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Anxiety – Information Sheet

Discover the types, causes and treatments for anxiety disorders.

What is Anxiety?

Anxiety is a term that describes a normal emotion that people experience when they face a ‘perceived’ or real threat. This threat can be physical (e.g. a car screeching to a stop behind us at the traffic lights) or psychological (e.g. our colleague frowning while reading a report we have just finished). When problems with anxiety lead to major impacts on a person’s life, it may be diagnosed as an, ‘anxiety disorder’, which is a temporary condition and treatable. Anxiety can stop people from living their lives fully, making new changes, and asking for what they want or need.

While a great deal of attention during these times is focused on maintaining staff wellness, there is also a need to increase support provided to HR staff and leaders – to assist them to lead resilient teams and develop a change resilient organisation.

Why Learn About Anxiety?

Anxiety Disorders can have a significant impact on a person’s thoughts, feelings and behaviour such as:

  • 1. Feeling constantly wound up and ‘on edge’
  • 2. Feeling irritable
  • 3. Feeling physically unwell
  • 4. Difficulty concentrating and making decisions
  • 5. Difficulty with relaxing or sleep routine
  • 6. Constant worrying and unable to ‘switch off’ unpleasant thoughts
  • 7. Difficulty going out, mixing with people
  • 8. Having a negative outlook on yourself and the future

Having a clear understanding of anxiety disorders and treatments, including how to better manage the symptoms, can reduce the impact of anxiety on your quality of life.

The Role Of The Fight Or Flight Mechanism

Irrespective of the type of threat (or high demand) we face, our automatic, protective survival instinct is activated and this produces the ‘fight or flight response’. The fight or flight response results in our involuntary nervous system releasing hormones such as adrenaline to send messages to our body about the need for urgent action. Once this physical response is activated we are ready to respond to the threat by ‘fight’ (tackling it head on) or ‘flight’ (fleeing from the threat). A third, less common, response is termed ‘freeze’ occurs when we are so overwhelmed we are unable to respond (become indecisive).

Common signs of the body’s preparation to respond are displayed in figure 1.

Figure 1: (Adapted from Patient Treatment Manual Clinical Research Unit for Anxiety Disorders St.
Vincents Hospital, Sydney, 1999)x

In primitive times this response helped us to survive against very present, very real physical threats (e.g. being eaten by a predator). However, in the modern world we face fewer physical threats to our survival. In fact, most of the threats that we deal with on a day-to-day basis are psychological in nature. Our fight or flight mechanism is therefore activated by things such as: the perception of negative judgment or criticism from others; rejection; embarrassment; failure or loss of control. In these situations it is rarely appropriate to fight (e.g. push someone or be aggressive because they frowned while reading our report) or flight (e.g. run out of the office because someone is frowning). As a result of the body’s physical response we are left with uncomfortable physical sensations (e.g. dizziness; heart palpitations; hyperventilation). For some people these are so uncomfortable or scary that they end up finding ways to avoid being in situations that might lead to these feelings (e.g. call in sick on the day a manager is due to review a project).

For those of us who are vulnerable to anxiety, continued avoidance can lead to an exaggeration of the perception, or thoughts that the threat is real. This means that you may start to expect that the worst will happen e.g. you might believe that if your boss doesn’t like your project you will be fired. In these situations, the fight or flight response can become too sensitive, like a car alarm that is triggered by the slightest brush against the car. You may find that you are becoming anxious in situations where other people would not feel anxious. This could indicate an Anxiety Disorder and might be worth you exploring further.

What Causes An Anxiety Disorder?

For each person who experiences anxiety there may be different underlying causes or contributing factors. These can include:

 

Environmental Factors High stress levels can exacerbate or sometimes cause anxiety. If we are always on alert and ready to respond to threats, it increases the sensitivity of our fight/flight response. Contributory environmental factors may include social isolation, traumatic events, physical illness, excessive alcohol or illicit substance use.
Genetic Factors People who have a close relative with an anxiety disorder have a greater chance of developing it compared to the general population.
Biochemical Factors Anxiety can also be the result of a chemical imbalance in the brain i.e. not enough serotonin.
Personality Factors Some people tend more towards worry and therefore may be more prone to developing an anxiety disorder.
Depression A large proportion of people diagnosed with clinical depression also report symptoms of anxiety, and a number of symptoms of depression are similar to those of anxiety (eg. sleep disturbance, physical aches and pains; physical agitation; restlessness).

Types Of Anxiety Disorders

The type of Anxiety Disorder depends on the underlying focus of the fear (e.g. social situations; contamination; worry about everything). It is possible to experience more than one Anxiety Disorder at the same time:

  • Generalised Anxiety Disorder

The individual experiences excessive, uncontrolled worry and anxiety about everyday situations and events. They are often apprehensive that bad things will happen to themselves and loved ones (e.g. financial disasters; serious health problems; interpersonal conflict). The impact of this disorder is extensive, as the person is likely to worry about most situations. For this reason they can find it difficult to get sleep and physically it may manifest as headaches and stomach aches.

  • Agoraphobia

The fear of being in places or situations from which it maybe difficult or embarrassing to escape, or that help may be unavailable if required. This can result in avoidance of supermarkets and shopping centers, crowds, confined spaces, public transport, lifts, motorways or tall buildings. This can lead to problems with isolation, employment and activities such as shopping and driving.

  • Panic Disorder

The occurrence of panic attacks in ordinary, everyday situations. A panic attack is a sudden onset of intense anxiety or terror where the person experiences heart palpitations, shaking, the sensation of shortness of breath and tightness of chest, chills/hot flushes and light headedness. The individual may have an overwhelming feeling of fear with thoughts of loss of control or death during the attack. These symptoms may be mild or severe and may last a short or long time. The person will often avoid situations where they are afraid they may have another episode, leading to the development of panic disorder with agoraphobia.

  • Specific Phobia

An overwhelming and irrational fear about a specific object or situation (e.g. heights; spiders; water; dust). The intense feelings of fear and anxiety are not experienced until the person encounters the object or situation, so the individual learns to avoid the ‘triggers’ of their anxiety in attempt to control their feelings. Unfortunately, this coping strategy only serves to cement the irrational fear, making it more difficult to confront and the person more likely to avoid the object or situation.

  • Social Phobia

A persistent fear of being humiliated or embarrassed in social situations which can lead to panic. The individual believes in the company of others they will act inappropriately, be judged negatively and cause ridicule themselves. This can result in avoidance of situations where the person believes there is potential for the fear to occur. For example some people stop eating, drinking or speaking in public and gradually isolate themselves.

  • Obsessive Compulsive Disorder (OCD)

A condition where the individual experiences constant, unabated and unwanted thoughts (obsessions). These obsessions result in intense feelings of anxiety and panic. In an attempt to control the thoughts and reduce the anxiety, the person engages in elaborate and repetitive rituals (compulsions), which may consist of hand washing, checking and counting tasks. These compulsions are often very time consuming and impact significantly on daily functioning.

  • Post-Traumatic Stress Disorder (PTSD)

An anxiety condition where the person re-experiences the fear and terror of a traumatic life event after the situation has passed. The individual re- experiences the traumatic event through distressing thoughts, flashbacks (sensory hallucinations of the event), nightmares, acute physical anxiety symptoms and hyper arousal (e.g. being excessively alert and jumpy to loud noises). The person is likely to avoid any situations or stimulus that could possibly act as a ‘trigger’ to these thoughts and feelings. This often results in extreme isolation and can impact on daily functioning.

What Treatments Are Available For Anxiety Disorders?

  • (a) Psychological support such as Cognitive Behavioural Therapy (CBT)

There is a common misperception that situations cause us to feel the way we do. CBT challenges this myth and instead operates on the premise that situations can contribute but they DO NOT cause us to feel and respond in a particular way. If that were true then everyone experiencing the same situation would feel and respond exactly the same way, which doesn’t happen.
For example, a pass grade on a group assignment might elicit feelings of failure in one person (behaviour = withdrawal), relief in another (behaviour = celebration) and anger in another (behaviour = shouting/blaming others). According to CBT, the differences in our emotional and behavioural reactions are a direct result of our perceptions or thoughts about the situation. CBT helps us to identify and correct any negative, irrational thoughts that are unhelpful and which can exacerbate symptoms of anxiety and depression. The aim is realistic thinking NOT positive thinking.

In anxiety, unhelpful thoughts tend to be catastrophic:
(a) exaggerate the likelihood of the worst possible outcome:
“I’m not going to have enough time to prepare properly.” “It’ll be wrong” “I’ll fail the test” “I’ll develop a fatal illness”
(b) underestimate their ability to cope:
“I’m just not good enough to succeed at this” “I’ll just fall apart”

CBT is not just about changing your unhelpful thinking patterns. It also looks at changing those behaviours that can maintain or exacerbate anxiety such as avoidance. While avoidance seems to help in the short term, the drop in anxiety that it produces means it serves to reinforce or support the fears, in the long term. For example, if you call in sick to avoid seeing the frown you are convinced you will see on your boss’s face as he looks at your project, you will avoid the uncomfortable anxiety feeling. However, next time you are in the same situation you will probably feel and react the same way because you never found out that your boss thinks your effort is satisfactory, or that his frown actually means he is concentrating, or that you do not lose your job just because he is unhappy with one project.

These can be so ingrained that we can’t identify them and therefore having the help of a psychologist who can help explore these with us, is a good idea. The other important thing is that they can help set us up to gradually start facing our fears, rather than the unhelpful situation of setting ourselves too big a challenge and finding we are overwhelmed and distressed.

  • (b) Medication

Antidepressant medication is often prescribed to help reduce the overwhelming feelings of anxiety and panic as well as to treat depression, which is commonly an underlying condition that exacerbates the anxiety symptoms.

The most commonly prescribed antidepressants to treat anxiety are the SSRI’s (Selective Serotonin Re-uptake Inhibitors). The SSRI’s are the newest of the antidepressants and examples include: sertraline (Zoloft); citalopram (Cipramil); paroxetine (Aropax); fluvoaxamine (Prozac); fluvoxamine (Luvox).

Benzodiazepines can be used to help relive acute anxiety symptoms and to facilitate sleep. However, they are prescribed with care and are for short-term use only as they can be highly addictive as well as having adverse effects such as drowsiness as well as impaired memory and coordination. Examples are diazepam (Valium), alprazolan (Xanax) and oxazepam (Serepax).

  • (c) Reading and Learning about Anxiet

Books
Living with IT: A Survivor’s Guide to Panic Attacks – Bev Aisbett
Living It Up: The Advanced Survivor’s Guide To Anxiety-Free Living – Bev Aisbett
Overcoming Shyness And Social Phobia – Ron Rapee

Websites
• www.beyondblue.org.au
• www.anxieties.com
• www.anxietyaustralia.com.au
• www.moodgym.anu.edu.au
• www.psychology.org.au/publications/tip_sheets/anxiety/

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