Psychologist and Anxiety Specialist

Lyn Birrell

MA (Hons), PG Dip Prof Prac (Massey)

Registered Psychologist

I am a Registered Psychologist and member of the NZ Psychological Society. My passion and expertise is helping people manage and reduce their levels of distress so they can live happy and fulfilling lives.

In individual therapy I use the most appropriate, evidence-based therapy including CBT (Cognitive Behavioural Therapy), ACT (Acceptance and Committment Therapy), DBT (Dialectical Behaviour Therapy) and Solution Focussed Therapy. (See "Resources" section below for more information on these therapies).

I also use mindfulness and applied relaxation training to counteract some of the negative effects of worry, anxiety, rumination, procrastination etc while we work towards creating a sense of wellbeing and purpose.

I offer a safe and confidential space for exploring whatever problems or situations you are struggling with. Together we will develop a personalised action plan to address your specific needs. The good news is most anxiety related conditions respond very well to therapy. You will learn a set of practical skills that you can apply when needed. Your initial appointment is called a Needs Assessment (see below) after which therapy sessions may be scheduled twice weekly or weekly depending on what would be most beneficial to you. Typically one hour sessions are scheduled once a week initially and then extended to fortnightly or monthly to maintain gains and prevent relapse.

Your first appointment is called a "Needs Assessment" and we will spend an hour getting to know each other and identifying the problems you want help with. At this time we will try and work out the most appropriate next steps as to how you can be best helped. I will discuss treatment options with you and provide some initial education about how anxiety affects you physically, emotionally and mentally. You are welcome to bring along family or support people to this assessment.

• One in four Kiwis experience anxiety or depression.

• Help is available.

• Ask your GP for a referral or email me for details on how you can do a self-referral.

If you suffer from anxiety, the first thing you need to know is that anxiety disorders are real and common.

They can be debilitating and chronic – but are not widely known about.

Anxiety and depression are often seen together, with anxiety generally predating depression. Anxiety disorders are twice as common as depression in NZ, but the focus of most public health campaigns is depression.

It is estimated that only 30% of those with anxiety disorders are diagnosed.

Good news is that they are very treatable.

Anxiety and fear are normal, emotional and physical responses and when working appropriately involve accurate perception of danger and appropriate safety seeking behaviours. However anxiety can become a chronic state (characterised by ‘what if’ thoughts, muscle tension and poor sleep) or a person may suffer from repeated full blown fear response (as in phobias and panic attacks)

What is normal fear and when not? Seek help when the fears

cause significant distress
have been present for long periods
are beyond what is developmentally appropriate
and are causing significant interference in a person’s life

Fees

Fees are $180 per standard clinical hour (incl GST).

You may qualify for a Work and Income ‘Disability Allowance – Counselling’ to go towards covering the cost of your therapy if:

· You are low income earner or

· You are on a benefit or

· You are unemployed or

· You are on a pension

Contact me for further information or to arrange an initial consultation.

Your enquiry is welcome.

Email: lyn@anxietyhelp.co.nz

Send me an email with your contact details and I will try to get in touch with you within 24 hours.

Please note: Appointments can be arranged.

Appointments are currently on Zoom.

“How to help a loved one recover from anxiety”

Supporting or caring for someone suffering from anxiety can be a strain and a challenge, at times. Often, family, friends and supporters don’t understand what is wrong, how they can help or know who to turn to. Sometimes, in their efforts to help, they can actually make things worse.

Anxiety in the family can actually end up making care givers themselves anxious and depressed.

It is important to be educated about what anxiety is, what to look for, what’s normal and what’s not normal.

It is also important to understand the various aspects of anxiety - the physical, the emotional, the cognitive and behavioural consequences of anxiety.

The workshop also covers brief interventions and strategies and importantly, self care for the carers.

We usually have some time for questions and discussion.

If you are interested please email me, for further information.

lyn@anxietyhelp.co.nz

Some of the conditions I help people with on a regular basis include…

Agoraphobia

Fear of being away from one’s perceived safety zone or anywhere that potentially restricts escape or ability to get away, whether it is in an enclosed place or far from safety or a safe person. Continued avoidance of places where a panic attack may occur could lead to developing agoraphobia.

Generalised Anxiety Disorder

Chronic and exaggerated worry and tension. Anticipating disaster, catastrophising, imagining worst case scenario, “what ifs…” Often focussed on health, money, family or work. Usually the impairment is mild and people don’t feel too restricted or avoidant. However, if severe, GAD can be very debilitating, making it difficult to carry out ordinary daily activities

Phobias

Phobias are very common and involve a specific fear of a particular object or situation. The fear is out of proportion to the danger

Social anxiety

An intense fear of social situations where the sufferer feels that he or she will act in a way that will be humiliating. A fear of being assessed, judged or criticized in some way. Very commonly seen in adolescents. Some of the fears include: becoming the focus of others, speaking in front of others, writing in front of others, answering the phone.

OCD

‘Obsessions’ are persistent, intrusive and distressing thoughts. Examples of obsessions include: persistent fears that harm may come to self or a loved one or fear about becoming contaminated or an excessive need to do things correctly or perfectly. ‘Compulsions’ are behaviours and rituals performed in an attempt to neutralise the obsessive thought eg washing, cleaning, checking, and repeating.

Trichotillomania

Compulsive urge to pull one’s hair and sometimes that of others. Most often one hair is plucked at a time, from one or more sites on the body, most commonly the scalp, eyebrows and eyelashes. Also may include skin picking behaviours.

PTSD

A condition characterized by intense fear, helplessness and horror resulting from exposure to extreme trauma. Symptoms include persistent re-experiencing of the traumatic event / nightmares and avoidance of stimuli associated with it. Persistent anxiety with significant distress plus impairment of social and occupational functioning.

Resources

Self care

Often people with anxiety or low mood suffer from poor sleep – not able to fall asleep readily or waking up repeatedly during the night or waking up too early. Some people feel as though they sleep only shallowly and wake up tired in the morning. Sometimes this can set up a vicious cycle of day-time fatigue, the need for stimulants such as caffeine, followed by poor sleep at night. If this pattern becomes chronic it can interfere with people’s functioning. Sleep is so important that there’s a whole science behind good sleep, called ‘sleep hygiene.’ It is recommended that people protect their night time sleep by not having day time sleeps. Some other recommendations include establishing a wind down period after dinner, not using technology (phones, ipads, TVs, internet) in the bedroom or doing anything that will stimulate the brain (eg no scary movies, study, checking email) before bed.

Here are some easy to read general guidelines:

http://www.cci.health.wa.gov.au/docs/Info-sleep%20hygiene.pdf

Even though some people practice good sleep hygiene they still struggle getting quality sleep. Other suggestions include using ‘white noise’ in the bedroom (eg the noise from a fan) or download one of the many relaxing sleep apps available. If used on a regular basis people come to associate the sound with sleep. Some people may benefit from a relaxation or hypnosis download.

I have used the ones from Hypnosis Downloads and found them very helpful. If you'd like to know more, check out the link below.

http://www.hypnosisdownloads.com/?6714

If you're interested in checking your own level of self-care, here is a link to a self-assessment that I like and which you might find helpful.

https://www.ecu.edu/cs-dhs/rehb/upload/Wellness_Assessment.pdf

Therapies

CBT (Cognitive Behavioural Therapy) is a well regarded, well researched, evidence-based therapy that combines cognitive therapy and behaviour therapy. It was created by Aaron Beck in the 1960s and has since been shown to treat a wide range of issues including anxiety and depression. There are numerous studies that show that CBT is as effective as medication for depression, anxiety, phobias and obsessions. It is a short term, goal-oriented therapy that takes a hands-on and practical approach to problem-solving. Basically CBT focuses on how you think about things (your thoughts, images, beliefs and attitudes i.e. your cognitive processes) and how this impacts on how you feel and behave. Part of the therapy involves identifying unhelpful patterns of thinking (e.g. catastrophising, self-criticism) and how you can change patterns of thinking that may be contributing to your difficulties. The good news is that thoughts, feelings, and behaviours are all inter connected, so if you make change in one domain, it has an effect on the other areas - so if you can make a change to the way you think and behave it will have a flow on effect to the way you feel. CBT is said to be a ‘present based’ therapy which means it tends to focus on what is going on in the present rather than the past. However, the therapy may also look at how your past experiences may be impacting how you see the world today.

Some more information about CBT

https://www.anxietybc.com/sites/default/files/What_is_CBT.pdf

Some more information about unhelpful thinking patterns

http://www.cci.health.wa.gov.au/docs/ACFE1D0.pdf

Acceptance and Commitment Therapy (ACT)

The ACT approach (pronounced ACT not A-C-T) teaches you psychological flexibility skills to help you deal with painful thoughts and feelings effectively – in such a way that they have much less impact and influence over you. ACT differs from CBT in that rather than challenging unhelpful thoughts by looking for evidence against the thought it focuses on acknowledging and then unhooking from painful thoughts and feelings. This ability is developed through learning particular mindfulness skills. Another goal of ACT is to help you clarify what is truly important and meaningful to you in your life (ie your values) and then use that knowledge to guide, inspire and motivate you to act in a way that moves you towards a richer fuller life.

An overview of ACT:

http://www.actmindfully.com.au/upimages/dr_russ_harris_-_a_non-technical_overview_of_act.pdf

http://www.getselfhelp.co.uk/act.htm

Brief description about what mindfulness is:

http://www.getselfhelp.co.uk/docs/Mindfulness.pdf

Other resources

You tube clips:

The Body Scan by Dr Elisha Goldstein. This is a 10 minute body scan practice to begin training your mind to be more aware of how you are thinking and feeling and to be present to your life and recognize more clarity, opportunity, possibility and choice.

Search for: "Handling stressful thoughts. ACT leaves on a stream exercise", by Artofmindliving. This is a 20 minute defusion exercise. Explains defusion and is nice to do before bedtime.

Panic

Here are some resources on panic attacks and panic disorder.

Panic attacks

A panic or anxiety attack is one of the most terrifying experiences a human being can ever have. It can happen seemingly ‘out of the blue’ for no obvious or apparent reason almost anywhere eg at home, at work, in a supermarket, on the street or in a car. During a panic attack the sufferer may feel out of control. While it is occurring they will have a sense of impending doom and may believe they are going mad or will die. A panic attack is more likely to happen to someone who has been under a great deal of stress or has anxiety problems.

A person will experience several intense bodily symptoms such as

They feel their heart pounding and racing which may lead some people to believe they are having a heart attack or stroke or some other medical problem and that they may die.
They may feel they can’t breathe or are choking and start to hyperventilate. (In fact, while they feel as they are not getting enough oxygen the opposite is true and they are getting too much).
They may feel dizzy, light headed and faint.
They may tremble or shake.
They may sweat a lot due to the fear they feel, or feel cold.
They may feel nauseous, like throwing up.
They may feel that suddenly the whole world around them has become unreal or even they themselves feel detached from their body.

Any combination of four of these bodily symptoms, including the fear of dying or going mad make up a panic attack. but usually it will reach a peak within 10 minutes. While then the person will start to calm down but may be in a state of shock.

Any person suffering from these symptoms should contact their GP or seek medical attention to rule out any medical causes for these symptoms. Once ruled out they should contact a qualified mental health professional to evaluate whether they may be suffering from Panic Disorder (on going fear of having another panic attack). Untreated panic disorder can sometimes lead to agoraphobia.

If you suffer from panic attacks five things you can do to relieve panicky feelings include

1. Focusing on slowing down your breathing – calm, slow breathing is the key to restoring the oxygen/carbon dioxide equilibrium. Hold your breath for as long as you can and then breathe out very slowly and smoothly. Resume breathing very slowly in through your nose - all the way down into your belly (as though your belly is a balloon you are filling up) and then again even more slowly out through your nose. Making the out breath longer than the in breath eg in for a count of 7 and out for a count of 11.

2. Say some kind and calming messages to yourself eg “I am safe…I can cope... I’ve been through this before and been OK. I can get through this...” etc

3. Anchor yourself by pushing your feet into the ground, your back into your chair and then take a few moments to take a look around and reconnect with wherever you are. Notice 5 things you can see. 5 things you can hear.

4. Shake out any tension in your hands. You are in flight and fight mode and shaking out your hands will use up some of the adrenaline surging around your body. Continue with calming self talk and calming breathing. Check you’re maintaining a healthy posture so you can breathe into your diaphragm and continue to do these things until you calm down.

5. The last area to focus on is your tense muscles – especially your jaw, shoulders and upper back. These muscles can become tight and tense as a result of stress and anxiety. Allow your lower jaw to drop open a little so that your teeth are not touching. Let your jaw relax and be loose. Relax your shoulders and let them drop. You can do some shoulder circles or shrugging to loosen them. Raise your arms above your head and have a big stretch up to the sky.

If someone is having a panic attack what can you do to help?

Speak calmly and reassuringly.Advise them that the panic attack will dissipate and pass.
If they are hyperventilating or over-breathing, then ask them to hold their breath for as long as they can.Then ask them to breathe in slowly and smoothly through the nose, down into their belly, holding for a couple of seconds and then breathing out through the nose even more slowly.
Offer a drink of water and try distraction techniques
Get them to refocus their attention on certain things in their immediate surroundings - you can do this by asking questions such as “what is the colour of the walls/carpet/curtains” or ask them to describe something they can see or hear in their surroundings in detail. This will help to engage the ‘thinking’ brain rather than the ‘emotional brain’.
Suggest having a drink of water or something small to eat.
Do not be alarmed or impatient with the sufferer – they cannot control what is happening to them.
Wait with them until they feel safe.

The physiology of the flight/fight or freeze response (what happens when we get triggered)

The fear response is called ‘the flight or fight’ response. It is a swift, automatic, physiological reaction triggered by a perceived threat. Once activated chemicals are released into the bloodstream, breathing increases. The heart races, blood leaves the stomach into our muscles and limbs ready to run or fight. We feel a sudden surge of fear (edge of the cliff type fear) and we are in survival mode. The fear subsides when we feel safe. While we share this basic instinct with many other animals, humans’ ability to imagine and foresee problems can increase the likelihood of this response.

http://www.getselfhelp.co.uk/docs/Adrenaline.pdf

NZ’s Mental Health Foundation link to info about panic disorder:

https://www.mentalhealth.org.nz/get-help/a-z/resource/40/panic-disorder

Dr Claire Weekes was a world renowned expert in panic disorder.

This link will take you to some of her audio files -

http://www.junior-anxiety-depression-exchange.org.uk/relax.html

Scroll down until you get to her audio files called "How to recover from anxiety" (there are 4 files which continue after each other). While she sounds very 'old school' she says some really important things about panic.

In the News

Links to recent articles of interest.

I add new articles from time to time - the latest ones are at the bottom of this section.

http://www.independent.ie/life/health-wellbeing/mental-health/the-upside-of-anxiety-31384730.html

Living with OCD.

http://thewireless.co.nz/articles/living-with-obsessive-compulsive-disorder

13 things to know when someone you love has anxiety.

http://yourhealthguardian.org/13-things-to-know-when-someone-you-love-has-anxiety/

Informative article about anxiety and CBT.

http://www.forbes.com/sites/jeenacho/2016/05/21/when-human-interactions-triggers-anxiety-living-with-social-anxiety-disorder/#1e4fda011656

People with anxiety give advice.

http://www.theguardian.com/society/2016/may/20/how-not-to-talk-to-someone-with-anxiety