system) has two subsystems called the sympathetic and the parasympathetic.  These two subsystems are in a kind of balance with each other, so that when one is more active the other is less active.  The sympathetic side is more active when we are more active, and the parasympathetic is more active when we are at rest and our body is digesting nutrients and doing repairs and restorative work.  During the fear response, sympathetic activity increases hugely, and parasympathetic functions such as digestion and repair shut down.  The body is preparing for action, possibly of an extreme kind – fighting for or running for your life.
 
Various parts of the brain and nervous system are involved in this response.  The adrenal glands (which sit on top of the kidneys) release a hormone called epinephrine – otherwise known as adrenaline – which produces a whole set of responses in the body.  Everyone has heard of adrenaline – we talk about an ‘adrenaline rush’ when we do something scary and/or exciting such as go on a roller coaster ride.  The body can’t really tell the difference between excitement and fear, it’s all in how we perceive the event.  If we enjoy roller coaster rides, we won’t be afraid and it will seem exciting, but if we don’t like them it may seem very scary.

What happens in the body during the ‘fight-or-flight’ response?
  • Breathing rate increases – to get plenty of oxygen into your blood
  • Heart beats faster and stronger – it needs to pump lots of oxygenated blood to your muscles
  • Blood is redirected to the skeletal muscles – so that we can fight or run away
  • Digestive processes reduce – you might experience stomach ache or nausea
  • Salivation reduces  – you might experience a dry mouth
  • Perspiration increases
  • Pupils dilate – so you can see (the danger, your escape route, etc.) more clearly
  • Increased alertness, senses may become more sensitive
These things also happen during some normal activities that are not associated with fear, such as during physical exercise.  The sympathetic and parasympathetic are always finding the right balance according to the needs of the body at the time.  When we are exercising, we expect to breathe faster and harder, we expect our hearts to pump faster and for our skin to perspire.  This is all normal stuff and not scary at all to most of us.

So far, so good, this is all normal stuff…
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