Anxiety: What is it? What causes it? What can I do about it?
What is it?
Anxiety is a general term for several disorders that
cause nervousness, fear, apprehension, and worrying. These disorders affect how
we feel and behave, and they can manifest real physical symptoms. Mild anxiety
is vague and unsettling, while severe anxiety can be extremely debilitating,
having a serious impact on daily life.
People often experience a general state of
worry or fear before confronting something challenging such as a test,
examination, recital, or interview. These feelings are easily justified and
considered normal. Anxiety is considered a problem when symptoms interfere with
a person's ability to sleep or otherwise function. Generally speaking, anxiety
occurs when a reaction is out of proportion with what might be normally
expected in a situation.
Anxiety is a natural response to feeling threatened or unsafe. Consider
that early Human beings date back over 2 million years. According to historical
data it is generally accepted that advanced civilisation began to flourish
around ten to twelve thousand B.C. The relative safety and security we enjoy
today is recent. For our ancestors dealing with truly life threatening
situations was an everyday occurrence. Historically that might be
predatory animals who see us as a meal, warring tribes, famine, drought,
plague, pestilence, ice age....you name it...as a species we've endured it! Why
is this relevant? Well, it's simple. The human being has a powerful built in
warning system to deal with these very real threats. This warning system is
primitive in nature since it has been with us from the very beginning. In many
ways one can say it is a part of the "animal body" and indeed the
area of the brain that is associated with the warning system response is often
referred to as the "mammalian brain". When we feel threatened in
some way, then the warning system is activated and we experience fear, anger or
depression.
Fear/Anxiety - Fear is the feeling that tells us to
either leave a situation or to not go into that situation in the first place.
The assumption by the animal mind is that we are in danger. By design
therefore fear is necessarily extremely uncomfortable because its purpose is to
get our attention so we take evasive action! This is fine when the danger is
real, but is crippling when the anxiety/fear mechanism is responding
inappropriately to everyday situations and stimuli which really don't require
evasive action.
We
can experience anxiety in response to single stimuli (phobia) or we can
experience generalised anxiety too (Generalised Anxiety Disorder). Panic is a
form of extreme fear which is caused by a build up of anxiety over a period of
time which is suddenly released causing a "panic attack". Panic does
not exist in isolation (without anxiety generally being present). If you are
experiencing panic attacks, then you can take it as a given that your anxiety
generally is far too high.
What causes it?
Excessive
stress is the primary cause of anxiety. We experience stress when we feel
overwhelmed and any number of factors can cause us to experience stress. Stress
is very subjective, and our individual tolerance to stress also varies
greatly. Here are just a few of the most common forms of stress,
but this list is by no means exhaustive. The first bullet point here is perhaps
the most important cause of stress.
·
Disempowerment - A lack of power or influence over one's life.
·
Poor sleep (Also a response to stress as well as a cause).
·
Victimisation (Being bullied).
·
Losing a loved one (Bereavement or the loss of a relationship)
·
Family difficulties (Children, sex, divorce, lovelessness)
·
Boredom/Lack of direction in life.
·
A lack of time or energy to do everything that needs to be done.
·
Poor self-image/Lack of self-worth.
·
Negative Thinking
·
Negative Outlook
·
Guilt, Blame and Shame.
·
Financial difficulties (Debt!)
·
Misuse of drugs/alcohol.
·
Work pressure.
·
Illness
·
Loneliness
·
Failing Relationships
We
might have included past stress and trauma here too, but I wish to highlight a
very important point here. It is true that past hurt and trauma does affect us
in the present, but the assumption that we feel terrible today because of
something that happened in the past is often misleading. What happens in fact
is that what we think and feel today is based on what we have learned in life
through past experiences. We experience stress and anxiety when our lives are
not working in the present. If however past experiences have taught us that we are powerless
in certain areas, then this sense is carried with us into the future. This is
known as "learned helplessness", and it contributes strongly to our
sense of stress on a daily basis because if we feel "powerless" in
any area of life then it means that at a deep level we also feel vulnerable and
if we are feeling vulnerable, then we are feeling "threatened".
Follow the logic and you will recognise that this is exactly what the
"animal mind" is responding to...feeling threatened. In other words,
feeling vulnerable creates anxiety. Further though, if we are feeling anxious
the unconscious mind seeks to pin this feeling on something. Since the nature
of this mind is to search back through past experience for something which
pattern matches to the feeling of anxiety it invariably comes up with an image
of the last time we experienced a terrible time. Thus, we can easily then make
the erroneous assumption that this memory of a terrible time is the cause of
our problem when in fact the true cause is that we are lacking control in the
present. So it's really important to recognise that although past experience
needs to be acknowledged (and possibly worked through therapeutically), it is
just as important to make sure that our lives are functioning well in the
present, and what this means in real terms is making changes which will bring
about more control.
Anxiety
disorders may be caused by environmental factors, medical factors, genetics,
brain chemistry, substance abuse, or a combination of these. It is most
commonly triggered by the stress in our lives. Usually anxiety is a response to
outside forces, but it is possible that we make ourselves anxious with
"negative self-talk" - a habit of always telling ourselves the worst
will happen.
Environmental and
external factors
Environmental factors that are known to cause several types of
anxiety include:
§ Trauma
from events such as abuse, victimization, or the death of a loved one
§ Stress
in a personal relationship, marriage, friendship, and divorce
§ Stress
at work
§ Stress
from school
§ Stress
about finances and money
§ Stress
from a natural disaster
§
Lack of oxygen in high altitude
areas
Medical factors
Anxiety is associated with medical factors such as anemia,
asthma, infections, and several heart conditions. Some medically-related causes
of anxiety include:
§ Stress
from a serious medical illness
§ Side
effects of medication
§ Symptoms
of a medical illness
§ Lack of
oxygen from emphysema, or pulmonary embolism (a blood clot in the lung)
Substance use
and abuse
It is estimated that about half of patients who utilize mental
health services for anxiety disorders such as GAD, panic disorder, or social
phobia are doing so because of alcohol or benzodiazepine dependence. More
generally, anxiety is also know to result from:
§ Intoxication
from an illicit drug, such as cocaine or amphetamines
§ Withdrawal
from an illicit drug, such as heroin, or from prescription drugs like Vicodin,
benzodiazepines, or barbiturates
Genetics
It has been suggested by some researchers that a family history
of anxiety increases the likelihood that a person will develop it. That is,
some people may have a genetic predisposition that gives them a greater chance
of suffering from anxiety disorders.
Brain
chemistry
Research
has shown that people with abnormal levels of certain neurotransmitters in the
brain are more likely to suffer from generalized anxiety disorder. When
neurotransmitters are not working properly, the brain's internal communication
network breaks down, and the brain may react in an inappropriate way in some
situations. This can lead to anxiety
What can I do about it?
There are really three options available.
Anxiety
Attacks & Anxiety Disorders
it’s normal to feel anxious when facing a challenging situation,
such as a job interview, a tough exam, or a blind date. But if your worries and
fears seem overwhelming and interfere with your daily life, you may be
suffering from an anxiety disorder. There are many different types of anxiety
disorders—and many effective treatments and self-help strategies. Once you
understand your anxiety disorder, there are steps you can take to reduce your
symptoms and regain control of your life.
Understanding anxiety disorders
Anxiety is
the body’s natural response to danger, an automatic alarm that goes off when
you feel threatened, under pressure, or are facing a stressful situation.
In
moderation, anxiety isn’t always a bad thing. In fact, anxiety can help you
stay alert and focused, spur you to action, and motivate you to solve problems.
But when anxiety is constant or overwhelming, when it interferes with your
relationships and activities, it stops being functional—that’s when you’ve
crossed the line from normal, productive anxiety into the territory of anxiety
disorders.
Do your symptoms indicate an
anxiety disorder?
If you
identify with several of the following signs and symptoms, and they just won’t
go away, you may be suffering from an anxiety disorder.
§ Are you
constantly tense, worried, or on edge?
§ Does
your anxiety interfere with your work, school, or family responsibilities?
§ Are you
plagued by fears that you know are irrational, but can’t shake?
§ Do you
believe that something bad will happen if certain things aren’t done a certain
way?
§ Do you
avoid everyday situations or activities because they cause you anxiety?
§ Do you
experience sudden, unexpected attacks of heart-pounding panic?
§ Do you
feel like danger and catastrophe are around every corner?
Because
anxiety disorders are a group of related conditions rather than a single
disorder, they can look very different from person to person. One individual
may suffer from intense anxiety attacks that strike without warning, while
another gets panicky at the thought of mingling at a party. Someone else may
struggle with a disabling fear of driving, or uncontrollable, intrusive
thoughts. Yet another may live in a constant state of tension, worrying about
anything and everything.
Despite
their different forms, all anxiety disorders share one major symptom:
persistent or severe fear or worry in situations where most people wouldn’t
feel threatened.
Emotional symptoms of anxiety
In
addition to the primary symptoms of irrational and excessive fear and worry,
other common emotional symptoms of anxiety include:
§ Feelings of
apprehension or dread
§ Trouble
concentrating
§ Feeling tense and
jumpy
§ Anticipating the
worst
|
§ Irritability
§ Restlessness
§ Watching for signs
of danger
§ Feeling like your
mind’s gone blank
|
Physical symptoms of anxiety
Anxiety is
more than just a feeling. As a product of the body’s fight-or-flight response,
anxiety involves a wide range of physical symptoms. Because of the numerous
physical symptoms, anxiety sufferers often mistake their disorder for a medical
illness. They may visit many doctors and make numerous trips to the hospital
before their anxiety disorder is discovered.
Common
physical symptoms of anxiety include:
§ Pounding heart
§ Sweating
§ Stomach upset or
dizziness
§ Frequent urination
or diarrhea
§ Shortness of breath
|
§ Tremors and twitches
§ Muscle tension
§ Headaches
§ Fatigue
§ Insomnia
|
The link between anxiety symptoms
and depression
Many
people with anxiety disorders also suffer from depression at some point. Anxiety and depression
are believed to stem from the same biological vulnerability, which may explain
why they so often go hand-in-hand. Since depression makes anxiety worse (and
vice versa), it’s important to seek treatment for both conditions.
Anxiety
attacks, also known as panic attacks, are
episodes of intense panic or fear. Anxiety attacks usually occur suddenly and
without warning. Sometimes there’s an obvious trigger— getting stuck in an
elevator, for example, or thinking about the big speech you have to give—but in
other cases, the attacks come out of the blue.
Anxiety
attacks usually peak within ten minutes, and they rarely last more than thirty
minutes. But during that short time, the terror can be so severe that you feel
as if you’re about to die or totally lose control. The physical symptoms of
anxiety attacks are themselves so frightening that many people believe they’re
having a heart attack. After an anxiety attack is over, you may be worried
about having another one, particularly in a public place where help isn’t
available or you can’t easily escape.
Symptoms of anxiety attacks include:
§ Surge of
overwhelming panic
§ Feeling of losing
control or going crazy
§ Heart palpitations
or chest pain
§ Feeling like you’re
going to pass out
§ Trouble breathing or
choking sensation
|
§ Hyperventilation
§ Hot flashes or
chills
§ Trembling or shaking
§ Nausea or stomach
cramps
§ Feeling detached or
unreal
|
Generalized anxiety disorder
If
constant worries and fears distract you from your day-to-day activities or
you’re troubled by a persistent feeling that something bad is going to happen,
you may be suffering from generalized
anxiety disorder (GAD). People
with GAD are chronic worrywarts who feel anxious nearly all of the time, though
they may not even know why. Anxiety related to GAD often shows up as physical
symptoms like insomnia, stomach upset, restlessness, and fatigue.
Anxiety attacks (Panic disorder)
Panic
disorder is characterized by
repeated, unexpected panic attacks, as well as fear of experiencing another
episode. Panic disorder may also be accompanied by agoraphobia, which is a fear
of being in places where escape or help would be difficult in the event of a panic
attack. If you have agoraphobia, you are likely to avoid public places such as
shopping malls or confined spaces such as an airplane.
Obsessive-compulsive disorder
Obsessive-compulsive
disorder (OCD) is characterized
by unwanted thoughts or behaviors that seem impossible to stop or control. If
you have OCD, you may be troubled by obsessions, such as a recurring worry that
you forgot to turn off the oven or that you might hurt someone. You may also
suffer from uncontrollable compulsions, such as washing your hands over and
over.
Phobia
A phobia is an unrealistic or exaggerated fear
of a specific object, activity, or situation that in reality presents little to
no danger. Common phobias include fear of animals such as snakes and spiders,
fear of flying, and fear of heights. In the case of a severe phobia, you might
go to extreme lengths to avoid the thing you fear. Unfortunately, avoidance
only strengthens the phobia.
Social anxiety disorder
If you
have a debilitating fear of being seen negatively by others and humiliated in
public, you may have social
anxiety disorder, also known as social phobia. Social anxiety disorder can be
thought of as extreme shyness. In severe cases, social situations are avoided
altogether. Performance anxiety (better known as stage fright) is the most
common type of social phobia
Post-traumatic stress disorder
Post-traumatic
stress disorder (PTSD) is an
extreme anxiety disorder that can occur in the aftermath of a traumatic or
life-threatening event. PTSD can be thought of as a panic attack that rarely,
if ever, lets up. Symptoms of PTSD include flashbacks or nightmares about what
happened, hypervigilance, startling easily, withdrawing from others, and
avoiding situations that remind you of the event.
Self-help for anxiety, anxiety attacks, and
anxiety disorders
An easy-to-follow recipe for feeling safe and
reducing anxiety.
Not everyone who worries a
lot has an anxiety disorder. You may be anxious because of an overly demanding
schedule, lack of exercise or sleep, pressure at home or work, or even from too
much coffee.
The bottom
line is that if your lifestyle is unhealthy and stressful, you’re more likely
to feel anxious—whether or not you have an anxiety disorder. So if you feel
like you worry too much, take some time to evaluate how well you’re caring for
yourself.
§ Do you
make time each day for relaxation and fun?
§ Are you
getting the emotional support you need?
§ Are you
taking care of your body?
§ Are you
overloaded with responsibilities?
§ Do you ask
for help when you need it?
If your
stress levels are through the roof, think about how you can bring your life
back into balance. There may be responsibilities you can give up, turn down, or
delegate to others. If you’re feeling isolated or unsupported, find someone you
trust to confide in. Just talking about your worries can make them seem less
frightening.
Self-help for anxiety attacks and anxiety disorders
#1: Challenge negative thoughts
§ Write down your worries. Keep a pad
and pencil on you, or type on a laptop, smartphone, or tablet. When you
experience anxiety, write down your worries. Writing down is harder work than
simply thinking them, so your negative thoughts are likely to disappear sooner.
§ Create an anxiety worry period. Choose one
or two 10 minute “worry periods” each day, time you can devote to anxiety.
During your worry period, focus only on negative, anxious thoughts without
trying to correct them. The rest of the day, however, is to be designated free
of anxiety. When anxious thoughts come into your head during the day, write
them down and “postpone” them to your worry period.
§ Accept uncertainty. Unfortunately, worrying about all the things that could go wrong
doesn’t make life any more predictable—it only keeps you from enjoying the good
things happening in the present. Learn to accept uncertainty and not require
immediate solutions to life’s problems.
Self-help for anxiety attacks and anxiety disorders
#2: Take care of yourself
§ Practice relaxation techniques. When
practiced regularly, relaxation techniques such as mindfulness meditation,
progressive muscle relaxation, and deep breathing can reduce anxiety symptoms
and increase feelings of relaxation and emotional well-being.
§ Adopt healthy eating habits. Start the day right with breakfast, and continue with frequent
small meals throughout the day. Going too long without eating leads to low
blood sugar, which can make you feel more anxious.
§ Reduce alcohol and nicotine. They lead to more anxiety, not less.
§ Exercise regularly. Exercise is a natural stress buster and anxiety reliever. To
achieve the maximum benefit, aim for at least 30 minutes of aerobic exercise on
most days.
§ Get enough sleep. A lack of sleep can exacerbate anxious thoughts and feelings, so
try to get 7 to 9 hours of quality sleep a night.
While
self-help coping strategies for anxiety can be very effective, if your worries,
fears, or anxiety attacks have become so great that they’re causing extreme
distress or disrupting your daily routine, it is important to seek professional
help.
If you’re
experiencing a lot of physical anxiety symptoms, consider getting a medical
checkup. Your doctor can check to make sure that your anxiety isn't caused by a
medical condition, such as a thyroid problem, hypoglycemia, or asthma. Since certain drugs and supplements can cause anxiety, your doctor will also want to
know about any prescriptions, over-the-counter medications, herbal remedies,
and recreational drugs you’re taking.
If your
physician rules out a medical cause, the next step is to consult with a therapist
who has experience treating anxiety attacks and anxiety disorders. The
therapist will work with you to determine the cause and type of your anxiety
disorder and devise a course of treatment.
Anxiety
disorders respond very well to treatment—and often in a relatively short amount
of time. The specific treatment approach depends on the type of anxiety
disorder and its severity. But in general, most anxiety disorders are treated
with behavioral therapy, medication, or some combination of the two. Sometimes
complementary or alternative treatments may also be helpful.
Behavioral therapy for anxiety disorders
Cognitive-behavioral
therapy and exposure therapy are types of behavioral therapy, meaning they
focus on behavior rather than on underlying psychological conflicts or issues
from the past. Behavioral therapy for anxiety usually takes between 5 and 20
weekly sessions.
§ Cognitive-behavior therapy focuses on thoughts—or cognition—in addition to behaviors. In
anxiety disorder treatment, cognitive-behavioral therapy helps you identify and
challenge the negative thinking patterns and irrational beliefs that fuel your
anxiety.
§ Exposure therapy for anxiety disorder treatment encourages you to confront your
fears in a safe, controlled environment. Through repeated exposures to the
feared object or situation, either in your imagination or in reality, you gain
a greater sense of control. As you face your fear without being harmed, your
anxiety gradually diminishes.
Medication for anxiety disorders
Is anxiety medication right for
you?
Anxiety
medications can be habit forming and cause unwanted side effects, so be sure to
research your options. It’s important to weigh the benefits and risks so you
can make an informed decision about whether anxiety medication is the right
treatment for you.
A variety
of medications, including benzodiazepines and antidepressants, are used in the
treatment of anxiety disorders. But medication is most effective when combined
with behavioral therapy and anxiety self-help strategies. Medication may
sometimes be used in the short-term to relieve severe anxiety symptoms so that
other forms of therapy can be pursued.
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