Introducing Cognitive Behavioural Therapy (Introducing...) (5 page)

If you are suffering from problems with anxiety, you are certainly not alone. Difficulties with anxiety are common within the general population. One in eight adults will suffer from an anxiety disorder at some point in their life.

There are several types of anxiety disorder – generalized anxiety disorder (GAD), panic disorder, agoraphobia, obsessive-compulsive disorder (OCD), phobias, post-traumatic stress disorder (PTSD), social anxiety disorder, health anxiety and stress reaction disorder. They all have some symptoms in common.

Listed below are the key areas which point to problems with anxiety. Do any of these describe you?

• Difficulty relaxing?
  
• Nervous, anxious or edgy?
  
• Easily annoyed or irritable?
  
• Restless and unable to settle?
  
• Unable to stop or control worrying?
  
• Worrying about practically everything?
  
• Fearing something awful might happen?
  

If any frequently apply to you, it may be useful to see your GP and talk through what’s going on and what help is available, including of course self-help books like this one.

What is an anxiety disorder?

Let’s look in more detail at the different types of anxiety disorders. They all share many common elements. We will then explore the techniques CBT employs to help people deal with them.

Generalized anxiety disorder (GAD)

Suffering from
GAD
means you’ll be feeling anxious, tense and will worry most days, often about things other people consider quite minor. If you don’t tackle it, the problem can last years, severely interfering with quality of life. Generalized anxiety can frequently be something that people feel they have always experienced to an extent – ‘I’ve always been a bit of a worrier’ – but which becomes more disabling during or following periods of increased or intense stress. Sometimes it can become more of a problem following distressing events such as bereavement, redundancy or a relationship break-up, and can start some considerable time after these events.

Women are more likely than men to be diagnosed with GAD, perhaps partly because women are more willing to see their doctor and admit to such feelings. You are more likely to experience GAD if you are aged 35–54, if you are divorced or separated, or if you are a single parent – but anyone can develop this problem.

Usually someone with GAD recognizes their worries are excessive and inappropriate. Sometimes, though, they aren’t even aware of what it is they’re worried about – they just feel uncomfortable and can’t settle or relax. For a diagnosis of GAD you’ll usually also have three or more of the following symptoms:

• Restlessness
  
• Irritability
  
• Tiredness
  
• Physical tension
  
• Disturbed sleep
  
• Problems concentrating or feeling as if your mind just goes blank.
  

Case study – Jane (GAD)

Jane is in her early thirties. Her young child has just started school. Jane’s back at work and wants to make a good impression on her new boss who was appointed during her maternity leave. She’s always been a bit of a perfectionist, but previously had time available to devote extra hours to meeting her excessively high standards. Now with the additional demands of motherhood and work, she feels it is all too much. At work, she worries about not being as quick and efficient as colleagues who haven’t had a maternity break. She also experiences anxiety about how her child is coping, feeling she should be a full-time mum, but knowing her income is required to make ends meet. There’s no peace at home – work-related thoughts intrude constantly, as do self-critical thoughts about her ability both as a mother and a wife. As for GAD symptoms, she has a full house! Constant worry and restlessness, sleep problems, physical feelings of tension and various aches and pains.

Post-traumatic stress disorder

When people experience a trauma such as being involved in a car accident or being attacked or mugged it is very common for them to experience fear, recurrent and distressing thoughts and memories of the event, a sense of emotional numbness, a distance from those around them and intense anxiety. They may also try to avoid any reminders of the event or its consequences. These symptoms are all very normal and are part of a process of adjusting to and making sense of what has happened. Generally, these symptoms diminish in the few weeks following a trauma and most people recover well with time and support. For some people, however, these symptoms persist or even worsen over time and it feels impossible to move on from what has happened. In some cases symptoms can continue or even suddenly begin months or even years after the trauma. This is
post-traumatic stress disorder
. We discuss it and suggest ways of coping with it in
Chapter 7
, which covers using CBT to cope with difficult life events.

Phobias

A
phobia
is a strong fear or dread which is out of proportion to the reality of the situation causing it. Coming near or actually in contact with the feared thing or situation causes anxiety, and just thinking of what you are phobic about is frightening and upsetting. You may sometimes be able to avoid the feared situation, but in many cases this can mean restricting your life. Also, the more you avoid, the more you may want to avoid and this can become more and more limiting over time.

There are many phobias of specific things or situations. Common examples include claustrophobia (fear of confined spaces or of being trapped), fears of specific animals and fears of injections, vomiting or choking. There are dozens of phobias, but the treatment for them all follows the same principles of
graded exposure
which we discuss later in this chapter.

Social phobia

Social phobia
or social anxiety disorder is possibly the most common phobia. You become very anxious about what other people may think of you, or how they may judge you. You fear meeting people, or ‘performing’ in front of others, especially strangers. You fear that you will act in an embarrassing way and that other people will think that you are stupid, inadequate, weak, foolish or even crazy. You avoid such situations as much as possible. Psyching yourself up to go somewhere is really hard – you often leave invitations open to the last minute, so as not to have to commit yourself. If you do go to the feared situation, you are often very anxious and distressed, and may well leave early. As with all anxiety disorders, the key to overcoming social phobia is to use a combination of
thought challenging
and
behavioural experiments
(see later in this chapter).

Panic disorder

People with
panic disorder
experience recurring panic attacks. A panic attack is a severe attack of anxiety and fear which occurs suddenly, often without warning, and for no apparent reason. The physical symptoms of anxiety during a panic attack can be severe and may include: a thumping heart, trembling, feeling short of breath, chest pains, feeling faint, numbness or pins and needles. Each panic attack usually lasts 5–10 minutes but sometimes they come in waves for up to 2 hours. Panic attacks are incredibly frightening experiences and whilst they are happening people can really feel as if they are dying. This naturally leads to fear of fear – feeling scared that an attack will occur and that
this
time it will finally be the one where something terrible
really
does happen. People often try to cope by avoidance, shying away from any situation in which they think an attack might happen or where they might not be able to escape from the panic. This can severely limit someone’s life and for some people is also associated with agoraphobia, which is described shortly.

The Panic Cycle

Agoraphobia

Agoraphobia
literally means in ancient Greek ‘fear of the market place’. The term describes a fear of open spaces and frequently includes difficulties being in public places – shops, crowds, on public transport, crossing bridges or even simply being away from home. It is usually difficult, if not impossible, to do these things alone, though some sufferers of agoraphobia may manage to go out and about if accompanied by someone they trust.

All the different situations which cause difficulties for people with agoraphobia are united by one underlying fear – that of being in a place where you are overwhelmed by panic, no help is available, and you’ll find it difficult if not impossible to escape to a safe place (usually to your home). When you are in a feared place you become very anxious and distressed and have an intense desire to escape. To avoid this anxiety and panic many people with agoraphobia stay inside their home for most or all of their time. Sadly, however, they can then experience panic attacks even in their home and so feel they have to have someone with them at all times.

Agoraphobia and panic disorder affect around 5% of the population, affect women more than men, and most commonly occur between the ages of 25 and 35. Agoraphobia affects up to one third of people with panic disorder and occurs before the onset of an attack. The fear means that the person tries to avoid places where they are likely to have panic attacks and, while avoidance can be successful to some degree in keeping panic attacks at bay, the restrictions on a person’s life usually just keep increasing, affecting both the person and those close to them.