Anxiety
Worry is a common emotion experienced throughout life- we worry about what we care about (e.g., family, work, health). A certain level of worry is even necessary to motivate us to perform well and persist even when tasks or relationships become challenging. Anxiety by itself isn’t necessary a “bad thing,” but it can reach levels where it is no longer helpful, and that’s a good indicator it may be time to get some help managing it. Anxiety disorders occur when the level of fear and worry becomes chronic and excessive to the situations that are triggering the anxious response. If you find yourselfconsistently preoccupied with concerns about the future, tend to imagine the worst possible outcomes, and frequently avoid situations due to fear, it would be beneficial to seek support from a mental health professional to learn effective ways to cope with anxiety.
Symptoms of Anxiety
Anxiety symptoms can be grouped into three categories: cognitive (affecting our thoughts), behavioral (affecting our actions) and physiological (bodily responses to the emotion). Anxiety symptoms can vary greatly across individuals and anxiety can be general (worrying about many situations) or focused (one specific trigger). Below are some of the symptoms associated with anxiety (APA. 2013a):
Cognitive
· Feelings of excessive worry that is difficult to control
· Difficulty concentrating on the task at hand
· Assuming the worst-case scenario
· Fear of negative evaluation of others
· Irritability
Behavioral
· Avoidance of situations that trigger anxiety
· Restlessness, fidgeting
· Difficulty sleeping
· Seeking reassurance or safety from others
Physiological
· Fatigue
· Sweating
· Chest pain
· Stomach problems
· Increased heart rate
Causes of Anxiety
There is no one identifiable cause for anxiety. Anxiety disorders are attributed to a combination of biological, psychological, and social factors. A diathesis stress model is a psychological framework that can be used to explain anxiety as “an individual may have a genetic vulnerability for anxiety (diathesis) which is triggered by trauma or life events (stress).” Here is a list of some common cause of anxiety:
· Genetic- Anxiety is a heritable condition and runs in families.
· Health challenges- Individuals with chronic health issues or who have a history of physical illness are more likely to experience anxiety.
· Side of effects of substance use or medications- Substance use is highly co-morbid with anxiety and using mood altering substances can trigger symptoms of anxiety and feelings of fear. Also, side effects of certain medications can trigger the physical symptoms of anxiety.
· Adverse Childhood Experiences: Childhood trauma including emotional abuse and neglect has been found to predict the development of anxiety disorders through adulthood.
· Personality: Certain personality traits are more likely to be associated with anxiety disorders including high levels of neuroticism and perfectionism.
· Stress: Experiencing high levels of stress over a long period of time can also trigger anxiety and burnout.
Prevalence
Research on the prevalence of anxiety disorders in the United States show varying rates. According to the CDC's 2019 data, 9.5% of adults reported mild symptoms of anxiety, 3.4% reported moderate symptoms, and 2.7% experienced severe symptoms. Notably, anxiety symptoms were most prevalent among individuals aged 18 to 29, and
females were more likely to endorse anxiety symptoms compared to males. This gender difference might be attributed to females being more proactive in seeking treatment for anxiety than men. However, since the outbreak of COVID-19, anxiety symptoms have shown an increase. In a 2022 report on adults in the US, approximately 32% of females and 24% of males exhibited symptoms of anxiety disorder.
Types of Anxiety Disorders
Generalized Anxiety Disorder (GAD): In GAD, individuals experience anxiety across various domains including school, work, household tasks and relationships. A person with GAD often wonders “what if” and may be at work worrying about what if they left the stove on, what if their dog is hungry, or what if the traffic bad on the way home. In GAD, the anxiety is chronic, excessive, and causes an individual a great deal of distress.
Social Anxiety Disorder (SAD): Individuals with SAD experience anxiety in social situations related to fear of being negatively judged, evaluated, embarrassed or humiliated. These individuals may avoid social situations or experience them with great deals of distress. As with all anxiety disorders, a certain level of social anxiety is normal, but if its excessive to the situation or interferes with an individual’s ability to form relationships, it may be clinically significant.
Panic Disorder: Some individuals with anxiety experience panic attacks which refers to a surge of intense fear or discomfort that reaches a peak within minutes and includes physical symptoms (fast heart rate, shaking, dizzy, shortness of breath etc.). In these panic attacks, individuals may fear they are dying, going “crazy” or losing control. Individuals with panic disorder may avoid situations out of fear of having a panic attack and not being able to escape or being embarrassed in front of others. Panic attacks can be associated with specific triggers or occur randomly.
Agoraphobia: Individuals with agoraphobia experience fear or anxiety about several of the following situations: being in enclosed spaces, leaving the home alone, being in a crowd or using public transportation. Individuals with agoraphobia may rarely leave the home or only leave the home with a companion. Often the fear is associated with having a panic attack in an unfamiliar situation and feeling trapped or embarrassed.
Specific Phobia: Specific phobia is the most common type of anxiety disorder diagnosed in the United States and is characterized by anxiety that is limited to a particular situation or object. Examples of specific phobias experienced include fears related to animals, blood, heights, and airplanes.
Illness Anxiety Disorder: Individuals with illness anxiety disorder experience excessive worry about becoming sick and are overly concerned with minor bodily sensations. Individuals with this disorder are not typically reassured from negative test results and will often see many different doctors and research their symptoms. An individual with this disorder typically does not have a severe illness but operates under the fear that they have one that has not been accurately diagnosed.
Sexual Anxiety: Sexual anxiety refers to fear of engaging in sexual intercourse and can often impair an individual’s ability to be intimate. The anxiety regarding sex varies across individuals and can be related to fear of not performing well, not satisfying your partner or not being able to orgasm. For women, the sexual anxiety may be more related to body image concerns and difficulty with arousal, while for men, this fear can be related to difficulty getting an erection and fear of ejaculating sooner than preferred.
Separation anxiety disorder: This disorder is commonly diagnosed in children and involves displaying excessive fear or anxiety when separated from attachment figures, which is developmentally inappropriate given their age. For example, all children will have some challenges leaving their parents at first for school, however a child with separation anxiety disorder may refuse to go to school out of fear of the separation and experience fear of their caregiver getting hurt.
High functioning anxiety: While not a diagnostic category, high functioning anxiety refers to individuals who are highly achieving and meeting their expectations while living with anxiety. These individuals are often experiencing great deals of distress, but their symptoms can go unnoticed or undetected because, on the surface, they are able to function effectively. These individuals may experience constant worrying, fear of failure, self-doubt, and the need to be perfect. High functioning anxiety often co-occurs with burnout.
Treatments for Anxiety
Cognitive behavioral therapy (CBT) is the gold standard and an empirically supported intervention for anxiety and related disorders. CBT is the umbrella term for interventions that focus on how our thought patterns and belief systems impact our feelings and behaviors. Below is an overview of explanation of CBT but this intervention is modified based on the specific type of anxiety disorder an individual has and symptoms experienced.
Cognitive Therapy: In CBT, an individual learns to identify their anxious thought patterns that contribute to their negative interpretation of events. Once an individual can identify and label these thoughts as anxious and irrational, they then work on modifying these thought to a more effective and factual thought (e.g., original thought: ‘I tripped in front of my coworkers, I am such a loser and failure’; modified thought: ‘That was a little awkward but it’s not the end of the world’). Often, individuals have developed negative belief systems about themselves and the world such as ‘I am the worst person ever’ or ‘the world is a dangerous place.’ Throughout CBT, an individual learns to modify these existing belief systems which then change the types of thoughts one experiences. For example, if you believe that you are unlikable, you will always interpret situations through this lens versus if you have a more balanced view of yourself that you are overall a good person with some flaws like everyone else. With the second type of belief system, if you trip in front of your coworkers, you are less likely to beat yourself up and assume that this one action will have a catastrophic outcome. In CBT, individuals gain a better understanding of what contributed to the development of their anxiety and learn effective strategies to respond differently to their triggers.
Exposure Therapy: A central part of CBT for anxiety disorders include exposure therapies. In this type of therapy, an individual is exposed to their fears in a gradual way where they learn to tolerate their anxiety. For example, an individual with a fear of dogs would work with their therapist to build up their tolerance being around dogs. This may include activities such as looking at pictures and videos of dogs. Eventually, at the client’s pace, sessions would include the client exposing themselves to a dog at a pet store or dog park. While the feared situation was once met with avoidance, through therapy, an individual is learning they can master this phobia and tolerate the anxious feelings and symptoms. The types of exposures implemented in sessions are specific to each client and their goals for treatment. In clients with panic disorders, exposures include inducing the feared physical symptoms in sessions (dizziness, shortness of breath, fast heart rate) through activities like intense exercise and breathing through a straw. As clients complete the different exposures, they start to learn that they can experience a physical symptom like shortness of breath and are able to tolerate the sensations, allowing them to move forward.