Consider that across the lifespan, 1 in 4 people will have anxiety serious enough to be diagnosed as a disorder. Many more struggle with anxiety at a “sub-clinical” level – meaning, not severe enough to be called a disorder but nonetheless unpleasant, uncomfortable, and at times getting in the way of work, relationships, or social activities. Given all this, maybe It makes sense that anxiety is sometimes called the common cold of mental health. However, while anxiety may be as common as a cold, an anxiety disorder is not something people typically recover from in 7-10 days.
How can you tell if anxiety is normal worry or a disorder? There are three markers that suggest anxiety might benefit from further assessment and professional treatment: Severity, duration, and impact on day to day life. If worry or anxiety occurs most days for 6 months or more, is severe enough to interrupt desired life goals or activities, such as being able to perform one’s job, pursue a different job, or participate in certain social activities for example, one may have an anxiety disorder. Whether it is a disorder or not, if anxiety or worry is limited your life in any way, it can be very helpful to talk to someone about it. There are good treatments that work well.
Different Anxiety Disorder
There are 7 different types of anxiety. Two common categories are described below. As you read through these, bear in mind they overlap with each other and often the same person will experience more than one kind of anxiety disorder at the same time or at different times in their lives.
Generalized anxiety disorder (GAD): GAD is characterized by excessive and uncontrollable worry about common everyday things. Perhaps the worry is focused on work or school success (or failure), the health or well-being of loved ones or oneself, the future, natural disasters or something else. The person usually describes worrying a lot, every day, to a degree that it creates distress.
Phobias: There are three different kinds of phobia disorders, including social phobia, a specific phobia, and agoraphobia. These have in common the fact that certain situations or things cause irrational fear or terror to the point that the person actively avoids them or endures them with difficulty. Social phobia is at it sounds: an irrational fear of social situations. Typically, the person is afraid of being watched, judged, embarrassed, or humiliated in front of others. Ultimately, the person fears being rejected or thought of as stupid or boring. Specific phobias are intense fear responses to things that others would generally not respond to in that way. For example, a fear of elevators, spiders, needles, or flying. Agoraphobia is a fear of open spaces, or crowded public spaces. Typically, the person fears having a panic attack in those spaces and being unable to escape quickly.
In addition to GAD, and the three different kinds of phobias, people often think of two other anxiety related disorder: Obsessive compulsive disorder involves thinking repetitive thoughts that cause distress, and/or engaging in repetitive, irrational behaviours, such as excessive handwashing or checking certain things they have already checked several times. The other is post-traumatic stress disorder (PTSD), which may be familiar. PTSD is no longer technically considered an anxiety disorder though anxiety may be part of the experience. It involves a cluster of symptoms that can occur for some people as a result of witnessing or experiencing a very traumatic event. Symptoms include things like flashbacks, nightmares, and mood disruptions.
How is anxiety treated? There are a lot of self-help strategies that can help anxiety. Things like getting regular exercise, sufficient sleep, and using strategies to relax on a regular basis can all be helpful. Enough exercise, for example, meaning 150 minutes a week of moderately intense activity, has been shown to be as effective as medication for mild to moderate anxiety. However, if anxiety is moderate to severe, it will not be enough.
Canadian guidelines suggest that anxiety can be treated with either psychological interventions or pharmacological treatments (medications) or both. The choice of treatment depends on a whole range of factors, including the person’s preference, their motivation and ability to participate in psychological treatments, and the availability of psychological treatments, to name a few. When an anxiety disorder is severe, medication is often needed, certainly initially so that someone can concentrate sufficiently to participate in the psychological therapy. The medications that are used most often for depression are the same as those that treat depression and include two classes of medications: selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs).
Psychological treatments are important for long term management of anxiety and include education about the specific anxiety disorder and basic coping strategies as well as cognitive behavioral therapy (CBT). CBT is not one treatment, however, but is made up of several strategies that target the specific aspects of behavior that are most problematic and that perpetuate the anxiety. For example, a common behavior that anxious people engage in is avoidance of the feared or anxiety provoking situation. One CBT approach, called exposure, involves helping the person to face their fears gradually and safely. Over time, the person gradually learns to cope with situations that were previously upsetting. Once the person learns to feel more comfortable in one situation, the increased confidence helps them to tackle other situations also.
Another approach is to learn to manage the sense of arousal that anxiety causes. These might include, for example, increased heart rate, fast breathing, and “butterflies” or stomach upset. These effects are often counteracted with specific breath or relaxation exercises of strategies. Over time, with practice, relaxation becomes easier to accomplish and arousal is lessened.
While both medication and psychological strategies are helpful, the Canadian guidelines recommend trying one before trying another. So, for example, psychological interventions might be offered over 12-20 sessions. If not effective, or not effective enough, medication might be added. Or, treatment might occur in the reverse order, with medication offered first. Typically, full effects of SSRIs and SNRIs can take up to 12 weeks before deciding that the medication is not effective. It can take a few tries to find a medication that is helpful.
Anxiety is very common. However, anxiety disorders are under-diagnosed and under-treated, resulting in more suffering for people than might be necessary otherwise. If you or someone you know struggles with anxiety, consider talking to your family doctor. He or she is likely to be able to help.