Anxiety

Welcome to this Blog on anxiety. The Blogs listed below can be accessed using the Blog archive on the right of the screen.

1. When is anxiety a problem?

2. Types of anxiety

3. Anxiety symptoms

4. Panic attacks

5. Trauma

6. Health anxiety

7. Social anxiety 

8. Chronic worry

9. Phobias

10. OCD

When is anxiety a problem

Every one experiences anxiety from time to time because anxiety is our natural warning device which alerts us to potential dangers. 
 1. Although anxiety in itself is not an abnormal emotional reaction, anxiety can become become problematic when a person becomes frequently distressed by their anxiety reactions. 
2. Anxiety can also be problematic when a person experiences frequent high levels of anxiety which can create ongoing emotional, psychological or physical distress. 
3. Anxiety can also shrink a persons life by creating major restrictions, which prevent them from undertaking their everyday activities.

Types of anxiety

Some people develop problems with anxiety which result in chronic or persistent worries, other people experience anxiety in the form of panic attacks. For some people obsession or compulsions become a way of coping with high levels of anxiety, whilst other people develop anxiety difficulties concerning their health. Some people also develop problems with anxiety concerning interacting with people in social or work place situations. 

Some people also experience anxiety in the form of specific phobias about certain objects, activities, places, people or animals. It is also not uncommon to experience two or more different types of anxiety together. For example, a person might experience a panic attack whilst engaging in a social situation, or experience panic when encountering a feared object. 

It is also important to mention that when people experience a traumatic event, the symptoms and problems associated with the trauma, are often similar to the problems connected to anxiety.

Anxiety symptoms

It is not uncommon to have psychological, emotional and physical reactions when experiencing high levels of anxiety. 

1. Psychological

Some people experience psychological reactions such as a racing mind, or their mind going blank, or feeling cut off from the world. 

2. Emotional 

Some people may feel a sense of dread or intense fear, or a sense of a looming catastrophe. 

3. Physical 

Some people also experience one or more of the following physical sensations:

• Palpations or increased heart rate
• Feeling like you are suffocating or unable to breath
• Dry mouth
• Upset stomach
• Dizziness
• Sweating
• Feeling sick
• Muscular tension
• Trembling or shaking
• Tightness in the throat
• Tightness in the chest
• Chest pain
• Tingling in the body
• Blurred vision 

Panic attacks

 What is a panic attack

• A panic attack is when you experience a sudden unexpected increase of intense anxiety. 
• During a panic attack the speed at which your anxiety levels increase, is like going from 0 to 80 miles an hour in a few seconds.

Why panic attacks are distressing

• Panic attacks are very distressing because you can experience a range of disturbing psychological and physical sensations. 
• During a panic attack you may feel afraid that you are going crazy or dying. 
• Also during a panic attack you are likely to experience intense bodily sensations.

The following are typical symptoms which people report when they experience a panic attack. 

• Heart palpations or racing heart
• Feeling like you are suffocating 
• Breathlessness 
• Dizziness
• Sweating
• Choking
• Chest pain or tightness
• Trembling or shaking
• Feeling unreal or distant feelings
• Hot of cold flushes
• Nausea
• A fear of dying or going crazy 

Some people also experience other symptoms. See the blog on anxiety symptoms. 

Trauma

What is trauma 

• When people experience a trauma they often become distressed by memories, flashbacks or nightmares of a frightening event. 
• Witnessing or being threatened by violent death, suffering a serious injury or rape, or experiencing a catastrophe such as a hurricane, accident, fire, flood or earth-quake or terrorist attack often lead to people developing traumatic response to these events.
• Traumatic responses are often marked by a range of anxiety symptoms such as chronic worry, panic attacks, avoidance and feeling unreal as well as somatic symptoms such as fatigue, muscle tension, nausea, palpations or increased heart rate and physical pain. 

Why are the symptoms of trauma distressing

• The symptoms of trauma are distressing because they often result in a person experiencing a series of debilitating symptoms which are often referred to as post-traumatic stress disorder or PTSD. 
• A person with PTSD will frequently re-experience the traumatic event, and this may lead to them being on consent alert in case something dangerous happens. 
• A person with PTSD may also avoid experience negative thoughts or mood changes, and feel numb to the world or estranged from other people. 

Health anxiety

 What is health anxiety 

• People with health anxiety often become overly preoccupied with their bodily signs, symptoms and physical changes.
• People with health anxiety develop fears that they have a serious illness or disease, or that they are developing a serious illness or disease.

Why is health anxiety distressing

• Health anxiety is distressing because people often seek out multiple medical assessments or clinical investigations.
• Health anxiety is distressing because when people seek out multiple consultations, these do not alleviate their fears and beliefs that they have a medical problem or a serious health issue.

Social Anxiety

What is social anxiety

• Social anxiety is a persistent fear of social situations where you need to interact with others or perform a task in public.
• Some people become fearful of interactions with others, such as having a conversation or making small talk with people. 
• Some people also become fearful of social situation where you need to perform a task such as giving a presentation, or a talk to others at work. 

Why social anxiety is distressing 

• When people have social anxiety, interacting with other people, or perform a task in public can create enormous fears. 
• If you have social anxiety you will avoid social situations, or endure them with a sense of dread. 
• In social situations you will be fearful that other people are judging you harshly. 
• Underlying social anxieties are often beliefs that other people are viewing you as either overly anxious, weak, or that people see you as either crazy or stupid. 
• The fear of being harshly judged can restrict your social activities. 

Chronic worry

What is chronic worry

• If you are experiencing chronic worry you will probably find yourself worrying most days, and that your worries and worrying creates a feeling of high levels of anxiety and distress.

Worrying

• Worrying can take the form of feeling worried but not being able to pin point why.  Worrying can also involve repeatedly worrying about one or many different things. Worrying can also involve focusing on negative streams of thoughts or images which fee uncontrollable or distressing. Worry tends to focus on things that have not yet happened. Worrying often involves the fear of dread or an impending catastrophe. 

Ruminating

• Another type of worry is called rumination. When a person is ruminating they go over and over things again and again. Rumination is different to worry in that it is focused on things that have already happened. 

Symptoms

• You may find that your worry or ruminations can last minutes or hours. 
• Worry often feels uncontrollable, because various anxieties connected to worrying makes it feel like your worries are difficult to control for the following reasons.  
• You may feel compelled to worry so that you can reason out your problems. 
• You may also feel compelled to worry to keep yourself safe, and so that you can prevent a dangerous situation from occurring. 
• You may also worry about worry itself, especially when you begin to experience worry failing to help you solve your problems. 
• Worry about worry can often focus on worry about the symptoms of anxiety such as tension in the body, or other forms of anxiety listed below concerning your emotions, thoughts, behaviours and physical or somatic symptoms. 
  

Emotions

• Feeling anxious or apprehensive most of the time
• High anxiety
• One or many anxieties
• A sense of dread or doom
• Feeling high levels of frustration
• Feeling like you are on the edge of mental or physical collapse or both.

Thoughts

• You may feel you are in danger because something terrible might happen.
• You may believe that worry is difficult to control
• You may feel keyed up and on the edge
• You may have difficulty concentrating
• You may experience your mind racing or going blank
• You may feel unreal or disconnected (An other word for this is dissociation).

Behaviours

• Restlessness
• Irritability
• Avoiding or neglecting things

Physical and somatic

• Difficulty relaxing because your body can feel constantly tense
• Feeling easily fatigued or muscle tension
• Racing heart, trembling, shaking or feeling sick
• Difficulties falling or staying asleep or restless unsatisfying sleep      

                                                                    

Phobias

What are phobias

• Phobias are a persistent fear of either a specific activity, event, place, person, social situation, animal or certain types of objects. 
• Some phobias can be simple such as a fear of spiders, blood, or needles, but social and medical phobias can be quite complex. 
• People can often develop phobias related to everyday activities such as using lifts or travelling by trains. 

Why are phobias distressing

• Having a phobia can be distressing because for some people high levels of anxiety can be generated just by thinking about the feared activity, event, place, person, social situation, animal, or using a certain object. 
• For other people being in contact with the source of the phobia is what creates high levels of anxiety. 
• Phobias are also distressing because they can severely restrict a persons ability to work, socialise or complete everyday activities. 

Anxiety symptoms

• People with phobias often report the following types of anxiety symptoms: sweating, feeling sick or an upset stomach, increased heart rate or palpitations, shortness of breath and shaking or trembling. 
• People can also experience other types of anxiety symptoms. See the blog on anxiety symptoms. 

OCD

OCD is short hand for an anxiety disorder which involves obsessions or compulsions.                                                                                                       

Obsessions

• Obsessions are persistent thoughts, impulses or images which people can experience as intrusive or inappropriate. 
• The most common types of obsessions concern thoughts about being contaminated, doubts about having done something, fears about being aggressive or losing control, or fears about recurring sexual imagery.                                                                                           

Compulsions

• Compulsions are repetitive behaviours which are overt or covert. Some of the most common overt behaviours people experience can involve hand washing, checking, or the ordering or alignment of objects. 
• Some of the most common covert behaviours people experience can involve counting, repeating words, focusing, distraction, rumination or mind control.               

Why is OCD distressing

• OCD is distressing because obsessions and compulsions can eat away at a persons ability to undertake everyday tasks and activities.

Why do people develop OCD

• Often people develop obsession or compulsions to reduce anxiety and distress, or prevent a feared event from happening. 
• Some times people develop compulsions which are performed according to specific rules, as a way of warding off a feared event, situation or perceived looming catastrophe.

What is a panic attack

* A panic attack is when you experience a sudden increase of intense anxiety

* During a panic attack you may be afraid that you are going crazy or dying

* Also during a panic attack you are likely to experience intense bodily sensations
                                                 
Why are panic attacks so distressing?
Panic attacks are distressing because you can experience a range of disturbing bodily sensations including: heart palpations, dizziness, sweating, choking, trembling or shaking, breathlessness and feeling unreal. These intense physical sensations can make you feel like you are suffocating, and this is what makes you feel as though you are either dying or going crazy.

What can trigger a panic attack?
A number of things can trigger a panic attack
1. Feared situations                                                                                                                              Sometimes situations which create fear can cause you to have a panic attack
2. Waking from sleep
Panic attacks can also occur on waking from sleep. In these situations you may wake from sleep in a state of intense anxiety 
3. Phobias
Panic attacks can also occur as a result of phobias such as social or agoraphobia and claustrophobia.

Nothing triggers my panic attacks?
You are likely to experience a panic attack occurring spontaneously or un-expectantly, and that's why you often feel like there is nothing obvious which has triggered your panic attack.
  
What we know about Panic attacks

Panic attacks have triggers
It is widely understood that panic attacks follow a particular sequence of events which begin with a trigger. Often you might be unaware of the threat leading to an increase in fear and anxiety, this is because once a trigger fuels a panic attack, you become caught up in a rapid increase of anxiety. A rapidly increase in anxiety, also makes it difficult to think about what actually triggered the increase in your anxiety.

Vicious circles
The second feature of panic attacks is what is called vicious anxiety circles. In vicious circles, thoughts, emotions and sensations stoke anxiety like wood stoking a fire. This is why panic attacks flare into high anxiety very quickly.

An imagined catastrophe
Vicious circles of anxiety develop because of the underlying belief in panic attacks of an impending catastrophe. These imagined catastrophes are usually based on you misreading your bodily sensations or state of mind.

a). Misunderstanding your body
In a panic attack you are likely to misinterpret your bodily sensations as sign of an immediate impending disaster, such as having a heart attack, collapsing, suffocating, or going crazy. For example, some people think that dizziness is a sign that they are about to faint, or a speeded heart rate as a sign that you are about to have a heart attack.

b). Misunderstanding your thoughts
In a panic attack you are also likely to find yourself with racing thoughts, and often this is mistakenly thought of as a sign of a psychological or social catastrophe, such as losing control of one’s mind or behaviour.

c) Misunderstanding other sensations
Sometimes people also misunderstand bodily sensations which are not a result of anxiety. For example light headedness resulting from low blood sugar, or changes in blood pressure due to changes into body posture, can also trigger anxiety which might lead to a panic attack.

Reference
Wells, A. (1997). Cognitive Therapy of Anxiety Disorders. Wiley.

What is social anxiety?

* Social anxiety is a persistent fear of social situations.

* When you Interact with other people, or perform a task in public this can create enormous fears.

* If you have social anxiety you will avoid social situations, or endure them with a sense of dread.                                                                                                                                                                             
Fear of judgement
In social situations you will be fearful that other people are judging you harshly. Underlying social anxieties are often beliefs that other people are viewing you as either overly anxious, weak, or that people see you as either crazy or stupid. The fear of being harshly judged can restrict your social activities in the following ways.

Social anxiety shrinks your life

Everyday tasks
You may become overly anxious about performing activities in public such as eating, signing your name, standing or even walking, because you fear that other people are scrutinizing your every actions. You may also become anxious about eating in public because you believe others will see that your hands are trembling with fear.

Interacting with people
You may be very fearful about meeting or speaking to people, and fearful that you may appear inarticulate or too emotional in conversations. You may also become fearful about showing signs of nervousness such as trembling, stumbling over words, or blushing.

At work or university

At work or university you may become fearful about working and speaking in groups, giving presentations, or socialising during lunch and coffee breaks. You might also become fearful that you may appear socially awkward or incompetent to other people, which will lead to people rejecting or socially humiliating you.

Distressing thoughts, feelings & sensations 

Fear
You are likely to experience everyday routines, work or social life as being significantly disrupted by fear. Having your daily routines frequently disrupted can also increase your distress.

High anxiety

You will usually experience anxiety as soon you begin to think about, or are faced with your feared social situations.  Anxiety can take the form of trembling, feeling hot, breathlessness, feeling paralysed, a racing mind or going blank. Sometimes you may also experience panic attacks.

Panic attacks
If you have a panic attacks in social situations, you will tend to experience four or more of the following symptoms which suddenly increase rapidly: palpations, dizziness, sweating, choking, trembling or shaking, breathlessness, depersonalization, a fear of dying, suffocating or going crazy.

What causes social anxiety
Negative thoughts
Social anxiety leads to you overly focusing on negative thoughts connected to how well you are doing in a social situation, as well as other people’s perceptions of how well you may be doing. Focusing intensely on yourself in social situations, also tends reduce your competence in social settings. Also, by focusing intensely on yourself in a social situation, this leads to a situation where you do not experience other people’s real perception of your performance.

Overly focusing on bodily sensations
Social anxiety tends to lead to you overly focusing on your bodily sensations such as trembling, feeling hot, breathlessness, or feeling paralysed.

Vicious circles
With social anxiety you become absorbed and trapped in vicious circles of thinking about your bodily sensations, social performance and other peoples' feared judgements.

References
Wells, A.& Clark, D. M (1997). Social Phobia: A Cognitive approach. In Davey. D,. C. L (Ed), Phobias: A Handbook of Description, Treatment and Theory. Chichester. Wiley.

Wells, A. (1997). Cognitive Therapy of Anxiety Disorders. Wiley.