“Adversity is like a strong wind. It…tears away from us all but the things that cannot be torn, so that afterwards we see ourselves as we really are, and not merely as we might like to be.”
Anxiety is more than just feeling stressed or worried. While stress and anxious feelings are a common response to a situation where we feel under pressure, they usually pass once the stressful situation has passed, or ‘stressor’ is removed.
Anxiety is when these anxious feelings don’t go away – when they’re ongoing and happen without any particular reason or cause. It’s a serious condition that makes it hard to cope with daily life. Everyone feels anxious from time to time, but for someone experiencing anxiety, these feelings aren’t easily controlled.
What causes anxiety?
An anxiety condition isn’t developed or caused by a single factor but a combination of things. A number of other factors play a role, including personality factors, difficult life experiences and physical health.
Family history of mental health conditions
Some people who experience anxiety conditions may have a genetic predisposition towards anxiety and these conditions can sometimes run in a family. However, having a parent or close relative experience anxiety or other mental health condition doesn’t mean you’ll automatically develop anxiety.
Research suggests that people with certain personality traits are more likely to have anxiety. For example, children who are perfectionists, easily flustered, timid, inhibited, lack self-esteem or want to control everything, sometimes develop anxiety during childhood, adolescence or as adults.
Ongoing stressful events
Anxiety conditions may develop because of one or more stressful life events. Common triggers include:
- work stress or job change
- change in living arrangements
- pregnancy and giving birth
- family and relationship problems
- major emotional shock following a stressful or traumatic event
- verbal, sexual, physical or emotional abuse or trauma
- death or loss of a loved one.
Physical health problems
Chronic physical illness can also contribute to anxiety conditions or impact on the treatment of either the anxiety or the physical illness itself. Common chronic conditions associated with anxiety conditions include:
- hypertension and heart disease
Some physical conditions can mimic anxiety conditions, like an overactive thyroid. It can be useful to see a doctor and be assessed to determine whether there may be a medical cause for your feelings of anxiety.
Other mental health conditions
While some people may experience an anxiety condition on its own, others may experience multiple anxiety conditions, or other mental health conditions. Depression and anxiety conditions often occur together. It’s important to check for and get assistance for all these conditions at the same time.
Some people who experience anxiety may use alcohol or other drugs to help them manage their condition. In some cases, this may lead to people developing a substance use problem along with their anxiety condition. Alcohol and substance use can aggravate anxiety conditions particularly as the effects of the substance wear off. It’s important to check for and get assistance for any substance use conditions at the same time.
Everyone’s different and it’s often a combination of factors that can contribute to developing an anxiety condition. It’s important to remember that you can’t always identify the cause of anxiety or change difficult circumstances. The most important thing is to recognise the signs and symptoms and seek advice and support.
My anxiety started with the onset of Complex PTSD due to childhood sexual abuse which resurfaced it’s ugly head four years ago. The symptoms of anxiety conditions are sometimes not all that obvious as they often develop slowly over time and, given we all experience some anxiety at various points in our lives, it can be hard to know how much is too much. This is how it was for me. It was just small panic attacks at firsts but then it escalated overtime.
For example normal anxiety tends to be limited in time and connected with some stressful situation or event, such as a job interview. The type of anxiety experienced by people with an anxiety condition is more frequent or persistent, not always connected to an obvious challenge, and impacts on their quality of life and day-to-day functioning. While each anxiety condition has its own unique features, there are some common symptoms including:
Physical: panic attacks, hot and cold flushes, racing heart, tightening of the chest, quick breathing, restlessness, or feeling tense, wound up and edgy
Psychological: excessive fear, worry, catastrophising, or obsessive thinking
Behavioural: avoidance of situations that make you feel anxious which can impact on study, work or social life
Before I knew where I was in a matter of months I was unable to go out of the house alone my anxiety had got so bad. I could not predict when my panic attacks might come on and they were compounded by flashbacks whose triggers were also unpredictable. It became a vicious circle. I experienced a complete breakdown and was hospitalised and that was when my symptoms were properly diagnosed and were treated. It was a long process and it takes time as Complex PTSD has a myriad of co-morbid symptoms and conditions that exist with it such as dissociation identity disorder, derealisation, suicidality and self-harm. Through EMDR and Psychotherapy things have improved enormously.
For anxiety the following strategies may be helpful. There isn’t a one size fits all.
Cognitive Behaviour Therapy
Getting better means gaining control over worry. A number of psychological treatments have shown to help people with Generalised Anxiety Disorder (only one of many anxiety disorders), but cognitive behavioural therapy (CBT) produces the most consistent and long-lasting improvements.
It appears that the following components of treatment are most important:
- An approach where people are taught skills to manage their anxiety, as well as taking responsibility for change and control over their thoughts, feelings, and behaviour.
- Actively identifying and challenging worrying thoughts.
- Relaxation training (usually a form of progressive muscle relaxation) to control physical tension.
Some medications, such as antidepressants, have been shown to reduce worry and associated physical symptoms in people with GAD, but it appears that the improvements only last as long as the medications are taken. Benzodiazepines such as Valium provide temporary relief from symptoms, but are addictive. These drugs are not recommended for long-term use. Your doctor will be able to provide more information on medication, but used alone this treatment option will not be as good as when combined with CBT.
EDUCATION ABOUT ANXIETY
- Anxiety is experienced as symptoms of the flight or fight response:
- Respiration increase – shortness of breath
- Blood is redirected from gut to muscles – nausea
- Sweating increases – cold sweat
- Heart rate increases – palpitations
- Muscle tension increases – shaking and trembling
- Pupils dilate – things look unreal
- Mental arousal – selective attention
- Management of the fight-or-flight response
There are two tasks:
1 solve the problem that is making you anxious
2. control your level of anxiety so that it helps you problem solve
People are often tempted to avoid threatening situations, but if you do, the anxiety will be worse the next time you are in that situation. The best strategy is to confront the feared situation. Usually, it is better than you thought, and if not, you will have learned valuable coping skills by confronting your fears.
TRAINING STRATEGIES FOR CONTROLLING ANXIETY AND REDUCING STRESS:
- Use relaxation methods, such as progressive muscle relaxation, as people with generalised anxiety tend to have increased overall levels of arousal.
- Plan short-term activities
- Plan short-term activities that are enjoyable or distracting (particularly those activities that have been helpful in the past).
Exercise is helpful in managing worry, as exercising releases brain chemicals that counteract anxiety and low mood. It also gives time away from worries, and works off “nervous energy.” It is recommended that people do at least a half hour a day, three days a week, of cardio exercise.
Use structured problem solving to deal with stressors that may contribute to worry. When faced with difficult life problems, many people do not have adequate coping skills and consequently feel that they are not able to control what is happening to them. These feelings contribute greatly to the development of worry. While everybody has problems in their lives, these problems can become more apparent and more difficult to manage if you are prone to worry. Training in structured problem solving may be extremely useful. Effective problem-solving skills can reduce, minimise, control, or even prevent excessive worrying in daily living.
If you avoid situations or activities because of anxiety, gradually confront the things you fear using graded exposure. For example, a hierarchy, depending on how fearful you find each step, could be:
1. Not checking the phone for one hour
2. Showing up late to a meeting
3. Grocery shopping without a list
4. Organising a birthday party
5. Accepting an invite without looking at your calendar first
6. Leaving your mobile at home for the day
Make use of cognitive interventions:
Most people with GAD commonly make two errors in their thinking: overestimation (they overestimate the likelihood of something bad happening; i.e., “This will be a disaster; I had better prepare for the worst”) and underestimation (they underestimate their ability to cope; i.e., “I will have a breakdown; I won’t be able to control myself”). Challenge these worrying thoughts by learning to recognise distressing thoughts, testing whether the thought is realistic (i.e., “What evidence do I have that does not support these thoughts?”), and identifying more realistic alternatives (i.e., “How likely is it that my fearful predictions will actually occur?”)
People with GAD should also work toward challenging their beliefs and assumptions about themselves. For example, your worry might be “I’ll never be prepared in time,” which may be accompanied by the assumption that “if anything goes wrong, it’s my fault” and the underlying belief that “I am a failure.” Cognitive therapy strategies can help you identify and challenge these assumptions and develop alternative and more realistic beliefs.
People with GAD should explore and challenge their beliefs about worry. You may believe that worrying helps control potentially negative events or that worrying is helpful, but such positive beliefs about worry maintain worry and anxiety.
Once you have identified and challenged your negative thoughts, practice shifting attention away from the thought. Mindfulness-based interventions can also help you remain present focused.
Use emotion regulation and mindfulness. Research suggests that worry may serve as a way of avoiding emotional processing. Engage in emotion regulation strategies and mindfulness skills as they will help you identify and experience underlying emotions.
Avoid using sedative medication or alcohol to control your anxiety.
Refer for specialist consultation or iCBT if symptoms persist for longer than three months despite the above measures.
COPING WITH SYMPTOMS OF ANXIETY
When you find yourself worrying, ask yourself the following questions:
Is Your Worry Reasonable?
Is the thing you fear really likely to happen? How can you be sure? Is there another possible explanation or outcome? Are you trying to predict things in the distant future that you can’t possibly know anything about? If it does happen, how much will it really matter? How would someone else see this worry?
What Is The Effect Of Thinking The Way You Do?
If your worry has some basis, but there is nothing you can do about it right now, then see if you can accept the worry and let it go. This can seem difficult for expert worriers, but try to say “There’s nothing I can do to change this right now, thinking about it will only make me more upset. I’ll accept the worry and get busy with something else for now”.
Is There a True Problem To Be Solved?
If there is a realistic problem, then you may need to focus on finding solutions for it. Good problem solving can be thought of as helpful or adaptive worry.
- Try The Six-Step Structured Problem Solving Technique
- Write down exactly what you believe the main problem to be.
- Write down all possible solutions, even bad ones.
- Think about each solution in practical terms.
- Choose the most practical solution.
- Plan how you will carry that solution out.
- Do it.
Did that help you solve the problem? If not, have you learnt a better way of defining it? if so, write down the new problem and do the six steps again. This is as good as medication for many people.
The most important thing to remember about anxiety is that it’s not your fault.
Anxiety is made worse by life’s stressors, and has characteristic symptoms that affect a person’s thoughts, feelings, and everyday functioning.