1. Managing your
anxiety
Fleur-Michelle Coiffait
Fiona Gellatly
Trainee Clinical Psychologists
University of Edinburgh & NHS Lothian
Monday, 14 May 2012

2. Welcome
 Introductions
 Housekeeping
 Outlineof 2 sessions
 Expectations
Monday, 14 May 2012

3. Who gets anxious?
 Research shows that almost 1 in
5 of us will suffer from anxiety at
any one time
 In Edinburgh alone there will be
22,305 people suffering from
anxiety
 We all get anxious but it becomes
a problem if we can’t cope with it
Monday, 14 May 2012

4. 14 Most common signs
reported by people in the
 Worry  Feeling on edge
 Anger  Unable to switch off
 Poor sleep  Poor concentration
 Tiredness  Tearful
 Feeling irritable  Drinking too much
 Feeling worthless  Feeling hopeless
 Waiting for the  Panic attacks
worst to happen
Monday, 14 May 2012

5. How anxiety can affect us
Environment
Thoughts Behaviour
Anxiety
Emotions Body
Monday, 14 May 2012

6. Group exercise
 Take some post-it notes
 On each one, write one example of
how anxiety affects you
 E.g.
Anxiety makes me go out less
Anxiety means that my heart races
 15 mins
Monday, 14 May 2012

7. Break
 15 minute break
Monday, 14 May 2012

8. Fight / flight / freeze
 Instinct (e.g. animals)
 Stress/anxiety is an instinct
 Alerts mind and body to threat
 Keeps us ‘on alert’ until danger passes
 Ancient survival mechanism
 Example: walking alone at night
 Sensing danger -> adrenaline
Monday, 14 May 2012

9. Adrenaline
 Body’s activator -> energy
 Adrenal glands in our kidneys
 Carried through bloodstream, affects
autonomic nervous system (ANS)
 ANS controls functions such as our heart
rate, pupil dilation, and secretion of
sweat and saliva
Monday, 14 May 2012

10. Fight / flight / freeze
Sweating Pupils dilate
Heart rate Adrenaline
Breathing and Heightened
oxygen awareness
Muscle tension Bladder/bowels
Monday, 14 May 2012

11. Fight / flight / freeze
 This reaction does not wear off
instantly
 Our bodies are concerned the threat
may return
 Hot, flushed, tired
 Calm much later
 We don’t decide to react this way
Monday, 14 May 2012

12. However…
 Today the threats we experience
often do not require us to fight or
flee
 Now there is less focus on survival
but more on social factors such as
our own and others perceptions of
ourselves.
We will consider ways of combating
this later.......
Monday, 14 May 2012

13. How anxiety can affect us
Environment
Thoughts Behaviour
Anxiety
Emotions Body
Monday, 14 May 2012

14. How anxiety can affect our:
Behaviour
Avoidant Behaviour Negative Behaviour
Making decisions Speaking too fast
Driving Unable to sit at peace
Shopping Poor performance
Socialising Always rushed
Staying alone Smoking/drinking more
Talking to neighbours Accident prone
Reading about illness Irritable, Stammering
Using buses/trains Nail biting
Responsibility
Monday, 14 May 2012

15. How anxiety can affect our:
Behaviour
 Anticipate we will cope badly
 Common sense is ‘stressed? then avoid it!’
 Unfortunately, this is not helpful
 No easy way around this
 Stress can often be invisible
 Visible in our behaviour
 Often aware of our reaction, self-conscious
Monday, 14 May 2012

16. How anxiety can affect our:
Body
Bladder/ Heart
Bowel Dry rate
Sleep Faint Headache
mouth
Chest
Numb Shaking Unreal
pain
Anxiety Anxiety
Jelly Pins & Muscle
Breathless
legs needles pain
Choking Nausea Tired Sweating
Monday, 14 May 2012

17. Break
 15 minute break
Monday, 14 May 2012

18. How anxiety can affect our:
Thoughts
 Thoughts can be a bit like a football
commentator
 Whether we pay attention depends on
many things
 No two people worry about the same
thing, although there are common themes
 How we feel can affect the strength and
type of thought we have
 How we think affects how we behave
Monday, 14 May 2012

19. Fearful Thoughts
 Can include fears of:
Looking foolish Worry
Madness Poor concentration
Illness/disease Irritability
Challenges Feeling keyed up
Losing control Nightmares
Being alone Loss of interest
Being criticised  Feeling ‘cut off’
Rejection Easily startled
Meeting people Self criticism
Monday, 14 May 2012

20. Worrying about worrying:
A vicious circle
Notice
Worry
symptoms
Symptoms Worry about
increase worrying
Monday, 14 May 2012

21. Emotions
 Worried  Despair
 Sad  Frustration
 Guilty  Injustice
 Fear  Low
 Angry  Let down
 Insecure  Helpless
 Resentful  Flat
 Unreal  Jealous
Monday, 14 May 2012

22. What causes anxiety?
 Personality factors/genetic make-up
 Childhood experiences
 Modelling
 Perception
 Life events
 Changes or breaks in routine
Monday, 14 May 2012

23. Reducing anxiety:
Breathing exercise
Monday, 14 May 2012

24. Calming breath
Quick strategy to reduce bodily
symptoms, can be used in any situation:
 Breathe in through nose on a count of 4
 Hold for 2 seconds
 Release slowly over 6 seconds
 Say the word “relax” as you breathe out
Monday, 14 May 2012

25. End of day one
 Thank you very much
 See you tomorrow –
same time, same place!
Monday, 14 May 2012

26. Day two
 General discussion
 Any thoughts or issues that came
up overnight that you would like to
share?
Monday, 14 May 2012

27. Day two
 Maintaining factors and how to
intervene in the vicious cycle
 Progressive muscle relaxation
 General questions
Monday, 14 May 2012

28. Anxious thoughts
 They often happen out of the blue
 You may be unaware of them
 Although they are not necessarily ‘true’
people believe them at the time
 The thoughts often appear when you least
want them
 They are usually about the near future
 If other people believed the thoughts, they
would become anxious
Monday, 14 May 2012

29. Anxious thoughts increase due
to other changes…
Become more and
more self-
Self-esteem and Question your
conscious
self-confidence ability to cope
drop
Feel threat from all Anxious
Worry becomes
sides thoughts second nature
increase
Problems keep Body reacts
coming easily, or for no
Brings out the reason
worst in you
Monday, 14 May 2012

30. Understanding our
thoughts: Unhelpful thinking
 Catastrophising
 Black and white thinking
 ‘Shoulds’ and ‘musts’
 Jumping to conclusions
 Mental filter
 Emotional reasoning
 Over-generalisation
 Personalisation
Monday, 14 May 2012

31. Break
 15 minute break
Monday, 14 May 2012

32. Distraction
Dwelling on worries leads to more worries
1. Try mantras, e.g. “I am calm”
(flashcard) “Relax”
“I am in control”
Close your eyes and slowly repeat the words
2. Describe everything you can see or hear in detail
Monday, 14 May 2012

33. Exercise and activity
 Anxiety gives you lots of energy
 Reduce the anxiety by burning up the
excess energy
 Cardiovascular exercise is best:
E.g. walking, swimming, jogging, fitness
classes, sports
 Exercise gets you out of the house
and meeting others
 Added benefit of improved health
Monday, 14 May 2012

34. Avoidance
 Common sense says if doing something makes
you more tense, you should avoid it
 So-called common sense can be unhelpful!
 Face up to your problems
 If you ignore them they will feed the
anxiety and may get bigger
 This may be hard in the short-term, but it
will help in the long-term
Monday, 14 May 2012

35. Alcohol
 Some physical symptoms of anxiety (nausea,
sweating, shaking) may be related to too much
alcohol
 Heavy drinking makes anxiety worse, and can cause
slowed breathing and heart-rate in the short-term
Driving Limit
80mg in 100ml of blood – not easily translated into a number of
drinks, depends on age, weight, gender, metabolism
We all need at least two days a week without alcohol
Consider reducing drinking or stop altogether
Monday, 14 May 2012

36. Caffeine
 Strong links between intake of caffeine and
anxiety
 You find caffeine in:
 Tea and coffee
 Fizzy drinks, e.g. coke, diet coke, red bull
 Chocolate
 Cold and flu remedies/painkillers
 Caffeine tablets, e.g. pro-plus
Monday, 14 May 2012

37. Progressive muscle relaxation
 PMR teaches you how to relax your body and
mind
 Allows you to become aware of how anxiety
affects your body
 Relaxation is a skill and benefits from practice
 Lets have a go
Prevention is better than cure
Monday, 14 May 2012

38. Break
 15 minute break
Monday, 14 May 2012

39. Strategies to manage
anxiety
 Prepare yourself
 work out which situations cause you
anxiety
 use relaxation before you have to
face up to them
 Stay in control and face the anxiety
 younow have a way of fighting back
when anxiety threatens
Monday, 14 May 2012

40. ? Questions ?
Monday, 14 May 2012

41. Handouts
 ‘25 ways to cope’
 Problem solving
 Sleep problems
 PMR
 Breathing
 Unhelpful thinking styles
Monday, 14 May 2012

42. What Next???
 Online Resources
 Bibliotherapy
 Voluntary Organisations
 Stress Control Group
Monday, 14 May 2012