When Our Survival Mechanism Backfires...

                                        

The emotional experience of fear and the physiological stress reaction (the 'fight or flight' reaction: increased heart rate, faster breathing, sweating etc.) are very useful responses to dangerous situations or objects: our ancestors had it, apes and mice have it, even reptiles do. If it wasn't for this unconditioned response to danger, most species - humans included - would not have survived the natural selection. Apart from enabling us to fight, freeze or flee in the face of danger, the physiological stress reaction also enables us to learn to avoid the same dangerous situation or object in future.

But what happens when this useful survival mechanism backfires on us as it inevitably does now that we live in an environment where there are very few real dangers to our survival. Instead of the real predators, our stress response is chronically triggered by non-lethal threats, such as looming deadlines, annoying people, parking tickets... It is this chronic minor stress that results in a variety of psychological difficulties, including anxiety disorders and depression.

 

What are Anxiety Disorders?

Anxiety is an unpleasant feeling of fear and apprehension. Unlike the normal stress reaction described above, which serves an adaptive purpose as it helps us to deal effectively with threatening situations, the fear that characterizes anxiety disorders is excessive and debilitating as it actually impairs our ability to deal with difficulties.

If the fear has no discernible cause or is triggered by any number of situations which are incorrectly perceived as threatening or dangerous (the 'free-floating' anxiety, excessive worrying), the person is said to be suffering from generalized anxiety disorder (GAD). A disorder related to but quite different from GAD is the obsessive-compulsive disorder (OCD). Sufferers of OCD are able to control and reduce their anxiety by performing certain behaviours, such as hand-washing, checking if the hobs are off, doors are locked etc. Such behaviours may produce a temporary reduction in anxiety but people feel compelled to repeat those actions over and over again to the point that such 'ritual behaviours' severely disrupt their daily life.

In contrast to the free-floating anxiety, excessive fear related to a specific object or situation which often leads to avoidance of such objects/situations is considered to be a phobia. Very often the fear experienced in the presence of a phobic stimulus (the feared situation or object) escalates into a fully blown panic attack: racing heart, breathing difficulties, shaking, dizziness, sense of terror and impending death, etc. Likewise, experiencing a panic attack for the first time in a particular context may lead to the development of phobia and subsequent avoidance of such contexts. When panic attacks occur regularly (either triggered by a specific stimulus or unprovoked), a person is said to be suffering from panic disorder.

A distinct category of anxiety disorders and probably the only one which is caused by real threats is the post-traumatic stress disorder (PTSD). As its' name says, PTSD is a disorder which develops following a serious life-threatening event (e.g. car accident, attack, etc.) although even non-life threatening but extremely disturbing experiences (e.g. abuse, childbirth, etc.) may also result in PTSD.


                                                              


Generalized Anxiety Disorder (GAD)

A person suffering from GAD (also known as the 'free floating' anxiety) may be experiencing a variety of symptoms, including constant worrying, irritability, fear of madness/impending death, sleep problems, inability to concentrate, stomach discomfort, indigestion and diarrhoea, dizziness, headaches, racing heart, chest pain or tightness, etc. Very often GAD runs in families (it is genetically transmitted) and develops gradually over a number of years although negative life events and stress also play a major part in the development and maintenance of symptoms.

As the cause of anxiety seems to be mainly biological, the first choice of treatment in the short-term are usually anti-anxiety medications (the benzodiazepines, such as valium, lorazepam etc.). These drugs increase the function of the brain chemical ('neurotransmitter') called GABA which acts to suppress the activity of brain cells ('neurones'), particularly in the area called the amygdala, the 'panic button' of the brain responsible for triggering the fight-or-flight response. Although these medications can be a life-saver for some, they are only helpful in the short-term as they are addictive and can also decrease alertness and interfere with cognitive performance. For a chronic condition such as GAD, the use of benzodiazepines is therefore contraindicated and another drug class, antidepressants, is the first line of treatment.

Kava extract was considered to be an effective herbal alternative to benzodiazepines – research has found it to be as effective in reducing anxiety symptoms and it was also helpful with the management of withdrawal from benzodiazepines. However, as with all herbal remedies, reduced side-effect profile does not mean that they are completely harmless. Similarly to alcohol use, a person taking Kava should avoid driving and operating heavy machinery since both drugs (Kava and alcohol) induce drowsiness and sedation.  This herbal extract may also adversely interact with other legal and illegal drugs, it has a high abuse potential and, most alarmingly, chronic use may lead to severe liver damage which is why it has recently been banned from sale in the UK.

There are many alternatives to pharmacotherapy in the treatment of GAD which are certainly more effective in the long term and also without the adverse side-effects.

A non-pharmacological way to reduce the overactivity of the amygdala which underlies GAD and other anxiety disorders is the neuro-cognitive intervention known as the Eye-Movement Desensitisation and Reprocessing (EMDR) and other related techniques (e.g. Wingwave Coaching). Although a number of clinical studies provided evidence for their effectiveness (particularly with PTSD patients, where EMDR has become the treatment of choice), it is not yet known how such approaches result in the reduction of anxiety symptoms. However, research into the neurobiology of sleep suggests that by simulating the rapid-eye movement (REM) phase of sleep (the phase when we experience dreams) EMDR-based approaches may facilitate desensitisation of the amygdala by allowing the adaptive processing and integration of negative emotional content.

Apart from the biological underpinnings, there are quite a few cognitive aspects of GAD, such as intolerance of uncertainty, false beliefs about worry, negative problem orientation and cognitive avoidance, which can be challenged and modified by psychological interventions. These include the cognitive behavioural therapy (CBT), neuro-linguistic programming (NLP), hypnotherapy, applied relaxation and other related approaches. A number of research studies have also found Mindfulness practice to be very effective in regulating anxiety.

                                                              


Stress-Busting Techniques for Managing Generalized Anxiety Disorder (GAD):

Emotional Freedom Technique (EFT) Hypnotherapy
Jin Shin Jyutsu (JSJ) Mindfulness
NeuroLinguistic Programming (NLP)
Psycho-Neuro-Immunology (PNI)
Thought Field Therapy (TFT)® wingwave® Coaching


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Obsessive Compulsive Disorder (OCD)

OCD affects about 1-2% of the population and although the symptoms very often start in childhood they may start later and continue to develop into adulthood. Obsessive worrying about certain things (e.g. cleanliness) and compulsively performing behavioural rituals to relieve the worrying (e.g. hand washing) can produce significant disruption to a person’s life, often leaving them unable to think about or engage in any other activities.

The causes of OCD are thought to be primarily biological and there seems to be a fairly strong genetic component. The treatment of choice are usually drugs, primarily the selective serotonin reuptake inhibitors and other antidepressants (e.g. fluoxetine, clomipramine etc.) although psychotherapeutic approaches, such as cognitive behavioural therapy (CBT), as well as other talking therapies such as neuro-linguistic programming (NLP) and hypnotherapy can also be helpful in targeting the ‘belief systems’ that are evident in many OCD sufferers. Such psychological interventions encourage OCD sufferers to break the vicious cycle that contributes to the frequent performance of compulsive rituals and are thus more effective than drugs in the long term. Combining drug therapy and psychological interventions is likely to be the most effective way of treating OCD though not necessarily at the same time.

                                                              


Stress-Busting Techniques for Managing Obsessive Compulsive Disorder (OCD):

Cognitive Behavioural Therapy (CBT) Hypnotherapy
NeuroLinguistic Programming (NLP)
 


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Phobias

A phobia is excessive fear related to a specific object or situation which often leads to avoidance of such objects/situations. The extent of phobia varies from person to person, with some people simply not wanting to touch the phobic object (e.g. a spider in the case of arachnophobia) to others not being able to be in the same room with the object or even unable to look at a picture of it! Panic attacks are very common in phobia sufferers and can be very distressing.

Avoiding a phobic object/situation may have a major negative impact on people’s lives , especially in complex cases such as agoraphobia (fear of open spaces), claustrophobia (fear of enclosed spaces) or social phobia (fear of social situations) where avoiding the phobic situation essentially results in the complete disruption of individual’s life.

Sometimes there is a discernible cause of a phobia, a particularly traumatic incident which the person remembers and which subsequently caused them to avoid the situation (e.g. the experience of drowning is likely to trigger hydrophobia; being mugged or having a panic attack in a street is likely to cause agoraphobia), but more often than not the person is not aware of a cause or the cause simply doesn’t exist. Many of our fears and phobias are also learned behaviours acquired in early childhood through observation of others (e.g. parents or older siblings) who displayed excessive fear of certain objects/situations (e.g. fear of dogs).

Although a variety of drugs (antidepressants, benzodiazepines, beta-blockers) can be used to control the distressing symptoms of phobias, these approaches cannot be considered as long-term options as they do not tackle the root-cause of phobias, which is primarily psychological. All approaches to treating phobias are thus psychological although recent research indicates that certain drugs can be used alongside psychological interventions to enhance their effectiveness.

Systematic desensitisation is one of the most common psychotherapeutic approaches whereby the phobia sufferer is gradually exposed to the phobic stimulus. This can be performed with a therapist or alone, and hypnotherapy and self-hypnosis can be used as additional interventions. Talking therapies such as counselling, cognitive behavioural therapy or psychodynamic therapy may also be effective as well as the neuro-linguistic programming (NLP)-based ‘fast phobia cure’ and Wingwave Coaching. Emotional Freedom Technique (EFT) has also been gaining popularity as a treatment for phobias, and recent research showed it to be superior to self-relaxation techniques both in the short- and the long-term.

                                                              


Stress-Busting Techniques for Treating Phobias:

Cognitive Behavioural Therapy (CBT) Emotional Freedom Technique (EFT)
Hypnotherapy NeuroLinguistic Programming (NLP)
Thought Field Therapy (TFT)® wingwave® Coaching


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Panic Disorder

Panic attacks are sudden feelings of terror that strike without warning. The age at which people are most likely to have their first panic attack is usually between 15-19 years. Panic attacks are often unexpected and unprovoked unless triggered by a phobic stimulus. Likewise, experiencing a panic attack for the first time in a particular context may lead to the development of phobia and subsequent avoidance of such contexts. When panic attacks occur regularly (either triggered by a specific stimulus or unprovoked), a person is said to be suffering from panic disorder.

A panic attack is often disabling, including symptoms such as racing heart, breathing difficulties, shaking, dizziness, sweating, sense of terror and impending death, etc. The fact that panic attacks are unpredictable means that individuals suffering from panic disorder are likely to experience severe disruption to their lives, often avoiding to leave the house altogether lest they experience an attack in an ‘unsafe’ place (that’s why panic disorder often co-occurs with agoraphobia – the fear of open spaces).

Treatment options for panic disorder are similar to those for phobias although somewhat greater emphasis is placed on drug treatments and self-relaxation techniques. Combined pharmacological and psychological interventions are probably the best treatment choice in the long run.

                                                              


Stress-Busting Techniques for Managing Panic Symptoms:

Cognitive Behavioural Therapy (CBT) Hypnotherapy
Jin Shin Jyutsu (JSJ) NeuroLinguistic Programming (NLP)
Time Line Therapy (TLT)® wingwave® Coaching


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Post-Traumatic Stress Disorder (PTSD)

PTSD refers to a number of symptoms which an individual may start experiencing following a serious life-threatening event (e.g. accident, heart attack, rape, etc.) although even non-life-threatening but extremely disturbing experiences (e.g. abuse, childbirth, etc.) may also result in PTSD. The symptoms include flashbacks, panic attacks and anxiety, nightmares, and other potentially debilitating symptoms.

PTSD is not simply a normal response to a major stressful event, but represents an abnormal or disordered reaction which appears to be mediated by specific neurochemical and neuroanatomical dysfunctions. If untreated, the symptoms of PTSD can last for years, causing severe distress and disruption to the person’s life.

The neurobiological mechanisms of PTSD are still unclear as is the fact that some people develop it whereas others do not, even if they had experienced the same traumatic event. One of the main disturbances that are noticeable in the brains of PTSD sufferers are increased activation of the amygdala (the ‘panic button’ of the brain, involved in the processing of emotional stimuli and the perception of threat which triggers the fight-or-flight response) and reduced volume and impaired function of the hippocampus (the area involved in memory formation). This disruption in the amygdala-hippocampus circuit (the ‘emotional memory system’ of the brain) is responsible for the insufficient processing of traumatic events, resulting in traumatic memories that are different from other kinds of memories and significantly more vivid. Such memories are very long-lasting, they are easily triggered and their highly emotional quality can make them difficult to translate into words.

PTSD is still a fairly new diagnostic category and while different drug treatments have been explored (antidepressants being the most popular choice), by far the most effective treatment is the Eye-Movement Desensitisation and Reprocessing (EMDR) technique. EMDR involves simulating the rapid eye movements (REM) which characteristically occur during the phase of sleep when we have dreams and that is also the time when the amygdala-hippocampus circuit actively reprocesses all emotional information that has accumulated during the day. Although the client is fully awake during this intervention, simulating the eye movements seems to achieve the same effect as the REM sleep, facilitating the desensitisation of the amygdala by allowing the adaptive processing and integration of the traumatic memories.

EMDR is most commonly used in a psychotherapeutic or counselling context, usually alongside the cognitive behavioural therapy (CBT), although an increasing number of PTSD sufferers choose another EMDR-related approach, the Wingwave Coaching. Wingwave Coaching is a novel neuro-cognitive method which combines awake REM simulation with neurolinguistic programming (NLP) and kinesiology (the myostatic test). The advantage of this coaching technique over standard EMDR-containing therapies is that Wingwave is completely content-free so the client is not required to describe any details of the traumatic incident to the therapist.

                                                              


Stress-Busting Techniques for Managing PTSD:

Cognitive Behavioural Therapy (CBT) Emotional Freedom Technique (EFT)
Hypnotherapy Jin Shin Jyutsu (JSJ)
Mindfulness NeuroLinguistic Programming (NLP)
Reflexology Tai Chi
wingwave® Coaching Yoga


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Published by  Hove StressBusters
September 2012