Anxiety is nature’s built-in alarm system to keep us safe. ‘Normal’ anxiety is how nature has designed our brains and our bodies to coordinate to keep us safe from danger and to motivate us to prepare for difficult challenges. It is appropriate to be anxious before a public speech or on the first day of a new job. When anxiety is present at healthy levels, it fades once the threat situation is over. Sometimes the alarm system is too sensitive or can not turn off.
An anxious condition develops into a disorder when anxiety is unrelenting, intense, and may not be directly related to an obvious threat, or at least obvious to others. The person may be fearful even when others may not perceive any danger. The symptoms of an anxiety disorder may initially be difficult to detect because they may develop gradually over time without seeming to be too much. It is only when the person can not cope effectively with ordinary daily challenges for a sustained period that others may notice and be concerned.
In Australia, one in seven Australians are suffering from an anxiety disorder, and up to one-third of women and one-fifth of men will experience anxiety during their lifetimes. As such, anxiety is the most common mental health condition in Australia.[1] Over the past decade, young people are being diagnosed in unprecedented numbers.
By reflecting on your feelings in the past four weeks and answering ten questions on an Anxiety and Depression Checklist (K10) test you can self-assess your current state of wellbeing on Beyond Blue’s website: https://www.beyondblue.org.au/the-facts/anxiety-and-depression-checklist-k10
Anxiety disorders
Anxiety is a collection of mental health conditions. There are distinct types of anxiety disorders and people with anxiety experience symptoms from more than one type at different stages of their lives or even at the same time.
For example, Alison is a 20-year-old girl for whom high school was a challenging time. She was diagnosed with obsessive compulsive disorder when she was 14 years old and went on to develop anxiety and depression. As the pressure of school work increased she started to have panic attacks. Her use of social media meant that how she looked, how she achieved academically mattered and she developed an eating disorder in order to look her best in her posts. As a high achiever, she dreaded being known as the girl with depression or the girl with anxiety so she did not reach out for help until she could not sit her Year 12 exams because of her panic attacks.
So, anxiety is caused by a combination of factors. These factors include:
1. Family history of mental health conditions
Anxiety sufferers often report a history of mental health conditions in a parent or a close relative. However, a family history of mental illness does not mean that a person will automatically develop anxiety.
Ongoing physical health problems can also trigger anxiety. Some common medical conditions that are known to do this are:
- hormonal problems e.g.
• overactive thyroid,
• women-specific conditions – reproductive hormones such as estrogen are neurosteroids that act on the brain. Psychological conditions that only women face at childbirth, monthly hormonal fluctuations and menopause are not yet well understood. - diabetes
- asthma and
- heart disease.
3. Stressful life events such as:
- Natural disasters
- Job stress, job loss
- Relationship breakdown, family problems
- Fertility or sexual issues
- Experiencing abuse that is verbal, sexual, physical, emotional and/or psychological
- Experiencing or witnessing a traumatic event
- Death of a loved one
- Financial stress
4. Substance use
Heavy or long-term use of alcohol, cannabis, and amphetamines can cause people to develop anxiety as the effects of the substance wears off. People with anxiety also tend to self-medicate with drugs and alcohol which leads to using more substances to cope with the withdrawal symptoms.
Why and how anxiety emerges in one person and not another in response to life’s challenges is still a big question with a complex answer. There is some evidence that the ability to tolerate uncertainty is protective. Widening one’s window of tolerance to mental distress and developing psychological flexibility are mental skills that psychologists are trained to teach.
What are the symptoms of anxiety?
Signs and symptoms of anxiety
While each anxiety condition has its own symptoms, here are some common symptoms that occur for all types of anxiety disorders:
- Feeling worried and anxious most of the time
- Experiencing thoughts that keep looping round and round
- Avoiding situations and people that cause anxiety
- Feeling agitated and difficult to calm down
- Experiencing ongoing intrusive thoughts and images after a traumatic event
- Feeling overwhelmed
- Experiencing fright from sudden feelings of intense panic
Thoughts:·
- ‘My heart is going a million an hour and my mind is racing’
- ‘I can’t stop the thoughts in my head’
- ‘I’ll always be alone, no one likes me’
- ‘I’m going to die because I did not wear my mask in the supermarket’
- ‘I can’t do it. I’m not good enough’
- ‘My partner did not kiss me goodbye this morning, he wants to break up’
- ‘I am going to fail the test tomorrow because I am a loser’
You may have difficulty with
- Getting to sleep, frequent waking
- Trembling hands, sweaty palms, pins and needles
- Headaches, dizziness, light-headedness
- Concentrating and focussing
- Nausea, fatigue as digestive issues
Why is it so difficult to seek treatment?
Researchers found that only one out of four anxiety sufferers get proper care. They found that shame, stigma, logistics, and finances are the most common barriers to seeking treatment. In fact, those who were experiencing more severe anxiety symptoms reported more perceived barriers to treatment and a belief that treatment would not help with their symptoms. This is concerning because it is they who may benefit most from treatment who are failing to recognise their need for treatment. Others reported not knowing where to seek treatment. The following are some of their concerns about seeking proper treatment: · ‘I wanted to handle my problems on my own’
- ‘I felt embarrassed about my problems’
- I felt embarrassed about needing help for my problems’
- I was worried about being judged or criticised by my friends/ my family if I sought treatment’
- ‘I did not think treatment could help with my problems’
- ‘I did not know who to see or where to go for treatment’
- ‘I was worried about the cost of treatment’
- ‘There is not in my schedule for treatment’
- ‘My health insurance does not cover treatment’
The role of social media in making anxiety worse for young people is well documented. While social media is a great means to stay connected with friends, the need to present a perfect online image can be extremely anxiety-provoking.
If you are one of these people, it is important that you seek treatment before your worrying gets out of control. Your symptoms may not go away on their own and they can start to take over your life. Find out more here
What are the different types of Anxiety Disorders?
The four most common types of anxiety are
- Generalised anxiety disorder,
- Social anxiety disorder (Social Phobia),
- Post-traumatic stress disorder (PTSD)
- Panic disorder
Generalised Anxiety Disorder
Over the past six months, on most days, have you been worrying about day-to-day issues for no reason? Do you find yourself expecting disaster to strike or do you worry excessively about health, work, family, money? Does daily life feel like a constant stream of worry and dread? Has it affected your daily activities such as working or socialising or the way your spend time in your family? If you do, you may have a type of anxiety disorder called generalised anxiety disorder (GAD). GAD is treatable.
Normal anxiety is occasional and an appropriate part of life. People with GAD are anxious and worried all the time. Their worries are intense and persistent and prevent them from enjoying life. They worry about everything, not just the serious aspects of work, family, health, and finances but also the minor details of household chores such as the right kind of pet food, being late for an appointment, or not having the right kind of bread. Their worry is not only intense and uncontrollable but also conveys a dread that something terrible is about to happen.
People with GAD can spend hours being excessively anxious each day, making it difficult to concentrate or complete daily tasks. They experience fatigue, aches and pains, or shortness of breath which impair their functioning. These symptoms fluctuate over time and worsen during times of stress such as during a conflict, meeting a dateline, or during a physical illness.
- 1. Who experiences GAD?
This condition tends to affect more women than men and can occur at any time in life although generally, it starts around 30 years of age and they often describe themselves as a “worrier”.
Children and adolescents with GAD typically worry excessively about their performance at school or sports, catastrophes and they worry about the health of other family members. They tend to be perfectionistic, over-conforming, unsure of themselves, seeking regular and frequent reassurance from others.
- 2. What causes GAD?
- Genetics. Studies support the finding that anxiety disorders “run in families”. More recent research points to a biological cause for anxiety. In 2021, a Queensland team of researchers QIMR Berghofer Medical Research Institute led by Jackson Thorpe demonstrated a strong genetic basis for both conditions. They identified 611 genes linked to anxiety and about three-quarters are associated with depression as well which means that most of us are at some genetic risk to develop anxiety. Many of us have the genetic risk yet do not develop anxiety because of epigenetics which is the genes’ ability to turn themselves on and off in response to environmental triggers.
- Environment. Researchers have also found that experiencing a traumatic event or being in a stressful environment can increase the risk of developing GAD.
- Personality Traits. Some personality traits such as emotional sensitivity, low tolerance for uncertainty and perfectionistic traits increase a person’s risk to GAD.
- Social media: Social media has been shown to cause mental health conditions especially in girls and women.
1Genetic heterogeneity in self-reported depressive symptoms identified through genetic analyses of the PHQ-9 JG Thorp, AT Marees, JS Ong, J An, S MacGregor, EM Derks Psychological medicine 50 (14), 2385-2396
The platforms in social media are designed to be addictive through the uncertainty of a desired outcome in the future. Not knowing how many ‘likes’ a picture will get, who will ‘like’ the picture keeps users engaged. They post content to receive positive feedback and in reviewing others’ social activity, users make comparisons, searching for validation digitally that serves to replace real life connection. For instance, new mums are bombarded with social media images of the “perfect family” increasing anxiety and perinatal depression when real life as a new mum did not live up to the image.
- 3. How is GAD treated?
Beyond Blue has published ‘A Guide to What works for Anxiety’ authored by the Centre for Mental Health, University of Melbourne
which gives evidence-based reviews on a wide range of treatments for anxiety disorders for the public to be better informed. For GAD (pp19-21) the best treatments are cognitive behaviour therapy (CBT), Computer-aided psychological therapy (CAP) which CBT is delivered over the internet, anti-depressants and Relaxation Therapy.
CBT is a form of talk therapy (psychotherapy) which has been well studied and is the gold standard for psychotherapy. CBT teaches the person different ways of thinking, behaving and responding to situations in order to feel less worried and anxious. Acceptance and Commitment therapy (ACT) is a newer version of CBT and takes a different approach to negative thoughts. ACT uses mindfulness and goal setting to reduce anxiety.
- 4. How can you support yourself and others with regards to GAD?
- 1. Inform yourself. Become familiar with the symptoms, learn about treatment options and current research. Use the following symptom checklist from Beyond Blue (see below). Remember that many people struggle to speak openly about their mental health and you may be the one trusted friend that makes a difference.
- 2. Communicate. If you are experiencing GAD symptoms, have an honest conversation with a trusted friend or a health professional such as your GP.
- 3. Know when to seek help. If your anxiety starts to interfere with your daily life, it is time to seek professional health.
Beyond Blue Symptom Checklist for GAD
For six months or more, on more days than not, have you:
- felt very worried about a number of events or activities
- found it hard to stop worrying
- found that your anxiety made it difficult for you to do everyday activities (e.g. work, study, seeing friends and family)?
If you answered yes to all of these questions, have you also experienced three or more of the following:
- felt restless or on edge
- felt easily tired
- had difficulty concentrating
- felt irritable
- had muscle tension (e.g. sore jaw or back)
- had trouble sleeping (e.g. difficulty falling or staying asleep or restless sleep)? If you have answered yes, you may be experiencing generalised anxiety disorder.
Social Anxiety Disorder (Social Phobia)
- 1. What is social anxiety disorder?
Social anxiety disorder (SAD) is a common type of anxiety disorder and is more than just shyness. People with SAD experience extreme anxiety and fear in social situations even the most harmless everyday situations. They fear being scrutinized, evaluated, or judged by others in
- Performance situations such as speaking in public, a job interview, dating, meeting new people
- Interacting in social situations such as eating and drinking in front of others and making small talk. People with SAD may worry about engaging in social situations for weeks before they happen. Sometimes, they may avoid places or events that cause distress.
Social anxiety disorder can also be specific to behaving in a situation or an experience such as just attending meetings. SAD usually starts in childhood as extreme shyness or avoidance of social interactions. It occurs more frequently in females than in males.
- 2. Signs and symptoms of social anxiety disorder?
When having to perform before others, people with SAD may:
- Blush or stammer when trying to speak
- Sweat or tremble
- Feel their mind going blank or feel nauseated
- They may rigidify in posture and speak very softly
- Avoid eye contact, avoid being around people they don’t know or making small talk
- Feel intense self-consciousness and fear that people will judge them negatively
A diagnosis of SAD is made when the symptoms are present and the person has avoided going to events and struggled with activities in their daily lives.
- 3. What causes social anxiety disorder?
Risk for SAD may run in families. Researchers have found parts of the brain involved in fear and anxiety. Stress and environmental factors also play a part in this disorder.
- 4. How is social anxiety disorder treated?
In Beyond Blue’s publication ‘A Guide to What works for Anxiety’ authored by the Centre for Mental Health, University of Melbourne (pp. 19 – 21)
The psychological interventions which work are Behaviour therapy (including exposure therapy), Cognitive behavior therapy (CBT), Computer-aided psychological therapy (CAP). Antidepressants, such as selective serotonin reuptake inhibitors (SSROs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are also effective in treating SAD. Beta-blockers can help control the physical symptoms of SAD and are commonly the medication of choice for “performance anxiety” type of SAD.
Post-traumatic stress disorder (PTSD)
A major disruption in a person’s life can affect the ability to function normally, which may result in a post-traumatic stress disorder or PTSD diagnosis. Everyone experiences some kind of fear and stress when going through a traumatic event. These feelings allow people to protect themselves from harm and violence. However, for some people, strong emotional and physical feelings cause a disruption in the brain processes.
What is PTSD?
PTSD Is a condition that causes someone to re-live a traumatic event over and over again. The replaying of the event feels so real as if it were happening again. In order for a diagnosis of PTSD to be made, a person must have some of the following symptoms for at least one month:
- Re-experiencing symptoms. The person has flashbacks or nightmares related to the traumatic event.
- Avoidance symptoms. The individual stays away from people and social settings, particularly those that remind them of the trauma.
- Reactivity symptoms. The victim with PTSD has trouble sleeping and has emotional outbursts. When they go out, they are hyper-aware of their surroundings.
- Negative cognitions and mood symptoms. The person suffers from mood swings and has negative thoughts of themselves and others leading to ongoing strong feelings of fear, anger, horror, guilt, or shame.
Children and teens’ reactions to trauma
Older children and teens usually show symptoms similar to adults but they may also develop disruptive, disrespectful, or destructive behaviours. They may also feel guilty for their helplessness and have thoughts of revenge.
Children younger than six may show different symptoms to adults such as:
- Wetting the bed after being completely toilet trained
- Going mute – being unable to talk
- Acting out the scary event in play
- Being unusually clingy to a parent or other adult
Why does PTSD only affect some people?
We know that not everyone who lives through a dangerous event develops PTSD. For instance, not every survivor of sexual assault develops PTSD and not every war veteran has violent flashbacks. Research shows that PTSD occurs when brain processes are disrupted by an extreme stress response.
Some of the risk factors for PTSD include previous childhood trauma, having nobody to turn to afterward, having a history of mental illness or substance abuse, feeling extreme powerlessness, and dealing with extra stress after the event. The things that help to reduce the likelihood of PTSD include being supported, accepting one’s actions in the traumatic event, learning from the traumatic event, and learning to accept the fear.
How is PTSD treated?
It is essential for someone with PTSD symptoms to work with a mental health professional who has experience treating PTSD. The main treatments are psychotherapy and medication. Some people with PTSD are still living in their traumatic situations such as being in an abusive relationship. In order to be effective, treatment needs to address the traumatic situation and the symptoms.
One common type of psychological therapy called cognitive behavioural therapy (CBT) aims to help a person identify and change troubling emotions, thoughts, and behaviours. Some types of psychotherapy target PTSD symptoms and others focus on social, family, or job-related issues.
The two essential elements of psychological therapy used in PTSD treatment are:
- Exposure therapy helps people to manage and tolerate their fear by gradual exposure to selected elements of the trauma in a safe way. Victims will be taught self-soothing skills which they practice while re-experiencing carefully selected features of the traumatic event.
- Cognitive restructuring helps people make sense of the traumatic event. Cognitive restructuring can help people with PTSD think about what happened in a realistic and balanced way.
Olivia was paralysed in a car accident at the age of 17, ending a competitive swimming career. With the help of family and an intense rehabilitation program, she learned to walk again and went on to study medicine, specializing in emergency medicine. She has traveled to war-torn countries and to disaster areas to provide care while based in a busy major hospital and continues to walk with a limp. Today, she credits the accident for transforming her from a “self-centered, privileged brat” to appreciating life and her relationships with others. She feels she has much to offer others and enjoys the small tasks of daily living.
Post-traumatic growth (PTG) is a theory that explains this kind of transformation following trauma developed by psychologists Tedeschi and Calhoun in the 1990s. They claim that people who endure extreme psychological struggle following adversity can often experience positive growth in the aftermath. PTG is not an automatic result of trauma and is different from resilience, which is the personal attribute of bouncing back. PTG is what happens to someone who struggles to bounce back from a traumatic event that challenges his or her core beliefs about the benevolence, predictability, and controllability of the world; his or her identity and sense of the future, endures psychological struggle such as PTSD and during the process finds a sense of personal growth.
It can be compared to experiencing a physical and psychological earthquake, rebuilding the self from the rubble into a new self that incorporated the trauma into one’s present and future reality. Psychologists say that this is a process that takes a lot of time, struggle, and energy. Observable changes that occur in PTG are greater appreciation of life and changed priorities; warmer, more intimate relationships, a greater sense of personal strength; recognition of new paths/possibilities, and spiritual development.
Ironically, someone who is already resilient when the trauma occurred, won’t experience PTG because a resilient person will not be rocked to the core and does not have to find a new belief system. People who are open to experience and have extraversion are more likely to experience PTG. That is because they are more likely to reconsider their belief systems and extroverts are more likely to seek out connections with others in response to trauma.
Panic disorder refers to the condition of experiencing recurrent panic attacks which are disabling and disruptive to day-to-day functioning.
A panic attack is a sudden, ‘out of the blue’ experience of intense fear or discomfort which peaks within a few minutes and is accompanied by at least four of the following sensations:
- Pounding heart
- Shaking
- Breathlessness/ choking
- Chest pains
- Nausea
- Chills or sweats
- Lightheadedness, dizziness, or feeling faint
- Numbness or tingling in extremities
- Feeling unreal or feeling detached from oneself
- Fear of dying
- Fear of going mad.
There are two kinds of panic attacks, unexpected and unexpected. Expected panic attacks are linked to a particular trigger such as being in a crowded room. Unexpected panic attacks do not have an identifiable cue and can occur at any time including when the person is asleep.
A person is diagnosed with a panic disorder when he or she experienced at least one unexpected panic attack followed by a month or more of worrying about the panic attack and future panic attacks and changing behaviors to prevent future attacks. While symptoms of panic disorder can occur at any age, the typical age of onset is in early adulthood.
What is the cause of Panic disorders?
A number of factors may contribute to the development of panic disorders:
- Genetic: Having an immediate family member with panic disorder increases the chance of developing the disorder.
- Brain: the fear circuitry in the brain of some individuals may be over-sensitive.
- Cognitive factors: People with panic disorder are more sensitive to their internal bodily sensations and interpret increased heart rate and breathing patterns as life-threatening,
• Stressors in childhood and adulthood
• Temperament.
• Smoking and substance use.
Treatment
Cognitive Behaviour Therapy (CBT) is considered to be the most effective treatment for panic disorder. However, before CBT can be applied, you need to understand the architecture of a panic attack in order to reverse it.
- Psychoeducation about the physiological cascade of panic. Severe fear activates the flight/fight response which triggers hyperventilation and increases heart rate resulting in changes in blood gases and a state of delirium in the brain. The delirium is due to too much O2 in the blood which results in respiratory alkalosis and the fear becomes terror. That’s a panic attack. A panic attack can be reversed by accumulating CO2. There are two ways to do that:
- Intense movement such as running up and down the stairs causes the muscles to generate CO2 which corrects the alkalosis in about a minute and stops the panic attack.
- Slow the breathing down – SLOW, not DEEP. Deep breathing worsens the alkalosis because you are getting rid of more CO2. Make sure the exhale is longer than the inhale. Slow breathing takes longer and requires the person to practice when calm.
- Then there is the mammalian dive reflex which induces bradycardia and makes your heart rate slow down. This has nothing to do with psychology. It is an ancient reflex that is present in all mammals, even newborns. It is triggered when a mammal’s face comes in contact with cold water. When this occurs, receptors are activated within the nasal and sinus cavities as well as areas in the face connected to the trigeminal nerve. Information that the face has encountered water is transmitted to the brain and the autonomic nervous system through the vagal nerve, resulting in the immediate closure of the airway as well as a number of physiological changes to optimize the body’s conservation of oxygen.
- Cold on your face over eyes and nasal bridge using an icepack
- Assume a dive position, head between knees
- Hold your breath for 20-30 seconds
- Come up slowly – you may feel lightheaded. Repeat 2-3 times.
After the panic attack is reversed, exposure therapy is needed to achieve mastery over the cues/ triggers and fears that trigger your panic response. Self-monitoring and cognitive re-structuring of unhelpful thoughts and misinterpretation of panic symptoms are CBT techniques that help a person to identify ineffective thoughts and develop a more helpful style of thinking.
Who Can Treat Anxiety
There is a range of professionals who can treat anxiety but perhaps, the most common combination is a GP, a psychiatrist, and a psychologist. Then there are mental health nurses, accredited mental health social workers, occupational therapists in mental health, and complementary health practitioners. You are referred to the Beyond Blue booklet “ A guide to what works for anxiety” which looks at which treatment approaches have been tried and tested.
Enquire today about working with one of our psychologists in Adelaide to help you manage your anxiety. Call us at (08) 8363 3974 or fill out our contact form or Visit: https://rosyuen.com.au/services/anxiety-counselling/
