Anxiety is a normal human emotion which we all experience from time to time. It is usually triggered by a perceived threat either from our environment or from within i.e. negative thoughts, emotions and physiological sensations.
We all seem to deal with anxiety in similar ways by trying to control our environment or our internal processes: avoiding the perceived threat, reassuring ourselves or asking for reassurance from others, rationalising, trying to predict possible outcomes and so on.
However, sometimes the ways in which we respond to anxiety can become a problem when it starts interfering with our lives and our day to day activities. These problematic responses to anxiety are known as Anxiety Disorders.
Anxiety Disorders can often be treated using Cognitive and Behavioural Therapy.
What is Anxiety?
Anxiety occurring in stressful situations is natural and helpful. For example, most people feel anxious before sitting an exam, or when their life is threatened. The automatic rush of adrenaline and nerve impulses which we have in response to stress can help us “fight or flight”.
When we are anxious, we feel fearful and tense: the release of stress hormones such as adrenaline causes physiological symptoms: fast heart rate, palpitations, feeling sick, shaking, sweating, dry mouth, chest pain, headache and muscle tension to name a few.
These intense internal experiences when misinterpreted can result in Anxiety Disorders.
You may have an anxiety problem if anxiety interferes with your life. It is a common problem in our society: about 1 in 20 people have an anxiety disorder at any one time (Mental Health Foundation Statistics 2005).
Anxiety problems have been classified into different disorders according to symptoms, triggers and thoughts. It is common to have features of more than one disorder since they all share the same symptom: i.e. anxiety.
Anxiety may be a reaction to Stress
Acute reaction to stress
Usually occurs after an unexpected life crisis: accident, bereavement, family problems, bad news, etc. Symptoms described above, settle quickly but can last a few weeks. One can also feel irritable, low in mood, poor sleep, poor concentration, emotional ups and down.
Similar to the above, but symptoms can develop days or weeks after the stressful situation as a reaction or adjustment to the problem. Other symptoms can include depression. Again these symptoms improve quite quickly.
Post-traumatic stress disorder (PTSD)
Usually followed by a severe trauma such as a serious assault or a life threatening accident. Symptoms last at least a month and years if not treated. Anxiety is only one symptom of PTSD, the others are:
- Recurring thoughts, memories, images, dreams, or “flashbacks” of the trauma which are extremely distressing.
- Avoidance of situations, thoughts, feelings, conversations, people or anything that may remind the person of the trauma.
- Feeling “numb”, “detached” from life and others
- Loss of enjoyment, interests and plans for the future.
- Increased “arousal”: difficulties sleeping and concentrating and “increased vigilance”
- Panic Attacks.
Phobic Anxiety Disorders
Social Anxiety Disorder
Probably the most common anxiety problem, social Anxiety can be defined as a fear of negative evaluation. The anxiety a person experiences in social situations ranges from shyness to extreme panic and anxiety. The anxiety can be experienced in all social situations or in very specific situations such as public speaking.
People experiencing social anxiety often feel self-conscious and fear that others will judge them negatively, humiliate them, reject them and so on. They tend to avoid social situations, and if they cannot avoid social contact, they put in place a series of safety behaviours to protect them from others seeing what they fear could be true about them. They hold negative beliefs about themselves since childhood and/or adolescence which get reinforced by their avoidance of social situations, their self-focused attention and their safety behaviours.
Again this is a common problem, and best described as a fear of public places, open places and unknown places. People with this problem often feel safe at home and the further they go away from their place of safety the greater anxiety they experience. They fear that away from their safety zone, help will not be available, or they will not be able to escape. Hence, they often avoid shops, crowds, travelling in trains, tube, planes, being on a bridge or in a lift, being in a cinema, a restaurant and anywhere they feel trapped, unable to escape to safety. Again, when confronted by their fear, people will feel extremely anxious, panicky and have intense urges to get out.
There are so many other phobias of a specific thing or situation: claustrophobia (confined spaces), animal, insect and reptile phobias, fear of blood or injections, fear of vomiting, fear of being alone, fear of choking and many more.
Other Anxiety Disorders
It is better known as recurring panic attacks. A panic attack is a severe attack of anxiety which occurs suddenly, often without warning and for no apparent reason. The anxiety symptoms that accompany a panic attack are usually extremely uncomfortable and include: a thumping heart, trembling, shortness of breath, chest pains, feeling faint or dizzy, numbness or pins and needles. They usually last 5-10 minutes and can come in waves for up to two hours.
Generalised Anxiety Disorder (GAD)
It is best described as a general state of anxiety, feeling fearful, worried and tense most of the time for as long as one can remember. The anxiety tends to be about various life stressors, often minor. The symptoms which have been described in the above conditions often come and go and are persistent. People often describe GAD as always worrying about something: feeling restless, on edge, unable to concentrate, feeling irritable, muscle tension and poor sleep.
Mixed Anxiety and Depressive Disorder
Some people experience anxiety as a symptom of depression. Other symptoms of depression are: low mood, intense sadness, sleeps disruptions, poor appetite, irritability, poor concentration, and decreased sex drive, loss of energy, guilt feelings, headaches, aches, pains and finding no enjoyment in life. (see section on depression)
Obsessional Disorders: Obsessive-Compulsive Disorder (OCD), Health Anxiety and Body Dysmorphic Disorder (BDD)
Obsessive-Compulsive Disorder (OCD)
OCD manifests itself in recurring obsessions and compulsions. Obsessions are intrusive recurrent thoughts, images, or urges that causes anxiety and disgust. Common obsessions are fear of contamination and fear of causing harm to self or others. Compulsions are thoughts or actions that one feels compelled to do and repeat as a result of the obsessions. The aims of the compulsions are to keep them or others safe. For example, someone with a fear of contamination, will repeatedly wash, avoid contaminant, check, and try to reassure oneself that they or their loved ones are safe. They will also engage in covert compulsive behaviours, such as doubting and questioning themselves and their thoughts, rationalising, justifying, debating, checking, counting, neutralising and self-monitoring, comparing and avoidance. This problem is accompanied with high levels of anxiety, panic attacks and depression. The condition can be all consuming and can be extremely debilitating.
Health anxiety manifests itself as an over preoccupation about one's health. The preoccupation often takes the form of intrusive feelings, sensations and thoughts about ill health. It is accompanied with safety behaviours not dissimilar to the compulsions described above. Furthermore, the person suffering from Health anxiety will either avoid their GP or make frequent visits to reassure themselves of the intrusive symptoms of ill health they experience and research the internet to self-diagnose. This problem is also accompanied with very high levels of anxiety, panic attacks and depression.
Body Dysmorphic Disorder (BDD)
Body Dysmorphic Disorder manifests itself as a debilitating preoccupation about one's appearance. It could be a specific aspect of one's appearance or many aspects. A person suffering will often describe themselves or a specific aspect of their appearance as ugly, deformed, disproportionate, not quite right or totally wrong. This preoccupation results in similar compulsions as those described above and in addition, the person may attempt to camouflage using clothes and make-up, change the physical appearance of the perceived defect by DIY surgery or withdraw completely or only come out when there is little chance of being seen. Again, this problem is accompanied with high levels of anxiety, panic attacks and depression. It is extremely debilitating and can lead to total isolation.
Cognitive and Behavioural Treatment of Anxiety Disorder
Cognitive and Behavioural Therapy define anxiety disorders as an unhelpful response to a naturally occurring emotion. The problem is not the anxiety per se but the response people have to their anxiety.
The Cognitive and Behavioural Treatment approach is slightly different for each anxiety disorders and symptoms described above and it is therefore important to receive the right treatment. I specialise in the treatment of Anxiety disorders and I am experienced in treating all anxiety problems described above. CBT is a goal orientated approach. The first meeting aim at gaining an understanding of the problem and identifying goals for treatment. The subsequent meetings aim at learning new ways of coping with anxiety, practising new skills between sessions and getting one’s life back.