AJH Psychology

Therapy - Counselling - Psychological Services

Anxiety

Anxiety is a response that prepares us to cope with threats in our environment. For instance, if you are walking in the woods and you encounter a bear, anxiety will prepare you to respond to that potential threat. This is known as the flight or fight response. It entails a number of physiological changes that takes place in our bodies in order to take instant action to deal with a threat. In that way, anxiety helps us to respond to a threat in order to protect us from a dangerous situation, constituting an adaptive response that is vital for our survival.

However, this flight or fight response may be activated even in situations where the threat is not imminent or not even real. For instance, anxiety may be triggered because you are going to a job interview. In that case it could be that the idea of being interviewed may feel threatening for you but that does not threaten your survival. Nonetheless, we react in similar ways to real, potential or even imagined threats. That is why human beings do experience anxiety from time to time and that is, as discussed, an adaptive response to threat. However, if anxiety becomes overwhelming because of its frequency, intensity or duration, that is likely to have a harmful effect on you. The experience of excessive anxiety has been categorised into different types of anxiety. Here follows the most prevalent ones:

Panic attacks
Social Anxiety or Social Phobia
Agoraphobia
Specific Phobia
Generalised Anxiety Disorder (GAD)
Obsessive Compulsive Disorder (OCD)
Post-traumatic stress disorder (PTSD)
Health Anxiety

Panic Attacks

Panic attacks are sudden experiences of intense and overwhelming fear that last for several minutes. They may manifest themselves in the form of heart palpitations, chest pain, shortness of breath, sweating, nausea and trembling or shaking. As such symptoms could be linked to a physical issue, it is advisable to see a GP in order to rule out any physiological condition. Panic attacks are extremely frightening and distressing experiences that may or may not be triggered by a particular stressor and whose frequency may vary among individuals. If you suffer from panic attacks, you may fear going out because you are afraid that a panic attack may take place while you are out. Therefore you may avoid leaving your home, which in turn may lead to withdrawing from activities such as shopping, meeting friends or going for walks. Additionally, this worry about having your next panic attack raises your anxiety which then increases the likelihood of another panic attack taking place.

Social Anxiety or Social Phobia

If you suffer from social phobia, you experience an intense fear of and worry about being in social situations. In such instances, you may be concerned that people are going to notice your anxiety and that you are going to do or say something that is embarrassing or humiliating. Additionally, you may also think that others are constantly observing and judging you. This may lead to an avoidance of social situations, which then perpetuates your isolation. Paradoxically, those who suffer from social anxiety want to make friends, participate in group activities or engage in social interactions. It is their anxiety that prevents them from socialising with others. Social phobia has a detrimental effect on people’s self-esteem, relationships, and on occupational or educational aspects of their lives. Although you may think that social phobia would be impossible to overcome, it is a condition that can be effectively treated.

Agoraphobia

If you suffer from agoraphobia, you may experience significant anxiety or fear in certain situations such as using public transport, being in enclosed spaces (such as shops) or open spaces (e.g. parking lots, parks), being in a crowd or standing in line. You may avoid the feared environment and you may generally try to find somebody else who can accompany you in order to help you to cope with the feared situation. This may lead you to stop going out alone which then may have a significant impact on your independence.

Specific Phobia

People suffering from a phobia experience significant fear or anxiety about a situation such as flying, heights or an object, such as spiders or dogs. Although, we may all fear a situation or an object from time to time, the fear experienced by people with a specific phobia is out of proportion to the actual danger or it is more intense than it is considered necessary. That fear produces marked impairment in social, occupational or other important areas of an individual’s functioning.

Generalised Anxiety Disorder (GAD)

Although it is normal to worry about the future or about uncertain events, someone who suffers from GAD worries about a number of events or activities, finding it difficult to control their worry. A main feature of GAD is that the intensity, duration and frequency of people’s worry are out of proportion to the actual prospect or impact of the predicted event. This anxiety or worry manifests itself in the form of difficulties concentrating, irritability, restlessness or sleep difficulties. Sufferers from GAD, experience anxiety that is diffused, unfocused, free floating and on-going, leaving them often fatigued and mildly depressed (Maxmen et al., 2009).

Obsessive Compulsive Disorder (OCD)

Those who suffer from OCD experience certain thoughts that are frequent, persistent, intrusive and unwanted. For example, they may experience thoughts of contamination or images of violent scenes. These kinds of thoughts are known as obsessions and cause OCD sufferers significant distress and anxiety. In order to decrease the distress caused by obsessions, sufferers of OCD engage in compulsions, which are repetitive behaviours or rituals, such as washing hands, checking, or counting. Such rituals are time-consuming and may cause significant distress or difficulties in social or work situations. OCD sufferers fear that something terrible would happen if they don’t do what they feel compelled to do. For instance, “I will get terribly sick if I don’t wash my hands several times after touching a certain object”. Although those individuals generally know that what they do is not rational, they can’t help engaging in those activities. Consequently, as they know that their behaviour is irrational, they are likely to conceal their symptoms from others due to embarrassment (Maxmen et al., 2009). This leaves them with a sense of not being understood and being isolated.

Post-traumatic stress disorder (PTSD)

Those who suffer from PTSD have been exposed to an extremely traumatic event such as being threatened by death, suffering a serious injury or being subject to sexual violence. Not everyone who has experienced a major trauma develops PTSD. Indeed, some people are able to assimilate the trauma without professional help. However, those who develop this condition experience a number of distressing symptoms.

Following the stressful event, an individual suffering from PTSD will shift between engaging in denial or avoidance and re-experiencing the situation. During the first phase of PTSD sufferers experience “psychic numbing” which means feeling detached from others. They may then minimize the importance of their stress, forget that it took place, lose interest in life and/or abuse alcohol or drugs. The second phase of PTSD involves re-experience of the traumatic event. This may take the form of nightmares and/or flashbacks whereby a person feels or acts as if the traumatic event was taking place. Such experiences are likely to trigger the production of adrenaline which prepares the body for action as explained earlier. This will then make the person hyper vigilant, irritable, unable to relax and sleep well. It is worth pointing out that in spite of the aforementioned stressful symptoms, PTSD can be successfully treated even when it develops many years after a traumatic event (www.nhs.uk).

Health Anxiety

Although many people worry about their health at certain points of their lives, for some people their health concerns become overwhelming. These worries may involve a persistent preoccupation that they have acquired a serious medical condition which may or may not involve physical symptoms. This preoccupation causes significant distress to the individual. Consequently, people who suffer from health anxiety may seek continuous reassurance from doctors, friends and family members. People with health anxiety may also feel that nobody understands them or takes their distress seriously. In an attempt to ease their anxiety they may refer to the internet in search for answers, which then, due to the vastness and sometimes inaccuracy of certain web sites, leads to an increase of their confusion and anxiety.

As we have seen, anxiety difficulties may take different forms and therefore treatment may differ depending on its presentation. For the treatment of anxiety difficulties I tend to integrate a number of therapeutic approaches which will be tailored to your specific needs. If you need help with anxiety difficulties please contact me.

Sources:
www.nhs.uk

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Maxmen, J.R., Ward, N.G. & Kilgus, M. (2009). Essential Psychopathology and Its Treatment. London: W W Norton.

Royal College of Psychiatrists - Post Traumatic Stress Disorder