INFORMATION AND RESOURCES

SLEEP PROBLEMS

May 6th, 2021

Difficulty with getting enough or uninterrupted sleep is common: one sleep health survey by the Sleep Health Foundation from 2016 reported inadequate sleep may affect up to 33-45% of Australian adults. Resources that have been developed to help people with their sleep include: 

• Self-help resources, such as the ones offered (free of charge) by the Centre for Clinical Interventions (CCI). CCIs simple handouts are on topics such as education about sleep, sleep-hygiene tips, record-keeping tools, and other strategies. Link

• The online "Managing Insomnia Course" offered by This Way Up, is a guided 4-lesson program based on Cognitive Behavioural Therapy (CBT). Link

• You can also speak to your psychologist about psychological interventions for insomnia - at Marka Clinical Psychologists if you wish to work on your sleep problem primarily, you will be guided through a structured CBT intervention for insomnia. 

ANXIETY!

May 25, 2021

A brief summary of anxiety is provided below, including how anxiety is understood from the perspective of cognitive-behavioural therapy (CBT). 

Fear and anxiety are normal emotions. These emotional responses usually help alert us to threats in our environments. However, for some, fear and anxiety can become a challenge when experienced as pervasive or when leading to unhelpful thinking and behaviour patterns. For example, anxiety and fear can manifest as worry, panic attacks, or fears and avoidance that can impact people for a long time. 

Breaking it down:

• FEAR! – immediate and strong emotions associated with the fight, flight, or freeze (FFF) response. 

• ANXIETY – often about outcomes or events expected in the near future, includes symptoms of FFF.

• WORRY - a chain of anxiety-provoking thoughts aimed at problem solving. Worry tends to be more prolonged, and can be associated with physical sensations such as tension. 

Some examples of different types of anxiety problems are mentioned below:

• Panic disorder: Sudden bursts of extreme anxiety that are accompanied by symptoms like a pounding heart, sweaty palms, and shortness of breath or nausea. 

• Agoraphobia: Anxiety about being in places or situations from which it is difficult to escape should a panic attack occur. 

• Social phobia (also called social anxiety disorder): Strong fear of negative evaluation by others, and therefore, social interaction or performance situations, because of the potential for embarrassment or humiliation. 

• Generalised anxiety disorder: Is characterised by long periods of uncontrollable and catastrophic worry about everyday issues or events, which is typically accompanied by feelings of fatigue, restlessness or difficulty concentrating. 

• Health Anxiety (or Illness Anxiety): Recurrent anxiety about developing an illness of the body or mind, associated with preoccupation about illness, including worry and vigilance about symptoms of illness, reassurance seeking, and avoidance. 

• Post-traumatic stress disorder: Recurrent and intrusive memories of a trauma, feelings of emotional numbing and detachment, or increases in emotional arousal, such as irritability and disturbed sleep, resulting from a previous traumatic event. 

• Obsessive-compulsive disorder: Repeated thoughts, images or impulses that the person feels are inappropriate, and repetitive behaviours, designed to reduce the anxiety generated by the thoughts. 

                                                                                                                                                       (adapted from Slade et al., 2009)

Anxiety and the fight, flight, or freeze (FFF) response

An evolutionary psychology explanation of anxiety is that animals experienced environmental pressure to react to threatening stimuli very quickly. The FFF response (fight, flight or freeze) provided them with the mechanisms to rapidly respond to threats.

When the FFF is set in motion, The autonomic nervous system - a control system that acts largely unconsciously and regulates the body (e.g. heart rate, digestion, respiratory rate) - kicks into motion and activates the sympathetic nervous system. The sympathetic nervous system’s main function is to activate the physiological changes that occur during the FFF response.

What is the role of behaviour?

A feeling of fear or anxiety is often associated with an urge to avoid what we believe is the source of threat or danger. This can be helpful when there is an actual threat, but may become a problem if avoidance occurs outside of actual threats, and when it starts to limit the person’s life or lead to other forms of distress. For example a person with panic disorder may start to avoid situations in which they fear they may have a panic attack. Over time they may start to become isolated and feel lonely. 

Our understanding of anxiety is partly based on the notions of Pavlovian fear conditioning and Operant conditioning. The two-factor model suggests that anxiety may arise from Pavlovian pairing of stimulus with fear, then be maintained by negative reinforcement in the form of a person engaging in escape or other anxiety-reducing actions (i.e. operant conditioning). For example, an individual with social anxiety may choose to avoid going to a party. This leads to a reduction in anxiety in the short-term, but also teaches the person to avoid parties in the long-term.

Unfortunately, repeated avoidance may maintain preoccupation with threats and prevent disconfirmation of fear-beliefs and assumptions. 

Safety behaviours are an other form of avoidance. For example, a person may do something (e.g. carrying around an object) because they believe it will reduce the chance of, or prevent, a bad thing from happening. 

What is the role of thinking?

When we feel anxious about something, it is usually because we think about negative outcomes happening. It may be we are afraid that others will evaluate us negatively, thinking of harm occurring to ourselves or others, or even fear we may experience emotions we won’t be able to tolerate. Therefore, the way we think is important. 

Both thoughts in the moment (Negative Automatic Thoughts or NATs) and more underlying beliefs or assumptions play important roles in anxiety according to cognitive-behavioural theory. These thoughts and beliefs, when inspected closely, may reveal overestimation of danger or threat or underestimation of a person’s coping ability. Indeed, thinking in the context of anxiety may reflect cognitive biases, such as black and white thinking, catastrophising or jumping to conclusions, amongst others.

What is the role of attention?

Perhaps related to biases in thinking, attention can also be biased towards aspects of threat when a person is anxious. That is, when a person feels anxiety or fear, they may start to notice things about a situation that are perceived as a threatening rather than noticing other aspects that are neutral or even positive about the situation. 

For example, a socially anxious person’s attention may be hyper-focused on how they appear to others: they may focus on any sign that they may be showing to others of being nervous (e.g shaking), while neglecting to notice potentially positive aspects of the situation, such as the other person’s pleasantness or their ability to maintain conversation well despite feeling anxious. 

At Marka Clinical Psychologists, CBT is the approach taken for working with anxiety and anxiety disorders. Specifics of the intervention are decided on the basis of understanding the type of anxiety or anxieties the person is presenting with, and then working on exploring, addressing and/or better managing key behaviours, thinking, and attentional patterns that may play a role. 

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More information on anxiety can be found on:

• the American Psychological Association’s (APA) website on effective treatments (link)

• The Clinical Research Unit for Anxiety and Depression (CRUfAD) (link)

• Beyond Blue (link)

References:

Slade, T., Johnston, A., Teesson, M., Whiteford, H., Burgess, P., Pirkis, J., Saw, S. (2009) The Mental Health of Australians 2. Report on the 2007 National Survey of Mental Health and Wellbeing. Department of Health and Ageing, Canberra.