Anxiety is not just a medical term; it’s a shared human experience, weaving through the lives of countless individuals in myriad, often invisible ways. 

I am seeing a patient, Miss Sally (not her real name), a bright university graduate whose life took an unexpected turn. She was on her way to a job interview when she was unfortunately trapped in a lift for almost an hour. Sally experienced her first panic attack, marked by shortness of breath, chest discomfort, giddiness, headache, and an overwhelming fear of impending doom. She was late for her job interview and she was too discouraged to attend another session, even though the company was sympathetic.

After her traumatic experience in the life, Sally’s anxiety escalated significantly. She began to fear having more panic attacks, a concern that soon extended to various aspects of her daily life. Initially, she started avoiding taking the lift alone, a direct response to her initial panic attack. However, her anxiety gradually grew to include other enclosed spaces like public transport. This progression of her anxiety led to her avoiding leaving her house altogether, significantly restricting her day-to-day activities and impacting her overall quality of life. Her world became increasingly limited, dominated by the fear of experiencing another panic attack and the physical and emotional distress that accompanies it. Sally’s parents did not understand why their daughter could not find the job or even leave the house after graduation, and this led to conflicts between them.

Sally’s story is a stark reminder of how anxiety can envelop one’s life, casting a shadow over everyday activities and relationships. As a psychiatrist, I’ve seen how such experiences can lead to a withdrawal from social interactions, a loss of self-confidence, and a sense of isolation, even when surrounded by supportive family and friends. Some of them develop a co-morbid depressive disorder. It’s a poignant example of the hidden struggles many faces, often masked by a veneer of normalcy.

But Sally’s narrative is just one among many. Anxiety wears numerous faces – from the constant worry of generalised anxiety disorder to the specific, intense fears of phobias, or the daunting challenge of social anxiety. Each individual’s experience with anxiety is as unique as their fingerprint, yet there’s a common thread of needing understanding, support, and effective coping mechanisms.

In this short write-up, I hope to shed some light on the realities of anxiety, debunk myths, and explore the myriad of treatments available, all while keeping sight of the most important aspect – the human experience at the heart of it all.

Recognising Anxiety 

Anxiety, a common yet complex emotion, is something we’ve all experienced at various points in our lives. It’s a natural response to stress, uncertainty, or fear. However, when these feelings become persistent and overwhelming, they may indicate an anxiety disorder.

Cognitively, anxiety manifests in several ways. It often appears as constant, excessive worrying about everyday activities, where the level of concern is disproportionate to the actual risk or impact. This worrying can be so intense that it interferes with the ability to focus, leading to difficulty in concentrating or a sense of the mind going blank. There’s also a tendency to anticipate the worst, even in relatively benign situations, and to struggle with decision-making due to the fear of making the wrong choice. Intrusive thoughts, which are repetitive and unwelcome, can dominate the mind, contributing to a state of constant fear or apprehension.

Behaviourally, anxiety influences our actions and choices. It often leads to the avoidance of situations or activities that trigger fear or discomfort. This avoidance can significantly restrict one’s life, limiting opportunities and experiences. Compulsive behaviors may emerge as a coping mechanism, where repetitive actions are performed in an attempt to reduce or control the anxiety. Restlessness is common, manifesting as an inability to relax or sit still, and there can be a tendency to procrastinate or have difficulty completing tasks, rooted in the anxiety itself. People with anxiety often seek reassurance from others, needing constant validation to alleviate their fears.

Physically, anxiety has a range of manifestations. It can cause palpitations or an unusually rapid heart rate, often accompanied by chest pain. Excessive sweating, unrelated to physical exertion or environmental temperature, is another common symptom. Physical signs of nervousness, such as trembling or shaking, are observable, and gastrointestinal problems like nausea, diarrhoea, or an upset stomach frequently occur. Additionally, muscle tension, leading to headaches and other physical discomforts, is often a physical representation of anxiety.

It’s important to note that these symptoms can vary widely among individuals. Not everyone with anxiety will experience all these symptoms, and their intensity and frequency can differ. Recognising these symptoms in oneself or others is vital for early identification and intervention. Understanding these signs is the first step in managing anxiety effectively, allowing for strategies and treatments to be tailored to the individual’s specific experiences and needs.

Myths, Misunderstandings and Misrepresentations About Anxiety 

The term ‘anxiety‘ is commonly used to describe both everyday feelings of worry and also a clinical psychiatric condition. This dual usage can lead to misunderstandings and oversimplifications of the disorder. For instance, when anxiety is portrayed as just an extreme state of nervousness, it minimises the complex nature of anxiety disorders, which are profound mental health issues impacting one’s life, relationships, and ability to function normally.

The misconception that anxiety can be overcome solely by willpower is another simplification. It overlooks the intricate interplay of biological, psychological, and environmental factors that contribute to anxiety disorders. Effective management often requires a multifaceted approach, including psychological therapy, medication, and lifestyle adjustments. This myth also perpetuates a stigma, suggesting that those who struggle with anxiety are simply not trying hard enough, or are too “weak” mentally.

Furthermore, the belief that anxiety is always visible fails to recognise that many individuals with anxiety present a calm exterior despite experiencing intense internal distress. This can lead to underestimation of their struggle and inadequate support from others.

Given that ‘anxiety’ is used to describe both normal and pathological states, there’s a tendency to either underestimate the severity of the condition or misinterpret normal stress responses as pathological. And because everyone has experienced anxiety at some point, there may be preconceived notions about how one can ‘recover’ from it. However, the experience of anxiety is deeply personal and varies greatly from one individual to another. What may be a minor stressor for one person could be a significant source of anxiety for another. This variation in experiences can lead to misunderstandings about the nature of anxiety disorders and the challenges faced by those who struggle with them. Recognising that each person’s anxiety is unique is crucial in providing appropriate support and avoiding oversimplification of their experiences.

Types of Anxiety Disorders

Anxiety disorders are also not a monolithic condition; they represent a spectrum, each type characterised by an underlying theme of excessive fear and worry, yet presenting distinct symptoms.

Examples:

1. Generalised Anxiety Disorder (GAD) is characterised by chronic and pervasive worry about a range of topics, often disproportionate to the actual threat.
2. Panic Disorder involves recurrent, intense panic attacks with physical symptoms like shortness of breath and chest pain.
3. Social Anxiety Disorder is marked by a deep fear of social interactions due to concerns about judgment or embarrassment.
4. Specific Phobias involve irrational fears of particular objects or situations, leading to avoidance behaviors.
5. Obsessive-Compulsive Disorder (OCD) consists of unwanted thoughts and repetitive behaviors aimed at reducing anxiety.
6. Post-Traumatic Stress Disorder (PTSD) stems from traumatic experiences and includes symptoms like flashbacks and avoidance behaviors.

Sometimes symptoms don’t fit neatly into these categories, particularly when they are evolving or atypical. The focus in psychiatry is always on the individual person and their unique experiences, emphasising the dynamic and evolving nature of mental health disorders. We treat the person, not the label.

Is Anxiety Curable?

While anxiety disorders are complex and long-term conditions, there is a beacon of hope in treatment. People with anxiety disorders often respond positively to a combination of therapies. This includes pharmacological treatments i.e. medication, and non-pharmacological approaches, such as cognitive behavioral therapy and lifestyle changes. An integral part of managing anxiety is the support from one’s network – family, friends, school, colleagues, and employers. Their understanding and encouragement can significantly bolster treatment effectiveness, creating an environment conducive to recovery and well-being.

Treatment for Anxiety Disorders can be broadly divided into two categories:

1. Pharmacological Treatments: Medications play a significant role in managing anxiety disorders. These include Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) that help balance brain chemistry. Benzodiazepines are effective for short-term relief of acute anxiety symptoms but are generally not recommended for long-term use due to the risk of dependence. Beta-blockers like Propranolol can also be prescribed to manage physical symptoms of anxiety, such as palpitations and tremors.
2. Non-Pharmacological Treatments: Cognitive Behavioral Therapy (CBT) is highly effective, particularly for panic disorders and generalised anxiety disorder, focusing on changing thought patterns and behaviors. Techniques like mindfulness, relaxation exercises, and exposure therapy are also integral parts of non-pharmacological treatment. Alternative therapies like hypnotherapy or brain stimulation techniques (like transcranial magnetic stimulation) have shown promise in some cases, and are being researched extensively.
3. Integrated Care Approach: Often, a combination of pharmacological and non-pharmacological treatments is most effective. Integrated care, which involves coordinating psychological therapy with medication management and lifestyle changes, is considered the best approach for treating anxiety disorders. This holistic approach addresses the multifaceted nature of anxiety, ensuring that treatment is tailored to the individual’s specific needs and circumstances.

Treatments can lead to significant improvements in symptoms and quality of life. However, it’s important to note that discontinuing treatment can result in a recurrence of symptoms, highlighting the need for ongoing management.

Conclusion

In closing, understanding and managing anxiety is a journey both challenging and hopeful. While anxiety disorders are complex and vary from person to person, effective treatments and supportive networks provide a pathway to better managing this condition. Through a combination of therapy, medication, and lifestyle changes, individuals can find relief and improve their quality of life. Remember, anxiety is a part of the human experience, and with the right support and interventions, it can be navigated successfully. There’s always hope and a way forward.

Epilogue 

Sally’s journey towards recovery has seen significant progress thanks to a combination of medication and psychological treatment. Psychoeducation for her family played a crucial role in improving their understanding and support, which has been immensely beneficial. I’m delighted to share that Sally is now preparing to start a new job in two weeks, marking a hopeful turn in her journey.