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MOOD and ANXIETY DISORDERS IN TSC. Dr Petrus de Vries, Developmental Neuropsychiatrist & Lorraine Cuff, CBT Therapist. October 2009. Mental Health problems in adults with TSC. High rates of a number of mental health problems in TSC

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mood and anxiety disorders in tsc

MOOD and ANXIETY DISORDERS IN TSC

Dr Petrus de Vries, Developmental Neuropsychiatrist

&

Lorraine Cuff, CBT Therapist

October 2009

mental health problems in adults with tsc
Mental Health problems in adults with TSC
  • High rates of a number of mental health problems in TSC
  • Children and adolescents: Autism spectrum disorders, ADHD (25-50%)
  • Adults: Mood and Anxiety Disorders (30-60%)
  • What causes these?
anxiety disorders in tsc
Anxiety Disorders in TSC

Different types:

  • Panic Attacks
  • Agoraphobia
  • Social Phobia
  • Specific Phobias
  • Generalised Anxiety Disorder (GAD)
  • Obsessive-Compulsive Disorder (OCD)
management of anxiety
Management of Anxiety

Two main strands of treatment:

  • Medications (e.g. SSRIs)
  • ‘Talking Therapies’ such as Cognitive Behavioural Therapy (CBT)

The best effects are seen when medications and CBT are combined.

what is anxiety
WHAT IS ANXIETY?

A NATURAL EMOTIONAL AND PHYSICAL RESPONSE TO ENVIRONMENTAL AND/OR INTERNAL STIMULI WHICH ACTS AS A PROTECTIVE FACTOR TO KEEP US SAFE ( See Fig. 1)

slide6

Shakiness – effect of adrenaline

being released into the body

Feeling the urge to empty bladder

and/or bowels – the body’s

way of ‘lightening the load’

enabling greater flight

Heart pounding – increased heart

rate to pump blood to all muscles

giving the ability to run away

faster - Flight

Feeling hot – result of increased

blood flow around the body

Hyperventilation – increased

breathing which increases oxygen,

supplying oxygen rich blood to

muscles

Fight/flight - Physical

Responses

Feeling sick – result of adrenaline

being released

Muscle tension and pain – result

of increased blood flow to muscles

Sweating – the body’s way of

cooling itself down

Cognitive Responses

Fear through increased adrenaline

Thoughts of danger which increase

alertness and make the person

‘scan’ for danger

Fig. 1

when does anxiety become a disorder
WHEN DOES ANXIETY BECOME A DISORDER?

ANXIETY RESPONSES BECOME ANXIETY DISORDERS WHEN DISTORTED THINKING, STRESS, PHYSICAL SYMPTOMS AND AVOIDANCE INCREASE AND CREATE SIGNIFICANT PROBLEMS IN DAILY LIFE.

what is cognitive behavioural therapy
WHAT IS COGNITIVE BEHAVIOURAL THERAPY?
  • A therapy using a mixture of cognitive (thought processing) and behavioural techniques to look at the links between a person’s environment, thoughts, feelings and behaviours and the impact of these on their health and functioning
  • Cognitive techniques address thoughts and thought patterns which may be ‘unhelpful’ and may trigger and/or increase anxiety
  • Behavioural techniques address behaviours which may be used by a person to reduce their anxiety or avoid it altogether
principles of cbt
Principles of CBT
  • A person’s environment, emotions, thoughts (cognitions) and behaviours are all linked (see fig. 2).
  • Our thoughts, ideas, mental images, beliefs and attitudes can sometimes be ‘errors’ which are unhelpful and lead to emotional disturbances and physical reactions.
  • These emotional and physical disturbances result in behavioural patterns which are intended to reduce anxiety (safety and escape behaviours) or avoid anxiety-provoking situations (avoidance behaviours).
  • Although the behaviours may initially reduce the physical symptoms of anxiety, in the longer term they make the symptoms worse and create vicious cycles (see fig 3).
slide10

Overly negative

Self-critical

Thinking things are going to go wrong

Thinking there is danger

Imagining people will judge you harshly

Imagining that you will look foolish

Heart pounding

Feeling hot

Sweaty

Shakiness

Headache

Stomach ache/cramps

Nausea

Unpleasant

Anxious

Angry

Depressed

Avoid situations

Run away from situations (escape)

Give up

Don’t try to go places or do things

Fig. 2

what is the aim of cbt
WHAT IS THE AIM OF CBT?
  • To increase self-awareness
  • To encourage a better self-understanding
  • To help us recognize the ‘negative traps’ or ‘vicious cycles’ we get caught in (see fig. 3)
  • To improve self-control by developing more appropriate cognitive and behavioural skills
slide12

SITUATION

Fig. 3

Stallard, P. 2002

what can you do
COGNITIVE

Identify negative thoughts and thinking patterns which make you feel unpleasant using a thought diary (Appendix A)

Label the type of ‘thinking error’ (Appendix B)

Develop balanced thinking by looking for evidence for and against the thoughts and finding new evidence you might otherwise miss

Learn new skills i.e. distraction, positive self-talk, problem-solving skills

BEHAVIOURAL

Activity monitoring – link activity, thoughts and feelings

Become more active – this leaves you less time to worry or listen to your negative thoughts

Increase pleasant activities

Break tasks into small achievable steps

Face your fears – try to break negative cycles by dropping avoidance, escape and safety behaviours

WHAT CAN YOU DO?