The anatomy of the brain

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Generalised Anxiety Disorder (GAD)

What is it?   Generalised Anxiety Disorder, also known as ‘GAD’, is characterised by excessive anxiety and worry about a variety of daily stressors for a period of 6 months or more (Rowa & Antony, 2008). Anxiety disorders are the most common mental disorders in Australia and women are more likely to suffer from GAD than men (Australian Bureau of Statistics, 2012). GAD usually begins during childhood or adolescence and is rated as a ‘disorder’ because the associated worries are so frequent and intense that they may become debilitating.

Why Does It happen?   Genetics and environment can play a role in the development of GAD. Although GAD can run in families it is not considered to be an inherited disease (Hoge, Ivkovic, & Fricchione, 2012). In terms of biology, GAD may be caused by a lack of neurotransmitters such as serotonin. Traumatic experiences and multiple stressors in life such as challenging family and relationship situations may also lead to GAD.

What are the symptoms?   You may have GAD if, for 6 months or more, on more days than not, you have:
1) Felt very worried,
2) Found it hard to stop worrying, and
3) Found that anxiety made it difficult for you to carry out everyday activities (e.g., work, study, self-care).

In addition to uncontrollable and persistent worry, if you also experience three or more of the following:
1) Feeling restless or on edge,
2) Having difficulty concentrating,
3) Feeling irritable,
4) Muscle pain (e.g., sore jaw or back),
5) Feeling tired easily, and
6) Have trouble sleeping (e.g., difficulty falling or staying asleep).

What can I do about it?
Cognitive Behavioural Therapy (CBT) focuses on changing beliefs about worries and may help guide you away from unhelpful attempts to control the worry (Hoge, Ivkovic, A, Fricchione, 2012). Anxious thought patterns can be reduced by evaluating your thoughts and impressions more objectively. CBT can teach you how to see problems in a different way and how to use techniques such as imagery and relaxation to alleviate anxiety.

Relaxation response training in the form of progressive muscle relaxation or diaphragmatic breathing can help, and is sometimes used with CBT. This can help reduce muscle tension.

Mindfulness training can teach you to increase awareness of present moment experiences, such as thoughts and emotions, without judgment. This therapy focuses on accepting problems rather than striving for immediate change, and can help foster a compassionate and non-judgmental awareness of your experiences (which can help with clearer decision making).  It can help you to focus on present moment experiences instead of worries.

Sleep hygiene. Given the high frequency of sleep disturbance in this disorder, education on sleep hygiene can be useful. It is sometimes used with CBT to ensure the best possible sleep efficiency and quality.

Other treatment options may include physical exercise, healthy eating, reducing use of caffeine, alcohol and other drugs.

Medication. Pharmacological approaches include antidepressants, for example selective serotonin reuptake inhibitors (SSRIs) – benzodiazepines, the anticonvulsant pregabalin, and serotonin-norepinephrine (noradrenaline) reuptake inhibitors (SNRIs). Medication aims to change the balance of neurotransmitters in the brain, which may help to reduce some symptoms of anxiety (Goncalves & Byrne, 2012).

Gina Huisy (13th November 2013).

References

Australian Bureau of Statistics. (2012).  4125.0 – General indicators, Australia, Jan 2012  Mental Health. Retrieved 10 March 2013, from Australian Bureau of Statistics http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4125.0~Jan%202012~Main%20Features~Mental%20health~3150

Goncalves, D. C., & Byrne, G. J. (2012). Interventions for generalized anxiety disorder in older adults: Systematic review and meta-analysis. Journal of Anxiety Disorders, 26, 1-11. doi: 10.1016/j.janxdis.2011.08.010

Hoge, E. A., Ivkovic, A., & Fricchione, G. L. (2012). Generalized anxiety disorder: Diagnosis and treatment. BMJ. doi: 10.1136/bmj.e7500

Rowa, K., & Antony, M. M. (2008). Generalized Anxiety Disorders. In W. E. Craighead, D. J. Miklowitz & L. W. Craighead (Eds.), Psychopathology: History, diagnosis, and empirical foundations (1 ed., pp. 78-114). Hoboken, New Jersey: John Wiley & Sons, Inc.

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TED Talks

As of late I have been watching a lot of TED Talks.  It is addictive!

This is one I’d like to share with you from Health Psychologist Kelly McGonigal: How to make stress your friend!

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Face-to-face with China, Shanghai

As an Australian-Chinese psychologist, I’m what they call ‘multicultural’; I live in two worlds. Recently my partner and I travelled to Hong Kong, returning to my roots, and then on to Shanghai. The purpose of this trip went beyond a simple vacation (and shopping – but that’s a topic for a different blog). It was an opportunity to spend time with family whom I hadn’t seen face to face in over 10 years and to see real Chinese life and culture up close and personal, in places where Chinese culture was formed.

IMAG0296They say that in Adelaide we are laid back and easy going. This is more true for some people than others, but by way of comparison;

  • Shanghai workers do long hours, minimum 10 per day, often up to 16, for 6 or 7 days per week.
  • Young children often live away from their parents (who work hard in Shanghai) with their grandparents. I met a woman from Sichuan, a province in China, who said she only sees her son once a year on Chinese New Year.
  • For the working class in Shanghai, work is what people do to survive. Career choice and what city you live in is less of a lifestyle decision so much as a way to feed yourself and family and put a roof over their head.  Basically, you are either rich, or you work at a customer service role until you are unable to do so.
  • Girls are often a commodity in Shanghai – there are 10 boys for every girl and a girl often won’t marry a man unless he has a home of his own. The emphasis is on the man to acquire the car, the apartment, and to provide for his wife (although unless a couple are rich, both husband and wife will almost certainly work to survive).
  • Sure there are well to do people in Shanghai for whom work is less survival focused, but the emerging middle class in China is still very small. A tiny percentage of people are very rich, but these are the exception. For most, the daily grind is unrelenting.

SHMy father left Shanghai over 30 years ago and, for all that the city has changed immensely since then, the no holds barred competitiveness and survival focused work culture honed my understanding of his upbringing and view of the world. The culture and real world pressures that shaped his life, as well as the lives of so many Australians from countries less easy going than Adelaide, have implications for how we as Psychologists seek to develop a professional understanding of the unique circumstances of our client’s situation, and the approach taken in supporting our clients to overcome personal life challenges and improve their social and emotional well-being.

Gina Huisy (July, 2013).

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Cross Cultural Psychology

Recently, I was invited to present to a class of students working toward a Certificate IV in Aboriginal Primary Health – Social and Emotional Well Being. The student group were mainly Aboriginal Health and Community workers who work in Aboriginal communities. In putting together some notes around psychological theories I was reminded that I am weird. More specifically, W.E.I.R.D. free_5696774

The WEIRD acronym stands for Western, Educated, Industrial, Rich and Democratic. It’s a neat summary of the world view of many psychologists, and the world view in which much of the knowledge of contemporary psychology was developed. While all such acronyms have to be taken with a pinch of salt, this one is particularly relevant for a western psychologist working with people across diverse cultures, and its relevance was very much in focus as we discussed the value and use of psychological theories during the Certificate IV class. It’s also particularly important to remember that most of the seven billion or so human beings currently sharing our world are not W.E.I.R.D. Two thirds of people are Eastern for a start, and even if we have the E.I.R.D parts in common, the differences between eastern, western and other cultures still strongly influence everything from spirituality, our roles in society and what is most important to us in living a quality life.

So what does this mean for practicing psychology, or for that matter, going to a psychologist to make use of the service we offer? I’m personally of the view that to genuinely develop an understanding of the situation someone is in, to genuinely support someone in working through life challenges – be they traumatic, medical, present difficulties or the consequences of past events – then the psychologist needs to have some knowledge of the culture you live within. Fortunately, there are some ways in which psychologists can broaden their understanding of different cultures; through experience, cultural mentors and employing culturally sensitive therapeutic approaches such as Narrative Therapy. These approaches won’t suddenly make a psychologist ‘of a different culture’, however through these approaches the assumptions and biases we have inherited from our own culture can at least be set aside.

We have the good fortune at Huisy Howland Psychology to have worked extensively across diverse cultures. Gina Huisy is a Chinese Australian Psychologist, with a wealth of lived experience in Australian and Chinese cultures and I have worked closely with Social and Emotional Well Being counselors and case workers in Aboriginal communities for some time now – long enough to have developed an appreciation of how people from minority cultures in Australia often live in two worlds; that of ‘mainstream’ Australia and that of their cultural heritage.

Of course, the East/West divide isn’t where cultural similarity and difference begin and end… there is still the wealth of difference in life opportunity, expectations and world view between people with different levels of personal wealth, access to education, rural versus metropolitan living and so on. Ultimately the onus is on us, as psychologists, to be able to see beyond our own W.E.I.R.D-ness in genuinely attending to the unique needs, values and circumstances of clients who come to work with us.

P.S. As an afterthought, I was considering describing myself as W.E..I.r.D – a small r for rich. I don’t drive a flash car or live in a mansion. Then I remembered the holiday to Bali my partner and I are planning, and the Australian Dollar exchange rate (one A$ is currently buying more than ten thousand Indonesian Rupiah). A sober reminder that even those of us of modest means in Australia are wealthy compared to most of our seven billion fellow human beings.

Christoher Howland (2012).

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Stress and personal management

Over the years I have worked with lots of people who were experiencing levels of stress that had become unsustainable and a detriment to their wellbeing. Because of my focus on Work and Organisational Psychology, the causes of stress were often work related, but regardless of what causes your stress, leaving it to develop unchecked and unmanaged will increasingly take a toll on your personal health and wellbeing.

Broadly speaking, there are two main types of stress; acute, and chronic stress. Acute stress is the sudden rush of adrenaline and fear that comes from a shock or fright of some sort – like someone nearly hitting your car, or being surprised by someone when you thought you were alone, or getting yelled at by your manager. This response to an immediate threat is the “fight or flight” response, and mostly involves your body getting ready to protect itself from whatever might be going on.

The other sort of stress is chronic stress. This is the day in, day out constant pressure that comes from things not being right in the world; problems not being resolved, relationships continuing to be difficult, unhappiness at work, conflict at home and so on. Often we will deny this sort of stress, and make excuses for how we feel.

A good way of spotting if you are experiencing chronic stress is if you:

  •  Brush it off as temporary, even though you can’t remember the last time you weren’t stressed.
  • See yourself as just being a bit of a stress head.
  • Describe your work or home life as just naturally stressful.
  • Blame stress on other people or things.
  • Consider a high level of stress as ‘normal’.

The problem is, if you don’t manage chronic stress, it can make you sick. It can drain your energy, make it harder to think and to work through problems, slow you down at work and undermine your relationships with partner, family and friends. Worse yet, there is a wealth of medical research that tells us chronic stress contributes to the development of all sorts of medical conditions such as; obesity, high blood pressure, cancer, heart disease and even chronic pain. No doubt you can spot the circular nature of stress: Unmanaged stress causes health problems which in turn become new sources of stress. Until you get some sort of control, it really is a vicious circle.

So what can you do to manage stress?

Well, if you are like lots of people, you may have adopted an unhealthy habit or two. Here is the short list of things not to do when dealing with stress:

  •  Smoking.
  • Drinking too much
  • Eating too much.
  • Eating too little.
  • Using drugs (prescribed, over the counter or otherwise).
  • Too much TV.
  • Withdrawing from friends and family.
  • Sleeping too much.
  • Procrastinating.
  • Making yourself busy all day everyday to avoid thinking about problems.
  • Lashing out at others.

Sound familiar? We’ve all done some of these from time to time, but it’s really not helpful and just causes more stress in the end.

If you really want your stress levels to reduce, then there’s nothing for it but to take charge yourself. There are a few ways of doing this and The Four A’s approach is one of them:

The Four A’s.

Avoid Unnecessary Stress

  • Learn to say ‘no’.
  • Spend less time with people who stress you out.
  • Take control of your environment.
  • Avoid talking about things that get you worked up.
  • Go through your ‘to do list’ and scrap anything that isn’t necessary or making you feel better.

Alter the situation

  • Express your feelings constructively instead of bottling them up.
  • Be willing to compromise.
  • Be more assertive (sure this can take practice, but no reason not to get started).
  • Manage your time.

Adapt to the Stressor

  • Look for opportunities in a difficult situation.
  • Look at the big picture – how much of a big deal is the problem anyway?
  • Adjust your standards (careful with this one; we’re talking about putting aside the perfectionism and setting reasonable expectations of yourself and others, not abandoning standards altogether).
  • Focus on the positive.

Accept those things you can’t change

  • Don’t try to control the uncontrollable – focus on the things you can control. No one person can fix all the woes of the world.
  • Look for the positive aspects of the situation – what you can gain from this life experience.
  • Share your feelings – with a trusted friend, a psychologist or your GP.
  • Learn to forgive. None of us are perfect.

It’s worth noting that not all stress is bad for you. A little bit of stress can get you motivated to tackle the challenges of the day, at work and at home. Too little stress, however, and we can become lethargic, lazy and miss out on opportunities for a fuller life. Too much stress and we suffer poor health. A good balance of stress can support a productive and rewarding lifestyle. Being honest with ourselves about what a good balance looks like is the key.

Does all this sound easier said than done? Well it can seem that way when you are overloaded with stress, so here is a quick list of small things you can do to give yourself a head start on the Four A’s:

  • Go for a walk.
  • Spend time in a park.
  • Call a good mate.
  • Get in some exercise.
  • Write in a personal journal.
  • Light some scented candles (not near the curtains – trust me on that).
  • Take a long bath.
  • Meditate.
  • Savour a warm drink (not too much caffeine).
  • Play with a pet.
  • Get a massage.
  • Read a good book.
  • Listen to music.
  • Watch a comedy show.
  • Work in your garden.
  • Improve your diet.
  • Get the right amount of sleep.
  • Spend at least a little of each day doing something you like.
  • Keep a good sense of humour.

Well, maybe not all of these all at once, but make a start on a few and build on it. And remember the last point – keep a good sense of humour. This includes learning to have a laugh at yourself and to be ok with that. A good laugh helps the body fight off stress. I laugh at myself quite often.

More info on this:

http://www.helpguide.org/mental/stress_management_relief_coping.htm

http://www.comcare.gov.au/healthyatwork/my_self

http://www.psychologytoday.com/articles/200811/take-job-and-love-it

Christopher Howland (2012).

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West vs East – Anxiety Disorders

skyline

Diagnostic tools used to assess mental illnesses appear to be largely based on a Western sample. Currently, to our knowledge, there are no peer reviewed studies detailing worrying as a construct in the context of Asian sample population groups. Earlier research suggests that worrying is a predictor of anxiety (Mathews, 1990; Wells, 1995). A large amount of the current literature on anxiety and its cognitive factors such as worrying and rumination have been based on Western sample groups (Roelofs, Huibers, Peeters, et al. 2010; Stapinski, Abbott, & Rapee, 2010). However, people in other cultures may worry about things that mainstream Australian families don’t fret over. For instance, Lan (2002) identified that having to uphold collective values such as filial piety is a source of stress and anxiety for some members of Asian communities.

Furthermore, in a study conducted in Korea, Yook, Kim & Suh, et al. (2010) found that intolerance of uncertainty (ambiguity) was associated with worrying. Drawing from the above, a perceived need to maintain collective values may also be a source of worry, particularly within Eastern cultures. Furthermore, recent research has revealed that people of Eastern countries reported a higher level of social anxiety and more positive attitudes towards socially avoidant behaviour, which leads us to believe that there are likely to be cross-cultural differences in the symptoms of anxiety and worry (Schreier, Heinrichs, Alden et al. 2010). At the present time, little is known about the role of worrying within Asian populations, nor culturally specific considerations regarding the diagnosis, symptomology and treatment of anxiety within Asian populations.

Given the increasing number of Asian migrants and temporary residents, and the availability of Medicare benefits for psychological treatment, research in the screening of symptoms and treatment for anxiety amongst people of Asian heritage (i.e., a cross-cultural comparison) would have implications for health care provision and policy development. Efforts to target mental health for the Asian population in Australia will need to consider Asian cultural perspectives.

Health Practitioners who work with Clients of other cultures, in particularly the Asian population should read this article by Dominic Murphy, titled “Strange or just plain weird? Cultural variations in mental illness”.

Gina Huisy & Christopher Howland (2012 October).

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