People with anxiety experience continual and uncontrollable worry even if there is no apparent reason to worry. Anxiety results in low functioning and a person may become impaired. There are four major anxiety disorders: Generalised anxiety disorder, obsessive-compulsive disorder, panic disorder and social anxiety disorder. Understanding the type of anxiety a person may be experiencing is helpful in planning treatment.
What is Anxiety?
Everybody feels anxious from time to time, in stress-inducing or dangerous situations. Still, it may not be an anxiety disorder rather a protective biological response to danger that increases your heartbeat, breathing and pumps oxygenated blood to prepare to fight or flee. That’s normal! “Healthy” anxiety can persuade you to start working, meet deadlines and/or react appropriately in certain situations. However, sometimes the systems underlying our anxiety responses get dysregulated, and we overreact to situations which do not require any worry or response.
When should you worry?
- Excessive worrying to the point you are unable to cope. Women are 60% more likely to develop an anxiety disorder than men.
- Persistent anxiety that is routinely triggered by situations that do not pose a threat.
What is Generalised Anxiety Disorder (GAD)?
Symptoms include heart palpitations, trembling, sweating, irritability, restlessness, and headaches. GAD can also cause insomnia, difficulty concentrating and indecisiveness. A person with GAD would want to be in control and expect perfectionism. Physical symptoms can have a debilitating effect on a person’s social life leading to isolation and low self-esteem. As soon as an individual with GAD resolves a problem, they excessively start worrying about the next issue that may arise. Individuals predict the worst possible outcomes and start ignoring/avoiding situations that make them anxious. Thus, this may increase the disorder’s intensity because the person never gets a chance to gather evidence that their fears may be unfounded. GAD is diagnosed when a person is weighed down with worries and fears for majority of the days in a six-month period, or longer.
What is Social Anxiety Disorder (SAD)?
People experiencing SAD have an overwhelming fear of being judged or embarrassing themselves in social situations. They may be anxious only in specific situations such as public speaking or as soon as they step out of their homes. The person is self-conscious and evaluates everything negatively. They dwell on past situations and obsess over how people may have perceived them. They over plan and rehearse anticipated situations. This can lead to isolation, depression and poor performance at work or school.
Symptoms before social interaction: Preparing and rehearsing excessively.
During interactions: trembling, rapid breathing, racing heart. The fight or flight system of the body is activated. In extreme cases, the person may experience a panic attack.
After interaction: the individual is self-critical, dissects conversations and body language, giving themselves negative feedback.
What is Obsessive Compulsive Disorder (OCD)?
OCD is an anxiety-related disorder characterised by intrusive and obsessive thoughts that are followed by repetitive impulses, compulsions or urges. It is an excessive sense of responsibility to keep others safe and it is an overestimation of threats. OCD is cyclical and often starts with an obsessive thought followed by raising anxiety levels which leads to checking and rechecking if everything is in order. Following rituals can give temporary relief but the distress returns soon after. OCD related intrusive thoughts are time-consuming and can disrupt daily life activities. Trauma or any other event in which the person felt they were responsible could trigger OCD. Another reason for OCD is family history and personality traits.
“An average person can have four thousand thoughts a day, and not all of them are useful or rational” – David Adam.
What is Panic Disorder?
Panic attacks are an exaggerated response to anxiety. A person may experience a panic attack without any reason. They last for approximately 20 minutes and are uncomfortable. Symptoms of panic attacks can be misinterpreted, and a person may think they are dying or having a heart attack. Individuals who have recurring panic attacks live in fear waiting for the next one. One in 10 people suffer from occasional panic attacks. Traumatic events can trigger panic disorder and family history also plays a part. Environments with high carbon dioxide and other illnesses, such as overactive thyroid can cause panic attacks. Before diagnosing you with a panic disorder, a doctor will need to rule out the possibility of other illnesses.
What are some of the effective treatments of anxiety?
- Lifestyle changes Skip caffeine, reduce vigorous exercise and avoid substances that may cause anxiety symptoms.
- Self-Help Includes affirmations, attend social events, and record yourself disproving negative assumptions. Engage in supportive listening and go easy on yourself!
- Mind-body approaches Engage in meditating, mindfulness, deep breathing, and techniques to relieve muscle tension.
- Medicine Your psychiatrist may prescribe you low doses of benzodiazepines and/or antidepressants to lower anxiety symptoms.
1. Cognitive Behavioural Therapy (CBT) identifies triggers, negative thoughts, habitual avoidance, and safety behaviours. It targets unhelpful negative beliefs/values and work to challenge and change them.
2. Behavioural Therapy (BT) identifies new behavioural goals and develops achievable and realistic steps to achieve set goals. BT is based on the concepts of classical conditioning (learning by association) and operant conditioning (learning through reinforcement).
3. Psychoeducation to provide information and support to the person having trouble and to the carers, this may reduce the chances of the disorder persisting.
4. Specialised residential treatment is used in addition to therapy and medication in severe cases of OCD.
5. Trauma-focused therapy works with reducing current perceived threats by working on the triggering memory. Trauma-focused therapy uses elements from CBT (challenging thoughts and beliefs).
6. Group Therapy includes assertiveness training and building self-esteem which helps to counteract unhelpful thoughts and unfounded fears. Being in a group promotes a sense of normalcy and individuals do not feel alone anymore.