Conditions and Treatments
This text gives an overview into the conditions an IAPT service will treat. It
has been prepared here for you to use as you see fit in your locally produced
materials.
All material has been taken from NHS Choices and is therefore nationally
approved at the time of this toolkit’s publication. More in depth and up to date
information can be found online at NHS Choices www.nhs.uk
The Information Prescription Service available on NHS Choices is an
excellent service covering the many different aspects of depression and
anxiety disorders.
NHS Choices online: www.nhs.uk
For more information on Depression go to:
http://www.nhs.uk/pathways/Depression/pages/landing.aspx
http://www.nhs.uk/Conditions/Anxiety/Pages/Symptoms.aspx
Anxiety
Feeling anxious sometimes is perfectly normal but, for people with
generalised anxiety disorder (GAD), feelings of anxiety are much more
constant and tend to affect their day-to-day life.
There are several conditions for which anxiety is the main symptom. Panic
disorder, phobias, and post-traumatic syndrome can all cause severe anxiety.
Generalised anxiety disorder (GAD)is a long-term condition that makes
people feel anxious about a wide range of situations and issues, rather than
one specific event.
People with GAD feel anxious most days and often struggle to remember the
last time they felt relaxed. GAD affects about one in 50 people at some stage
in their life and can cause both psychological and physical symptoms.
Slightly more women are affected than men, and the disorder is most
common among people in their 20s. GAD can significantly affect daily life,
making it difficult to perform everyday tasks.
Panic disorder causes people to have feelings of anxiety, stress and panic at
any time, usually for no obvious reason.
Panic attacks cause a rush of intense psychological and physical symptoms,
which may include an overwhelming sense of fear, apprehension and anxiety.
Physical symptoms, such as nausea, sweating, trembling and a sensation of
irregular heart beats (palpitations) may also occur.
A panic attack can be very frightening and intense but is not dangerous and
will not cause physical harm.
At least one person in 10 experiences occasional panic attacks, usually
triggered by a stressful event or situation, but people with panic disorder have
recurring and regular attacks, often for no apparent reason. Some people may
have one or two attacks each month, while others may have several attacks a
week.
In the UK, about one person in 100 has panic disorder and it is around twice
as common in women as it is in men.
Phobia is a constant, extreme or irrational fear of an animal, object, place or
situation that would not normally worry most people.
It is characterised by an overwhelming need to avoid any contact with the
specific cause of the anxiety or fear. Even the thought of coming into contact
with the cause of the phobia causes anxiety or panic.
Everyday life is not affected much if it is unlikely that you will come into
contact with the object of your phobia (for example, snakes) but agoraphobia
and social phobia can make it very hard to lead a normal life.
Simple phobias ares about a single object, situation or activity. Common
examples are a fear of insects, heights, snakes, enclosed spaces, dentists or
flying.
Complex phobias, like agoraphobia involve several anxieties, including fear of
entering shops, crowds and public places, or of travelling in trains, buses or
planes. It also includes anxiety of being unable to escape to a place of safety,
usually home.
Social phobia is another complex phobia involving 1-2% of men and women
who fear social or performance situations, such as a wedding or public
speaking in case they embarrass themselves or are humiliated in public. In
extreme cases, some people are too afraid to leave their home.
Obsessive compulsive disorder (OCD) is one of the most common mental
health conditions affecting an estimated 1-3% of adults and 2% of children
and teenagers. It is a chronic condition usually associated with both
obsessive thoughts and compulsive behaviour.
An obsession is an unwanted thought, image or urge that repeatedly enters a
person’s mind. A compulsion is a repetitive behaviour or mental act that a
person feels compelled to perform.
A person with OCD gets no pleasure from their compulsive behaviour but
feels they need to carry out their compulsion to prevent their obsession
becoming true. For example, a person who is obsessed with the fear that they
will catch a serious disease may feel compelled to have a shower every time
they use a public toilet
OCD symptoms can begin at any time, including childhood, but in men usually
begin in adolescence and in women usually start in the early 20s. Causes are
unknown but symptoms can range from mild to severe. Some people with
OCD will spend around one hour a day engaged in obsessive compulsive
thinking and behaviour, while for others, the symptoms completely dominate
their life. The causes of OCD are unknown.
With treatment, the prognosis for OCD is good. Some people achieve a
complete cure and others can reduce their symptoms and achieve a good
quality of life. Cognitive behavioural therapy (CBT), can be very successful in
helping many people with OCD.
Post-traumatic stress disorder (PTSD) is a psychological and physical
condition that can be caused by extremely frightening or distressing events,
such as military combat, natural disasters, serious accidents, terrorist attacks,
violent deaths, and personal assaults, such as rape, or other situations in
which the person felt extreme fear, horror, or helplessness.
It affects around 5% of men and 10% of women some time in their life and
can happen at any age. About 40% of people with PTSD develop it as a result
of someone close to them suddenly dying.
Someone with PTSD often relives the experience through nightmares and
flashbacks, and has difficulty concentrating and sleeping, feeling isolated and
detached. from life. These symptoms can be lasting and severe enough to
impair the person's daily life significantly.
Symptoms usually develop immediately or within three months of a traumatic
event but, occasionally, they do not begin until years later.
PTSD has been called shell shock or battle fatigue syndrome because it first
came to prominence in the First World War, with soldiers' memories of the
trenches. Now, it is recognised that traumatic events outside conflict situations
can have similar effects.
Stress
Stress is the way you feel when under pressure to do something. A little bit of
pressure can be productive, give you motivation, and help you perform better
at something - but too much or prolonged pressure can be unhealthy and lead
to physical, mental and emotional problems.
Everyone reacts differently to stress, and some people may have a higher
threshold than others. In the UK, anxiety and depression are the most
common mental health problems, and the majority of cases are caused by
stress.
When faced with a situation that makes you stressed, your body releases
chemicals, including cortisol, adrenaline and noradrenaline, which invoke the
'fight or flight' feelings that help us deal with the situation. But in a situation
where fighting or escaping is impossible, such as being on an overcrowded
train, these chemicals are not used and can increase blood pressure, heart
rate and sweating as well as releasing fat and sugar into the bloodstream and
preventing the immune system functioning properly.
Depression
For people with depression, the usual feelings of sadness that we all
experience temporarily remail for weeks, months and years. Depressed
people may fee; worthless, hopeless and constantly tired. Daily life can be
affected so that they cannot work normally, don’t want to be with family and
friends and stop enjoying the things they usually do.
In milder cases, people can probably carry on although they find everyday
tasks difficult but in severe cases people may find their feelings so unbearable
that they start thinking about suicide.
About one in 10 of us develops some form of depression in out lives and one
in 50 has severe depression. It affects families and friends as well as the
depressed person. Studies suggest women are about twice as likely to have
depression as men but this may be because women are more likely to seek
help.
Some studies suggest depression is more likely as we get older and it’s more
common among people who face difficult social and economic circumstances.
Depression isn’t a sign of weakness, it’s a chronic condition that may require
long-term management or treatment. Some people only have depression
once but many people have repreated episodes.
With the right treatment and support, most depressed people make a full
recovery so it is important that people who think they may be deptessed seek
help from their GP.
Causes of depression are complex and may increase as a result of
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A stressful life event such as bereavement or relationship breakdown
Diagnosis of a chronic or life-threatening illness
Being vulnerable to depression due to low self esteem or being overly
self-critical
Having recently given birth, because of hormonal and physical changes
Being cut off from family and friends
Drinking excessively, using drugs or substance abuse
Effective treatment for depression has been identified by the National
Institute for Health and Clinical Excellence (NICE).
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For people with mild depression, further assessment is required,
usually within two weeks as the patient may recover without
intervention. Anti-depressants are not recommended at this stage but
guided self help, such as computerised cognitive behavioural therapy,
should be considered.
For people with mile to moderate depression, psychological treatments
should be considered – mainly cognitive behavioural therapy (CBT),
perhaps with antidepressant drugs. Selective serotonin reuptake
inhibitors (SSRIs) should be considered over tricyclic antidepressants
because of better safety and fewer side effects. Patients should be
informed that withdrawal symptoms may occur when stopping, missing
a dose or reducing the dose.
For people with severe depression, a combination of antidepressants
and individual CBT should be considered as combining the treatments
is more effective than using them on their own.
Cognitive behavioural therapy helps you understand your current thoughts
and behaviours and how they’re affecting you. It recognises how events in
your past may have shaped you but concentrates mostly on how you can
change the way you think, feel and behave in the present day. It is the most
well-known and best-studied talking treatment for depression and is used to
treat all types of depression.
Computerised CBT can be delivered on a personal computer, via the internet
or by telephone using voice-response systems. It can help people who don’t
want to take antidepressants and may be useful for those who have a phobia
about going out because it can be used at home.
Inter-personal therapy is sometimes used to treat people with mild to
moderate depression. It originated from the work and theories of 1930's
psychiatrist Harry Sullivan who suggested that patients’ interpersonal contact
with others might help to shed light on their mental disorders. Interpersonal
therapy does not belong to any particular school of psychotherapy, but is
based on the experimental work of individual practitioners. The approach is
concerned with reducing the symptoms of depression and improving the
client's interpersonal interaction with others.
Couples therapy is sometimes used to treat people with mild to moderate
depression where relationship issues are a main factor. Couples will take part
in between 16 and 20 sessions spread over four to six months.