+254722457898What is Anxiety Disorder?
Anxiety is a normal response to a stressful situation which helps one to remain alert and ready to respond to any dangerous situation. It is an anticipation of something that will happen in the future. Anxiety is characterized by fear, muscle tension and avoidance behavior(phobias). Fear is often an emotion that manifests when we are in danger and it prepares one to fight or take a flight. When one is anxious, they may experience a general feeling of worry, nervousness, or unease. One may also manifest physical signs such as a pounding heart and sweating.
Experiencing a little anxiety is normal if you have an upcoming event whose outcome you are uncertain of. It may be an interview, appointment, date, exam, a problem at work or any issue you are unsure of how to handle. Naturally, anxiety is supposed to keep us safe and avoid danger. It enables us to realize dangerous/threatening situations in our environment and to focus our attention and energy in staying safe (fight or flight response).That said, when anxiety intensifies (exceeds regular nervousness and fear), it can be disruptive. At that point, one may be diagnosed with an Anxiety Disorder.
Anxiety Disorder is a type of mental health condition that causes a person to respond to certain situations with excessive fear and dread beyond normal nervousness, anxiousness or unease.An anxiety disorder has developed if you observe the following:
- It interferes with your ability to function e.g someone with social anxiety may avoid interacting with other people.
- You exhibit exaggerated response to internal or external signals of perceived danger or threat.
- You overreact when something triggers your emotions/state of calm.
- You cannot control how you respond in certain situations especially for people who have developed phobias.
Types of anxiety disorder
Generalised anxiety disorder
Generalised anxiety disorder is a condition in which one is excessively worried and tense about day to day activities to an extent that it interferes with normal functioning. The person may feel restless, easily fatigued, difficulty concentrating or sleeping, feeling on the edge and muscle tension. The worries may be about work, health, family and responsibilities that one has.
Phobias/specific phobias
A specific phobia is an excessive fear that persists of a specific object, situation or activity which is generally not harmful. A person may know that their fear is not justified but overcoming it is an issue. Due to the distress one experiences as a result of the fear, one may develop avoidance of the object, situation or activity that evokes the fear. Some of the situations may be heights, flying, fear of animals. Public speaking among other situations.
- · Health Anxiety
- · Agoraphobia and
- · Post Traumatic Stress Disorder
- · Obsessive Compulsive Disorder
- · Social Anxiety Disorder
- · Panic Attacks
- · High Functioning anxiety
- · Separation Anxiety
- · Acute stress Disorder
Statistics/Prevalence of Anxiety Disorder
An estimated 275 million suffer from anxiety which translates to around 4% of the world population. In every country, averagely 2.5% to 6.5% of the population are affected with anxiety. Anxiety is more common in women with a prevalence 62% against 38% in women. Notably, the numbers may be higher due to under reporting.
Generally, anxiety disorders have an early onset and may prolong despite treatment. Anxiety can cause much distress, impair your ability to function fully thus resulting in considerable economic burden. Anxiety disorder commonly occur alongside depression, bipolar, schizophrenia and substance abuse disorders.
Causes/Triggers of Anxiety Disorder
- · Being in a stressful career or workplace.
- · Travelling to new places.
- · Driving when you have little experience.
- · Heredity-Anxiety can run in families.
- · Certain medications: Stimulants, anti-depressants, thyroid medication, corticosteroids, nasal decongestants & antihistamines, rescue inhalers, recreational drugs, tapering medication(absence of medication: stimulants, anti-depressants, anxiolytics, recreational drugs-rebound anxiety).
- · Withdrawal symptoms from substance abuse.
- · Interviews, appointments, meeting.
- · Trauma
- · phobias, such as agoraphobia (fear of crowded or open spaces) and claustrophobia (fear of small spaces)
- · Some chronic illnesses like heart disease, diabetes, or asthma
- · chronic pain
- · having another mental illness such as depression
- · Caffeine
Common Signs and Symptoms of Anxiety Discussed
The most common symptoms of anxiety can be categorised into three main groups. Those that result in apprehension, motor tension and autonomic reactivity.
Apprehension – worrying about future misfortunes, feeling on edge, having difficulty concentrating, a feeling of dread.
Motor Tension – restlessness and fidgeting, tension headaches, trembling, inability to relax
Autonomic Over Activity – lightheadedness, sweating, abnormally high heart-rate (tachycardia) or abnormally rapid breathing (tachypnoea), pain in the upper abdomen (epigastric discomfort), dizziness, and dry mouth.
Discussion of Common Signs of Anxiety
a. Worrying: Anxiety disorder can manifest in the form of excessive worrying about work, school, social interactions, personal relationships, our health, finances and many other issues. A little of stress about any of the above is normal. However, when worrying extends for more than 6 months despite knowing that our concerns may be irrational, we may need to seek help.
b. Lack of Sleep/Restlessness: Its normal to be restless and even experience difficulties sleeping the day before an event. One may toss and turn in bed because of feeling uneasy. However, if the lack of sleep/insomnia continues for a prolonged duration, then one may be having an anxiety disorder.
c. Fatigue is another common symptom of anxiety. In most cases, it may be attributed to lack of sleep. Nonetheless, it’s possible that one may be sleeping well but they still experience fatigue. Additionally, one may easily feel tired during the day. The overthinking/worrying can also exhaust you mentally and emotionally. The mental and emotional exhaustion can alter our mood exposing one to depression.
d. Difficulty Concentrating: Most people struggling with anxiety have difficulties concentrating. This can be attributed to worrying and fatigue (due to lack of sleep). Consequently, completing tasks and assignments becomes an issue. There is also a tendency to procrastinate.
e. Irritability: Anxiety may make one to be easily angered and likely to lash out when suddenly interrupted. They are also less patient than before. This symptom is likely to affect one’s social life.
Other common symptoms of anxiety include:
- · Increased or irregular heartbeat/palpitations especially for those suffering from panic attacks and social anxiety,
- · Excessive sweating,
- · High blood pressure,
- · Churning stomach,
- · Nausea and feeling dizzy,
- · Headaches/backaches,
- · Grinding of teeth especially at night,
- · Changes in sex drive,
- · Trembling uncontrollably (especially hands). The trembling is as a result of adrenaline rash (flight or fight response).
- · Shortness of breath(dyspnea) as a result of increased temperature.
- · Feeling of dread: Feeling as though something terrible is about to happen.
Prevention, Managing and Coping with Anxiety
As noted above, anxiety disorder is a serious mental illness and can disrupt normal functioning. Some of the negative effects of anxiety include:
Negative Effects of Anxiety
- · Find it hard to take care of oneself,
- · Loss of employment due to poor performance,
- · Difficulty relating with others and forming relationships,
- · Finding it hard to try new things and enjoying one’s leisure time and hobbies.
Dealing with anxiety
A combination of psychotherapy, medication and natural remedies/coping mechanisms can be used to treat anxiety disorder. Ordinarily, before medication is prescribed for any anxiety disorder, one will be referred to psychological therapies. Common psychological therapies used to treat anxiety include Cognitive Behavioral Therapies. In fact, for a condition such as Generalized Anxiety Disorder, the benefits of CBT far outweigh those of medication. Through CBT, a client is equipped with skills to confront the negative thoughts which generate fear and worry.
Medication for treating anxiety
There are four main types of medication used to treat anxiety. They include: Selective Serotonin Reuptake Inhibitors (SSRIs), Selective Noradrenaline Reuptake Inhibitors (SNRIs), Benzodiazepines and some anticonvulsants (Pregabalin). Notably, medication can only be prescribed by a qualified Psychiatrist or General Physician. The medication treat physical and psychological symptoms. The medication may have side effects and as such, one needs to visit the doctor regularly so as to track the progress.
Selective Serotonin Reuptake Inhibitors (SSRIs) for Anxiety
The first line of treatment which one will be prescribed are: Selective Serotonin Reuptake Inhibitors(SSRIs). SSRIs are a form of antidepressants which trigger the increase of Serotonin in one’s brain. Examples of SSRIs include Satraline, escritalopram and paroxetine.
SSRIs may take several weeks before they start working. However, if you don’t see any impact after 8 weeks, one is advised to visit their doctor.
Albeit effective, SSRIs have side effects when prescribed for anxiety. Common side effects of SSRIs include: feeling agitated and sick, indigestion, diarrhea/constipation, loss of appetite & weight, dizziness, blurred vision, excessive sweating, dry mouth, headache, insomnia, low sex drive/erectile dysfunction and difficulty reaching an orgasm. However, it’s noteworthy that side effects with sex drive may persist longer.
Selective Noradrenaline Reuptake Inhibitors (SNRIs) for Anxiety
When SSRIs fail, the second line of treatment is Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs). This are also anti-depressants which increase the amount of serotonin and noradrenaline in the brain. SNRIs include: venlaxafine and duloxetine. Like SSRIs, SNRIs do have side effects which include: feeling sick, headaches, insomnia, sweating, stomach problems, dry mouth, feeling drowsy and dizzy.
Anticonvulsants (Pregabalin) for Anxiety
When SSRIs and SNRIs don’t work, an anticonvulsant known as Pregabalin may be used. Normally, it is used to treat Epilepsy but in some cases, it may be suitable to treat anxiety. It has side effects which similar to those attributed SSRIs and SNRIs. Notably, it affects sex drive and its more serious than SSRIs and SNRIs.
Benzodiazepines for Anxiety
Benzodiazepines are sedatives which may at times be used to treat anxiety. The most common benzodiazepine is diazepam. It relieves symptoms with 30 to 90 minutes hence very effective in treating severe anxiety. They are used for short term treatment due to their addictive nature. They should not be used for more than 4 weeks. Benzodiazepines cause the following side effects when used to treat anxiety: feeling drowsy, low libido, headaches, lack of concentration, vertigo and tremors. When under this medication, one should not take alcohol or opiates as side effects can be adverse.
Wellbutrin is also a common antidepressant that may be prescribed to treat types of anxiety especially if the anxiety is caused with depression.
Natural Therapies of Treating Anxiety
Other form of therapies such as exercise, deep breathing, meditation and yoga may be used.
Psychotherapy/ Talk Therapy for Treating Anxiety
How to Cope with Anxiety
Below are some practical tips you can apply to calm your anxiety.
a. Focus on the present
Our main business is not to see the future but to focus on what lies before us today. Shut out the past which is now dead and close your eyes to the unborn tomorrow. The burdens of yesterday when added to the load of tomorrow can break even the strongest of us. The only future you need to worry of is today. The day of changing your future is today. Focus your intelligence and enthusiasm on today’s work.Notably, that one step of today is enough. Anything no matter how hard can be done for a day. The philosopher Heraclitus noted that life is full of ceaseless change. The only certainty is today. Don’t waste your energy trying to solve tomorrows problems which you are not sure of. Dale Carnegie also notes that, yesterday is but a dream. Tomorrow is only a vision. But today well lived makes yesterday a dream of happiness and every tomorrow a vision of hope.
b. Be Optimistic and believe that things will be okay
Avoid the ‘reality is’ mentality. Because something terrible happened yesterday does not mean it will happen today. Avoid negativity and believe that you are worthy and deserve the very best. Too much worrying can only yield fear, tension and nervous breakdown. If you must think about something, focus on its cause and effect and plan constructively on how to deal with it.
c. Change the activity you are doing
If fear and worry get the best of you while doing something, you can embark on a different activity that is enjoyable and involving. For instance, you can cook, clean, call a friend or read. At all costs, avoid being idle as it gives your brain ample time to imagine all kinds of things which may make the anxiety worse. As you get busy, you can listen to soothing music which evokes good memories. Music is a powerful dopaminergic, it can alter your thoughts and how you feel.
d. Be open-minded and accept what has happened
Approach the future with an open mind. Be flexible. Also, believe that nothing comes your way is impossible. When what you did not anticipate happens, accept the outcome. No amount of worrying or tension can change the situation. As William James noted, be willing to have things as they are or bound to be. When you accept the worst that may happen, you have nothing to lose and therefore, nothing to worry about.Once acceptance sets in, analyze the situation objectively and honestly. Try to figure out what is the worst that could possibly happen as a result of this failure. Accept it and always remember, things could have been worse than that. Then channel your time and energy to improve the worst which could help. Find out ways in which you can reduce the damage.Lastly, deep breathing, exercise, yoga and meditation do help. If you follow the techniques, you’ll develop a calmness of mind that will give you new energy. If you are overwhelmed, see a counsellor/psychologist.
e. Question/ Challenge your Thoughts
Negativity can distort your thoughts making you worry about things which either untrue or trivial. Whenever you feel anxious, take time to identify your thoughts at that point. For instance, what you are worried about can be a good place to start. Write down the worrying thoughts and describe them clearly.
Once you’ve listed the thoughts, examine them one by one. Ask yourself whether your thoughts/fears are true or false. If they are false, then reassure yourself calmly that the fears are not true and that you will be okay. Do it repeatedly until you start feeling calm. Envision yourself being calm, relaxed and worry free.
If the thoughts/fears are true, then evaluate how serious they are. If what worrying you is trivial, dismiss it and reassure yourself that you will be okay. If its something serious, write down what you can do to make the situation better. Be realistic. After you know what you can do, do it. Start small if what needs to be done is a lot.
Importantly, if what’s worrying is beyond your control, then it’s pointless stressing over it. Accept the situation and cut your loses. Remind yourself that for as long as what is happening/happened hasn’t killed you, you’ll be fine and you’ll find another way. Remind yourself of a time in the past when you were in a more serious crisis, and you were able to overcome it or things just worked out. Factually, most of the things we dread don’t materialize, so why worry.
f. Deep Breathing
Deep breathing works by calming our tense muscles, racing heart and distracting our active thoughts even for a few moments. Take in and out 4 deep breaths. Don’t be in a hurry. Take your time. Hold the breath for some time. Close one nostril and use the other. Alternate them while at it. Trying to feel the air going in and out of your lungs.
The exercise should take around 5 minutes and it helps to calm you down. While at it, imagine you are breathing in workable solutions and positive energy while breathing out all the negativity and issues that are bothering you. Also, remind yourself that in the same way you are controlling your breath, you are in control of your life.
Read more on 4-7-8 breathing technique developed by Dr. Andrew Weil. It can also teach your effective ways of undertaking deep breathing.
g.Take a Walk
Taking a walk can help immensely in distracting yourself from a stressful situation that makes you feel tense. As you walk away, envision yourself walking away from the problem. Take around 15 minutes and play soothing music. During the work, avoid thinking about the situation. Instead, be mindful of your environment. Take note of the weather, the people around you and what they are doing, any movements by vehicles/people. Try and identify something that will make you smile/laugh.
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