Understanding anxiety

and managing it
without drugs
with Joe Griffin
BSc (Hons) Psych., M.PHIL. (Psych), AFBPsS, FHGI

STRESS

Stress is on the increase

40 million working days are lost every

year due to stress overload

Cost of stress to employers is estimated

at between 79 billion annually

Every day some 270,000 people are taking

time off due to a stress related illness

Up to 60% of employees suffer from

excessive stress at some point
N

Stress is on the increase

There has been up to a 90% increase in

mental and psychological claims to health
insurance over the past 5 years

Doctors and teachers are prominent

among claimants

10% of the population have suffered in the

past year from Panic/Anxiety Disorder
(6 million people)
N

Symptoms of stress include:

Insomnia
Drug abuse
Migraines
Skin complaints
Burn out
Increased risk of certain cancers
Increased risk of hypertension
Anxiety disorders
Depression

Human Givens
Human givens are what we are born with. In
other words, they are natures endowment to
each one of us.
These givens come in two kinds:
The physical and emotional needs evolution has
programmed into us, which seek their fulfilment
through our interaction with the environment.
The resources (or tools) nature provided us with
to help us get those needs met.
N

Human Givens

These templates for instinctive behaviours are

genetically programmed into us during REM
sleep in the womb

They seek completion in the environment by

means of metaphorical pattern matching
the inner connecting to the outer

This is natures solution to the need for

mammals to be flexible and adaptable

Our instinctive endowment is protected by

another human given dreaming

Emotional needs include:

The need for meaning (which stretches us)

A sense of our own achievements and competence
The need for intimacy (emotional connection to
others)
Being part of a wider community
The need for attention (to give as well as receive it)
Privacy time to reflect upon and consolidate
experiences
Status respect (connected to community)
Having a sense of autonomy and control
Security safe territory, the space to grow

Resources we have evolved include:

The ability to develop long-term memory patterns

The ability to understand the world and other people

through metaphor pattern matching

An observing self that part of us that can step back, be more

objective and recognise itself as a unique centre of awareness

The ability to empathise and connect with others

Imagination, which can allow us to focus our attention away

from our emotions in order to problem solve more objectively

Emotions and instincts

A rational mind that can check out emotions
A dreaming brain

Cortex and
neo-cortex
(Human)

Limbic system
(Mammalian)

Brainstem and
cerebellum
(Reptilian)

What dreaming does for us

Dreams are metaphorical translations of

unfulfilled expectations (positive or negative)

Expectations that cause emotional arousal

which is not dispersed by being acted upon
or resolved another way, become dreams

Dreams deactivate the emotional arousal

which frees the brain to respond afresh
to each new day

Fundamental principle
Dreaming is Natures way
of de-stressing us.

Fundamental principle
A healthy sleep pattern does
much to reduce stress and allow
the mind to relax and look at
problems from other
points of view.

Fundamental principle
However, if the dreaming
mechanism is put under too
much stress, our mental
stability is affected.

Psychotherapy vs. Medication

1/2
for anxiety disorders
Results of a nationwide study of Alprazolam,
compared with exposure therapy and placebo for
panic disorders with Agrophobia which also included
a 6 month drug-free follow-up, showed that
patients receiving Alprazolam began improving by
week 2, but showed no further improvement and
worsening symptoms by week 4.
After 8 weeks follow up therapeutic gains were lost.

Psychotherapy vs. Medication

2/2
for anxiety disorders
Exposure therapy was twice as
effective as the drug therapy and
improvements were maintained.
Marks, I. M. et al British Journal of Psychiatry (1983) 162, 776787

Behaviour therapy versus

antidepressants for panic disorder
with agoraphobia

A recent meta-analysis suggests that there is

no specific advantage in adding drug therapy to
effective behaviour therapy

Adding behaviour therapy to antidepressant

drugs increases success rate from 60% to 90%

Tranquillisers may diminish the effectiveness of

behaviour therapy
Danton, Antonuccio, The Therapist, Autumn 1997

Perception of danger in
anxiety disorders
EXTERNAL
TRIGGERS

Life threatening PTSD

Stressful life change Adjustment disorder

Feared situation/object Phobias

The world/chronic apprehension GAD

Intense autonomic symptoms PD

INTERNAL
TRIGGERS

Intrusive thoughts/imagined harm OCD

N

Features of anxiety
Psychic symptoms

Worry

Apprehension

Anticipation

Forgetful

Fear

Irritability

Loss of sense

Physiological symptoms

Heart pounds

Tension

Cold or sweaty palms

Indigestion

Nausea

Diarrhoea

Cant relax

Hold breath

Skin rashes

Poor sleep & fatigue

ANXIETY
PANIC

of humour

Cognitive symptoms

Hyper-vigilance

Fuzzy perception

Poor concentration/judgement

Cynicism

Behavioural symptoms

Avoidance

Nervousness

Inhibition

Disorganised

Criteria for panic attack

1/3

A discrete period of intense fear or discomfort

in which four (or more) of the following
symptoms develop abruptly and reach a peak
within 10 minutes:

palpitations, pounding heart or accelerated

heart rate
sweating
trembling or shaking
N

Criteria for panic attack

sensations of shortness of breath or

smothering, feeling of choking

chest pain or discomfort

2/3

nausea or abdominal distress

feeling dizzy, unsteady, light-headed
or faint

Criteria for panic attack

derealisation (feelings of unreality)

or depersonalisation (being detached
from oneself)

fear of losing control or going crazy

3/3

fear of dying
paraesthesia (numbness or tingling
sensations)
N

Beliefs that fuel panic attacks

Dying from a heart attack

Dying from suffocation
Having a stroke
Going to faint
Having a nervous breakdown
going crazy
Losing control
Feeling weak
Believing you are going to be embarrassed
or humiliated
N

Symptoms of hyperventilation

Light headedness

Giddiness

Dizziness

Shortness of breath

Heart palpitations

Numbness

Chest pain

Dry mouth
Clammy hands
Swallowing difficulty
Tremors
Sweating
Weakness
Fatigue

N

Test for hyperventilation

The client should over-breathe for 1.5 minutes
 Pay attention to any sensations
 If too uncomfortable client can stop but try to
get them to complete the test
 After the test the client should place the brown
paper bag over their nose and mouth allowing as
little air to escape as possible until symptoms remit
 List all the sensations they had during the
test to see if they need breathing retraining
N

4 ways to stop hyperventilation

Hold your breath to prevent the dissipation of
carbon dioxide. A period of 1015 seconds,
repeated a few times, is sufficient
 Breathe in and out of a brown paper bag to
quickly restore the normal blood PH level
 Vigorous exercise while breathing in and out
through your nose
 Deep diaphramatic breathing slow deep
breathing to the bottom of the lungs

Agoraphobia

The AWARE technique

Accept the anxiety
Watch and scale your anxiety
Act with the anxiety
Repeat the above three steps
Expect the best
N

Social phobia

Fear of public speaking

Fear of eating in public

Fear of urinating in public

Fear of blushing

Life Style Changes

Questionnaire

The person recognises that the fear is

excessive or unreasonable

The phobic situation(s) is avoided or else is

endured with intense anxiety or distress

The avoidance, anxious anticipation, or

distress in the feared situation(s) interferes
significantly with the persons normal routine,
occupational functioning, or social activities or
relationships, or there is marked distress about
having the phobia

In individuals under the age of 18 years, the

duration is at least 6 months

Post Traumatic Stress Disorder

Disturbing flashbacks or memories

Disturbing dreams about traumas
Avoids stimuli such as people associated with
the trauma
TWO OF THE FOLLOWING:
hyperventilation, anger, insomnia,
exaggerated startle response
Symptoms must be present for more
than one month
N

The rewind technique:

The one session cure for trauma and phobias

also known as

The Fast Phobia cure

or the

V/K Dissociation Technique

V = Visual

K = Kinaesthetic (feelings)
N

The one session rewind cure

for trauma and phobias

Dissociation separates the observing self

from the feelings. Watching yourself doing
something is a 1st position dissociation

A 2nd position dissociation occurs when

you watch yourself watching yourself doing
something on TV. This increases the separation
between the observing self and the feelings
and makes feelings appear much less intense
N

Removing the trauma or phobia

Deeply relax the patient using guided imagery
of a safe, peaceful place special to them
 Ask the client to imagine a TV/VCR with a
remote control in the special place
 Get the client to imagine they are watching
the TV screen. Now have them float out of
their body, to one side and watch themselves
watching the film of the traumatic event
N

Removing the trauma or phobia

Repeat until they can do this calmly
 Have client float into the film at the end of it,
when the client knows they are safe, and run it
backwards as a fast rewind
 When they have done that ask them to watch
the film pressing the fast forward button
 Repeat steps 5 & 6 several times until the
scenes evoke no emotion
N

Obsessive Compulsive Disorder

(OCD)

Anxiety about dying

Anxiety about childbirth

Sexual anxiety

The five most effective

techniques for reducing anxiety

The 7/11 breathing technique

New metaphors eg. Smoke alarm
The AWARE technique
Guided imagery
The fast trauma cure
N

Thank you for your time and effort.

We look forward to seeing
you again soon.