Anxiety or fear is a normal response to a real or imagined threat. Everyone feels anxious from time to time. This is normal. Anxiety can be a healthy emotion. It can actually prepare us better in certain situations. For example, a bit of anxiety in the lead up to an exam or speech can motivate us to prepare for the task and perform well.
However, some people experience pervading anxiety or anxiety that stops them from doing certain things. An anxiety disorder is when anxiety causes significant distress and starts to impact your life. About 1 in 3 of us will experience an anxiety disorder at some point in our lives. Wherever you are in Australia, Espsychiatry can provide you access to treatment for your anxiety. Contact us today to speak with one of our experienced Psychiatrists and Psychologists.
Healthy anxiety is short-lasting and goes away when there is no ‘threat’. Whereas problematic anxiety can last for months or even years. It may persist in the absence of danger. Healthy, or normal, anxiety is often related to an event or an upcoming situation. For example, at a party or when giving a speech. A specific event isn’t always the cause for problem anxiety. Problem anxiety may pop up out of the blue, with no clear trigger. If the anxiety is healthy it shouldn’t stop you from doing things. In fact, it might actually help you perform better. You might feel anxious before giving a speech However, if it’s within the healthy range, this type of anxiety shouldn’t stop you from giving the talk. When anxiety is unhealthy, it will likely prevent you from doing the things that are important to you. For example, speaking in public, going outdoors, learning a new skill. If you do follow through with the task, unhealthy anxiety will mean that you endure it with great amounts of distress.
With healthy or normal anxiety, the worries are often relative to the size of the actual threat. In other words, you are likely to be able to accurately assess the degree of risk. Secondly, assess your capacity to respond to it. When anxiety is problematic, perception can get distorted. The threat may seem bigger to us than it actually is. People with anxiety disorders are prone to 1) overestimate the threat, and 2) underestimate their capacity to cope with it. This biased way of thinking is a key factor that keeps excessive anxiety going. As a result, it is often a target in psychotherapy for anxiety disorders.
There are several signs and symptoms of anxiety disorders. Speaking in three broad categories. These symptom categories include 1) thoughts, 2) feelings (emotions and body sensations), and 3) behaviours. Below, we discuss some of the key signs and symptoms of anxiety in each category.
People with an anxiety disorder will experience changes in their thinking. Often, their mind will focus on perceived threats. So they get thoughts about ‘what could go wrong’ are likely to cause distress and occupy a large amount of their time. People with anxiety often worry a lot, fear or predict the worst and have difficulty tolerating uncertainty. Intense obsessive thoughts are also common. Such as in the process of rumination, whereby the person perseverates and focuses intently on negative thoughts for an excessive amount of time. People with anxiety often think in unhelpful and irrational ways. For instance, commonly, the threat is overestimated and the person’s coping capacity is underestimated. Common examples of anxious thoughts are things like “everything will go wrong”, “what if [insert feared outcome] happens”, and “I can’t focus on anything but my worries”.
You may feel a persistent sense of anxiety, intense worry or fear, or a general sense of unease. Feeling ‘wound up. People with anxiety often feel restless or on edge and find it difficult to wind down or relax. Many report a strong feeling of dread, danger or foreboding to be present most of the time. Anxiety can also present as feeling irritable or agitated, panicky, nauseous or detached from your body. Anxiety is commonly held in the body. It is experienced as physical tension or muscle tightness. Many people experience a range of body symptoms as a result of their anxiety. Firstly, tightness of the chest, racing heart, trouble breathing, lightheadedness, hot and cold flushes and excessive sweating. Secondly, panic attacks are an example of an extreme physical response to anxiety, whereby a person experiences a range of intense somatic symptoms.
As people’s thinking changes, their behaviour may also change. People with anxiety commonly avoid certain tasks, hold off or withdraw from aspects of life. In addition, they tend to rely on unhelpful coping strategies (e.g. alcohol or overeating) to manage their distress. People with anxiety may also have greater difficulty making decisions. They can shut down for the fear of a bad outcome. If you are unable to completely avoid an anxiety-provoking task or situation, you may engage in what we call ‘safety behaviours’. Safety behaviours are a more subtle form of avoidance. They designed to reduce anxiety in situ. For example, someone with a fear of going out may still be able to leave the house. However, this may only be at certain times of the day and in the company of a trusted friend or family member. Avoidance and safety behaviours are key in keeping anxiety going. They are often important targets of therapy for anxiety disorders.
Medication, as a treatment option for anxiety, is often considered after psychological therapy has been tried. If your anxiety is severe, medication can be considered alongside psychology.
Selective serotonin reuptake inhibitors (SSRIs) are generally the first class of medication considered to treat anxiety. An advantage of SSRI medications is that they can also be used to treat depression. Mood disorders commonly occur alongside anxiety. Like all medications, SSRIs can cause side effects and can interact with other medications. Serotonin and noradrenaline reuptake inhibitors (SNRIs) are another class of medication used to treat anxiety. If you have side effects in response to taking an SSRI, it may be worth considering an SNRI.
Psychiatrists have expert knowledge and practice in prescribing medications for mental health. If you are suffering from anxiety, it is worth discussing your options with one of our Epsychiatry psychiatrists
Psychological therapies are considered first-line treatment for anxiety disorders. There are several high quality, psychological self-help programs available online, many of which are free to access. If your anxiety is severe and distressing, it may be more appropriate to see a psychologist in person or online via telehealth. Self-help programs are great, but seeing a psychologist one-to-one allows the treatment to be individualised. It can be tailored to your specific needs. Psychiatrists can also provide therapy for anxiety, along with medications.
Cognitive Behaviour Therapy (CBT) has the largest research base for the treatment of anxiety disorders. CBT is based, in part, on the basis that the way we think and behave affects the way we feel. CBT involves working to understand the patterns of thinking and acting that cause and maintain your anxiety. Once you recognise these patterns, you can make changes to replace them with more helpful strategies to reduce your anxiety.
Behavioural therapies can form part of CBT. Exposure therapy is an example of behavioural therapy to treat anxiety. Exposure therapy involves breaking down a feared task into smaller, more manageable steps. In this way, the person gradually confronts the task and learns along the way that 1) the feared outcome is unlikely to occur, and/or 2) that they are better able to cope than originally predicted. For example, if you have a fear of flying. Graded exposure starts by simply looking at photos of planes. You would repeat this step as many times as needed to feel comfortable with it. Depending on your case, the next steps on the exposure hierarchy may involve things like thinking about yourself on a plane. Then watching videos of planes, driving past or visiting an airport, and, eventually, sitting on a plane. Gradually, with repeated exposure, your fear of flying will likely diminish.
Whilst websites such as Beyond Blue offer checklists for anxiety. There are no online tools or questionnaires that can give you a firm diagnosis of an anxiety disorder. If you are experiencing distress and your symptoms are impacting on areas of your life. We recommend seeking professional advice to ensure you are correctly diagnosed. Secondly, to help access the right treatment. As part of the assessment and diagnosis process, a doctor will want to rule out medical causes for your symptoms. To do this, they might request blood tests. Secondly, carry out a physical examination, and collect information about your medication and medical history. Several anxiety-like symptoms can be caused by other medical conditions (e.g. thyroid problems). So it is important to make sure we are treating the right thing.
Once other causes have been ruled out, a doctor or psychologist can consider a mental health diagnosis for your symptoms. The diagnosis of an anxiety disorder is usually based on set diagnostic criteria. For example, those outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Your mental health clinician will work with you to understand your symptoms and make a diagnosis where appropriate. In some cases, your symptoms may not meet diagnostic criteria for an anxiety disorder. This does not stop you from seeking treatment. It just means that your symptoms fall short of the criteria in number, intensity or duration. Below threshold symptoms can significantly interfere with your quality of life. In other words, you don’t need a diagnosis to access treatment to improve your mental health.
There is a significant overlap between anxiety and depression. When two disorders occur together like this, we call them ‘co-morbid. Some estimates suggest that over 60% of people with anxiety will also have symptoms of depression. The numbers are similar in reverse. While we don’t know for certain why depression and anxiety disorders commonly overlap, there are several theories. Living with an anxiety disorder is tiring and it makes sense that, over time, this can get you down. Similarly, living with depression can mean you fall behind in your duties, thereby increasing stress and subsequent feelings of anxiety. Other theories for the high rates of comorbidity between anxiety and depression include the idea that they both share similar biological causes in the brain. That they both have a number of overlapping symptoms, and both can be a response to external stressors. As an example of the potential overlap of these disorders, a person with depression may lack motivation and take time off work, which in turn, might increase worry about finances, failure to meet deadlines, and colleagues’ opinions about their absence.
There are different types of anxiety disorders. The different types of anxiety are often separated in terms of the nature of the worry. Secondly, what triggers the worry and the behaviours that occur as a result of that worry. We have listed some of the different types of anxiety below, however, this is not a complete list. If you have questions regarding diagnosis, it is best to speak with your psychologist or psychiatrist.
They are brief episodes of intense anxiety. They either come out of the blue or be brought on by a specific trigger (e.g. a job, place, thought etc.). People describe intense physical symptoms, like finding it hard to breathe and tingling in the arms and hands. Coupled with this is often an intense sense of dread and the fear that one might collapse, go ‘mad’ or even die. Panic attacks are not physically dangerous but are very frightening and leave you feeling vulnerable.
Ongoing, irrational and excessive fear of a particular situation, object or animal. Common phobias include a fear of public speaking, fear of clowns, snakes and spiders. A phobia causes the person to avoid the trigger and/or endure it with great distress. There are many types of phobias. They can have a varying impact on how people live their lives. As fear of snakes will not change how we live our lives in the city. However, a fear of crowded places will prevent us from using buses and trains.
Is a long term condition where someone experiences constant anxiety across a wide range of areas in life. Their worries affect several aspects of daily functioning, including work, finances, health and/or relationships. People with GAD also often report physical symptoms, such as muscle tension and poor sleep.
This is a type of anxiety where the person worries about their health when there is no real cause for concern. People with health anxiety often mistake their normal bodily feelings as dangerous. They worry that they have a serious illness. They often visit their doctor regularly, request tests or examinations, and are left feeling that their fears are brushed aside.
Involves out of proportion fear, anxiety, or embarrassment caused by being with other people. The anxiety is often driven by worry about being judged or shamed by others. There is no test for social anxiety disorder, however, there are tick box tests that can help with making a diagnosis.
General Practitioners manage the majority of anxiety presentations in Australia. They are often the first port of call for a range of common mental health concerns. GPs are an excellent resource and are capable of providing holistic treatment for your anxiety.
We encourage you to discuss your concerns about anxiety with your GP.
Psychologists are highly trained in the area of mental health. They are skilled at providing a range of therapeutic interventions for psychological problems. Anxiety disorders are highly prevalent and psychologists are experienced in diagnosing and helping people overcome these conditions. In working with you to treat your anxiety, a psychologist can:
Often, the process of diagnosis involves a series of questions about your past and current problems. In addition, sometimes, the completion of some self-report tests. A psychologist will help track your progress as you get better.
Its origins and the factors that cause and maintain it. For example, work stress, relationship troubles. For some being bullied in your younger years, avoidant coping and your temperament/personality style may all play a role. Through the process of understanding your difficulties, you will be in a better place to make the changes you need for improvement.
Provide individual, evidence-based therapies known to be effective in treating anxiety disorders (e.g. Cognitive Behaviour Therapy). For example, you may learn strategies to challenge unhelpful patterns of thinking and behaviour. Thereafter you can develop problem-solving and social skills to address factors that keep you feeling anxious.
Psychologists often work with people one-on-one. However, they can also work with significant others in your life (e.g. family, support workers, carers) if felt helpful. This may be of benefit during the assessment and education phases, and in developing a well-rounded treatment plan. Speak with them, agree on what is ok and not ok to share.
Refer you to other local supports. Provide psychological reports for a range of purposes and provide feedback to your GP regarding your progress. Your psychologist can provide letters to get other help. Our psychologists at Espychiatry are highly experienced in working with people who suffer from anxiety in all its forms. If you are struggling with anxiety, you can give us a call today to book.
Psychiatrists are medical doctors who have completed extra training in mental health. As a result of their medical training, they often prescribe medications. They also manage the medical or biological aspects of a patient’s care. Your psychiatrist will be able to help with:
Talking about your concerns, conducting a thorough assessment and making appropriate diagnoses. This will include an all-around mental state examination. Plus often a health examination (e.g. blood tests, scans etc.) to uncover the origins of your difficulties
Providing specialist input into other aspects of your mental health, including any co-occurring illnesses. They will look into how your work, family life, your character all play a part in your mental health.
Prescribing tablets to manage your mental health symptoms, checking for side effects. Secondly, they will tell you how to start, increase and come off your tablets. They can also advise your family doctor on how to manage your tablets. There are certain medications for anxiety that only psychiatrist can interact with. Finally, they will ensure that other aspects of your physical health (e.g. cardio and metabolic health) remain stable.
Providing psychological therapies to treat your anxiety. Similar to the talking therapy described above. You can also see your doctor for medicine and have your therapy with someone else.
Working with your GP and psychologist to make your care is right from a holistic and multi-disciplinary perspective.
Our psychiatrists can speaking with your friends and family, if you deem this to be beneficial, to further educate them about your condition. In addition, they can advise on how they can best support you through your recovery.Contact Epsychiatry’s friendly support team today to book an appointment with one of our psychiatrists.