http://niclucas.com Learn about anxiety disorder and panic attacks from a medical researcher and health professional who has recovered from them without medication and without formal therapy.

1. Anxiety

2. Nic Lucas BSc, MHSc, MPainMed, GDipClinEpid PhD (Cand) – Diagnostic Medicine But most importantly – a real person who suffered anxiety and panic disorder and beat the sucker

3. Anxiety – but what type? Stress? Generalized Anxiety Disorder Panic Disorder Social Phobia Specific Phobia Obsessive Compulsive Disorder Post Traumatic Stress Disorder

4. Symptoms Feelings of distress Fear / Extreme Fear Physical Sensations Heart Rate Breathing Rate Sensations (tingling, light-headedness) Depersonalization / Derealization

5. Treatment that works? What do we mean by ‘works’?

6. Treatment that works Reduce symptoms? Which ones? By how much? For how long? Improve life? Regain function Long term goals Positive self-concept

7. Treatment that works How do we really know if it works? Randomized Controlled Trials Rely on accurate diagnosis Apply to ‘average’ sufferers What about me? What about the individual? I think the current research findings are actually quite amazing

8. Anxiety – a biomedical problem? ‘Imbalance’ in the brain? Implies we know what a balanced brain is! Simplistic thinking Multi-causal world Multiple variables Fixed and modifiable variables

9. Biomedical solutions Modify brain chemicals Dominant pharmacological model General Disclaimer

10. Benzodiazapines Martin & colleagues 1,217 articles 137 were relevant 23 were good quality Martin JLR, Sainz-Pardo M, Furukawa TA, Martin-Sanchez E, Seoane T, Galan C. Review: Benzodiazepines in generalized anxiety disorder: Heterogeneity of outcomes based on a systematic review and meta-analysis of clinical trials. Journal of Psychopharmacology 2007; 21: 774-782

11. Benzodiazapines “This systematic review failed to find convincing evidence of the short-term effectiveness of benzodiazepines in the treatment of generalised anxiety disorder.” “Benzodiazepines do not even prove to be definitively superior to placebo in the short term”.

12. SSRI’s Baldwin and Polkinghorn Baldwin DS, Polkinghorn C. Evidence-based pharmacotherapy of generalized anxiety disorder. International Journal of Neuropsychopharmacology 2005; 8: 293-302

13. SSRI’s Overall it would seem that SSRI’s are the best drugs to try for the first line treatment of anxiety or panic disorder assuming of course that drugs are going to be your first line treatment choice

14. Antidepressants Kapczinski and colleagues Kapczinski F, Lima MS, Souza JS, Schmitt R. Antidepressants for generalized anxiety disorder. Cochrane Database Syst Rev 2003: CD003592

15. Antidepressants Antidepressants like imipramine (Tofranil), venlafaxine (Effexor) and paroxetine (Paxil) were found to be better than placebo drugs for anxiety, however they only worked in 1 out of every 5 patients.

16. Antidepressants Antidepressants don’t work in 4 out of every 5 people with anxiety who leave the doctors office with a script

17. Antidepressants There is even a systematic review of all the clinical trials for treatment of anti-depressant induced sexual dysfunction! So, basically, they’re trying to figure out the best drug to give people who have sexual dysfunction that is caused by antidepressants. Taylor MJ, Rudkin L, Hawton K. Strategies for managing antidepressant-induced sexual dysfunction: systematic review of randomised controlled trials. J Affect Disord 2005; 88: 241-54

18. GABA? Gamma Aminobutyric Acid … Reduced in the Occipital Lobe by 20% of people with ‘anxiety’ Simple solution – give people GABA?

19. GABA? GABA doesn’t make a mention in any official guidelines No evidence Large potential for side effects?

20. Anxiety – A behavioral problem? Focus on stimuli rather than brain physiology Our ‘behavior’ changes brain physiology

21. Cognitive Behavioral Therapy CBT is one of the most extensively researched forms of psychotherapy CBT has a large effect in the treatment of social phobia posttraumatic stress disorder anxiety panic disorder

22. Cognitive Behavioral Therapy Focus on individual cognitions That initiate anxiety That are incorrect Focus on modifying individual behaviors

23. Cognitive Behavioral Therapy Socratic questioning Visual imagery Examining the evidence Relaxation training Breathing control Graded exposure

24. Cognitive Behavioral Therapy Hunot and collegaues 85 studies 23 relevant / good quality Hunot V, Churchill R, Teixeira V, Silva De Lima MS. Psychological therapies for generalised anxiety disorder. Cochrane Database of Systematic Reviews 2007: Art. No.: CD001848

25. Cognitive Behavioral Therapy People who received CBT were more likely to experience an immediate reduction in their anxiety compared to those people who received usual treatment. CBT was also found to be effective in reducing secondary symptoms such as depression.

26. Cognitive Behavioral Therapy Norton and colleagues Reviewed the reviews Norton PJ, Price EC. A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders. Journal of Nervous and Mental Disease 2007; 195: 521-531

27. Cognitive Behavioral Therapy First, CBT was effective in treating all types of anxiety disorders. Second, CBT appeared to be more effective for generalized anxiety and posttraumatic stress disorder than for social anxiety. Third, CBT wasn’t better than relaxation treatment.

28. Hmm…

29. Others…? Self-help Exercise Herbal Treatments Kava kava St Johns Wort Valerian Yoga Meditation Reiki and Therapeutic Touch

30. “Well I looked my demons in the eye, laid bare my chest and said do your best to destroy me. Ya’ see I’ve been to hell and back so many times I must admit you kind of bore me”www.raylamontagnemusic.com

31. How did I overcome anxiety and panic? My Story

32. As it turns out – very neatly 10 Steps Avoidance Distraction Observation Acknowledge improvement Education Authentic emotion Breathing Relaxation Exercise Challenging those thoughts …

33. Avoidance Input / Stimuli Situations Thoughts People Visual (TV / Movies / Text) Auditory (Conversations / Music)

34. Authentic Emotion Love Humour Anxiety! Anger

35. Education Brain physiology Treatment effectiveness Treatment side-effects

36. Challenging those thoughts Anxiety is an emotion not a logical thought process … “It’s hard to use logic to remove an idea that was not formed in logic” However, is the anxiety based on an ‘illogical internal argument”?

37. Favorite quote “When a person who is honestly mistaken hears the truth, they either cease to be mistaken or cease to be honest”

38. www.fromanxioustohappy.com