Ocd - anxiety

From : http://www.firststeps-surrey.nhs.uk/anxiety.htm
Anxiety: the low-down

We all experience anxiety from time to time. Anxiety is part of the body’s natural response to danger – a means of alerting the mind to impending threat and ensuring we stay out of its way. But for some people anxiety can become overwhelming, continuing for prolonged periods of time and seriously affecting their ability to get on with everyday things. It’s estimated that more than one in ten people are likely to have a ‘disabling anxiety disorder’ at some point in their lives.



With generalised anxiety it’s not always clear what is making someone feel anxious. People often report being aware of feeling anxious all the time. When there’s no identifiable cause, people can then become anxious about feeling anxious, and a vicious circle begins. This type of anxiety can often relate to a particular underlying thought or belief that a person has about themselves or about the world in general. It can be very difficult for an individual to spot these kinds of beliefs because they are often a part of what makes us the people that we are.



Sometimes anxiety can take the form of panic. During a panic attack, the heart starts pounding and the person can feel shaky, sick or unable to breathe properly. Serious panic attacks can prevent people from going out or going to work. For more information on panic attacks, click here.



Anxiety can also manifest itself as a phobia, whereby people develop intense fears of particular situations or things. With phobias, people can be afraid of going outside, of being in crowded places, or of particular animals or insects.



In another expression of anxiety, people develop what is known as an Obsessive-Compulsive Disorder (OCD). This is when people try to control their anxious feelings by performing certain actions over and over again, such as washing their hands, checking they have locked the door or turned off the gas. For more information on OCD, click here.



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Causes

Why do people suffer anxiety disorders? It is likely that many factors contribute to a person’s chances of developing an anxiety disorder. Experts have broken down the potential causes into three groups: genetics, brain chemistry, and the ‘fight or flight’ mechanism.

* Genetics

o Anxiety disorders tend to run in the family. If a parent has anxiety problems, their children will have a higher chance of developing anxiety themselves.
o Growing up in an abusive household can also influence predispositions or tendencies for nervousness and anxiety.
o Research shows a genetic tendency for chemical imbalances (see below) in people with anxiety, which owes much to inherited brain structure and processes.

* Brain chemistry

o Chemical imbalances in the brain can affect the way our ‘neurotransmitters’ (chemical messengers) regulate our thoughts and feelings. An imbalance of the brain’s two main neurotransmitters, serotonin and dopamine, can cause people to feel anxious or depressed.

* ‘Fight or flight’

o When the body is under threat it automatically prepares to either defend itself or run. This ‘fight or flight’ mechanism (that also triggers feelings such as anger, causes our heart rate to increase, our eyes to dilate, and the body to ready itself for a dangerous situation. Even though these effects are intended to help us survive, sometimes the body misunderstands a situation; perceiving danger when in reality there is none (sitting an exam, giving a speech, etc), leading to anxiety.

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Signs and symptoms

Anxiety is a mixture of thoughts, feelings, physical and behavioural symptoms.

Physical symptoms:

* Dizziness
* Headaches
* Periods of intense heart-pounding
* Tingling sensations and/or pins and needles
* Tremors
* Muscle aches
* Stomach upsets
* Loose bowel movements
* Periods of feeling winded
* Excessive thirst
* Frequent passing of water
* Failure to respond to sexual stimulation
* Painful or stopped periods in women

Thoughts and feelings:

* Worries and catastrophic thoughts (anticipating the worst outcome)
* Overestimation of danger
* Underestimation of coping abilities
* Underestimation of help available
* Feeling nervous, anxious or panicky
* Feeling irritable, easily lose their patience
* Becoming depressed and/or
* Becoming preoccupied or obsessed with one particular subject
* Having difficulty concentrating
* Having difficulty sleeping

Behavioural symptoms:

* Avoiding situations where anxiety may occur
* Leaving situations when anxiety begins to occur
* Trying to do things perfectly to prevent danger
* Trying to unrealistically predict the future in order to control events and therefore manage anxiety

The relationship between thoughts, feelings, physical symptoms and behavioural symptoms can create a vicious anxiety cycle that can be easily triggered and hard to break. If people fear or are anxious in certain situations, they can experience some of the physical symptoms above. These symptoms are unpleasant and can trigger thoughts such as ‘Something awful is going to happen’, ‘I am going to faint or have a heart attack’. Such thoughts can then lead people to behave in a way that will get them out of the situation or take precautions they think will help them cope (e.g. having a drink), but which in turn can just reinforce the anxiety.



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Selfhelp toolbox
Self-help: dealing with anxiety

The good news is that there are some very effective techniques for dealing with anxiety disorders. Most of these take a practical, step-by-step approach to coming to terms with the problem and addressing the physical symptoms and unhelpful thoughts and behaviours. Here are few examples:



1. Relaxation



To manage your anxiety you must first reduce the severity of your physical symptoms through relaxation. Relaxation could merely consist of doing something you find relaxing, such as reading, watching TV, listening to music or doing exercise. Such activities can help you unwind by taking your mind off any tension you might be experiencing.

Or, relaxation can take the form of a very specific technique, such as:



Distraction techniques help to take your attention away from anxious thoughts:

* Try to visualise a pleasant scene in your mind; perhaps somewhere you’ve been where you felt calm and happy – or an object, like a flower or your favourite car. Really concentrate on it, bring it to life in your mind.

* A ‘bridging object’ such as a photograph or souvenir from a happy time can, when looked at, help trigger positive thoughts and reduce anxiety.

* Try doing a puzzle or sums in your head, or reading a good book, or counting the number of red doors you see on your way home, or imagining what the people you see do for a living.

Once you are able to use distraction techniques effectively, try not to remain dependent on them, but also learn to challenge the anxious, frightening thoughts you’re experiencing (see number 2 below).



Simple breathing techniques can also help you relax. When you become anxious or frightened you often start to breathe more quickly, irregularly and shallowly, causing oxygen to be pumped around the body faster than normal, leading to tingling sensations, faintness and dizziness. One of the effects of over-breathing, often associated with anxiety, is that you feel you need more air when actually you don’t.



Try to recognise if you’re doing this and slow your breathing down. If breathing can be controlled, the severity of symptoms may be reduced and conditions successfully managed. It’s important that you establish a regular breathing rhythm, such as “in two-three, out two-three”, until things have returned to normal. To find out more about how to get your breathing under control, click here.



Deep muscle relaxation is great for anyone experiencing stress or anxiety. To practice deep muscle relaxation:

* Find a quiet, warm and comfortable place

* Choose your most relaxed time of day

* Lie down, get comfortable, close your eyes and concentrate on your breathing for a few minutes, breathing slowly and calmly

* Say the word “calm” or “relax” to yourself as you breath out

* Breathe in when you tense your muscles and breathe out when you relax

Then, work through your muscles in order:

* Start with your hands. Clench one fist tightly and take note of the tension this produces in the muscles in you hand and forearm. Concentrate on this tension and then relax your hand

* Do the same with the other hand

* Now work through other muscle groups in the same way. Each time you relax a group of muscles think how they feel when they are relaxed. Don’t try to relax but just let go of the tension. Allow your muscles to relax as much as you can. Think about the difference in the way they feel when they are relaxed and when they’re tense

It is useful to stick to the same order as you work through the muscle groups:

* Hands - clench fists, then relax

* Arms - bend your elbows and tense your arms. Feel the tension especially in your upper arms. Remember, do this for a few seconds and then relax

* Neck - press your head back and roll it from side to side slowly. Feel how the tension moves. Then bring your head forward into a comfortable position

* Face - there are several muscles here, but it is enough to think about your forehead and jaw. First lower your eyebrows in a frown. Relax your forehead. You can also raise your eyebrows, and then relax. Now, clench your jaw, notice the difference when you relax

* Shoulders - shrug your shoulders up - then relax them

* Chest - take a deep breath, hold it in for a few seconds, notice the tension, then relax. Let your breathing return to normal

* Stomach - tense your stomach muscles as tightly as you can and relax

* Buttocks - squeeze your buttocks together and relax

* Legs - straighten your legs and bend your feet towards your face then relax

To make best use of relaxation you need to:

* Try to practice regularly – ideally every day if you can

* Start to use relaxation in everyday situations

* Learn to relax without having to tense your muscles first

* Use parts of relaxation to help in difficult situations, eg breathing slowly

* Try to develop a more relaxed lifestyle

2. Identify common thinking errors and challenge unhelpful thoughts.



Initially, try to identify any patterns in your anxiety by making a note of the times when you are more anxious than usual (e.g. if you would normally rate your anxiety at 6 on a scale of 1 – 10 where 1 is not anxious and 10 is extremely anxious, make a note of the times when your anxiety goes up to an 8 or 9). Then, once the times have been identified, try to think about what was happening at those times. What were you doing, who were you with, what time of day was it etc.? The next thing to note down and try to identify is: “What was I thinking at the time that led me to feel more anxious”? If you find this difficult or if nothing comes to mind, have a think about any images or memories that came up. Quite often, when our thoughts have been identified, they can be categorised into common thinking errors. These are:



Awfulising/catastrophising : thinking the worst and overestimating the chances of disaster, e.g. whatever can go wrong will go wrong, or viewing a setback as being part of a never-ending pattern of defeat. Ask yourself:

* What is the evidence for and against these thoughts?

* How many times have you had these thoughts?

* Have your worst fears ever materialised?

* What would you say to a friend who expressed similar thoughts about themselves or their lives?

The process could look something like this:



Anxious thought
I want to go on holiday, but I’m afraid that my plane will crash.



Evidence for
Aeroplanes crash from time to time.



Evidence against
Flying is actually the safest form of transport. Air crashes are very rare.



New Thinking
If I’m afraid of flying I should be afraid of driving too, as there are more accidents on the roads than in the air. So, maybe I shouldn’t worry about flying anymore. I’m going on holiday!



Jumping to conclusions (predicting the future): e.g. “I’ll never be able to do that.” Look for the evidence, how do you know you won’t be able to? Think of previous successes you have had.



Living by fixed/inflexible rules: e.g. constantly saying “must, should, ought…” Tell yourself to stop trying to be perfect. You can live according to your principles/rules, but don’t punish yourself if you can’t always keep to them.



All or nothing thinking: thinking in absolutes with no middle ground; black and white or good and bad, and a tendency to judge people or events using general labels, such as: “If I do that they’ll think I’m stupid”, “I’m a failure”. Try to see and allow for a middle ground and think about what evidence there is for and against your labelling.



Personalising: taking responsibility and blame for everything that goes wrong. Try to recognise the role of other factors and people when things go wrong, and remember that sometimes in life things just go wrong with nobody to blame.



Once you have identified what thinking error(s) you might be making, try to challenge your anxious thoughts. If you can’t think of how to challenge them, ask for advice from (or imagine the advice you would give and get from) two people you trust/admire.



3. Get active



Another strategy is to take aerobic exercise. Any low impact physical activity that leaves the heart racing slightly (e.g. swimming, brisk walking, gardening, dancing, yoga), but not involving carrying heavy weights or sudden exertion, will help.



By effectively giving the heart exercise it will, like any other muscle, become stronger. Exercise will help to release anxious tension and will stimulate the body’s own natural antidepressant chemicals, for more information about physical activity/exercise click here. A stronger heart will be less prone to the kind of pounding that can make the physical symptoms of anxiety so unpleasant.



4. Put your foot down – say “no” from time to time



It’s all too easy to become overloaded. Saying ‘yes’ all the time to other people’s demands and taking on more and more can lead to excessive pressure, which in turn leads to stress and anxiety. It’s healthy and perfectly acceptable to put your foot down and say “no” now and then.



This may mean a quick lesson in assertiveness: assertiveness is a way of expressing feelings, thoughts and beliefs in an open and honest manner without violating the rights of others. Assertiveness is a healthy alternative to aggression (where we abuse other people’s rights) or passiveness (where we abuse our own rights).

By being more assertive people can make sure their needs and rights are met, which can reduce tension.

For information on assertiveness, click here or visit www.pmhtglos.org.uk/assertive.htm



5. Improve communication



Talking things over with family, friends and loved ones, or other people that you trust, can be a very helpful process. Whatever you’re going through, open and honest communication can lift the burden and make you feel a whole lot better. Certainly don’t bottle things up. Talk to people about how you feel. If you find this difficult, your GP/doctor may be able to recommend a counsellor.

Alternatively, try contacting one of the telephone/email support agencies listed below and in the Useful Contacts section of this website.



There are probably many people out there who are experiencing similar feelings to you. If you think you would benefit from talking to them, there may be a local group in your area, or a website forum where you can chat online. Call First Steps to find out what’s available locally.



For other general self-help techniques, click here.