Situational Anxiety

Advice and help about Situational Anxiety

Anxiety is a common emotion, however, many find controlling these emotions to be difficult. Further assistance such as self-help, therapy and medications can help control the symptoms of anxiety disorders and reduce the likelihood of panic attacks. An estimated 5% of the UK experience anxiety and the number is higher for mental illnesses in general. Phobias, past events or certain situations can trigger anxiety but there are many ways you can combat feelings of fear, apprehension and nervousness.

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What is anxiety?

Anxiety is often used as a term used to describe feelings of worry and nervousness. It is a highly common emotion to have, however, some are formally diagnosed with anxiety disorder, which is classed as a mental illness that can be treated with medications and/or self-help.

There are different strains of the disorders, the most extreme resulting in panic attacks and a continual worry that causes a decline in your standard of living. Whilst it is normal to feel anxious, if you feel your level of anxiety causes mental and physical symptoms that are impacting on your day-to-day life, it is important to seek advice and manage the triggers effectively.

With many levels, here we explain the stages of anxiety, symptoms and how you can treat any appending apprehension.

Mental disorders such as anxiety are increasingly common in the UK with the most common being a mix of anxiety and depression. According to Anxiety UK, the World Health Organization (WHO) found that the impact of depression alone was twice as impactful on a person's life than any of the three common physical disorders (heart/angina conditions, asthma and diabetes). Furthermore, only 25% of those diagnosed will obtain treatment - that equates to approximately 8 million UK adults that don't seek any additional help with their mental disorder, which can often be necessary to improve their quality of living.

Whilst a significant number don't seek help for anxiety or other mental health illnesses, figures show anxiety diagnoses are on the rise. It is now estimated that 1 in 6 adults in the UK will experience a 'neurotic health problem'. With many not seeking treatment or diagnosis at all, this figure could be even higher.

Despite the stigma surrounding mental health, these barriers are becoming smaller with charities and NHS support offered, self-help options shared online and medications used to aid your everyday life.

What are the stages of anxiety?

There are many different levels of anxiety. This can make it difficult to establish what is a normal level of anxiety and what is more serious disorder. For example, it is normal for most to feel slightly nervous before a work presentation but if this is crippling fear and a panic attack, this could be a stage of the anxiety disorder.

Generalised Anxiety Disorder (GAD)

To have generalised anxiety, you will find yourself worrying about most or any aspects of your life. These worries are often completely irrational and unfounded.

To combat any apprehension about work, family life, money or health, GAD sufferers tend to be quite withdrawn and always think about the worst scenario of any event.

Generalised anxiety is just that, there is no particular cause of the anxiety, but you may find you have certain triggers and Jsituations that can result in intense worry. This could be the commute to work, falling ill or a family occasion.

Panic Attacks

Experiencing a panic attack can be an unnerving experience. Rather than a continual development of anxiety, a panic attack is an intense build-up of emotion that can develop quickly after a particular experience, or as a result of a lot of stress over time. Depending on the severity of the attack, the comedown of such a high level of emotion can be a number of hours.

Symptoms of panic attacks include shaking anywhere over the body, dizziness, breathlessness, nervousness and nausea. You may also feel confusion. The trigger of a panic attack will vary with each individual.

Phobias

Phobias are classed as a form of anxiety. They produce similar symptoms such as fear, nervousness and apprehension, often derived from an unnecessary fear.

Whilst phobias are classed as "irrational" or "unnecessary", having an intense fear of a particular animal, object or situation is something nearly everyone can relate to.

Agoraphobia

Being agoraphobia is often categorised separately to phobias when discussing anxiety as it is the fear of scenarios that you cannot escape.

For example, avoiding phobias is a prevention for anxiety if that happens to be a trigger for the individual, but for agoraphobia, this is seldom an option unless the quality of life is severely affected. For agoraphobics, this can range from a fear of wide-open spaces, or in contrast small crowded public spaces. In both scenarios, this is not 100% unavoidable.

Social Anxiety Disorder

This strain of the anxiety disorder is classified as a fear of judgement from your peers, especially when linked to impulsive actions. The result of social anxiety fear includes common phrasing you will recognise such as "stage fright", the fear of public embarrassment (public speaking, tripping over) and even a fear of intimacy. This can lead to you withdrawing from social events and limiting human contact.

Whilst extroverts can be perceived as more outgoing, social anxiety can affect both introverts and extroverts.

Obsessive Compulsive Disorder (OCD)

OCD is a common condition affecting approximately 12 people out of every 1,000 in the UK according to OCDUK. It is stereotyped as an issue with cleanliness, however in reality, it can manifest in many forms not related to tidiness and cleaning; just because an individual is tidy does not mean they have an OCD.

Having an OCD is, again, classed as irrational and can involve the following:

  • Walking in a certain pattern or direction
  • Turn off all light sockets
  • The continual cleaning of hands or items
  • Fear of security (appliances are on or doors are unlocked)

Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress is often simple to diagnose in comparison to other anxiety disorders as it manifests through a traumatic event. Whilst during the World Wars, this was relatively unknown, further studies have established that military combat, hostage situations and other life-changing accidents (vehicle incidents for example) can result in PTSD. PTSD is often linked to flashbacks of the traumatic event.

The general symptoms of anxiety are listed below. PTSD has a number of other symptoms in addition:

  • Flashbacks
  • Nightmares
  • Avoidance
  • Hypervigilance

Separation Anxiety Disorder

This strain of anxiety can be linked with children, especially babies and toddlers, that are fully dependable on their parents. This can continue throughout life. Whilst it's associated with families, you can experience separation anxiety of certain places. This is linked to feeling secure and safe.

If you relate with any of the stages of anxiety listed below - as well as any symptoms included on this page - and haven't contacted your doctor to discuss your options, this can be the first step to combating anxiety.

What are the causes of anxiety?

The causes of anxiety can depend on the strain of anxiety you have. For generalised anxiety disorder, it can be more difficult than other forms to pinpoint. Discovering the causes of your anxiety is important when preventing panic attacks and symptoms. It can also be out of your control, especially if anxiety runs in the family or is a trigger directly from the brain.

These can be split into genetics, biochemical (so a chemical issue in the brain) and a result of an event or situation.

  • Environmental and Social
  • Genetics
  • Brain Chemistry
  • Drug and Alcohol Abuse
  • Everyday Stress
  • Negativity and Lack of Self-Confidence

Anxiety caused by the environment

Anxiety when triggered by the environment doesn't necessarily mean it is caused by a natural disaster or changes in the air (a lack of oxygen, for example). This can be the following:

  • Work or School Stress
  • Finance Woes
  • Environment Stresses – i.e. Natural Disasters
  • Relationship, Friendship and Marriage
  • Bereavement and Loss
  • Physical or Emotional Abuse or Illness
  • Loneliness
  • Drug or Alcohol Dependency

Genetics

Like many mental illnesses, anxiety can be linked to direct family and genetics.

Anxiety and brain chemistry

Studies have been conducted to discover a link with anxiety and neurotransmitters. If the neurotransmitters aren't functioning correctly, the communication falters, breaks down and anxiety is more likely.

Medical factors such as medications and other illnesses can trigger anxiety. This also includes pulmonary embolism or a lack of oxygen, side effects of a medication or other symptoms of certain conditions.

Drug and Alcohol Abuse

There is not much research to suggest that alcohol alone can cause anxiety, however, it can certainly worsen the condition if you already have it. Alcohol also works as a depressive so if you are one of many with a combination of depression and anxiety, this can certainly worsen the condition.

Drug abuse can worsen any condition including mental illnesses. In addition, recreational drug abuse such as cocaine, amphetamines and heroin are also highly detrimental.

Prescription drugs and medications can be detrimental to mental illnesses. This includes Vicodin, barbiturates and some benzodiazepines.

How is anxiety diagnosed?

If you are diagnosed with anxiety, you will have had excessive symptoms of anxiety (detailed just below) of a high intensity. This will be present for a few months and you will find the symptoms difficult to control.

  • Continual feelings of apprehension, fear and/worry
  • These emotions are difficult to control (you feel swamped)
  • You feel nervousness and can't concentrate
  • These causes you to be easily panicked, and can lead to attacks

Bouts of nervousness differ from being diagnosed with anxiety and other linked mental health illnesses. If you continually experience worry, nervousness or fear, this can be a sign of anxiety as a disorder, especially if it is linked to particular events or activities listed above.

Meeting your doctor regarding anxiety

If you wish to speak to a medical professional about anxiety, you can firstly book an appointment with your GP. As they are not strictly mental health professionals, your doctor can refer you to a relevant individual such as a physiatrist. It's important to remember that many cases of mental health illnesses don't necessarily require a physiatrist and there are options offered beforehand such as self-help, group counselling, medications and NHS/charity support.

Upon booking your initial appointment, your doctor may ask you the following:

  • Medical history
  • Personal history
  • Quick physical examination
  • Occasionally, you may have a laboratory test if the symptoms of your anxiety is linked to a physical condition

Diagnosing levels of anxiety can be difficult as everyone experiences this emotion. The key is to recognise the frequency and severity of nervousness. If you find yourself highly concerned about any apprehension you feel, visiting a doctor to pinpoint triggers and the strain of anxiety can help to treat the condition.

Symptoms of anxiety

Feeling anxious is somewhat different to being diagnosed with anxiety. Whilst we all experience nervousness, fear and apprehension every now and then, anxiety also includes the following symptoms:

  • Intense fear, worry, nervousness, apprehension
  • Nausea
  • Heart palpitations
  • Sweating/flushing
  • Trembling
  • Diarrhoea/stomach upset
  • Headaches
  • Fatigue
  • Difficulty concentrating
  • Confusion
  • Difficulty sleeping and/or odd dreams
  • Irritable or impatient
  • Aches and muscle tension (particularly backache)
  • Urge to urinate
  • Trembling/visual shaking
  • Breathlessness
  • Dizziness
  • Chest pains
  • Pins and needles
  • Dry mouth

Treatments for anxiety

Treating anxiety should always be taken seriously. There are prescription medications available, self-help options and counselling. Depending on the type of your anxiety and severity of symptoms, you will be advised appropriate treatment by your doctor.

Self-help

Identifying and managing anxiety triggers is an initial treatment option. It is often used in conjunction with medications and counselling. Self-help methods for anxiety include:

  • Keeping organised – This is handy for work stress and deadlines. Keeping diaries for specific reasons can keep on top of approaching deadlines and stop you panicking at short notice. Placing a couple of alarms on phones or devices can also help. It is key not to overload yourself with tasks. List your most important and give yourself a break or treat when completing large challenges.
  • Stay relaxed – Give yourself a break! There are free meditation and mindfulness apps for your device that just requires a few minutes everyday. Therapy colouring books have peaked in popularity and yoga and Pilates are still proven relaxation techniques. Books on zen and mindfulness can also be helpful. If those aren't of interest, simply reading any book can help reduce stress. Taking a walk or relaxing with a meal, nap or game.
  • Positivity – A common habit of anxiety disorders is to think of the worst possible situation, and to worry continually about many scenarios. By listing the possible positive outcomes of every situation, you can begin to lessen those negative thoughts and begin to have a better outlook. This can also begin to increase confidence.
  • Deep breathing – If symptoms persist, or you feel a panic attack developing, practising deep breathing slowly through your nose and out through your mouth. This is good for those who experience breathlessness or heart palpitations.
  • Exercising – Studies have shown that exercising can increase a positivity in the mind. It stimulates oxygen around the body and helps you lose weight, further boosting confidence. Exercising also aids in sleep, combating one common symptom of anxiety disorders.
  • A daily/weekly relaxing routine – Popular aids including taking a bath, reading before bed, resting in a dimly lit room, going to a stroll, partaking in a hobby, jogging, mediating and more can be incorporated into daily life. Always embrace the hobbies that make you smile to avoid day-to-day stress building that results in anxiety.

Anxiety Medications

Using prescription medications to combat anxiety and other mental illnesses is common and extremely helpful. As there is sometimes a stigma when using antidepressants, tricyclics, beta-blockers and benzodiazepines, further acceptance is needed. It is perfectly acceptable to use tablets to manage a mental illness in the same way as physical conditions such as inhalers, type 2 diabetes and high blood pressure, for example.

Anxiety medications must be used on a continual daily basis, even if you're not experiencing symptoms of the condition. They can significantly improve the standard of living.

  • Beta blockers can be used to effectively treat anxiety as well as heart conditions. Medications include propranolol (Inderal).
  • Buspirone is used to control neurotransmitters that, in turn, control anxiety. Some side effects are reported including an addictive nature.
  • Monoamine oxidase inhibitors (MAOIs) are an antidepressant and includes tranylcypromine (Pranate) and phenelzine (Nardil).
  • Tricyclics studies have shown uses for anxiety and obsessive-compulsive disorder, and this includes imipramine (Tofranil) and clomipramine (Anafranil).
  • Benzodiazepines such as diazepam (Valium), alprazolam (Xanax) and lorazepam (Ativan) can induce side effects, especially of an addictive nature, so aren't usually a first choice for combating anxiety. This option is not recommended for older people.
  • Serotonin reuptake inhibitors (SSRI) are a common treatment and an antidepressant. SSRIs include fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft).

Counselling

There are many options including group therapy sessions, one-to-one therapy and charities you can ring 24/7.

  • Psychotherapy either privately or through the NHS
  • Charities such as Mind and Samaritans

Cognitive-behavioural therapy (CBT)

CBT can be highly effective. Its aim is to focus these feelings of anxiety towards certain situations, people and objects and challenges you to change your behaviour.

Cognitive-behavioural therapy works in two ways to pinpoint anxiety. Firstly, the cognitive aspect helps you identify warped emotions regarding your trigger(s) whilst the behavioural aspect focuses on changing the way you respond and react. The good thing about cognitive-behavioural therapy is that it makes you confront the triggers of anxiety instead of hiding or masking them.

If you're interested in CBT, you can talk to your GP and ask for a referral to a therapist. It may take a few sessions. Anxiety should always be treated if you are displaying the symptoms and are struggling to cope with them.

Preventing anxiety

To prevent further anxiety, there are some technique and lifestyle improvements that can end up making a big difference.

  • Plenty of sleep
  • Relax
  • Exercising
  • A good diet
  • Reducing alcohol intake
  • Limiting caffeine
  • Be proud of your achievements

Sometimes self-help and prevention alone doesn't make a significant improvement. Counselling and therapy sessions are always on-hand through the NHS or privately. Charities also offer confidential and free calls any time of the day should you need to talk. In addition, using medication are clinically proven for many types of anxiety.

Long-lasting effects of anxiety

Anxiety is triggered in the brain so any long-lasting feelings of extreme anxiety, or severe bouts of anxiety can have a detrimental effect on your health in the long-term. As fear and stress isn't appropriately filtered, these triggers in the brain can stretch to other areas. The traditional structure of the brain can alter and affect you in other ways.

Continued stress can weaken your immune system by preventing a quick response to other illnesses. This is due to the lessened production of a chemical called cytokines that is used to rally cells together to fight an infection. This is also the reason why stress, a lack of sleep and worry can trigger acne outbreaks, cold and flu viruses and bouts of genital herpes too.

When you are stressed, this can affect your digestive system resulting in stomachaches and quite likely diarrhoea. The quicken of the heartbeat can lead to chronic heart conditions such as high blood pressure and heart attacks. Stress teamed with the lack of exercise, sleep and healthy diet can lead to weight gain.

Prolonged anxiety causes muscle spasms and aches around the body that can result in migraines.

Dr Hilary Jones Independent Medical Adviser

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