Anxiety

What is Anxiety | Common Signs & Symptoms of Anxiety | Causes & Risk Factors of Anxiety | Treatment for Anxiety Disorders | FAQ

Anxiety is a response pattern of negative emotions and cognitions that is more oriented to the future [1]. Anxiety disorders often occur alongside other mental health conditions, such as substance abuse and depression. If left untreated, it can occur chronically [2].

Anxiety is a part and parcel of life. It is normal and healthy to feel anxious when you find yourself facing a worrying situation — an exam, a speech, or an interview, for example. It is necessary for our survival as it helps us plan and prepare for potential danger. 

Anxiety turns unhealthy, however, when it gets severe and causes distress that disrupts your daily life. It may further develop into an anxiety disorder when individuals experience intense and persistent anxiety (for more than 6 months) at a level disproportionate to the actual threat that ultimately interferes with their daily life [2, 3]. This is vastly different from the normal levels of worry and stress that one may experience as a result of life challenges (refer to FAQ for more).

Anxiety disorders are generally characterised by having unrealistic, irrational fears or anxieties of disabling intensity. The type of disorders differs from one another in the types of objects or situations that induce fear, anxiety, or avoidance behaviour, and the associated cognitive ideation. The disorders recognised in The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) include [4]:

1. Specific Phobia
2. Social Anxiety Disorder (social phobia)
3. Panic Disorder
4. Agoraphobia
5. Generalised Anxiety Disorder

The DSM-5 states that each anxiety disorder is diagnosed only when the symptoms experienced are not attributed to physiological effects of a substance/ medication or to another medical condition or are not better explained by another mental disorder [4]. 

Involves a negative mood, as well as excessive and intrusive worry. Such levels of worry and negativity tend to stem from (but are not limited to): 

• Excessive worry about possible future threats or danger
• Maladaptive thought processes where individuals engage in black-and-white thinking (where it is either perfect or a complete disaster) or catastrophize negative outcomes (where the implications of not doing well are blown up in their minds)
• Engagement in anxious self-preoccupation where individuals experience a heightened concern over their perceived shortcomings and inadequacies
• Struggles with the feeling of being out of control

Often creates a state of tension and chronic overarousal, which suggests a heightened tendency to assess possible future risk and a readiness for dealing with danger should it occur (“Something awful may happen, and I had better be ready for it if it does”). Common symptoms experienced include [5]:

• Gastrointestinal (GI) problems
• Increased heart rate
• Panic attacks feature prominently within the anxiety disorders as a particular type of fear response [6]

May result in a strong inclination to avoid situations where danger might be encountered through escapism behaviours [5] — in avoidance of feared situations — such as procrastination, absenteeism, or presenteeism (where a person is physically present but not mentally present and engaged).

Anxiety response patterns are generally a result of conditioning [7]. This means that there are situations that we have come to associate as anxiety-inducing. When a particular situation (e.g., a child witnessing her parents fight at dinner) happens frequently enough, an initially neutral event (e.g., having a family dinner) may accidentally become a cue that causes the child to anticipate something threatening and unpleasant to happen, in turn causing the child to feel anxious. 

Our thoughts and images can also serve as conditioning stimuli capable of eliciting the fear or anxiety response pattern.

While the risk factors for each type of anxiety disorder vary, researchers have found that both genetics [8] and environmental factors add to the risk of developing an anxiety disorder [2]. Some general risk factors that put individuals at higher risk of anxiety disorders include: [3]:

• Exposure to stressful and negative treatment or events [9]
• Traumatic childhood, or harsh or overprotective parenting styles [2]
• A history of anxiety or other mental illnesses in biological relatives
• Some physical health conditions, such as thyroid problems or heart arrhythmias, or caffeine or other substances/medications, can produce or aggravate anxiety symptoms

Personality traits were also found to influence the development of anxiety disorders. Individuals who possess temperamental traits of shyness or behavioural inhibition during childhood [3], or were overly self-critical, or experienced a lot of negative thoughts and feelings as young adults [10] were found to be at increased risk of suffering from anxiety and depressive disorders. 

Most often, psychotherapy is most helpful in helping individuals identify negative thought patterns and trigger situations that give rise to anxious feelings, and develop more positive coping strategies to cope with those anxious feelings or anxiety-inducing situations. 

Cognitive Behavioural Therapy (CBT) is often used to facilitate the process of identifying their personal feeling-thought-behaviour loop of the anxious thoughts that lead to certain behaviours, which in turn impacts how a person continues to feel and think. Thereafter, the therapist collaborates with the client to explore more healthy coping and emotional management strategies. 

While CBT is the most common modality, each therapist has different styles of helping and facilitating the process of self-exploration and development of positive coping strategies for better life outcomes. 

A psychiatrist may prescribe medication to relieve patients from unpleasant anxiety-related symptoms.

Benzodiazepines are the most common type of medication to reduce symptoms of anxiousness, panic attacks, or intense worry or fear [3]. Examples are alprazolam (Xanax) and clonazepam (Klonopin). They work quickly, but you can become dependent on them. Doctors usually prescribe them to help manage or reduce of symptoms anxiety disorder treatment, but it should not be a long-term option [11].

Antidepressants help improve the way your brain uses certain chemicals that control mood or stress [3], which in term helps to reduce symptoms of anxiousness.

Selective serotonin reuptake inhibitors (SSRIs) and Serotonin and noradrenaline reuptake inhibitors (SNRIs) are typically the first drugs prescribed to someone with an anxiety disorder. Examples of SSRIs are escitalopram (Lexapro) and fluoxetine (Prozac). SNRIs include duloxetine (Cymbalta) and venlafaxine (Effexor) [11]. 

Relaxation techniques are a self-help strategy that is effective in helping oneself regulate personal feelings of anxiety such that one is able to de-escalate when feeling strong emotions of stress, fear, panic, and more. 

Common relaxation techniques are deep breathing, guided imagery, progressive muscle relaxation, and mindfulness.