Replacing Panic With Peace: Understanding Disorders How’s This Workin’ for You? Outline

• Anxiety defined • Types of anxiety disorders – Generalized anxiety – – Agoraphobia – Obsessive Compulsive Disorder – PTSD • How to support a peer with anxiety • Tips for self-care • Clinical treatment • Pastoral care Understanding Anxiety

• A state of apprehension and • Uncontrolled fear, physical arousal in which nervousness and/or worry you believe you can’t about trivial or non-existent control or predict things. potentially aversive future • Individuals generally have events. insight that reasoning is • Driven by “what if” thinking illogical, but have difficulty • We become anxious over reducing anxious symptoms. imagined future adverse events or catastrophes Understanding Anxiety

Anxiety disorders are • Generalized anxiety the most common disorder psychiatric illnesses in • Panic disorder the US for both • children and adults. • Agoraphobia • 18% of adults • disorder • 20% of teens • Obsessive-compulsive disorder • 13% of kids 8-15 • Medication-induced GAD-7 On a scale of 0 to 3 please rate the following: 1. Feeling nervous, anxious, or on edge 2. Not being able to stop or control worrying 3. Worry too much about different things 4. Trouble relaxing 5. Being so restless that it is hard to sit still 6. Becoming easily annoyed or irritable 7. Feeling afraid as if something awful might happen Generalized (GAD) • Prolonged period of near constant anxiety not related to a specific item, person, or situation. • Worry is usually wide range of things (i.e. performance, health, finances, relationships) • Individual finds it difficult to control worry, or event recognize persistent worry. • Anxiety/Worry is often associated with feeling of being on edge, easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbance Reflection Questions

Have you experienced “being afraid when you don’t have to be?”

What was worse – the fear or the “fear of the fear?” Panic Disorder

• Repeated unexpected panic attacks • Panic attacks are abrupt surges of intense anxiety/fear that peak within 10-30 min accompanied with: – Palpitations, sweating, trembling/shaking, shortness of breath, feelings of choking, chest pain/discomfort, nausea/abdominal distress, dizziness/light-headed/faint, numbness or tingling, feelings of unreality, fear of losing control/going crazy, fear of dying • Persistent concern/worry about additional panic attacks or their consequences Reflection Questions

Have you had parishioners be ambulanced to Emergency only to be told their heart was fine? What was that outcome like for them? Agoraphobia

• Significant fear or anxiety about difficulty about being able to escape or have a in 2 or more of 5 situations: – Public transportation (i.e. buses, cares, trains, planes) – Open spaces (i.e. parking lots, parks) – In enclosed places (i.e. theaters, shops) – Crowds or standing in line – Being outside of the home alone. • These situations are actively avoided, require a companion, or endured with intense anxiety Reflection Questions

What ideas do you have to provide ministry support to those experiencing agoraphobia? Obsessive Compulsive Disorder (OCD) Obsessions Compulsions • Repeated and persistent • Repetitive behaviors or thoughts, urges, or images mental acts that one feels experienced unwantedly driven to perform in that cause significant response to an obsession or distress rigidly applied rules. • Attempts of suppression • They are meant to prevent come with other thoughts or reduce anxiety/distress or actions (i.e. compulsive or prevent dreaded behaviors). event/situation

Obsessions and/or compulsions are time-consuming or significant distress or impairments in social, occupational, or other important areas of functioning. Reflection Questions

Do you know people for whom these tendencies can be a professional strength and a personal weakness? Post-Traumatic Disorder Posttraumatic Stress Disorder (PTSD) • Exposure – actual or threat of “stressing/traumatic event” by various manner of situations or repeated exposure to aversive details of the event(s) • Re-experiencing – Intrusive memories, flashbacks, . Often triggered by sights, sounds, smells. • Avoidance – staying away from anything that reminds you of the event. Often includes alcohol and drug abuse. • Negative thoughts and mood – Negative beliefs about one self and others, shame, anger, fear. Doesn’t have to be logical to be powerful. • Hyper-arousal – hypervigilance, startle response, inability to relax. Quick-tempered. Defensive. Always on edge.

How to Help a Peer with Anxiety

• Listen • Offer grace • Encourage help-seeking without shame • At the correct time, share your story • Promote medical care and/or the EAP • If concerned about suicide risk……ASK and Act Getting Better: Self-care

• Acknowledge it. “I am really • Limit screen time – especially anxious right now.” social media and news television • Evaluate: Was it really a bad day • Set limits and learn to say No. or did I define the whole day by • Prepare for the day first thing in one bad event? the morning or first thing at work. • Prayer and meditation • Establish a bedtime routine. (Mindfulness) • Journal • Exercise • Find something to do with your • “Gather your troops and then hands. build a moat.” Intentionally seek • More water and less caffeine. out supportive people and set • boundaries with toxic people. Practice gratitude Getting Better: Clinical Help

• Anxiety disorders are highly treatable and the vast majority of people can be helped with professional care. • Psychotherapy – Cognitive Behavior Therapy – – Psychodynamic Therapy • Medication Getting Better: Pastoral Care

• Be aware that some people are • Provide education regarding mental anxious all the time and some health issues so that people equate it become anxious about things that do with physical health. not threaten you. • Promote a culture where help- • Build relationships of trust so that seeking is seen as a sign of strength people dare to be open with you and valued as a healthy behavior. about their anxiety. • Promote transparency by sharing • Do not introduce ridicule, sarcasm, or personal stories and inviting judgment regarding anxiety. members of your congregation to talk • Structure groups in ways that flexibly about their struggles with anxiety. allow people to opt in and/or out. • Teach that anxiety does not equate to • Share messages of safety, provision, a lack of faith. Greater faith is in and hope from your faith beliefs. evidence when someone is afraid and These could be memorized passages still moves forward because of their or songs. faith. • Replace inaccurate thoughts of fear • Celebrate when someone “does it with thoughts of faith. scared.” Peace From Familiar Ground Reflection Questions

• What doctrinal/scriptural/tenets of belief/practices from your faith have been helpful? QUESTIONS?

Now time for additional Q&A with presenters.