Here is a list of easy ways to keep balance and maintain a healthy lifestyle.

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Causes of Stress

Situations and pressures that cause stress are known as stressors.  We usually think of stressors as being negative events such as an exhausting work schedule or a rocky relationship, but stressors can be also positive events such as getting married, buying a house, going to college, or receiving a promotion.  What causes stress depends, at least in part, on each individual’s perception of it.

Common external causes of stress

• Major life changes

•Work

• Relationship difficulties

• Financial problems

• Being too busy

• Children and family

Common internal causes of stress:

• Inability to accept uncertainty

• Pessimism

• Negative self-talk

• Unrealistic expectations

• Perfectionism

• Lack of assertiveness

Effects of Chronic Stress

The body doesn’t distinguish between physical and psychological threats, so when you’re stressed over a busy schedule, an argument with a friend, a traffic jam or a mountain of bills, your body reacts the same as if you were facing a life-or-death situation.  If you have a lot of responsibilities and worries, your emergency stress response may be “on” most of the time.

Long-term exposure to stress can lead to serious health problems.  Chronic stress disrupts nearly every system in your body and it can raise blood pressure, suppress the immune system, increase the risk of heart attack and stroke, contribute to infertility and speed up the aging process.  Long-term stress has also been linked with a vulnerability towards experiencing anxiety and depression.

If you would like to print a copy of the Managing Stress – Tip Sheet, click on this link.

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ACT offers a simple and modest approach to gaining health and wellbeing at an emotional, physical and mental level.  Through teaching mental flexibility, ACT encourages the acceptance of things that are out of your control.  Through clarifying values and morals, ACT encourages a commitment to take action in accordance to those things that are important and meaningful within your life.

The goal of ACT is to teach:

1). Strategies to manage difficult thoughts more effectively, particularly those that are unhelpful and plague one’s mind repeatedly

2). Effective approaches to experiencing painful feelings without being caught up in their intensity and in turn lessening the control they have over you.

3). How to maintaining focus on what is most important to you and promoting value-driven action towards those things that improve and enrich your life, provide meaning and purpose to you and lead to a vibrant and rich future.

ACT is based on mindfulness strategies, awareness, psychological flexibility and a gentle nature for approaching life.  All of these can be learnt and applied with just a little training and practice… and the result is to live a meaningful and enjoyable life.

Often those afflicted will experience significant anticipatory anxiety which can bring on additional panic attack which can then cycle and repeat itself.

Panic attacks can occur randomly and without warning however often occur in similar places to those where panic attacks have previously been experienced.  In general panic attacks only last minutes and rarely more than an hour, but to sufferers they can feel endless. These attacks begin with an intrusive fear, apprehension or terror and are then accompanied by physical symptoms which include:

• Increased heart rate

• Dizziness

• Faintness

• Sensations of choking or being smothered

• Chest pain

• Trembling

• Feeling detached from surroundings

• Sweating

• Nausea

• Numbness

• Hot or cold flashes

• Feeling of loss of control

Individuals are generally diagnosed with panic disorder when they have reoccurring and unexpected panic attacks. As a result of the panic attacks, sufferers also become worried about having more panic attacks. Usually diagnosis of this disorder involves the sufferer having reoccurring and unexpected panic attacks.

Sufferers of panic attacks can also experience a condition called agoraphobia.  Agoraphobia is the fear of leaving one’s home or entering public or wide open spaces that could potentially be embarrassing or hard to escape from.  Due to the fact that sufferers of panic attacks avoid leaving their home due to the fear that a panic attack could happen while they are in a public place, they therefore have the potential to develop agoraphobia.  Though this may happen it does not happen to all sufferers of panic attacks or panic disorder.  If a sufferer of panic attacks also suffers from agoraphobia they may be able to leave their home, but it is usually done reluctantly and almost always with a high level of anxiety.

The treatment method that is most commonly used for treating panic disorder or panic attacks is Cognitive Behavioural Therapy (CBT) or acceptance and commitment therapy (ACT) in combination with graded exposure.  This treatment method aims to show sufferers that their fears or that the panic attacks that they may suffer do not really have such terrifying consequences as they may think. By systematically desensitising sufferers to their panic attacks and showing their fears in a different light, the anxiety that they may feel can start to be reduced and in turn the fear of another panic attack can also be reduced.

If you would like to print a copy of the Panic Attacks – Tip Sheet, click on this link.

The acceptance of the label ‘clinical depression’ would be viewed as experiencing low mood and there would be varying levels of distress that come from this.  We would not suggest that depression does not exist but rather see it as a fluid moving series of mood states that fluctuate naturally over time and also in response to situations.  How would this change the way we treat mental illness such as depression.

Firstly, in this new paradigm, mental illness would not exist.  There would be only preferences of how one would like to feel and acceptance of non-preferable states of mood (thoughts and feelings/sensations).  Therefore one would learn to enjoy their preferred mental states (and feelings) when they arise and accept as normal the more uncomfortable mental states (and feelings).  This would build a preson’s resilience and therefore assist them in having a psychological buffer to being depressed about feeling depressed.

Secondly, mental illness would not necessarily be treated with medication as there would be no need for it.  Mental illness would be understood as a particular mood state that is changing in intensity and cyclical.  Just like seasons change in nature, mood also changes such as seasonal depression (or seasonal affective disorder).  We would therefore use a mindful approach to understanding depression and in turn know that depression is impermanent, changes from moment to moment and cannot last forever.  This would help in accepting unexplainable feelings that a person cannot find precipitating factors for (i.e., “why am I feeling depressed when I have a great job, a beautiful and caring spouse, am financially secure and have two healthy children?”

Mental illness would be treated through education and practice.  Awareness of thoughts as being thoughts and feelings as being feelings, neither good nor bad would be at the heart of treatment.  There would not be debate about trying to stop thoughts as we would teach flexibility in how to hold thoughts such as asking oneself “is this thought useful to me?”  If the answer is yes, we may want to act on the thought however if the answer is no we may want to recognise the thought as simply being a thought and allow it to be there without further judgement.  This mindful practice could be used with all mental illness as it does not judge any thought as being disordered, dysfunctional, abnormal, strange or odd.

This new paradigm would also mean we accept others for who they are and not prescribe that they are wrong in their thinking because it is not in line with our own view.  Maybe this is the greatest challenge for us all.

Please note this is written to create thought provoking discussion exploring the use of labels in mental health and is not the views of psychology, psychiatry, medicine or Strategic Psychology.

Generalised Anxiety Disorder

Generalised Anxiety Disorder (GAD) is one of the various forms of anxiety disorders. GAD is believed to be characterised by a person feeling anxious, nervous or worried for most of the time for at least 6 months when they are not under threat of any particular danger. Situations and events that commonly contribute to anxiety are generally based on details relating to finances, family, health, friendship problems, death, workplace issues, trying to maintain others happiness and not wanting to be judged.  Approximately 2.7% of adult Australians experience GAD, which is almost 1 in 33 people.

Symptoms of the disorder generally differ from person to person, but for a person to be diagnosed with GAD they must find it difficult to control the worry and experience at least 3 of the following symptoms:

• Feeling restless, keyed up or on edge

• Poor concentration

• Irritability

• Muscle tension or feeling tight

• Fatigue or being easily fatigued

• Sleep difficulty

Although the above symptoms are used to formally diagnose GAD, other symptoms are commonly found among sufferers such as:

• A heightened worry about certain situations occurring

• Feeling overwhelmed or trapped in ruminating thought

• Feeling uneasy

• Fear of death

• Fear of not being in control (can’t stop my thoughts racing around)

• Agitation

• Increased heart rate

• Headaches

The cause of the GAD is not entirely understood, but can range from a number of factors which include genetics (family history, personality type) and environmental aspects (childhood parenting, role models, traumatic and/or stressful events).

GAD usually begins in childhood or teen years, but is also able to arise in adults.  It can be precipitated by traumatic or highly stressful events (though not everyone who experiences such events will develop GAD).  People who also have a history of being consistently worried or distressed about how things will turn out can be susceptible to developing GAD.

A person with GAD can also find it hard to function in different everyday life situations such as a lack of work place efficiency, difficulty maintaining concentration during conversation and being preoccupied with worry.  As the disorder can affect a person’s ability to function it is important for the sufferer to seek treatment.

Treatment methods used to support the management of GAD include cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), group therapy and relaxation training.  All these treatment approaches aid people in learning how to lessen the affects of negative thoughts and in turn help to reduce the affects of GAD.  Other aspects of treatment may include psychoeducation to help sufferers understand how to better eat, sleep, relax and create some distance from their thoughts.  Using these aspects of treatment, a person can learn better coping strategies instead of being pushed around by their worries/thoughts.

Kleptomania is a psychological disorder in which a person feels an overpowering urge to go out and steal items which have no real use or value to them. A person who suffers from kleptomania generally will feel an urge or tension to steal a vast category of items ranging from paper clips to laptops.  When a person with kleptomania steals an item the tension that they feel is suppressed for that moment, but often sufferers find that the urge will just come back stronger.

Kleptomania can be debilitating to a person.  It arises as an urge, feels like it needs to be suppressed and the only way to suppress or relieve oneself from the urge is to get a “thrill” from stealing objects.  This is harmful to a person because it is not only against the law, but often after a person steals an item they will feel guilty which can have an effect on their self-esteem and self worth.  The act of stealing is also often against the persons moral code.

Another disorder which shares similarities with kleptomania is hoarding.  This disorder of hoarding, like kleptomania, involves acquiring objects, but a person with compulsive hoarding will find it difficult to discard items that they have.  A sufferer of hoarding will often feel an urge to go out and purchase items they may perceive to be of value, or could potentially be of value, and can often purchase the same type of items numerous times.  A person who hoards items will buy items they do not have yet, however after a while they can forget or not realise how many items they have acquired and purchase items they already have stored somewhere.

Hoarding greatly affects a person in that they can acquire so many objects or items that they start to build up to great numbers, and in extreme cases can take over a person’s entire home.  The objects that the person obtains can soon build up a sentimental value to them which can make the item very hard to throw away.  Not only space consuming, but hoarding can be financially straining and time consuming to the sufferer which can be very debilitating.

Though both of these disorders can over-run a person’s normal way of living, treatments are available and can reduce the urges that a person with either of these disorders may feel.  With the aid of a psychologist a person can learn how the disorder affects them, understand their pattern of urges and urge relieving actions and in turn begin breaking the belief of needing to hold onto an item or steal an item.

The most common and most effective form of treatment is systematic desensitisation, which involves gradually coming to terms with identifying when the urge arises and what can be done to suppress the urge without having to acquire/steal or hold onto items.  For a person who hoards items, systematic desensitisation would gradually ease into discarding unneeded items until the urge a person feels to hold onto items is reduced.  And for a person experiencing kleptomania, systematic desensitisation would aid them to imagine themselves in a situation in which an urge could arise and gradually assist them in relaxing themselves in such situations to avoid the action of theft.  Both these approached allow a person to develop more helpful patterns of managing their urges.

Agoraphobia is an anxiety disorder described as being fearful of public or open spaces which may be difficult or embarrassing to escape or get away from.  A person with agoraphobia will often distance themselves from situations such as crowds, large social interactions, marketplaces, shopping centres, trains, planes etc.  Essentially a person with agoraphobia will try to not leave a place in which they perceive to be safe such as their home, and will try to avoid any place they perceive to be dangerous to them, or difficult to escape from.  Though busy or crowded places may be frightening to a sufferer of agoraphobia, the situation does not have to necessarily be noisy or have lots of activity happening.  For example a person with agoraphobia may find churches to be a threatening situation.  In addition, people experiencing agoraphobia will often try to avoid places in which they have suffered a panic attack before in the fear that returning to the location could illicit another panic attack.

The symptoms of agoraphobia include:

• A rise in anxiety when away from places of perceived safety

• breathlessness, dizziness, sweating, nausea, increased heart rate – all of which are common symptoms of anxiety

• Increased anxiety in anticipation of having to leave a safe environment

• Low self esteem and confidence

• Reluctance to leave familiar surroundings

• Fear of being embarrassed or humiliated

Agoraphobia can often be a very debilitating and difficult to overcome.  It can greatly affect a person’s normal way of living as it may restrict them from going to public places or being able to go to their workplace.  In extreme cases a person with agoraphobia can even become a prisoner in their own home as they may feel it is the only safe haven for them.

Treatment for agoraphobia is often long term and requires a sensitive approach by the therapist.  Cognitive behavioural therapy (CBT) is often used and helps by teaching a person with agoraphobia how to deal with difficult situations or public events by using:

1. Cognitive Therapy: helping change a person’s thinking patterns and attitudes towards a situation
2. Behavioural Therapy: Helping change a person’s fear response by strategically and systematically supporting them to safely meet the feared situation and in turn allow them to learn new coping strategies

In addition to CBT, other approaches to treating agoraphobia include exposure therapy and acceptance and commitment therapy however all treatment models generally share the common feature of systematic desensitisation.

Systematic desensitisation is useful in treating agoraphobia as it teaches the sufferer how to prevent provocation of anxiety in the feared situation by gradually confronting the fear while the sufferer is in a relaxed state.  This technique involves the sufferer to first identify what provokes anxiety in them, then imagining themself in this anxiety triggering situations while at the same time learning how to relax themselves (deep breathing, visualising peaceful and safe places, muscle relaxation), which over time desensitises them to the situation.  This is repeated with various triggers of anxiety (varying in intensity) and over time the sufferer learns to ease into situations which illicit anxiety and eventually even enter a previously anxiety provoking situation with a sense of confidence and control.

Morning Plan

• Routine is important. Get out of bed around the same time every day, weekends included, and once awake don’t ‘snooze’ for an extra 10 minutes.

• Have something important or meaningful to get up for.

Day Plan

• Exercise but only during the day, avoid exercising in the late evening.

• Avoid taking naps, particularly late in the afternoon or after work in the evening.

• Maintain a healthy balance between stress and relaxation in your day (i.e., if work or study is stressful, make sure to take several gentle slow walks to even out the stress).

• Limit your intake of caffeine.  No caffeine after midday is preferred.

• Do not eat, read, or watch TV in bed, use your bedroom for sleep and intimacy only.

Evening Plan

• Participate in calming activities and avoid heightening your senses before bedtime such as playing a competitive game, watching an exciting program on television or playing a stimulating computer game.

• Although drinking alcohol can sometimes create a feeling of being relaxed, if consumed within 5 hours of going to bed, it can contribute to night time awakenings.

• Avoid foods, beverages, and medications that may contain stimulants.

• Avoid eating large heavy meals or a lot of liquid close to bedtime.  Do not go to bed too hungry or too full.

• Create a relaxing bedtime routine such as having a warm bath or warm herbal tea.

Bedroom Plan

• If worry keeps you awake, keep a ‘to do’ diary next to the bed. Write down all that you’re worrying about for review the next day. This will help keep your mind clear.

• Keep the temperature in your bedroom comfortable.

• Keep your bedroom quiet, dark and tidy.

If You Can’t Fall Asleep Plan

• Do not command yourself to go to sleep. This makes your mind and body more alert.

• Try not to focus on falling asleep by ‘clock watching.’ Turn the clock around.

• If after about 20 minutes you are unable to fall asleep, get out of bed and find a quiet place to do a quiet activity. You could read a non-suspenseful book or magazine,

meditate, listen to music, or do a relaxing puzzle until sleepy.

• Do not use alcohol to help you fall asleep.

If You Have Medicine to Help You Sleep

• Place your sleep medicine and a glass of water close to your bed. Take your medication as prescribed by your doctor.  If taking over the counter medication, take only if you are unable to fall asleep, or if you wake up within a couple hours of falling asleep.

• Some sleep medications may make you drowsy and tired the next day. Notify your doctor or pharmacist if this happens and do not perform any activities that require alertness.

If you would like to print a copy of the Sleep Hygiene – Tip Sheet, click on this link.

If you are still having sleep difficulties after using these sleep hygiene tips, please contact us or your GP to discuss alternate sleep management strategies.

Everyone experiences stress in their lives.  However for some, stress levels can become damaging when left for prolonged periods of time and not addressed. In order to regain some balance to your busy life, there are some exercises which can be used to help you restore a healthy equilibrium.  A four step system moving through progressive muscle relaxation, slow breathing, calming meditation and finally relaxing imagery can be helpful to reduce stress levels and begin feeling more centered again. The following techniques can also be performed individually to help you find some inner balance.

Muscle Relaxation

When starting any relaxation process you should try and relax your muscles a little as they can generally hold on to tension.

• Lie down or sit in a comfortable position where you feel warm and it is quiet.

• By tensing the muscles in your hands make a fist and hold for 5 to 10 seconds. Be aware of the tension building and then release the stress from your hands. Notice your hands feeling more relaxed.

• Now do the same your forearms followed by your upper arms and shoulders.

• Continue the process moving onto your head, firstly with your forehead then eyes, followed with your nose, cheeks and jaw.

• Carry on with the rest of your body starting with the neck, moving through the chest, abdomen, pelvis, thighs, calves, and feet.  Now move down to the neck and carefully tighten so that you feel tension, now release.

Your body should now be feeling relaxed.

Slow Breathing

Now that your muscles are feeling more relaxed its time to focus on your breathing for a few minutes.

• Try to slow the rhythm of your breathing.

• With your eyes closed, take a comfortable and deep breath through your nose.

• Hold your breath for only a moment and breathe out very slowly through your mouth.

• Continue this exercise for 3 to 5 minutes or until you feel settled and calm.

Meditation

At this point you should be feeling much more relaxed.  Now we can begin the practice of meditation.

• Again you should be sitting or lying in a comfortable position. Make sure that there are no distractions or noises near you.

• Begin to watch your breath as you resume the slow breathing exercise.

• Focus on observing your breath.

• If your mind starts wonder gently bring your attention back to the breath without judgement. Continue repeating this process.

Meditation is the practice of focusing the mind with awareness. It is a practice not a destination and therefore requires a little patience. Begin with practicing meditation for 5 minutes at a time; slowly increase until practicing 30 minutes per day.

Imagery

The final phase of relaxation is imagery. Imagery is used to create a peaceful environment where you feel total relaxed both mentally and physically.

• Close your eyes while taking 3 slow and deep breaths.

• Now imagine yourself sitting in completely serene place, it could be a beach, a temple, a park or even a rain forest.  It is your place of peace.

• Wander around slowly noticing everything you can see, smell, taste, touch and hear.  The more detail and vivid, the better.

• Smell your environment; do you smell salt or fresh grass? Do you hear birds or waves?

• Stay in your place and enjoy the stillness, it is whatever you make it… a place of escape.

If you would like to print a copy of the Relaxation – Tip Sheet, click on this link.

If you are still feeling stressed after following these exercises, please contact us or your GP to discuss alternate stress management strategies.