GENERALISED ANXIETY DISORDER (GAD)

You are unlikely to be surprised that ‘Anxiety’ and ‘Worry’ are both very common but manageable for many people.

GAD on the other hand is characterised by excessive, uncontrollable and often irrational worry accompanied with high levels of apprehension about events or activities and constantly anticipating ‘something bad is going to happen’. This excessive worry often interferes with one’s daily functioning. People experiencing GAD are overly concerned about everyday matters such as health issues, money, death, family problems, friendship problems, interpersonal relationship problems, or work difficulties.

Excessive worry results in many symptoms of anxiety which affects our body and can lead to many unpleasant physical symptoms such as palpitations, shallow or fast breathing, feeling nauseous, headaches, sweating or shaking. Most of us would have experienced some of these symptoms at some point. However, for people who experience GAD, these symptoms can be almost constant with little respite and therefore understandably very distressing.

Anxiety also affects our mind that tends to produce many anxious thoughts. People who have GAD often refer to ‘rushing thoughts’, unable to rationalise and feeling ‘overwhelmed’.
It I’s important to emphasise that anxiety is a normal reaction to danger and an important survival mechanism. For example, feeling nervous before a job interview can have its advantages as ‘speeding up’ means that we are ready for action and can think on our feet and perform better. Of course, when we are in real danger such as crossing a road whilst a car is approaching too fast, these physical symptoms need to alert us to act, in this instance, walk much faster.

Anxiety can become a problem when there is no danger, but our mind imagines danger’. For example, if you have the tendency to have hypothetical worries such as ‘What if get burgled or What if I get involved in a road traffic accident’, it is understandable that your body will produce ‘fight or flight’ response to prepare you for danger even though it is not real. Think about it like a test fire alarm, the sound is the same but there is no real danger of fire.
For many of us anxiety may begin when we are going through a stressful time or we can also feel anxious when we perceive that we are not able to deal with all the demands of life and work or have sufficient resources to manage stress. Your personality will play a role. Some people are better at managing stress and multiple demands but unfortunately others may find stress more difficult to handle, tend to react to stress differently, often experiencing thoughts such as ‘I cannot cope’, they may benefit from learning how to manage stress and anxiety better.

Most people I see who present with GAD experience unhelpful thoughts about their physical symptoms as their symptoms may be frightening. For example, it is common that people think that there is something physically wrong with them, they are feeling ‘out of control’ or believe that they are going mad.

There are several strategies for controlling anxiety. Relaxation techniques can help with physical symptoms, for example controlled breathing or progressive muscle relaxation (learning how to tense and release different muscle groups) and using imagery and creating a safe place.
You can also learn how to recognise your anxious thoughts and look for the evidence for what you think, identifying any alternative views, asking yourself what is the worst that could happen, what is the best that can happen and what is the most realistic scenario. For example, using my previous example of a job interview, the worst that can happen is that your mind would freeze, and you would be silent during the interview or be physically sick, the best scenario you would sail through it with no anxiety and the most realistic scenario is that anxiety would mobilise you and improve your performance.

GAD can become disabling for many people as they start avoiding and their life becomes very restrictive. If you think you have GAD which is negatively impacting on your life, you may benefit from the evidence-based therapy such as Cognitive Behavioural Therapy. If you live with someone with appears to have GAD, encourage them to get help.

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NEW YEAR – TIME FOR CHANGE?

Perhaps you are someone who has been putting off therapy for some time and your New Year resolution is to make changes in your life. I would encourage anyone who can benefit from talking, to give it a try. Everyone and anyone can benefit from therapy, just think of it as a safe space to talk and explore what’s going on for you.

One of the most damaging preconceptions is that therapy is a sign of vulnerability. I always say to my clients that it is the exact opposite, it takes a lot of courage to be in therapy, look at your fears, hopes and discuss your wish to change. Therapy can be helpful for people from all walks of life.

Thinking about entering therapy can feel daunting, especially if you have no previous experience of seeing a therapist. Many questions may surface in your mind, such as “What if I do not like a therapist?, What if they are unable to help?, What if they do not understand or judge me?”

Please be assured that these worries are very common and understandable. Therapists understand and respect that you are letting them into your internal world and you may be a private person who does not find talking about your difficulties and feelings easy. You may feel embarrassment or even experience shame about asking for help and if funding private therapy, feel guilty about spending money on yourself. You may be blaming yourself for ‘not coping’ and feeling ‘overwhelmed’.

Good therapy involves treating you as a unique individual with a therapist helping you to making sense of your difficulties in a collaborative way. It may be helpful to think that you are the expert on your difficulties and how they impact on your life whereas your therapist is an expert on how to identify your needs and help you. In therapy you are an active participant and your motivation for change is important.

Good therapy can also increase your self-awareness and provide you with a better understanding of the causes of your distress and which factors maintain or sustain it. It can also teach you coping strategies to manage your distress and build resilience.

In this process, a good therapeutic relationship is paramount, therefore if you are not comfortable with your therapist, you should not hesitate to choose another therapist you feel more at ease with. My key message is to persevere and find a therapist who can facilitate change.

Another observation that I would like to share with you that sometimes people feel that they do not deserve therapy as they believe that other people are worse off or it is selfish to talk about oneself. What might help you to challenge this belief is to know that human distress lies on a continuum and comparing the intensity of suffering is not helpful.

Many people I meet are initially ambivalent about starting therapy and there are people who “do not believe in therapy”. However, how do you know that therapy is not for you? Understandably, you may have certain preconceptions and feel unsure or even fearful. My advice is to try one session and see how it is for you.

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SEASONAL AFFECTIVE DISORDER (SAD)

Colder winter days are when most of us wish to hibernate and getting out of bed is getting more difficult as we might feel sleepy and cosy under the duvet.

However, for some people winter months become very challenging due to an apparent decline in their mood. The winter season can lead to developing SAD, which is a type of depression that occurs only during winter months.

Symptoms include the following: sleeping longer than usual and difficulty of getting up, feeling lethargic, experiencing the loss of pleasure or interest in everyday activities and feelings of guilt or despair. Furthermore, symptoms may include overeating, and for some, the weakened immune system can lead to many colds and infections making winter months even more challenging.

Although the exact cause of SAD isn’t fully understood, research shows that changes to the levels of two hormones play a part; namely melatonin and serotonin. The lack of sunlight results in overproduction of melatonin. This is a hormone that is important for sleep and in winter months the body produces more melatonin compared to summer months thus we tend to sleep more.

In addition, the production of serotonin can be also affected. This hormone is very important for our mood, appetite and sleep. The lack of sunlight may lead to reduction of serotonin levels and less serotonin in the brain is generally related to depressive moods.
So what can you do to prevent the likelihood of developing SAD?

Firstly, lifestyle adjustments may help, such as getting out as much as possible during the sun light. Exercising, maintaining a healthy diet despite increased cravings for carbohydrates and sugar rich foods and taking vitamin D may also have beneficial outcomes. For those who experience clinical symptoms of SAD several therapies have been proven to help; light therapy, talking therapies and antidepressant medication.

The light therapy involves a special light lamp that simulates exposure to sunlight and can be used either on its own or in conjunction with other therapies. The light box contains very bright fluorescent tubes, usually 10 times more intense compared to our household lights. They are available at different sizes and it is advised that for SAD sufferers at least 2500 lux is required to have the desired effect. They are readily available online from many different manufacturers.
Another option you may like to consider is taking St John’s wort; this herbal remedy available over the counter, can be effective for mild to moderate depressive symptoms as an alternative to antidepressant medication.

Lastly, going on holiday to sunny countries during winter months is the most expensive option but worthwhile if finances allow. If you believe that you might have SAD please talk to your GP who can prescribe antidepressants or refer you to therapy. Remember that SAD is more than winter blues that we all experience and can have detrimental effect on your quality of life for several months each year, thus it is certainly worthwhile getting adequate help and support.

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SELF-COMPASSION

Research shows that developing self-compassion increases our sense of well-being and general health. You may be wondering why self-compassion can help your mental and physical health. Perhaps you are someone who is hard on yourself and self-critical. You may feel exhausted from being always on the go, judging yourself and unable to switch off. If this is the case, you may benefit from self-compassion.

Self-compassion is a skill that can be learnt. One of the important things about self-compassion is to learn how to become more sensitive to your needs (e.g. the need for recognition and respect from others, the need for confidence, independence etc).

From my clinical experience, it is not uncommon that people struggle to identify their needs and recognise when they are not met. Another tendency is to find it much easier to be kinder to others rather than to ourselves and adopt ‘double standards’ when it comes to kindness. For example, we are less likely to think of someone else as ‘useles’ when they make a mistake as opposed to judging ourselves when the same occurs.

Another important facet of self-compassion is to learn how to be opened to our feelings and tolerate them without harsh judgement. I think you would agree that it can be rather challenging when we experience low mood, anxiety or big disappointment. On the other hand, it is easier experiencing happiness or excitement. In other words, we have the tendency to categorise our feelings as positive and negative.

The key aspect of self-compassion is learning how to tolerate and become less frightened of our feelings. It is helpful to know that our experiences of emotions and desires emerge from the patterns created in our brains and bodies. It is useful to think about three different operating systems; threat, incentive and soothing system. Let me explain their different functions.
The function of the threat system is to pick up on threats quickly and generate feelings such as anxiety which then alerts us and urges us to act against the threat and to self-protect (fight and fight). Our brains can over-estimate threats because that's how they are designed to work.
The incentive system is important to give us positive feelings that guide, motivate and encourage us to seek out things and resources in order to survive and prosper. We are motivated and pleased by seeking out, consuming and achieving nice things (e.g. food, places to live, comforts, friendships, and so on).

However, if this system becomes over stimulated it can also drive us to wanting ‘more and more’ and if things are not going smoothly, experience ‘frustration and disappointment’. When our desires and goals are blocked we are in the threat system and can become overwhelmed, judgmental of our feelings, self-critical and ‘unhappy’.

Operating in the soothing system on the other hand results in feelings of contentment, social affiliation and peacefulness. Many people struggle with self-compassion because their soothing system is not well developed.

Cultivating self-compassion is not easy and we need to practice it and prioritise it. We all need time to stop, reflect, process our feelings, being with the loved ones, have a cuddle and sometimes just simply ‘be’ rather than always ‘do’.

Noticing when we are harsh on ourselves and judging feelings can be helpful. Noticing when we are not kind to ourselves is also beneficial; perhaps we are overworking, not sleeping enough, pleasing others but not recognising our needs.

When we practice meditation, mindfulness and ‘slowing down’, we are not concerned with wanting or striving, we tend to feel more connected with others and contented. Many people I see are striving to achieve this sense of contentment.

Have you recognised yourself? Are you someone who can benefit from self-compassion and self-soothing? Ask yourself what makes you happy and how you can recognise when threat and incentive system become over-stimulated at the detriment of the very important soothing system.

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