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Across the spectrum of anxiety
There are plenty of things to worry about. For many, life is fast-paced, demanding and full of expectations. Much of what we face cannot be controlled or influenced. The fall-back solution may be to worry, and by doing so, provide ourselves with a little insurance: "I'll be ready when disaster strikes."
We know that to be afraid is to be human. Fear and anxiety are biologically determined responses to perceived threats of danger. Our success as a species is likely related to this predictable sequence of physiological and psychological reactions. For example, a racing heart, profuse sweating and changes in breathing assist the body to ready itself for "fight or flight." This response can be adaptive and helpful, causing us to move quickly to avert a physical threat, and improving performance by pumping adrenaline through the body. But it can also be signaled in error. When the system is tripped too easily and fires out of proportion to the trigger event, anxiety becomes a problem. For example, a person may be "triggered" into a heightened state of readiness when there is no obvious threat or danger. Resolution and relief seem difficult to achieve and the state of fear, vigilance and readiness lingers for far longer than it should. The resulting anxiety is a kind of pre-occupation that interferes with many aspects of day-to-day functioning. |
| The severity of anxiety can be understood in terms of a continuum. | |
Occasional and episodic worry is likely a normal and adaptive response to certain events. Mild to moderate anxiety lasts longer, may exist outside of threatening situations or events, and may be chronic and "free-floating." This type of anxiety might extend to normal activities and result in behaviours such as avoidance which are an attempt to decrease distress.
An example of this might be refusing an invitation to socialize due to heightened anxiety. In the short-term, avoidance strategies may prevent discomfort but will ultimately add to feelings of isolation and under-confidence. In other words, attempts to limit anxiety are sometimes self-defeating. Self management of mild to moderate anxiety is possible with the recognition of typical thoughts, behaviours and physical symptoms . By challenging anxiety-based thoughts people can learn to increase their tolerance for uncertainty, balance negative thinking and manage perfectionism. Relaxation techniques and home self-awareness exercises can be found at www.anxietybc.ca.
Moderate to severe anxiety requires professional intervention. Anxiety is the most commonly diagnosed mental health problem, with one in ten adults diagnosed and 6% of adolescents and children, and can go undiagnosed for many years.
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| Symptoms of moderate to severe anxiety occur over prolonged periods, sometimes for no apparent reason, and may include: |
- Intense and difficult to control worry over everyday events
- Poor sleep, fatigue
- Depressed mood
- Restlessness or feeling on edge
- Difficulty concentrating
- Irritability
- Muscle tension
- Unexplained physical symptoms
- Intrusive unwanted thoughts or compulsion-like behaviours
- Most dramatically, can look like a medical emergency
It is important to know that depression and substance abuse often occur along with anxiety disorders.
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| Who is at risk? | |
Anxiety disorders emerge for many reasons, and are not the result of a character flaw. Some families are more prone to anxiety. This may be due to modeled behaviours or a genetic pre-disposition. For many, problems begin in childhood or adolescence and may be tied to a traumatic event or fear-provoking environment. When psychological trauma occurs, feelings of terror, horror or helplessness result. The processing of the event may become very difficult for some people, and a web of triggers develop, that act like trip-wires over the surface of the person's life. In some forms, anxiety disorders alter psychological and biological systems. Psychiatrist Ruth Lanius at the University of Western Ontario reports that there is evidence of complex bio-psycho-social influences that determine who will develop post-traumatic stress disorder and how they will respond to treatment. This is likely true for all anxiety disorders.
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| Types of anxiety disorders: |
- Generalized anxiety disorder
- Panic disorder
- Phobias
- Social anxiety
- Obsessive compulsive disorder
- Post traumatic stress disorder
Unfortunately, labels such as "disorder" and "mental illness" can set up a stigma for sufferers, preventing them from seeking help when they first become aware of the problem. Early recognition and treatment of anxiety significantly improves lifetime outcomes for people.
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| What helps? | |
For help, someone suffering from anxiety needs to meet with a professional who has an understanding of anxiety and the different treatment modalities that are available. These professionals might include psychiatrists, physicians, psychologists, psychotherapists, social workers and nurses. It is important to see a physician in order to rule out other underlying causes of the symptoms.
There are specific treatments for anxiety. Psychotherapy, medication, and mindfulness training have all been shown to be effective.
Several psychotherapeutic approaches have been shown to be effective.
No single face-to-face psychotherapeutic approach has been shown to be substantially more effective over other approaches for all anxiety sufferers. The single most important variable in psychotherapeutic success has been shown to be the quality of the engagement between the client and their psychotherapist. Direct interaction with a psychotherapist, whether face-to-face or over other medium, has been shown to be more effective than reading or Internet use on its own.
There are well-developed psychotherapeutic approaches that have proven track records. Cognitive Behavioral Therapy, EMDR and Exposure Therapy are commonly used evidence based approaches for helping clients with anxiety.
Medication needs to be prescribed by a physician, either a family doctor or psychiatrist. According to the Canadian Psychiatric Association, drug therapy is considered "about equal" as an effective treatment for anxiety for the average person compared to Cognitive Based Therapy (CBT).
Combining drug therapy and psychotherapy has also been shown to be effective.
Mindfulness is an approach to general well-being as well as a process that has been shown to significantly reduce anxiety. Some psychotherapists teach mindfulness practice as part of their overall intervention. There are also mindfulness teachers.
Jack Kornfield, a clinical psychologist who teaches mindfulness, says it's important to understand that vulnerability and insecurity are part of human existence. Learning to relax in the face of uncertainty is a way we can protect ourselves from the wear and tear of fear in all its forms, enabling life wisdom to emerge from the discomfort we encounter.
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| What contributes to success? | |
Early recognition, getting help when it's needed, understanding that recovery happens in stages and motivation to recover are the "keys to success."
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FSEAP offers confidential professional assistance on a wide variety of personal and work-related issues. For more information on your EAP, call 1.800.668.9920 or visit your MyEAP Web site at www.myfseap.com.
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*Clicking on this link will open a new window and take you to a Web site that is not affiliated with myfseap.com or Family Services Employee Assistance Programs. Links to other sites of interest are provided here as a service to you, however, we can make no claim as to the accuracy or validity of any information contained on these sites. As always, speak with a counsellor or physician for advice that is specific to you and your situation. |
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This newsletter is to provide timely information to readers; contents are not intended as advice to individual problems. Please contact your EAP professional for assistance. Editorial material is to be used at your discretion and does not necessarily imply endorsement by Family Services Employee Assistance Programs. |
All articles © Family Services Employee Assistance Programs (FSEAP), except where noted otherwise. Please note that the posting of the Solutions newsletters or any articles in whole or part on any public Web site is prohibited. Customers and clients of FSEAP can access an online archive of current and back issues: log on to www.myfseap.com using your assigned Group Name and Password and select Solutions Newsletter from the MyHealth menu. To request permission to reprint specific Solutions articles, contact FSEAP at info@fseap.com. |
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