Understanding Anxiety

Anxiety is Normal

Anxiety is a normal part of the human experience. It is something each of us will experience to some degree nearly every day. More than 1 out of 20 Canadians are affected by an anxiety disorder (CMHA.ca, “Anxiety disorders affect 5% of the household population”) and 61% of university students in North America report having felt overwhelming anxiety in the last 12 months . If you are struggling with feelings of anxiety, you are normal.

 

Anxiety is Natural

Before we had buildings and techologies to protect us, anxiety was a key factor in our survival. It has a role to play in our lives today as well. It can motivate us to be productive, help us to perform better by ensuring good preparation, and help us make fast decisions if we find ourselves in danger. It is our fight or flight response and it is there for a reason.

Is Your Anxiety Affecting Your Daily Life?

Anxiety can be a problem when we experience it in a way that is extreme and seemingly without reason or that is disproportionate to what is going on around us. Problematic anxiety can produce difficulty engaging in work, social life, or other obligations or when it produces persistent troubling symptoms (panic, fear, repetitive thoughts, incessant worry, sleep issues, etc.). Talking with a professional about problematic anxiety is the first step in overcoming it.

Anxiety can be affected by many factors (e.g., genetics, past experiences, current stressful events). Regardless of the cause, it is helpful to know how anxiety works. Anxiety lives in three main areas that impact each other to create a cycle of anxiety.

1. Our Thoughts

We often never acknowledge them, but our automatic thoughts go a long way in informing our relationship with anxiety. Automatic thoughts are often built on assumptions and faulty thinking. Acknowledging our automatic thoughts and exposing their errors is a great first step in overcoming anxiety.

2. Our Emotions

Instant, uncomfortable, and we want them to go away. Understanding that emotions are often reactive to our automatic thoughts and cannot be controlled or changed can allow us to redirect our energy from “trying to control” to “trying to understand.” If we can learn to identify our emotions, we can gain good information about our automatic thoughts.

3. Our Behaviors

When our emotions rise and we start to feel panic, our brain starts looking for a threat in our circumstance, ignoring our thoughts all together. When it identifies the “threat” it encourages us to behave in a way that is designed to keep us safe. These safety behaviors (e.g., avoidance, escapism, reassurance checking) often work in the moment to reduce intensity of emotion, but give way to new circumstances. This may add to the original automatic thought, continuing the cycle.

Example

An individual is to go out with friends. When the time comes they are filled with anxiety. Their brain incorrectly concludes that going out with friends is a threat and informs the behavior of cancelling last minute (avoidance). If they had identified the automatic thought (“I don’t belong”) and the emotion (inadequacy), they could have seen how their anxiety was built on faulty thinking, not circumstance. Furthermore, they would see how their behavior would worsen this thought over time (“You can’t belong if you never go”).

Generalized Anxiety

Having excessive worry that occurs most days related to everyday things, events, or activities. This worry is difficult to control and interferes with everyday life. Results in difficulty relaxing, concentrating, and sleeping.

Social Anxiety

Having a persistent fear of a particular social or performance situation. An intense fear of being evaluated in a negative manner by others can also be present. Someone dealing with social anxiety will choose to avoid feared situations.

Obsessive Compulsive Disorder (OCD)

OCD is characterized by having recurring and intrusive upsetting thoughts as well as compulsive or ritualistic behaviors designed to mitigate these thoughts or relieve anxiety. These behaviors may include hand washing, arranging items, counting, specific prayers or actions, etc.

Posttraumatic Stress Disorder (PTSD)

PTSD occurs after a person experiences a traumatic event. This event may have occurred previously or happened recently. Someone dealing with PTSD may avoid reminders of the trauma.

Specific Phobias

These are intense, persistent, and excessive fears of things such as animals, seeing blood, flying, and being in enclosed places.

Panic Attack

Having sudden episodes of intense fear in a situation that does not involve danger. The panic attack can be accompanied by a fear of dying or losing control. Someone dealing with panic attacks will worry about having additional panic attacks.

• Frequent procrastination,
• Persistent fears of failure,
• Insisting on perfection,
• Difficulty relaxing,
• Excessive worrying,
• Overwhelming spells of panic,
• Avoiding places or situations from which escape might be difficult or embarrassing,
• Fearing something catastrophic will happen,
• Persistent concern about having anxiety attacks,
• Significant changes in behaviour as a result of anxiety,
• Avoiding certain social or performance situations,
• Intrusive thoughts and/or repetitive behaviours,
• Family and/or friends notice something is wrong,
• Depending heavily upon others because of anxiety,
• Substance use to manage anxiety,
• Missed classes and/or unmet deadlines,
• Poor or declining grades,
• Lost relationships because of anxiety, and
• Concern about own levels of anxiety.

Anxiety, at any level, can be treated. The sooner you get started the faster it can be resolved. Accessing support is a necessary step regardless of what treatment you require.

Self-treatment

If you find that your anxiety tends to be reasonable and is often circumstantial, you may be able to manage well with the support of family, friends, and materials such as this. Acknowledge your automatic thoughts and ask yourself if they are faulty or valid. Challenge yourself when met with the urge to avoid anxiety provoking situations. Self-care strategies for anxiety may include: talking to someone you trust, looking after your physical health, practicing breathing exercises, keeping a diary, accessing peer support, or attending an anxiety information group.

Counselling

If you find that your anxiety is unreasonably high and producing persistent unwelcome symptoms or is compromising your ability to function in day-to-day life you may want to consider counseling. Talking to a mental health professional can help you through the recovery process by addressing the relationships between your automatic thoughts, emotions, and safety behaviors. A counsellor can help in managing anxiety symptoms and avoidances, challenging automatic thoughts, developing strategies to address safety behaviors, and learn different ways to cope through anxiety provoking times.

Medication

If you find that the intensity of your anxiety is such that you have lost the ability to participate in your obligations (e.g., school, work, relationships), you may require medication. Medications for anxiety can help to reduce the level of intensity allowing you to effectively engage in the necessary work with your thoughts, emotions, and behaviors. Medication and counseling at the same time is often the quickest and most comfortable road to recovery. Speaking to your doctor about options is an appropriate first step.

• Suggestions to Help Provide Support

  • Learn more about anxiety,
  • Remember that it is not your job to cure the anxiety,
  • Be patient,
  • Show sincere interest and optimism,
  • Acknowledge the anxiety without being harsh or judgmental,
  • Acknowledge any progress you see, no matter how small or slow,
  • When asked, provide honest and gentle feedback,
  • Be cautious about accompanying your friend or family member to feared situations,
  • Be aware that, in some situations, providing reassurance may actually work against improved anxiety management,
  • Have fun together, and
  • Encourage them to seek assistance from a physician or mental health professional.

Student Wellness Centres Mental Wellness staff provide Anxiety Drop-in Group Sessions each term.

A panic attack is a relatively brief period of intense fear that has a sudden onset and usually reaches a peak in intensity within ten minutes or less.

A particularly frustrating aspect of panic attacks is the fact that they occur in familiar settings, and in situations that do not involve real danger. Nonetheless, the episodes are often accompanied by a sense of impending doom and/or an intense urge to escape from wherever the attack is occurring.

Common Symptoms of a Panic Attack

• Sweating
• Trembling
• Chest pain
• Choking sensation
• Hot or cold flashes
• Shortness of breath
• Feeling dizzy or faint
• Accelerated heart rate
• Nausea or upset stomach
• Numbness or tingling sensations
• Fear of dying, going crazy or losing control
• Feelings of unreality or of being detached from oneself

After experiencing a panic attack, many panic sufferers worry about having additional attacks. They may also begin to avoid certain situations in which they fear they may experience panic (e.g., being in a crowd, standing in line, traveling in an automobile).

Panic Disorder occurs when individuals experience recurrent, unexpected panic attacks accompanied by persistent concern about having additional attacks, worry about the consequences of having panic (e.g., “going crazy”) or making a significant behavioral change because of panic (American Psychiatric Association, 1994).

When Does Panic Happen?

Problems with panic usually begin between the ages of 18 and 35, with the peak time of onset in the mid-twenties.

(Beckfield, 1994)

The frequency and severity of panic attacks vary widely. Some people have frequent attacks (e.g., 8 times/month for many months). Others report short bursts of frequent attacks followed by periods without any panic (American Psychiatric Association, 1994).

This typical fluctuation of panic symptoms over time often contributes to the feeling that panic is uncontrollable and occurs for no reason. However, if the timing of panic is closely examined, most people discover that attacks are related to certain thoughts, feelings, or events.

For Some Individuals, the Following May Prompt a Panic Attack

• Stress
• Suppression of anger
• Separation or loss (e.g., death of a family member)
• Interpersonal conflict
• Hormonal events (e.g., birth of a child) (Beckfield, 1994)

Why Me?

It is likely that a combination of factors make some individuals more vulnerable to panic. These include the following:

Genetics

There are indications of a genetic contribution to the development of panic. Individuals who have first-degree relatives who suffer from panic have a 4-7 times greater chance of developing panic themselves (American Psychiatric Association, 1994).

Temperament

Individuals who are born with a temperament characterized by shyness, cautiousness, and discomfort with unfamiliar situations may be at increased risk to experience panic (Beckfield, 1994).

Family Experiences

Individuals who have experienced losses, traumatic separations, or chaotic family situations as children may be more susceptible to panic as adults. There is also some indication that being raised in an overprotective home can contribute to panic (Bourne, 2000).

Stressful Life Events

Problems with panic can develop during periods of significant loss (e.g., end of a relationship, death of a family member), life change (e.g., starting university, having a baby), or stress (e.g., final exams, financial setback) (Bourne, 2000).

How Do I Deal With Panic Attacks?

• See your family doctor or a physician at the Student Wellness Centre. It is important to rule out a physical cause for your anxiety symptoms. If you are experiencing severe anxiety, your physician may suggest the use of anti‑anxiety medication. It is UNLIKELY that medication alone will assist you in overcoming problems with recurring panic. The use of medication to manage panic attacks should be combined with counselling.
• See a counsellor who has experience treating difficulties with anxiety, and can show you how to make changes in your thinking (cognitions) and behavior to reduce panic.
• Remember that panic attacks are NOT dangerous. They are not hazardous to your heart and will not cause you to suffocate, faint, etc. (Bourne, 2000).
• Remind yourself that panic attacks ALWAYS end. Trust your body to look after you.
• The most effective way to overcome anxiety is to face and accept it. Rejecting and resisting your own anxiety consumes your time and energy. If you can make a shift in how you look at panic (e.g., to stop seeing it as the enemy), feelings of tension reduce. The less you wait for and worry about panic, the more freed up you are to enjoy your life.
• Pay less attention to physical sensations (e.g., stop monitoring your heart rate). People with panic tend to be more alarmed by physical reactions and are more likely to interpret these as indications of physical danger (e.g., to believe that difficulty swallowing could result in choking or suffocation).
• When you first notice yourself beginning to feel anxious, slow down your breathing. Take slow, deep breaths.
• When feeling panicky, slow down your entire body (e.g., stop pacing and sit quietly).
• Panic suffers engage in catastrophic thinking (e.g., “What if I pass out!” “I’m going to have a heart attack!) which involves misinterpreting uncomfortable physical symptoms as signs of true danger (e.g., believing that tingling sensations are a sign of a stroke). Replace anxiety-provoking thoughts with brief, supportive and believable self-statements (e.g., “I’m feeling panicky. This is not dangerous. This will pass. I can cope”).
• Work to better identify, accept and express your own feelings. Unresolved emotions, such as anger and grief, can result in anxiety that feeds episodes of panic.
• Stop avoiding situations and places where you fear you will experience panic. When you eliminate avoidance behavior you learn that disasters are unlikely, your panic symptoms do diminish and you can cope.
• Maintain healthy habits (e.g., choose nutritious meals, establish an exercise routine, get enough rest and control your caffeine and alcohol use).
• Seek the support of understanding friends and family members.
• Learn more about managing panic. Check your local library or the Internet for helpful resources.

Where Can I Receive Help?

If you think you may be experiencing problems with panic, and require professional assistance, contact the Student Wellness Centre or talk to your family doctor.

References

1. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: Author.
2. Beckfield, D. (1994). Master Your Panic and Take Back Your Life: Twelve Treatment Sessions to Overcome High Anxiety. San Luis Obispo: Impact Publishers.

Bourne, E. (2000). The Anxiety and Phobia Workbook. Oakland: New Harbinger.

Supports at the USask:

• Student Wellness Centre: 306-966-5768
• Student Affairs and Outreach: 306-966-5757
• Drop-in Peer Support

 

More information:

• Check out other pamphlets and online articles on “Managing Stress,” “Worry Less,” and “How to Get Through Exams” .
• Student Wellness Centre workbook on anxiety.