This document outlines a training workshop on anxiety and how to manage it. The workshop covers demystifying anxiety, different types of anxiety disorders, theoretical models of anxiety, signs and symptoms, and treatment options. Treatment includes physiological approaches like medication and relaxation techniques, as well as cognitive behavioral therapy. CBT involves behavioral therapy like exposure therapy and cognitive techniques like challenging negative thoughts and using coping statements. The workshop also discusses videos on anxiety's impact and has a quiz to uncover myths about anxiety.

1. PSO TRAINING
ANXIETY & HOW TO MANAGE
IT
BY PIP WALKER
POLICE PSYCHOLOGIST
S/HSO
JULY 2015

2. OUTLINE OF WORKSHOP
1. Demystifying anxiety
2. “Normal” Vs “Pathological” Anxiety
3. The development of Anxiety Disorders
4. Different types of anxiety disorders
5. Theoretical models to understand anxiety disorders
6. Signs & symptoms of anxiety disorders to look out for
7. Treatment/Interventions for managing anxiety
disorders
8. Resources on anxiety disorders

3. Videos about the Impact of Anxiety on
people’s lives
ACTIVITY: Discuss thoughts/reflections from videos

4. QUIZ:
UNCOVERING THE
MYTHS OF ANXIETY!

5. WHAT IS “NORMAL” ANXIETY?
 Psychological & physiological state characterised
by physical, emotional, cognitive & behavioural
components
 Normal, adaptive response to perceived or actual
threat – everyone gets anxious occasionally
 Time limited, transient
 Can be beneficial
 Doesn’t usually interfere with daily functioning or
achievement of goals

6.  Anxiety Vs Fear
 Fear – concrete danger occurring at present
time
 Anxiety – perceived or actual threat that is
occurring in future; usually a FALSE
ALARM
 Fight or flight response is the inborn, primitive,
automatic, survival FEAR response to a
perceived or actual threat, or the absence of
people or objects that signify safety

7. WHEN “NORMAL” ANXIETY
DEVELOPS INTO AN ANXIETY
DISORDER
Anxiety becomes “pathological” or “abnormal” and can turn into an Anxiety Disorder
when it:
 Increases in excessive rates of:
 Duration
 Intensity
 Frequency
 Causes significant distress
 Impairs daily functioning & decreases quality of life
 Is disproportionate to the situation that elicited the anxious response
 Leads to irrational, illogical thinking & behaviour
 Is associated with maladaptive coping (e.g., avoidance, withdrawal)

9. ANXIETY DISORDERS
 Often have an early onset - teens or early twenties
 Show 2:1 female predominance
 Have a waxing and waning course over lifetime

10. TYPES OF ANXIETY DISORDERS

11. THEORETICAL MODELS TO
UNDERSTAND ANXIETY
Biopsychosocial Model
Multiple, inter-related causes of pathological anxiety:
 Biological
 Psychological
 Social (environmental)

12. Behaviourism – Learning Theory Model
 Focuses on observable behaviours
 Behaviours linked to anxiety and/or phobias are learned
through classical conditioning and maintained through
operant conditioning.
 Pavlov’s Dog Experiment – Classical Conditioning
 Skinner – Operant Conditioning

16. Biological/Neuroscience model

17. 1st Brain: Reptilian
 Reptiles
 Reflex/Instinct
 Low level control
 Motor control (breathing, heartbeat & motor skills)
2nd Brain: Limbic system
 Mammalian
 Emotions
 Reactionary (Fight/Flight, Pleasure/Reward & pain)

18. 3rd Brain: Thinking
 Human
 Foresight
 High level control / Executive Functioning
(Thinking - Reasoning, judgment, perception,
motivation, memory & learning)

19. Amygdala & Hippocampus are the two main parts of the brain
involved in anxiety.
 Amygdala
 Almond-shaped structure that begins functioning before
birth.
 If something is perceived as a threat, the amygdala
activates the Fight or Flight Response
 Hippocampus
 Assesses the accuracy of the threat after the fight or flight.
Our brains are wired to “shoot first, ask questions later!”
 Records and stores memories

22. Fight, Flight or Freeze Response
 We are wired to avoid fear/pain/discomfort more than we are to
seek pleasure.
 The neo-cortex is usually aware that there is no real threat, but the
deeper, primitive parts of the brain respond as if survival is at stake.
 “Fight” is about destroying the threat.
 “Flight” is about getting out of the way, running away or avoiding
the threat.
 “Freeze” is an optional third response: remaining still.
 It takes 15-30 minutes to reduce heightened threat arousal back to
‘normal’/homeostasis, if the process isn’t short circuited by the
relaxation response (e.g., deep breathing).

27. WHAT CAUSES ANXIETY
DISORDERS
Often a combination of factors lead to a person developing an
anxiety disorder:
 Genetics
 Ongoing stressful events e.g.:
 Job stress or job change
 Change in living arrangements
 Pregnancy and giving birth
 Family and relationship problems
 Major emotional shock following a stressful or traumatic event
 Verbal, sexual, physical or emotional abuse or trauma
 Death or loss of a loved one.

28.  Physical health problems
 Hormonal problems (e.g. overactive thyroid)
 Diabetes
 Asthma
 Heart disease.
 Substance use
 Personality factors
 - Perfectionists,
 - Unrealistic expectations
 - Low self-esteem
 - Lack of assertiveness
 - Pessimism
 - Low tolerance of ambiguity or uncertainty,
 - External locus of control

29. SIGNS & SYMPTOMS OF ANXIETY
DISORDERS
See Handout for details

30. TREATMENT/INTERVENTIONS
FOR ANXIETY DISORDERS
 Early intervention is essential - recognise the signs and
symptoms and encourage people to seek support early
 The sooner a person seeks help, the sooner they can
recover
 Anxiety disorders are unlikely to go away on their own. If
ignored and left untreated, anxiety disorders can last for
months, or years, and have far reaching negative effects on
a person’s life and their loved ones.
 Encourage the person to seek support from their family,
friends and local community.

31. 1. Physiological – Symptom Control
 Medication (Anti-depressants, PRN Benzodiazepines), if
necessary – refer to GP or Psychiatrist
 Self-monitoring of anxiety symptoms (e.g., symptom diary)
 Self-care/Stress Management:
Minimum of 20 mins exercise per day (natural anti-
depressant/anti-anxiety drug - alters levels of chemicals in the
brain, such as endorphins and stress hormones).
Balanced Diet
Adequate Sleep Hygiene
Reduce or avoid stimulants (e.g., coffee, tea, alcohol)
Delay making major life changes or decisions, if possible
Schedule pleasurable activities
Relaxation training

34. Relaxation Training
 Diaphragmatic breathing – Using the diaphragm to slow down &
deepen the breath, relax the autonomic, sympathetic nervous system
& prevent hyperventilation. Excellent for managing anxiety and panic
attacks. Requires lots of practise.
 Progressive Muscle Relaxation (PMR) - Learn to monitor & distinguish
between relaxed & tense muscles in the body. Good for managing
muscle tension and headaches. Simple & easy.
 Guided visual imagery – Utilises visualisation & the remaining senses
to imagine being in a relaxed place – a powerful way to enter a
relaxed state. Similar to self-hypnosis & visualisation.
 Grounding/mindfulness – Learn to manage difficult and distressing
thoughts, focus on the present moment in a non-judgmental
manner, the mind-body connection. Excellent for managing
overwhelming anxiety/distress/panic. e.g., 5 senses mindfulness
meditation, mindfulness of the breath, body scan. Requires practise.

35. 2. COGNITIVE BEHAVIOURAL –
ALTERING BEHAVIOUR & PERCEPTION

36. BEHAVIOURAL THERAPY
Exposure & Response Prevention:
 Anxiety should subside after gradually exposing
person to their fears until their behavioural and
sensory response diminishes over time, after
repeated exposure to feared stimulus
(Habituation).
 Refraining from undesirable behaviour (e.g.,
compulsions/rituals, avoidance, escape, safety
behaviours).
 Excellent for OCD, Panic Disorder with or without
Agoraphobia, PTSD, Social Anxiety

42. CBT FOR ANXIETY IN A NUTSHELL
 Psychoeducation
 Behavioural therapy (e.g., Exposure & Response Prevention)
 Listen to, identify and challenge Negative Automatic Thoughts and self-
defeating core beliefs; Use Socratic questioning and reality testing to reframe
perception of threat and appraisal of situations
 Positive self-talk and coping statements
 Designated worry time
 Assertiveness training/Limit setting
 Incorporating mindfulness – focusing on the present moment, being non-
judgmental about thoughts and emotions, living an authentic life aligned
with one’s true values

43. GENERAL TIPS ON HOW YOU CAN HELP
STAFF WITH AN ANXIETY DISORDER
 Have an RUOK conversation
 Let the person know if you’ve or their manager or colleague has
noticed a change in their behaviour.
 Spend time talking with the person about their experiences and let
them know that you’re there to be a support and listen without
being judgmental.
 Suggest the person see their GP or health professional (including
HSO) and/or help them to make an appointment.
 Offer to go with the person to the doctor or health professional.
 Help the person to find information about anxiety (e.g., library,
internet, HSO).

44.  Encourage the person to try to get enough sleep, exercise and eat
healthy food.
 Discourage the person from using alcohol or other drugs to feel better.
 Encourage friends and family members to invite the person out and
keep in touch, but don’t pressure the person to participate in activities.
 Encourage the person to face their fears with support from their
doctor/psychologist.
 It would be unhelpful to:
- Put pressure on them by telling them to “snap out of it” or “get their
act together”
- Stay away or avoid them
- Tell them they just need to stay busy or get out more

45. VIDEO ACTIVITY
http://learn.beyondblue-elearning.org.au/BeyondBlue/conversations/index.html
 What symptoms of anxiety does Sarah seem to have?
 If you were the PSO in this situation, what steps would you
take to assist Sarah?
 Reflections on approach that Sarah’s manager adopted

46. ANXIETY RESOURCES
Websites:
 Beyond Blue
 Anxiety Australia
 Sane
 Mindspot
 Mental Health Online
Apps
 iCouch CBT
 Cognitive diary CBT Self-help
 Smiling Minds
 Self-help for Anxiety Management (SAM)
 eCBT Calm

47. Books:
 The Anxiety and Phobia Workbook by Edmund Bourne
 Living with It: A Survivor’s Guide to Panic Attacks by Bev Bissett
 Overcoming Social Anxiety and Shyness: A Self-Help Guide Using
Cognitive Behavioral Techniques by Gillian Butler
 The Feeling Good Handbook by Dr David Burns
 The 10 best ever anxiety management techniques: Understanding How
Your Brain Makes You Anxious and What You Can Do to Change It
by Margaret Wehrenberg
 Get out of your mind and into your life by Steve Hayes
CDs:
Cancer Council Queensland Learning to Relax CD (FREE)