Download ANXIETY DISORDERS

ANXIETY
DISORDERS
Anxiety vs. Anxiety Disorder
 Biological pathways
 Major anxiety disorders:
development & treatment
 Post Traumatic Stress Disorder
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The Anxiety Disorders
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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).
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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
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Most common mental illness in the U.S. with 19
million of the adult (ages 18-54) U.S. population
affected
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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
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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
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Common in normal children
The clinician must distinguish
developmentally normal from abnormal
Infants
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Fear of loud noises
Fear of being startled
Fear of strangers (around 8 – 10 months)
Normal Fear and Worry (2)
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Toddlers
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Fears of imaginary creatures
Fears of darkness
Normative separation anxiety
School-age Children
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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)
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School Age Children (continued)
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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)
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Adolescents
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Fears related to school
Fears related to social competence
Fears related to health issues
ANXIETY
Symptoms of Anxiety
Common Causes
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There is no one cause for anxiety disorders. Several
factors can play a role
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Genetics
Brain biochemistry
Overactive "fight or flight" response
 Can be caused by too much stress
Life circumstances
Personality
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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?
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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
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Panic attack
Panic Disorder
without agoraphobia
Panic Disorder with
agoraphobia
ObsessiveCompulsive
Disorder
Substance induced
Anxiety Disorder
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Post-traumatic
Stress Disorder
Generalized Anxiety
Disorder
Anxiety Disorder
due to a general
medical condition
Anxiety Disorder Not
otherwise specified
Anxiety disorders…
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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
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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:
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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
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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
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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
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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
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Generalized Anxiety Disorder
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Obsessive Compulsive Disorder
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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
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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
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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
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Conditioning
Mowrer’s two-factor model
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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
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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)
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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
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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
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Self-focused attention
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Negative self-evaluation
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Anxious apprehension
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Avoidance and escape
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Behavioral disruption of normal
functioning
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Skills deficits
Negative Expectations
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They will reject me
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I will be found out as incompetent
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They will think I’m weird
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I can’t even do the simplest things
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I had better not blow it again
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I can’t (don’t know how to) do this
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I will tremble and my boss will fire me
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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
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Social Phobia/Anxiety
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Common anxiety provoking social situations include:
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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
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Mainly behavioural or cognitive behavioural
techniques are used
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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)
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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
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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)
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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
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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
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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
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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
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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.
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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
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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
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Medical: particularly high doses of SSRIs
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Psychoanalysis
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Cognitive-behavioural therapy
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Exposure and response prevention
Thought-stopping not generally effective alone
Generalised Anxiety Disorder
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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
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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
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Is it an anxiety disorder?
Main diagnostic criteria:
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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…
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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
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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
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Medication (treats the symptoms, but
minimally effective)
Exposure Therapy
Critical Incident Stress Debriefing
Supportive psychotherapy
Eye Movement Desensitisation and
Reprogramming (EMDR)
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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)
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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
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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
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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
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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
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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
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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
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loss of sustaining faith
sense of hopelessness and despair
Treatment of Complex PTSD
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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
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The same disorder?
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Danger of both minimising and maximising
with diagnosis of Complex PTSD
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Political and legal consequences of
diagnostic category
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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
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Medications (Drug Therapy):
Behavioral Therapy
Cognitive Behavioral Therapy
Psychodynamic Psychotherapy
Alternative Treatments
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Acupuncture
Aromatherapy
Breathing Exercises
Exercise
Meditation
Nutrition and Diet Therapy
Vitamins
Self Love
Crank up the serotonin
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Cornerstone of treatment for anxiety
disorders is increasing serotonin
Any of the SSRIs or SNRIs can be used
Medications
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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