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Anxiety

This information sheet has been compiled by Q-Psych psychologist, Gail Corrigan. 

What is Anxiety?

Portrait Of Girl Biting NailsAnxiety is a term used to describe feelings of nervousness, fear, or worry. Usually anxiety occurs in stressful situations, such as prior to, or during, public speaking. These situations can can provoke worried thoughts of a possible negative outcome, such as not being able to do a good enough job. Along with these thoughts and feelings, changes occur on a physical level and can include sensations of nausea, ‘butterflies’ in the stomach, muscle tension, increased heart rate and light headedness. These feelings are considered a natural response to stress and can arise across a range of situations, though these may not be situations others consider to be obviously stressful, such as reluctance to leave home. If persistent and a source of   considerable distress, they may form the basis of an anxiety disorder.

What is an Anxiety disorder?

There are a range of anxiety disorders, which differ in the context in which the anxiety symptoms occur.   These include:

  • Panic Disorder: The presence of recurrent panic attacks and worry about the possibility of future panic attacks. Panic attacks are periods of acute anxiety that include physical symptoms (e.g. racing heart rate, sweating), catastrophic thoughts (e.g. fear of losing control or of dying), and feelings of unreality (derealisation) or of being detached from oneself (depersonalisation). There must also be a change in behaviour associated with theses symptoms, such as avoiding situations believed to trigger a panic attack.
  • Social Anxiety Disorder: Individuals describe significant fear of being harshly judged or evaluated by others, which is coped with by avoidance. This can include avoidance of social functions or employing behaviours to cope reduce the possibility of negative evaluation, such as remaining silent and unobtrusive.
  • Agoraphobia: Extreme anxiety is experienced across a range of situations, such as leaving the home, taking public transport, being in large, open spaces or in crowds. An individual with agoraphobia may still enter these situations rather than avoid them completely but rely on the company of other people to endure theses anxiety-provoking situations. Anxiety is felt both when anticipating entering the feared situation and once in the situation.
  • Specific Phobia: Individuals with this condition describe intense anxiety that is experienced around specific objects or situations, such as fear of flying, spiders, or fear of heights. The fear must be out of proportion to the actual danger or threat in the situation, after taking cultural considerations into account.
  • Generalised Anxiety Disorder: The experience of persistent worrying thoughts that span a range of areas, including worry about health, relationships, and school or work. Worrying thoughts occur to the extent that they interfere with daily functioning and relationships, create difficulty making decisions or lead to avoidance of activities.
  • Separation Anxiety Disorder: Intense distress that occurs, or is anticipated, in the context of separation from a primary attachment figure (e.g. mother). This can include worrying thoughts or nightmares about the possibility of separation and the symptoms must be of at least six months duration. Symptoms can include complaints of physical ailments, particularly in children, such as head or stomach aches when separation is anticipated.
  • Selective Mutism: Anxiety in social contexts where there is an expectation of speaking, which is coped with through mutism (not speaking).

Other conditions that are characterised by intense anxiety, include:

  • Obsessive Compulsive Disorder: OCD has historically been considered an anxiety disorder. However, in recent years, with greater knowledge of the condition, OCD has begun to be thought of as a disorder that involves both anxiety and other disorders, such as tic, mood and grooming disorders. OCD is characterised by the experience of obsessions, which are persistent thoughts, images or impulses that are a source of distress, and compulsions, which are repetitive behaviours, rituals (e.g. hand-washing) or mental acts (counting or reciting statements) that a person with OCD feels compelled to complete to reduce their distress. People with OCD describe being unable to stop the obsessions and compulsions, though generally understand that these symptoms are an over-reaction.
  • Post-Traumatic Stress Disorder: PTSD is classified as a trauma-related disorder distinct from an anxiety disorder, though intense anxiety is characteristic of the condition. The difference between PTSD and most other mental health conditions is that PTSD symptoms are considered to emerge from exposure to an identified traumatic event (or series of events). PTSD is characterised by intrusive symptoms (e.g. recurrent, involuntary and intrusive memories), avoidance (e.g. of reminders of the event) and altered behaviour and physical symptoms (e.g. aggression, hypervigilance, poor concentration, sleep disturbance) that persist for more than one month and cause significant distress or interfere with day-to-day life.

What causes Anxiety?

Anxiety disorders are the most common mental health disorders that Australians experience. There is no one particular cause, however, there are a range of factors that are known to increase risk of developing an anxiety disorder. These include:

  • Family History: The risk of developing anxiety can be higher for individuals who have a family history of anxiety disorders. However, even with a possible genetic risk for anxiety, it is not a foregone conclusion that an individual will go on to develop an anxiety disorder. Other factors can combine to increase or decrease risk of symptoms emerging.
  • Physiological Factors: Physical health conditions have been associated with increased risk of anxiety, including diagnoses of heart disease, asthma, stroke and cancer.
  • Psychological Factors: Risk of anxiety is increased for individuals who tend to rely on unhelpful thinking styles, including a tendency toward perfectionism, focusing on negative aspects in their lives, or focusing on the negative outcomes that might happen (catastrophise). These thinking styles can contribute to low self-esteem and critical self-talk.
  • Social Factors: The experience of stress and stressful events can increase risk of developing an anxiety disorder. This includes acute stress, e.g. a relationship breakdown, or prolonged stress associated with adversity (e.g. poverty, chronic illness).

Who is affected by Anxiety?

Anxiety affects people across the life span with approximately 1 in 8 Australians (12.8%) between 16 and 85 years meeting criteria for an anxiety disorder. In younger people, the rates are higher, with approximately 1 in 5 children and adolescents reporting elevated anxiety.

How is Anxiety treated?

Cognitive Behaviour Therapy (CBT) has the strongest evidence base and so is the gold standard treatment for anxiety disorders. CBT is a form of psychotherapy that addresses unhelpful thinking styles and behaviours associated with anxiety. It can be delivered individually, in groups and by distance (books, phone, internet-based treatments). Medications to treat anxiety symptoms may also be used in conjunction with CBT. Treatment should be individualised with a range of factors considered, including the particular symptoms reported, the severity and course of the symptoms, and the presence of co-morbid conditions.

CBT can include the following treatment components:

  • Psycho-education: Information provided to increase knowledge and awareness of anxiety.
  • Self-monitoring: Monitoring of anxiety symptoms to build awareness of symptoms and to track treatment progress.
  • Cognitive restructuring: The process of helping the person identify and challenge unhelpful thoughts and beliefs that maintain anxiety provoking thinking habits.
  • Exposure techniques: The process of supporting and guiding the person through opportunities for confronting their fears. The aim is to assist the person to gradually learn that they can cope in their feared situation, which leads to a reduction in the anxiety response.
  • Problemsolving strategies: This component of CBT assists the person to develop strategies for solving problems and containing their distress. It is particularly useful for working with individuals who experience Generalised Anxiety Disorder, who may experience worried thoughts and difficulty arriving at a solution.
  • Social skills training: This component aims to support the person to develop greater social competence and confidence and is particularly useful for treatment of Social Anxiety Disorder.

Mindfulness based approaches are also gaining efficacy in the treatment of anxiety, both with Cognitive Behavioural and Acceptance and Commitment Therapies.

For children, Q-Psych offers the suite of Cool Kids® programs, developed and regularly evaluated by Macquarie University. These programs are structured, skills-based programs that utilise CBT to teach anxious children and teens, and their parents, how to better manage their anxiety in a variety of settings.

How do I find out more?

To find out more, you are welcome to contact Q-Psych to discuss your needs and arrange an appointment.

Links to other sites that you may also find helpful are below:

References

  • Australian Bureau of Statistics. (1997). National Survey of Mental Health and Wellbeing of Adults. Canberra: Author.
  • Australian Psychological Society. www.psychology.org.au
  • Clarke, DM & Currie, KC (2009). Depression, anxiety and their relationship with chronic diseases: A review of the epidemiology, risk and treatment evidence. Medical Journal of Australia, 190(7): 54-60.
  • Diagnostic and statistical manual of mental disorders. 5th edn. Washington DC: American Psychiatric Association, 2013.
  • Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602.
  • National Institute for Health and Clinical Excellence. Anxiety in adults: The treatment and management of anxiety in adults.  NICE clinical guideline 90, 2009. http://publications.nice.org.uk/anxiety-in-adults-cg90

© Gail Corrigan, Q-Psych psychologist, 2016.

 

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