What is Anxiety?
The family of anxiety disorders include generalised anxiety disorder, panic disorder and agoraphobia, social anxiety disorder, obsessive compulsive disorder and post traumatic stress disorder. Generalized anxiety disorder (GAD) is the most common and is characterised by persistent, excessive worrying about everyday events and activities which the person finds difficult to control. While most people worry about everyday things such as family, work pressures, health, or money, worrying about these kinds of things does not typically get in the way of everyday functioning. However, people with GAD find that their worry is excessive (they worry more about a situation or scenario than others do or “blow things out of proportion”), difficult to control, and pervasive (the worry begins about a specific event but then extends to all similar or related events). GAD often results in occupational, social, and physical impairment, as well as emotional distress.
There is a 9% chance of a person developing Generalised Anxiety Disorder at some point in their life, and 3% of the population will be diagnosed with GAD in a given year. This disorder is one of the most common diagnoses at the primary care level. The age of onset of GAD is quite variable, ranging from twenty to forty years of age, but most report that they have always been worriers and that the worrying is only now becoming a handicap. Females are more likely to develop GAD than males.
GAD tends to develop gradually and fluctuate in severity over time. Although most people appear to be symptomatic for the majority of time since the onset of the disorder, about one quarter of people with GAD exhibit periods of remission (three months or longer without symptoms).
Research has identified various core issues in the development and maintenance of GAD. For example, intolerance of uncertainty about the future has been identified as one of the core issues in GAD. The role of “worry about worry,” in which people believe that worry is uncontrollable or inherently dangerous, is also central. Excessive worry can also be a way of avoiding emotional processing related to fear, and the role of emotion dysregulation and experiential avoidance may also be central to GAD.
What are the Signs of Anxiety?
In GAD they are:
- Excessive worrying that lasts for months, plus some or all of the following:
- Feeling restless, keyed up, or on edge.
- Being easily tired.
- Having difficulty concentrating, or having your mind go blank.
- Being irritable.
- Having tense or sore muscles.
- Having difficulty falling asleep, staying asleep, or having restless, unsatisfying sleep.
- Excessive list making
- Seeking reassurance from others
What Causes Anxiety?
Being anxious, tense, fearful when threatened is normal and helpful, as the anxiety increases the ability to flee or fight the threat. People who inherit or develop a nervous temperament see the ordinary world as threatening and, if they do not learn to cope, will react to minor threats as if they were major. Hence the persistent and pervasive worrying.
How to Deal with Anxiety
Getting better means gaining control over worry. A number of psychological treatments have shown to help people with GAD, 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:
- solve the problem that is making you anxious
- 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 generalized anxiety tend to have increased overall levels of arousal.
- 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, minimize, 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:
- 1Not checking the phone for one hour
- 2Showing up late to a meeting
- 3Grocery shopping without a list
- 4Organizing a birthday party
- 5Accepting an invite without looking at your calendar first
- 6Leaving 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 recognize 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.