Any of us can experience anxiety in everyday life.
It alerts us to danger and is designed to protect us. However anxiety even in short bursts (for example before an exam) can be unpleasant. When a person is anxious they may experience a number of symptoms including increased heart rate and palpitations, dizziness, needing the toilet more, increased sweating, dry mouth, tremor and rapid breathing.
Anxiety for most people happens in response to a situation e.g., being late or an interview. It can also occur for no apparent reason.
When anxiety gets out of control it can be a problem.
As well as being overwhelming it can prevent us from feeling able to do everyday tasks. The person starts to avoid situations and lose all sense of perspective of the actual threat they pose. As a consequence they may avoid certain everyday situations which can impact on their quality of life.
People with intellectual disabilities experience anxiety at greater rates than the wider population and experience greater difficulty in accessing treatment and education programmes for managing anxiety. Reduced cognitive and social abilities can make accessing support for people with intellectual disabilities more difficult e.g., communication difficulties can make it difficult for the person to describe how they are feelings and what is worrying them.
Early recognition and treatment aimed at reducing the symptoms of anxiety can help to improve outcomes both in the short and longer term. Guided Self-help is a brief low intensity intervention that equips the person with strategies to manage their anxiety and general mental well-being. It aims to allow the person to have more control and be less reliant on services.
Although Guided Self-help is a recommended intervention for anxiety and depression there is little evidence of it being used when treating people with intellectual disabilities. Below is a brief case study to illustrate this approach.
John is in his mid 40s. Since his late teens he has suffered from periods of mild depression and anxiety which prevents him from leading a full and active life. When John feels low he worries about unpleasant things that might happen, for example people pestering him for money or schoolchildren being unkind by making cruel comments. These thoughts at times can trigger panic attacks, which John describes as feeling like he is going to die. John finds it difficult to get support at the right times and when he feels he needs it. Because of his anxiety John saw a nurse at his local mental health service and completed a course of Guided Self-help. The Guided Self-help sessions allowed John to talk about his feelings and how they affected him. During the treatment sessions John rated his mood and anxiety levels and told the facilitator about everyday situations that made him worried and anxious and how he coped. John’s answer to his problems was to avoid situations that made him stressed. During the sessions practical strategies were suggested to John to manage his anxiety such as deep breathing, relaxation and how to access support. John was allowed to talk about the situations he found difficult and was given ideas of positive ways to manage these. To help with this John’s support worker was invited to the session with John’s consent. As John’s anxiety occurred mainly out of the house the aim was to reduce anxiety and make going out a positive experience. Initially, as part of his homework, John was accompanied on trips out and given encouragement and positive support to manage his anxiety. John kept a diary of his feelings and how he coped in different situations. The diary was used in sessions to show to John his progress and to improve his resilience. At the end of treatment John had learned a number of techniques to manage his anxiety. His diary also showed John was able to identify his feelings and was able to use coping strategies and was less dependent on his support worker to help with this. Following treatment John still writes in his diary, this helps him tell others how he feels and is one of the things he has started to do to improve his general mental wellbeing, which have included exercise and meeting friends.
About Eddie Chaplin
Eddie Chaplin is the author of Guided Self-help for People with Intellectual Disabilities and Anxiety and Depression.
Eddie is a research and strategy lead for the Behavioural and Developmental Psychiatry department at the South London and Maudsley NHS Foundation Trust and visiting researcher at the Institute of Psychiatry, King’s College London. As a nurse, he has managed a number of national services for people with neurodevelopmental disabilities. Recently, he has developed courses and modules at postgraduate level in mental health in intellectual disability and forensic intellectual disability.