Preventing and Reducing Anxiety

Posted Dec 4, 2019


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Occasionally experiencing anxiety and worry is normal. However, when anxiety is sustained over time, this normally helpful emotion can become destructive and prevent you from performing your best.

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Interviewer: Welcome to today’s webinar, Preventing and Reducing Anxiety.  We’re very fortunate to have Dr. Samantha O’Connell as our presenter.  Dr. O’Connell earned her PhD 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 a Child Development where she also heads a sport psychology and performance department.

Dr. O’Connell is Chief Psychologist at Aspire Health Alliance 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.  And now, Dr. O’Connell, I will turn it over to you.

Dr. O’Connell: Thank you so much.  Hi everybody.  I’m really happy that you’re taking some time to talk about this topic of preventing and reducing anxiety, because if we’re a human, we have some sort of relationship with anxiety.  Although, it will look different, depending on who you are and what your life experiences are.

As we talk today, I want you to all just sort of think about how anxiety might be something that we actually really, really don’t want to be without.  Now, that may seem crazy to people who suffer from anxiety-related disorders or have a family member who does.  But as I was working with a client the other day, he said something really profound.  And the thing that he said was, “You know what?  Anxiety give things importance,” and that really resonated in many ways.  This young man had been struggling with a lot of depression which wasn’t allowing him to really feel enough motivation to do a lot of the things in his life and he found himself thinking, “Gosh, if only I could have a little anxiety right now.”

And while that may seem wild, the notion that anxiety gives things importance certainly is true.  We wouldn’t ever want to be without anxiety.  It keeps us safe.  So, as we do talk about anxiety, I wanted to just sort of think about -- it’s not a bad thing.  In fact, if anyone told me that they could do an anxiety-ectomy, I’d be totally against it because it wouldn’t be safe.

So, we’ll talk about our biological needs.  We’ll talk about anxiety and then, we’re going to talk about, okay, when is anxiety actually something that we need to treat or we need to get help with when it’s causing us disruption and disturbance in our life?  Those D words, we’ll be hearing a lot.
So, before I’d even move further in this webinar though, I want you all to sort of get warmed up by thinking about something a bit different.  When everyone should think for a minute about alarms, different kinds of alarms.  So, what do we know about?  We know -- maybe some of you are thinking about alarm clocks or maybe you’re about car alarm or maybe even a smoke detector.  So, as you think about these alarms, I want you to consider what are these alarms tell us?  Well, basically, they give us a message.  They gave us a message to do something.  It might be to get up or move around, maybe there is a danger, there is a fire.  It just tells us -- these alarms tell us that there is something that we need to do.  Okay.  So, now, let’s think about these alarms.  Think about if any of you -- which I’m sure you had, have had an experience where one of these alarms -- alarm clock or fire alarm or smoke detector has gone off when there actually wasn’t a treat.  So, I’m sure you have.  For example, maybe your alarm clock goes off on a Saturday and that’s not a work day for you.  So, think about just the sound of the alarm.  Does it sound different when it’s a Saturday?  Saying, “Hey, Dr. O’Connell, no need to be up.  Go back to sleep.  Get a few more rest minutes,” and no, it doesn’t sound like that at all.  It says, “Beep, beep, beep, beep, beep.”  So, what do we do?  We look around and we say, “My gosh, it’s Saturday.  I forgot to turn that off.”  All right.
And think also maybe a smoke detector.  Maybe you’re cooking.  Maybe you just left it in the oven for a little bit too long and the smoke detector is alerted.  Does it sound different when it’s not actually a danger?  Does it say in a nice gentle tone, “Just take that turkey out of the oven because it’s just been smoking a little bit”?  No.  The alerts go up.  The alarm is super, super loud.  Just like with kids in a fire drill at school.  It sounds exactly the same, but we know that there actually isn’t a danger.

So, now, I want you think for a minute about anxiety.  An anxiety is our body’s alarm clock.  So, sometimes, sure, we might want to take batteries out. To not feel the anxiety.  But we must really know is that anxiety is the alarm that we get when there are sensations in our body that tells us that we need to do something.  So, obviously, we would not want to have anxiety-ectomy, because we need those messages to give us importance around do something or don’t do something.  But, let’s also think that just like some of our smoke detectors are a little -- the wiring is a bit sensitive.  At least, that’s my story and I’m sticking to it, that some of us have wiring in our body system where the wiring is sensitive.  And so, maybe that alarm goes off and gives us the message that something is important when maybe it may actually not be as important as our body’s alarm is telling us.

So, as we talk about anxiety, we’ll talk about the alarm certainly isn’t a tone like it is with the alarm clock or a fire alarm, but there is an alert signal.  Things like your heart rate and your breathing.  And so, when we talk about anxiety, we’ll talk about the necessary things that we need, the necessary signs that we need to give things importance, but we talk about anxiety-based disorders.  That’s when we’re going to talk about anxiety that actually impacts our life because the wiring is sensitive in a way that it’s disrupting us from doing what we really need to do as it directs our attention.

So, let’s talk about what we’re actually talk about in this webinar in totality.  So, we’ll define anxiety a bit more and then I’ll also talk about six basic types of anxiety disorders.  And then, we will talk a bit about the causes and risks factors for developing an anxiety disorder.  Remember, all of us have anxiety and need anxiety, but an anxiety based-disorder is when it’s causing a disturbance and a disruption in our life and pulling us from things that we need to be doing.  And then, my favorite part, we’ll be talking about treatment options for anxiety disorders, which is a really hopeful thing around this topic because anxiety is one of the most treated mental health issues that we have and we really, really, really know it works.  So, it’s always a pleasure to be able to talk about some of the things that we know absolutely can help somebody find some relief while also being safe.  And then finally, we’ll talk about some prevention and reduction strategies.  If you do have an anxiety disorder or if someone you love does.
All right, so, defining anxiety.  Well, you see in the slide, it’s a reaction.  So, anxiety and its most basic definition is this reaction.  And it’s a reaction to real or imagined threat.  So, an alarm as we’ve talked about maybe has a tone, has a sound, has a light.  Well, inside us, it is a reaction.  All of those symptoms that we can talk about, the changes in our breath, the hearth rate, all different kinds of things, feelings in your stomach, general feelings of uneasiness or dread, basically, all of those are part of a fight-flight reaction.  That is what anxiety is.  It’s stress.  It’s your body’s natural response to threat, and the most common reactions are fight-flight-freeze.  This is what your body does when it feels dread, you either fight.  Flight means to run away or to try to get away from it and then freeze is -- you can imagine how -- some animals play dead and that actually is a biologically adaptive process for some animals to survive in the wilderness.

So, our reactions that are a flavor of fight, flight, running away, avoiding or freezing up, all of these things are part of our anxiety reaction.  Of course, they look different in different people and as we talk about it, there will be different types of anxiety-based disorders.  But, all of them are reaction to a real or imagined threat.

So, I go back to the point.  If we don’t to be without anxiety, because we need it when the threat is real.  We need things to have the importance, so that we pay attention to them.  But, when there is an imagined threat, an anxiety causes us to react or avoid or do something that isn’t adaptive in our life, that’s when we start getting into something where we could -- we can learn more about it, so that we can react differently.  But basically, with that third point, it’s a normal response to danger, threat or extreme stress.

So, this is exactly what we know.  Anxiety is not a bad thing.  But what causes anxiety disorders?  So, again, it’s that D word, disorder, that means when anxiety has impacted our life in a way where it’s not just working for us.

Maybe we’re just feeling absolutely torn up inside with worry.  We’ll talk about something that could impact like our appetite and our life activities and our sleep, our (00:10:14) to use substances.  All of these things can happen, why might it get to that level?  Well, first, genetics, family history.
So, this is where you thank your parents and your ancestors and those before them for your blue eyes, your dark skin, your large feet and your anxiety.  A lot of things we know are genetically transmitted and anxiety is one of them, where there’s a much higher rate of -- if a child has anxiety, it’s quite common for a parent and there to be anxiety through a genetic line.

Again, depending on your culture and how you express symptoms within your family, within your culture, within your own life, that could look different, but we do know that things can be transmitted through genetics.  Anxiety is one of them.  It is one of the most transmittable disorders actually and some of the things that we just know is anxious parents tend to have more anxious kids.  Of course, it’s not a one-to-one ratio.  There’s plenty of anxious parents who have free-willing kids without a worry in the world and vice versa.

And so, we’ll talk about other things.  There are other things on this list such as life events, personality, biochemistry.  So, just say that there’s a blanket statement, “If you have anxiety, it must come from your genetics”, that’s absolutely not accurate.  But sometimes, some people feel like, “Gosh, I have all of this anxiety and it doesn’t match my life.  It doesn’t match my life experiences.  And yet I feel it all of the time.  That alarm is going off all of the time or much more than I would like it to and it’s not matching my life.  I’m safe.  I’m fine.”  And so, in those cases, sometimes we look at generationally, genetically transmitted anxiety.

And there are some psychological ways of thinking that could be not only is this in our neurons, carried in our neurons nor genetics, but there can also just be burdens that are transmitted genetically as well.  Things that our ancestors have gone through that we sort of are carrying in our DNA.  And there are pretty interesting epigenetic studies that are out there right now, but that’s beyond the scope of this presentation.  But it’s true, it’s out there.

So, biochemistry, this is -- we’re all made up different.  We all have different chemicals, different abundances flowing through our body and our biology is different.  So, some things, for example, that might correlate with feeling more anxious might be somebody who has -- I don’t know, my neuropsychological testing (00:12:56) intelligence.  And if somebody has a split between -- say, they’re verbal or they’re language intelligence and they’re non-verbal intelligence, this can lead to feeling really tense like the world is unpredictable, because some things are really hard and yet others in comparison are just not?  that can actually lead to someone feeling more anxiety, because they can’t really put a finger on why they feel tense.  Well, the answer, if we really look into it, might be because they don’t know what to expect.  When is the world become hard?
So, without a good understanding of one’s biochemistries, sometimes -- or without a good understanding of why a person might be anxious, it might not be that something bad has happened to them or that they’re carrying genetically transmitted anxieties, it might just be part of how their own chemistry.

There’s also personality.  People are born with different temperaments.  Some may just get stressed out more easily, just like we talked about my smoke detector in my kitchen, maybe the wiring is too sensitive.  And for some people, they just have more sensitive wiring.  They’re just much more likely to feel nervous than others.  You may also have heard about type A personality.  It’s the kind of personality trait that’s often talked about that’s usually associated with somebody being more agitated I suppose or just really -- they may call the person obsessive or compulsive, and really just tells me there’s a part of that person that is working really, really hard and feels that it has to.  So, there’s just different types of personality traits that seemed to correlate with having more anxiety, and so much so that it can become disordered.

So, you’ll also see it during the slight upbringing.  So, the way a person was brought up.  Many of might have been thinking when I said, “Anxious parents may be more likely to have anxious kids.”  Well, is that in your chemistry or is that because of parent is teaching a child to be afraid of things, or to be cautious about things.

Maybe, that parent’s life history has taught them that them that they have to be on guard or alert, or they would be in danger.  And is there a way that we transmit that to our children and to those people around us, just by example?  So, there can be a way that upbringing and just modeling can lead to someone having different levels of anxiety.  And the treatments are a bit different sometimes.  If we’re trying to think about it just biologically based, or is this a way that you think about things.  The truth is, it can be really hard to disentangle them.  That’s why there’s a variety of treatment options out there.

But second to the last bullet point there, Life Events, there are things that can happen in our lives that absolutely lead to fear and stress reaction.  We’ll talk about post-traumatic stress reactions and acute stress reactions.  Things happen and we become really anxious.  Long after the danger is over.  This can stay in our bodies, in our neurochemistry, in our minds, and the way we think about the world being unpredictable and unsafe which -- there is, of course, very normal reactions to horrible things.  And when it becomes disordered, or when it may get the label of anxiety disorder, that’s when it’s just staying within your system for much longer than it really needs to.  Where that wiring has stayed sensitive, even in the absence of danger, over a long period of time where it’s impacting your life and leading you to not do things or to do things to reduce that tension inside.

The last bullet of Substance Use, in the correlation with anxiety disorders, I just wanted to comment on, sure, substances can lead to anxiety.  Many people have taken a substance use that I do not like, so, that makes me feel inside.  it made me feel more anxious, sure.  But the truth is, what we really know about substance use and anxiety disorders is that more likely, there’s an anxiety disorder underneath the substance use.  So, in my experience, and most of the literature suggests that, it’s not necessarily that substance use causes anxiety disorders.  Although, it can.  But it’s much more likely that anxiety disorders lead to substance use.  And I say that because if we go back to that very beginning “What is anxiety?”, it’s a fight-flight-freeze reaction.  And flight, meaning going away, avoiding, substances can certainly change one’s emotional experience by numbing it or by allowing a person to go away in their mind.

So, I just did want to make a point about that one, because often, a part of a person is using substances, and until that part of a person believes that they can be safe without it -- and again, this can defy all logic, then a person may continue to be at risk for substance use.
So, what are the kind of anxiety disorders?  There are a lot and if you look here, it’s listed six of them.  Six of really the most common or the most -- these are the disorders that you may have heard more about.  And so, the first one, Generalized Anxiety Disorder.  Well, that one is one of the most common actually, and it is a bit what it sounds like.  There’s this fear reaction around a lot of things.  It’s not just one thing.  It’s not related to just one experience.  It can be, when a person just feels like there’s constant worry about a number of things.  We’ll talk a bit more about this when we focus on it on the next slide.

But there’s also Panic Disorder, which is different from anxiety.  The thoughts that go along with anxiety.  The difference between panic disorder and anxiety disorder really is, in an anxiety-based disorder or as you’ll see on this slide, there are specific phobias or social anxiety.  With certain types of anxiety -- there are three parts of anxiety.  It’s what you feel on your body, which we’ve talked about, racing heart, all those alarm signs that are -- you feel them in your body, and it’s also what we think about, “My gosh.  I can’t be away from my mom,” or “I will not be safe,” a specific phobia, “I can’t go in the elevator or I will die.  I can’t take X lines --” we could talk about specific phobias.  There’s a thought.
So, three parts of anxiety, what you think, what you do, how you feel.  The do part is we avoid it.  We try to get away.  We fight-flight, or freeze.  But for panic disorder, it’s actually, a person may have no idea cognitively in their mind and their thoughts what they’re afraid of.

Someone may suddenly develop these, the alarm going off in their body, racing heart, feeling dizzy, feeling like they may pass out, the need to run, the need to escape, but there’s nothing in front of them that, in our minds, would elicit that reaction.  So, panic disorder can be tricky and the treatment is a little bit different, actually, because there isn’t a thought about a specific thing that we’re afraid of.  What happens is the feelings in the body seem to come first and then, a person may feel, like literally feel, like they’re having a heart attack or something’s wrong because there’s nothing in front of them that would lead to this reaction.

And so, often, people who are having a panic attack may end up in the emergency room, because there’s nothing to ping this on, since there was no elevator in front of me, there was no speech to give, there was no mom to be away from, but then my body is reacting.  It would be analogous to a smoke detector going off without any smoke, really, or a fire alarm going off or searching, searching, “What is that reason?  There must be something medically wrong with me.”

So, panic disorder is actually a different type of anxiety where a person becomes afraid of their body-based symptoms.  When their heart starts racing, that brings the fear or thought of, “There’s something wrong.  I’m going to die.  I need to get out of here.  I need to run,” the fight-or-flight reaction.  So, that is a different one, and the treatments would involve actually exposing a person, perhaps, to these body-based feelings in a non-threatening situation to show, “Okay, you can be okay.  You’re not going to die.”  It’s also an education about what exactly is happening in the body.
But the third bullet there, obsessive-compulsive disorder you may hear, and that’s where somebody is having disturbance in their life because of either repetitive, obsessive thoughts that aren’t congruent.  They’re not congruent with the person’s personality.  They may have these obsessions that they’re going to hurt somebody or that they’re going to do something bad and they wouldn’t, or obsessions about cleanliness or germs, or certain letters or colors, or numbers, or having to walk a certain way down the sidewalk.  These obsessive kinds of thoughts that really take up real space(ph) in a person’s mind, impacting concentration in doing things, some things can take a very, very long time, especially when there’s compulsions that go along with this.

Now, to have OCD, you really only need the obsessions or the compulsions, although many people have both, but when there are the compulsions, there are these impulses to do something that may not logically make sense, but you feel the pull to do it.  And when you do it, it feels better, so you’re much more likely to do it over and over again.

So, there are a whole lot of subcategories to obsessive compulsive disorder, but it is a type of anxiety-based diagnosis and to get it, it has to be chronic, lasting, uncontrollable thoughts that repeatedly enter your mind and you don’t want them to.  All of us have times when we can’t get certain things out of our mind, and again, it’s a message that maybe we need to work through them, maybe we need to work through them, maybe we need to do something about it and, often, we do, you know?  It might be about a family member, a job, or relationship, and we can’t get the thought out of our head.  Well, that’s not OCD.  That’s pretty typical human behavior, but when it’s OCD, it’s again when these thoughts come into your mind when they really don’t serve an apparent purpose and you can’t get them out of your mind, and it’s not just the Baby Shark song and that kind of thing.  It’s just really where it disrupts your life and you try hard to make the thoughts go away or to not have to do the compulsions, but over time, that actually get worse.  So, that’s a different type of anxiety disorder.

And then, as I’ve alluded to specific phobias, they’re more rare than we think, actually.  It’s when a person has an extreme fear around something that really the harm doesn’t match the fear.  But to have a true phobia, there has to be a disruption in your life where it’s actually impacting your life.  It’s in the diagnostic criteria.  Few may not like heights.  Again, anxiety and heights are nature’s biological, internal response saying, “It would hurt if you fell from here,” or being in closed places may not be safe in some ways.  We’ve learned that they could not be safe.  But a specific phobia is where you have this intense fear about something that doesn’t really match the situation.  It’s persistent.  It’s prolonged, and the person’s life is impacted.

So, maybe a person can’t take a job because they have to travel over a certain bridge, or someone may spend excessive amounts of time if they’re afraid of a bridge, going different routes, so that it really impacts their day and even though they really, really want to and need to do something related to going in an elevator or being near bugs, or whatever the phobia could be and there’s a lot.The person really can’t do it, or at least can’t do it without a significant amount of stress.  So, that would be a specific phobia.  It’s really just related to something.  And often, people can get past them because they find work around, not being near the bugs, or the planes, or the elevators, or whatever it is that they’re phobic of.

We’ll talk a bit more about social anxiety, generalized anxiety in the next slide, but social anxiety is where a person has an intense fear of doing things, perhaps in front of other people.  But really, there’s this thinking part where there’s the worry that they’re always being thought of as less than or won’t be able to do things as well, or fears of being humiliated or embarrassed, so much so that maybe somebody can’t get to work, can’t get to school.  It’s not just social worries.  Most people don’t like being put on the spot in different ways, but it becomes a disorder because it’s a true disruption in a person’s life because of this fear, that they will be negatively evaluated.  So, often, a person with social anxiety disorder avoids a lot of things, but you may not really know that because they’re not sharing with you all of the thoughts that are going on in their minds.

And then, the final bullet here, post-traumatic stress disorder, well, this diagnosis originally stemmed from, you may have heard of shellshock, when veterans came back from the war, but what we know about is post-traumatic stress disorder is now related to a whole lot of other things that aren’t war-related.  Traumatic stress is just one of them.  Basically, to meet criteria, there has to be one of them.  So, this happened to you, either real or a threatening event where you felt intense fear, and now there’s a lot of gray area here, because it can be intense fear of your physical well-being, where you actually thought you were going to die, where you almost did die, but it also can be an intense humiliation or shame, or injury, all kinds of different things, but you have to have the event, you have to have experienced a major fear reaction, and then when that thing’s happened, we all feel that, but it might become prolonged.

When it lasts longer than a month, longer than three months, and where a person may remain hypervigilant, like on edge, where they may avoid triggers, things make them feel anxious when there’s nothing unsafe about them, someone who has been around a lot of gunshots.  I recently was talking with a young man who had some post-traumatic stress due to being on the streets and some of his friends were shot, and now the popcorn popping and firecrackers actually elicit a real panic response in him because it reminds him, it can bring him right back to those terrifying events.

So, post-traumatic stress, again, it has to cause significant distress and disturbance.  Usually, there’s flashbacks and dreams and, again, that fight-flight reaction where a person may be quick to anger, or slight(ph), a person may be quick to run away or avoid, or even freeze up, you may have heard the word, dissociation, where a person just isn’t present in reality and often, it’s when they’re triggered and they sort of are out of their body, remembering this intense fear state.

So, these are some types of anxiety disorders and, again, generalized anxiety disorder is one of the most common, and so I do want to spend a few more moments just looking at what are some of the symptoms.  Before, I’ve alluded to this idea that anxiety has three parts.  It’s what you think, what you feel in your body, and then what you do.  So, then, when you think about generalized anxiety disorder, let’s look at some of the emotional impacts.  A person is having uncontrollable, constant worry.

So, it’s not just the worries here and there about their job, their kids, their health, their partners, their pets, whatever it is.  It’s uncontrollable and constant worry, worry that you can’t just put on aside.  It is there.  It is driving the bus.  Persistent feelings of dread and nervousness.  Again, persistent, so it’s happening a whole lot even when the situation isn’t really dread-inducing, and some people experience excessive or uncontrollable crying.  Now, some behavioral correlations of generalized anxiety disorder, or GAD, which is the acronym, people will see difficulty concentrating. And, yeah, your mind is pulled in nine-million directions.

It can look like attention deficit, but it’s anxiety.  Your mental real estate is being taken up by worry, so yes, it’s difficult to concentrate.  Another behavioral change is avoiding situations that make you anxious.  So, if it’s a phobia, you avoid the thing that makes you phobic.  If it’s social anxiety, you may avoid social situations.  But, for generalized anxiety disorder, because the worry thoughts are broad, they could span worrying about the weather, to health, to relationships, to what people think about you, to anything.

It’s hard to live in that way because the fight-flight freeze reaction, avoidance, is the body’s natural reaction when things are uncomfortable.  But when so many things are persistently making you feel dreadful or nervous, it’s really hard to live when we have to avoid a lot of situations.  And also, if you think about this last behavioral symptom here, restlessness or becoming tired, well, when a part of your body is revved up and on edge, if anyone has ever been in a situation where, for a while, they felt fear, after when your body switches between the sympathetic and parasympathetic nervous systems, you are working hard inside.  It can be exhausting.

Like treading water fervently for hours and hours, that’s what the inner system could feel like when you’re worrying and worrying, your heart’s beating fast, your mind is racing.  It can take up real, real physical toll on the body.  There’s no surprise that there’s a great correlation between physical symptoms and anxiety, especially generalized anxiety disorder.  Some of the physical symptoms are stomach issues, muscle soreness, sleep problems, difficulty settling, waking up, there’s just a lot of physical symptoms because like that alarm that we first talked about, the fire alarm is just as loud when it’s a fire drill versus a real true fire alarm inside your body; that alarm is going off like it’s the real deal.  And if it’s going off a lot, then your body thinks it’s a real deal.

Even if you understand that there is no real threat because your body feels it, then it makes it true on your body.  And so, again, no surprise why there’s a great correlation between you know, even some of the immune system being more at risk when there’s a lot of stress.  So, let’s just break this down a little bit, normal-worry, right?  We need it.  Nobody can have an anxiety-ectomy versus generalized anxiety disorder.  Let’s just break this down for some examples here.  So, a normal worry.  Your worrying doesn’t really get in the way of your daily activities and responsibilities.

Maybe it does here and there, normal.  But generalized anxiety disorder is where you’re worrying significantly, disrupts your job, your activities or your social life.  So, in a really big way and not just here or there, in normal worry, you’re able to control your worrying.  You can sort of put in a box, compartmentalize it, you can sort of say “not now, I’ll get to this later”, or “I can at least do my life activities, parent, go to my job, go to school, but I can control my worrying”.  And generalized anxiety disorder, it feels like it’s controlling you.

Your worried part, that’s the one driving the bus.  You may have your logical brain suiting you know, mid-bus, you may have your adventurous brain sitting at the back of the bus, but when you have GAD your worrying feels like it’s the one driving the bus and you feel that you have no control over it.  For normal worry, your worries are unpleasant, but they don’t cause you significant distress.  But again, for generalized anxiety disorder, they’re extremely upsetting and stressful.  In normal worry, there might be limited to specific small number of realistic concern, we worry for a reason.  But, in generalized anxiety disorder, there can be worry about all sorts of things and you just expect the worst all the time.
In normal worry, your bouts of worrying are just for a short period, but in generalized anxiety disorder, by definition, you worry almost every day for at least six months.  All right, so I hope that brings a little bit of clarity that even if you have normal worry, it doesn’t mean that there aren’t things that you could have support with or make shift, but with generalized anxiety disorder is when it becomes a real medical condition, it’s impacting your body and it’s impacting your life.  So, what kinds of things can we do to prevent and reduce anxiety?  There really are actually a lot.  Even just attending a webinar like this where you learn a little bit about the interplay between our thoughts, our feelings or reactions that just knowing.  So, I encourage all of you to even just think for a minute “Okay, what are my stresses?”.

They may be very, very different than the person’s next to me.  And sometimes, they may have no logic, they could just be transmitted to you genetically.  But what are your stresses and what triggers your anxiety?  So, knowing about this, tracking it, can actually reduce anxiety just by paying attention to it and not trying to just push it under the rug or avoid.  Avoidance is the typical to feeling uncomfortable.  I’ve said it a bunch of times because it’s just normal.  If you feel like something is uncomfortable, it is normal to want to avoid it.  How do you avoid things?  How do you react or cope with stress?  How do you make that go away?  Do you isolate more?  Maybe use a substance or drink a little bit more than you feel like you should?  Just sort of determining what the anxiety and behavior relationship is, is really important.

Because once we know what are our barriers or what are ways that our body and mind are doing the best that they can to help your inner world make that alarm a little less loud.  If we first just think about it that way, that we’re doing the very best we can to feel better, then we have a little bit more compassion and we can sort of think “Okay, are there other ways that we might be able to increase our resilience?”  You know, we do want to know what it is that’s going on here.  Some medical conditions can feel you know, like heart racing and all kinds of things.  So, definitely, seeing your doctor to rule out other conditions can be a great first step, but some people might find “Ah, everything got ruled out but I still don’t feel right,” that’s anxiety.

The absence of information that says there’s something wrong, that’s not always the case, of course doctors can miss things.  But, anxiety can make you feel like “Even though I know there’s nothing wrong, I feel like there is, so this might be what I need to get treatment for.”  So, really, I do encourage you to listen to your own reactions and have conversations about yourself.  Have conversations with yourself about “Are there boundaries also that I need to be setting right now?”  You know, we may have this idea that we have to keep doing and doing and doing for people we get worried that they won’t like us, they won’t do the job, we won’t -- whatever it is.

But, if we continue to tread water so to speak in this way, we won’t be any good for anybody.  And so, being able to set some boundaries around what is good and what is good enough, what’s the boundary that I might set around my work, around a number of activities, as much as the amounts that I give  Because in the end, if we’re not paying attention to that, we can become overloaded with anxiety and so much that it can become disordered even when we have the best intentions as well.  So, there’s things such as maintaining a positive attitude.  This one, of course, if I had a dime for every time I heard a client say, “They told me just to look on the bright side” because your thoughts may be able to do that, but your body has a really hard time believing that because the alarm feels and sounds exactly the same.

So, again, some self-compassion around a part of you has a positive attitude, but a part of you doesn’t.  Let’s find out a bit more about what could really be helpful.  And again, it could be around protecting your peace a little bit.  Saying no to protect your peace where that could lead you to actually feeling much less likely to get burnt out, have medical issues, what have you.  So, stress reduction techniques can be very different depending on your own biochemistry.  Some people you know, will say yoga, some may say running or boxing or being revved up calms me down.
Whatever it is that reduces your stress, you know what reduces your stress.  Also, keeping in mind though that some things like drugs or alcohol can reduce the stressful feeling in the moment, but often, they set you up for actually feeling higher levels of baseline anxiety to start.  So, one of the take-home points is the more you may avoid that feels good in the moment, but it reinforces the behavior and so then you’re just much more likely to need to do it.  So, thinking about stress reduction techniques that are really good for your mind and your body over time can be really helpful.  So, some other things aside from just healthy lifestyle, you know, asking for help, finding a support group, spending time with positive people that you enjoy.  You know, that fourth bullet a part of you feels really preoccupied with things you can’t control but trying to have an awareness of “Okay, what’s my control bucket and what’s that at the control bucket?”

The truth is, there’s only one moment that is in your control bucket and that is right this minute.  You can’t control the past, although some of us spend so much time worrying about the past.

You can’t control the future, although many of us continue to worry so much.  The only thing we literally can control is this moment and sometimes that perspective can just bring a bit of peace.

Say you find yourself in the midst of disorder and anxiety.  All right.  So, you’ve listened to this webinar, you already know it.  What kind of treatment options are out there?  I’ve listened in number of different types of anxiety disorders and I really would encourage you to be a wise consumer around knowing that there are different interventions that help for different things.  Different medications can treat chemicals that are associated with say obsessive-compulsive kinds of stress that may be different from other kinds of anxieties.

So really, talking with a doctor if you feel like that’s one route to go, but there are also ways to heal what’s lying underneath.  Cognitive behavioral therapy is a therapy that really helps the person first to understand the relationship between what they think, how they feel and how they act.  In the behavioral part is learning a bit more about how avoidance, the fight-flight freeze reaction, even though it’s a normal reaction that helps you feel better in the moment, there are things that we probably are doing that perpetuated.  And there is different kind of relaxation technic, types of treatment as well.

One of my favorite types of psychotherapy is one called internal family systems actually.  It’s about understanding our whole systems as having parts as if there’s different people inside of us and a part may feel anxious while another part may be saying that’s crazy to think like that and the therapy is around developing a relationship with the different parts including the anxious one and once you do that, you can ask it to unblent and I’ve just seen some great outcomes with helping a person actually heal what’s underneath so that it doesn’t just continue to manifest in a different form or the person may not need to take a medication for longer than is helpful.

So, there’s lots of different types of intervention.  I encourage you to research them, talk with knowledgeable providers out there.  There’s a lot in the internet that isn’t helpful so certainly (00:42:19) the help of a knowledgeable provider when you’re exploring options.  Just points to remember that both children and adults can develop an anxiety disorder.  They vary from person to person, culture to culture within the families.  Symptoms can include difficulty concentrating, sleep issues and just learning the strategies about how to cope with anxiety can take time so it can be frustrating.  You want to sort of -- many of us are searching for that magic pill or magic technic.  But like many things you have to build up that anxiety reduction muscles, so practice.  So even if you start to feel better, it’s got to really stamp in those technics and lifestyle changes.  They are highly treatable, medical conditions just like other mental health disorders and different options include different types of therapies, IFS, CBT, relaxation technics and medications.

So, as you listen to this webinar, you may have thought, “You know what?  Maybe I should contact somebody about my anxiety or a family member’s anxiety.”  And you do have an EAP, an employee systems program that can help with these things.  It’s free, it’s confidential.  The next slide sort of indicates how, you know, 24/7 no cost, absolutely confidential, 24/7 a viability.  If I go back to the slide though, sure, they could help with anxiety related issues but there’s also other things like planning for life events, managing depressions, strengthening relationships.  So, I’m going to sort of waving the -- it just the encouragement to use your EAP because it is a really great free and I can’t emphasize more that confidential part.  Nobody really has to know, you can keep your privacy for you and your family members.  But I do encourage you to take a moment, consider what you need, consider your stresses and your anxieties and if anything in this webinar has lead you to believe that you could probably have more relief, I encourage you to contact your EAP and continuing to think about how you might be able to make those small changes that could provide you some more peace in your life.

So, thank you so much for listening and be well.

Interviewer: Thank you so much Dr. O’Connell for sharing this important and insightful information and thank you to everyone who was able to participate in today’s webinar.  As Dr. O’Connell mentioned, your EAP is the confidential counseling service that’s dedicated to helping you achieve your goals at work and in your personal life.  The EAP is staffed by licensed professional counselors you will work with you as your personal consultant to help you find solutions to a variety of challenges you may face in your life.  If you have additional questions about anxiety or any other challenging situations, please contact your Beacon Health Options and play the assistance program.

Thank you again everyone and have a wonderful day.





By Samantha OメConnell, Ph.D. ©2018-2019 Carelon Behavioral Health

The information provided on the Achieve Solutions site, including, but not limited to, articles, assessments, and other general information, is for informational purposes only and should not be treated as medical, health care, psychiatric, psychological, or behavioral health care advice. Nothing contained on the Achieve Solutions site is intended to be used for medical diagnosis or treatment or as a substitute for consultation with a qualified health care professional. Please direct questions regarding the operation of the Achieve Solutions site to Web Feedback. If you have concerns about your health, please contact your health care provider.  ©Carelon Behavioral Health



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