Cognitive-Behavioural Therapy

Anxiety is a feeling of unease. Anxiety is only considered to be a mental health problem when it is prolonged, severe and is interfering with everyday activities. Fortunately, most anxiety disorders are highly treatable with psychotherapy, drugs, or a combination of both. There are at least nine identified types of anxiety disorders, include generalized anxiety disorder, social anxiety, obsessive compulsive disorder, panic disorder, post traumatic stress disorder, specific phobia, separation anxiety, school avoidance, and agoraphobia. Anxiety disorders in children can range from a simple adjustment disorder to more difficult and debilitating disorders such as panic disorder and posttraumatic stress disorder. It’s normal to feel anxious when facing something difficult or dangerous, and mild anxiety can be a positive and useful experience. Excessive anxiety is often associated with other mental health problems, such as depression. Unfortunately, many people with anxiety disorders don’t seek treatment because they do not believe they have a legitimate illness, or they fear the reaction of family and friends.

Sometimes anxiety can be associated with a physical illness, such as thyroid disorder. For this reason it’s advisable to see your GP in order to rule out a physical cause. Symptoms occur with varying frequency and intensity but may include all of those listed above as well as trembling, chest pain, nausea, and fear. You may fear you are going crazy or dying. Some people may also have a sense of being detached from reality. Anxiety can be a long-term disorder where you feel worried most of the time about things that might go wrong. Cognitive behavioral therapy is often used, as is psychotherapy and stress management techniques. Drugs used to treat anxiety include selective serotonin reuptake inhibitors, tricyclic antidepressants, beta-blockers, and monoamine oxidase inhibitors. Often, a combination of therapies works best.

What are the types of Anxiety disorders?

There are several major types of anxiety disorders:

1. Generalized Anxiety Disorder (GAD): People with Generalized Anxiety Disorder feel anxious nearly all of the time, though they may not even know why.

2. Phobias: A phobia is an unrealistic or exaggerated fear of a specific object, activity, or situation that in reality presents little to no danger. Common phobias include fear of animals such as snakes and spiders, fear of flying, and fear of heights.

3. Social Phobia: Social anxiety disorder can be thought of as extreme shyness.

4. Obsessive Compulsive Disorder (OCD): It is characterized by unwanted thoughts or behaviors that seem impossible to stop or control.

5. Separation Anxiety: Separation anxiety is a normal part of child development.

6. Panic Attacks and Panic Disorder: Panic disorder is characterized by repeated, unexpected panic attacks.

Symptoms of Anxiety:

The symptoms can include:

1. Abdominal discomfort.

2. Rapid heartbeat or palpitations.

3. Shortness of breath.

4. Frequent urination

5. Feeling worried or uneasy all the time

6. An inability to concentrate

7. Depersonalisation.

Treatment For Anxiety disorders:

The treatment will depend upon which type of anxiety you are experiencing and how severe it is. Cognitive-behavior therapy is very effective in the treatment of anxiety disorders. Tranquilisers, such as benzodiazepine tablets, may help to relieve some short-term stress-related anxieties. However, they shouldn’t be taken for long periods because of the risk of addiction. For this reason they aren’t usually prescribed. Antidepressants can treat certain anxiety disorders such as generalised anxiety disorder, social phobia, OCD, and anxiety associated with depression.

The latter type, sometimes referred to as ‘clinical depression’, is defined as ‘a persistent exaggeration of the everyday feelings that accompany sadness’.

If you have severe depression you may experience low mood, loss of interest and pleasure as well as feelings of worthlessness and guilt. You may also experience tearfulness, poor concentration, reduced energy, reduced or increased appetite and weight, sleep problems and anxiety. You may even feel that life is not worth living, and plan or attempt suicide.

Depression can affect anyone, of any culture, age or background. About twice as many women as men seek help for depression, though this may reflect the greater readiness of women to discuss their problems.

One thing that may make it hard for doctors to recognise depression is that people with depression often complain of physical problems, commonly headaches, lethargy, stomach upsets or joint pains, rather than low mood, sometimes because these can be significant symptoms, but sometimes because they find it difficult to admit to feeling emotionally distressed for reasons they may not even be able to identify.

Depression is usually related to upsetting life events, such as bereavement, relationship difficulties, physical illness, or job or money worries.

Someone with bi-polar affective disorder has both ‘high’ and ‘low’ mood swings, along with changes in thoughts, emotions and physical health.

About 1 in 10 women experience postnatal depression in the first year after having a baby.

Some people describe feeling depressed regularly at certain times of the year. Usually this kind of depression starts in the autumn or winter, when daylight is reduced.

Keep in touch with you friends. If you are already depressed you find it very difficult to be sociable, and this can make you feel more depressed. So it is important for you to keep in contact with friends and find someone to talk to when you are feeling low.

Keep active. Being more active is associated with lower levels of depression. Outdoor activity seems to be particularly important in staving off depression in older men. Review your eating habits. Recent research has suggested that people who are depressed may have low levels of certain essential fatty acids, which are found in fish oils. It has therefore been suggested that people with depression should change their eating habits, for example eating more oily fish such as sardines, or should take fish oil supplements.

Investigate herbal medicine. St John’s Wort ( Hypericum perforatum) can help many people with mild to moderate depression. Before taking St John’s Wort check with your doctor or pharmacist especially if you are taking other kinds of medication, for example for heart disease, epilepsy, asthma or migraine.

Investigate self-help techniques. Some people have reported benefits from various self help techniques such as meditation, listening to music, and acupuncture.

Take control. Some people find it helps if they have some control over what happens. This helps to guard against the kind of ‘hopelessness’ which is associated with depression. Activities that involve making a ‘fresh start’ have been shown to help people recover from long-lasting depression. Similarly, learning to set small or manageable goals can give you a sense of achievement and make you feel better.

There are a number of self-help books, guides, and software programmes which can help you to learn ways of coping with mild to moderate episodes of depression.

Anti-depressant drugs act by increasing the activity of those brain chemicals which affect the way we feel. Anti-depressants are thought to help 2 out of 3 of people with depression.

Tricyclic antidepressants, such as dothiepin, imipramine, and amitryptyline are often prescribed for moderate to severe depression. These usually take up to two weeks to start working and may have side effects.

Newer antidepressant drugs (SSRIs and SNRIs) target specific chemical ‘messengers’ in the brain. The most well-known SSRI is fluoxetine (Prozac) but there are several other brands. These newer drugs are popular because they tend to have fewer side effects than older drugs.

Lithium carbonate is sometimes prescribed to people with severe depression. High levels of lithium in the blood are dangerous so anyone taking lithium must have regular blood tests.

If you are prescribed drugs for depression you will probably be advised to take them for at least six months – or longer if you have a previous history of depression. You may experience withdrawal effects if you stop taking antidepressant drugs, particularly if you stop suddenly. These effects can include headache, nausea, dizziness and even hallucinations. Always consult your doctor before stopping taking anti-depressants. Do not stop taking medication suddenly as the withdrawal effects may be severe.

Cognitive behavioural therapy (CBT) is a type of ‘talking’ treatment. It is based on the fact that the way we feel is partly dependent on the way we think about events (cognition). It also stresses the importance of behaving in ways which challenge negative thoughts – for example being active to challenge feelings of hopelessness.

Interpersonal therapy (IPT) focuses on people’s relationships and on problems such as difficulties in communication, or coping with bereavement. There is some evidence that IPT can be as effective as medication or CBT but more research is needed.

Counselling is a form of therapy in which counsellors help people think about the problems they are experiencing in their lives and find new ways of coping with difficulties. They give support and help people find their own solutions, rather than offering advice or treatment.

ECT is a controversial treatment which is intended only to be used for people with severe depression who have not responded well to medication or other treatments. The person receiving ECT is given an anaesthetic and drugs to relax their muscles. They then receive an electrical ’shock’ to the brain, through electrodes placed on the head. Most people are given a series of ECT sessions. Some people say that ECT is very helpful in relieving their depression, although others have reported unpleasant experiences, including memory problems.

For free advice on Depression or for a free consultation over the phone or in person ring 0151 678 3358 or 07714853 524 or visit http://www.clairehegarty.co.uk

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