Loud Speaker Magazine 5th Issue - Final (Fears & Anxieties)

LoudSpeaker
Th e Monsoon 2016
Amplifying the voice of mental health
Fears & AnxietIES
Exam Anxiety: 9
How to Handle
27
Facing their Anxieties
Helping Other People
Manage Anxiety
20 The Management of
Insomnia
14 25
Shyness and Coping with the
Social Anxiety Loss of a Partner
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...Plus Our Regular Features

1Amplifying the voice of mental health
NIMHANS Center for Well-Being
A Center for Mental Health Promotion
#1/B, 9th main, 1st Phase, 1st Stage, BTM Layout, Bengaluru– 76.
Phone: 080-26685948 / 9480829670 email: nimhans.wellbeing@gmail.com
www.facebook.com/nimhanscentreforwellbeing
Mental health for persons with medical illnesses
Marital enrichment services
Stress management
Trauma recovery
Brief psychotherapies &

counseling services
Enhancing positive mental health

Services
Family counseling
Parents support group

Offered
Support in intimate partner
violence
Prevention & early treatment for addiction
Enhancing parenting skills & child mental health
Services for healthy use of technology
Workshops & training programs in mental health
Elderly helpline & mental health helpline
Youth Well-Being
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2 Amplifying the voice of mental health

LoudSpeaker
The
Editor
Dr. Prabha S. Chandra

Professor of Psychiatry
Coordinator
NIMHANS Centre for Well-Being
Chief Editor:
Dr. Prabha S Chandra
Editorial Team: Sub Editors

Dr. Prasanthi Nattala, Mrs. D. Padmavathy, Dr. Meena.K.S.
Mr. Manoj Chandran, Mr. Prabhudev. Dr. Prasanthi Nattala
Associate Professor of Nursing
Editor’s Note
NIMHANS
T
he month of July augurs rain, thunderstorms and the fear of floods Smt. D. Padmavathy
and traffic jams. It brings back memories that may be filled with In-charge Staff Nurse
panic and worries. Anxiety as an emotion has been experienced since NIMHANS Centre for Well-Being
time immemorial. In fact anxiety is usually a useful emotion and helps in
enhancing preparation and performance. It is when it becomes excessive
and unmanageable that it becomes a clinical condition. However, it is
important for us to learn to manage our anxieties and fears in a manner
that they work for us rather than against us. This issue of Loudspeaker Editorial Board
deals with a range of conditions in the realm of anxieties and fears.
Mr. Manoj Chandran
We at the Editorial Board of the Loudspeaker try to make the magazine Mr. Prabhu Dev
relevant to the information needs of the public in the context of mental
health. Most people are resilient and have enough internal resources to
handle even the toughest of life’s problems. Sometimes just understanding
that you are on the right path or getting a few helpful tips helps in
Conceptualized and produced by
dampening the intensity of the problem and prevents a symptom from
becoming a disorder. NIMHANS Center for Well-Being
This is our fifth issue and we are pleased that the magazine finds place in
all City Central libraries across our state. We would like it to be available Cover photos:
to many more people and with our digital edition we hope that more NIMHANS Center for Well-Being
people will have access to it.
We are grateful to the R.N. Moorthy Foundation for continuing to fund the
next few issues. This support for mental health information delivered by Photo Credits:
experts in a distilled and simple form is a step forward in the promotion
of mental health.
Printing of the Magazine funded by: Dr. Ramachandra N National Institute of Mental
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The
Moorthy Foundation for Mental Health and Neurological Sciences Health & Neuro Sciences
3
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Contents
Health Anxiety
Dr. Sundarnag Ganjekar
Dr. Geetha Desai
14
6
Certain tips to handle health
Shyness and social anxiety
anxiety, a condition in which
individuals experience Ms. Systla Rukmini
excessive concerns and Dr. Paulomi M. Sudhir
worries about health. Distinction between shyness and Social Anxiety
Disorder; ways to manage.
Exam Anxiety: How to

handle it?
16
9
Specific phobias and how to deal with them?
Dr. M Manjula
Ms. Systla Rukmini
Handy tips for managing the Dr. Paulomi M. Sudhir
stress and anxiety related to
Specific phobias (intense fear related to a specific
exams.
situation/ object) and their management.
Are you overly anxious? How can you manage it? Living with someone who has
Dr. N. Manjunatha Obsessive-Compulsive Disorder
Insights into Generalized Anxiety Disorder and its Dr. Sabina Rao
management. Insights into Obsessive-Compulsive Disorder (a condition
where a person experiences uncontrollable, recurring
thoughts and behaviors); tips for family members.
11
18
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20 Facing their anxieties - Helping
other people manage their anxiety
Mr. Sanjay Patnaik
The Management of Insomnia Understanding and accepting
Dr. Ajit Bhalchandra Dahale
27
individual differences in the ability
Insomnia (not getting enough sleep or good to handle life stresses; helping
quality sleep): ways of handling, Sleep Hygiene others to handle their anxieties
Rules. and stressful situations.
First aid for Mental Health

Problems
Dr. K.S Meena
Basic intervention measures to
help people in mental health crisis. 29
22 Childhood Fear
Ms. Chaithra Holla
32
Insights into handling fears and
You have Panic attack, Not a heart attack
anxieties in children.
Dr. N. Manjunatha
Distinction between panic attack and heart attack;
ways of handling panic attacks.
Coping with the Loss of a Partner War with my thoughts

Dr. Veena A.S Mr. Pradeep Jakka
Coming to terms with the loss of a loved one, a The story of one of our young clients who is in a
reality all will face at some point in life. journey to conquer his illness - hear his story, in his
own words.
34
25
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5
Health Anxiety
Case Example house. From then onwards he has not been able
to leave home by himself. He has visited multiple
Prasanna, a 35 year old autorickshaw driver has specialists and has undergone many investigations.
been an anxious person since his childhood. He The specialists have ruled out any heart problems.
had difficulty in learning to ride the autorickshaw. However, Prasanna continues to be excessively
His trainer used to make fun of him as he would concerned about his health.
apply brakes very often as he was worried about
head on collision. He used to be anxious to drop The above descriptions highlight excessive concerns
passengers to destinations far from his area. He about health.
used to get thoughts “what if I lose my way back” ,
“what if I met with an accident away from my area Detailed evaluation of his anxiety was done. His
and nobody came to my rescue? . One of his best symptoms were validated. He was started on
friends died of a heart attack while at work, and antianxiety medication. Relaxation techniques were
since that day he has started having palpitations, taught to him and he was asked to practice it daily
tremors of hand, perspiration and impending doom along with medication. He underwent cognitive
whenever he starts his autorickshaw. Recently behavioral therapy along with medication for 6 weeks
when he was riding his autorickshaw through with which he reported significant improvement in
the crowded market he suddenly felt uneasy with his symptoms. He has been able to venture out alone
palpitations, tremors, cold sensations in his limbs. and ride his autorickshaw to different destinations
He immediately abandoned his auto and ran to his away from his home.
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What is health anxiety?
Health anxiety is a clinical condition where the

individual is preoccupied with an idea or the thought
that he/she is experiencing a physical illness. Most
commonly people suffering from health anxiety are
preoccupied about having serious illnesses such as
cancer, HIV, AIDS, heart attack, etc. This anxiety can
become overwhelming, cause significant distress,
and affect every day functioning. Men and women
may be equally affected.
Factors that may trigger health anxiety:
• Having a family member or friend with What are the symptoms of health anxiety?
serious illness
• The person experiencing health anxiety often
• Death of close relative/friend with serious attributes his/ her bodily symptoms to life
illness threatening conditions, e.g. the person may
• Suffering from obsessive-compulsive interpret his/ her headache as a sign of brain
disorder/ other anxiety disorder tumor. He/ she may also attribute non-
physical symptoms such as poor concentration
• Having a belief that healthy persons should or sleep disturbance to a major illness.
not experience any physical symptoms at all • Persons suffering from health anxiety have
• Having close family members who themselves repeated thoughts about the illness and
have health anxiety. constantly check for signs of any illness. They
also seek information about the illness from
various sources such as newspapers, health
magazines and health sites on the internet.
The anxiety may often be precipitated by some
information about an illness (e.g. obtained
from a newspaper or other media).
• Persons with health anxiety might subject
themselves to investigations repeatedly, and
consult multiple health professionals, often
spending large amounts of money and time
to do so. Often, lack of diagnosis is attributed
to poor medical care or unqualified doctors.
Conversely, there may also be avoidance of
consultations and hospitals for fear that a
serious illness might be detected.
How can you recognize health anxiety?
You may be suffering from health anxiety if:

• You have been preoccupied for many weeks
with the thought that you may be having a
serious illness
• If this preoccupation is causing you significant
distress
• If it is affecting your work, family life or sleep
• If you feel the need to seek constant
reassurance from the doctors, family, friends
about your health.
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How and what help can you get? • Keep a check on excessive thoughts about
your health and learn to say “stop” to the
If you feel you are suffering from health anxiety, thoughts
consult a mental health professional. The following • Remember that your thoughts, feelings and
are simple techniques adopted by the health behaviors are interconnected. If you are
professional to help you to overcome your health worried about having an illness, you are more
anxiety: likely to perceive the normal bodily sensations
as abnormal or signs of an illness which might
1. Understanding your health anxiety and its make you more anxious. Try distracting
impact on you yourself form these thoughts
2. Reducing your focus on health symptoms and • You can try relaxation exercise under
worries supervision
• It is essential to have a regular healthy diet
3. Re-evaluating excessive health related
and exercise
thinking
• It is important to be aware of any sudden or
4. Teaching you techniques to reduce checking persistent changes in your health status and
and reassurance seeking seek timely help.
5. Helping you to overcome avoidance and
safety behaviors. Safety behaviors include
immediately seeking help from a doctor,
asking various people for reassurance or
getting investigations done. Unfortunately,
safety behaviors only offer immediate relief Dr. Sundarnag Ganjekar
but ultimately worsen the anxiety. Assistant Professor
Department of Psychiatry
What can you do ? NIMHANS, Bengaluru
• Discuss your concerns about your health with

Dr. Geetha Desai
a family member
Associate Professor
• Gather health information from reliable
Department of Psychiatry
sources
NIMHANS, Bengaluru
• Reduce the time spent on reading about
illnesses on the internet
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Exam Anxiety: How to Handle?
Exam anxiety is a feeling of fear, nervousness, The bodily symptoms include rapid heartbeat,
uneasiness and stress before or during an exam. It headache, dry mouth, stomach problems, loss of
interferes with learning, reduces memory, increases appetite, sleep problems, bodily aches and pains
mistakes and lowers test performance. Everyone or falling sick. Cognitively they may have difficulty
feels nervous and experiences some anxiety before in concentration and recall, in understanding and
an exam; however about 20-35% students suffer remembering, may go blank during the exam, forget
from exam anxiety that interferes with performance. answers because of excessive anxiety. Psychological
symptoms include negative thoughts, lack of
Factors contributing to exam anxiety: confidence, pessimism, hopelessness, anxiety, panic
Exam anxiety may result from any of the following and sadness. To handle the anxiety students may
factors: involve in avoidance behaviors (such as avoiding
studies, exams), become restless and irritable, or
• Excessive competition for getting their desired resort to use of substances such as alcohol, smoking
course/seat in desired college/school or excessive coffee/tea intake.
• Lack of preparation and fear of failure
How can exam anxiety be handled?
• Fear of not achieving their goals and the
perceived ridicule from significant others
Healthy lifestyle practices: Adopting healthy
• Fear of not meeting expectations of parents lifestyle practices such as eating healthy food,
and self, which is perceived as failure adequate sleep, physical activities, balanced time
• Worrying nature of the individual and a schedule allowing for study, recreation and sleep,
tendency to anticipate negative outcomes goes a long way in preventing exam related stress
such as failure, forgetting answers, difficult and anxiety.
exam, etc.
Practice of relaxation methods such as deep
Symptoms of exam anxiety breathing/pranayama, meditation, deep muscle
relaxation, mindfulness exercises, positive imagery
Exam anxiety may manifest through bodily symptoms, helps in reducing physiological symptoms of anxiety
behaviors, cognitions and psychological symptoms. as well as worrisome thoughts and feelings.
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and ultimately your performance in the exam. It is
also important for you to have realistic expectations
and set realistic goals. Remember that ‘you are not
just your grades’, there are many aspects to you as a
person, exams are just a part of learning and there
is always more than one option in life. It is most
important to be open to all options, have a never-say
die attitude, and believe in yourself.
In case you are not able to handle the negative

thinking and worries by yourself, it is beneficial to
consult a psychologist.
Good study habits:
There is no short cut to hard work and good Role of parents: Role of parents is very crucial
preparation! Thus if one plans studies from the during the stressful periods in their children’s lives
beginning of the year and covers the syllabus – examinations, in this context. Parents need to
systematically, anxiety is less. Though preparing work on their own anxieties and be supportive, so
from the beginning is ideal, pressure is more as that they can help their children to stay focused and
the exams draw near, thus preparation during the relaxed. It is also important for parents to not see
months before exam becomes crucial. For utilizing their children as extensions of themselves and expect
the time adequately it is important to assess one’s them to achieve what they (viz. the parents), could
assets and difficulties, level of preparation, and not achieve in their own lives. Although they may
make a realistic timetable for studies. It is equally be your children, you, as parents, need to remember
important that your timetable should allot sufficient that your children are individuals in their own right.
time for revision, otherwise it may be still difficult to They need to be respected and encouraged to do
remember the study material during exams. their best, regardless of the result. The bigger picture
would be to mold them into honest citizens, than just
Eliminate all distractions during studies, stay focused toppers in an exam or acquirers of seats in coveted
and use study methods which work best for you, educational courses.
depending on the subject (e.g. writing, making charts,
reading aloud, group study and discussion, etc.). Dr. M Manjula
Associate Professor
On the day of the examination: Have a good breakfast, Department of Clinical Psychology
reach the place early, try and relax before going into NIMHANS, Bengaluru
the exam hall. Keep repeating self-statements that
you are going to do well, you are going to remember
all answers, you will pass the exam.
After the exam starts: Stay calm, read the question

paper thoroughly, and make sure you have
understood the questions properly. Allocate time
for each section, thereby ensuring that you answer
all questions as well as you can. First select the order
of answering the questions – for instance, you may
want to start by answering the easier questions first.
Also, highlight points, use graphs and figures to
enhance the quality of the answers. Make sure you
have at least 5-10 minutes to spare before the exam
ends, so that you can go through your answers and
tie up any loose ends.
Role of positive thinking and having realistic

expectations: In general, cultivate positive
thinking, which improves memory, concentration
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Are you Overly Anxious? How
can you Manage it?
Anxiety is a feeling of worry, nervousness, or unease to become dysfunctional, and in short, causes more
about something which the individual feels may harm than good, to the individual.
have a negative outcome. Anxiety is a fundamental
and universal emotion of human beings. A certain Let us see whether you have a problem with anxiety.
level of anxiety is adaptive and survival oriented, Please tick your answer for the following questions
and facilitates adjustment with the environment. and calculate total score. Over the past two weeks,
However, anxiety is abnormal when it fails to how often have you been bothered by the following
perform this adaptive function, causes the person problems?
No Item Not at all Several days More than half the days Nearly every day
Feeling nervous, anxious or on
1 0 1 2 3
edge?
Not being able to stop or
2 0 1 2 3
control worrying
A score of 3 or more in above questions indicates commonest anxiety disorder in the world. So please
that you see a doctor / psychiatrist since you may be remember that you are not alone, and read on, as
having an anxiety disorder, called as “Generalized we provide you with some information about GAD,
Anxiety Disorder (GAD). A survey by the World which can help you to understand this condition
Health Organization reports that GAD is the better and obtain help.
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 The anxiety, worry, or physical symptoms
cause clinically significant distress or
impairment in social, occupational, or other
important areas of functioning.
GAD may also present with physical symptoms such

as shortness of breath, rapid heart rate, dry mouth,
trembling, headache, nausea, muscle tension, cold
hands and dizziness. Since these symptoms overlap
with other medical illness such as hypothyroidism,
cardiac problems, these medical conditions should
be assessed with a complete physical examination
and if needed, laboratory investigations.
4. What are the causes of GAD?

The exact cause of GAD is unknown till date.
1. What is Generalized Anxiety Disorder (GAD)? However, biological, environmental, and
Excessive anxiety and worry are the main symptoms psychological factors are thought to contribute to the
of GAD. This affects many aspects of daily life of development of GAD. The general understanding is
individuals from family/social life to occupational that psychological factors interact with biological and
function. environmental factors in leading to the development
and maintenance of GAD.
In general, everyone usually worries about their
family, job, and health, but people with GAD 5. What treatments are available for GAD?
have unrealistic, excessive fears and worries. Effective treatments are available to control the
They often feel overwhelmed and live their lives symptoms of GAD and promote recovery. Early
anticipating disaster. This worry is generally out of and effective treatment is necessary to prevent the
proportionate with reality, so that they are unable to emergence of another more serious anxiety disorder
relax, concentrate, or sleep. If diagnosed and treated or depression.
early, suffering will come down and quality of life
can improve significantly. GAD is primarily treated with medications and /
or with psychotherapy. In our country, traditional
2. Who are commonly affected? healing practices are also available for treatment
People of all races and cultures are equally affected. such as yoga, relaxation exercises or meditation,
However, women tend to suffer more with GAD. acupuncture, relaxation exercises, meditation,
GAD tends to begin in the early 20’s, and has a long- acupuncture.
standing course.
One effective therapy commonly used for GAD
3. What are the signs and symptoms of GAD? is Cognitive-Behavioral Therapy (CBT). This helps
patients to develop healthier thought patterns, and
A diagnosis of GAD is generally made when: helps to teach them new ways of handling anxiety-
producing situations. CBT is generally carried out in
 Excessive anxiety and worry (apprehensive a session of 30-40 minutes once or twice a week for
expectation) occurs for at least 6 months about approximately 12 weeks.
several events or activities
 There is difficulty controlling the worry Commonly prescribed medications are
 Anxiety and worry are associated with 3 (or antidepressants and anti-anxiety medications.
more) of the following most of the time, for at Antidepressants commonly used to treat GAD are
least 6 months: restlessness or feeling on edge, Selective Serotonin Reuptake Inhibitors (SSRIs) such
fatigue, difficulty concentrating, irritability, as fluoxetine, escitalopram, sertraline, etc. Relief
muscle tension, sleep disturbance from symptoms is usually obtained within 3 to 4
 Anxiety and worry are not due to substance weeks, and the individual may have to continue the
abuse or another medical or mental disorder medicines for one year.
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Anti-anxiety medications called benzodiazepines, that GAD more often is undiagnosed and untreated
provide immediate relief from anxiety symptoms, for quite long. If diagnosed early, with available
but continued use may be addictive / habit-forming. treatments, suffering can be reduced to a large extent
Hence, these medications should only be used for an and quality of life can be improved.
initial short period of time. and exactly according to
prescription. 8. What is role of family and friends in GAD?
Support from families and friends of individuals
6. What are the complications of GAD in the with GAD is crucial in promoting a quicker recovery
long run? from GAD. Family members and friends should
There are other mental disorders that can co-occur understand that GAD is a real, serious, but treatable
with anxiety such as depression, other anxiety medical condition. It is important not to downplay
disorders (e.g. social phobia, panic disorder, post- the seriousness of the symptoms by saying that they
traumatic stress disorder, and obsessive compulsive will get better on their own.
disorder), and substance abuse and dependence. Family and friends can be helpful by listening
When these set in, diagnosing may be complex since without judging, providing helpful suggestions and
symptoms often overlap with GAD. Often, people encouraging positive coping skills, bringing them
with GAD are found to ‘self-medicate’ with addictive for treatment at the earliest, and by being flexible
substances such as alcohol, tobacco, caffeine, etc. to and supportive during stressful periods.
get relief from symptoms. Without proper treatment,
people can continue to be disabled, with poor quality
of life. Dr. N. Manjunatha
Assistant Professor
7. How long can GAD persist? Department of Psychiatry
In general, GAD is a long standing illness with NIMHANS, Bengaluru
multiple relapses and remissions. The challenge is
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Shyness and Social Anxiety
Social Anxiety disorder (SAD) or Social Phobia
gained recognition as a clinical disorder by the Social Anxiety
American Psychiatric Association in 1980. However Disoder
its definition has undergone many revisions Shyness • Anxiety at
since then, including raising questions about • Personality trait least present
differentiating between a person who is shy and one • Doesn’t always for 6 months
who has SAD. cause distress • Causing
• No avoidance difficulties
Does being a shy person mean that one has Social in work,
Anxiety Disorder? In order to understand these two interpersonal
seemingly overlapping constructs, it is important to relationships
understand how they have both been described:
• Shyness is defined as feeling anxious and Distinguishing between shyness and social anxiety
inhibited in many social situations such as
meeting new people or making a presentation. Shyness is part of a person’s personality which
• Social Anxiety Disorder (SAD) is defined as the means it is present since an early age and across
experience of significant fear, embarrassment many different situations. Even though a person
or humiliation in social situations, to the point feels nervous or anxious when giving a speech or
that the person avoids these situations, or faces meeting new people, this does not stop him/ her
them with a high level of distress. Persons from entering into that situation or talking to others.
with SAD also fear negative evaluations and The anxiety is also manageable and can reduce as
are highly sensitive to interpersonal judgment
and criticism.

Since the term social anxiety was introduced, there
have been differing viewpoints, with some stating
that it is a normal part of personality, while others
have felt that shyness is the same as social anxiety
albeit in a less severe form. Research on young
children has highlighted differences between
shyness and social anxiety. As seen below, these two
are different, and yet overlapping concepts:
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a person becomes engrossed in talking to others. A On the other hand, SAD needs to be treated, as it
shy person is not excessively worried about being causes significant distress, as well as interferes with
embarrassed or ridiculed by others and so does not the achievement of life goals. SAD can be effectively
avoid social situations. Being shy is also not seen as a managed using various treatment modalities such
negative trait or weakness, on the contrary it can be as medications and psychological interventions,
seen positively. Shyness also does not hinder people primarily Cognitive-Behavioral Therapy (CBT). CBT
from fulfilling their life goals as they are able to face aims at modifying the factors which maintain anxiety
and negotiate with situations when required. such as negative thoughts or beliefs and reducing
avoidance. Therapy can also involve teaching people
On the other hand, Social Anxiety Disorder (SAD) is skills to interact in anxiety-producing situations
not considered a normal or positive part of people’s and learning to manage anxiety through relaxation
lives or personality. Shyness is diagnosed because techniques.
the people affected by it are enduring fear, anxiety,
stress, embarrassment, and humiliation on a daily In summary, shyness is not the same as social anxiety
basis and are greatly distressed by it. The severity disorder nor is it a less severe form of it. Both of them
of SAD hinders people from meeting their life goals can cause unique difficulties which can be overcome
and this furthers their distress. Many times social either through individual efforts or various effective
anxiety can start during adolescence or in early forms of therapy.
twenties which can lead to loss of valuable years of
their life. Ms. Systla Rukmini
PhD Scholar
Shyness does not lead to SAD nor does it necessarily Department of Clinical Psychology
mean having SAD. It is not just a less severe form NIMHANS, Bengaluru
of SAD as many people with SAD do not report
being shy. Extroverts also face difficulties when in
social situations if they have worries about being Dr. Paulomi M. Sudhir
embarrassed or ridiculed. Additional Professor
Department of Clinical Psychology
Early identification of SAD and ways to overcome NIMHANS, Bengaluru
There is a crucial need to understand the differences

between shyness and SAD since mistaking SAD for
mere shyness can lead to delay in seeking treatment.
People who consider themselves to be shy are often
able to manage social interactions and demands
when they have to. However in order to be able
to further overcome shyness, one could try to
interact with others in social situations more often,
particularly those which have been previously
avoided - for example, starting a conversation
in a get together or making inquiries at stores.
These initiatives will gradually help individuals
to overcome their anxiety and face these situations
with confidence.
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Specific Phobias and How
to Deal with Them?
Case Example As her fears have increasingly affected her life over
Sheela is a 35 year old lady who is working in a school. the last few years, Sheela decided to seek professional
As a child Sheela was an outgoing person, with lots of help, and was diagnosed to have specific to have
friends. During one summer holiday, while playing a specific phobia for closed spaces.
game called dark room, Sheela’s cousins locked her
up in the basement and the door got jammed, leaving Many situations or objects in the modern world
her stuck for a long time. After this incident, Sheela can be dangerous to one’s well-being such as loose
started becoming uneasy every time she had to be in electrical wires, stray dogs, or an old lift. When
dark places, such as lifts, theaters and closed spaces. one experiences fear which is proportional to the
At home she has to leave all the lights on when alone danger these objects present, anxiety can be helpful
and finds it difficult to travel or visit places due to and of survival value. However, the anxiety which
this and cannot work in buildings that have only lifts. Sheela experiences for closed spaces is excessive as
Her family has also been affected by Sheela’s fears it is present even when there is little danger, and
as she insists on leaving lights on in rooms and must irrational because there is no logical reason for
have someone with her at all times and she refuses to being afraid of that object or situation. Her fears
go to movies, unless the seats are near the exit. have limited her career growth and also affected her
ability to interact with others. This type of anxiety
which is disproportionate to the danger presented
by that situation or object is called “phobia”.
Specific phobia which is excessive or irrational fear of

a specific object, animal or situation, can disrupt daily
routine, limit work efficiency, reduce self-esteem,
and strain relationships. However despite realizing
that one does not need to be afraid the person cannot
control his/ her anxiety. Some of the commonly
reported phobias are listed in the below table:
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Blood-injection-
Animals Natural Environment Situation
injury*
• Snakes • Heights • Elevator • Seeing blood or
• Spiders • Water • Air travel injury
• Dogs • Darkness • Closed spaces • Exposure to
treatment for injures
• Injections
Signs and symptoms for habituation of fear and eventually extinction of

The intense arousal experienced either when facing the fear. Through exposure the person also gains a
the phobic object or in anticipation of facing it is greater sense of self-efficacy and confidence in facing
also called the fight-or flight-reaction. People may the phobic object/ situation. Family members may be a
experience all or some of the following symptoms: part of the therapeutic program.
• Feeling of impending doom or danger, need
to escape Systematic desensitization (SD) is another therapeutic
• Increased heart rate, breathing difficulties approach, which combines relaxation response to
• Sweating, trembling imaginal exposure to a feared object, thereby causing
• Uneasiness in the stomach the relaxation to block or inhibit anxiety. The key
• Headache ,nausea, feeling dizzy differences between graded exposure and SD is that
• A sense of things being unreal or being outside in SD there is imaginal exposure, anxiety is paired
of the body systematically with relaxation, while in GE there
• Feelings of losing control or going “crazy”. is real life exposure (In vivo) to the feared object
without use of any relaxation training.
Who develops phobias and how?
About 5 – 10% of the population experience specific Applied relaxation is yet another method by which
phobias. Phobias may develop due to a genetic phobia can be overcome. This involves teaching the
vulnerability (blood-injection-injury subtype), person to use relaxation as a coping skill when having
strong negative experiences associated with the to face the feared situation. The person is trained in
object, or vicariously by seeing others go through a various steps of relaxation, eventually reducing time
negative or aversive experience. taken to relax to a mere 30 seconds. The person is
then asked to apply this relaxation at earliest sign of
Management of specific phobia anxiety, while continuing to face the feared situation
The two main treatments available for phobias (application phase). It must be ensured that applied
include pharmacotherapy and psychological relaxation is not to be used to distract oneself from
interventions. Medications are often used in a the experience of anxiety and works well only when
combination with psychological interventions such used to counter the earliest sign of anxiety.
as behavioral and Cognitive Behavior Therapy (CBT)
and help in reducing arousal. In summary, specific phobia is a condition where the
person experiences intense fear to a specific situation/
CBT is aimed at reduction of physiological object based on past learning, characterized by
symptoms, avoidance of the feared situation avoidance and impairment. There are effective
that often maintains fears and prevents alternate treatments available for overcoming phobias and
learning, graduated exposure to the feared situation, include behavioral and cognitive techniques such
identifying and modifying irrational thinking as graded exposure, applied relaxation, systematic
responsible for maintaining anxiety. desensitization and cognitive restructuring..
Graded exposure (GE) is the most effective technique for Ms. Systla Rukmini
overcoming phobia. It is based on learning theories PhD Scholar
which explain that the development of phobia is Department of Clinical Psychology
through a process of learning negative associations NIMHANS, Bengaluru
or conditioning towards the feared object. GE aims
to weaken these negative associations by gradually
exposing the person to the cues associated with the fear, Dr. Paulomi M. Sudhir
while preventing avoidance. Exposure is carried out Additional Professor
systematically, using a list of feared situations, arranged Department of Clinical Psychology
in an ascending order (least to most feared ones). While NIMHANS, Bengaluru
facing these situations the person is instructed not to
avoid, or use any other means of distraction, allowing
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17
Living With Someone Who Has
Obsessive-Compulsive Disorder
“This is exhausting, can you just stop doing it!!!!” that he was constantly late to work. She was afraid he
would lose his job. Since she was not working and they
Mr. Kumar went with his wife to the clinic on her had 2 small kids, she was worried about the financial
insistence. She was tired of seeing him repeatedly switch consequences of her husband losing his job.
on and switch off his vehicle for several minutes before
leaving for work, go through some elaborate rituals before The above vignette typically illustrates what is
sleep and constantly checking things around the house. known as Obsessive-Compulsive Disorder (OCD).
She heard from a friend that there was a psychiatrist who
practiced very close to where they lived. What is Obsessive-Compulsive Disorder (OCD)?
OCD is a disorder in which a person has
Mrs. Kumar told the doctor that ever since she was married uncontrollable, re-occurring thoughts (obsessions) and
to him, her husband would do several things before going behaviors (compulsions) that he or she feels the urge to
to bed, such as tapping on the floor, getting into bed, repeat over and over. People with this illness can have
getting out of bed, again tapping the floor with his fingers, obsessions, compulsions or both. The obsessions and
sometimes 2-3 hours at a time. What made her bring him compulsions affect all aspects of the individual’s life.
to the doctor was that he was starting and stopping the Additionally, the obsessions and compulsions can
engine of his car so many times before leaving for work interfere with the life of the whole family.
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instance, saying “This must be so hard for you” will
be better than “Can you stop it!” or “Get over it!”
Talk to your doctor about how you can set limits

on your loved one’s compulsions. The limits might
include things such as the time spent in reassurance,
the time spent on participating in the compulsions,
etc. The idea is to “normalize” family life as much
as possible.
You also need to remember to be patient, as the

illness tends to run a prolonged, fluctuating course.
This is harder than the marriage itself! Your expectations might have to change from hoping
Having a partner with OCD can be exhausting and for leaps and bounds of rapid improvement to small
many times frustrating. It can feel like the partner’s improvements and relapses.
ritualistic behaviours control the relationship. One
can get easily sucked into the rituals. Dr. Sabina Rao, MD
Consultant Psychiatrist
For example, the loved one might start spending a Sakra World Hospital
lot of time of in the bathroom, take an extraordinarily Bengaluru
long time to get dressed, appear more irritable and
anxious, do things repeatedly which might appear
very odd to you. He or she might repeatedly ask you
for reassurance. Sleep can become disturbed while
your loved one is completing “tasks”, eating habits
might change. For example, your wife might spend
hours cleaning the kitchen at the end of the day, to a
point that you notice she is not finished even at 1 AM.
What does it feel like to have OCD and how can I

help?
A lot of the improvement in OCD depends on taking
prescribed medications regularly. Be sure to support
your relative in this regard, in terms of taking his/
her medication, and making sure he/ she adheres to
follow-up appointments with the doctor.
For the most part, people with OCD know what

they are doing or repeatedly thinking is illogical and
irrational. A small percentage is unable to identify
the strangeness of these thoughts and behaviors.
For those persons with OCD who have some insight
into their behavior, the thoughts and behaviours can
be exhausting and frustrating, yet not thinking in a
particular way or doing things in a specific way can
create immense anxiety.
Telling your loved one with OCD that what they

are doing is bizarre or illogical or blaming them
for it, will not help. It will only increase the levels
of anxiety which will in turn increase the symptoms
of OCD. Instead, acknowledge the difficulties faced
by the person with OCD. You can be a partner in
the fight against the symptoms of this illness. For
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19
The Management of
Insomnia
Providence has given us hope and sleep as a Why we should bother about having less sleep?
compensation for the many cares of life - Voltaire. Can we not use the extra time to work, enjoy or
relax more? The answer is No. Research shows
As noted above by the French philosopher-writer, that inadequate sleep or poor quality sleep results
sleep is a gift given to us by nature to deal with the in many problems such as - day-time sleepiness,
worries of life. Yet, some people believe that it may poor attention and concentration (which can lead
be just a waste of time spent doing nothing. Is it really to accidents), poor judgment and memory, fatigue,
so? Science has shown us that sleep is a necessity in anger, nervousness and depression. In severe
our daily life and has multiple functions. Sleep has cases, hallucinations, suspiciousness and impaired
a role in restoration of body and mind after a day’s disorientation can also occur. Sleep problems can
wakeful state, forming and organizing memories, affect our physical health as well. Hence, insomnia
brain development and immunity. Several people knowingly or unknowingly hits us hard. Insomnia
are affected by different types of sleep related is assessed clinically by taking a detailed sleep
problems of which ‘insomnia’ is the commonest. history and maintaining a sleep diary. Sleep diary
Insomnia can be termed as `not getting enough sleep consists of systematic recordings using a standard
or not getting good quality and refreshing sleep’. It format of sleep pattern and related events in a book.
can be occasional or chronic. In fact it has been found Further assessment includes physical examination
that insomnia affects around one-third of the world to rule out any contributing factor like obesity
population occasionally and one-tenth of it on a long or cardiac, neurological or respiratory problem.
term basis (for more than six months). Psychological examination is also done to rule out
stress, anxiety or depression as well as to assess the
Insomnia may occur due to many reasons such psychological effects of insomnia. Investigations
as- preoccupation with sleep and its effects, poor like polysomnography where an all night sleep
sleeping habits, use of addictive substances and recording is done to assess the pattern of sleep may
excessive use of caffeine, change of place, stressful also be needed in some people.
events, shift-work, frequent air-travel, presence of
medical problems causing significant discomfort or Treatment of insomnia depends on its cause or
pain and psychiatric problems like depression or contributing factors, for e.g if a person is not getting
anxiety. Some people may have insomnia without proper sleep due to pain, treating the pain will help
any of the above reasons, which is then called the person sleep better. If somebody is not able to sleep
idiopathic insomnia. Women and the elderly are because of working on shifts, changing to daytime
known to have higher risk for developing insomnia. shift/work would help overcome the problem.
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Medications and psychological therapy are the and behaviours are analyzed and resolved in a
common treatments for insomnia. Medications are systematic way. Other psychological interventions
not the first choice of treatment and sleeping pills are include thought suppression (specially worrying
used only for a few weeks and then tapered slowly. thoughts), and relaxation training. Whenever it
They can sometimes cause imbalance and respiratory appears that sleep problems are not coming down
difficulties specially in the elderly and have to be in a few days, we should check for the above
used with caution. Modifying environmental factors mentioned causes and sleep related behaviors and
and sleep related habits are `easy to do’ interventions try to modify them. If the problem still persists
and useful in most situations. Changes like a stable then we can consult a doctor. We should all take
diet and exercise schedule, avoiding excess coffee or care of our sleep… and sleep will take care of our
tea, avoiding day-time sleep, not using the bed for happiness and dreams.
work or watching TV, doing moderate exercise in the
evening, and maintaining a peaceful environment
are helpful. Dr. Ajit Bhalchandra Dahale
Assistant Professor
Psychological interventions are also available, Department of Psychiatry
of which most studied is cognitive behaviour NIMHANS, Bengaluru
therapy, where sleep related unhelpful thoughts
Sleep Hygiene Rules

Rule 1: Do not drink beverages like caffeine or tea at least 2-3 hours prior to bedtime.
Rule 2: Do not smoke within several hours prior to bedtime.
Rule 3: Establish a regular exercise pattern. However, avoid strenuous exertion after 6 p.m.
Rule 4: Use common sense measures to make your environment most conducive to sleep (comfortable
room, dim lighting, no noise etc).
Rule 5: Avoid excessive fluids before bedtime, so that you don’t have to awaken in the middle of the
night to use the toilet.
Rule 6: Do not go to bed until you are really sleepy.
Rule 7: Have a regular sleep schedule. Get up at approximately the same time each morning, including
weekends.
Rule 8: Do not take naps during day-time.
Rule 9: Do not use your bed or bedroom for any activities other than sleep. For instance, you should not
read, write, or eat in bed. Teaching your body that the bed is for sleeping, and not for worrying,
tossing and turning, is probably the most important rule to follow.
Rule 10: Establish regular pre-sleep routines which signal that bedtime approaches. For e.g, lock the
door, set the alarm for the next morning, and any other activities that make sense for this time
of night.
Rule 11: Once you get into bed, if you find that you cannot fall asleep after a few minutes, get up and go
into another room. Engage in some quiet activity until you begin to feel drowsy and then come
back to your bed.
Rule 12: If you still do not fall asleep within a brief time, repeat rule 11. Repeat this process as often as
needed, and also if you wake up in the middle of the night and are unable to return to sleep
within about 10 minutes.
Rule 13: Put worrying thoughts out of your mind. Anxiety is the most common cause of insomnia. Write
down everything that is worrying you and promise yourself that you will deal with it in the
morning.
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All the above rules may not work for all individuals.
One should choose what best suits him/ her. All said
and done, it is important to take care of our sleep
pattern, and ensure we get adequate amount of
sleep, for good health, happiness, and longevity.
Source: Prasanthi Nattala, Pratima Murthy,

Nagarajaiah. (2013). Relapse Prevention in Alcohol
Dependence: A family-based approach - Treatment
Provider’s Manual. Helping persons with addiction
Manual Series 3. Bangalore: Center for Addiction
Medicine, National Institute of Mental Health and
Neuro Sciences, Publication No. 87, ISBN 81-86436-
00-X.
You Have a ‘Panic Attack’,

Not a ‘Heart Attack’!!!
A 35-year married lady was rushed at midnight to the and sent for some blood tests which were all normal.
Emergency of a nearby nursing home with complaints of Meanwhile, the patient became calm, but she feared that
sudden chest discomfort, difficulty breathing, dizziness, she had experienced a ‘heart attack’. The doctor informed
sweating, shaking of body, and fast heart beat lasting a her that she was perfectly normal and the problem might
couple of minutes. Doctors examined her, did an ECG have been due to ‘tension’.
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A month later she had another similar attack and she During the same attack, people may also experience
started worrying that she was having a serious heart any of the following psychological symptoms:
problem. She even went to a cardiologist for a heart
checkup and was found to be normal. She was asked to  feeling of being out of control or ‘goning mad’
meet a psychiatrist who treated her and she improved  feeling that things are not real
within a month.  thoughts such as - like ‘I am going to die right
now’.
Did the above lady suffer from a heart attack or
something else? Often people focus only on physical symptoms
No, the lady definitely did NOT suffer from a heart which makes them very scared that they are having
attack. She suffered from another medical condition a heart attack.
called a ‘panic attack’. A panic attack is experienced
like a heart attack; both are medical emergencies. What is the difference between panic attack and
However, while a heart attack can have serious panic disorder?
consequences, a panic attack is a not a serious medical This difference is very important since a large
condition. However, it can make people feel extremely number of people experience one panic attack in
scared and often apprehensive of another attack. their lifetime without recurrence. Some people also
experience panic attacks at predictable situations
What is the difference between a panic attack and and with warning signs, which may not be a panic
a heart attack? disorder. This predictable panic attack could be
In simpler words, ‘heart attack’ originates in the a sign of other illness such as depression, other
‘heart’, whereas, ‘panic attack’ comes from the ‘mind’ anxiety disorder. On the other hand, when panic
attacks occur repeatedly and unexpectedly without
How common is panic attack/disorder? any warning signs and in an unpredictable way, it
This lady is not alone. Around 5-6% of population qualifies for the illness “Panic Disorder”.
around us may be suffering from this condition.
What to do when a panic attack occurs?
When does panic disorder start?
It often begins in the late 20s or early 30s, and is more • First, stay calm.
common in women.
• Second, tell yourself that it is not a heart attack,
Why does panic attack occur? and there is nothing wrong with your heart.
The exact cause is not known, however, research Instead, it is coming from the mind.
shows that imbalance of biochemical parameters in
the brain is one of the important causes. To a certain • Third, tell yourself that this attack will fade
extent, hereditary predisposition and stress can also away on its own in a couple of minutes.
be the reason for panic disorder. Treatment is thus
targeted at balancing this biochemical imbalance in • Finally, meet a doctor/psychiatrist at the
the brain. earliest for further advice and treatment.
Symptoms of panic attack:

A panic attack starts suddenly and comes down on
its own, usually in 10 to 20 minutes.
People experience the following physical symptoms

during a panic attack:
 fast heart beat

 sweating
 weakness, faintness, or dizziness
 feeling a hot flush or a cold chill
 tingly or numb hands
 chest pain
 feeling nauseous or stomach pain
 shaking of the whole body.
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How is panic disorder diagnosed? begin, in this interim period doctors often prescribe
Panic disorders are diagnosed by interviewing the a mild anti-anxiety medication.
individual in detail about his/ her symptoms. .
There are no specific laboratory tests to diagnose Psychological treatment focuses on teaching new
panic disorder. However, physical examination and skills including education about the illness, changing
diagnostic tests (e.g. thyroid function test, ECG) may the thought process specially at the time of the attack
be required to exclude other medical conditions and building confidence to handle the panic attack.
which may be causing the symptoms. If the person avoids situations such as bein alone
or going out, gradual exposure with relaxation is
Is panic disorder curable? taught to enhance the feeling of confidence and
At present, there is no complete cure for panic safety. Psychotherapy is usually carried out in 12-
disorder. However, it is a ‘controllable’ medical illness 20 sessions, each session lasting 30-45 minutes each.
similar to other chronic illnesses like blood pressure,
diabetes or arthritis. Early treatment is advantageous What is the benefit of early treatment?
to enjoy your life and to prevent complications such as Early diagnosis and treatment have several
addiction to sleeping pills, and to reduce difficulties advantages. First, the suffering and fear come down
in personal and professional life. which saves unnecessary time and costs related to
multiple visits to doctors. Secondly, addiction to
What kind of treatment is available for panic `sleeping pills’ is avoided and finally, individuals
disorder? can enjoy their lives without the disruption caused
This condition is treated with medications, by panic disorder.
psychological treatment , or both. Anti-depressants
are the preferred medicines to treat panic disorder. Dr. N. Manjunatha
Treatment should be continued for at least 6-9 Assistant Professor
months after the attacks stop completely. Since the Department of Psychiatry
benefits of these medications take 2 to 4 weeks to NIMHANS, Bengaluru
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Coping with the
Loss of a Partner
Losing a loved one through death is extremely is when one spouse survives in the road traffic
painful and overwhelming. As told by Gautama accident while the other succumbs to death. The
Buddha, all of us will experience this at some point survivor is left feeling that they could have done
in our life. Coping with the loss of a loved one, in something to avert the tragedy. The feeling is worse
this case, a spouse or partner, can be particularly if the survivor was riding the bike and the deceased
traumatic if the death was sudden and untimely, was a pillion rider.
as in the case of a young man or lady succumbing
to a road traffic accident or suicide. Typical stages Among the elderly who experience the loss of a
of emotional reactions experienced in this scenario spouse, the experience is particularly painful as
include: shock- upon hearing about the sudden they may have spent several years together. Loss
demise of one’s spouse; denial- that one’s spouse in this context is typically a consequence of the
is no more; anger- towards anyone (including aging process itself and/or illness. The surviving
themselves and even God!) who they think was spouse may experience a deep sense of loneliness,
directly or indirectly responsible for their spouse’s particularly if he/ she has to live alone away from
death; sadness-profound grief about the loss, and children or is now physically and emotionally
finally; acceptance of the loss. dependent on children for care and support.
Coping with the loss of a spouse or partner can The nature of grief experienced is therefore a
also be difficult if the surviving spouse experiences function of many factors: the context in which
“survivor guilt”. A scenario where this may happen death occurred-- sudden Vs. prolonged illness and
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25
restore a normal routine too soon. While it is
important to do as much as you are able to,
don’t be too harsh on yourself or push yourself
more than you should. Important decisions
can wait.
h. Children may be grieving too: Crises such as these
affects the whole family. Others in your family
will also be grieving and so may sometimes
NOT be able to give you the attention you
need. Do NOT take it personally.
i. Plan for your future: It is important to plan for
your future (without your partner)- who you
will stay with, managing finances, handling
any unfinished business, etc.
j. Finding meaning /Religious and Spiritual
suffering; the survivor’s personality—sociable practices: Try to find meaning in the loss.
Vs. Reserved, independent Vs. dependent on the Spiritual practices are known to help you
deceased; and the survivor’s relationship with the reach a state of acceptance. Offering prayers,
deceased—intimate Vs. conflictual. reading spiritual texts, meditation are some
useful practices.
Different people cope with their loss in different k. Don’t be afraid to seek professional help:
ways. While the old adage holds true, that “time is Remember that help is available and that it is
the best healer”, the survivor can take the following alright to seek help when you are in need. This
proactive steps to cope with their loss more may include taking medication for symptoms
effectively. you may have and/or seeing a counsellor who
can facilitate the grieving process for you. Talk
a. Mourning: Participating in religious to someone who may be able to direct you/
ceremonies and rituals to mourn the deceased escort you to a professional.
facilitates emotional healing and therefore it is
important to get involved in these activities. Coming to terms with the loss of a loved one is a
b. Expressing your grief: Talking to your close reality we all will face at some point in our life.
friends and relatives about your loss, your Although there is no such thing as being ‘fully
memories of the deceased is another important prepared’ for it, we can take a few steps to help
way to overcome grief. ourselves and those around us to adapt to the loss in
c. Stay connected with friends and family: Being a way that is effective.
around people who care about you is known
to help during times like these. Do NOT keep
yourself away from people or be isolated. Dr. Veena A.S
d. Self-care: Ensure that you are eating well, Assistant Professor
getting adequate rest and exercise. Older Department of Clinical Psychology
survivors who have health problems should NIMHANS, Bengaluru
ensure that they are taking medication
regularly like before.
e. Have a routine: Try to get back to your previous
routine to the extent possible. Having activities
to do keeps you active although for you to feel
interested in these activities will take time.
f. Pursue your interests and hobbies: Try to revive
your interest in hobbies that you can pursue.
Doing activities that you like or enjoy will
help you overcome negative emotions.
g. Grieving takes time, don’t be in a hurry to makes
changes or bounce back: In today’s fast paced
life, people are in a hurry to bounce back and
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Facing their Anxieties – Helping
Other People Manage Anxiety
Arvind had been struggling with thoughts of the impending know what you are feeling. Don’t say anything to your
board examination. Although he was a bright student, the father, he will be very disappointed. Everything will be
fear of disappointing his family had started to take a toll okay, you just concentrate on your revision.” Now, with
on him. “He’s going to ace these exams; top of his class!” three days left for his first exam, Arvind sat to attempt a
his parents would proudly tell anyone they came across. mock test, and he drew a complete blank. Overcome by
Arvind had always been a little nervous before important panic, he suffered a complete breakdown.
events such as exams, debates and sports events. These
board exams, however, were different. “You make it in this Good anxiety Vs bad anxiety
exam, you are set for life,” is what he had grown used Anxiety is our brain’s natural response to a stressful
to hearing; but each time it induced a sense of panic.His situation, such as an examination, a job interview, or
worry had become so intense that he found it impossible a big match. Some anxiety is good, as it makes us
to think about anything else. He wasn’t eating well and more alert and helps us perform better. However,
looked extremely tired but his parents put it down to him for some people anxiety can become overwhelming
working hard on his exam preparation. In the past few days and cause them to panic. This hinders their ability to
he had tried to talk to his mother about these heightened perform regular functions because they experience
worries. “It’s your board exam, of course you will be a loss of control. The sense of doom can become
nervous,” she said, the first couple of times. But when his severely debilitating and the person can feel
complaints persisted, she too began to worry. “You don’t extremely lonely.
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So why is knowledge so crucial in such a scenario?
Without an understanding of what another person is
experiencing, it is close to impossible to help them,
no matter what the cause of their distress. Empathy
alone is not enough; in fact empathy without
knowledge can be damaging in some cases. Take
Arvind’s case for example. His mother obviously
cares about him and wants him to do well. But in
her lifetime she may have found many ways to
cope with her own anxieties, so she is unaware of
the effects that severe anxiety can have on her son.
While her intentions are good, she is unable to
help Arvind because she doesn’t know what he is
experiencing. Moreover, she projects her anxieties
upon him unknowingly, when she asks him not to
talk to his father. This makes Arvind feel even more
isolated and increases his distress further.
How others react to anxiety
How do we react when someone around us is How can we help people help others with anxiety?
worried? Typically there are three types of behavior It is safe to assume, that if Arvind’s mother was
that a person would exhibit towards someone who is aware of anxiety disorders, her approach would
extremely worried: have been different. This highlights the fact that
the right knowledge would better enable us to be
• Avoiding the panicky person because “it’s empathetic towards others.
not my problem,” or “you are just creating a
scene.” It is important for people to know what anxiety is
• Underplaying the person’s worry because and how it can lead to distress and poor performance;
“everyone has problems in life,” and “there is they also need to be aware that telling people to stop
no need for you to overreact.” worrying or change their mind-set. Understanding
• Trying to comfort the person with reassurance. and accepting that different people maybe anxious
about different aspects of their life enables us not
The first two reactions result from a general lack just to be empathetic but also to help the person find
of awareness about anxiety and how severe it can solutions. Solutions may include simple relaxation
be, and a lack of empathy. Many people are able to techniques, diverting oneself from worrying
cope with their worries, irrespective of whether it’s thoughts, brainstorming with well-wishers for
a small matter or something extremely serious and productive solutions for problems, etc. In some cases,
hence maybe ignorant of the fact that anxiety can be one may need to direct the person for professional
a severe condition that can hamper daily function. assistance.
To such people, someone’s inability to cope with
their anxieties or worries may come across as a sign
of weakness. This in turn may prevent them from
empathizing with an anxious person; they don’t find
it worthwhile to try and understand what the person
is going through.
There are yet another set of people who project their

own anxieties onto someone who is experiencing
panic. For instance, a person who is extremely
worried about some poor financial investments,
confides in his colleague about his worries. Rather
than reassure this person that it will be okay or that
it’s not such a huge loss, the colleague starts talking
about the alarming rate at which the cost of living
is increasing or the losses that he has had. This only
fuels the person’s anxiety further.
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Sanjay works at White Swan Foundation, a not-for-
Helping someone who is extremely anxious profit providing knowledge services in the area of mental
health. For more information, visit
• Remain calm: It is important that you remain www.whiteswanfoundation.org
calm and patient so that you can provide
reassurance to the person.
• Speak to the person in short and simple
sentences.
• Help the person to slow his/ her breathing slow
their breathing: Anxiety causes an elevated
heart rate and rapid breathing, Help the person
slow down his/ her breathing: if necessary,
demonstrate slow and deep breathing. Mr. Sanjay Patnaik
• Try and move the person to a calm place.
• Stay with the person till he or she feels less
anxious.
First Aid for Mental Health

Problems
When we see a person suffering a cardiac arrest of it or tell him/ her that things will get better.
or snake bite, we may have some awareness about However, such emotional states, especially if
what to do as basic first aid. But are we skilled severe or prolonged, are signs of mental health
enough to provide the same when we see a person crisis, and warrant attention and basic intervention
extremely anxious, tensed, sad or depressed? measures, which may be referred to as ‘Mental
Often the response is to ask the person to snap out Health First Aid’.
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are facing. If left without active intervention, these
problems can escalate to diagnosable mental health
disorders. Thus, it is of utmost importance to find
ways of improving the general public’s knowledge
and skills to provide first hand support to people
with mental health problems.
Who can be a Mental Health First Aider?

Anybody who is interested in connecting with
people, and wants to reach out when a person is in
distress, can be a Mental Health First Aider.
How can I go about it?

1. Identify the signs of mental health problems
and intervene
As a Mental Health First Aider, it is very important
to identify the early signs of a mental health problem.
The possible signs could be:
- Looking dull and listless

- Looking sad
Why Mental Health First Aid? - Lack of interest in surroundings
Myths and misconceptions are widely prevalent - Crying spells
about mental health and mental illness. This might - Talking of death and dying or suicidal
prevent people from talking about any mental health behavior
issues they may be experiencing, with family, friends - Irritability
or others. This can even cause a delay in seeking - Withdrawal from social gatherings
professional help. Thus, many individuals continue - Anger outbursts or aggression
to suffer silently. All of us face problems in our day - Unusual and unexpected behavior
to day life. However, while some of us are able to
cope effectively, some of us are not. When we are If you notice any of the above signs, approach the
not able to cope, it can manifest as various negative person with empathy and try to establish rapport.
emotional states like anger, irritability, and fear, to Once established, try to engage the person in talking
name a few. Such negative emotions, particularly about what could be bothering him/ her and ask if
when intense and prolonged, often stem from he/ she would be willing to talk about it. Make the
various issues such as being victims of bullying or person feel comfortable that he/ she can confide
domestic violence, going through critical stages of in you. Provide room for the person to decide
the life cycle such as old age, major life events such how much he/ she would like to share with you.
as, job loss, failure in academics, loss of loved ones, However, remember that the person may take time
migration, etc. . to confide in you. In many instances, just sitting with
the person, and letting him/ her know that you are
Friends and family members can have difficulty available, can gradually help the person to trust you
in identifying a person who is undergoing a and talk about any mental health problems he/ she
mental health problem. They might be aware that may be facing.
something is going wrong with their dear ones, but
feel helpless in providing aid. It may be often due 2. Avoid being judgmental
to lack of awareness of mental health problems At times, in trying to help others, we let our own
and what needs to be done. Availing mental health views dominate our communication, which can be
services may not be considered as the first option, detrimental. We may judge the person based on our
and delay in recognition and treatment could lead to views with respect to people or their problems. It is
worsening of the mental health problem. important to recognize this and learn to put our own
opinions and values on hold, while helping people
As a society, we are, and continue to be ignorant, in need of our support. For instance, avoid making
of the mental health problems that the members moral statements such as “This is not the age for
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you to fall in love” or “you need to realize that it is help individuals in defending themselves against
not right to think like that”, etc. Refrain from asking crisis situations that may come their way. Also
too many probing questions. The person may not be provide information about local support groups
ready to answer to you initially and can withdraw with which he/ she can connect, , participate and
from talking. Instead, engage more in listening, share his/ her problems.
which will allow the person to ventilate the issues
that may be bothering him/ her. Try summarizing at 5. Follow up
the end to make sure you have understood what the It would also help the person if you connect with
main problem areas are. him/ her occasionally to find out how he/ she is
doing and ask if any further assistance is required.
3. Encourage professional help
Once you are sure that the person is experiencing In conclusion, you can play a crucial role in
mental health problems, probe gently whether he/ identifying and intervening with mental health
she would like to get help. At times, the person problems, and making prompt referrals as needed.
affected may not be aware that help may exist for Such strategies will go a long way in preventing
the kind of problems he/ she is facing. If he/ she the problems from turning into a mental disorder.
appears keen, provide information as to where Mental Health First Aid is also simple, which
such help can be obtained, e.g. a psychiatrist/ anyone interested in helping can learn and practice,
psychologist/ counselor. Assure them that it’s and make a difference in the lives of people.
perfectly acceptable for them to seek professional
help. Instil hope that things will get better and
The Department of Mental Health Education,
problems will be professionally addressed.
NIMHANS, initiated training in First Aid for
Mental Health Problems in April 2016.
4. Build up coping strategies
Apart from medicines and psychotherapy sessions,
encourage the person to enhance his/ her coping Dr. K.S Meena
skills by expanding social network, developing new Assistant Professor
hobbies, reading books, volunteering for a social Department of Mental Health
cause, and so on. Strengthening coping skills can Education
NIMHANS, Bengaluru
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31
Childhood Fear
3 year old Vikram’s mother was shouting at him objects/situations when he or she sees his or her
Mom: Come and poo in the potty parent being anxious about the same. E.g., a vigilant
mother may scream or shout when she loses the
Vikky (Whining): No… child in a social gathering/crowd and she may cry
Mom: You will soil your pant if you don’t go now. after finding the child.
Vikky: No mommy, I’m scared to sit on the potty. When does a child feel fear?
There are various situations when a child can feel
Mom: What are you afraid of ?
fear:
Vikky: I’m afraid that I would fall in.
“It is very scary in the dark”.
What is fear? “The devil will come and eat me alive. So I can’t go
Fear is a normal part of child development. It helps to that dark room.”
children to avoid taking risks and hence ensures “Mommy, what if I get hurt in your absence?”
safety. For example, the child avoids going near a “Where are you going, leaving me alone?”
snake, when he/she is scared of it. However, the “The strange and crazy looking masks are
parents have to consider fear as serious when it frightening.”
interferes with the child’s daily activities, friendships “I don’t want to see a doctor because he hurt me with
and school. For instance, the child avoids attending a needle last time I met him.”
the school frequently because he/she is scared of the “I am scared of cockroaches because they might eat
teacher. me.”
How does fear develop in a child? How to identify fear?

Some children develop fear from their personal Children might have difficulty in talking about
experiences, e.g., a dog attack; however, in others, their fear. Instead, a child is likely to express fear
there may not be any events which triggered fear in through behaviors like crying, clinging, avoidance,
them. Children also develop fear by observing other discomfort and physical complaints such as stomach
children, for example, when a child is punished by ache, headache, sweaty palms or trembling. Often,
the teacher or when they observe others expressing parents and others may feel that the child is behaving
fear of monsters. Children also learn such behaviors this way to avoid school or other similar to school.
at home observing their parents. A child believes a But in reality, children could be genuinely afraid of
particular thing is unsafe and develops fear towards something.
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Help children to manage their fear • Provide support to the child. This doesn’t mean
that the parents have to be overprotective. It
• The first step in addressing their fear is to wouldn’t help the child if the parents keep the
understand that it is very normal for a child child completely out of fearful situations. For
to face fears for his/her age. The parents instance, it will not help the child if he/she is
need not expect the child to act brave and never sent to nearby shops because he/she is
show appropriate behavior. The parent has to scared of crossing the road. Instead, the parents
understand that the child might be fearful when can initially assist the child to cross the road
he/she cries and not necessarily disobedient. and help him to go to the shops.
Hence, showing a genuine acknowledgement
of understanding and listening to the child • In specific situations, the parents may need to
would help him/her. engage in overcorrection. For instance, if the
child soils clothes because he/ she is afraid to
• Keep reassuring the child that he/ she is safe. go use the toilet, the parents can get him/ her
For instance, parents can say, “I know it is to clean his/ her clothes, and the , place where
scary in the dark. So let’s do one thing. Let’s he/ she poops.
switch on the lights around the house when it
is dark and I’ll also make sure that you’ll have • Too much attention given by the parents can
a bed lamp at night in your room.” If the child maintain the fearful behavior in the child. This
continues to express fear, just tell him/her, is because avoiding the fearful situation can
“I’ve just explained it to you”, and leave it at bring in other privileges which may be adverse
that, there’s no need to repeat the same over for his/her development. For example, when a
and over. child is kept from going to school, it may reduce
his/her anxiety related to the teacher, but at the
• In certain situations, you may need to model same time, he would also get exempted from
appropriate behavior to the child. For home-work and other school-related activities
instance, it is very normal for a child to be necessary for his growth. Therefore, parents
scared of strangers, so let the child take time need to be understanding of the child, and yet
to feel comfortable with an unfamiliar person. firm, and gently persuade the child to attend
Meanwhile, stand beside the child and show school regularly. In instances where the child
friendly behavior yourself. Also, instead of displays extreme fear and anxiety, parents may
shouting at the child after finding him/her in a need to address the root of the problem. For
huge crowd (when they thought they had lost example, they may need to find out if the teacher
the child), say “It is confusing for me to search is engaging in harsh behavior towards the child,
for you in the crowd. Hence, you need to inform painful physical punishment, mental humiliation
me before leaving my hand and meeting your of the child, etc. In such cases, the parents may
friend.” need to approach the school authorities or take
other practical steps as relevant.
• Never force a child to encounter a situation all
of a sudden. But gradually expose the child • Other practical measures include physical
to fearful situations. For example, making activities which can help to reduce stress
the child to touch a dog if he/she is scared of in children and also help them sleep well at
dogs would only worsen the situation. Instead night. Stories at bedtime or when children are
initiate a discussion about dogs which could anxious, can help to reduce their fear.
be in the form of stories or one’s own good
memories associated with dogs. Gradually, the • In instances where nothing seems to be helping
parent can introduce dog’s images, then show and the children continue to be fearful or avoid
a dog in a video, and later show a dog from a situations, consult a professional at the earliest.
distance, once the child is comfortable. Later
the child can be taken near a dog. The whole Ms. Chaithra Holla
process of exposing the child to a dog should Research Assistant,
be done in a gradual manner and it requires Project BCHADS,
constant appreciation, encouragement and NIMHANS, Bengaluru
reward from the parents.
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33
War with My Thoughts
“Thoughts are powerful servants, but terrible Why do I call it a War with My Thoughts?
masters.” - Vedas
“Thoughts are like open ocean, they can either
My life is a war with my thoughts. The war move you forward within its waves, or sink you
started at the age of 17 years when I was studying under its abyss.” - Anthony Liccione
Intermediate in Narayana Junior college, Kurnool,
Andhra Pradesh, in the year 2004. The enemy in my It is indeed a war with my thoughts. I am calling this
thoughts, waging a war, was schizophrenia. The as a war because Schizophrenia is a thought disorder.
allies of my enemy were hallucinations, delusions, This thought disorder is because of certain neuro
negative thinking, and anger. It took eleven years transmitters in the brain that become unbalanced.
for me to conquer my enemies completely. Now I am Awareness of the war with your thoughts is the first
doing Ph.D in Psychology from Sri Venkateshwara step to cure yourself.
University, Tirupati. I also qualified in National
Eligibility Test (NET), conducted by University 5 ‘E’ formula to Win War with the Thoughts:
Grants Commission (UGC), on December 28,
2014, and State Eligibility Test (SET) conducted by 1) ENDURANCE: “What cannot be cured, has to be
Osmania University on February 15, 2015. I have endured.” Most psychological problems cannot
written two self-help books in Telugu language be cured. But with endurance, we can minimize
titled “Jeevana Parishkaralu” and “Ee kshanam the losses created by it. The determination of the
Dhyanam” (translated as ‘Life Solutions’, and patient to fight with his own thoughts, emotions,
‘The Meditation of this Moment’, respectively) My and behavior is crucial. Accepting the fact that I
third book “Chaduvu Kuntunnama..? Chaduvu am the problem is the first step to win in a war like
Kontunnama..?” (which translates as “Are We Schizophrenia. I was admitted as an in-patient
Studying, or Buying Education?”) is also under and I was treated for three weeks. I dropped out of
publication. college twice in my pursuit to study engineering.
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I was unable to continue my education because calming his mind and enabling him/ her to sleep
of my problems related to Schizophrenia. Voices well. When I was studying my Intermediate, I
in my head, telling me that I am not a male, and couldn’t sleep at nights due to undesirable
voices coming from T.V. pictures and commenting thoughts going through my mind and making
on my daily routine persisted till 2012. me restless. But, after taking medication I found it
easy to have a good night’s sleep.
Later, I decided to pursue distance education and
joined Bachelor of Arts (B.A), and M.Sc Psychology “Right thought plus right people in the right
from S.V. University, Tirupati. It never was an easy environment at the right time for the right reason
ride; even there I had to battle poor concentration, is equal to right result.” - John C. Maxwell
and was unable to read my text-books or write for
a long time. I failed a few times, but somehow, 4) EFFECTIVE COUNSELING: A psychologist
with the help of my Dad and brother, I crossed this in Tirupati gave me a lot of emotional support,
hurdle. I worked as an Academic Consultant in so that I was able to face my thought disorder
Psychology at Yogi Vemana University, Kadapa, courageously. This contributed to my speedy
for six months. I heard about NET and SET exams recovery. In his magazine Jeevana Vikasam, my
for the first time from my colleagues while at this articles were published for two years. He is the
university. I decided to take a shot at it in order to one who had encouraged me initially to write
pursue a career in teaching, and finally succeeded self-help articles and later I wrote books, learning
after 5 attempts. some basics from him. He has also encouraged me
to give training programs in Sri Venkateshwara
What particularly helped me was that I was a Employee Training Academy (SVETA) for
voracious reader, and read a lot of self-help books. Tirupati Tirumala Devestanam (TTD) employees.
Also, the practice of Kriya Yoga for one year I have given twenty training classes. I have learnt
helped me to improve my concentration and win from him that a counselor should also act as a
the war with my thoughts. friend, motivator and a compassionate family
member, if necessary.
“some people see hopeless end, others see endless
hope.” - E.B.Norton “The value of life lies not in the length of days but
in the use we make of them. A man may live long
2) ENCOURAGEMENT: My father Sri J.Venkata but yet live very little.” - Montaigne
Swamy, and my mother Smt. J. Radhika, are a
big support to me in every aspect of my life. They 5) EXERCISES: Daily physical activities, doing
are the pillars of my success. Frankly speaking, exercises help to maintain fitness levels of the
I had even beaten my mother once in 2004. Yet, patient. It helps to reduce obesity, because one of
they tolerated my anger, and showed unlimited the side effects of the medication is overweight.
compassion and love. They never discouraged Exercises also reduce anxiety, help in getting a
me and never criticized me saying that I am good night’s sleep, maintain good mood, and
mad and can’t achieve anything. They adjusted reduce depression. So regular exercise and
their attitude according to my health condition practice of Yoga is a great recipe for sound mental
and fully cooperated and supported me. My and physical health.
brother also loves me so much. I also thank my
publisher and Professors for supporting me in my Yes I agree that schizophrenia is a deadly disorder.
academics. But it is possible to overcome it. The above 5 E’s
are extremely helpful for the patient to win the
“Love all. Serve all. Help ever. Hurt never.” - Sathya odds against Schizophrenia. It is important to
Sai Baba understand and encourage the people suffering
from schizophrenia.
3) EFFICIENT DOCTORS: Efficient doctors have
been treating me from a long time. It is extremely Mr. J Pradeep
important to take medications and go for check- M.B.A;M.Sc(psychology);
ups regularly, in order to experience maximum P.G.D.G.C;NET;SET;(Ph.D)
recovery. Medication helps to maintain chemical
balance in the brain. They also help the patient by
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35
Mental Health for Everyday Life
Public Lecture series at the NIMHANS Centre for Well-Being, BTM Layout
The NIMHANS Centre for Well-Being is starting a regular series of public lectures on mental
health issues that we face every day. These topics aim to de-mystify mental health issues and
create a bridge between experts and the community. There will be thought provoking talks
by prominent mental health professionals from NIMHANS. The lecture will be held for a
small and intimate audience of 40-50 people to encourage interaction.
Public lectures planned in the next six months include topics such as -
Parenting; Alcohol use; Creating a mentally healthy workplace; Handling emotional
situations in relationships; Making aging an easier experience and Technology addiction.
Lectures will be held every Third Saturday at the NIMHANS Centre for Well-Being between
5 and 6 pm. All lectures will be available for later viewing.
Venue
NIMHANS Centre for Well-Being
1/B, 9th Main, Ist Stage, Ist Phase, BTM Layout, Bengaluru-560076
To Register Contact: 080-26685948 or 9480829670
Printing of the Magazine funded by: Dr. Ramachandra N Moorthy Foundation for Mental
Health and Neurological Sciences
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Loud Speaker Magazine 5th Issue - Final (Fears & Anxieties)

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LoudSpeaker

Amplifying the voice of mental health

Fears & AnxietIES

...Plus Our Regular Features

Mental health for persons with medical illnesses

Marital enrichment services

Brief psychotherapies &

Enhancing positive mental health

Parents support group

Prevention & early treatment for addiction

Enhancing parenting skills & child mental health

Services for healthy use of technology

Workshops & training programs in mental health

Elderly helpline & mental health helpline

2 Amplifying the voice of mental health

Amplifying the voice of mental health

Dr. Prabha S. Chandra

Editorial Team: Sub Editors

Amplifying the voice of mental health

Exam Anxiety: How to

4 Amplifying the voice of mental health

First aid for Mental Health

Coping with the Loss of a Partner War with my thoughts

Amplifying the voice of mental health

6 Amplifying the voice of mental health

Health anxiety is a clinical condition where the

Factors that may trigger health anxiety:

How can you recognize health anxiety?

You may be suffering from health anxiety if:

Amplifying the voice of mental health

• Discuss your concerns about your health with

8 Amplifying the voice of mental health

Amplifying the voice of mental health

In case you are not able to handle the negative

After the exam starts: Stay calm, read the question

Role of positive thinking and having realistic

10 Amplifying the voice of mental health

Amplifying the voice of mental health

GAD may also present with physical symptoms such

4. What are the causes of GAD?

12 Amplifying the voice of mental health

Amplifying the voice of mental health

14 Amplifying the voice of mental health

There is a crucial need to understand the differences

Amplifying the voice of mental health

Specific phobia which is excessive or irrational fear of

16 Amplifying the voice of mental health

Signs and symptoms for habituation of fear and eventually extinction of

Amplifying the voice of mental health

18 Amplifying the voice of mental health

Talk to your doctor about how you can set limits

You also need to remember to be patient, as the

What does it feel like to have OCD and how can I

For the most part, people with OCD know what

Telling your loved one with OCD that what they

Amplifying the voice of mental health

20 Amplifying the voice of mental health

Sleep Hygiene Rules

Amplifying the voice of mental health

Source: Prasanthi Nattala, Pratima Murthy,

You Have a ‘Panic Attack’,

22 Amplifying the voice of mental health

Symptoms of panic attack: