What is Anxiety?
Anxiety is the body and mind's natural reaction to threat or danger. In the appropriate situation high levels of anxiety even panic is considered normal and helpful if it prompts us to escape from danger.
Anxiety in performance situations such as interviews and exams can help us perform to the best of our ability.However, when anxiety becomes excessive or debilitating then it is considered an Anxiety Disorder. Over the last few decades there has been a dramatic improvement in our understanding of anxiety and how it can be treated.Types of Clinical AnxietyAnxiety can be the main or "primary" problem or it can be a secondary problem which means that it is a symptom of another disorder.
Depression and substance or alcohol misuse are often associated with high levels of anxiety, but in these cases lasting benefit will come from treating the underlying problem rather than focusing solely on the anxiety symptoms.
In primary Anxiety Disorders the symptoms tend to have followed a set pattern over several months or years. In these cases the anxiety symptoms occur independently of other mental health problems, though they can be made worse by for example depression and life stress.
Sudden episodes of acute severe anxiety associated with a fear of death or collapse
A fear of being away from a place of safety. Often is associated with panic. In severe cases sufferers become house bound or confined to a small "safe" area.
Excessive anxiety and self consciousness in social situations with a central fear of being judged negatively or harshly or appearing foolish. Leads to avoidance of social or performance situations such as public speaking as well as subtle forms of hiding away in social gatherings.
Often present from childhood these are intense automatic fears of triggers such as rats, spiders, heights, enclosed spaces or more unusually vomiting or thunderstorms. They are associated with an intense desire to avoid or escape from the trigger.
Obsessive Compulsive Disorder
This is a complex disorder that can be tremendously disruptive to sufferers and their families. Sufferers feel compelled to ward off contamination, disaster or other negative events by carrying out time consuming rituals such as washing, checking or ruminating (thinking things through in a circular way). Sufferers have an exaggerated sense of responsibility for preventing harm and have a heightened awareness of risk and danger.
Generalised Anxiety Disorder
This is a disorder of uncontrolled worrying. Sufferers spend long periods agonising over what they anticipate might go wrong in the future. This causes distress, sleep disturbance and exhaustion. Unlike Obsessive Compulsive Disorder there are fewer neutralising acts or compulsions and the fear tends to spread across numerous everyday themes rather than fixating on specific dangers.
Post Traumatic Stress Disorder
This is a carefully defined disorder that results from a trauma such as a road traffic accident or an assault. Sufferers are troubled with intrusive memories or flash blacks of the incident and they are on a state of high alert. They tend to avoid reminders or triggers of the trauma. It is important to distinguish the disorder from normal reactions to traumatic events, which are similar but shorter lived and less intense.
How common are Anxiety Disorders?
Anxiety Disorders are the most common mental health problem along with depression, affecting the population of Ireland and Europe. They account for a similar level of stress and disability within society as cancer or heart disease.
It is estimated that 1 in 9 individuals will suffer a primary anxiety disorder over their lifetime. Only a fraction of these individuals receive appropriate treatment which is a great pity as it has been demonstrated consistently that with expert therapy the majority of sufferers can achieve a lasting improvement.
Causes of Anxiety Disorders
Anxiety can be primary or secondary to other mental health problems such as depression or substance misuse. Primary Anxiety Disorders are thought to result from a combination of genetic predisposition and life stress triggering a vicious cycle. Physiological reactions in the brain and body, distorted thoughts and beliefs about risk and danger and patterns of behaviour such as avoidance or safety seeking all interact to develop and maintain the problem.
Cognitive Behaviour Therapy treatments are highly effective in Anxiety Disorders and target exaggerated danger beliefs and safety behaviours in a collaborative way with the aim of breaking the vicious cycle and helping the sufferer achieve greater confidence in the face of what they fear.
By learning about the vicious cycle of anxiety and by challenging beliefs and behaviours at the centre of the anxiety problem, sufferers gradually master their fears and regain their functioning. CBT work can be greatly supported by meditational strategies such as mindfulness meditation, occupational therapy and various drug treatments.
Serotonin boosting anti-depressant drugs are very helpful in easing anxiety states and combine nicely with CBT work. Sedative anti-anxiety drugs can also be used in the short term to ease the worst of the anxiety during the acute phase.
Best results are achieved by carefully focused Cognitive Behaviour Therapy combined with other forms of help as needed.