Generalized Anxiety Disorder - Patient Treatment Manual.pdf

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Generalized Anxiety Disorder
Patient Treatment Manual
This manual is both a guide to treatment and a workbook for persons who
suffer from generalized anxiety disorder. During treatment, it is a workbook
in which individuals can record their own experience of their disorder,
together with the additional advice for their particular case given by their
clinician. After treatment has concluded, this manual will serve as a self-help
resource enabling those who have recovered, but who encounter further
stress or difficulties, to read the appropriate section and, by putting the
content into action, stay well.
1999
Clinical Research Unit for Anxiety Disorders
St. Vincent’s Hospital, Sydney.
i
CONTENTS
1. About this programme
What is Generalized Anxiety Disorder?………………………….…….
1
Generalized Anxiety Disorder and Everyday Worry …………………..
2
Medication ……………………………………………………………..
2
2. The Nature of Anxiety and Worry
The Nature of Anxiety …………………………………………………
4
The Anxiety Cycle ……………………………………………….……
5
Anxiety and Performance ……………………………………………..
6
Chronic Anxiety ………………………………………………………..
7
Why do the Symptoms of Tension and Anxiety Begin? ………………
7
The Nature of Worry …………………………………………………..
8
Worry about Worry ………………………………………………...….
9
Behaviours that can Maintain Anxiety and Worry …………..………..
10
Keeping a Record of your Anxiety and Worry ………………………..
11
3. De-arousal Strategies
Control of Hyperventilation …………………………………………..
15
Slow Breathing Technique …………………………………………….
17
Daily Record of Breathing Rate ……………………………………….
18
What is Relaxation Training? …………………………………………
19
Importance of Relaxation Training ……………………………………
19
Components of Relaxation Training …………………………………..
20
Important points about Learning to Relax Quickly ……………..…….
23
Difficulties with Relaxation …………………………………….…….
23
4. Thinking Strategies ……………………………………………….……...
25
Identifying anxiety-provoking thoughts ………………………….……
27
Challenging anxiety-provoking thinking ………………………..……..
28
Generating alternative thinking ……………………………….………
32
Assumptions and core beliefs …………………………………………
33
5. Managing worry
Problem solving …………………………………………………..……
35
Indecision ……………………………………………………………….
35
Worry about worry ………………………………………………….….
36
Letting go of worries …………………………………………………..
37
6. Structured Problem Solving ……………………………………………..
38
Problem solving work sheet ……….. …………………….……….…..
43
7. Dealing with Behaviours that Maintain Anxiety or Worry …………….
44
8. Keeping Your Practice Going
Emotional problems During Setbacks ………………………………….
48
Expect To Lapse Occasionally …………………………………..……..
48
References and Recommended Reading ……………………………….
50
ii
Section 1
About this programme
This programme will aim to teach you to manage your worry and anxiety by learning to
change the way you think and the way you react to your thinking and other events. In
essence you will be learning new methods of control.
It is important to realize that achieving control of worry and anxiety is a skill that has to
be learnt. To be effective, the skill must be practiced regularly and you will need to take
responsibility for change. The more you put into the programme, the more you will get
out of it. It is not the severity of your anxiety, or how long you have been anxious, or how
old you are that predicts the success of this programme, but rather it is your motivation to
change your reactions.
What is Generalized Anxiety Disorder?
Generalized anxiety disorder is a disorder that is characterized by persistent feelings of
anxiety and worry. The worry is typically out of proportion to the actual circumstances, it
exists through most areas of a person’s day-to-day life, and is experienced as difficult to
control. The anxiety and worry is described as generalized, as the content of the worry
can cover a number of different events or circumstances, and the physical symptoms of
anxiety are not specific and are part of a normal response to threat.
Individuals with generalized anxiety disorder describe themselves as sensitive by nature
and their tendency to worry has usually existed since childhood or early adolescence.
The symptoms of anxiety typically experienced by individuals with generalized anxiety
disorder are
•
feeling restless, keyed up, or on edge
•
being easily tired
•
having difficulty concentrating, or having your mind going blank
•
feeling irritable
•
having tense, tight or sore muscles
•
having difficulty sleeping; either difficulty falling or staying asleep, or restless
unsatisfying sleep.
Generalized anxiety disorder is one of the more common anxiety disorders in the
community. A recent Australian survey has suggested that, in a 12 month period, 3 in 100
people will have a generalized anxiety disorder.
1
Generalized anxiety disorder and everyday worry.
Everybody worries or gets anxious at some time in their lives. The worry in generalized
anxiety disorder is identical in nature to that experienced by anybody else, but it tends to
be out of proportion, pervasive, and difficult to control, unlike the worry most people
experience. Hence it significantly interferes with an individual’s functioning. The
constant anxiety-provoking thinking and the accompanying physical symptoms of
anxiety can be disabling, particularly if experienced over a long period of time.
Another feature of generalized anxiety disorder is that it has usually been present for
much of an individual’s life. From time to time, people may become unusually stressed,
because of a physical illness or a life event such as divorce, bereavement, or loss (or
threat of loss) of employment. During these times people may worry and become
significantly more anxious, but after the stress resolves, the person can usually return to
their usual functioning. This is not generalized anxiety disorder, but a temporary period
of difficulty adjusting to stress.
Medication
You may be taking medication to help you cope with anxiety. If you are taking
medication, you may need to talk about the issues discussed below with your therapist.
Antidepressant medication
Many of the medications that are useful to treat a depressive disorder are also useful to
help control anxiety. If your doctor has prescribed you this type of medication,
particularly if you have been depressed, it is important that you continue to take the
medication for several months, and only stop taking it in consultation with your doctor.
This medication typically has few side-effects, it is safe, and will not cause you to build
up tolerance or become dependent.
When you are ready to stop this medication (usually after you have been feeling calm and
in control for a number of months), it is very unlikely that you will experience a relapse
of your anxiety if you have been able to learn and put into practice the strategies taught
on this programme.
Sedatives, tranquilizers and sleeping pills.
This class of medication is the benzodiazepines. They dampen the feelings of anxiety
very effectively, but also produce the following problems:
•
they can interfere with thinking and your ability to remember new information;
•
they can make you feel drowsy and sleepy;
•
they can interfere with your natural sleep cycle and rhythms;
•
they can produce tolerance, so that you might need bigger and bigger doses for the
same effect;
•
they can produce dependence, so that you come to rely on them and experience an
increase in anxiety without them;
2
•
they can produce withdrawal symptoms when you stop or cut down, producing
unpleasant anxiety-like symptoms;
•
they can make it easier for you not to use the strategies taught in this programme.
If you are taking this type of medication would already have been asked to gradually cut
down, with the aim to stop completely. If you are experiencing any difficulties with this
process, please discuss it with your therapist who can then work with your doctor in
achieving the goal of successfully stopping the medication.
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