Understanding and Managing Anxiety
Everyone occasionally experiences some anxiety. It is a normal response to a stressful event or perceived threat. Anxiety can range from feeling uneasy and worried to severe panic. The aim of this Tip Sheet is to inform people about what anxiety is and to provide some tips to help manage anxiety when it becomes a problem.
What is anxiety?
Anxiety is an uncomfortable feeling of fear or impending disaster and reflects the thoughts and bodily reactions a person has when they are presented with an event or situation that they cannot manage or undertake successfully. When a person is experiencing anxiety their thoughts are actively assessing the situation, sometimes even automatically and outside of conscious attention, and developing predictions of how well they will cope based on past experiences.
Although some anxiety is a normal response to a stressful situation, when the anxiety level is too high a person may not come up with an effective way of managing the stressful or threatening situation. They might "freeze", avoid the situation, or even fear they may do something that is out of character.
Anxiety generally causes people to experience the following responses:
- An intense physical response due to arousal of the nervous system leading to physical symptoms such as a racing heartbeat.
- A cognitive response which refers to thoughts about the situation and the person's ability to cope with it. For someone experiencing high anxiety this often means interpreting situations negatively and having unhelpful thoughts such as "This is really bad" or "I can't cope with this".
- A behavioural response which may include avoidance or uncharacteristic behaviour including aggression, restlessness or irrational behaviour such as repeated checking.
- An emotional response reflecting the high level of distress the person is experiencing.
What causes anxiety?
There is no one cause of high anxiety. Rather, there are a number of factors that may contribute to the development of anxious thoughts and behaviour. Some causes of anxiety are listed below.
Research has shown that some people with a family history of anxiety are more likely (though not always) to also experience anxiety.
Research suggests that people who experience a high level of anxiety may have an imbalance of chemicals in the brain that regulate feelings and physical reactions. Medication that helps to correct this imbalance can relieve some symptoms of anxiety in some people.
Certain life experiences can make people more susceptible to anxiety. Events such as a family break-up, abuse, ongoing bullying at school, and workplace conflict can be stress factors that challenge a person's coping resources and leave them vulnerable to experiencing anxiety.
Certain personality types are more at risk of high anxiety than others. People who have a tendency to be shy, have low self-esteem, and a poor capacity to cope are more likely to experience high levels of anxiety.
Certain thinking styles make people more at risk of high anxiety than others. For instance, people who are perfectionistic or expect to be in constant control of their emotions are more at risk of worrying when they feel stress.
Certain ways of behaving also place people at risk of maintaining high anxiety. For instance, people who are avoidant are not likely to learn ways of handling stressful situations, fears and high anxiety.
What are the symptoms of anxiety?
The experience of anxiety will vary from person to person. Central features of anxiety include ongoing worry or thoughts that are distressing and that interfere with daily living. In addition to worry or negative thinking, symptoms of anxiety may include:
- Rapid heartbeat
- Difficulty breathing
- Upset stomach or nausea
- Avoidance behaviour
How is anxiety treated?
Psychological treatment, particularly cognitive-behaviour therapy, has been found to be very effective in the treatment of anxiety. Cognitive behaviour therapy is made up of two components. The first component, cognitive therapy, is one of the most common and well supported treatments for anxiety. It is based on the idea that a person's thoughts in response to an event or situation causes the difficult feelings and behaviours (i.e., it is often not an event that causes distress but a person's interpretation of that event). The aim of cognitive therapy is to help people to identify unhelpful beliefs and thought patterns, which are often automatic, negative and irrational, and replace them with more positive and helpful ways of thinking. The second component of cognitive-behaviour therapy involves assistance with changing behaviours that are associated with anxiety, such as avoidance or restlessness. These may be dealt with through learning relaxation techniques and through changes in the way that certain situations are handled.
Other treatments used to address anxiety include medication and making lifestyle changes such as increasing exercise, reducing caffeine and other dietary changes.
Your general practitioner or psychologist will be able to provide you with more information on these treatment options.
Tips on how to manage anxiety
Identification of stress and trigger factors
The first step in managing anxiety is to identify the specific situations that are making you stressed or anxious and when you are having trouble coping. One way to do this is to keep a diary of symptoms and what is happening when anxiety occurs. It is also helpful to identify any worrying thoughts as this can lead to finding ways to solve the specific problem that is of concern.
People tend to have a greater ability to manage stressful events than they sometimes realise. Once you have identified a specific situation that is causing the anxiety, problem-solving is a useful technique to help resolve anxiety by addressing the problem. Structured problem solving involves the following steps:
- Identify the problem. When you have identified the situations that are contributing to your anxiety, write down the problem and be very specific in your description, including what is happening, where, how, with whom, why, and what you would like to change.
- Come up with as many options as possible for solving the problem, and consider the likely chances that these will help you overcome your problem.
- Select your preferred option.
- Develop a plan for how to try out the option selected and then carry it out.
- If this option does not solve the problem remember that there are other options to try.
- Go back to the list and select your next preferred option.
When people feel anxious they often breathe more rapidly. This rapid breathing can lead to many of the unpleasant feelings such as light-headedness and confusion that may be experienced when anxious. Learning a breathing technique to slow down breathing can often relieve symptoms and help a person to think more clearly. The following simple breathing technique can slow down breathing and reduce symptoms of anxiety. You should begin by timing your breathing and then complete the following steps.
- Breathe in through your nose to the count of three (3 seconds) and say to yourself: "IN, TWO, THREE".
- Breathe out through your nose, again counting to three, and say to yourself: "RELAX, TWO, THREE".
- Keep repeating this for two to three minutes, and then time your breathing.
This breathing technique can be used to slow down breathing whenever a person feels anxious and can be done anywhere without anyone else noticing.
People who feel anxious most of the time report that they have trouble relaxing. Knowing how to release muscle tension is an important anxiety treatment. Relaxing can bring about a general feeling of calm, both physically and mentally. Learning a relaxation technique and practising it regularly can help a person to maintain a manageable level of anxiety. A psychologist or other health professional can teach you relaxation techniques or they can be self-taught by using books or CDs that guide you through the steps.
Thought management exercises are useful when a person is troubled by ongoing or recurring distressing thoughts. There is a range of thought management techniques. For instance, gentle distraction using pleasant thoughts can help take attention away from unpleasant thoughts. Alternatively, one can learn ‘mindfulness techniques' to redirect attention from negative thinking. A simple technique is ‘thought replacement' or using coping statements. Develop a set of statements that will counteract worrying thoughts (e.g., "This is difficult but I have been through it before and have got through it okay", "Hang in there, this will not last much longer"). Substitute one of the reassuring or coping statements for the troubling thought. The choice of thought management technique will depend on the type of anxiety problem. A psychologist can help you decide on thought management strategies that are likely to be most helpful.
- Plan to take part in a pleasant activity each day.
This doesn't have to be something big or expensive as long as it is enjoyable and provides something to look forward to that will take your mind off your worries.
- Increase exercise.
Regular exercise will help to reduce anxiety by providing an outlet to let off stress that has been built up in your body.
- Reduce caffeine intake.
Caffeine is a stimulant and one of its side-effects is to keep us feeling alert and awake. It also produces the same physiological arousal response that is triggered when we are subjected to stress. Too much coffee will keep us tense, and aroused, leaving us more vulnerable to anxiety.
- Reduce alcohol intake.
Alcohol is frequently used to help deal with stress, anxiety and depression. However, too much alcohol leaves us more vulnerable to anxiety and depression.
- Improve time-management skills.
Having a busy lifestyle can add daily pressure to your life and serve to increase stress and anxiety. Much of this stress may be associated with poor time management. Plan and schedule time throughout the day but be prepared to be flexible. Ensure to plan some rest time and some leisure activities and be realistic about time limitations, not scheduling too much into the day.
For some people the feeling of high anxiety can become severe and interfere with their functioning, making it difficulty for them to cope with normal daily demands. If this high anxiety persists over a long period of time an anxiety disorder may be diagnosed. Almost 30 per cent of the population will experience some form of anxiety disorder at some point in their lives. A range of anxiety disorders can be diagnosed depending on the symptoms experienced. People with an anxiety problem can frequently experience a number of specific anxiety disorders at the same time. If a person is concerned about having an anxiety disorder it is important to seek professional help to determine the best form of treatment to manage the anxiety.
Generalised Anxiety Disorder
This disorder involves persistent and excessive worry, often about daily situations like work, family or health, with associated physical symptoms. This worry can be difficult to control, leading to problems in concentration, restlessness and difficulty sleeping.
People with a specific phobia experience extreme anxiety and fear if exposed to a particular feared object or situation. Common phobias include fear of flying, spiders and other animals, heights or small spaces.
Panic Disorder occurs when a person has sudden surges of overwhelming fear that come without warning. These panic attacks often only last a few minutes, but repeated episodes may continue to occur.
Obsessive Compulsive Disorder (OCD)
In OCD a person has repeated, upsetting thoughts called obsessions (e.g., "there are germs everywhere"). To make these thoughts go away, the person will often perform certain behaviours, called compulsions, over and over again (e.g., repeated hand washing). These compulsions can take over a person's life and while people with OCD usually know that their obsessions and compulsions are an over-reaction, they can't stop them.
Social Anxiety Disorder
In Social Anxiety Disorder the person has severe anxiety about being criticised or negatively evaluated by others. This leads to the person avoiding social events and being afraid of doing something that leads to embarrassment or humiliation.
Post-Traumatic Stress Disorder (PTSD)
PTSD can occur after exposure to a frightening and traumatic event. People with PTSD re-experience the traumatic event through memories and/or dreams, they tend to avoid places, people, or other things that remind them of the event, and are extremely sensitive to normal life experiences that are associated with the event.