Acta Psychiatrica Scandinavica

Objective

This review explores the influence of anxiety and depression on the experience of positive psychotic symptoms, and investigates the possibility of a causal role for anxiety and depression in the emergence and persistence of psychosis.

Method

A systematic literature search was undertaken, producing a number of papers which comment on the links between anxiety and depression, and the experience of delusions and hallucinations. In addition, evidence which could contribute to our understanding of the causal role of anxiety and depression was highlighted.

Results

The findings show that both anxiety and depression are associated in meaningful ways with the severity of delusions and hallucinations, the distress they elicit and their content. However, the cross-sectional nature of the majority of studies and the focus on certain symptom subtypes tempers the validity of the findings. Data from non-clinical samples, studies which track the longitudinal course of psychosis and those which examine the impact of anxiety and depression on the prognosis for people experiencing psychosis, offer some support for the possibility of an influential role for anxiety and depression.

Conclusion

We conclude that anxiety and depression are related to psychotic symptom severity, distress and content and are also linked with sub-clinical experiences, symptom development, prognosis and relapse. These links may imply that anxiety and depression could be targets for therapeutic intervention. The article concludes with suggestions for further research, highlighting avenues which may circumvent the limitations of the body of work as it stands.

Source:  http://onlinelibrary.wiley.com/doi/10.1111/acps.12080/abstract

Do you feel anxious and on edge?

D
o you feel anxious and on edge? Do you shy away from meeting new people? Are these feelings of avoidance causing you to hide from the world? You're not alone. Over 40 million Americans report feelings of anxiety; that's over 18% of the adult population.
However, recent studies have reached some surprising conclusions about what causes anxiety in the first place.
Previously, there had been a great debate over nature vs. nurture. Is it the bills piling up and the overbearing boss, or are you just a naturally "high-strung" person? Everyone is born with a natural hard-wired response to stress and anxiety. But like any other mechanism, it has its flaws. If one moving part goes wrong, the entire system can spin out of control.
In prehistoric times, we needed this heightened level of awareness and caution with danger lurking around every corner. But in modern times, this same survival mechanism that is meant to protect you can make you feel nervous and anxious for no reason. How many times have you said to yourself, "There is nothing to be nervous about," but the anxiety is still there and you can't help feeling this way?
New England researchers agree that it is not your fault. These researchers have pinpointed the cause of anxiety to a shortage of GABA and serotonin compounds in your body. GABA and serotonin are nature's natural anxiety and stress relievers.
But there is an even greater problem. So many of these 40 million Americans who are plagued by anxiety turn to prescription medication. They are trying to solve a natural problem with chemicals.
This new research says that you don't have to change your body's chemistry and open yourself up to harmful side effects or even addiction. You can treat this problem in an easy and inexpensive way that does not involve uncomfortable doctor visits or awkward therapy sessions.
Over the last 18 months, researchers in an FDA-certified laboratory in New York have been perfecting how the three safest and most potent herbs to fight anxiety can be combined into one natural compound.
It's called A2X, and here's how it works.
Three natural herbs in the A2X formula work together to aid your body's natural defense against anxiety. Ashwagandha, L-Theanine and Passion Flower have been clinically proven to boost GABA and serotonin levels in the human body. The result? You're more relaxed. Worries don't seem as big. Anxiety disappears. And over time, A2X helps to calm your body's natural response to anxiety so you can feel like yourself again.
Studies have shown that these natural ingredients can stimulate the production of GABA and serotonin in your body so worry goes away and you feel calm and anxiety-free. And best of all was A2X's safety rating. There were no reported side effects.
A2X is not available in stores. But they are offering a limited number of samples to the public.
How good is prescription medication if the side effects are worse than your original problem? A2X was created to be not only effective but also safe for long-term use with no side effects. A2X is made in a GMP-certified, FDA-approved laboratory in New York to ensure the highest standards of safety.
The entire A2X compound fits into two pills with low-dosage, high-efficiency ingredients for immediate relief. Taken daily, your body will safely absorb A2X's natural ingredients and help you feel calm and relaxed each and every day.
Source: http://www.a2xanxiety.com/reports/anxiety.html?utm_medium=google_display&utm_campaign=uk_scm&utm_source=panicdisorder.about.com&utm_term=anxiety%20disorder%20medication&utm_content=32515916851&utm_device=c

Therapy for Anxiety

 Therapy for Anxiety

Anxiety is one of the most common reasons people seek therapy. Anxiety is defined as nervousness and an inability to relax. Some level of anxiety is normal in human beings; however, excessive anxiety can interfere with relationships, sleeping patterns, eating habits, work, school, and all areas of life. Anxiety can take several forms, including phobias, obsessive-compulsions, and panic attacks, and it is often associated with depression. Anxiety is often found in people with psychotic symptoms, especially those who are paranoid. Excessive anxiety can also be a symptom of posttraumatic stress.

Therapy for Anxiety
Anxiety is a normal response to human experience and survival. Not unlike the fight, flight, or hide response, humans need anxiety in order to act and to protect themselves from suffering. Because anxiety is normal, most people experience anxiety at some points in their life, however limited or mild. Yet, many people experience a heightened and uncomfortable level of anxiety causing one to seek treatment. Rather than medicating the anxiety away as a permanent solution, the psychotherapy process approaches a person's anxiety with intense curiosity in an effort to help the person to understand and heal the source of the anxiety. Through the process of focusing internally a person can understand, unravel, and transform their anxiety.

Sometimes anxiety is the result of an inner polarization. Sometimes anxiety is the result of unresolved trauma leaving the individual in a heightened physiological state of arousal in which certain experiences have the potential to reactivate the old trauma, as is often the case with Post-Traumatic Stress. Sometimes anxiety results from a lack of, or inexperience at, knowing how to self-sooth. And there are other psychological and emotional reasons for anxiety. Whatever the cause, anxiety can be reduced if not resolved completely with therapy. Indeed, anxiety may be hereditary to some degree, in that some people may be more predisposed than others to develop anxiety in response to life events. Whether one is predisposed to anxiety or not, there is nonetheless a great benefit in addressing anxiety with therapy.

Anxiety and the Body
People with anxiety may experience physical symptoms including:

• Psychomotor agitation
• Pacing
• Shaking
• Trembling
• Quivering
• Sweaty palms
• Racing heartbeat
• Insomnia
• Tension
• Headaches
• Nausea
• Difficulty breathing

A panic attack occurs when these somatic symptoms are severe and acute, sometimes mimicking the symptoms of a heart attack (though there is no record of panic attacks leading to actual coronary arrest).

Anxiety and the Mind
Anxiety can include racing thoughts, worries, excessive guilt, excessively fearful thoughts, obsessions, and magical thinking. Anxiety is a dysphoric excitement or “apprehensive expectation” (DSM-IV), and may entail feelings of fear, confusion, frustration, and possibly shame and despair. Affect is worried and tense.

Anxiety and Social Life
People who are anxious may display social avoidance, nervousness, neediness, blaming, and an inability to maintain relations or employment. Some people with anxiety can develop social phobia and agoraphobia, in which they experience intense anxiety in public and isolate from others in order to maintain a stable mood.

Medication for Anxiety
The medical model approach to the understanding and treatment of anxiety views anxiety as a disease or disorder of the nervous system. The most popular medical treatment for anxiety is psychotropic medication, such as Celexa, Lexapro, Luvox, Paxil, Prozac, and Zoloft. These medications are helpful, and sometimes absolutely lifesaving for those who are paralyzed with anxiety or suffering intense panic. However useful these medications may be at symptom reduction, they fail to address the emotional and psychological causes of anxiety, which more often than not, play a powerful role in the formation and maintenance of anxiety.

Using Alcohol to Numb Anxiety - Case Example
Hillary, 23, experiences severe panic attacks whenever she is afraid she has failed or done something to anger a family member or coworker. Whenever she receives criticism, she begins to have trouble breathing, becomes sweaty, and may break out in hives. Her mind becomes completely focused on the offense she has committed, and she may cry, though she suppresses the tears and prevents catharsis. She drinks large quantities of alcohol to help numb herself to these feelings, and may miss work for days, which furthers her anxiety, as she has little income.

Social Anxiety – Case Example
Benji, 45, is popular at work and very competent, feels highly anxious whenever he is out in public, especially around crowds. He races home each night, locks his door, and reads in bed, feeling fine once he is alone with the apartment secure. He cannot identify the cause of his anxiety, but in therapy discovers a great deal of repressed anger, which may explain his fear of being in public--people trigger his rage, which he has avoided for years.

“People Pleasing” Anxiety – Case Example
Anna, 26, comes to therapy because of intense anxiety. Anna has not experienced a panic attack, but is often on edge, worried, stressed, and has a difficult time sleeping through the night. In therapy, Anna discovers that although a part of her wants to marry her fiancé, Jeff, another part of herself, which she has suppressed, is not in love with him. Identifying this internal conflict temporarily intensifies Anna's anxiety because now she has to face something she hasn't wanted face. Historically Anna has been a people pleaser. It's difficult for her to say "no" for fear of hurting other's feelings and then feeling her own guilt. Anna gains awareness about this and, through the process of unburdening her long-harbored guilt, Anna feels less anxiety others to feel pain. Although Anna hasn't yet decided what she's going to do about getting married, she feels less anxiety now that she is no longer suppressing her ambivalence and feels greater confidence about communicating how she really feels.

Share Your Story About Anxiety
Would you like to share your personal story about anxiety with others who may have had similar experiences? You are invited to write about your experiences with anxiety and submit your story to GoodTherapy.org's Share Your Story. Selected stories will be published live on The Good Therapy Blog.

Resource:  http://www.goodtherapy.org/therapy-for-anxiety.html#Therapy%20for%20Anxiety

How to Stop Worrying

Self-Help Strategies for Anxiety Relief

Worrying can be helpful when it spurs you to take action and solve a problem. But if you’re preoccupied with “what ifs” and worst-case scenarios, worry becomes a problem. Unrelenting doubts and fears can be paralyzing. They can sap your emotional energy, send your anxiety levels soaring, and interfere with your daily life. But chronic worrying is a mental habit that can be broken. You can train your brain to stay calm and look at life from a more positive perspective.

Why is it so hard to stop worrying?

Constant worrying takes a heavy toll. It keeps you up at night and makes you tense and edgy during the day. You hate feeling like a nervous wreck. So why is it so difficult to stop worrying?
For most chronic worriers, the anxious thoughts are fueled by the beliefs—both negative and positive—they hold about worrying.
On the negative side, you may believe that your constant worrying is harmful, that it’s going to drive you crazy or affect your physical health. Or you may worry that you’re going to lose all control over your worrying—that it will take over and never stop.
On the positive side, you may believe that your worrying helps you avoid bad things, prevents problems, prepares you for the worst, or leads to solutions.
Negative beliefs, or worrying about worrying, add to your anxiety and keep worry going. But positive beliefs about worrying can be just as damaging. It’s tough to break the worry habit if you believe that your worrying protects you. In order to stop worry and anxiety for good, you must give up your belief that worrying serves a positive purpose. Once you realize that worrying is the problem, not the solution, you can regain control of your worried mind.

Why you keep worrying

You have mixed feelings about your worries. On one hand, your worries are bothering you—you can't sleep, and you can't get these pessimistic thoughts out of your head. But there is a way that these worries make sense to you. For example, you think:

• Maybe I'll find a solution.
• I don't want to overlook anything.
• If I keep thinking a little longer, maybe I'll figure it out.
• I don't want to be surprised.
• I want to be responsible.

You have a hard time giving up on your worries because, in a sense, your worries have been working for you.
Source: The Worry Cure: Seven Steps to Stop Worry from Stopping You by Robert L. Leahy, Ph.D.

Worry and anxiety self-help tip #1: Create a worry period

It’s tough to be productive in your daily life when anxiety and worry are dominating your thoughts. But what can you do? If you’re like many chronic worriers, your anxious thoughts feel uncontrollable. You’ve tried lots of things, from distracting yourself, reasoning with your worries, and trying to think positive, but nothing seems to work.

Why trying to stop anxious thoughts doesn’t work

Telling yourself to stop worrying doesn’t work—at least not for long. You can distract yourself or suppress anxious thoughts for a moment, but you can’t banish them for good. In fact, trying to do so often makes them stronger and more persistent.
You can test this out for yourself. Close your eyes and picture a pink elephant. Once you can see the pink elephant in your mind, stop thinking about it. Whatever you do, for the next five minutes, don’t think about pink elephants!
How did you do? Did thoughts of pink elephants keep popping in your brain?
“Thought stopping” backfires because it forces you to pay extra attention to the very thought you want to avoid. You always have to be watching for it, and this very emphasis makes it seem even more important.
But that doesn’t mean there’s nothing you can do to control your worry. You just need to try a different approach. This is where the strategy of postponing worrying comes in. Rather than trying to stop or get rid of an anxious thought, give yourself permission to have it, but put off thinking any more about it until later.

Learning to postpone worrying:

1. Create a “worry period.” Choose a set time and place for worrying. It should be the same every day (e.g. in the living room from 5:00 to 5:20 p.m.) and early enough that it won’t make you anxious right before bedtime. During your worry period, you’re allowed to worry about whatever’s on your mind. The rest of the day, however, is a worry-free zone.
2. Postpone your worry. If an anxious thought or worry comes into your head during the day, make a brief note of it on paper and postpone it to your worry period. Remind yourself that you’ll have time to think about it later, so there’s no need to worry about it right now. Save it for later and continue to go about your day.
3. Go over your “worry list” during the worry period. Reflect on the worries you wrote down during the day. If the thoughts are still bothering you, allow yourself to worry about them, but only for the amount of time you’ve specified for your worry period. If the worries don’t seem important any more, cut your worry period short and enjoy the rest of your day.

Postponing worrying is effective because it breaks the habit of dwelling on worries in the present moment. Yet there’s no struggle to suppress the thought or judge it. You simply save it for later. As you develop the ability to postpone your anxious thoughts, you’ll start to realize that you have more control over your worrying than you think.

Worry and anxiety self-help tip #2: Ask yourself if the problem is solvable

Research shows that while you’re worrying, you temporarily feel less anxious. Running over the problem in your head distracts you from your emotions and makes you feel like you’re getting something accomplished. But worrying and problem solving are two very different things.
Problem solving involves evaluating a situation, coming up with concrete steps for dealing with it, and then putting the plan into action. Worrying, on the other hand, rarely leads to solutions. No matter how much time you spend dwelling on worst-case scenarios, you’re no more prepared to deal with them should they actually happen.

Distinguish between solvable and unsolvable worries

If a worry pops into your head, start by asking yourself whether the problem is something you can actually solve. The following questions can help:

• Is the problem something you’re currently facing, rather than an imaginary what-if?
• If the problem is an imaginary what-if, how likely is it to happen? Is your concern realistic?
• Can you do something about the problem or prepare for it, or is it out of your control?

Productive, solvable worries are those you can take action on right away. For example, if you’re worried about your bills, you could call your creditors to see about flexible payment options. Unproductive, unsolvable worries are those for which there is no corresponding action. “What if I get cancer someday?” or “What if my kid gets into an accident?”
If the worry is solvable, start brainstorming. Make a list of all the possible solutions you can think of. Try not to get too hung up on finding the perfect solution. Focus on the things you have the power to change, rather than the circumstances or realities beyond your control. After you’ve evaluated your options, make a plan of action. Once you have a plan and start doing something about the problem, you’ll feel much less worried.

Dealing with unsolvable worries

But what if the worry isn’t something you can solve? If you’re a chronic worrier, the vast majority of your anxious thoughts probably fall in this camp. In such cases, it’s important to tune into your emotions.
As previously mentioned, worrying helps you avoid unpleasant emotions. Worrying keeps you in your head, thinking about how to solve problems rather than allowing yourself to feel the underlying emotions. But you can’t worry your emotions away. While you’re worrying, your feelings are temporarily suppressed, but as soon as you stop, the tension and anxiety bounces back. And then, you start worrying about your feelings, “What’s wrong with me? I shouldn’t feel this way!”

Learn how emotional savvy reduces worry

Watch 2:50 min. video: Developing emotional awareness

The only way out of this vicious cycle is by learning to embrace your feelings. This may seem scary at first because of negative beliefs you have about emotions. For example, you may believe that you should always be rational and in control, that your feelings should always make sense, or that you shouldn’t feel certain emotions, such as fear or anger.
The truth is that emotions—like life—are messy. They don’t always make sense and they’re not always pleasant. But as long as you can accept your feelings as part of being human, you’ll be able to experience them without becoming overwhelmed and learn how to use them to your advantage. The following tips will help you find a better balance between your intellect and your emotions.

Worry and anxiety self-help tip #3: Accept uncertainty

The inability to tolerate uncertainty plays a huge role in anxiety and worry. Chronic worriers can’t stand doubt or unpredictability. They need to know with 100 percent certainty what’s going to happen. Worrying is seen as a way to predict what the future has in store—a way to prevent unpleasant surprises and control the outcome. The problem is, it doesn’t work.
Thinking about all the things that could go wrong doesn’t make life any more predictable. You may feel safer when you’re worrying, but it’s just an illusion. Focusing on worst-case scenarios won’t keep bad things from happening. It will only keep you from enjoying the good things you have in the present. So if you want to stop worrying, start by tackling your need for certainty and immediate answers.

Challenging intolerance of uncertainty: The key to anxiety relief

Ask yourself the following questions and write down your responses. See if you can come to an understanding of the disadvantages and problems of being intolerant of uncertainty.

• Is it possible to be certain about everything in life?
• What are the advantages of requiring certainty, versus the disadvantages? Or, how is needing certainty in life helpful and unhelpful?
• Do you tend to predict bad things will happen just because they are uncertain? Is this a reasonable thing to do? What is the likelihood of positive or neutral outcomes?
• Is it possible to live with the small chance that something negative may happen, given its likelihood is very low?

Adapted from: Accepting Uncertainty, Centre for Clinical Interventions

Worry and anxiety self-help tip #4: Challenge anxious thoughts

If you suffer from chronic anxiety and worries, chances are you look at the world in ways that make it seem more dangerous than it really is. For example, you may overestimate the possibility that things will turn out badly, jump immediately to worst-case scenarios, or treat every negative thought as if it were fact. You may also discredit your own ability to handle life’s problems, assuming you’ll fall apart at the first sign of trouble. These irrational, pessimistic attitudes are known as cognitive distortions.
Although cognitive distortions aren’t based on reality, they’re not easy to give up. Often, they’re part of a lifelong pattern of thinking that’s become so automatic you’re not even completely aware of it. In order to break these bad thinking habits and stop the worry and anxiety they bring, you must retrain your brain.
Start by identifying the frightening thought, being as detailed as possible about what scares or worries you. Then, instead of viewing your thoughts as facts, treat them as hypotheses you’re testing out. As you examine and challenge your worries and fears, you’ll develop a more balanced perspective.

Stop worry by questioning the worried thought:

• What’s the evidence that the thought is true? That it’s not true?
• Is there a more positive, realistic way of looking at the situation?
• What’s the probability that what I’m scared of will actually happen?
• If the probability is low, what are some more likely outcomes?
• Is the thought helpful? How will worrying about it help me and how will it hurt me?
• What would I say to a friend who had this worry?

Cognitive Distortions that Add to Anxiety, Worry, and Stress
All-or-nothing thinking - Looking at things in black-or-white categories, with no middle ground. “If I fall short of perfection, I’m a total failure.”
Overgeneralization - Generalizing from a single negative experience, expecting it to hold true forever. “I didn’t get hired for the job. I’ll never get any job.”
The mental filter - Focusing on the negatives while filtering out all the positives. Noticing the one thing that went wrong, rather than all the things that went right.
Diminishing the positive - Coming up with reasons why positive events don’t count. “I did well on the presentation, but that was just dumb luck.”
Jumping to conclusions - Making negative interpretations without actual evidence. You act like a mind reader, “I can tell she secretly hates me.” Or a fortune teller, “I just know something terrible is going to happen.”
Catastrophizing - Expecting the worst-case scenario to happen. “The pilot said we’re in for some turbulence. The plane’s going to crash!”
Emotional reasoning - Believing that the way you feel reflects reality. “I feel frightened right now. That must mean I’m in real physical danger.”
'Shoulds’ and ‘should-nots’ - Holding yourself to a strict list of what you should and shouldn’t do and beating yourself up if you break any of the rules
Labeling - Labeling yourself based on mistakes and perceived shortcomings. “I’m a failure; an idiot; a loser.”
Personalization - Assuming responsibility for things that are outside your control. “It’s my fault my son got in an accident. I should have warned him to drive carefully in the rain.”

Worry and anxiety self-help tip # 5: Be aware of how others affect you

How you feel is affected by the company you keep, whether you’re aware of it or not. Studies show that emotions are contagious. We quickly “catch” moods from other people—even from strangers who never speak a word (e.g. the terrified woman sitting by you on the plane; the fuming man in the checkout line). The people you spend a lot of time with have an even greater impact on your mental state.

• Keep a worry diary. You may not be aware of how people or situations are affecting you. Maybe this is the way it’s always been in your family, or you’ve been dealing with the stress so long that it feels normal. You may want to keep a worry diary for a week or so. Every time you start to worry, jot down the thought and what triggered it. Over time, you’ll start to see patterns.
• Spend less time with people who make you anxious. Is there someone in your life who drags you down or always seems to leave you feeling stressed? Think about cutting back on the time you spend with that person or establish healthier relationship boundaries. For example, you might set certain topics off-limits, if you know that talking about them with that person makes you anxious.
• Choose your confidantes carefully. Know who to talk to about situations that make you anxious. Some people will help you gain perspective, while others will feed into your worries, doubts, and fears.

Worry and anxiety self-help tip #6: Practice mindfulness

Worrying is usually focused on the future—on what might happen and what you’ll do about it. The centuries-old practice of mindfulness can help you break free of your worries by bringing your attention back to the present. In contrast to the previous techniques of challenging your anxious thoughts or postponing them to a worry period, this strategy is based on observing and then letting them go. Together, they can help you identify where your thinking is causing problems, while helping you get in touch with your emotions.

• Acknowledge and observe your anxious thoughts and feelings. Don’t try to ignore, fight, or control them like you usually would. Instead, simply observe them as if from an outsider’s perspective, without reacting or judging.
• Let your worries go. Notice that when you don’t try to control the anxious thoughts that pop up, they soon pass, like clouds moving across the sky. It’s only when you engage your worries that you get stuck.
• Stay focused on the present. Pay attention to the way your body feels, the rhythm of your breathing, your ever-changing emotions, and the thoughts that drift across your mind. If you find yourself getting stuck on a particular thought, bring your attention back to the present moment.

Using mindfulness meditation to stay focused on the present is a simple concept, but it takes practice to reap the benefits. At first, you’ll probably find that your mind keeps wandering back to your worries. Try not to get frustrated. Each time you draw your focus back to the present, you’re reinforcing a new mental habit that will help you break free of the negative worry cycle.

Authors: Melinda Smith, M.A., Robert Segal, M.A., and Jeanne Segal, Ph.D. Last updated: August 2013.

Shyness and Social Anxiety

Self Help for Social Anxiety

• Do you feel anxious or self conscious during social situations (e.g. parties; eating in public; or one to one conversations)?
• Do you find it hard to participate in the things you want to because of your shyness?
• Do you tend to avoid speaking to people when you can?
• Do you worry that people think badly of you in social settings?
• Do you worry that you have nothing interesting to contribute to conversations?
• Do you worry that you are the centre of attention and everyone can see how anxious you are?

If the answer to any of these questions is 'yes,' you may be experiencing symptoms of social anxiety and you may find this workbook helpful. This workbook aims to help you to:

• recognise whether you may be experiencing symptoms of social anxiety.
• understand what social anxiety is, what causes it and what keeps it going.
• find ways to reduce your social anxiety. 

The complete text can be read by clicking the link
Reference:-
http://www.moodjuice.scot.nhs.uk/shynesssocialphobia.asp