Dr Anita Rose Director of Clinical Service: Consultant in Neuropsychology & Rehabilitation

Dr Anita Rose Director of Clinical Service: Consultant in Neuropsychology & Rehabilitation

Hope this finishes soon as I am hungry Did I lock my car when I left it in the car park? Will today finish in time for my train? Did I get the dinner out of the freezer? Can I pay the bills this month? Why does my boss want to see me tomorrow? Shall I paint my toe nails tonight?

Most people worry about current and future events regularly Normal part of life and human condition Can be a motivational drive for change spur you on to action But if you re preoccupied with what ifs and worst-case scenarios, worry becomes a problem of its own Unrelenting doubts and fears paralyse Not motivating or productive. Sap emotional energy Interfere with your day-to-day life The everyday worrying can become anxiety leading to stress

Anxious thoughts are fuelled negative beliefs Negative beliefs worrying about worrying increases anxiety the anxiety cycle THOUGHTS BEHAVIOURS FEELINGS

Issue of control Reduced/reducing ability to control environments Unable to problem solve Being done to Disabling rather than enabling Symptom part of the condition E.g. MS, PD Biologically driven?

TOP TIPS 1. Help accept uncertainty 2. Worry times 3. Challenge negative thoughts 4. Teach relaxation 5. Enable self care

The inability to tolerate uncertainty plays a huge role in anxiety Strong need to know with 100% certainty what s going to happen not possible with LNC Thinking about all the things that could go wrong doesn t make life any more predictable Help patient to come to an understanding of the disadvantages and problems of being intolerant of uncertainty encourage them to ask the following questions Is it possible to be certain about everything in life? What are the advantages of requiring certainty, versus the disadvantages? Or, how is needing certainty in life helpful and unhelpful? Do you tend to predict bad things will happen just because they are uncertain? Is this a reasonable thing to do? What is the likelihood of positive or neutral outcomes? Is it possible to live with the small chance that something negative may happen, given its likelihood is very low? How do others cope with uncertainty? (e.g. Close friend)

When intolerant of uncertainty their mind tends to be focused on the future Encourage practice becoming more present focused and accepting of current experience Mindfulness The past is history, the future s mystery, today is a gift that s why it s called the present....

Trying to stop worrying doesn t work - at least not for long Rather than suppress anxious thoughts encourage developing the habit of postponing worrying Create a worry time. Choose a set time and place for worrying. It should be the same every day (e.g. In the living room from 5:00 to 5:20 p.m.) and early enough that it won t make increase anxiety right before bedtime. During the worry time, they are allowed to worry about whatever s on their mind. The rest of the day, however, is a worry-free zone. Postpone worries. If an anxious thought or worry comes into their head during the day, make a brief note of it on paper and postpone it to their worry time. Remind themselves that they ll have time to think about it later, so there s no need to worry about it right now. Save it for later and continue to go about their day.

Go over the worry list during the worry time Reflect on the worries they wrote down during the day. If the thoughts are still bothering them, allow time to worry about them, but only for the amount of time specified for their worry time. If the worries don t seem important any more, cut the worry period short and enjoy the rest the day 10 mins to start will decrease over time Increases control It works try it yourself!

Cognitive distortions/thinking errors e.g. Black & white (all or nothing) Exaggerated thinking Negative bias Should or Ought thinking Encourage questioning/challenging of such thoughts: What s the evidence that the thought is true? That it s not true? Is there a more positive, realistic way of looking at the situation? What s the probability that what I m scared of will actually happen? If the probability is low, what are some more likely outcomes? Is the thought helpful? How will worrying about it help me and how will it hurt me? What would I say to a friend who had this worry? Encourage the creation of a negative thoughts and positive answers journal

Anxiety is more than just a feeling. It s the body s physical fight or flight reaction to a perceived threat heart pounds, breathe faster, muscles tense up, light-headed. Relaxed state complete opposite Impossible to be anxious and relaxed at the same time Strengthening a body s relaxation response is a powerful anxiety-relieving tactic

Imagery Progressive Calm Breathing Meditation Mindfulness Yoga Tai chi

A healthy, balanced lifestyle plays a big role in keeping anxiety, fears, and worry at bay Build support system Anxiety and worry get worse when feeling powerless and alone Encourage accepting support Support groups Online In locality Healthy eating habits Breakfast Reduce/eliminate caffeine Look at alcohol intake Reduce or stop smoking

Exercise Move it DVD Start new hobby Sleep get enough Sleep hygiene Therapeutic intervention

Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference. (Reinhold Niebuhr)