All about anxiety and panic attacks


Published on Learn about anxiety disorder and panic attacks from a medical researcher and health professional who has recovered from them without medication and without formal therapy.

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All about anxiety and panic attacks

  1. 1. Anxiety<br />
  2. 2. Nic Lucas<br />BSc, MHSc, MPainMed, GDipClinEpid<br />PhD (Cand) – Diagnostic Medicine<br />But most importantly – a real person who suffered anxiety and panic disorder and beat the sucker<br />
  3. 3. Anxiety – but what type?<br />Stress?<br />Generalized Anxiety Disorder<br />Panic Disorder<br />Social Phobia<br />Specific Phobia<br />Obsessive Compulsive Disorder<br />Post Traumatic Stress Disorder<br />
  4. 4. Symptoms<br />Feelings of distress<br />Fear / Extreme Fear<br />Physical Sensations<br />Heart Rate<br />Breathing Rate<br />Sensations (tingling, light-headedness)<br />Depersonalization / Derealization<br />
  5. 5. Treatment that works?<br />What do we mean by ‘works’?<br />
  6. 6. Treatment that works<br />Reduce symptoms? <br />Which ones?<br />By how much?<br />For how long?<br />Improve life?<br />Regain function<br />Long term goals<br />Positive self-concept<br />
  7. 7. Treatment that works<br />How do we really know if it works?<br />Randomized Controlled Trials<br />Rely on accurate diagnosis<br />Apply to ‘average’ sufferers<br />What about me? <br />What about the individual?<br />I think the current research findings are actually quite amazing<br />
  8. 8. Anxiety – a biomedical problem?<br />‘Imbalance’ in the brain?<br />Implies we know what a balanced brain is!<br />Simplistic thinking<br />Multi-causal world<br />Multiple variables<br />Fixed and modifiable variables<br />
  9. 9. Biomedical solutions<br />Modify brain chemicals<br />Dominant pharmacological model<br />General Disclaimer<br />
  10. 10. Benzodiazapines<br />Martin & colleagues<br />1,217 articles<br />137 were relevant<br />23 were good quality<br />Martin JLR, Sainz-Pardo M, Furukawa TA, Martin-Sanchez E, Seoane T, Galan C. Review: Benzodiazepines in generalized anxiety disorder: Heterogeneity of outcomes based on a systematic review and meta-analysis of clinical trials. <br />Journal of Psychopharmacology 2007; 21: 774-782<br />
  11. 11. Benzodiazapines<br />“This systematic review failed to find convincing evidence of the short-term effectiveness of benzodiazepines in the treatment of generalised anxiety disorder.”<br />“Benzodiazepines do not even prove to be definitively superior to placebo in the short term”.<br />
  12. 12. SSRI’s<br />Baldwin and Polkinghorn<br />Baldwin DS, Polkinghorn C. Evidence-based pharmacotherapy of generalized anxiety disorder. International Journal of Neuropsychopharmacology 2005; 8: 293-302<br />
  13. 13. SSRI’s<br />Overall it would seem that SSRI’s are the best drugs to try for the first line treatment of anxiety or panic disorder<br />assuming of course that drugs are going to be your first line treatment choice<br />
  14. 14. Antidepressants<br />Kapczinski and colleagues<br />Kapczinski F, Lima MS, Souza JS, Schmitt R. Antidepressants for generalized anxiety disorder.<br />Cochrane Database Syst Rev 2003: CD003592<br />
  15. 15. Antidepressants<br />Antidepressants like imipramine (Tofranil), venlafaxine (Effexor) and paroxetine (Paxil) were found to be better than placebo drugs for anxiety, however they only worked in 1 out of every 5 patients.<br />
  16. 16. Antidepressants<br />Antidepressants don’t work in 4 out of every 5 people with anxiety who leave the doctors office with a script<br />
  17. 17. Antidepressants<br />There is even a systematic review of all the clinical trials for treatment of anti-depressant induced sexual dysfunction! <br />So, basically, they’re trying to figure out the best drug to give people who have sexual dysfunction that is caused by antidepressants. <br />Taylor MJ, Rudkin L, Hawton K. Strategies for managing antidepressant-induced sexual dysfunction: systematic review of randomised controlled trials. J Affect Disord 2005; 88: 241-54<br />
  18. 18. GABA?<br />Gamma Aminobutyric Acid …<br />Reduced in the Occipital Lobe by 20% of people with ‘anxiety’<br />Simple solution – give people GABA?<br />
  19. 19. GABA?<br />GABA doesn’t make a mention in any official guidelines<br />No evidence<br />Large potential for side effects?<br />
  20. 20. Anxiety – A behavioral problem?<br />Focus on stimuli rather than brain physiology<br />Our ‘behavior’ changes brain physiology<br />
  21. 21. Cognitive Behavioral Therapy<br />CBT is one of the most extensively researched forms of psychotherapy<br />CBT has a large effect in the treatment of <br />social phobia<br />posttraumatic stress disorder<br />anxiety<br />panic disorder<br />
  22. 22. Cognitive Behavioral Therapy<br />Focus on individual cognitions<br />That initiate anxiety<br />That are incorrect<br />Focus on modifying individual behaviors<br />
  23. 23. Cognitive Behavioral Therapy<br />Socratic questioning<br />Visual imagery<br />Examining the evidence<br />Relaxation training<br />Breathing control<br />Graded exposure<br />
  24. 24. Cognitive Behavioral Therapy<br />Hunot and collegaues<br />85 studies<br />23 relevant / good quality<br />Hunot V, Churchill R, Teixeira V, Silva De Lima MS. Psychological therapies for generalised anxiety disorder. Cochrane Database of Systematic Reviews 2007: Art. No.: CD001848<br />
  25. 25. Cognitive Behavioral Therapy<br />People who received CBT were more likely to experience an immediate reduction in their anxiety compared to those people who received usual treatment. <br />CBT was also found to be effective in reducing secondary symptoms such as depression. <br />
  26. 26. Cognitive Behavioral Therapy<br />Norton and colleagues<br />Reviewed the reviews<br />Norton PJ, Price EC. A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders. Journal of Nervous and Mental Disease 2007; 195: 521-531<br />
  27. 27. Cognitive Behavioral Therapy<br />First, CBT was effective in treating all types of anxiety disorders. <br />Second, CBT appeared to be more effective for generalized anxiety and posttraumatic stress disorder than for social anxiety.<br />Third, CBT wasn’t better than relaxation treatment.<br />
  28. 28. Hmm…<br />
  29. 29. Others…?<br />Self-help<br />Exercise<br />Herbal Treatments<br />Kava kava<br />St Johns Wort<br />Valerian<br />Yoga<br />Meditation<br />Reiki and Therapeutic Touch<br />
  30. 30. “Well I looked my demons in the eye, laid bare my chest and said do your best to destroy me. Ya’ see I’ve been to hell and back so many times I must admit you kind of bore me”<br />
  31. 31. How did I overcome anxiety and panic?<br />My Story<br />
  32. 32. As it turns out – very neatly<br />10 Steps<br />Avoidance<br />Distraction<br />Observation<br />Acknowledge improvement<br />Education<br />Authentic emotion<br />Breathing<br />Relaxation<br />Exercise<br />Challenging those thoughts …<br />
  33. 33. Avoidance<br />Input / Stimuli <br />Situations<br />Thoughts<br />People<br />Visual (TV / Movies / Text)<br />Auditory (Conversations / Music)<br />
  34. 34. Authentic Emotion<br />Love<br />Humour<br />Anxiety!<br />Anger<br />
  35. 35. Education<br />Brain physiology<br />Treatment effectiveness<br />Treatment side-effects<br />
  36. 36. Challenging those thoughts<br />Anxiety is an emotion not a logical thought process …<br />“It’s hard to use logic to remove an idea that was not formed in logic”<br />However, is the anxiety based on an ‘illogical internal argument”?<br />
  37. 37. Favorite quote <br />“When a person who is honestly mistaken hears the truth, they either cease to be mistaken or cease to be honest”<br />
  38. 38.<br />