Anxiety - JANET MEEHAN & PARTNERS

We have all experienced feelings of anxiety. Anxiety feels like fear. It also produces symptoms in our bodies such as shaking, sweating, dizziness and palpitations.

When it's there a lot of the time, caused by a problem in our life that can't be solved, we call it worry.

If it is a sudden reaction to a threat, like looking over a cliff or being confronted by an angry dog, we call it fear.

Although worry, fear and anxiety are unpleasant, they can also be helpful. Psychologically, they alert us to the fact that a problem exists and requires our attention. They keep us alert and give us the motivation to deal with problems. Physically, they make our bodies ready for action - to run away from danger or to attack it – the “fight or flight” response caused by release of adrenaline.

These feelings become a problem when they are too strong or when they carry on even when we don't need them anymore. They can make you uncomfortable and stop you from doing the things you want to do.

Is Anxiety bad for you?

Some anxiety is good for you. It keeps you alert and can help you to perform well, for example during an exam or an interview.

If it gets too intense, or goes on for too long, it can make you feel bad and interfere with your life. It can make you depressed and damage your physical health.

What does Anxiety feel like?

In the mind

Feeling worried all the time
Feeling tired
Unable to concentrate
Feeling irritable

In the body

Fast or irregular heartbeats (palpitations)
Sweating
Pale complexion
Dry mouth
Muscle tension and pains
Trembling
Numbness or tingling in fingers, toes or lips
Breathing fast
Dizziness
Faintness
Indigestion
Passing water frequently
Nausea, stomach cramps
Diarrhoea

The physical symptoms caused by anxiety are not imagined or “in your mind”, they are real and can be frightening. It's easy to worry that these feelings are the signs of a serious physical illness.

When anxiety and panic go on for a while, they can lead to depression - you start to feel down, lose your appetite, have difficulty sleeping and see the future as bleak and hopeless.

There are different anxiety disorders, which tend to respond to different treatments, so diagnosis is important. In many people, there can be an overlap in the three main types of anxiety.

Generalised Anxiety Disorder (GAD)

You have the symptoms of worry, anxiety and its physical effects most of the time.

Panic Attacks

You get unpredictable, sudden and intense attacks of anxiety - often in a situation that is likely to make you anxious. The feelings come on suddenly and reach a peak in 10 minutes or less. You may also feel:

that you are going to die.
frightened of “going crazy” or losing control.
short of breath and that you are choking.

About a quarter of people who go to an emergency department with chest pain thinking that they may be having a heart attack are actually having a panic attack.

Panic attacks produce discrete but very intense feelings of anxiety. When panic attacks are recurrent and there is no other form of anxiety present, the condition is referred to as Panic Disorder.

Phobias

You feel really frightened of something that is not actually dangerous and which most people do not find troublesome.

The nearer you get to the thing that makes you anxious, the more anxious you get and therefore you tend to avoid it. Away from it you feel fine.

Common phobias include:

agoraphobia - a fear of open spaces and going where there are other people, which can stop you from leaving the house.
social phobias - a fear of being with and interacting with other people, which can make it hard to talk to other people.
Specific phobias – for example fear of needles, hospitals or spiders. The affected person only experiences anxiety in anticipation of the feared object or when in contact with the feared object.

Are these problems common?

About one in every ten people will have difficulties with anxiety or phobias at some point in their lives. However, most people with these problems never ask for any help.

When should I get help for Anxiety?

Anxiety is very common and many of us overcome it or cope with it without professional help. However, if it is severe or goes on for a long time, anxiety can interfere with your functioning or cause physical health problems. It can also increase the risk of using substances such as alcohol and illegal drugs.

Forms of Self-Help

Talk to a trusted friend or relative
Join a self-help group. This may be a group that meets face to face or a virtual group using a platform such as Facebook. Some groups focus on the symptoms of the anxiety itself and how to manage them, others relate to the possible root cause of the anxiety, for example bereavement, relationship breakdown or a history of childhood abuse.
Learn relaxation techniques. There are support groups/ books/ apps available.
Learn to meditate. There is good evidence that mindfulness (a form of meditation) can provide relief from the symptoms of anxiety and depression. Again, there are local support groups/ books and apps available. A commonly used app is called Headspace.
Self-administered cognitive behavioural therapy (CBT). There is good evidence that CBT works for various forms of anxiety. A number of self-help books and online courses can be purchased.

Family and friends

Someone with troublesome anxiety may not talk about their feelings, even with family or close friends.

Even so, it is usually obvious that things are not right. The sufferer will tend to look pale and tense and may easily be startled by normal sounds such as a door-bell ringing or a car's horn.

They may be irritable, and this can cause arguments with those around them, especially if they don't understand why the person feels that they cannot do certain things.

Although friends and family can understand the distress of an anxious person, they can find them difficult to live with, especially if the fear seems unreasonable.

Other types of help

If you have an anxiety problem which just won't go away, you may not ask for help because you worry that people might think that you are "mad". They won't. It's a common problem and it's much better to get help rather than suffer in silence. The first port of call is your GP.

Your GP will evaluate your symptoms and the effect that they are having on your life in general. They will ask you if you have tried any form of self-help. Unless the anxiety symptoms are severe, you are likely to be referred to psychological therapies for cognitive behavioural therapy (CBT).

CBT is a talking treatment which can help you to understand how some of your thought patterns can make anxiety worse, or even cause it. It can also help you to explore possible underlying reasons for your anxiety. The treatment can take place in groups or individually and is usually delivered in 6 to 12 weekly sessions.

Some GPs can help you to access computerised CBT, which you deliver to yourself. There are now a number of computer programs available, for example Beat the Blues and Mood Gym. The National Institute for Health and Clinical Excellence (NICE) recommend a program called Fearfighter for panic or phobia.

If this is not enough, there are several different kinds of professionals who may be able to help including a psychiatrist, a psychologist, a social worker, mental health nurse or counsellor.

Medication

Medication can play a part in the treatment of some people with anxiety or phobias. The most commonly prescribed drugs are SSRI anti-depressants such as Sertraline or Citalopram. Citalopram is the drug of choice in panic disorder. An SNRI anti-depressant called Venlafaxine is licensed for use in generalized anxiety disorder. Anti-depressants usually take two to four weeks to take effect.

For the short-term relief of severe anxiety or agitation benzodiazepines (most sleeping tablets also belong to this class of drug) can be helpful. Commonly prescribed examples are Diazepam and Clonazepam. They are very effective in relieving anxiety, but they are also very addictive after four to six weeks of regular use. When people try to stop taking them, they may experience unpleasant withdrawal symptoms.

Beta-blockers which slow down the heart rate can be useful in controlling the physical manifestations of anxiety i.e. shaking, sweating and palpitations. They do not tend to affect anxious thought patterns or worry.

Which treatments work best?

The most effective treatment is likely to be CBT or a combination of CBT and anti-depressant therapy. Self-help books can also work for some people although the benefits may not be sustained over time.