Anxiety treatments available at the luna clinic

 We can all experience anxiety at some point in our lives from childhood through to elderhood.  This can look like worrying about any number of things as in Generalised Anxiety Disorder (GAD), overwhelming anxiety in response to specific situations as an example a Specific Phobia of heights, social anxiety or anxiety in response to intrusive thoughts that occurs in Obsessive Compulsive Disorder (OCD) or another anxiety type.  

Worrying is a normal human experience, however when it becomes so 'loud' that it impacts our behaviour, our functioning, our relationships and our engagement with our lives, we may benefit from psychological support to build understanding, strategies and skills to reduce the impact that 'cognitive' and 'physiological' worry can have upon our ability to live a fulfilling life.  Statistically, one in four people will develop a level of anxiety that would be considered to be a 'disorder' and require psychological treatment and/or medication.  These numbers increase during and following traumatic events, natural disasters, pandemics and economic crises.  During our lifetimes, we may be more vulnerable to escalating anxiety including when starting or finishing school or university, when parents separate, transitioning into adulthood, when relationships end, following the death of a significant person, the birth of a child, menopause, and retirement (to name but a few).

Below we have listed information on types of anxiety that the Luna Clinic are able to provide psychological assessment and treatment for:

Social anxiety refers to feelings of anxiety and fear that occur in response to social situations. Even though we all feel a little nervous before a presentation or meeting new people, social anxiety can cause overwhelming feelings of distress and a fear of being unable to cope. This is usually in response to anxiety about being watched while doing something, being the centre of attention, being introduced to new people, talking with people in authority, public speaking, or within an existing friendship group where you might worry about people thinking negatively about you. For some people, the anxiety can be present across a few key situations, and for others the anxiety may be present for most of the time when engaging socially. 

What are the signs and symptoms?

Social anxiety is often a persistent worry about saying or doing something that will lead to humiliation, embarrassment, or social rejection. This can lead to a number of compensatory behaviours, negative thoughts and emotions, and physiological responses.

Someone who struggles with social anxiety may begin to avoid situations that cause distress, including social withdrawal, decreased work performance, or limiting eye contact or speaking softly. For some, when faced with social situations that are unavoidable, they might use alcohol or nicotine to cope with the experience. These are compensatory behaviours that are intended to decrease the likelihood of negative evaluation from others.

Often social anxiety can lead to negative self-evaluation, including rumination about past social situations or fear of upcoming situations where you feel you are likely to be judged or criticised by others. More often than not, the negative criticism is self-inflicted due to feeling inadequate, embarrassed, or worried about something you said or did. This can lead to feeling sad or depressed, particularly with increased social withdrawal. Over time, social situations cause anxiety but also low mood and depression.

Social anxiety can cause a physiological fear response like that which we experience when facing real danger. This can include:

• Heart palpitations, increased heart rate, or pounding heartbeat
• Sweating, trembling, shaking, numbness or a tingling sensation
• Shortness of breath, heavy pressure or tightness in your chest
• Lightheadedness, dizziness, feeling faint, tunnel vision or foggy feeling
• Nausea
• Dry throat, mouth, difficulty swallowing, talking or eating
• Blushing, hot and cold chills

How do we treat Social Anxiety?

Research in the area has indicated that medications and psychological treatment, particularly Cognitive Behavioural Therapy (CBT) and Acceptance Commitment Therapy are highly effective in treating and managing the symptoms of social phobia. Working with a psychologist, the key components of treatment for social phobia involve providing you with tools to understand and manage your experience of social anxiety. Some of these tools include relaxation training, and strategies to help you identify your triggers for social anxiety and learning and developing more adaptive interpretations of social situations. Treatment for social phobia also incorporates exposure to a variety of social situations with varying degrees of difficulty, to enable you to face your fears, and social skills training to help you gain confidence in social situations. 

Sources:

Retrieved from: https://socialanxietyinstitute.org/what-is-social-anxiety
Retrieved from: https://www.healthdirect.gov.au/social-anxiety-disorder
Retrieved from: https://www.cci.health.wa.gov.au/-/media/CCI/Mental-Health-Professionals/Social-Anxiety/Social-Anxiety—Information-Sheets/Social-Anxiety-Information-Sheet—01—What-is-Social-Anxiety.pdf
Retrieved from: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/social-phobia#treatment-options-for-social-phobia 

Illness Related Anxiety occurs in people who have experienced a significant health concerns such as cancer, autoimmune disease, or even COVID-19. It can also occur in people close to those who were diagnosed with the health issue, particularly household family members or carers. Illness Related Anxiety is different from Hypochondriasis or Health Anxiety in that the threat of disease, illness and even death was real and experienced. This threat to safety and wellbeing can lead to hypersensitivity to symptoms that may suggest an illness is getting worse or returning, and worrying thoughts about the illness. Although the illness was once real, Illness Related Anxiety can often lead to misinterpretation of bodily sensations or hypervigilance to new symptoms. This type of anxiety can lead to a preoccupation with future outcomes or mentally exploring all the possible outcomes from having the illness. 

What are the signs and symptoms?

People with Illness Related Anxiety often report feeling “on” all the time, analysing physical sensations, worrying about potential new symptoms, fear of the future, and hypervigilance to bodily changes. Unfortunately, it is often the case that the feared outcome from the illness is likely or a possibility, making it difficult to combat negative thoughts and worries with evidence to the contrary.

Like many anxiety disorders, a person may experience:

• Increased heart rate or heart palpitations (often described as one’s heart beating out of their chest)
• Sweating, shaking, trembling, or tense muscles
• Dry mouth
• Hot or cold flushes
• Nausea or “butterflies”
• Racing thoughts or mental preoccupation
• Irritability, restlessness, and difficulties with sleep

How do we treat Illness Related Anxiety?

Psychological interventions used to treat and manage anxiety can be just as effective with Illness Related Anxiety. However, your Psychologist will also work with you to better understand your illness or chronic health condition in a sensitive and compassionate manner. This allows for a shared understanding of the problems you are facing physically and how this is impacting on your mental health.

ACT can be useful in the treatment of Illness Related Anxiety, helping you to distance yourself from your anxious thoughts and accept that thoughts can be present without causing you distress. This is complimented by mindfulness-based practices that allow you to be more present and attentive to your everyday life. ACT aims to help a person create a meaningful and enjoyable life despite the physical and emotional pain that comes with having a serious or terminal illness. Where ACT is not helpful or does not meet your treatment goals, CBT can also be used to help deal with unhelpful thinking patterns, maladaptive coping strategies, and you emotional and behavioural reactions to anxiety provoking situations. We can also support you with treatment and medication adherence, behavioural strategies for re-engaging with the things you love in life, and problem-solving strategies for managing your health condition.

Sources:

 Lebel, S., Mutsaers, B., Tomei, C., Leclair, C. S., Jones, G., Petricone-Westwood, D., Rutkowski, N., Ta, V., Trudel, G., Laflamme, S. Z., Lavigne, A., & Dinkel, A. (2020). Health anxiety and illness-related fears across diverse chronic illnesses: A systematic review on conceptualization, measurement, prevalence, course, and correlates. PioS One, 15(7), 1-48. https://doi.org/10.1371/journal.pone.0234124 

Specific Phobia is exactly how it sounds… An irrational and unrealistic fear to a specific object, place, or situation. Most people experience anxiety, fear or discomfort when anticipating a painful or frightening experience or are faced with potential danger. However, people with specific phobia have developed an extreme fear which is usually disproportionate to the object, situation, or place. The result of this phobia is a high level of anxiety and distress when they encounter what it is that they fear, leading to extreme precautionary measures of avoidance. The combination of anxiety and avoidance not only exacerbates their fear long-term, but significantly impacts on their day-to-day activities and quality of life. 

What are the signs and symptoms?

People with a specific phobia will often experience a persistent and unrealistic worries about and fear of certain situations, objects, or activities and go to great lengths to avoid instances where they may be confronted by this fear. Often the levels of distress and avoidance associated with their fear impacts on daily functioning including difficulties with concentration, avoiding previously enjoyed activities, people, or places, decreased social engagement, decreased work or school performance, and time or energy spent on managing their fear rather than pleasurable activities. Specific phobias can cause a person to feel a fear of losing control, an intense need to escape, and knowing the fear is irrational but feeling powerless to overcome it.

The body has a physiological response to anxiety (fear) and symptoms can include:

• Sweating
• Shaking
• Increased heart rate
• Feeling dizzy, nauseous, short of breath, fidgety and/or agitated
• Hot or cold flushes
• A sense of tunnel vision or feeling “foggy”

Anxiety can also impact on a person’s thought processes including experiencing racing thoughts, obsessive thinking, a lack of concentration, lapses in memory, and distractibility.

How do we treat Phobias?

Cognitive Behavioural Therapy (CBT) is an effective evidence-based treatment for individuals with specific phobia. This approach includes exposure therapy as part of the treatment, allowing an individual to face their phobias in a safe, measurable, and controllable environment to reduce and eventually diminish their irrational fear and avoidance.

Sources:

Retrieved from: https://www.psycom.net/specific-phobias/
Retrieved from: https://www.psychology.org.au/for-the-public/Psychology-topics/Phobias 

 People often talk about having a “panic attack” and feeling “panicked” in an anxiety provoking situation, alluding to a state of heightened anxiety and arousal. Panic attacks tend to start relatively quickly, and peak within 10 minutes. This peak generally lasts for approximately 5-10 minutes before gradually declining. However, it can take longer for all the symptoms of subside. Panic Disorder is characterised by repeated panic attacks which occur often without warning and are accompanied with a preoccupation with the fear of experiencing another attack. It typically begins in adolescence or early adulthood; however, children can also experience panic-like symptoms and panic disorder. Panic Disorder affects 1-2% of the Australian population each year, and women seem to be two times more likely to develop it than men.

What are the signs and symptoms?

A Panic Attack is defined by a sudden period of intense fear or discomfort, which reaches a peak within minutes, and during which time, four or more of the following symptoms occur:

• Palpitations, pounding heart, or accelerate heart rate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath or smothering
• Feeling of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Feeling dizzy, unsteady, lightheaded, or faint
• Derealisation (feeling ‘unreal’) or depersonalisation (feeling detached from yourself)
• Fear of losing control or going crazy
• Fear of dying
• Numbness or tingling sensations
• Chills or hot flushes

For panic attacks to become Panic Disorder, at least one of the panic attacks is followed by persistent worry about further panic attacks or their consequences (e.g., having a heart attack, embarrassment), and significant changes to a person’s behaviour to attempt to mitigate the chance of a panic attack (e.g., avoidance of places or situations). These must be present for one month or more.

How do we treat Panic?

Cognitive Behavioural Therapy (CBT) is an effective first-line treatment for panic attacks and panic disorder. Working with a psychologist, CBT teaches you to develop different ways of thinking and behaving in response to the feelings and sensations that come with a panic attack. Treatment for panic disorder also incorporates gradual exposure to bodily sensations and/or situations previously avoided due to panic attacks, with the goal of gradually decreasing the sensitivity of the anxiety system so that it is less frequently activated.

Other forms of therapy that are also effective in treating panic disorder include Acceptance and Commitment Therapy (ACT) and Mindfulness-based CBT. These strategies differ from traditional CBT in that they provide individuals with the tools to separate and distance themselves from their thoughts and feelings, and accept that these can be present without making a negative impact on their lives.

OCD is when a person gets caught in a cycle of obsessions and compulsions. Obsessions are intrusive and unwanted thoughts, images, or urges that trigger highly distressing feelings. This often causes a person to attempt to lessen their distress through compulsive behaviours. It’s often suggested that someone is “a little OCD”, however a clinical diagnosis of OCD means a person’s cycle of obsessions and compulsions are extreme and impacting the quality of their life including excessive amounts of time engaging in compulsions which interferes with functioning at school or work, social activities, relationships, and normal routines. This often causes significant distress.

What are the signs and symptoms?

An obsession develops when a thought, image or impulse repeatedly comes to mind, often disrupting other thoughts and mental focus. These thoughts tend to be distressing in nature, and can lead to an anxiety response. An individual with OCD usually feels an overwhelming need to reduce their anxiety resulting from these obsessions, and therefore engages in compensatory compulsive mental acts or behaviour(s). 

A compulsion is a behaviour that a person feels compelled to act upon to engage in, to reduce or relieve the distress their obsessive thoughts are causing them. Often people with OCD believe that the consequences for not acting on their thoughts will result in negative outcome(s), which is usually disproportionate to reality; we call this “Magical Thinking”.

How do we treat OCD?

The most successful psychological treatment for OCD is Cognitive Behavioural Therapy (CBT) and Exposure Response Prevention (ERP).  There is evidence to support that certain medications prescribed by a psychiatrist may also assist to reduce symptoms.

CBT identifies, challenges, and helps sufferers’ overcome their dysfunctional thoughts, behaviours and overwhelming emotions, by changing their thought processes, allowing them to think and act differently in relevant situations.

ERP is when individuals are gradually and repeatedly exposed to their underlying anxieties or fears until they diminish or significantly reduce, with the support and guidance of a trained healthcare professional. This allows them to deal with their challenging thoughts as they learn other coping strategies to reduce their anxiety, instead of avoiding the situation, or engaging in their compulsive actions.

Our Clinical Psychologist, Dee Thompson, is experienced in working with OCD. If you are concerned that you, a friend, or relative may be experiencing OCD, it is strongly recommended to seek advice from a healthcare professional immediately. 

Sources:

Retrieved from: https://beyondocd.org/ocd-facts/what-is-ocd
Retrieved from: https://www.psychiatry.org/patients-families/ocd/what-is-obsessive-compulsive-disorder
Retrieved from: https://iocdf.org/about-ocd/