Counselling & Psychotherapy
Nicholas King
General Anxiety Disorder
Generalised Anxiety Disorder (GAD) is defined as "excessive anxiety and worry occurring more days than not for a period of at least 6 months about a number of events or activities" (DSM -IV-TR, APA).
People suffering with this type of anxiety are caught in a chronic cycle of worry and fear and typically feel anxious about almost everything.
GAD causes a state of constant worry and may be characterised by the absence of any identifiable source. Rather than being concerned about a specific issue the individual will experience worry about a range of areas which can include health, work, relationships, finances, past behaviours or experiences and future fears. The anxiety experienced by a GAD sufferer feels perpetual and intense and can seem as though it occupies every waking moment. Because of the difficulty experienced in trying to control the anxiety the disorder can be particularly distressing.
How can I help you with GAD?
As well as offering counselling approaches to therapy I use CBT to help with common mental health problems such as anxiety. Being in an anxious state can be enormously distressing and I know from personal experience just how effective CBT can be in helping us to manage our anxiety symptoms on a day-to-day basis - freeing us up so that we can get on with enjoying life again. We may not be able to live lives completely free from anxiety (and some anxiety may even be helpful when it alerts us to a genuine threat) but we can learn skills and techniques that can give us the confidence to do all the things we would usually like to do if we weren't feeling so worried or distressed. GAD is a particularly upsetting form of anxiety because it can feel relentless - it's as though our anxious thoughts and feelings will never leave us alone.
CBT is based on the idea that there are links between our thoughts, feelings, behaviours and physical sensations and recognizes that we can often get caught in a cycle of unhelpful or negative thinking that influences how we feel and then behave. These negative patterns act to maintain our problems keeping us trapped in a vicious cycle that can feel difficult to break. CBT works by helping us to break these cycles of negative thoughts, feelings and behaviours by learning alternative ways to approach our problems and then practising these until they become second nature.
Working together in sessions I can help you to understand your anxiety symptoms better so that you don't feel like they dominate your every waking moment and with a little practice you will find your confidence in coping with anxiety will increase. Eventually, you will feel calmer and more relaxed and be able to manage anxiety independently - and on future occasions when you experience anxiety you will be able to confront it instead of feeling overwhelmed by it.
If you are feeling anxious please get in touch and I will be able to suggest how therapy can help you to feel better soon.
Social Anxiety
Social Anxiety or Social Phobia is the experiencing of intense anxiety in social interactions. People suffering from this form of anxiety become highly self-conscious and feel that they are being judged or appraised negatively by those around them. Being socially anxious can severely limit our ability to form friendships or find a partner. Because it often leads to feelings of inferiority, embarrassment and low confidence social anxiety can have an adverse effect on our performance at work as well as preventing us from taking up hobbies or interests that we might otherwise like to try out. As a result, depression and low mood symptoms can often accompany this form of anxiety.
Symptoms
The physical symptoms of social anxiety include blushing, sweating, trembling/shaking, dry mouth, tension. Because these symptoms are thought to be visible the sufferer may feel convinced that their anxiety is apparent to the people they are interacting with and sending out embarrassing signals that seem to say: "Hey look at me everyone I'm blushing!!". To alleviate this "visible" anxiety, attempts are often made to try to hide the physical symptoms but in reality can actually have the opposite affect of drawing attention to them. For example, a person who feels themselves to be going red during a conversation might try to cover up blushes by holding a hand over their face and turning away from the other person - behaviours which are likely to be more noticeable than if the sufferer had been able to tolerate the "redness" and stay engaged in the conversation.
Some of the situational triggers for social anxiety include:
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Meeting someone for the first time
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Being the centre of attention
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Being watched doing a task such as a presentation or public speaking
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Romantic or friendship relationships and encounters
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Speaking to authority figures such as a boss/senior manager
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Encounters with people who tease or criticise
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Waiting to take turn to speak e.g. group introductions
Avoidance and Self-Focusing
Avoidance Behaviours and Self-Focusing or Self-Monitoring are the two main characteristics of social anxiety. A socially anxious person may use Avoidance behaviours to prevent themselves from feeling embarrassed or humiliated in social situations that feel threatening . This might include getting out of attending a work meeting or phoning in sick.
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The thought of going to a party and meeting new people is often anticipated with fear and an invitation might therefore be declined. If the person does attend then leaving early - escaping - may provide temporary relief but in the long-term is likely to prove unhelpful.
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How Avoidance and Self-Focusing keep social anxiety going
The difficulty with Avoidance Behaviours is that, on the face of it, they actually appear to work by reducing the immediate affects of anxiety. For example, if we feel anxious during a business meeting we might try not to be noticed by sitting at the back or by "hiding" away in a corner. This might feel helpful in containing our anxiety so long as we can stay "hidden" but we are likely to feel even more anxious if we are subsequently asked a question or have to make a presentation.
When we come to rely upon avoidant behaviours in this way we make it more and more difficult to cope with future social interactions. The result long-term is that we never get to face up to our fears and learn how to manage our anxiety in social situations. Self-Focusing causes the individual to monitor how they appear or anything they say or do doing during social interactions in case this makes them appear to be incompetent, inadequate, uninteresting, stupid etc. The fear of looking foolish or feeling embarrassed means the sufferer feels endlessly self-conscious. Because the social occasion is perceived as potentially threatening they are unable to relax let alone enjoy. Responding to every new social interaction in this defensive, on-guard mode keeps the problem going and does nothing to resolve it. Psychologists refer to this as a maintenance factor.
If you feel you may be suffering from Social Anxiety then get in touch. I can help you work through the issues and live a more fulfilling life.
Health & Anxiety Phobias
People suffering with Health anxiety develop an obsessional preoccupation with the idea that they have contracted a physical illness or will become ill in the future. Common examples of health anxieties include fixations on life-threatening illnesses such as cancer or HIV but may include a range of health concerns. Until recently the term hypochondriasis was widely used to describe health anxiety but, due to its pajorative overtones is now considered to be unhelpful in understanding the distressing symptoms experienced as a result of this disorder.
Health anxiety causes sufferers to become overly focused on bodily sensations and misinterpret them catastrophically as indicators of a serious disease or medical condition. Sensations felt in the chest, for example may be thought to signal the onset of a heart attack. Another example might be when areas of the body are given prolonged attention or checking resulting in a belief that cancer has been detected.
What keeps Health Anxiety going?
For most people fears about health are usually alleviated after a G.P examination gives the all-clear. However, health anxiety causes a state of chronic worry that can prompt an endless cycle of reassurance seeking either from friends or family or by making repeat visits to the doctor. Other characteristics of the disorder include continual symptom checking and scouring the internet for details about illness, or joining illness themed chat room forums . These behaviours are known as safety behaviours and are continued because they appear to offer some relief from anxious thoughts and feelings. However, the relief they provide is likely to be temporary and in the long-run these sorts of behaviours act as maintaining factors that keep the anxious thoughts and feelings going. In this way, the disorder remains unresolved.
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The pattern of negative thoughts and behaviours found in health anxiety is highly distressing for the individual and can often place considerable strain on family and relationships. The most effective treatment for Health Anxiety is cognitive behavioural therapy. CBT takes a structured approach to the symptoms of health anxiety which helps individuals to confront their fears and learn that it is safe to drop their reliance on checking and reassurance seeking and adopt a more realistic attitude to health concerns. Using a series of exercises and practice the maintenance factors that keep Health Anxiety going can be treated very successfully allowing sufferers to regain their confidence and manage anxious thoughts and feelings less catastrophically in the future.
OCD
Obsessive Compulsive Disorder (OCD) consists of frequently recurring thoughts - obsessions - that are unwanted but persistent. These thoughts generate irrational fears and lead to anxiety that is often felt to be intolerable. In order to alleviate the anxiety caused by obsessive thoughts sufferers may feel compelled to perform certain specific behaviours – compulsions and often do so in a ritualised or repetitive manner. For some people OCD compulsions come in the form of further thoughts rather than a compulsive behaviour - this means, for example, that you might have obsessive thoughts about harming someone and then, because these thoughts feel like they must be telling you something important, you feel compelled to focus on them endlessly trying to understand if they mean you are actually capable of harming someone. In reality no-one ever carries out an act based on an intrusive thought and it's precisely because people with OCD have a heightened sense of responsibility that they worry obsessively about beliefs which seem to show that they might have caused harm. Compulsive hand-washing is often referred to as a well-known example of OCD and is based on a fear of germs or contamination.
Another example is the excessive checking of doors or windows due to fears about a perceived threat to security. Because people with OCD tend to experience a drop in their anxiety levels once the compulsion has been completed this reinforces the belief that the washing or checking behaviour are useful in helping to manage the anxious feelings. In reality, the behaviour is merely acting as a maintenance factor that keeps the anxiety going and in this way the cycle of repetitive anxious thoughts and corresponding compulsions is perpetuated and the distress continues.
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The meaning and importance of thoughts in OCDThe key to understanding OCD lies in the meaning that is given to the obsessive thoughts. People with OCD feel that their thoughts are occurring for a reason and that they must therefore be important. If the thoughts were to be ignored the sufferer often feels an increase in anxiety fearing that something bad will happen either to themselves or to another. The thoughts themselves may seem bizarre and irrational but despite knowing this the sufferer feels they must attend to them otherwise a catastrophe will occur. The solution is for the individual to learn that their thoughts are just thoughts and don’t necessarily provide evidence that something bad is going to happen.
If you are suffering from OCD then don't despair, I can help.
Panic Disorder
Panic disorder is a form of anxiety which causes individuals to have recurring panic attacks. During a panic attack, normal bodily sensations become catastrophically misinterpreted by the sufferer who then views these as a threat. During a panic attack an individual may become convinced that the physical sensations they feel must be a symptom of a life-threatening illness such as a heart-attack or stroke. Panic attacks are often described as coming out of the blue, from nowhere without an obvious trigger.
This can mean that a person can feel fine one minute and out of control the next and in the grip of a panic attack. As well as causing intense fear and terrifying thoughts panic attacks also produce very real physical symptoms that provide further "evidence" to the sufferer that something must be wrong with them. Physical symptoms include a racing heartbeat, sweating, shaking, nausea, dizziness and feeling faint. During a panic attack a person may feel convinced that they are going to die and these thoughts and feelings can have a devastating affect on their ability to cope day to day.
Panic Attack symptoms
During a panic attack, physical symptoms can build up with alarming speed causing a crescendo of anxiety. These symptoms include:
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A pounding or racing heartbeat
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Feeling faint, dizzy or light-headed
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Feeling very hot or very cold
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Sweating, trembling or shaking
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Nausea (feeling sick)
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Pain in your chest or abdomen
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Struggling to breathe or feeling like you're choking
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Feeling like your legs are shaky or are turning to jelly
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Feeling disconnected from your mind, body or surroundings (often referred to as dissociation)
A panic attack can cause you to believe that your life in danger and you may feel as though you are:
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Losing control
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Going to faint
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Having a heart attack
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Going to die
What is the treatment for Panic Disorder?
Panic Disorder can be treated effectively with a course of Cognitive Behaviour Therapy.
CBT can help us to gain more understanding about the symptoms of our panic attacks as well as the thoughts and behaviours that we tend to adopt when we feel a panic attack coming on. When we look more closely at the thoughts and behaviours that seem to help when we feel panicky we can often be surprised to learn that these are actually keeping the disorder going in the long-term. Safety and avoidant behaviours refer to any behaviours that appear to give some relief from the panic symptoms - for example if you feel dizzy and light-headed during a panic attack you might believe that you need to find somewhere quiet and sit down.
If you somehow feel better when you sit down it's easy to see that you will soon build up a belief that this is what you must do every time you experience a panic attack and, since our brains tend to encourage us to repeat behaviours that seem to work, you'll carry on doing this every time you feel this way. In reality though, sitting down is unlikely to have contributed anything to the sense of relief you now feel and in the process you will have missed a valuable opportunity to test out the possibility that your anxiety would have subsided on its own without actually doing anything at all other than insisting that you remain standing.
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This is because anxiety creates the belief that we are under and immediate threat and need to do something to protect ourselves but the fact is that anxiety tends to decrease the more we learn to tolerate it - it may well feel unpleasant in the moment but eventually the intensity of the feelings will reduce and the panic will fade away. This means that the key to overcoming a panic attack is to simply stay with and tolerate the feelings - the more that we can allow ourselves to experience our anxious thoughts and feelings the less scary they will feel and the more we will learn to manage them more effectively.
If you feel you may be suffering from Panic Disorder I can help, please reach out today.