Table of Contents

Anxiety and its Management

What is anxiety ?

{{:worried_look.jpeg?200 |}}Anxiety (also called angst or worry) is a psychological and physiological state characterized by various components :

  • somatic
  • emotional
  • cognitive
  • behavioural .

It is the unpleasant feeling of fear and concern. The root meaning of the word anxiety is 'to vex or trouble'

Anxiety can create feelings of fear, worry, uneasiness, and dread. Anxiety is considered to be a normal reaction to a stressor. It may help an individual to deal with a demanding situation by prompting them to cope with it. When anxiety becomes excessive, it may become a disease.

Anxiety is a generalized mood that can occur without an identifiable triggering stimulus. As such, it is distinguished from fear, which is an appropriate cognitive and emotional response to a perceived threat. Additionally, fear is related to the specific behaviors of escape and avoidance, whereas anxiety is related to situations perceived as uncontrollable or unavoidable.

It is important to make the distinction between future and present dangers which divides anxiety and fear.

Fear is short lived, present focused, geared towards a specific threat, and facilitating escape from threat; while anxiety is long acting, future focused, broadly focused towards a diffuse threat, and promoting caution while approaching a potential threat.

Anxiety is a general term for several disorders that cause nervousness, fear, apprehension, and worrying. These disorders affect how we feel and behave, and they can manifest real physical symptoms. Mild anxiety is vague and unsettling, while severe anxiety can be extremely debilitating, having a serious impact on daily life in a very anxious and stressed man

People often experience a general state of worry or fear before confronting something challenging such as a test, examination, recital, or interview. These feelings are easily justified and considered normal. Anxiety is considered a problem when symptoms interfere with a person's ability to sleep or otherwise function. Generally speaking, anxiety occurs when a reaction is out of proportion with what might be normally expected in a situation.

Generalized Anxiety Disorder (GAD)

Generalized Anxiety Disorder (GAD) is a chronic disorder characterized by excessive, long-lasting anxiety and worry about nonspecific life events, objects, and situations. GAD sufferers often feel afraid and worry about health, money, family, work, or school, but they have trouble both identifying the specific fear and controlling the worries. Their fear is usually unrealistic or out of proportion with what may be expected in their situation. Sufferers expect failure and disaster to the point that it interferes with daily functions like work, school, social activities, and relationships.

What are the causes of anxiety?

Anxiety disorders may be caused by environmental factors, medical factors, genetics, brain chemistry, substance abuse, or a combination of these. It is most commonly triggered by the stress in our lives. Usually anxiety is a response to outside forces, but it is possible that we make ourselves anxious with "negative self-talk" - a habit of always telling ourselves the worst will happen.

Genetics

It has been suggested by some researchers that a family history of anxiety increases the likelihood that a person will develop it. That is, some people may have a genetic predisposition that gives them a greater chance of suffering from anxiety disorders.

Brain chemistry

Research has shown that people with abnormal levels of certain neurotransmitters in the brain are more likely to suffer from generalized anxiety disorder. When neurotransmitters are not working properly, the brain's internal communication network breaks down, and the brain may react in an inappropriate way in some situations. This can lead to anxiety.

Symptoms of anxiety

Physical Symptoms of anxiety

People with anxiety disorders present a variety of physical symptoms in addition to non-physical symptoms that characterize the disorders such as excessive, unrealistic worrying. Many of these symptoms are similar to those exhibited by a person suffering general illness, heart attack, or stroke, and this tends to further increase anxiety. The following is a list of physical symptoms associated with GAD:

  • Trembling
  • Churning stomach
  • Nausea
  • Diarrhea
  • Headache
  • Backache
  • Heart palpitations
  • Numbness or "pins and needles" in arms, hands or legs
  • Sweating/flushing
  • Restlessness
  • Easily tired
  • Trouble concentrating
  • Irritability
  • Muscle tension
  • Frequent urination
  • Trouble falling or staying asleep
  • Being easily startled

Those suffering from panic disorders may experience similar physical symptoms to those with GAD. They also may experience

  • chest pains
  • A sense of choking
  • shortness of breath
  • and dizziness.

Post-traumatic stress disorders have a range of symptoms that are unique to this form of anxiety. Frequent symptomatic behaviors include:

  • Flashbacks or nightmares of re-experiencing the trauma
  • Avoidance of people, places, and things that are associated with the original event
  • Difficulty concentrating or sleeping
  • Closely watching surroundings (hypervigilance)
  • Irritability and diminished feelings or aspirations for the future

Psychological symptoms of anxiety

  • Inner tension.
  • Agitation.
  • Fear of losing control.
  • Dread that something catastrophic is going to happen, such as a blackout, seizure, heart attack or death. Irritability.
  • Feelings of detachment, as if being trapped in a bubble separate from the world.

Environmental and external Triggers of anxiety

Environmental factors that are known to cause several types of anxiety include:

Trauma from events such as abuse, victimization, or the death of a loved one Stress in a personal relationship, marriage, friendship, and divorce Stress at work Stress from school Stress about finances and money Stress from a natural disaster Lack of oxygen in high altitude areas

Stress and stressors.

What is stress?

Stress is the "wear and tear" our bodies experience as we adjust to our continually changing environment; it has physical and emotional effects on us and can create positive or negative feelings.

What may cause this to happen?

People may become stressed and experience severe anxiety as a result of one major life change or through a combination of different and perhaps less significant experiences.

//The following are some recognised causes of stress and anxiety://

Life changes such as:

  • Death of a loved one
  • Divorce, separation, broken romance
  • Loss or change of job
  • Job pressures
  • Moving house
  • Serious ill-health/disability/deformity.

Day to day hassles such as:

  • Too many things to do
  • Chronic money matters
  • Constant work pressures
  • Persistent family/relationship problems
  • Examination pressures/desire to succeed/fear of failure
  • Loneliness and a lack of friendship.

Trauma such as:

  • War and bombings
  • Car and other accidents and incidents
  • Sexual and domestic abuse
  • Deprivation.

External Stressors such as:

  • Noise
  • Pollution
  • Poor lighting
  • Overcrowding
  • Unpleasant relationships
  • Uninteresting work or poor conditions
  • Too much or too little responsibility and too many "rules".

Internal Stressors such as:

  • Poor diet
  • Little exercise
  • Physical strain on the body
  • Experiencing conflict or taking things too seriously
  • Sexual frustration
  • Finding little meaning in life
  • Having no time for yourself.

Vulnerability Factors

Individual

  • Genetic factors
  • Temperament
  • Behavioral inhibition
  • Anxiety sensitivity
  • Preexisting psychiatric/Medical disorder
  • Autonomic reactivity
  • Respiratory sensitivity
  • Neurobiological factors
  • Neuroendocrine factors

Exogenous

  • Exposure to stress
  • Drug use
  • Parenting
  • Modeling
  • Sensitization
  • Life events

Anxiety in Women and Men

Women have consistently higher prevalence rates of anxiety disorders, but less is known about how gender affects age of onset, chronicity, comorbidity, and burden of illness. Gender differences are established fact. The lifetime and 12-month male:female prevalence ratios of any anxiety disorder are 1:1.7 and 1:1.79, respectively. Women had higher rates of lifetime diagnosis for anxiety disorders, except for social anxiety disorder which showed no gender difference in prevalence. No gender differences were observed in the age of onset and chronicity of the illness. However, women with a lifetime diagnosis of an anxiety disorder were more likely than men to also be diagnosed with another anxiety disorder, bulimia nervosa, and major depressive disorder. Furthermore, anxiety disorders were associated with a greater illness burden in women than in men, particularly among European American women and to some extend also among Hispanic women. These results suggest that anxiety disorders are not only more prevalent but also more disabling in women than in men.

The anxious personality

Avoidant personality disorder or anxious personality disorder is a personality disorder recognized in the Diagnostic and Statistical Manual of Mental Disorders in a person characterized by a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of social interaction.

People with avoidant personality disorder often consider themselves to be socially inept or personally unappealing and avoid social interaction for fear of being ridiculed, humiliated, rejected, or disliked. Avoidant personality disorder is usually first noticed in early adulthood. Childhood emotional neglect and peer group rejection (e.g. bullying) are both associated with an increased risk for the development of AvPD.

There is controversy as to whether avoidant personality disorder is a distinct disorder from generalized social phobia and it is contended by some that they are merely different conceptualisations of the same disorder, where avoidant personality disorder may represent the more severe form. This is argued because generalized social phobia and avoidant personality disorder have a similar diagnostic criteria and may share a similar causation, subjective experience, course, treatment, and identical underlying personality features, such as shyness.

Managing Stress

How could we reduce the impact of stress on our psychological wellbeing. Firsg sep is to learn to spot stressors and stay in control it builds up.

Learning stress relief takes time, knowing yourself and practice like any educational task.

How to recognize stress

As some spend much time in a stressed state they have forgotten what it feels like to be fully relaxed and alert.

  • being in full of joy like a baby
  • a balanced emotional state
  • maintaining a calm state of energy, alertness, and focus.

  • Notice your breathing : has it changed, faster than usual or is it laboured?

  • Are your muscles tense?
  • Are you tired, your eyes feel heavy.
  • Are you happy, and laugh easily.

Observe your muscles and insides: * Are your muscles tight/sore? * Is your stomach tight or sore? * Are your hands clenched? * Observe your breath. Is your breath shallow? * Place one hand on your belly, the other on your chest. * Watch your hands rise and fall with each breath. * Notice when you breathe fully or when you "forget" to breathe.

Identify your body's stress response

  • We all respond to stress the same:
  • our blood pressure rises
  • our heart pumps faster
  • our muscles constrict.

We respond to stress in three different ways: * being angry * being agitated * being space out or withdraw * freezing up.

You need to identify your specific stress response.

Overexcited stress response

If you tend to become angry, agitated, or keyed up under stress, manage stress by activities that calm you down.

If you tend to become depressed, withdrawn, or spaced out under stress, seek activities that are stimulating and that energize your nervous system.

If you tend to freeze: speeding up in some ways while slowing down in others, try activities that provide both safety and stimulation.

There are countless techniques for preventing stress. Yoga and meditation work wonders for improving our coping skills.

The quickest way to relieve stress is by engaging your senses: - sight - sound - taste - smell - touch - movement

Everyone responds to sensory input differently. Identify your responses to each sensation.

Talking to someone

Talking about your stress makes you feel better. - Select a close, honest, good and sympathetic listener. - Build a good friendship network.

Your sensory preference

If you’re a music lover, listen to many different artists and types of music until you find the type of music which lifts and relaxes you.

If you’re a visual person, surround yourself with soothing and uplifting images. You can also try closing your eyes and imagining the soothing images. Here are some examples : * Look at a group of your favourite photos. * Surround yourself with plant and flowers. * Enjoy the beauty of nature–a garden, the beach, a park, or your own backyard. * Surround yourself with colours that lift your spirits. * Close your eyes and picture a situation or place that feels peaceful.

Sound

You may be sensitive to sounds and noises. Reduce the noise around you. Replace cacophony by harmony.

Are you a music lover? Experiment with the following: * Sing or join choir. * Listen to uplifting music. * Listen to sound of waves, the wind rustling the trees, birds singing. * Enjoy the soothing sound of water from a small fountain at home or office. * Hang wind chimes near an open window.

Smell & Scents

If you tend to freeze out when stressed, use energizing smells. If you tend to become agitated under stress, use comforting and calming scents.

  • Light a scented candle or burn some incense.
  • Lie down in sheets scented with lavender.
  • Smell the roses-or another type of flower.
  • Enjoy the clean, fresh air in the great outdoors.
  • Spritz on your favorite perfume or cologne.

Touch

Experiment with playing with different tactile sensations. Handle things that make you feel relaxed. Try the following suggestions:

  • Wrap yourself in a warm blanket.
  • Pet a dog or cat.
  • Hold a comforting object (a stuffed animal).
  • Soak in a hot bath.
  • Give yourself a hand or neck massage.
  • Wear clothing that feels soft against your skin.

Taste

Giving yourself a treat can be very relaxing, but remember that eating when stressed may add to your stress and your weight. Do not indulge your sense of taste excessively and eat in moderation. Eat slowly, focusing on the feel of the food in your mouth and the taste on your tongue:

  • Chew a piece of sugarless gum.
  • Indulge in a small piece of dark chocolate.
  • Sip a steaming cup of coffee or tea or a refreshing cold drink.
  • Eat a perfectly ripe piece of fruit.
  • Enjoy a healthy, crunchy snack (celery, carrots, or trail mix).

Movement

If you tend to freeze and clench your muscles when you’re under stress, try stress-relieving activities that get you moving. Engage your muscles or get involved in active work. Here are a few suggestions:

  • Run in place or jump up and down.
  • Dance around.
  • Stretch or roll your head in circles.
  • Go for a short walk.
  • Squeeze a rubbery stress ball.

The power of imagination

Sensory rich memories can also reduce stress.

Learn to imagine vivid sensations when stressed. Memory of a calming situation on your brain is as effective as seeing a photo. So if you can recall a strong sensation, you’ll never be without access to a quick stress relief technique.

Take a break from technology

Taking a short break from the television, computer, cell phone, and iPad will give you respite to your senses.

  • Listen to relaxing music instead of talk radio.
  • Try riding in silence for 10 minutes.
  • Pay attention to what you hear and see.

Quick stress relief at home

Entertaining. * Playing lively music. * Light candles. * Wear clothes that make you feel relaxed.

Kitchen. * Breathing in the scent of every ingredient you use. * Delight in the delicate texture of an eggshell. * Appreciate the weight of an onion.

Children and relationships. * keep cool during arguments by breathing and squeezing the tips of your thumb and forefinger together. * When your toddler tantrums, rub lotion into your hands then breathe in the scent.

Sleep. * Too stressed to snooze? Try using a white noise machine for background sound. * Use a humidifier with a diffuser for a light scent in the air.

Creating a sanctuary. * If clutter is upsetting, spend 10 minutes each day to tidy and organize. * Paint the walls with a fresh coat of your favourite calming colour. * Display photos and images that make you feel happy. * Throw open the curtains and let in natural light whenever possible.

Quick stress relief at work

Meetings. * During stressful sessions, stay connected to your breath. * Massage the tips of your fingers. * Wiggle your toes. * Sip coffee.

On the phone. * Inhale something energizing, like lemon, ginger, peppermint or coffee beans. * While talking, stand up or pace back and forth to burn off excess energy. * Conduct phone business outside when possible.

On the computer. * Work standing up. * Do knee-bends in 10-minute intervals. * Wrap a soft scarf around your neck. Suck on a peppermint.

Lunch breaks. * Take a walk around the block or in the parking lot. * Listen to soothing music while eating. * Have a quick chat with someone you love.

Your workspace. * Place family photos on your desk and display images and mementos that remind you of your life outside the office.

Physical illness and symptoms of anxiety:

Anxiety is associated with medical diseases either because the illness induces symptoms similar to anxiety, or it triggers symptoms of anxiety or because the person feels anxious over his physical illness. For example, in anaemia, asthma, infections, and several heart conditions there are symptoms of anxiety.

Some medically-related causes of anxiety include:

  • Stress from a serious medical illness
  • Side effects of medication
  • Symptoms of a medical illness
  • Lack of oxygen from emphysema, or pulmonary embolism (a blood clot in the lung)

Substance use and abuse

It is estimated that about half of patients who utilize mental health services for anxiety disorders such as Generalised anxiety disorder, panic disorder, or social phobia are doing so because of alcohol or benzodiazepine dependence. More generally, anxiety is also know to result from:

  • Intoxication from an illicit drug, such as cocaine or amphetamines
  • Withdrawal from an illicit drug, such as heroin, or from prescription drugs like Vicodin, benzodiazepines, or barbiturates

Diagnosis of anxiety:

A psychiatrist, clinical psychologist, or other mental-health professional is usually enlisted to diagnose anxiety and identify the causes of it. The physician will take a careful medical and personal history, perform a physical examination, and order laboratory tests as needed. There is no one laboratory test that can be used to diagnose anxiety, but tests may provide useful information about a medical condition that may be causing physical illness or other anxiety symptoms.

To be diagnosed with generalized anxiety disorder (GAD), a person must:

  • Excessively worry and be anxious about several different events or activities on more days than not for at least six months
  • Find it difficult to control the worrying
  • Have at least three of the following six symptoms associated with the anxiety on more days than not in the last six months: restlessness, fatigue, irritability, muscle tension, difficulty sleeping, difficulty concentrating

Generally, to be diagnosed with GAD, symptoms must be present more often than not for six months and they must interfere with daily living, causing the sufferer to miss work or school.

If the focus of the anxiety and worry is confined to a particular anxiety disorder, GAD will not be the diagnosis. For example, a physician may diagnose panic disorder if the anxiety is focused on worrying about having a panic attack, social phobia if worrying about being embarrassed in public, separation anxiety disorder if worrying about being away from home or relatives, anorexia nervosa if worrying about gaining weight, or hypochondriasis if worrying about having a serious illness.

Patients with anxiety disorder often present symptoms similar to clinical depression and vice-versa. It is rare for a patient to exhibit symptoms of only one of these.

Types of anxiety:

Anxiety takes several forms: * phobia * social anxiety * obsessive-compulsive * post-traumatic stress.

The physical effects of anxiety may include heart palpitations, tachycardia, muscle weakness and tension, fatigue, nausea, chest pain, shortness of breath, headache, stomach aches, or tension headaches. As the body prepares to deal with a threat, blood pressure, heart rate, perspiration, blood flow to the major muscle groups are increased, while immune and digestive functions are inhibited (the fight or flight response). External signs of anxiety may include pallor, sweating, trembling, and pupillary dilation. Someone who has anxiety might also experience it subjectively as a sense of dread or panic.

Although panic attacks are not experienced by every person who has anxiety, they are a common symptom. Panic attacks usually come without warning and although the fear is generally irrational, the subjective perception of danger is very real. A person experiencing a panic attack will often feel as if he or she is about to die or lose consciousness. Between panic attacks, people with panic disorder tend to suffer from anticipated anxiety- a fear of having a panic attack may lead to the development of phobias. Anxiety is the most common mental illness in America as approximately 40 million adults are affected by it.

The emotional effects of anxiety may include "feelings of apprehension or dread, trouble concentrating, feeling tense or jumpy, anticipating the worst, irritability, restlessness, watching (and waiting) for signs (and occurrences) of danger, and, feeling like your mind's gone blank" as well as "nightmares/bad dreams, obsessions about sensations, deja vu, a trapped in your mind feeling, and feeling like everything is scary."

The cognitive effects of anxiety may include thoughts about suspected dangers, such as fear of dying. "You may... fear that the chest pains are a deadly heart attack or that the shooting pains in your head are the result of a tumour or aneurysm. You feel an intense fear when you think of dying, or you may think of it more often than normal, or can’t get it out of your mind."

The behavioural effects of anxiety may include withdrawal from situations which have provoked anxiety in the past. Anxiety can also be experienced in ways which include changes in sleeping patterns, nervous habits, and increased motor tension like foot tapping.

Separation Anxiety Disorder

Separation Anxiety Disorder is characterized by high levels of anxiety when separated from a person or place that provides feelings of security or safety. Sometimes separation results in panic, and it is considered a disorder when the response is excessive or inappropriate.

Existential anxiety

Angst, Existential crisis, and Nihilism

The philosopher Søren Kierkegaard, in The Concept of Anxiety, described anxiety or dread associated with the "dizziness of freedom" and suggested the possibility for positive resolution of anxiety through the self-conscious exercise of responsibility and choosing. In Art and Artist (1932), the psychologist Otto Rank wrote that the psychological trauma of birth was the pre-eminent human symbol of existential anxiety and encompasses the creative person's simultaneous fear of – and desire for – separation, individuation and differentiation.

The theologian Paul Tillich characterized existential anxiety[29] as "the state in which a being is aware of its possible nonbeing" and he listed three categories for the nonbeing and resulting anxiety: ontic (fate and death), moral (guilt and condemnation), and spiritual (emptiness and meaninglessness). According to Tillich, the last of these three types of existential anxiety, i.e. spiritual anxiety, is predominant in modern times while the others were predominant in earlier periods. Tillich argues that this anxiety can be accepted as part of the human condition or it can be resisted but with negative consequences. In its pathological form, spiritual anxiety may tend to "drive the person toward the creation of certitude in systems of meaning which are supported by tradition and authority" even though such "undoubted certitude is not built on the rock of reality".

According to Viktor Frankl, the author of Man's Search for Meaning, when a person is faced with extreme mortal dangers, the most basic of all human wishes is to find a meaning of life to combat the "trauma of nonbeing" as death is near.

Test and performance anxiety

Main articles: Test anxiety, Mathematical anxiety, Stage fright, and Somatic anxiety

According to Yerkes-Dodson law, an optimal level of arousal is necessary to best complete a task such as an exam, performance, or competitive event. However, when the anxiety or level of arousal exceeds that optimum, the result is a decline in performance.

Test anxiety is the uneasiness, apprehension, or nervousness felt by students who had a fear of failing an exam. Students who have test anxiety may experience any of the following: the association of grades with personal worth; fear of embarrassment by a teacher; fear of alienation from parents or friends; time pressures; or feeling a loss of control. Sweating, dizziness, headaches, racing heartbeats, nausea, fidgeting, and drumming on a desk are all common. Because test anxiety hinges on fear of negative evaluation, debate exists as to whether test anxiety is itself a unique anxiety disorder or whether it is a specific type of social phobia.

While the term "test anxiety" refers specifically to students, many workers share the same experience with regard to their career or profession. The fear of failing at a task and being negatively evaluated for failure can have a similarly negative effect on the adult.

Stranger and social anxiety

Anxiety when meeting or interacting with unknown people is a common stage of development in young people. For others, it may persist into adulthood and become social anxiety or social phobia. "Stranger anxiety" in small children is not considered a phobia. In adults, an excessive fear of other people is not a developmentally common stage; it is called social anxiety. According to Cutting,[30] social phobics do not fear the crowd but the fact that they may be judged negatively.

Social anxiety varies in degree and severity. Whilst for some people it is characterized by experiencing discomfort or awkwardness during physical social contact (e.g. embracing, shaking hands, etc.), while in other cases it can lead to a fear of interacting with unfamiliar people altogether. There can be a tendency among those suffering from this condition to restrict their lifestyles to accommodate the anxiety, minimizing social interaction whenever possible. Social anxiety also forms a core aspect of certain personality disorders, including Avoidant Personality Disorder.[citation needed]

Generalized anxiety

Overwhelming anxiety, if not treated early, can consequently become a generalized anxiety disorder (GAD), which can be identified by symptoms of exaggerated and excessive worry, chronic anxiety, and constant, irrational thoughts. The anxious thoughts and feelings felt while suffering from GAD are difficult to control and can cause serious mental anguish that interferes with normal, daily functioning.[31]

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) includes specific criteria for diagnosing generalized anxiety disorder. The DSM-IV states that a patient must experience chronic anxiety and excessive worry, almost daily, for at least 6 months due to a number of stressors (such as work or school) and experience three or more defined symptoms, including, “restlessness or feeling keyed up or on edge, being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep).”[32]

If symptoms of chronic anxiety are not addressed and treated in adolescence then the risk of developing an anxiety disorder in adulthood increases significantly.[33] “Clinical worry is also associated with risk of comorbidity with other anxiety disorders and depression” which is why immediate treatment is so important.[33]

Generalized anxiety disorder can be treated through specialized therapies aimed at changing thinking patterns and in turn reducing anxiety-producing behaviors. Cognitive behavioral therapy (CBT) and short-term psychodynamic psychotherapy (STPP) can be used to successfully treat GAD with positive effects lasting 12 months after treatment.[34] There are also other treatment plans that should be discussed with a knowledgeable health care practitioner, which can be used in conjunction with behavioral therapy to greatly reduce the disabling symptoms of generalized anxiety disorder. Trait anxiety

Anxiety can be either a short term 'state' or a long term "trait." Trait anxiety reflects a stable tendency to respond with state anxiety in the anticipation of threatening situations.[35] It is closely related to the personality trait of neuroticism. Such anxiety may be conscious or unconscious.[36]

OCD and Anxiety

What is Obsessive-Compulsive Disorder (OCD)?

Obsessive-Compulsive Disorder (OCD) is an anxiety disorder characterized by thoughts or actions that are repetitive, distressing, and intrusive. OCD suffers usually know that their compulsions are unreasonable or irrational, but they serve to alleviate their anxiety. Often, the logic of someone with OCD will appear superstitious, such as an insistence in walking in a certain pattern. OCD sufferers may obsessively clean personal items or hands or constantly check locks, stoves, or light switches.

PTSD and Anxiety

What is Post-Traumatic Stress Disorder (PTSD)?

Post-traumatic Stress Disorder (PTSD) is anxiety that results from previous trauma such as military combat, rape, hostage situations, or a serious accident. PTSD often leads to flashbacks and behavioral changes in order to avoid certain stimuli.

Panic disorder and Anxiety

What is Panic Disorder?

Panic Disorder is a type of anxiety characterized by brief or sudden attacks of intense terror and apprehension that leads to shaking, confusion, dizziness, nausea, and difficulty breathing. Panic attacks tend to arise abruptly and peak after 10 minutes, but they then may last for hours. Panic disorders usually occur after frightening experiences or prolonged stress, but they can be spontaneous as well. A panic attack may lead an individual to be acutely aware of any change in normal body function, interpreting it as a life threatening illness - hypervigiliance followed by hypochondriasis. In addition, panic attacks lead a sufferer to expect future attacks, which may cause drastic behavioral changes in order to avoid these attacks.

Phobia and Anxiety: Social Anxiety

What is a Phobia?

A Phobia is an irrational fear and avoidance of an object or situation. Phobias are different from generalized anxiety disorders because a phobia has a fear response identified with a specific cause. The fear may be acknowledged as irrational or unnecessary, but the person is still unable to control the anxiety that results. Stimuli for phobia may be as varied as situations, animals, or everyday objects. For example, agoraphobia occurs when one avoids a place or situation to avoid an anxiety or panic attack. Agoraphobics will situate themselves so that escape will not be difficult or embarrassing, and they will change their behavior to reduce anxiety about being able to escape.

Social Anxiety Disorder

Social Anxiety Disorder is a type of social phobia characterized by a fear of being negatively judged by others or a fear of public embarrassment due to impulsive actions. This includes feelings such as stage fright, a fear of intimacy, and a fear of humiliation. This disorder can cause people to avoid public situations and human contact to the point that normal life is rendered impossible.

Treatments For Anxiety

Anxiety can be treated medically, with psychological counseling, or independently. Ultimately, the treatment path depends on the cause of the anxiety and the patient's preferences. Often treatments will consist of a combination of psychotherapy, behavioral therapy, and medications.

Sometimes alcoholism, depression, or other coexisting conditions have such a strong effect on the individual that treating the anxiety disorder must wait until the coexisting conditions are brought under control.

Self treatment

In some cases, anxiety may be treated at home, without a doctor's supervision. However, this may be limited to situations in which the duration of the anxiety is short and the cause is identified and can be eliminated or avoided. There are several exercises and actions that are recommended to cope with this type of anxiety:

  • Learn to manage stress in your life.
  • Keep an eye on pressures and deadlines, and commit to taking time away from study or work.
  • Learn a variety of relaxation techniques.
  • Practice deep abdominal breathing.
    • //This consists of breathing in deeply and slowly through your nose, taking the air right down to your abdomen, and then breathing out slowly and gently through your mouth. Breathing deeply for too long may lead to dizziness from the extra oxygen.//
  • Learn to replace "negative self talk" with "coping self talk."
    • //Make a list of the negative thoughts you have, and write a list of positive, believable thoughts to replace them. Replace negative thoughts with positive ones.//
  • Picture yourself successfully facing and conquering a specific fear.
  • Talk with a person who is supportive.
  • Meditate.
  • Exercise.
  • Take a long, warm bath.
  • Rest in a dark room.

Medication and anxiety:

{{:medication.jpg?200 |}}Medical treatments for anxiety utilize several types of drugs. If the cause of the anxiety is a physical ailment, treatment will be designed to eliminate the particular ailment. This might involve surgery or other medication to regulate a physical anxiety trigger. Often, however, medicines such as antidepressants, benzodiazepines, tricyclics, and beta-blockers are used to control some of the physical and mental symptoms.

Anxiety historically has been treated with a class of drugs called benzodiazepines. Their use has declined, however, due to their addictive nature. These drugs tend to have few side-effects except for drowsiness and possible dependency. Some common benzodiazepines include:

  • Diazepam (Valium)
  • Alprazolam (Xanax)
  • Lorazepam (Ativan)
  • Clonazepam (Klonopin)

Anti-depressants - especially those in the class of serotonin reuptake inhibitors (SSRI) - are also commonly used to treat anxiety even though they were designed to treat depression. SSRIs have fewer side effects than older anti-depressants, but they are still likely to cause jitters, nausea, and sexual dysfunction when treatment begins. Some anti-depressants include:

  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)
  • Escitalopram (Lexapro)
  • Citalopram (Celexa)
  • Venlafaxine (Effexor)

Tricyclics are a class of drugs that are older than SSRIs and have been shown to work well for most anxiety disorders other than obsessive-compulsive disorder. These drugs are known to cause side-effects such as dizziness, drowsiness, dry mouth, and weight gain. Two types of tricyclics include:

Imipramine (Tofranil)
Clomipramine (Anafranil)

Additional drugs used to treat anxiety include monoamine oxidase inhibitors (MAOIs), beta-blockers, and buspirone. MAOIs, such as phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan), are an older type of anti-depressant that are used to treat some anxiety disorders. These drugs carry with them several restrictions on diet and prevent one from taking other medications such as pain relievers. Beat-blockers, such as propranolol (Inderal), are usually used to treat heart conditions, but they can also treat physical symptoms that accompany some anxiety disorders. Buspirone (Buspar) is another type of medication that affects neurotransmitters to control anxiety but lacks the side effects of sleepiness and dependency. However, it has been associated with dizziness, headaches, and nausea.

Anxiolytics:

An anxiolytic (also antipanic or antianxiety agent)[1] is a drug used for the treatment of anxiety and its related psychological and physical symptoms. Anxiolytics have been shown to be useful in the treatment of anxiety disorders.

Beta-receptor blockers such as propranolol and oxprenolol, although not anxiolytics, can be used to combat the somatic symptoms of anxiety.

Anxiolytics are also known as minor tranquilizers.[2] The term is less common in modern texts, and was originally derived from a dichotomy with major tranquilizers, also known as neuroleptics or antipsychotics.[citation needed] Contents

1 Types of anxiolytics/anti-anxiety drugs
    1.1 Benzodiazepines
    1.2 SSRIs
    1.3 Azapirones
    1.4 Barbiturates
    1.5 Hydroxyzine
    1.6 Pregabalin
    1.7 Herbal treatments
    1.8 Over-the-counter pharmaceutical drugs
    1.9 Future drugs
2 Alternatives to medication

Benzodiazepines

Benzodiazepines are prescribed for short-term relief of severe and disabling anxiety. Benzodiazepines may also be indicated to cover the latent periods associated with the medications prescribed to treat an underlying anxiety disorder. They are used to treat a wide variety of conditions and symptoms and are usually a first choice when short-term CNS sedation is needed. Longer-term uses include treatment for severe anxiety. There is a risk of a benzodiazepine withdrawal and rebound syndrome after continuous usage for longer than two weeks, and tolerance and dependence may occur if patients stay under this treatment for longer.[3] There is also the added problem of the accumulation of drug metabolites and adverse effects.[4] Benzodiazepines include:

  • Alprazolam (Xanax)
  • Chlordiazepoxide (Librium)
  • Clonazepam (Klonopin, Rivotril)
  • Diazepam (Valium)
  • Etizolam (Etilaam)
  • Lorazepam (Ativan)
  • Oxazepam (Serax)

Benzodiazepines exert their anxiolytic properties at moderate dosage. At higher dosage hypnotic properties occur.

Tofisopam (Emandaxin and Grandaxin) is a drug that is a benzodiazepine derivative. Like other benzodiazepines, it possesses anxiolytic properties, but, unlike other benzodiazepines, it does not have anticonvulsant, sedative, skeletal muscle relaxant, motor skill-impairing, or amnestic properties.

SSRIs : Selective serotonin reuptake inhibitor

Selective serotonin reuptake inhibitors or serotonin-specific reuptake inhibitor[6] (SSRIs) are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, and some personality disorders. SSRIs are primarily classified as antidepressants and typically higher dosages are required to be effective against anxiety disorders than to be effective against depression but nevertheless most SSRIs have anxiolytic properties, but are anxiogenic when first initiating treatment, and in some individuals continue to be anxiety-provoking. For this reason, a low dose of a benzodiazepine is often used for several weeks when initiating SSRI/SNRI therapy in order to counteract the initial anxiety caused by the drugs until the therapeutic delay of the SSRI/SNRI is finished and the drug becomes effective. Older tricyclic antidepressants (TCAs) are very anxiolytic as well, however, side effects are greater. Examples include: imipramine, doxepin, amitriptyline, and the unrelated trazodone. Mono-amine oxidase inhibitors (MAOIs) are very effective for anxiety, but due to drug dangers, are rarely prescribed. Examples include: Nardil and Parnate.

Azapirones

Azapirones are a class of 5-HT1A receptor agonists. They lack the sedation and the dependence associated with benzodiazepines and cause much less cognitive impairment.[citation needed] They may be less effective than benzodiazepines in patients who have been previously treated with benzodiazepines as they do not provide the sedation that these patients may expect or equate with anxiety relief. Currently approved azapirones include buspirone (Buspar) and tandospirone (Sediel). Gepirone (Ariza, Variza) is also in clinical development. Barbiturates Main article: Barbiturate

Barbiturates exert an anxiolytic effect linked to the sedation they cause. The risk of abuse and addiction is high. Many experts consider these drugs obsolete for treating anxiety but valuable for the short-term treatment of severe insomnia, though only after benzodiazepines or non-benzodiazepines have failed. They are rarely prescribed anymore. Hydroxyzine

Hydroxyzine (Atarax) is an old antihistamine originally approved for clinical use by the FDA in 1956. It possesses anxiolytic properties in addition to its antihistamine properties and is also licensed for the treatment of anxiety and tension. It is also used for its sedative properties as a premed before anesthesia or to induce sedation after anesthesia.[7] It has been shown to be as effective as benzodiazepines in the treatment of generalized anxiety disorder, while producing fewer side-effects.[8] Pregabalin

Pregabalin's therapeutic effect appears after 1 week of use and is similar in effectiveness to lorazepam, alprazolam, and venlafaxine, but pregabalin has demonstrated superiority by producing more consistent therapeutic effects for psychic and somatic anxiety symptoms. Long-term trials have shown continued effectiveness without the development of tolerance, and, in addition, unlike benzodiazepines, it does not disrupt sleep architecture and produces less severe cognitive and psychomotor impairment; it also has a low potential for abuse and dependence and may be preferred over the benzodiazepines for these reasons.[

Over-the-counter pharmaceutical drugs

Picamilon is a prodrug formed by combining niacin with GABA that is able to cross the blood-brain barrier and is then hydrolyzed into GABA and niacin. It is theorized that the GABA released in this process activates GABA receptors, with potential to produce an anxiolytic response.[17][18] Picamilon is sold in the United States as a dietary supplement, while in Russia it is sold over the counter.

Chlorpheniramine (Chlor-Trimeton)[19] and diphenhydramine (Benadryl) have hypnotic and sedative effects with mild anxiolytic-like properties (off-label use). These drugs are approved by the FDA for allergies, rhinitis, and urticaria.

Melatonin has anxiolytic properties, likely mediated by the benzodiazepine/GABAergic system.[20] It has been used experimentally as an effective premedicant for general anesthesia in surgical procedures.[21]

Herbal Treatments

Certain natural substances are reputed to have anxiolytic properties, including the following:

  • Bacopa monnieri (Brahmi)
  • Lactuca virosa (Opium Lettuce)
  • Rhodiola rosea (Arctic Weed/Golden Root)
  • Hypericum perforatum (St. John's Wort)
  • Matricaria recutita (German Chamomile)
  • Mitragyna speciosa (Kratom)
  • Piper methysticum (Kava)
  • Sceletium tortuosum (Kanna)
  • Scutellaria spp. (Skullcap)
  • Scutellaria lateriflora[11]
  • Valeriana officinalis (Valerian)
  • Salvia splendens (Not to be confused with Salvia divinorum)
  • Coriandrum sativum (Coriander)[12]
  • Myristica (Nutmeg)
  • Salvia elegans (Pineapple Sage)[13]
  • Inositol
  • Cannabidiol (Cannabis)[16]

Psychological Treatments

Counselling

A standard method of treating anxiety is with psychological counseling. This can include cognitive-behavioral therapy, psychotherapy, or a combination of therapies.

Cognitive-behavioral therapy (CBT) aims to recognize and change the patient's thinking patterns that are associated with the anxiety and troublesome feelings. This type of therapy has two main parts: a cognitive part designed to limit distorted thinking and a behavioral part designed to change the way people react to the objects or situations that trigger anxiety.

For example, a patient undergoing cognitive-behavioral therapy for panic disorder might work on learning that panic attacks are not really heart attacks. Those receiving this treatment for obsessive-compulsive disorder for cleanliness may work with a therapist to get their hands dirty and wait increasingly longer amounts of time before washing them. Post-traumatic stress disorder sufferers will work with a therapist to recall the traumatic event in a safe situation to alleviate the fear it produces. Exposure-based therapies such as CBT essentially have people confront their fears and try to help them become desensitized to anxiety-triggering situations

Psychotherapy is another type of counseling treatment for anxiety disorders. It consists of talking with a trained mental health professional, psychiatrist, psychologist, social worker, or other counselor. Sessions may be used to explore the causes of anxiety and possible ways to cope with symptoms.

Psychotherapy

CBT, STDT, Gestalt - what does it all mean? Here's a layman's cheat sheet for several types of psychotherapy used to treat anxiety disorders...

Two of the most effective forms of psychotherapy used to treat anxiety disorders are behavioral therapy and cognitive-behavioral therapy.

Behavioral Therapy Behavioral therapy helps you to unlearn self-defeating patterns and habits in your day-to-day actions. It teaches you new, healthy skills and ways of reacting to situations that trigger anxiety. Behavioral therapy is action based. It assumes that if you can learn to change your behavior, then your thoughts, feelings, and attitudes will change too. Behavioral strategies may include progressive muscle relaxation techniques, gradual exposure to the anxiety trigger, changing breathing patterns, positive and negative reinforcement, and learning empowering ways of relating to others.

Cognitive Therapy

Cognitive therapy is based on the belief that faulty thinking patterns and belief systems can cause psychological problems. It assumes that by changing self-defeating thought patterns and transforming them into more successful belief systems you can improve your mental and emotional health. The main focus of cognitive therapy is to change emotions and behavior by changing our self-defeating thoughts, such as all or nothing beliefs, negative assumptions, labeling, and so on.

Cognitive-Behavioral Therapy (CBT)

Cognitive-behavioral therapy, or CBT, is a combination approach that uses both cognitive therapy and behavioral therapy. Cognitive and behavioral therapies compliment each other. When used together, they stimulate areas of growth that are difficult to achieve using one or the other by itself. Cognitive-behavioral therapy addresses both the thoughts and behaviors that promote and perpetuate anxiety.

Psychoanalytic Therapy

Psychoanalytic therapy helps bring unconscious thoughts, feelings, motivations, and experiences into the conscious mind. It assumes that behavior is determined by unconscious motivations, drives, and instincts from the first few years of life. This "classic" psychoanalysis is an intensive and long-term process of bringing these unconscious feelings to the surface. Through this process the therapist helps you to find patterns in your thoughts and behaviors and interpret how they might relate to your current problems.

Gestalt Therapy

Gestalt therapy uses techniques such as role-playing and confrontation that help increase awareness of feelings. These techniques are designed to strengthen your ability to face current situations and problems and realize the power you hold to change yourself. You and the therapist work together to help you understand yourself by experiencing the present together rather than talking about past situations or events.

EMDR

Eye Movement Desensitization and Reprocessing, or EMDR, is a tool for helping people who suffer from trauma, post traumatic stress, anxiety, panic, and grief. In its simplest form EMDR involves visualizing an image (pictures, feelings, sounds) of "the problem," while watching the therapist's systematic hand or finger movements. The goal of EMDR is to assist the brain in releasing the negative memories and emotions stored in the nervous system and help it process the traumatic experience successfully. EMDR is designed not to be a complete solution in and of itself, but rather to be part of a comprehensive treatment plan.

Emotional Freedom Technique (EFT)

Emotional Freedom Techniques (EFT), can be described as psychological acupressure. It combines ideas from Traditional Chinese Medicine and Applied Kinesiology, the study of the principles of mechanics and anatomy in relation to human movement. EFT involves a gentle tapping sequence in which you touch specific energy points in the body to clear emotional charges, allowing you to release many types of emotional blocks. Like EMDR, this technique is typically designed to be part of a comprehensive treatment plan, rather than a stand-alone solution.

Short-Term Dynamic Therapy (STDT)

Short-Term Dynamic Therapy, or STDT, uses the same basic principles as psychoanalytic therapy. However, it is practiced differently and has different goals. The goal of STDT is to be a short-term therapy to help you gain insight into how life events, relationship dynamics, and ongoing situations contribute to your anxiety. Because the therapist takes a more active role in this type of therapy, trust is especially important. Very early in the treatment the therapist identifies your defenses and resistances. Then he/she interprets them to help you re-experience painful events and express unresolved emotions.

Art Therapy/Music Therapy/Play Therapy

These "creative" therapies use art, music, and play as ways to express deep feelings and understand yourself better. Each of these therapies is based on the idea that the right (creative) hemisphere of the brain is helpful in identifying what's going on emotionally and encouraging the healing process. Play therapy is used most often with children.

The Eclectic Approach

Most therapists are flexible, adjusting the types of techniques and therapies used to fit your unique needs. This is called an "eclectic approach." The eclectic approach incorporates elements of several types of therapy to create the most effective and successful treatment plan for you. Most therapists realize that what's most important is not the therapist's orientation or technique, but whether or not the therapy "clicks" for you at a gut level and enables positive change.

Personal experience and research have shown me that each type of therapy has something to offer. In reality each individual's needs are usually much too complex for any one technique to be used in isolation. That's why our Conquer Anxiety Success Program uses an eclectic approach. Our course consists mainly of cognitive-behavioral therapy (CBT) techniques - combined with elements of Gestalt therapy, psychoanalytic therapy, Short-Term Dynamic Therapy (STDT), the creative therapies, and several alternative therapies. We believe this eclectic approach enables positive change by offering you a comprehensive set of tools to guide you in making the leap from intellectual understanding to personal insight and power.

Support Groups:

Local Support Groups

Relaxation techniques

Learning how to relax

  • Choose a quiet place where you won't be interrupted.
  • Before you start, do a few gentle stretching exercises to relieve muscular tension.
  • Make yourself comfortable, either sitting or lying down.
  • Start to breathe slowly and deeply, in a calm and effortless way.
  • Gently tense, then relax, each part of your body, starting with your feet and working your way up to your face and head.
  • As you focus on each area, think of warmth, heaviness and relaxation.
  • Push any distracting thoughts to the back of your mind; imagine them floating away.
  • Don't try to relax; simply let go of the tension in your muscles and allow them to become relaxed.
  • Let your mind go empty. Some people find it helpful to visualise a calm, beautiful place such as a garden or meadow.
  • Stay like this for about 20 minutes, then take some deep breaths and open your eyes, but stay sitting or lying for a few moments before you get up.

Practising a regular relaxation routine

It's important that you make time to practise a thorough routine on a regular basis.

Relaxation is one of the most effective self-help activities for mental health. It can be a useful addition to any other form of treatment as well as being an effective measure to prevent the development of stress and anxiety, and at the end of the day to help you sleep.

Relaxation exercises can be divided into two broad categories: those for the body and those for the mind. Body-centred exercises also have an effect on the mind. Having a relaxed body may not prevent a constant flow of anxiety-inducing thoughts but it's a good basis for getting some control of them. So for best results try to combine the two techniques.

Quieting the Mind and Body

Women with recurring symptoms of anxiety and nervous tension are usually barraged by a constant stream of negative "self-talk." Throughout the day your conscious mind may be inundated with thoughts, feelings, and fantasies that trigger feelings of upset. Many of these thoughts replay unresolved issues of health, finances, or personal and work relationships. This relentless mental replay of unresolved issues can reinforce the anxiety symptoms and be exhausting. It is important to know how to shut off the constant inner dialogue and quiet the mind.

By emptying your mind, you give yourself a rest. Meditation allows you to create a state of deep relaxation, which is very healing to the entire body. Metabolism slows, as do physiological functions such as heart rate and blood pressure. Muscle tension decreases. Brain wave patterns shift from the fast beta waves that occur during a normal active day to the slower alpha waves, which appear just before falling asleep or in times of deep relaxation.

Grounding Techniques

Many women suffering from anxiety episodes often feel ungrounded and disorganized. There is a pervasive sense of "things falling apart." When anxiety episodes occur, it often takes a concentrated effort just to get through the day, accomplishing such basic daily tasks as cooking, housecleaning, taking care of children, or getting to work or school.

Releasing Muscle Tension

  • Discovering Muscle Tension
  • Progressive Muscle Relaxation
  • Release of Muscle Tension and Anxiety
  • Shrinking Stress
  • Erasing Stress

Healing the Inner Child

Many of our anxieties and fears come from our inner child rather than our adult self. Sometimes it is difficult to realize that the emotional upsets we feel are actually feelings left over from childhood fears, traumas, and experiences. When unhealed, they remain with us into adulthood, causing emotional distress over issues that competent "grown up" people feel they should be able to handle. For example, fear of the dark, fear of being unlovable, and fear of rejection often originate in early dysfunctional or unhappy experiences with our parents and siblings. While many of these deep, unresolved emotional issues may require counselling, particularly if they are causing anxiety episodes, there is much that we can do for ourselves to heal childhood wounds. T

Visualization

Color therapy, as it applies to human health, has a long and distinguished history. In many studies, scientists have exposed subjects to specific colors, either directly through exposure to light therapy, or through changing the color of their environment. Visualizing color in a specific part of the body can have a powerful therapeutic effect, too, and can be a good stress management technique for relief of anxiety and nervous tension.

Tension Release Through Color

Energizing Through Color

Affirmations

Affirmations provide a method to change negative belief systems to thoughts that preserve peace and calm. Positive statements replace the anxiety inducing messages with thoughts that make you feel good.

Positive Mind/Body Affirmations

Hydrotherapy

For centuries, people have used warm water as a way to calm moods and relax muscles. You can have your own "spa" at home by adding relaxing ingredients to the bath water. I have found the following formula to be extremely useful in relieving muscle pain and tension.

Sound

Music can have a tremendously relaxing effect on our minds and bodies. Slow, quiet music classical music is particularly good. This type of music can have a pronounced beneficial effect on your physiological functions. It can slow your pulse and heart rate, lower your blood pressure, and decrease your levels of stress hormones. It promotes peace and relaxation and helps to induce sleep. Nature sounds, such as ocean waves and rainfall, can also induce a sense of peace and relaxation. Play relaxing music often when you are aware of increased emotional and physical tension.

Massage

Massage can be extremely therapeutic for women who feel anxious. Gentle touching either by a trained massage therapist, your relationship partner, or even yourself can be very relaxing. Tension usually fades away relatively quickly with gentle, relaxed touching. The kneading and stroking movement of a good massage relaxes tight muscles and improves circulation.

Breathing Techniques

Learn classic anxiety breathing techniques combining slow, deep breathing with acupressure and self-massage. These form a powerful self therapy for anxiety, nervousness, emotional stress and tension.

Emotions and breathing have a reciprocal relationship - when you are anxious, nervous or upset your breathing quickens and may even become erratic. When you are relaxed and composed your breathing is slow, calm and rhythmical. By controlling your breath, through regular practice of specific exercises, your mind and your emotions can be stilled.

Acupressure massage involves pressing and rubbing certain points on your body known for their ability to relax the mind and calm the emotions. Doing acupressure in conjunction with anxiety breathing techniques, like the one below, greatly enhances the effectiveness of both methods in controlling and preventing anxiety, nervousness, stress and tension.

Cognitive Therapy

Cognitive behavioural therapy (CBT) is the most widely-used therapy for anxiety disorders. Research has shown it to be effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalized anxiety disorder, among many other conditions.

Cognitive behavioral therapy addresses negative patterns and distortions in the way we look at the world and ourselves.

The basic premise of cognitive behavioural therapy is that our thoughts–not external events–affect the way we feel. In other words, it’s not the situation you’re in that determines how you feel, but your perception of the situation.

Thought challenging in cognitive behaviuoral therapy

Thought challenging–also known as cognitive restructuring–is a process in which you challenge the negative thinking patterns that contribute to your anxiety, replacing them with more positive, realistic thoughts. This involves three steps:

Complementary therapies for anxiety disorders

Biofeedback – Using sensors that measure specific physiological functions—such as heart rate, breathing, and muscle tension—biofeedback teaches you to recognize the body’s anxiety response and learn how to control them using relaxation techniques.

Hypnosis – Hypnosis is sometimes used in combination with cognitive-behavioral therapy for anxiety. While you’re in a state of deep relaxation, the hypnotherapist uses different therapeutic techniques to help you face your fears and look at them in new ways.

Making anxiety therapy work for you

There is no quick fix for anxiety. Overcoming an anxiety disorder takes time and commitment. Therapy involves facing your fears rather than avoiding them, so sometimes you’ll feel worse before you get better. The important thing is to stick with treatment and follow your therapist’s advice. If you’re feeling discouraged with the pace of recovery, remember that therapy for anxiety is very effective in the long run. You’ll reap the benefits if you see it through.

You can also support your own anxiety therapy by making positive choices. Everything from your activity level to your social life affects anxiety. Set the stage for success by making a conscious decision to promote relaxation, vitality, and a positive mental outlook in your everyday life.

  • Learn about anxiety. In order to overcome anxiety, it’s important to understand the problem. That’s where education comes in. Education alone won’t cure an anxiety disorder, but it will help you get the most out of therapy.
  • Cultivate your connections with other people. Loneliness and isolation set the stage for anxiety. Decrease your vulnerability by reaching out to others. Make it a point to see friends; join a self-help or support group; share your worries and concerns with a trusted loved one.
  • Adopt healthy lifestyle habits. Physical activity relieves tension and anxiety, so make time for regular exercise. Don’t use alcohol and drugs to cope with your symptoms, and try to avoid stimulants such as caffeine and nicotine, which can make anxiety worse.
  • Reduce stress in your life. Examine your life for stress, and look for ways to minimize it. Avoid people who make you anxious, say no to extra responsibilities, and make time for fun and relaxation in your daily schedule.

Diet

Medical experts are forever trying to find new ways to fight anxiety. Changing one’s diet is a successful way of combating the condition. The diet of patients with anxiety disorders must be enriched with natural supplements to fight stress. A combination of foods is needed when choosing the diet that's right for you. Foods rich in amino acids are good especially those rich in tryptophan. So include chicken, cheese, eggs, and milk in your diet as they generate serotonin. Diets for combating depression and anxiety help improve mood swings by increasing serotonin levels.

Remember anxiety-specific diets do not provide a cure for symptoms. It may prevent severity and frequency of attacks.

  1. Water is a good diet for anxiety as it improves mood and prevents fatigue.

  2. Fluctuating blood sugar decreases serotonin levels, so diets for anxiety should keep sugar levels steady. Anxiety diets should include complex carbohydrates like whole wheat pasta, brown rice, and whole meal bread for slow and steady release of glucose.

  3. Foods that increase serotonin should be added to a diet for anxiety. Bananas are excellent for generating serotonin.

  4. Add vitamin D to your diet. The sun is the best source.

  5. Your diet must be free from caffeine. Too much tea, coffee, and other fizzy drinks can cause nervousness.

  6. Limit or cut out alcohol from your diet.

  7. Oats, soy, peanuts, and sesame seeds are some other foods that are good for anxiety.

  8. One can’t go wrong with kiwi fruits. Kiwi is rich in minerals like magnesium, manganese, and potassium which are needed to combat anxiety.

  9. A diet rich in vitamin B complex helps combat anxiety. Vitamin B1 (thiamine) is found in beef, yeast, nuts, and orange should be a part of an anxiety diet. Vitamin B3 (niacin) is found in yeast, milk, eggs, and meat. Cereals, legumes, carrots, and spinach are rich in vitamin B6 (pyridoxine). Your diet must include plentiful animal products such as fish, meat, poultry, eggs, and milk.

  10. An anxiety disorder diet should cut out fast, fatty, and fried foods. Walnut oil, oily fish like salmon, and fish oil supplements are good to include in your diet.

Exercise and Sport

Patients who exercised regularly reported reduction in anxiety symptoms compared to those who did not exercise.

Exercise sessions greater than 30 minutes were better at reducing anxiety than sessions of less than 30 minutes, the researchers found. But surprisingly, programs with a duration of between three and twelve weeks appear to be more effective at reducing anxiety than those lasting more than 12 weeks. The researchers noted that study participants were less likely to stick with the longer exercise programs, which suggests that better participation rates result in greater reductions in anxiety.

Regular aerobic exercise can bring remarkable changes not just to body, metabolism, and your heart, but also to your spirits.

Aerobic exercise is the key for your head, just as it is for your heart. It has a unique capacity to exhilarate and relax, to provide stimulation and calm, to counter depression and dissipate stress. Endurance athletes commonly experience the restorative power of exercise, and this has been verified in clinical trials that have used exercise to treat anxiety and depression.

The mental benefits of aerobic exercise have a neurochemical basis. Exercise reduces levels of the body’s stress hormones, such as adrenaline and cortisol. It also stimulates the production of endorphins, the body’s natural painkillers and mood elevators.

Behavioural factors contribute to the emotional benefits of exercise. Exercise and sports also provide opportunities to enjoy some solitude or to make friends and build networks. And if you need more help with stress, consider autoregulation exercises involving deep breathing or muscle relaxation.

Good Sleep

  • Set a regular bedtime. Go to bed at the same time every night. Choose a time when you normally feel tired, so that you don’t toss and turn. Try not to break this routine on weekends when it may be tempting to stay up late. If you want to change your bedtime, help your body adjust by making the change in small daily increments, such as 15 minutes earlier or later each day.
  • Wake up at the same time every day. If you’re getting enough sleep, you should wake up naturally without an alarm. If you need an alarm clock to wake up on time, you may need to set an earlier bedtime. As with your bedtime, try to maintain your regular wake–time even on weekends.
  • Nap to make up for lost sleep. If you need to make up for a few lost hours, opt for a daytime nap rather than sleeping late. This strategy allows you to pay off your sleep debt without disturbing your natural sleep–wake rhythm, which often backfires in insomnia and throws you off for days.
  • Be smart about napping. While taking a nap can be a great way to recharge, especially for older adults, it can make insomnia worse. If insomnia is a problem for you, consider eliminating napping. If you must nap, do it in the early afternoon, and limit it to thirty minutes.
  • Fight after–dinner drowsiness. If you find yourself getting sleepy way before your bedtime, get off the couch and do something mildly stimulating to avoid falling asleep, such as washing the dishes, calling a friend, or getting clothes ready for the next day. If you give in to the drowsiness, you may wake up later in the night and have trouble getting back to sleep.

Melatonin is a naturally occurring hormone that helps regulate your sleep-wake cycle. Melatonin production is controlled by light exposure. Your brain should secrete more in the evening, when it’s dark, to make you sleepy, and less during the day when it’s light and you want to stay awake and alert. However, many aspects of modern life can disrupt your body’s natural production of melatonin and with it your sleep-wake cycle.

Spending long days in an office away from natural light, for example, can impact your daytime wakefulness and make your brain sleepy. Then bright lights at night—especially from hours spent in front of the TV or computer screen—can suppress your body’s production of melatonin and make it harder to sleep. However, there are ways for you to naturally regulate your sleep-wake cycle, boost your body’s production of melatonin, and keep your brain on a healthy schedule.

Increase light exposure during the day * Remove your sunglasses in the morning and let light onto your face. * Spend more time outside during daylight. Try to take your work breaks outside in sunlight, exercise outside, or walk your dog during the day instead of at night. * Let as much light into your home/workspace as possible. Keep curtains and blinds open during the day, move your desk closer to the window. * If necessary, use a light therapy box. A light therapy box can simulate sunshine and can be especially useful during short winter days when there’s limited daylight.

Boost melatonin production at night

  • Turn off your television and computer. Many people use the television to fall asleep or relax at the end of the day. Not only does the light suppress melatonin production, but television can actually stimulate the mind, rather than relaxing it. Try listening to music or audio books instead, or practicing relaxation exercises. If your favorite TV show is on late at night, record it for viewing earlier in the day.
  • Don’t read from a backlit device at night (such as an iPad). If you use a portable electronic device to read, use an eReader that is not backlit, i.e. one that requires an additional light source such as a bedside lamp.
  • Change your light bulbs. Avoid bright lights before bed, use low-wattage bulbs instead.
  • When it’s time to sleep, make sure the room is dark. The darker it is, the better you’ll sleep. Cover electrical displays, use heavy curtains or shades to block light from windows, or try an eye mask to cover your eyes.
  • Use a flashlight to go to the bathroom at night. As long as it’s safe to do so, keep the light to a minimum so it will be easier to go back to sleep.

Create a relaxing bedtime routine

If you make a consistent effort to relax and unwind before bed, you will sleep easier and more deeply. A peaceful bedtime routine sends a powerful signal to your brain that it’s time to wind down and let go of the day’s stresses. Make your bedroom more sleep friendly

Make Sure Your Bed Is Comfortable

  • Keep noise down. If you can’t avoid or eliminate noise from barking dogs, loud neighbors, city traffic, or other people in your household, try masking it with a fan, recordings of soothing sounds, or white noise. You can buy a special sound machine or generate your own white noise by setting your radio between stations. Earplugs may also help.
  • Keep your room cool. The temperature of your bedroom also affects sleep. Most people sleep best in a slightly cool room (around 65° F or 18° C) with adequate ventilation. A bedroom that is too hot or too cold can interfere with quality sleep.
  • Make sure your bed is comfortable. You should have enough room to stretch and turn comfortably. If you often wake up with a sore back or an aching neck, you may need to invest in a new mattress or a try a different pillow. Experiment with different levels of mattress firmness, foam or egg crate toppers, and pillows that provide more support.
  • Reserve your bed for sleeping and sex

Relaxing bedtime rituals to try

  • Read a book or magazine by a soft light
  • Take a warm bath
  • Listen to soft music
  • Do some easy stretches
  • Wind down with a favourite hobby
  • Listen to books on tape
  • Make simple preparations for the next day

Eat right and get regular exercise

Your daytime eating and exercise habits play a role in how well you sleep. It’s particularly important to watch what you put in your body in the hours leading up to your bedtime.

  • Stay away from big meals at night. Try to make dinnertime earlier in the evening, and avoid heavy, rich foods within two hours of bed. Fatty foods take a lot of work for your stomach to digest and may keep you up. Also be cautious when it comes to spicy or acidic foods in the evening, as they can cause stomach trouble and heartburn.
  • Avoid alcohol before bed. Many people think that a nightcap before bed will help them sleep. While it may make you fall asleep faster, alcohol reduces your sleep quality, waking you up later in the night. To avoid this effect, so stay away from alcohol in the hours before bed.
  • Cut down on caffeine. You might be surprised to know that caffeine can cause sleep problems up to ten to twelve hours after drinking it! Consider eliminating caffeine after lunch or cutting back your overall intake.
  • Avoid drinking too many liquids in the evening. Drinking lots of water, juice, tea, or other fluids may result in frequent bathroom trips throughout the night. Caffeinated drinks, which act as diuretics, only make things worse.
  • Quit smoking. Smoking causes sleep troubles in numerous ways. Nicotine is a stimulant, which disrupts sleep. Additionally, smokers actually experience nicotine withdrawal as the night progresses, making it hard to sleep.

Ways to get back to sleep

It’s normal to wake briefly during the night. In fact, a good sleeper won’t even remember it. But if you’re waking up during the night and having trouble falling back asleep, the following tips may help.

  • Stay out of your head. The key to getting back to sleep is continuing to cue your body for sleep, so remain in bed in a relaxed position. Hard as it may be, try not to stress over the fact that you’re awake or your inability to fall asleep again, because that very stress and anxiety encourages your body to stay awake. A good way to stay out of your head is to focus on the feelings and sensations in your body.
  • Make relaxation your goal, not sleep. If you are finding it hard to fall back asleep, try a relaxation technique such as visualization, deep breathing, or meditation, which can be done without even getting out of bed. Remind yourself that although they’re not a replacement for sleep, rest and relaxation still help rejuvenate your body.
  • Do a quiet, non-stimulating activity. If you’ve been awake for more than 15 minutes, try getting out of bed and doing a quiet, non-stimulating activity, such as reading a book. Keep the lights dim so as not to cue your body clock that it’s time to wake up. Also avoid screens of any kind—computers, TV, cell phones, iPads—as the type of light they emit is stimulating to the brain. A light snack or herbal tea might help relax you, but be careful not to eat so much that your body begins to expect a meal at that time of the day.
  • Postpone worrying and brainstorming. If you wake during the night feeling anxious about something, make a brief note of it on paper and postpone worrying about it until the next day when you are fresh and it will be easier to resolve. Similarly, if a brainstorm or great idea is keeping you awake, make a note of it on paper and fall back to sleep knowing you’ll be much more productive and creative after a good night’s rest.

Know when to see a sleep doctor

If you’ve tried the tips above, but are still struggling with sleep problems, you may have a sleep disorder that requires professional treatment. Consider scheduling a visit with a sleep doctor if, despite your best efforts at self–help, you are still troubled by any of the following symptoms:

  • Persistent daytime sleepiness or fatigue
  • Loud snoring accompanied by pauses in breathing
  • Difficulty falling asleep or staying asleep
  • Unrefreshing sleep
  • Frequent morning headaches
  • Crawling sensations in your legs or arms at night
  • Inability to move while falling asleep or waking up
  • Physically acting out dreams during sleep
  • Falling asleep at inappropriate times

Alcohol and Anxiety

Drinking alcohol is linked to both anxiety and depression. A recent British survey found that people suffering from anxiety or depression were twice as likely to be heavy or problem drinkers. Alcohol has also been linked to self-harm, suicide and psychosis.

Apart from affecting mental health, consuming alcohol also affects your memory and brain function. Soon after drinking alcohol, brain processes slow down. For example, the effect on men’s driving skills is measurable after the consumption of three to four units. At this level of consumption, alcohol is in the bloodstream at around 50mg per 100ml. Women can reach this same concentration by drinking just two or three units.

People often feel rough after a session of heavy drinking, feeling that their memory and thinking is impaired. It’s difficult to be sure whether this is a genuine effect, just part of the folklore about hangovers, or because there is still alcohol in the tissues the next day. Some people, even when they no longer have alcohol in the bloodstream, are probably slightly ‘slowed’ mentally the next day.

Self-harm and alcohol are often linked. In 2006, a survey was carried out among 3,004 self-harm patients at Scottish accident and emergency departments. It found that 62% of males and 50% of females reported consuming alcohol immediately before or while self-harming, and 27% of men and 19% of the women cited alcohol as the reason for self-harming. It has been estimated that alcohol plays a part in up to 65% of suicides in the UK.

Extreme levels of drinking (e.g. more than 30 units per day for several weeks) can occasionally cause ‘psychosis’, a severe mental illness where hallucinations and delusions of persecution develop. Psychotic symptoms can also occur when very heavy drinkers suddenly stop drinking and develop a condition known as ‘delirium tremens’.

There are basically 6 reasons why alcohol consumption and hangovers make many people anxious.

  1. Mood

Alcohol can affect our mood because it can affect the level of serotonin in the brain. Serotonin is a feel good brain chemical that when in short supply can cause feelings of anxiety and depression.

  1. Drop in blood sugar

A drop in blood sugar can cause dizziness, confusion, weakness, nervousness, shaking and numbness. These symptoms can most certainly trigger a bout of anxiety.

  1. Dehydration

This has been known to cause nausea, dizziness, fatigue, light-headedness and muscle weakness. These symptoms wouldn’t cause anxiety per say but they add to a sense of illness which fosters anxiety.

  1. Nervous System

The nervous system is affected because in order for the body to fight off the sedative effects of alcohol it puts the body into a state of hyperactivity in order to counteract this effect. This hyperactivity can lead to shaking, light/sound sensitivity and sleep deprivation.

  1. Heart Rate

Your heart rate can become elevated as a result of consuming alcohol which can cause a palpitation false alarm and put you into a state of anxious anticipation.

  1. Concentration

A hard night of drinking can also make you hazy, bring on headaches and create a sense of disorientation.

In addition, although alcohol does have a sedative effect it should not be used as a coping tool. This type of behaviour can lead to alcoholism and worse yet, more anxiety.

Nictonine and Anxiety

Despite widespread knowledge about the negative health effects of smoking (and other forms of tobacco and nicotine use) some people still smoke. The rates for people with anxiety disorders including generalized anxiety disorder (GAD) are even higher. Some of the risk factor associated with anxiety and tobacco use include * (a) stressful childhood * (b) difficulty tolerating negative emotions * (c) impulsiveness.

Nicotine Only Temporarily Lowers Anxiety. It only produces a temporary relief from anxiety, that also compromises overall physical health. Many people turn to cigarettes when they are anxious, and the physiological effects of the nicotine can create a calming sensation. However, this usually only works until the substance work through your system, meaning that ongoing anxiety provoking situations will return the person to same level of anxiety as he/she had before the cigarette.

There are many treatment options available for anxiety problems like GAD that are not as physically destructive that can also have long lasting effects.

Smoking is highly prevalent across most anxiety disorders. Tobacco use increases risk for the later development of certain anxiety disorders, and smokers with anxiety disorders have more severe withdrawal symptoms during smoking cessation than smokers without anxiety disorders.

Caffeine and Anxiety

Caffeine has a role in panic and other anxiety disorders. The American Psychiatric Association has recognized three caffeine related disorders : caffeine intoxication, caffeine-related anxiety, and caffeine-related sleep disorders.

Coffee, tea, and caffeine-containing soft drinks are not simply beverages but are psychoactive drug. Caffeine can exacerbate anxiety and panic disorders.

Most people drink coffee and tea or use caffeine-containing medicines. At the same time, panic and other anxiety disorders have become the most common mental illnesses.

Technically, caffeine works by blocking the depressant function of a chemical called adenosine. This gives the pleasurable sense of energy and focus. Caffeine enhances alertness, concentration, and memory.

Excessive consumptions of coffee and tea can cause tension and shakiness. In people predisposed to anxiety disorders, caffeine can trigger sweaty palms, a pounding heart, ringing in the ears that leads to a full-blown panic attack.

Susceptible people experience caffeine's effects as signs of impending doom. Once that happens, anxiety can take on a life of its own. Many give up coffee to avoid the caffeine's disturbing side effects. Someone may attribute feelings of panic to their current circumstances rather than to caffeine.

To help people with panic and related anxiety disorders, psychologists typically ask patients to cut down caffeine use. Patients can learn to interpret their symptoms. A fast-beating heart is the body's normal reaction to a stimulant like caffeine -- not a sign of an impending heart attack.

Life Style

Although anxiety disorders cannot be prevented, there are ways to reduce your risk and methods to control or lessen symptoms. Recommendations include:

  • Reducing caffeine, tea, cola, and chocolate consumption.
  • Checking with a doctor or pharmacist before using over-the-counter or herbal remedies to see if they contain chemicals that may contribute to anxiety.
  • Exercising regularly.
  • Eating healthy foods.
  • Keeping a regular sleep pattern.
  • Seeking counseling and support after a traumatic or disturbing experience.
  • Avoiding alcohol, cannabis.

Meditation and Yoga

Yoga is a blend of physical postures (asanas) and breathing techniques (pranayama).

The postures help to relax and stretch the muscles. Yoga’s added benefit is that it brings about deep muscle relaxation. The gentle movements of yoga are soothing and bring about a sense of well-being and calmness, thus reducing anxiety levels.

Pranayama’s deep-breathing techniques are also helpful in expelling deep-rooted anxieties. Prana is the vital energy of the universe. The deep breathing of pranayama aids intake of more oxygen into the blood and thus restores the balance of prana in the body. Most of us do not realize the importance of proper deep breathing in our everyday lives. Caught up in our hectic schedules we generally tend to take short, shallow breaths, which not only lead to various ailments from heart attacks to fatigue, but also causes rise in anxiety levels.

Deep breathing is a wonderful stress-buster and works like magic for general good health. Pranayama encourages you to inhale deeply through your nose. As you inhale, you also simultaneously push down the diaphragm. Once the lung is full of air, you exhale slowly. You can practice this anywhere, anytime – while waiting for a bus or during a boring lecture or just while waiting for your computer to boot.

The following yoga postures are also effective for reducing anxiety and stress:

  • Sun Salutation - Surya Namaskara
  • Shoulder Stand - Sarvanga Asana
  • Fish Pose - Matsya Asana
  • Plough Pose - Hala Asana
  • Thunder Pose - Vajra Asana
  • Camel Pose - Ushtra Asana
  • Cool Breath - Shitali Pranayama
  • Corpse Pose - Shava Asana
  • Deep Yogic Sleep – Yoganidra

Meditation has long been touted as a way to achieve calm and inner peace, so it’s not surprising that it can help relieve anxiety problems.

Mindfulness meditation.

This type of meditation, which has its roots in Buddhism, concentrates on getting you more in touch with your thoughts and feelings so you can truly live in the moment. Many types of meditation fall under the “mindfulness” category, like vipassana, which involves focusing on your breathing in order to diminish awareness of worrisome thoughts. “As soon as your mind wanders or you notice noises outside or sensations in your body, you just come back to the breath,” Maria says. Another form of mindfulness meditation is walking meditation. In this type of mediation, you walk slowly, carefully paying close attention to each step you take. “The idea with walking meditation is that you are present and as mindful as possible,” Maria says. With each movement you make as you walk, your attention is fully in the present moment, she explains. Mindfulness meditation aimed at stress relief is sometimes called mindfulness-based stress reduction, or MBSR.

Mantra-based meditation.

This form of meditation was popularized in the 1960s by Maharishi Mahesh Yogi, who famously taught his techniques to the Beatles. It involves the use of a mantra, a phrase or word that is repeated in the mind over and over again. Repeating a phrase “allows you to transcend [negative thoughts and to get] some distance from those thoughts, so you can observe them, instead of letting them control your life,” Maria says. Mantras are usually developed for each individual with the help of an instructor, but here’s one to try: As you slowly inhale, say the word “so”; as you exhale, say the word “hum.” Repeat.

Mindfulness-based cognitive therapy.

While not purely a form of meditation, this blend of cognitive therapy and mindfulness-based stress reduction, which is usually done in groups, has been shown to ease anxiety. One small study published in the Journal of Anxiety Disorders found that people who underwent this type of therapy experienced considerable relief from their depression and anxiety symptoms.

Zen meditation.

Also known as zazen meditation, this form of meditation integrates breathing, posture, and even visualization to increase self-awareness and release troublesome thoughts. Participants usually kneel or sit in a Buddha-like position and breathe very deliberately, which slows down the mind and helps encourage feelings of tranquility. Sometimes a visual image, or mandala, may be concentrated on as well.

Massage

Patient's symptoms of anxiety improve with massage. This improvement resembles that reported with psychotherapy, medications, or both. Massage may be no more effective than simple relaxation in a room alone with soft, soothing music.

Massage therapy is among the most popular complementary and alternative medical (CAM) treatments for anxiety.

Role of Faith

Many religious rituals and activities promote relaxation and shifting mind away from daily worries and concerns. Belief in supreme being who is protective, guiding and all-knowing helps to enhance courage to face life calamities and fears.

Religious group activity allow support from others and the clergy. Many find religious books a source of hope and wisdom.

Change your life style

A healthy lifestyle is an essential companion to any stress-reduction program. People can enhance their general health and stress resistance by getting regular exercise, eating a diet rich in a variety of whole grains, vegetables, and fruits, and avoiding excessive alcohol, caffeine, and tobacco.

Exercise

Exercise in combination with stress management techniques is extremely important for many reasons:

  • Exercise is an effective distraction from stressful events.
  • Exercise may directly blunt the harmful effects of stress on blood pressure and the heart (exercise protects the heart).

Vary the exercise program, combining aerobic exercise with strength training. Start slowly. Strenuous exercise in people who are not used to it can be very dangerous. In addition, half of all people who begin a vigorous training program drop out within a year. Discuss any exercise program with a physician before starting. The key is to find activities that are exciting, challenging, and satisfying. The following are some suggestions:

  • Aerobics classes at a gym
  • Brisk walking (even short brisk walks can relieve bouts of stress)
  • Swimming
  • Yoga or Tai chi

As in other areas of stress management, making a plan and executing it successfully provides feelings of mastery and control, which are very beneficial in and of themselves. Start slowly. Just 10 minutes of exercise three times a week can build a good base for novices. Gradually build up the length of these sessions to 30 minutes or more.

Listen to music.

Music is an effective stress reducer in both healthy individuals and people with health problems. Research finds that listening to soothing music can decrease blood pressure, heart rate, and anxiety levels in heart patients.

Take long weekends or vacations.

If the source of stress is in the home, plan times away, even if only for an hour or two a week.

Replace unnecessary time-consuming chores with pleasurable or interesting activities.

Make time for recreation. This is as essential as paying bills or shopping for groceries.

Own a pet. Research finds that pet owners have a lower blood pressure increase in response to stress than people who do not own pets.

Discuss Feelings.

The concept of communication and letting your feelings out has been so excessively promoted and parodied that it has nearly lost its value as good psychological advice. Nevertheless, feelings of anger or frustration that are not expressed in an acceptable way may lead to hostility, a sense of helplessness, and depression.

Expressing feelings does not mean venting frustration. In fact, anger may cause a spike in blood pressure in some people. Some therapists strongly recommend just talking, rather than venting anger.

The primary goal is to explain and assert one's needs to a trusted individual in as positive a way as possible. Direct communication may not even be necessary. Writing in a journal, writing a poem, or composing a letter that is never mailed may be sufficient.

Expressing one's feelings solves only half of the communication puzzle. Learning to listen, empathize, and respond to others with understanding is just as important for maintaining the strong relationships necessary for emotional fulfillment and reduced stress.

Keep Perspective and Look for the Positive. Reversing negative ideas and learning to focus on positive outcomes helps reduce tension and achieve goals.

Use Humor.

Research has shown that humor is a very effective mechanism for coping with acute stress. Keeping a sense of humor during difficult situations is a common recommendation of stress management experts. Laughter not only releases the tension of pent-up feelings and helps a person maintain perspective, but it also appears to have actual physical effects that reduce stress hormone levels. It is not uncommon for people to laugh intensely during tragic events, such as the death of a loved one, because this laughter helps them endure the emotional pain of the experience. Relaxation and Other Alternative Techniques

Acupuncture. Some evidence suggests that acupuncture might improve some of the physical factors associated with both stress and health problems. For example, acupuncture may improve stress-related heart muscle activity in heart failure patients, which could provide an important benefit to these patients. However, acupuncture has no effect on stress-related blood pressure or heart rate.

Hypnosis. Hypnosis may benefit some people with severe stress. In one study of patients with irritable bowel syndrome, stress reduction from hypnosis led to improvements in many bowel symptoms.

Herbal and Natural Remedies

Try herbal or natural remedies. However, just as with standard drugs, so-called natural remedies can cause health problems, which can sometimes be serious.

Aromatherapy. The smell of lavender has long been associated with a calming effect. In addition, several other aromatherapies are now used for relaxation. Use caution, however, as some of the exotic plant extracts in these formulas have been associated with a wide range of skin allergies.

Valerian. Valerian is an herb that has sedative qualities, and it may reduce stress and its associated physical effects. This herb is on the FDA's list of generally safe products. However, the herb's effects could be dangerously increased if it is used with standard sedatives. Side effects include vivid dreams. High doses of valerian can cause blurred vision, excitability, and changes in heart rhythm. Other interactions and long-term side effects are unknown.

Generally, manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. Just like drugs, however, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. There have been numerous reported cases of serious and even lethal side effects from herbal products. Always check with your doctor before using any herbal remedies or dietary supplements.

Special Warning on Kava. Kava has been commonly used to reduce anxiety and stress. It is now highly associated with liver injury and even liver failure in a few cases. Experts now strongly warn against its use.

People seeking relief from stress should be wary of any product that promises a quick cure, or that requires the purchase of expensive treatments. These treatments may be useless and sometimes even dangerous.

Friends: Talk it out

A supportive relationship is one where one can talk about his or her feelings without fear of judgment or repercussion. The supportive friend, when hearing that a certain person or situation is causing his or her friend anxiety, will try to relate or sympathize with the person suffering anxiety. Supportive friends will also try to help in any way they can, and are always available to chat and are generally good about returning calls promptly and making appointments. Being able to disclose feelings that bother us, like anxiety, leads to an increased level of emotional well-being and happiness.

When someone discloses these anxious feelings and is heard and understood, that makes the person feel valued. This feeling of happiness and value means that a person's anxiety level reduces. Even though it may seem small, each and every time a person discloses anxiety successfully, he or she reduces his or her anxiety and increases his or her relaxation and happiness.

Unsupportive friends are by far the majority of people. People in general do not know how to talk to one another, or have very superficial friendships. This accounts for probably 90% of all relationships on earth, and yes, the author does realize how drastic of a claim this is, but it seems to be true. An unsupportive friend, when hearing that his or her friend struggles with anxiety, will dismiss the feeling as being invalid. He or she may tease the anxiety sufferer, laugh at him or her, state that his or her own problems are much worse, say that this issue is really not a big deal, or may simply tell the sufferer simply to get over the problem. These types of responses make the anxiety sufferer feel invalidated, humiliated, stupid for having such "silly" problems, and just generally worthless. This increases the sufferer's anxiety level, reduces his or her relaxation and happiness, and encourages the sufferer to keep his or her feelings to himself and not trust other people, which is a difficult way to live life.

Be Hopeful

Conventional psychotherapy has tended to focus almost exclusively on relieving the symptoms of a mental health ailment, such as anxiety or depression, and declaring success. But increasingly, psychologists are offering an alternative—hope therapy, a process of identifying goals, then planning the strategies and sustaining the motivation to reach them. An offshoot of the positive psychology movement, hope therapy aims to help people help themselves by working with their strengths.

Hope, as defined by psychologists, is the belief that you have the skills and energy to make your dreams a reality.

Hope therapy has shown itself to be an effective tool to combat mild mood disorders, anxiety, lack of enthusiasm and the general sense of feeling unmoored.

In short, hopeful people are happier.

Hope therapy takes place in either group or individual sessions, and begins with the psychologist helping the client identify a goal. As easy as that may seem, many people struggle to pinpoint what they want, rather than what their boss may demand or their spouse may need.

Hope therapists don’t advocate disregarding negative emotions or ignoring signs that your efforts aren’t going well. On the contrary, high-hopers are quick to experiment with alternative approaches when things go wrong. But contrary to popular belief, building high expectations doesn’t necessarily set you up for a harder fall.

Determination and flexibility make people who aim high more likely to succeed than low-hopers who settle on a simple project.

Trust Life

When you trust in life, you stop resisting well-being – You will notice around you that people who have a deep trust in the goodness of life are the ones who are living benevolent realities, while people who are constantly complaining about life are always attracting negative circumstances around them.

Trust Yourself

Nurture yourself by eating right, exercising regularly and taking time out to relax. You can't trust yourself when you're on edge or feeling guilty. Minimize restrictive behaviour by allowing yourself the occasional treat and only engaging in physical activity you really enjoy.

See your mistakes as gifts. They're valuable learning experiences because we learn the most from the things we do wrong. Write down the lessons you've learned from your bad experiences in your blank book and refer to them when similar situations arise.

Minimize your regrets. Learning from mistakes isn't the same as feeling bad about what you did. When you're at fault, use your journal constructively to work through your misbehaviour and understand why you acted as you did.

Practice self-forgiveness. Actually formulate the words "I forgive myself for..." in your journal as often as you need to let go of your mistakes. Then come up with solutions to avoid such behavior in the future.

Celebrate your accomplishments in your journal. Forget admonishments from your past that you're not allowed to be vain or show off. Your blank book is a loving friend that wants to hear about the great things you've done.

Concentrate on following your intuition. This can be difficult if you've been taught to rationalize every decision. Life is dynamic and living authentically requires flexibility.

Try new things. You don't need to visit exotic places or take risks to prove you trust yourself. Taking a drawing class when you're convinced you have no artistic talent, for example, can really teach you things about yourself.

Trust People

Look for the good. Having been hurt in the past people, tend to look for the bad in other people. Mistrust is hard to move past, but if you force yourself to find the good in people in general you will be able to find it in those closest to you.

Communicate with those you love. Talk openly with the people you want to be close to and trust. Be honest with your loved ones and they will be honest with you.

Love yourself. By looking into your reasons for not being able to trust others, and replaying the events that led to your mistrust, you will be able to triumph over letting these things happen again. Pay close attention to your memories and list the characteristics of those who hurt you. Instead of projecting these characteristics onto every new person in your life, you will be able to find the trust-worthy qualities in them instead.

Trust one person at a time. If you have been severely hurt by someone's actions in the past, it can be hard to trust others. Force yourself to go beyond your comfort zone and choose one person at a time to put your trust in. They may not all deserve your trust, but to stop trusting is to stop living and loving.

Nurture trust. Take pride in the fact that people in your life trust you. It is an honour, and should be treated as such. If you actively nurture the trust you have been given you will see that others will return it. Trust others, and they will trust you.

Happiness, personality, and skills

Happiness is subjective and relative Happiness is not determined by objective factors, but by how you feel about them. Happiness is relative in another sense, too: it is relative to your expectations.

We are quite poor at predicting the strength of our emotional reactions to future events. We overestimate the misery we will experience after a romantic breakup, failure to get a promotion, or even contracting an illness. We also overestimate the pleasure we will get from buying a nice car, getting a promotion, or moving to a lovely coastal city. So: lower your expectations about the pleasure you'll get from such expenditures.

Flow and mindfulness

People are happiest when they are in a state of "flow." Flow is the state you're in when you are fully engaged in a task that is interesting, challenging, and intrinsically rewarding to you. This is the experience of "losing yourself in the moment" or, as sports players say, "being in the zone."

If you're struggling with negative thoughts, achieving flow is probably the best medicine.

While being "lost in the moment" may provide some of your happiest moments, research has also shown that when you're not in flow, taking a step outside the moment and practicing "mindfulness" - that is, paying attention to your situation, your actions, and your feelings - can reduce chronic pain and depression, reduce stress and anxiety, and produce a wide range of other positive effects.

How to be happier

Happiness, then, is an enormously complex thing. Worse, we must remember the difference between experienced happiness and remembered happiness.

Moreover, happiness will be achieved differently for different people. A person suffering from depression due to chemical imbalance may get more help from a pill than from learning better social skills. A healthy, extroverted, agreeable, conscientious woman can still be unhappy if she is trapped in a bad marriage. Some people were raised by parents whose parenting style did not encourage the development of healthy self-esteem, and they will need to devote significant energy to overcome this deficit.

Improve your self-esteem and optimism.

Improve your agreeableness.

Improve your conscientiousness. Conscientiousness involves a variety of tendencies: useful organization, strong work ethic, reliability, planning ahead, etc. Each of these individual skills can be learned.

Develop the habit of gratitude.

Find your purpose and live it.

Find a more fulfilling job.

Improve your relationship with your romantic partner, or find a different one.

Go outside and move your body.

Spend more time in flow.

Practice mindfulness regularly.

Avoid consumerism.


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