This week is Mental Health Awareness Week and the theme is Anxiety. Anxiety is a normal emotion in us all, but sometimes it can get out of control and become a mental health problem.
The Lead Neuropsychologist at Cygnet Brunel, Dr Henk Swanepoel, answers some common questions about anxiety, including some tips for how to manage the condition if you find yourself experiencing its symptoms. Cygnet Brunel is a mental health hospital for men run by Cygnet Health Care.
1. What are the common types of anxiety disorders?
The general perception is that anxiety should be removed from a person’s life, however anxiety is a normal part of life and serves as the body’s security alarm. Furthermore, everyone has anxiety about many aspects, e.g. finances, relationship problems, health, future etc.
However, anxiety disorders affect a person in such a way where the anxiety does not go away, and in fact increases over time. The anxiety symptoms then interfere with relationships, employment and all general abilities to function.
Professionals use the Diagnostic and Statistical Manual (DSM5) to diagnose patients struggling with anxiety disorders. It is more commonly called the DSM5 today.
There are 11 different types of anxiety disorders:
1. Specific phobia – This occurs when a person anticipates exposure or are exposed to a feared stimulus, e.g., blood injection type (needles), animals (dogs, spiders), environmental fears (heights), situational type (enclosed spaces), other type (none of the above).
2. Social anxiety disorder or social phobia- fear of social situations due to fear of criticism during social interaction. Often this results in avoidance of the social situations.
3. Panic disorder – Often a recurrent condition of extreme fear, generally due to a perceived loss of control. It can be that there is no trigger for a panic attack, but general symptoms are dizziness, racing heart, trembling, hyperventilation, fear of dying / impeding doom.
4. Generalised anxiety disorder (GAD) – A persistent worry about everyday demands. GAD can cause problems with concentration due to this constant fear.
5. Agoraphobia – The fear of situations that may cause feelings of helplessness, panic, or embarrassment, e.g. waiting in a queue, crowds, lifts. People with this condition can also have recurrent panic attacks.
6. Separation anxiety disorder – a constant fear of being away from home or without an attachment figure.
7. Selective mutism – mostly seen in children. It is an inability to speak in specific social situations. This type of anxiety can last into adulthood.
8. Substance/medication-induced anxiety disorder – This usually occurs after using alcohol, drugs, or medication.
9. Anxiety disorder due to another medical condition – The diagnosis is used only if anxiety symptoms are present due to a medical condition, e.g. thyroid disease.
10. Other specified anxiety disorder – Only if a person has most but not all of the criteria for an anxiety disorder.
11. Unspecified anxiety disorder – Often used in hospitals when there may be a lack of information to make a complete diagnosis.
2. What can cause people to feel anxious? What are any triggers?
Many situations can cause a person to feel anxious. A common cause is historical or childhood experiences. In this regard, experiencing trauma and distress as a child can have a big impact, e.g. physical or emotional abuse, neglect, the death of a parent, bullying, overprotection.
Current life circumstances can also result in anxiety e.g. exhaustion, built-up stress, constant change / adjustment, unemployment, financial problems, excessive concern about the environment, bereavement, feeling lonely, being harassed.
Significant changes to day-to-day life can be a particular trigger, e.g. coronavirus pandemic responses. Other causes can be due to physical or mental health problems, e.g. living with an ongoing physical health condition, mental health problem such as depression, drug use, alcohol and medication, too much caffeine.
Other causes can include using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, being outside of the home alone (examples of agoraphobia). Separation fears often manifest in a worry that something bad might happen to a loved one and a fear of speaking in specific social situations despite having normal language skills can result in selective mutism.
3. What does anxiety do to our mind and body?
Anxiety can cause the brain to release stress hormones on a regular basis, which may result in an increase of the frequency of symptoms, such as headaches, depression and dizziness. When a person feels anxious, the brain ‘floods’ the central nervous system (CNS) with hormones and neurochemicals meant to assist the person respond to the perceived threat, e.g. adrenaline and cortisol.
Constant exposure to stress hormones and neurochemicals can for example, contribute to weight gain (cortisol). Furthermore, anxiety disorders can cause rapid heart rate, palpitations, and chest pain (cardiovascular system problems), which increases the risk of heart disease and high blood pressure.
Anxiety can also affect a person’s excretory and digestive systems which might manifest in stomach cramps, nausea, diarrhoea and loss of appetite. A person’s fight or flight response, which releases a flood of neurochemicals and hormones, like adrenaline, can affect the immune system. It also increases a person’s pulse and breathing rate, so the brain can get more oxygen. This prepares a person to respond appropriately to an intense situation.
Chronic anxiety stress can weaken the immune system, because the body never gets the signal to return to regular functioning (homeostasis), leaving the individual vulnerable to viral infections, illnesses, or vaccines may not work as well. Also, anxiety can negatively affect the respiratory system due to frequent rapid / shallow breathing.
4. What is the treatment for anxiety?
Anxiety disorders are generally treated with psychotherapy, medication, or both. Psychotherapy will be tailored to the needs of the patient. Using Cognitive Behavioural Therapy (CBT) is an example of one type of psychotherapy that can help people with anxiety disorders. This approach teaches the individual alternative ways of thinking, behaving, and reacting to situations that are perceived as anxiety provoking. Another form of CBT is exposure therapy which focuses on confronting fears. Exposure therapy is sometimes used alongside relaxation exercises.
Another treatment option for some anxiety disorders is ACT, or acceptance and commitment therapy. Different to CBT, where the focus in on negative thoughts, ACT applies strategies such as mindfulness and goal setting. Stress management techniques, such as exercise, mindfulness, and meditation, can also reduce anxiety symptoms. This is also done in order to enhance the effects of psychotherapy.
Medication can also be used, although it does not cure anxiety disorders but can help relieve the symptoms. Some types of medication may work better for specific types of anxiety disorders and so individuals must liaise closely with their health care provider. Other substances such as caffeine, some over-the-counter cold medicines, illicit drugs, and herbal supplements can also aggravate the symptoms of anxiety, or interact with prescribed medication.
People with anxiety disorders often benefit from support groups which are available both in-person and online.
5. What are some self-care tips to help with anxiety?
Self-care tips should be applied in conjunction with a person’s personal preferences and personality, e.g. keeping physically active.
Not all people like sporty activities, but those who do can develop a routine as a means for a stress reducer. It also help you to stay healthy.
Another self-care tip is to avoid alcohol and recreational drugs, because these substances often worsen anxiety. Drinking caffeinated beverages as well as nicotine can also worsen anxiety.
A person should also consider using stress management and relaxation techniques, e.g. meditation and yoga. It is very important to make sleep a priority and eat healthy foods. A nutritional diet that incorporates vegetables, fruits, whole grains and fish may be linked to reduced anxiety.
Psychoeducation can also empower the anxious person to find out what might be causing the anxiety, which may involve family and friends interactions. Consistency is key therefore a person must stick to the treatment plan, e.g. to take medications as directed and keep therapy appointments in order to learn what situations trigger the anxiety.
Another helpful technique is to keep a journal, because keeping track of personal events may assist the person to identify what’s causing the distress. As people are generally speaking social beings, it is important to socialise. A person should not withdraw socially as loved ones can also assist with alleviating anxiety.
6. If I am a loved one of someone suffering with anxiety, what can I do to help?
It is firstly important to get a comprehensive understanding of their anxiety symptoms and how this impacts their life, because anxiety affects people differently. Reading up on anxiety and the different symptoms can assist with this understanding of what the loved one is going through.
In turn, this can help with empathy, thus to understand how they are ‘feeling in their shoes’, and gain awareness to know what they need. Emphasise that you’re here for them, which includes explaining to the loved one that you have observed that they seem more anxious lately and that you want to help. More often than not this might come as a relief to your loved one because they can know that they do not have to carry this anxiety alone.
This confirmation also gives your loved one the opportunity to see that they have people who care about them, who want to listen and who want them to feel better.
Equally, your loved one can also inform you as to ways you can help manage their anxiety symptoms better. Your loved one may want assistance to break down a challenge that causes the anxiety, or your loved one may want you to distract them from a specific trigger. By taking the time to listen to your loved one, you can give them comprehensive and personalised emotional support.
A challenge can be finding the correct words to say when a person is anxious, but a very effective way is to use active listening techniques to show you want to understand. You can ask your loved one how you can help them, or that you have noticed anxiety in them recently, or that you will always be there for them. Be mindful that when it comes to helping someone with anxiety, always maintain an open line of communication via 1:1 time, but also agree on keeping in touch by phone calling or sending a texts every so often to find out how they are.
On the other hand, also be mindful that your loved one’s anxiety can also affect you, therefore ensure that you also look after yourself by talking to other friends or family members about how you are feeling. The key factor is that by looking after yourself, you will be in a much better position to help your loved one.
