Your Mental Health and CBT

Generalised Anxiety Disorder

GAD is a very common mental health disorder and its main central feature is excessive worry about lots of different events and things in day to day life. There are generally a lot of ‘what if’ thoughts present and a popular theme of ‘intolerance of uncertainty’ running through life. The worry can lead a person to avoid things or over compensate and over prepare and plan. Checking behaviours are also common such as reassurance seeking. People with GAD will want to have as much control as possible in their life to try and relieve the anxiety and stress they feel when things are uncertain. ​​

Symptoms can include:

• ​Feeling anxious or on edge
• ​Feeling irritable
• ​Lack of concentration and memory trouble
• ​Sense of dread​
• Worrying too much about lots of different things

​Treatment for GAD works on calming the body when anxious, as well as experimenting with tolerating more uncertainty gradually. Also working on lessening those what if thoughts and creating more balanced thought patterns.

Health Anxiety

Health anxiety/hypochondria is when you worry that you have an illness or that you will become severely ill and even that you will die. Like a lot of anxiety disorders an individual with health anxiety will probably engage in a lot of safety behaviours. This could include checking behaviours like searching the internet for symptoms, going to their GP on a regular basis, or constantly checking their symptoms in their own body.

The individual engages in these behaviours to try and stop them missing something important as this is a big worry for them. However, by engaging in these checking behaviours, it actually maintains the symptoms and keeps the anxiety cycle going.

Common symptoms of health anxiety include:

• Constantly worrying about your health
• Checking your body for any signs of illness
• Asking people for reassurance that you are healthy
• Questioning your doctors ability and worry that they might have missed something
• Searching the internet for symptoms of illnesses
• Avoiding watching medical TV programmes or reading medical booklets

Physical symptoms of anxiety can make people think they are unwell and often get mistaken for signs of illness. Treatment In CBT we will identify these safety behaviours and conduct experiments to reduce them. This will gather positive evidence to show you that you are ok and you can face situations without the need for reassurance. By exposing you to the feared consequence and collecting and noting down the evidence, the body and the brain will habituate to the feared situation and the distress levels will reduce.

Obsessive Compulsive Disorder

OCD is often misunderstood. It is not always and/or solely linked to being neat or clean. ​OCD is categorised by a fear of something bad happening, often to a loved one. These fears come as intrusive thoughts and often cause a lot of distress. The person will try and reduce that fear and anxiety by engaging in a safety behaviour to make themselves feel better. This is known as a compulsion.

​For example:

• Intrusive thought = My house will be burgled and my family will lose everything​.
• Compulsion = check locks on windows and doors 5 times each morning and night.

CBT works with OCD to identify how this cycle is unhelpful, as in the long term as it is only giving short term relief and in the long term the anxiety is getting worse, not better. We work on changing your belief system about needing the compulsions and gradually exposing to the things that cause anxiety whilst resisting the compulsive behaviours. Helping you gain more confidence that most of the time nothing bad will happen. Nothing is 100% guaranteed, learning to live with that level of uncertainty.

Panic Disorder

Panic disorder is an anxiety disorder that results in regular panic attacks. Anxiety is a natural human reaction and everyone experiences some symptoms of anxiety at some point in their life, but people with panic disorder can get panicky at any time for no apparent reason. A panic attack is when your body experiences a rush of adrenaline and can come on very quickly and for no reason. It can be very scary and often mimics the symptoms of a heart attack which creates a lot of fear for some people.​

Symptoms include:

• Racing heart
• Sweating
• Light headed
• Feeling faint
• Nauseous
• Shallow breathing
• Shaking
• Chills
• Choking sensation
• Pins and needles
• Dry mouth
• Needing to use the toilet
• Depersonalisation
• Derealisation ​

Treatment

NICE guidelines recommend CBT as the number one treatment method for panic disorder. CBT works a lot on psychoeducation, helping you understand what your panic cycle is and how its being maintained. Working on the unhelpful meanings people can attach to panic attacks. Also challenging any unhelpful thoughts around the condition. Exposure work is also present for panic disorder to gradually expose the person to feared situations and to gather the outcome evidence. Prolonged exposure if important, allowing the person to expose themselves to the feared situation until their distress levels reduce and their body habituates. This allows the brain to learn that you can cope with panic and don’t have to be controlled by it.

Post-Traumatic Stress Disorder

PTSD occurs when an individual is involved in or hears about a distressing incident such as an accident, abuse, traumatic labour etc. The first four weeks after a traumatic incident are known as acute distress disorder and can be a natural reaction to trauma, but and if your symptoms persist after four weeks, you may have PTSD.​

What happens in PTSD? ​

There is a part of the brain called the Amygdala – it is wired for survival and is the brain’s alarm system. The Hippocampus is responsible for storing memories and holds the sense of time. ​When we are faced with a threat the amygdala becomes hyperactive and survival mode kicks in. This means the hippocampus shuts down as it cannot cope, and so the events and information don’t get processed properly or filed away neatly. ​This keeps the brain stuck in threat mode and the trauma remains unprocessed. This can then cause intense anxiety and flashbacks around any triggers relating to the trauma, memories of it.

Treatment ​

CBT works on prolonged exposure to triggers of the trauma and works on reliving in a safe and calm environment. This helps the information pass over into the left hemisphere of the brain and it becomes processed properly as a memory. We may work on discrimination lists to help the brain notice what was then and what is now. Also there may be negative core beliefs attached to the traumatic incident such as self blame ‘I am weak’, ‘I should have stopped it’ etc. CBT can help work re-script these unhelpful thoughts for you.

Social Anxiety

Social anxiety is a very common anxiety based on social situations. It is often when an individual worries how they will come across in front of other people. Worry about negative judgement, how they will sound or how they will look. Worry about getting visible physical symptoms of anxiety such as being red in the face, hot, sweaty, shaking and that people will notice and think they look silly. This encourages them to have a lot more self focus on these symptoms in their body, which leads them to be even more anxious. People will tend to avoid social situations or escape from them early, cancelling plans, making excuses to leave etc. This in turn isolates them and affects their mental health even more.

Treatment

​We work on exposure for social anxiety using experiments. Gradually working from the least feared situation to the most feared. Building confidence as you go along and working on challenging anxious thoughts and gathering evidence that the anxious predictions are not the same as the outcomes. Also working on relaxation to calm the body and help change that focus from inward to outward.

Phobias

Phobias are very common and there can be a lots of different topics. A phobia is an intense fear of a situation, or an object, or an animal. Being around the feared stimuli will create intense fear and often a lot of physical symptoms.

These can include:

• Shaking
• Light headedness
• ​Increased heart rate
• ​Sweating​
• Shortness of breath​
• Tense muscles
• Nausea​

Treatment for phobias involves graded exposure to the phobia. We would develop a hierarchy and gradually climb that hierarchy like climbing a ladder, one rung at a time. Gradually increasing the steps until you are no longer afraid of the stimuli, or at least until it doesn’t control your life anymore. Along side your exposure thought work will also be taking place, as your brain learns there is no threat to fear, therefore improving your thought patterns.