Preventing and Reducing Anxiety
Melanie O’Brien: Hello and welcome to today’s webinar titled “Preventing and Reducing Anxiety.” My name is Melanie O’Brien and I will be the host of today’s webinar.
Our presenter today is Sam O’Connell. Dr. O’Connell earned her Ph.D. in Clinical Psychology from Suffolk University, and she currently works as a psychologist in many different capacities. She performs neuropsychological and personality assessments at the Integrated Center for Child Development, where she also heads Sport Psychology and Performance Department.
Dr. O’Connell is the Chief Psychologist at South Shore Mental Health, where she directs the employee assistance program and works as an outpatient therapist and consultant for businesses, families, couples, and individuals across the developmental lifespan.
We are very pleased to have Dr. O’Connell with us today and so without further delay, Dr. O’Connell, I will turn it over to you.
Dr. Samantha O’Connell: Thank you so much! Hey everybody! How are you today? I really appreciate you taking this time out of your day to chat with me and to listen about something that we all feel, at least in some capacity, which is anxiety.
The thing is if we didn’t experience anxiety, it would be a really, really unsafe thing for us. Anxiety helps us make decisions, which do indeed keep us physically and emotionally protected.
So today, we are going to be talking about the kind of anxiety that gets to be too much, worth interfering with our life. It’s when those words feelings and those thoughts do actually calm—cause more harm than good. So we will talk a little bit about what the biological need for anxiety is, why we actually want it, why we would never want anybody to have a treatment for an anxiety-ectomy. We never want that to happen.
And so we will talk more about the biological needs about anxiety, why we have it but really what we are going to focus on and when those worries cause distress, a whole lot of distress and disruption in our life, that’s when it gets to be the kind of anxiety that just is interfering with our life.
But before I begin, I would like you all just to think for a making about something different. OK, so shake off inside of our head and just I want you think for a minute about alarms, just alarms in the world. So let’s get warmed up.
What kind of alarms do you know about? So some of you may be thinking, all right, different types of alarm maybe an alarm clock right, may be some of you are thinking about a car alarm, may be a smoke detector. So whatever alarm you are thinking about, take a second I think all right, what does this alarm tell us?
Well, basically they just give us a message to do something, right? It might be get up, move out, there is danger, a fire. It just tells us that there is something that we need to do and usually, it’s a message about keeping us safe or keeping us going in some way.
So all right, great, we knew alarms. So let’s think for a minute about any of these alarms. Have you ever had an experience when one of these alarms has gone off either accidentally or when there's no real threat or real problem or real need for a message?
So yeah, I mean maybe you think about OK, your alarm clock went off on a Saturday morning and Saturday isn’t a work day for you. Now, does this different, does this still go beep, beep, beep, beep, beep or is it like ‘hey, Sam, it’s Saturday, you can turn me off now and snuggle up and go back to sleep, don’t press snooze, just turn me off.’
No, of course not, wouldn't that be great if it did, but no, it says beep, beep, beep, beep, it sounds exactly the same as your alarm clock for a regular workday. Now, maybe some of you are thinking about like a smoke detector, maybe you're a fabulous cook like I am who happens to get distracted.
So maybe you something on brail and it just gets little too smoky because you forgot about it, and when the smoke detector goes off, does it still sound like the loud obnoxious smoke detector sound or is it more gentle, does it say, ‘hi Sam, it’s me, this is not a real alarm, just wanted to let you know it’s OK that you got distracted, go ahead and just take that out of the oven and open up a window, no need to hose down your house.’
No, of course not, it sounds exactly the same, right? So in a fire drill, think about kids in a fire drill, I mean it sounds exactly the same, right, these are alarms. So let’s bring back to the topic for today, right, I promise I'm not totally random here.
So anxiety is actually our body’s alarm. It’s the alarm that where we get these sensations from inside of our body and many of you know these really well, right, your palms may be sweaty, your heart may be beating fast, you may have these thoughts of anxiety and basically, you have this urge to do fight-flight-freeze, right, you have an urge to do something when you feel these things in your body or you start thinking these things.
Now, for some of us, our anxiety alarm is wired in a more sensitive way that other people. So just like my cooking smoke detector might be more sensitive, maybe not but maybe it’s just a bit more sensitive or you may have a car alarm where you brush passed it in and it goes off. That wiring is just a little bit more sensitive than is perfectly adaptive, right?
So anxiety is our alarm and again, we never would want to take the batteries out of that alarm clock but we may wish they it was rewired a little bit differently so that we could better understand when it was a real danger situation versus when it wasn't, when it was just a message based on wiring, it was a little too sensitive.
So I just want you to think about that as we go through this that we all have this alarm in our body but sometimes it’s going off in times when it just doesn't make that much sense, okay. So lets’ talk a little bit about what exactly are we going to cover today.
Well, I will talk a little bit more about what anxiety actually is, that word is thrown around a lot, but let’s talk about what exactly it is and then we will generally talk about six specific types of anxiety disorders and then, I will talk about causes and risk factors for developing an anxiety disorder.
I will move on to one of my favorite parts which is treatment options for anxiety disorders, this is—anxiety is one of those areas that is so backed in literature and research. We really, really know what works and so why it is one of the most common mental health issues, there's so many things that actually work and different things work for different types of anxiety.
So we will talk about that and then, also importantly, we will talk about some prevention and risk reduction strategies for anxiety of any type in the specific anxiety disorder set I talked about.
So what is anxiety?
Take a look at the slide here, it’s a reaction. So anxiety can be due to a real threat, you go out to the woods, you see a bear, you go into fight-flight-freeze, right, most of us would probably run the other way. Although, it's perfectly adaptive for some animals to play dead, right that’s an adaptive response to threat but that’s a real threat, right?
But then there is also an imagined threat and that's when we have anxiety and worries about something that isn't—hasn’t happened, may not happen, it could just be what we think would be but it still is anxiety. It’s basically a reaction and it’s the thought, you know.
So we will talk a little bit about how anxiety has—really has three parts, it’s what you think, it’s how you feel, and it’s also what you do and all three of those things can perpetuate it or make it go away. But it’s a general feeling of uneasiness or dread so whether there's something real to be afraid of or something that our mind has made into something bigger than it is, we know that feeling, it’s dread, it’s uneasiness.
And of course, there is a spectrum from feeling there is a little bit of worry to straight up panic, but it's important to note that anxiety is a normal response to danger, threat or extreme stress. All of us have it, all of us need it, and again, we would never want an anxiety-ectomy, we never want anxiety to be taken out of our brains and our bodies. Of course, muting it could make things much more comfortable and make us more adaptive at our job with our families etc.
So this is what anxiety is but let’s think what causes anxiety disorders so that word disorder is—if you're going to have a diagnosis and we will talk about what those are but really the D-word from me is disturbance. So anxiety may just be a part of us that is coming out and driving the bus and it's really the level of disturbance that it’s taking in our life.
We all have it but some of us can't work because anxiety is taking over or it's hard to really be present in a conversation because we are constantly thinking about the past or we're constantly thinking about the future, what will happen.
And so that D, I would really like to think about it for all of us as what causes anxiety disruptions like that real disruption rate impacts our life and there is a lot of things, so the first bullet there, genetics.
Thanks mom and dad, grandma and grandpa, ancestors, what have you. We know that there is a genetic link between anxiety, it’s one of the most transmittable disorders and we might think, all right, is that biologically genetically transmitted or do anxious parents tend to have more anxious kids because of how they are teaching them to be in this world.
It’s hard to disentangle. A lot of these bullet points on this anxiety disorder slide really can be subsumed under this theory that’s called biopsychosocial. It’s the one that I like to scribe to, means genetically, your biology maybe a predisposition to have more anxiety, maybe you were born with just a more sensitive temperament, your alarm in your body is just a bit more sensitive, right. Everybody is different.
But there does seem to be a genetic component. So if you're the kind of person who is having a lot of disruption from anxiety and nothing major has happened in your life to engender that You might look toward the genetics and think okay, this is sort of a legacy burden that I have. It just been carried on through, through my genetics.
Biochemistry, the way that somebody is just made up and there could be a lot of things. Again, it can be just how one's regulatory system is configured. It may just be more sensitive. And also these things like, like if a person, say a person saw me for a neuropsychological evaluation and I get their IQ score, most people have a balanced system but many of us have some stronger and some more modest capacities.
And when there is a big difference say between your verbal IQ and your non-verbal IQ, that can engender this internal tension.
So there may not be actually anything out there in the world that’s making you feel tense or at least nothing that you can put your finger on, but it may just actually be the way that you navigate through life feeling that some things are really easy and yet some things feels so hard and you don’t have a good reason for it.
So that can just be tension producing in and of itself and that's a less visible one. It's hard to understand, but that can be part of your biochemistry and then there is personality factors.
Some people you may have heard—there is some literature out there about the type A personality, I personally would rather like to understand that as a Type A part, meaning that somebody may be a bit act in a more hostile way or be act really stressed out all the time, to me, when I step back I think oh, that's probably a part of that person that is trying really, really hard to manage something.
So, but we may hear about different personality factors or at least parts of a person that can lead to more disruptive anxiety.
As you see by halfway through slide upbringing, right, I have mentioned that anxious parents may have at a greater risk for having anxious kids and that could just be the messages that you get growing up. Did you live in a household where it would go with the flow and things happen and we take risks, or did you live in a household where you have to worry about everything, and maybe you did have to worry about everything, and maybe you just had a parent that did worry about everything.
But there's just a lot of different reasons, and of course, life events. So we will talk in a little bit about a particular kind of anxiety disorder that has to do with a reaction to trauma.
So something happens to you and then you become more fearful. So that can range all the way from a post-traumatic stress reaction or even just having more things happen to you that really make you feel that the world is not a safe place.
And so depending on what you make of those events and what you think those events will say about your future, can absolutely lead to compounded anxiety that eventually becomes what we would call an anxiety disorder.
Substance use is a tricky one. Most often in my experience those who use or abuse substances have anxiety underneath. Again, while we could criticize substance use, you know the way I think about it is that that probably is another really powerful part of the person trying hard to maintain order and peace. It's just coming out in a different way.
But substance use we do know using a lot of substances and then withdrawing from it can be anxiety provoking. So it can go both ways, but often when somebody is abusing in a way there is something underneath that and often it is tension or anxiety or different kind of worldview.
So let's talk about these are six specific types of anxiety disorder. It is not one-size-fits-all. It doesn’t all look the same. There is actually a whole lot of different manifestations of anxiety disorders.
And again, when we use that D-word, many of us may be little bit worry about a lot of things. We may feel panicky at times in our life, we may say that's my obsessive-compulsive part coming out, we may feel nervous to give a speech in terms of a social anxiety, and we may be really freaked out when something happens to us, but it doesn’t necessarily mean that you will have a anxiety disorder.
Again that D is more about distress and disturbance, impacts on your life. And again, I prefer to use the language of anxiety parts that are just getting, getting in your way or not letting you live the kind of life that you wish to, or work in the way you wish to.
So the first one and I will have a different slide coming up in a bit more specific about generalized anxiety disorder, but that’s where there are just a whole lot of worries.
For generalized anxiety a person may anticipate disaster all of the time or at least most of the time. There could be disaster across the health domain, maybe worried about accidents or messing up, social situations, grades, job performance, any kind of performance, world events, it's just a whole lot and it's happening all lot of the time about a whole number of things.
It is one of the most common types of anxiety problems, but before we talk about that, let's talk about some of these more, less common.
So the word I had a panic attack that can—people talk about that quite often and true panic disorder is far, far less common than we—than one would imagine. There is a difference between panic attacks and anxiety attacks.
So an anxiety attack is where you know exactly what you are anxious about. There is an elevator. I am terrified of elevators. I do not want to go into the elevator. I am experiencing my alarm go off, I am freaked out. This is an anxiety attack.
A panic attack on the other hand often comes from out of the blue. There's not a thing in front of you that you know about at least that's making you completely get become overwhelmed, and honestly feel like you are dying.
A true symptom of panic disorder that many people describe is it that you feel like you're dying, and there is nothing in the outside world perhaps that can point to why you're feeling this way. There is no huge threat in front of you, but you feel your heart beating fast, you are having the sweats, your heart is racing incredibly. You may field disassociated like out of reality a little bit. The world may not feel real and it's completely—can completely freak you out. And that's panic disorder.
So it's the alarm going off in your system that fight, fight for you alarm, but you don't actually have something in the outside environment that's making that happen and that's a big distinction between an anxiety attack and a panic attack.
And so panic disorder is when these things happen over and over again and then there's a fear about having another one.
So as soon as you start feeling your heart race, you may begin worrying that you will have another panic attack, and of course that can lead you to want to avoid a whole lot of things, because well, in our life our heart beats fast whether we are exercising or excited about something or fearful and so panic disorder can be quite disruptive.
Obsessive-compulsive disorder is another one. This one gets thrown around and we usually think about if somebody who is afraid of germs or washing their hands over and over and over again. And sure, there are sub types of OCD or obsessive-compulsive disorder that, that do revolve around intrusive thoughts about germs and checking and then compulsions to you know either wash hands or check a lock, but there is also a whole lot of sub-categories.
To have the diagnosis of OCD you really only need obsessions or compulsions. Compulsions people can see, obsessions well, only you have the privilege of having those and they can be really disruptive. It's chronic, lasting, uncontrollable thoughts that repeatedly enter your mind and you don't want them to.
Often there is personality incongruence meaning you may have intrusive thoughts that you are going to hurt somebody or that somebody is going to hurt you, but this isn't in line with your personality and you never would, but cannot stop with this intrusive thought.
And then often there is an undoing—an undoing behavior, meaning that somebody will count or check or recite numbers in their mind or whole lot of behaviors that can either be mental or physical and where you—there is a compulsion where you do something over and over again and you get temporary relief but the more you do it the more you feel like you have to do it.
So obsessive-compulsive disorder is marked by either obsessions, intrusive thoughts or compulsions where you feel like you just don't have control over it.
Specific phobias are where there is just a major fear that's irrational and intense, intense fear. Somebody who like say I was actually treating with man a little while ago who didn't like flights, but really there was a phobia and he only knew this when he couldn't take a new job because he, he couldn't get on the plane and his income depended on it, his family depended on it, but he couldn't get on that plane.
And so at that point he had reached distress and disturbance in his life. He couldn't get what needed to be done done and so—and it was irrational. Sure. People do get in plane crashes and things do happen, but most of the time they don't and most of us we may feel a little nervous but a phobia is where the fear is, it's irrational and the level of the fear is irrational.
On a side note, specific phobias are very easy to treat and the treatments are typically exposure based, meaning slowly exposing someone to small, small, small, small, small non-threatening examples of what they're afraid of, maybe viewing pictures, watching somebody else do the thing eventually doing until a person can become just kind of normal and bored by it.
But that’s a specific phobia, specific irrational fear and then there is social anxiety disorder. So again, a lot of us get nervous about a lot of things, right, and social anxiety is definitely different from shyness. Shyness is a personality trait and there is a whole spectrum.
You can be introverted or extroverted but real social anxiety is marked by a person who has intense fear of being evaluated negatively. Like intense worry that there is going to be mistakes, that they are going to be humiliated, embarrassed.
And the thoughts are not quite accurate. Everybody is going to think that I'm a total loser when I give this presentation on anxiety disorders and not being able to move forward because I have this worry. It’s just more pervasive and it's a very black and white thinking style where in somebody’s head, they’re always worried that they will be judged and there is just an intense anxiety reaction that goes with it.
So there may be a whole lot of times when avoiding social situations and then if they are in the situations, just thinking and over thinking and worrying and just being intensely uncomfortable with what happened, even if there's no data that says, people aren’t thinking about you or you really did mess up, sort of like being under a big microscope and feeling really, really—or a big magnifying glass and really uncomfortable by that.
Finally, on this slide, post-traumatic stress disorder, this is one that we have learned a whole lot more about through the years and there is a couple of components here and one is that you have to have experienced a traumatic thing. So something has to have happened to you and not everyone who experiences a traumatic thing gets PTSD and not everyone who had PTSD has actually gone through it.
But there has to be a perception that either a life was in danger and it can be your own like your true being like a situation where you were humiliated or shamed or felt like you might be so intensely that you have a reaction that leaves you with a few specific kinds of symptoms.
And those are an intense fear reaction, where you also are hyper vigilant meaning you are super, super, super on edge and you may be avoiding situations that somehow reminds you of that are triggering, even if they don't seem so related, there might be somehow the association or sensory experience might be.
There is a lot of—we think of our soldiers and our service men and women and not everyone experiences post-traumatic stress disorder when they have seen some very horrible things or have had their life threatened. But some people do and it’s definitely a specific type of anxiety disorder and that one is more of a reactive disorder. So something has to have happened and then there's a reaction.
All of us feel stressed and often want to avoid a situation that was scary or life-threatening but usually that dissipates in about 30 days and when it lasts longer, then it may be either an adjustment reaction or all the way to a post-traumatic stress reaction or stress disorder.
So let’s just look about this, this generalized anxiety disorder, often referred to as GAD is the most common anxiety disorder that we have, at least here in the United States and you can see here there are emotions, behaviors, and some physical things that happen. So emotionally you may have some of uncontrollable or constant worrying, a lot of dread and nervousness about a lot of things and often it’s accompanied by excessive or uncontrollable crying. You're always in that fear reaction and it’s just terribly uncomfortable.
Behaviorally, it might be hard to concentrate. I would say it is hard to concentrate, if you have persistent feelings of dread and then it also can manifest in restlessness or becoming fatigued and of course, avoiding situations that make you anxious. The typical think is that the more you avoid the less—the less out of you have that tells you, actually I could be safe in that situation so avoiding perpetuates anxiety which is really, really hard, when you're having the physical features of anxiety. And as you hear some things could be stomach issues, your muscles tightening and sleep problems.
So let’s look at this chart here, as we start—you may be thinking about yourselves or people you know so what is normal worry and how is that different from something that we might consider GAD; generalized anxiety disorder. We will list more typical worry, your worrying doesn’t get in the way of your daily activities or responsibilities, you can move on, it’s there but you are okay.
And generalized anxiety, it significantly disrupts your job, your social life and any activity. Go over to the normal worry side, you're able to control your worrying but with general anxiety, you just do not feel like you're in control of it.
In the normal side, you worries don’t—they are unpleasant, they do not feel good, but they don’t cause significant distress; whereas on the other side when it becomes more of a diagnosable condition they are extremely upsetting and stressful. A normal worry, there is something coming up in your life or at work or with your family and you are worried about it. But in generalized anxiety, it’s all sorts of things and they rotate and you tend to expect the worse.
For more typical worry, worrying lasts for a short period of time or until the stress is over but for generalized anxiety, it’s a persistent worry, almost every day for at least six months.
So how do we prevent this from happening, right? How do we keep our anxiety the way that works for our life versus how do we make that go away or reduce. So one of the first things is knowing yourself, knowing what stresses you out or what triggers your anxiety, really taking some time to understand what’s the domain that I get the most stressed out in.
How do I react to cope with stress, being mindful, do I do things that can perpetuate anxiety or do I avoid things so much that I have a bigger problem at the end of it, how could I and how might I do that better, are there people out there in the world that are doing it batter, what are they doing.
Sometimes, it’s simply listening to the types of things, listening to your own reaction and not trying to push it away but understanding why it’s there and having that conversation with yourself about all right, is this my worry about the past which I can’t control or the future which I can’t control or is it this moment because only when we stay in that moment, we can be anxiety free in the way that we need to be.
If that moment is a bear for us, we are like yeah we got to fight-flight-freeze but when we are stuck worrying about the past, that's just getting in the way and when we are stuck thinking about the future well that’s getting in the way too and that doesn’t mean not to set, think about our past and have us learn from that, it just means overly thinking about the things we can't control, the past and the future can really impact our concentration and our enjoyment.
Things that increase your resilience, exercise, self-care, being around positive people, all of these things, getting back up once you fall down, increasing your resilience. If there are medical conditions, checking with your doctor and getting a rule out of the things because of course, anxiety can feel like some medical conditions.
I really like that—the last bullet of setting boundaries, protecting your peace. There may be parts of you that say that you always have to be the helper, or you always have to do this or that and if there's a should in there, I should be doing this or I should be doing that, often that’s just a part of you saying you should but maybe there's another way that you can protect your peace and in that sense, be more available for the things you really want to do and be more available for people in a more holistic way and the way you truly want to be.
Maintaining a positive attitude; easier said than done. But trying to consider all the different ways that you could think about a situation might help you to leave more on the OK, you know what, that happened in the past but it does not mean it will happen in the future. There is a way that I can look at this that could be more health promoting even if the other way has some accuracy. Any stress reduction techniques, breathing, mindfulness, for some people it’s more active, it can range from yoga to running to boxing, whatever reduces your stress, that’s the way to go.
Some other strategies are basically living a healthy lifestyle, asking for help, there is lots of the kind of help support groups especially for things like social anxiety, support groups are awesome. It can be helpful to connect with like-minded peers who are also smart and capable, who just also have perhaps a sensitive alarm system.
Accepting that life sometime in stressful in that, you know what if that part of you is reacting in an anxious way, instead of hating that part really thinking that part because it’s trying to do something for you. But then gently asking it to step aside so that you can take control of the situation and it's not that worry part.
It’s so hard to not become preoccupied but remember anything from this webinar, I would imagine thinking about a line where the present is the only thing you can control and we can’t control the past and we certainly can't control the future.
So some things that—if you feel like, you are listening to this webinar and you are someone you love feels like all right, yeah I have worries and they're causing distress and disturbance in my life, well there are certainly things you can do.
There is medications that are meant for this, but I also wouldn’t be surprised if you are doing some sort of therapy like a cognitive behavioral therapy where your provider might say, actually medication isn’t indicated for this type because sometimes it is and sometimes it’s not and so certainly consulting with your doctors or medical professionals about that.
Cognitive behavioral therapy is a type of therapy where they—you really think about those three parts, what you think, how you feel, and what you do.
I think I am going to be horrible at this presentation. I feel super anxious, and so I start tripping over my words, or I think that OK, you know what, I may not be the best speaker on anxiety in the world but I can do OK so it feel somewhat competent and then I will just speak from my—from my heart and my knowledge.
So a cognitive behavioral therapist will help you recognize when your thinking is getting a little funny, a little maladaptive, and helping you to switch those cognitions which could impact how you feel and then certainly what you do.
So all kinds of treatments, relaxation techniques, and different types of therapies, and often you know which one feels the best for you.
So in conclusion, anyone can develop an anxiety disorder. Symptoms can vary. They can be all kinds of different types of anxiety disorders and really let's think about it as just anxious parts that are driving the bus. And if that bus is going in the wrong direction and impacting your life, well then we know that that might be something that needs attention.
There is all kind of strategies, you will have to practice just like anything but if it's really disrupting your life, then I promise you that practice of the techniques will certainly help. And they are highly treatable.
So this might be something that you go to EAP for. The EAP certainly has licensed professionals that will help you and your family with those anxiety disorders and all kinds of things.
And there is also other things; life events, strengthening relationship, positive things like achieving your goals, balancing your work, financial futures.
Your EAP is there and it's free and it's confidential, 24 hours a day. So I encourage if while listening to this you are thinking you know what, I am ready to take my anxiety out of the driver seat, although keep it on the bus, then you might reach out to your EAP.
But thanks for listening and thinking with me about the parts of ourselves that that manifest an anxiety and I hope that you are more able to live in the present today and all your days.