Normal Anxiety and an Anxiety Disorder

Normal Anxiety and an Anxiety Disorder

Normal Anxiety and an Anxiety Disorder

To be covered this week

• Understanding the difference between normal anxiety and an anxiety disorder

• Recognise the symptoms of anxiety as a stress response

• Differentiate different anxiety disorders from each other

• Understand common trauma and stress-related disorders

• Consider management strategies for anxiety and trauma- & stress-related disorders

CLICK HERE TO ORDER YOUR Normal Anxiety and an Anxiety Disorder

Anxiety

• Is normal • Stress, fear and anxiety occur in response to a stressor (e.g. a sabre toothed tiger ) • The purpose of anxiety is to prepare the body for ‘fight’ or ‘flight’ (not fright). • All animals have anxiety systems that are designed to help them survive. • The anxiety system alerts the body for action and enables us to react swiftly and efficiently. • Anxiety helps us to conquer the unknown and survive. • It drives us forward, giving us the impetus to succeed. Without making use of anxiety systems, man would

never have evolved, never reached the moon or even explored the world. • It is by making positive use of the physical reaction of anxiety that humans have become the dominant

species on earth. • Animals are controlled by anxiety; humans have learned to control theirs.

Anxiety occurs on a continuum

• Mild uneasiness/hyperalertness terrifying panic

Anxiety disorders are characterised by symptoms that • Are more severe • Are longer lasting • Interfere with occupational, social and relational functioning

Anxiety Disorders

• “anxiety symptoms are commonly experienced as high levels of fear with thoughts of imminent danger and perception of risk, escape/avoidance behaviours and notable physiological arousal on presentation of an anxiety trigger” (Elders, 2017).

• 5 Signs And Symptoms Of Anxiety & Panic Attacks • https://www.youtube.com/watch?v=YtBvjo3wCzQ

How does anxiety work?

• The physical sensations of anxiety are triggered by the brain interpreting a given situation as anxiety provoking.

• The sympathetic nervous system passes a message to the adrenal glands, which in turn pour the hormone adrenalin into the blood stream.

• Anxiety is closely related to other emotions such as excitement and anger. The only difference between these emotions is the interpretation the brain places on it.

• Imagine two passengers in the back seat of a very fast car. One might interpret the situation as exciting and exhilarating whilst the other might interpret it as fearful and anxiety provoking. They would both be experiencing the same physiological reaction (the release of adrenaline). The difference is in the interpretation of the situation (the psychological).

Physiological Response

Cardiovascular • Palpitations • Racing heart • Increased blood pressure • Feeling faint or actually fainting

Respiratory

• Rapid breathing • Shortness of breath • Shallow breathing • Breath holding • Choking sensation

Neuromuscular

• Muscle spasms • Tremors • Muscle rigidity • Fidgeting • Heightened reflexes • Wobbly legs • Back pain

Gastrointestinal

• Abdominal discomfort • Nausea • Vomiting • Loose bowel motions • Poor appetite • Gastric reflux

Skin

• Flushed • Pale • Sweating • Cold and clammy • Itching • Hot and cold

Cognitive Symptoms

• Hazy, cloudy, foggy mind. • Hypervigilance • Feelings of unreality – depersonalisation/derealisation • Difficulty thinking • Confusion • Unable to control thinking • Racing thoughts • Fear of losing control

Emotional symptoms

• Fear • Terror • A sense of impending doom • Dread

5 Signs And Symptoms Of Anxiety & Panic Attacks

• https://www.youtube.com/watch?v=YtBvjo3wCzQ

What Goes Wrong?

• Basically we learn to be anxious when there is no threat to our being. • We do this by interpreting events as stressful when they’re not. • The body has no way of knowing if a stressful situation is real or imagined unless the brain thinks

it is so. • When we start to get anxious we tend to think negatively and this negative thought pattern creates

the environment for more frequent episodes of anxiety. • Negative thoughts turn safe situations into stressful situations and this leads to increasing anxiety. • Example: Bob learns to be anxious

The anxiety course

• Stress Anxiety Negative Thinking Avoidance Reduced Anxiety

• Avoidance reduces anxiety but avoidance results in severe limitations to people’s lives • Avoidance reinforces/strengthens anxiety

Generalised Anxiety Disorder • Constant excessive worry about everyday things Diagnostic Criteria • Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at

least 6 months, about a number of events or activities (such as work or school performance). • The individual finds it difficult to control the worry. • The anxiety and worry are associated with three (or more) of the following six symptoms (with at

least some symptoms having been present for more days than not for the past 6 months): • Note: Only one item is required in children. • Restlessness or feeling keyed up or on edge. • Being easily fatigued. • Difficulty concentrating or mind going blank. • Irritability. • Muscle tension. • Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep) (APA,

2013).

Generalised Anxiety Disorder

• GAD (5 minutes 10 sec) • https://www.youtube.com/watch?v=9mPwQTiMSj8

Panic Disorder

Diagnostic Criteria • Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense

discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:

• Note: The abrupt surge can occur from a calm state or an anxious state. • Palpitations, pounding heart, or accelerated heart rate. • Sweating. • Trembling or shaking. • Sensations of shortness of breath or smothering. • Feelings of choking. • Chest pain or discomfort. • Nausea or abdominal distress.

Panic Disorder

• Feeling dizzy, unsteady, light-headed, or faint. • Chills or heat sensations. • Paresthesias (numbness or tingling sensations). • Derealization (feelings of unreality) or depersonalization (being detached from oneself). • Fear of losing control or “going crazy.” • Fear of dying. • (APA, 2013) • Panic disorder is essentially the fear of having a panic attack.

Specific Phobia

Diagnostic Criteria • Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving

an injection, seeing blood). • Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging. • The phobic object or situation almost always provokes immediate fear or anxiety. • The phobic object or situation is actively avoided or endured with intense fear or anxiety. • The fear or anxiety is out of proportion to the actual danger posed by the specific object or

situation and to the sociocultural context. • The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. • (APA, 2013).

Social Anxiety Disorder

Diagnostic Criteria • Marked fear or anxiety about one or more social situations in which the individual is exposed to

possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).

• The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).

• The social situations almost always provoke fear or anxiety. • Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, clinging,

shrinking, or failing to speak in social situations. • The social situations are avoided or endured with intense fear or anxiety. • The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the

sociocultural context. • The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

Agoraphobia Diagnostic Criteria • Marked fear or anxiety about two (or more) of the following five situations:

• Using public transportation (e.g., automobiles, buses, trains, ships, planes). • Being in open spaces (e.g., parking lots, marketplaces, bridges). • Being in enclosed places (e.g., shops, theatres, cinemas). • Standing in line or being in a crowd. • Being outside of the home alone.

• The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear of incontinence).

• The agoraphobic situations almost always provoke fear or anxiety. • The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with

intense fear or anxiety. • The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the

sociocultural context. • The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more. • (APA, 2013)

Trauma and Stressor-Related Disorders

• Posttraumatic Stress Disorder (PTSD) • Adjustment Disorder • Acute Stress Disorder

PTSD Note: The following criteria apply to adults, adolescents, and children older than 6 years. A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the

following ways: • Directly experiencing the traumatic event(s). • Witnessing, in person, the event(s) as it occurred to others. • Learning that the traumatic event(s) occurred to a close family member or close friend. In

cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.

• Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).

• Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.

B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s):

• Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).

PTSD

• Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).

• Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.)

• Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

• Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

PTSD

C. Persistent avoidance of stimuli associated with the traumatic event(s) D. Negative alterations in cognitions and mood associated with the traumatic event(s) E. Marked alterations in arousal and reactivity associated with the traumatic event(s) (APA, 2013).

Anxiety Management Strategies

• 5 Top Tips on How To Reduce Anxiety (9 minutes 20) • https://www.youtube.com/watch?v=pq1IMQFTLSM

Monitoring Your Anxiety

Date/Time Anxiety was Felt

Where were you?

What were you doing?

What symptoms did you experience?

How long did the anxiety last?

How did you cope?

Medications

Anxiolytics/Benzodiazepines (e.g Alprazolam, Clonazepam, Diazepam, Lorazepam) • Rapid onset of effect • Reduces anxiety so that people can better engage in psychological treatments • Disadvantages: short half-life; dependence/abuse potential

Beta Blockers (e.g. Propranolol, Atenolol) • Decrease the autonomic response • Disadvantages: worsen asthma and diabetes.

Medications

Antidepressants: (e.g. Fluoxetine, Sertraline, Citalopram) • Anxiolytic properties • Assist with co-morbid symptoms of depression • Disadvantages: dependence/withdrawal symptoms

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

• Elders, A. (2017). Anxiety, trauma and stress-related disorders. In K. Evans, D. Nizette, & A. O’Brien. Psychiatric and mental health nursing, 4th ed. Chatswood, NSW: Elsevier Australia.