September 18, 2024

Understanding and managing anxiety

TELUS Health

Anxiety is a term used to describe emotional and physical sensations of worry and fear. These sensations are related to the “fight or flight” response and are normal reactions when our body perceives a threat. However, more severe anxiety can interfere with your ability to work, enjoy life, or form close relationships.

Anxiety disorders usually do not go away on their own, but getting the right kind of help can enable you to find ways to confidently deal with them.

What are some common anxiety disorders?

It’s common to feel tense or unsure about a potentially stressful situation, such as an exam or new job. However, if these feelings are intense or long-lasting, they may be symptoms of an anxiety disorder.

According to major clinical diagnostic references, anxiety disorders fall into these broad groups:

Generalised anxiety disorder (GAD). People with generalised anxiety disorder feel anxious or nervous most of the time. Some worry excessively about their work, school performance, families, health, or finances. Others can't identify a specific cause for their anxiety. They may feel tense, exhausted, nauseous, irritable, unable to concentrate, and lightheaded, or out of breath. They may experience a sense of dread or racing thoughts. They may perspire more than others, or have sleep disturbances, headaches, muscle tension, or digestive issues. Their symptoms typically last for at least six months, or longer without treatment. The severity may cause them to avoid certain situations, withdraw from family and friends, and find work difficult—causing further worry and low self-esteem.

Panic disorder (PD). Panic disorder involves sudden and repeated episodes of terror that strike without warning. These panic “attacks” typically can range from as brief as five minutes, to as long as an hour. The episodes may involve palpitations or a pounding heart, feelings of dread, shaking, sweating, hot flushes, or chills. People may feel dizzy, numb, or lightheaded. Some feel as if they are dying, unable to breathe, or having a heart attack or stroke. Some may think that the world is spinning out of control. Even brief panic attacks can arrive so unexpectedly that people may worry intensely about when the next one will occur, leading to avoidance of certain situations.

Triggers that set off a panic attack can be identified, but sometimes are harder to pinpoint. Due to the intensity of symptoms—particularly feelings of fear and terror—many people with panic disorder have difficulty relaxing between attacks, living in ”fear of fear.” This anticipatory anxiety can negatively impact self-confidence and may disrupt a person's ability to function on a day-to-day basis.

Phobias. There are a wide variety of objects or situations over which someone could develop a phobia. Phobias are intense fears of things that are relatively safe. Specific or simple phobias centre around a particular object, animal, situation, or activity, such as heights, thunderstorms, tunnels or bridges, dogs or snakes, flying, or driving a car. Complex phobias tend to be disabling, such as agoraphobia and social phobia. People who have these phobias often know their fears are irrational, but still feel afraid of them and avoid them when possible. The symptoms of phobias tend to be similar to those experienced during a panic attack.

Social anxiety disorder (SAD). Also known as social phobia, social anxiety disorder is the fear of being humiliated, embarrassed, or judged by others, causing difficulties in social situations. People with this disorder may feel painfully self-conscious or see minor mistakes as major problems. They may be afraid to attend parties, speak in public, eat in restaurants, or talk on the phone.

Obsessive-compulsive disorder (OCD). OCD is marked by intrusive thoughts and repetitive behaviour. For example, an irrational fear of germs may lead to excessive hand washing. These thoughts and acts are persistent, recurrent, and unpleasant. Though the person experiencing them often knows that these obsessions and compulsions are unrealistic, they can still cause a great deal of distress.

What treatments are available?

Anxiety disorders are usually treated with therapy, medication, or both. Treatment may include these therapies:

Behavioural therapy helps you learn techniques for stopping or controlling unwanted behaviour. These techniques may include deep breathing for panic attacks and exposure therapy, or desensitisation, for phobias.

Exposure therapy provides a safe space where you can gradually and systematically be exposed to the objects or situations you find frightening, while developing coping skills. For example, if you fear dogs, you might first be shown dogs in pictures, then go to see them in a safe setting such as an animal shelter, before facing dogs on a lead.

Cognitive-behavioural therapy (CBT) encourages you to challenge your negative and anxious thoughts, feelings, and behaviour by helping you understand how they affect each other and could be leading to avoidance. For example, if you worry about public speaking, you can learn to identify and question the self-defeating negative messages you send yourself before presentations and how to replace them with more realistic, positive ones. Instead of thinking, "I always make mistakes when I speak in front of a large crowd and people judge me" you could think, "I am prepared for my speech. My topic is interesting to this group of people."

Medication may be used along with other forms of therapy. For long-term treatment, doctors may prescribe selective serotonin reuptake inhibitors (SSRIs also known as antidepressants) which act on the parts of the brain that regulate anxiety. Other medications, such as benzodiazepines (also known as tranquillisers) act on the central nervous system by slowing it down and have an immediate effect on lowering anxiety. These are prescribed only for short periods of time because there is a risk of addiction. It can be important to control panic attacks with medication so that they do not become more frequent or intense, making it harder to manage them. Beta blockers are a type of medication that treats high blood pressure and heart issues. However, doctors may prescribe them (most commonly propranolol) to help reduce the “fight or flight” stress hormone, which would control the physical symptoms of anxiety. Other options include serotonin-noradrenaline reuptake inhibitors (SNRI), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs).

It may take time for medications to have full effect, or to find the right dose or medication for you. Taking medication is an individual choice and it’s important to speak openly to your doctor about any concerns and possible side effects.

Eye Movement Desensitisation and Reprocessing (EMDR) is a brief, cost-effective treatment that can help you process and feel better about difficult memories. During EMDR, you are asked to think of a troubling memory while following a therapist's moving finger with your eyes and paying attention to any images, sensations, or emotions that may arise. The therapist then guides your attention towards more positive ones, helping your brain reprocess the memory and make it less upsetting over time.

Some anxiety disorders may respond well to a single form of treatment while others may require a combination of medication and therapy. Depending on the nature of the condition, you may see progress in a relatively short time, or may need to continue treatment further.

Dealing with anxiety disorders

If you believe you may have an anxiety disorder, consider these tips for reducing stress in your everyday life:

See a healthcare professional (e.g., therapist, nurse, doctor). A good first step is to have an initial physical exam. Many symptoms of anxiety disorders are similar to those of medical conditions, so it’s best to rule these out first. A health care professional can also provide you with referrals or information about relevant supports.

Eat a balanced diet. You may benefit from eating a healthier diet, taking vitamins, and limiting your intake of sugar, caffeine, and nicotine.

Get physically active. Regular physical activity is one of the most effective ways to cope with anxiety. It can release tension and be a substitute for less healthy habits. Some physical activity in the mornings or afternoons may help improve problems with sleep disturbance.

Find ways to unwind. You can start with simply doing things you enjoy, like listening to music or walking in nature. Techniques like progressive muscle relaxation, breathing exercises, and yoga stretches can also reduce stress, help relax your body, and improve your wellbeing.

Take up meditation or mindfulness. Meditation and other forms of mindfulness can help to lower blood pressure and rapid heartbeat. Mindfulness means focusing your awareness on the present moment and acknowledging your thoughts and emotions non-judgmentally as they come. This can reduce anxiety by creating space for it and gradually quieting your racing thoughts and worries.

Use visualisation. Visualising a positive outcome or calm and peaceful scene may make you feel less tense and more in control. It may help to hang a picture of a soothing place (such as a beach or a forest) in a place where you can see it frequently. If you tend to feel anxious at work, you could put such a picture in your desk drawer, for example.

Try to distract yourself. You may be able to distract yourself from anxiety by repeating a positive word or phrase, or a short poem or prayer. You could also try to redirect your focus by counting backwards or forwards, snapping a rubber band lightly against your wrist, or chewing gum.

Learn about your condition. Staying up to date on research and treatment methods can provide ideas for techniques that might help or alert you to subjects to bring up with a doctor or therapist. Self-help resources, such as Beyond Blue, have a list of information and resources to help you become more aware of your symptoms of anxiety.

Try reassuring yourself. Tell yourself that you are feeling anxiety, that it isn’t dangerous, and that it will pass. This reassurance can help make you feel calmer and less fearful of future attacks.

Join a support group. Engaging with others who are having the same experience can be helpful. It can be comforting to know you are not alone. Sharing your experiences can also be another coping skill for your “toolkit.”

Look into resources at work. If you have a benefits plan through your employer, you may have access to mental health supports, such as therapy. Depending on your comfort level, you may wish to discuss your concerns with a manager or Human Resources representative.

Anxiety disorders can be difficult to manage. But with your efforts and help from a professional, you can begin to learn new ways to manage symptoms and enjoy life without the fear and dread that anxiety can cause.