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All About Anxiety

August 9th, 2021

What is Anxiety?

We have all experienced anxiety at some point in our lives – those scary, racing thoughts; that intense fear of a threatening or dangerous situation; those feelings of dread and panic; and the unpleasant physical sensations that go along with it, like a pounding heart or sweaty, trembling hands. Believe it or not, anxiety is actually an adaptive, evolutionary response that has kept us living and thriving as a species for millennia.

So, is anxiety actually a good thing? Well, yes…and no. Without this alarm system hardwired into our brains and our bodies, we would be unable to notice and respond to the threats in our environment. Imagine how poorly our ancestors would have fared if their brains weren’t wired to notice that saber-toothed tiger in the bushes, eyeing them as a meal!

As we have evolved as a species, our threats have changed; most of us are no longer facing down large wild animals in our typical day to day lives, but the mechanism that helped us cope with that is still the same. So, when you’re facing that big presentation at work, are going on that first date, or anticipating an important phone call from your doctor, your brain’s alarm system will interpret the threat (either physical or psychological), in the same way, and so you’re hit with a flood of anxiety symptoms. The problem arises when our brain’s alarm system starts going off in situations that are not necessarily threatening (or responds with an anxiety alarm that does not match the level of threat), and the symptoms of intense fear and distress become so overwhelming that the person is unable to function across activities of their daily lives.

Anxiety as a Diagnosis – The Main Types of Anxiety Disorders

As a diagnosis, anxiety disorders are one of the more common types of mental health concerns, affecting approximately 5% of Canadians at any given time, causing mild to severe impairment across many domains of life (and this number has likely jumped significantly since the start of the pandemic!) According the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5), there are several main types of anxiety disorders:

Generalized Anxiety Disorder

One of the more common types of anxiety, generalized anxiety disorder (GAD) is marked by persistent, generalized worries or fears that are accompanied by additional physical symptoms, such as muscle tension, headaches, or gastrointestinal distress. The worries frequently star everyday events and relationships, such as work, family, health, or finances, and the affected individual frequently finds themselves imagining worst-case scenarios and asking themselves distressing “What if…?” questions. People who struggle with GAD experience excessive anxiety and worry more days than not, and have great difficulty controlling their worry to the extent that they experience impairment in social, occupational, or other important areas of functioning.

Panic Disorder

Panic disorder is an anxiety disorder characterized by the experiencing of unexpected and recurrent panic attacks. Panic attacks are sudden, intense episodes of fear and dread that are accompanied by at least four physical symptoms (such as a racing heart, sweating, shortness of breath, shaking), and typically reach a peak within 10 minutes of onset. Panic attacks can happen out of the blue, with no apparent cause, or may be related to particular triggers, and may occur more than once per day. Often, the affected person has fears that they are dying, “going crazy”, or losing control. Between episodes, the person with panic disorder experiences fear and anxiety over the possibility of experiencing another panic attack and may shape their life to attempt to reduce the chances of having one (e.g. avoiding certain places or people). Often, the anxiety over having panic attacks and the attempts to avoid them may be more debilitating than the attacks themselves.

Phobias, Specific Phobia

A phobia is a persistent and exaggerated fear of a specific object, activity, or situation. Common phobias include fear of flying, fear of public speaking, fear of needles, and fear of animals (e.g. snakes). Even though some people with phobias may recognize that their fear is irrational or excessive, they feel unable to stop or control it. Often, people will go to extreme lengths to avoid what they fear, sometimes with detrimental consequences for their lives (e.g. avoiding job interviews or important medical tests).

Agoraphobia

Agoraphobia is a type of anxiety disorder marked by an intense of fear of places or situations where a person’s ability to escape may be compromised, where they may be unable to access help in the event of a panic attack, or where they may experience social rejection or embarrassment. Common themes with agoraphobia include open or closed spaces, elevators, using public transportation, and being in a crowd or lineup of people. The person with this condition may or may not also struggle with panic attacks, and copes with their condition by avoiding triggering places or activities, ensuring the company of a safe person, or enduring the anxiety with great distress. Sometimes, the disorder can become so debilitating that a person has great difficulty leaving their home without distress. Agoraphobia is diagnosed if this fear has persisted for 6 months or more, is deeply upsetting to the individual, and/ or interferes with their normal life activities.

Social Anxiety Disorder (Previously called Social Phobia)

Social anxiety disorder is an anxiety disorder characterized by an intense anticipation and fear of social rejection, embarrassment, judgment, or humiliation in social situations. Themes may include public speaking, handling conversations with people in positions of authority, meeting new people, or interactions with peer groups. An affected person experiences extreme anxiety and distress during these situations and takes great steps to avoid the encounter or endures it with great anxiety. Symptoms typically last for 6 months or more and often significantly interfere with daily functioning.

Separation Anxiety Disorders

Separation anxiety disorders are marked by an extreme, persistent fear or anxiety that arises as a result of real or imagined separation from loved ones. The symptoms are persistent, lasting longer than 4 weeks for children and 6 months for adults, and are beyond what is considered appropriate for the person’s developmental age. Affected people may experience fears of something bad happening to a loved one, anxiety when physically apart from a loved one, nightmares and intrusive thoughts, and refusals to go to sleep or be separated from loved ones. Physical symptoms of the disorder, such as headaches or stomachaches, may present in childhood, but the disorder can persist well into adulthood. Separation anxiety disorder may cause significant disruptions to functioning across many life domains.

Selective Mutism

Selective mutism is an anxiety disorder that usually presents in childhood and is characterized by an intense fear of speaking in situations where the person does not feel safe and relaxed (e.g. at school or social situations). Though affected persons are able to speak in situations where they feel comfortable, such as with family, they may feel angry or distressed when approached to speak in situations were speaking is expected or demanded. Symptoms may interfere significantly with functioning in various areas of life, including in social and school settings.

Note: As of the newest revision, the DSM-5 no longer categories post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) as anxiety disorders, but rather places them in separate categories. Other anxiety disorders not discussed here are substance/medication induced anxiety disorder and anxiety disorders due to another medical condition.

Risk Factors

There is no one specific cause of anxiety disorders. The current research literature points to a likely combination of risk factors, including those relating to genetic, psychological, environmental, and developmental factors. Anxiety disorders may affect multiple people in the same family, suggesting that there is a combination of genetic predisposition, social or familial “learning” of anxiety, and environmental stressors that can lead to the development of an anxiety disorder in an individual.

Regardless of the particular constellation of risk factors an individual may present with, it’s important to remember that it is never the affected person’s fault for experiencing anxiety.

Treatment

If you suspect that you may have an anxiety disorder, you aren’t alone! Many people struggle with anxiety daily, and help is available. The first step is to make an appointment with your family doctor, or visit a clinic doctor, to rule out an underlying medical condition. Your doctor may wish to refer you to a psychiatrist for a more in-depth assessment of your concerns.

If an anxiety-related mental health condition is diagnosed, two forms of treatment are typically recommended that can be given alone or in combination. The first is treatment with a prescription medication. This will not “cure” your anxiety, but will help to manage the symptoms of your anxiety. The second is psychotherapy, or “talk therapy”, with a qualified mental health professional. The gold standard treatment for anxiety disorders is “Cognitive Behavioural Therapy”, or “CBT”, which helps people to become aware of the thoughts and interpretations that are contributing to their distressing feelings and unhelpful behaviours. With professional support and practice between sessions, clients are able to learn skills and strategies to develop new and healthier ways of thinking, feeling, and behaving to manage their anxiety.

Is there anything you can do right now to help your anxiety? Some helpful self-help strategies include:

Ensuring the pillars of mental health, NESTS, are met: Nutrition, Exercise, Sleep, Time for Self, Social Support
Practicing relaxation strategies, such as muscle relaxation techniques and deep belly breathing
Mindfulness strategies
Starting a meditation practice
Joining a support group
Avoiding caffeine, alcohol, and other substances

If you would like support in managing the symptoms of your anxiety, please reach out to our counselling program at Back in Motion. One of our Master’s-level trained Registered Clinical Counsellors would be happy to support you and help you find ways to cope with your anxiety.

Author: Jennifer Baker, MEd, RCC

Jennifer Baker is a Registered Clinical Counsellor in British Columbia. She has both professional expertise and personal experience in working with anxiety disorders.

References

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