Let’s talk about anxiety

“The fear of the ominous unknown”

What are the difference types of anxiety?

When we speak about anxiety, there are many ways to view it or conceptualize it. In fact, fear and anxiety are two different things, often occurring at the same time. Fear relates to the emotional experience of real or perceived fear that is more linked to the autonomic processes in which we use the “fight or flight” response to react to danger. Whereas anxiety is more about the anticipation of future threats; including muscle tension, vigilance in preparation for future danger and avoidant thoughts and behaviours (DSM, 2013).

The object, situation or environment that induces fear and anxiety can be different and that leads to different diagnoses such as; generalized anxiety disorder, agoraphobia (which includes the old claustrophobia), other specific phobias, social anxiety and panic disorder.

Is anxiety physical or psychological?

With generalized anxiety, individuals often feel restlessness, on edge, being easily tired, difficulty concentrating, mind going blank, irritability, muscle tension and sleep disturbances (especially difficulty falling or staying asleep due to worry). Being in a constant state of worry and fear is not only psychological, but also comes with a great deal of physical anxiety. In this way, anxiety is both physical and psychological.

Physically, some may be more aware of the symptoms such as a racing heart, sweating, shaking, difficulty breathing, pain or discomfort, nausea, stomach cramps, feeling light-headed in anxiety-provoking situations. Psychologically, features such as ruminating thoughts, over thinking, catastrophising, predicting the worst, constant worry are often present. Some are more aware of the physical experience than the psychological. In this circumstance, if a panic attack where to occur, the experience of the intense burst of fear can be over interpreted as a physical experience only, when there is a lot going on psychologically as well. The experience of having one panic attack can evoke so much fear that it will happen again, to the point where the greatest fear is having another panic attack – which can trigger a panic attack. One can start to over-interpret physical sensations as the beginning of a panic attack in anticipation of one. It can be a difficult cycle to break but luckily there is very effective treatment (see end of article).

Is my anxiety normal?

On a level, most humans do worry to an extent and when seen in context, worry can usually be completely appropriate. Let us not over pathologize worry; however the problem comes in when the fear is constantly activated to the point where you are unable to or have difficulties functioning at work, school, in relationships or other important areas of functioning.

For example, if I have a fear of heights, there is no need for treatment or a diagnosis if it does not interfere with any part of your life. But, if your workplace is on the 20^th floor of a high rise building and you are no longer able to go to work, there could be cause for intervening – if you want to continue working there that is. Similarly, if you are unable to maintain relationships or go to school due to anxiety, it could be cause for intervention or treatment.

The problem with anxiety is that we develop avoidant behaviours to reduce anxiety. For example, if an individual struggles with social anxiety, the fear of evaluation and of being embarrassed in front of others can become so strong that the person no longer wants to go to work or speak to colleagues and avoids all social events. In this way, whilst avoiding the situation to reduce anxiety, we also lose the opportunity to prove ourselves otherwise. We lose the opportunity to debunk our own myths living in our minds. We believe these thoughts and the cycle continues.

Are you suffering in silence?

Anxiety can be very illusive. It need not be as overt as the examples mentioned above. Anxiety hides amongst us, perhaps with our best friend, colleague, partner – often without us detecting their discomfort. Anxiety does not have a face. Whilst the person may feel that everyone can notice their anxiety, it’s usually the opposite. Fear and anxiety can be very pervasive. It can infiltrate our minds where we believe things that are not true. We may believe we are not good enough, to the point where we are over thinking, ruminating and procrastinating all day over something that may or may not be real. Whilst this happens, our thoughts are usually on the worst case scenario, and never on the best case scenario.

Some people can mask their anxiety well, for others it may be more visible. It can be debilitating and crippling when avoidant behaviours take hold. Some may self-medicate anxiety with substances (often cannabis and alcohol) to help alleviate the worry and to feel more socially comfortable. Anxiety also happens in the context of other illnesses such as depression, or in the context of having a medical illness.

When health professionals face mental health issues too.

I feel what you feel. I too have struggled with anxiety. I’ve always been an over thinker and a generally “functional” anxious person in the world. However, at times it gets the better of me too. Anxiety is also a complicated web of our own traumas and experiences; that could have triggered the initial fear. Although this is no longer a threat, we continue to interpret it as such. For example, constant self-doubt, a fear of performing or failing at tasks didn’t keep me away from work but it kept me from being more confident in myself or grabbing opportunities, when I would instead focus on “what if I fail?” Worrying about the unknown and predicting the worst even when we logically know it’s unlikely to happen, can really keep us immobile. My approach has luckily improved; I try to look at “what can I learn and gain” and using the best case scenario as opposed to the worst.

Anxiety can become our own worst enemy, and it’s all based on our thoughts and not necessarily factual reality. Facing the fear can feel unbearable but perhaps we will surprise ourselves. Perhaps the situation goes better than you expect, maybe the worst won’t happen, and maybe you are good enough.

This is especially important topic to tackle because as psychologists and health professionals, our wellbeing is the vehicle through which we can help others. It’s something I too need to constantly reflect on and work on personally and professionally. Many health professionals would not discuss such things publically however; I hope it will be a reflection of humanity within the profession.

What are some interventions for anxiety?

• Psychotherapy is the treatment offered by psychologists for anxiety – one type of therapy called Cognitive Behavioural Therapy (CBT) is especially effective with a lot of supporting research and evidence base for its effectiveness. Therapy can assist in reflecting on personality traits, dynamics, stressors that may be more likely to cause anxiety. Through identifying experiences in our upbringing that may have contributed to our anxiety is often very helpful. One of my favourite psychodynamic approaches to understanding anxiety is Attachment theory and self-psychology.
• Anxiety can be treated psychopharmacologically, i.e. with medication. There are different treatment options that would need to be managed in conjunction with your GP or psychiatrist.

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Amy Glover is a practicing Clinical Psychologist based in Cape Town. She has her masters degree in Clinical Psychology and Community Counselling (cum laude) from the University of Stellenbosch. She divides her time between a private practice in Vredehoek, Cape Town and developing practitioner-led resources to equip professionals to navigate online platforms for mental health services. She is passionate about preventative mental health and works with individuals and couples. Amy Glover is available to see clients online for therapy. Email: amygloverpsychologist@gmail.com or contact here.