Yearly Archives - 2016

Performance anxiety

Performance Anxiety

Performance Anxiety Cardiff

Most performers have experienced performance anxiety at some point in their careers. When that “big” opportunity comes along to shine and demonstrate your knowledge, talents and skills, it can be normal to get the “jitters” leading up to and during your performance. Some nervousness is not always a bad thing; it encourages a state of readiness and alertness.

Musical performance anxiety
Performance anxiety can affect the most competent performers

But performance anxiety can devastate the careers of some of the most competent performers. When it is persistent and overwhelming, your own mind can rob you of the endless preparation from which you have passionately dedicated your performing life. For some of you, performance anxiety can adversely suffocate those life-changing, testing situations that seem to fall into your lap once in a while. You plan, rehearse (and revise) for the big day, but find that your anxiety can destroy what you were doing so perfectly whilst practicing just hours or days earlier.

Managing your fear is an essential part of being able to “nail it” in your performance. When you can control your anxiety and the associated symptoms, you are free to demonstrate your creative abilities.

 

What is performance anxiety?

  • As a performer, it can be defined as your perceived conflict between the demands of the performance situation and your ability to meet those demands.
  • Performance anxiety is the overwhelming negative mental, emotional and physical response prompted in a performer when performing.
  • It can be experienced in anticipation of, or during a performance to a given audience (or potential audience if you are making a recording).
  • The heightened negative state of arousal provokes a distressing response that limits or undermines the ability to accomplish the performance in the desired manner.
  • The anxiety can affect you in various ways e.g. hand tremors, nausea, muscular tension, petrification etc. are just some of the unwanted symptoms that you can experience.
  • Unfortunately, the part (or organ) commonly affected by the anxiety is the part primarily used in your performanceg. singers may find that their voice is distorted or musicians will tense up their hands (or their lips/embouchure etc. depending on the instrument played.)
  • Your performance anxiety may be part of a deeper social anxiety trait characterised by shyness, fear of embarrassment, negative social attention and social criticism. Essentially you are preoccupied with what others are thinking about you and this becomes more severe when a certain audience-type is observing you e.g. a competitor. (But not all anxious performers have social anxiety.)

 

Who is affected by performance anxiety?

Performance anxiety can be experienced by anyone. Even the most competent performers can accumulate a few “bad experiences” and the way that you react to it can alter how you function in your future performances.

  • Performing artists and other professionals – You are passionate about expressing your creativity on a day to day basis. You thrive on communicating your chosen art form, but when you develop performance anxiety, it annihilates your spirit and destroys the essence of who you are. Actors, dancers, musicians, singers, comedians, entertainers, athletes, politicians, lecturers and professional speakers are included in this category.
  • Professionals who want to promote themselves – The success of your profession has brought you into the limelight. Your followers request your presence to personally share your expertise. Going on “stage” was not your intended path; it has arrived and now you need to make a decision: confront your fear or hide in the shadows of your potential success. Teachers, writers, lawyers, managers, doctors, engineers and architects are included in this category.
    Performance anxiety during an interview
    Anxiety during an interview can affect your performance
  • Occasional “performers” – You are aware of your performance anxiety but you keep the subject-matter hidden from your peers. You are ashamed to admit it because the issue creates a mass of insecurity. Work requests a presentation from you, but you cleverly manage to avoid it or you delegate it to other subordinate staff. You may be required to speak at an informal occasion now and again e.g. a wedding, or sports presentation, and this is where your avoidance finally catches up with you. Years can go by when all is quiet on the performance front, but when the situation comes knocking at your door, you want to pretend that nobody is in! Avoidance can leak into those informal situations and take you by surprise e.g. with sexual performance anxiety or during in an interview.
  • Anxious “avoiders” – You have known from a very young age that you struggle with social attention and social embarrassment. Your chosen career and social pursuits keep you safe from the threat of being on stage. You know how to avoid these situations and can aggressively refuse the opportunity if it is demanded of you. You may have let down some people close to you e.g. when refusing to give a best man’s speech. You regret not having developed the skills and courage to deal with those special occasions.

 

Types of performance anxiety

Performance anxiety is broadly categorised as a type of social anxiety, but not all performers have social anxiety. As a performer, even without social anxiety your own personal traits can work against you in situations when you are need to perform e.g. when you are a perfectionist.

Performance anxiety can be placed into three broad categories (with some overlap):

1.Cognitive performance anxiety,

2.Social performance anxiety and

3.Skills (or motor) performance anxiety.

  1. Cognitive performance anxiety

This category is defined as the anxiety experienced when using previously learned knowledge and applying it to a specific situation such as a written test or exam in school, college or in your profession. All categories of performance anxiety involve a level of cognitive functioning, but this category considers the use of internal “mind” processes that are usually then written or typed in a time-restricted situation.

Unlike the majority of the situations in the other categories of performance anxiety, there may not be an immediate “audience” in this situation. However, the consequences of the exam could become known to a potential audience e.g. your peer group will know about your grade at a later stage.

Test and exams are the common assessment methods to establish levels of academic competence in school, further and higher education, and employment. The higher the grade, the more likely you will gain entrance into your choice of university and advance your chosen career; exams undoubtedly have a high level of cultural importance.

So what turns the exam into a performance anxiety situation?

Anticipatory (or pre-exam) anxiety – This affects you hours, days or weeks before the big day. It can include issues like whether you have done enough revision, will be able to recall the information on the day or will have the right (or wrong!) questions appearing in the exam. You then worry about the consequences of failing and how this will affect your future career.

Managing anticipatory anxiety is an issue in itself. You have to suspend your ability to deal with something and get it out of the way now because the event takes place in the near future. Anticipatory anxiety tends to fool your mind into believing that you will have a catastrophe e.g. sleep-in and miss your morning exam, have a “mind-blank” or panic attack that numbs your mind for the whole duration. Known stress-related symptoms e.g. insomnia, IBS, nausea can also be added into the overall fear of what might negatively affect the big day.

Anticipatory anxiety also builds up your worry and physical tension levels to such a degree that by the time you get to the exam day, you feel exhausted. High anxiety can also negatively distort your clear thinking; it predisposes you to exaggerate the things that could go wrong.

Exam performance anxiety
Anxiety can block your concentration in an exam

Mid-exam stress/anxiety – You arrive in the exam room and the “fight or flight” mode kicks-in. Having too much adrenaline can stifle your thinking, concentration, understanding, recall and problem-solving abilities. You worry about how the next couple of hours will go, how you can manage your time, and the implications of your unsuccessful exam performance.

Post exam anxiety – “Pens down!” and that’s it, it’s over! Did you interpret that question correctly? Did you forget some of the answers to question 5? Should you discuss with your peers how others have answered it? Or look at your class notes just to ease your mind? What if you haven’t done enough? How will it affect your application or job prospect if you have failed? How long do you have to wait before you know the outcome? These are the common anxious post-exam questions that the student will ruminate over. This accumulates the anxiety into your next exam or series of exams.

Medical background and personality traits – Certain medical conditions, personality types and attitudes can affect your cognitive performance anxiety. If you suffer with general anxiety disorder, panic disorder and obsessive compulsive disorder, you are likely to be overwhelmed by the whole exam process.

Your personality traits, values and situation can also affect how you perceive doing exams. They can include:

  • Perfectionism.
  • Being self-critical.
  • Using exam grades as markers for your self-esteem. This can increase the pressure of achieving high grades.
  • Having unrealistic expectations.
  • A fear of failure.
  • Low motivation.
  • Low self confidence.
  • Being in fear of judgements from your family and peer group.
  • Poor study and exam skills. As the pressure mounts, you can overload your timetable of study with little attention to balancing lifestyle habits (diet, sleep, rest and exercise) inhibiting your learning potential, recall and concentration abilities in the exam.
  • Even teachers who are aiming to motivate their students can inadvertently inflict fear (and thus more stress) onto their students. Rather than the highlighting the benefits of passing, teachers may project your mind onto the consequences of failing by saying that “if you don’t pass your exams, you won’t get into University!” A reason for doing this can be because a teacher’s effectiveness is often based on high student outcomes.

 

  1. Social performance anxiety

Social performance anxiety is the anxiety experienced when performing or communicating in a social situation. Social performance anxiety is intensified by general anxiety disorder and social anxiety disorder (social phobia).

With social performance anxiety, you are externally focused on the reactions of others. Typically, you are preoccupied with the belief that your audience is criticising, judging or rejecting you in some way. What you say or do (or don’t say or do) has the effect of drawing unwanted attention, generating feelings of embarrassment, humiliation, insecurity and worthlessness. You can become preoccupied with your own anxiety symptoms (e.g. panic attacks, blushing, stammering and physical tension) disrupting how you want to communicate with your audience. You believe that these anxiety symptoms make you “visible” to them and incapable of achieving the high standards you want, or of those expected of you. Anticipation of the event can trigger anxiety for weeks or sometimes months ahead of the situation.

Social performance anxiety can be divided into two areas:

  • Formal social performance anxiety can be defined as the anxiety experienced when you are required to present (usually rehearsed and structured) information to an audience.
  • Informal social performance anxiety can be defined as the anxiety experienced when you are required to communicate socially (either verbally or non-verbally) with your audience.

 

  • Formal social performance anxiety

Formal social performance anxiety usually involves presenting rehearsed (or sometimes spontaneous) content to an audience without their active participation in the situation (i.e. only you are required to speak to your audience). It can also include interactive formal situations where you and what you present are the focus of the situation but the audience are required to respond/interact with you in some way e.g. when teaching or being interviewed.

With rehearsed content, formal social performance anxiety often involves a number of preparatory stages including: researching your content; organising it into a coherent and logical structure; learning, rehearsing and memorising the content; considering any stage management issues and use of visual aids; taking into account any situational and personal limitations, and of course, managing your performance anxiety on the day.

Some common examples include:

  • Public speaking – speaking at a formal dinner, funeral or in a courtroom (as a lawyer or witness giving evidence)
    Formal social performance anxiety
    Giving a formal lecture can seem daunting at first
  • Presentations – promoting yourself/your business, or speaking as part of a school class or college assessment
  • Stage performances – acting in a theatre production or making announcements in a school assembly
  • Lectures – giving a formal lecture to students or other professionals in your niche
  • Speeches – speaking at a wedding or special occasion
  • Interviews – identifying typical questions that you will be asked and rehearsing the most appropriate answers ready for the interview
  • Oral exams – being assessed in language exams or discussing your thesis (viva voce)
  • Meetings – Speaking, presenting or chairing formal meetings at work or for an organisation
  • Singing – Being examined giving a solo vocal performance or as a part of a band in front of an audience
  • Selling or sales performance – The pressure of achieving your sales targets can affect your selling technique

 

  • Informal social performance anxiety

Informal social performance anxiety involves an interactive exchange of talking, listening and reacting to your audience. This situation can include communicating to one person, a group or a much larger audience. The situation is spontaneous and for many, it is more socially demanding; you believe that you can only deal with it when you get there and thus are required to “think on your feet”.

Those who “hide” behind excessive preparation as a way of managing social anxiety in formal situations can struggle with the impromptu nature of these informal situations.

Some common examples include:

  • Meeting new people and making polite conversation
  • Attending parties or large social occasions
  • Being criticised or teased
  • Talking to important people or authority figures e.g. teachers, bosses, police officers
  • Going on a date or chatting someone up
  • Making an important phone call when in the presence of others or when you are alone

In some (more formal) informal social performance anxiety situations, you want to speak or are required to speak without much time to prepare your answer. There is a momentary “spike” in your anxiety which diminishes when you have finished.

Some examples include:

  • Participating in role-play as part of work-based development training
  • Asking/answering a question in class and worrying that you may get the answer wrong
  • Introducing yourself or speaking up in a work meeting
  • Ordering food in a restaurant
  • Answering unrehearsed questions at the end of a presentation, meeting or interview
  • Asking for help – asking for directions when you are lost
  • Dealing with conflict – dealing with aggressive people

Informal social performance anxiety can also involve doing common day-to-day obligations that might “put you in the spotlight” and become the focus of attention in social situations.

  • Being observed whilst eating, drinking, learning, writing or working
  • Walking into a room full of peopleg. a party or classroom
  • Arriving late or having to leave early from a meeting
  • Leaving a cinema or theatre to go to the toilet
  • Doing something that draws attention to you e.g. sneezing, coughing etc. in a lecture room
  • Shopping – feeling visible to other shoppers or sales staff
  • Having your photo taken or being videoed
  • Using a public toilet – feeling so self conscious in the toilet that your bodily functions become affected e.g. you develop shy bladder or feel constipated
  • Being stared at when walking past a group of people
  • Making eye contact with people in general

 

  1. Motor (or skills) performance anxiety
    Skills or motor performance anxiety
    A driving test or just driving can create anxiety

Motor-based (or skills) performance anxiety is the anxiety experienced when physically moving or demonstrating learned (behavioural) skills in front of an audience. The anxiety can also be experienced when performing to a potential audience i.e. when you are being videoed.

As with the other types of performance anxiety, you can experience symptoms for many weeks leading up to the actual performance. The anxiety can affect you during practise or training sessions. It can also affect you when you are away from practise (i.e. when worrying).

The term “motor” performance anxiety is a Latin term from the word movēre. It refers to movement (rather than something exclusively related to cars!) As with the other previous types of performance anxiety, motor performance anxiety can be intensified by general anxiety and social anxiety disorder.

Motor (or skills) performance anxiety can be divided into two areas:

  • Formal motor performance anxiety affects your ability to demonstrate rehearsed “skills” in front of an audience. The skills can be applied in a “closed” or set routine. Or the skills can be performed in an “open” field of play when responding to how others are performing (with you or against you).
  • Informal motor performance anxiety affects your ability to demonstrate everyday physical skills, tasks and movement in more casual and social situations.

 

Formal motor performance anxiety

Formal motor performance anxiety situations can include those situations in which you are taught or coached in training sessions (lessons) leading up to the actual performance. The anxiety usually accumulates as the day of the performance beckons, heightening your physical tension levels and affecting the fluency of your skills. It may peak immediately before or as you start your performance. There may also be specific parts of the performance that are perceived as more difficult/pressured and more likely to force an error. In turn, you believe that the mistake will draw more negative attention e.g. when missing a penalty kick that knocks you out of the cup tournament. Additionally, you may be fearful of your ability to recover during the performance if something were to go dreadfully wrong e.g. having a sustained panic attack or show of nerves during a performance could destroy your reputation!

The anxiety can be associated with any audience members, including a future audience when making a video. They can include your managers, teaching or coaching staff, peers (other team members), the opposition, the general audience/spectators, clients, examiners etc. The audience do not have to be present to generate anxiety; what you tell your future audience (family, peer group or colleagues) about the negative outcome can be a continuous preoccupation during the performance; “what will they think of me?”

As with the other types of performance anxiety, the part of your body that is primarily used in the performance e.g. the hands when playing an instrument, can become excessively tense, dysfunctional and prone to “locking” when compared to how it is freely used during practise.

Some examples of formal motor performance anxiety include:

  • Musical (instrumental) performances – This includes the precise bi-lateral coordination of the arms, hands and fingers used to play instruments (and legs e.g. when playing a drum kit). Woodwind and brass instruments also require the synchronised use of breath and embouchure to create a harmonised sound.
  • Dance performances – Any sequence of rehearsed rhythmical movements that can be mistimed, forgotten or petrified e.g. ballet, tap dancing, modern etc.
  • Skilled stage entertainment – This can include circus acts, magic shows, physical comedy (slapstick, clowning and mime) etc.
  • Practical lectures/presentations/demonstrations – This includes live visual illustration of artistic, creative and educational skills e.g. during cookery demonstrations, when teaching mechanical skills etc.
  • Medical skills – This includes training in hospital wards, clinics or theatre. Skills can include injections, dressing wounds, manipulations, surgical operations etc.
  • Sports performance – This includes any sporting situations with the performance of “closed” skills e.g. throwing darts, shooting at a goal in ball sports, shooting with a rifle, taking a penalty, potting a ball in snooker, golf strokes, serving in tennis, field events in athletics. Or anxiety experienced during “open” match play e.g. tackling, defending, dribbling, sparring, running etc.
  • Driving test – Passing your driving test is your ticket to being mobile and boosts certain job opportunities. The driving test can expose hidden skills-based performance anxiety in a one-off situation that you may have avoided in other parts of your “performing” life. Your driving instructor may be unaware of its severity in driving lessons until you have failed your test (maybe several times).
  • Practical exams – This includes being practically assessed with a time limit in any vocational course e.g. hairdressing, car mechanics, electrician, plumbing etc. A catastrophe in your exam can throw away one of two years of study when anxiety takes hold of your performance.
  • Practical interviews – As with practical exams, you may be required to solve a timed practical problem with very little notice to prepare e.g. build a bridge that can support a small weight using only 5 sheets of paper.

 

Informal motor performance anxiety

Informal motor performance anxiety situations can include those situations which are spontaneous, casual and may not require a (perceived) rehearsed skill; you may believe (because of social expectation or fear of embarrassment) that you just ought to be able to perform the task perfectly in the given situation.

As with other types of performance anxiety, the physical tension accumulates and can peak just before or during the situation. You can also be overwhelmed with your physical anxiety symptoms and they can preoccupy you, affecting your ability to concentrate on the desired task.

How you perceive your audience can affect the level of your anxiety. It can be higher with a larger audience, or because some of the specific members of the audience are considered important or more threatening e.g. your competitor is in the audience. But even with fewer individuals in your audience, your perceived relationship with them can vary the intensity and timing of your anxiety. For example:

  • You may know them well and trust them as is often the case with family and close friends.
  • You may know them to some degree, but may not see them for some time, leaving you unsure of their opinion of you, as can be the case with colleagues or other members of a club.
  • You may not know them at all and are unable to judge their response.

You can assume that the more you know them, the safer you feel, but this isn’t always the case. Some people feel more embarrassed in front of their family performing certain tasks. And for some people, performing in front of strangers can feel safer than group (ii) because you don’t care about them. With group (ii) you have to confront them again at some later stage and it’s that period of time where you are left worrying about their opinion that causes the embarrassment to fester. “What will they say to you when you see them next?!!”

Some examples of informal motor performance anxiety can include:

Sexual performance anxiety
Fear of embarrassment can impact on your sexual performance
  • Sexual performance – Conditions like erectile dysfunction, premature ejaculation and delayed ejaculation for men can be influenced by anxiety. Anxiety can also affect women’s sexual arousal with conditions like vaginismus, low sex drive and inorgasmia.
  • Practical training days at workRole-plays are a common training activity that is used to demonstrate the learning of work-related skills. Without the ability to prepare your “presentation script” and identify what each role-play is about, role-plays remain an embarrassing dread for many employees and employers.
  • Trading stress – Making calculated risks when you are facing volatile and uncertain markets can leave the trader feeling petrified when it comes to hitting the “BUY NOW!” button. You can lose sight of your formulaic strategies when your capital is dwindling.
  • Exercising at the gym – When joining a gym or a new exercise class, wanting to look fit and coordinated so that you can blend in with the crowd can take a few sessions. For some fitness novices, the embarrassment of standing out from the crowd is too high. You muster the courage to join the health club and then the anxiety takes over and the attendance level suddenly drops!
  • Being watched whilst eating, drinking, writing, cooking, and driving – These are common daily activities that can draw social attention when your anxiety symptoms inhibit the activity in some way e.g. a shaking hand can stop you writing or a fear of choking can stop you eating or drinking in public.
  • Being observed when working – When you are moved into an open style office from a private office, you can feel self-conscious when making phone calls or feel visible when struggling with difficult new work task.
  • Writer’s or any creator’s block – Completing your book, assignment, project, song, composition, work of art, order etc. for a client/customer or future audience can be obstructed by your perfectionism or deadline stress. Your creative ideas are suppressed by your stressed mind when you are anxious and functioning in “urgency” mode.
  • Operating an unfamiliar device in public – This can include using vending machines, self-service ticket machines, self-service tills or obtaining a parking voucher from a meter. Not knowing how to operate these (sometimes faulty) machines and being too embarrassed to ask for help, is a common reason to avoid using them. Knowing that you have a long queue of people behind you just adds to the pressure.
  • Using a public toilet – Bladder shyness or irritable bowel syndrome (IBS) can be distressing for the sufferer. You may avoid drinking or eating certain foods or avoid certain social situations depending on the location and layout of the public toilet. When you need to use the toilet, you fear “clamping” your bladder or being constipated. With anxiety-related IBS, being anxious about messing up the toilet with diarrhoea can just make the symptoms worse.
  • Walking or being out in public – When you are agoraphobic, just leaving your home is traumatic. You fear having a panic attack in a public place. When you are away from the “safety” of your home, you feel constantly visible and fearful of your own panic attack response.

 

Informal performance anxiety associated with past traumas, fear or phobias

Some performance situations may not involve an audience, but instead associate with a trauma, fear or phobia from your past. This past trauma prevents you from achieving a specific goal and triggers the past emotional distress e.g. pain, physical tension, nausea, disgust etc.

Some of these situations might be considered as “medical” situations where the individual is required to self-administrate the procedure but “locks” of fails to achieve the goal at the last moment. Examples include:

  • When inserting/removing contact lenses but responding by clamping the eyelids closed.
  • When inserting dentures but failing due to gagging or vomiting.
  • When self-injecting medication with a needle but resisting due to feeling too anxious, tense or disgusted.

 

What causes performance anxiety?

The causes of performance anxiety are related to the causes of social anxiety disorder.

Biological factors – With social anxiety, the part of the brain responsible for regulating the “fight or flight” centre (the amygdala) is active when confronting social situations. This neurological response exaggerates your perceived threat from those people in the social situation. With social anxiety, it’s as if your brain is registering those people present are about to attack you.

There is a genetic factor also linked to social anxiety indicating a possible brain structure and chromosome that can be inherited from your parents.

Socio-psychological factors – The development of social anxiety can be influenced by child-parent interactions. This can happen when a parent (or both parents) with social anxiety encourage social inhibition rather than teaching a child social confidence skills. The developing child can also imitate the parents’ anxious behaviour when the child observes (models) how the parents interact with other people.

Away from one’s parents, the shy developing child can struggle to confront new situations and unfamiliar people. They display a range of insecure and anxious behaviour that researchers define as “Behavioural inhibition”. A child that displays behavioural inhibition is more likely to develop a social phobia.

Traumas such as bullying, social neglect and major social changes e.g. moving schools or a family bereavement can impact on the growing child’s social development. Observing social embarrassment or humiliation towards your peers (or being the focus of it) can further reinforce social anxiety particularly during adolescence. These embarrassing situations traumatise the individual to excessively fear the judgements of others particularly when you need to “perform” (in whatever context) in front of your audience.

Adolescent children can recognise that the degree of social threat in many social situations is irrational, yet you can feel overwhelmed by your anxiety symptoms, avoidance behaviour and feelings of inferiority (it ultimately affects your self-esteem). Some adolescent children can attempt to mask your social anxiety, displaying anger as an alternative way of (not) coping.

By adulthood, many life choices will have been determined by social anxiety. For example, social situations, relationships, exams, hobbies, occupational preferences, promotional prospects etc. can all be limited by the level of perceived social anxiety (or overwhelming social responsibility in the new role or situation). But the socially anxious person can still deny the existence of your condition by disguising your anxiety with superficial excuses for not participating e.g. “I’m not feeling well”, “I’m too busy!” or “It will probably fail, so there’s no point trying!” are common self-limiting coping mechanisms.

Having disguised the social anxiety for much of your life, the threat of say a public speaking obligation in adulthood can expose the need to finally admit that you struggle with it or have the condition (as a specific issue or general disorder or phobia). Avoidance is no longer an option.

 

What are the common performance anxiety symptoms?

Performance anxiety symptoms are not just experienced during the performance; they can be experienced weeks leading up to it. Even after the performance, the negative interpretation of the experience accumulates the “alertness” in preparation for the next one.

There are 4 categories of performance anxiety symptoms:

  1. Cognitive, 2. Physical, 3. Behavioural and 4. Emotional

1. Cognitive performance anxiety symptoms relate to your thoughts and beliefs. They can include:

  • Negative self image e.g. “I don’t think I’m good enough to do this!”
  • Rejecting compliments/praise e.g. “They didn’t mean that; they are only saying this to make me feel good!”
  • Negative self evaluation e.g. “I’m really messing this up!”
  • High self expectations e.g. “I have to make this perfect!”
  • Self blame/responsibility e.g. “I’m going to let the whole team down!”
  • Catastrophic thinking e.g. “If this goes wrong my reputation is ruined!”
  • Superstitious beliefs e.g. “I fail when I have morning exams!”
  • Over-generalising e.g. “Everyone thinks that I’m not capable!”

 

2. Physical performance anxiety symptoms relate to how parts of your body are affected by the “fight or flight” response. The part that you consider to be the most important for the success of your performance can be the part that is most affected by anxiety.

You can be preoccupied with your anxiety or panic attack symptoms to the extent that you (or your symptoms) are believed to be visible to your audience. Your anxiety symptoms can also dominate your attention, causing you to lose concentration, make mistakes, have memory lapses, become petrified etc.

Symptoms can include:

Performance anxiety symptoms
Sweating is a common symptom of performance anxiety
  • Severe muscle tension, spasm, locking or trembling
  • Numbness and tingling sensations
  • Laboured, rapid and shallow breathing
  • Rapid heartbeat that feels like it is pounding, irregular or fluttering
  • Stammering or a strained choking voice that can sound weak, high pitched and shaky
  • Increased sweating and feeling of hotness (or coldness)
  • A knotted stomach or feeling of butterflies
  • Frequent urination
  • Cramped “gurgling” digestion, upset stomach and nervous diarrhoea
  • Feeling nauseous, light-headed, dizzy and distracted
  • Blushing, hot flashes or chills
  • Dry mouth
  • An exaggerated startle response
  • Disturbed sleep and fatigue

 

3. Behavioural performance anxiety symptoms relate to how you attempt to cope with your anxiety symptoms. It generally reflects what you do (or don’t do) leading up to the performance. Ironically, many of these activities make the anxiety worse in the long term.

Symptoms can include:

  • Avoidance behaviour – You avoid individual practises because it reminds you of the anxiety. But in addition to avoiding activities, it can also include avoiding peopleg. seeing those people who are likely to ask about the performance and create further fear or guilt for not attending. Or it can include avoiding situations e.g. training days.
  • Withdrawal – this is similar to avoidance, you may isolate yourself from social interaction and stay housebound. This is because your anxiety is generally affecting your sociability; you don’t want to inflict your worries on anyone.
  • Perfectionism – you may over-practise certain parts of performance creating fatigue and then lose the awareness of other important issues in your life such as your health or relationships.
  • Procrastination – you participate in “pleasant” non-related performance activities to justify that you are busy e.g. cleaning and tidying, but in reality you are avoiding the constructive preparation that will help your performance.
  • Compulsive behaviours – you participate in risky, unhealthy or destructive behaviours to break or divert the hold that anxiety has on you. This can include excessive binge eating, over spending (consumerism), drinking, smoking, drug taking or other addictions. It can also include engaging in high risk, or highly exciting (adrenaline-filled) activities such as aggressive sports, gambling or sexual activity.
  • Attachment – you seek comfort in people who are over-protective of you, or visiting places that will keep you “safe” e.g. staying home. Or you seek comfort in routine or ritualistic activities that comfort your mind such as comfort eating, watching television and social media.

 

4. Emotional performance anxiety symptoms relate to feelings that can accompany your anxiety or they describe the different adjectives that reflect the degree of your anxiety.

Anxiety can be distressing even though you (as a child) may not be able to express how you are feeling at the time. It’s the physical and behavioural components of anxiety that can consciously be the most troublesome in terms of your daily functioning.

Emotional anxiety symptoms can include feeling:

  • Fearful
  • Overwhelmed
  • Panicky
  • Terrified
  • Irritable, jumpy or edgy
  • Sensitive (to criticism or rejection)
  • Preoccupied (with other’s responses)
  • Worried, apprehensive, nervous or uneasy

Over a period of time, the four components of anxiety accumulate and combine to drive you and your performance into submission. Anxiety can destroy your expressive creativity contained within your talents and skills if it is not affectively managed.

 

Common treatments for performance anxiety

Medication – The medication commonly prescribed by your GP for performance anxiety is beta blockers (propranolol and atenolol). A beta blocker will help to dull the physical effects of the stress hormones when the “fight or flight” response is activated. They are best for specific situations, like one-off performances, but they won’t help with the emotional symptoms of anxiety. As with all medication, there can be side effects.

Talking therapy – Talking therapies can include CBT (Cognitive Behavioural Therapy). Talking therapies aim to help you change your thinking, control your anxiety and confront your performance situations. Some approaches can take a significant time to change your perception of your performance however.

Self-help therapy – This considers certain lifestyle changes that can alter the physical effects of anxiety e.g. doing exercise, meditation or yoga to lower your levels of physical tension. This approach may also consider confronting the behavioural anxiety symptoms that are drowning your energy levels e.g. maintaining healthy sleeping patterns or cutting back on alcohol consumption. Or it can involve gaining help from your teaching professional or colleagues to alter some of the cognitive anxiety symptoms.

 

How can hypnotherapy help your performance anxiety?

Hypnotherapy can help you stay in the “zone”

Hypnotherapy for performance anxiety
Hypnotherapy can help your performance anxiety

The zone is considered to be a state of focused awareness in which you coordinate all of the effective parts of mind and body to achieve a peak level of performance. Hypnotherapy can help access and stay in the zone when stress and anxiety are disturbing your performances.

Anxiety control

Anxiety control is a major part of achieving excellence in your performance situation. When anxiety is high, your cognitive, affective and (motor) skills suffer. Hypnotherapy can offer you “mind tools” that will ensure that you are getting the very best out of your abilities when the situation demands it.

Manage anticipatory anxiety

Anticipatory anxiety can fool your mind into believing that those catastrophes are inevitable. It can consume your mental and physical build-up to the performance day as if that day is happening right now. Anxiety symptoms can disrupt your relaxation time, sleep and sociability. Hypnotherapy can alter that apprehension ensuring that you remain positive and focused on your performance success.

Reframe past traumas

Past traumas act as negative seeds of belief in your historical timeline. That “bad” performance, failure, near miss, injury or criticism gets stored in the deepest part of your mind coated with “Danger – Avoid!” So when you prepare to enter the arena again, your unconscious mind discharges stress signals (adrenaline) to warn you of the threat of a repeat traumatic performance. Hypnotherapy regression techniques can be used to release the emotion of these traumas, so that you can look ahead without the negative emotional bias.

Positive visualisation

Positive visualisation acts as the mental rehearsal for your peak performance experience. Hypnotherapy provides the mental platform to create an intense visualisation of your desired capabilities. When you can visualise performing confidently in front of your feared audience (e.g. assessor, examiner, competitor etc.) you will activate the beliefs, emotions and physical sensations necessary to achieve your reality.

Desensitise your anxiety/panic response

Practising your skills in isolation is very different to performing your skills with your audience. Some “performance” situations that include your feared audience are hard to create until the situation arrives. Along with positive visualisation, hypnotherapy can help you to you “get used” to your audience. By gradually adding your stressors into visualisations in a safe way, you can be desensitised to your threats and feel ready to deal with them on the performance day.

 

For further information on using hypnotherapy to treat your performance anxiety in Cardiff, contact Hypnotherapy Cardiff

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The Zone

The Zone

Access The Zone in Cardiff

 

What is The Zone?

The zone and peak performance
The zone is a state of optimal focused awareness
The Zone (sometimes called the “flow” mental state and the peak performance zone) is considered to be a state of optimal functioning. It is a heightened state of focused awareness and inner clarity in which your acquired knowledge, creativity, emotions, skills, motivation, passion and practised skills are synchronised, automated and “flowing”. You are not “consciously” trying to perform; you have immersed yourself “in” the state of performing The zone is a state of optimal focused awareness and every part of you is harmoniously operating within the essence of your peak performance. You are very much inspired “in” this moment; with no ego or fear of outcomes.When you are in the “zone”, your brainwave activity level is reduced down from the Beta level (which dominates when you are focused on the outside world) to the “Alpha” level. In the Alpha state, you are conscious but you are relaxed. Alpha brain waves dominate when you are being creative, emotionally connected and decisive.  

The informal zone

You will have experienced the zone in informal situations. Have you been immersed in any of the following activities?
  • Having a conversation and being “connected” with your partner.
  • Writing effortless flowing content for your essay or thesis.
  • Feeling drawn into the suspense of a thriller movie.
  • Playing a video game.
  • Reading a good book in a public place and not noticing people walking by.
  • Playing a game of chess and losing track of time.
  • Feeling emotional when hearing someone talk about their journey of achievement.
    The informal zone
    The zone can be accessed in informal situations
  • As an audience member being fascinated by the presenter (lecturer, teacher, speaker or entertainer etc.) and the content of their presentation.
The informal zone is a natural state of relaxed focused awareness. Your behaviour may not be goal-directed as might be in a skilled performance, but you are still fully absorbed in your activity.  

Getting into the zone to enhance your performance

The “performance zone” or “peak performance mind state” is a term that has been synonymous with elite sports performers. Consider the level of concentration and skill demonstrated by professional sports people when participating in golf, shooting or archery, or of elite athletes immediately before and during a sprint track and field event.The performance zone is not exclusive to sports people however, you can sometimes see professional musicians completely absorbed into the emotion of their performance; their eyes are closed and they are barely conscious of their surrounds. Similarly, actors can be seen in the stage sides, deep in concentration and rehearsing their script, just prior to their stage entrance. They then appear on stage seamlessly recalling extensive, emotion-filled dialogue as is reading from an autocue.The performance zone can be considered as a highly productive state of awareness particularly when you can access it to achieve work tasks. Employers value employees who can maintain long periods of concentration.Getting into the performance zone at work is easier if:
  • You are passionate about the task.
  • You believe in the need to complete it.
  • You can develop your creative abilities.
  • You can use/transfer a few previously learned skills.
  • You can visualise (at some level) the potential solution.
  • You have an incentive but it is more intrinsic.
  • The work situation (physical structure, resources, personnel, reasonable timescale etc.) meets your needs to fulfil the task.
  • Life outside work is stable.
  

Strategies to enhance your performance zone

Do you find that in your practise sessions, you are “nailing it” but when it comes to the big occasion, your performance is below standard? If this happens on a regular basis, then it’s time to review your performance strategies. Consider introducing some the following performance zone strategies to boost the performance of your skills:
The zone in sports performance
Focusing in the moment will help you stay in the zone
  • Focus on the requirements of this moment – as close to the present as possible.
  • Remove any judgment about your performance – that includes your own (internal) or from the audience, coach, peers or opposition (external)
  • Centre on the quality of the next one objective and let it go when it’s completed – the result will take care of itself.
  • Cut through perfectionism by focusing on the function of your performance.
  • Distance any external problems or distractions – unload them well before you get on the performance stage or the arena.
  • Identify and focus on the relevant performance cues that are specific to enhancing your performance in your activity e.g. when defending your opponent with the ball in basketball, by watching their midsection, you are less likely to be faked. Discuss this with your coach/teacher.
  • Simplify your approach when you are on the performance stage. Analyse the complexity in the practise session/tutorial, when you are away from the performance stage.
  • Keep your mood playful – that doesn’t mean that your performance is not important; a playful state lowers the stress you place on your performance.
  

How can you practise staying in the performance zone?

In the early stages of your new skill acquisition, you are unlikely to access the zone. This is because you are conscious of what you are doing and what is required of you. You are also unpractised and unrehearsed. It’s a bit like experiencing your first day at work or learning to play a piece of music for the first time; you feel overloaded with information due your own high expectation of wanting to appear capable.With focused practise sessions (e.g. when being coached), the formation of individual practise skills combine to create a network of coordinated schemes. Gradually, the schemes become familiar and fluent. With continued practise the schemes can then become automated and operate at an unconscious level. Repetition is an essential physical part of accessing your performance zone.Is accessing the zone just down to practise? Accessing the zone in performance situations requires the use and development of your imagination, emotions and beliefs. These can then combine with your practised physical skills.
Visualisation and the zone
Visualisation can help you access the zone
Breathing techniques, meditation, mental rehearsal, mindfulness and visualisation are useful tools to help cultivate your performance zone; these mind tools require you to imagine how you want to be during your performance (not what you are dreading happening i.e. the negative “what if’s”). Find a suitable situation in which you can regularly practise the mental rehearsal of your peak performance.Here are some visualisation techniques to practise when you are away from the performance stage, as it gets closer to your performance and during the interval breaks. Find a relaxing situation, close your eyes and use relaxed breathing techniques to lower the level of your brain activity i.e. get into your “alpha” state:
  • Imagine that you are performing at the highest level for your activity, with all the features of your performance present. By doing this, you can train your mind to get used to performing under pressure.
  • Identify your most emotionally confident and resourceful state. Visualise how you would be demonstrating this confidence when performing at your peak level.
  • Recall the feeling of confidence from past experiences of your achievements. Or visualise confidence demonstrated from a role model in your area of expertise. “Paste” this feeling into your next performance.
  • To maximise body (or any part of you, including your voice) functionality, imagine your body part being the perfect “fit” in your performance situation.
  • Practise focusing your mind on empowering affirmations (positive statements), images/symbols, emotions, and words that will inspire, energise and motivate you e.g. passion, power, rhythm, intensity, determination, invincibility, flow, belief etc.
  • Identify and narrow down the key qualitative processes/techniques of your peak performance e.g. fluency and rhythm. Practise imprinting them into your mental scheme.
  • Visualise removing the feeling of “trying”. Instead, access the feeling of “being”.
  

What disrupts the performance zone?

Excessive stress and anxiety can shatter your peak performance zone. When you are worried about something or you are getting frustrated with your performance, your level of brain activity increases. You are taken up, out of the automated “alpha” state and placed back into the “beta” state where you are conscious of your surrounds and trying to force your skills. Stress and anxiety management is thus an important part of staying in the zone.What is your stress? Stress can be different for everyone. What destroys one performer can motivate another. Your beliefs about yourself and your ability are essential components for keeping you mentally focused and in the zone. Negative traits can be learned from early parent conditioning, peer criticism, and your own interpretation of failed performances. Negative traits act as the source of your future insecurities and worries. They pull you away from the present, away from your performance zone. When you can identify the nature of your negative beliefs, you can work on centring this negativity. Using visualisation, you can realign your distortions to remove fear and judgement. With practise you can access positive thinking states.Here are some common negative beliefs (stressors) that can take you out of your performance Zone and ways to correct them:● You doubt yourself and your ability – You don’t believe that you or your skills are good enough to succeed. How you think and communicate also reflects this. In your mind, you believe that you can’t do it!

Zone Tip - Visualise displaying your skills with complete confidence. Picture the peak of your playing abilities to acquire your performance zone.

Stress, anxiety & the zone
Stress can take you out of the zone
● You are a perfectionist – Your refusal to accept anything short of perfection means that you apply yourself rigidly to your performance. This can work when you are in control, but when something takes you off your path, it can strain other parts of your life.

Zone Tip - Visualise having a wider, balanced perspective to access your performance zone.

● You are easily intimidated – Opponents will stare at you, mock you and physically attack you (when the referee is not there) in the hope to rattle you and knock your concentration. They want to undermine your self-worth.

Zone Tip – Visualise keeping your “cool” and boosting your own self esteem to acquire your performance zone.

● You want results now! – You are impatient and that exposes your inability to be disciplined with your effort. When things go wrong you get angry.

Zone Tip – To access your performance zone, visualise having a calmed patience. Imagine reaping your rewards in the long term by staying on your mission.

● You fear (another) injury – Having been injured or seen your peers sit on the sidelines for extensive periods, your fear of injury is holding back your progress. You are restrained and shy in attack.

Zone Tip - Visualise having a mental toughness when you compete. This is a necessary part of acquiring your performance zone.

● You fear failure – Linked to perfectionism, your sensitivity to making mistakes builds your fear of failure. You are so preoccupied with avoiding mistakes that it impedes your ability to do what is right.

Zone Tip - Visualise your ability to bounce back from errors or blips; learning from your mistakes will keep you resilient in your performance zone.

● You try too hard – Your aggressive style overwhelms your skills set. You force your playing style, wrongly equating over-exertion with successful performance. You risk injury and fatigue.

Zone Tip – Visualise balancing your effort with other important skills e.g. agility, rhythm. Appreciate what is “smarter” (not harder) to achieve your performance zone.

● You are sensitive to criticism – Your sensitivity to people’s comments eats away at your soul because you may believe that you need to be right. You become preoccupied with their criticism; it gnaws at your self-esteem and your performance. You are unable to distinguish if it was said as an attack or as feedback to help you improve your abilities.

Zone Tip – Meditate with the comment to identify if there is anything that you can learn from it. Then consider if it can be discussed to clarify its meaning. If not, let it go. Visualise that you are worth more than the attack made on you to keep you in your performance zone.

● You have high expectations – It’s good that you have ambitions, but your high expectations create an inner feeling of constant emptiness. You create unrealistic and unachievable goals that ultimately cause you to doubt your abilities.

Zone Tip – Reorganise your goals so that your interim objectives are realistically achievable. This will lift your confidence in your abilities. Visualise the combination of your long term goals and short term objectives to ultimately achieve what you want.

● You stay in your comfort zone – You underplay your potential and lack the “grit” to go up a few gears when the situation demands it. Low pain threshold, tiredness and apathy prevent you from achieving a higher ranking.

Zone Tip – Visualise your power, resilience and determination to develop your physical and mental stamina. This will keep you in your performance zone.

  

Can the zone be addictive?

The performance zone is a desirable mind state; you develop it to improve your ability in a performance situation. The informal zone however has a more recreational purpose e.g. when being connected in conversation. In the informal zone, you are using the zone to relax or distance yourself from a different situation in your life. Participating in an activity for some “flow” therapy can be a way of switching off and escaping from your external worries. But anything that can be beneficial can be overused when the external stress is persistent.
Gambling & the zone
Zone therapy can be addictive
Overdosing in potentially compulsive activities like playing video games, shopping, sex and gambling can become addictive. They possess a “meditative” yet adrenaline-filled zone of escapism. As the addiction grows, the insatiable need for the “flow” state can be to the neglect of your other responsibilities e.g. family relationships, your health, finances etc. When addictions take over your life, the previous solution to your problem becomes the new problem. 

Hypnotherapy and the zone

What does accessing the performance zone mean to you? Are you looking to improve your sports performance or have the edge over other elite professionals? Maybe your performance anxiety is inhibiting your stage performance in some way. Or perhaps you are looking to improve your creativity in your art or concentration levels for your exams. Hypnotherapy can be the treatment that will accelerate your success.● Hypnotherapy can help you access your performance zone Essentially, the zone or the “flow” mental state is similar to a hypnotic state of awareness. You lose your self-consciousness; your attention is focused and absorbed into the activity, and time has become irrelevant. These are all phenomena commonly experienced in hypnosis.  The hypnotherapy treatment will help you reach deeper levels of concentration when you want to connect with your performance zone.● Hypnotherapy can help you identify your emotional blocksNegative beliefs can weigh down your peak performance zone. If you don’t know what they are, the treatment will be instrumental in helping you identify them. You may already know what they are, but feel overwhelmed by their presence. With your unconscious mind open to suggestion, you can access new positive beliefs, replacing the emotional blocks that are holding you back.● Hypnotherapy can improve your confidence and self-beliefConfidence and self-belief are essential personal characteristics of the performance zone. Your positive thoughts, emotions and behaviour can help you push through your own restrictive barriers. Visualising confidence and self-belief in hypnosis will boost your feeling of superiority over your skilled performance.● Hypnotherapy can help you reframe your past “traumas”The unresolved handling of injuries, criticism, failures, errors, mistakes etc. can remain stored in your mind keeping you safe from having yet another set-back. Traumas that have not been resolved generate your self-doubt, indecision and hesitancy. Once these traumas have been reframed, you can freely access the confidence in your performance zone.
Hypnotherapy Cardiff & the zone
Hypnotherapy can help you access the zone
● Hypnotherapy can intensify your visualisationConscious interference and anxiety can blur your visualisation abilities. You can be wrestling with what you want to achieve and what you are trying to avoid. In hypnosis, your visualisation can be guided without conscious interference, picturing your skills and goals as “real” events. This enhanced mental rehearsal can integrate your mind and body functioning so that it can actualise into your performance.● Hypnotherapy can help you overcome performance anxietyThe cognitive and behavioural symptoms of performance anxiety can devastate your performance zone. To overcome your performance anxiety, your practises need to gradually incorporate “live” situation stress, where you can adjust to your perceived threat e.g. members of your audience. Hypnotherapy can be used to identify the nature of your threat and help you to visualise confidence with your audience. This will help you to lower the anxiety symptoms on the performance day.● Hypnotherapy can change your negative internal self-talkSelf talk is natural to all of us. The various parts of your mind can make themselves known when your emotions are compromised; one part will say “do it!” and the other will say “run away!” Hypnotherapy can help your confident voice dominate your experience in your performance.● Hypnotherapy can help you re-align your goalsHow you are structuring your long-term and short-term goals can make a difference to your experience in your performance zone. Unrealistic goals can leave you doubting your ability. Hypnotherapy will help you make changes that will work with you and your performance aspirations.● Hypnotherapy can help your motivationYour motivation can be deflated when your performance is suffering (and vice versa). Your motives can be re-established to fuel the drive in your area of expertise. Accessing feelings of desire to perform successfully is a fundamental ingredient in accessing your performance zone.

Are you ready to access your performance zone?

  

The Zone Cardiff: for further information on accessing the performance zone, contact Richard J D’Souza Hypnotherapy Cardiff

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Post-Traumatic Stress Disorder Cardiff | PTSD Cardiff

Post-Traumatic Stress Disorder

What is post-traumatic stress disorder (PTSD)?

Robbery and Post-Traumatic Stress Disorder
Direct traumas can have a serious impact on Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is a reoccurring stress response that follows the exposure to a traumatic event. PTSD can be acquired when:• You directly experienced the trauma (e.g. you believed you were in danger or your life was threatened). Or you have been involved in managing the traumatic incident (e.g. you helped the person in danger and/or interacted with an attacker in some way). • You witnessed a trauma in close proximity “with your own eyes”, but without direct involvement e.g. you saw someone else in danger, being injured, or actually die. • You learned about the trauma from family or close friends who were involved in the incident. • You were informed about the trauma from external sources e.g. the media such as television news or factual documentaries. External sources are likely to affect you if you are highly sensitive to viewing distressing scenes. They can also re-activate your PTSD symptoms if you have suffered a previously related trauma. 

Does everyone get post-traumatic stress disorder following a trauma?

Post-traumatic stress disorder is a distressing reactive revisit to a past traumatic event, but most people do not develop PTSD following the trauma. It is common to have an ‘acute stress response’ within the first month where your mind is coming to terms with the traumatic events. Your understanding of the trauma and the emotional connection that you have made with it is being processed and released. But for about 30% of those who have suffered a trauma, you can find that your symptoms persist for longer than a month. When you have Post-traumatic stress disorder, you are unable to come to terms with the traumatic events and the “normal processing” of the trauma is obstructed. The post-traumatic stress symptoms become the new problem; a series of “aftershocks”, creating the disorder (PTSD) in the long term. 

Post-traumatic stress disorder risk factors

A group of people can be exposed to the same trauma, but only some people in that group will suffer with Post-traumatic stress disorder. So why are some people more likely than others to get PTSD following an exposure to a trauma? Research suggests that genetics can increase your susceptibility to PTSD. So if you are exposed to any traumatic events, what you have inherited from your family genes will dictate how you manage the trauma.Certain subcultures and biological groups can also be vulnerable to Post-traumatic stress disorder. They include those with learning difficulties, mental illness, children and adolescents, females and certain minority groups. It is considered that some of these groups have a heightened sensitivity to trauma, or can have a different biological pathway that affects the brain’s response to trauma.Some risk factors are more situational. They include:
  • Frequency of traumatic events – You have dealt with a number of traumas in your life either due to your occupation, lifestyle or by circumstance. This accumulation of different traumas has compounded your symptoms.
  • Duration of traumas – One or several of your traumas have been experienced over a period of time increasing your feeling of helplessness. You may have been trapped in your traumatic situation for a long period.
  • Suddenness of traumas – When the trauma is unexpected, the degree of alertness is intensified. Sudden shocks prevent any preparation or rehearsed coping strategies.
  • Severity of trauma – This can be subjective depending on your sensitivity and connection with the trauma (some young children have reported being traumatised by horror films). But those traumas in which you are personally involved in (rather than being told about it after the event), have a higher death rate, involve children and involve the mutilation of body parts will increase your risk of Post-traumatic stress disorder. Man-made (rather than natural) traumas are also considered to increase the risk of PTSD possibly because they destroy trust in other human beings.
  • You work in a high risk occupation – This can include the military, police, medical and rescue services.
  • You are a refugee or asylum seeker – Being forced to leave your home, family and friends under harrowing circumstances and then face the uncertainty of rebuilding your life in a new country can be a cause of Post-traumatic stress disorder
  • Presence of a prior psychological condition – Having another condition prior to exposure to your trauma e.g. depression, anxiety disorder and high stress levels from a non-related issue may increase the effect of a trauma. It is important to remember that some conditions may not have been diagnosed prior to the trauma. If you have a negative emotional trait e.g. prone to feeling guilt, the negative emotion can influence your negative processing of the incident. Thus if you have survived the trauma and other family members died, excessive guilt would become part of your PTSD symptoms.
  • A lack of support following the trauma – Dealing with the trauma in isolation may mean that you suppress or repress the effects of the trauma. By refusing to accept help or deny that there is an issue, you may be reinforcing your negative interpretation of the trauma e.g. blaming yourself for the trauma or your mistaken handling of the trauma.
    domestic violence and post-traumatic stress disorder
    Post-traumatic stress disorder: you expect your partner to be trustworthy
  • Violence in the homeParental violence in the home can have the same traumatising effect on children as combat has on soldiers. It is thought that those children who have been exposed to violence in the home adapt their brains in the long term to be hyper-aware of external danger, increasing the risk of Post-traumatic stress disorder. Even with domestic violence inflicted on partners, the same adaptive responses can happen in the long-term abused partner. This is because your partner (who you would expect to be trustworthy and nurturing) ends up betraying you. This can cause you to feel abandoned, ashamed and helpless. The traumatising effects accumulate because the abuser often denies the abused person any medical or psychological support. In a family situation, feelings of hopelessness suppress the courage needed to escape with your children to a safe place. Even when you have managed to flee the domestic situation, the “aftershocks” (or PTSD as the condition) continue to haunt you.
There are some factors that are considered to reduce your risk of developing Post-traumatic stress disorder and are given the term “resilience” factors. Believing that you acted positively through the trauma e.g. that you helped to save lives in the face of fear, can lower your risk of developing PTSD. The risk is also lowered when there is time to plan and apply a coping strategy that has helped you and others to “survive” the trauma. Accepting support from people (e.g. family, friends, colleagues, professional counsellors or support groups) to help you “deal” with the trauma can further lower your risk of developing PTSD. 

What traumas cause Post-Traumatic Stress Disorder?

Post-traumatic stress disorder symptoms can begin following any traumatic event, but usually involve those traumas with intense fear, horror or helplessness. Here are some examples:
  • Personal violent attacks including mugging, robbery, sexual assault and physical abuse.
  • Severe domestic neglect or abuse as a child (or adult).
  • Having a traumatic childbirth as the mother or witnessing partner.
  • Being diagnosed with a life-threatening illness.
  • Serious accidents including road accidents and fires.
  • Military combat including being a prisoner of war.
  • Acts of terrorism including being held hostage.
  • Natural disasters such as earthquakes, tsunamis or major flooding.
  • Witnessing violent injuries or deaths.
  • Losing a partner, member of the family or close friend in distressing circumstances.
These traumatic experiences can compromise your feeling of safety and security. They can weaken your sense of what is fair in your life. When you survive a traumatic experience, it can expose your fear that you (and others close to you) are not invincible. 

What are Post-Traumatic Stress Disorder symptoms?

There are many Post-traumatic stress disorder symptoms, but they tend to fall into 4 categories:1. Re-living aspects of the traumaThese are associations that draw you back to the trauma and can be caused internally (in your own mind) or by some external event or situation.
Flashbacks are symptoms of PTSD
Flashbacks are a common symptom of PTSD
• Flashbacks – Flashbacks are intense memories replaying in your mind and feel like you are experiencing the emotions of the trauma over again. Flashbacks can be in the form of images, sounds, smells, feelings and physical sensations (see below). Flashbacks indicate that your mind is struggling to cope and is overwhelmed by the emotion of the trauma. • Nightmares – You can sustain vivid dreams of the actual trauma, disturbing “distorted” dreamed accounts of the trauma (usually emphasising your negative emotions) and unrelated yet adrenaline-filled dreams with night sweats. • Physical responses – You can experience distressing physical symptoms when you are reminded of the trauma e.g. when watching the news or a movie, hearing a sound or seeing images that symbolised the trauma (such as hearing explosions or seeing an object used in the attack). The physical responses can be similar to those experienced in a panic attack.2. Avoidance behaviourWhen you experience a trauma, it is common to exhibit avoidance patterns of behaviour to protect you from the reactions outlined in 1 (above).• Changing routines – At first, subtle changes are made to your routines to try and cope with the associations you have made with your traumatic experience. But the associations grow, making it more difficult to function on a daily basis as more situations, objects, people and events are met with avoidance. • Social isolation – You don’t want people to see your stress reactions, so you avoid certain people or larger groups. But the importance of “having” to go to formal events e.g. a wedding, builds up the anticipatory anxiety, making the situation harder to cope with when the event arrives. • Withdrawal – As you become more aware of your stress reactions in different situations, you lose interest in what you used to enjoy. You withdraw from hobbies, locations, people and events as a way coping with the effects of the trauma. Even when you are with people, you feel tense and self-absorbed because you are confused about where the next anxiety attack will come from. • Depression – Your life feels increasingly out of control since it is dominated by anxiety and other negative emotions (guilt, distrust, self-blame and shame). This situation becomes more hopeless because you ultimately lose the enthusiasm for those things that you once enjoyed. Some trauma survivors feel suicidal. • Emotionally numb – You suppress your emotions to get through each event; it feels like each day is a survival task. You may abuse certain substances e.g. alcohol or drugs. • Amnesia of the traumatic event – Conscious and unconscious “blanking” of the traumatic event is part of your survival method to protect you from re-awakening those distressing emotions.3. Hyper-alertness
Sensory hypersensitivity and post-traumatic stress disorder
Post-traumatic stress disorder: Your senses can become hypersensitive
This is where you remain on a state of constant hyper-vigilance causing you to feel tense and irritable.• You are easily startled – Your senses are over-attentive causing you to feel “jumpy” when they are stimulated e.g. loud noises overwhelm you. • Daily functioning is affected – you struggle to concentrate, relax, eat food (due to nausea), and sleep. You develop a variety of stress-related symptoms e.g. migraines, aches and pains. • Impending doom – You are on the continuous “red alert” waiting for something disastrous to happen.4. DetachmentThis is where your mind disengages from reality to keep you safe from further harm. Due to the extreme states of hyper-attentiveness (see 3. above), the constant fatigue can also cause you feel emotionally absent.• You feel disconnected – It’s as if something in your sub-consciousness is constantly drawing your attention, demanding to be dealt with when you are trying to relax. • General amnesia – In addition to forgetting the traumatic event, you struggle to remember recent events and things that need to be done. • Confused identity – You may be questioning who you are and how you ought to behave in situations following your traumatic encounter. • Hallucinations – Depending on the nature of your trauma, you may imagine that the trauma is happening to you again (when in reality nothing is happening). Or you imagine that it is happening to people around you, or affecting certain objects or situations. Images can be distorted, leaving you confused about whether you are really seeing these distortions or are just imagining them. 

Children’s PTSD symptoms

Older children (teenagers) tend to show Post-traumatic stress disorder symptoms that are very similar to adults, but they can also be more externally aggressive and disrespectful as a way of coping with the trauma. PTSD Symptoms in children, particularly in the very young, can be different to those experienced by adults. Young children can experience:
  • Insecurity – They worry that something traumatic will happen to you. They feel more anxious when you are about to leave them or are away from them for extended periods. They can be unusually clingy in your presence and seek reassurance that you are not in any danger.
  • Re-living the trauma – A tendency to express the negative emotions of the trauma in art, role-play and stories.
  • Disturbed sleep – Restless nightmares (with sleep walking) directly related to the trauma, or anxious sleep patterns with unidentifiable content.
  • Loss of functional habits – Young children can be become incontinent and suffer with enuresis (bedwetting). Speech patterns can also become inhibited.
  • New fears and phobias – Fears become exaggerated for very young children e.g. fear of the dark, ghosts and monsters.
  • More anxiety-related symptoms – These can include loss of appetite, aches and pains, nausea etc.
  • Aggression – As with older children, younger children can also display anger directly or in the form of tantrums/mood swings.
 

Why does Post-Traumatic Stress Disorder happen?

By understanding the difference between normal memory storage and traumatic memory storage, you can appreciate why certain symptoms are experienced following a traumatic incident.Normal memory storage – In basic terms, the brain is like an ever-changing wardrobe full of clothes that has been neatly arranged according to many factors e.g. your beliefs and values. Your brain (wardrobe) prefers that clothes are processed (washed, ironed and labelled) before being placed into the wardrobe. This makes it easy for the retrieval and selection for the clothes in different situations. When you have an experience, you are given some items of clothing to store away in the right place. You may put it on the temporary holding rail if they are “dirty” or doesn’t have a category yet (you haven’t made sense of them) or you may need to “compress” some of the clothes in a category when a section has become full. But the experiences (clothing) need processing before they can be stored comprehensively in the wardrobe.Once stored, the clothing then becomes a memory. When it has been stored in the right place, it can be accessed easily and worn to suit the right occasion. So under normal conditions (low to moderate stress), the storage and retrieval of your clothing (experiences and memories) is an organised and coordinated system (we won’t go into fancy dress parties just yet!)
PTSD and traumatic memory storage
PTSD: your mind has misfiled the traumatic experience
Traumatic memory storage – In traumatic memory storage however (and using the analogy), the processing of the clothing (traumatic experience) is suspended. The traumatic experience increases the load by a few hundred items and because of the stressful nature of the experience, the clothing is heavily soiled. So clothing is randomly stuffed into the wardrobe without being processed, causing the wardrobe doors to bulge in places. The soiled clothing contaminates the other clothes (causing internal conflicts e.g. panic attacks). Feeling overloaded and about to burst open, clothing is expelled back into the processing area (into your consciousness as flashbacks), demanding to be sorted. You end up wearing the wrong clothes to different situations causing your to feel out of place (detached). You can keep throwing the clothes back into the wardrobe unprocessed (as avoidance), but the wardrobe will keep rejecting them until they have been processed properly. Each time that you go back into the wardrobe to access an individual item of clothing (memory), random or traumatic clothes (memories) are forced up into your consciousness.Summary of why Post-traumatic stress disorder happens - During a traumatic experience, high levels of adrenaline are released to help you deal with the trauma. The need to survive is the priority, so the mind interrupts and fragments the processing and storage of the traumatic event until the perceived danger has passed. During this continued red alert period, the “events”, emotions and sensations of the trauma can become distorted. Some memories are “forgotten” and others are re-presented for storage causing the individual to have disturbing flashbacks.Distressing emotions that were experienced at the time of the trauma can also be re-experienced at random moments. This can cause feelings of extreme helplessness and fear because acute anxiety is felt when there is an absence of any external danger. The processing of sensations (e.g. sounds) experienced during the trauma can also be “misfiled” when being presented for memory storage. Hypersensitivity to the sounds heard during the trauma can be increased with Post-traumatic stress disorder and you can suffer hallucinations i.e. believe that you are hearing sounds of gun fire when there are none. The processing and storage abilities in the mind can be restored when the system has been stabilised (i.e. stress and anxiety have been reduced). Repairs to the processing and storage of the traumatic experience can then be completed in gradual stages, re-analysing the experience in manageable “chunks”. 

Common Treatments for Post-Traumatic Stress Disorder

Treatment for Post-traumatic stress disorder will aim to reduce the effect that the acute stress is having on your body. It will also help you deal with the trauma in stages to reduce the symptoms you are experiencing.Medication – In consultation with your doctor or consultant, medication can be prescribed to increase serotonin levels. This can reduce your anxiety and depression and any other symptoms associated with your PTSD. Medication may be chosen as the main treatment when the threat of the trauma is recurrent (e.g. with domestic abuse). It may also be used if other treatments have not been beneficial for you or you prefer not to be treated with trauma focused psychological therapy.Psychological therapy – There are various types of trauma focused therapy (psychotherapy) including
  • Cognitive behavioural therapy (CBT) – CBT can help you challenge your irrational (or distorted) thoughts and feelings associated with the trauma.
  • Exposure therapy – This therapy helps you to gradually deal with the traumatic events in small steps. As you go through the desensitisation process, you relearn how to control your fearful responses to the trauma.
  • Eye-Movement Desensitisation and Reprocessing (EMDR) – This therapy incorporates CBT with eye movements, sounds or tapping movements with the hand. As with the other therapies, it aims to reprogram your reactions to the traumatic memories.
Each therapy can have varying degrees of success. This can depend on the skill of the therapist, the issues that you bring to the treatment and the quality of your interaction with your therapist. 

How can Hypnotherapy help your PTSD?

Post-Traumatic Stress Disorder and hypnotherapy
Post-Traumatic Stress Disorder sufferers are considered to be very receptive to hypnosis
A (2005) study showed that hypnotherapy is an ideal treatment choice for post-traumatic stress disorder because if you suffer with PTSD, you are considered to be very susceptible to hypnosis. This study also showed that symptoms of PTSD are very similar to the phenomena experienced whilst in hypnosis. In another study, hypnotherapy has also been shown to reduce Post-traumatic stress disorder symptoms.Using the analogy of the wardrobe (above), hypnotherapy can help you unpack the wardrobe of jumbled and contaminated clothes (memories); sort, launder and iron them, and then reorganise and store the contents again into a coherent and orderly arrangement.• Hypnotherapy can help you understand how PTSD is affecting youThis understanding will come more from my experience as a therapist to objectively listen to your individual traumatic account. Your medical history and value system prior to your trauma can heavily bias your coping with the trauma. When you can appreciate how your Post-traumatic stress disorder is affecting you, it can reduce some of your stress symptoms and help you be open to learning new ways of managing your PTSD.• Hypnotherapy can help you to reduce stressIncreased stress levels influence you to perceive innocent situations as threatening ones. Whilst you stay on the “high alert”, you continue to believe that a panic attack that happened in a specific location or social occasion is a new situation to keep away from. Avoidance behaviour is your attempt to cope with your fear, but it only makes those situations worse in your mind. Hypnotherapy incorporates stress reduction as an integral part of the treatment diminishing your state of hyper-vigilance. Learning breathing techniques can also help you to reduce your stress symptoms.• Hypnotherapy can help you identify what is triggering your symptomsPost-traumatic stress disorder triggers can be internally provoked e.g. by an emotion or physical symptom such as a racing heartbeat. They can also be externally generated by events, situations or objects that remind you of the trauma e.g. from reading a similar news item, going to a nearby location or a seeing a person that looked like someone from the original trauma. By indentifying and dissociating these triggers, you can have more control over these situations and reduce your distressing reactions to them.• Hypnotherapy can help you to safely process the trauma in stagesDistressing flashbacks are your mind’s attempt to correct the fragmented processing and storage of the traumatic incident. Visualisation in hypnosis can help you to reprocess and store the traumatic events in a detached and safe way. As a form of graduated exposure, this technique has the benefit of reducing the frequency and severity of anxiety that you are suffering when a flashback is triggered.• Hypnotherapy can reduce your PTSD symptomsPost-traumatic stress disorder symptoms such as flashbacks and detachment can be considered as trance or dream states, similar to the awareness experienced in hypnosis. But PTSD trance states are distressing, whilst hypnotic “trance” is a pleasant relaxed state. PTSD will keep you locked into your traumatic experience replaying the trauma over and over again. The awareness in hypnosis however can used to therapeutically change the content of the flashbacks helping you to have more control over these symptoms.• Hypnotherapy can release the emotions that caused your PTSDStrong negative emotions and beliefs affect the way that you interpret and cope with traumatic stress. They can continue to cause your Post-traumatic stress disorder symptoms and often prevent you from closing “chapters” of your trauma. For example flashbacks can express beliefs such as self-blame, guilt and shame as themes that want to be processed and released. Hypnotherapy can provide the platform for emotional release, helping you to re-frame the trauma and reduce the severity of the symptoms that you are now having. 

Hypnotherapy for Post-traumatic stress disorder summary

It is normal to feel anxious when starting any new treatment. As your hypnotherapy course progresses, the feeling of being constantly under threat will reduce. As the meaning of the traumatic events is re-framed, you will be able to think about them in a calmer way and chose when you want to think about them (rather than being overwhelmed by them at inappropriate times).

For further information on treating your post-traumatic stress disorder (PTSD) in Cardiff, contact Richard J D’Souza Hypnotherapy Cardiff

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