Worry
Why do we spend so much time worrying?
By Clinicial Psychologist Elizabeth Galt
Worry is something that almost everyone will do from time to time. However, sometimes people find that their worry has become a large and interfering part of their daily life. They may not like it but might believe that it is a part of who they are – to be a worrier. Or they may think that it is necessary to worry as much as they do. Sometimes it is hard for people to acknowledge how much they are worrying because the thoughts seem to be justified if about their real life problems. Often their worrying is pointed out to them by other people.
Frequent and interfering worry is associated with anxiety but not all people who worry a lot are aware of feeling anxiety in their body. Some people may have habituated to a higher level of daily anxiety, accepting it as their normal.
Worry is different from constructive problem solving. Problem solving is “here and now” action. Worry typically becomes repetitive and looping patterns of thought that don’t resolve to any practical action or outcome. For example, problem solving a bill that might be difficult to pay could look like calling the company and making a payment arrangement. In the same scenario a worry pattern would look like repeated thoughts of “what if I can’t pay it?”, “what will happen if I can’t pay it?” and similar.
Not all situations that provoke worry will be able to be problem solved. Some situations may be completely out of our control or may require time or other events to unfold. Often people get into the worry habit because it paid off for them a few times. Maybe they were prepared for a situation or felt partly protected from disappointment when something went wrong. It might seem counterintuitive but often people will have some positive ideas or beliefs about the value or benefits of worry. Unfortunately worry tends to get worse over time and then people find themselves worrying more and more about minor things. Then they can become worried about how much they are worrying, or feel stressed about how easily they are getting stressed.
The good news is that worry doesn’t have to keep its hold and reduce a person’s quality of life. A psychologist can assist with helping an individual to understand their worry pattern and why it has been persisting in their life. The psychologist can then provide strategies and activities that reduce the worry pattern.
There are also self-help approaches that target worry. Resources for these can be accessed at many reputable mental health websites. The Black Dog Institute has some tip sheets available (see http://www.blackdoginstitute.org.au) and the Centre for Clinical Interventions has full modules and workbooks available in their Resources section (see http://www.cci.health.wa.gov.au)
PTSD
Posttraumatic Stress Disorder (PTSD) helped by cultivating compassion.
By Dr Stan Steindl
Joe (not his real name) sits with me in my office, wringing his hands as his legs twitch. His experiences as a soldier in Afganistan have been the topic of our conversation. Despite a growing amount of time since his return to Australia following this deployment, he continues to be troubled by thoughts, memories and flashbacks of road side explosions, hunkering down among the rocks and dirt of the desert, and injured children caught in the cross fire. Right now, he’s feeling pretty angry.
Posttraumatic stress disorder (PTSD) is a common disorder that develops following trauma, especially trauma in which the person feels fear, helplessness and horror. It has far reaching implications for the individual, and also for the community. Apart from the many symptoms of re-experiencing the symptoms through flashbacks, symptoms of avoidance and emotional numbing, and symptoms of hyperarousal, fear and anger, a central problem of PTSD is the severe self-criticism, self-loathing, guilt and shame that is often associated.
While psychological therapies such as cognitive-behavioural therapy have been found to be effective in the treatment of PTSD, there is a growing interest in helping veterans further through programs aimed at cultivating compassion, and also self-compassion.
I invite Joe to close his eyes. “Think of someone in your life you care about. Develop a picture of that person in your mind. Feel the presence of that person in your life, in this room.” Joe sighs, shifts his body in the chair, and then settles. “Now consider and say to yourself, that person is just like me. And just like me, this person’s had ups and downs in his or her life. Just like me, this person’s had goals and dreams.”
We go on to explore other people in Joe’s life, people he knows, people he doesn’t know, people in other places in the world, and eventually all sentient beings. And eventually, we come to a place of compassion also for himself.
Compassion is very difficult for Joe. In combat, and throughout his training, he learned to think of everyone as a potential threat. Fear and distrust were essential for survival and you can’t allow yourself to see the enemy as a human being “just like me”. But with PTSD, things stay that way, even after combat is over. The veteran with PTSD finds it so difficult to relate to people as just people, let alone to relate to themselves with acceptance and forgiveness.
Compassion meditation, such as the one Joe and I practiced, is about getting that ability back, learning to see oneself in others, and learning to accept and forgive oneself as well. And results are encouraging. Compassion and self-compassion can be learned and practiced through meditation techniques (Jazaieri et al., 2012) and such approaches can help to reduce anxiety and stress (Berger et al., 2012).
About 15 minutes later the meditation comes to an end. Joe opens his eyes, rubs them a little and stretches his arms and shoulders. He gives me a wry smile. “Never thought I’d be a hippy,” he says, “But I know what you’re saying. I feel more relaxed. It’s good to just let go of the anger.”
References
Berger, R., Gelkopf, M., & Heineberg, Y. (2012). A teacher-delivered intervention for adolescents exposed to ongoing and intense traumatic war-related stress: A quasi-randomized controlled study. Journal of Adolescent Health, 51, 453–461
Jazaieri, H., Jinpa, G., McGonigal, K., Rosenberg, E., Finkelstein, J., Simon-Thomas, E., Cullen, M., Doty, J., Gross, J., & Goldin, P. (2012). Enhancing compassion: A randomized controlled trial of a Compassion Cultivation Training program. Journal of Happiness Studies. doi: 10.1007/s10902-012-9373-z
Acceptance and Commitment Therapy
ACT GROUP THERAPY
Acceptance and Commitment Therapy (ACT, pronounced as the word ‘act’) is now recognised as a powerful evidence-based therapy for a range of conditions – from depression, anxiety, and stress, to post-traumatic stress disorder, drug and alcohol abuse, and even schizophrenia.
Case Study
Obsessive Complusive Disorder
By Dr Stan Steindl, BA PGDipPsych MClinPsych PhD(Clin) MAPS
Matt, a 25-year-old store man who lives with his parents, was having difficulties with excessive washing. This compulsive washing he explained was conducted to cleanse himself from the contamination of the past. He was obsessed about the past and had developed elaborate, compulsive washing rituals to manage his feelings of anxiety about the contamination.
Panic Disorder
By Kathryn Smith, BA GradDipPsychEd MPsych(Clin) MAPS
Psychologists treat the emotional side of panic attacks
Perhaps the most prevalent psychological conditions fall under the umbrella of anxiety. Panic Disorder is one of the most common presentations with many individuals diagnosed with the disorder also meeting criteria for Agoraphobia. A diagnosis of Agoraphobia is given if (a) the patient reports anxiety about places or situations where escape may be difficult or embarrassing or in which help may not be immediately available, and (b) these situations are avoided or endured with marked distress.
Patients who present with panic attacks may appear as composed, competent individuals with full and fulfilling lives, however, beneath the surface they are enduring extreme discomfort and are often struggling to keep going. A patient may be experiencing a panic attack if they report discrete periods of intense fear in which 4 or more of the following anxiety symptoms develop abruptly and reach a peak within 10 minutes:
- Palpitations, pounding heart
- Sweating
- Trembling or shaking
- Shortness of breath or smothering
- Feeling of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, lightheaded or faint
- Feelings of unreality or being detachment
- Fear of losing control or going crazy
- Fear of dying
- Numbness or tingling sensations
- Chills or hot flushes
- Panic Disorder is diagnosed if panic attacks are:
Recurrent and unexpected
Have been followed by 1 month of either persistent concern about additional attacks, worry about the implications of the attack, or a significant change in behaviour related to the attacks
Not due to the direct physiological effects of a substance or general medical condition
Treatment of Panic Disorder may require a combination of pharmacological and psychological treatment. Pharmacological treatment has come to include selective serotonin reuptake inhibitors, tricyclic antidepressants, high-potency benzodiazapines, as well as certain anticonvulsants.
Psychological treatment focuses on the emotional side of panic targeting the anxiety that builds in anticipation of an attack or leads to agoraphobic avoidance. Psychologists work with the cognitive and behavioural features of the disorder in an attempt to deal with the triggers of physiological reactions. By addressing the underlying cognitive features, the cycle of anxiety is frequently broken and the individual is able to learn skills to better manage high anxiety.
There is ongoing debate about whether treatment should focus initially on cognitive-behavioural or pharmacological approaches, however, a combination of treatments has been well documented to lead to greater maintenance of good treatment results. Thoughtful application of the available therapies alone, or in combination may enable individuals to experience resolution of disabling distress, regain confidence, and compensate for a vulnerability to anxiety.
Self-Help Resources for Patients
Aisbett, B. (1995). Living With It: A Survivor’s Guide to Panic Attacks, Harper & Collins Publishers, Sydney.
Beckfield, D.F. (1994). Master Your Panic and Take Back Your Life!, Impact Publishers, California