Dealing with generalised anxiety disorder – part 2

Picking up from where we left off with my previous blog, we learned that generalised anxiety disorder is a higher level of anxiety which threatens your ability to stay in control of your life. It prevents you from enjoying each moment since you are caught up compulsively thinking and dwelling on a future which has not happened yet. Given the severity of these symptoms, it must be equally matched with an extensive treatment program.

Firstly, let’s outline the treatments of generalised anxiety disorder that are typically administered to you from your local psychologist or mental healthcare professional:

  • CBT- (“Cognitive behavioral therapy”) a goal directed form of talking therapy
  • Mindfulness- teaching you how to relax your mind and be more in the present
  • Medication-SSRI’s (selective serotonin re-uptake inhibitors), SNRI’s (serotonin and noradrenaline re-uptake inhibitors), pregabalin and benzodiazepines.
  • Online Self-Help Courses/Group Courses- Useful tips on how to treat anxiety using workbooks or computer-based programs.

Now that you know the popular options, I will give you my humble opinion on each of these options which is guided by my research and the professionals I have conversed with. When evaluating CBT’s effectiveness for anxiety we have to first consider it’s approach. Due to it’s goal directed nature, it may work with anxiety if it isn’t pushed too strongly on the patient to change their thoughts. Instead if the goals are directed towards encouraging more self-care practices and teaching the patient how to manage the stressful symptoms then I believe progress can be made.

CBT formulation chart
Figure 1

Typically a formulation chart (see Figure 1 to the right)  is used in CBT to show the client, the relationship between their thoughts, behaviour, bodily sensations and emotions. The idea is if you change one factor in this cycle the rest will also eventually follow. So if we decide to focus on working with a client’s emotions first through mindful breathing and acceptance practices, the client will start to emotionally become more resilient and feel better. From feeling better they will naturally start to think more positive thoughts and so they will start to take more actions in their life. Hence, with all these changes the physical symptoms of heart palpitations and blood pressure will also decrease.

As you saw in my example, you can often combine forms of therapy such as CBT with mindfulness. Mindfulness on it’s own serves as a powerful tool to treat anxiety because it introduces the client to their senses. So they learn that they do not need to rely on their thoughts and learn that their thoughts do not hold as much power as they once believed. For example, it is a common practice in mindfulness-based stress reduction workshops to work on engaging the senses using “mindful anchors”. Whilst many thoughts are flying through your mind you can use the weight of your feet on the ground as an anchor to focus on. Through focusing on the sensation of your foot touching the ground you then take your attention away from your thoughts and more into your body. As a result of this, your thoughts do not seem as heavy to you. Any thoughts that do occur will eventually pass as long as you choose to engage in your senses. The idea is not to stop thinking however. The goal is to give yourself the luxury of choice. To choose to simply engage your attention elsewhere when your thoughts are a burden, and even focus on different thoughts and play with them in your mind. Mindfulness can be seen as a skill and the more you practice it, the better you become at it. As a result of this, you become better at allowing your thoughts and feelings to pass, and better at actively focusing your attention to different sensations you experience in the present moment.

With regards to treating the physical symptoms, often mental health professionals deem it necessary to respond immediately with medication. Many believe that as long as we can treat the hormonal and neurotransmitter imbalances then this should be enough to eradicate anxiety on it’s own. Examples of drugs include: Prozac, SSRI’s (selective serotonin re-uptake inhibitors), Zoloft, Paxil, Lexapro and Celexa. These are often the same drugs used to treat depression and are actually referred to as “antidepressants”. Often, these medications are controlled in terms of the volume of dosage as well as how often you are told to take them. This precautionary measure of administrating medication does alleviate the risks of adverse side-effects. Generally as a rule of thumb, it is best to follow the advice from a psychiatrist who knows more about your specific symptoms. However in some cases patients can still experience some adverse side-effects, therefore I feel it’s important to cover natural alternatives to medication. These options I will cover in the next blog since there is a plethora of research related to it.

In between or even before therapy, there are a wealth of self-help guides that clients can use which can be quite beneficial. Self-help knowledge is likely to improve the client’s openness to therapy. If self-help knowledge is proactively followed and the client administers the appropriate lifestyle changes, the client may even recover before needing therapy. However, in severe cases self-help knowledge is more effective as an additional catalyst for recovery in addition to therapy. Self-help guides are often provided in the form of handouts, leaflets, and online courses by charities and the mental health practices alike. Typically for anxiety they give you a summary of how to relax the mind and body, e.g. progressive muscle relaxation techniques. Some guides detail the common forms of toxic thinking to avoid in order to stop the cycle of rumination. For example, catastrophisation is an example of a distortive thought pattern which involves a person exaggerating their circumstances and making the situation out to be more personal than it is. For more examples of distortive thinking patterns, I encourage you to check out my blog called “Understanding yourself using metacognitive awareness”. In my experience, what helped me to recover from mental illness was my openness and willingness to seek help and research multiple methods of recovery. Therefore, I would say that self-help knowledge is a good foundation to have before you go out and seek help from a professional. I would relate this advice to all other mental illnesses as well as anxiety.

As a summary, the most popular forms of treatment which are mindfulness, CBT, medication and self-help guides may or may not be sufficient when used individually. However, if a person suffering from anxiety were to experiment with all of these treatments and other alternatives that I will cover in the next blog; then this will increase that person’s chance of recovery tenfold! So keep an open-mind, utilise all your resources and most importantly do not be afraid to reach out. Everyone may not experience severe anxiety like you or someone you know, but as human beings we have all experienced stress and have had brief spells of anxiety in our lifetime.

Wishing you all the best.

Azeem.

 

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