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Anxiety disorders

Anxiety is a natural and usually short-lived reaction to a stressful situation, associated with feelings of worry, nervousness or apprehension.

It typically occurs in new, unfamiliar or challenging situations, where the person might not feel up to the task, or where the outcome is uncertain.

The first day of school, sitting an exam, speaking in front of an audience, or attending a job interview are all situations in which most people feel some anxiety.

For people with anxiety disorders however, anxious thoughts, feelings, or physical symptoms are severe, upsetting, frequent, and interrupt daily life.

Symptoms

Common symptoms of anxiety include:

  • difficulty concentrating
  • restlessness
  • rapid heartbeat
  • trembling or shaking
  • feeling light-headed or faint
  • numbness or nausea
  • sweating
  • avoidance.1-3

Anxiety disorders

While anxiety is usually a natural and short-lived reaction to a stressful situation, for some people anxious thoughts, feelings, or physical symptoms can become chronic, severe and upsetting, and interrupt daily life.4 Severe, frequent, recurring, and persistent anxiety symptoms may be considered an anxiety disorder.1 Anxiety disorders are the most common type of mental health disorder diagnosed in Australia affecting around 14% of Australians every year. 1, 5, 6

There are different types of anxiety disorders:

Generalised anxiety disorder (GAD) is characterised by persistent and excessive worry, often about daily situations like work, family or health. This worry is difficult to control and interferes with the person’s day-to-day life and relationships.

Specific phobia involves extreme anxiety and fear of particular objects or situations. Common phobias include fear of flying, fear of spiders and other animals, and fear of injections.

Panic disorder is characterised by the experience of repeated and unexpected panic attacks – sudden surges of overwhelming fear and anxiety accompanied by physical symptoms such as chest pain, heart palpitations, dizziness and breathlessness. In panic disorder, these panic attacks come ‘out of the blue’ with no apparent trigger.

Agoraphobia involves intense anxiety in situations and places where the person feels it would be difficult for them to get out quickly or get help if needed. This includes situations such as using public transport, being in a lift or a cinema, standing in a queue, being in a crowd, or being outside of the home alone.

Obsessive compulsive disorder (OCD) presents in people as recurring, persistent and distressing thoughts, images or impulses known as obsessions (e.g., a fear of catching germs), or feeling compelled to carry out certain repetitive behaviours, rituals or mental acts, known as compulsions (e.g., handwashing). Some people with OCD have both obsessions and compulsions. These thoughts and behaviours can take over a person's life and, while people with OCD usually know that their obsessions and compulsions are an overreaction, they feel they are unable to stop them.

Social anxiety disorder is characterised by severe anxiety about being criticised or viewed negatively by others. This leads the person to avoid social events and other social situations for fear of doing something that leads to embarrassment or humiliation.

Causes

While there is no single known cause of anxiety disorders, there are a number of risk factors or triggers that may contribute.3 These differ between the different anxiety disorders but in general, the following factors may play a role.

Genes

Certain anxiety disorders appear to have a genetic component, with some anxiety disorders running in families.

Biology

Some anxiety disorders might have a basis in how the brain processes and responds to stress and physical arousal, and how the body releases stress hormones such as adrenalin.

Thinking style

Patterns of thinking characterised by anticipating the worst, persistent negative self-talk, difficulty accepting uncertainty and low self-esteem are often linked to anxiety. Sensitivity to your body’s physical responses, such as increased heart rate, and misinterpreting these physical symptoms as indicating something catastrophic might also increase the risk of developing certain anxiety disorders.

Coping strategies

Unhelpful coping strategies, such as a tendency to avoid situations that trigger the person’s anxiety, rather than facing such situations, can increase the risk for developing an anxiety disorder.

Stressful life events

Stressful events such as a marriage breakdown, work or school deadlines, and financial hardship can act as a trigger for the development of an anxiety disorder. Early life stress and trauma can also increase the likelihood of developing an anxiety disorder later in life.

Treatments

Cognitive behaviour therapy

Cognitive behaviour therapy (CBT) has been found to be the most effective treatment for anxiety disorders.7-9 CBT helps you change unhelpful thoughts and behaviours that can contribute to anxiety, and aims to build skills to manage anxiety when it arises.10 CBT for anxiety includes some of the following strategies:

  • Cognitive restructuring: a technique used by psychologists to help a person to challenge negative thoughts and develop more helpful and constructive ways of thinking.3
  • Problem-solving: a technique used to help a person work through day-to-day problems. Problem-solving has been shown to help people feel more confident tackling life’s challenges, and to decrease general anxiety. Structured problem solving involves identifying the problem, developing a range of potential solutions, selecting one to test out, implementing the solution and evaluating its helpfulness.10
  • Exposure therapy: a treatment in which the psychologist guides the person through a series of real or imaginary scenarios to confront specific fears. Through this gradual process, the person learns to cope more effectively with these fears, and with practise, the anxious response naturally decreases.
  • Relaxation: a range of techniques such as meditation or progressive muscle relaxation which, when practised regularly, have been found to effectively reduce anxiety.2

Mindfulness

Mindfulness has been found to effective in the treatment of anxiety. In mindfulness, instead of avoiding, withdrawing, or fighting against anxious thoughts, feelings and physical symptoms, the person is helped to remain present and aware of the symptoms, without judging them. Over time, the person becomes more open to and accepting of anxious experiences, less overwhelmed by them, and better able to engage fully with life.11, 12

Lifestyle changes

Lifestyle changes such as getting regular exercise, reducing alcohol and caffeine intake (which can act as stimulants and make anxiety symptoms worse), taking part in enjoyable activities, improving time-management skills and having adequate sleep can help reduce stress and anxiety.13

Seeking help

Seeing a psychologist

If anxiety is affecting your day-to-day life, a psychologist may be able to help. Psychologists are highly trained and qualified professionals, skilled in diagnosing and treating a range of mental health concerns, including anxiety disorders. A psychologist can help you to identify and manage the factors that contribute to your anxiety.

Psychologists usually see clients individually, but can also include family members to support treatment where appropriate. Psychologists sometimes offer group therapy, involving a small number of people with similar issues.

If you are referred to a psychologist by your GP, you might be eligible for a Medicare rebate. Ask your psychologist or GP for details.

There are number of ways to access a psychologist. You can:

  • use the Australia-wide Find A PsychologistTM directory or call 1800 333 497
  • ask your GP or another health professional to refer you.

Getting a medical check-up

A medical check-up with a GP is also important to see if a health issue might underlie your symptoms. A GP or other medical specialist might also offer advice and assistance where medication might be of benefit.

Tips to manage anxiety

Check your self-talk

When we are upset and anxious we sometimes say negative things to ourselves. Unhelpful self-talk might include things like, “I’m hopeless”, “I’m going to be terrible at this”, or “I’ll never get this done”. Negative self-talk gets us down, can increase anxiety and can get in the way of us achieving our goals.

Notice what you say to yourself and work on more helpful, calming and encouraging self-talk, such as, “I am coping well given what I have on my plate”, “This stressful time will pass”, or “I got through it last time”.

Keep things in perspective

When we are worried and upset it is easy to see things as worse than they really are, and to start anticipating all sorts of problems down the track. Take a step back and look at one of your worries in the bigger scheme of your life. Ask yourself:

  • am I getting ahead of myself, assuming something bad will happen when I really don’t know the outcome?
  • is the outcome certain to happen, possible, or quite unlikely?
  • if the worst were to happen, what could I do about it?

Sometimes thinking about how you would cope, even if the worst were to happen, puts things into perspective.

Don’t let anxiety stop you from doing things

Try not to avoid situations which trigger your anxiety, but work on facing these situations. If this seems too difficult, get the help of a psychologist or other mental health professional to work out a plan for facing your fears and increasing your confidence, step-by-step.

Practise relaxation, meditation or mindfulness

Practising relaxation, meditation and mindfulness on a regular basis will allow your body and nervous system the opportunity to routinely settle and readjust to a calm state.

Look after your health

Exercise, diet and other health behaviours can help support you to manage anxiety, so it is important to:

  • make sure you are eating well
  • get regular exercise
  • avoid using alcohol, tobacco and other drugs to cope when you are finding things difficult.

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington DC: Author.
  2. NICE. (2011). Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults. London: National Institute for Health and Clinical Excellence.
  3. Hambrick, J. P., Comer, J. S., & Albano, A. M. (2010). Cognitive–behavioral treatment of anxiety disorders: Model and current issues. In H. B. Simpson, Y. Neria, R. Lewis-Fernandez & F. Schneier (Eds.), Anxiety disorders: Theory, research, and clinical perspectives (pp. 204-215). New York, NY: Cambridge University Press.
  4. Andrews, G., Creamer, M., Crino, R., Hunt, C., Lampe, L., & Page, A. (2003). The treatment of anxiety disorders: Clinican guides and patient manuals (2nd ed.). New York, NY: Cambridge University Press.
  5. Australian Bureau of Statistics. (2008). National survey of mental health and wellbeing: Summary of results, 2007. Retrieved 7 May, 2013, from http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4326.02007?OpenDocument
  6. World Health Organization. (2008). ICD-10: International statistical classification of diseases and related health problems (10th Rev.). New York, NY: Author.
  7. Australian Psychological Society (APS). (2010). Evidence-based psychological interventions in the treatment of mental disorders: A literature review (3rd ed.). Melbourne: Author.
  8. Hunot, V., Churchill, R., Silva de Lima, M., & Teixeira, V. (2007). Psychological therapies for generalised anxiety disorder. Cochrane Database Systematic Reviews, 24(1).
  9. Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Panic Disorder and Agoraphobia. (2003). Australian and New Zealand clinical practice guidelines for the treatment of panic disorder and agoraphobia. Australian and New Zealand Journal of Psychiatry, 37(6), 641-656. doi: http://dx.doi.org/10.1111/j.1440-1614.2003.01254.x
  10. Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York, NY: Guilford Press.
  11. Vøllestad, J., Nielsen, M. B., & Nielsen, G. H. (2012). Mindfulness- and acceptance-based interventions for anxiety disorders: A systematic review and meta-analysis. British Journal of Clinical Psychology, 51(3), 239-260. doi: http://dx.doi.org/10.1111/j.2044-8260.2011.02024.x
  12. Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol, 78(2), 169-183. doi: http://dx.doi.org/10.1037/a0018555
  13. Kaplan, A., & Laygo, R. (2003). Stress managment. In W. O'Donohue, J. E. Fisher & S. C. Hayes (Eds.), Cognitive behavior therapy: Applying empirically supported techniques in your practice (pp. 411-417). New Jersey: John Wiley & Sons.

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