Stress




Printer Friendlier Version

<<< back to [Home]

Stress is a Choice
Anxiety Disorders
     Generalised Anxiety Disorder
     Panic Disorder
     Agoraphobia
     Phobias
     Social Anxiety Disorder
     Obsessive-Compulsive Disorder
     Post-Traumatic Stress Disorder
     Separation Anxiety
Stress Management Strategies
     EFT, TFT and Amagdala Retraining
     Exercises to Calm The Mind
     Distraction and Escapism
     Emotional or Psychic 'Vampires'
     Gentle Exercise
     Treatments
     Limit Internet Usage
     Laugh and Smile

 
Stress is a Choice:

What is stress? Why does stress grip us? Think of stress as our physiological and psychological/emotional response to external stimuli, rather than an external event or a situation. No situation or event or word has any meaning apart from that which we give it. We give the situation its power. Our stress response to a certain issue or situation is a learned behaviour, a bad habit, the dynamics of which we are often not conscious of. A event that triggers our stress we can call a 'trigger'. This trigger activates a belief we have about a situation, which may be something that conflicts with our values or our morals of how things should be or what is reasonable. Or what we were expecting and wanting to happen. A stress trigger may be generated internally, as a fear of the event or set of conditions which result in our stressed state, occurring. This is in a sense anxiety about becoming anxious, fear of fear, or stress about stress. This is just as destructive as the actual stress response to the set of conditions we perceive as being stressful. External stress stimuli can be perceived or can be physical stimuli (i.e. being assaulted, or working very hard physically). Internal stress stimuli may be fear of a situation happening or an unwanted situation perhaps unfolding to some extent, based on past memories and associations.

Unfortunately if we base our happiness and inner calm on everything around us happening the way we like it, we are destined to be very unhappy, stressed and not in control of our emotions. This strategy is destined to fail. If nothing else, people and life would be boring, it could be something you could write and create in a computer program, not unlike the movie The Matrix. It would be boring and not worth living in. We need some chaos and unpredictability as much as we need stability and predicatability. Sometimes it is negative, but that should not dictate our emotional response. It may inspire our actions but that is a different story.

The stress 'trigger' is a series of conditions that must be fulfilled in order for us to feel stressed. This tends to be event, thought or idea-based. It is the body's natural 'fight or flight' response. It is called up when the unconscious mind believes that the body is in physical danger. It increases our adrenaline output and hopefully our ability to concentrate. In many individuals, the fight or flight response is overpowering, to the point where the individual simply freezes and shuts down, which is of course counter productive in terms of being able to protect the physical body.

However, there are other ways we can feel stressed. We can have a continual background level of stress which stays with us, regardless of the situation. It may almost disappear or disappear momentarily during a hilarious comedy or a relaxing time doing something we love, or be considerably reduced during focussed activity such as meditation or Qi Gung practice, but the rest of the time it is there. Preventing us from ever properly relaxing or having too positive thoughts about ourselves or situations around us. It often prevents us from ever really enjoying anything to the maximum and from being truly relaxed and playful. This kind of background stress is in a sense being stuck in the fight or flight mind state. The body perceives threats all around it or that it is in danger, on some level, even if you consciously don't entertain this, the unconscious feels it, and we know it. The body does not allow us to relax as it wants to keep us in this state of mind. Why should the mind relax when there is 'danger' around us still? It is no good just denying it is there because it is. This fight or flight response mode that we can be stuck in for periods of time or in some cases, permanently, is a result of the Amagdala. This is one of the more ancient parts of the brain, linked to the hypothalamus, that acts as the brain's interpretation machine, in particular for negative emotions such as fear and disgust. In a sense it regulates our more primal animal instincts. Incorrect interpretations and associations can trigger this fight or flight response too often. It locks the mind into the downstream effects of the stress so it is unable to detach from the physical symptoms or obsessive/compulsive focus on a particular external concern (e.g. material) and thus gain clarity, calm and perspective; to genuinely calm the mind down and to let go. In such cases, simply stopping ourselves at the point of deciding to follow the 'trigger' is not so applicable here and various relaxation exercises, focus/belief brainstorming, and mind retraining exercises are necessary to overcome this background level of stress and continual fight or flight response mode that we are in. To some degree it is the ego striving for significance and holding onto the mechanism that makes us feel important or cared for. This is examined below. However it is likely a combination of the two mechanisms at work, with clearly unfavourable consequences. Continuous stress is however still a choice, like following the trigger for stress slavishly, but it is a different kind of choice. Are we going to stop denying to ourselves the true picture and that we suffer from excessive stress and take it seriously and really get motivated and dedicate ourselves to tackling it, starting now, and regularly and consistently for a period of many months, to reclaim our lives? Or are we just going to let it carry on or make half hearted attempts, be inconsistent or simply use the wrong techniques to try to reduce/overcome our stress, and later just give up? The choice is yours? With the right tools, and Will, anything is possible.

Stress affects us all to some degree. However, excessive and constant stress is not clever and is not just some masochistic 'treat' we can keep inflicting upon ourselves over years without consequence. It manifests itself physically in our bodies, in terms of muscle tension, stiffness, and a gradual decline in biochemical health. Elevated adrenaline levels for long periods of time can play havoc with the adrenal glands, the heart and the immune system, as discussed on the Neurotransmitter page in the Health Section. Adrenal gland 'burn out' can result, to varying degrees, resulting in impaired hormone and neurotransmitter processes, fuelled on by the continuous fight or flight response that prevents them from getting back to normal balance. This can be seen all to clearly in the health section, which focusses on Chronic Fatigue Syndrome, one of the contributary factors in many individuals is stress. Stress is also said to very quickly deplete our Jing or vital essence according to Traditional Chinese Medicine. Some people can be observed to have contorted or assymetrical facial expressions or mannerisms - these are sometimes, but not always, a result of stress in some form. Nervous mannerisms, fidegeting or comfort eating/overeating are other expressions of stress. Stress destroys our quality of life in all areas and is not something we should allow our egos to nurture and hold onto, as if our very lives depended on stress for our survival. Cause and effect has the last laugh.

Sometimes we take ourselves too seriously and it just isn't worth it. The issue is totally meaningless and unimportant and will happen again and again all over the country. A stress response is often about significance and ego. Being stressed or depressed for example makes us feel significant and important. Taking everything too seriously is a mechanism for feeling significance. But there is a price to pay. They are not helpful for us as people. They satisfy the ego. Sometimes the ego likes illness as it provides us with a sense of significance and importance. And it allows us to focus on ourselves whereas normally we would not do this. We need to change our beliefs and values and behaviour to give ourselves the significance we need, so we don't get it in destructive ways.

We are connected to everyone and everything around us, and the perception that we are separate from everyone else comes from the ego and serves to disconnect us from our ability to manifest what we want in our lives and to be free from stress. By feeling that we are in competition with others rather than in competition with ourselves (to better ourselves regardless of what everyone else is doing); by feeling we have to win at everything to feel good; by judging our own personal value from our performance; by feeling that we need something else, or more of something to be happy (which is a sign of lack of gratitude for what we have, relying on external objects or conditions to feel good - what a bit set of rules we create that need to be fulfilled before we allow ourselves to feel good!); by needing to be right, especially in an argument and being reluctant to acknowledge that the other person is right in many areas (but just picking on we don't agree on); by walking around seeking something to be offended about - being easily offended by things around us that we have no control over and often which have no meaning and are quite trivial (a colour scheme that doesn't work, the way someone talks, someone's appearance, the way someone acts, offensive language or ideas); by feeling we have to take ourselves too seriously; by needing to be seen to be looking good or be cool, or have have a great reputation or image (spending much of one's time faking it and trying to make people like your projected image rather than just being yourself and letting people like you because you have a kick ass personality); all of these things are trappings of the ego that inevitably result in excessive and unnecessary stress, aggravation and sadness. If we can free ourselves of these addictions, then we can experience real peace, calmness and happiness. And clarity of mind.

Stress may be a result of excessive desires to control situations and the world around us to a neurotically 'perfect' state, i.e. one that suits us or panders to our neurosies (distrusting them to take care of themselves). The conscious mind may be so used to getting involved in every little thing around us that it prevents us letting go and feeling our intuition or more peaceful states. We lock our minds into a 'fight or flight' state. One example might be mentally 'driving' when you are a passenger in someone else's car, rather than letting go and relaxing, and having faith in the other person or your surroundings to take care of themselves. What will happen after you have died? Who will keep figeting to make the world just as you want it then? Clearly it won't matter then, and it doesn't matter now either.

As well as an emotional state brought on by the negative excesses of the ego, stress is also in a sense a misuse of the imagination. Positive use of the imagination and visualisation is to see yourself as succeeding in a key goal or objective of yours, seeing yourself where you want to be and putting a unique and positive spin on your current situation. Or perhaps seeing the funny side of it. Negative use of the imagination and visualisation is spending your energy imagining all sorts of negative meanings associated with a situation, that will cause you to feel anxious, upset or annoyed. Reducing your stress is on some level an exercise in taming your imagination to do what you want it to do, not being a slave to its addictive negative patterns and your negative pattern of focus.

The best way to build rapport is to take an interest in the other person and not just talk about what you want to talk about. The internet often encourages people to talk 'at' others, at it is an abstract and unnatural form of communication, and to dispense with the usual social pleasantries and ways of bonding, such as using people's name, intonation etc.; and if one does not get the response one wants from the other person (that sense of significance), one feels ultimately disappointed. In a business environment, personal or certain types of sensitive commercial matters should always be communicated sensitively, respectfully and verbally wherever possible, and only ever in writing as a last resort - a conversation is gone as soon as it began, whereas words stay forever and can be referred back to and used as 'evidence'. However, internet communities use written communication ALL THE TIME. And what is more, not all users of the internet have gone to typing college and are fluent in high speed touch typing. It is an inevitable chore for many people to have to type so much. Unless a person is very caring and conscientious, he or she is likely to rush communications as they are keen to communicate something and move onto the next thought. This often results in poor sentence construction, grammar and jumping around without making the meaning 100% clear and very short communications (which can be interpreted as being rude). Given the fact that the vast majority of our person to person communication is through body language and intonation, and through looking at the response of the other person's body language, and only a small part of is based on what we are actually saying, it is no surprise that communicating via the internet and building relationships via the internet is hard work and often fraught with misunderstandings. The internet's answer to this is sideways smiley faces and emoticons, which are often ambiguous in any case. The internet and internet-based communities often result in as much stress and aggravation as they do laughs and enjoyment for their members. That comes down to individual choice and how one chooses to use the mediums of communicatio available and whether or not one becomes a slave to them and relies excessively on them and replaces other forms of more personal communication with them. Even creating one's own personal web site is a form of narcissism and ego-oriented activity to an extent, seeking significance and connection, depending on what the content is or purpose of the site is to some degree, even something like this web site.

Our stressed response to a perceived bad, stressful or annoying situation won't prevent it happening again, won't prevent the vividly visualised negative potential outcome and won't reduce the event. For example, becoming stressed behind the wheel of the car is not going to speed up the slow driver in front or cause the queue we are stuck in to move more quickly, even though our ego thinks it can help by interfering and trying to control the situation in its own way. We have to just accept that situations that are beyond our control are just that, people are as they are and that not everyone is fortunate to be gifted with good parents, a good education and to have control of their own life or mind. Many people aren't really there, they are just on auto-pilot, running a set of learned behaviours and replicating their patterns amongst their friends and the next generation. Get over it! If people aren't as educated or considerate, haven't had the same life experiences or lessons that you have, you can't expect them to behave the same way as you or share the same values. Often we feel that we must react to something or be offended by something rather than just letting it pass and taking very little interest in it. If you do want to react in a small way, you might choose to find it amusing. Judging the other person as stupid or as an idiot or not as good as you however will not serve any positive purpose and will only serve to reinforce your own demanding values and high standards which can never all be met. Often we may break our own rules when we are in a hurry or 'stressed', but conveniently forget this and not consider it important or relevant, but react strongly when others do the same thing. We are not perfect. Nor is anyone else. We have to forgive ourselves as well as others for moments of poor behaviour or loss of judgement.

Our values often dictate that we have a right to feel stressed or that we are justified in feeling stressed or anxious in response to certain inputs or stimuli or situations. These criteria are of course arbitrary. We often establish very loose criteria for feeling stressed but very hard to fulfil criteria for allowing ourselves to feel good. Indeed, sometimes when a number of small external triggers occur, being nothing in particular, we may become stressed and feel that there was a good reason for feeling this stressed, that something big must have occurred, however, if we search our minds, we cannot actually find anything, but a series of small minor irritations. However, if we do not question why we have become stressed in this manner, our brain tends to not want to focus on the cause, but on the ego-pleasing stressed state, which is what it really wanted, in order to feel acknowledged, significant or to feel 'close' to oneself. It is useful after the event to analyse the triggers that made up feel stressed and ask ourselves whether it was really worth it or not, and whether the situation was responded to in a disproportionate manner or not. If we feel a build up on expectations, tasks or chores, then sometimes we have 'become stressed' or decide to be stressed, as a form of protest and so we can feel like a victim, rather than just getting on with it, taking it like a 'man', and not making a fuss. The fuss often requires more energy that the actual business of action and completing the given tasks in any case. We could also view the tasks and whether they are really that important and require our immediate attention, and prioritise them etc.; rather than feeling that each task must be 'neurotically' dealt with immediately. We are allowedt o have open-ended issues and feel relaxed and comfortable with them too. If we do not try to feel relaxed about it, and seek to complete the tasks in order to relax, we avoid dealing with this problem or attitude. From a Feng Shui perspective it is good to resolve your personal affairs, but certainly not in an addictive manner, and we shouldn't feel bad about something that has not been completed. This is a negative trait of the Blue Personality Type (according to the book 'The Color Code'). If we can analyse what we have left 'open' and how much stress it is actually causing (which is sometimes not something we are consciously aware of until it is completed or removed), then we can work on our attitude towards it.

So when you perceive an external stress 'trigger', and the response (based on the belief system/value conflict) the brain looks for in the belief filing system and presents to you, don't just accept it and go with it! You have no doubt gone with it and become angry, frustrated, mildly irritated or stressed many times before and it likely did you no good at all. So why are we keen to do it again? And again? 1000s or 10,000s of times? Your brain is presenting you with a conflict of input vs library, which can be quite useful depending on the context. It is up to you to be aware of the conflict/offer of information and to press the 'yes I'm going to go along with the stress/anger/value response that is being presented' or the 'thanks for the information, but no I'm not interested' button. We very often just press the yes button without realising we have done it and that there was even a no button or a choice. But the no button is indeed there! Why do we so often go along with the stress response and hit the yes button? Well, it's a bad habit, learned behaviour. The more you do it, the more you do it automatically and without being aware of it. Your ability or rather the concentration required to press the no button will get easier the more you do it. You will unlearn your previous pattern and replace it with a more empowering alternative response. i.e. no response.

It is a bit like the dream you may have had where a sick serial killer drives past you, and stops. You know he's a sick killer and he asks you to step inside and come for a ride. 'Wanna come for a ride kid???' You know he is a sick killer, yet you say yes and get in the car. And he stabs you many times. And then you say to yourself, 'why did I do that? Why did I get in the car with him?! I knew what would happen and that it would be very bad!!!' Suddenly you aren't dead, and the same guy pulls up in his car. This time he has slime on his face. He asks you again. 'Wanna come for a ride kid???' And you say yes. Keep repeating this over and over. If the outcome was fun and attractive, yet occasionally fatal, then you might take a chance, but if the outcome is always disasterous, then why go along with it! You don't have to! Maybe in this dream one might consider saying 'No! Get the [insert option expletive] out of here!'. So go back to the value conflict situation. The outcome makes you feel bad, annoyed, unwell, so let's not choose that option! Especially in Chronic Fatigue Syndrome patients, as examined in the Health Section, a bad stress response may cause fatigue, inability to relax and feelings of impending doom for days or weeks on end in worst case scenario. Let's go for the 'so what' option. It is there and waiting for you to choose it. Don't be shy! The irony is with a value conflict situation is that we beat ourselves up about it, about why we should have stood up for ourselves, should have said something and put the person in their place and 'corrected their behaviour' or 'punished them'. But we never get angry about the fact that we chose the stress response to the situation. We blame the situation. Or our lack of action. Perhaps we should start questioning why we reacted the way we did and get angry at all. And get annoyed about that!! This is often invisible to us however, because of ingrained patterns of behaviour (auto-pilot). It is usually wise not to live one's life in auto-pilot as it is not emotionally rewarding. We are never free. We are never really us. It's not really being alive! So remember, if you want to stop yourself going on the rollercoaster ride of stress response, you need to be aware of the trigger events, why they cause a value conflict (i.e. you need to be honest with yourself about the core values they conflict with), and to scrub out these values and replace them with empowering values.

In addition, we may have just built up negative mental associations with particular people or events because of a number of stressful experiences with that person or event. That should mean we need to have that response again when we come across that person or event. However, it becomes an 'automatic conditioned response', which we must interrupt (or press the 'NO' button to), and uncondition, and condition another more productive and positive response. This can be done by thinking of a happy situation or feeling or amusing or ironic/tongue in cheek thought about that person/situation, then quickly switching to person's face or event back and forth again and again. The latter method takes the power out of the event/person and the seriousness with which we regard it and have come to associate with it. This helps to 'scrub' the association.

The moment where we can choose whether to respond to a 'stressor' or trigger is a moment of choice. However, where we are so conditioned to response adversely to it, it is almost no longer a choice, or a very limited choice. The brain may try to hide the fact that it is indeed a choice. If we are able to interrupt the pattern or the stress response, and psychologically take a step back from the stressful emotional state, negative thought or desire to become stressed, then we are in a sense in a position of choice. We can see two forks ahead of us, one is going back to negative thoughts and self-loathing, the fight or flight response, and the other side is a relaxed, positive and empowering way forward. The natural tendency is for the mind to revert back to its original or 'normal' state, which may be a stressed state, as although we may not enjoy it, it is what the mind has been conditioned to do. The more we interrupt the pattern and the strong urge to respond stressfully to that trigger or triggers, the more that elastic cord pulling us back to an undesirable emotional state will be weakened. Like scratching up an old record so it can't play any more. We also need to work on consciously relaxing and dissociating from the situation and to envisage an empowered and positive future path forwards, in other to reinforce this positive habit and way of being. When we have no internal or external stress triggers, we may find ourselves starting to fill our minds with conscious distracts or garbage, which may be a direct or indirect path back to the stressful state again. Perhaps the mind is disguising or presenting these distractions as 'innocuous'. But if you dont' make an effort to keep reinforcing your relaxed state and conditioning it further and further, so it is a habit, your mind will over time revert back to its old habit. However, the more you break the negative habit and reinforce the positive, the easier it gets and the better you feel. It just gets easier and better as you go along! The hardest part is to get started. But don't lose that motivation. It is easy to settle for mediocre, as we've lost all our milestones and goals, and the less painful our situation is, the less motivated we may become to strive for excellence. This is however often a slippery slope back down to the bottom.

The stress response in response to non-life threatening situations is a form of self-sabotage and prevents one from experiencing the here and now and from experiencing normal relaxation and even full health.

Some of the stress disorders described below are a result of a single traumatic event, creating a severe fight or flight response which a person may end up stuck in or may find themselves dragged back into depending on certain triggers. In other cases it may be a gradual build up of anxiety over time, one anxiety fuelling another and taking over the conscious mind so that the compartments of anxiety grow bigger and gradually take over one's whole conscious experience without the mind noticing. Some stressed individuals who have been stressed since early childhood may not necessarily be so because they are 'stressed personalities'. Some people assume that stress for some people is set in stone and is an inextricable part of their personality. This is not correct. There are certain negative potential characteristics with every personality type. However, those who are 'more sensitive' or more highly strung may just be that way because of a lack of encouragement/support/reassurance/explanation and/or bullying influences which over time results in an individual always feeling slightly insecure or nervous, i.e. being entrained and stuck in a minor fight or flight mode continuously. Some never fully get over this and remain like this their entire lives. Such individuals usually have worse health than their more relaxed peers.

Pattern interrupts are a great way to stop a destructive or unwanted addictive behaviour in its tracks. The more we apply it, the harder it is to repeat the pattern. And indeed, brainstorming our core beliefs and addressing those that fuel our destructive negative behaviours will indeed help to reduce our unwanted behaviours and unwanted things we focus on even more. As will EFT. However, with certain types of pattern, those are we do in response to something, for example stress, it is often more effective to actually stop the response actually happening rather than interrupting the pattern once it has taken hold of us.

Emotional Freedom Technique (EFT) can greatly assist in removing the negative beliefs that cause us to get caught up in a stress response to a situation and also interrupting the constant background stress that we have a result of these negative beliefs (e.g. lack of confidence is based upon negative beliefs, not just the lack of positive beliefs). It is an important tool and will help to put us into a position where we can 'press the no button' more easily.

Stress in a sense is a positive thing. It is life providing you with feedback that you have a core belief in a particular area that perhaps needs fine tuning, whether it be your fear of a consequence or potential outcome, or your anger over an event or experience. Clearly the stress is telling you something useful. Often we think we know what our core beliefs are, but stress over a particular event or situation will bring to our attention an attitude perhaps we don't give much attention but which causes us unnecessary aggravation.

The exact physiological effect of the external stimuli on a person is determined to a large extent, if not completely, by the filters we have in place. Everyone filters information otherwise the brain would be overloaded continuously. Are you aware of every sensation in every part of your body, whilst at the same time aware of the position of every object in a room, the exact texture, colour of these objects, the shadows in a room, every tiny little different sound, all smells, the body language of every person in the room? Probably not! Filters work on different situations in different ways, and we may filter out background noise or interruptions very well in one scenario, but extremely poorly in another. We may be addicted to listening to every conversation we can hear around us or every event around us and become annoyed or stressed by it. For example, some people can happily concentrate on studying or reading in a noisy room or environment, whereas others feel compelled to listen to every external sound rather than filter it out and focus on their book, becoming more and more stressed in the process. It is as if we are super-sensitive to certain sounds or inputs more than others, as if the volume switch on the microphone is switched up to maximum for certain types of sound or input, playing so loudly in our heads that it blots out everything else. Part of the problem is not concentrating enough on/immersed in what we are currently doing or easily affected when we are relaxed. It is up to us to work on our filters, to remove those that aren't useful, that stop us appreciating the beauty of the world around us and also work on filters that stop us becoming stressed by events around us. This is partly achieved through working on beliefs. But partly through practice and mental discipline. Managing filters is a core part of NLP theory.

It is no use simply telling yourself that you will relax eventually and allowing the stressed pattern to continue in your behaviour, mind and body. Relaxation is not about waiting for your physiology and nervous system to calm down and then relaxing with it when it does so (if it ever does so). Relaxation is a proactive approach. To relax to have to proactively do the things that relaxed people do. To act the way relaxed people act, and your nervous system will follow. The mind likes congruency and if you fake an emotion, the mind usually follows and makes that become a real experience. This is why feigning confidence can eventually result in real confidence, and feigning relaxation can eventually result in relaxation. The purpose of having a conscious mind and independent thought is to regulate and manage your own mind and body and affairs. Thus if you are stressed or unable to relax or calm down fully, then you need to cultivate this yourself. Slow things down, slow down your breathing and think in a relaxed manner or at least try to emulate these things. This will trickle down into your belief systems which will slowly adapt to your new behaviours. If you don't do this, your desired goal may never arrive. Too many people passively ride the way of their minds or nervous systems and wait for confidence to come out of nowhere, or happiness or relaxation to come to them, whilst they sit on the metaphorical mental 'asses' and do nothing to help achieve the goal. However, this does not take into account the way the ego and addictive patterns of stress do everything they can to keep their hold over you, putting you through auto-pilot type patterns of thought of behaviour and losing you your mental freedom and objectivity, and perception of the here and now. You cannot trust your addictive ego stress to release its hold and allow you to relax. Passivity is not an option and rarely works. You have to proactively shape your present and future if you want to get what you want in life.

The effects of our possessions, working and living spaces and how they are organised or how cluttered they are can exert a subtle psychological stress effect on the subconscious, which is only partially consciously acknowledged in many cases. A simple de-cluttering of our lives can have a huge impact on lowering our constant background stress levels.

back to top

 
Anxiety Disorders:

Building on the brief discussion of stress and anxiety above, there are more complicated and deep rooted types of anxiety, which are chronic and debilitating in nature, with severe physical symptoms, which are recognised in the medical and psychiatric community. These disorders are thought to develop from a complex set of factors including personality type, life events, the formation of beliefs and neurological associations between a trigger and an emotional state, brain chemistry and even perhaps genetics. An estimated 40 million adult Americans suffer from anxiety disorders. They are the most common psychiatric illnesses affecting children and adults. Anxiety disorders are highly treatable, yet only about one-third of those suffering from an anxiety disorder receive treatment (some of which is inappropriate and purely drug based).

I will not discuss conventional treatment (alleviation of symptoms) methods for these, but is merely intended to look at some of these categories and definitions, which may apply to some of the other areas on this site. Some readers, including myself, may well recognise elements of some of these anxiety disorders in their own psyche. Virtually all people suffer from stress and anxiety to some degree in their lives, and these anxiety disorders listed below are not binary, or 'on and off' but can develop quickly or over many years and their analysis may shed light on our own stress and anxiety.

http://en.wikipedia.org/wiki/Anxiety_disorder

back to top

 
Generalised Anxiety Disorder (GAD):

http://en.wikipedia.org/wiki/Generalized_anxiety_disorder

'Generalized anxiety disorder (GAD) is an anxiety disorder that is characterized by excessive, uncontrollable and often irrational worry about everyday things that is disproportionate to the actual source of worry. This excessive worry often interferes with daily functioning, as individuals suffering GAD typically catastrophise, anticipate disaster, and are overly concerned about everyday matters such as health issues, money, family problems, friend problems or work difficulties. They often exhibit a variety of physical symptoms, including fatigue, headaches, nausea, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, insomnia, and hot flashes. These symptoms must be consistent and on-going, persisting at least 6 months, for a formal diagnosis of GAD to be introduced. Approximately 6.8 million American adults experience GAD.

According to the Diagnostic and Statistical Manual IV-Text Revision (DSM-IV-TR), the following criteria must be met for a person to be diagnosed with Generalized Anxiety Disorder.
- Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about a number of events or activities (such as work or school performance).
- The person finds it difficult to control the worry.
- The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children.
a) restlessness or feeling keyed up or on edge
b) being easily fatigued
c) irritability
d) muscle tension
e) difficulty falling or staying asleep, or restless unsatisfying sleep
f) difficulty concentrating or the mind going blank

Symptoms can also include nausea, vomiting, and chronic stomach aches.
- The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a panic attack (as in panic disorder), being embarrassed in public (as in social phobia), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in anorexia nervosa), having multiple physical complaints (as in somatization disorder), or having a serious illness (as in hypochondriasis), and the anxiety and worry do not occur exclusively during post-traumatic stress disorder.
- The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.

The World Health Organization's Global Burden of Disease project did not include generalised anxiety disorders.[3] In lieu of global statistics, here are some prevalence rates from around the world:
- Australia: 3 percent of adults:
- Canada: Between 3-5 percent of adults
- Italy: 2.9 percent
- Taiwan: 0.4 percent
- United States: approx. 3.1 percent of people age 18 and over in a given year (6.8 million)

The usual age of onset is variable - from childhood to late adulthood. Women are two to three times more likely to suffer from generalized anxiety disorder than men.'

back to top

 
Panic Disorder:

http://en.wikipedia.org/wiki/Panic_disorder

'Panic Disorder is a psychological condition characterized by recurring panic attacks in combination with significant behavioral change lasting at least a month, and of ongoing worry about the implications or concern about having other attacks. The latter is called Anticipatory Attacks(DSM-IVR).'

Panic Disorder sufferers usually have a series of intense episodes of extreme anxiety during panic attacks. These attacks typically last about ten minutes, but can be as short-lived as 1Ð5 minutes and last as long as twenty minutes or until medical intervention. However, attacks can wax and wane for a period of hours Ñ panic attack rolling into another. They may vary in intensity and specific symptoms of panic over the duration (i.e. rapid heartbeat, perspiration, dizziness, dyspnea, trembling, psychological experience of uncontrollable fear, hyperventilation, etc.). Some individuals deal with these events on a regular basis; sometimes daily or weekly. The outward symptoms of a panic attack often cause negative social experiences (i.e. embarrassment, social stigma, social isolation, etc.). However, experienced sufferers can often have intense panic attacks with very little outward manifestations of the attack occurring. As many as 36% of all individuals with Panic Disorder also have agoraphobia. Limited symptom attacks are similar to panic attacks, but have fewer symptoms. Most people with PD experience both panic attacks and limited symptom attacks.

Panic Disorder is a serious health problem but can be successfully treated. It is estimated that up to 1.7 percent of the adult American population has Panic Disorder at some point in their lives. It typically strikes in early adulthood; roughly half of all people who have Panic Disorder develop the condition before age 24, especially if the person has been subjected to a traumatic experience. However, some sources say that the majority of young people affected for the first time are between the ages of 25 and 30. Women are twice as likely as men to develop Panic Disorder.

Panic Disorder can continue for months or even years, depending on how and when treatment is sought. If left untreated, it may worsen to the point where the person's life is seriously affected by panic attacks and by attempts to avoid or conceal the condition. In fact, many people have had problems with friends and family or employment while struggling to cope with Panic Disorder. Some people with Panic Disorder may begin to lie to conceal their condition. In some individuals symptoms may occur frequently for a period of months or years, then many years may pass symptom-free. In others, the symptoms persist at the same level indefinitely. There is also some evidence that many individuals (especially those who develop symptoms at an early age) may experience a cessation of symptoms naturally later in life (i.e. past age 50).

A growing body of evidence exists that shows a link between substance abuse and panic disorder. Several studies have found that cigarette smoking increases the risk of panic attacks and Panic Disorder in young people.[2][3] While the mechanism of how smoking increases panic attacks is not fully understood, a few hypotheses have been derived. Smoking cigarettes may lead to panic attacks by causing changes in respiratory function (e.g. feeling short of breath). These respiratory changes in turn can lead to the formation of panic attacks, as respiratory symptoms are a prominent feature of panic.[4][5] Respiratory abnormalities have been found in children with high levels of anxiety, which suggests that a person with these difficulties may be susceptible to panic attacks, and thus more likely to subsequently develop Panic Disorder. Nicotine is also a stimulant which could contribute to panic attacks.

back to top

 
Agoraphobia:

http://en.wikipedia.org/wiki/Agoraphobia

'Agoraphobia is an anxiety disorder, often precipitated by the fear of having a panic attack in a setting from which there is no easy means of escape. As a result, sufferers of agoraphobia may avoid public and/or unfamiliar places. In severe cases, the sufferer may become confined to their home, experiencing difficulty traveling from this "safe place." The word "agoraphobia" is an English adaptation of the Greek words agora and phobos, and literally translates to "a fear of the marketplace." Agoraphobia is a condition where the sufferer becomes anxious in environments that are unfamiliar or where he or she perceives that they have little control. Triggers for this anxiety may include crowds, wide open spaces or traveling, even short distances. This anxiety is often compounded by a fear of social embarrassment, as the agoraphobic fears the onset of a panic attack and appearing distraught in public. Agoraphobics may experience panic attacks in situations where they feel trapped, insecure, out of control or too far from their personal comfort zone. In severe cases, an agoraphobic may be confined to his or her home. Many people with agoraphobia are comfortable seeing visitors in a defined space they feel they can control. Such people may live for years without leaving their homes, while happily seeing visitors in and working from their personal safety zones. If the agoraphobic leaves his or her safety zone, they may experience a panic attack.

The one-year prevalence of agoraphobia in the United States is about 5 percent. According to the National Institute of Mental Health, approximately 3.2 million Americans ages 18-54 have agoraphobia at any given time. About one third of people with panic disorder progress to develop agoraphobia.

Agoraphobia occurs about twice as commonly among women as it does in men. The gender difference may be attributable to social-cultural factors that encourage, or permit, the greater expression of avoidant coping strategies by women. Other theories include the ideas that women are more likely to seek help and therefore be diagnosed, that men are more likely to abuse alcohol as a reaction to anxiety and be diagnosed as an alcoholic, and that traditional female sex roles prescribe women to react to anxiety by engaging in dependent and helpless behaviors.[6] Research results have not yet produced a single clear explanation as to the gender difference in agoraphobia.

There are a number of factors that contribute to the development of agoraphobia. These factors include:
-Family factors:
a) Having an anxious parent role model.
b) Being abused as a child.
c) Having an overly critical parent.
- Personality factors:
a) High need for approval.
b) High need for control.
c) Oversensitivity to emotional stimuli.
- Biological factors:
a) Oversensitivity to hormone changes.
b) Oversensitivity to physical stimuli.
c) High amounts of sodium lactate in the bloodstream.

Research has uncovered a linkage between agoraphobia and difficulties with spatial orientation. Normal individuals are able to maintain balance by combining information from their vestibular system, their visual system and their proprioceptive sense. A disproportionate number of agoraphobics have weak vestibular function and consequently rely more on visual or tactile signals. They may become disoriented when visual cues are sparse as in wide open spaces or overwhelming as in crowds. Likewise, they may be confused by sloping or irregular surfaces. Compared to controls, in virtual reality studies, agoraphobics on average show impaired processing of changing audiovisual data.

Attachment theory:
Some scholars have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base. Recent empirical research has also linked attachment and spatial theories of agoraphobia.

Spatial theory:
In the social sciences there is a perceived clinical bias in agoraphobia research. Branches of the social sciences, especially geography, have increasingly become interested in what may be thought of as a spatial phenomenon. One such approach links the development of agoraphobia with modernity.

Feminist theory:
Feminist scholars have applied feminist theory in an attempt to construct agoraphobia and other anxiety disorders as gendered issues. One such theory explains agoraphobia as a fear of the hysterical woman, meaning a fear of being perceived by others as overly feminine and out of control.

back to top

 
Phobias:

A phobia is often defined as a fear being out of proportion to the actual danger and results in a repeated and conditioned behavioural response to a given situation or perception of the possibility of that situation arising. The perception of danger can lead to genuine panic in sufferers. The various degrees of fear (mild fear to outright panic) often result in a person trying to avoid the object, situation or conditions which are perceived as potentially resulting in that situation.

Mind, the mental health charity, defines a phobia as 'an intense fear of a situation or an object that wouldn't normally worry other people'. There are estimated to be 10 million suffers in the UK (in 2006, according to the National Phobics Society), which is approximately 17% of the population! It is the 3rd most common psychiatric disorder, after depression and alcoholism. Some of the most common phobias in the UK (in 2006) were Social phobia (17%), Agoraphobia (9.9%), Vomit phobia (2.6%), Blushing phobia (1.2%), Driving phobia (11%).

Phobias usually develop in two main ways. After a negative experience, for example, an accident, mistake, unpleasant situation or crime, but they can also be learnt from peers, siblings and parents etc. e.g. if children see that their parents are afraid of heights, spiders, losing keys, getting wet, being seen to be wrong or making a mistake, afraid of next alcoholic binge, being mugged, etc. (this is why fears tend to run in families, and also within social groups); or by watching television or reading the tabloids.

Phobias in a sense act like a bully - if you give in to your phobia, it becomes reinforced and much worse the next time it is experienced; much like many other addictive, negative patterns of behaviour. It becomes a conditioned response that after time we may perceive as part of our identity and impossible to break. Breaking the cycle of the phobia requires addressing the flawed thinking that created it, addressing those core beliefs and reference points (the legs of a table) that keep those beliefs solid and stable. We need to work on questioning and breaking down these references or table legs, to bring the table crashing down! Most sufferers of phobias use the strategy of avoidance, as it seems like the best idea, i.e. avoiding those situations entirely, so that one does not have to experience the fear in the first place. However, this is hardly a 'cure', and it psychologically reinforces the phobia's belief that there is danger. Actively avoiding such situations is not the same as not having happened to have come across such a situation, and if it did occur, it would not be a big deal. It is important not to kid yourself here.

Often phobias are not what they seem. A phobia may be a symptom of an underlying fear, issue or insecurity or negative belief about oneself. A result of low self-esteem. We might not be aware of this underlying fear, but only those fears that affect us on a daily basis. We might call this a phobia shift or a fear shift. Working alone, with a friend or with a therapist to try to identify the underlying beliefs or phobias that are likely to be the root cause. Some might theorise that a fearful mindset or fight or flight type responses to lower level physical perceived threats or requirements not being met are the result of being lower down on Maslow's hierarchy of needs, which can prevent one from developing one's personality and self-actualising and expressing oneself on a higher level, i.e. meeting one's higher level needs as a mature being.

Clearly any phobia you have that is not a real physical danger is something that we as people must try to work on and remove, so that our minds can be free of their bullying and terror. To become calmer, more relaxed and rounded people and to allow for more full psychological and spiritual growth. Fears in one area tend to spread onto other areas, and even when the trigger for the fear is not present, one can in a sense 'feel' that restriction in one's personality/subconscious in the background constantly. A fear in one area is likely to reinforce fears in other unrelated areas, the overall effect being greater than the sum of the parts.

Examples of phobias or fear could include giving a presentation, complaining, being assertive with a certain person, e.g. a family member or colleague (the belief that you simply CANNOT say what you think with them, when in reality it is no big deal, and once they are used to it, they won't 'freak out' - if they expect you to be scared of being assertive, they will cement their position with you, until you change your position with them, when the balance simply readjusts).

http://en.wikipedia.org/wiki/Phobia

'Phobias (in the clinical meaning of the term) are the most common form of anxiety disorders. An American study by the National Institute of Mental Health (NIMH) found that between 8.7% and 18.1% of Americans suffer from phobias. Broken down by age and gender, the study found that phobias were the most common mental illness among women in all age groups and the second most common illness among men older than 25.

It is generally accepted that phobias arise from a combination of external events and internal predispositions. In a famous experiment, Martin Seligman used classical conditioning to establish phobias of snakes and flowers. The results of the experiment showed that it took far fewer shocks to create an adverse response to a picture of a snake than to a picture of a flower, leading to the conclusion that certain objects may have a genetic predisposition to being associated with fear. Many specific phobias can be traced back to a specific triggering event, usually a traumatic experience at an early age. Social phobias and agoraphobia have more complex causes that are not entirely known at this time. It is believed that heredity, genetics, and brain chemistry combine with life-experiences to play a major role in the development of anxiety disorders, phobias and panic attacks.

Phobia is also used in a non-medical sense for aversions of all sorts. These terms are usually constructed with the suffix -phobia. A number of these terms describe negative attitudes or prejudices towards the named subjects. See Non-clinical uses of the term below.

Phobias are more often than not linked to the amygdala, an area of the brain located behind the pituitary gland in the limbic system. The amygdala secretes hormones that control fear and aggression, and aids in the interpretation of this emotion in the facial expressions of others. When the fear or aggression response is initiated, the amygdala releases hormones into the body to put the human body into an "alert" state, in which they are ready to move, run, fight, etc. This defensive "alert" state and response is generally referred to in psychology as the Fight-or-flight response.

Most psychologists and psychiatrists classify most phobias into three categories:

- Social phobia, also known as social anxiety disorder - fears involving other people or social situations such as performance anxiety or fears of embarrassment by scrutiny of others, such as eating in public. Social phobia may be further subdivided into generalized social phobia, and specific social phobia, which are cases of anxiety triggered only in specific situations. The symptoms may extend to psychosomatic manifestation of physical problems. For example, sufferers of paruresis find it difficult or impossible to urinate in reduced levels of privacy. That goes beyond mere preference. If the condition triggers, the person physically cannot empty their bladder.

- Specific phobias - fear of a single specific panic trigger such as spiders, snakes, dogs, elevators, water, waves, flying, balloons, catching a specific illness, etc.

- Agoraphobia - a generalized fear of leaving home or a small familiar 'safe' area, and of possible panic attacks that might follow. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), social phobia, specific phobia, and agoraphobia are sub-groups of anxiety disorder. Many of the specific phobias, such as fear of dogs, heights, spiders and so forth, are extensions of fears that a lot of people have. People with these phobias specifically avoid the entity they fear. Phobias vary in severity among individuals. Some individuals can simply avoid the subject of their fear and suffer only relatively mild anxiety over that fear. Others suffer fully-fledged panic attacks with all the associated disabling symptoms. Most individuals understand that they are suffering from an irrational fear, but are powerless to override their initial panic reaction.

Severe fears are present in about 10-15% of children and specific phobias are found in about 5% of children. Children with specific phobias experience an intense fear of an object or situation that does not go away easily and continues for an extended period of time. Children often have specific phobias of the dark, varieties of insects, spiders, bees, heights, water, choking, snakes, dogs, birds, and other animals. For many children, these fears and phobias interfere with their participation in and enjoyment of various activities. It may also interfere with their education, family life, or their social life. However, effective treatment is available for children who experience phobias.

back to top

 
Social Anxiety Disorder (SAD):

http://en.wikipedia.org/wiki/Social_Anxiety_Disorder

Social phobia (DSM-IV 300.23), also known as social anxiety disorder (DSM-IV 300.23) is a diagnosis within psychiatry and other mental health professions referring to excessive social anxiety (anxiety in social situations) causing abnormally considerable distress and impaired ability to function in at least some areas of daily life. The diagnosis can be of a specific disorder (when only some particular situations are feared) or a generalized disorder. Generalized social anxiety disorder typically involves a persistent, intense, and chronic fear of being judged by others and of potentially being embarrassed or humiliated by one's own actions. These fears can be triggered by perceived or actual scrutiny by others. While the fear of social interaction may be recognized by the person as excessive or unreasonable, considerable difficulty can be encountered overcoming it. Approximately 13.3 percent of the general population may meet criteria for social anxiety disorder at some point in their lifetime, according to the highest survey estimate, with the male to female ratio being 1:1.5. Physical symptoms often accompanying social anxiety disorder include excessive blushing, sweating (hyperhidrosis), trembling, palpitations, nausea, and stammering. Panic attacks may also occur under intense fear and discomfort. An early diagnosis may help in minimizing the symptoms and the development of additional problems such as depression. Some sufferers may use alcohol or other drugs to reduce fears and inhibitions at social events. It is very common for sufferers of social phobia to self-medicate in this fashion, especially if they are undiagnosed and/or untreated. This can lead to alcoholism or other kind of substance abuse....

In cognitive models of Social Anxiety Disorder, social phobics experience dread over how they will be presented to others. They may be overly self-conscious, pay high self-attention after the activity, or have high performance standards for themselves. According to the social psychology theory of self-presentation, a sufferer attempts to create a well-mannered impression on others but believes he or she is unable to do so. Many times, prior to the potentially anxiety-provoking social situation, sufferers may deliberate over what could go wrong and how to deal with each unexpected case. After the event, they may have the perception they performed unsatisfactorily. Consequently, they will review anything that may have possibly been abnormal or embarrassing. These thoughts do not just terminate soon after the encounter, but may extend for weeks or longer. Those with social phobia tend to interpret neutral or ambiguous conversations with a negative outlook and many studies suggest that socially anxious individuals remember more negative memories than those less distressed. An example of an instance may be that of an employee presenting to his co-workers. During the presentation, the person may stutter a word upon which he or she may worry that other people significantly noticed and think that he or she is a terrible presenter. This cognitive thought propels further anxiety which may lead to further stuttering, sweating and a possible panic attack.

Social anxiety disorder is a persistent fear of one or more situations in which the person is exposed to possible scrutiny by others and fears that he or she may do something or act in a way that will be humiliating or embarrassing. It exceeds normal "shyness" as it leads to excessive social avoidance and substantial social or occupational impairment. Feared activities may include almost any type of social interaction, especially small groups, dating, parties, talking to strangers, restaurants, etc. Physical symptoms include "mind going blank", fast heartbeat, blushing, stomach ache. Cognitive distortions are a hallmark, and learned about in CBT (cognitive-behavioral therapy). Thoughts are often self-defeating and inaccurate.

The groundless fear of the telephone is typical, both calling somebody and answering the phone. It may appear early in childhood. According to psychologist B.F. Skinner, phobias are controlled by escape and avoidance behaviors. For instance, a student may leave the room when talking in front of the class (escape) and refrain from doing verbal presentations because of the previously encountered anxiety attack (avoid). Minor avoidance behaviors are exposed when a person avoids eye contact and crosses arms to avoid recognizable shaking. A fight-or-flight response is then triggered in such events. Preventing these automatic responses is at the core of treatment for social anxiety.

Physiological effects, similar to those in other anxiety disorders, are present in social phobics. Faced with an uncomfortable situation, children with social anxiety may display tantrums, weeping, clinging to parents, and shutting themselves out. In adults, it may be tears as well as experiencing excessive sweating, nausea, shaking, and palpitations as a result of the fight-or-flight response. The walk disturbance may appear, especially when passing a group of people. Blushing is commonly exhibited by individuals suffering from social phobia.[5] These visible symptoms further reinforce the anxiety in the presence of others. A 2006 study found that the area of the brain called the amygdala, part of the limbic system, is hyperactive when patients are shown threatening faces or confronted with frightening situations. They found that patients with more severe social phobia showed a correlation with the increased response in the amygdala.

There is a high degree of comorbidity with other psychiatric disorders. Social phobia often occurs alongside low self-esteem and clinical depression, due to lack of personal relationships and long periods of isolation from avoiding social situations. To try to reduce their anxiety and alleviate depression, people with social phobia may use alcohol or other drugs, which can lead to substance abuse. It is estimated that one-fifth of patients with social anxiety disorder also suffer from alcohol dependence. The most common complementary psychiatric condition is unipolar depression. In a sample of 14,263 people, of the 2.4 percent of persons diagnosed with social phobia, 16.6 percent also met the criteria for clinical depression. Besides depression, the most common disorders diagnosed in patients with social phobia are panic disorder (33 percent), generalized anxiety disorder (19 percent), post-traumatic stress disorder (36 percent), substance abuse disorder (18 percent), and attempted suicide (23 percent). In one study of social anxiety disorder patients who developed comorbid alcoholism, panic disorder or depression, social anxiety disorder preceded the onset of alcoholism, panic disorder and depression in 75 percent, 61 percent, and 90 percent of patients, respectively. Avoidant personality disorder is also highly correlated with social phobia. Because of its close relationship and overlapping symptoms with other illnesses, treating social phobics may help understand underlying connection in other psychiatric disorders. There is research indicating that social anxiety disorder is often correlated with bipolar disorder. Some researchers believe they share an underlying cyclothymic-anxious-sensitive disposition. In addition, studies show that more socially phobic patients treated with anti-depressant medication develop hypomania than non-phobic controls, although this can be seen as the medication creating a new problem, and also has this adverse effect in a proportion of those without social phobia.

Research into the causes of social anxiety and social phobia is wide-ranging, encompassing multiple perspectives from neuroscience to sociology. Scientists have yet to pinpoint the exact causes. Studies suggest that genetics can play a part in combination with environmental factors.

It has been shown that there is a two to threefold greater risk of having social phobia if a first-degree relative also has the disorder. This could be due to genetics and/or due to children acquiring social fears and avoidance through processes of observational learning or parental psychosocial education. Studies of identical twins brought up (via adoption) in different families have indicated that, if one twin developed social anxiety disorder, then the other was between 30 percent and 50 percent more likely than average to also develop the disorder. To some extent this 'heritability' may not be specific - for example, studies have found that if a parent has any kind of anxiety disorder or clinical depression, then a child is somewhat more likely to develop an anxiety disorder or social phobia. Studies suggest that parents of those with social anxiety disorder tend to be more socially isolated themselves (Bruch and Heimberg, 1994; Caster et al, 1999), and shyness in adoptive parents is significantly correlated with shyness in adopted children (Daniels and Plomin, 1985); Adolescents who were rated as having an insecure (anxious-ambivalent) attachment with their mother as infants were twice as likely to develop anxiety disorders by late adolescence, including social phobia. A related line of research has investigated 'behavioural inhibition' in infants Ð early signs of an inhibited and introspective or fearful nature. Studies have shown that around 10-15 percent of individuals show this early temperament, which appears to be partly due to genetics. Some continue to show this trait in to adolescence and adulthood, and appear to be more likely to develop social anxiety disorder.

A previous negative social experience can be a trigger to social phobia. perhaps particularly for individuals high in 'interpersonal sensitivity'. For around half of those diagnosed with social anxiety disorder, a specific traumatic or humiliating social event appears to be associated with the onset or worsening of the disorder; this kind of event appears to be particularly related to specific (performance) social phobia, for example regarding public speaking (Stemberg et al., 1995). As well as direct experiences, observing or hearing about the socially negative experiences of others (e.g. a faux pas committed by someone), or verbal warnings of social problems and dangers, may also make the development of a social anxiety disorder more likely. Social anxiety disorder may be caused by the longer-term effects of not fitting in, or being bullied, rejected or ignored (Beidel and Turner, 1998). Shy adolescents or avoidant adults have emphasised unpleasant experiences with peers or childhood bullying or harassment (Gilmartin, 1987). In one study, popularity was found to be negatively correlated with social anxiety, and children who were neglected by their peers reported higher social anxiety and fear of negative evaluation than other categories of children. Socially phobic children appear less likely to receive positive reactions from peers[37] and anxious or inhibited children may isolate themselves.

Cultural factors that have been related to social anxiety disorder include a society's attitude towards shyness and avoidance, affecting ability to form relationships or access employment or education. One study found that the effects of parenting are different depending on the culture - American children appear more likely to develop social anxiety disorder if their parents emphasize the importance of other's opinions and use shame as a disciplinary strategy (Leung et al., 1994), but this association was not found for Chinese/Chinese-American children. In China, research has indicated that shy-inhibited children are more accepted than their peers and more likely to be considered for leadership and considered competent, in contrast to the findings in Western countries. Purely demographic variables may also play a role - for example there are possibly lower rates of social anxiety disorder in Mediterranean countries and higher rates in Scandinavian countries, and it has been hypothesised that hot weather and high-density may reduce avoidance and increase interpersonal contact.

Problems in developing social skills, or 'social effectiveness', may be a cause of some social anxiety disorder, through either inability or lack of confidence to interact socially and gain positive reactions and acceptance from others. The studies have been mixed, however, with some studies not finding significant problems in social skills while others have. What does seem clear is that the socially anxious perceive their own social skills to be low. It may be that the increasing need for sophisticated social skills in forming relationships or careers, and an emphasis on assertiveness and competitiveness, is making social anxiety problems more common, at least among the 'middle classes'. An interpersonal or media emphasis on 'normal' or 'attractive' personal characteristics has also been argued to fuel perfectionism and feelings of inferiority or insecurity regarding negative evaluation from others. The need for social acceptance or social standing has been elaborated in other lines of research relating to social anxiety.

A long-accepted evolutionary explanation of anxiety is that it reflects an in-built 'fight or flight' system, which errs on the side of safety. One line of research suggests that specific dispositions to monitor and react to social threats may have evolved, reflecting the vital and complex importance of social living and social rank in human ancestral environments. Charles Darwin originally wrote about the evolutionary basis of shyness and blushing, and modern evolutionary psychology and psychiatry also addresses social phobia in this context. It has been hypothesised that in modern day society these evolved tendencies can become more inappropriately activated and result in some of the cognitive 'distortions' or 'irrationalities' identified in cognitive-behavioural models and therapies.

Some scientists hypothesize that social phobia is related to an imbalance of the brain chemical serotonin. A recent study report increased Serotonin and Dopamine transporter binding in psychotropic medication-naive patients with Generalized Social Anxiety Disorder. Sociability is also closely tied to dopamine neurotransmission. Low D2 receptor binding is found in people with social anxiety. The efficacy of medications which affect serotonin and dopamine levels also indicates the role of these pathways. There is also increasing focus on other candidate transmitters, e.g. Norepinephrine, which may be over-active in social anxiety disorder, and the inhibitory transmitter GABA.

Individuals with social anxiety disorder have been found to have a hypersensitive amygdala, for example in relation to social threat cues (e.g. someone might be evaluating you negatively), angry or hostile faces, and while just waiting to give a speech.[48] Recent research has also indicated that another area of the brain, the 'Anterior cingulate cortex', which was already known to be involved in the experience of physical pain, also appears to be involved in the experience of 'social pain', for example perceiving group exclusion.

Research has indicated the role of 'core' or 'unconditional' negative beliefs (e.g. I am inept) and 'conditional' beliefs nearer to the surface (e.g. If I show myself, I will be rejected). They are thought to develop based on personality and adverse experiences and to be activated when the person feels under threat. One line of work has focused more specifically on the key role of self-presentational concerns. The resulting anxiety states are seen as interfering with social performance and the ability to concentrate on interaction, which in turn creates more social problems, which strengthens the negative schema. Also highlighted has been a high focus on and worry about anxiety symptoms themselves and how they might appear to others. A similar model emphasises the development of a distorted mental representation of their self and over-estimates of the likelihood and consequences of negative evaluation, and of the performance standards that others have. Such cognitive-behavioral models consider the role of negatively-biased memories of the past and the processes of rumination after an event, and fearful anticipation before it. Studies have also highlighted the role of subtle avoidance and defensive factors, and shown how attempts to avoid feared negative evaluations or use 'safety behaviours' (Clark & Wells, 1995) can make social interaction more difficult and the anxiety worse in the long run. This work has been influential in the development of Cognitive Behavioural Therapy for social anxiety disorder, which has been shown to have efficacy.'

back to top

 
Obsessive Compulsive Disorder (OCD):

http://en.wikipedia.org/wiki/Obsessive-compulsive_disorder

'Obsessive-compulsive disorder (OCD) is a chronic anxiety disorder most commonly characterized by obsessive, distressing, intrusive thoughts and related compulsions. Compulsions are tasks or "rituals" which attempt to neutralize the obsessions. OCD is distinguished from other types of anxiety, including the routine tension and stress that appear throughout life. The phrase "obsessive-compulsive" has become part of the English lexicon, and is often used in an informal or caricatured manner to describe someone who is meticulous, perfectionistic, absorbed in a cause, or otherwise fixated on something or someone. Although these signs are often present in OCD, a person who exhibits them does not necessarily have OCD, and may instead have obsessive-compulsive personality disorder (OCPD) or some other condition.

To be diagnosed with OCD, a person must have either obsessions or compulsions alone, or obsessions and compulsions, according to the DSM-IV-TR diagnostic criteria. The Quick Reference to the diagnostic criteria from DSM-IV-TR (2000) states six characteristics of obsessions and compulsions:

Obsessions:
- Recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress.
- The thoughts, impulses, or images are not simply excessive worries about real-life problems.
- The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action.
- The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind, and are not based in reality.

Compulsions:
- Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly.
- The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts are not actually connected to the issue, or they are excessive.
- In addition to these criteria, at some point during the course of the disorder, the individual must realize that his/her obsessions or compulsions are unreasonable or excessive. Moreover, the obsessions or compulsions must be time-consuming (taking up more than one hour per day), cause distress, or cause impairment in social, occupational, or school functioning. OCD often causes feelings similar to those of depression.

OCD manifests in a variety of forms. Studies have placed the prevalence between one and three percent, although the prevalence of clinically-recognized OCD is much lower, suggesting that many individuals with the disorder may not be diagnosed. The fact that many individuals do not seek treatment may be due in part to stigma associated with OCD. Another reason for not seeking treatment is because many sufferers of OCD do not realize that they have the condition.

The typical OCD sufferer performs tasks (or compulsions) to seek relief from obsession-related anxiety. To others, these tasks may appear odd and unnecessary. But for the sufferer, such tasks can feel critically important, and must be performed in particular ways to ward off dire consequences and to stop the stress from building up. Examples of these tasks are repeatedly checking that one's parked car has been locked before leaving it, turning lights on and off a set number of times before exiting a room, repeatedly washing hands at regular intervals throughout the day, touching objects a certain amount of times before leaving a room, or walking in a certain routine way. Physical symptoms may include those brought on from anxeties and unwanted thoughts, as well as tics or Parkinson's disease-like symptoms: rigidity, tremor, jerking arm movements, or involuntary movements of the limbs.

There are many other possible symptoms, and it is not necessary to display those described in the lists below to be considered as suffering from OCD. Formal diagnosis should be performed by a psychologist, a psychiatrist or psychoanalyst. OCD sufferers are aware that their thoughts and behavior are not rational, but they feel bound to comply with them to fend off feelings of panic or dread. Although everyone may experience unpleasant thoughts at one time or another, these are short-lived and fade away in time. For people with OCD, the thoughts are intrusive and persistent, and cause them great anxiety and distress.

A major subtype of the fear category is the fear of contamination:(see mysophobia); some sufferers may fear the presence of human body secretions such as saliva, blood, sweat, tears, vomit, or mucus, or excretions such as urine, semen or feces. Some OCD sufferers even fear that the soap they are using is contaminated. These anxiety-driven fears may cause a person to experience significant distress, which may make it difficult for a person with OCD to tolerate a workplace, venture into public locations, or conduct normal social relationships.

Symptoms related to performing tasks may include repeated hand washing or clearing of the throat; specific counting systems or counting of steps; doing repetitive actions -- more generally, this can involve an obsession with numbers or types of numbers (e.g., odd numbers). These obsessive behaviours can cause individuals to feel psychological distress, because they are very concerned about having "made mistakes" in the number of steps that they have taken, or the number of stairs on a staircase. For some people with OCD, these obsessive counting and re-counting tasks, along with the attendant anxiety and fear, can take hours of each day, which can make it hard for the person to fulfill their work, family, or social roles. In some cases, these behaviours can also cause adverse physical symptoms: people who obsessively wash their hands with antibacterial soap and hot water (to remove germs) can make their skin red and raw with dermatitis.

Intrusive thoughts are unwelcome, involuntary thoughts, images or unpleasant ideas that may become obsessions, are upsetting or distressing, and can be difficult to be free of and manage.[8] Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, usually falling into three categories: inappropriate aggressive thoughts, inappropriate sexual thoughts, or blasphemous religious thoughts.[9] Most people experience these thoughts; when they are associated with OCD or depression, they may become paralyzing, anxiety-provoking, and persistent. Many people experience the type of unpleasant or unwanted thoughts that people with more troubling intrusive thoughts have, but most people are able to dismiss these thoughts. When intrusive thoughts co-occur with OCD, patients are less able to ignore the unpleasant thoughts and may pay undue attention to them, causing the thoughts to become more frequent and distressing.

Intrusive thoughts may involve violent obsessions about hurting others or one's self. They can include such thoughts as harming an innocent child, jumping from a bridge, mountain or the top of a tall building, urges to jump in front of a train or automobile, and urges to push another in front of a train or automobile. A survey of healthy college students found that virtually all of them had intrusive thoughts from time to time, including [11] imagining or wishing harm upon a family member or friend, impulses to attack or kill a small child, or animal, or shout something rude or violent. A person with OCD may meet up with their best friend, to whom they bear no ill will, and an image of them stabbing their friend may "pop" into their head.

While some individuals with OCD who have these unwanted images pop into their minds are able to dismiss the images as random "static" generated by the mind, others are tormented by the thoughts, and they may worry that they are actual desires that they may act on, or that they are "going crazy." In some cases, the person struggling with these horrible images may try to deal with them by developing compulsions. For example, a person who is tormented by unwanted thoughts of them stabbing their mother with a kitchen knife may ensure that all kitchen knives are kept locked away, to prevent the perceived danger that they may "act upon" the horrible thoughts. The possibility that most patients suffering from intrusive thoughts will ever act on those thoughts is low; patients who are experiencing intense guilt, anxiety, shame, and upset over bad thoughts are different from those who actually act on bad thoughts. The history of violent crime is dominated by those who feel no guilt or remorse; the very fact that someone is tormented by intrusive thoughts, and has never acted on them before, is an excellent predictor that they won't act upon the thoughts. According to Baer, a patient should be concerned that intrusive thoughts are dangerous if the person doesn't feel upset by the thoughts, rather finds them pleasurable; has ever acted on violent or sexual thoughts or urges; hears voices or sees things that others don't see; or feels uncontrollable irresistible anger.

Sexual obsessions involve intrusive thoughts or images of "kissing, hugging a lot, touching, fondling, oral sex, anal sex, intercourse, and rape" with "strangers, acquaintances, parents, children, family members, friends, coworkers, animals and religious figures", involving "heterosexual or homosexual content" with persons of any age.[13] Like other intrusive, unpleasant thoughts or images, most people have some inappropriate sexual thoughts at times[citation needed], but people with OCD may attach significance to the unwanted sexual thoughts, generating anxiety and distress. The doubt that accompanies OCD leads to uncertainty regarding whether one might act on the bad thoughts, resulting in self-criticism or loathing.

One of the more common sexual intrusive thoughts occurs when an obsessive person doubts his or her sexual identity, a symptom of OCD called homosexuality anxiety or HOCD. As in the case of most sexual obsessions, sufferers may feel shame and live in isolation, finding it hard to discuss their fears, doubts, and concerns about their sexual identity. A person experiencing sexual intrusive thoughts may feel shame, "embarrassment, guilt, distress, torment, fear that you may act on the thought or perceived impulse and, doubt about whether you have already acted in such a way." Depression may be a result of the self-loathing that can occur, depending on how much the OCD interferes with daily functioning or causes distress. The possibility that most patients suffering from intrusive thoughts to sexually assault people will ever act on those thoughts is low; patients who are experiencing intense guilt, anxiety, shame, and upset over bad thoughts are different from those who actually act on bad thoughts.

OCD is often confused with the separate condition obsessive-compulsive personality disorder. The two are not the same condition, however. OCD is ego dystonic, meaning that the disorder is incompatible with the sufferer's self-concept. Because disorders that are ego dystonic go against an individual's perception of his/herself, they tend to cause much distress. OCPD, on the other hand, is ego syntonic Ñ marked by the individual's acceptance that the characteristics displayed as a result of this disorder are compatible with his/her self-image. Ego syntonic disorders understandably cause no distress. Persons suffering from OCD are often aware that their behavior is not rational and are unhappy about their obsessions but nevertheless feel compelled by them. Persons with OCPD are not aware of anything abnormal about themselves; they will readily explain why their actions are rational, and it is usually impossible to convince them otherwise. Persons with OCD are ridden with anxiety; persons who suffer from OCPD, by contrast, tend to derive pleasure from their obsessions or compulsions.[16] This is a significant difference between these disorders.

Equally frequently, these rationalizations do not apply to the overall behavior, but to each instance individually; for example, a person compulsively checking their front door may argue that the time taken and stress caused by one more check of the front door is considerably less than the time and stress associated with being robbed, and thus the check is the better option. In practice, after that check, the individual is still not sure, and it is still better in terms of time and stress to do one more check, and this reasoning can continue as long as necessary.

Some OCD sufferers exhibit what is known as overvalued ideas. In such cases, the person with OCD will truly be uncertain whether the fears that cause them to perform their compulsions are irrational or not. After some discussion, it is possible to convince the individual that their fears may be unfounded. It may be more difficult to do ERP therapy on such patients, because they may be, at least initially, unwilling to cooperate. For this reason OCD has often been likened to a disease of pathological doubt, in which the sufferer, while not usually delusional, is often unable to realize fully what sorts of dreaded events are reasonably possible and which are not.

OCD is different from behaviors such as gambling addiction and overeating. People with these disorders typically experience at least some pleasure from their activity; OCD sufferers do not actively want to perform their compulsive tasks, and experience no pleasure from doing so. OCD is placed in the anxiety class of mental illness, but like many chronic stress disorders it can lead to clinical depression over time. The constant stress of the condition can cause sufferers to develop a deadening of spirit, a numbing frustration, or sense of hopelessness. OCD's effects on day-to-day life Ñ particularly its substantial consumption of time Ñ can produce difficulties with work, finances and relationships. There is no known cure for OCD as of yet, but there are a number of successful treatment options available.

People with OCD may be diagnosed with other conditions, such as generalized anxiety disorder, anorexia nervosa, social anxiety disorder, bulimia nervosa, Tourette syndrome, asperger's syndrome, compulsive skin picking, body dysmorphic disorder, trichotillomania, and (as already mentioned) obsessive-compulsive personality disorder. There is some research demonstrating a link between drug addiction and OCD as well. Many who suffer from OCD suffer also from panic attacks. There is a higher risk of drug addiction among those with any anxiety disorder (possibly as a way of coping with the heightened levels of anxiety), but drug addiction among OCD patients may serve as a type of compulsive behavior and not just as a coping mechanism. Depression is also extremely prevalent among sufferers of OCD. One explanation for the high depression rate among OCD populations was posited by Mineka, Watson, and Clark (1998), who explained that people with OCD (or any other anxiety disorder) may feel depressed because of an "out of control" type of feeling.

Some cases are thought to be caused at least in part by childhood streptococcal infections and are termed PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). The streptococcal antibodies become involved in an autoimmune process. Though this idea is not set in stone, if it does prove to be true, there is cause to believe that OCD can to some very small extent be "caught" via exposure to strep throat (just as one may catch a cold). However, if OCD is caused by bacteria, this provides hope that antibiotics may eventually be used to treat or prevent it.

Scientists studying obsessive-compulsive disorder are split into two factions disagreeing over the illness's cause:

One side believes that obsessive-compulsive behavior is a psychological disorder; the other side thinks it has a neurological origin. From the 14th to the 16th century in Europe, it was believed that people who experienced blasphemous, sexual, or other obsessive thoughts were possessed by the Devil. Based on this reasoning, treatment involved banishing the "evil" from the "possessed" person through exorcism.[19] In the early 1910s, Sigmund Freud attributed obsessive-compulsive behavior to unconscious conflicts which manifested as symptoms.[19] Freud describes the clinical history of a typical case of "touching phobia" as starting in early childhood, when the person has a strong desire to touch an item. In response, the person develops an "external prohibition" against this type of touching. However, this "prohibition does not succeed in abolishing" the desire to touch; all it can do is repress the desire and "force it into the unconscious".

The cognitive-behavioral model suggests that the behaviour is carried out to remove anxiety-provoking intrusive thoughts. Unfortunately this only brings about temporary relief as the thought re-emerges. Each time the behaviour occurs it is negatively reinforced (see Reinforcement) by the relief from anxiety, thereby explaining why the dysfunctional activity increases and generalises (extends to other, related stimuli) over a period of time. For example, after touching a door-knob a person might have the thought that they may develop a disease as a result of contamination. They then experience anxiety, which is relieved when they wash their hands. This might be followed by the thought "but did I wash them properly?" causing an increase in anxiety once more, the hand-washing once again rewarded by the removal of anxiety (albeit briefly) and the cycle being repeated when thoughts of contamination re-occur. The distressing thoughts might then spread to fear of contamination from e.g. a chair (someone might have touched the chair after touching the door handle).

There are many different theories about the cause of obsessive-compulsive disorder. The majority of researchers believe that there is some type of abnormality with the neurotransmitter serotonin, among other possible psychological or biological abnormalities; however, it is possible that this activity is the brain's response to OCD, and not its cause. Serotonin is thought to have a role in regulating anxiety, though it is also thought to be involved in such processes as sleep and memory function. In order to send chemical messages, serotonin must bind to the receptor sites located on the neighboring nerve cell. It is hypothesized that OCD sufferers may have blocked or damaged receptor sites that prevent serotonin from functioning to its full potential'.

back to top

 
Post-Traumatic Stress Disorder (PTSD):

http://en.wikipedia.org/wiki/Post-traumatic_stress_disorder

Post traumatic stress disorder (PTSD) is an anxiety disorder that can develop after exposure to one or more terrifying events that threatened or caused grave physical harm. It is a severe and ongoing emotional reaction to an extreme psychological trauma. This stressor may involve someone's actual death, a threat to the patient's or someone else's life, serious physical injury, or threat to physical or psychological integrity, overwhelming usual psychological defenses coping. In some cases it can also be from profound psychological and emotional trauma, apart from any actual physical harm. Often, however, the two are combined. PTSD is a condition distinct from traumatic stress, which has less intensity and duration, and combat stress reaction, which is transitory. PTSD has also been recognized in the past as railway spine, shell shock, traumatic war neurosis, or post-traumatic stress syndrome (PTSS).

PTSD is believed to be caused by psychological trauma Possible sources of trauma includes experiencing or witnessing childhood or adult physical, emotional or sexual abuse. In addition, experiencing or witnessing an event perceived as life-threatening such as physical assault, adult experiences of sexual assault, accidents, drug addiction, illnesses, medical complications, or the experience of, or employment in occupations exposed to war (such as soldiers) or disaster (such as emergency service workers). Traumatic events that may cause PTSD symptoms to develop include violent assault, kidnapping, torture, being a hostage, prisoner of war or concentration camp victim, experiencing a disaster, bad car accidents or getting a diagnosis of a life-threatening illness. Children may develop PTSD symptoms by experiencing sexually traumatic events like age-inappropriate sexual experiences. Witnessing traumatic experiences or learning about these experiences may also cause the development of PTSD symptoms. The amount of dissociation that follows directly after a trauma predicts PTSD. Individuals who are more likely to dissociate during a traumatic event are considerably more likely to develop chronic PTSD. Many servicemen and women returning from Iraq and Afghanistan have PTSD. The diagnosed cases of PTSD in United States troops sent to either Afghanistan or Iraq rose 46.4 percent in 2007, bringing the five year total to almost 40,000 (from U.S. military data). Members of the Marines and Army are much more likely to develop PTSD than Air Force and Navy personnel, because of greater exposure to combat. A preliminary study found that mutations in a stress-related gene interact with child abuse to increase the risk of PTSD in adults.

PTSD displays biochemical changes in the brain and body that differ from other psychiatric disorders such as major depression. Individuals diagnosed with PTSD respond more strongly to a dexamethasone suppression test than individuals diagnosed with clinical depression.[citation needed] In addition, most PTSD also show a low secretion of cortisol and high secretion of catecholamine in urine, with a norepinephrine/cortisol ratio consequently higher than comparable non-diagnosed individuals. This is in contrast to the normative fight-or-flight response, in which both catecholamine and cortisol levels are elevated after exposure to a stressor. Brain catecholamine levels are low,[citation needed] and corticotropin-releasing factor (CRF) concentrations are high. Together, these findings suggest abnormality in the hypothalamic-pituitary-adrenal axis (HPA). Given the strong cortisol suppression to dexamethasone in PTSD, HPA axis abnormalities are likely predicated on strong negative feedback inhibition of cortisol, itself likely due to an increased sensitivity of glucocorticoid receptors. Some researchers have associated the response to stress in PTSD with long-term exposure to high levels of norepinephrine and low levels of cortisol, a pattern associated with improved learning in animals. Translating this reaction to human conditions gives a pathophysiological explanation for PTSD by a maladaptive learning pathway to fear response through a hypersensitive, hyperreactive and hyperresponsive HPA axis.

Low cortisol levels may predispose individuals to PTSD; following war trauma, Swedish soldiers serving in Bosnia and Herzegovina with low pre-service salivary cortisol levels had a higher risk of reacting with PTSD symptoms, following war trauma, than soldiers with normal pre-service levels. Because cortisol is normally important in restoring homeostasis after the stress response, it is thought that trauma survivors with low cortisol experience a poorly containedÑthat is, longer and more distressingÑresponse, setting the stage for PTSD. However, there is considerable controversy within the medical community regarding the neurobiology of PTSD. A review of existing studies on this subject showed no clear relationship between cortisol levels and PTSD. Only a slight majority have found a decrease in cortisol levels while others have found no effect or even an increase.

back to top

 
Separation Anxiety Disorder:

http://en.wikipedia.org/wiki/Separation_anxiety_disorder

Separation anxiety is a psychological condition in which an individual has excessive anxiety regarding separation from home or from people to whom the individual has a strong emotional attachment (like a father and mother).

Present in all age groups, adult separation anxiety disorder (affecting roughly 7% of adults) is more common than childhood separation anxiety disorder (affecting approximately 4% of children). Separation anxiety disorder is often characterized by some of the following symptoms:

- Recurring distress when separated from the subject of attachment (such as significant other, the father or the mother, or home)
- Persistent, excessive worrying about losing the subject of attachment
- Persistent, excessive worrying that some event will lead to separation from a major attachment
- Excessive fear about being alone without subject of attachment
- Persistent reluctance or refusal to go to sleep without being near a major attachment figure, like a significant other or mother
- Recurrent nightmares about separation
Often, separation anxiety disorder is a symptom of a co-morbid condition. Studies show that children suffering from separation anxiety disorder are much more likely to have ADHD, bipolar disorder, panic disorder, and other disorders later in life.

Separation Anxiety Disorder should not be confused with Separation Anxiety, which occurs as "a normal stage of development for healthy, secure babies." Separation anxiety occurs as babies begin to understand their own selfhoodÑor understand that they are a separate person from their primary caregiver. At the same time, the concept of object permanence emergesÑwhich is when children learn that something still exists when it is not seen or heard. As babies begin to understand that they can be separated from their primary caregiver, they do not understand that their caregiver will return, nor do they have a concept of time. This, in turn, causes a normal and healthy anxious reaction. Separation anxiety typically onsets around 8 months of age and increases until 13-15 months, when it begins to decline.

back to top

 
Stress Management Strategies:

When it comes to working out a strategy or programme to reduce one's stress levels or eliminate stress entirely, there are a number of areas that should be explored and equally a variety of different tools and techniques available. Some of these are examined below. Clearly many of the pages in this psychology section are relevant to reducing stress, as well as alleviating depression and indeed generally making slight enhancements to what may already be quite a good quality of life. The minimum of repetition will be made.

Some of the methods or techniques above are examined below. Most are discussed in the relevant sections elsewhere in the Psychology Section.

back to top

 
EFT, TFT and Amagdala Retraining

The most powerful way to break down negative and limiting (stress causing) beliefs and thereby dramatically reduce or eliminate the actual stress, besides the usual negative belief busting exercises, is by Emotional Freedom Technique (EFT). This works on the basis of an NLP pattern interrupt combined with tapping acupressure points on the body. A free manual can be downloaded from the web site below. Alternatively, an EFT practitioner can guide you through the process in person, as finding the correct points may be difficult from a book. EFT can be used to alleviate symptoms of one's body's 'messages', as described above, e.g. headaches, pains or aches, as well as interrupting negative behaviour patterns, removing stress and negative beliefs. If combined with Quantum Touch for example, it can be even more powerful.

www.emofree.com/downloadeftmanual.asp

Similar to EFT is a discipline known as TFT, or Thought Field Therapy. More information is available on the links page.

Ashok Gupta's Amagdala Retraining, a.k.a. The Advanced CFS/ME Recovery Programme, is all about interrupting the thought patterns that reinforce one's negative mind state and detaching the conscious mind from the causes/effects of stress on the body, in order to reduce excessive adrenal output, to allow healing to actually take place. I am currently trialling this technique and will provide a full review in this section in due course. Watch this space.

back to top

 
Exercises to Calm The Mind:

Breating exercises, meditation, tai chi or yoga can also help a person to relax and feel good about himself. If you do try meditation, and your conscious mind cannot shut up and you cannot meditate without constantly thinking about things, then this is a sign that you really need to do much more, so that you can arrive at a point where your conscious mind is quieter, and you can fully let go when you want to.

One type of meditation uses technological aids to promote a deeper state of meditation, and specific brain wave frequences. These most commonly use binaural beats and are very powerful entrainment and meditation tools.

Progressive Muscle Relaxation Therapy is a type of exercise that is used for stress relief and also to calm the mind and release muscle tension. It has been tested in laboratory conditions and shown to lower cortisol levels. It involves tensing a certain muscle group or muscle area in the body for a few seconds, then releasing and relaxing it, then moving onto the next body part, until one has gone over all the muscles of the body, including the face, pectorals, neck, throat, toes etc. It is reputed to be an excellent tool for relaxation and can be performed prior to taking a nap or prior to going to sleep (depending on how sensitive one is to such exercise). It may take up to 20 minutes. Do not rush the exercise as it may cause stress or become exhausting (particularly if your mitochondrial function is very poor). If your mitochondrial function is very poor, then you may want to make sure you rest a few minutes in between each exertion (for example), and perhaps as mentioned further above, make sure you perform the exercise earlier in the evening (as too much exertion close to going to bed may prevent you getting to sleep). Some people fall asleep immediately after performing this exercise.

back to top

 
Distraction and Escapism:

Stress is often about controlling one's focus and addictive negative patterns of focus. Focus can be shifted by certain internal or external stimuli, known as triggers. One type of trigger is sound or music.

For example, if you are driving in your car, one great way to relax is to actually play a tape or CD of the sounds of a rainforest or the sounds of waves crashing onto the shore, or even a stream. You may well find it more relaxing when in heavy traffic than even listening to your favourite music.

You may be 'transported' to a tropical rainforest and feel you are really there, smell it, feel it, rather than focussing on the past or imagined future and its associated stressful meanings. Give it a try!

Some regard watching a relaxing escapist movie or reading a fantasy or relaxing novel a good way or relaxing, in opposition to watching current affairs programmes or reading a non-fictional book.

back to top

 
Emotional or Psychic 'Vampires':

Judith Orloff M.D., in her book Emotional Freedom: Liberate Yourself from Negative Emotions and Transform Your Life (2009), defines 'emotional vampires' in four different ways. These embody some of the negative traits of Taylor Hartman's core building blocks of personality. You may recognise these in yourself and in others. Those that indulge excessively in one or more of these traits require careful handling or should even be avoided.

- The Narcissist - those who hog attention, crave admiration and have elevated sense of self-importance and entitlement. They lack empathy and have a limited ability to show love. Everything revolves aroudn them. If they don't get their way, they may punish otherwise or withhold. Perhaps this is the negative aspect of the yellow personality. These are emotionally limited people. Keep your expectations realistic. Never put your sense of self-worth conditional upon them. To get the best out of such people, you need to show how something can be to their benefit (ego stroking) - if the relationship really is unavoidable.

- The Victim - those with a 'poor me' attitude. Those who hate to take responsibility for their own actions. Everything is always someone else's fault, and the world is always against them. They are a poor, pure, innocent victim all the time. They dislike solutions as it means they have to stop feeling sorry for themselves or complaining. Set firm but fair limits. Listen briefly but set limits on their self-indulgence on your time; or empathise but explain you must get back to your work etc. Or emphasise you are on a deadline and use closed body language. Some people don't pay any attention to this, at which point you must make up any excuse and walk away. Or simply avoid to start with. You could also try pre-empting their self-pity by distracting their focus onto something they might like or find beautiful. Sometimes this doesn't work as they are too sulky.

- The Controller - people who have an opinion about everything and must always be right, and try to control and dictate to you how you should think and feel. They may invalidate/dismiss you or put you don't if you don't fit into their set of rules that they've arbitrarily created. They'll prescribe solutions to you all the time. It serves to leave the recipient of this control feeling dominated or patronised. In a way, they represent the negative blue personality, the scolding parent role. Or perhaps the negative side of the red personality. It is hard to control the controller, unless they do have a more impartial side to their character and just got 'carried away in the moment' through tunnel vision. Healthy assertiveness or pointing out the facts as opposed to dictating to the controller what he or she should believe is a shrewd strategy. Focus on the main issue rather than the peripherals, and if necessary, tell the person that you value their advice but would like to try to work through it on your own right now. Or simply avoid!

- The Splitter - are dualistic type personalities, seeing everything in black and white terms, and you are either loved or hated. They may go from idealising you as a fantasy version of who you are, and when you fail to meet these unrealistic expectations (or standards which they have set, not you), then you are rejected and hated, and scorn or loathing poured on you. They may seek to punish or retaliate against you if they feel you have 'wronged' them or 'jerked' them around. They seek out targets to despise as it makes them feel better about themselves or gives them purpose, as they lack self-knowledge and self-esteem. They rely on fantasy images of people to make them feel good. One may have to tread carefully around them. Splitters feed off anger, as they become righteous as vindicated. It is best to set limits and be firm but fair, providing them with a structure such as acknowledging they are upset now but that one will talk later at a given time or date. If such a person tries to manipulate you to take sides in a disagreement then politely refuse to play their game. Be aware if the Splitter tries to play games with your friends of families to try to split people apart or cause trouble. Such people as any of the above are best avoided if possible!

back to top

 
Gentle Exercise:

Gentle exercise, including walking, if possible, may help sufferers of stress and in particular, chronic illnesses such as Chronic Fatigue Syndrome, to relax and to maintain their metabolism and cardiovascular fitness. However, each person must find his or her own optimum level and frequency of exercise which does not drain the person's energy. In some stages of a person's illness, any exercise simply makes things worse, and a person should avoid all exercise if possible until mitochondrial function improves and inflammation levels reduce (as exercise will merely increase inflammation and burn up the mitochondrial enzymes and membranes). Overdoing exercise may result in a 'crash'. In addition, muscles and tendons may be weaker than in a completely healthy person and weight training should be increased very slowly if the person can cope well with it. Often the ego is a major hurdle in recovery in general, and can result in overdoing stretching, overdoing weight training and frequent reinjury and pushing and ignoring one's limits rather than working within them and feeling where they are. Gentle exercises such as tai chi chu'an, qi gong and yoga may also help relaxation and fitness, and also energetically too. Please note that one should try to receive tuition from the best possible instructor one can find. A bad instructor may cause you injury.

A gentle/short bike ride may also be a good form of light exercise, depending on whether you are able to do this or not. It can be a good excuse to get out of the house and have a little adventure! Cue relevant joke below.

The body clock is set so that exercise is most efficiently accommodated in the late afternoon or early evening, when the body is warmer and functioning most efficiently (physically). The heart is most under strain between 9am and 11am so it is best to avoid exercise then or first thing in the morning in general.

back to top

 
Treatments:

If one can afford it, try having regular energetic or physical therapy treatments to aid in relaxation, muscle relaxation, general bodily health and because it can be fun! Energetic treatments include acupuncture, acupressure, cupping therapy, shiatsu, bio-energy healing, quantum touch, and many others. Physical treatments include cranio-sacral therapy, body stress release, osteopathy, shiatsu, and many others.

Many energetic/physical treatment therapists are in this field because they care about people and are often very interested in their clients and are surrogate agony aunts, who can listen to your problems and lend a sympathetic ear and be your friend. Be aware that energetic treatments may not be enough to cure you, as you have to tackle certain obstacles such as toxicity, nutritional deficiencies and digestive disorders (i.e. the problems causing continual negative energetic impact on your body) before the treatment of the negative effects these problems have had on the body will be fully successful.

In addition, because of the complex nature of severity of many energetic problems in CFS sufferers or those with related conditions, a few sessions may not be enough, and it is likely that a large number of regular sessions are required to make any real progress. The effectiveness of course depends on the therapy. Many therapies, such as bio-energy healing and body stress release, may still be effective after a large number of sessions, but appear to be at their most effective for the first 5 times or 10 times when the body first experiences them. After this the body will probably still respond to the treatments, but probably not as greatly as it used to. Of course, the responsiveness of the body varies between individuals. It may therefore be sensible to use such treatments at the appropriate time, when you believe that conditions are such that they will be most effective. For example, if you have chronic nutritional deficiencies, harmful micro-organism overgrowth or toxicity issues, then it is best to deal with these prior to commencing such a course of treatment. Otherwise you may 'waste' the 'optimum window' for such treatments and also your own money.

Oriental medicine believes that extremes of emotions can be very damaging to your organs, overall energetic balance and qi circulation. For the vast majority of the population, excesses of emotion are usually the negative emotions, such as stress, anger, sadness, depression, anxiety, hatred etc. Of course an excess of happiness is highly enjoyable but can unbalance the internal energetic system. The pursuit of eternal happiness is rarely achievable and in general for the vast majority of people, increasing their happiness is only a good thing. The mind requires balance and calmness. The psychology section of this web site is aimed at reducing the incidence and severity of one's negative emotions and increasing the incidence, regularity and severity of one's positive emotions. However, you may want to bear this in mind if you want to achieve maximum energetic strength, balance and longevity!

It has been determined experimentally that physical contact in the right context, for example, touch, hugging, holding hands or massaging helps to reduce stress levels, reduce perceived sense of threat, and to increase relaxation and well being. Conversely, unwelcome physical contact can be stressful for many people. It may well be that any physical therapy that involves massaging or close physical contact may be beneficial for relaxation and wellbeing. How much is the placebo effect, the effect of physical contact, the environment treatments are held in (smells, atmosphere, reassuring technical wallcharts etc.), the personal interaction with the person giving the treatment, and how much is the effect of the actual technique is of course a matter of debate and will vary from treatment to treatment. Of course one does not necessarily need to pay for treatments to get the benefits of touch contact, as one can share pats on the back, hand shaking, hand holding, hugs and other personal physical contact with friends, family and loved ones for free.

back to top

 
Limit Internet Usage:

The internet is another place for the nurturing of ego, narcissism and ultimately stress. Creating personal profiles (e.g. www.myspace.com or facebook.com etc.) and demonstratively communicating to one's contacts in front of onlookers to a profile is really about the ego and getting attention. Why do we do it? The culture of blogging is very narcissistic, and whilst it may be easier to write a blog or bulletin, write a comment on your 'mood' for everyone to see and have everyone looking at it, than emailing each 'friend' on your list, it is often a narcissistic and anally retentive exercise. It seems to be about getting attention in one form or other, either by wanting to look 'cool', 'happening' or to extract sympathy from people.

Everyone wants everyone else to look at their profile and make them feel significant and appreciated. Chat rooms are very similar in that it is often all about showing off, appearing cool, and doing things to get attention; and frequently bullying. People often love to focus on themselves and talk about themselves. But often do not take such an interest in others. The internet is often accused of being full of 'nutters' but internet communities, chat rooms and internet addiction are clearly factors in the increase in levels of mental illness in our society. The practice of stalking has a new stomping ground on the internet and it becomes very easy to harrass and stalk people in a rather cowardly manner. If the internet encourages the shy to network, it also encourages/empowers the cowardly to behave badly towards others.

Networking sites are great ways to misunderstand the actions and statements of others and to take them out of context and/or take them personally, or interpret them in the worst possible way, as to inflict as much hurt, pain or stress on ourselves as we can; the ego seeking ways to be as offended as possible and the thought process that gives people the benefit of the doubt or does not assume anything requiring conscious cultivation. Often people clumsily type in a sentence or two about why they ares stressed out about something, without giving any specifics and with no context, assuming everyone else understands what they are talking about or simply because they are too shy or can't be bothered. This may cause stress in others as they leave comments one after the other trying to figure out what the person was actually saying. This often results in going off on a tangent and even getting into disagreements on occasion! What's it all for? Some people 'live' on networking sites and treat the various limited mechanisms for expression on there as some kind of cool scene and actually representing real life. Any event that happens on line is regarded as severe as the action with the same name in real life (e.g. losing a 'friend' - in many cases, the on line equivalent is not really a friend, but someone on your 'list', who you hardly know). Networking sites are treated like 'real life' for many people.

Some people make a big effort in producing a reply to an email, and others are very nonchalant about it, clumsily typing in just a few sentences or maybe generalising as they can't be bothered to look up references to the subject matter in hand. Over time, this discepency or mismatch in expectations or levels of effort in one's relationship can cause friction, upset or stress with one of the parties, the other party being quite oblivious. Sometimes people only comment on what they don't agree with, and say little or nothing about what they do agree with. This may give a false (negative) impression to the other person that they are ignoring some parts and picking holes in others. People often do not bother to change the subjects of emails, when the topic changes, making cross referencing emails difficult. Many times one will pull up someone's email as one can't find it in one's address book and use that email as a basis for a new email rather than replying to the original statement. This can give the impression one is ignoring the original person's email. The use of exclamation marks or capital letters also stresses some people out as it implies one is being aggressive. There are numerous codes on conduct on internet forums that are generally learnt by seasoned forum 'geeks', and the internet opens up a new area of psychology, as communicating without body language or intonation and being anonymous or able to 'run away' is throught with different permutations of antisocial behaviour. In addition, because of this, some people take forums very seriously (too seriously?) Should these people be spending so much time on the computer?

The trouble with the internet is that whilst it allows you to communicate with people from all over the world, and with people both at work and at home, that is its very problem. You may easily end up communicating with people in different timezones, both at home and work, so effectively your inbox or networking site profile is bombarded with communications and demands on your time to reply 24 hours a day. It never stops! There is no sense of decorum and respect to daily rituals and appropriateness of timing - computer usage should really only be allowed by yourself during a certain time of the day, not on and off all day and night, which creates this constant sense of excitation. Computer usage should be one brief part of your day (if at all) and respect your other rhythms, not rule it and totally take over it. Beware the amalgamation of all of your waking hours into one grey sludge of computer excitation and mental overstimulation. You need downtime! And relaxation time should not be interrupted by urges to log on to the computer during or afterwards. The internet is like some big cities, it never stops. Humans however can't keep pace or it ultimately destroys their health. Days, weeks or months away from the computer may be useful to do every so often. Just because you can.

Studies have shown that internet usage tends to encourage a different mode of thinking, where one is inundated with information, like an information overload, bombarded with links to look at etc. and the user tends to jump from one link or subject to the next, investing a very small amount of time in each subject, wanting to get a high level overview of that subject before leaving it for the next. It is a form of skipping that is synonymous with short attention spans and resulting in a somewhat restless, dissociated state. We are living in an instant sensory culture, with film, music and internet readily accessible anywhere. People now want to have their senses titillated, rather like drug users, rather than make an effort to use their brains. Today's students complain more and more about having to actually read a book as part of their courses! More and more children are growing up to only have the patience to read a few paragraphs on a subject at a time but they lose interest. The self-discipline or motivation is not there. Internet usage in a sense encourages people to be lazy, and this can often be seen on forums where members cannot be bothered to use the search function or make an effort, but ask other members everything, so they can do the work for them. One might call it 'brain rot'. We are consumed rather than being consumers. Previous generations used other forms of thinking and studying, where they would immerse themselves in a subject for a long period of time (years) and really get to grips with it. There was more self-discipline also. Today, few can be bothered on account of the pull of access to other topics or forms of entertainment that do not require the use of one's brain. They may be more widely educated, but rarely know anything in any detail for it to be really usable. The internet generation are in a sense trying to keep on top of an impossible task. South Korea is one of the most on-line cultures in the world, and also a country with the highest success rates at University. However, it also has the highest levels of computer-user stress and addiction in the world. Lack of internet time results in mood swings, depression and apathy.

If you want to avoid stress and excessive brain stimulation, then you may want to consider avoiding an internet relationship like the plague (if you would even consider such a thing to start with). There are multiple reasons for this. Expectations of time, and waiting for replies, spending months getting to know someone up to a certain level when one could achieve more in 30 seconds in person. Ultimately unsatisfying nature of the relationship and interaction. If you live in different time zones, add another complication and source of rhythm breaking (as per above paragraph).

It should be noted that addiction to computers and the internet serve to create a constant background level of stress and over brain stimulation and excitation, which is not conducive to relaxation or recovery from illness. One should try to exercise self-discipline in such areas, as one may find hours spent on the computer when one only consciously told oneself that one would be on for 5 minutes, thereby creating stress and detracting from time spend in relaxing activities etc. Don't kid yourself. If you spot an addictive pattern, try to break it.

back to top

 
Laugh and Smile:

The average child laughs 300 times a day. The average adult laughs 15 times per day. It's time to laugh more! You need it!

Laugh and smile as much as you can (this might be useful for everyone!) Even if you don't want to. Force yourself! Go on! If you don't practice your laughing and smiling 'muscles' (neuro pathways) enough, then they become harder to perform. Try to do it, even if you really are not in the mood. The less you do it, the harder it will become, and the more miserable you will feel. Your body may not be producing enough seratonin, but don't let that dictate your mood all the time. The more you smile, even if you don't feel happy, you will fool the brain and you will eventually feel happy. Remember that a smile can ruin a perfectly bad mood! Embarrass yourself.

If you are stressed, tense, angry and frustrated, you may well have every right to be, but it is not helping you and it won't help to speed up your recovery. You can however nurture these feelings if you really want to! You can do whatever you want to, but you have to accept the consequences. This is not meant to sound judgemental. We are not suggesting that you beat yourself up about feeling sad, depressed or serious all the time. Many people don't have the energy to feel up all the time, and may spend most of the time feeling serious or feeling nothing. We are suggesting that if you catch yourself in a glum or depressed mood, that you try to interrupt your pattern and distract yourself with something, preferably something entertaining. See the psychology section of this web site for more tips on this.



Treat yourself to your favourite comedy shows or recall hilarious memories. Picture someone that makes you laugh. If necessary, picture a comically angry or sour face. I prescribe Seinfeld DVDs to everyone. Some of my favourites are Seinfeld, Fawlty Towers, Minder, Peep Show, Bottom, Brittas Empire, Red Dwarf and various movies by Marx Brothers.

Below is a web site that examines the therapeutic and health benefits of laughter in recovering patients. Please click on the link below.

www.jesthealth.com/ch_pulm.html back to top


back to home