Tuesday 12 December 2017

Accepting your anxiety is healthier than denying it

Dr Harry Barry speaking at the Console World Suicide Prevention Day. Photo: El Keegan
Dr Harry Barry speaking at the Console World Suicide Prevention Day. Photo: El Keegan

Patricia Casey

It is easy to assume that depressive illness is the only mental health condition worth discussing in the public square. Yet anxiety is there too. At its most basic, anxiety is another word to describe the worries of everyday life. The student worrying about an exam, the sick person worried about survival. These would not be considered psychiatric disorders but as of the understandable suffering of humanity that everybody experiences in some way or another during their lives.

More significant are those who are inherently anxious and for whom trivial occurrences are a source of distress and angst. This innate tendency to worry excessively does cross the threshold into illness. Moving up the gradient are those who experience intense feelings of panic, acute feelings of impending doom, persistent fears of meeting people, inordinate fear of specific situations such as lifts and overwhelming anxiety symptoms after major life threatening events.

These are the group of conditions that are termed anxiety disorders.

There has been little public discussion of these yet they are more common than depressive illness and as debilitating. The terror of the person experiencing a panic attack, that they may be dying or the crippling fear that some have of meeting people, are real and distressing. Imagine not being able to go to the shops because of fear of leaving home. These anxiety disorders are now the subject of a book written by Dr Harry Barry, formerly a GP and now a psychotherapist specialising in cognitive behaviour therapy.

His most recent book, Flagging Anxiety and Panic: How to Reshape your Anxious Mind and Brain, is one in a series of seven. But this one is unique as it the first to incorporate links to YouTube videos that will further assist people who have a range of anxiety disorders. These videos will be available by simply googling 'flagging anxiety and panic YouTube'.

This is a book that not only explains the various anxiety conditions but provides case examples and embeds these within the cognitive behaviour therapy approach. He includes conversations with sufferers and walks them, step by step, through the therapies. Using the a,b,c approach the therapy begins by identifying the activating event. Then the beliefs/demands that event posed are explored and finally the consequences for emotions, behaviours and physical symptoms are identified.

He painstakingly does this in a number of worked examples for each of the common anxiety disorders such as panic disorder, generalised anxiety disorder, social anxiety and phobias. He also used this model to offer help for post-traumatic stress disorder and obsessive compulsive disorder.

A very interesting and novel section deals with the anatomy of anxiety. For example, the role of various brain parts such as the amygdala, long known to be involved in anxiety and post-traumatic stress disorder, and of the pre-frontal cortex, which controls impulses and forward plans, are discussed in detail in Chapter 14. A chapter on brain anatomy might seem turgid, but by giving the relevant centres colloquial names (the amygdala is called "the gunslinger", the prefrontal cortex "the logical brain") the reader's comprehension is enabled; the interlinking of the various parts is better understood. This is also assisted by very colourful, simplified diagrams at the back of the book.

An element discussed in the book, that will be new to many readers, is "neuroplasticity". We assume that brain tissue is fixed and unchangeable. Yet there is increasing evidence that parts of the brain can change. If we watch a movie and remember it, some part of our memory centre (the hippocampus or "memory box" in this book) will have changed. This is the impact of therapy - to change parts of our brain. There are now studies using brain imaging techniques to demonstrate changes to the brain with medications and with talking therapies, as a result of neuroplasticity. In the case of anxiety disorders, the impact of cognitive therapy will be on the amygdala and on the connections it makes to other brain areas.

Dr Barry does make the further point that for severe disorders something other than talk therapy is necessary and this is usually medication. He also indicates that treatment is hard work and takes time. Mindfulness is touched upon, albeit briefly.

This is an important book because the depth and breadth of information it provides is so extensive but also because it is so palatable. There is now good evidence that those who accept their illnesses and embrace them, so to speak, by becoming knowledgeable, have a much better outcome than those who deny them.

This book is less than €15 and will be an invaluable asset for those struggling with anxiety and panic.

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