* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download ANXIETY DISORDERS
Obsessive–compulsive personality disorder wikipedia , lookup
Rumination syndrome wikipedia , lookup
Autism spectrum wikipedia , lookup
Controversy surrounding psychiatry wikipedia , lookup
Schizoaffective disorder wikipedia , lookup
Excoriation disorder wikipedia , lookup
Antisocial personality disorder wikipedia , lookup
Obsessive–compulsive disorder wikipedia , lookup
Mental disorder wikipedia , lookup
History of psychiatry wikipedia , lookup
Emergency psychiatry wikipedia , lookup
Classification of mental disorders wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Conduct disorder wikipedia , lookup
Causes of mental disorders wikipedia , lookup
Selective mutism wikipedia , lookup
Conversion disorder wikipedia , lookup
Dissociative identity disorder wikipedia , lookup
Narcissistic personality disorder wikipedia , lookup
Asperger syndrome wikipedia , lookup
Spectrum disorder wikipedia , lookup
Depersonalization disorder wikipedia , lookup
History of mental disorders wikipedia , lookup
Abnormal psychology wikipedia , lookup
Child psychopathology wikipedia , lookup
Panic disorder wikipedia , lookup
Claustrophobia wikipedia , lookup
Anxiety disorder wikipedia , lookup
ANXIETY DISORDERS Anxiety vs. Anxiety Disorder Biological pathways Major anxiety disorders: development & treatment Post Traumatic Stress Disorder The Anxiety Disorders Anxiety disorders cost the U.S. more than $62 billion a year, almost one-third of the country's $168 billion total mental health bill, according to "The Economic Burden of Anxiety Disorders," a study commissioned by ADAA (The Journal of Clinical Psychiatry, 60(7), July 2014). More than $32.84 billion of those costs are associated with the repeated use of health care services; people with anxiety disorders seek relief for symptoms that mimic physical illnesses. The Anxiety Disorders Most common mental illness in the U.S. with 19 million of the adult (ages 18-54) U.S. population affected Many have a median onset as early as 13 years of age to 90% by age 23 May interfere with being able to form and sustain relationships May interfere with obtaining or sustaining employment Depression often accompanies anxiety disorders Anxiety Statistics Anxiety Disorders One-Year Prevalence (Adults) Percent Population Estimate* (Millions) Any Anxiety Disorder 13.3 19.1 Panic Disorder 1.7 2.4 Obsessive-Compulsive Disorder 2.3 3.3 Post-Traumatic Stress Disorder 3.6 5.2 Any Phobia 8.0 11.5 Generalized Anxiety Disorder 2.8 4.0 * Based on 7/1/12 U.S. Census resident population estimate of 143.3 million, age 18-54 Andrews, Wahlberg, Montgomery (2003) 70 60 50 40 30 Frequency 20 10 0 Black Hispanic Native American White Employment 60 50 40 30 Frequency 20 10 0 Employed Umemployed SOCIAL ANXIETY: 5:00 MEASURING FEAR HANDOUT 12-10 17-19 year olds Complete H.O. Highest 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Untimely death Death of a loved one Speaking before a group Snakes Not being a success Being self-conscious Illness or injury to loved one Making mistakes Looking foolish Failing a test Suffocating Normal Fear and Worry Common in normal children The clinician must distinguish developmentally normal from abnormal Infants Fear of loud noises Fear of being startled Fear of strangers (around 8 – 10 months) Normal Fear and Worry (2) Toddlers Fears of imaginary creatures Fears of darkness Normative separation anxiety School-age Children Worries about injury and natural events (e.g., storms, lightening, earthquakes, volcanoes) Children who are characterized as confident and eager to explore novel situations at 5 years are less likely to manifest anxiety in childhood and adolescence Children who are passive, shy, fearful, and avoid new situations at 3 and 5 years are more likely to exhibit anxiety later in life (Caspi et al, 1995) Normal Fear and Worry (3) School Age Children (continued) In general, girls tend to endorse more anxiety symptoms than boys Younger children are more likely to experience anxiety symptoms than older children Anxious children interpret ambiguous situations in a negative way and may underestimate their competencies (attribution bias) The most common anxiety disorders in middle childhood are Separation Anxiety, GAD, and Specific Phobias Normal Fear and Worry (4) Adolescents Fears related to school Fears related to social competence Fears related to health issues ANXIETY Symptoms of Anxiety Common Causes There is no one cause for anxiety disorders. Several factors can play a role Genetics Brain biochemistry Overactive "fight or flight" response Can be caused by too much stress Life circumstances Personality People who have low self-esteem and poor coping skills may be more prone Certain drugs, both recreational and medicinal, can lead to symptoms of anxiety due to either side effects or withdrawal from the drug. In very rare cases, a tumor of the adrenal gland (pheochromocytoma) may be the cause of anxiety. When does anxiety become a disorder? Anxiety is a normal human response to objects, situations or events that are threatening Anxiety is different from fear due to its cognitive component (i.e. fear of the future) Anxiety can be helpful and adaptive (e.g. anxiety about giving lectures!) Anxiety becomes a disorder when out of proportion or when it significantly interferes with life. The Anxiety Disorders Panic attack Panic Disorder without agoraphobia Panic Disorder with agoraphobia ObsessiveCompulsive Disorder Substance induced Anxiety Disorder Post-traumatic Stress Disorder Generalized Anxiety Disorder Anxiety Disorder due to a general medical condition Anxiety Disorder Not otherwise specified Anxiety disorders… Highly treatable yet also resistant to extinction Often begins early in life Reported more by women than men Reported more in Western countries Often comorbid both with other anxiety diagnoses and with other disorder groups (e.g. Mood disorders, psychoses) Clinical Presentation Children with anxiety disorders may present with fear or worry but may not recognize their fears as unreasonable Younger kids often cannot articulate their feelings, and so we often see physical symptoms presenting first, which include: Headaches, upset stomach or nausea, increased heart rate, diarrhea or constipation, sleep disturbance, increased vulnerability to common viruses, tightness in chest, tight neck or back, appetite change, fatigue & exhaustion What To Look For Physical complaints (H/A, GI, dramatic) Sleep (early/middle insomnia, repeated visits to parent’s room) Change in eating Avoidance of outside and interpersonal activities (school, parties, camp, slumber parties, safe strangers) Excessive need for reassurance (new situations, bedtime, school, storms, “is it bad?”) Inattention and poor school performance Not necessarily pervasive (some areas of function remain intact) Explosive outbursts Physical Symptoms (Provoked and Non-Provoked) Anxious children listen to their bodies (too much!) Headache & stomachache Sick in the morning Frequent urge to urinate or defecate Shortness of breath Chest pain, tachycardia Sensitive gag reflex/fear of choking or vomiting Difficulty swallowing solid foods Dizziness Tension/exhaustion Derealization/depersonalization Avoidance to present physical symptoms SEPARATION ANXIETY [CHILD]: 5:00 SEPARATION ANXIETY [ADULT]: 2:00 Clinical Presentation: Separation Anxiety Disorder Excessive fear when separated from home or attachment figures Can be seen before separation or during attempts at separation Excessive worry about their own or their parents’ safety and health when separated Symptoms include difficulty sleeping alone, nightmares with themes of separation, somatic complaints, school refusal Commonly, the earliest age of onset among anxiety disorders Gender ratios are generally equal These children often come from singe-parent and low SES homes A nonspecific precursor to a number of adult psychiatric conditions, including depression as well as any anxiety d/o Clinical Presentation: Phobias Fear of a particular object or situation which is avoided or endured with great distress More than one phobia is common (does not in and of itself constitute a diagnosis of GAD) Adolescents and adults typically recognize that the fear is unreasonable; children often do not Avoidance is key Generally begins in childhood 4. More considered response based on cortical processing 1. Thalamus receives stimulus and sends to both amygdala and cortex Sensory Input 2. Amygdala registers danger 3. Amygdala triggers fast response • Parts of the brain involved in fear response = thalamus, amygdala, hypothalamus, which then instruct the endocrine glands and autonomic nerv.sys. • Evolved fear module (pink) versus considered response (green) = “fight or flight” versus “feel the fear and do it anyway (or do it differently)”! Anxiety can be your friend Yerkes-Dodsen Specific Disorder Facts Generalized Anxiety Disorder Obsessive Compulsive Disorder Women are twice as likely to be afflicted than men. Very likely to exist along with other disorders. It is equally common among men and women. One third of afflicted adults had their first symptoms in childhood. Panic Disorder Women are twice as likely to be afflicted than men. Occurs with major depression in very high rates. 2003 Anxiety Disorders Association of America Specific Phobias Selective, persistent and out of proportion Includes cognition that leads to behavioural response, whether or not the threat is present May be genetically, neurologically or experientially based Maintained through the processes of classical and operant conditioning. Agoraphobia Etiology of Specific Phobias Conditioning Mowrer’s two-factor model Pairing of stimulus with aversive UCS leads to fear (Classical Conditioning) Avoidance maintained though negative reinforcement (Operant Conditioning) Copyright 2009 John Wiley & Sons, NY 53 Specific Phobias Table 5.2 Words Used to Describe Highly Unlikely Phobias Fear Phobia Anything new Neophobia Asymmetrical things Asymmetriphobia Books Bibliophobia Children Pedophobia Dancing Chorophobia Englishness Anglophobia Garlic Alliumphobia Peanut butter sticking to the roof of the mouth Arachibutyrophobia Technology Technophobia Mice Musophobia Pseudoscientific terms Hellenophobia Source: Drawn from www.phobialist.com. Copyright 2009 John Wiley & Sons, NY 55 Table 5.3 Types of Specific Phobias Type of Phobia Source of Fear Associated Characteristics Animal Animals (e.g., snakes, insects) Generally begins during childhood Natural environment Aspects of the natural environment Generally begins during childhood (e.g., storms, heights, water) Blood, injection, injury Blood, injury, injections, or other Clearly runs in families invasive medical procedures Situational Specific situations (e.g., public Tends to begin either in childhood or transportation, tunnels, bridges, in mid-20s. elevators, flying, driving, closed spaces) Other Fear of choking, fear of contracting an — illness, etc.; children’s fears of loud sounds, clowns, etc. Copyright 2009 John Wiley & Sons, NY 56 Social Phobia A more pervasive, highly cognitive type of phobia Distinguishing feature is the fear of doing something in front of others May be situation or context (e.g. performance versus interaction anxiety) specific Fear of one’s own behaviour causing negative attention from others Social Anxiety Disorder (Social Phobia) With an incidence of 13%, it is the most common of the anxiety disorders The course tends to be chronic and debilitating (delaying achievement and interfering with relationships for more severe cases) More women than men receive the diagnosis, but men are slightly more likely to seek treatment Depression is frequently comorbid Onset Average age of onset is 16 years Behaviorally inhibited children are at increased risk for the disorder Most patients describe an insidious onset Occasionally patients will describe specific humiliation episodes linked to onset Regardless of onset, CBT tends to focus on the self-perpetuating patterns that help maintain the disorder Core Patterns In Social Phobia Self-focused attention Negative self-evaluation Anxious apprehension Avoidance and escape Behavioral disruption of normal functioning Skills deficits Negative Expectations They will reject me I will be found out as incompetent They will think I’m weird I can’t even do the simplest things I had better not blow it again I can’t (don’t know how to) do this I will tremble and my boss will fire me If they see how anxious I am, they will think I’m crazy Consequences Of Negative Expectations Negative Expectations Vigilance To Perceived Danger “Failure” - Focused Attention (and overestimation of the cost of everyday failures) Symptoms Self-focused attention during performance Perception of anxiety or errors Errors Negative evaluations by others Figure 5.1 Spectrum Model of Social Phobia and Avoidant Personality Disorder 64 Social Phobia/Anxiety Common anxiety provoking social situations include: public speaking talking with people in authority dating and developing close relationships making a phone call or answering the phone interviewing attending and participating in class speaking with strangers meeting new people eating, drinking, or writing in public using public bathrooms driving shopping Therapeutic Treatment of Phobia Mainly behavioural or cognitive behavioural techniques are used Systematic Desensitisation (with or without relaxation training) Flooding (with or without relaxation training) Modelling Cognitive restructuring, skills training, gradual exposure [Relaxation not recommended for blood phobia where fainting is a risk] • Hypnosis • Medication (mainly social phobia) MOAIs SSRIs What specific diagnoses are included here? • Panic Disorder Without Agoraphobia (300.01)1 • Panic Disorder with Agoraphobia (300.21) • Agoraphobia Without History of Panic Disorder (300.22) 1 If you make this diagnosis early and initiate treatment quickly, you may prevent many complications. Panic Disorder Two major types: with or without agoraphobia Consists of a pattern of recurring panic attacks Emotional, physical, cognitive and behavioural components Main fear is of losing control (consequence = dying, going crazy, embarrassment, not being able to get help) The fear of having a panic attack becomes a problem of itself, possibly leading to agoraphobia (fear of open spaces, crowds etc. Any place where escape or finding help is difficult or embarrassing) or other phobias Panic and the Brain Panic Disorder • • • • • • The abrupt onset of an episode of intense fear or discomfort, which peaks in approximately 10 minutes, and includes at least four of the following symptoms: A feeling of imminent danger or doom The need to escape Palpitations Sweating Trembling Shortness of breath or a smothering feeling • A feeling of choking • Chest pain or discomfort • Nausea or abdominal discomfort • Dizziness or lightheadedness • A sense of things being unreal, depersonalization • A fear of losing control or "going crazy" • A fear of dying • Tingling sensations • Chills or hot flushes Panic Disorder There are three types of Panic Attacks: 1. Unexpected - the attack "comes out of the blue" without warning and for no discernable reason. 2. Situational - situations in which an individual always has an attack, for example, upon entering a tunnel. 3. Situationally Predisposed - situations in which an individual is likely to have a Panic Attack, but does not always have one. An example of this would be an individual who sometimes has attacks while driving. Treatment of Panic Disorder Debate about the extent to which Panic Disorder is biological versus psychological (most likely both) Genetic and medication studies support biological view Cognitive strategies - reality testing, psycho education, cognitive restructuring, graded exposure - all may add to effectiveness of treatment supporting psychological argument Obsessive-Compulsive Disorder Obsessive Compulsive Disorder Classified as anxiety disorder, but with unique presentation Characterised by obsessions and compulsions (in most cases) Compulsions may be physical or mental Types of presentation: contamination fear; doubt/checking; magic thinking; symmetry; hoarding Severity = frequency + capacity to resist + interference with normal functioning Obsessive-Compulsive Disorder Compulsions are repetitive behaviors or rituals performed by the OCD sufferer, performance of these rituals neutralize the anxiety caused by obsessive thoughts, relief is only temporary. Cleaning. Repeatedly washing their hands, showering, or constantly cleaning their home; Checking. Individuals may check several or even hundreds of times to make sure that stoves are turned off and doors are locked; Repeating. Some repeat a name, phrase or action over and over; Slowness. Some individuals may take an excessively slow and methodical approach to daily activities, they may spend hours organizing and arranging objects; Hoarding. Hoarders are unable to throw away useless items, such as old newspapers, junk mail, even broken appliances In order for OCD to be diagnosed, the obsessions and/or compulsions must take up a considerable amount of the sufferers time, at least one hour every day, and interfere with normal routines . Aetiology of OCD Psychoanalytical theories: attempt to suppress instinctual drives – sexual and aggressive – arising from the anal stage Biological theories: Brain injury/trauma/acute disease and/or neurochemical (serotonin); Genetic factors Behavioural and Cognitive theories: conditioning; modelling; memory deficits Treatment of OCD Medical: particularly high doses of SSRIs Psychoanalysis Cognitive-behavioural therapy Exposure and response prevention Thought-stopping not generally effective alone Generalised Anxiety Disorder Characterised by persistent and global worry: worry about “everything”, “worry about worry” Distinguished from normal worry by severity, interference, irrationality Common problem but little is known Resistant to change A product of Western society? Treatment of GAD Medication (SSRIs used more for GAD than other anxiety disorders) Psychoanalysis: GAD is caused by conflict between the ego and id impulses. The ego fears punishment but id cannot be extinguished = constant anxiety and conflict (has not been displaced as with phobia) Behavoural Techniques: difficult to implement due to global nature of GAD. May choose themes or priorities Cognitive Therapy: apparently most useful but still shows limited success Others: Rational Emotive Therapy, Existential Therapy, Gestalt Therapy, Narrative Therapy Post Traumatic Stress Disorder Explanations of PTSD Vulnerability Sociocultural factors 1. Social support 2. Nature of trauma itself (severity, etc.) Psychological factors 1. Personal assumptions 2. Distress 3. Coping styles Biological factors 1. Physiological hyperactivity 2. Genetics Post Traumatic Stress Disorder Is it an anxiety disorder? Main diagnostic criteria: Witness or experience of an event that (a) involved actual or threatened death or injury, and Feelings of intense fear, horror, or helplessness Person must relive the event in some way (e.g. dreams, “flashbacks”, internal distress, physiological reactions) Avoidance (subconscious and/or conscious) Hyperarousal or mood instability Usually persisting for at least three months PTSD contd… Inclusion in DSM-III due to awareness of symptoms in Vietnam veterans Control and helplessness often key factors Severity most determined by perceived threat Unexpectedness? Typified by delayed onset and lack of insight Past experience may increase vulnerability (e.g. past trauma, psychological issues, personality) No good data to suggest some more likely to develop than others, although prognoses may differ Types and Aetiology Acute versus Chronic (< 3 mths vs. > 3 mths) May be caused by personal encounters, war, natural event/disaster, extreme events [outside normal human experience] May develop slowly or rapidly, acutely or after a long time Can be difficult to recognise or diagnose Therapeutic Treatment of PTSD Medication (treats the symptoms, but minimally effective) Exposure Therapy Critical Incident Stress Debriefing Supportive psychotherapy Eye Movement Desensitisation and Reprogramming (EMDR) Rapid saccadic eye movements coupled with exposure and positive thought Huge movement but has attracted much criticism due to its secrecy and lack of controlled studies Complex PTSD (Judith Herman: “Trauma & Recovery” 1992) Argument for a new PTSD classification Current criteria and understanding do not ‘fit’ with those in situations of chronic, ongoing abuse or subjugation Controversial: history of PTSD and lack of recognition of abuse Symptoms are entrenched, prognosis tends to be poorer Often present as other ‘disorders’ (e.g. personality, mood, dissociative, other anxiety) Complex PTSD contd. A history of subjection to totalitarian control over a prolonged period (months to years). Examples include hostages, prisoners of war concentration-camp survivors and survivors of some religious cults. Examples also include those subjected to totalitarian systems in sexual and domestic life, including survivors of domestic battering, childhood physical or sexual abuse, and organized sexual exploitation. 1. Alterations in affect regulation, including persistent dysphoria (a state of anxiety, dissatisfaction, restlessness or fidgeting) chronic suicidal preoccupation self-injury explosive or extremely inhibited anger (may alternate) compulsive or extremely inhibited sexuality (may alternate) 2. Alterations in consciousness, including amnesia or hyperamnesia for traumatic events transient dissociative episodes depersonalization/derealization (depersonalization - an alteration in the perception or experience of the self so that the usual sense of one's own reality is temporarily lost or changed; derealization - an alteration in the perception of one's surroundings so that a sense of the reality of the external world is lost) reliving experiences, either in the form of intrusive posttraumatic stress disorder symptoms or in the form of ruminative preoccupation 3. Alterations in self-perception, including sense of helplessness or paralysis of initiative shame, guilt, and self-blame sense of defilement or stigma sense of complete difference from others (may include sense of specialness, utter aloneness, belief no other person can understand, or nonhuman identity) 4. Alterations in perception of perpetrator, including preoccupations with relationship with perpetrator (includes preoccupation with revenge) unrealistic attribution of total power to perpetrator (caution: victim’s assessment of power realities may be more realistic than clinician’s) idealization or paradoxical gratitude sense of special or supernatural relationship acceptance of belief system or rationalizations of perpetrator 5. Alterations in relations with others, including isolation and withdrawal disruption in intimate relationships repeated search for rescuer (may alternate with isolation and withdrawal) persistent distrust repeated failures of self-protection 6. Alterations in systems of meaning loss of sustaining faith sense of hopelessness and despair Treatment of Complex PTSD Ongoing concern of how best to deal therapeutically with this type of presentation Very difficult cases to work with: complexity, severity, disturbance to sense of self Long term treatment probably best, although may be delivered in short courses Difficult to study outcomes based on current research methodology PTSD Issues The same disorder? Danger of both minimising and maximising with diagnosis of Complex PTSD Political and legal consequences of diagnostic category Social consequences Physical Reaction to Anxiety Auditory and Visual Stimuli: sights and sounds are processed first by the thalamus, which filters the incoming cues and shunts them either directly to the amygdala or to the other parts of the cortex. Olfactory and tactile stimuli: Smells and touch sensations Bypass the thalamus altogether, Taking a shortcut directly to the Amygdala. Smells, therefore, Often evoke stronger memories Or feelings than do sights or Sounds. Physical Reaction to Anxiety Thalamus: The hub for sights and sounds, The thalamus breaks down Incoming visual ques by size, Shape and color, and auditory Cues, by volume and Dissonance, and then signals The appropriate part of the Cortex. Cortex: It gives raw sights and sounds meanings, enabling the brain to become conscious of what it Is seeing or hearing. One region, the prefrontal cortex, may be vital to turning off the anxiety response once a threat has passed. Physical Reaction to Anxiety Amygdala: emotional core of the brain, the amygdala has the primary role of triggering the fear response. information that passes through the amygdala is tagged with emotional significance. Bed Nucleus of Stria Terminalis: unlike the Amygdala, which sets off an immediate burst of fear, the BNST perpetuates the fear response, causing the longer term unease typical of anxiety. Physical Reaction to Anxiety Locus Ceruleus: It receives signals from the amygdala and is responsible for initiating many of the classic anxiety responses: rapid heartbeat, increased blood pressure, sweating and pupil dilation. Hippocampus: This is the memory center, vital to storing the raw information coming in from the senses along with the emotional baggage attached to the data during their trip through the amygdala. Treatment Allopathic Treatments Medications (Drug Therapy): Behavioral Therapy Cognitive Behavioral Therapy Psychodynamic Psychotherapy Alternative Treatments Acupuncture Aromatherapy Breathing Exercises Exercise Meditation Nutrition and Diet Therapy Vitamins Self Love Crank up the serotonin Cornerstone of treatment for anxiety disorders is increasing serotonin Any of the SSRIs or SNRIs can be used Medications Buspirone: shown to be effective but usually takes 3-4 weeks, particularly useful in elderly patients Benzodiazepines: include Xanax and Valium, act rapidly and successfully but can be addictive and loses effectiveness over time Side Effects: dizziness, headaches, nausea, impaired memory Behavioral and Cognitive Therapy Teaches patient to react differently to situations and bodily sensations that trigger anxiety Teaches patient to understand how thinking patterns that contribute to symptoms Patients learn that by changing how they perceive feelings of anxiety, the less likely they are to have them Examples: Hyperventilating, writing down list of top fears and doing one of them once a week, spinning in a chair until dizzy; after awhile patients learned to cope with the negative feelings associated with them and replace them with positive ones Psychotherapy Psychodynamic Psychotherapy Psychodynamic therapy is a general name for therapeutic approaches which try to get the patient to bring to the surface their true feelings, so that they can experience them and understand them. Psychodynamic Psychotherapy uses the basic assumption that everyone has feelings held in the subconscious which are too painful to be faced. We then come up with defenses (such as denial) to protect us knowing about these painful feelings. Psychodynamic psychotherapy assumes that these defenses have gone wrong and are causing more harm than good, making you seek help. It tries to subdue them, with the intention that once you are aware of what is really going on in your mind the feelings will not be as painful. Takes an extremely long time and is labor intensive Acupuncture Caused by the imbalance of chi coming about by keeping emotions in for too long Emotion effects the chi to move in an abnormal way: when fearful it goes to the floor, when angry the neck and shoulders tighten Redirects the chi into a balanced flow, releases tension in the muscles, increases flow of blood, lymph, and nerve impulses to affected areas Takes 10-12 weekly sessions Aromatherapy Calming Effect: vanilla, orange blossom, rose, chamomile, and lavender Reducing Stress: Lavender, sandalwood, and nutmeg Uplifting Oils: Bergamot, geranium, juniper, and lavender Essential Oil Combination: 3 parts lavender, 2 parts bergamot, and 1 part sandalwood Exercise Benefits: symbolic meaning of the activity, the distraction from worries, mastery of a sport, effects on self image, biochemical and physiological changes associated with exercise, symbolic meaning of the sport Helps by expelling negative emotions and adrenaline out of your body in order to enter a more relaxed, calm state to deal with issues and conflicts Meditation Cultivates calmness to create a sense of control over life Practice: Sit quietly in a position comfortable to you and take a few deep breaths to relax your muscles, next choose a calming phrase (such as “om” or that with great significance to you), silently repeat the word or phrase for 20 minutes Nutrition and Diet Therapy Foods to Eat: whole grains, bananas, asparagus, garlic, brown rice, green and leafy veggies, soy products, yogurt Foods to Avoid: coffee, alcohol, sugar, strong spices, highly acidic foods, foods with white flour Keep a diary of the foods you eat and your anxiety attacks; after awhile you may be able to see a correlation East small, frequent meals Vitamins B-Vitamins stabilize the body’s lactate levels which cause anxiety attacks (B-6, B-1, B-3) Calcium (a natural tranquilizer) and magnesium relax the nervous system; taken in combination before bed improves sleep Vitamin C taken in large doses also has a tranquilizing effect Potassium helps with proper functioning of adrenal glands Zinc has a calming effect on the nervous system Self Love The most important holistic treatment of all Laugh: be able to laugh at yourself and with others; increases endorphin levels and decreases stress hormones Let go of frustrations Do not judge self harshly: don’t expect more from yourself than you do others Accept your faults Where to Get Help SFSU Health Center - The services of the Center are open to regularly enrolled (matriculated) undergraduate and graduate students. Office hours are 8AM to Noon and 1PM to 7PM Monday through Thursday and until 5PM on Friday. Appointments may be made by phone (415) 338-2208 or in person at Student Services Building Room 208. Any licensed psychologist or psychiatrist U.S. Dept. of Health & Human Services – Substance Abuse & Mental Health Services Administration – find resources in your area http://www.mentalhealth.samhsa.gov/databases The End