Symptoms and Diagnosis of PTSD ( II)

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Symptoms and Diagnosis of PTSD
By Harold Cohen, Ph.D.


There are three main kinds of symptoms that clinicians look for when diagnosing posttraumatic stress disorder (PTSD). These include re-experiencing symptoms, avoidant symptoms and symptoms of increased arousal.

Re-experiencing symptoms include ways in which the person persistently re-experiences the traumatic event. These symptoms may include the following:

•Intrusive memories of the traumatic event
•Recurrent, distressing dreams about the traumatic event
•Acting or feeling as if the traumatic event is reoccurring
•Mental and physical discomfort when reminded of the traumatic event (e.g., on the anniversary of the traumatic event)
Avoidant symptoms are ways in which the person tries to avoid anything associated with the traumatic event. These symptoms may also include a “numbing” effect, where the person’s general response to people and events is deadened. Avoidant symptoms include the following:

•Avoiding thoughts or feelings, people or situations (anything that could stir up memories) associated with the traumatic event
•Not being able to recall an important aspect of the traumatic event
•Reduced interest or participation in significant activities
•Feeling disconnected from others
•Showing a limited range of emotion
•Having a sense of a shortened future (e.g., not expecting to have a normal life span, marriage or career)
Symptoms of increased arousal may be similar to symptoms of anxiety or panic attacks. Increased arousal symptoms include the following:

•Difficulty concentrating
•Exaggerated watchfulness and wariness
•Irritability or outbursts of anger
•Difficulty falling or staying asleep
•Being easily startled
Difficulty in Diagnosing PTSD
Identifying people with PTSD can be difficult and this disorder is often unrecognized. PTSD is unique among psychiatric disorders in that it is identified not only by symptoms, but also by the precursor of the illness (the traumatic event). Since talking about trauma may evoke painful emotions, people often refrain from discussing past traumatic events.

When a person is unable or unwilling to discuss a traumatic event, accurate diagnosis is difficult. For example, domestic violence and sexual abuse are subjects that many persons feel uncomfortable in raising, even with professionals. For others, feelings of shame and guilt related to the event and social pressures to “deal with” the symptoms that come afterward make talking about it difficult. Additionally, persons with PTSD often have other disorders, such as substance abuse or depression. These other disorders share some of the symptoms of PTSD and can also make diagnosis more difficult.

Doctors and health professionals may also ignore the signs and symptoms of PTSD. Indeed, it has been argued that at times society turns a blind eye to the existence of traumatized individuals, denying that posttraumatic responses constitute a disorder. Indeed, PTSD has only recently been recognized by the official psychiatric nomenclature. Persons who suspect that they are suffering from PTSD should seek out professionals who have experience with this disorder.



Differential Diagnosis of PTSD SymptomsBy Harold Cohen, Ph.D.


While the symptoms of posttraumatic stress disorder (PTSD) may seem similar to those of other disorders, there are differences. For example, PTSD symptoms may seem similar to those of anxiety disorders, such as acute stress disorder or obsessive-compulsive disorder. However, there are distinct differences between these disorders.

In general, the symptoms of acute stress disorder must occur within four weeks of a traumatic event and come to an end within that four-week time period. If symptoms last longer than one month and follow other patterns common to PTSD, a person’s diagnosis may change from acute stress disorder to PTSD.

While both PTSD and obsessive-compulsive disorder have recurrent, intrusive thoughts as a symptom, the types of thoughts are one way to distinguish these disorders. Thoughts present in obsessive-compulsive disorder do not usually relate to a past traumatic event. With PTSD, the thoughts are invariably connected to a past traumatic event.

PTSD symptoms can also seem similar to adjustment disorder because both are linked with anxiety that develops after exposure to a stressor. With PTSD, this stressor is a traumatic event. With adjustment disorder, the stressor does not have to be severe or outside the “normal” human experience.

Treatment of PTSD
There are two primary types of treatment for posttraumatic stress disorder (PTSD) — psychotherapy and medications.

Psychotherapy for PTSD
Most people who experience post-traumatic stress disorder undergo some type of psychotherapy (most commonly either cognitive-behavioral therapy or group psychotherapy, or combination of the two). You can learn more about psychotherapy for PTSD now.

Psychotherapy techniques commonly prescribed include group psychotherapy, cognitive-behavioral therapy, EMDR and hypnotherapy.

Medications for PTSD
Medications are nearly always used in conjunction with psychotherapy for PTSD, because while medications may treat some of the symptoms commonly associated with the disorder, they will not relieve a person of the flashbacks or feelings associated with the original trauma. If one is receiving a medication from a general practitioner or their doctor, they should nearly always seek a psychotherapy referral in addition to the prescription.

Antidepressants

The most commonly prescribed class of medications for PTSD (and the one approved by the U.S. Food and Drug Administration) are the selective serotonin reuptake inhibitor (SSRI) antidepressants. These include drugs such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). Research shows that this group of medicines tends to decrease anxiety, depression, and panic associated with PTSD in many people. These types of antidepressants may also help reduce aggression, impulsivity, and suicidal thoughts that can occur in people with PTSD.

This class of antidepressants generally takes 6 to 8 weeks to work, so patience is needed when taking them. Many people don’t always respond to the first type of antidepressant tried, so another antidepressant may need to be tried if the first one is ineffective. A relapse of posttraumatic stress disorder is less likely if antidepressants are prescribed for at least a year. Antidepressants are particularly useful in patients who also suffer from depression (although they can be useful even in the absence of depression). They are also useful when there is a history of abuse of alcohol or other substances,

Other Medications
There are a variety of other medications often prescribed to try and help reduce the symptoms associated with PTSD. The most common alternative to antidepressants are the atypical antipsychotics. Atypical antipsychotics include medications such as risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel). Antipsychotic medicines seem to be most useful in the treatment of PTSD in those who suffer from agitation, dissociation, hypervigilance, intense suspiciousness (paranoia), or brief breaks in being in touch with reality (brief psychotic reactions).

Other less directly effective but nevertheless potentially helpful medications for managing PTSD include mood stabilizers like lamotrigine (Lamictal), tiagabine (Gabitril), and divalproex sodium (Depakote). Medicines that help decrease the physical symptoms associated with PTSD include drugs such as clonidine (Catapres), guaneficine (Tenex), and propranolol.

Benzodiazepines (commonly referred to as minor tranquilizers, sleeping tablets, or anti-anxiety medications) are sometimes prescribed for certain symptoms of PTSD because they provide rapid relief of anxiety, but are also associated with dependence. In general, there is far more evidence for the use of antidepressants in PTSD than for the use of benzodiazepines. There is even a small amount of data indicating that although the benzodiazepines can provide immediate relief of symptoms, over the long haul they can exacerbate PTSD.

In general, medications should be prescribed for PTSD only by a psychiatrist. Specialists may prescribe two medications at the same time for people with PTSD who fail to respond to various single medications.

PTSD

What is posttraumatic stress disorder?
Posttraumatic stress disorder (PTSD) is an emotional illness that usually develops as a result of a terribly frightening, life-threatening, or otherwise highly unsafe experience. PTSD sufferers re-experience the traumatic event or events in some way, tend to avoid places, people, or other things that remind them of the event (avoidance), and are exquisitely sensitive to normal life experiences (hyperarousal). Although this condition has likely existed since human beings have endured trauma, PTSD has only been recognized as a formal diagnosis since 1980. However, it was called by different names as early as the American Civil War, when combat veterans were referred to as suffering from "soldier's heart." In World War I, symptoms that were generally consistent with this syndrome were referred to as "combat fatigue." Soldiers who developed such symptoms in World War II were said to be suffering from "gross stress reaction," and many troops in Vietnam who had symptoms of what is now called PTSD were assessed as having "post-Vietnam syndrome." PTSD has also been called "battle fatigue" and "shell shock."

Complex posttraumatic stress disorder (C-PTSD) usually results from prolonged exposure to a traumatic event or series thereof and is characterized by long-lasting problems with many aspects of emotional and social functioning.

Statistics regarding this illness indicate that approximately 7%-8% of people in the United States will likely develop PTSD in their lifetime, with the lifetime occurrence (prevalence) in combat veterans and rape victims ranging from 10% to as high as 30%. Somewhat higher rates of this disorder have been found to occur in African Americans, Hispanics, and Native Americans compared to Caucasians in the United States. Some of that difference is thought to be due to higher rates of dissociation soon before and after the traumatic event (peritraumatic), a tendency for individuals from minority ethnic groups to blame themselves, have less social support, and an increased perception of racism for those ethnic groups, as well as differences between how ethnic groups may express distress. In military populations, many of the differences have been found to be the result of increased exposure to combat at younger ages for minority groups. Other important facts about PTSD include the estimate of 5 million people who suffer from PTSD at any one time in the United States and the fact that women are twice as likely as men to develop PTSD.

Almost half of individuals who use outpatient mental-health services have been found to suffer from PTSD. As evidenced by the occurrence of stress in many individuals in the United States in the days following the 2001 terrorist attacks, not being physically present at a traumatic event does not guarantee that one cannot suffer from traumatic stress that can lead to the development of PTSD.

PTSD statistics in children and teens reveal that up to more than 40% have endured at least one traumatic event, resulting in the development of PTSD in up to 15% of girls and 6% of boys. On average, 3%-6% of high school students in the United States and as many as 30%-60% of children who have survived specific disasters have PTSD. Up to 100% of children who have seen a parent killed or endured sexual assault or abuse tend to develop PTSD, and more than one-third of youths who are exposed to community violence (for example, a shooting, stabbing, or other assault) will suffer from the disorder.

What causes PTSD?
Virtually any trauma, defined as an event that is life-threatening or that severely compromises the emotional well-being of an individual or causes intense fear, may cause PTSD. Such events often include either experiencing or witnessing a severe accident or physical injury, receiving a life-threatening medical diagnosis, being the victim of kidnapping or torture, exposure to war combat or to a natural disaster, exposure to other disaster (for example, plane crash) or terrorist attack, being the victim of rape, mugging, robbery, or assault, enduring physical, sexual, emotional, or other forms of abuse, as well as involvement in civil conflict. Although the diagnosis of PTSD currently requires that the sufferer has a history of experiencing a traumatic event as defined here, people may develop PTSD in reaction to events that may not qualify as traumatic but can be devastating life events like divorce or unemployment.


What are the risk factors and protective factors for PTSD?

Issues that tend to put people at higher risk for developing PTSD include increased duration of a traumatic event, higher number of traumatic events endured, higher severity of the trauma experienced, having an emotional condition prior to the event, or having little social support in the form of family or friends. In addition to those risk factors, children and adolescents, females, and people with learning disabilities or violence in the home seem to have a greater risk of developing PTSD after a traumatic event.

While disaster-preparedness training is generally seen as a good idea in terms of improving the immediate physical safety and logistical issues involved with a traumatic event, such training may also provide important preventive factors against developing PTSD. That is as evidenced by the fact that those with more professional-level training and experience (for example, police, firefighters, mental-health professionals, paramedics, and other medical professionals) tend to develop PTSD less often when coping with disaster than those without the benefit of such training or experience.

Some medications have been found to help prevent the development of PTSD. Some medicines that treat depression, decrease the heart rate, or increase the action of other body chemicals are thought to be effective tools in the prevention of PTSD when given in the days immediately after an individual experiences a traumatic event.

What are the signs and symptoms of PTSD?

The three groups of symptoms that are required to assign the diagnosis of PTSD are

•recurrent re-experiencing of the trauma (for example, troublesome memories, flashbacks that are usually caused by reminders of the traumatic events, recurring nightmares about the trauma and/or dissociative reliving of the trauma),

•avoidance to the point of having a phobia of places, people, and experiences that remind the sufferer of the trauma and a general numbing of emotional responsiveness, and

•chronic physical signs of hyperarousal, including sleep problems, trouble concentrating, irritability, anger, poor concentration, blackouts or difficulty remembering things, increased tendency and reaction to being startled, and hypervigilance to threat.
The emotional numbing of PTSD may present as a lack of interest in activities that used to be enjoyed (anhedonia), emotional deadness, distancing oneself from people, and/or a sense of a foreshortened future (for example, not being able to think about the future or make future plans, not believing one will live much longer). At least one re-experiencing symptom, three avoidance/numbing symptoms, and two hyperarousal symptoms must be present for at least one month and must cause significant distress or functional impairment in order for the diagnosis of PTSD to be assigned. PTSD is considered of chronic duration if it persists for three months or more.

A similar disorder in terms of symptom repertoire is acute stress disorder. The major differences between the two disorders are that acute stress disorder symptoms persist from two days to four weeks, and a fewer number of traumatic symptoms are required to make the diagnosis as compared to PTSD.

In children, re-experiencing the trauma may occur through repeated play that has trauma-related themes instead of through memories, and distressing dreams may have more general content rather than of the traumatic event itself. As in adults, at least one re-experiencing symptom, three avoidance/numbing symptoms, and two hyperarousal symptoms must be present for at least one month and must cause significant distress or functional impairment in order for the diagnosis of PTSD to be assigned. When symptoms have been present for less than one month, a diagnosis of acute stress disorder (ASD) can be made.

Symptoms of PTSD that tend to be associated with C-PTSD include: problems regulating feelings, which can result in suicidal thoughts, explosive anger, or passive aggressive behaviors; a tendency to forget the trauma or feel detached from one's life (dissociation) or body (depersonalization); persistent feelings of helplessness, shame, guilt, or being completely different from others; feeling the perpetrator of trauma is all-powerful and preoccupation with either revenge against or allegiance with the perpetrator; and severe change in those things that give the sufferer meaning, like a loss of spiritual faith or an ongoing sense of helplessness, hopelessness, or despair.

How is PTSD treated?

Treatments for PTSD usually include psychological and medical treatments. Providing information about the illness, helping the individual manage the trauma by talking about it directly, teaching the person ways to manage symptoms of PTSD, and exploration and modification of inaccurate ways of thinking about the trauma are the usual techniques used in psychotherapy for this illness. Education of PTSD sufferers usually involves teaching individuals about what PTSD is, how many others suffer from the same illness, that it is caused by extraordinary stress rather than weakness, how it is treated, and what to expect in treatment. This education thereby increases the likelihood that inaccurate ideas the person may have about the illness are dispelled, and any shame they may feel about having it is minimized. This may be particularly important in populations like military personnel that may feel particularly stigmatized by the idea of seeing a mental-health professional and therefore avoid doing so.

Teaching people with PTSD practical approaches to coping with what can be very intense and disturbing symptoms has been found to be another useful way to treat the illness. Specifically, helping sufferers learn how to manage their anger and anxiety, improve their communication skills, and use relaxation techniques can help individuals with PTSD gain a sense of mastery over their emotional and physical symptoms. Individual or group cognitive behavioral psychotherapy can help people with PTSD recognize and adjust trauma-related thoughts and beliefs by educating sufferers about the relationships between thoughts and feelings, exploring common negative thoughts held by traumatized individuals, developing alternative interpretations, and by practicing new ways of looking at things. This treatment also involves practicing learned techniques in real-life situations.

Eye-movement desensitization and reprocessing (EMDR) is a form of cognitive therapy in which the practitioner guides the person with PTSD in talking about the trauma suffered and the negative feelings associated with the events, while focusing on the professional's rapidly moving finger. While some research indicates this treatment may be effective, it is unclear if this is any more effective than cognitive therapy that is done without the use of rapid eye movement.

Families of PTSD individuals, as well as the sufferer, may benefit from family counseling, couples' counseling, parenting classes, and conflict-resolution education. Family members may also be able to provide relevant history about their loved one (for example, about emotions and behaviors, drug abuse, sleeping habits, and socialization) that people with the illness are unable or unwilling to share.

Directly addressing the sleep problems that can be part of PTSD has been found to not only help alleviate those problems but to thereby help decrease the symptoms of PTSD in general. Specifically, rehearsing adaptive ways of coping with nightmares (imagery rehearsal therapy), training in relaxation techniques, positive self-talk, and screening for other sleep problems have been found to be particularly helpful in decreasing the sleep problems associated with PTSD.

Medications that are usually used to help PTSD sufferers include serotonergic antidepressants (SSRIs), like fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil), and medicines that help decrease the physical symptoms associated with illness, like clonidine (Catapres), guanfacine (Tenex), and propranolol. Individuals with PTSD are much less likely to experience a relapse of their illness if antidepressant treatment is continued for at least a year. SSRIs are the first group of medications that have received approval by the U.S. Food and Drug Administration (FDA) for the treatment of PTSD. These medicines have been found to help PTSD sufferers modify information that is taken in from the environment (stimuli) and to decrease fear. Research also shows that this group of medicines tends to decrease anxiety, depression, and panic. SSRIs may also help reduce aggression, impulsivity, and suicidal thoughts that can be associated with this disorder. Although other medications like duloxetine (Cymbalta), bupropion (Wellbutrin), and venlafaxine (Effexor) are sometimes used to treat PTSD, there is little research that has studied their effectiveness in treating this illness.

Other less directly effective but nevertheless potentially helpful medications for managing PTSD include mood stabilizers like lamotrigine (Lamictal), tiagabine (Gabitril), divalproex sodium (Depakote), as well as mood stabilizers that are also antipsychotics, like risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel). Antipsychotic medicines seem to be most useful in the treatment of PTSD in those who suffer from agitation, dissociation, hypervigilance, intense suspiciousness (paranoia), or brief breaks in being in touch with reality (brief psychotic reactions).

Benzodiazepines (tranquilizers) such as diazepam (Valium) and alprazolam (Xanax) have unfortunately been associated with a number of problems, including withdrawal symptoms and the risk of overdose, and have not been found to be significantly effective for helping individuals with PTSD.

How can people cope with PTSD?

Some ways that are often suggested for PTSD patients to cope with this illness include learning more about the disorder as well as talking to friends, family, professionals, and PTSD survivors for support. Joining a support group may be helpful. Other tips include reducing stress by using relaxation techniques (for example, breathing exercises, positive imagery), actively participating in treatment as recommended by professionals, increasing positive lifestyle practices (for example, exercise, healthy eating, distracting oneself through keeping a healthy work schedule if employed, volunteering whether employed or not), and minimizing negative lifestyle practices like substance abuse, social isolation, working to excess, and self-destructive or suicidal behaviors.

Phobias Picture Slideshow: What Are You Afraid Of on MedicineNet.com

Phobias Picture Slideshow: What Are You Afraid Of on MedicineNet.com

personality development and personality disorders

A personality disorder is identified by a pervasive pattern of experience and behavior that is abnormal with respect to any of the following two: thinking , mood , personal relations, and the control of impulses.
Personality is the total of a person's internal and external patterns of adjustment to life, determined in part by the individual's genetic make-up and by life experiences. Thus, the dynamics of personality development become increasingly complex throughout the lifespan as one continually interacts with the envionment and experience various stages of physical and psychological maturation. Factors influencing psychological maturation include genetic endowments such as inheritedtraits, potentials, and characteristics ; environmental stressors including parental relationships, peer relationships, and cultural and social experiences; individual accomplishments that are the results of learning and adaptation; and one's mental health status at each developmental stage. Thus, a newborn or infant reacts differently to a given environmental stimulus than does an adolescent, a young adult, or an elderly person.

Theories of personality Development
Various theories of personality maturation are presented in development psychology classes as part of the curriculum in nursing programs. Generally , these theories are categorized as ssychoanalytic, cognitive, behavioristic, and interpersonal .A summary of the more common theories , such as those of Sigmund Freud, Eric Erikson, and Jean piaget, are presented in this chapter.
Freud's psychoanalytic Theory of Personality Development
Freud's theory of personality development describes three major categories. the development of personality, the organization or structure of personality, and the dynamics of personality. Freud expalins the development of the personality. Freud explains the development of the personality by describing three levels of consciousness: the unconscious, preconscious ( subconscious) , and consciuos THe unconscious level consistsof drives, feelings,ideas, and urges outside of the person's awareness. This is the most significant level of consciousness because of its effect on behavior.A considerable amount of psychic energy is used to keep unpleasant memories stored in the unconscious level of the mind. The preconciuos or subconscious level, consists of feelings, ideals, drives, and ideas that are out of one's ongoing awareness but can ve recalled readily. The conscious level of the personality is aware of the present and controls purposeful behaviors.
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The organization or structure of the personality consists of he id, which is an unconscious reservoir of primitive drives and instincts dominated by thinking and the plesure principle: the ego , which meets and interacts with the outside world as an integrator or mediator and is the executive function of the personality that operates at all three levels of consciousness; and the superego , which acts as the censoring force or conscience of the personality and is composed of morals, mores, values, and ethics largely derived from one's parents. THe superego operates at all three levels of consciousness.
According to Freud's explanation of the dynamics of the personality, each person has a certain amount of psychic energy to cope with the problems of everyday living. The id's energy is used to reduce tension and may be exhibited, for example, by frequency of urination, daydreaming, or eating. THe eogps energy controls the impulsive actions of the id nd the moralistic and idealistic actions of the superego. One whose energy is controlled primarily by the superego generally behaves in anoverly moralistic manner because the structure of the personality monopolizes the psychic energy that governs the person's behavior.
In his psychosexual theory , Freud also describes five phases of the psychobiologic process that have a great impact on personality development : oral,anal , phallic oroedipal, latency and genital.
+ The oral phase ( O to 18 mos) is a period in which pleasure is derived mainly through the mouth by the actions of sucking or biting.
+ During the anal phase ( 18 mos to 3 years) , attention focuses on the excretory function, and the fuondation is laid for the development of the superego.
+ In the phallic or oedipal stage ( 3 to 7 years) , a stage of growth and developnent , the child identified with the parent of the same sex, forms a deep attachment to the parent of the oppersite sex develops a sexual identity of male or female role, and begins to expericence guilt.
+ During the latency phase ( 7 years to adolescence) , the person learns to recognize and handle reality , has a limited sexual image, develops an inner control over aggressive or destructive impilses, and experiences intellectual and social growth.
+ In the genital phase ( puberty or adolescence into adult life) , the final stage of psychosexual development , the individual develops the capacity for object love and mature sexuality and establishes identity and independence.

Tips to Reduce Morning Anxiety

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Tips to Reduce Morning Anxiety
Is Your Anxiety Worse in the Morning?
If you have a panic disorder or another anxiety disorder, you may find mornings especially difficult. Many people with an anxiety disorder experience the start of each day with fear. Do you awaken filled with anxiety, feeling like you just want to curl up under the covers and not face the day ahead? If your answer is yes, then there are some things you can do to minimize your morning anxiety.


1. Examine Your Sleep Habits
Are you getting enough sleep? Or are you plagued with difficulty falling asleep or waking up too early? Poor sleep patterns and insomnia are known to cause a variety of psychological and physical complaints. These include headaches, decreased energy, poor concentration, short-term memory problems, irritability and anxiety. By regulating your sleep patterns, you can reduce morning anxiety and improve your ability to carry out your daily activities. If you find you are unable to sleep well despite practicing good sleep hygiene, talk with your doctor. There are a variety of safe and effective medications that may help you get your 40 winks.

2. Examine Your Morning Stressors
Can you identify parts of your morning routine that you find anxiety-provoking? For example, are you jolted awake from a peaceful slumber by the screeching sound of an alarm clock? Perhaps an alarm clock that wakes you to soothing music would be better. Do you feel anxious because you’re rushed in the morning? Make sure you’re giving yourself enough time to start your day without the added stress of being hurried. This may mean doing some of your morning tasks the night before (i.e., packing lunches, preparing clothes, etc.).


3. Start Your Day with Some Relaxation Exercises
Doing some relaxation exercises in the morning only takes about 10 to 15 minutes, but you’ll probably feel the benefits all day. If you start your day relaxed and focused, you may feel a sense of emotional balance that carries you through your day. Some techniques to try include:

* Deep Breathing
* Progressive Muscle Relaxation
* Guided Imagery
* Meditation
* Journaling

4. Start Your Day with Positive Thoughts and Affirmations
If you’ve been dealing with morning anxiety for some time, it’s possible that you have developed automatic negative thought patterns: your mind awakens, and without any conscious effort on your part, worried and anxious thoughts take center stage, leading to more anxiety. It takes practice, but you can change these negative thought patterns. First, identify the thoughts that need change, and then develop your own positive counter statements. For example:

You wake up and your first thoughts are:
I feel terrible.
How am I going to drive to work today?
I’ll never get through the day.
What’s wrong with me?

You can replace these negative thoughts with positive statements, such as:

Yes, I feel anxious this morning, but I have felt this way before and have been able to handle it.
If I have trouble with anxiety during the day, I can use relaxation techniques that will calm me down.
I am in control.
Anxiety is a normal human emotion, and it is my cue to relax.

The idea is that by changing your thoughts, you can change how you feel. The goal is to interrupt your pattern of negative thoughts and replace them with positive thoughts and affirmations. Negative thoughts are fuel for anxiety. Positive, encouraging and optimistic thinking, on the other hand, makes it much more difficult for anxiety to be maintained.

Elizabeth Scott, your About.com guide to stress management, provides an insightful look at using positive affirmations to reduce anxiety.
5. Consider Your Diet
Studies have shown that people with panic disorder are more sensitive to certain substances than are people without the disorder. When these substances are given to people with panic disorder, the result is increased anxiety or a panic attack. Alcohol, caffeine and nicotine are known triggers. It’s best to nix the alcohol nightcap and the morning cup of caffeinated pick-me-up.
Some people have found that decreases in blood sugar can result in anxiety. The drop in blood sugar during the long hours of sleep may account for some morning anxiety. Try eating a high-protein snack before bed. If you suspect your morning anxiety is caused from a drop in blood sugar, you can keep healthy snacks on your nightstand to be eaten before you get out of bed in the morning. It’s best to stick with healthy snacks high in protein or complex carbohydrates (i.e., fruits, vegetables). Avoid sugary snacks as these will likely cause your blood sugar to drop just as fast as it went up.

6. Talk to Your Therapist or Doctor
If you take medications, review your regimen with your doctor. Perhaps changing medications or changing the times you take them may help your morning anxiety. Ask your therapist about additional ways you can cope with your specific morning tension and anxiety.

Deep breathing exercise

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Deep breathing exercise : Abdominal Breathing
Proper Breathing to Reduce Anxiety
Breathing is a necessity of life that usually occurs without much thought. When you breathe in air, blood cells receive oxygen and release carbon dioxide. Carbon dioxide is a waste product that is carried back through your body and exhaled. Improper breathing can upset the oxygen and carbon dioxide exchange and contribute to anxiety, panic attacks, fatigue and other physical and emotional disturbances.
Is the Way You’re Breathing Contributing to Your Anxiety and Panic?
Most people are not really conscious about the way they are breathing, but generally there are two types of breathing patterns:
1. Thoracic (chest) breathing
2. Diaphragmatic (abdominal) breathing
When people are anxious they tend to take rapid, shallow breaths that come directly from the chest. This type of breathing is called thoracic or chest breathing. When you’re feeling anxious, you may not even be aware that you’re breathing this way.
Chest breathing causes an upset in the oxygen and carbon dioxide levels in the body resulting in increased heart rate, dizziness, muscle tension and other physical sensations. Your blood is not being properly oxygenated and this may signal a stress response that contributes to anxiety and panic attacks.
In contrast, during abdominal or diaphragmatic breathing, you take even, deep breaths. This is the way newborn babies naturally breathe. You are also probably using this pattern of breathing when you are in a relaxed stage of sleep.
How Can I Tell the Difference Between Chest and Abdominal Breathing?
The easiest way to determine your breathing pattern is to put one hand on your upper abdomen near the waist and the other on the middle of your chest. As you breathe, notice which hand raises the most. If you are breathing properly, your abdomen should expand and contract with each breath. It is especially important to be aware of these differences during stressful and anxious times when you are more likely to breathe from your chest.
Simple Abdominal Breathing Exercise for Relaxation
The next time you’re feeling anxious try this simple relaxation technique:
1. Inhale slowly and deeply through your nose. Keep your shoulders relaxed. Your abdomen should expand, and your chest should rise very little.
2. Exhale slowly through your mouth. As you blow air out, purse your lips slightly, but keep your jaw relaxed. You may hear a soft “whooshing” sound as you exhale.
3. Repeat this breathing exercise for several minutes.

You can perform this exercise as often as needed. It can be done standing up, sitting down or lying down.
If you find this exercise difficult or believe it is making you anxious or panicky, stop for now. Sometimes people with panic disorder initially feel increased anxiety or panic while doing this exercise. This may be due to anxiety caused by focusing on your breathing, or you may be unable to do the exercise correctly without some practice. If that happens to you, stop for now. Try it again in a day or so and build up time gradually.
Progressive Muscle Relaxation Can Help You Reduce Anxiety and Prevent Panic
Progressive muscle relaxation (PMR) is a stress and anxiety management technique developed by Chicago physician Edmund Jacobson in the 1920s. Jacobson theorized that anxiety and stress lead to muscle tension, which, in turn, increases feelings of anxiety. When the body is in a relaxed state, however, there is little muscle tension, leading to decreased anxious feelings. Jacobson believed that if one’s body is relaxed, one’s mind cannot be in a state of angst.
Distinguish Between Tense and Relaxed Muscles
If you have panic disorder, agoraphobia or another type of anxiety disorder, you may experience frequent muscle tension. In fact, chronic muscle tension may be so automatic that it seems normal, and you may have forgotten what it feels like when your muscles are completely relaxed. By employing the progressive muscle relaxation technique, you will be able to quickly rediscover the distinctions between relaxation and tension of various muscle groups.
Try this simple exercise: Make a tight fist while simultaneously flexing your hand upward at the wrist. Focus on the sensations you feel while these muscles are tensed. Hold this position for about 10 seconds and release. Let your hand and arm go limp. Focus on how your relaxed muscles feel. Repeat this a couple of times. Focus on the different feelings and physical sensations between tensing and relaxing your fist.
How Does PMR Ease Anxiety?
Anxiety triggers certain physical changes and sensations, including:

* Increased blood flow to the muscles
* Muscle tightening
* Rapid or shallow breathing
* Increased heart rate
* Slowed digestive functioning
By using PMR, you can counter these physical changes and sensations to achieve a “relaxation response.” A relaxation response comes from using relaxation techniques to calm your body. During PMR, your breathing slows and your heart rate and blood pressure decrease. When muscles are relaxed, they don’t require as much oxygen as when they are tense. This allows redirection of blood flow from the tense muscles to other areas of the body, which reduces many of the unpleasant physical effects of anxiety.
What Are the Benefits of PMR?
PMR has been shown to be beneficial in easing anxiety, and reducing anxiety has been shown to improve the symptoms of many psychological and medical conditions. This technique is often recommended for people with anxiety disorders, insomnia, chronic pain and other disorders. In fact, some studies of breast cancer patients have shown PMR not only reduces anxiety but depression and treatment induced nausea and vomiting as well.
How to Do Progressive Muscle Relaxation
Basically, a progressive muscle relaxation exercise involves systematically constricting and relaxing various muscle groups from your feet upward or your head downward. You focus on tensing and relaxing muscle groups in the feet, legs, buttocks, stomach, back, hands, arms, chest, shoulders, neck and face.
To be most effective, you should be sitting or lying down in a comfortable position. Your eyes may be opened or closed, but most people find closing their eyes helps maintain focus during the exercise. Loosen any restrictive clothing, make sure your surroundings are quiet and follow these basic steps:
1. Do some deep breathing before you begin. Inhale slowly and deeply through your nose and exhale through your mouth. Repeat this several times.
2. Begin tensing and relaxing muscle groups. Bend your feet upward from the ankle toward your face, flexing as much as you can. Hold this position for about 5 to 10 seconds. Quickly release the tension and remain still for about 20 to 30 seconds.
3. Gradually work your way upward by tensing and relaxing each set of muscle groups. Hold each tensed position for about 5 to 10 seconds. Allow 20 to 30 seconds of relaxation before moving on to the next muscle group.
4. Focus on how you feel while you are tensing your muscles and while you are relaxed.
5. After you’ve completed all of the muscle groups, continue deep breathing and focus on how you feel in this relaxed state. Notice the difference between how you feel now and how you felt at the start of the exercise.
Practice Is a Must
All relaxation techniques are essentially skills, and skills get better with practice. By practicing progressive muscle relaxation regularly, you should be able to achieve a greater depth of relaxation in a shortened amount of time. Once mastered, you should be able to relax tense muscles on cue in many stressful situations.
Special Considerations

* If you experience feelings of emotional distress while using progressive muscle relaxation, stop and talk to your doctor.
* If your muscles are sore or if you have an injury to any body part that you want to target with PMR, talk to your doctor before using this technique.
* If you experience any intense muscle pain while performing this exercise, stop immediately and call your doctor.
How To Reduce Stress by Deep Breathing
Deep breathing can be an important coping skill to learn. It may sound silly, but many people do not breathe properly. Natural breathing involves your diaphragm, a large muscle in your abdomen. When you breathe in, your belly should expand. When you breathe out, your belly should fall. Overtime, people forget how to breathe this way and instead use their chest and shoulders. This causes short and shallow breaths, which can increase stress and anxiety.
Fortunately, it is not too late to "re-learn" how to breathe and help protect yourself from stress. Practice the simple exercise below to improve your breathing.
Difficulty: Easy
Time Required: 10 minutes
Here's How:
1. Find a comfortable position either lying on your back or sitting. If you are sitting down, make sure that you keep your back straight and release the tension in your shoulders. Let them drop.
2. Close your eyes.
3. Place one hand on your stomach and the other on your chest.
4. Take a few breaths as you normally would. Does your belly rise and fall with every inbreath and outbreath? If you can answer "yes," that is good. This is the natural way of breathing. If your belly stays still but your chest rises and falls with every breath, practice breathing by only allowing your belly to rise and fall when you breathe in and out.
5. Continue to take deep breaths, concentrating on only moving your belly.
6. Continue as long as you would like!
Tips:
1. It can take some time to re-learn how to breathe. The more you practice, the easier it becomes. Take some time each day to practice this exercise. You can do it anywhere.
2. Try to practice this exercise at a time when you are already relaxed. This will make it easier to take deeper breaths.
3. If you are having trouble taking deep breaths, try breathing in through your nose and exhaling through your mouth. Also, slowly count to five in your head as you breathe in and out.
How to Breathe: Breathing and Walking
Breathing is important for walking and learning breathing techniques can enhance walking or even turn it into a more energizing, more stress-relieving, and even spiritual experience.
You've Been Breathing Wrong'
The breathing cycle should start in the belly. Drawing the belly out brings the diaphragm down, inflating the lungs. Next, the ribcage is expanded to draw in more air. Finally, the shoulders and clavicles are drawn back to bring in the final small increase in lung volume. To exhale, it is the reverse.
Many people keep their stomachs sucked in and tight continuously, thereby depriving themselves of the belly-expanding major portion of each breath. As a result, most people breathe very shallowly using only the shoulders/clavicles and the ribcage for inhalation and exhalation.
While shallow "paradoxical" breathing will keep you alive, it becomes a large detriment in situations where you need more oxygen, such as when walking at a moderate pace. Athletes of all kinds are coached to learn to breathe with their bellies to get a full inhalation and exhalation.
Practicing a Full Complete Breath

* Suck in your stomach, drawing your belly button towards your spine.
* Exhale
* Now expand your belly button outward, drawing in breath.
* Then allow your ribs to open out
* Finally, draw back your shoulders and clavicles.
* To exhale, first allow out the air at the top of your chest
* Next, draw in the rib cage
* Finally, draw the belly button back towards the spine
* Repeat for a few minutes each day to retrain yourself to normal full breathing.
Breathing and Walking
Consciously attend to your breathing for a few minutes during each walk. Concentrate on complete breaths from belly to chest to clavicles and back. This technique can be especially helpful when tackling a hill, giving your body the oxygen it needs to fuel effort.

How to Stop Worrying: You Can Break Free From Chronic Worry

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It is actually possible to learn how to stop worrying. But first, it is important to know that worry can be normal and even beneficial in certain circumstances. For example, if you’re worried about doing well on an upcoming exam, you may be motivated to study hard. But, sometimes worry becomes pervasive and interferes with our ability to live a happy and peaceful existence. And instead of being a motivating factor, chronic worry can interfere with the actions necessary to achieve our goals.
A friend once told me she felt as if she was worrying her life away. When I asked her what she was worried about, she replied, “Everything.” As our conversation continued, I soon discovered that she did, indeed, worry about everything – even when there was no apparent reason. Her financial status was excellent, but she worried about finances. She worried about the smallest details surrounding the health of herself and her family. She even worried that she would not pack the right clothes for an upcoming trip. Worse, her worrisome thoughts left little room for anything else in her life.

Worry and Anxiety Disorders
Worry can be a symptom of an anxiety disorder. For example, generalized anxiety disorder (GAD) is characterized by excessive worry about routine matters. The worry associated with GAD is out of proportion and may even exist when there is little or no need for concern. Panic disorder often comes with worry about one’s health or when and where the next panic attack will strike.
The good news is that anxiety disorders are very treatable conditions. If you believe your worrying may be a symptom of an anxiety disorder, it is important to get help. There are many treatments available, including medications and psychotherapies that can reduce or stop your symptoms.
You may have a problem with worry if you:
* Consistently worry about future failures, dangers or other types of negative outcomes
* Ruminate, or repeat in your mind, the same worry or worries
* Try to stop worrying by anxious avoidance of certain situations
* Become paralyzed with worry and are unable to focus on, or implement, constructive solutions to your problems
How to Stop Worrying
1. Learn and Practice Relaxation Techniques
By leaning and practicing relaxation techniques, you may be able to reduce intrusive worry. Some techniques that may be helpful include:
Deep Breathing
Progressive Muscle Relaxation
Guided Imagery
Meditation
Journaling
2. Use Thought Stopping
One effective and quick technique to help you with the intrusive worrisome thoughts is called “thought stopping.” The basis of this technique is that you consciously issue the command, “Stop!” when you experience repeated worrisome, unnecessary or distorted thoughts. You then replace the worrisome thought with something more positive and realistic.
3. Other Tips to Stop Worrying
Do you find yourself worrying about a future event because you are picturing a negative outcome? Analyzing your worrisome thoughts and analyzing the risks realistically is important in overcoming chronic worry. Here you will find more tips on how to stop worrying.

Irritable Bowel Syndrome Irritable Bowel Syndrome and Anxiety Disorders

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Irritable Bowel Syndrome
Irritable Bowel Syndrome and Anxiety Disorders : Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome is not a specific disease, but is used to describe a group of symptoms that may include:

* Stomach pain
* Flatulence (gas)
* Bloated or swollen abdomen
* Diarrhea, constipation or a combination of both
* Whitish mucus in the stool
The label “IBS” is often used when medical testing does not result in a specific diagnosis for the symptoms. Irritable Bowel Syndrome is usually chronic, but symptoms may be absent for long periods of time between episodes.
IBS Related to Anxiety and Depression
Stress and anxiety have been shown to interfere with gastrointestinal function. It is estimated that up to 60% of people who seek medical care for IBS also report anxiety and/or a mood disorder. Some researchers believe that people with IBS are sensitive to certain stress chemicals, resulting in an exaggerated response of the colon.
Some things that aggravate panic disorder may also worsen symptoms of IBS. For example, stress, alcohol and caffeine tend to trigger panic attacks and have, also, have been linked to increased IBS symptoms. And, if you worry about being away from a nearby restroom, you may experience increased symptoms of agoraphobia.
If you are receiving medication for panic disorder, it is important to talk to your doctor if you have symptoms of IBS. Some medications used to treat PD may produce side effects that worsen your IBS symptoms. On the other hand, some PD medications may relieve IBS symptoms.
Self-Help Tips to Manage Your IBS Symptoms
1. Find Your Dietary Triggers
Many times, the symptoms of IBS are aggravated by certain foods or beverages. These are often called “triggers,” and they are different for everyone. Common triggers that have been shown to increase IBS symptoms, include:
* Caffeine
* Alcohol
* Insoluble fiber (i.e., raw vegetables, the skin on fruits)
* Foods high in fat
* Carbonated beverages
* Dairy products
You may have these and many other dietary triggers. By keeping a food diary and following an elimination diet, you can discover what aggravates your IBS symptoms.
2. Manage Stress
Excessive stress has been linked to increased IBS symptoms and increased symptoms of panic disorder. It is important to help both your IBS symptoms and your PD symptoms by being aware of you stress level and incorporating stress management techniques into your life.
What is IBS?
Irritable bowel syndrome (IBS) is a digestive disorder that many people have, but few people talk about. It is estimated that IBS affects up to 15% of the population with its symptoms of chronic abdominal pain and major disturbance of bowel functioning. IBS can entail bouts of urgent diarrhea, episodes of chronic constipation, or a pattern of alternating between the two. IBS is considered a functional disorder, in that it involves a malfunction in how the intestinal system works, but doesn’t show up in any visible disease process or tissue damage. If you have IBS, you know first hand how intense the disorder can be and how it can cause significant disruption in the ability to attend to the tasks of daily life.
Causes
Researchers are not yet quite clear why people develop IBS. Often the disorder manifests itself following a severe bout of gastroenteritis, otherwise known as the stomach flu. Sometimes symptoms appear after the experience of an extremely stressful event. A high incidence of IBS in adults were the victim of sexual or physical abuse in childhood. As you can see, stress and IBS often go hand in hand, but the relationship is not yet fully understood. New research avenues are looking at dysfunction in the neurochemical systems of the gut and the brain to better understand the role that stress plays in the onset and maintenance of IBS symptoms.
Other Digestive Disorders
IBS is generally diagnosed after other disorders have been ruled out through routine diagnostic testing. The Inflammatory Bowel Diseases, Ulcerative Colitis and Crohn’s disease, have similar symptoms, but involve visible tissue inflammation. Colon cancer is often a concern due to the high level of discomfort of IBS symptoms. However, there are many key differences between the symptoms of colon cancer and IBS. Blood in the stool, anemia, pain and cramping not relieved by a bowel movement, and significant weight loss are not generally associated with IBS and would require further investigation. In any case, if you have any marked change in bowel functioning, it is essential that you bring this to the attention of a qualified physician.
Treating IBS
Individuals with IBS frequently feel as if they have lost control of their life and they just want to “feel normal” again. Although IBS does tend to have a chronic course, there are many interventions that have been shown to significantly reduce the frequency, severity and duration of symptoms. Whether it is through the use of prescription medication (for diarrhea or constipation), over the counter remedies, nutritional changes, psychotherapy or stress management techniques, be assured that the impact of IBS on your quality of life can be significantly minimized. You can also be reassured with the knowledge that IBS does not involve a shorter life expectancy or lead to more serious disorders. In fact, making the lifestyle changes necessary to deal with IBS can lead to a focus on better self care with positive effects seen in terms of your overall health.
IBS Treatment
(IBS) treatment is generally not a 'one size fits all' plan. A multi-faceted approach is often called for, including having a good working relationship with your physician, the possible use of prescription medicine (for diarrhea or constipation) and over-the-counter (OTC) remedies, nutritional and lifestyle changes, and in some cases, psychotherapy. Working with your physician, and with a little trial and error, you can find your own pathway for treating your IBS. As you try to find your way, be reassured that although IBS can be detrimental to your quality of life, it is not detrimental to your overall health or life expectancy.
Medication
Can medicine help IBS? Yes and no. There is no one drug cure for IBS, but a variety of medications are available that address specific symptoms. The problem is that IBS can be a chronic condition, and patients are often cautioned against taking a medication over a long period of time. Thus, for an ongoing condition like IBS, it is a good idea to explore non-drug treatment alternatives instead of, or in addition to, medication.
For the treatment of severe symptoms, your physician does have a variety of prescription options.

* Antispasmodics: These medications may be prescribed for the treatment of abdominal pain and cramping and are best taken on an as-needed basis.
* Antidepressants: Medications in this class can be taken over a longer period of time and may be chosen for their pain-reducing capability or to treat a co-existing depression or anxiety disorder.
* Medications that target the neurotransmitters (chemicals that pass information in the nerves of the brain and gut) that affect the speed of muscle contraction, secretion of mucus, and the absorption of fluids in the intestines are available for the treatment of diarrhea and constipation, but with strict guidelines as to who they can safely be prescribed for. The major medications in this class are Lotronex for diarrhea, and Zelnorm for constipation.
* Antibiotics: A newer, but still controversial, option for IBS is the use of specific antibiotics to target a possible overgrowth of bacteria in the small intestine.
Over-the-Counter Remedies
These products are available without a prescription and may be helpful in reducing certain abdominal symptoms. Remember that it is always important to check with your doctor before using any OTC product.
* Imodium (Loperamide): Used to control the symptoms of diarrhea.
* Fiber Supplements: (Benefiber, Citrucel, Metamucil) Supplements to increase dietary fiber.
* Probiotics: Dietary supplements that contain bacteria that may help to balance the intestinal tract.
Dietary Modifications
One of the most common ways that individuals try to cope with IBS is through dietary restriction. Faced with such traumatic symptoms, it is easy to point to food as a culprit. However, there is limited research support for the role of specific foods in causing IBS symptoms. An important fact to keep in mind is that the simple act of eating, in particular eating large or fatty meals, can stimulate bowel contractions. Stress and hormonal changes also contribute to IBS symptoms, so that a food that is poorly tolerated on one occasion may be enjoyed without consequence on another.

* Keep a food diary. A helpful way to determine the role of food in relation to your symptoms is to keep a food diary, an ongoing account of what you eat and how you feel. It is recommended that if you have identified a particular food as being a possible culprit, to eliminate that food for a period of about three months to see if this has any effect on your symptoms. If not, try eating the food again and repeat the process with the next food on your list. Common offenders are gas-producing vegetables, artificial sweeteners, caffeine and alcohol.
* Eat smaller, more frequent meals.
* For constipation, try to eat a large breakfast, as this may be the best time to encourage intestinal contractions and the urge to defecate.
* Increase fiber, but use caution. Fiber is generally recommended due to its many health benefits. However, research is somewhat mixed as to the effectiveness of the two types of fiber, soluble fiber and insoluble fiber for relieving IBS symptoms, and some types of fiber might actually exacerbate symptoms. So, add fiber slowly and evaluate the effects on your symptoms. A starting guide may be to increase soluble fiber, particularly in the form of psyllium, for diarrhea-predominant IBS, and insoluble fiber for the treatment of constipation.
Psychotherapy
Two forms of psychotherapy have been shown to be clinically effective in reducing the frequency, intensity and duration of IBS symptoms: Cognitive Behavioral Therapy (CBT) and Hypnotherapy. CBT is a form of therapy in which the individual is taught strategies for modifying maladaptive thinking patterns as well as new behaviors for managing anxiety and handling stressful situations. Hypnotherapy involves the induction of a relaxing and comfortable state of consciousness in which specific suggestions are offered in order to lead to a permanent change in behavior. In either form, psychotherapy offers the advantage of helping you to learn long-term strategies for handling your IBS without the risk of possible negative side effects associated with medication.

Coping Styles for Anxiety

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If you are someone who experiences a lot of anxiety in your life, learning to cope with it can potentially be the most important thing you can do. Below are several major coping styles that you can apply to improve how to tackle your anxiety. For more specific strategies, check this article.
Model of Stress
Before discussing coping, it is important to highlight an overview of how people generally deal with stress. The first stage is that a stressful event is experienced. Next, the person appraises the event as positive, neutral, or negative, with the negative including potential harm, threat, or challenge. Third, the individual determines if the stressor is within personal control, and searches for coping strategies and how to deal with the stressor if possible. Finally, the stress response can include physiological changes, emotions, and a behavioral response.
Problem-Focused Coping
This coping style is focused on dealing with the stress itself to make changes and bring relief. For example, if you get a reduction in pay at work, it can cause stress and anxiety. A problem-focused approach would be to try and regain some of the pay at work or to find another job that would replace the income. This method is effective when the person actually has some control over the stressor, or can make adjustments to reduce the impact of it.
Emotion-Focused Coping
This style focuses on reexamining the stressor and dealing with the emotional response to it. One part of an emotion-focused approach is identifying feelings associated with he stressor. A second part is reframing the stressor as something that is less anxiety-provoking or stressful. An example would be a breakup. Identify the emotions associated with the breakup (sadness, anxiety, anger), and then think of ways to take away the power of this. Examples might be thinking that “This is a chance to do something new” or “It is for the best.”
Avoidance Strategies
Many people use a variety of avoidance strategies to deal with stress and anxiety. Simply avoiding the problem, denying its existence, or minimizing it can be effective short-term strategies. But overall, they will prove to be ineffective in most situations. Learning to tolerate a temporary increase in stress and anxiety and employing one of the other strategies can let you experience a shorter duration of stress and anxiety overall.
Problem-Focused Coping for Anxiety


Coping with Anxiety Anxiety Symptoms Anxiety Disorder How to Relieve Stress How to Deal with Depression

Problem-focused coping is a style of coping with anxiety that attempts to directly deal with the stressor that is causing anxiety as a way to bring relief, such as learning financial skills to deal with money problems that are causing anxiety. If you're wondering why these things cause the sensation of anxiety, it may be helpful to read about the origins of anxiety.

Example of Problem-Focused Coping
The classic example of using problem-focused coping for anxiety is a scenario about something we all do: Pay bills. Suppose you realized that the money you make at work may no longer be able to cover your current living expenses. For most people, this would rightfully lead to some anxiety.
But for people with generalized anxiety disorder, this could cause a significant amount of worry and even debilitating anxiety about the potential outcomes. Instead of worrying and ruminating about the situation, try to take a problem-focused approach.
5 Ways to Cope with Anxiety

This style could look different for each person but all would result in action. Some potential problem-focused solutions would be to take action to find more income, reduce expenses, talk with the companies that you owe money to, and make a plan of how to deal Learning how to cope with anxiety, particularly for people with generalized anxiety disorder, is essential to living a satisfying life. Beyond professional and self-help treatment methods, these pieces can help you manage daily anxiety. Read more on coping styles and anxiety here.
1. Reassurance
As a therapist, I think that the most helpful coping method is simply reassurance. Learning how to reassure yourself that you will be OK, that you can tolerate the feelings you are experiencing, and that the moment will eventually pass, can be profoundly helpful. Doing this regularly and trusting it are the keys.
2. Identify the Source
Many people with GAD struggle to identify the actual source of their anxiety. Some of this may be due to a fear of what it could possibly be, and thus some people do not allow themselves to find it. Being honest with yourself and searching for the cause, whether it is what you hope it to be or something more serious, is important for coping effectively.
3. Solve the Problem
Anxiety compels us to take action and solve problems. If the problem is something you can have some influence over, taking thoughtful action can be a great way to calm anxiety in the short term. Unfortunately, not all problems are solvable. Learning to manage uncertainty and lack of control is another important part of coping and treatment.
4. Remember it Will Pass
Few things in life (if any) are permanent. This includes the stressor you are experiencing, your internal physiological state, and your current stage of worry. Being able to stay strong when the fire of anxiety gets hot, holding tightly to your confidence, and remembering that it will pass are important during periods of increased stress and anxiety.
5. Relaxation
Learning some quick relaxation techniques can be a great way to cope. Doing a brief muscle-relaxation exercise, breathing slowly from your diaphragm (not your chest), and having a quick mindfulness meditation session will do wonders to calm your body and mind. Read more on mindfulness here. with the economic reality. All of these are using the natural anxiety as a fuel to take action, which will likely lead to reduced anxiety.

Insomnia treatment tips ( III )

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Insomnia treatment tips III: Alternative therapies and herbal remedies
There are several alternative treatments that have been used for insomnia. While scientific evidence is still being gathered for these remedies, you may find that some of them work wonderfully for you.
Herbal Supplements and Hormones

* Herbal supplements. There are several herbal remedies thought to help sleep. Examples include chamomile, valerian root, kava kava, chamomile, lemon balm, passionflower, lavender, and St. John’s Wort. These remedies have not yet been scientifically proven to work, although many do try them. Note that the effectiveness of herbal supplements has not been evaluated by the Food and Drug Administration. Herbal supplements can have side effects. Check with your healthcare professional if you are trying these, as they may interfere with some prescribed medications. St. John’s Wort, for example, can limit the effectiveness of many prescribed medications such as blood thinners, birth control pills and some anticancer medications.
* Melatonin. Melatonin is a naturally occurring hormone whose levels peak at night. It is triggered by dark and levels remain elevated throughout the night until light decreases it. For this reason, melatonin has been studied for use as a sleep aid. However, most study results have not found it to be beneficial when compared to a sugar pill (placebo). Some positive results have been shown in helping adjustment to jet lag and shift workers who work nights. However, it’s unclear whether simple exposure to light at the right time is more effective, and there is no risk of side effects with light exposure. Long term uses of melatonin are unknown.

Alternative therapies

* Bright light therapyuses artificial light to simulate the effects of sunlight on the body’s circadian rhythms. It is generally used to treat people who have circadian rhythm sleep disorders or sleep problems associated with jet lag or shift work.
* Acupunctureinvolves the insertion of very fine needles into the body at specific points. It can have a calming effect on your nervous system and also stimulates the production of brain chemicals, including serotonin, which promote sleep. Similarly, acupressure involves finger pressure on the same body points as acupuncture. The advantage of acupressure over acupuncture is that you can do acupressure on yourself. Massage may also help you to relax and sleep better.
* Aromatherapy involves the use of certain scents from herbs, usually distilled into essential oils. The smell is thought to affect the body and is used to treat a wide variety of ailments. Common essential oils for aromatherapy include lavender, jasmine, clary sage, and chamomile. Although research has not conclusively shown aromatherapy to be effective, a scent that you find pleasant can be a cue for sleep in your bedtime routine.

Keeping a sleep diary
A sleep diary can be a helpful way to keep track of your sleeplessness. Although a sleep diary is not a cure in itself, awareness of your sleep patterns can help you discover the cause of your insomnia. The details can be important, and a sleep diary might reveal that your pre-bedtime behavior is thwarting your chance for a good night’s sleep.
Learn about your sleep patterns and habits by keeping a daily sleep diary. See Helpguide's sample sleep diary or make up your own, and include:

* Time you went to bed and woke up;
* Total sleep hours;
* Quality of sleep;
* Times that you were awake during the night and what you did (e.g. stayed in bed with eyes closed or got up, had a glass of milk and meditated);
* Amount of caffeine or alcohol you consumed and times of consumption;
* Types of food and drink and times of consumption;
* Feelings - happiness, sadness, stress, anxiety;
* Drugs or medications taken, amounts taken and times of consumption.