Mon, 19 Feb, 2018Danielle McCarthy

Anxiety: How to recognise, understand and manage it

Anxiety: How to recognise, understand and manage it

I am, and always have been, very claustrophobic. The thought of being trapped in a lift literally makes my heart race, my palms sweat, and a feeling of panic sweep through my body. Thankfully, I am usually able to avoid lifts and opt to take the stairs instead. However, this condition also means that I hate flying – not because I have any fear at all that it isn't safe or that the plane is about to plummet out of the sky, but because the doors to the outside are shut and I can't get out… irrational I know, but somehow that doesn't really help!

Luckily for me I don't have to fly every week, but it is a relatively regular occurrence and I have had to learn a whole raft of skills so that I can hop on a flight without spending a sleepless week before it, worrying about how I will cope. 

Anxiety is awful, and for many people it will be much more pervasive and persistent than it is for me. Whereas I get a few episodes a year and have a very obvious trigger that I can predict and learn to cope with, for others anxiety is a constant state, gnawing away at them all the time, with perhaps only brief periods of respite. I suspect this is exhausting, and often those around us will underestimate the impact it can have on quality of life – health professionals included, I am sure. 

About one in 20 people have an "anxiety disorder" at any one time, though many more than that will suffer from intermittent anxiety. Anxiety disorder is an umbrella term that includes specific diagnoses such as phobias, panic disorder, obsessive-compulsive disorder, and generalised anxiety. To be classified as an anxiety disorder your anxiety needs to be at a level where it interferes with your day-to-day life, and you suffer from the symptoms more days than not. The experience of anxiety will differ from person to person, but can encompass a wide range of symptoms:

  • Feeling fearful or tense
  • Poor concentration – finding it hard to focus on anything other than the thing that is making you anxious
  • Poor sleep
  • Irritability
  • Feeling of losing control or "going crazy"
  • Restlessness and an inability to relax
  • Physical symptoms are often marked and can include sweating, racing heart, trembling or shaking, dizziness, shortness of breath, chest pain, gut symptoms (such as a churning tummy, diarrhoea, pains), muscle aches, a choking sensation, dry mouth.

These physical symptoms are a normal (and often healthy) bodily response – when we are faced with possible danger (something like an important race or exam), our bodies are programmed to release lots of chemicals into the bloodstream, including adrenaline. These chemicals elicit a "fight-or-flight" reaction, enabling us to escape or defend ourselves if needed. The symptoms described above result from these chemicals and are only a problem if the danger isn't "real" or you experience them all the time.

Often it is these physical symptoms that scare people the most – patients often describe fearing they are about to have a heart attack or die because they can't breathe properly. Understanding that they are a normal physiological response, and that they will ease after a few minutes, is a big part of managing anxiety. 

As well as recognising that you have anxiety, and understanding why it makes you feel so physically awful, there are other effective things you can try as well:

1. Recognising and modifying your triggers – This isn't helpful or practical for everyone, but if, for example, your very busy job is the source of stress and anxiety, acknowledging this and trying to change it is a great first step.

2. Practice "helpful"behaviours – Identify things that make you feel happy, calm and positive. Think of places you go that give you that nice sense of wellbeing, people who always make you feel good, or hobbies that distract and calm you. They don't have to cost money – for me walks on the beach or in the bush give me this feeling. Then start to make time for them every day – it will reduce your anxiety level and counteract all the stress hormones racing around your system. If this involves being outside and physical exercise all the better – they both promote good sleep patterns, and being well-rested will reduce your anxiety as well.

3. Learn to meditate, or practice mindfulness or grounding.

4. Explore self-help websites and apps – Learning how to deal with your anxiety using tools such as muscle relaxation, mindful breathing, or self-hypnosis can be really empowering as well as effective.

5. "Talking therapies" – Counselling or psychology is really helpful, especially if your anxiety has been around for a long time. Ask your GP about free or low-cost options near you.

6. Medication – Definitely not a first-line for everyone, but it can work really well as an adjunct to the things mentioned above. Options include medicines called beta-blockers that can be used "as required" to reduce the physical symptoms of anxiety, or regular antidepressants such as those in the SSRI family (such as fluoxetine, escitalopram, sertraline and others). Antidepressants should be used for several months otherwise symptoms are likely to recur, and in my experience are really useful as a "springboard" to enable other sorts of therapy to be more effective. The last group of drugs available for anxiety are the benzodiazepines, such as diazepam or lorazepam – although really effective, they are highly addictive so can only be used for very short periods of time. Worth considering if you have very sporadic anxiety related to a particular trigger or event.

Written by Dr Cathy Stephenson. Republished with permission of Stuff.co.nz.