Anxiety

The World Cup and Managing Great Expectations

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I, like many other people in England and around the world, spent a month watching the ups and downs, and the twists and turns, of a brilliant football World Cup. For me, what made it extra special was that the England team actually gave us something that it had lacked for many years – hope.

What was even more special was that it came out of nowhere. Going into the World Cup, nothing was expected from the England team. Getting to the quarter finals would have been a good achievement, but not an expectation.

The momentum that built up around the country was astounding – something which I have never experienced. With each win and positive media coverage, England could really start to dream that maybe their team could win. But did it matter?

Of course, we know now that England got to the semi-finals but were beaten in extra time. A cruel, devastating result, but one which that can be looked at with pride rather than with embarrassment.

Why? Because England exceeded expectations. The nation got caught up with the ride, but it was so much more than the football results. They had a manager who finally seemed to understand the role and what was needed from the players, as well as what the nation wanted from their team. A manager who showed passion, trust…and a very smart waistcoat.

For me, England’s World Cup gave a great example of what happens when expectations are low and they are exceeded; the joy is all the sweeter.

So if a person is seen to always be someone who exceeds in life – the one who does everything in the ‘perfect’ way – that is a lot to live up to. What happens when it goes wrong? Will this person know how to cope? Perhaps the way to deal with this is to stop expecting great things from people who may just not achieve it. Better to aim high and expect middle as life can’t always be predicted.

Better to be like England 2018.

*Sarah Keeping is currently undertaking a Counselling Skills course in London and is looking to change her professional subject area to Counselling Psychology. Previous qualifications are in Investigative Psychology, Psychology, Applied Criminology, and Criminology and Sociology. Follow Sarah on twitter at @SKeeping_Psych

Mental Illness Stigma: Living with Others’ Judgements

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At Brighton Wellness Centre, we are well aware of the mental health stigma that pervades our society. Even today, with the many pioneering organisations and charities helping those with mental illnesses, the rise of medications such as anti depressants and mood stabilisers and an awareness of psychotherapy, there is still stigma. People can react negatively, be harsh or not understanding because they do not understand the complexity that is mental ill health and the effects it has on the brain and behaviour.

Common stigmatised reactions may include language such as ‘You aren’t crazy, why do you need to take those pills?‘, ‘You should be locked up’,’You are behaving so bipolar‘, ‘People with depression are weak’ and so on. Mental illness is still sadly associated by some (who have no experience of it) with doctors’ white coats, straight jackets, life long hospital stays and never making a full, complete recovery. It may take generations to change these attitudes, although we are beginning to turn the tide!

While these perceptions of mental illness may have been the case 60 or more years ago, today the mental health world in the UK and other Western countries has moved on. Since the 1950s, the rise of medications that worked to help illnesses such as bipolar disorder, schizophrenia, psychosis, depressive/anxiety disorders and eating disorders have improved drastically. With the rise of SSRI medications that work on the brain as anti depressants as well as newly developed anti psychotic medications, mental illness sufferers are able, in most cases, to return to their normal lives. This coupled with psychotherapy can truly change lives. The policy of recovery is also a great shift from the past. Psychiatrists, psychologists and psychotherapists don’t just aim to manage symptoms, they aim to set you on the path to recovery.

The feeling of judgement and of someone thinking you are ‘crazy’ is awful, sad and terrifying. For every person that understands and supports, you may get those who can’t and won’t understand you. You can lose friends or loved ones due to this, which is appalling. Support networks are badly needed for those with an illness in particular. So, don’t be stigmatised to those with an illness. Help and love your friend and loved one, give to them, provide a listening ear and a hug.

As someone with experience of mental health, I would say there is still a long way to go in terms of stigma. I talk and blog about my experiences, raise money for mental health charities and have just started reaching a wider audience. However, I still feel I cannot fully disclose my illness under my real name. This is due to the fact that it is still not hugely understood in society, so to be associated with it could be upsetting. Yet, I hope that within a decade or two, this will change. I blog to change attitudes and highlight awareness which is badly needed.

This is why I support Jessica Valentine at Brighton Wellness Centre. She focuses particularly on womens wellness and provides a therapeutic setting and a listening ear to all her clients. Psychotherapy of any kind is truly beneficial in helping you manage symptoms and difficult emotions. By taking the step to going to psychotherapy, you are battling stigma as well as helping yourself move forward.  Remember, there is nothing wrong or weak in talking to a therapist. In fact, you are being incredibly strong for seeking help and reaching out. Hopefully, any therapy you undergo will also help you to change your life for the better.  Reach out today.

Why Do I Have Social Anxiety? Can Social Anxiety be Treated?

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by Holly Woodley

Social anxiety is an intense fear or worry over social situations and is surprisingly common in the general population, although rarely reported unless severe.

One of the most influential explanations of the onset of social anxiety disorder is the cognitive model:

  • Faulty cognitions in the individual manifest during social situations that possess them to believe that they are in danger of being seen as inept, boring or stupid, which could lead to people disliking them or ignoring them.
  • The model begins with the social situation, which activates the assumptions of perceived social danger, and in turn, the processing of the self as a social object.
  • These cognitive processes can lead to behavioural symptoms, for example the patients’ avoidance behaviour, or somatic and cognitive symptoms, such as the intrusive thoughts of what others may think.
  • The theory proposes that people don’t initially possess the symptoms of social anxiety disorder, they simply have to believe that they do, and their actions of avoidance help to reinforce these biases, which in effect helps them to manifest.
  • Early maladaptive schemas affect the way the individual thinks and processes situations, and have been shown to be more commonly present in those with social phobia particularly, in the sense of disconnection or rejection, but also including self-focused attention, anticipatory processing and post-event processing.
  • Post-event rumination is suggested to be one of the main cognitive biases in those suffering from social phobia. It is suggested that socially anxious individuals negatively perceive themselves and the way they have previously behaved in a social situation, which takes over their attentional resources causing them to negatively over-evaluate . This in turn will influence avoidance of similar situations in the future.
  • In addition, the idea of pre-event rumination has been offered, which involves the individual negatively anticipating an event with obsessive faulty thinking, which may influence them to avoid it before anything negative has actually happened.
  • Those with social anxiety disorder also appear to have attentional biases to threatening stimuli, which may account for why they find social situations particularly intimidating. If all the focus is on the negative aspects of a situation, the individual will feel a heightened sense of fear. This has been shown in studies where attention is monitored, and individuals with social anxiety disorder pay more attention to relevant negative stimuli, for example threatening faces compared to neutral ones influencing a state of panic.

There is also an overall feeling of low self-efficacy that is suggested to result from childhood relationships, for example peer rejection or overprotective parenting styles. This could potentially arise through acts of conditioning, for example observing others being embarrassed or humiliated in social situations. It has been suggested that because shyness has a negative stigma, this promotes social avoidance.

Genetics and biological processes are also proposed theories of the manifestation of social anxiety. Evidence has been suggested to support a biological explanation of social anxiety in terms of neuropeptides. Oxytocin is believed to be a peptide linked to social behaviour as it facilitates approach behaviours, and impacts on social bonding and trust, by linking the amygdala to socio-emotional areas of the cortex. It has been observed that those with social anxiety possess lower levels of oxytocin than controls, due to a variation in the CD38 gene that regulates its secretion. A-allele carriers on the SNP rs3796863 appear to have higher levels of trait anxiety with particular vulnerabilities to developing social anxiety than the C-C allele.

The function of this neuropeptide is to reduce excessive amygdala activation to threatening stimuli, therefore with a reduced amount, this repression is dampened, increasing the fear that those with social anxiety feel. In addition, there is also reduced functional communication between these areas of the brain during stress inducing situations, reducing the positive emotional effects that the peptide has on social behaviour.

An additional biological perspective is associated with genetics and heritability. Data has shown that direct relatives of those with social phobia manifest higher rates of the same disorder than control patients do. For example, it has been found that the phobia is more likely to manifest in children when one or both of their parents suffer from the disorder also.

Risk factors for social anxiety have been found to be highly hereditable (66%), which appear to have higher impact in young people, suggesting that genetic risk factors have higher influence in those who develop social anxiety in their youth.

It is suggested that the overall process is that genetic vulnerabilities make those more susceptible to environmental influences concerning the onset of social anxiety disorder, which integrates both explanations of the manifestation of the disorder. There have been significant gene environment interactions found in terms of stress or attachment types for example, suggesting that this interplay between nature and nurture is a solid explanation for the onset of social anxiety disorder.

One of the most common form of treatment of social phobia is cognitive behavioural therapy (CBT). Patients can attend between 8 to 12 sessions with a therapist in a one on one setting. The therapy involves forms of exposing patients to their feared situations with support, and should aim to help the individual understand the irrationality of their fears. This individual therapy may also involve teaching different types of social skills, either verbal or non verbal. These may involve anything from keeping eye contact and retaining posture, to specific word use, voice, volume and tone, or easy conversation topics. Methods of relaxation are also taught, to help diminish feelings of apprehension or the general physical arousal induces from social situations. What is described as ‘cognitive restructuring’ is another tactic used which aims to correct faulty cognitions within the patient. This works by getting the individual to analyse their own statements or social expectations to understand why they may be irrational, which may in turn aid in reshaping the maladaptive schemas.

Once someone appears to be making some form of improvement, cognitive behavioural group treatment may be suggested, to help ease them into a welcoming social situation with others who have the same feelings as themselves. This gentle ease may drastically help the treatment process. Sessions may include discussing various social skills techniques with others, and learning interaction techniques with each other. Group members may also find themselves being exposed to anxiety provoking situations in a structured and graded way, starting with minimal exposure which gradually increases once the phobic becomes at ease. The efficacy of group therapy for anxiety has been shown by Mychailyszyn, Brodman Read and Kendall (2012) who found that 64% of children who participated in the FRIENDS (a specialized form of CBGT for adolescents) programme no longer met clinical criteria for social phobia after treatment.

An emerging form of group therapy that may also be an option is mindfulness and acceptance based group therapy. In these therapy session mindfulness strategies are used to increase the feelings of acceptance of unwanted physical symptoms, for example trembling, or anxious thoughts, such as feelings of embarrassment. This in turn reduces the feeling of panic that a phobic will experience when they sense their face blushing or their hands shaking. There has been an effect size of 43% observed for the success of this treatment in those with social anxiety.

Trials have shown group therapies to have a positive effect on the reduction of symptoms in social anxiety, for example decreases in subtle avoidance behaviours, cognitive distortions and attention focusing and rumination. However, there do appear to be more issues with group therapy as opposed to individual therapy, for example, a group first needs to be formed before therapy can begin therefore potentially taking longer to initiate. It has been suggested that overall individual therapy is more successful for those with social anxiety disorder, as a majority of patients find the group setting too intimidating to handle whilst still going through treatment, which could potentially worsen their feelings of fear. More feelings of self-consciousness may be induced with feelings of scrutiny. In addition, individual therapy allows the therapist to form a more careful and personal assessment of the patient, in turn catering for a more effective treatment system.

Both therapies have their advantages and disadvantages, however the right programme should be based on the patient’s individual progress and preference.

To see references, turn to the next page.

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