Gary Vaughan

Clinical Psychologist
& Psychotherapist

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Treatment Approaches
Offered

• Cognitive Behaviour
  Therapy
• Psychodynamic
  Psychotherapy

Problems Treated

• Stress
• Panic
• Anxiety
• Depression
• Anger
• Self-esteem
• Relating & Relationship
  Difficulties
• Trauma
• Childhood Abuse & Trauma
• Grief & Loss

Copyright©2011 Gary Vaughan

Anxiety

Anxiety is a common everyday experience. Despite being an unpleasant experience, it is normal. It is adaptive, and we are meant to have it. Anxiety is a response to danger or threat (whether real or perceived). Its purpose is to protect and prepare us via the ‘fight or flight response’, which involves physical, behavioural, and mental changes geared towards helping us to better deal with the danger.

In moderation, anxiety can enhance performance by helping us to perform more efficiently (e.g., when playing sport, sitting an exam, or attending a job interview). Even high levels of anxiety can be appropriate when they are consistent with the demands of the situation (such as when in real and serious danger). However, anxiety becomes problematic when it is experienced too frequently and/or too intensely. Excessive and unreasonable anxiety (i.e., not reasonable to the situation or circumstances) often causes a person distress and/or it interferes with a person’s life/functioning (personally, socially, at work, etc.).

The focus of the anxiety or fear can often be specific, and can fall into one (or more) of the following types:

Panic disorder

This is where individuals experience recurrent unexpected panic attacks, followed by a persistent concern about having another panic attack. Individuals often worry that they are going to lose control, that they are going crazy, or that they are going to die (from a heart attack). Agoraphobia is the fear of places or situations where the individual has experienced a panic attack, or where it might be difficult to escape or get help should an attack occur. This typically leads to the avoidance of such situations. (see Panic)

Social anxiety

Some individuals have a profound difficulty with negative evaluation (with being criticized and judged poorly; with being ridiculed). As a result, they fear any situation where they may be open to the scrutiny or evaluation by others (as they anticipate being evaluated/judged negatively). They are overly concerned that they will do or say something humiliating (which typically includes showing signs of being anxious).

In its more extreme form (social phobia), individuals can have difficulty with writing, eating, or drinking in public; with using public transport; with using public toilets; with standing in line; and particularly with public speaking of any kind.

But in its more common form (social anxiety), individuals can have difficulty with asking questions or contributing in meetings and in groups; with asking for what he or she wants, or saying “no” to what he or she does not want; with being open and natural when meeting new people … essentially, a difficulty with ‘being themselves’.

Specific phobia

This is where individuals have a persistent and irrational fear of a particular object or situation. This fear is excessive, and leads to avoidance of the object or situation. Common phobias include animals (spiders, insects, dogs); elements of the environment (heights, storms, water); particular situations such as planes/flying and enclosed places; or blood and injections.

Generalized anxiety

This is where individuals worry excessively and persistently about a number of areas of their lives, including their family, health, job, or finances.

Obsessive-compulsive disorder (OCD)

OCD is where individuals experience persistent, intrusive, unwanted thoughts, images, or impulses (obsessions) that they are unable to control. Obsessional thoughts are usually concerned with contamination, harm to self or others, disasters, blasphemy, violence, sex, or other distressing topics. Such thoughts are often very distressing and result in discomfort.

Individuals may also engage in rituals or compulsions, which are persistent needs or urges to perform certain behaviours in order to reduce the anxiety or discomfort. The most common rituals involve washing and/or checking. Others include counting, or arranging or doing things in a rigid, orderly fashion. Both the obsessions and the compulsions can occur without the other, but often the compulsions are associated with an obsessional thought. Most OCD sufferers can see the uselessness and absurdity of their actions but they still feel compelled to perform their various rituals. However, the relief (from performing the compulsion) is usually short-lived because either they were uncertain that they did it right or thorough enough (doubt), or because the obsessional thought has re-occurred.

This leads to where the individual is repeating the behaviour or ritual over and over. This is distressing, not to say often very time-consuming. Subsequently, avoidance of situations or objects that may trigger discomfort from obsessions and/or rituals is common.

Adjustment disorder

This is where individuals experience a period of distress and emotional disturbance that is excessive and/or interferes with normal functioning, following a significant life change or stressor (e.g., an illness, a job loss, a divorce).

Posttraumatic stress disorder

This is where individuals have experienced a terrifying trauma commonly thought to be outside the range of usual human experience (e.g., combat or prison camp experiences, natural disasters, car accidents, or threats to personal safety such as assault or rape). The symptoms experienced can involve a persistent re-experiencing of the traumatic event (e.g., images, dreams, flashbacks); an avoidance of cues that act as reminders of the event; and persistent levels of anxiety and hyper-arousal. (see Trauma)

Treatment approach for anxiety

While drug treatment (such as anti-depressants or benzodiazepines) may be useful (perhaps necessary) for some individuals, the more the individual can learn to rely on and trust using self-management techniques, the stronger will be his or her sense of self-efficacy and self-mastery (and in turn, the less anxious he or she will be). After all, it is often the case that some of the individual’s anxiety comes from his or her sense that he or she is unable to manage the anxiety (leading to being anxious about being anxious).

Cognitive Behaviour Therapy (CBT) is a profoundly useful and essential approach in enabling individuals to better manage their anxiety. I emphasize ‘manage’ because often individuals want to have ‘control’ over whether they get anxious … and that just is not possible. Remember anxiety is normal and we are meant to have it.
With most types of anxiety, the CBT approach involves:

• providing information about the nature of the disorder and the symptoms of anxiety that are experienced;
• the demonstration and practice of skills/strategies for managing anxiety – including slow breathing, relaxation, and cognitive restructuring; and
• implementing graded exposure to the relevant feared object, situation, or bodily sensation.

The treatment approach for OCD is quite different however. Referred to as exposure and response prevention, it involves the deliberate exposure to obsessional triggers/cues and the prevention of the behaviours (rituals or compulsions) that the sufferer typically engages in to lessen the anxiety. Repeated, prolonged exposure and response prevention allows ‘habituation’ to take place. The exposure is graded from the least through to the most anxiety provoking situation. While there is no doubt that this treatment can be difficult (and therefore drug treatment may be necessary for some), the condition itself is already very difficult for sufferers and this treatment can be quite effective for a lot of sufferers.

For some individuals, better managing their anxiety and the respective situations involved, is sufficient. However, for others, particularly those who have suffered anxiety for a long time, they may want to understand and to work through the deeper issues underlying the anxiety (i.e., the source of the anxiety). For this, psychodynamic psychotherapy would be the appropriate approach.