Anxiety Disorder

What is Anxiety?

Anxiety is the body and mind's natural reaction to threat or danger.  In the appropriate situation high levels of anxiety even panic is considered normal and helpful if it prompts us to escape from danger.  Anxiety in performance situations such as interviews and exams can help us perform to the best of our ability.

However, when anxiety becomes excessive or debilitating then it is considered an Anxiety Disorder.  Over the last few decades there has been a dramatic improvement in our understanding of anxiety and how it can be treated.

Types of Clinical Anxiety

Anxiety can be the main or "primary" problem or it can be a secondary problem which means that it is a symptom of another disorder. Depression and substance or alcohol misuse are often associated with high levels of anxiety, but in these cases lasting benefit will come from treating the underlying problem rather than focusing solely on the anxiety symptoms. 

In primary Anxiety Disorders the symptoms tend to have followed a set pattern over several months or years. In these cases the anxiety symptoms occur independently of other mental health problems, though they can be made worse by  for example depression and life stress.

Panic Disorder
Sudden episodes of acute severe anxiety associated with a fear of death or collapse

Agoraphobia
A fear of being away from a place of safety. Often is associated with panic.  In severe cases sufferers become house bound or confined to a small "safe" area.

Social Anxiety
Excessive anxiety and self consciousness in social situations with a central fear of being judged negatively or harshly or appearing foolish. Leads to avoidance of social  or performance situations such as public speaking as well as subtle forms of hiding away in social gatherings. 

Specific phobias
Often present from childhood these are intense automatic fears of triggers such as rats, spiders, heights, enclosed spaces or more unusually vomiting or thunderstorms. They are associated with an intense desire to avoid or escape from the trigger.

Obsessive Compulsive Disorder
This is a complex disorder that can be tremendously disruptive to sufferers and their families.  Sufferers feel compelled to ward off contamination, disaster or other negative events by carrying out time consuming rituals such as washing, checking or ruminating (thinking things through in a circular way).  Sufferers have an exaggerated sense of responsibility for preventing harm and have a heightened awareness of risk and danger. 

Generalised Anxiety Disorder
This is a disorder of uncontrolled worrying.  Sufferers spend long periods agonising over what they anticipate might go wrong in the future.  This causes distress, sleep disturbance and exhaustion.  Unlike Obsessive Compulsive Disorder there are fewer neutralising acts or compulsions and the fear tends to spread across numerous everyday themes rather than fixating on specific dangers. 

Post Traumatic Stress Disorder
This is a carefully defined disorder that results from a trauma such as a road traffic accident or an assault.  Sufferers are troubled with intrusive memories or flash blacks of the incident and they are on a state of high alert.  They tend to avoid reminders or triggers of the trauma.  It is important to distinguish the disorder from normal reactions to traumatic events, which are similar but shorter lived and less intense.

How common are Anxiety Disorders?

Anxiety Disorders are the most common mental health problem along with depression, affecting the population of Ireland and Europe. They account for a similar level of stress and disability within society as cancer or heart disease. It is estimated that 1 in 9 individuals will suffer a primary anxiety disorder over their lifetime.  Only a fraction of these individuals receive appropriate treatment which is a great pity as it has been demonstrated consistently that with expert therapy the majority of sufferers can achieve a lasting improvement.

Causes of Anxiety Disorders

Anxiety can be primary or secondary to other mental health problems such as depression or substance misuse.  Primary Anxiety Disorders are thought to result from a combination of genetic predisposition and life stress triggering a vicious cycle. Physiological reactions in the brain and body, distorted thoughts and beliefs about risk and danger and patterns of behaviour such as avoidance or safety seeking all interact to develop and maintain the problem.

Treatments

Cognitive Behaviour Therapy treatments are highly effective in Anxiety Disorders and target exaggerated danger beliefs and safety behaviours in a collaborative way with the aim of breaking the vicious cycle and helping the sufferer achieve greater confidence in the face of what they fear.  By learning about the vicious cycle of anxiety and by challenging beliefs and behaviours at the centre of the anxiety problem, sufferers gradually master their fears and regain their functioning.  CBT work can be greatly supported by meditational strategies such as mindfulness meditation, occupational therapy and various drug treatments. Serotonin boosting anti-depressant drugs are very helpful in easing anxiety states and combine nicely with CBT work.  Sedative anti-anxiety drugs can also be used in the short term to ease the worst of the anxiety during the acute phase. Best results are achieved by carefully focused Cognitive Behaviour Therapy combined with other forms of help as needed. 

Anxiety Disorders Service

The Anxiety Disorders Service is a comprehensive, multi-disciplinary, assessment, treatment and aftercare service for sufferers from primary Anxiety Disorders.  It aims to deliver the best available treatments for anxiety in an accessible and flexible way as well as providing follow up care and support for those that need it.

Assessments
Appropriate referrals are seen for assessment at the Dean Clinic in Capel Street.  The assessment involves the use of standardised rating scales and assessment tools and is carried out by a Multi Disciplinary Team under the direction and supervision of Dr. Michael McDonough, the consultant on the team and the Director of the Anxiety Disorders Programme.  A detailed report is complied and sent to the referrer. A copy of this report can be made available to the patient if they so wish.  At this assessment meeting a comprehensive treatment plan is devised which may involve referral for inpatient admission (based on Grattan Ward), referral to attend the Anxiety Programme as a day patient, (which includes individual Cognitive Behaviour Therapy), referral for individual Cognitive Behaviour Therapy alone on an outpatient basis, advice on drug treatment or recommendations for other forms of therapy depending on what is felt to be most helpful.  Admissions to St Patrick's Hospital either as a day patient or an inpatient are covered by all the standard Health Insurers.

The Anxiety Disorders Programme
The programme is delivered over 2-3 days per week at St Patrick's Hospital and involves psychoeducational groups, goal setting groups, groups on Cognitive Behaviour Therapy Strategies, mindfulness-meditation instruction, Occupational Therapy groups and exercise groups as well as other elements.  The Multi Disciplinary Team includes Clinical Nurse Specialists, a Psychologist, an Occupational Therapist and a Psychiatry Team. Those attending the programme will also have available to them, individual Cognitive Behaviour Therapy sessions, individual Occupational Therapy Sessions and medical input on drug prescribing depending on their needs.  The programme is a 4 week rolling programme, but the time spent on the programme varies according to each individual's needs and response (usually 4 to 12 weeks).

After Care
After care groups are available to all who have completed the programme.  They occur weekly and attendance is flexible.  They provide advice, problem solving and mutual support and are based on CBT principles.  They are facilitated by a senior member of the Anxiety Programme team. Outpatient follow-up is also provided by Dr McDonough and the psychiatry team.

Research and Development

The Anxiety Disorders Service is based on the very best available treatments.  The programme team will continue to expand and develop the programme in line with developments in the treatment of Anxiety Disorders internationally, and as a result of our own research and audit.  We invite all those participating in the programme to contribute to this process.  St Patrick's Hospital Group is a teaching and research centre affiliated with Trinity College, Dublin.  The Anxiety Disorders Service has close links with the college's Cognitive Behaviour Therapy training programme. 

Referrals

Referrals can be directed to
Dr. Michael McDonough,
Consultant Psychiatrist & Anxiety Programme Director,
Dean Anxiety Clinic,
St Patrick's Hospital
James's Street
Dublin 8

Referrers are invited to use the hospital's standard referral form.  Referrals are accepted from all medical practitioners such as G.P.s and Psychiatrists. 

Anxiety Disorders Programme Team

 

Clinical Nurse Specialist and Programme Coordinator	Judy Moran
Acting Programme Coordinator	Debbie Van Tonder
Cognitive Behavioural Therapists	Colette Kearns
	Patricia Maher
	Shauna Collins
Senior Clinical Psychologist	Dr. Richard Booth
Senior Occupational Therapist	Sarah Carter
Programme Director	Dr. Michael McDonough