Understanding Anxiety and Trauma

At times, all of us have felt anxious and moody. Anxiety, in fact, is one of the universal behavioral indicators that are shared across regional and cultural boundaries. Anxiety and depression, in fact, are a completely normal part of human life. Who hasn’t studied for an exam without having test anxiety, only to score much more than what we’d anticipated?

As an evolutionary mechanism, anxiety was fundamentally important to our survival as a species – it kept us alert and prepared for any foreseeable difficulty. Trouble, however, starts when anxiety and depression seem to strike out of nowhere, last for weeks to month, and make everyday life difficult, if not impossible, then we are talking about a serious medical condition, not mere mood swings.

Believe it or not, anxiety and depression are two of the most common mental illnesses in the world that strikes pretty much everybody at some point or time or the other in their lives. Collectively, a combination of anxiety, depression and sudden panic attacks are classified under “anxiety disorders”.

People suffering from anxiety disorder may display one or several of the following physical symptoms: trembling, sweating, muscle aches, nausea, fatigue, palpitation, dry mouth, and cold and clammy hands. On a deeper level, such people are usually emotionally apprehensive and irritable and suffer from a misconstrued feeling of impending doom. One of the most common feature of anxiety disorder patients is a feeling of extreme self-consciousness. Such patients often feel that they are under continuous scrutiny, which, in the extreme forms, may even lead to complete immobilization, keeping the patient house-bound for months to years.

At the other end of the spectrum is depression, which is a serious medical condition that can persist for years and have some truly fatal consequences. It can affect your eating, sleeping habits, impact one’s self image and self-worth. It must be kept in mind that a depression is not the same as a blue mood, neither is it a result of personal “weakness” – a long standing, albeit misguided belief in society. Moreover, depression is not something that can be easily wished away if one lacks the physical and emotional environment to pull oneself out of it.

Without treatment, depression can last for weeks to years; treatment usually involves medications and if required, psychotherapy. Both anxiety and depression remain the two most widespread forms of mental illnesses in the world. But at the same time, they are also the most easily treatable – a fact that patients often look over.most common and most treatable mental illnesses in the world.

PTSD and the Emergency Services

Post Traumatic Stress

The Facts:
Police, fire brigade, army or ambulance workers are more likely to be exposed to traumatic experiences and suffer with PTSD.

Most people, in time, get over experiences like this without needing help. In some people though, traumatic experiences set off a reaction that can last for many months or years which is now known as PTSD.

Physical Signs:
Adrenaline is a hormone our bodies produce when we are under stress. It "pumps up" the body to prepare it for action. When the stress disappears, the level of adrenaline should go back to normal.

In PTSD, it may be that the vivid memories of the trauma keep the levels of adrenaline high. This will make a person tense, irritable, and unable to relax or sleep well.

Why is PTSD often not recognised? -
None of us like to talk about upsetting events and feelings. - We may not want to admit to having symptoms, because we don't want to be thought of as weak or mentally unstable. - Doctors and other professionals are human. They may feel uncomfortable if we try to talk about gruesome or horrifying events. -

People with PTSD often find it easier to talk about the other problems that go along with it - headache, sleep problems, irritability, depression, tension, substance abuse, family or work-related problems.

Which treatments first?
The National Institute for Clinical Excellence (NICE) guidelines suggest that trauma-focussed psychological therapies (CBT or EMDR) should be offered before medication, wherever possible.
What is Anxiety?

Anxiety is the body and mind's natural reaction to threat or danger. In the appropriate situation high levels of anxiety even panic is considered normal and helpful if it prompts us to escape from danger.

Anxiety in performance situations such as interviews and exams can help us perform to the best of our ability.However, when anxiety becomes excessive or debilitating then it is considered an Anxiety Disorder. Over the last few decades there has been a dramatic improvement in our understanding of anxiety and how it can be treated.Types of Clinical AnxietyAnxiety can be the main or "primary" problem or it can be a secondary problem which means that it is a symptom of another disorder.

Depression and substance or alcohol misuse are often associated with high levels of anxiety, but in these cases lasting benefit will come from treating the underlying problem rather than focusing solely on the anxiety symptoms.

In primary Anxiety Disorders the symptoms tend to have followed a set pattern over several months or years. In these cases the anxiety symptoms occur independently of other mental health problems, though they can be made worse by for example depression and life stress.

Panic Disorder
Sudden episodes of acute severe anxiety associated with a fear of death or collapse

A fear of being away from a place of safety. Often is associated with panic. In severe cases sufferers become house bound or confined to a small "safe" area.

Social Anxiety
Excessive anxiety and self consciousness in social situations with a central fear of being judged negatively or harshly or appearing foolish. Leads to avoidance of social or performance situations such as public speaking as well as subtle forms of hiding away in social gatherings.

Specific phobias
Often present from childhood these are intense automatic fears of triggers such as rats, spiders, heights, enclosed spaces or more unusually vomiting or thunderstorms. They are associated with an intense desire to avoid or escape from the trigger.

Obsessive Compulsive Disorder
This is a complex disorder that can be tremendously disruptive to sufferers and their families. Sufferers feel compelled to ward off contamination, disaster or other negative events by carrying out time consuming rituals such as washing, checking or ruminating (thinking things through in a circular way). Sufferers have an exaggerated sense of responsibility for preventing harm and have a heightened awareness of risk and danger.

Generalised Anxiety Disorder
This is a disorder of uncontrolled worrying. Sufferers spend long periods agonising over what they anticipate might go wrong in the future. This causes distress, sleep disturbance and exhaustion. Unlike Obsessive Compulsive Disorder there are fewer neutralising acts or compulsions and the fear tends to spread across numerous everyday themes rather than fixating on specific dangers.

Post Traumatic Stress Disorder
This is a carefully defined disorder that results from a trauma such as a road traffic accident or an assault. Sufferers are troubled with intrusive memories or flash blacks of the incident and they are on a state of high alert. They tend to avoid reminders or triggers of the trauma. It is important to distinguish the disorder from normal reactions to traumatic events, which are similar but shorter lived and less intense.

How common are Anxiety Disorders?

Anxiety Disorders are the most common mental health problem along with depression, affecting the population of Ireland and Europe. They account for a similar level of stress and disability within society as cancer or heart disease.

It is estimated that 1 in 9 individuals will suffer a primary anxiety disorder over their lifetime. Only a fraction of these individuals receive appropriate treatment which is a great pity as it has been demonstrated consistently that with expert therapy the majority of sufferers can achieve a lasting improvement.

Causes of Anxiety Disorders
Anxiety can be primary or secondary to other mental health problems such as depression or substance misuse. Primary Anxiety Disorders are thought to result from a combination of genetic predisposition and life stress triggering a vicious cycle. Physiological reactions in the brain and body, distorted thoughts and beliefs about risk and danger and patterns of behaviour such as avoidance or safety seeking all interact to develop and maintain the problem.

Cognitive Behaviour Therapy treatments are highly effective in Anxiety Disorders and target exaggerated danger beliefs and safety behaviours in a collaborative way with the aim of breaking the vicious cycle and helping the sufferer achieve greater confidence in the face of what they fear.

By learning about the vicious cycle of anxiety and by challenging beliefs and behaviours at the centre of the anxiety problem, sufferers gradually master their fears and regain their functioning. CBT work can be greatly supported by meditational strategies such as mindfulness meditation, occupational therapy and various drug treatments.

Serotonin boosting anti-depressant drugs are very helpful in easing anxiety states and combine nicely with CBT work. Sedative anti-anxiety drugs can also be used in the short term to ease the worst of the anxiety during the acute phase.

Best results are achieved by carefully focused Cognitive Behaviour Therapy combined with other forms of help as needed.

Mental Helth Professionals (Overview)

Mental Health Professionals
Mental health services in Ireland offer a multidisciplinary approach, where a number of professionals offer their particular skills in a co-ordinated and complementary way.

• General Practitioner (G.P.)
The G.P is often the first person to seek help from. He/she will assess the problem and may either provide medication and monitor the patient, or may refer the patient to a specialist e.g. psychiatrist, psychologist or counsellor if necessary. The G.P. may be able to recommend a support group for the particular problem.Where others are involved in the patient’s care (e.g. psychiatrist, social worker, family members, etc.) the G.P. may liaise with them in order to provide the best overall care. The psychiatrist is a medical doctor with a specialist qualification in mental health.

• Psychiatrist
A psychiatrist usually works in a psychiatric hospital or unit, or as part of a community care team. Referral to a psychiatrist is normally through a G.P. An emergency 24-hour service is provided by the doctor on duty at the hospital or psychiatric unit.A psychiatrist will assess the person, usually at a hospital out-patient clinic, forms a diagnosis and treats accordingly. This may involve treatment with medication or referral to a member of the mental health team.Admission to hospital, in a small number of cases, may be suggested if the person’s difficulties are severe.

• Psychologist
A psychologist is trained in the study of human behaviour and experience. When involved in the area of mental health, the psychologist usually works as a clinical, community or counselling psychologist, and unless also medically qualified, does not prescribe medication.

. Clinical Psychologist
The clinical psychologist has a specialist qualification in mental health and works as part of the mental health team in a unit or hospital and is involved in assessment and counselling therapy. Family therapy may be provided where appropriate, and a particular approach may be used for specific problems, such as a cognitive-behavioural approach for phobias. Referral is often through a G.P or psychiatrist, but self-referral is possible.

Community Psychologist
The community psychologist has a clinical qualification and works as part of a community based team, with e.g. social workers, speech therapists, community welfare officers etc. The community psychologist is involved in assessing andworking with those with a wide range of problems, including children with behavioural, educational and other difficulties.

Counselling Psychologist
A counselling psychologist has a qualification in counselling and often works privately, offering help for a wide range of problems such as relationship difficulties, anxiety, poor self-esteem, etc. Not all counsellors are psychologists.

• Counsellor
Some counsellors are qualified psychologists, but many are not. Those who are not may have a basic degree or training in other areas and/or relevant work experience (e.g. teaching, nursing, etc.) plus a counselling qualification. There are many forms of counselling available for a wide range of problems, and many counsellors specialise in particular areas such as addiction, bereavement, etc.All approaches emphasise non-judgemental, attentive listening and respect for the client. Counselling aims to enable people to take control of their own lives, and the counsellor may not adhere to one particular theory.Self-referral is the usual route to counselling, although a GP, psychiatrist or trusted friend may be able to recommend someone suitable. Counselling is often one session per week and tends to be short-term rather than longer-term, although this can vary.

• Psychotherapist
Psychotherapy tends to be more in-depth than counselling. Psychotherapists usually undertake a long post-graduate training which demands that trainees themselves have therapy, often twice per week, for several years.Like counselling, there are many forms of psychotherapy, many of which aim for self-understanding rather than simply the relief of symptoms. Many forms of psychotherapy take account of the unconscious processes which affect us, with some based on the belief that lasting, personal change is not possible without analysis of the unconscious.The techniques and interventions used by the psychotherapist vary according to the theoretical framework within which he or she is working.

• Psychiatric Nurse
The psychiatric nurse plays a central role in the care of the psychiatric patient, both in a hospital setting and in the community. He or she works within a psychiatric service as part of a health care team.The nurse’s activities are varied, depending on the individual needs of the patient. In hospital, the nurse administers prescribed drugs and attends to the patient’s needs on a day to day basis. The community psychiatric nurse usually follows up patients on discharge from hospital, calling to their homes and attending out patient clinics and day care centres.He or she provides a link between community and hospital and between the patient and G.P. Family support is often provided and community psychiatric nurses may also be involved in patients’ rehousing needs.

• Mental Health Social WorkerA mental health social worker is involved in the provision of a direct social work service for patients who are under psychiatric care and for their relatives.The mental health social worker liaises with members of the various services involved in the care of patients (e.g. G.P.s, Public Health Nurses, Community Welfare Officers and voluntary bodies) and also with relatives and employers.The range of possible services provided can include help with accommodation, rehabilitation, social and community skills as well as advocacy work on behalf of mental health patients who may be unable to utilise the various services themselves.

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