The earthquake of September 4th 2010 and again on February 22nd 2011 have had a significant effect on most people living in Canterbury. Our reactions to the earthquakes are not universal, but are as individual as we are. One person’s reactions and coping styles might be completely different to the next person’s. We know that allowing ourselves time to grieve and process what has happened, in our own way, is essential to the recovery process.

Most people are affected by further aftershocks, images, sounds, or movements that remind us of the earthquakes. Usually our reactions to these reminders will fade after time. However, some people may continue to experience very high levels of anxiety which impacts on their quality of life. They may feel unable to return to activities they engaged in prior to the earthquakes and may find themselves ‘stuck’ in unhelpful thinking.

An example may be “Lydia” who avoids going anywhere without her handbag, in particular her cellphone, and refuses to go into multi-storey buildings. This is causing her problems as her work place is on the fourth floor. In addition to this, she takes very short showers for fear that another earthquake could occur while she is in the shower and she would be unable to seek help. Lydia also spends a great deal of her day worrying about the possibility of another earthquake and what she would do if this happened. She reports a lot of “what if” thinking and she tends to ignore any information that does not support her worries.

People experiencing on-going high levels of anxiety, which negatively impact on their ability to return to life as normal may benefit from Cognitive Behavior Therapy (CBT). CBT is a time limited, skilled based therapy, which helps people recognise and manage unhelpful thoughts and behaviors.

Using CBT, Lydia firstly explored her beliefs about the earthquake. The concept of uncertainty was explored – whereby she recognised that a lot of her anxiety stemmed from the need to gain certainty about the next earthquake. She recognised that no-one is able to be certain about when earthquakes occur. Specific techniques were taught to allow Lydia to ‘sit with’ her uncertainty, instead of struggling against it. She also recognised that she had been ignoring a lot of information that contradicted her worries. For example, Lydia remembered that during the February earthquake, she did not have a mobile phone and she managed extremely well.

A number of behavioral experiments were established to help Lydia test out her fears. For example, she agreed to walk around the block without her handbag or mobile, to test out her fear that “there could be another earthquake and I wouldn’t be able to get help”. She also decided to have showers for increasingly longer periods of time to test out her same fear. Lydia started to go into multi-story buildings to test out her fear that there could be another earthquake, but also her fear that she would become overwhelmed with anxiety and have to leave.

As a result of engaging in these experiments, Lydia noticed that her anxious predictions did not occur and her anxiety reduced. A big step for Lydia was recognizing that her anxiety had no impact on when another earthquake might occur, nor did it help her to cope in any way. In fact, she realised that instead of helping her, her anxiety was holding her back from re-building her life after the earthquake.

As a result of engaging in CBT, Lydia reported that her anxiety had significantly reduced and that she was starting to enjoy activities that she used to engage in before the earthquake (including going back to work) – as a result, she noticed her mood improved, too. She gained a sense of control of her feelings about the earthquake and said that she no longer felt terrified.

If you are noticing recurrent unhelpful thoughts, avoiding things you used to do, and feel that this is negatively impacting on your quality of life, seeing a CBT therapist may be of benefit to you.

The western world is relatively new to the practice of mindfulness, which derives from ancient ideas most notably linked to the Buddha some 25 centuries ago. The suggestion is that we create our own suffering because of our expectations that we will get what we want and that it will remain. Unfortunately, unwanted things happen frequently in our lives and wanted things, when they do arise, soon change. Also, we change, so how we perceive ourselves and our lives also changes. We quickly become used to what we have, and are soon dissatisfied again. Mindfulness involves awareness of these simple, but far reaching universal realities (everything changes and nothing is satisfying forever), in a way that can free us of the suffering associated with our constant desire for things to be a different way, and our disappointment when our satisfaction wanes.

Mindfulness approaches are now formally being integrated into a range of traditional therapies, and are used to treat a wide array of human suffering from physical pain, health recovery and stress, to many psychiatric disorders. Mindfulness practice is also used to enhance everyday life and develop genuine lovingkindness towards oneself and others.

The practice of mindfulness has been defined as “paying attention in a particular way – on purpose, in the present moment, and non-judgementally”. Usually this is done in a meditation in a seated position and attention is focused on the sensations within the body, with a gentle removal of all evaluations of those sensations. Practicing this way helps to train us to be less judgemental, and less engaged with the desire to seek pleasure and avoid pain.

In our lives, a negative event may occur. We may become upset and may focus on the idea that we have been wronged in some way, building up miserable feelings as we become trapped in our thoughts. Our own reactions, full of judgements and recriminations and emotional pain, hold us in a habit of ‘attaching’ to this method of problem-solving which frequently leaves us with unresolved pain. Alternatively, when we suffer unexpected loss or trauma, we may remain stuck in processing the emotion and avoiding situations linked to the trauma. In effect, we have trouble integrating the different aspects of experience (thoughts, emotions and body sensation) and gaining perspective.

Mindfulness suggests that thoughts and physical sensations have the same characteristics of arising and passing away – as if they are the ripples on the surface of the ocean. When we take the stance of a scientific observer of ourselves, we are better able to perceive our thoughts and judgements as ripples, accepting that they will pass, and therefore developing mastery over our reactions and our lives. The practice of mindfulness develops the capacity to “see with wisdom” – without judgement, evaluation, or prejudice.

Research evidence suggests that when we engage in evaluations – negative or positive – stress responses are activated and the body experiences sensations. The body’s sensations also arise from external environmental sources and exist at all times throughout the body above and below our level of awareness. Our unhelpful behaviours are maintained by our reactions to these sensations. If we are to adequately process stressful information, we require the pathways to be strengthened between the brain’s deep emotional centres and the more controlling areas of the brain, thereby preventing the brain’s emotional centres ‘hijacking’ all of our attention. Regular mindfulness practice, by strengthening these pathways, enhances mental and behavioral flexibility and resilience. You can learn more about Mindfulness at these websites www.aboutmindfulness.com and; www.mindfulness.net.au.

Prue Fanselow-Brown is a registered clinical psychologist working at the Child and Family Psychology Centre. Visit www.christchurchpsychology.co.nz to learn more about Prue and her work.

There’s a complicated relationship between people and their stuff, and this relationship can lead people to become compulsive hoarders. Compulsive hoarders collect and keep stuff to the point where there is no space (physical, emotional, or intellectual) in their lives for anything else; they become isolated because they stop socializing or working; and they can become really ill from hoarding unsanitary stuff or neglecting their health and hygiene.

There is arguably an evolutionary imperative to gather resources – the more stuff you have, the more likely you are to survive. But this simple survival motivation for collecting and keeping stuff can get distorted when there are other forces at play. If you don’t have friends and feel alone in the world, the stuff can become your friends – you can imagine how hard it is to part with the stuff under these circumstances. There is also a buzz involved in acquiring stuff – the thrill of the hunt for the perfect thing, and the thrill of capturing this perfect thing, and dragging it home to your lair! We know that compulsive shopping has something to do with this thrill, and it can become addictive.

You might wonder where the thrill is in collecting empty food packets from rubbish bins, but it’s there, nonetheless – compulsive hoarders report feeling pleasure when they are in the acquisition phase of their disorder. Now you can see there’s a feedback loop in play – feeling lonely or unwanted can be alleviated (at least for a short time) by acquiring something you didn’t have before, and so the pleasure of the new stuff makes you feel less lonely or sad. The pleasure of acquisition, which we all experience to some extent, becomes the only source of pleasure in life, and this drives the endless collecting of stuff and the inability to discard it. Anxiety and depression can also be alleviated by these little bursts of pleasure, so the collecting is used as an antidote to feeling bad, and there are high rates of anxiety and depression among compulsive hoarders.

Not only are there emotional reasons to hoard, there can also be thinking problems associated with hoarding. For example, people who tend to hoard also tend to have attention and concentration problems, and often struggle to make decisions. This may be why a hoarder’s collection can contain stuff with no sentimental or other value mixed with piles of cash or other objects of value – the hoarder struggles to make a distinction between what is valuable and what is not. This decision is just too difficult, so the hoarder keeps it all.

In addition, hoarders struggle to categorise things – each individual thing is seen as unique in its own right so cannot be lumped with anything else. Imagine how difficult it would be to choose among the myriad things available for gathering (like everything in every shop and at every garage sale and in every garbage skip) if you couldn’t categorise things into valuable/valueless; useful/useless; good/bad; or even ugly/pretty! Relatedly, how can you throw things away (except maybe one at a time) when you can’t put them in piles or categories? So, 500 newspapers cannot be discarded because each one is an individual thing – they’re not all just newspapers. Finally, hoarders are reported to have memory deficits – it’s almost as though collecting and keeping stuff helps you remember things.

So, when you’re trying to decide whether you really need another piece of clothing or recipe book or gardening tool or magazine or DVD, or you’re trying to decide what to get rid of – picture yourself surrounded by stuff to the extent that there is no space left in your life for friends, family, hobbies, work, or fun! Suddenly, the stuff loses it’s importance, and it’s easy to let go of it and get your pleasure in satisfying relationships or fun activities or rewarding creations.

Common symptoms experienced by those who have PTSD or a psychological reaction to trauma include: experiencing unwanted distressing thoughts or images of the event; nightmares; strong emotional responses to reminders of the trauma (e.g., feeling overwhelmed when around men whose body shape is similar to someone that assaulted them); and powerful physical reactions to reminders (e.g., feeling shaky and hot). People may experience flashbacks, which are strong intrusive memories that feel like the event is happening again. Flashbacks may include re-experiencing sounds, physical sensations, smells, and the emotions felt at the time of the trauma. Other frequent symptoms include, problems getting to or staying asleep, concentration difficulties, increased anger, being more easily startled and jumpy, feeling constantly on alert for danger, and feeling numb or having difficulty connecting to emotions. Understandably, people with PTSD will begin to avoid any reminders of the event, including people and places. They may withdraw socially and may feel disconnected from others. For some who survive a traumatic event, they may experience distressing levels of grief and guilt.

About half of those with PTSD may recover without treatment in the first year following a traumatic event. However, if someone has had trauma symptoms for longer than six months following the event and the symptoms have not improved, then it would be advisable to discuss this with a doctor. With effective treatment the majority of people get better. Cognitive Behaviour Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) are two psychological treatments that research trails have noted as effective interventions for trauma reactions, including PTSD. Both aim to reduce trauma symptoms by helping the sufferer experience the trauma memories in a less disturbing way. That is, trauma memories often feel like they are “frozen” in time along with all the intense feelings experienced during the trauma. CBT and EMDR help to unfreeze such memories so that they are less overwhelming and less vivid. This helps the person perceive the memories in a different way that may lead to less repetitive intrusive thoughts. CBT helps people view the event and themselves in a less distressing way and helps the person rebuild their lives by reducing avoidance. If you or someone you know is are struggling with trauma symptoms, then the self-help book “Overcoming Traumatic Stress” by Herbert and Wetmore is an excellent guide towards recovery. However, some people may benefit further from seeing a clinical psychologist.

The spate of celebrities, such as Brooke Shields and Courtney Cox, who have publicised their experiences, has been very positive in that it has helped women realise that ‘it can happen to anyone’. However, there are still a number of barriers that prevent women from seeking help. Often women realise something is not right, but find it difficult to distinguish between normal levels of distress or tiredness and distress that warrants help. Women also don’t want to say that they are having difficulty coping, and therefore struggle on alone.

Maintaining good mental health in the postnatal period can help both prevent, and recover, from postnatal depression or anxiety. It’s important to plan regular weekly time without the baby. Often things reach crisis point before everyone rallies to help. It’s much better to take a preventative approach. Often just knowing that you have, for example, a couple of hours break each Sunday morning, can keep you going. Physical activity is also a helpful way to manage low mood and anxiety even if this is just a short morning walk with the baby. Usual household chores and outings can feel overwhelming, so by planning activities for specific times in advance, most important things get done. The more social support you have from friends and family, the less vulnerable you will be to anxiety and stress. Mothers’ groups can be a good way to connect with other mothers. But it is important to seek out like-minded others who are willing to be honest. If you’re in a mothers’ group where everyone is saying things are perfect, you won’t relate to them. Develop a list of what works best for you for those times when you feel down or anxious. Your list might include; going for a walk, a bath, being outside in the sunshine, or putting on some music. Most importantly tell someone, such as your partner, a family member, midwife or GP if you are finding it difficult to cope. There is well researched treatment available for Postnatal depression and anxiety that does not necessarily include medication. There are also a number of support agencies and health professionals in Christchurch who work in this specific field. Further information about postnatal depression and anxiety can be obtained from www.mothersmatter.co.nz

Dr Michelle McCarthy is in private practice. She can be contacted at The Anxiety Clinic and Centre for Cognitive Behavioural Therapy.

Essentially, social anxiety is driven by beliefs the person holds, such as they will say or do something embarrassing or make a fool of themselves; that others are thinking about or judging them negatively; or that there is something wrong with their appearance. Understandably, such beliefs lead to the person focusing on themselves in social situations rather than on the person they’re talking to. This increased self-consciousness increases feelings of anxiety and embarrassment, and unpleasant, but harmless, physical responses such as feeling hot, sweaty, shaky, and blushing. Naturally, when people fear the worst in social situations they tend to avoid those situations. Alternatively, they may face the social situation but do things to prevent their worst-case scenarios from occurring. This might include avoiding eye contact by looking away or wearing sunglasses, rehearsing what they are going to say, using alcohol for “Dutch courage”, wearing make-up to hide blushing, and doing things to make them feel less obvious like sitting in a corner or not asking questions. While these behaviours may seem helpful at the time, they actually maintain social anxiety rather than reducing it. For example, try rehearsing what you are going to say to someone while you are talking to them – we become distracted and in turn give the impression that we are not interested in the other person. Similarly, avoiding eye contact may give the impression that we are rude. Simply avoiding social situations means that you don’t get to find out that things can go well!

Fortunately, there is an effective treatment for Social Phobia. Cognitive Behaviour Therapy (CBT) has been found to be effective in treating and reducing social anxiety. CBT is a practical therapy that focuses on the here and now and encourages people to gradually let go of behaviours that are maintaining anxiety. This includes decreasing avoidance and reducing unhelpful behaviours such as limited eye contact, and adapting the way we think about social situations and ourselves. Further, CBT aims to reduce self-consciousness by developing the ability to focus on the person you are talking with and losing yourself in conversation, rather than being focused on focused on the impression you believe you are giving.

SLOW BREATHING

1. Breathe in through your nose for a count of three seconds (one-one-thousand, two-one-thousand, three-one-thousand). Concentrate on filling the bottom of your lungs, not the top. Feel your lower ribs move out as you breathe in – not your shoulders moving up. Breathe very quietly so no-one can hear you (this will make you breathe slowly rather than deeply).
2. Breathe out through your nose or mouth for a count of three seconds.
3. Repeat this exercise three times.

MUSCLE RELAXATION

1. Find a private place and a comfortable chair, close your eyes and sit quietly, letting go of any distracting thoughts
2. Tense your face (10 seconds). Now relax your face and as you relax, feel the tension drain away and say to yourself "r-e-l-a-x".
3. Tense your arms, shoulders, neck and chest (10 seconds). Now relax them and as you relax, feel the tension drain away and say to yourself "r-e-l-a-x".
4. Pull in your stomach hard and tense your lower back (10 seconds). Now relax and as you relax, feel the tension drain away and say to yourself "r-e-l-a-x".
5. Extend your legs, pull up your toes hard and tense them (10 seconds). Now relax them and as you relax, feel the tension drain away and say to yourself "r-e-l-a-x".
6. Repeat steps 2-5.
7. Visualise a pleasant relaxing scene as you let your body feel relaxed, warm and heavy (time yourself for 2 minutes).