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LizzA


Member

Posted Fri Aug 28th, 2009 1:20am Post subject: Beta-blockers (anxiety, panic attacks)

Hey there, everyone. <3

So, l went to my GP the other day about panic attacks and anxiety and got prescribed some beta-blockers (propanolol). I was on 40mg a day, but that wasn't nearly enough, so my dose was upped to 3x 40mg, which gave me side effects (extreme tiredness, wheezing, breathing difficulties). So my dose was reduced again to 2x 40 mg, which both gives me the side effects yet leaves me with anxiety (I had my first panic attack in over a week on Monday).

I just would like to know if anyone has been/is on beta-blockers and could share their experience. I'd also like to know if there are any alternatives, because I'm really not keen on the side effects (I can't see my GP for over a week, and I's like to know if there's anything better before then).

Thanks, all!


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Anonymous


Unregistered

Posted Fri Aug 28th, 2009 1:30am Post subject: Beta-blockers (anxiety, panic attacks)

Well, CBT addresses panic disorder effectively:

.

"Panic disorder is the experiencing of feelings of extreme fear which strike unexpectedly for no apparent reason. It is caused by the misinterpretation of physical sensations the person is experiencing at the onset of the panic attack. The sensation of panic is accompanied by intense physical symptoms of discomfort. Sufferers also experience anticipatory anxiety, worrying about their next panic attack, and avoiding situations that are likely to cause its onset (Gross & McIlveen 2005, p.63). CBT addresses the client’s misinterpretation that benign or harmless events predict something catastrophic happening or being about to happen (Beck 1995, p.297, from Beck 1987)."

from:

WORKING WITH ANXIETY

Theoretical background

Anxiety disorder is contained in the idea that it is an individual’s overestimation of the risk in a situation and the underestimation of their capacity to deal with it - the distance between these two estimations is a measure of the degree of anxiety being felt .

Anxiety is a naturally-evolved response to the threat of danger and keeps humans safe in a world that contains many risks. Anxiety becomes anxiety disorder when someone’s anxiety is disproportionate to the threat being faced and is routinely disrupting the person’s life.

Intense worry or fear characterises anxiety. It manifests as difficulties in concentration, irrational thinking, confusion and tearfulness, feelings of hopelessness, and loss of self-esteem and confidence. These psychological symptoms are accompanied by physical symptoms which include muscle tension, a dry mouth, shortness of breath, palpitations and a racing heart, tightness or pain in the chest, nausea and sweating. Anxiety will also frequently bring about stomach upsets and headaches. The physical symptoms of anxiety can themselves cause increased levels of anxiety in the sufferer, particularly in Panic Disorder.

During anxiety there is a strong belief that the object of the anxiety is real, irrespective of this rationally being the case. This belief then affects behaviour, emotions and physiology. A typical response to anxiety is avoidance. This is a main factor in maintaining an individual’s anxiety. Although it seems reasonable to keep ‘safe’ by avoiding the cause of the anxiety, this strategy causes it to remain unresolved. Overcoming anxiety involves understanding its causes, and through behavioural experiments, gradually testing out whether the individual’s perception of the cause is reasonable or accurate.

It is important to note that depression is differentiated from anxiety by the global sense of ‘hopelessness’ which characterises depression. Research (Beck et al, 2006) shows that anxious patients consistently have a significantly lower measure of hopelessness about resolving life problems than do depressed patients.

Types of anxiety disorder

There are three main types of anxiety disorder: generalised anxiety disorder (GAD), panic disorder (PD), and phobic disorder. In addition, a further two disorders are included within DSM-IV as anxiety disorders: obsessive-compulsive disorder (OCD), the presence of persistent and unwanted thoughts, together with the compulsion to act out ritualistic behaviour, and post-traumatic stress disorder (PTSD), the repetitive and uncontrolled mental re-experiencing of stressful emotional states.

Generalised anxiety disorder is characterised by exaggerated and worrisome thoughts about everyday life-events. Not linked to specific situations, the sufferer will be unable to pinpoint the exact causes of anxiousness. CBT responds to generalised anxiety by socialising the client into more realistic assessments of the threats being anticipated, and reinforcing their ability to cope with situations they see as threatening (Beck 1995, p.297, from Beck & Emery, 1985).

Panic disorder is the experiencing of feelings of extreme fear which strike unexpectedly for no apparent reason. It is caused by the misinterpretation of physical sensations the person is experiencing at the onset of the panic attack. The sensation of panic is accompanied by intense physical symptoms of discomfort. Sufferers also experience anticipatory anxiety, worrying about their next panic attack, and avoiding situations that are likely to cause its onset (Gross & McIlveen 2005, p.63). CBT addresses the client’s misinterpretation that benign or harmless events predict something catastrophic happening or being about to happen (Beck 1995, p.297, from Beck 1987).

Phobic disorder relates to extreme and irrational fears about particular objects or situations. Avoidance of the feared object or situation causes dysfunction in the sufferer’s life. Phobia is different from a milder fear or dislike of something. The phobia is irrational because the sufferer realises that the object of fear is generally harmless, but nevertheless they still experience fear (Gross 2005, p.776). Agoraphobia is fear of being unable to escape from an unsafe situation. Social phobia is an excessive fear of being amongst other people. Specific phobia relates to a fear of particular objects or situations such as spiders or being in the darkness.

Approaches to treating anxiety disorder

In addition to CBT, other therapeutic responses to anxiety include treatment within the medical, psychodynamic and behavioural models of illness. However the aim of all responses is to manage rather than banish anxiety (Grant et al, 2004). Common to all models of treatment is the need to treat comorbidity in the client, i.e. other diagnosed disorders such as an addiction or depression.

The medical model of health is based on the idea that mental illness has physical causes and so should be treated with physical responses (Gross & McIlveen, 2005 p.11). Accordingly, the medical response implies the use of pharmaceutical medication to treat anxiety, typically SSRI-type anti-depressants and/or ‘beta-blockers’.

The psychodynamic model of health describes mental health problems as the result of unconscious ‘defence mechanisms’ stemming from the client’s historical experiences. These defence mechanisms protect the conscious mind from intolerable anxiety. However, this protective measure becomes unhelpful when the cause of the distress is no longer present, and the person consequently becomes ‘ill’. The psychodynamic psychotherapist seeks to instil cognitive and emotional insight in the client about how he or she thinks, feels and behaves through the re-enactment of elements of the client’s past, using the therapeutic relationship between therapist and client as a vehicle for this work (Geraghty, 2004). (!)

The behavioural model of health infers that illness is ‘learnt’, and therefore it can be ‘unlearnt’. In the case of anxiety, treatment is centred on learning how to control symptoms of distress through relaxation, reducing avoidance of anxiety-provoking situations through graded exposure to them, and the building of confidence by re-engagement in “pleasurable and rewarding activities” (Butler et al, 1991).

CBT and anxiety

The cognitive model of health, developed by Aaron Beck in the 1960’s, is founded on the idea that distressing feelings and unhelpful or inappropriate behaviours stem from a distorted interpretation of an individual’s thoughts – ‘The individual’s ‘emotional reactions are essentially a function of how [he/she] construes the world.’ (Gross, 2005, p. 827, from Beck, 1967).

Cognitive Behavioural Therapy therefore ‘reframes’ the thoughts influencing a person’s emotions and behaviour by challenging the automatic assumptions and attitudes the client holds about self, others and the world at large. Negative automatic thoughts maintain distorted thinking by preventing the opportunity to experience alternative interpretations about the issue(s) causing distress. An accompanying lack of self-confidence also reduces belief in the ability to carry out activities successfully. The function of the therapist is to interrupt this negative and self-perpetuating circle of symptoms and behaviours.

The ‘cognitive’ aspect of the therapeutic response is to recognise that anxiety can be controlled by identifying anxious thoughts and then seeking more realistic and helpful alternatives to them. The ‘behavioural’ element in the therapy is the use of experiments that behaviourally test out alternative interpretations of thinking patterns. The outcomes of these experiments are assessed (by the client) in terms of reduction of symptoms and levels of distress. In this way the CBT client progressively modifies their thinking errors and behaviours, ameliorating the distress they experience.

In the therapy these behavioural experiments or interventions will usually be set as ‘homework’ for the client to carry out in the periods in between the therapy sessions. In addition, the use of assessment tools such as the Beck Anxiety Inventory gives indications of change during the course of the therapy, as well as highlighting aspects of the client’s problems that may particularly need addressing. After an appropriate period of treatment the client is able to reduce his/her level of anxiety, avoiding excessive anxiety itself, rather than (as previously) avoiding its causes.

An assessment of CBT as an effective response to anxiety

There is a body of clinical research evidence suggesting that CBT is a more effective response to anxiety than either pharmacological treatment (NICE, 2004, Clinical guideline 22, Section 1.7.1) or standard behavioural therapy.

An example is the Butler study ((Butler et al, 1991)) carried out at Oxford University in the early 1990’s, in which it was found that after treatment twice the proportion of subjects in a CBT group achieved a particular target level on anxiety scales, compared to a parallel Behavioural Therapy (BT) group (32% against 16% respectively). Furthermore, at a subsequent six-month assessment, the proportions meeting the target anxiety scale criteria were 42% and 5% respectively for the CBT and BT groups. These results indicate that cognitive-behavioural therapy is more effective than behavioural therapy as a treatment for anxiety disorder, but also, importantly, that the therapeutic effect of cognitive-behavioural therapy is more enduring.

Conclusion

Anxiety is a natural response to danger or the threat of danger, but excessive anxiety that leads to dysfunction in an individual’s life is an anxiety disorder. Psychological symptoms of anxiety are accompanied by physical symptoms which may themselves cause increased levels of anxiety. The aim of the therapeutic response to anxiety disorder is to manage rather than banish the individual’s anxiety. The cognitive-behavioural model of health holds that distressing feelings and unhelpful behaviours stem from distorted interpretations of the individual’s thoughts. The cognitive-behavioural response to anxiety disorder recognises that anxiety can be controlled by seeking more realistic interpretations to anxious thoughts, which are then validated through behavioural experiments, leading to a reduction of symptoms and distress.

Assignment bibliography and references

Beck, A.T. (1987). Cognitive Model of Depression. Journal of Cognitive Psychotherapy: An International Quarterly, 1, 5-37.
Beck, A.T., Brown, G., Riskind, J.H., Steer, R.A. & Wenzel, A. (2006). Specificity of Hopelessness about Resolving Life Problems: Another Test of the Cognitive Model of Depression. Journal of Cognitive Therapy and Research, 30, 773-781.
Beck, A.T. & Emery, G. (1985). Anxiety Disorders and Phobias: A Cognitive Perspective. New York: Basic Books.
Beck, J.S. (1995). Cognitive Therapy - Basics and Beyond. New York: The Guilford Press.
Butler, G., Fennell, M., Robson, D. & Gelder, M. (1991). Comparison of behaviour therapy and cognitive-behaviour therapy in the treatment of generalised anxiety disorder. Journal of Consulting and Clinical Psychology, 59, 167-175.
DSM-IV. (1994). American Psychiatric Association - The Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition.
Grant, A., Mills, J., Mulhern, R. & Short, N. (2004). Cognitive Behavioural Therapy In Mental Health Care . London: Sage Publications Limited.
Gross, R. (2005). Psychology – The Science of Mind and Behaviour. London: Hodder Arnold.
Gross, R. & McIlveen, R. (2005). Abnormal Psychology. London: Hodder & Stoughton Educational.
NICE. (2004). National Institute for Clinical Health and Excellence. Anxiety - Management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. Clinical guideline 22. December 2004.

Chris Budden 2007 - free to copy

_______________________________________


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LizzA


Member

Posted Fri Aug 28th, 2009 1:43am Post subject: Beta-blockers (anxiety, panic attacks)

Woah, thanks for that wealth of info! ^.^

And yeah, I want that and so does my GP, but I'm moving at the end of Sept to uni accomodation so noone will take me on. I'm stuck to pills until I can get a new GP in my new place and a new referral.

Which is a point - if I get a new GP, do I lose my place with the GP I have now? 'Cause she's really nice, and helpful (sort of like a surrogate therapist until I move).


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Anonymous


Unregistered

Posted Fri Aug 28th, 2009 1:54am Post subject: Beta-blockers (anxiety, panic attacks)

she should 'hand you over' + your notes.

medication has a place - it depends what the person needs at that time - what works to make life more manageable while a better plan is developed (if necessary).

It was easy to put that up, it's just part of my coursework stacked up in Word files, and seemed to reply to what you were saying.

The key thing about panic attacks is that they commence with the person misinterpreting the PHYSICAL sensations they are experiencing. The second key thing is that they can be prompted by the physiological responses the person automatically has to the (anxious) thought 'I might have a panic attack', known a 'anticipatory anxiety'.

There should be a Uni counselling service that will provide counselling in the CBT model if you ask. I don't think anyone really traoins in other models now, not to work in real life with ordinary mental distress. (Probably different if you are able to spend years having psychoanalysis, but most people just want to feel better, so for this reason it would be the most likely response you will get to anxiety disorder in a modern university setting.

Hope all this helps

Chris


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LizzA


Member

Posted Fri Aug 28th, 2009 2:12am Post subject: Beta-blockers (anxiety, panic attacks)

Thank you, it does. I'm going to bed & I'll digest, and maybe post again tomorrow with thoughts.

Thanks again!


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LizzA


Member

Posted Fri Aug 28th, 2009 2:32pm Post subject: Beta-blockers (anxiety, panic attacks)

Dormouse said:

The key thing about panic attacks is that they commence with the person misinterpreting the PHYSICAL sensations they are experiencing.

Could you explain that more? I don't think I understand completely.

Do you also know what might happen with my medication? I don't want to get off them and go back to the panic attacks, but I also do't want the side effects - do I just have to choose?


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Anonymous


Unregistered

Posted Fri Aug 28th, 2009 5:49pm Post subject: Beta-blockers (anxiety, panic attacks)

interesting questions to consider after some coffe and so on....


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Soph


Member

Posted Fri Aug 28th, 2009 6:26pm Post subject: Beta-blockers (anxiety, panic attacks)

Hallo LizzA. : ] I'm on Propranolol, I'm on it for anxiety and panic attacks. I've been on it for a few months after I came off Valium. It's upside is that it isn't at all addictive but the downside is that it only takes care of the physical sides of anxiety, which means feelings of worry and dread are still very much there. Beig on Propranolol and another medication I still get frequent panic attacks so it doesn't work great for me but it is much better than if I were to go alone. I'm regularly tired because of the drug but I put up with it. I haven't had any other side effects.

If Propranolol is working for you and you aren't getting panic attacks, I do think you should carry on with it, particularly because it isn't addictive. An alternative is Valium/Diazepam, however it is highly addictive. You may have to put up with the side effects to manage your anxiety. Although I don't know the extent of your side effects so I really musn't advise. Make sure you discuss your concerns with your GP, they know much more than me. However, I am on it and I can only share with you my experience.
: ]

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Anonymous


Unregistered

Posted Fri Aug 28th, 2009 8:17pm Post subject: Beta-blockers (anxiety, panic attacks)

post appear


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LizzA


Member

Posted Fri Aug 28th, 2009 8:35pm Post subject: Beta-blockers (anxiety, panic attacks)

Soph said:
Hallo LizzA. : ] I'm on Propranolol, I'm on it for anxiety and panic attacks. I've been on it for a few months after I came off Valium. It's upside is that it isn't at all addictive but the downside is that it only takes care of the physical sides of anxiety, which means feelings of worry and dread are still very much there. Beig on Propranolol and another medication I still get frequent panic attacks so it doesn't work great for me but it is much better than if I were to go alone. I'm regularly tired because of the drug but I put up with it. I haven't had any other side effects.

If Propranolol is working for you and you aren't getting panic attacks, I do think you should carry on with it, particularly because it isn't addictive. An alternative is Valium/Diazepam, however it is highly addictive. You may have to put up with the side effects to manage your anxiety. Although I don't know the extent of your side effects so I really musn't advise. Make sure you discuss your concerns with your GP, they know much more than me. However, I am on it and I can only share with you my experience.
: ]

Hi! Thank you for the post.

I didn't have any panic attacks for the week that I had the highest dose (3x 40mg), but I was also wheezing a fair bit and had some breathing difficulties, which my GP was pretty concerned about. Now, on 2x 40mg it's mostly just breathlessness, but I'm also getting panic attacks as frequently as without the pills, and the anxiety comes back around 3 hours after each dose.

I could live with the side effects if it weren't for the fact that I'm having a hell of a problem concentrating on these - my concentration wasn't that good to start with, and as I'll be going to uni soon...!
As it is, it's taken me about an hour to post this! D:


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Anonymous


Unregistered

Posted Fri Aug 28th, 2009 9:59pm Post subject: Beta-blockers (anxiety, panic attacks)

Dormouse said:

The key thing about panic attacks is that they commence with the person misinterpreting the PHYSICAL sensations they are experiencing.

LizzA said:

Could you explain that more? I don't think I understand completely.

Do you also know what might happen with my medication? I don't want to get off them and go back to the panic attacks, but I also do't want the side effects - do I just have to choose?

______________

There are different issues here -

something about anxiety and panic, and how panic attacks are precipitated by physiological effects that respond to the situation you are in or the situation you ARE THINKING you are GOING to be in

and something about the different approaches to treating panic disorder, and who has responsibility in that, and the role that internet forums can have in that.

Taking the second first...

you said "Do you also know what might happen with my medication? I don't want to get off them and go back to the panic attacks, but I also do't want the side effects - do I just have to choose?".

In the description of anxiety above I mentioned four 'models' of treatment - in other words the four different ways that psychiatrists and others believe that mental distress is caused and treated.

These models are

medical
psychodynamic
behavioural
humanistic (or 'person-centred')

the medical model states that illness has physical causes and is treated by physical means. Examples of causes are heredity (genes), viruses, chemical variation, and of treatments, medication, surgery, ECT (a physical treatment using electrical current, a physical thing).

the behavioural model (including cognitive-behavioural approaches0 take the basis of illness to be that we have 'learnt' how to be distressed and that to treat it we 'unlearn' our behaviours (hence behavioural model) An example is that we have learnt that if we don't put up our hand in class we don't get to feel crap as a result = behaviour of withdrawal. Somewhere we have picked up the belief that we will not 'perform' adequately under the relentless scrutiny of our peers in the schoolroom. To unlearn this we create better conditions in which to see IF WHAT WE HAVE LEARNT (OUR PREDICTIONS) ARE REALLY TRUE and HOW TRUE if true to some degree, and if that how true matches our predicted state of embarrassment and so on. We see if BEHAVING DIFFERENTLY alters the feeling we get afterwards - cos we don't feel great staying out of everything either - we are mentally or emotionally discontent.

The other two models are described above

If you think abourt someone who is strongly depressed - one might [if a prescribing doctor or psychiatrist] decide that the depressed person would benefit from 'talking therapy' [CBT, in the behavioural model of health] but that in order for them to engage with CBT it would need there low mood first to be raised a bit - which is of course the aim of the CBT - Catch 22. The doctor may prescribe anti-depressants for a period - 6 months say - during which time the patient/client's mood lifted sufficiently to engage psychotherapy, because the physical reality of the depressed person's brain is that its chemistry is not at optimum, and the a/d will physically alter that, in the absence of the client'ds self-ability to alter their chemical balance by the sort of thoughts they have.

What this demonstrates ids that different models of health are not necessarily self-excluding (is that what i mean - you know, don't necessarily preclude the use of other models at the same time).

Your doctor is prescribing the beta-blocker Propanolol and he/she is doing this in the medical model. This does not preclude you from working in the Cognitive Behavioural Therapy (CBT) model of health (perhaps after you have started at the University or when there is the right circumstance).

The issue of the prescription is (and I am sure this view would be echoed by the Moderators of the Board) solely between yourself and the prescribing doctor. Part of the reason for this is self-explanatory, in that it is a medical-model responseand so can only be judged by someone trained in the medical model, ie a qualified medical doctor.

There is useful experience to be shared by co-users, and this may form part of the judgement you bring to the table with your doctor when you decide between you what is the best thing to do, and what other factors should be taken account of.

So, i have no view as to what you should do about medication except to be transparent with your doctor about it, and as informed as possible.

I hope the above has been helpful in setting the stage the Propanolol is playing on, and how medication can be seen in the light of other choices.

I also recomentd this, around section 17 i think it is - about the efficacy of medication v cbt in the treatment of anxiety disorder (available to read on-screen I think):

NICE. (2004). National Institute for Clinical Health and Excellence. Anxiety - Management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. Clinical guideline 22. December 2004.

_________________

the second issue - how does panic disorder manifest - come about ... well .... coffee

Chris


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Soph


Member

Posted Fri Aug 28th, 2009 10:13pm Post subject: Beta-blockers (anxiety, panic attacks)

LizzA said:
Hi! Thank you for the post.

I didn't have any panic attacks for the week that I had the highest dose (3x 40mg), but I was also wheezing a fair bit and had some breathing difficulties, which my GP was pretty concerned about. Now, on 2x 40mg it's mostly just breathlessness, but I'm also getting panic attacks as frequently as without the pills, and the anxiety comes back around 3 hours after each dose.

I could live with the side effects if it weren't for the fact that I'm having a hell of a problem concentrating on these - my concentration wasn't that good to start with, and as I'll be going to uni soon...!
As it is, it's taken me about an hour to post this! D:

I think with anxiety and panic attacks in order to overcome them you have to get to the root of the problem that's causing it. No medication is going to take care of it completely, they often don't work as well as you'd hope. Propranolol, either works for you or it doesn't, it doesn't work for everyone. You have to decide, given the choice by your GP whether or not it's worth you having the side effects for what you're getting out the medication. Breathlessness doesn't sound too healthy, I must admit.

I've just turned 19, by the way. : ] And the dreaded thought alone of going to Uni brought me major amounts of anxiety. And so I'm unable to go. My anxiety has full control over me. Even though I'm on medications to try and illiminate the anxiety it doesn't work greatly but I feel for the very little that it does for me it's worth me taking them.

I don't know what else to add so I apoligies for my lack of usefulness!
I do hope you find your answers, take care.

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Anonymous


Unregistered

Posted Fri Aug 28th, 2009 10:48pm Post subject: Beta-blockers (anxiety, panic attacks)

In replying to LizzA I was going to ay something about the differences between generalised anxiety and panic , and wonder if this would interest you too Soph with what you said at the end there

but going to make some coffee


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Soph


Member

Posted Fri Aug 28th, 2009 11:04pm Post subject: Beta-blockers (anxiety, panic attacks)

Dormouse said:
In replying to LizzA I was going to ay something about the differences between generalised anxiety and panic , and wonder if this would interest you too Soph with what you said at the end there

but going to make some coffee

Sure, that would be appreciated. : ]

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Anonymous


Unregistered

Posted Fri Aug 28th, 2009 11:11pm Post subject: Beta-blockers (anxiety, panic attacks)

If i just paste some short bits of the big post on anxiety disorders ...

.

Anxiety is a naturally-evolved response to the threat of danger and keeps humans safe in a world that contains many risks. Anxiety becomes anxiety disorder when someone’s anxiety is disproportionate to the threat being faced and is routinely disrupting the person’s life.

...During anxiety there is a strong belief that the object of the anxiety is real, irrespective of this rationally being the case. This belief then affects behaviour, emotions and physiology. A typical response to anxiety is avoidance. This is a main factor in maintaining an individual’s anxiety. Although it seems reasonable to keep ‘safe’ by avoiding the cause of the anxiety, this strategy causes it to remain unresolved. Overcoming anxiety involves understanding its causes, and through behavioural experiments, gradually testing out whether the individual’s perception of the cause is reasonable or accurate.

and

The medical model of health is based on the idea that mental illness has physical causes and so should be treated with physical responses (Gross & McIlveen, 2005 p.11). Accordingly, the medical response implies the use of pharmaceutical medication to treat anxiety, typically SSRI-type anti-depressants and/or ‘beta-blockers’.

...The cognitive model of health, developed by Aaron Beck in the 1960’s, is founded on the idea that distressing feelings and unhelpful or inappropriate behaviours stem from a distorted interpretation of an individual’s thoughts – ‘The individual’s ‘emotional reactions are essentially a function of how [he/she] construes the world.’ (Gross, 2005, p. 827, from Beck, 1967).

Cognitive Behavioural Therapy therefore ‘reframes’ the thoughts influencing a person’s emotions and behaviour by challenging the automatic assumptions and attitudes the client holds about self, others and the world at large. Negative automatic thoughts maintain distorted thinking by preventing the opportunity to experience alternative interpretations about the issue(s) causing distress. An accompanying lack of self-confidence also reduces belief in the ability to carry out activities successfully. The function of the therapist is to interrupt this negative and self-perpetuating circle of symptoms and behaviours.

and

Generalised anxiety disorder is characterised by exaggerated and worrisome thoughts about everyday life-events. Not linked to specific situations, the sufferer will be unable to pinpoint the exact causes of anxiousness. CBT responds to generalised anxiety by socialising the client into more realistic assessments of the threats being anticipated, and reinforcing their ability to cope with situations they see as threatening (Beck 1995, p.297, from Beck & Emery, 1985).

Panic disorder is the experiencing of feelings of extreme fear which strike unexpectedly for no apparent reason. It is caused by the misinterpretation of physical sensations the person is experiencing at the onset of the panic attack. The sensation of panic is accompanied by intense physical symptoms of discomfort. Sufferers also experience anticipatory anxiety, worrying about their next panic attack, and avoiding situations that are likely to cause its onset (Gross & McIlveen 2005, p.63). CBT addresses the client’s misinterpretation that benign or harmless events predict something catastrophic happening or being about to happen (Beck 1995, p.297, from Beck 1987).

_________________

What can we learn from this - that i did a lot of writing over the two years

and ....

The Verve Catching The Butterfly http://www.youtube.com/watch?v=z-kpSpzobkY

and important is this -

"Anxiety is a naturally-evolved response to the threat of danger and keeps humans safe in a world that contains many risks. Anxiety becomes anxiety disorder when someone’s anxiety is disproportionate to the threat being faced and is routinely disrupting the person’s life.

Although it seems reasonable to keep ‘safe’ by avoiding the cause of the anxiety, this strategy causes it to remain unresolved. Overcoming anxiety involves understanding its causes, and through behavioural experiments, gradually testing out whether the individual’s perception of the cause is reasonable or accurate."

__________

........Soooo, anxiety is natural but can get in the way. Panic is intense anxiety that is getting in the way, generalised anxiety is anxiety that is getting in your way. It is keeping you so 'safe' that one person has to have meds she doesn't like and another has to delay things that are important to her. And as Soph says I think, medication does not remove the cause of the anxiety or allow you to adjust to it - it enables you to cope.

Generally when medication stops the anxiety-based difficulties re-emerge, if no change has been made to the cause of the anxiety - [reference: Layard, R. (2006). The Depression Report: A New Deal For Depression and Anxiety Disorders. London: London School of Economic; The Centre For Economic Performance’s Mental Health Policy Group; see also: Butler, G., Fennell, M., Robson, D. & Gelder, M. (1991). Comparison of behaviour therapy and cognitive-behaviour therapy in the treatment of generalised anxiety disorder. Journal of Consulting and Clinical Psychology, 59, 167-175.]

Which takes the idea to HERE:

"Overcoming anxiety involves understanding its causes, and through behavioural experiments, gradually testing out whether the individual’s perception of the cause is reasonable or accurate."

In this way we 'unlearn' unhelpful and inaccurate or partially inaccurate beliefs about ourselves, others and the world about us.

Why is panic precipitated by physiological responses to the situation we are in or we imagine (literally) we are going to be in if....

Hhhmmm, thats a coffee sized question, little dormouse!

Chris


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