Anxiety

Anxiety can feel like a background hum that never quite stops, or it can arrive suddenly as panic, dread, or physical alarm. It often shows in worrying, avoidance, bodily tension, or difficulty switching off. Many people carry it quietly for years. Different forms of psychotherapy can help with most anxiety patterns. In some cases, medication can provide extra support.

If you are in Ireland and want a practical overview of therapy, GP routes, crisis support, and medication questions, see Anxiety Treatment in Ireland.

Often, anxiety is a signal of other emotions underneath it and that something or some things in life may not be aligned with one’s needs, values, and aspirations. This may be a work situation or a relationship. An important goal of therapy can be to make things work again.

When anxiety centres on a partner or relationship, it may help to read about relationship anxiety and real relationship problems, as well as the broader relationship problems hub.

Many people suffer from anxiety in silence. This often masks the suffering on the inside and the debilitating quality of anxiety. Often people feel helpless. They don’t know what to do, they feel trapped in a box by their own anxiety, which limits life more and more. There are many approaches that can be helpful against anxiety, such as psychotherapy, counselling, meditation, certain forms of exercise, and in specific cases also medication.

Anxiety is your body’s and your brain’s natural response to stress. Anxiety is not the same as fear, which is targeted at something specific. For example, one can be afraid of snakes or a specific outcome of a situation. Anxiety, on the other hand, is when there is the uncertainty itself one is afraid of. Anxiety can lead to reduced enjoyment in life, and in more extreme cases avoidance. For example, one might be anxious about social situations, and so avoid being around people. avoiding people, however, can cause a painful dilemma, in which one actually wants to be with people but at the same time feels too anxious to do so.

Anxiety disorders are very common, and they can affect anyone at any age. Women tend to be more often diagnosed with an anxiety disorder than men, but it may also be that women seek out help earlier.

Anxiety and Depression

Anxiety and depression quite often tend to go together. This does not mean one cannot experience them separately, but there is a significant correlation between the two. Heightened anxiety, for example, may worsen depressed feelings. On the other hand, anxiety can even be a symptom of depression. Diagnostically, it is important to keep them apart, if possible.

Many of the same treatment approaches help against both depression and anxiety. For example, enough sleep, stress reduction, better strategies for fulfilling wants, needs and aspirations, healthy and supportive relationships, and someone to discuss problems with, such as a therapist or close understanding friends, can all help against depression and anxiety. Important is that in at least the more severe cases one seeks out professional help, because the earlier these conditions are treated, the quicker they are to go away and to stay away.

Therapy and counselling can also be helpful in milder cases of anxiety and depression. One does not even have to be anxious or depressed to benefit from counselling. Very often we use strategies and interaction patterns in daily life that we have learned and acquired a long time ago, but which might not be as effective anymore. Therapy can help identify and replace them with better working ones.

Some Background on Anxiety

Anxiety is an emotion characterized by an unpleasant state of inner turmoil, often accompanied by nervous behaviour, such as pacing back and forth, somatic complaints, and rumination. [1] Unlike anxiety, fear is a response to a real or perceived threat [2]. Fear, on the other hand, is the expectation of a future threat. [3] Usually, in anxiety, there is a sense of existential fear or imminent doom. Frequent is a fear of death. [2] When anxiety is experienced regularly the individual may suffer from an anxiety disorder. [3]

Physical Symptoms of Anxiety

Anxiety is often accompanied by muscular tension [3] restlessness, fatigue and problems in concentration. The physiological symptoms of anxiety may include:[5][6]

• Neurological, as headache, paresthesias, vertigo, or presyncope.
• Digestive, as abdominal pain, nausea, diarrhoea, indigestion, dry mouth, or bolus.
• Respiratory, as shortness of breath or sighing breathing.
• Cardiac, as palpitations, tachycardia, or chest pain.
• Muscular, as fatigue, tremors, or tetany.
• Cutaneous, as perspiration, or itchy skin.
• Uro-genital, as frequent urination, urinary urgency, dyspareunia, or impotence.

People facing anxiety may withdraw from situations which have provoked anxiety in the past.[4] Furthermore, anxiety has been linked with physical symptoms such as Irritable Bowl Syndrome (IBS) and can heighten other mental health illnesses such as OCD and panic disorder.

Distortions in Thinking

Cognitive distortions such as overgeneralizing, catastrophizing, mind reading, emotional reasoning, binocular trick, and mental filter can result in anxiety. For example, an overgeneralized belief that something bad “always” happens may lead someone to have excessive fears of even minimally risky situations and to avoid benign social situations due to anticipatory anxiety of embarrassment. Such unhealthy thoughts can be targets for successful treatment with cognitive therapy.

Psychodynamic Explanations

Psychodynamic theory posits that anxiety is often the result of opposing unconscious wishes or fears that manifest via maladaptive defence mechanisms (such as suppression, repression, anticipation, regression, somatization, passive aggression, and dissociation) that develop to adapt to problems with early objects (e.g., caregivers) and empathic failures in childhood. For example, persistent parental discouragement of anger may result in repression/suppression of angry feelings which manifests as gastrointestinal distress (somatization) when provoked by another while the anger remains unconscious and outside the individual’s awareness. Such conflicts can be targets for successful treatment with psychodynamic therapy.

Where does it come from?

Anxiety disorders are partly genetic but may also be triggered, due to drug use, including alcohol and caffeine, as well as withdrawal from certain drugs. They often occur with other mental disorders, particularly major depressive disorder, bipolar disorder, certain personality disorders, and eating disorders. The term anxiety covers four aspects of experiences that an individual may have: mental apprehension, physical tension, physical symptoms and dissociative anxiety.[7] The emotions present in anxiety disorders range from simple nervousness to bouts of terror.[8] There are other psychiatric and medical problems that may mimic the symptoms of an anxiety disorder, such as hyperthyroidism. Common treatment options include lifestyle changes, therapy, and medications. Medications are typically recommended only if other measures are not effective.[9] Anxiety disorders occur about twice as often in females as males and generally begin during childhood.[10] As many as 18% of Americans and 14% of Europeans may be affected by one or more anxiety disorders. [11]

Social Anxiety

Social anxiety varies in degree and severity. For some people, it is characterized by experiencing discomfort or awkwardness during physical social contact (e.g. embracing, shaking hands, etc.), while in other cases it can lead to a fear of interacting with unfamiliar people altogether. Those suffering from this condition may restrict their lifestyles to accommodate the anxiety, minimizing social interaction whenever possible. Social anxiety also forms a core aspect of certain personality disorders, including avoidant personality disorders. [12] Humans generally require social acceptance and thus sometimes dread the disapproval of others. Apprehension of being judged by others may cause anxiety in social environments.[13] Anxiety during social interactions, particularly between strangers, is common among young people. It may persist into adulthood and become social anxiety or social phobia. “Stranger anxiety” in small children is not considered a phobia. In adults, an excessive fear of other people is not a developmentally common stage; it is called social anxiety. People with social phobia usually do not fear the crowd but the fact that they may be judged negatively. [14]

If you want to read more about anxiety, you may be interested in the following articles:

REFERENCES

[1] Davison, Gerald C. (2008). Abnormal Psychology. Toronto: Veronica Visentin. p. 154. ISBN 978-0-470-84072-6.

[2] American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. p. 189. ISBN 978-0-89042-555-8.

[3] Bouras, N.; Holt, G. (2007). Psychiatric and Behavioral Disorders in Intellectual and Developmental Disabilities (2nd ed.). Cambridge University Press.

[4] World Health Organization (2009). Pharmacological Treatment of Mental Disorders in Primary Health Care (PDF). Geneva. ISBN 978-92-4-154769-7.

[5] Testa A, Giannuzzi R, Daini S, Bernardini L, Petrongolo L, Gentiloni Silveri N (2013). “Psychiatric emergencies (part III): psychiatric symptoms resulting from organic diseases” (PDF). Eur Rev Med Pharmacol Sci (Review). 17 Suppl 1: 86–99. PMID 23436670.

[6] Diagnostic and Statistical Manual of Mental DisordersAmerican Psychiatric Associati. (5th ed.). Arlington: American Psychiatric Publishing. 2013. pp. 189–195. ISBN 978-0890425558.

[7] Phil Barker (7 October 2003). Psychiatric and mental health nursing: the craft of caring. London: Arnold. ISBN 978-0-340-81026-2. Retrieved 2010-12-17.

[8] Patel, G; Fancher, TL (Dec 3, 2013). “In the clinic. Generalized anxiety disorder.”. Annals of Internal Medicine. 159 (11): ITC6–1, ITC6–2, ITC6–3, ITC6–4, ITC6–5, ITC6–6, ITC6–7, ITC6–8, ITC6–9, ITC6–10, ITC6–11; quiz ITC6–12. doi:10.7326/0003-4819-159-11-201312030-01006. PMID 24297210.

[9] Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (June 2005). “Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication”. Arch. Gen. Psychiatry. 62 (6): 617–627. doi:10.1001/archpsyc.62.6.617. PMC 2847357. PMID 15939839.

[10] Öhman, Arne (2000). “Fear and anxiety: Evolutionary, cognitive, and clinical perspectives”. In Lewis, Michael; Haviland-Jones, Jeannette M. Handbook of emotions. New York: The Guilford Press. pp. 573–93. ISBN 978-1-57230-529-8.

[11] Scarre, Chris (1995). Chronicle of the Roman Emperors. Thames & Hudson. pp. 168–9. ISBN 978-5-00-050775-9.

[12] Stephan, Walter G.; Stephan, Cookie W. (1985). “Intergroup anxiety”. Journal of Social Issues. 41 (3): 157–175. doi:10.1111/j.1540-4560.1985.tb01134.

[13] Thomas, Ben; Hardy, Sally; Cutting, Penny, eds. (1997). Mental Health Nursing: Principles and Practice. London: Mosby. ISBN 978-0-7234-2590-8.

[14] Settipani, Cara A.; Kendall, Philip C. (2012). “Social Functioning in Youth with Anxiety Disorders: Association with Anxiety Severity and Outcomes from Cognitive-Behavioral Therapy”. Child Psychiatry & Human Development. 44 (1): 1–18. doi:10.1007/s10578-012-0307-0. PMID 22581270.

© Christian Jonathan Haverkampf. All rights reserved.

Psychotherapeutic Counselling, Communication-Focused Therapy. Dublin, Ireland.

This article is solely a basis for academic discussion and no medical advice can be given in this article, nor should anything herein be construed as advice. Always consult a professional if you believe you might suffer from a physical or mental health condition.

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