Anxiety

What is Anxiety?

    ‘Anxiety’ is a rather common term used today. Anxiety involves a general feeling of apprehension about possible future danger. This is not to be confused with fear - an alarm reaction that occurs in response to immediate actual danger. Anxiety disorders are characterised by unrealistic, irrational fears or anxieties that cause significant distress and/or impairments in functioning. According to Barlow, the anxiety response pattern is a complex blend of unpleasant emotions and cognitions that is both more oriented to the future and much more diffuse than fear.   

What are Anxiety Disorders?

Though anxiety disorders may seem the least harmful, anxiety disorders have the earliest age of onset out of all mental disorders, making them a serious cause for concern. Anxiety Disorders often result in frequent intense, excessive and persistent worry as well as fear about everyday situations. A wide variety of neutral stimuli may thus accidentally trigger or serve as cues that something threatening and unpleasant is about to happen. Often, they tend to include repeated episodes of sudden feelings of intense anxiety. 


What are the different Anxiety Disorders? 
    The DSM-5 currently recognises five anxiety disorders. Namely: 

1. General Anxiety Disorder (GAD) 
2. Specific Phobia 
3. Social Anxiety Disorder (SAD) 
4. Panic Disorder 
5. Agoraphobia

General Anxiety Disorder (GAD): 
   
Specific Phobia 
    A phobia is present if a person shows strong and persistent fear that is triggered by the presence of a specific object or situation and leads to significant distress and/or impairment in a person’s ability to function. When encountering a phonic stimulus, those with specific phobia would often react immediately with a fear response that resembles a panic attack. The anticipation of encountering a phobic object/situation would also result in them going to great lengths to avoid such encounters with their phobic stimulus. The occurrence of this anxiety disorder is rather common, occurring in around 12% of people at some point in their lifetime. 

According to the DSM-5, there are five sub-types of specific phobias: 

1. Animal: Snakes, Spiders, Dogs, Insects, Birds 
2. Natural Environment: Storms, Heights, Water
3. Blood-Injection-Injury: Seeing blood or an injury, receiving an injection, seeing a person in a wheelchair
4. Situational: Public transportation, Tunnels, Bridges, Elevators, Flying, Driving, Enclosed Spaces
5. Other: Choking, Vomiting, “Space Phobia” (fear of falling down if away from walls or other support)

Social Anxiety Disorder (SAD)
    SAD, also known as Social Phobia, occurs when a person experiences disabling fears of one or more specific social situations (such as public speaking, urinating in a public bathroom, or eating or writing in public.) This fear usually occurs when a person believes that he or she is a social object exposed to the scrutiny and potential negative evaluation of others or that they might act in an embarrassing or humiliating manner. Such fears thus cause people with SAD to avoid such situations or endure them with great distress. The DSM-5 recognises 2 sub-types of SAD: 

1. Performance: Giving presentations at work/school, evaluations under formal settings 
2. Non-Performance: Being in public spaces, Attending social gatherings

Unfortunately, approximately 12% of the population meets the diagnostic criteria for SAD at some point in their lives. This disorder occurs more commonly amongst women and typically begins during adolescence or early adulthood.

Panic Disorder 
    Panic Disorder can be described as the occurrence of panic attacks that often seem to come “out of the blue.” A DSM-5 criteria for panic disorder is the requirment for the person to have experienced recurrent, unexpected attacks and must have been persistently concerned about having another attack for at least a month. For an event to qualify as a full blown panic attack, there must be abrupt onset of at least 4 of the 13 symptoms listed below as stated by the DSM-5: 

1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating.
3. Trembling or shaking. 
4. Sensations of shortness of breath or smothering. 
5. Feelings of choking. 
6. Chest pain or discomfort.
7. Nausea or abdominal distress. 
8. Feeling dizzy, unsteady, light-headed, or faint. 
9. Chills or heat sensations. Paresthesias (numbness or tingling sensations). 
10. Derealization (feeling of unreality) or depersonalization (being detached from oneself). 
11. Fear of losing control or “going crazy”.
12. Fear of dying. 

    Panic attacks are often unexpected and appear even when unprovoked by any identifiable aspects of the immediate situation. In some other cases, panic attacks may however be situationally predisposed, occurring only sometimes while the person is in a particular situation such as driving or being in a crowd. 

Agoraphobia: 

    Agoraphobia simply put is the fear and avoidance of public and crowded places such as shopping malls, movie theatres and stores. It is often a frequent complication of panic disorderPeople with agoraphobia are usually concerned that they may have a panic attack or get sick in public places. This results in anxiety about being in places or situations from which escape would be difficult or embarrassing, or in which immediate help would be unavailable if something happened (DSM-5 criteria). In most cases, people with this disorder are typically anxious when venturing outside their homes alone. In extremely severe cases, agoraphobia is extremely dysfunctional and disabling in which the person is unable to even venture beyond the narrow confines of their home. 

When should your anxiety be classified as a disorder? 

Experiencing occasional anxiety is a normal part of life. 
A person might feel anxious when placed under pressure, in high-stakes situations such as taking a test, going for a job interview, or making crucial decisions. However, some indicators of anxiety disorder that warrant diagnosis include the following.

• Experiencing disproportionate anxiety over everyday activities and it’s interfering with your work, relationships and other parts of your daily life
• Your fear, worry and anxiety is upsetting to you and difficult to control
• You think your anxiety could be linked to a physical health problem
• Suicidal thoughts or behaviours: SEEK EMERGENCY TREATMENT IMMEDIATELY if you have this symptom

How can I cope with anxiety disorder? 

1. Limit alcohol and caffeine, which can aggravate anxiety and trigger panic attacks.
2. Get enough sleep. Deep sleep rejuvenates the brain’s emotion regulatory mechanism, which lowers physiological and emotional reactivity and prevents the rise of anxiety. 
3. Exercise daily. Research has shown that regular participation in aerobic exercise decreases overall levels of tension, elevates and stabilises mood, and improves sleep and self-esteem. 
4. Learn what triggers your anxiety and break the pattern. Journal down the circumstances surrounding each panic attack, and determine what you must do differently to prevent or diminish the next one.
5. Rely on your loved ones for support, and talk to a therapist for professional help. Sharing your situation with others allows them to work with you in coping with your anxiety, and lessens the stress of having to handle the situation on your own. 

If you need somebody to talk to and you are not sure who to turn to, drop us a call at  +65 6970 5611 to schedule a session, or sign up using the form on our website.

How do we help someone suffering from an anxiety attack? (Mental First Aid)

    According to the Mental Health First Aid, appropriate first aid response can decrease hypervigilance about physical symptoms or fear future panic attacks. The steps recommended by the MHFA can be summarised into the simple acronym of ALGEE: The Action Plan.

ASSESS: 

• The Mental Health First Aider should first identify themselves if they are not known to the person 
• Speak to the person in a reassuring but firm manner 
• Speak clearly and slowly 
• Use short, clear sentences 
• Know the symptoms of a panic attack 
• Ask the person if they are aware what is happening 
• Ask the person if they have ever had a panic attack before
• If the person loses consciousness

• Apply regular first aid principles (check for breathing and pulse) 
• Call an ambulance 

LISTEN: 

• Remain calm and avoid becoming caught up in panic 
• Be patient with the person 
• Acknowledge that the terror feels very real to them

GIVE:

• Rather than making assumptions about what the person needs, ask them directly 
• Reassure the person that a panic attack, while very frightening

• Is not life threatening 
• Is not dangerous

• Do not belittle the person’s experience 
• Reassure the person that they’re safe 
• Reassure the person that the symptoms will pass, rarely lasting more than ten minutes
• Explain symptoms of panic attacks and panic disorder where relevant 

ENCOURAGE: 

• Assure the person that effective treatments are available for panic disorder 
• Be aware of the range of professional help available for panic attacks 
• Tell the person that if the panic attacks recur, and are causing them distress, they should speak to an appropriate health professional
• Assure the person that panic attacks and panic disorder can be effectively treated 
• Ask the person if they know where they can seek help and advice about panic attacks 
• After the panic attack has stopped, the first aider should explain where they can get more information 

    While anxiety disorders may seem rather common and harmless, they are in fact extremely detrimental to clients. Those who border on the severe side for such disorders often find themselves unable to live a fully functional life. It is thus of the utmost importance that we educate ourselves on the different aspects of anxiety disorders.


References used:
Sandoiu, A. (2019, November 6). Deep sleep may help treat anxiety. Medical News Today. https://www.medicalnewstoday.com/articles/326926