Resources

The information below has been taken from: THIS WAY UP online treatment, education and research in anxiety and depression. This site provides on-line courses which may complement individual counselling sessions.

The Black Dog Institute has also launched a website that provides free help for people to manage mild to moderate stress, depression and anxiety online.

Are you struggling with some aspect of your thoughts or behaviour? Worried about a loved-one? Or simply interested in mental health? Spend some time to learn about various disorders and conditions.

Depression

Depression is one of the common human emotional states. It is normal to experience feelings of sadness and tiredness in response to life events, such as losses or disappointments. In most cases, as you come to terms with changes in life, the sad feelings resolve. In situations such as bereavement, these feelings may persist for months and return at significant times such as birthdays and anniversaries related to the lost loved one. In major depressive disorder, there is sadness and loss of interest, difficulty concentrating, negative thoughts about your own performance and thoughts that you would be better off dead. Treatment is indicated when a person has three or more of these symptoms more days than not.

Sometimes people continue to feel sad, even if there seems to be no apparent reason. Some people may become depressed without any clear precipitating event. This is the type of depression which may need more assertive management. Depression may be seen along a continuum: from transient feelings of sadness, to a severe persistent mood change with physical symptoms. Between 20-30% of people will experience a major depressive episode at some stage in their lives.

What is Major Depressive Disorder?

Major depression is a syndrome characterized by persistent low mood, loss of enjoyment and biological symptoms.

Its features include:

  • Low mood or feelings of sadness or irritability, most of the time. The mood may be worse at certain times of day, typically in the morning.
  • Loss of interest in one's surroundings, loss of enjoyment in activities, decreased sex drive.
  • Sleep disturbance: difficulty getting off to sleep, or waking in the early hours of the morning and finding yourself unable to get back to sleep.
  • Negative thoughts regarding yourself, surroundings and future. Often a person may become guilty over real or perceived misdeeds. In severe depressions of a 'psychotic' type, the person may develop untrue beliefs regarding themselves and others, and may experience hallucinations.
  • Appetite disturbance: increase or decreased, which may be accompanied by weight changes.
  • Fatigue and loss of energy
  • Physical symptoms such as vague abdominal discomfort and headaches, often associated with anxiety.
  • Problems with concentration and memory difficulties.
  • Feelings of agitation or feeling 'slowed down'.
  • Thoughts of death or suicide: such thoughts indicate the need for professional help.

Anxiety

Having an anxiety disorder is not the same as being highly anxious. The level of anxiety (difficulty catching your breath, heart beating fast, shaking and sweating) depends on the stress you are under and your ability to cope with that stress. Becoming moderately anxious is valuable, because it will enable you to cope better. Becoming too anxious can be a problem because severe anxiety reduces capacity to cope with stress. Everyone should learn strategies to manage their level of anxiety. The anxiety disorders are different and are characterised by specific patterns of thoughts, behaviours, and emotions that persist even when there is no stress, in fact, the thoughts themselves generate anxiety.

Panic Disorder

Panic Disorder occurs when the person has both recurrent panic attacks and either a fear of having another panic attack or a fear of losing control, having a heart attack, or "going crazy". If the person avoids certain situations out of fear that these attacks will occur, they may have Agoraphobia as well as Panic Disorder.

What are panic attacks?

Panic attacks are sudden periods of intense anxiety or fear, where four (or more) of the following symptoms develop abruptly and peak within 10 minutes:

  • Pounding heart
  • Panic
  • Sweating
  • Trembling or shaking
  • Shortness of breath
  • Feeling of choking
  • Chest pain or discomfort
  • Nausea, abdominal pain
  • Feeling dizzy, unsteady, faint or lightheaded
  • Numb or tingling feelings
  • Hot flushes or chills
  • Feelings of unreality or of being detached from oneself
  • Fear of losing control or going crazy
  • Fear of dying

You will notice that the last two symptoms mentioned are different to all the others because they are fears rather than physical sensations. One of the most frightening things about a panic attack is that the person does not know what is happening to them or why. Because there doesn't seem to be any reason for these sudden and intense physical symptoms, most people interpret them to mean that they are about to lose control, have a heart attack, die, or go crazy. In other words, they take the symptoms as a sign that something dangerous and terrible is happening. As you will see in the treatment section, this interpretation is very important because it can inadvertently contribute to the cycle of panic.

What causes all those feelings you get during a panic attack?

A lot of different processes in the human body take place automatically, without us having to think about them at all, like breathing. When we exercise, the muscles in our body need more oxygen so we start to breathe more quickly, but we don't choose to do this, it just happens automatically.

Another automatic process in the human body is called the "fight or flight response". This is an in-built safety device which allows us to respond very quickly whenever we are threatened or in danger. Since most of the threats to our survival as human beings were once physical threats, this response is designed to help us move quickly to fight off a predator or escape from a dangerous situation. So when our fight or flight response goes off we release adrenaline which causes various changes throughout the body, such as increasing our heart rate and breathing rate, and tensing our muscles ready for action. We also start to sweat and have a strong urge to flee. These reactions would be useful if we had to run or fight, but in most situations nowadays it is not appropriate to run or fight. So all that extra oxygen you're breathing in and carbon dioxide you're breathing out can start to make you feel dizzy and light-headed, even nauseous. Your arms and legs may start to shake and you may get muscle cramps from being tense for too long. Do these symptoms sound familiar?

If you think this sounds like the symptoms of a panic attack, you're right! A panic attack happens when your fight or flight response goes off and you breathe more than you need. These feelings cannot hurt you. They occur because your body is trying to protect itself from danger.

But what sets off my fight or flight response?

The fight or flight response occurs whenever we judge a situation to be dangerous. In Panic Disorder or Agoraphobia this can be triggered simply by saying to yourself &#34what if I lose control and have a panic attack?&#34 or by remembering that you had a panic attack in the same place once before. This happens because the thought of a panic attack is itself very scary, usually because the person believes that they might not survive the next panic attack - that they might go crazy or have a heart attack and die. If this were true you would be in great danger, and so your body activates the fight or flight response.

Agoraphobia

Agoraphobia occurs when the person is anxious about being in places or situations where they might have a panic attack. Hence they either:

  • avoid these situations, or
  • only go places with a companion, or
  • endure these situations despite severe anxiety

Most commonly agoraphobia involves a fear of going into places where it might be difficult or embarrassing to escape quickly if they have a panic attack and need to get away, or places where there would be no quick access to medical help.

How common is Panic Disorder and Agoraphobia?

Recent surveys of the general population have found that about 2% of adults have had Panic Disorder or Agoraphobia in the last twelve months. That is approximately one out of every fifty adults. Panic Disorder occurs at the same rate in men and women, whereas Agoraphobia is twice as common in women than it is in men. Studies have also shown that as many as 40% of people have had spontaneous panic attack at some stage in their life, but have not gone on to develop Panic Disorder or Agoraphobia.

Social Phobia

Social phobia is a fear of social situations that involve interactions with other people. If you have social phobia you tend to worry about being judged badly by other people - being criticised, "put down" or embarrassed.

How common is Social Phobia?

Social phobia is equally common in men and women and is found across different cultures. Approximately 3 percent of the population suffer from social phobia.

A much larger percentage of the population describe themselves as shy. In addition, many people in the general population report fear associated with public speaking, and anxiety associated with other social situations such as meeting new people and dealing with criticism. Most of these people would not be identified as having social phobia, however, unless the fear and avoidance significantly interfered with their life.

Some people with social phobia fear only a few situations where they might be the centre of attention. Others, suffering from generalised social phobia, fear many situations.

Feared situations:

Some typical social situations feared by people with social phobia include:

  • Speaking in a group
  • Giving a presentation or speech
  • Meeting new people
  • Being introduced
  • Talking to someone in authority
  • Being observed doing an activity
  • Eating or drinking in public
  • Using the telephone
  • Going to a party
  • Expressing your opinion
  • Returning faulty goods
  • Using public toilets
  • Being the centre of attention
  • Speaking to someone you're attracted to

If you have social phobia you usually worry that others will notice your anxiety because of your blushing, sweating, shaking, or difficulty getting your words out, (for example).

Physical symptoms:

There are a number of typical physical symptoms experienced by people with social phobia. These include:

  • Blushing
  • Shaking or trembling
  • Heart going fast
  • Sweating
  • Mind going blank
  • Shaky or soft voice
  • Problems concentrating
  • Urge to use the toilet
  • Breathe faster
  • Dizziness
  • Nausea or vomiting
  • Urge to escape

Behavioural symptoms:

As a result of your fears, you may do a number of things to try to prevent something bad from happening. These may include:

  • Avoiding the situation altogether
  • Avoiding similar sorts of situations
  • Leaving prematurely
  • Focusing on yourself
  • Trying not to draw attention to yourself
  • Keeping quiet
  • Not looking at other people

What is Avoidant Personality Disorder?

If you have had generalised social phobia for most of your life you may think that others see you as too quiet or boring. You may avoid meeting other people and not want to risk telling others much about yourself in case they reject you. If you have these sorts of fears, you may have a more severe social phobia, called avoidant personality disorder.

About one-third of people seen at specialist anxiety clinics for treatment of social phobia have avoidant personality disorder. If you have this more severe social phobia, it is very likely that you will have experienced episodes of depression.

Coping with severe social anxiety for most of your life may have badly affected your self esteem. You may also have become quite socially isolated. If you have spent many years avoiding social situations or speaking to certain people because of fears about what others think, you need to be aware that it will probably take longer to improve with treatment.

Worry and Generalised Anxiety Disorder (GAD)

Although most of us worry, it is useful to recognise when that worrying becomes a problem. It is generally true that all people tend to worry about the same sorts of things, so it is not the content of the worry that is the problem. Instead, worrying becomes a problem when it is excessive and/or difficult to control.

When worry becomes a problem

As most of us worry, it is useful to recognise when that worry becomes a problem. It is generally true that all people tend to worry about the same sorts of things, so it is not the content of the worry that is the problem. Instead, worry becomes a problem when it is excessive and/or difficult to control.

Worry is excessive when it is too intense, happens too often, or takes up too much time than is warranted by the realistic importance of the event or the actual likelihood of the event occurring. For example, worrying about being fired from a job which most people think you do well, worrying about the devastating consequences of contracting an illness for which you have few risk factors, or worrying about people you don&#39t know disliking you is probably excessive. This excessiveness becomes all the more so if the worry happens most days, and occupies much of your waking hours!

Your worry is difficult to control if you are unable to dismiss it easily from your mind or often find it difficult to sleep because of worry.

Most people worry. When we see a potential problem in the future we might spend a lot of time thinking about it ... what will happen? ... what could we do about it? ... how might we cope? Much of our worry is focussed on everyday events - paying the bills, dealing with difficult people at work, or trying to decide what to buy or where to send the kids to school. Another type of worry concerns the sorts of things that might happen in the future, such as illness, accidents, or any other event that might affect our safety or wellbeing, or that of our families or others we care about. In scientific terms worry is described as "a predominantly verbal thought activity concerned with negative views of future events".

Worry is the central feature of a common anxiety disorder called Generalized Anxiety Disorder (GAD). People are said to have GAD when they have had excessive worry that is difficult to control that has lasted for more days than not over six months or more. In addition people with GAD experience a number of other problems that tend to be associated with the worry.

Problems associated with worry in Generalised Anxiety Disorder:

  • Feeling restless, keyed up, or on edge
  • Being easily tired
  • Having difficulty concentrating, or having your mind go blank
  • Being irritable
  • Having tense or sore muscles
  • Having difficulty falling asleep, staying asleep, or having restless unsatisfying sleep

What treatments work for GAD?

A number of psychological treatments have shown to help people with GAD, but cognitive behavioural therapy (CBT) produces the most consistent and long-lasting improvements. CBT can help people gain control over worry so that they cease experiencing the problems that are normally associated with excessive worry.

It appears that the following components of treatment are most important:

  • An approach where people are taught skills to manage their anxiety and to take responsibility for change and control over their thoughts, feelings, and behaviour
  • Actively identifying and challenging worrying thoughts
  • Relaxation training (usually a form of progressive muscle relaxation) to control physical tension

Specific Phobias

A phobia is a fear which is unreasonable in its degree or nature, yet so powerful that the person with phobia tries to avoid the feared object or situation or becomes extremely anxious, even panic-stricken, if forced to confront it. The person with phobia often becomes anxious simply at the thought of the feared object or situation.

Compulsions & Obsessive Compulsive Disorder (OCD)

Obsessive Compulsive Disorder (OCD) is an anxiety disorder characterised by unwanted, intrusive thoughts (called obsessions) and behavioural or mental rituals (called compulsions).

What are obsessions?

Obsessions are thoughts, images or impulses which come into your head no-matter how hard you try to block them out. They are always about something dangerous or upsetting and they make you feel anxious, guilty or scared in case the thought is true. Examples include thoughts like "did I turn off the stove?" (maybe the house will burn down), or "my hands are contaminated" (I might get sick). Obsessions can also be images of frightening or upsetting things, like stabbing someone or running someone over, or they may be urges to do something you don't want to do. Obsessions are always disturbing and unpleasant because they focus on things which are important to you and which you don't want to be true. Most people try to cope with their obsessions by reassuring themselves that the thought is not true or by doing something to lessen the risk of danger (e.g. checking the stove, washing your hands).

What are compulsions?

Compulsions can be anything you do in response to an obsession in order to prevent it from coming true or to take away the fear created by your intrusive thoughts. They can be visible behaviours, like checking or washing, or they can be things you do in your mind that no-one can see, like praying, counting, or repeating words silently. Compulsions are also called 'rituals' because most people feel like they have to do them in a very precise way, and they cannot rest until they've been done properly. So instead of performing compulsions just once, people with OCD repeat these behaviours over and over until they are satisfied that danger has been averted, or until the anxiety and distress are reduced.

Common Obsession and Compulsion Pairings

Sometimes there will be an obvious connection between the obsession and the compulsion (e.g. contamination and washing), but in other cases the connection may be more personal, depending on the individual&#39s beliefs and superstitions (e.g. counting to a certain number to avoid harm befalling a loved one).

How common is OCD?

OCD can occur in both adults and children, with most people developing their first symptoms before the age of thirty. Boys usually show their first symptoms at a younger age than girls, so OCD is twice as common in boy children than girls. In adults the number of men and women with OCD is equal. Since mild obsessional symptoms are common in the general population, you don&#39t get a diagnosis of OCD unless your obsessions and compulsions interfere with your life or stop you from doing some of the things you want to do. Population surveys have shown that approximately one in two hundred adult people experience OCD. Once you have OCD it is rare for it to go away without proper treatment, so if the symptoms described above sound familiar you should seek help from a professional who is familiar with the treatment of OCD.

Trauma

Traumatic events include actual or threatened physical harm to oneself or another person, or a threat to the personal beliefs of oneself or others. Examples include violent assaults (e.g., sexual or physical assault or mugging), torture, and severe car accidents.