Stress & Mood Management. Managing Anxiety and Panic. Course Slides. Keeping Yourself Safe

Transcription

1 Course Slides Stress & Mood Management Managing Anxiety and Panic To obtain a copy of the course slides, log on to: Alternatively, smm@sssft.nhs.uk. Please do not send any other requests or queries to this address as it is not monitored by clinical staff Those without access to the internet can request a paper copy. Keeping Yourself Safe Sometimes difficult emotional problems can lead to feelings of despair, including thoughts about hurting yourself, ending your own life or hurting others. Please see your handouts for sources of support Info Cards are available on request Reflections on the Previous Session What was useful from last session? What did you try and how did you get on? Was there anything that you wanted to try? What got in the way of your change and how can you overcome that this time? Inclusion Thurrock 1

2 Session Aims Symptoms of Anxiety To normalise the symptoms of anxiety and panic. To learn techniques to manage anxiety and panic. To learn how to challenge our unhelpful thinking. To begin facing our fears. Thoughts race Changes in vision Heart beats faster Muscle tension Nausea Sweaty Dizzy or lightheaded Dry mouth Rapid breathing Breathlessness Bladder urgency Shaking Fight or Flight Response What is Anxiety and how does it differ from Panic? Inclusion Thurrock 2

3 Case Study: Tina Tina s Unhelpful Thinking Tina has been experiencing anxiety for a number of years. She worries about blushing when anxious and that people will notice. Tina spends a considerable amount of time worrying about her performance at work, in particular when chairing meetings. When there is a pending meeting, Tina gets a headache, often gets hot and sweaty and she needs the toilet more often. Situation I have been asked to chair a meeting at work Thoughts Colleagues will ask me questions and I won t know the answers I will go red and everyone will notice I must perform perfectly or my colleagues will think I m stupid I m just not good enough at my job Feelings / Sensations Anxious 90% Headaches, tension in neck and shoulders Bladder urgency Feeling hot and sweaty Upset 60% Sinking feeling Thoughts Colleagues will ask me questions and I won t know the answers I will go red and everyone will notice I must perform perfectly or my colleagues will think I m stupid Tina s Unhelpful Thinking How might Tina s thoughts influence her behaviour? I m just not good enough at my job Feelings / Sensations Anxious 90% Headaches, tension in neck and shoulders Bladder urgency Feeling hot and sweaty Upset 60% Sinking feeling Behaviour Procrastinating Staying up late worrying Not drinking as much to prevent needing the toilet Trying to get out of chairing the meeting Avoiding her boss Fortune Telling Believing you know the negative outcome of events yet to happen. I ll go but I wont enjoy myself. That won t work out, so there is no point in trying. Inclusion Thurrock 3

4 Demand Statements Thinking or saying I should (or shouldn t), have to, ought to and must puts pressure on ourselves and sets up unrealistic expectations. Mind Reading Assuming you know what others are thinking about you. I know that look means; he is unhappy with me. Emotional Reasoning Basing reaction on your emotions rather than rational thought. I feel anxious so this must be a bad situation Catastrophising Imagining and believing that the worst possible thing will happen. If this course can t help me, I ll never get any better and I ll always feel like this and it will probably get worse. I won t be able to cope! Inclusion Thurrock 4

5 Challenging Unhelpful Thinking Exercise One Is this a fact, or just a thought? Is there another way of looking at it? What would someone else make of it? What unhelpful thinking habit is this? What advice would I give someone else? What evidence is there that this thought is true? Where is thinking like this getting me? What are the pros and cons of holding this belief? How could Tina look at this differently? What could she tell herself instead that might be more helpful to her? Use Tina s thought diary in your handout to help. Tina s Revised Thinking Thoughts Colleagues will ask me questions and I won t know the answers. I will go red and everyone will notice. Revised Thoughts This is fortune telling I can t be expected to know everything. If I am unsure of anything I can get back to them. Blushing is a common reaction to anxiety. It probably doesn t notice as much as I think. My colleagues will not think badly of me if I do go red. Old Feelings Anxious 90% Tina s Revised Thinking Revised Thoughts This is fortune telling I can t be expected to know everything. If I am unsure of anything I can get back to them. Blushing is a common reaction to anxiety. It probably doesn t notice as much as I think. My colleagues will not think badly of me if I do go red. New Feelings Anxious 50% I must perform perfectly or my colleagues will think I m stupid. I m just not good enough at my job. I am putting unnecessary pressure on myself. Nobody is perfect. I wouldn t be this harsh on my colleagues. My boss wouldn t ask me to do this if he thought I was incapable. Upset 60% I am putting unnecessary pressure on myself. Nobody is perfect. I wouldn t be this harsh on my colleagues. My boss wouldn t ask me to do this if he thought I was incapable. Upset 20% Inclusion Thurrock 5

6 Anxiety is a physiological reaction which is triggered by our thoughts about the scariness of a situation. A simple equations sums up anxiety perfectly: Anxiety = Summary of Anxiety Perceived Threat Perceived Ability to Cope Salkovskis & Forrester (2002) Case Study: Bob Bob had his first panic attack six months ago. After an important meeting about redundancy he felt an intense wave of fear, the room started spinning and he felt like he was going to be sick. His whole body was shaking, he couldn t catch his breath and his heart was pounding. He gripped his desk until the episode passed but it left him deeply shaken. Bob had the next panic attack three weeks later on his way to the shops. Since then, they ve been occurring with increasing frequency. He never knows when or where but he s afraid of having one in public. Consequently, he s been staying home rather than going out with friends. He has also been avoiding going shopping, particularly to busy supermarkets. Cycle of Panic Internal or External Trigger Bob s Panic Cycle Internal or External Going to Trigger the supermarket Perceived Threat I ll have a panic Perceived attack and Threat everyone will notice Anxiety Anxiety Catastrophic Misinterpretation Physical / Cognitive Symptoms People I m I feeling don t are Catastrophic going feel dizzy right to notice Everyone I might Misinterpretation This pass going isn t out to normal look collapse at me Physical Heart Hyperventilating Sweating palpitations / Cognitive Difficulty Thoughts Depersonalisation Symptoms focusing racing Safety Behaviours Shop Online Inclusion Thurrock 6

7 Common Beliefs in Panic I might die from a heart attack. The heart is designed to react in the way it does during a panic attack. It can feel unnatural because this type of heart activity is usually reserved for vigorous activity, when you don t notice it as much. However, unless you have a heart condition, it is not usually a threat to the heart. If you are worried about this, see your medical practitioner. I m having a nervous breakdown, or going crazy. If you were really going insane would you be aware or worried about going insane? I might die from suffocation. You are less likely to suffocate during a panic attack than at any other time because you naturally take in more air. The shortness of breath you may feel is due to your body increasing its demand for oxygen, or because of hyperventilation. I m having a stroke. When you don t understand what is happening to you, it s perfectly natural to try and explain in it terms you understand. However, strokes have nothing to do with panic attacks. Common Beliefs in Panic I m scared of fainting. Fainting is not a survival option when being chased by a wild animal Fear of fainting is often due to the sense of dizziness which accompanies hyperventilation. Believing that you are going to be embarrassed or humiliated. Have you actually been humiliated or embarrassed by a panic attack? If you ever have been, was it really that bad? During an attack, it is very common and quite natural to worry that your body can t take what is happening. The fact is that panic is a short-term response. Feeling so weak that you cannot move or might fall down. The feeling of weakness is caused by shaking. In fact, you are stronger when panicking than at any other time as your large muscles are being supplied with plenty of oxygen. Losing control. It can feel like you have lost control but all that has happened is that control has shifted from your conscious to your unconscious mind, so things are still being regulated, just differently. Safety Behaviours Avoidance Keeping phone in hand Over the counter remedies Paper bags Reassurance seeking Carrying water Keeping near a place of safety Facing Your Fears F ace E verything A nd R ecover Inclusion Thurrock 7

8 Bob s Goal: To get my food shopping from the supermarket Graded Exposure To visit the bigger supermarket using a trolley To visit the bigger supermarket using a basket To visit the smaller supermarket at a busier time using a basket To visit the small local supermarket at a quiet time using a basket To visit local corner shop Make it graded: don t start with a task that is unachievable or overwhelming otherwise you might make the problem worse for yourself. Keep doing it: repeat each step, building confidence with each step that you can manage your anxiety. Tips for Success Experience the anxiety: ensure you withdraw from using any safety behaviours when you are doing a task as this will prevent you from facing up to the source of your anxiety. Tolerate the anxiety: stay with it long enough for your anxiety to naturally begin to fall and reduce by half. REMEMBER: Anxiety doesn t last forever! Escaping from the situation Staying in the situation Breathing Techniques Short relaxed breathing breathe through your nose in for 7 out for 11. Diaphragmatic breathing - focus on taking breaths which are based around the level of your belly button. Focus on having your stomach go out when you take a breath in. Regular breathing breaks - combine physical relaxation with breathing awareness to create an energy break. Taking a number of 1-3 minute breaks like this keeps your mental and physical energy high. Inclusion Thurrock 8

9 Review of Session Aims To normalise the symptoms of anxiety and panic. To learn techniques to manage anxiety and panic. To learn how to challenge our unhelpful thinking. To begin facing our fears. Home Practice Between now and next session we suggest you: Add learning points to your recovery blueprint. Continue keeping a thought diary and question your thinking. Try graded exposure. Practice relaxation and breathing techniques. Check out the additional resources on the website. Remember to log on and complete feedback about this session at Relaxation Techniques Progressive Muscle Relaxation Jacobson 1939 Inclusion Thurrock 9