Psychological support for anxiety

If you are experiencing social anxiety, panic attacks, or general anxiety, you are not alone. According to the National Survey of Mental Health and well-being, around one-in-ten  Australians will meet criteria for an anxiety disorder in their lifetime. People with anxiety are also more likely to be depressed or be dependent on alcohol and/or drugs. 

Avoiding situations to provoke anxiety

Intense anxiety is really unpleasant and it makes sense that we quickly learn to avoid situations that provoke anxiety. The pattern of avoidance may look different in the case of social anxiety, panic attack and general anxiety (see FAQs below). It is not your fault that you avoid situations that might lead to further suffering. We all do things based on what we learned to do in the past.

But at what personal cost? 

Research tells us that all forms of anxiety have negative quality of life impacts on physical health, mental health, social functioning, work, and family life. The struggle with anxiety can consume our attention and make it likely that our behaviour is driven by inner experiences (thoughts, feelings, memories, body sensations) that we automatically want to avoid. 

How can I live a more rich full and meaningful life? 

If it was super easy, you would probably be doing it already. So support from a professional is important. By learning and applying new skills you can do more things that are personally meaningful. This involves being more aware of our inner experiences AND really tuning into what is really going on around us (making better decisions). It also involves being open and willing to experience anxiety AND still choosing to do what matters. Fighting and struggling to reduce anxiety, can be counterproductive. Instead, your preferred life becomes the focus of our work, and therapy tailored to address obstacles that prevent you behaving in ways that move you toward the people and activities that really matter. 

How do I take the next step? 

Talking to your GP, to rule out potential underlying physical causes such as cardiovascular disease, is an important first step. You and your GP can discuss suitable treatments such as evidence-based therapy from a psychologist. If you obtain a Mental Health Treatment Plan from your GP, you will be eligible to receive a Medicare rebate of $84.80 (for a general psychologist such as myself) per individual session for up to 10 sessions per calendar year. 

Frequently asked questions about anxiety

How does avoidance play a role in social anxiety?

In the case of social anxiety, this may include saying no to invitations to do things with people we care about. We might start avoiding a specific social situation,  where we previously felt socially judged. However we can quickly find ourselves feeling anxious in similar situations. Before we know it, we have had to dramatically restrict where and what we do socially. And, when we do venture out, our mind is constantly scanning the environment for people who might be judging us harshly.

This makes it difficult to connect and enjoy the company of others when we are so internally focused. Soon, feelings of self-consciousness, humiliation and embarrassment build up. Leaving the social situation to escape the feelings of anxiety brings some short-term relief. However, once intensity of our feelings subside, we are left with the nagging conclusion that we are missing out. Loneliness and social isolation can quickly develop.

How does avoidance play a role in panic attacks?

In the case of a panic attack, the trigger may be known or the panic may appear out of the blue. Typically there are intense feelings and body sensations such as palpitations, sweating, shaking, shortness of breath, choking, chest pain, nausea, dizziness, unreality (derealisation), detachment from oneself (depersonalisation),  going crazy, dying, tingling and chills or hot flushes.  Under other situations, these kinds of experiences would signal extreme danger.

Dealing with a panic attack can be exhausting. We quickly learn to avoid situations that our mind tells us could lead to another panic attack. For many, this avoidance strategy can come at a personal cost and impact our freedom, relationships, social participation in study, work and getting about. We may worry about potential future panic attacks. We may constantly monitor our body for signs of a panic attack starting. We may restrict our life to minimising exposure to situations that might trigger  a panic attack. The mental energy invested in in worrying, monitoring and restricting, can leave us tired, isolated and feeling down.

How does avoidance play a role in generalised anxiety (GAD)?

In the case of general anxiety, excessive worry that is difficult to control can involve restlessness, fatigue, difficulty concentrating, irritability, aching muscles and difficulty sleeping.  General anxiety can fly under the radar for decades before it is recognised and treatment provided.

In the short-term,worrying can give us the feeling that we are doing something productive about things we care about yet can not totally control. In the longer term, worry itself can become something we try to avoid. This struggle with worry can rob of the energy to engage in the sort of life we would prefer to lead.

Is ACT an evidence-based treatment for anxiety?

Acceptance and Commitment Therapy (ACT) is a modern form of cognitive behaviour therapy (CBT), that teaches specific, structured evidence-based skills to help you better manage difficult thoughts and feelings, so they are less an obstacle to values-guided life actions.

ACT is an evidence-based approach for psychological problems, with an impressive research base. Over 200 Randomised Control Trials (RCTs) have been published supporting the effectiveness of ACT. ACT helps people experiencing anxietyas effectively as other established psychological treatments.

How does ACT work with anxiety?

In a nut-shell, ACT involves being:

  • being open – unhooking and making room for thoughts, feelings memories, and body sensations
  • being present –engagement with the hear and now as well as being able to step back and observe thoughts and feelings
  • doing what matters – being clear about your values, setting goals and taking action

Have a read here for a nice overview of the ACT processes.

In the case of anxiety, this requires:

  • noticing thoughts about what might go wrong, make space for feelings of anxiety and worry. Also noticing with curiosity body sensations such as muscle tenseness or nausea.
  • noticing and observing non-judgmentally thoughts and feelings related to anxiety. And, still experiencing what is happening around us so that we can learn and respond usefully.
  • taking action to live our preferred life, despite the presence of anxiety and worry. Acknowledging that our mind has noticed the uncertainty associated with  something important to us, and is trying to be helpful by generating feelings of anxiety.
What happens in therapy for anxiety?

You probably will not be surprised the hear that no two sessions are the same, individuals are unique, and effective therapy needs to be tailored to in individuals situation and personal recovery journey. That said there are some common components to therapy for anxiety:

  • Initial session.
    • Once you book a session, emailing you a basic welcome letter to provide information on finding the office, contact details, administration and payment details, and a few sentences about our first session.
    • In the waiting room, completing some brief psychological measures to get a baseline before we start our work together. The common ones I use are:
      • a short measure of depression, anxiety and stress
      • an ultra-brief session-by-session assessment of areas of life functioning known to change as a result of therapeutic intervention
      • a brief measure of valued living
      • a brief measure of psychological flexibility (the main ingredient of ACT).
    • Initially covering confidentiality, administration and billing and checking to see if you have any questions.
    • What brought you to therapy (presenting issue) and clarifying what symptoms, such as anxiety that may be a concern.
    • Collaboratively developing clear and realistic goals therapy.
    • Getting to know each other – to build trust.
    • A quick tour of your life – relationship with your parents, school experiences, salient experiences during childhood, adolescent and adulthood. Helpful to put your presenting issue in some wider context.
    • Exploring together a recent example of the presenting issue. Applying what we learnt together from the tour of your life, to make sense of how the presenting issue is playing out in your life.
    • Identifying what skills and experiences are needed to help you achieve your therapy goals.
    • Agreeing on some skills and exercises to experiment with between now and next session.
    • End the session by completing a brief measure of the effectiveness of the therapeutic relationship and discussing what to do differently in the next session.
  •  Subsequent sessions
    • To gauge progress (therapy effectiveness), complete measures for progress on goals, life functioning, valued living, psychological flexibility. Discuss what  the measures are telling us about therapy effectiveness so far.
    • Debrief on the skills and exercises you experimented with between sessions
    • Choose a focus for the session, informed by progress to date.
    • Explore a resent real-life example of a challenging situation and experiment with applying different ACT skills to what is happening in the session
    • Identifying what further skills and experiences are needed to help you achieve your therapy goals.
    • Agreeing on some skills and exercises to experiment with between now and next session.
    • End the session by completing a brief measure of the effectiveness of the therapeutic relationship and discussing what to do differently in the next session.

 

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