1. 1. PSO TRAINING ANXIETY & HOW TO MANAGE IT BY PIP WALKER POLICE PSYCHOLOGIST S/HSO JULY 2015
2. 2. OUTLINE OF WORKSHOP 1. Demystifying anxiety 2. Normal Vs Pathological Anxiety 3. The development of Anxiety Disorders 4. Different types of anxiety disorders 5. Theoretical models to understand anxiety disorders 6. Signs & symptoms of anxiety disorders to look out for 7. Treatment/Interventions for managing anxiety disorders 8. Resources on anxiety disorders
3. 3. Videos about the Impact of Anxiety on peoples lives ACTIVITY: Discuss thoughts/reflections from videos
4. 4. QUIZ: UNCOVERING THE MYTHS OF ANXIETY!
5. 5. WHAT IS NORMAL ANXIETY? Psychological & physiological state characterised by physical, emotional, cognitive & behavioural components Normal, adaptive response to perceived or actual threat everyone gets anxious occasionally Time limited, transient Can be beneficial Doesnt usually interfere with daily functioning or achievement of goals
6. 6. Anxiety Vs Fear Fear concrete danger occurring at present time Anxiety perceived or actual threat that is occurring in future; usually a FALSE ALARM Fight or flight response is the inborn, primitive, automatic, survival FEAR response to a perceived or actual threat, or the absence of people or objects that signify safety
7. 7. WHEN NORMAL ANXIETY DEVELOPS INTO AN ANXIETY DISORDER Anxiety becomes pathological or abnormal and can turn into an Anxiety Disorder when it: Increases in excessive rates of: Duration Intensity Frequency Causes significant distress Impairs daily functioning & decreases quality of life Is disproportionate to the situation that elicited the anxious response Leads to irrational, illogical thinking & behaviour Is associated with maladaptive coping (e.g., avoidance, withdrawal)
8. 8. ANXIETY DISORDERS Often have an early onset - teens or early twenties Show 2:1 female predominance Have a waxing and waning course over lifetime
9. 9. TYPES OF ANXIETY DISORDERS
10. 10. THEORETICAL MODELS TO UNDERSTAND ANXIETY Biopsychosocial Model Multiple, inter-related causes of pathological anxiety: Biological Psychological Social (environmental)
11. 11. Behaviourism Learning Theory Model Focuses on observable behaviours Behaviours linked to anxiety and/or phobias are learned through classical conditioning and maintained through operant conditioning. Pavlovs Dog Experiment Classical Conditioning Skinner Operant Conditioning
12. 12. Biological/Neuroscience model
13. 13. 1st Brain: Reptilian Reptiles Reflex/Instinct Low level control Motor control (breathing, heartbeat & motor skills) 2nd Brain: Limbic system Mammalian Emotions Reactionary (Fight/Flight, Pleasure/Reward & pain)
14. 14. 3rd Brain: Thinking Human Foresight High level control / Executive Functioning (Thinking - Reasoning, judgment, perception, motivation, memory & learning)
15. 15. Amygdala & Hippocampus are the two main parts of the brain involved in anxiety. Amygdala Almond-shaped structure that begins functioning before birth. If something is perceived as a threat, the amygdala activates the Fight or Flight Response Hippocampus Assesses the accuracy of the threat after the fight or flight. Our brains are wired to shoot first, ask questions later! Records and stores memories
16. 16. Fight, Flight or Freeze Response We are wired to avoid fear/pain/discomfort more than we are to seek pleasure. The neo-cortex is usually aware that there is no real threat, but the deeper, primitive parts of the brain respond as if survival is at stake. Fight is about destroying the threat. Flight is about getting out of the way, running away or avoiding the threat. Freeze is an optional third response: remaining still. It takes 15-30 minutes to reduce heightened threat arousal back to normal/homeostasis, if the process isnt short circuited by the relaxation response (e.g., deep breathing).
17. 17. WHAT CAUSES ANXIETY DISORDERS Often a combination of factors lead to a person developing an anxiety disorder: Genetics Ongoing stressful events e.g.: Job stress or job change Change in living arrangements Pregnancy and giving birth Family and relationship problems Major emotional shock following a stressful or traumatic event Verbal, sexual, physical or emotional abuse or trauma Death or loss of a loved one.
18. 18. Physical health problems Hormonal problems (e.g. overactive thyroid) Diabetes Asthma Heart disease. Substance use Personality factors - Perfectionists, - Unrealistic expectations - Low self-esteem - Lack of assertiveness - Pessimism - Low tolerance of ambiguity or uncertainty, - External locus of control
19. 19. SIGNS & SYMPTOMS OF ANXIETY DISORDERS See Handout for details
20. 20. TREATMENT/INTERVENTIONS FOR ANXIETY DISORDERS Early intervention is essential - recognise the signs and symptoms and encourage people to seek support early The sooner a person seeks help, the sooner they can recover Anxiety disorders are unlikely to go away on their own. If ignored and left untreated, anxiety disorders can last for months, or years, and have far reaching negative effects on a persons life and their loved ones. Encourage the person to seek support from their family, friends and local community.
21. 21. 1. Physiological Symptom Control Medication (Anti-depressants, PRN Benzodiazepines), if necessary refer to GP or Psychiatrist Self-monitoring of anxiety symptoms (e.g., symptom diary) Self-care/Stress Management: Minimum of 20 mins exercise per day (natural anti- depressant/anti-anxiety drug - alters levels of chemicals in the brain, such as endorphins and stress hormones). Balanced Diet Adequate Sleep Hygiene Reduce or avoid stimulants (e.g., coffee, tea, alcohol) Delay making major life changes or decisions, if possible Schedule pleasurable activities Relaxation training
22. 22. Relaxation Training Diaphragmatic breathing Using the diaphragm to slow down & deepen the breath, relax the autonomic, sympathetic nervous system & prevent hyperventilation. Excellent for managing anxiety and panic attacks. Requires lots of practise. Progressive Muscle Relaxation (PMR) - Learn to monitor & distinguish between relaxed & tense muscles in the body. Good for managing muscle tension and headaches. Simple & easy. Guided visual imagery Utilises visualisation & the remaining senses to imagine being in a relaxed place a powerful way to enter a relaxed state. Similar to self-hypnosis & visualisation. Grounding/mindfulness Learn to manage difficult and distressing thoughts, focus on the present moment in a non-judgmental manner, the mind-body connection. Excellent for managing overwhelming anxiety/distress/panic. e.g., 5 senses mindfulness meditation, mindfulness of the breath, body scan. Requires practise.
23. 23. 2. COGNITIVE BEHAVIOURAL ALTERING BEHAVIOUR & PERCEPTION
24. 24. BEHAVIOURAL THERAPY Exposure & Response Prevention: Anxiety should subside after gradually exposing person to their fears until their behavioural and sensory response diminishes over time, after repeated exposure to feared stimulus (Habituation). Refraining from undesirable behaviour (e.g., compulsions/rituals, avoidance, escape, safety behaviours). Excellent for OCD, Panic Disorder with or without Agoraphobia, PTSD, Social Anxiety
25. 25. CBT FOR ANXIETY IN A NUTSHELL Psychoeducation Behavioural therapy (e.g., Exposure & Response Prevention) Listen to, identify and challenge Negative Automatic Thoughts and self- defeating core beliefs; Use Socratic questioning and reality testing to reframe perception of threat and appraisal of situations Positive self-talk and coping statements Designated worry time Assertiveness training/Limit setting Incorporating mindfulness focusing on the present moment, being non- judgmental about thoughts and emotions, living an authentic life aligned with ones true values
26. 26. GENERAL TIPS ON HOW YOU CAN HELP STAFF WITH AN ANXIETY DISORDER Have an RUOK conversation Let the person know if youve or their manager or colleague has noticed a change in their behaviour. Spend time talking with the person about their experiences and let them know that youre there to be a support and listen without being judgmental. Suggest the person see their GP or health professional (including HSO) and/or help them to make an appointment. Offer to go with the person to the doctor or health professional. Help the person to find information about anxiety (e.g., library, internet, HSO).
27. 27. Encourage the person to try to get enough sleep, exercise and eat healthy food. Discourage the person from using alcohol or other drugs to feel better. Encourage friends and family members to invite the person out and keep in touch, but dont pressure the person to participate in activities. Encourage the person to face their fears with support from their doctor/psychologist. It would be unhelpful to: - Put pressure on them by telling them to snap out of it or get their act together - Stay away or avoid them - Tell them they just need to stay busy or get out more
28. 28. VIDEO ACTIVITY http://learn.beyondblue-elearning.org.au/BeyondBlue/conversations/index.html What symptoms of anxiety does Sarah seem to have? If you were the PSO in this situation, what steps would you take to assist Sarah? Reflections on approach that Sarahs manager adopted
29. 29. ANXIETY RESOURCES Websites: Beyond Blue Anxiety Australia Sane Mindspot Mental Health Online Apps iCouch CBT Cognitive diary CBT Self-help Smiling Minds Self-help for Anxiety Management (SAM) eCBT Calm
30. 30. Books: The Anxiety and Phobia Workbook by Edmund Bourne Living with It: A Survivors Guide to Panic Attacks by Bev Bissett Overcoming Social Anxiety and Shyness: A Self-Help Guide Using Cognitive Behavioral Techniques by Gillian Butler The Feeling Good Handbook by Dr David Burns The 10 best ever anxiety management techniques: Understanding How Your Brain Makes You Anxious and What You Can Do to Change It by Margaret Wehrenberg Get out of your mind and into your life by Steve Hayes CDs: Cancer Council Queensland Learning to Relax CD (FREE)