Anxiety disorders

Common symptoms of anxiety include:

• difficulty concentrating
• restlessness
• rapid heartbeat
• trembling or shaking
• feeling light-headed or faint
• numbness or nausea
• sweating
• avoidance

While anxiety is usually a normal reaction to a stressful situation, for some people anxious thoughts, feelings, or physical symptoms can become chronic, severe and upsetting, and interrupt daily life. Severe, frequent, recurring, and persistent anxiety symptoms may be considered an anxiety disorder. Anxiety disorders are the most common type of mental health problem diagnosed in Australia affecting around 16% of Australians every year.

There are different types of anxiety disorders, including:

Generalised anxiety disorder (GAD) is characterised by persistent and excessive worry, often about a range of daily situations like work, family or health. This worry is difficult to control and interferes with the person’s day-to-day life and relationships.

Specific phobia involves extreme anxiety and fear of particular objects or situations, which is out of proportion to the actual danger present. Common phobias include fears of flying, spiders and other animals, and injections.

Panic disorder is characterised by the experience of repeated and unexpected panic attacks – sudden surges of overwhelming fear and anxiety accompanied by physical symptoms such as chest pain, heart palpitations, dizziness and breathlessness. In panic disorder, these panic attacks come ‘out of the blue’ with no apparent trigger.

Agoraphobia involves intense anxiety in two or more situations and places where the person feels it would be difficult for them to get out quickly or get help if needed. This fear is out of proportion to the actual danger present. This includes situations such as using public transport, being in enclosed places (e.g. shops, cinema), standing in a line, being in a crowd, or being outside of the home alone.

Social anxiety disorder is characterised by severe fear of one or more social situations in which a person could potentially be scrutinised by others (e.g., being observed while eating, having a conversation, meeting unfamiliar people, giving a speech in front of others). The person fears their anxiety symptoms will be obvious and will be negatively evaluated (e.g., they will feel embarrassed or other people will be offended or reject them). The fear is out of proportion to the actual threat present.

While there is no single known cause of anxiety disorders, there are a number of risk factors or triggers that may contribute. These differ between the anxiety disorders but in general, the following factors may play a role.

Genes

Certain anxiety disorders appear to have a genetic component that may put some individuals at higher risk of developing problems.

Biology

Some anxiety disorders might have a basis in how the brain processes and responds to stress and physical arousal, and how the body releases stress hormones such as cortisol.

Thinking style

Patterns of thinking characterised by anticipating the worst, persistent negative self-talk, and difficulty accepting uncertainty as well as low self-esteem are often linked to anxiety. Sensitivity to one’s body’s physical responses, such as increased heart rate, and misinterpreting these physical symptoms as indicating something catastrophic might also increase the risk of developing certain anxiety disorders.

Coping strategies

Unhelpful coping strategies, such as a tendency to avoid situations that trigger anxiety, rather than facing such situations, can result in an increase of an anxious symptoms.

Stressful life events

Stressful events such as a marriage breakdown, work or school deadlines, and financial hardship can act as triggers for the development of an anxiety disorder. Early life stress and trauma can also increase the likelihood of developing an anxiety disorder later in life.

Anxiety is a common reason for people to seek help from mental health professionals, and research suggests that there are several effective psychological treatments available. A psychologist will take time to understand your individual situation and work with you to find the best way of working with you to improve your situation over a number of sessions. Their strategy will depend on how your anxiety developed, what triggers your anxiety, and how you are affected by it.

Some of the techniques they might use include:

Cognitive behaviour therapy

Cognitive behaviour therapy (CBT) has been found to be the most effective treatment for anxiety disorders. CBT helps you change unhelpful thoughts and behaviours that can contribute to anxiety and aims to build skills to manage anxiety when it arises. CBT for anxiety includes some of the following strategies:

• Education about the nature of anxiety and the importance of self-monitoring one’s symptoms. 
• Cognitive restructuring: a technique used by psychologists to help a person to challenge negative thoughts and develop more helpful and constructive ways of thinking.
• Problem-solving: a technique used to help a person work through day-to-day problems. Problem-solving has been shown to help people feel more confident in tackling life’s challenges, and to decrease general anxiety. Structured problem solving involves identifying the problem, developing a range of potential solutions, selecting one to test out, implementing the solution and evaluating its helpfulness.
• Exposure therapy: a treatment in which the psychologist guides the person through a series of real or imaginary scenarios to confront specific fears. Through this gradual process, the person learns to cope more effectively with these fears, and with practise, the anxious response naturally decreases so you are more comfortable when undertaking that activity.
• Relaxation: a range of techniques such as meditation or progressive muscle relaxation which, when practised regularly, have been found to effectively reduce anxiety. 

Acceptance and commitment therapy

Acceptance and commitment therapy (ACT) has been found to effective in the treatment of anxiety. Using mindfulness, instead of avoiding, withdrawing, or fighting against anxious thoughts, feelings and physical symptoms, the person is helped to remain present and aware of the symptoms, without judging them. Over time, the person becomes more open to and accepting of anxious experiences, less overwhelmed by them, and better able to engage fully with life.

Lifestyle changes

Lifestyle changes such as getting regular exercise, reducing alcohol and caffeine intake, taking part in enjoyable activities, improving time-management skills and getting adequate sleep can help reduce anxiety.

Seeing a Psychologist

If anxiety is affecting your day-to-day life, a psychologist may be able to help. Anxiety may also be a symptom of other mental health issues, so it is worthwhile seeking support if you are experiencing anxiety. Psychologists are highly trained and qualified professionals skilled in helping people with a range of mental health and wellbeing concerns.

There are a few ways you can access a psychologist. You can:

• Use the Australia-wide Find a Psychologist service or call 1800 333 497
• Ask your GP or another health professional to refer you.

If you are referred to a psychologist by your GP, you might be able to get a Medicare rebate to cover part of the cost of your treatment. You may also be able to receive psychology services via telehealth so you don’t need to travel to see a psychologist. Ask your psychologist or GP for details.

Getting a medical check-up

A medical check-up with a GP is also important to see if a health issue might underlie your symptoms. A GP or other medical specialist might also offer advice and assistance where medication might be of benefit.

It is normal to feel anxious sometimes when facing difficult situations. There are a number of ways you can help yourself cope:

Check your self-talk

When we are upset and anxious, we sometimes say negative things to ourselves. Unhelpful self-talk might include things like, “I’m hopeless”, “I’m going to be terrible at this”, or “I’ll never get this done”. Negative self-talk gets us down, can increase anxiety and can get in the way of us achieving our goals.

Notice what you say to yourself and work on more helpful, calming and encouraging self-talk, such as, “I am coping well given what I have on my plate”, “This stressful time will pass”, or “I got through it last time”.

Keep things in perspective

When we are worried and upset it is easy to see things as worse than they really are, and to start anticipating all sorts of problems down the track. Take a step back and look at one of your worries in the bigger scheme of your life. Ask yourself:

• am I getting ahead of myself, assuming something bad will happen when I really don’t know the outcome?
• is the outcome certain to happen, possible, or quite unlikely?
• if the worst were to happen, what could I do about it?
• maybe I could stop worrying and asking “what if”. I don’t know what will happen yet and I will deal with it IF it happens.

Sometimes thinking about how you would cope, even if the worst were to happen, puts things into perspective.

Don’t let anxiety stop you from doing things

Try not to avoid situations which trigger your anxiety, but work on facing these situations. If this seems too difficult, get the help of a psychologist or other mental health professional to work out a plan for facing your fears and increasing your confidence, step-by-step.

Practise relaxation, meditation or mindfulness 

Practising relaxation, meditation and mindfulness on a regular basis will allow your body and nervous system the opportunity to routinely settle and readjust to a calm state.

Look after your health 

Exercise, diet, and other health behaviours can help support you to manage anxiety, so it is important to:

• make sure you are eating well
• get regular exercise
• avoid using alcohol, tobacco and other drugs to cope when you are finding things difficult

Utilise self-help resources 

A number of self-help resources are available where you can learn ways of managing anxiety, including through common treatment approaches like CBT. The Federal Government’s Head to Health website provides information and links to reputable digital mental health services. These can be a good starting point or can be an additional means of support to complement sessions with a psychologist.

Head to Health

The Federal Government’s website linking the public to reputable and evidence-based digital mental health services.

www.headtohealth.gov.au

beyondblue

Provides information on anxiety, depression, and related disorders

www.beyondblue.org.au

headspace

Australia’s National Youth Mental Health Foundation, providing assistance for individuals aged 12-25

www.headspace.org.au

Lifeline

A 24-hour counselling, suicide prevention and mental health support service

Telephone: 13 11 14

www.lifeline.org.au

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