Anxiety Disorders
Fear and anxiety are normal human emotions that serve an important evolutionary function – to help us survive – and that is why we need these emotions even though it can be distressing and uncomfortable. It is a part of the normal human experience to feel these emotions from time to time. However, these emotions can become a problem if they start to interfere with the way we live our lives (for example, preventing us from leaving our house), or if they start to cause us too much distress.
Below are some common anxiety disorders. With each of these disorders, people’s fear or anxiety dictate what they can and cannot do in their day-to-day lives, causing significant interference and distress. The goal of psychological treatment is to help people understand what maintains their vicious cycle of anxiety and learn how to break out of that vicious cycle in order to manage their anxiety.
Panic Disorder
People who have Panic Disorder experience repeated panic attacks that come out-of-the-blue. Panic attacks are discrete episodes involving a sudden increase in intense physical symptoms (e.g., dizziness, shortness of breath, increased heart rate, etc), and these physical symptoms reach a peak level of discomfort within minutes. People with Panic Disorder tend to worry a lot about having more panic attacks or what the panic attacks mean. They become afraid of their own bodily sensations. Some people might also start to change their lifestyle habits and behaviours to try and prevent further panic attacks – for example, avoiding exercising or drinking coffee because it brings on strong physical sensations.
Although the physical sensations we experience in a panic attack can feel extremely intense and uncomfortable, research has shown that these sensations are actually not dangerous or harmful to us. In treatment, we help people to develop skills to evaluate the realistic dangerousness of these physical sensations, and to learn strategies to manage their panic attacks.
Agoraphobia
People with Agoraphobia fear or avoid a variety of situations (e.g., going to the supermarket, using public transport, being in a crowd, leaving the house alone) because they are afraid that they will not be able to escape or get help in the event that they feel panicky or develop other incapacitating or embarrassing symptoms (e.g., vomiting). As a result of this fear, people with Agoraphobia can end up having a very restricted lifestyle and/or become very dependent on other people or safety objects in order to be able to face those situations.
In treatment, we help people to develop skills to evaluate the realistic dangerousness of these situations, and to build up their confidence in their ability to cope in these situations. In doing so, we also help people to become less dependent on other people and safety objects.
Generalised Anxiety Disorder (GAD)
Everyone worries about things in their day-to-day lives. Worry is a normal part of the human mind. It only becomes a problem when people find themselves worrying almost all the time (e.g., even when there is nothing to worry about) and when the worries are so hard to control that people have difficulty concentrating on the tasks at hand. When the worries become so excessive and uncontrollable, people can also start to experience physical symptoms of stress (e.g., tension, restlessness, agitation, difficulty sleeping).
In treatment, we help people to develop skills to evaluate the accuracy and helpfulness of their worries, and to be able to differentiate between productive worry vs unproductive worry. We also help people to develop more effective problem-solving skills for the worries that are realistic and productive, and to learn new strategies to manage the worries that are unhelpful and unproductive.
Obsessive-Compulsive Disorder (OCD)
All of us can have random thoughts, images, or urges that pop into our minds from time to time, and most of us are able to dismiss these thoughts, images, or urges as irrelevant and to move on with what we are doing. However, for people with OCD, these thoughts, images, or urges are unwanted and intrusive, and they pop up repeatedly and persistently – like emails that come with a “High Importance” alert that refuse to go away until you do something about it. These are obsessions. Obsessions cause so much distress that people often try to suppress them or to neutralise them with an action. Some people with OCD can also feel the need to repeat a certain action (e.g., repeatedly clean/wash, repeating some phrase in their mind over and over again), often to counteract or neutralise the obsessions. These are compulsions or rituals. These obsessions and compulsions take up so much time that even simple daily tasks (e.g., brushing your teeth, etc) can be hard.
In treatment, we help people with OCD to understand what obsessions are, what maintains their obsessions, and to learn skills to cope with these obsessions without having to perform a compulsion/ritual.
Specific Phobia
Most of us have fears about certain things/situations (e.g., animals and insects, flying, injections), and most of us are able to go about our day-to-day lives without too much interference. However, for people with a specific phobia, their fears are very intense and severe, and can start to dictate what they can or cannot do, or where they can or cannot go.
In treatment, we help people to develop skills to evaluate the realistic dangerousness of the feared object/situation. We also work together with people to help them gradually confront their feared objection/situation, and to build up their confidence in their ability to cope with their fears.
Evidence-Based Treatment
Cognitive-behavioural therapy (CBT) is the first-line treatment for a wide range of psychological disorders, including anxiety and mood disorders. Research has consistently shown strong evidence to support the efficacy and effectiveness of CBT in treating such disorders (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012; Olatunji, Cisler, & Deacon, 2010).
CBT is founded on the idea that there are very important fundamental links between how people think (cognitions), how people feel (emotions), and what they do (behaviour) in a situation. From a CBT perspective, it is the way people think and their subsequent actions that maintain their anxiety and mood issues in the long run.
The Role of Thoughts
People often assume that it is the situation that they are in that is causing them to feel a certain way. For example, how many people have had the thought “I’m stressed because I have so much work to do” at some point in their lives? In some cases, people are indeed in genuinely difficult or stressful situations. However, from a CBT perspective, we believe that the way that people think about their situation and/or themselves is often more influential in causing, or at least further exacerbating, their negative feelings. We also know from research that when people are feeling anxious or down, their thoughts can be overly-exaggerated or negative and might not always reflect reality. Thus, the thoughts that people have in difficult situations tend to make them feel worse – worse than the situations warrant.
The Role of Behaviour
When people feel anxious or sad, they often engage in unhelpful behaviours, such as avoidance, in an attempt to alleviate or reduce the unpleasant feelings. Whilst these behaviours are very effective in reducing anxiety temporarily, the problem is that they maintain anxiety in the long run. For example, by consistently avoiding a feared situation, a person never gets the opportunity to learn what would happen if they stayed in the situation. Their catastrophic predictions about the feared situation will be maintained, or even strengthened, and will be triggered again the next time they are in that situation.
CBT: A skills-based therapy
The goal of CBT is to break the vicious cycle of anxiety and depression by targeting the maintaining factors – unhelpful thoughts and behaviours. CBT is an active skills-based, time-limited, and goal-oriented therapy that aims to teach people strategies on how to evaluate whether their thoughts are accurate, how to challenge those overly-exaggerated and negative thoughts, and how to redirect their attention away from the unhelpful thoughts so that they can focus on the task at hand. The behavioural component of CBT involves helping people to gradually confront their fears through a graded hierarchy of situations or tasks that range in level of anxiety and difficulty. Starting with the least anxiety-provoking step, the therapist and client then work their way up the hierarchy to the most anxiety-provoking step. In doing this, people can build up their confidence in their ability to cope.
References
Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012).The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36, 427-440.
Olatunji, B. O., Cisler, J. M., & Deacon, B. J. (2010). Efficacy of cognitive behavioral therapy for anxiety disorders: A review of meta-analytic findings. Psychiatric Clinics of North America, 33, 557-577.
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Social Anxiety Disorder (or Social Phobia)
Most people would feel a bit nervous about giving a speech in front of an audience or having a conversation with a stranger, and most of us are able to cope with the nerves and carry on with what we need to do. For people with Social Anxiety Disorder, however, the fear in social situations is intense and prolonged. They are extremely worried that other people will judge or think negatively of them, or that they will do something to embarrass themselves. Social situations can trigger intense anxiety before, during, or even after the event. As a result of this anxiety, people with Social Anxiety Disorder tend to avoid these situations as much as possible.
In treatment, we help people to develop skills to evaluate their perceptions of how they appear in social situations, and their beliefs about other people’s judgment of them. We also work together with people to help them to gradually confront these feared social situations, so that they can build up their confidence in their ability to cope in such situations.