Our Anxious Minds: Understanding Anxiety and Anxiety Disorders

Anxiety is an emotional & physical reaction that happens due to anticipation about future concerns and is associated with muscle tension and avoidance behaviour (rephrase). Anxiety can be a normal response to stressors and can be helpful in alerting us about dangers and paying attention to them, especially when the anxiety is mild. Anxiety Disorders are different from normal anxiety/nervousness and involve excessive fear/anxiety that is disproportionate to the situation involved and causes hindrances in day-to-day life. (as understood by the American Psychiatric Association

Anxiety Disorders are one of the most common mental health disorders and can be debilitating for someone to experience. But people can experience anxiety without it being a disorder, worrying about health, money, or family problems is normal but when this anxiety persists or becomes intense (irrespective of the stressor) is when, it might be considered a disorder.

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Physical Symptoms - Imagine this, you have a very important meeting the next day, you spend hours the previous day to prepare for it, you have practiced for the meeting, any potential questions and made sure to do your best. Despite this, on the day of the meeting, you notice your hands getting clammy, your heart beating rapidly, and you feel sweaty and nauseated or even light-headed.

These are usually very common signs of anxiety (irrespective of whether we have an anxiety disorder or not) that everybody might experience sometimes or the other. This type of anxious reaction is more situation-specific and temporary.

However, anxiety disorders are more persistent, and the symptoms can permeate into a person’s day-to-day life. People may find it difficult to go out, have meaningful conversations, or even work, and so the impact of anxiety disorders can be debilitating. It can be highly frustrating for someone with anxiety disorders (and other disorders, too) because it can feel like we are trapped by our minds even when we are told that things are fine. Kindness and understanding towards ourselves and others who go through this can help them not feel as isolated by their experiences.

Different types of anxiety disorders

Anxiety disorders are classified into ten different categories according to DSM -5.

• Generalized Anxiety Disorder- People with this disorder experience excessive worry about different areas of their life. They may experience constant worry about work, school or home life and find it difficult to manage their anxiety. They may appear restless, tired, irritable, on edge and experience sleep disturbances and difficulty concentrating.

• Separation Anxiety Disorder- A person with a separation anxiety disorder experiences atypical anxiety and fear of separation from attachment figures for their developmental level or age. Once again, there is persistent and excessive anxiety or fear of separation from, harm to or even death of attachment figures. People might experience nightmares and different physical symptoms, too. While the symptoms may develop during childhood, people may experience them throughout adulthood, too.

• Selective Mutism- A person with selective mutism is consistently unable to meet social expectations to speak (even when they can speak in other circumstances or understand the spoken language). It is more common among young children than among adolescents and adults.

• Social Anxiety Disorder- Social anxiety disorder is marked by intense fear or anxiety from being part of social situations where one could be scrutinized. One may fear being perceived negatively, humiliated, embarrassed, offended, or rejected. One always feels anxious or scared of being in these situations and can either avoid or face these circumstances with intense fear.

• Specific Phobia—People who have specific phobias are scared or anxious about particular objects or situations and will try to either avoid them or be consumed by fear or anxiety when facing them. When exposed to specific objects/situations that bring up fear-based, anxious, or avoidance reactions, people immediately feel those emotions intensely and disproportionately (to the actual danger from those objects/situations).

• Panic Disorder- Panic disorders majorly constitute panic attacks, which are sudden surges of fear or discomfort that are intense and reach a peak within minutes; people with this disorder also tend to avoid activities or situations just so that future occurrences of panic attacks can be prevented. Some of the physical and cognitive symptoms associated with panic disorder are- palpitations, sweating, shortness of breath, fear of going crazy, or fear of dying

• Agoraphobia- The Merriam- Webster defines an agora as a gathering place or, specifically, a marketplace in ancient Greece. People with this disorder experience at least two (if not more) of the following circumstances: feeling fearful and anxious being in open spaces, being in enclosed places like in movie theatres or shops, while using public transportation, while being in a crowd or while standing in a line and (or) while being outside of the home alone. The person with agoraphobia is fearful of not being able to escape these situations/ not finding any help when they panic (or experience panic-like symptoms) and other embarrassing or debilitating symptoms.

• Anxiety disorders due to other medical conditions- Hypothyroidism, hypoglycemia or hypercortisolism and similar endocrine disorders; people suffering from cardiovascular disorders lie congestive heart failure, arrhythmia or pulmonary embolism; metabolic issues like B12 or porphyria; asthma and pneumonia; neurological disorders like neoplasms, encephalitis and seizure disorders- these health conditions can be the physiological consequences of these medical conditions too.

• Substance/Medication-induced anxiety disorder- People who experience substance intoxication, withdrawal symptoms or medical treatments may also experience symptoms related to anxiety.

What helps deal with anxiety and anxiety disorders

1. De-pathologizing anxiety (not anxiety disorders, though) Knowing the difference between anxiety as a natural reaction to stressful situations and an anxiety disorder is important since this is a preliminary step to understanding what interventions are necessary. I have spoken to people who have been working in rigid and oppressive work environments (where they faced prejudice, discrimination or little to no work-related support, poor definition of roles, etc.) and believe that their stress and anxiety are signs of their weakness (being anxious is not a weakness irrespective of whether it is a disorder or not). But it is natural to feel stressed, fearful or anxious (say) in a harmful environment where you don’t feel a sense of security.

2. Medications for anxiety disorders: Medicines can be effective in managing symptoms of anxiety. Reaching out to a psychiatrist might seem scary, or we might fear about society’s judgement, but people with anxiety disorders feel better when they follow a plan of combining medicines with therapy.

3. Psychotherapy: Counselling and therapy efficiently target how we feel, think and act when anxious. Even people who feel anxious but may not be diagnosed with an anxiety disorder find it helpful to learn different coping skills, communication or other related skills to manage their emotions or to problem-solve. However, therapy modalities like cognitive behavioural therapy can prove to be very effective in managing anxiety. Acceptance and Commitment Therapy is another therapy modality which is effective in managing our thoughts and emotions related to different mental health disorders, including anxiety.

4. Maintain predictability in things that we can control: Upon talking to a lot of people who experience anxiety, I have observed that many of us when anxious (even people who don’t have a diagnosed anxiety disorder) want to control situations or even people as much as possible. Avoidance can be an effective way to prevent the consequences we face/don’t face. So, if public speaking makes me feel anxious and I avoid speaking to large groups of people, I am controlling the number of experiences I have where I will feel those emotions (I am making my life more predictable and known). But this can cause us more harm than good- we may be isolated from opportunities, healthy connections, fun leisure activities, and even habituating ourselves to discomfort.

On the other hand, trying to add predictability to daily life is beneficial to some extent, too. The difference is that we don’t stop ourselves from doing something; rather, we build a routine and add structure (which can also be predictable). Some people like to set a routine, including mealtimes, sleep schedules, workout schedules, and list meetings, if any, or other personal responsibilities. The idea is to shift our focus from what we can’t predict to what we can consistently do.

5. Journaling: Journaling, in general, can be a beneficial practice in our routine. Our thoughts can be very abstract, and yet they can influence how we feel or act, but when we journal- and write down our thoughts on a piece of paper, we are also making these thoughts more visible (and in some ways tangible). Thought diary is a journaling technique with its foundation in CBT and is an efficient way to write down our thoughts, how we feel, what the situations that made us think/feel the way we did, and to see if our feelings/thoughts match the situation that led to it.

6. Progressive Muscle Relaxation: When we are stressed or anxious, our muscles are tense, too. This technique helps us focus on how our muscles feel when tensed and how they feel like when we relax them. The therapist or practitioner helps the person gradually tense and relax different muscle groups one at a time, which may help them become more mindful of their physical sensations related to anxiety. For many people, this helps calm them down significantly.

Referenced used (Links)

https://www.nimh.nih.gov/health/topics/anxiety-disorders

https://invermeresummityouthcentre.org/anxiety/

https://www.nm.org/healthbeat/healthy-tips/emotional-health/the-science-of-anxiety

https://link.springer.com/referenceworkentry/10.1007/978-1-4419-1005-9_1556

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5879019/

https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders

https://www.ncbi.nlm.nih.gov/books/NBK470361/

https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders#:~:text=Anxiety%20is%20a%20normal%20reaction,involve%20excessive%20fear%20or%20anxiety.

https://www.sciencedirect.com/science/article/pii/S1744388120302784

https://www.atlantis-press.com/proceedings/iciap-17/25896720

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378489/