“Does that person not like me? Did I leave the stove on? Did I offend that person? Oh no – I’m going to be late! How am I going to find parking? What if something goes wrong? What if I embarrass myself? It’s so hot in here! I need air and water because my mouth is so dry! Did I lock the front door? I know I checked twice but maybe I didn’t check properly. Why hasn’t my brother replied to my text – is he upset at me? My heart is beating outside of my chest – am I going to have a heart attack? Everyone is looking at me. Can they tell I’m nervous? My work friend hasn’t arrived yet – I hope he hasn’t had a car accident! I have 3 assignments due next week, how am I going to cope? I’m going to fail university! Can I just go home now? I’ll relax at home. I can watch a movie and escape. But I need to check that my DVD’s are in alphabetical order. I hope I can concentrate on the movie instead of worrying. It’s so stupid. I know it’s silly but I can’t help it. What’s wrong with me? Will it EVER end?”
Do these thoughts sound familiar to you? If so, you might be suffering from anxiety.
What is anxiety?
It is normal to be nervous or stressed about an important event such as an exam, interview or performance. However if you feel you worry excessively, to the point where it is interrupts your day-to-day functioning, you may be suffering from Anxiety. Anxiety is a general term for several mental illnesses characterised by consistent or irrational worrying. It is reported as the most common mental illness among Australians, particularly women. On average, 1 in every 4 Australians (1 in 3 women and 1 in 5 men) will experience anxiety at one point in their life. Research also shows it is often comorbid with depression, and can significantly impact a person’s quality of life. Anxiety disorders take various forms, from an all-pervasive form known as generalised anxiety disorder, to panic disorder, to obsessive compulsive disorder (OCD), to post-traumatic stress disorder (PTSD), and more specific phobias. Social anxiety and PTSD are reported as the most common anxiety disorders amongst Australians.
What are the casual influences on anxiety?
There is no one specific cause for anxiety. In fact, there is much debate over, and extensive research into, potential causes of anxiety. Nonetheless, research identifies a range of biological factors and environmental factors, and a combination of these factors, as potential triggers of anxiety. Some of these are mentioned below.
Biological factors may include:
- Genetics, such as a history of anxiety in the family or a shy and withdrawn temperament.
- Chemical imbalances, such as decreased levels if serotonin or increased dopamine.
Environmental factors may include:
- A negative or overprotective parenting style.
- Experiencing traumatic events such as physical, emotional or sexual abuse.
- Long term stress
- Learning anxiety from anxious family members/parents
- Being bullied or neglected
- Experiencing poor social reactions in childhood
Experiencing small or large changes –e.g. changing a job or experiencing a divorce.
General symptoms of anxiety:
While the physiological, psychological or behavioural symptoms vary for each type of anxiety, some general physiological signs include:
- Feelings of panic, fear and uneasiness.
- Erratic sleeping patterns
- Inability to stay still
- Lack of concentration
- Cold or sweaty hands or feet
- Vomiting or nausea
- Dry mouth
- Inability to talk
- Numbness or tingly sensation in the hands or feet
- Muscle tension
- Shortness of breath
- Increased heart palpitations
Types of anxiety in more depth:
General Anxiety Disorder (GAD) is an anxiety disorder characterized by constant and pervasive worrying about non-specific events. People with GAD can be understood as having ‘free-floating anxiety’ as they worry about a combination of things such as health, finance, relationships, work and more. It is common for them to seek reassurance regarding their concerns from close friends/family, whom often recognise their concerns as excessive or catastrophic. In order to be diagnosed with the mental illness, an individual must experience severe, uncontrollable worry for at least 6 months, coupled with at least three physical/cognitive symptoms such as muscle tension, irritable mood, reduced concentration, insomnia or fatigue. Effecting approximately 5.9% of the Australian population at any time in the life, GAD is more common amongst women compared to men, and the elderly compared to youthful individuals. It can significantly impact a person’s quality of life. In fact, reports show that 80% of individuals diagnosed with GAD also suffer from other mental illnesses, the most common being depression. In addition to this, reports show that GAD is often comorbid with substance use disorder, as sufferers may turn to drugs and/or alcohol to deal with, or escape from, their anxieties.
Social Anxiety Disorder (SAD) or Social Phobia is reported as the second most common anxiety disorder after PTSD, affecting approximately 10.6% of Australians at any point in their life. To be diagnosed with SAD, a person must experience constant, excessive, and/or pervasive worry specific to social situations for 6 or more months. They must actively avoid such anxiety-provoking situations and/or endure them but with uncomfortably high levels of anxiety, negatively impacting their day-to-day function, relationships, academic/occupational duties or mental stability. An individual is typically worried about being negatively criticised by, or humiliated in front of, other individuals. Therefore social anxiety typically manifests when interacting with others and performing. Social interactions include making phone calls, attending social gatherings, making enquiries at stores, engaging with authority, and more. Performing includes events such as eating and drinking publicly, entering the classroom/meeting late, singing or dancing in front of others, and most commonly speaking in public. SAD should be distinguished from shyness, as while there are some similarities, SAD is associated with higher levels of avoidance, negative anticipation, fearfulness and is much more debilitating than shyness. The condition is more common in women compared to men, and the age of onset is usually adolescence. Regarding children, it is important to diagnose and treat SAD as early as possible. Reasons for this are to help prevent the development of comorbid mental/physical illnesses, and to minimize the chance of SAD impeding on their academic/occupational performance.
Panic Disorder is characterised by recurrent and disabling panic attacks, which usually occur out of the blue with no prior warnings. They can even strike during sleep where there is no clear reason for the attack. They are accompanied by both cognitive and physical symptoms, lasting anywhere between a few minutes to half an hour, leaving the person feeling tired or exhausted. Symptoms include psychosomatic issues such as increased heart rate; chest pain; dizziness; choking sensation; difficultly breathing; sweating/trembling; gastrointestinal issues; hot or cold flushes; numbness or tingling in the legs; fear of dying, losing control, or going crazy; and feeling as if things are unreal. To be diagnosed with panic disorder, a person must experience recurrent panic attacks, along with either at least one month of persistent fear of another attack occurring, or a change in behaviour related to panic attacks (e.g. avoiding the place the last attack occurred). The disorder affects approximately 5.2% of Australians at any time in their life and is more common amongst women compared to men. Rates of panic disorder in children and younger adolescents have been shown to be less than 1%. The condition presents slightly differently in children, as they tend to report the physical symptoms rather than the psychological symptoms, and they are more likely to attribute their symptoms to an external danger such as a spider. If left untreated, other areas of a child’s life may be negatively impacted (peer relationships, schooling) and they may develop additional mental illnesses.
Obsessive Compulsive Disorder (OCD) consists of anxiety-provoking obsessions (recurrent and intrusive thoughts, images or impulses) or compulsions (deliberate and repetitive behaviours), or both. Recently, OCD has been differentiated from other anxiety disorders (SAD, GAD, PTSD, PD, phobias) due to its compulsive features. For example, while other anxiety disorders may involve obsessive thoughts, they will not be accompanied by compulsions. Compulsions are behaviours exhibited typically to alleviate some anxiety, and are commonly associated with cleaning or checking things to prevent harm or contamination. Examples include repeatedly cleaning one’s hands/teeth/body, cleaning the house, checking the door is locked, checking gas and electrical appliances are switched off, ensuring objects are placed in a specific way and exhibiting patterned/numbered/symmetrical behaviours. Obsessions are involuntary and unwanted, and often concern aggressive, sexual or blasphemous thoughts, with aggressive thoughts being the most common. Examples include thoughts of strangling one’s parents, sexually assaulting a child, being contaminated or contaminating others and thinking God is bad. For one to be diagnosed with OCD, they need to be exhibiting obsessions and compulsions for at least one hour per day, or be significantly distressed, or displaying impairments in their daily functioning (e.g. work or social life). Affecting approximately 2.8% of Australians at any point in their life, OCD is only slightly more common amongst women than men, with the illness typically manifesting in adolescence. OCD in children and adolescents are similar to adults. However some notable differences are that children are less preoccupied with sexual obsessions compared to adolescents and adults, and children/adolescents are more likely to hoard than adults. In addition to this, children/young adolescents are usually unaware that their actions/thoughts are abnormal, unlike adults, who find them distressing and embarrassing.
Post Traumatic Stress Disorder (PTSD) is reported as one of the most common types of Anxiety Disorders amongst Australians. In order for an individual to be diagnosed with PTSD, they need to have directly encountered or witnessed a traumatic event, know of a friend or family member who experienced trauma, or be exposed to stimuli related to trauma on a regular basis (i.e. a forensic investigator). Traumatic events typically include life-threatening events, sexual assault, physical assault, traumatic childbirth or sudden death of a loved one. Some of the symptoms include being easily panicked, angered and agitated, re-experiencing the trauma through nightmares and flashbacks, avoiding memories and external reminders of the trauma, experiencing intense physical symptoms such as sweating, heart palpations and a tight chest. The illness is associated with poor functioning and low quality of life and is often comorbid with other mental illnesses such as depression, drug-use and dependence. It affects approximately 12.2% of Australians and is more common amongst women compared to men, and veteran individuals compared to non-military personnel. Recently there has been awareness surrounding PTSD in children as it often goes undiagnosed. It is important for medical professionals to pay particular attention for PTSD in children as research has shown PTSD to detrimentally impact a child’s developmental process (cognitive, emotional, social) and physical health.
Specific Phobias are recognised as an excessive, irrational fear of a particular situation, object or event. Unlike GAD, the fear is specific. However, that does not mean people who suffer from specific phobia are limited to fearing one thing, in fact, it’s more common for them to fear multiple stimuli (typically three). To be diagnosed with a specific phobia, a person must display pronounced fear, anxiety or avoidance towards a stimulus, persistently for at least 6 months, resulting in severe distress or interference with one’s daily life. The level of fear experienced is out of proportion to the level of actual danger. Whilst a person can develop a specific phobia at any time in their life, on average, onset occurs in childhood. The development of a specific phobia mostly follows a traumatic event. Despite this, an affected individual usually cannot recall the triggering event. Specific phobias are separated into five different types – animal (e.g. fear of spiders), environmental (e.g. fear of heights), blood/injection/injury (e.g. fear of injections), situational (e.g. fear of elevators) and other (e.g. fear of choking, fear of coughing up phlegm). More than 100 types of specific phobias have been identified. Some of the most common include Glossophobia (performance), Acrophobia (heights), claustrophobia (enclosed spaces), Aviatophobia (flying), Dentophobia (dentist), Hemophobia (blood), Arachnophobia (spiders), Cynophobia (dogs), Ophidiophobia (snakes) and Nyctophobia (darkness). Specific phobias are often accompanied by panic attacks and mental illnesses such as depression and other anxiety disorders. Children are most likely to develop specific phobias compared to any other type of anxiety disorder (PTSD, GAD, SAD, PD). Phobias in children can be difficult to identify, however, behaviours such as crying, freezing, or throwing tantrums may be indicative of a child suffering a specific phobia.
Stress vs. Anxiety:
· Results from pressures that interrupt one’s usual balance in life. Once the stressor (stressful event e.g. exam, meeting) ends, stress should be alleviated.
· Reaction to the now.
· Stress is not usually clinically significant, but can benefit from treatment.
· Stress is characterised by psychosomatic issues such as a racing heartbeat, rapid breathing and muscle tension.
· Marked by frustration and nervousness relating to taking on too many tasks, work commitments, time-pressures and so on.
· Results from fear and apprehension of an object, event or situation believed to be out of one’s control. Anxiety may be caused by something specific or general.
· Anticipation of future negative events including getting anxious about being anxious. This results in avoidance of the feared stimulus.
· Anxiety is usually clinically significant and requires treatment.
· Psychosomatic issues extend from a racing heartbeat, rapid breathing and muscle tension to panic attacks, headaches, chest pains and hot flushes.
· Marked by excessive, persistent, uncontrollable and irrational worry and fear.
Fear vs. Anxiety:
· Response/Reaction to real & known danger.
· Associated with survival tactics.
· Considered to be a normal human reaction, other people would likely react the same way. For example, anyone would be fearful if attacked by a stranger.
· Fear is not clinically significant.
· Not a result of a known threat, rather it is Worry/anticipation about the possibility of threat.
· Associated with the need to be prepared.
· Not necessarily a normal human reaction. For example, an anxiety-affected individual may have a phobia of pigeons, which may be viewed by others as excessive or catastrophic.
· Anxiety is usually clinically significant and requires treatment.
How can Psylegal help you with anxiety?
Psylegal Melbourne provides anxiety treatment that helps you learn how to control your anxiety so it doesn’t control you. Some common treatments for anxiety include:
- Cognitive Behavioural Therapy (CBT) has been reported as one of the most effective in treating individuals with various mental health problems, including anxiety. It involves teaching individuals how to identify the automatic negative thoughts and beliefs that cause their anxiety. Thoughts are messages generated automatically and randomly from our brain. We cannot stop and control our thoughts, but we can choose how we react to them. By becoming more aware of our thoughts, feelings, and body sensations, we give ourselves the possibility of not getting into the same old “mental ruts” that may have caused problems in the past. It also teaching individuals how to challenge negative thinking styles and change entrenched behavioural patterns.
- Systematic desensitisation is a therapeutic technique effective in treating anxiety disorders, particularly phobias. It involves exposing an individual to their fear whilst they practice relaxation techniques, in a safe environment. It is a gradual, step-by-step process, sometimes referred to as ‘hierarchy therapy’ or ‘graduated exposure therapy’. Treatment begins by presenting the individual with their fear in a way they consider least threatening (e.g. an image of a spider at 10ms away), once they are able to cope with the stimulus, they are presented with a slightly more threatening stimulus (e.g. an image of a spider 5ms away). Slowly, slowly, the individual is able to overcome the pattern of avoiding their feared stimulus, and realise the stimulus is not as frightening as it once seemed!
- Flooding also known as “exposure therapy” or “prolonged exposure therapy” is similar to systematic desensitization. However, rather than it being an incremental process, the anxious individual is presented with their fear in the most threatening way they could imagine. For example, a person fearful of spiders may be left in a room alone with a spider. Whilst this may technique is quick and still effective, it can be fairly traumatizing for the patient.
- Relaxation techniques such as practicing deep breathing, meditation and mindfulness. Deep breathing can be extremely beneficial for calming individuals, especially those experiencing symptoms such as heart palpitations, as it will bring back their usual heart rate. Mindfulness and meditation is effective in helping an individual focus on the here and now, improving their self-awareness, and accepting negative feelings and thoughts without letting them take over. Relaxation techniques can be extremely effective in helping an individual cope with the symptoms of anxiety, in turn, making them feel more in control.
The psychologists at Psylegal are very experienced and knowledgeable. They are aware that each anxiety disorder is different, and therefore are effective in providing you with treatment tailored to your needs. If you feel you may be suffering from anxiety and would like help, give us a call today on 1300 79 22 09. The sooner you seek treatment, the better!
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Medicare rebates are available. You will need a referral from your doctor.